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Administración de heparina subcutánea lenta versus rápida para la prevención de la equimosis y la intensidad del dolor en el sitio de inyección

Esta versión no es la más reciente

ver la versión actual 08 junio 2021

Appendices

Appendix 1. CENTRAL search strategy

Search run on Mon Mar 20 2017

#1

MESH DESCRIPTOR Heparin EXPLODE ALL TREES

3883

#2

*heparin*:TI,AB,KY

9079

#3

LMWH:TI,AB,KY

847

#4

(nadroparin* or fraxiparin* or enoxaparin* or Clexane or klexane or lovenox or dalteparin* ):TI,AB,KY

2110

#5

(ardeparin or normiflo or tinzaparin or logiparin or Innohep or certoparin or sandoparin or reviparin or clivarin* or danaproid or danaparoid ):TI,AB,KY

371

#6

(Fragmin or Kabi 2165 or Kabi2165 or FR 860 or FR860):TI,AB,KY

209

#7

(antixarin or ardeparin* or bemiparin* or Zibor or cy 222 or cy222 or embolex or monoembolex or parnaparin* or rd 11885 or tedelparin or Kabi 2165 or Kabi2165 ):TI,AB,KY

154

#8

(emt 966 or emt966 or emt 967 or emt967 or pk 10169 or pk10169):TI,AB,KY

8

#9

(cy 216 or cy216 or seleparin* or tedegliparin or seleparin* or tedegliparin* or tedelparin or calciparin*):TI,AB,KY

70

#10

(kb 101 or kb101 ):TI,AB,KY

3

#11

(lomoparan or orgaran):TI,AB,KY

28

#12

(parnaparin or fluxum or lohepa or lowhepa or parvoparin ):TI,AB,KY

34

#13

(op 2123 or op2123 ):TI,AB,KY

1

#14

(AVE5026 or AVE 5026):TI,AB,KY

2

#15

#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14

10033

#16

MESH DESCRIPTOR Injections, Subcutaneous EXPLODE ALL TREES

3847

#17

subcutan*:TI,AB,KY

16583

#18

(sc or s.c):TI,AB,KY

7296

#19

#16 OR #17 OR #18

19485

#20

MESH DESCRIPTOR Contusions

93

#21

bruis*:TI,AB,KY

486

#22

contus*:TI,AB,KY

537

#23

indurat*:TI,AB,KY

858

#24

MESH DESCRIPTOR Hematoma

402

#25

haematoma*:TI,AB,KY

525

#26

hematoma*:TI,AB,KY

2882

#27

MESH DESCRIPTOR Pain EXPLODE ALL TREES

34252

#28

pain*:TI,AB,KY

94480

#29

#20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28

102440

#30

#15 AND #19 AND #29

303

#31

* NOT SR‐PVD:CC AND 31/08/2013 TO 28/02/2017:DL

79662

#32

#30 AND #31

63

Appendix 2. Trials registries searches

ClinicalTrials.gov

12 studies found for: heparin AND subcutaneous AND pain

4 studies found for: heparin AND subcutaneous AND bruising

World Health Organization International Clinical Trials Registry Platform

5 records for 5 trials found for: heparin AND subcutaneous AND bruising (2 NEW and not NCT)

6 records for 6 trials found for: heparin AND subcutaneous AND pain (2 new not in NCT)

ISRCTN Register

3 results subcutaneous AND heparin AND pain (0 new)

1 results subcutaneous AND heparin AND bruising (0 new)

Appendix 3. Authors' Iranian search strategy

1

Heparin AND Subcutaneous AND Injection (title or abstract)

12

Appendix 4. Google Scholar search strategy

1

((heparin OR enoxaparin OR LMWH) AND subcutaneous AND injection AND (duration OR speed) AND (bruising OR pain) AND trial)) ABSTRACT

3900

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Slow versus fast heparin injections, Outcome 1 Intensity of injection pain.
Figuras y tablas -
Analysis 1.1

Comparison 1 Slow versus fast heparin injections, Outcome 1 Intensity of injection pain.

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Comparison 1 Slow versus fast heparin injections, Outcome 2 Bruise size 48 hours after injection.
Figuras y tablas -
Analysis 1.2

Comparison 1 Slow versus fast heparin injections, Outcome 2 Bruise size 48 hours after injection.

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Comparison 1 Slow versus fast heparin injections, Outcome 3 Bruise size.
Figuras y tablas -
Analysis 1.3

Comparison 1 Slow versus fast heparin injections, Outcome 3 Bruise size.

