FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 337:663-669 September 4, 1997 Number 10 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Low-molecular-weight heparin appears to be at least as effective and safe as standard, unfractionated heparin for the treatment of deep-vein thrombosis, but only limited data are available on the use of low-molecular-weight heparin to treat acute symptomatic pulmonary embolism.

Methods We randomly assigned 612 patients with symptomatic pulmonary embolism who did not require thrombolytic therapy or embolectomy to either subcutaneous low-molecular-weight heparin (tinzaparin) given once daily in a fixed dose or adjusted-dose, intravenous unfractionated heparin. Oral anticoagulant therapy was begun between the first and the third day and was given for at least three months. We compared the treatments at day 8 and day 90 with respect to a combined end point of recurrent thromboembolism, major bleeding, and death.

Results In the first eight days of treatment, 9 of 308 patients assigned to receive unfractionated heparin (2.9 percent) reached at least one of the end points, as compared with 9 of 304 patients assigned to low-molecular-weight heparin (3.0 percent; absolute difference, 0.1 percentage point; 95 percent confidence interval, -2.7 to 2.6). By day 90, 22 patients assigned to unfractionated heparin (7.1 percent) and 18 patients assigned to low-molecular-weight heparin (5.9 percent) had reached at least one end point (P = 0.54; absolute difference, 1.2 percentage points; 95 percent confidence interval, -2.7 to 5.1). The risk of major bleeding was similar in the two treatment groups throughout the study.

Conclusions Under the conditions of this study, initial subcutaneous therapy with the low-molecular-weight heparin tinzaparin appeared to be as effective and safe as intravenous unfractionated heparin in patients with acute pulmonary embolism.

Source Information

From Hôpital Antoine Béclère, Clamart (G.S.); Hôpital Laennec, Paris (H.S.); Hôpital Trousseau, Tours (B.C.); Hôpital Bellevue, St. Etienne (Y.P.); Hôpital Hôtel Dieu, Paris (J.-P.L.); Hôpital André Mignot, Versailles (R.A.); Hôpital Hôtel Dieu, Rennes (M.L.); Hôpital Henri Duffaut, Avignon (J.-L.H.); Hôpital Pasteur, Nice (E.F.); Hôpital Universitaire, Grenoble (J.-L.B.); Hôpital de la Cavale Blanche, Brest (D.M.); and Leo Pharmaceuticals, St. Quentin en Yvelines (B.B.) — all in France.

Address reprint requests to Dr. Simonneau at the Service de Pneumologie et Réanimation, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141 Clamart, France.

Full Text of this Article

This article has been cited by other articles:

• Nutescu, E. A, Spinler, S. A, Wittkowsky, A., Dager, W. E (2009). Low-Molecular-Weight Heparins in Renal Impairment and Obesity: Available Evidence and Clinical Practice Recommendations Across Medical and Surgical Settings. The Annals of Pharmacotherapy 43: 1064-1083 [Abstract] [Full Text]  
• Squizzato, A., Galli, M., Dentali, F., Ageno, W. (2009). Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review. Eur Respir J 33: 1148-1155 [Abstract] [Full Text]  
• GHAYE, B, WILLEMS, V, NCHIMI, A, KOUOKAM, L, NOUKOUA, C, DE MAERTELAER, V, GEVENOIS, P A, DONDELINGER, R F (2009). Relationship between the extent of deep venous thrombosis and the extent of acute pulmonary embolism as assessed by CT angiography. Br. J. Radiol. 82: 198-203 [Abstract] [Full Text]  
