Scientific Poster Session II - Systematic Reviews/Meta-Analysis

Systematic Reviews/Meta-Analysis
  Sunday, October 13, 2024
  12:45 PM–02:15 PM

Abstract

Background: Guidelines recommend subcutaneous unfractionated heparin (UFH) 5000U twice (BID) or three times daily (TID) for venous thromboembolism (VTE) prophylaxis in medically-ill hospitalized adults, but data comparing dosing frequencies is limited. This systematic review’s objective was to compare VTE and bleeding in patients receiving BID or TID prophylactic UFH.

Methods: A search of PubMed, EMBASE via Elsevier, Web of Science, CINAHL Plus, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov was completed on 3/7/2024. The primary outcome in this review was VTE. Secondary outcomes were DVT, PE, or bleeding events. Individual study reporting of any of these outcomes warranted review inclusion. Non-human studies, review articles, non-English texts, and high VTE risk populations (e.g. surgery) were excluded. Bias was assessed using the Cochrane Risk-of-Bias or Newcastle-Ottawa Quality Assessment Form. Covidence and Excel were used for data organization/synthesis.

Results: Searching identified 2320 studies after deduplication. Nine observational and 12 randomized studies were included, published between 1973-2023. Four (44.4%) observational studies were rated good quality and 5 (55.6%) poor quality. Four (33.3%) randomized studies were rated low risk of bias, 3 (25.0%) with some concerns, and 5 (41.7%) high risk of bias. Patients had a 3.3% occurrence of VTE (10 studies, n=140/4193) with TID regimens compared to 4.0% (8 studies, n=217/5374) with BID regimens. Patients receiving TID regimens experienced 5.2% DVTs (9 studies, n=240/4642) and 0.4% PEs (9 studies, n=20/4912) compared to 9.9% DVTs (10 studies, n=198/2010) and 0.9% PEs (8 studies, n=17/1922) with BID regimens. Bleeding was less common in patients on BID (9 studies, 3.3%, n=198/6080) compared to TID regimens (12 studies, 4.4%, n=378/8562).

Discussion: Fewer VTE events and more bleeding occurred with TID prophylactic UFH compared to BID in medically-ill hospitalized adults. Limitations include a wide range of publication dates and data quality.

Other: The review was registered with PROSPERO (CRD42023493327). Funding was not received.

Presenting Author

Ashley Woodruff Pharm.D., BCPS
University at Buffalo School of Pharmacy and Pharmaceutical Sciences

Authors

Maya Chilbert Pharm.D., BCCP
University at Buffalo School of Pharmacy and Pharmaceutical Sciences

Stephanie Flint Pharm.D. Candidate 2025
University at Buffalo School of Pharmacy and Pharmaceutical Sciences

Molly Maloney MLS
University at Buffalo