Long-term Low-Molecular-Weight Heparin and the Post-Thrombotic Syndrome: A Systematic Review - 25/07/11
, Jane Liang, MSc a, Grace Townshend, MSc b
Requests for reprints should be addressed to Russell D. Hull, MBBS, MSc, Thrombosis Research Unit, 601 South Tower, Foothills Hospital, 1403 29th Street NW, Calgary, Alberta, Canada, T2N 2T9Abstract |
Objective |
Post-thrombotic syndrome causes considerable morbidity. The Home-LITE study showed a lower incidence of post-thrombotic syndrome and venous ulcers after 3 months of treating deep vein thrombosis with the low-molecular-weight heparin tinzaparin versus oral anticoagulation. This systematic review examined whether long-term treatment of deep vein thrombosis using low-molecular-weight heparin, rather than oral anticoagulation, reduces development of post-thrombotic syndrome.
Methods |
We identified 9 articles comparing treatment of deep vein thrombosis using long-term low-molecular-weight heparin with any comparator, which reported outcomes relevant to the post-thrombotic syndrome assessed ≥ 3 months post-deep vein thrombosis.
Results |
Pooled analysis of 2 studies yielded an 87% risk reduction with low-molecular-weight heparin in the incidence of venous ulcers at ≥ 3 months (P = .019). One study showed an overall odds ratio of 0.77 (P = .001) favoring low-molecular-weight heparin for the presence of 8 patient-reported post-thrombotic syndrome signs and symptoms. Pooled analysis of 5 studies showed a risk ratio for low-molecular-weight heparin versus oral anticoagulation of 0.66 (P < .0001) for complete recanalization of thrombosed veins.
Conclusion |
These results support the lower incidence of post-thrombotic syndrome and venous ulcers observed in Home-LITE. Long-term treatment with low-molecular-weight heparin rather than oral anticoagulation after a deep vein thrombosis may reduce or prevent development of signs and symptoms associated with post-thrombotic syndrome. Post-thrombotic syndrome and associated acute ulcers may develop more rapidly after deep vein thrombosis than previously recognized.
El texto completo de este artículo está disponible en PDF.Keywords : Deep vein thrombosis, Low-molecular-weight heparin, Post-thrombotic syndrome, Recanalization, Venous ulcer
Esquema
| Funding: LEO Pharma supported this study financially. |
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| Conflict of Interest: R. Hull has received grants/research support from Bayer Pharmaceuticals Corp, LEO Pharma Inc, and Sanofi-Aventis; been a consultant for Bayer Pharmaceuticals Corp, LEO Pharma, Inc, Pfizer Inc, GlaxoSmithKline, and Wyeth Pharmaceuticals; and sat on advisory boards for Bayer Pharmaceuticals Corp, Pfizer Inc, and Sanofi-Aventis. J. Liang has no conflicts of interest to declare. G. Townshend is an employee of Watermeadow Medical, which received payment from LEO Pharma for work on this manuscript. Editorial assistance was provided by Watermeadow Medical. |
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| Authorship: R. Hull had the original idea for the study, provided guidance and input into all drafts, and is the guarantor of the study. G. Townshend performed the literature searches, made the study selection, and wrote the first draft. J. Liang performed the statistical analyses. |
Vol 124 - N° 8
P. 756-765 - août 2011 Regresar al número
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