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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, Author, and Disclosure 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
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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).

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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

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