Testroote M et al, 2008, Netherlands | Patients with lower limb injuries managed as outpatients in lower limb plaster casts or braces | Six studies included (1490 patients), of which four studies included patients treated non-surgically (788 patients). 750 patients were given thromboprophylaxis with LMWH (level of evidence 1a) | Incidence of major bleeding | LMWH group: two patients (0.26%), Control group: one patient (0.14%) | Statistical and clinical heterogeneity. The numbers of patients included in the studies are small. The assessment of safety includes patients managed surgically. One of the studies included uses as a subprophylactic dose of LMWH |
Incidence of minor bleeding | LMWH group: 14 patients (1.87%), Control group: 12 patients (1.62%) | ||||
Otero-Fernandez R et al, 2008, Spain (157 centres) | Orthopaedic patients requiring outpatient thromboprophylaxis with Bemiparin. Included 6456 patients, of which 1789 patients were managed conservatively with cast immobilisation | Prospective uncontrolled multicentre cohort (level of evidence 2b) | Incidence of major bleeding | Overall: 0.17%, Plaster cast group: 0.11% | No control group. Two different doses of Bemiparin used (2500 IU and 3500 IU) selected at clinicians’ discretion |
Incidence of minor bleeding | Overall: 4.57%, Plaster cast group: 1.51% | ||||
Incidence of thrombocytopenia | Overall: 0.51%, Plaster cast group: 0.17% |
LMWH, low molecular weight heparin.