Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta-analysis.
casts
immobilization
network meta-analysis
risk
surgical
venous thromboembolism
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
03
05
2019
accepted:
21
10
2019
pubmed:
28
10
2019
medline:
15
5
2021
entrez:
27
10
2019
Statut:
ppublish
Résumé
Thromboprophylaxis has the potential to reduce venous thromboembolism (VTE) following lower limb immobilization resulting from injury. We aimed to estimate the effectiveness of thromboprophylaxis, compare different agents, and identify any factors associated with effectiveness. We undertook a systematic review and network meta-analysis (NMA) of randomized trials reporting VTE or bleeding outcomes that compared thromboprophylactic agents with each other or to no pharmacological prophylaxis, for this indication. An NMA was undertaken for each outcome or agent used, and a series of study-level network meta-regressions examined whether population characteristics, type of injury, treatment of injury, or duration of thromboprophylaxis were associated with treatment effect. Data from 6857 participants across 13 randomized trials showed that, compared with no treatment, low molecular weight heparin (LMWH) reduced the risk of any VTE (odds ratio [OR]: 0.52; 95% credible interval [CrI]: 0.37-0.71), clinically detected deep vein thrombosis (DVT) (OR: 0.39; 95% CrI: 0.12-0.94) and pulmonary embolism (PE) (OR: 0.16; 95% CrI: 0.01-0.74), whereas fondaparinux reduced the risk of any VTE (OR: 0.13; 95% CrI: 0.05-0.30) and clinically detected DVT (OR: 0.10; 95% CrI: 0.01-0.86), with inconclusive results for PE (OR: 0.40; 95% CrI: 0.01-7.53). Thromboprophylaxis with either fondaparinux or LMWH appears to reduce the odds of both asymptomatic and clinically detected VTE in people with temporary lower limb immobilization following an injury. Treatment effects vary by outcome and are not always conclusive. We were unable to identify any treatment effect modifiers other than thromboprophylactic agent used.
Sections du résumé
BACKGROUND
Thromboprophylaxis has the potential to reduce venous thromboembolism (VTE) following lower limb immobilization resulting from injury.
OBJECTIVES
We aimed to estimate the effectiveness of thromboprophylaxis, compare different agents, and identify any factors associated with effectiveness.
METHODS
We undertook a systematic review and network meta-analysis (NMA) of randomized trials reporting VTE or bleeding outcomes that compared thromboprophylactic agents with each other or to no pharmacological prophylaxis, for this indication. An NMA was undertaken for each outcome or agent used, and a series of study-level network meta-regressions examined whether population characteristics, type of injury, treatment of injury, or duration of thromboprophylaxis were associated with treatment effect.
RESULTS
Data from 6857 participants across 13 randomized trials showed that, compared with no treatment, low molecular weight heparin (LMWH) reduced the risk of any VTE (odds ratio [OR]: 0.52; 95% credible interval [CrI]: 0.37-0.71), clinically detected deep vein thrombosis (DVT) (OR: 0.39; 95% CrI: 0.12-0.94) and pulmonary embolism (PE) (OR: 0.16; 95% CrI: 0.01-0.74), whereas fondaparinux reduced the risk of any VTE (OR: 0.13; 95% CrI: 0.05-0.30) and clinically detected DVT (OR: 0.10; 95% CrI: 0.01-0.86), with inconclusive results for PE (OR: 0.40; 95% CrI: 0.01-7.53).
CONCLUSIONS
Thromboprophylaxis with either fondaparinux or LMWH appears to reduce the odds of both asymptomatic and clinically detected VTE in people with temporary lower limb immobilization following an injury. Treatment effects vary by outcome and are not always conclusive. We were unable to identify any treatment effect modifiers other than thromboprophylactic agent used.
Identifiants
pubmed: 31654551
doi: 10.1111/jth.14666
pmc: PMC7028118
pii: S1538-7836(22)01503-3
doi:
Substances chimiques
Anticoagulants
0
Heparin, Low-Molecular-Weight
0
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
422-438Subventions
Organisme : Department of Health
ID : HTA/15/187/06
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 Crown copyright. Journal of Thrombosis and Haemostasis © 2019 International Society on Thrombosis and Haemostasis.
