Low-molecular-weight heparin biosimilars: potential implications for clinical practice. Australian Low-Molecular-Weight Heparin Biosimilar Working Group (ALBW)

Efficacy and safety of low-molecular-weight heparin in patients with sepsis: a meta-analysis of randomized controlled trials

Low-molecular-weight heparin (LMWH) is part of standard supportive care. We conducted a meta-analysis to investigate the efficacy and safety of LMWH in septic patients. We searched Pubmed, Embase, CKNI and Wanfang database prior to July 2015 for randomized controlled trials investigating treatment with LMWH in septic patients. We identified 11 trials involving 594 septic patients. Meta-analysis showed that LMWH significantly reduced prothrombin time (mean differences [MD] −0.88; 95% CI −1.47 to −0.29), APACHE II score (MD −2.50; 95% CI −3.55 to −1.46), and 28-day mortality (risk ratio [RR] 0.72; 95% CI 0.57–0.91) as well as increased the platelet counts (MD 18.33; 95% CI 0.73–35.93) than the usual treatment. However, LMWH did not reduce D-dimer (MD −0.34; 95% CI −0.85 to 0.18). LMWH also significantly increased the bleeding events (RR 3.82; 95% CI 1.81–8.08). LMWH appears to reduce 28-day mortality and APACHE II score among septic patients. Bleeding complications should be monitored during the LMWH treatment. As for limited data about LMWH and sepsis in the English literature, only trials published in the Chinese were included in the meta-analysis.