Hartford Hospital, Pharmacy , Hartford, CT , USA.
Curr Med Res Opin. 2014 Mar;30(3):367-80. doi: 10.1185/03007995.2013.837818. Epub 2013 Nov 19.
To conduct a systematic review and mixed-treatment comparison (MTC) meta-analysis to compare the efficacy and safety of low molecular weight heparins (LMWHs) for venous thromboembolism (VTE) prophylaxis in hospitalized medically ill patients. As a secondary objective we compared all therapies within the network to each other.
We conducted a systematic literature search for randomized trials that evaluated pharmacologic VTE prophylaxis in hospitalized medically ill patients. We conducted a traditional meta-analysis for all pairwise comparisons using a random effects model, reporting relative risks (RRs) and 95% confidence intervals for each outcome. To determine the relative efficacy and safety of included therapies we conducted a MTC meta-analysis using a Bayesian framework, reporting odds ratios (OR) and 95% credible intervals.
Twenty trials met inclusion criteria. Enoxaparin, dalteparin, nadroparin and certoparin were the LMWHs evaluated although none in direct comparative trials. Upon MTC, the relative efficacy of all LMWHs was similar in preventing mortality and VTE as well as in the odds of major and minor bleeding. Dalteparin was not included in the network to evaluate deep vein thrombosis (DVT) and pulmonary embolism (PE) due to lack of reported data and the remaining LMWHs were found to be similar in relative efficacy in preventing these outcomes.
Traditional meta-analysis was not possible for many drug comparisons made within the MTC. Heterogeneity was observed in several of the traditional meta-analyses although this may be an inherent limitation of the studied population. Overall rarity of events contributed to imprecise estimates demonstrated by the wide confidence intervals.
Enoxaparin, dalteparin, nadroparin and certoparin are similar in relative efficacy for the prevention of mortality and VTE and in the odds of major or minor bleeding while enoxaparin, nadroparin and certoparin are similar in relative efficacy for the prevention of PE and DVT in hospitalized medical patients.
系统评价和混合治疗比较（MTC）荟萃分析比较低分子肝素（LMWH）用于预防住院内科患者静脉血栓栓塞症（VTE）的疗效和安全性。作为次要目标，我们比较了网络内的所有治疗方法。
我们对评估住院内科患者药物性 VTE 预防的随机试验进行了系统文献检索。我们使用随机效应模型对所有成对比较进行了传统荟萃分析，报告了每个结局的相对风险（RR）和 95%置信区间。为了确定纳入治疗方法的相对疗效和安全性，我们使用贝叶斯框架进行了 MTC 荟萃分析，报告了优势比（OR）和 95%可信区间。
20 项试验符合纳入标准。依诺肝素、达肝素、那屈肝素和亭扎肝素是评估的低分子肝素，尽管没有直接比较试验。在 MTC 中，所有 LMWH 预防死亡率和 VTE 的相对疗效以及大出血和小出血的几率相似。由于缺乏报告数据，达肝素未纳入网络以评估深静脉血栓形成（DVT）和肺栓塞（PE），其余 LMWH 在预防这些结局方面的相对疗效相似。
许多在 MTC 中进行的药物比较无法进行传统荟萃分析。尽管这可能是研究人群固有的局限性，但在几个传统荟萃分析中观察到了异质性。事件的总体罕见性导致置信区间较宽，表明估计结果不精确。
依诺肝素、达肝素、那屈肝素和亭扎肝素在预防死亡率和 VTE 以及大出血或小出血的几率方面的相对疗效相似，而依诺肝素、那屈肝素和亭扎肝素在预防住院内科患者的 PE 和 DVT 方面的相对疗效相似。
