title: Long-term low-molecular-weight heparin and the post-thrombotic syndrome: a systematic review.
abstract: OBJECTIVE
  Post-thrombotic syndrome causes considerable morbidity. The Home-LITE study showed a lower incidence of post-thrombotic syndrome and venous ulcers after 3 months of treating deep vein thrombosis with the low-molecular-weight heparin tinzaparin versus oral anticoagulation. This systematic review examined whether long-term treatment of deep vein thrombosis using low-molecular-weight heparin, rather than oral anticoagulation, reduces development of post-thrombotic syndrome.
  
  
  METHODS
  We identified 9 articles comparing treatment of deep vein thrombosis using long-term low-molecular-weight heparin with any comparator, which reported outcomes relevant to the post-thrombotic syndrome assessed ≥ 3 months post-deep vein thrombosis.
  
  
  RESULTS
  Pooled analysis of 2 studies yielded an 87% risk reduction with low-molecular-weight heparin in the incidence of venous ulcers at ≥ 3 months (P = .019). One study showed an overall odds ratio of 0.77 (P = .001) favoring low-molecular-weight heparin for the presence of 8 patient-reported post-thrombotic syndrome signs and symptoms. Pooled analysis of 5 studies showed a risk ratio for low-molecular-weight heparin versus oral anticoagulation of 0.66 (P < .0001) for complete recanalization of thrombosed veins.
  
  
  CONCLUSIONS
  These results support the lower incidence of post-thrombotic syndrome and venous ulcers observed in Home-LITE. Long-term treatment with low-molecular-weight heparin rather than oral anticoagulation after a deep vein thrombosis may reduce or prevent development of signs and symptoms associated with post-thrombotic syndrome. Post-thrombotic syndrome and associated acute ulcers may develop more rapidly after deep vein thrombosis than previously recognized.
authors.affiliation: University of Calgary, Alberta, Canada. rdhull@ucalgary.ca
authors.forename: Russell D
authors.initials: RD
authors.lastname: Hull
authors.forename: Jane
authors.initials: J
authors.lastname: Liang
authors.forename: Grace
authors.initials: G
authors.lastname: Townshend
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D017985:Dalteparin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000008:administration & dosage; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D017762:Nadroparin / Q000008:administration & dosage; D054070:Postthrombotic Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012720:Severity of Illness Index; D000078222:Tinzaparin; D014647:Varicose Ulcer / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014680:Veins / Q000473:pathology*; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight; D017762:Nadroparin; D000078222:Tinzaparin; C411345:bemiparin; D017985:Dalteparin