PMID- 10549723
OWN - NLM
STAT- MEDLINE
DCOM- 19991208
LR  - 20060307
IS  - 0094-6176 (Print)
IS  - 0094-6176 (Linking)
VI  - 25 Suppl 3
DP  - 1999
TI  - Low molecular weight heparins in the outpatient management of venous 
      thromboembolism.
PG  - 97-9
AB  - Low molecular weight heparin (LMWH) has challenged the position of unfractionated 
      heparin (UFH) as the treatment of choice in preventing progression, recurrence, 
      and complications of venous thromboembolism (VTE). A meta-analysis of 13 
      randomized trials has shown that subcutaneous LMWH is associated with lower rates 
      of recurrence, bleeding, and mortality than is intravenous UFH. The use of 
      subcutaneous LMWH yields substantial savings in pharmacy and nursing costs. 
      Recent trials have demonstrated that home treatment with enoxaparin and 
      dalteparin is at least as safe and effective as inpatient treatment with UFH, is 
      feasible in more than 70% of patients with VTE, and is associated with improved 
      quality of life. Home treatment saves as much as $6000 per patient relative to 
      inpatient treatment with UFH and nearly $3000 per patient relative to inpatient 
      treatment with LMWH. Of the three LMWH preparations available in the United 
      States, enoxaparin, dalteparin, and ardeparin, only enoxaparin is approved for 
      the treatment of deep-vein thrombosis. These LMWHs differ substantially in 
      molecular weight and molecular size distribution, bleeding indices in animal 
      models, anti-Xa activity, anti-Xa/anti-IIa ratio, and release of tissue factor 
      pathway inhibitor. Although the clinical relevance of these differences remains 
      uncertain, the United States Food and Drug Administration recognizes LMWHs as 
      distinct noninterchangeable drugs.
FAU - Bick, R L
AU  - Bick RL
AD  - Department of Medicine and Pathology, University of Texas Southwestern Medical 
      School, Dallas 75231, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Semin Thromb Hemost
JT  - Seminars in thrombosis and hemostasis
JID - 0431155
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - *Ambulatory Care
MH  - Animals
MH  - Disease Management
MH  - Heparin, Low-Molecular-Weight/chemistry/*therapeutic use
MH  - Humans
MH  - Thromboembolism/drug therapy
MH  - Venous Thrombosis/*drug therapy
RF  - 16
EDAT- 1999/11/05 00:00
MHDA- 1999/11/05 00:01
CRDT- 1999/11/05 00:00
PHST- 1999/11/05 00:00 [pubmed]
PHST- 1999/11/05 00:01 [medline]
PHST- 1999/11/05 00:00 [entrez]
PST - ppublish
SO  - Semin Thromb Hemost. 1999;25 Suppl 3:97-9.