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2016 ; 31
(11
): 1828-1837
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Pharmacological and Mechanical Thromboprophylaxis in Critically Ill Patients: a
Network Meta-Analysis of 12 Trials
#MMPMID27709864
Park J
; Lee JM
; Lee JS
; Cho YJ
J Korean Med Sci
2016[Nov]; 31
(11
): 1828-1837
PMID27709864
show ga
Thromboprophylaxis for venous thromboembolism is widely used in critically ill
patients. However, only limited evidence exists regarding the efficacy and safety
of the various thromboprophylaxis techniques, especially mechanical
thromboprophylaxis. Therefore, we performed meta-analysis of randomized
controlled trials (RCTs) that compared the overall incidence of deep vein
thrombosis (DVT) for between unfractionated heparin (UFH), low-molecular-weight
heparin (LMWH), and intermittent pneumatic compression (IPC) in critically ill
patients. A Bayesian random effects model for multiple treatment comparisons was
constructed. The primary outcome measure was the overall incidence of DVT at the
longest follow-up. The secondary outcome measure was the incidence of major
bleeding, as defined by the original trials. Our analysis included 8,622 patients
from 12 RCTs. The incidence of DVT was significantly lower in patients treated
with UFH (OR, 0.45; 95% CrI, 0.22-0.83) or LMWH (OR, 0.38; 95% CrI, 0.18-0.72)
than in patients in the control group. IPC was associated with a reduced
incidence of DVT compared to the control group, but the effect was not
statistically significant (OR, 0.50; 95% CrI, 0.20-1.23). The risk of DVT was
similar for patients treated with UFH and LMWH (OR, 1.16; 95% CrI, 0.68-2.11).
The risk of major bleeding was similar between the treatment groups in medical
critically ill patients and also in critically ill patients with a high risk of
bleeding. In critically ill patients, the efficacy of mechanical
thromboprophylaxis in reducing the risk of DVT is not as robust as those of
pharmacological thromboprophylaxis.
|Anticoagulants/*therapeutic use
[MESH]
|Bayes Theorem
[MESH]
|Critical Illness
[MESH]
|Databases, Factual
[MESH]
|Heparin, Low-Molecular-Weight/*therapeutic use
[MESH]