• GIBSON, P. S., POWRIE, R. (2009). Anticoagulants and pregnancy: When are they safe?. Cleveland Clinic Journal of Medicine 76: 113-127 [Abstract] [Full Text]  
• Authors/Task Force Members, , Torbicki, A., Perrier, A., Konstantinides, S., Agnelli, G., Galie, N., Pruszczyk, P., Bengel, F., Brady, A. J.B., Ferreira, D., Janssens, U., Klepetko, W., Mayer, E., Remy-Jardin, M., Bassand, J.-P., ESC Committee for Practice Guidelines (CPG), , Vahanian, A., Camm, J., De Caterina, R., Dean, V., Dickstein, K., Filippatos, G., Funck-Brentano, C., Hellemans, I., Kristensen, S. D., McGregor, K., Sechtem, U., Silber, S., Tendera, M., Widimsky, P., Zamorano, J. L., Document Reviewers, , Zamorano, J.-L., Andreotti, F., Ascherman, M., Athanassopoulos, G., De Sutter, J., Fitzmaurice, D., Forster, T., Heras, M., Jondeau, G., Kjeldsen, K., Knuuti, J., Lang, I., Lenzen, M., Lopez-Sendon, J., Nihoyannopoulos, P., Perez Isla, L., Schwehr, U., Torraca, L., Vachiery, J.-L. (2008). Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29: 2276-2315 [Full Text]  
• Schulman, S., Beyth, R. J., Kearon, C., Levine, M. N. (2008). Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133: 257S-298S [Abstract] [Full Text]  
• Kearon, C., Kahn, S. R., Agnelli, G., Goldhaber, S., Raskob, G. E., Comerota, A. J. (2008). Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133: 454S-545S [Abstract] [Full Text]  
• Crowther, M. A., Warkentin, T. E. (2008). Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood 111: 4871-4879 [Abstract] [Full Text]  
• Tapson, V. F. (2008). Acute Pulmonary Embolism. NEJM 358: 1037-1052 [Full Text]  
• Davies, C. W. H., Wimperis, J., Green, E. S., Pendry, K., Killen, J., Mehdi, I., Tiplady, C., Kesteven, P., Rose, P., Oldfield, W. (2007). Early discharge of patients with pulmonary embolism: a two-phase observational study. Eur Respir J 30: 708-714 [Abstract] [Full Text]  
• Umscheid, C. A., Agarwal, R., Gibson, G. (2007). Weight-Based Low-Molecular-Weight Heparin versus Weight-Based Intravenous Unfractionated Heparin. ANN INTERN MED 147: 433-434 [Full Text]  
• Perlroth, D. J., Sanders, G. D., Gould, M. K. (2007). Effectiveness and Cost-effectiveness of Thrombolysis in Submassive Pulmonary Embolism. Arch Intern Med 167: 74-80 [Abstract] [Full Text]  
• Moon, J.-W., Song, Y.-K., Jee, J.-P., Kim, C.-K., Choung, H.-K., Hwang, J.-M. (2006). Effect of subconjunctivally injected, liposome-bound, low-molecular-weight heparin on the absorption rate of subconjunctival hemorrhage in rabbits.. IOVS 47: 3968-3974 [Abstract] [Full Text]  
• Nutescu, E. A, Wittkowsky, A. K, Dobesh, P. P, Hawkins, D. W, Dager, W. E (2006). Choosing the Appropriate Antithrombotic Agent for the Prevention and Treatment of VTE: A Case-Based Approach. The Annals of Pharmacotherapy 40: 1558-1570 [Abstract] [Full Text]  
• Piazza, G., Goldhaber, S. Z. (2006). Acute Pulmonary Embolism: Part II: Treatment and Prophylaxis. Circulation 114: e42-e47 [Full Text]  
• Parakh, R., Kapadia, S., Agarwal, S., Grover, T., Bukhari, S., Yadav, A., Sen, I., Pankaj, P. (2006). Assessment of Total Thrombus Load in Symptomatic Patients With Venous Thromboembolism. CLIN APPL THROMB HEMOST 12: 369-372 [Abstract]  
