A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: Implications for research and policy decision-making

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dc.contributor.authorJohnston, Amy
dc.contributor.authorHsieh, Shu-Ching
dc.contributor.authorCarrier, Marc
dc.contributor.authorKelly, Shannon E.
dc.contributor.authorBai, Zemin
dc.contributor.authorSkidmore, Becky
dc.contributor.authorWells, George A.
dc.date.accessioned2018-11-13T15:29:40Z
dc.date.available2018-11-13T15:29:40Z
dc.date.issued2018
dc.identifier.citationA systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: Implications for research and policy decision-making Johnston A, Hsieh SC, Carrier M, Kelly SE, Bai Z, et al. (2018) A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: Implications for research and policy decision-making. PLOS ONE 13(11): e0207410. https://doi.org/10.1371/journal.pone.0207410
dc.identifier.urihttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207410
dc.identifier.urihttp://hdl.handle.net/10393/38421
dc.description.abstractBackground Venous thromboembolism (VTE) is a major global cause of morbidity and mortality. Low molecular weight heparin (LMWH) and fondaparinux (FDP) are frequently used to treat and prevent VTE and have a variety of safety and practical advantages over other anticoagulants, including use in outpatient settings. These medications are commonly listed on drug formularies, which act as a gateway for health plan prescription coverage by outlining the circumstances under which patients will be covered for specific drugs and drug products. Because patient access to medications is impacted by the nature of their listing on formularies, they must be rigorously reviewed and modernized as new evidence emerges. Methods As part of a broader drug class review team, we completed a systematic review of clinical practice guidelines to determine whether the recommendations they reported aligned with the indications listed for the coverage of LMWH and FDP in an outpatient drug formulary. Guideline quality was assessed using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. Recommendation matrices were used to systematically compare, categorize, and summarize included recommendations. Results Twenty-seven guidelines were included from which 168 eligible recommendations were identified. Generally, AGREE II domains were adequately addressed; however, domain five (applicability) was poorly addressed. Most recommendations were based on moderate- to low-quality/limited evidence and reported on the use of LMWHs generally; few reported on specific agents. Conclusions Our findings contributed to the recommendation that the formulary listing for LMWH and FDP be streamlined to include coverage for specific outpatient indications. The paucity of available evidence on the comparative efficacy of specific LMWH agents against each other and FDP limited agent-specific listing recommendations, highlighting the need for high-quality comparative studies on this topic.
dc.language.isoen
dc.titleA systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: Implications for research and policy decision-making
dc.typeArticle
CollectionICUO - Publications // UOHI - Publications

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