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Blood, 15 October 2005, Vol. 106, No. 8, pp. 2710-2715. Prepublished online as a Blood First Edition Paper on June 28, 2005; DOI 10.1182/blood-2005-04-1546. This Article Full Text (PDF) All Versions of this Article: 2005-04-1546v1 106/8/2710    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Martel, N. Articles by Wells, P. S Search for Related Content PubMed PubMed Citation Articles by Martel, N. Articles by Wells, P. S Related Collections Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted April 18, 2005 Accepted June 2, 2005 Risk of heparin induced thrombocytopenia with unfractionated and low molecular weight heparin thromboprophylaxis: a meta-analysis Nadine Martel, James Lee, and Philip S Wells* Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada * Corresponding author; email: pwells{at}ohri.ca. Heparin induced thrombocytopenia (HIT) is an uncommon but potentially devastating complication of anticoagulation with unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Our objective was to determine and compare the incidences of HIT in surgical or medical patients receiving thromboprophylaxis with either UFH or LMWH. All relevant studies identified in MEDLINE database (1984 to 2004), not limited to by language, and from reference lists of key articles were evaluated. Randomized and non-randomized controlled trials comparing prophylaxis with UFH and LMWH and measuring HIT or thrombocytopenia as outcomes were included. Two reviewers independently extracted data on thromboprophylaxis (type dose, frequency and duration), definition of thrombocytopenia, HIT assay and rates of the following outcomes: HIT, thrombocytopenia and thromboembolic events. HIT was defined as a drop in platelets > 50% or to < 100 x 109 / L and positive laboratory HIT assay.Fifteen studies (7287 patients) were eligible: two randomized controlled trials (RCTs) measuring HIT (1014 patients); three prospective studies (1464 patients) with non-randomized comparison groups in which HIT was appropriately measured in both groups; ten RCTs (4809 patients) measuring thrombocytopenia but not HIT. Three analyses were performed using a random-effects model and favored the use of LMWH: 1) RCTs measuring HIT showed an OR of 0.10 (95 % CI = 0.01-0.2), p=0.03; 2) Prospective studies measuring HIT showed an OR of 0.10 (95 % CI = 0.03-0.33), p= 0.0002; 3) All fifteen studies measured thrombocytopenia. The OR was 0.47 (95 % CI = 0.22-1.02), p=0.06. The inverse variance weighted average determined the absolute risk of HIT with LMWH was 0.2 % and with UFH the risk was 2.6 %. The majority of studies were post orthopedic surgery. There is a paucity of data regarding HIT in venous thromboembolism prophylaxis studies. Despite this, from the perspective of HIT risk, LMWH should be considered the drug of choice for prophylaxis in postorthopedic surgery patients. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: HIT as a preventable disease? Theodore E. Warkentin Blood 2005 106: 2600. [Full Text] [PDF] This article has been cited by other articles: J. Douketis, D. Cook, M. Meade, G. Guyatt, W. Geerts, Y. Skrobik, M. Albert, J. Granton, P. Hebert, G. Pagliarello, et al. Prophylaxis Against Deep Vein Thrombosis in Critically Ill Patients With Severe Renal Insufficiency With the Low-Molecular-Weight Heparin Dalteparin: An Assessment of Safety and Pharmacodynamics: The DIRECT Study Arch Intern Med, September 8, 2008; 168(16): 1805 - 1812. [Abstract] [Full Text] [PDF] M. L. Chapman, A. R. Martinez-Borges, and H. L. Mertz Lepirudin for Treatment of Acute Thrombosis During Pregnancy Obstet. Gynecol., August 1, 2008; 112(2): 432 - 433. [Abstract] [Full Text] [PDF] E. A. Akl, I. Terrenato, M. Barba, F. Sperati, E. V. Sempos, P. Muti, D. J. Cook, and H. J. Schunemann Low-Molecular-Weight Heparin