• Aujesky, D., Roy, P.-M., Le Manach, C. P., Verschuren, F., Meyer, G., Obrosky, D. S., Stone, R. A., Cornuz, J., Fine, M. J. (2006). Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J 27: 476-481 [Abstract] [Full Text]  
• Aujesky, D., Obrosky, D. S., Stone, R. A., Auble, T. E., Perrier, A., Cornuz, J., Roy, P.-M., Fine, M. J. (2006). A Prediction Rule to Identify Low-Risk Patients With Pulmonary Embolism. Arch Intern Med 166: 169-175 [Abstract] [Full Text]  
• Robinson, G. V (2006). Pulmonary embolism in hospital practice. BMJ 332: 156-160 [Full Text]  
• Nijkeuter, M., Hovens, M. M.C., Davidson, B. L., Huisman, M. V. (2006). Resolution of Thromboemboli in Patients With Acute Pulmonary Embolism: A Systematic Review. Chest 129: 192-197 [Abstract] [Full Text]  
• Rashid, S T, Thursz, M R, Razvi, N A, Voller, R, Orchard, T, Rashid, S T, Shlebak, A A (2005). Venous thromboprophylaxis in UK medical inpatients. JRSM 98: 507-512 [Abstract] [Full Text]  
• Kucher, N., Quiroz, R., McKean, S., Sasahara, A. A, Goldhaber, S. Z (2005). Extended enoxaparin monotherapy for acute symptomatic pulmonary embolism. Vasc Med 10: 251-256 [Abstract]  
• Harris, T, Meek, S (2005). When should we thrombolyse patients with pulmonary embolism? A systematic review of the literature. Emerg. Med. J. 22: 766-771 [Abstract] [Full Text]  
• Aujesky, D., Obrosky, D. S., Stone, R. A., Auble, T. E., Perrier, A., Cornuz, J., Roy, P.-M., Fine, M. J. (2005). Derivation and Validation of a Prognostic Model for Pulmonary Embolism. Am. J. Respir. Crit. Care Med. 172: 1041-1046 [Abstract] [Full Text]  
• Mismetti, P., Quenet, S., Levine, M., Merli, G., Decousus, H., Derobert, E., Laporte, S. (2005). Enoxaparin in the Treatment of Deep Vein Thrombosis With or Without Pulmonary Embolism: An Individual Patient Data Meta-analysis. Chest 128: 2203-2210 [Abstract] [Full Text]  
• Aujesky, D., Smith, K. J., Cornuz, J., Roberts, M. S. (2005). Cost-Effectiveness of Low-Molecular-Weight Heparin for Treatment of Pulmonary Embolism. Chest 128: 1601-1610 [Abstract] [Full Text]  
• Dager, W. E, King, J. H, Branch, J. M, Chow, S. L, Ferrer, R. E, Pak, S., Togioka, P. Y, White, R. H (2005). Tinzaparin in Outpatients with Pulmonary Embolism or Deep Vein Thrombosis. The Annals of Pharmacotherapy 39: 1182-1187 [Abstract] [Full Text]  
• Wells, P. S., Anderson, D. R., Rodger, M. A., Forgie, M. A., Florack, P., Touchie, D., Morrow, B., Gray, L., O'Rourke, K., Wells, G., Kovacs, J., Kovacs, M. J. (2005). A Randomized Trial Comparing 2 Low-Molecular-Weight Heparins for the Outpatient Treatment of Deep Vein Thrombosis and Pulmonary Embolism. Arch Intern Med 165: 733-738 [Abstract] [Full Text]  
• Haines, S. T., Nutescu, E. A. (2005). Current and emerging treatment options for venous thrombosis: A case discussion. Am J Health Syst Pharm 62: 593-605 [Full Text]  
• Pineo, G. F., Hull, R. D. (2005). Low-Molecular-Weight Heparin for the Treatment of Venous Thromboembolism in the Elderly. CLIN APPL THROMB HEMOST 11: 15-23 [Abstract]  
• McGuire, M., Dobesh, P. P. (2004). Therapeutic Update on the Prevention and Treatment of Venous Thromboembolism. Journal of Pharmacy Practice 17: 289-307 [Abstract]  
• Hirsh, J., Raschke, R. (2004). Heparin and Low-Molecular-Weight Heparin: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 188S-203S [Abstract] [Full Text]  
