Treatment of pulmonary embolism: The use of low-molecular-weight heparin in the inpatient and outpatient settings.
Pulmonary embolism (PE) remains a major clinical problem associated with considerable mortality and morbidity. In patients with PE, appropriate anticoagulant therapy has been shown to significantly reduce both recurrence and mortality. Low-molecular-weight heparin (LMWH) is at least as effective as unfractionated heparin (UFH) in the treatment of PE, with a similar risk of bleeding. Furthermore, LMWH offers more predictable pharmacokinetics and anticoagulant effects. As a result, current guidelines from both the American College of Chest Physicians and the joint American College of Physicians/American Academy of Family Physicians recommend the use of LMWH over UFH (in patients with submassive PE). Outpatient treatment with LMWH has been shown to be feasible in many patients, and offers the potential for cost-savings and improvements in health-related quality of life. Further data are needed to support an evidence-based recommendation for the use of LMWH in the outpatient treatment of PE.
Hull
Russell D
RD
Thrombosis Research Unit, 601 South Tower Foothills Hospital, 1403-29 Street NW, Calgary, Alberta, Canada T2N 2T9. rdhull@ucalgary.ca
D000553:Ambulatory Care; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007297:Inpatients; D008134:Long-Term Care; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D011788:Quality of Life; D012107:Research Design; D018570:Risk Assessment; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000191:economics
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight