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Correspondence| Volume 31, ISSUE 3, P627-628, March 01, 2013

Importance of meta-analysis of long-term trials of low–molecular-weight heparin vs vitamin K antagonist in pulmonary embolism

Published:January 21, 2013DOI:https://doi.org/10.1016/j.ajem.2012.12.012
Importance of meta-analysis of long-term trials of low–molecular-weight heparin vs vitamin K antagonist in pulmonary embolism
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      Numerous studies as well as meta-analyses showed that low–molecular-weight heparin (LMWH) was better than vitamin K antagonist (VKA) in the long-term therapy for venous thromboembolism (VTE) [
      • Lopez-Beret P.
      • Orgaz A.
      • Fontcuberta J.
      • et al.
      Low molecular weight heparin versus oral anticoagulants in the long term treatment of deep venous thrombosis.
      J Vasc Surg. 2001; 33: 77-90
      ,
      • Daskalopoulos M.E.
      • Daskalopoulou S.S.
      • Tzortis E.
      • et al.
      Long-term treatment of deep venous thrombosis with a low molecular weight heparin (tinzaparin): a prospective randomised trial.
      Eur J Vasc Endovasc Surg. 2005; 29: 638-650
      ,
      • Hull R.D.
      • Pineo G.F.
      • Brant R.F.
      • et al.
      LITE Trial Investigators. Self-managed long-term low–molecular-weight heparin therapy: the balance of benefits and harms.
      Am J Med. 2007; 120: 72-82
      ,
      • González-Fajardo J.A.
      • Martin-Pedrosa M.
      • Castrodeza J.
      • et al.
      Effect of the anticoagulant therapy in the incidence of post-thrombotic syndrome and recurrent thromboembolism: comparative study of enoxaparin versus coumarin.
      J Vasc Surg. 2008; 48: 953-959
      ,
      • Iorio A.
      • Guercini F.
      • Pini M.
      Low–molecular-weight heparin for the long-term treatment of symptomatic venous thromboembolism: meta-analysis of the randomized comparisons with oral anticoagulants.
      J Thromb Haemost. 2003; 1: 1906-1913
      ,
      • Hull R.D.
      • Liang J.
      • Townshend G.
      Long-term low–molecular-weight heparin and the post-thrombotic syndrome: a systematic review.
      Am J Med. 2011; 124: 756-765
      ]. This is mostly due to the recognized advantage of LMWH vs VKA in long-term VTE treatment of cancer patients [
      • Ferretti G.
      • Bria E.
      • Giannarelli D.
      • et al.
      Is recurrent venous thromboembolism after therapy reduced by low–molecular-weight heparin compared with oral anticoagulants?.
      Chest. 2006; 130: 1808-1816
      ,
      • Romera-Villegas A.
      • Cairols-Castellote M.A.
      • Vila-Coll R.
      • et al.
      Long-term use of different doses of low–molecular-weight heparin versus vitamin K antagonists in the treatment of venous thromboembolism.
      Ann Vasc Surg. 2010; 24: 628-639
      ]. Otherwise, long-term LMWH and VKA are believed to have similar risk/benefit ratio in VTE or pulmonary thromboembolism (PTE) patients [
      • Romera-Villegas A.
      • Cairols-Castellote M.A.
      • Vila-Coll R.
      • et al.
      Long-term use of different doses of low–molecular-weight heparin versus vitamin K antagonists in the treatment of venous thromboembolism.
      Ann Vasc Surg. 2010; 24: 628-639
      ]. After the exclusion of studies enrolling only cancer patients, LMWH was somewhat better: there was a 21% reduction of the risk of recurrent symptomatic VTE during treatment in favor of LMWH vs VKA; but it was statistically nonsignificant [
      • Ferretti G.
      • Bria E.
      • Giannarelli D.
      • et al.
      Is recurrent venous thromboembolism after therapy reduced by low–molecular-weight heparin compared with oral anticoagulants?.
      Chest. 2006; 130: 1808-1816
      ], whereas the risk of (major) bleeding was significantly lower in the LMWH group [
      • Iorio A.
      • Guercini F.
      • Pini M.
      Low–molecular-weight heparin for the long-term treatment of symptomatic venous thromboembolism: meta-analysis of the randomized comparisons with oral anticoagulants.
      J Thromb Haemost. 2003; 1: 1906-1913
      ,
      • van der Heijden J.F.
      • Hutten B.A.
      • Büller H.R.
      • et al.
      Vitamin K antagonists or low–molecular-weight heparin for the long term treatment of symptomatic venous thromboembolism.
      Cochrane Database Syst Rev. 2002; 1: CD002001
      ] or at least similar [
      • Ferretti G.
      • Bria E.
      • Giannarelli D.
      • et al.
      Is recurrent venous thromboembolism after therapy reduced by low–molecular-weight heparin compared with oral anticoagulants?.
      Chest. 2006; 130: 1808-1816
      ], which is important, indeed.
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      References