vs Unfractionated Heparin for Perioperative Thromboprophylaxis in Patients With Cancer: A Systematic Review and Meta-analysis Arch Intern Med, June 23, 2008; 168(12): 1261 - 1269. [Abstract] [Full Text] [PDF] T. E. Warkentin, A. Greinacher, A. Koster, and A. M. Lincoff Treatment and Prevention of Heparin-Induced Thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 340S - 380S. [Abstract] [Full Text] [PDF] W. H. Geerts, D. Bergqvist, G. F. Pineo, J. A. Heit, C. M. Samama, M. R. Lassen, and C. W. Colwell Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 381S - 453S. [Abstract] [Full Text] [PDF] V. F. Tapson Acute Pulmonary Embolism N. Engl. J. Med., March 6, 2008; 358(10): 1037 - 1052. [Full Text] [PDF] F. Kerendi, V. H. Thourani, J. D. Puskas, P. D. Kilgo, M. Osgood, R. A. Guyton, and O. M. Lattouf Impact of Heparin-Induced Thrombocytopenia on Postoperative Outcomes After Cardiac Surgery Ann. Thorac. Surg., November 1, 2007; 84(5): 1548 - 1555. [Abstract] [Full Text] [PDF] T. E. Warkentin and A. Greinacher So, Does Low-Molecular-Weight Heparin Cause Less Heparin-Induced Thrombocytopenia Than Unfractionated Heparin or Not? Chest, October 1, 2007; 132(4): 1108 - 1110. [Full Text] [PDF] T. A. Morris, S. Castrejon, G. Devendra, and A. C. Gamst No Difference in Risk for Thrombocytopenia During Treatment of Pulmonary Embolism and Deep Venous Thrombosis With Either Low-Molecular-Weight Heparin or Unfractionated Heparin: A Metaanalysis Chest, October 1, 2007; 132(4): 1131 - 1139. [Abstract] [Full Text] [PDF] J. H. Levy, K. A. Tanaka, and M. J. Hursting Reducing Thrombotic Complications in the Perioperative Setting: An Update on Heparin-Induced Thrombocytopenia Anesth. Analg., September 1, 2007; 105(3): 570 - 582. [Abstract] [Full Text] [PDF] T. E. Warkentin and J. W. Eikelboom Who Is (Still) Getting HIT? Chest, June 1, 2007; 131(6): 1620 - 1622. [Full Text] [PDF] C. A. Hutchison and I. 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Berkwits Trials That Matter: Can Patients with Venous Thromboembolism Be Treated with Fixed-Dose Subcutaneous Unfractionated Heparin? Ann Intern Med, December 19, 2006; 145(12): 929 - 931. [Full Text] [PDF] T. E. Warkentin, J.-A. I. Sheppard, C. S. Sigouin, T. Kohlmann, P. Eichler, and A. Greinacher Gender imbalance and risk factor interactions in heparin-induced thrombocytopenia Blood, November 1, 2006; 108(9): 2937 - 2941. [Abstract] [Full Text] [PDF] A. Greinacher, M. Gopinadhan, J.-U. Gunther, M. A. Omer-Adam, U. Strobel, T. E. Warkentin, G. Papastavrou, W. Weitschies, and C. A. Helm Close Approximation of Two Platelet Factor 4 Tetramers by Charge Neutralization Forms the Antigens Recognized by HIT Antibodies Arterioscler. Thromb. Vasc. Biol., October 1, 2006; 26(10): 2386 - 2393. [Abstract] [Full Text] [PDF] T. E. Warkentin Think of HIT When Thrombosis Follows Heparin. Chest, September 1, 2006; 130(3): 631 - 632. [Full Text] [PDF] B. Tardy, T. Lecompte, F. Boelhen, B. Tardy-Poncet, I. Elalamy, P. Morange, Y. Gruel, M. Wolf, D. Francois, E. Racadot, et al. Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin Blood, September 1, 2006; 108(5): 1492 - 1496. [Abstract] [Full Text] [PDF] G. M. Arepally and T. L. Ortel Heparin-Induced Thrombocytopenia N. Engl. J. Med., August 24, 2006; 355(8): 809 - 817. [Full Text] [PDF] T. W. Warkentin Thrombotic End Point for Assessing Argatroban Therapy for Heparin-Induced Thrombocytopenia: Learning From Secondary Analyses of Prospective Studies Chest, June 1, 2006; 129(6): 1396 - 1398. [Full Text] [PDF] T. E. Warkentin Think of HIT Hematology, January 1, 2006; 2006(1): 408 - 414. [Abstract] [Full Text] [PDF] T. E. Warkentin and A. Greinacher Unfractionated LMWH and the risk of HIT: are medical patients different? Blood, November 1, 2005; 106(9): 2931 - 2932. [Full Text] [PDF]

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