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

• Published in: Inflammopharmacology Vol. 28; no. 2; pp. 451 - 462
• Main Authors: Yang, Mingjin, Xu, Ying, Chen, Hong, Xu, Zhibo, Luo, Fengming
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2020
• Subjects: Allergology; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Biomedical and Life Sciences; Biomedicine; Dermatology; Gastroenterology; Hemorrhage - chemically induced; Heparin, Low-Molecular-Weight - administration & dosage; Heparin, Low-Molecular-Weight - adverse effects; Humans; Immunology; Original Article; Pharmacology/Toxicology; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Randomized Controlled Trials as Topic; Rheumatology; Thrombosis - prevention & control; Chronic obstructive pulmonary disease (COPD); Risk; Low molecular weight heparin (LMWH); Benefit; Meta-analysis
• ISSN: 0925-4692; 1568-5608; 1568-5608
• DOI: 10.1007/s10787-019-00659-5

Background 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. Methods 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. Results 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 (PaO 2 ) (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 PaCO 2 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. Conclusions When compared with single conventional therapy, addition of LMWH to conventional therapy may provide more clinical benefits in the acute exacerbation stage of COPD.