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Efficacy of heparins in prevention of thromboembolic events in non-surgical patients : overview |
Sang Thrombose Vaisseaux. Volume 12, Number 2, 76-82, Février 2000, Mini-revues
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 Résumé
Article gratuit
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Author(s) : Patrick Mismetti, André Kher, Silvy Laporte-Simitsidis |
Summary : The prophylactic efficacy of heparins in surgery has already largely been evidenced but considerably less data are available concerning their preventive efficacy in a medical setting. Meta-analyses of studies carried out in medical settings have shown that the preventive administration of low molecular weight unfractionated heparins causes a significant 60% reduction in the risk of deep venous thrombosis compared with no treatment. This risk reduction is observed in cases of myocardial infarction (659 patients, relative risk = 0.35; p < 0.001), cerebrovascular disease (791 patients; relative risk = 0.43; p = 0.002) as well as in internal medicine (845 patients; relative risk = 0.43; p < 0.001). This effect on DVT is moreover associated with a significant reduction in the risk of pulmonary embolism (PE) in internal medicine (14,843 patients, relative risk = 0.49; p < 0.001) whereas the effect on clinical PE in cases of cerebrovascular disease and myocardial infarction is not significant. However a significant reduction in global mortality was observed in cases of stroke. An increase in the risk of major haemorrhage is observed, particularly in internal medicine (12,621 patients, relative risk = 1.87; p < 0.001). The benefit-risk ratio is in favour of a preventive treatment in cases of myocardial infarction and cerebrovascular disease, whereas the populations studied in internal medicine are heterogeneous as far as the risk of venous thromboembolism is concerned; in this context, the cases in which the benefit-risk ratio of a preventive heparin therapy becomes favourable remain to be defined. |
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