Chest
Clinical InvestigationsEnoxaparin in the Treatment of Deep Vein Thrombosis With or Without Pulmonary Embolism: An Individual Patient Data Meta-analysis
Section snippets
Identification of Randomized Controlled Trials
We attempted to identify all published and unpublished randomized controlled trials that compared enoxaparin with UFH for the treatment of DVT with or without associated symptomatic PE. We searched MEDLINE and EMBASE electronic databases from January 1980 to January 2004 using the following groups of key words: “deep-vein thrombosis” or “thromboembolism” or “pulmonary embolism,” and “randomized” or “randomised” or “controlled trial” or “meta-analysis,” and “UFH” or “LMWH” or “enoxaparin” or
Descriptive Results
A total of five studies1323454647 comparing enoxaparin with UFH for the treatment of DVT were identified. Of these, one trial was excluded because clinical events at 3 months were not reviewed blindly by an independent committee.46 Another study was excluded because included patients presented with PE, with or without associated DVT, rather than DVT with or without associated PE, there was no proper generation of the allocation sequence (alternate odd and even numbers) for randomization and
Discussion
Results from this meta-analysis suggest that in terms of VTE recurrences, major bleeding, and death, enoxaparin is as effective and safe as UFH in the treatment of DVT with or without associated symptomatic PE. Similar results were found when comparing enoxaparin and UFH in patients presenting with a DVT and PE and in patients presenting with DVT alone. Emphasizing the robustness of our results, estimates of treatment effect were unchanged regardless of population considered (intention-to-treat
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2021, ChestCitation Excerpt :Enoxaparin is a low-molecular-weight heparin (LMWH) that is commonly given for DVT and pulmonary embolus at a dosage of 1 mg/kg twice daily. In patients receiving enoxaparin for DVT or pulmonary embolus, the incidence of major bleeding (defined as being clinically overt and associated with a hemoglobin decrease of 2 g/dL or requiring a transfusion of 2 units of packed RBCs) is 2.9% at 3 months.7 Monitoring of antithrombotic effects is not usually necessary but can be considered in obese patients and those with renal dysfunction, targeting an anti-Xa level of 0.6 to 1.0 units/mL measured 4 hours after the third dose.
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2021, Thrombosis ResearchCitation Excerpt :With the increase in obesity in our population, it is important to establish an effective and safe enoxaparin prophylactic and treatment dose for VTE to prevent adverse outcomes such as bleeding complications or VTE progression. Enoxaparin for VTE treatment is associated with a 2.1% risk of major bleeding (severe intracranial or gastrointestinal, or requiring blood transfusion or surgical intervention leading to patient mortality or morbidity) [15]. While 1.7% (63/3621) of study patients had major bleeds on prophylactic doses of enoxaparin, in obese patients on thromboprophylaxis bleeding rates of 1–2% have been reported [16].
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2017, Journal of Vascular Surgery: Venous and Lymphatic DisordersInternational clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer
2016, The Lancet OncologyCitation Excerpt :As presented in the 2013 CPGs,20 data pooled from randomised and retrospective studies indicated that patients with cancer who were initially treated with unfractionated heparin or low-molecular-weight heparin (LMWH) followed by a vitamin K antagonist (VKA) have a high prevalence of VTE recurrence (10·0–38·0% for unfractionated heparin and 6·7–17·0% for LMWH) and major bleeding (6·3–35·0% and 2·9–16·9%, respectively). With regard to recommendations for short-term LMWH versus short-term unfractionated heparin followed by VKA, the 2013 CPGs were based on several meta-analyses27–35 of subgroups of patients with cancer comparing short-term LMWH, unfractionated heparin, or fondaparinux in the initial treatment of VTE in the general population. Since our previous recommendations, two meta-analyses36,37 have compared short-term LMWH with unfractionated heparin in patients with cancer.
Safety of anticoagulation in the treatment of venous thromboembolism in patients with haematological malignancies and thrombocytopenia: Report of 5 cases and literature review
2016, Critical Reviews in Oncology/HematologyCitation Excerpt :Eleven of 24 intracranial bleeding episodes were fatal (Linkins et al., 2003). In another meta-analysis which compared the safety and efficacy of unfractionated heparin to enoxaparin in patients with VTE, the adjusted incidence of major bleeding at 3 months in patients on enoxaparin was 2.9% (Mismetti et al., 2005). In a pooled analysis of the bleeding risk of LMWH and VKA in patients with cancer, major bleeding occurred in about 6% of patients (Kamphuisen and Beyer-Westendorf, 2014).
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
Funding for this research was provided by Laboratoire Aventis, a subsidiary of the Sanofi Aventis group.