PMID- 15322504
OWN - NLM
STAT- MEDLINE
DCOM- 20040915
LR  - 20061115
IS  - 0022-2143 (Print)
IS  - 0022-2143 (Linking)
VI  - 144
IP  - 2
DP  - 2004 Aug
TI  - Low molecular weight heparin (dalteparin) is equally effective as unfractionated 
      heparin in reducing coagulation activity and perfusion abnormalities during the 
      early treatment of pulmonary embolism.
PG  - 100-7
AB  - Little is known about the differences between unfractionated heparin (UFH) and 
      low molecular weight heparin (LMWH) with regard to their effects on coagulation 
      activity during treatment for pulmonary embolism. The objective of this study was 
      to compare UFH and LMWH (dalteparin) in the early treatment of pulmonary embolism 
      in terms of control of coagulation markers and perfusion abnormalities. 
      Thirty-seven patients with acute pulmonary embolism were randomized to receive 
      intravenous UFH or subcutaneous dalteparin, each accompanied by acenocoumarol. 
      Daily blood samples were obtained for the measurement of thrombin generation 
      (fragments 1 and 2 [F1+2], thrombin-antithrombin (TAT) complexes and fibrin 
      monomers [FMs]) and fibrinolysis (d-dimer concentrations and clot-lysis times). 
      Ventilation-perfusion scintigraphies were performed, and with the data they 
      yielded, percentage of vascular obstruction scores (PVOs) were calculated on days 
      0 and 5. The international normalized ratio was within the therapeutic range in 
      both groups on day 3. F1+2 and TAT complexes rapidly normalized, without 
      differences between the groups (P =.5 and.4, respectively). FM levels did not 
      decrease and, in fact, showed an increase in the UFH group from day 3 on (P <.05 
      between groups). d-Dimer levels decreased over time, with no differences between 
      groups (P =.6). Clot-lysis times were shorter in the UFH group (P <.05). PVOs on 
      days 0 and 5 were not different (P =.5 and.8, respectively), but the decrease in 
      PVOs over time was greater in the dalteparin group (P =.04). These results show 
      that dalteparin is at least as effective as UFH in reducing coagulation activity 
      and perfusion abnormalities in the early treatment of pulmonary embolism.
FAU - Schutgens, Roger E G
AU  - Schutgens RE
AD  - Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the 
      Netherlands. schutgensvos@hetnet.nl
FAU - Esseboom, Earl U
AU  - Esseboom EU
FAU - Snijder, Repke J
AU  - Snijder RJ
FAU - Haas, Fred J L M
AU  - Haas FJ
FAU - Verzijlbergen, Fred
AU  - Verzijlbergen F
FAU - Nieuwenhuis, H Karel
AU  - Nieuwenhuis HK
FAU - Lisman, Ton
AU  - Lisman T
FAU - Biesma, Douwe H
AU  - Biesma DH
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - J Lab Clin Med
JT  - The Journal of laboratory and clinical medicine
JID - 0375375
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9001-31-4 (Fibrin)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.5 (Thrombin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - Female
MH  - Fibrin/analysis
MH  - Fibrinolysis
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Partial Thromboplastin Time
MH  - Pulmonary Embolism/*blood/*drug therapy
MH  - Thrombin/analysis
MH  - Time Factors
EDAT- 2004/08/24 05:00
MHDA- 2004/09/16 05:00
CRDT- 2004/08/24 05:00
PHST- 2004/08/24 05:00 [pubmed]
PHST- 2004/09/16 05:00 [medline]
PHST- 2004/08/24 05:00 [entrez]
AID - S0022214304001088 [pii]
AID - 10.1016/j.lab.2004.04.006 [doi]
PST - ppublish
SO  - J Lab Clin Med. 2004 Aug;144(2):100-7. doi: 10.1016/j.lab.2004.04.006.