Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: a systematic review and meta-analysis
- 1 March 2008
- journal article
- review article
- Published by Wiley in Journal of Thrombosis and Haemostasis
- Vol. 6 (3), 405-414
- https://doi.org/10.1111/j.1538-7836.2007.02847.x
Abstract
The effect of anticoagulant prophylaxis on the prevention of deep vein thrombosis (DVT) should include an investigation of both clinical and subclinical DVT. We conducted a systematic review to determine whether anticoagulant prophylaxis reduces the risk of asymptomatic DVT compared to no prophylaxis in at-risk hospitalized medical patients. MEDLINE, EMBASE, and the Cochrane Library were searched through March 2007 for randomized trials of anticoagulant prophylaxis for the prevention of asymptomatic DVT, assessed by venogram or ultrasound. We assessed four outcomes: all asymptomatic DVT, asymptomatic proximal DVT, major bleeding and mortality. Random effects meta-analyses were performed and results were expressed using relative risk (RR) and 95% confidence intervals (95% CIs). Four trials including 5516 patients were eligible. Our pooled analysis demonstrated that compared to placebo, anticoagulant prophylaxis was associated with a significantly lower risk of any asymptomatic DVT (RR 0.51; 95% CI 0.39-0.67) and asymptomatic proximal DVT (RR 0.45; 95% CI 0.31-0.65). Anticoagulant prophylaxis was associated with a significantly increased risk of major bleeding compared to placebo (RR 2.00; 95% CI 1.05-3.79). There was no significant difference in the pooled estimate for all-cause mortality. Anticoagulant prophylaxis conferred an absolute risk reduction of any DVT and proximal DVT of 2.6% and 1.8%, respectively, and was associated with a 0.5% absolute risk increase in major bleeding. Anticoagulant prophylaxis is effective in preventing asymptomatic DVT in at-risk hospitalized medical patients but is associated with an increased bleeding risk. The therapeutic benefits of anticoagulant prophylaxis appear to outweigh the risks of bleeding.This publication has 40 references indexed in Scilit:
- Venous Thromboembolism in the Outpatient SettingArchives of Internal Medicine, 2007
- Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgeryJournal of Thrombosis and Haemostasis, 2007
- Prevention of venous thromboembolism after major orthopaedic surgery: is fondaparinux an advance?The Lancet, 2003
- A Comparison of Enoxaparin with Placebo for the Prevention of Venous Thromboembolism in Acutely Ill Medical PatientsThe New England Journal of Medicine, 1999
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996
- DOUBLE-BLIND RANDOMISED TRIAL OF ORG 10172 LOW-MOLECULAR-WEIGHT HEPARINOID IN PREVENTION OF DEEP-VEIN THROMBOSIS IN THROMBOTIC STROKEThe Lancet, 1987
- LOW-DOSE SUBCUTANEOUS HEPARIN IN THE PREVENTION OF DEEP-VEIN THROMBOSIS AND PULMONARY EMBOLI FOLLOWING ACUTE STROKEAge and Ageing, 1986
- LOW-DOSE HEPARIN AS A PROPHYLAXIS AGAINST DEEP-VEIN THROMBOSIS AFTER ACUTE STROKEThe Lancet, 1977
- A DOUBLE-BLIND TRIAL OF LOW DOSES OF SUBCUTANEOUS HEPARIN IN THE PREVENTION OF DEEP-VEIN THROMBOSIS AFTER MYOCARDIAL INFARCTION*1The Lancet, 1973
- Heparin in the Prevention of Deep Vein Thrombosis after Myocardial InfarctionBMJ, 1972