• Levine, M. N., Raskob, G., Beyth, R. J., Kearon, C., Schulman, S. (2004). Hemorrhagic Complications of Anticoagulant Treatment: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 287S-310S [Abstract] [Full Text]  
• Buller, H. R., Agnelli, G., Hull, R. D., Hyers, T. M., Prins, M. H., Raskob, G. E. (2004). Antithrombotic Therapy for Venous Thromboembolic Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 401S-428S [Abstract] [Full Text]  
• McRae, S. J., Ginsberg, J. S. (2004). Initial Treatment of Venous Thromboembolism. Circulation 110: I-3-I-9 [Abstract] [Full Text]  
• Elting, L. S., Escalante, C. P., Cooksley, C., Avritscher, E. B. C., Kurtin, D., Hamblin, L., Khosla, S. G., Rivera, E. (2004). Outcomes and Cost of Deep Venous Thrombosis Among Patients With Cancer. Arch Intern Med 164: 1653-1661 [Abstract] [Full Text]  
• Aujesky, D. A., Cornuz, J., Bosson, J.-L., Bounameaux, H., Emmerich, J., Hull, R. D., Mackay, E., Perrier, A., Quan, H., Tsuyuki, R. T., Ghali, W. A. (2004). Uptake of new treatment strategies for deep vein thrombosis: an international audit. Int J Qual Health Care 16: 193-200 [Abstract] [Full Text]  
• Writing Committee for the Galilei Investigators, (2004). Subcutaneous Adjusted-Dose Unfractionated Heparin vs Fixed-Dose Low-Molecular-Weight Heparin in the Initial Treatment of Venous Thromboembolism. Arch Intern Med 164: 1077-1083 [Abstract] [Full Text]  
• Quinlan, D. J., McQuillan, A., Eikelboom, J. W. (2004). Low-Molecular-Weight Heparin Compared with Intravenous Unfractionated Heparin for Treatment of Pulmonary Embolism: A Meta-Analysis of Randomized, Controlled Trials. ANN INTERN MED 140: 175-183 [Abstract] [Full Text]  
• Cox, C. E., Carson, S. S., Biddle, A. K. (2003). Cost-effectiveness of Ultrasound in Preventing Femoral Venous Catheter-associated Pulmonary Embolism. Am. J. Respir. Crit. Care Med. 168: 1481-1487 [Abstract] [Full Text]  
• Linkins, L.-A., Choi, P. T., Douketis, J. D. (2003). Clinical Impact of Bleeding in Patients Taking Oral Anticoagulant Therapy for Venous Thromboembolism: A Meta-Analysis. ANN INTERN MED 139: 893-900 [Abstract] [Full Text]  
• Nutescu, E. A, Shapiro, N. L, Feinstein, H., Rivers, C. W (2003). Tinzaparin: Considerations for Use in Clinical Practice. The Annals of Pharmacotherapy 37: 1831-1840 [Abstract] [Full Text]  
• The Matisse Investigators, (2003). Subcutaneous Fondaparinux versus Intravenous Unfractionated Heparin in the Initial Treatment of Pulmonary Embolism. NEJM 349: 1695-1702 [Abstract] [Full Text]  
• Mousa, S. A., Bozarth, J., Barrett, J. S. (2003). Pharmacodynamic Properties of the Low Molecular Weight Heparin, Tinzaparin: Effect of Molecular Weight Distribution on Plasma Tissue Factor Pathway Inhibitor in Healthy Human Subjects. J Clin Pharmacol 43: 727-734 [Abstract] [Full Text]  
• Nutescu, E. A, Lewis, R. K, Finley, J. M, Schumock, G. T (2003). Hospital Guidelines for Use of Low-Molecular-Weight Heparins. The Annals of Pharmacotherapy 37: 1072-1081 [Abstract] [Full Text]  
• van Dongen, C. J. J., Vink, R., Hutten, B. A., Buller, H. R., Prins, M. H. (2003). The Incidence of Recurrent Venous Thromboembolism After Treatment With Vitamin K Antagonists in Relation to Time Since First Event: A Meta-analysis. Arch Intern Med 163: 1285-1293 [Abstract] [Full Text]  
• (2003). British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 58: 470-483 [Full Text]  
