Heparina de bajo peso molecular para la prevención del tromboembolismo venoso en pacientes con extremidades inferiores inmovilizadas
Información
- DOI:
- https://doi.org/10.1002/14651858.CD006681.pub4Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 06 agosto 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Vascular
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
AZ analyzed data, writing
KvL assessed trial quality, extracted data.
MvdH assessed trial quality, extracted data.
LJ co‐ordinated and advised on statistical methods, and redirected writing.
HMJJ cross‐checked information, supervised and redirected writing
Sources of support
Internal sources
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No sources of support supplied
External sources
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Chief Scientist Office, Scottish Government Health Directorates, The Scottish Government, UK.
The Cochrane Vascular editorial base is supported by the Chief Scientist Office.
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National Institute for Health Research (NIHR), UK.
This project was supported by the NIHR, via Cochrane Incentive Award funding (16/72/06) to Cochrane Vascular. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service (NHS), or the Department of Health.
Declarations of interest
AZ: none known
KvL: none known
MvdH: none known
LJ: none known
HMJJ: none known
Acknowledgements
The authors wish to acknowledge Dr M Testroote and Dr WAH Stigter for their contribution to previous versions of this review.
Version history
| Published | Title | Stage | Authors | Version |
| 2017 Aug 06 | Low molecular weight heparin for prevention of venous thromboembolism in patients with lower‐limb immobilization | Review | Aniek AG Zee, Kelly van Lieshout, Maaike van der Heide, Loes Janssen, Heinrich MJ Janzing | |
| 2014 Apr 25 | Low molecular weight heparin for prevention of venous thromboembolism in patients with lower‐leg immobilization | Review | Mark Testroote, Willem AH Stigter, Loes Janssen, Heinrich MJ Janzing | |
| 2008 Oct 08 | Low molecular weight heparin for prevention of venous thromboembolism in patients with lower‐leg immobilization | Review | Mark Testroote, Willem AH Stigter, Dianne C de Visser, Heinrich MJ Janzing | |
| 2007 Jul 18 | Low molecular weight heparin for prevention of venous thromboembolism in patients with lower leg immobilization | Protocol | Mark Testroote, Willem Stigter, Heinrich Janzing, Dianne C de Visser | |
Differences between protocol and review
'Risk of bias' and 'Summary of findings' tables added
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Anticoagulants [adverse effects, *therapeutic use];
- Cause of Death;
- Hemorrhage [chemically induced];
- Heparin, Low‐Molecular‐Weight [adverse effects, *therapeutic use];
- Immobilization [*adverse effects];
- Leg Injuries [*therapy];
- Pulmonary Embolism [epidemiology, prevention & control];
- Randomized Controlled Trials as Topic;
- Venous Thromboembolism [*prevention & control];
- Venous Thrombosis [epidemiology, prevention & control];
Medical Subject Headings Check Words
Adult; Humans;
PICO
PRISMA study flow diagram
Risk of bias graph: review authors' judgements about each risk of bias domain, presented as percentages across all included studies
Risk of bias summary: review authors' judgements about each risk of bias domain for each included study
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 1 Deep venous thrombosis: regardless of type of plaster, whether operated or not.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 2 Deep venous thrombosis: in below‐knee cast, whether operated or not.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 3 Deep venous thrombosis: conservative treatment (i.e. non‐operated patients).
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 4 Deep venous thrombosis: operated patients.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 5 Deep venous thrombosis: fractures.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 6 Deep venous thrombosis: soft‐tissue injuries.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 7 Deep venous thrombosis: distal segment.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 8 Deep venous thrombosis: proximal segment.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 9 Pulmonary embolism.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 10 Symptomatic venous thromboembolism.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 11 Mortality due to pulmonary embolism.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 12 Mortality due to other causes.
Comparison 1 Low molecular weight heparin versus no prophylaxis or placebo, Outcome 13 Adverse outcomes.
| Low molecular weight heparin compared to no prophylaxis or placebo in prevention of venous thromboembolism in patients with lower‐limb immobilization | ||||||
| Patient or population: prevention of venous thromboembolism in patients with lower‐limb immobilization | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Quality of the evidence | Comments | |
| Risk with no prophylaxis or placebo | Risk with low molecular weight heparin | |||||
| Deep venous thrombosis | Study population | OR 0.45 | 1676 | ⊕⊕⊕⊝ | ||
| 174 per 1000 | 87 per 1000 | |||||
| Pulmonary embolism | Study population | OR 0.50 | 2517 | ⊕⊕⊝⊝ | ||
| 7 per 1000 | 4 per 1000 | |||||
| Symptomatic venous thromboembolism | Study population | OR 0.40 | 2924 | ⊕⊕⊝⊝ | ||
| 21 per 1000 | 9 per 1000 | |||||
| Mortality due to pulmonary embolism | Study population | ‐ | 3111 | ‐ | No mortality due to pulmonary embolism was reported | |
| see comment | see comment | |||||
| Mortality due to other causes | Study population | OR 0.33 (0.01 to 8.15) | 3111 | ⊕⊕⊝⊝ | One death (in no prophylaxis/placebo group) was reported in the included studies | |
| 1 per 1000 | 0 per 1000 (0 to 5) | |||||
| Adverse outcomes | Study population | OR 2.01 | 3178 | ⊕⊕⊝⊝ | ||
| 40 per 1000 | 78 per 1000 | |||||
| *We calculated the assumed risk of the no prophylaxis or placebo group from the average risk in the no prophylaxis or placebo groups (i.e. the number of participants with events divided by total number of participants of the no prophylaxis or placebo group included in the meta‐analysis). The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Downgraded by one level as 3 out of 7 studies showed considerable risk of bias | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Deep venous thrombosis: regardless of type of plaster, whether operated or not Show forest plot | 7 | 1676 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.45 [0.33, 0.61] |
| 2 Deep venous thrombosis: in below‐knee cast, whether operated or not Show forest plot | 6 | 1080 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.49 [0.34, 0.72] |
| 3 Deep venous thrombosis: conservative treatment (i.e. non‐operated patients) Show forest plot | 5 | 974 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.31 [0.18, 0.53] |
| 4 Deep venous thrombosis: operated patients Show forest plot | 4 | 699 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.54 [0.37, 0.80] |
| 5 Deep venous thrombosis: fractures Show forest plot | 6 | 1003 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.33, 0.70] |
| 6 Deep venous thrombosis: soft‐tissue injuries Show forest plot | 5 | 658 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.39 [0.22, 0.68] |
| 7 Deep venous thrombosis: distal segment Show forest plot | 5 | 1208 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.42, 0.89] |
| 8 Deep venous thrombosis: proximal segment Show forest plot | 5 | 1217 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.41 [0.19, 0.91] |
| 9 Pulmonary embolism Show forest plot | 5 | 2517 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.50 [0.17, 1.47] |
| 10 Symptomatic venous thromboembolism Show forest plot | 6 | 2924 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.40 [0.21, 0.76] |
| 11 Mortality due to pulmonary embolism Show forest plot | 8 | 3111 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 12 Mortality due to other causes Show forest plot | 8 | 3111 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.15] |
| 13 Adverse outcomes Show forest plot | 8 | 3178 | Odds Ratio (M‐H, Random, 95% CI) | 2.01 [0.83, 4.86] |
