Benefits and risks of low molecular weight heparin in patients with acute exacerbation of chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials.

Mingjin Yang, Ying Xu, Hong Chen, Zhibo Xu, Fengming Luo

Inflammopharmacology 2020 Apr

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Low molecular weight heparin (LMWH) is an anticoagulant that has recently been found benefit in the acute exacerbation stage of chronic obstructive pulmonary disease (COPD). But its efficacy is controversial. The objective of this paper is to compare the harm/benefit of LMWH combined with conventional therapy versus single conventional therapy in the acute exacerbation stage of COPD. PubMed, Cochrane Library, EMBASE, CNKI, and Clinical Trials.gov were searched from inception until March 2019. Randomized control trials were included if they reported the use of LMWH for the treatment of COPD. Continuous variable data were reported as mean difference (MD), risk difference (RD), and Peto odds ratio (OR) with corresponding 95% CIs. Twelve RCTs (N = 1086 subjects) were included in the meta-analysis. Pooled results exhibited that LMWH treatment significantly improved the levels of arterial partial pressure of oxygen (PaO2) (MD = 4.58, 95% CI: 1.78-7.39, P = 0.001), forced expiratory volume in 1 s (FEV1) (MD = 0.19, 95% CI: 0.09-0.29, P = 0.0002), and FEV1/forced vital capacity (FVC) (MD = 10.44, 95% CI: 5.40-15.48, P < 0.0001), and significantly reduced the risk of thrombosis (RD, - 0.03; 95% CI, - 0.07 to 0.00; P = 0.05). There was a marginally but nonsignificant improvement in PaCO2 levels vs non-LMWH treatment. Moreover, pooled results exhibited that LMWH may increase the risk of hemorrhage. Subgroup analyses exhibited that LMWH treatment only was associated with a significantly increased risk of minor bleeding but not major hemorrhage. When compared with single conventional therapy, addition of LMWH to conventional therapy may provide more clinical benefits in the acute exacerbation stage of COPD.

Citation

Mingjin Yang, Ying Xu, Hong Chen, Zhibo Xu, Fengming Luo. Benefits and risks of low molecular weight heparin in patients with acute exacerbation of chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials. Inflammopharmacology. 2020 Apr;28(2):451-462