PMID- 15543773
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20050901
LR  - 20191109
IS  - 0034-9887 (Print)
IS  - 0034-9887 (Linking)
VI  - 132
IP  - 9
DP  - 2004 Sep
TI  - [Critical appraisal: Subcutaneous adjusted-dose unfractionated heparin vs 
      fixed-dose low-molecular-weight heparin in the initial treatment of venous 
      thromboembolism. Prandoni P, Carnovali M, Marchiori A, Galilei investigators. 
      Arch Intern Med 2004; 164: 1077-83].
PG  - 1140-3
AB  - BACKGROUND: Few reports have addressed the value of unfractionated heparin (UFH) 
      or low-molecular-weight heparin in treating the fill spectrum of patients with 
      venous thromboembolism (VTE), including recurrent VTE and pulmonary embolism. 
      METHODS: In an open, multicenter clinical trial, 720 consecutive patients with 
      acute symptomatic VTE, including 119 noncritically ill patients (16.5%) with 
      pulmonary embolism and 102 (14.2%) with recurrent VTE, were randomly assigned to 
      treatment with subcutaneous UFH with dose adjusted by activated partial 
      thromboplastin time by means of a weight-based algorithm (preceded by an 
      intravenous loading dose), or fixed-dose (adjusted only to body weight) 
      subcutaneous nadroparin calcium. Oral anticoagulant therapy was started 
      concomitantly and continued for at least 3 months. We recorded the incidence of 
      major bleeding during the initial heparin treatment and that of recurrent VTE and 
      death during 3 months of follow-up. RESULTS: Fifteen (4.2%) of the 360 patients 
      assigned to UFH had recurrent thromboembolic events, as compared with 14 (3.9%) 
      of the 360 patients assigned to nadroparin (absolute difference between rates, 
      0.3%; 95% confidence interval, -2.5% to 3.1%). Four patients assigned to UFH 
      (1.1%) and 3 patients assigned to nadroparin (0.8%) had episodes of major 
      bleeding (absolute difference between rates, 0.3%; 95% confidence interval, -1.2% 
      to 1.7%). Overall mortality was 3.3% in each group. CONCLUSIONS: Subcutaneous UFH 
      with dose adjusted by activated partial thromboplastin time by means of a 
      weight-based algorithm is as effective and safe as fixed-dose nadroparin for the 
      initial treatment of patients with VTE, including those with pulmonary embolism 
      and recurrent VTE.
FAU - Burotto, Mauricio
AU  - Burotto M
AD  - Departamento de Medicina Interna, Pontificia Universidad Catolica de Chile.
FAU - Gabrielli, Luigi
AU  - Gabrielli L
FAU - Crossley, Nicolas
AU  - Crossley N
LA  - spa
PT  - Comment
PT  - English Abstract
PT  - Journal Article
TT  - Analisis critico de un articulo. Heparina no-fraccionada subcutanea versus 
      heparina de bajo peso molecular en el tratamiento inicial de la enfermedad 
      tromboembolica. Prandoni P, Carnovali M, Marchiori A, Galilei investigators. Arch 
      Intern Med 2004; 164: 1077-83.
PL  - Chile
TA  - Rev Med Chil
JT  - Revista medica de Chile
JID - 0404312
CON - Arch Intern Med. 2004 May 24;164(10):1077-83. PMID: 15159264
EDAT- 2004/11/17 09:00
MHDA- 2004/11/17 09:01
CRDT- 2004/11/17 09:00
PHST- 2004/11/17 09:00 [pubmed]
PHST- 2004/11/17 09:01 [medline]
PHST- 2004/11/17 09:00 [entrez]
AID - 10.4067/s0034-98872004000900017 [doi]
PST - ppublish
SO  - Rev Med Chil. 2004 Sep;132(9):1140-3. doi: 10.4067/s0034-98872004000900017.