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SHORT-COURSE HEPARIN SUCCESSFULLY TREATS PROXIMAL VENOUS THROMBOSIS.

In most settings, therapy for proximal deep venous thrombosis (DVT) involves a 10-day course of continuous intravenous heparin, with warfarin begun on the fifth day. A team from McMaster University that has pioneered many advances in the diagnosis and treatment of DVT compared this regimen with a shorter course, in which heparin is given for five days and warfarin is begun on the first day. In a randomized trial of 199 consecutive patients, the frequency of thromboembolism was found to be equally low in the long- and short-course groups (7.0 percent and 7.1 percent, respectively), and the rate of major bleeding episodes was similar (6.0 percent and 7.1 percent, respectively).

The design of this study protected against many possible biases, and data collection was remarkable: none of the patients was lost to follow-up. However, the rate of thromboembolism in the long-course group was surprisingly low, compared with the findings of previous studies in apparently similar patients. Thus, it remains possible that this group of patients was somehow unrepresentative of the general population with DVT. As it stands, the study indicates that the short-course regimen is as effective as the long-course regimen and could save substantial costs by reducing the length of hospitalization.

— ALK

Published in Journal Watch General Medicine May 8, 1990

Citation(s):

Hull RD et al. Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis. N Engl J Med 1990 May 3 322 1260-1264.

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