Trials That Matter: Can Patients with Venous Thromboembolism Be Treated with Fixed-Dose Subcutaneous Unfractionated Heparin?
Authors: Samuel Z. Goldhaber, Michael Berkwits
Journal: Annals of Internal Medicine (2006)

Editorials19 December 2006Trials That Matter: Can Patients with Venous Thromboembolism Be Treated with Fixed-Dose Subcutaneous Unfractionated Heparin?Samuel Z. Goldhaber, MD and Michael Berkwits, MD, MSCE, Deputy EditorSamuel Z. Goldhaber, MDFrom University of Colorado at Denver and Health Sciences Center, Denver, Colorado, and American College of Physicians, Philadelphia, Pennsylvania.Search for more papers by this author and Michael Berkwits, MD, MSCE, Deputy EditorFrom University of Colorado at Denver and Health Sciences Center, Denver, Colorado, and American College of Physicians, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-145-12-200612190-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Unfractionated heparin (UFH) was the mainstay of initial treatment for acute venous thromboembolism (VTE) until low-molecular-weight heparin (LMWH) became available in the 1990s. Low-molecular-weight heparin was an attractive alternative to UFH because its excellent bioavailability allowed for convenient fixed, weight-based dosing. High-quality research subsequently confirmed the superior efficacy, safety, and cost-effectiveness of LMWH over UFH for treatment of deep venous thrombosis (1–4). As a result, most patients with this disorder who would require a minimum 5-day hospitalization if treated with UFH can now be treated with LMWH in an overnight stay or in the outpatient setting. Some evidence even supports ...References1. Gould MK, Dembitzer AD, Doyle RL, Hastie TJ, Garber AM. Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A meta-analysis of randomized, controlled trials. Ann Intern Med. 1999;130:800-9. [PMID: 10366369] LinkGoogle Scholar2. van Dongen CJ, van den Belt AG, Prins MH, Lensing AW. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev. 2004;:CD001100. [PMID: 15495007] MedlineGoogle Scholar3. Martel N, Lee J, Wells PS. 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[PMID: 15383478] CrossrefMedlineGoogle Scholar7. Handoll HH, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Milne AA, Gillespie WJ. Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev. 2002;:CD000305. [PMID: 12519540] MedlineGoogle Scholar8. Hommes DW, Bura A, Mazzolai L, Büller HR, ten Cate JW. Subcutaneous heparin compared with continuous intravenous heparin administration in the initial treatment of deep vein thrombosis. A meta-analysis. Ann Intern Med. 1992;116:279-84. [PMID: 1531108] LinkGoogle Scholar9. Faivre R, Neuhart Y, Kieffer Y, Apfel F, Magnin D, Didier D, et al. [A new treatment of deep venous thrombosis: low molecular weight heparin fractions. Randomized study]. Presse Med. 1988;17:197-200. [PMID: 2965375] MedlineGoogle Scholar10. Lopaciuk S, Meissner AJ, Filipecki S, Zawilska K, Sowier J, Ciesielski L, et al. Subcutaneous low molecular weight heparin versus subcutaneous unfractionated heparin in the treatment of deep vein thrombosis: a Polish multicenter trial. Thromb Haemost. 1992;68:14-8. [PMID: 1325076] CrossrefMedlineGoogle Scholar11. Belcaro G, Nicolaides AN, Cesarone MR, Laurora G, De Sanctis MT, Incandela L, et al. Comparison of low-molecular-weight heparin, administered primarily at home, with unfractionated heparin, administered in hospital, and subcutaneous heparin, administered at home for deep-vein thrombosis. Angiology. 1999;50:781-7. [PMID: 10535716] CrossrefMedlineGoogle Scholar12. Prandoni P, Carnovali M, Marchiori A. Subcutaneous adjusted-dose unfractionated heparin vs fixed-dose low-molecular-weight heparin in the initial treatment of venous thromboembolism. Arch Intern Med. 2004;164:1077-83. [PMID: 15159264] CrossrefMedlineGoogle Scholar13. Kearon C, Ginsberg JS, Julian JA, Douketis J, Solymoss S, Ockelford P, et al. Comparison of fixed-dose weight-adjusted unfractionated heparin and low-molecular-weight heparin for acute treatment of venous thromboembolism. JAMA. 2006;296:935-42. [PMID: 16926353] CrossrefMedlineGoogle Scholar14. Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, et al. Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349:146-53. [PMID: 12853587] MedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Samuel Z. Goldhaber, MD; Michael Berkwits, MD, MSCE, Deputy EditorAffiliations: From University of Colorado at Denver and Health Sciences Center, Denver, Colorado, and American College of Physicians, Philadelphia, Pennsylvania.Disclosures: Consultancies: S.Z. Goldhaber (Sanofi-Aventis, GlaxoSmithKline, Emisphere, Bayer, Boehringer Ingelheim); Grants received: S.Z. Goldhaber (Sanofi-Aventis, Eisai, GlaxoSmithKline).Corresponding Author: Samuel Z. Goldhaber, MD, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115.Current Author Addresses: Dr. Goldhaber: Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115.Dr. Berkwits: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byFacelift Complications and the Risk of Venous Thromboembolism: A Single Center’s ExperienceMortality in Outpatient SurgeryDisorders of pulmonary circulation 19 December 2006Volume 145, Issue 12Page: 929-931KeywordsDeep vein thrombosisHemorrhageHeparinPatientsPulmonary embolismSafetyVenous thromboembolism ePublished: 19 December 2006 Issue Published: 19 December 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...