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This Article Full Text (PDF) Free All Versions of this Article: chest.06-2518v1 132/4/1131    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Morris, T. A. Articles by Gamst, A. C. Search for Related Content PubMed PubMed Citation Articles by Morris, T. A. Articles by Gamst, A. C. Related Content Related Editorial

No Difference In Risk For Thrombocytopenia During Treatment Of Pulmonary Embolism & Deep Venous Thrombosis With Either Low Molecular Weight Heparin Or Unfractionated Heparin: a meta-analysis

¹Division of Pulmonary and Critical Care Medicine, University of California, San Diego ²University of California, Davis and Kaiser Permanente, Sacramento ³Division of Biostatistics, Department of Family and Preventative Medicine, University of California San Diego

t1morris{at}ucsd.edu

Abstract

BackgroundLow molecular weight heparin (LMWH) is a popular alternative to unfractionated heparin (UH) for pulmonary embolism (PE) and deep vein thrombosis (DVT), in part based on the perception of a lower risk for heparin-induced thrombocytopenia. To investigate the evidence supporting this perception, we performed a meta-analysis to compare the incidence of thrombocytopenia between LMWH and UH during PE and/or DVT treatment.

MethodsRandomized trials comparing LMWH with UH for PE and/or DVT treatment were searched for in the MEDLINE database, bibliographies and by correspondence with published investigators. Two reviewers independently selected high-quality studies and extracted data regarding heparin-associated thrombocytopenia (HAT), heparin-induced thrombocytopenia confirmed by laboratory testing (HIT) and thrombocytopenia complicated by thrombosis (HITT). Outcome rates between LMWH and UH were compared using a binomial generalized linear mixed model with a logit link and gaussian random effects for study.

ResultsThirteen studies involving 5275 patients met the inclusion criteria. There were no statistically significant differences in HAT rates between the two treatments (LMWH = 1.2%, UH = 1.5%; p = 0.246). The incidence of documented HIT and HITT was too low to make an adequate comparison between groups.

ConclusionsOur review disclosed no statistically significant difference in HAT between LMWH and UH and insufficient evidence to conclude that HIT and HITT rates were different between them. There was no evidence from randomized comparative trials to support the contention that treatment of PE or DVT with UH is more prone to these complications than treatment with LMWH.

Related Editorial

So, Does Low-Molecular-Weight Heparin Cause Less Heparin-Induced Thrombocytopenia Than Unfractionated Heparin or Not?

Theodore E. Warkentin and Andreas Greinacher
Chest 2007 132: 1108-1110. [Full Text] [PDF]

This article has been cited by other articles:

				T. E. Warkentin and A. Greinacher So, Does Low-Molecular-Weight Heparin Cause Less Heparin-Induced Thrombocytopenia Than Unfractionated Heparin or Not? Chest, October 1, 2007; 132(4): 1108 - 1110. [Full Text] [PDF]