• Raschke, R., Hirsh, J., Guidry, J. R. (2003). Suboptimal Monitoring and Dosing of Unfractionated Heparin in Comparative Studies with Low-Molecular-Weight Heparin. ANN INTERN MED 138: 720-723 [Abstract] [Full Text]  
• Schafer, A. I., Levine, M. N., Konkle, B. A., Kearon, C. (2003). Thrombotic Disorders: Diagnosis and Treatment. ASH Education Book 2003: 520-539 [Abstract] [Full Text]  
• Dalen, J. E. (2002). Pulmonary Embolism: What Have We Learned Since Virchow?: Treatment and Prevention. Chest 122: 1801-1817 [Full Text]  
• Cundiff, D. K. (2002). Significant Omission in Antithrombotic Supplement. Chest 121: 1378-1379 [Full Text]  
• Kakkar, V. V., Hoppenstead, D. A., Fareed, J., Kadziola, Z., Scully, M., Nakov, R., Breddin, H. K. (2002). Randomized trial of different regimens of heparins and in vivo thrombin generation in acute deep vein thrombosis. Blood 99: 1965-1970 [Abstract] [Full Text]  
• Wood, K. E. (2002). Major Pulmonary Embolism : Review of a Pathophysiologic Approach to the Golden Hour of Hemodynamically Significant Pulmonary Embolism. Chest 121: 877-905 [Abstract] [Full Text]  
• Goldhaber, S.Z. (2002). Modern treatment of pulmonary embolism. Eur Respir J 19: 22S-27s [Abstract] [Full Text]  
• Goldhaber, S. Z. (2001). Thrombolysis in Pulmonary Embolism: A Large-Scale Clinical Trial Is Overdue. Circulation 104: 2876-2878 [Full Text]  
• GIRARD, P., DECOUSUS, M., LAPORTE, S., BUCHMULLER, A., HERVE, P., LAMER, C., PARENT, F., TARDY, B. (2001). Diagnosis of Pulmonary Embolism in Patients with Proximal Deep Vein Thrombosis . Specificity of Symptoms and Perfusion Defects at Baseline and during Anticoagulant Therapy. Am. J. Respir. Crit. Care Med. 164: 1033-1037 [Abstract] [Full Text]  
• Tait, R C (2001). Anticoagulation in patients with thromboembolic disease. Thorax 56: ii30-37 [Full Text]  
• Hirsh, J., Anand, S. S., Halperin, J. L., Fuster, V. (2001). Guide to Anticoagulant Therapy: Heparin : A Statement for Healthcare Professionals From the American Heart Association. Arterioscler. Thromb. Vasc. Bio. 21 : e9-e9 [Full Text]  
• Hamel, E., Pacouret, G., Vincentelli, D., Forissier, J. F., Peycher, P., Pottier, J. M., Charbonnier, B. (2001). Thrombolysis or Heparin Therapy in Massive Pulmonary Embolism With Right Ventricular Dilation : Results From a 128-Patient Monocenter Registry. Chest 120: 120-125 [Abstract] [Full Text]  
• Hirsh, J., Anand, S. S., Halperin, J. L., Fuster, V. (2001). Guide to Anticoagulant Therapy: Heparin : A Statement for Healthcare Professionals From the American Heart Association. Circulation 103: 2994-3018 [Full Text]  
• Paterson, D. I., Schwartzman, K. (2001). Strategies Incorporating Spiral CT for the Diagnosis of Acute Pulmonary Embolism : A Cost-effectiveness Analysis. Chest 119: 1791-1800 [Abstract] [Full Text]  
• De Lorenzo, F., Noorani, A., Kakkar, V.V. (2001). Current trends in the management of thromboembolic events. QJM 94: 179-185 [Full Text]  
• Hirsh, J., Bates, S. M. (2001). Clinical Trials That Have Influenced the Treatment of Venous Thromboembolism: A Historical Perspective. ANN INTERN MED 134: 409-417 [Abstract] [Full Text]  
• Breddin, H. K., Hach-Wunderle, V., Nakov, R., Kakkar, V. V., The CORTES Investigators, (2001). Effects of a Low-Molecular-Weight Heparin on Thrombus Regression and Recurrent Thromboembolism in Patients with Deep-Vein Thrombosis. NEJM 344: 626-631 [Abstract] [Full Text]  
