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LOW-MOLECULAR-WEIGHT HEPARIN FOR THROMBOSIS.
Low-molecular-weight (LMW) fractions of heparin appear to have longer half-lives than conventional unfractionated heparin and may offer equal or better antithrombotic activity with lower risk. Two new studies test their efficacy and safety.
In a double-blind trial from the U.S. and Canada, Hull and colleagues compared fixed-dose subcutaneous LMW heparin given once daily with continuous infusions of conventional heparin. The subjects were 432 patients with proximal deep- vein thrombosis documented by venography. Patients receiving LMW heparin had marginally lower rates of new episodes of venous thromboembolism (2.8 vs. 6.9 percent), significantly lower rates of initial bleeding complications (0.5 vs. 5 percent), and significantly lower mortality (4.7 vs. 9.6 percent) than those receiving conventional heparin.
In the second study, French investigators randomized 101 patients with pulmonary embolism to receive either standard intravenous heparin or subcutaneous LMW heparin (400, 600, or 900 U/kg). The groups receiving the two higher doses of LMW heparin had increased rates of major bleeding compared with the other two groups. The group receiving 400 units of LMW heparin had equally good clinical outcomes and similar complication rates as the group receiving conventional heparin.
These data and other recent findings (see Journal Watch accession number 920306001) suggest that LMW heparin is at least as efficacious as conventional heparin. Although LMW heparin will surely be more costly, the increased cost may be offset by a reduced need for inpatient IV therapy.
— THL
Published in Journal Watch General Medicine April 21, 1992
Citation(s):
Salzman EW. Low-molecular-weight heparin and other new antithrombotic drugs. N Engl J Med 1992 Apr 9 326 1017-1019.
- Medline abstract (Free)
Thery C et al. Randomized trial of subcutaneous low-molecular-weight heparin CY 216 (Fraxiparine) compared with intravenous unfractionated heparin in the curative treatment of submassive pulmonary embolism: a dose-ranging study. Circulation 1992 Apr 85 1380-1389.
- Medline abstract (Free)
Hull RD et al. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. N Engl J Med 1992 Apr 9 326 975-982.
- Medline abstract (Free)
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