Extended Out-of-Hospital Low-Molecular-Weight Heparin for Prophylaxis against Deep Venous Thrombosis
Authors: Russell D. Hull, Graham F. Pineo, Andrew F. Mah
Journal: Annals of Internal Medicine (2002)

Letters1 October 2002Extended Out-of-Hospital Low-Molecular-Weight Heparin for Prophylaxis against Deep Venous ThrombosisRussell D. Hull, MBBS, MSc, Graham F. Pineo, MD, and Andrew F. Mah, BScRussell D. Hull, MBBS, MScUniversity of Calgary; Calgary, Alberta T2N 2T9, Canada (Hull, Pineo, Mah)Search for more papers by this author, Graham F. Pineo, MDUniversity of Calgary; Calgary, Alberta T2N 2T9, Canada (Hull, Pineo, Mah)Search for more papers by this author, and Andrew F. Mah, BScUniversity of Calgary; Calgary, Alberta T2N 2T9, Canada (Hull, Pineo, Mah)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-7-200210010-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Drs. Murashige and Schneider overstate the issue when they question the safety of extended prophylaxis, particularly in the context of patients receiving out-of-hospital LMWH after elective hip surgery. In our meta-analysis and in another study (1), we found that many randomized trials convincingly demonstrated safety in terms of an absence of major bleeding (0 of 1091 patients). The frequencies of minor bleeding (2.7%) and complicated wound hematoma (0.5%) were low and were similar to those observed in the placebo groups (1).Drs. Murashige and Schneider raise important issues about renal function, osteoporosis and associated vertebral fracture, and thrombocytopenia. ...References1. Hull RD, Pineo GF, Francis C, Bergqvist D, Fellenius C, Soderberg K, et al . Low-molecular-weight heparin prophylaxis using dalteparin extended out-of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients: a double-blind, randomized comparison. North American Fragmin Trial Investigators. Arch Intern Med. 2000;160:2208-15. [PMID: 10904465] CrossrefMedlineGoogle Scholar2. Siguret V, Pautas E, Février M, Wipff C, Durand-Gasselin B, Laurent M, et al . Elderly patients treated with tinzaparin (Innohep) administered once daily (175 anti-Xa IU/kg): anti-Xa and anti-IIa activities over 10 days. Thromb Haemost. 2000;84:800-4. [PMID: 11127859] CrossrefMedlineGoogle Scholar3. Monreal M, Lafoz E, Olive A, del Rio L, Vedia C. Comparison of subcutaneous unfractionated heparin with a low molecular weight heparin (Fragmin) in patients with venous thromboembolism and contraindications to coumarin. Thromb Haemost. 1994;71:7-11. [PMID: 8165649] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Calgary; Calgary, Alberta T2N 2T9, Canada (Hull, Pineo, Mah) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoExtended Out-of-Hospital Low-Molecular-Weight Heparin Prophylaxis against Deep Venous Thrombosis in Patients after Elective Hip Arthroplasty Russell D. Hull , Graham F. Pineo , Paul D. Stein , Andrew F. Mah , Susan M. MacIsaac , Ola E. Dahl , Matthew Butcher , Rollin F. Brant , William A. Ghali , David Bergqvist , and Gary E. Raskob Extended Out-of-Hospital Low-Molecular-Weight Heparin for Prophylaxis against Deep Venous Thrombosis Naoko Murashige and Roslyn F. Schneider Metrics 1 October 2002Volume 137, Issue 7Page: 621KeywordsCreatinineHemorrhageHeparinHipLow molecular weight heparinOsteoporosisProphylaxisRisk managementSafety studiesSurgery ePublished: 1 October 2002 Issue Published: 1 October 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...