[Low molecular weight heparins versus traditional heparins in thromboembolic diseases]

Mujika N, Bermejo M C, Capellan J F, Dorronsoro S
Record ID 32004000202
Original Title: Heparinas de bajo peso molecular versus clásicas en enfermedad tromboembólica
Authors' objectives: Determine the safety and efficiency of low molecular weight heparins (LMWH) in comparison with non-fractionated heprarins (NFH) in the treatment and preparation of deep vein thrombosis and pulmonary thromboembolism.
Authors' results and conclusions: Treatment: The population analysed suffers basically from deep vein thrombosis of the lower extremities. There is a great deal of variability with regard to treatment (type of low molecular weight heparin, method of administering, dosage and posology). Very low percentage of clinical trials (63%) with high quality (Jahad scale greater than 3). None shows greater efficiency or safety with non-fractionated heparin. Costs: All the articles find a higher cost effectiveness in the treatment of deep vein thrombosis with LMWH, and no articles have been found on a cost analysis with pulmonary thromboembolism. Prophylaxis: The predominant population analysed is the one treated with abdominal or orthopaedic surgery. Treatment is variable with regard to the type of LMWH and dosage, although it is uniform with regard to the posology and method of administering ( 63%). With regard to efficiency, two clinical trials (0.5%) show greater efficiency with non-fractionated heparin; 25% greater efficiency with LMWH and the rest is similar. As far as safety is concerned, the use of HBPM is 10% safer with non-fractionated heparin compared to 15% greater safety with LMWH, and the rest is similar. With regard to costs, 66% show that prophylaxis with LMWH is more cost effective than non-fractionated heparin. One trial concludes that the costs of prophylaxis with LMWH are too high to recommend their indiscriminate use.
Authors' recommendations: According to the scientific evidence, the efficiency and safety of low molecular weight heparin (LMWH) is at least similar or greater both in prophylaxis and in the treatment of thromboembolic diseases. More long-term surveys are required to assess the phlebitic complications in both treatments.
Authors' methods: Systematic review of the bibliography on the efficiency and safety of LMWH compared to NFH: The strategy followed. A.- P. I. O. questions (Patients: medical and surgical; Intervention: Treatment or prophylaxis of venous thromboembolic diseases with LMWH compared to NFH; Outcomes: Efficiency and safety.) B.- Search criteria: Heparin, that includes herparin and low molecular weight heparin, anticoagulants, includes heparin, heparinoids and low molecular weight heparin, embolism and thrombosis, includes venous thrombosis, pulmonary embolism and thromboembolism, randomised and controlled trials, controlled and clinical and trials, double blind or placebo and meta-analysis. MESH terms or free text. Only limit Human. No language restraints. C.- Sources of information: Books in electronic format (Up to date 8.3, SAM-CD, Clinical Evidence issue 4), databases (Cochrane Library issue 3 2001 - issue 1 2002, Medline via Pubmed, Best Evidence, DARE- NHS-EED-HTA, Teseo, Bandolier) Clinical Practice Guides (from Canada, America, Scotland, New Zealand, Catalonia), papers presented at conferences, inverse search. D.- Selection of articles: Reading of title and abstracts; discarding those unrelated to our subject, protocols and abstracts and clinical tests. E.- Critical reading of selected articles: The CASP template is used for clinical trials and for systematic reviews. The Jadad quality scale is applied. The Michael F. Drummond model is used for articles on cost analysis. F.- Conclusions: The efficiency and safety of both drugs are similar, both in treatment and in the prophylaxis of venous thromboembolic diseases
Project Status: Completed
Year Published: 2002
English language abstract: An English language summary is available
Publication Type: Full HTA
Country: Spain
MeSH Terms
  • Heparin
  • Heparin, Low-Molecular-Weight
  • Pulmonary Embolism
  • Thromboembolism
  • Venous Thrombosis
  • Embolism and Thrombosis
  • Anticoagulants
Organisation Name: Basque Office for Health Technology Assessment
Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz
Contact Name: Lorea Galnares-Cordero
Contact Email: lgalnares@bioef.eus
Copyright: <p>Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)</p>
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.