Flint Stephanie H, Woodruff Ashley E, Maloney Molly K, Chilbert Maya R
School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA.
Buffalo General Medical Center, Buffalo, NY, USA.
J Thromb Thrombolysis. 2025 Jun 26. doi: 10.1007/s11239-025-03137-8.
Guidelines recommend 5000U subcutaneous unfractionated heparin (UFH) for venous thromboembolism (VTE) prophylaxis in acutely ill hospitalized adults, but data comparing dosing frequencies is limited. This systematic review aimed to compare VTE and bleeding outcomes between twice daily (BID) and three times daily (TID) UFH regimens. A literature search was completed on 3/7/2024. The primary outcome was VTE occurrence (deep vein thrombosis (DVT) or pulmonary embolism (PE)). Secondary outcomes included bleeding events. Studies reporting any relevant outcomes were included, while non-human studies, reviews, non-English texts, and high VTE risk populations were excluded. Risk of bias was assessed using the Cochrane Risk-of-Bias or Newcastle-Ottawa Quality Assessment Form. Data were synthesized using Covidence and Excel. After screening, 24 studies were included: 9 observational and 15 randomized studies. Regimens with TID UFH had a 3.1% VTE occurrence (12 studies, n = 145/4653) compared to 4.0% with BID regimens (9 studies, n = 218/5426). Three times daily regimens demonstrated 4.8% DVTs (11 studies, n = 244/5102) and 0.4% PEs (11 studies, n = 24/5372), compared to 9.7% DVTs (11 studies, n = 199/2062) and 0.9% PEs (9 studies, n = 17/1974) with BID regimens. Bleeding events occurred in 3.2% of patients with BID (9 studies, n = 196/6080) and 4.3% with TID regimens (13 studies, n = 393/9044). Three times daily UFH regimens led to fewer VTE, DVT, and PE events but more bleeding compared to BID. Newer data suggests BID dosing may be more appropriate for general medical populations. Limitations include variability in data quality and publication dates. Registered with PROSPERO. No funding was received.
指南推荐对急性病住院成人采用5000单位皮下注射普通肝素（UFH）预防静脉血栓栓塞（VTE），但比较给药频率的数据有限。本系统评价旨在比较每日两次（BID）和每日三次（TID）UFH方案之间的VTE和出血结局。于2024年7月3日完成文献检索。主要结局为VTE发生情况（深静脉血栓形成（DVT）或肺栓塞（PE））。次要结局包括出血事件。纳入报告任何相关结局的研究，排除非人研究、综述、非英文文本以及高VTE风险人群。使用Cochrane偏倚风险评估或纽卡斯尔 - 渥太华质量评估表评估偏倚风险。使用Covidence和Excel对数据进行综合分析。筛选后，纳入24项研究：9项观察性研究和15项随机研究。每日三次UFH方案的VTE发生率为3.1%（12项研究，n = 145/4653），而每日两次方案为4.0%（9项研究，n = 218/5426）。每日三次方案的DVT发生率为4.8%（11项研究，n = 244/5102），PE发生率为0.4%（11项研究，n = 24/5372），相比之下，每日两次方案的DVT发生率为9.7%（11项研究，n = 199/2062），PE发生率为0.9%（9项研究，n = 17/1974）。每日两次方案的患者出血事件发生率为3.2%（9项研究，n = 196/6080），每日三次方案为4.3%（13项研究，n = 393/9044）。与每日两次方案相比，每日三次UFH方案导致的VTE、DVT和PE事件更少，但出血更多。最新数据表明，每日两次给药可能更适合普通内科人群。局限性包括数据质量和发表日期的变异性。已在PROSPERO注册。未获得资金。