• Riedel, M. (2001). VENOUS THROMBOEMBOLIC DISEASE: Acute pulmonary embolism 2: treatment. Heart 85: 351-360 [Full Text]  
• Merli, G., Spiro, T. E., Olsson, C.-G., Abildgaard, U., Davidson, B. L., Eldor, A., Elias, D., Grigg, A., Musset, D., Rodgers, G. M., Trowbridge, A. A., Yusen, R. D., Zawilska, K., for the Enoxaparin Clinical Trial Group*, (2001). Subcutaneous Enoxaparin Once or Twice Daily Compared with Intravenous Unfractionated Heparin for Treatment of Venous Thromboembolic Disease. ANN INTERN MED 134: 191-202 [Abstract] [Full Text]  
• Hirsh, J., Warkentin, T. E., Shaughnessy, S. G., Anand, S. S., Halperin, J. L., Raschke, R., Granger, C., Ohman, E. M., Dalen, J. E. (2001). Heparin and Low-Molecular-Weight Heparin Mechanisms of Action, Pharmacokinetics, Dosing, Monitoring, Efficacy, and Safety. Chest 119 : 64S-94S [Full Text]  
• Levine, M. N., Raskob, G., Landefeld, S., Kearon, C. (2001). Hemorrhagic Complications of Anticoagulant Treatment. Chest 119 : 108S-121S [Full Text]  
• Hyers, T. M., Agnelli, G., Hull, R. D., Morris, T. A., Samama, M., Tapson, V., Weg, J. G. (2001). Antithrombotic Therapy for Venous Thromboembolic Disease. Chest 119 : 176S-193S [Full Text]  
• O'Shaughnessy, D., Miles, J., Wimperis, J. (2000). UK patients with deep-vein thrombosis can be safely treated as out-patients. QJM 93: 663-667 [Abstract] [Full Text]  
• Martlew, V. J. (2000). Peri-operative management of patients with coagulation disorders. Br J Anaesth 85: 446-455 [Abstract] [Full Text]  
• Zidane, M., Schram, M. T., Planken, E. W., Molendijk, W. H., Rosendaal, F. R., van der Meer, F. J. M., Huisman, M. V. (2000). Frequency of Major Hemorrhage in Patients Treated With Unfractionated Intravenous Heparin for Deep Venous Thrombosis or Pulmonary Embolism: A Study in Routine Clinical Practice. Arch Intern Med 160: 2369-2373 [Abstract] [Full Text]  
• (2000). Guidelines on diagnosis and management of acute pulmonary embolism. Eur Heart J 21: 1301-1336  
• Bath, P. M. W., Iddenden, R., Bath, F. J. (2000). Low-Molecular-Weight Heparins and Heparinoids in Acute Ischemic Stroke : A Meta-Analysis of Randomized Controlled Trials. Stroke 31: 1770-1778 [Abstract] [Full Text]  
• Streiff, M. B. (2000). Vena caval filters: a comprehensive review. Blood 95: 3669-3677 [Abstract] [Full Text]  
• Thomas, M.D., Chauhan, A., More, R.S. (2000). Pulmonary embolism--an update on thrombolytic therapy. QJM 93: 261-267 [Full Text]  
• Heit, J. A., Mohr, D. N., Silverstein, M. D., Petterson, T. M., O'Fallon, W. M., Melton III, L. J. (2000). Predictors of Recurrence After Deep Vein Thrombosis and Pulmonary Embolism: A Population-Based Cohort Study. Arch Intern Med 160: 761-768 [Abstract] [Full Text]  
• Meignan, M., Rosso, J., Gauthier, H., Brunengo, F., Claudel, S., Sagnard, L., d'Azemar, P., Simonneau, G., Charbonnier, B. (2000). Systematic Lung Scans Reveal a High Frequency of Silent Pulmonary Embolism in Patients With Proximal Deep Venous Thrombosis. Arch Intern Med 160: 159-164 [Abstract] [Full Text]  
• Dolovich, L. R., Ginsberg, J. S., Douketis, J. D., Holbrook, A. M., Cheah, G. (2000). A Meta-analysis Comparing Low-Molecular-Weight Heparins With Unfractionated Heparin in the Treatment of Venous Thromboembolism: Examining Some Unanswered Questions Regarding Location of Treatment, Product Type, and Dosing Frequency. Arch Intern Med 160: 181-188 [Abstract] [Full Text]  
