![]() The quality of this evidence was downgraded because of the small number of events reported, leading to imprecision. The quality of evidence for the outcomes recurrent blood clots and death was moderate. However, comparison of only high‐quality studies for bleeding revealed no clear differences between LMWH and VKA. This systematic review of 16 trials with a combined total of 3299 participants (current until November 2016) found no clear differences in recurrent blood clots and deaths between LMWH and VKA, and fewer bleeding episodes with LMWH than with VKA. To assess the benefits and harms of long term treatment (three months) of venous thromboembolism with LMWH compared with long term treatment with VKAs. Low‐molecular‐weight heparins (LMWHs) are drugs that thin the blood and are used for people who are at risk of major bleeding, people who cannot take vitamin K antagonists, and pregnant women. Vitamin K antagonists (VKAs), 99% of which consist of warfarin, are effective in preventing renewed blood clot formation, because they thin the blood. These clots can be fatal when they travel to the lungs. Vitamin K antagonists or low‐molecular‐weight heparin for long term treatment of symptomatic blood clotsīlood clots (venous thromboembolism) sometimes cause blockages in veins after surgery, during bed rest, or spontaneously. ![]() We found no clear differences between LMWH and VKA in terms of mortality (Peto OR 1.08, 95% CI 0.75 to 1.56 P = 0.68 3299 participants 16 studies moderate‐quality evidence). However, when comparing only high‐quality studies for bleeding, we observed no clear differences between LMWH and VKA (Peto OR 0.62, 95% CI 0.36 to 1.07 P = 0.08 1872 participants seven studies). We found less bleeding with LMWH than with VKA (Peto OR 0.51, 95% CI 0.32 to 0.80 P = 0.004 3299 participants 16 studies low‐quality evidence). We found no clear differences in recurrent VTE between LMWH and VKA (Peto OR 0.83, 95% confidence interval (CI) 0.60 to 1.15 P = 0.27 3299 participants 16 studies moderate‐quality evidence). We downgraded the quality of the evidence for imprecision (recurrent VTE, mortality) and for risk of bias and inconsistency (major bleeding). According to GRADE, the quality of evidence was moderate for recurrent VTE, low for major bleeding, and moderate for mortality. Sixteen trials, with a combined total of 3299 participants fulfilled our inclusion criteria.
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