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Previous Volume 335:701-707 September 5, 1996 Number 10 Next

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ABSTRACT

Background Patients who have had major trauma are at very high risk for venous thromboembolism if they do not receive thromboprophylaxis. We compared low-dose heparin and a low-molecular-weight heparin with regard to efficacy and safety in a randomized clinical trial in patients with trauma.

Methods Consecutive adult patients admitted to a trauma center who had Injury Severity Scores of at least 9 and no intracranial bleeding were randomly assigned to heparin (5000 units) or enoxaparin (30 mg), each given subcutaneously every 12 hours in a double-blind manner, beginning within 36 hours after the injury. The primary outcome was deep-vein thrombosis as assessed by contrast venography performed on or before day 14 after randomization.

Results Among 344 randomized patients, 136 who received low-dose heparin and 129 who received enoxaparin had venograms adequate for analysis. Sixty patients given heparin (44 percent) and 40 patients given enoxaparin (31 percent) had deep-vein thrombosis (P = 0.014). The rates of proximal-vein thrombosis were 15 percent and 6 percent, respectively (P = 0.012). The reductions in risk with enoxaparin as compared with heparin were 30 percent (95 percent confidence interval, 4 to 50 percent) for all deep-vein thrombosis and 58 percent (95 percent confidence interval, 12 to 87 percent) for proximal-vein thrombosis. Only six patients (1.7 percent) had major bleeding (one in the heparin group and five in the enoxaparin group, P = 0.12).

Conclusions Low-molecular-weight heparin was more effective than low-dose heparin in preventing venous thromboembolism after major trauma. Both interventions were safe.

Source Information

From the Departments of Medicine (W.H.G., R.M.J., K.I.C.), Research Design and Biostatistics (J.P.S.), and Medical Imaging (E.A.S., P.A.H.) and the Clinical Epidemiology and Health Care Research Program (Sunnybrook Unit) (W.H.G., E.C., J.P.S.), Sunnybrook Health Science Centre, University of Toronto, Toronto.

Address reprint requests to Dr. Geerts at Sunnybrook Health Science Centre, Rm. D674, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada.

Full Text of this Article

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Prophylaxis against Venous Thromboembolism after Major Trauma
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Extract | Full Text  
N Engl J Med 1997; 336:586-587, Feb 20, 1997. Correspondence

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