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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

Forest plots: extracorporeal circuit thrombosis.Forest Plots comparing LMWH Vs UH for extracorporeal circuit thrombosis.
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fig-2: Forest plots: extracorporeal circuit thrombosis.Forest Plots comparing LMWH Vs UH for extracorporeal circuit thrombosis.

Mentions: None of the included studies assessed graft or fistula thrombosis. Six studies had reported extracorporeal circuit thrombosis, of which the study by Verzan et al. (2004), though it had mentioned that the LMWH group and UH group were similar with regards to the number of people with this outcome, did not report the exact numbers. Harenberg et al. (1995) reported that LMWH group (tinzaparin) did not differ with UH group as both groups had similar number of events (1/10 each). The remaining 4 studies Borm et al. (1986), Schrader et al. (1988), Saltissi et al. (1999) and Lord et al. (2002), had reported this outcome for the total number of dialysis sessions in each group. The number of extracorporeal circuit thrombosis/number of dialysis sessions encountered for the LMWH group in these 4 studies were respectively 4/10, 80/5045, 17/1111 and 32/378 compared to 4/10, 69/5197, 35/1141, 21/382 in the UH group. The risk ratio comparing LMWH to UH in these 4 studies were 1.00 (0.34–2.93), 1.19 [0.87, 1.64], 0.50 [0.28, 0.89], and 1.54 [0.90, 2.62] respectively (Table 3). The pooled risk ratio was 1.00 with a 95% CI [0.62–1.62]. (Fig. 2).


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)

Forest plots: extracorporeal circuit thrombosis.Forest Plots comparing LMWH Vs UH for extracorporeal circuit thrombosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig-2: Forest plots: extracorporeal circuit thrombosis.Forest Plots comparing LMWH Vs UH for extracorporeal circuit thrombosis.
Mentions: None of the included studies assessed graft or fistula thrombosis. Six studies had reported extracorporeal circuit thrombosis, of which the study by Verzan et al. (2004), though it had mentioned that the LMWH group and UH group were similar with regards to the number of people with this outcome, did not report the exact numbers. Harenberg et al. (1995) reported that LMWH group (tinzaparin) did not differ with UH group as both groups had similar number of events (1/10 each). The remaining 4 studies Borm et al. (1986), Schrader et al. (1988), Saltissi et al. (1999) and Lord et al. (2002), had reported this outcome for the total number of dialysis sessions in each group. The number of extracorporeal circuit thrombosis/number of dialysis sessions encountered for the LMWH group in these 4 studies were respectively 4/10, 80/5045, 17/1111 and 32/378 compared to 4/10, 69/5197, 35/1141, 21/382 in the UH group. The risk ratio comparing LMWH to UH in these 4 studies were 1.00 (0.34–2.93), 1.19 [0.87, 1.64], 0.50 [0.28, 0.89], and 1.54 [0.90, 2.62] respectively (Table 3). The pooled risk ratio was 1.00 with a 95% CI [0.62–1.62]. (Fig. 2).

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