Treatment of acute deep venous thrombosis and pulmonary embolism: use of low molecular weight heparin.
Over the past decade, the use of low molecular weight heparin (LMWH) preparations has revolutionized the approach to preventing and treating venous thromboembolism. For established deep venous thrombosis, numerous prospective clinical trials have indicated that these drugs are at least as safe and as effective as standard, unfractionated heparin (UFH) and perhaps even more effective at preventing recurrences. Advantages of low molecular weight heparin include superior bioavailability compared with standard heparin, once- or twice-daily subcutaneous delivery, and the lack of need to monitor in most clinical circumstances. Because of these advantages, increasing numbers of stable, compliant patients with deep venous thrombosis are being treated as outpatients. This approach requires an organized team effort with comprehensive patient education and carefully planned follow-up. Cost-benefit analyses have unequivocally proved that when treatment with low molecular weight heparin is utilized in the outpatient setting, there are substantial cost savings.
Tapson
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Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. tapso001@mc.duke.edu