Authors' objectives:

This aim of this report was to assess the effectiveness of low molecular weight heparin in comparison to unfractionated heparin for the management of pulmonary thromboembolism.

Authors' recommendations: Four randomised controlled trials and two evidence based clinical practice guidelines were identified comparing low molecular weight heparin (LMWH) with unfractionated heparin (UH) in the management of pulmonary embolism (PE). The studies included the LMWHs tinzaparin sodium, reviparin sodium and Fragmin and assessed the following outcomes: death, recurrent venous thromboembolism, and risk of major bleeding. None of the trials reported a significant difference between LMWH and UH for death and risk of major bleeding. Only one trial reported an increased risk of recurrent venous thromboembolism for the UH group compared to the LMWH group. The other three trials found no significant differences. Both guidelines recommend replacing UH with LMWH for treatment of pulmonary embolism. We are unable to reach definitive conclusions regarding the effectiveness of different types of LMWHs. The studies were of variable quality. One RCT was of very high quality, two were medium quality, and one study was of poor quality.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.med.monash.edu.au/healthservices/cce/evidence/

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Centre for Clinical Effectiveness

Contact Address: Monash Institute of Health Services Research, Block E, Monash Medical Centre, Locked Bag 29, Clayton, Victoria 3168, Australia. Tel: +61 3 9594 7505; Fax: +61 3 9594 7552.

Contact Name: cce@med.monash.edu.au.

Contact Email: cce@med.monash.edu.au.

Copyright: Centre for Clinical Effectiveness (CCE)