0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Editorials |

Trials That Matter: Can Patients with Venous Thromboembolism Be Treated with Fixed-Dose Subcutaneous Unfractionated Heparin?

Samuel Z. Goldhaber, MD; and Michael Berkwits, MD, MSCE, Deputy Editor
[+] Article and Author Information

From University of Colorado at Denver and Health Sciences Center, Denver, Colorado, and American College of Physicians, Philadelphia, Pennsylvania.


Potential Financial Conflicts of Interest: Consultancies: S.Z. Goldhaber (Sanofi-Aventis, GlaxoSmithKline, Emisphere, Bayer, Boehringer Ingelheim); Grants received: S.Z. Goldhaber (Sanofi-Aventis, Eisai, GlaxoSmithKline).

Requests for Single Reprints: Samuel Z. Goldhaber, MD, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115.

Current Author Addresses: Dr. Goldhaber: Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Berkwits: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.


Ann Intern Med. 2006;145(12):929-931. doi:10.7326/0003-4819-145-12-200612190-00011
Text Size: A A A

Unfractionated heparin (UFH) was the mainstay of initial treatment for acute venous thromboembolism (VTE) until low-molecular-weight heparin (LMWH) became available in the 1990s. Low-molecular-weight heparin was an attractive alternative to UFH because its excellent bioavailability allowed for convenient fixed, weight-based dosing. High-quality research subsequently confirmed the superior efficacy, safety, and cost-effectiveness of LMWH over UFH for treatment of deep venous thrombosis (14). As a result, most patients with this disorder who would require a minimum 5-day hospitalization if treated with UFH can now be treated with LMWH in an overnight stay or in the outpatient setting. Some evidence even supports the use of LMWH for less severe forms of pulmonary embolism (5).

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Use of Unfractionated Heparin
Posted on December 26, 2006
W. Robert Gronewald
Morristown Hamblen Hospital
Conflict of Interest: None Declared

I was pleased to see your editorial, "Trials that matter...", Annals vol 145,12 (Nov'06).

Because of a number of Coumadin failures, hospital stay restrictions by managed care, the cost differences between UFH and LMWH, and difficulty in administering IV UFH at home, I have been using self administered SQ UFH, in selected carefully instructed patients, at home, in doses less than 20,000u/day, in treatment of Venous Thrombosis and VTE, with good results. Even without prolonged OPD monitoring, bleeding complications have been rare.

The patients appreciate the cost savings, and I have failed to see any practically discernable difference between UFH and LMWH; except that I believe patients have been being transferred from Heparin to Coumadin too soon.

I would like to see more studies!

Conflict of Interest:

None declared

Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)