Comparison of efficacy and safety between low molecular weight heparin and other anticoagulants in preventing venous thromboembolism after spine trauma and spinal cord injury: a meta-analysis

English Keywords:Low molecular weight heparin  Venous thromboembolism  Spine trauma  Spinal cord injury  Direct oral anticoagulant

English Abstract:

  【Abstract】 Objectives: To compare the efficacy and safety between low molecular weight heparin(LMWH) and direct oral anticoagulants(DOACs) and unfractionated heparin(UFH) in preventing venous thromboembolism(VTE) after spine trauma and spinal cord injury. Methods: The literature on comparing the prevention of VTE in patients with spine trauma and spinal cord injury with LMWH and other anticoagulants such as DOACs and UFH published from the inception till April 20, 2022 was searched in CNKI, Wanfang database, VIP, SinoMed, and foreign language databases including PubMed, Cochrane Library, Embase, and Web of Science. Retrospective cohort studies and prospective randomized controlled trials(RCTs) that met the inclusion and exclusion criteria were screened. Relevant literature was included and data such as intervention and study design were extracted for meta-analysis with RevMan 5.3 software, and the results were presented by forest plots. RCTs were evaluated using the Cochrane risk of bias assessment tool, and cohort studies were evaluated by the Newcastle-Ottawa Scale(NOS) for quality assessment. Results: A total of 11 studies of medium and high quality were included, containing 8 retrospective cohort studies and 3 RCTs studies. Meta-analysis showed that DOACs were superior to LMWH in preventing deep venous thrombosis(DVT) (P<0.00001) and total VTE(P=0.002), but no statistical difference was found between the two in preventing pulmonary embolism(PE) (P=0.23). There was no significant difference between LMWH and UFH in the prevention of DVT, PE, and total VTE in patients with spine trauma and spinal cord injury. LMWH was further compared with low-dose unfractionated heparin(LDUH), and was found to be superior to LDUH in preventing PE in patients with spinal cord injury(P=0.0006), while there was no significant difference in the prevention of DVT and total VTE. In subgroup analysis based on study design, for the prevention of PE, LMWH was superior to LDUH in preventing PE in patients with spinal cord injury in retrospective cohort studies(P=0.004), and no significant difference between the two in RCTs(P=0.05). For comparison of safety, there was no significant difference between LMWH and LDUH in retrospective cohort study(P=0.67). Due to the small amount of literature included in the meta-analysis for each outcome indicator, sensitivity analysis and bias analysis were not performed. Conclusions: Comparing with LMWH, DOACs can provide more effective prophylactic treatment for VTE in patients with spine trauma and spinal cord injury, but there is no significant difference in efficacy between the two in the prevention of PE. Comparing with UFH and LDUH, LMWH is more suitable for the prevention of VTE in spine trauma and spinal cord patients in terms of combined prophylactic efficacy, safety, convenience and practicality.