• Hull, R. D., Raskob, G. E., Brant, R. F., Pineo, G. F., Elliott, G., Stein, P. D., Gottschalk, A., Valentine, K. A., Mah, A. F., for the American-Canadian Thrombosis Study Group, (2000). Low-Molecular-Weight Heparin vs Heparin in the Treatment of Patients With Pulmonary Embolism. Arch Intern Med 160: 229-236 [Abstract] [Full Text]  
• Wakefield, T. W. (2000). The Safety, Efficacy, and Cost Efficiency of Outpatient Treatment of Acute Deep Venous Thrombosis with Low Molecular Weight Heparin. PERSPECT VASC SURG ENDOVASC THER 13: 19-25 [Abstract]  
• Girard, P., Musset, D., Parent, F., Maitre, S., Phlippoteau, C., Simonneau, G. (1999). High Prevalence of Detectable Deep Venous Thrombosis in Patients With Acute Pulmonary Embolism. Chest 116: 903-908 [Abstract] [Full Text]  
• Zed, P. J., Tisdale, J. E., Borzak, S. (1999). Low-Molecular-Weight Heparins in the Management of Acute Coronary Syndromes. Arch Intern Med 159: 1849-1857 [Abstract] [Full Text]  
• Spyropoulos, A. C., Harrison, L., Liebowitz, R. S. (1999). Outpatient Protocols for Treatment of Venous Thromboembolism Using Low-Molecular-Weight Heparin: To Treat or Not to Treat at Home. Arch Intern Med 159: 1139-1140 [Full Text]  
• Gould, M. K., Dembitzer, A. D., Doyle, R. L., Hastie, T. J., Garber, A. M. (1999). Low-Molecular-Weight Heparins Compared with Unfractionated Heparin for Treatment of Acute Deep Venous Thrombosis: A Meta-Analysis of Randomized, Controlled Trials. ANN INTERN MED 130: 800-809 [Abstract] [Full Text]  
• Aguilar, D., Goldhaber, S. Z. (1999). Clinical Uses of Low-Molecular-Weight Heparins. Chest 115: 1418-1423 [Full Text]  
• Fraser, J. D., Anderson, D. R. (1999). Deep Venous Thrombosis: Recent Advances and Optimal Investigation with US. Radiology 211: 9-24 [Full Text]  
• Vouyouka, A., Silver, D. (1999). Is Low-Molecular-Weight Heparin the Answer for the Therapy of Acute Deep Vein Thrombosis?. VASC ENDOVASCULAR SURG 33: 125-128  
• Roche, N. (1999). Recent advances: Pulmonary medicine. BMJ 318: 171-176 [Full Text]  
• Bick, R. L. (1999). Therapy for Venous Thrombosis: Guidelines for a Competent and Cost-effective Approach. CLIN APPL THROMB HEMOST 5: 2-9  
• Grubb, N. R, Bloomfield, P., Ludlam, C. A (1998). The end of the heparin pump?. BMJ 317: 1540-1542 [Full Text]  
• Schrijvers, D., Van den Brande, J., Vermorken, J. B., Corbanese, U., Possamai, C., Blatt, P. M., Marlar, R. A., Joist, J. H., Fink, L. M., Goldhaber, S. Z. (1998). Pulmonary Embolism. NEJM 339: 1555-1557 [Full Text]  
• Hirsh, J. (1998). Low-Molecular-Weight Heparin : A Review of the Results of Recent Studies of the Treatment of Venous Thromboembolism and Unstable Angina. Circulation 98: 1575-1582 [Full Text]  
• MILLER, A C (1998). A fresh look at D-dimer in suspected pulmonary embolism. Thorax 53: 821-822 [Full Text]  
• Goldhaber, S. Z. (1998). Pulmonary Embolism. NEJM 339: 93-104 [Full Text]  
• Rachakonda, V., Rachakonda, L., Belliveau, R. R. (1998). aPTT in Heparinized Patients: Influence of the Interval Between Sampling and Testing. CLIN APPL THROMB HEMOST 4: 213-216 [Abstract]  
• Yu, D. R., Miller, R., Bray, P. F. (1998). Through Thick and Thin. NEJM 338: 1684-1687 [Full Text]  
• (1998). Low molecular weight heparins for venous thromboembolism. DTB 36: 25-29 [Abstract] [Full Text]