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Summary of findings for the main comparison. Slow versus fast subcutaneous heparin injection for prevention of bruising and site pain intensity

Slow vs fast subcutaneous heparin injection for prevention of bruising and site pain intensity

Patient or population: patients treated with subcutaneous heparin injections

Settings: hospital outpatient and inpatient units

Intervention: slow injection (injection speed of 20 or more seconds)

Comparison: fast injection (injection speed of less than 20 seconds)

Outcomes

Illustrative comparative risks* (95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk with fast injection

Corresponding risk with slow injection

Intensity of injection pain

immediately after injection

(VAS 0 to 10 cm)

0 (no pain) to 10 (worst possible pain)

Mean pain intensity reported by the 2 studies ranged across fast injection groups from 2 to 5.

Mean pain intensity in the slow injection group was 1.52 points less than in the fast group (3.56 lower to 0.53 higher; P = 0.15).

140
(2 RCTs)

⊕⊕⊝⊝a
low

Intensity of injection pain

48 hours after injection

(VAS 0 to 10 cm)

0 (no pain) to 10 (worst possible pain)

Mean pain intensity ranged across fast injection groups from 2.1 to 2.8.

Mean pain intensity in the slow injection group was 1.68 points less than in the fast group (2.91 lower to 0.45 lower; P = 0.007).

59
(2 RCTs)

⊕⊕⊝⊝b
low

Bruise size

48 hours after injection

(mm/mm2)

See comment.

Mean bruising size in the slow injection group was 0.6 SD lower than in the fast injection group (1.24 lower to 0.04 higher; P = 0.07).

459
(4 RCTs)

⊕⊕⊝⊝c
low

Bruise size was measured on different scales; therefore we used the SMD to pool data.

Haematoma at injection site

See comment.

No studies measured this outcome.

*The basis for the assumed risk (e.g. median control group risk across studies) for pain intensity was the range of mean pain score reported following fast injection by the 2 studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the mean difference of the intervention (and its 95% CI).
CI: confidence interval; cm: centimetre; mm: millimetre; RCTs: randomised controlled trials; SD: standard deviation; SMD: standardised mean difference; VAS: visual analogue scale.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aWe downgraded the quality of evidence by two steps owing to study limitations, as we identified few studies with small numbers of participants (imprecision) and high heterogeneity (I2 = 73%) (inconsistency).
bWe downgraded the quality of evidence by two steps owing to study limitations, as we identified few studies with small numbers of participants (imprecision) and high heterogeneity (I2 = 72%) (inconsistency).
cWe downgraded the quality of evidence by two steps owing to study limitations, as we identified few studies with small numbers of participants (imprecision) and high heterogeneity (I2 = 85%) across studies (inconsistency).

Figuras y tablas -
Summary of findings for the main comparison. Slow versus fast subcutaneous heparin injection for prevention of bruising and site pain intensity
Ir a la tabla de la revisión
Comparison 1. Slow versus fast heparin injections

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intensity of injection pain Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Immediately after each injection

2

140

Mean Difference (IV, Random, 95% CI)

‐1.52 [‐3.56, 0.53]

1.2 48 hours after injection

2

59

Mean Difference (IV, Random, 95% CI)

‐1.68 [‐2.91, ‐0.45]

1.3 60 hours after injection

1

40

Mean Difference (IV, Random, 95% CI)

‐1.0 [‐2.15, 0.15]

1.4 72 hours after injection

1

40

Mean Difference (IV, Random, 95% CI)

‐0.8 [‐1.70, 0.10]

2 Bruise size 48 hours after injection Show forest plot

4

459

Std. Mean Difference (IV, Random, 95% CI)

‐0.60 [‐1.24, 0.04]

2.1 Bruise size (mm2)

2

140

Std. Mean Difference (IV, Random, 95% CI)

‐0.30 [‐0.64, 0.03]

2.2 Bruise size (mm)

2

319

Std. Mean Difference (IV, Random, 95% CI)

‐1.69 [‐5.07, 1.70]

3 Bruise size Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 60 hours after injection (mm2)

1

40

Mean Difference (IV, Fixed, 95% CI)

‐3.85 [‐8.99, 1.29]

3.2 72 hours after injection (mm2)

2

140

Mean Difference (IV, Fixed, 95% CI)

‐2.29 [‐6.57, 1.99]
Figuras y tablas -
Comparison 1. Slow versus fast heparin injections
Ir a la tabla de la revisión