Low-Molecular-Weight Heparins in the Treatment of Venous Thromboembolism

Editorials15 June 1998Low-Molecular-Weight Heparins in the Treatment of Venous ThromboembolismMaria M.W. Koopman, MD and Harry R. Buller, MDMaria M.W. Koopman, MDUniversity of Amsterdam; Amsterdam, the NetherlandsSearch for more papers by this author and Harry R. Buller, MDUniversity of Amsterdam; Amsterdam, the NetherlandsSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-12_Part_1-199806150-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail For many decades, the conventional wisdom has been that patients with a diagnosis of acute venous thromboembolic disease confirmed by objective techniques should receive an initial continuous intravenous course of unfractionated heparin for at least 5 days to prevent early and late recurrences [1, 2]. Oral anticoagulant therapy can be started simultaneously and should be continued for at least 3 months [3]. Because the pharmacokinetic response of unfractionated heparin is unpredictable, daily laboratory monitoring and dose adjustments are required; therefore, hospital admission for treatment of acute thromboembolic disease is usually unavoidable [4].This standard practice is now being challenged by ...References1. Brandjes DP, Heijboer H, Buller HR, de Rijk M, Jagt TH, ten Cate JW. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis. N Engl J Med. 1992; 327:1485-9. Google Scholar2. Hull RD, Raskob GE, Rosenbloom D, Panju AA, Brill-Edwards P, Ginsberg JS, et al. Heparin for 5 days as compared with 10 days in the initial treatment of proximal-vein thrombosis. N Engl J Med. 1990; 322:1260-4. Google Scholar3. Hirsh J. Oral anticoagulant drugs. N Engl J Med. 1991; 324:1865-75. Google Scholar4. Hirsh J. Heparin. N Engl J Med. 1991; 324:1565-74. Google Scholar5. Weitz JI. Low-molecular-weight heparins. N Engl J Med. 1997; 337:688-98. Google Scholar6. Young E, Prins MH, Levine MN, Hirsh J. Heparin binding to plasma proteins. An important mechanism for heparin resistance. Thromb Haemost. 1992; 67:639-43. Google Scholar7. Warkentin TE, Levine MN, Hirsh J, Horsewood P, Roberts RS, Gent M, et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med. 1995; 332:1330-5. Google Scholar8. Turkstra F, Koopman MM, Buller HR. The treatment of deep vein thrombosis and pulmonary embolism. Thromb Haemost. 1997; 78:489-96. Google Scholar9. Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. The Columbus Investigators. N Engl J Med. 1997; 337; 657-62. Google Scholar10. Simonneau G, Sors H, Charbonnier B, Page Y, Laaban JP, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l'Embolie Pulmonaire. N Engl J Med. 1997; 337:663-9. Google Scholar11. Koopman MM, Prandoni P, Piovella F, Ockelford PA, Brandjes DP, van der Meer J, et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The TASMAN Study Group. N Engl J Med. 1996; 334:682-7. Google Scholar12. Levine MN, Gent M, Hirsh J, Leclerc J, Anderson D, Weitz J, et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med. 1996; 334:677-81. Google Scholar13. Lindmarker P, Holmstrom M. Use of low molecular weight heparin (dalteparin), once daily, for the treatment of deep vein thrombosis. A feasibility and health economic study in an outpatient setting. J Intern Med. 1996; 240:395-401. Google Scholar14. Spiro TE. A multicenter clinical trial comparing once and twice-daily subcutaneous enoxaparin and intravenous heparin in the treatment of acute deep vein thrombosis [Abstract]. Thromb Haemost. 1997; Suppl:373-4. Google Scholar15. Fiessinger JN, Charbonnier BA, Sixma J, Wenzel E, d'Azemar P, Sagnard L. Comparison of a once daily with a twice daily subcutaneous nadroparin calcium regimen in the treatment of deep vein thrombosis: the Fraxodi study. The Fraxodi Group [Abstract]. Thromb Haemost. 1997; Suppl:388. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Amsterdam; Amsterdam, the NetherlandsGrant Support: Dr. Buller is an Established Investigator of the Dutch Heart Foundation.Corresponding Author: Maria M.W. Koopman, Academic Medical Center, University of Amsterdam, Center for Haemostasis, Thrombosis and Atherosclerosis and Inflammation Research, F4-133, Postbox 22700, 1100 DE Amsterdam, the Netherlands.Current Author Addresses: Drs. Koopman and Buller: Academic Medical Center, University of Amsterdam, Center for Haemostasis, Thrombosis and Atherosclerosis and Inflammation Research, F4-133, Postbox 22700, 1100 DE Amsterdam, the Netherlands. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLow-Molecular-Weight Heparin for Treating Venous Thromboembolism Maria M.W. Koopman and Harry R. Büller Low-Molecular-Weight Heparin for Treating Venous Thromboembolism Michael Scott Mahoney and Marc Kahn The Hospitalist Movement Bradley Flansbaum , Steven A. Wartman , and Steven J. Walerstein The Hospitalist Movement Robert M. Wachter Metrics Cited ByAntithrombotic Therapy for Treatment of Acute Ischemic StrokePulmonary ThromboembolismAntithrombotic Therapy for Acute Ischemic StrokeA systematic review of economic analyses of low-molecular-weight heparin for the treatment of venous thromboembolismOutpatient treatment of deep vein thrombosis: translating clinical trials into practiceLow-Molecular-Weight Heparin for Treating Venous ThromboembolismMichael Scott Mahoney, MD and Marc Kahn, MD 15 June 1998Volume 128, Issue 12_Part_1Page: 1037-1039KeywordsDeep vein thrombosisHemorrhageHeparinLow molecular weight heparinOdds ratioPulmonary embolismResearch laboratoriesSafetySubcutaneous injectionsVenous thromboembolism Issue Published: 15 June 1998 CopyrightCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...