Références
Lancet. 2001 Sep 8;358(9284):837; author reply 839
pubmed: 11570399
J Thromb Haemost. 2013 Oct;11(10):1833-43
pubmed: 23965181
Injury. 2017 Apr;48(4):936-940
pubmed: 28279428
J Thromb Haemost. 2014 Oct;12(10):1580-90
pubmed: 25302663
Lancet. 1999 Apr 24;353(9162):1386-9
pubmed: 10227218
Cochrane Database Syst Rev. 2017 Aug 06;8:CD006681
pubmed: 28780771
Syst Rev. 2016 May 10;5:80
pubmed: 27160280
N Engl J Med. 2017 Feb 9;376(6):515-525
pubmed: 27959702
Br J Haematol. 2019 Sep;186(5):792-793
pubmed: 31168834
Thromb Haemost. 2001 May;85(5):940-1
pubmed: 11372694
Unfallchirurg. 1998 Jan;101(1):42-9
pubmed: 9522671
Heart. 2010 Jun;96(11):879-82
pubmed: 20478866
Thromb Res. 2019 Feb;174:62-75
pubmed: 30579148
J Thromb Haemost. 2020 Feb;18(2):422-438
pubmed: 31654551
Haemostasis. 1993 Mar;23 Suppl 1:20-6
pubmed: 8388353
Cochrane Database Syst Rev. 2014 Apr 25;(4):CD006681
pubmed: 24771319
J Thromb Haemost. 2005 Apr;3(4):692-4
pubmed: 15842354
PLoS Med. 2015 Nov 10;12(11):e1001899; discussion e1001899
pubmed: 26554832
Acta Orthop. 2007 Aug;78(4):528-35
pubmed: 17966008
J Orthop Trauma. 2015 May;29(5):224-30
pubmed: 25900749
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
Thromb Haemost. 2011 Apr;105(4):739-41
pubmed: 21225101
Foot Ankle Surg. 2018 Feb;24(1):19-27
pubmed: 29413769
Chest. 2012 Feb;141(2 Suppl):e278S-e325S
pubmed: 22315265
N Engl J Med. 2002 Sep 5;347(10):726-30
pubmed: 12213943
Emerg Med J. 2013 Nov;30(11):968-82
pubmed: 24142947
Syst Rev. 2014 Apr 15;3:37
pubmed: 24731537
Ann Intern Med. 1996 Jul 1;125(1):1-7
pubmed: 8644983
J Orthop Trauma. 2007 Jan;21(1):52-7
pubmed: 17211270
J Thromb Haemost. 2010 Apr;8(4):678-83
pubmed: 20040041
BMJ Evid Based Med. 2018 Apr;23(2):56-59
pubmed: 29595131
Lancet. 1995 Aug 19;346(8973):459-61
pubmed: 7637478
Emerg Med J. 2016 Jun;33(6):431-7
pubmed: 26101406
Thromb Haemost. 2015 Nov;114(5):1049-57
pubmed: 26134342
J Thromb Thrombolysis. 2018 May;45(4):562-570
pubmed: 29549559
J Bone Joint Surg Br. 2009 Mar;91(3):388-94
pubmed: 19258618
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
J Clin Epidemiol. 2013 Sep;66(9):973-81
pubmed: 22981249
BMJ. 2009 Oct 19;339:b4012
pubmed: 19841007
Health Technol Assess. 2019 Dec;23(63):1-190
pubmed: 31851608
Foot Ankle Surg. 2016 Sep;22(3):191-195
pubmed: 27502229
Foot Ankle Surg. 2015 Dec;21(4):266-8
pubmed: 26564729
Thromb Res. 2002 Mar 15;105(6):477-80
pubmed: 12091045
Foot Ankle Int. 2016 Nov;37(11):1218-1224
pubmed: 27521353