        • Lopez-Beret P.
        • Orgaz A.
        • Fontcuberta J.
        • et al.
        Low molecular weight heparin versus oral anticoagulants in the long term treatment of deep venous thrombosis.
        J Vasc Surg. 2001; 33: 77-90
        View in Article
        • Daskalopoulos M.E.
        • Daskalopoulou S.S.
        • Tzortis E.
        • et al.
        Long-term treatment of deep venous thrombosis with a low molecular weight heparin (tinzaparin): a prospective randomised trial.
        Eur J Vasc Endovasc Surg. 2005; 29: 638-650
        View in Article
        • Hull R.D.
        • Pineo G.F.
        • Brant R.F.
        • et al.
        LITE Trial Investigators. Self-managed long-term low–molecular-weight heparin therapy: the balance of benefits and harms.
        Am J Med. 2007; 120: 72-82
        View in Article
        • González-Fajardo J.A.
        • Martin-Pedrosa M.
        • Castrodeza J.
        • et al.
        Effect of the anticoagulant therapy in the incidence of post-thrombotic syndrome and recurrent thromboembolism: comparative study of enoxaparin versus coumarin.
        J Vasc Surg. 2008; 48: 953-959
        View in Article
        • Iorio A.
        • Guercini F.
        • Pini M.
        Low–molecular-weight heparin for the long-term treatment of symptomatic venous thromboembolism: meta-analysis of the randomized comparisons with oral anticoagulants.
        J Thromb Haemost. 2003; 1: 1906-1913
        View in Article
        • Hull R.D.
        • Liang J.
        • Townshend G.
        Long-term low–molecular-weight heparin and the post-thrombotic syndrome: a systematic review.
        Am J Med. 2011; 124: 756-765
        View in Article
        • Ferretti G.
        • Bria E.
        • Giannarelli D.
        • et al.
        Is recurrent venous thromboembolism after therapy reduced by low–molecular-weight heparin compared with oral anticoagulants?.
        Chest. 2006; 130: 1808-1816
        View in Article
        • Romera-Villegas A.
        • Cairols-Castellote M.A.
        • Vila-Coll R.
        • et al.
        Long-term use of different doses of low–molecular-weight heparin versus vitamin K antagonists in the treatment of venous thromboembolism.
        Ann Vasc Surg. 2010; 24: 628-639
        View in Article
        • van der Heijden J.F.
        • Hutten B.A.
        • Büller H.R.
        • et al.
        Vitamin K antagonists or low–molecular-weight heparin for the long term treatment of symptomatic venous thromboembolism.
        Cochrane Database Syst Rev. 2002; 1: CD002001
        View in Article
        • Das S.K.
        • Cohen A.T.
        • Edmondson R.A.
        • et al.
        Low molecular weight heparin versus warfarin for prevention of recurrent venous thromboembolism: a randomised trial.
        World J Surg. 1996; 20: 521-527
        View in Article
        • Monreal M.
        • Roncales J.F.
        • Ruiz J.
        • et al.
        Secondary prevention of venous thromboembolism: a role for low molecular weight heparin.
        Haemostasis. 1998; 28: 236-243
        View in Article
        • Beckman J.A.
        • Dunn K.
        • Sasahara A.A.
        • et al.
        Enoxaparin monotherapy without oral anticoagulation to treat acute symptomatic pulmonary embolism.
        Thromb Haemost. 2003; 89: 953-958
        View in Article
        • Kucher N.
        • Quiroz R.
        • McKean S.
        • et al.
        Extended enoxaparin monotherapy for acute symptomatic pulmonary embolism.
        Vasc Med. 2005; 10: 251-256
        View in Article
        • Erkens P.M.
        • Gandara E.
        • Wells P.S.
        • et al.
        Does the Pulmonary Embolism Severity Index accurately identify low-risk patients eligible for outpatient treatment?.
        Thromb Res. 2012; 129: 710-714
        View in Article
        • Moores L.
        • Zamarro C.
        • Gómez V.
        • et al.
        • on behalf of the IRYCIS Pulmonary Embolism Study Group
        Changes in PESI score predict mortality in intermediate-risk patients with acute PE.
        Eur Respir J. 2012; ([Epub ahead of print])
        View in Article
        • Jaff M.R.
        • McMurtry M.S.
        • Archer S.L.
        • et al.
        American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; American Heart Association Council on Peripheral Vascular Disease; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association.
        Circulation. 2011; 123: 1788-1830
        View in Article
        • Torbicki A.
        • Perrier A.
        • Konstantinides S.
        • et al.
        • Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology
        Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC).
        Eur Heart J. 2008; 29: 2276-2315
        View in Article
        • Koracevic G.P.
        Time to individualize duration of parenteral anticoagulation in pulmonary thromboembolism?.
        Am J Emerg Med. 2012; 30: 1004-1006
        View in Article
        • Marchetti M.
        • Pistorio A.
        • Barone M.
        • et al.
        Low molecular weight heparin versus warfarin for secondary prophylaxis of venous thromboembolism: a cost-effectiveness analysis.
        Am J Med. 2001; 111: 130-139
        View in Article
        • Kher A.
        • Samama M.M.
        Primary and secondary prophylaxis of venous thromboembolism with low–molecular-weight heparins: prolonged thromboprophylaxis, an alternative to vitamin K antagonists.
        J Thromb Haemost. 2005; 3: 473-481
        View in Article

      Article Info

      Publication History

      Published online: January 21, 2013
      Accepted: December 11, 2012
      Received in revised form: December 9, 2012
      Received: December 4, 2012

      Footnotes

      ☆This work has been supported by the Serbian Ministry of Education and Science (grant 175092 ).

      Identification

      DOI: https://doi.org/10.1016/j.ajem.2012.12.012

      Copyright

      © 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

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