[Treatment of deep venous thrombosis by low molecular weight heparins. Comments on the recommendations of the North American Consensus].
LMW heparins have recently come into use in North America for treatment of venous thrombosis. Their first line recommendation is a major innovation of the last north american consensus conference on antithrombotics published in Chest at the beginning of 2001. This recommendation is grade 1A regarding its advantageous benefit-risk ratio. An earlier oral vitamine K antagonist treatment and a more regular nomogram use allow to reduce the relay duration and to obtain more often the targeted INR. The more predictable anticoagulant response with weight-based doses induces a simplified anti-Xa activity survey limited to renal dysfunction and obese or less than 50 Kg body weight persons but a regular platelet count remains mandatory. Several questions need to be discussed: once or twice daily subcutaneous injection use and treatment duration which seem related to the persistence of triggering factors, the variety of thrombophilia and comorbidity conditions. Due to a greater evidence-based medicine, the antithrombotic strategy becomes more related to a closer evaluation of the individual thrombotic risk level.
Samama
M M
MM
Service d'hématologie biologique, Hôtel-Dieu, 1, place du parvis Notre-Dame, 75181 Paris, France. florence.roux@htd.ap-hop-paris.fr
Horellou
M H
MH
Conard
J
J
Achkar
A
A
Elalamy
I
I
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D010045:Outpatients; D010976:Platelet Count; D011247:Pregnancy; D011655:Pulmonary Embolism / Q000188:drug therapy; D012008:Recurrence; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications; D013924:Thrombophlebitis / Q000188:drug therapy*; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin