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Efficacy and safety of low molecular weight heparin compared to unfractionated heparin for chronic outpatient hemodialysis in end stage renal disease: systematic review and meta-analysis.

Palamaner Subash Shantha G, Kumar AA, Sethi M, Khanna RC, Pancholy SB - PeerJ (2015)

Bottom Line: Random effects model was used for meta-analysis.LMWH is as safe and effective as UFH.Considering the poor quality of studies included for the review, larger well conducted RCTs are required before conclusions can be drawn.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Wright Center for Graduate Medical Education , Scranton, PA , USA ; The Johns Hopkins University, Bloomberg School of Public Health , Baltimore, MD , USA.

ABSTRACT
Background. Low molecular weight heparin (LMWH) is an effective anti-coagulant for thrombotic events. However, due to its predominant renal clearance, there are concerns that it might be associated with increased bleeding in patients with renal disease. Objectives. We systematically evaluated the efficacy and safety of LMWH compared to unfractionated heparin (UH) in end stage renal disease (ESRD) patients. Search Methods. Pubmed, Embase and cochrane central were searched for eligible citations. Selection Criteria. Randomized controlled trials, comparing LMWH and UH, involving adult (age > 18 years), ESRD patients receiving outpatient, chronic, intermittent hemodialysis were included. Data Collection and Analysis. Two independent reviewers performed independent data abstraction. I2 statistic was used to assess heterogeneity. Random effects model was used for meta-analysis. Results. Nineteen studies were included for systematic review and 4 were included for meta-analysis. There were no significant differences between LMWH and UFH for extracorporeal circuit thrombosis [risk ratio: 1 (95% CI [0.62-1.62])] and bleeding complications [risk ratio: 1.16 (95% CI [0.62-2.15])]. Conclusions. LMWH is as safe and effective as UFH. Considering the poor quality of studies included for the review, larger well conducted RCTs are required before conclusions can be drawn.

No MeSH data available.


Related in: MedlinePlus

Article flow diagram.Details the process of study inclusion into the review
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fig-1: Article flow diagram.Details the process of study inclusion into the review

Mentions: In total we had 4,095 citations retrieved after searching the three databases. After removing duplicates we were left with a final list of 3,735 citations. Of these, 19 citations were included in the review and 4 were pooled in the meta-analysis. Please refer to Fig. 1 for the study flow details.


Efficacy and safety of low molecular weight heparin compared to unfractionated heparin for chronic outpatient hemodialysis in end stage renal disease: systematic review and meta-analysis.

Palamaner Subash Shantha G, Kumar AA, Sethi M, Khanna RC, Pancholy SB - PeerJ (2015)

Article flow diagram.Details the process of study inclusion into the review
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4359121&req=5

fig-1: Article flow diagram.Details the process of study inclusion into the review
Mentions: In total we had 4,095 citations retrieved after searching the three databases. After removing duplicates we were left with a final list of 3,735 citations. Of these, 19 citations were included in the review and 4 were pooled in the meta-analysis. Please refer to Fig. 1 for the study flow details.

Bottom Line: Random effects model was used for meta-analysis.LMWH is as safe and effective as UFH.Considering the poor quality of studies included for the review, larger well conducted RCTs are required before conclusions can be drawn.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Wright Center for Graduate Medical Education , Scranton, PA , USA ; The Johns Hopkins University, Bloomberg School of Public Health , Baltimore, MD , USA.

ABSTRACT
Background. Low molecular weight heparin (LMWH) is an effective anti-coagulant for thrombotic events. However, due to its predominant renal clearance, there are concerns that it might be associated with increased bleeding in patients with renal disease. Objectives. We systematically evaluated the efficacy and safety of LMWH compared to unfractionated heparin (UH) in end stage renal disease (ESRD) patients. Search Methods. Pubmed, Embase and cochrane central were searched for eligible citations. Selection Criteria. Randomized controlled trials, comparing LMWH and UH, involving adult (age > 18 years), ESRD patients receiving outpatient, chronic, intermittent hemodialysis were included. Data Collection and Analysis. Two independent reviewers performed independent data abstraction. I2 statistic was used to assess heterogeneity. Random effects model was used for meta-analysis. Results. Nineteen studies were included for systematic review and 4 were included for meta-analysis. There were no significant differences between LMWH and UFH for extracorporeal circuit thrombosis [risk ratio: 1 (95% CI [0.62-1.62])] and bleeding complications [risk ratio: 1.16 (95% CI [0.62-2.15])]. Conclusions. LMWH is as safe and effective as UFH. Considering the poor quality of studies included for the review, larger well conducted RCTs are required before conclusions can be drawn.

No MeSH data available.


Related in: MedlinePlus