How complete is the evidence for thromboembolism prophylaxis in general medicine patients? A meta-analysis of randomized controlled trials Financial Disclosures: None.
dc.contributor.author | Bump, Gregory M. | en_US |
dc.contributor.author | Dandu, Madhavi | en_US |
dc.contributor.author | Kaufman, Samuel R. | en_US |
dc.contributor.author | Shojania, Kaveh G. | en_US |
dc.contributor.author | Flanders, Scott A. | en_US |
dc.date.accessioned | 2009-07-06T15:38:01Z | |
dc.date.available | 2010-07-06T14:30:31Z | en_US |
dc.date.issued | 2009-05 | en_US |
dc.identifier.citation | Bump, Gregory M.; Dandu, Madhavi; Kaufman, Samuel R.; Shojania, Kaveh G.; Flanders, Scott A. (2009). "How complete is the evidence for thromboembolism prophylaxis in general medicine patients? A meta-analysis of randomized controlled trials Financial Disclosures: None. ." Journal of Hospital Medicine 4(5): 289-297. <http://hdl.handle.net/2027.42/63051> | en_US |
dc.identifier.issn | 1553-5592 | en_US |
dc.identifier.issn | 1553-5606 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/63051 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=19504490&dopt=citation | en_US |
dc.description.abstract | OBJECTIVES: Guidelines recommend pharmacologic prophylaxis for hospitalized medical patients at increased risk of thromboembolism. Despite recommendations, multiple studies demonstrate underutilization. Factors contributing to underutilization include uncertainty that prophylaxis reduces clinically relevant events, as well as questions about the best form of prophylaxis. We sought to determine whether prophylaxis decreases clinically significant events and to answer whether unfractionated heparin (UFH) or low molecular weight heparin (LMWH) is either more effective or safer. DATA SOURCES: The MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched through June 2008. Relevant bibliographies and conference proceedings were reviewed and LMWH manufacturers were contacted. STUDY SELECTION: Randomized trials comparing UFH or LMWH to control, as well as head-to-head comparisons of UFH to LMWH in general medicine patients. DATA EXTRACTION AND ANALYSIS: End points of deep venous thrombosis (DVT), proximal or symptomatic DVT, pulmonary embolism, mortality, bleeding, and thrombocytopenia were extracted from individual trials. Pooled relative risks were calculated using random effects modeling. RESULTS: We identified 8 trials comparing prophylaxis to control, and 6 trials comparing UFH to LMWH. Prophylaxis reduced DVT (relative risk [RR] = 0.55; 95% confidence interval [CI]: 0.36-0.92), proximal DVT (RR = 0.46; 95% CI: 0.31-0.69), and pulmonary embolism (RR = 0.70; 95% CI: 0.53-0.93). Prophylaxis increased the risk of any bleeding (RR = 1.54; 95% CI: 1.15-2.06) but not major bleeding. Across trials comparing LMWH to UFH, there were no differences for any outcome. CONCLUSIONS: Among medical patients, pharmacologic prophylaxis reduced the risk of thromboembolism without increasing risk of major bleeding. The current literature does not demonstrate superior efficacy of UFH or LMWH. Journal of Hospital Medicine 2009;4:289–297. © 2009 Society of Hospital Medicine. | en_US |
dc.format.extent | 473881 bytes | |
dc.format.extent | 3118 bytes | |
dc.format.mimetype | application/pdf | |
dc.format.mimetype | text/plain | |
dc.publisher | Wiley Subscription Services, Inc., A Wiley Company | en_US |
dc.subject.other | Life and Medical Sciences | en_US |
dc.subject.other | Hospital Medicine | en_US |
dc.title | How complete is the evidence for thromboembolism prophylaxis in general medicine patients? A meta-analysis of randomized controlled trials Financial Disclosures: None. | en_US |
dc.type | Article | en_US |
dc.rights.robots | IndexNoFollow | en_US |
dc.subject.hlbsecondlevel | Medicine (General) | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan | en_US |
dc.contributor.affiliationum | Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan | en_US |
dc.contributor.affiliationother | Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania ; Telephone: 412-802-6648; Fax: 412-692-4499 ; Gregory M. Bump and Madhavi Dandu contributed equally to this work. ; University of Pittsburgh Medical Center, UPMC Montefiore, 9 South, 200 Lothrop Street, Pittsburgh, PA 15213-2582 | en_US |
dc.contributor.affiliationother | Department of Internal Medicine, University of California San Francisco, San Francisco, California | en_US |
dc.contributor.affiliationother | Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada | en_US |
dc.identifier.pmid | 19504490 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/63051/1/450_ftp.pdf | |
dc.identifier.doi | 10.1002/jhm.450 | en_US |
dc.identifier.source | Journal of Hospital Medicine | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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