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Low-molecular-weight heparin therapy and mortality
K A Valentine1, R D Hull, G F Pineo
1Department of Medicine, Faculty of Medicine, University of Calgary, Alberta, Canada.
Seminars in Thrombosis and Hemostasis
|January 1, 1997
Summary
Subcutaneous low-molecular-weight heparins (LMWHs) offer a safe and effective alternative to intravenous unfractionated heparin for venous thromboembolism. This approach simplifies treatment, potentially enabling earlier discharge and outpatient management.
Area of Science:
- Pharmacology
- Hematology
- Clinical Medicine
Background:
- Venous thromboembolic disease (VTE) traditionally requires intravenous unfractionated heparin.
- Continuous intravenous administration necessitates laboratory monitoring and prolonged hospitalization.
Purpose of the Study:
- To evaluate the efficacy and safety of subcutaneous low-molecular-weight heparins (LMWHs) for initial VTE treatment.
- To explore the potential for outpatient management of VTE.
Main Methods:
- Review of clinical trial evidence comparing subcutaneous LMWHs with intravenous unfractionated heparin.
- Analysis of anticoagulant response, duration of action, and monitoring requirements.
Main Results:
- Subcutaneous LMWHs provide predictable anticoagulant effects and prolonged action, allowing once or twice daily dosing.
- Treatment with LMWHs does not require laboratory monitoring.
- Studies indicate LMWH is as effective and safer than unfractionated heparin, with potential for reduced mortality.
Conclusions:
- Subcutaneous LMWH is a justified and effective initial treatment for VTE.
- Simplified administration and lack of monitoring facilitate earlier patient discharge and potential outpatient VTE treatment.
- Further research is needed to confirm decreased mortality rates, especially in cancer patients.