Management of Venous Thromboembolism
Authors: Richard Schreiber
Journal: Annals of Internal Medicine (2007)

Letters2 October 2007Management of Venous ThromboembolismRichard Schreiber, MDRichard Schreiber, MDFrom Internists of Central Pennsylvania, Lemoyne, PA 17043.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-147-7-200710020-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I am surprised that the recently published guidelines on treatment of venous thromboembolic disease (1) do not include some comments about the added safety of LMWH compared with unfractionated heparin. There is clearly a lower incidence of heparin-induced thrombocytopenia with LMWHs (2–4). The reduced likelihood of thrombocytopenia also decreases the potential for the devastating and life-threatening consequences of warfarin-induced skin necrosis (5).Indeed, the price of 1 case of heparin-induced thrombocytopenia quickly offsets the increased initial acquisition cost of LMWH. Other savings accrue when using LMWH, such as decreased costs for intravenous solutions, laboratory tests, and nursing ...References1. Snow V, Qaseem A, Barry P, Hornbake ER, Rodnick JE, Tobolic T, et al. Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2007;146:204-10. [PMID: 17261857] LinkGoogle Scholar2. 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. [PMID: 7715641] CrossrefMedlineGoogle Scholar3. Lee DH, Warkentin TE. Frequency of heparin-induced thrombocytopenia.. In: Warkentin TE, Greinacher A, eds. Heparin-Induced Thrombocytopenia. 3rd ed. New York: Marcel Dekker; 2004:107-48. Google Scholar4. Lindhoff-Last E, Nakov R, Misselwitz F, Breddin HK, Bauersachs R. Incidence and clinical relevance of heparin-induced antibodies in patients with deep vein thrombosis treated with unfractionated or low-molecular-weight heparin. Br J Haematol. 2002;118:1137-42. [PMID: 12199798] CrossrefMedlineGoogle Scholar5. Srinivasan AF, Rice L, Bartholomew JR, Rangaswamy C, La Perna L, Thompson JE, et al. Warfarin-induced skin necrosis and venous limb gangrene in the setting of heparin-induced thrombocytopenia. Arch Intern Med. 2004;164:66-70. [PMID: 14718324] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Richard Schreiber, MDAffiliations: From Internists of Central Pennsylvania, Lemoyne, PA 17043. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoManagement of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians Vincenza Snow , Amir Qaseem , Patricia Barry , E. Rodney Hornbake , Jonathan E. Rodnick , Timothy Tobolic , Belinda Ireland , Jodi B. Segal , Eric B. Bass , Kevin B. Weiss , Lee Green , and Douglas K. Owens , and the Joint American College of Physicians/American Academy of Family Physicians Panel on Deep Venous Thrombosis/Pulmonary Embolism*Management of Venous Thromboembolism Emmanuel M. Bhaskar Management of Venous Thromboembolism Amir Qaseem and Vincenza Snow Management of Venous Thromboembolism Christopher Hughes Metrics 2 October 2007Volume 147, Issue 7Page: 519KeywordsConflicts of interestHeparinHeparin-induced thrombocytopeniaInpatientsLaboratory testsLow molecular weight heparinNecrosisSafetyTreatment guidelinesVenous thromboembolism ePublished: 2 October 2007 Issue Published: 2 October 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...