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Oncedaily vs. twicedaily dosing of enoxaparin for the management of venous thromboembolism: A systematic review and metaanalysis

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The present study aimed to determine whether there is any difference in the efficacy and safety of oncedaily vs. twicedaily enoxaparin when used for the initial treatment of venous thromboembolism (VTE). The PubMed, Embase, Cochrane Central Register of Controlled Trials, Science Direct and Google Scholar databases were searched for studies comparing oncedaily and twicedaily enoxaparin for the initial treatment of VTE added from inception up to 1st October 2019. Studies utilizing any other lowmolecularweight heparin and using enoxaparin for VTE prophylaxis were excluded. A total of 6 studies were included in the systematic review and 5 in the metaanalysis. Only one study was a randomized controlled trial (RCT). Pooled analysis of 460 patients receiving oncedaily enoxaparin and 464 patients receiving twicedaily enoxaparin indicated no significant difference between the two dosing regimens regarding VTE recurrence [odds ratio (OR)=1.48, 95%CI: 0.752.89, P=0.26; I2=0%]. No significant difference in major hemorrhagic complications was noted (OR=1.21, 95%CI: 0.522.81, P=0.66; I2=0%). Subgroup analysis based on study type and use of enoxaparin for bridging therapy did not change the overall results. In cancer patients, no statistically significant difference in the recurrence of VTE was obtained between oncedaily and twicedaily enoxaparin, but the confidence intervals were wide with a tendency to favor twicedaily dosing (OR=2.28, 95%CI: 0.915.75, P=0.08; I2=0%). The overall quality of the studies was determined to be average. To conclude, while the present results suggested no significant difference in efficacy and safety of oncedaily vs. twicedaily enoxaparin when used for the initial treatment of VTE, the quality of the evidence may not have been sufficiently high to support the conclusions with confidence. Further highquality and adequately powered RCTs are required to corroborate the present results.
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Document Type: Research Article

Affiliations: 1: Department of Vascular Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing 100020, P.R. China 2: School of Life Science, Tsinghua University, Beijing 100084, P.R. China

Publication date: October 1, 2020

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  • Experimental and Therapeutic Medicine aims to ensure the expedient publication, in both print and electronic format, of studies relating to biology, gene therapy, infectious disease, microbiology, molecular cardiology and molecular surgery. The journal welcomes studies pertaining to all aspects of molecular medicine, and studies relating to in vitro or in vivo experimental model systems relevant to the mechanisms of disease are also included.

    All materials submitted to this journal undergo the appropriate review via referees who are experts in this field. All materials submitted follow international guidelines with regard to approval of experiments on humans and animals.
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