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Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization.
[heparin-induced thrombocytopenia]
Immobilization
of
the
lower
leg
is
associated
with
venous
thromboembolism
(
VTE
)
.
Low
molecular
weight
heparin
(
LMWH
)
is
an
anticoagulant
treatment
which
might
be
used
in
adult
patients
with
lower-
leg
immobilization
to
prevent
deep
venous
thrombosis
(
DVT
)
and
its
complications
.
This
is
an
update
of
the
review
first
published
in
2008
.
To
assess
the
effectiveness
of
low
molecular
weight
heparin
for
the
prevention
of
venous
thromboembolism
in
patients
with
lower-
leg
immobilization
in
an
ambulant
setting
.
For
this
update
the
Cochrane
Peripheral
Vascular
Diseases
Group
Trials
Search
Co
-ordinator
searched
the
Specialised
Register
(
last
searched
June
2013
)
and
CENTRAL
(
2013
,
Issue
5
)
.
Randomized
controlled
trials
(
RCTs
)
and
controlled
clinical
trials
(
CCTs
)
that
described
thromboprophylaxis
by
means
of
LMWH
compared
with
no
prophylaxis
or
placebo
in
adult
patients
with
lower-
leg
immobilization
.
Immobilization
was
by
means
of
a
plaster
cast
or
brace
.
Two
authors
independently
assessed
trial
quality
and
extracted
data
.
The
review
authors
contacted
the
trial
authors
for
additional
information
if
required
.
Statistical
analysis
was
carried
out
using
Review
Manager
(
RevMan
5
)
.
We
included
six
RCTs
fulfilling
the
above
criteria
with
a
total
of
1490
patients
.
We
found
an
incidence
of
VTE
ranging
from
4
.
3
%
to
40
%
in
patients
who
had
a
leg
injury
that
had
been
immobilized
in
a
plaster
cast
or
a
brace
for
at
least
one
week
and
who
received
no
prophylaxis
,
or
placebo
.
This
number
was
significantly
lower
in
patients
who
received
daily
subcutaneous
injections
of
LMWH
during
immobilization
(
event
rates
ranging
from
0
%
to
37
%
;
odds
ratio
(
OR
)
0
.
49
;
fixed
95
%
confidence
interval
(
CI
)
0
.
34
to
0
.
72
;
with
minimal
evidence
of
heterogeneity
with
an
I
(
2
)
of
20
%
,
P
=
0
.
29
)
.
Comparable
results
were
seen
in
the
following
subcategories
:
operated
patients
,
conservatively
treated
patients
,
patients
with
fractures
,
patients
with
soft
-tissue
injuries
,
patients
with
proximal
thrombosis
,
patients
with
distal
thrombosis
and
patients
with
below-
knee
casts
.
Complications
of
major
bleeding
events
were
extremely
rare
(
0
.
3
%
)
and
there
were
no
reports
of
heparin-induced
thrombocytopenia
.
Use
of
LMWH
in
outpatients
significantly
reduces
VTE
when
immobilization
of
the
lower
leg
is
required
.
