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Efficacy and safety of low molecular weight heparin in patients with mechanical heart valves: systematic review and meta‐analysis
Author(s) -
Caldeira D.,
David C.,
Santos A. T.,
Costa J.,
Pinto F. J.,
Ferreira J. J.
Publication year - 2014
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.12544
Subject(s) - observational study , medicine , randomized controlled trial , low molecular weight heparin , meta analysis , odds ratio , confidence interval , heparin , mechanical heart , intensive care medicine , surgery
Summary Background Low molecular weight heparins ( LMWH s) are not approved for patients with mechanical heart valves ( MHV s). However, in several guidelines, temporary LMWH off‐label use in this clinical setting is considered to be a valid treatment option. Therefore, we reviewed the efficacy and safety of LMWH s in patients with MHV s. Methods MEDLINE and CENTRAL databases were searched from inception to June 2013. Review articles and references were also searched. We included experimental and observational studies that compared LMWH s with unfractionated heparin ( UFH ) or vitamin K antagonists ( VKA s). Data were analyzed and pooled to estimate odds ratios ( OR s) with 95% confidence intervals ( CI s) for thromboembolic and major bleeding events. Statistical heterogeneity was evaluated with the I 2 ‐test. Results Nine studies were included: one randomized controlled trial ( RCT ) and eight observational studies, with a total of 1042 patients. No differences were found between LMWH s and UFH / VKAs in the risk of thromboembolic events ( OR 0.67; 95% CI 0.27–1.68; I 2 = 9%) or major bleeding events ( OR 0.66; 95% CI 0.36–1.19; I 2 = 0%). Conclusions The best evidence available might support the temporary use of LMWH s as a prophylactic treatment option in patients with MHV s. However, conclusions are mostly based on observational data (with large CI s), and an adequately powered RCT is urgently needed in this clinical setting.