Low-molecular weight vs. unfractionated heparin for prevention of venous thromboembolism in general surgery: a meta-anal
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ORIGINAL ARTICLE
Low‑molecular weight vs. unfractionated heparin for prevention of venous thromboembolism in general surgery: a meta‑analysis Prachi Nair1 · Radhika Trivedi1 · Patrick Hu2 · Yingting Zhang3 · Aziz M. Merchant2 Received: 20 June 2020 / Accepted: 23 August 2020 © Italian Society of Surgery (SIC) 2020
Abstract To assess the association between low-molecular weight heparin (LMWH) and unfractionated heparin (UFH) in the prevention of venous thromboembolism (VTE) among participants undergoing general surgery. LMWH and UFH are the standard of practice in the prevention of VTE in surgery. However, in the context of general surgery, studies comparing the effectiveness of these treatments are limited. A systematic search was conducted to find studies which examined the comparative effectiveness between LMWH and UFH in the prophylaxis of VTE in the context of general surgery. The number of events of VTE in groups receiving LMWH or UFH was the primary outcome of interest, and was used to calculate odds-ratios. Amongst 33,068 participants pooled from twelve studies, the rate of VTE was 1.3% in those treated with LMWH, and 3.1% in those treated with UFH. Although there was a wide difference in rates due to clinical heterogeneity, there was no statistically significant difference between treatment effects [OR 0.77; 95% CI 0.58–1.03; p value = 0.0783; I2= 62.3%; 12 studies]. In terms of the sensitivity analysis, sources overly contributing to heterogeneity were removed. The random-effects model continued to show insignificance between LMWH and UFH in the prevention of VTE in participants undergoing general surgery [OR 0.86; 95% CI 0.69–1.08; p value = 0.2005; I2= 0%; 9 studies]. Results show an equal effectiveness in the prevention of VTE between participants undergoing general surgery in those allocated to receive LMWH to those allocated to receive UFH. Keywords General surgery · Hemorrhage/chemically induced · Heparin/adverse effects · Postoperative complications/ epidemiology · Thromboembolism
Introduction Venous thromboembolism (VTE), defined as deep vein thrombosis (DVT), pulmonary embolism (PE), or both, is a frequent postoperative complication and the fifth most common reason for unplanned hospital readmissions after surgery [1]. Additionally, VTE treatment poses a significant Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13304-020-00872-w) contains supplementary material, which is available to authorized users. * Aziz M. Merchant [email protected] 1
Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
2
Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Suite MSB G530, Newark, NJ 07103, USA
3
Robert Wood Johnson Library of the Health Sciences, New Brunswick, NJ, USA
economic burden—estimated healthcare cost associated with hospital-acquired VTE in 2011 was $9.0–$18.2 billion [2]. Although differing guidelines exist, the historical standard of care for
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