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Volume 334:677-681 March 14, 1996 Number 11 Next

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ABSTRACT

Background 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.

Methods 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.

Results 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.

Conclusions Low-molecular-weight heparin can be used safely and effectively to treat patients with proximal deep-vein thrombosis at home.

Source Information

From McMaster University, Hamilton, Ont. (M.L., M.G., J.H., J.W., J.G., A.G.T., P.P., A.W.); Hamilton Civic Hospitals Research Centre, Hamilton, Ont. (M.L., M.G., J.H., S.H., A.W.); Ontario Cancer Treatment and Research Foundation, Hamilton Regional Cancer Centre, Hamilton, Ont. (M.L.); McGill University, Montreal (J.L.); Dalhousie University, Halifax, N.S. (D.A.); Laval University, Quebec, Que. (C.D., L.D.); the University of Western Ontario, London (M.K., M.C., W.B.); the University of Toronto, Toronto (W.G.); and the University of Montreal, Montreal (J.K., J.C.) — all in Canada.

Address reprint requests to Dr. Levine at the Hamilton Regional Cancer Centre, 699 Concession St., Hamilton, ON L8V 5C2, Canada.

Full Text of this Article

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Unfractionated versus Low-Molecular-Weight Heparin for Deep Venous Thrombosis
Strandness D. E., Penner J., Levine M., Hirsh J., Gent M., Koopman M. M.W., Büller H. R.
Extract | Full Text  
N Engl J Med 1996; 335:670-672, Aug 29, 1996. Correspondence

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