PMID- 9606481
OWN - NLM
STAT- MEDLINE
DCOM- 19980730
LR  - 20181201
IS  - 1060-0280 (Print)
IS  - 1060-0280 (Linking)
VI  - 32
IP  - 5
DP  - 1998 May
TI  - Low-molecular-weight heparins in the treatment of deep-vein thrombosis.
PG  - 588-98, 601
AB  - OBJECTIVE: To compare the characteristics and clinical efficacy of 
      low-molecular-weight heparins (LMWHs) and unfractionated heparin (UFH) in the 
      treatment of deep-vein thrombosis (DVT). Adverse effects, dosing, and cost issues 
      are also discussed. DATA SOURCES: A MEDLINE search (January 1984-October 1997) 
      was used to identify pertinent French and English literature, including clinical 
      trials and reviews on LMWHs and their use in DVT. STUDY SELECTION: Trials 
      comparing dalteparin, enoxaparin, tinzaparin, and nadroparin with UFH were 
      selected. As studies were numerous, only randomized trials including more than 50 
      patients were reviewed. Moreover, all patients studied had a first episode of 
      symptomatic DVT confirmed by objective tests (i.e., venography, duplex 
      ultrasonography, impedance plethysmography). Clinical efficacy and safety of 
      LMWHs were assessed in these trials. DATA EXTRACTION: Results pertaining to 
      venographic assessment, recurrent thromboembolism, total mortality, and bleeding 
      complications were extracted from the selected studies. DATA SYNTHESIS: Compared 
      with UFH, LMWHs have a longer plasma half-life, better subcutaneous 
      bioavailability, more predictable anticoagulant response, and require less 
      intense laboratory monitoring. Most trials demonstrate comparable effects on 
      thrombus extension and incidence of recurrent thromboembolism. Compared with UFH, 
      LMWHs do not alter total mortality. Although animal trials predict a lower 
      hemorrhagic potential for LMWHs, the incidence of bleeding complications is 
      generally similar to that observed with UFH. Outpatient management of DVT with 
      LMWHs has shown comparable safety and efficacy with inpatient UFH use but a 
      shorter hospital stay. CONCLUSIONS: Because LMWHs are as safe and as effective as 
      UFH, and because of their more convenient method of administration, they can be 
      considered valuable alternatives for the treatment of DVT. Savings generated by 
      less intensive laboratory monitoring and the possibility of early hospital 
      discharge and outpatient therapy may outweight the higher acquisition cost of 
      LMWHs.
FAU - Martineau, P
AU  - Martineau P
AD  - Faculte de Pharmacie, Universite de Montreal, Quebec, Canada. 
      martip@ere.umontreal.ca
FAU - Tawil, N
AU  - Tawil N
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Nadroparin)
RN  - 7UQ7X4Y489 (Tinzaparin)
RN  - 9005-49-6 (Heparin)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Blood Platelets/drug effects/metabolism
MH  - Capillary Permeability/drug effects
MH  - Dalteparin/therapeutic use
MH  - Enoxaparin/therapeutic use
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/administration & dosage/adverse 
      effects/pharmacokinetics/*therapeutic use
MH  - Humans
MH  - Nadroparin/therapeutic use
MH  - Osteoporosis/chemically induced
MH  - Randomized Controlled Trials as Topic
MH  - Thrombocytopenia/chemically induced
MH  - Thrombosis/*drug therapy/economics/metabolism
MH  - Tinzaparin
RF  - 76
EDAT- 1998/06/02 00:00
MHDA- 1998/06/02 00:01
CRDT- 1998/06/02 00:00
PHST- 1998/06/02 00:00 [pubmed]
PHST- 1998/06/02 00:01 [medline]
PHST- 1998/06/02 00:00 [entrez]
AID - 10.1345/aph.16450 [doi]
PST - ppublish
SO  - Ann Pharmacother. 1998 May;32(5):588-98, 601. doi: 10.1345/aph.16450.