title: Monotherapy with enoxaparin for the prevention of recurrent venous thromboembolism.
abstract: This study aimed to determine whether a weight-adjusted dose of subcutaneous enoxaparin is as effective and safe as oral acenocoumarol for the secondary prophylaxis of pulmonary embolism. Three hundred and eighty consecutive noncancer outpatients hospitalized with an episode of symptomatic pulmonary embolism selected treatment with acenocoumarol or enoxaparin at a dose of 1 mg/kg once daily after being informed of the type of administration and expected frequency of laboratory monitoring for both medicinal products. Endpoints were symptomatic recurrent thromboembolic events evaluated by standard objective testing, and a composite endpoint of recurrent venous thromboembolism, major bleeding, and death from any cause. One hundred and ninety-nine patients (52%) chose acenocoumarol therapy and 181 chose enoxaparin monotherapy. Four patients in the enoxaparin group (2.2%) and six patients in the acenocoumarol group (3%) had an objective thromboembolic recurrence (hazard ratio, 1.35; 95% confidence interval, 0.38-4.79; P = 0.64). Nine patients in the enoxaparin group (5.0%) had a hemorrhagic complication compared with 11 in the acenocoumarol group (5.5%) (P = 0.81). The hospital length of stay was shorter with enoxaparin compared with acenocoumarol (11 versus 16 days, P = 0.0001). Enoxaparin is as effective and safe as acenocoumarol in the secondary prevention of recurrent thromboembolic disease and is associated with shorter hospitalization.
authors.affiliation: Respiratory Department, Hospital Ramón y Cajal, Madrid. djc_69_98@yahoo.com
authors.forename: David Jiménez
authors.initials: DJ
authors.lastname: Castro
authors.forename: Gema
authors.initials: G
authors.lastname: Díaz
authors.forename: David
authors.initials: D
authors.lastname: Martí
authors.forename: Carlos
authors.initials: C
authors.lastname: Escobar
authors.forename: Javier
authors.initials: J
authors.lastname: Ortega
authors.forename: Sergio
authors.initials: S
authors.lastname: García-Rull
authors.forename: Joaquin
authors.initials: J
authors.lastname: Picher
authors.forename: Antonio
authors.initials: A
authors.lastname: Sueiro
mesh_terms: D000074:Acenocoumarol / Q000008:administration & dosage / Q000633:toxicity; D000368:Aged; D000369:Aged, 80 and over; D017984:Enoxaparin / Q000008:administration & dosage* / Q000633:toxicity; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D066298:In Vitro Techniques; D007902:Length of Stay; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000188:drug therapy*; D055502:Secondary Prevention; D020246:Venous Thrombosis / Q000188:drug therapy*
chemical_list: D017984:Enoxaparin; D000074:Acenocoumarol