A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis
| Autor: | Louis Desjardins, Jean Cusson, William Brien, Jack Hirsh, Jeffrey I. Weitz, Michael Gent, Jeanine Kassis, Jacques R. Leclerc, Peter Powers, Alexander G.G. Turpie, Moira Cruickshank, Jeffrey S. Ginsberg, Andrew R. Willan, Mark Levine, David C. Anderson, Christine Demers, Susan Haley, Michael J. Kovacs, William Geerts |
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| Rok vydání: | 1996 |
| Předmět: |
Male
medicine.medical_specialty Popliteal Vein medicine.drug_class Home Nursing Deep vein Injections Subcutaneous Low molecular weight heparin Hemorrhage Self Administration Recurrence Thromboembolism medicine Humans Enoxaparin Infusions Intravenous Aged Dalteparin sodium business.industry Heparin Anticoagulant Warfarin Anticoagulants Thrombosis General Medicine Middle Aged medicine.disease Tinzaparin sodium Surgery Hospitalization medicine.anatomical_structure Treatment Outcome Anesthesia Female business medicine.drug |
| Zdroj: | The New England journal of medicine. 334(11) |
| ISSN: | 0028-4793 |
| Popis: | Patients with acute proximal deep-vein thrombosis are usually treated first in the hospital with intravenous standard (unfractionated) heparin. However, the longer plasma half-life, better bioavailability after subcutaneous administration, and more predictable anticoagulant response of low-molecular-weight heparins make them attractive for possible home use. We compared these two approaches.Patients with acute proximal deep-vein thrombosis were randomly assigned to receive either intravenous standard heparin in the hospital (253 patients) or low-molecular-weight heparin (1 mg of enoxaparin per kilogram of body weight subcutaneously twice daily) administered primarily at home (247 patients). The study design allowed outpatients taking low-molecular-weight heparin to go home immediately and hospitalized patients taking low-molecular-weight heparin to be discharged early. All the patients received warfarin starting on the second day.Thirteen of the 247 patients receiving low-molecular-weight heparin (5.3 percent) had recurrent thromboembolism, as compared with 17 of the 253 patients receiving standard heparin (6.7 percent; P=0.57; absolute difference, 1.4 percentage points; 95 percent confidence interval, -3.0 to 5.7). Five patients receiving low-molecular-weight heparin had major bleeding, as compared with three patients receiving standard heparin. After randomization, the patients who received low-molecular-weight heparin spent a mean of 1.1 days in the hospital, as compared with 6.5 days for the standard-heparin group; 120 patients in the low-molecular-weight- heparin group did not need to be hospitalized at all.Low-molecular-weight heparin can be used safely and effectively to treat patients with proximal deep-vein thrombosis at home. |
| Databáze: | OpenAIRE |
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