HEPARINS AND CURATIVE TREATMENT OF VENOUS THROMBOEMBOLIC DISEASE - METAANALYSIS

Heparin treatment of venous thromboembolic disease has been validated since 1960. Nevertheless no study was sufficient to determine an optim al therapeutic schedule between sub-cutaneous (SC) unfractionated hepa rin (UFH), intravenous (IV) UFH and low molecular weight heparin (LMWH ). One meta-analysis showed a significant risk reduction of recurrent thromboembolic events (OR = 0.58, CI 95 per cent [0.34-0.99]) and a no n-significant risk reduction of haemorrhagic events (OR = 0.78 [0.40-1 .52]) with UFH SC compared to UFH IV, but homogeneity testing was sign ificant (p < 0.001). Some discrepancy was shown between the results of the three meta-analyses which compared LMWH to UFH according to the s election criteria of clinical trials used. With an exhaustive selectio n, LMWH involved a. non-significant risk reduction of recurrent thromb oembolic events (OR = 0.66 [0.41-1.07], p = 0.09), and a non-significa nt risk reduction of haemorrhagic events (OR = 0.65 [0.36-1.16], p = 0 .15). So no definitive conclusion could be drawn but it seems that UFH can be recommended whatever the administration route or LMWH for deep vein thrombosis treatment.