Low molecular weight heparin for the out-of-hospital treatment of venous thrombosis: rationale and clinical results.
LMWH preparations have been proven to be safe and effective in the out-patient management of acute DVT. Although LMWHs are more expensive than unfractionated heparin, the lack of need for laboratory monitoring of LMWHs and their potential for out-patient treatment more than offsets the drug related cost difference and results in a net cost savings in favour of LMWH. LMWHs have undergone limited investigation for the secondary prevention of venous thromboembolism after an initial in-patient course of unfractionated heparin. To data, LMWHs have been given in prophylactic doses in these trials. In this setting, the LMWHs are associated with a similar risk of bleeding as fixed, intermediate dose unfractionated heparin in patients with a high risk of bleeding. In patients with no increase in bleeding risk, fixed prophylactic dose LMWH appears to be associated with both a lower risk of bleeding than warfarin (target INR of 2.0 to 3.0) and an increased risk of recurrence, although these findings need to be confirmed in larger trials.
Hirsh
J
J
Hamilton Civic Hospitals Research Centre, Ontario, Canada.
Crowther
M
M
D000553:Ambulatory Care / Q000379:methods*; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013924:Thrombophlebitis / Q000188:drug therapy* / Q000517:prevention & control; D016896:Treatment Outcome
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin