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Antecedentes y métodos: Se dispone de datos limitados sobre la utilidad de la profilaxis secundaria de la trombosis venosa profunda (TVP) con heparinas de bajo peso molecular (HBPM). Comparamos dos cohortes de pacientes diagnosticados de TVP. Un grupo tratado con HBPM y otro grupo tratado con anticoagulantes orales. Se valoró la seguridad a la terminación del tratamiento anticoagulante, al año y para la incidencia de fracturas a los 2,5 años. La seguridad se evaluó por la tasa de hemorragias mayores y de fracturas y la eficacia por la tasa de recidiva trombótica precoz (durante el tratamiento anticoagulante) y al año. Resultados: De 65 pacientes tratados con HBPM, presentaron una tasa de hemorragia mayor de 1,5% (IC95% 0,08-9,40) y de fractura de 7,7% (IC95% 2,87-17,75), presentaron recidiva temprana 1,5% (IC95% 0,08-9,40) y recidiva al año 3% (IC95% 0,53-11,64). De 118 pacientes tratados con anticoagulantes orales presentaron una tasa de hemorragia mayor de 3,4% (IC95% 1,09 a 8,97), odds ratio 0,33, una tasa de fractura de 11% (IC95% 16,23 a 18,44), odds ratio 0,66, recidiva temprana de 5% (IC95% 2,08 a 11,20), odds ratio 0,60 y recidiva al año de 3,4% (IC95% 1,09 a 8,97), odds ratio 0,33. Conclusiones: La profilaxis secundaria de la trombosis venosa profunda con HBPM es al menos tan eficaz y segura como el tratamiento con anticoagulantes orales. El tratamiento con HBPM no ha causado incremento de las fracturas. Background and methods: The available data on the utility of low-molecular-weight heparins (LMWH) in the secondary prophylaxis of deep vein thrombosis (DVT) are limited. We compared two cohorts of patients diagnosed of DVT. One group followed treatment with LMWH and the other group did with oral anticoagulants (acenocoumarol). Safety was evaluated by the rate of major hemorrhage and 2.5-years period fracture rate, and efficacy was evaluated as the rate of early recurrence and one-year recurrence rate. Results: Of 65 patients treated with LMWH, the hemorrhagic rate was 1.5% (95% CI 0.08-9.40), fracture rate was 7.7% (95% CI 2.87-17.75), early recurrence was 1.5% (95% CI 0.08-9.40) and one-year recurrence was 3% (95% CI 53-11.64). In 118 patients treated with oral anticoagulants the hemorrhagic rate was 3.4% (95% CI 1.09-8.97), odds ratio 0.33, the fracture rate was 11% (95% CI 16.23-18.44), odds ratio 0.66, the early recurrence rate was 5% (95% CI 2.08-11.20), odds ratio 0.60 and one-year recurrence was 3.4% (95%CI 1.09-8.97), odds ratio 0.33. Conclusions: Secondary prophylaxis of DVT with LMWH is as safe and effective as classical treatment with oral anticoagulants. In this study the 2.5-year period fracture rate was similar in both groups of treatment. |
