Treatment of Venous Thrombosis with Intravenous Unfractionated Heparin Administered in the Hospital as Compared with Subcutaneous Low-Molecular-Weight Heparin Administered at Home
ABSTRACT An intravenous course of standard (unfractionated) heparin with the dose adjusted to prolong the activated partial-thromboplastin time to a desired length is the standard initial in-hospital treatment for patients with deep-vein thrombosis, but fixed-dose subcutaneous low-molecular-weight heparin appears to be as effective and safe. Because the latter treatment can be given on an outpatient basis, we compared the two treatments in symptomatic outpatients with proximal-vein thrombosis but no signs of pulmonary embolism.
We randomly assigned patients to adjusted-dose intravenous standard heparin administered in the hospital (198 patients) or fixed-dose subcutaneous low-molecular-weight heparin administered at home, when feasible (202 patients). We compared the treatments with respect to recurrent venous thromboembolism, major bleeding, quality of life, and costs.
Seventeen of the 198 patients who received standard heparin (8.6 percent) and 14 of the 202 patients who received low-molecular-weight heparin (6.9 percent) had recurrent thromboembolism (difference, 1.7 percentage points; 95 percent confidence interval, -3.6 to 6.9). Major bleeding occurred in four patients assigned to standard heparin (2.0 percent) and one patient assigned to low-molecular-weight heparin (0.5 percent; difference, 1.5 percentage points; 95 percent confidence interval, -0.7 to 2.7). Quality of life improved in both groups. Physical activity and social functioning were better in the patients assigned to low-molecular-weight heparin. Among the patients in that group, 35 percent were never admitted to the hospital at all, and 40 percent were discharged early. This treatment was associated with a mean reduction in hospital days of 67 percent, ranging from 29 percent to 86 percent in the various study centers.
In patients with proximal-vein thrombosis, treatment with low-molecular-weight heparin at home is feasible, effective, and safe.
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ABSTRACT: Recent developments in antithrombotic therapy have provided us with choices between unfractionated heparin, low-molecular-weight heparin (LMWH), vitamin K antagonists (VKA), and inhibitors against factor Xa or against thrombin for the management of venous thromboembolism. The factors that influence our decision should be efficacy, safety, convenience, and, when there is weak evidence, also patient values and preferences. The available options have largely similar efficacy, the documented exception being LMWH as superior to VKA in patients with active cancer. For the majority of patients we have today strong evidence regarding safety from large randomized trials, but this does not apply to many of the subsets of patients. In this review the choice of treatment is focused on the risks that are known or can be predicted for the individual patient. Three principal decision points on how to tailor the therapy individually are discussed-at diagnosis, for hospitalized patients at the time of discharge and finally after 3 to 6 months. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Seminars in Thrombosis and Hemostasis 02/2015; DOI:10.1055/s-0035-1544157 · 3.69 Impact Factor
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ABSTRACT: La hospitalización a domicilio (HAD) es una modalidad asistencial eficaz en distintos campos de la patología médica y quirúrgica. El objetivo del estudio fue analizar la utilidad de la HAD en pacientes nefrológicos con procesos agudos.Pacientes y métodoSe revisa las solicitudes de traslado a la Unidad de Hospitalización a Domicilio (UHAD) desde el Servicio de Nefrología durante 3 años. Se compara estos resultados con los del resto de los pacientes atendidos en la UHAD.ResultadosSe registró 85 solicitudes, y se aceptó 79 (93%). Se trataba de pacientes con elevada comorbilidad (Charlson de 3,75) y con problemas clínicos activos. La estancia media en la UHAD fue de 12,65 días, la tasa de intervención global, de 1,23 intervenciones por paciente y día de estancia. Se procedió al alta hospitalaria en 71 casos (89,9%). Ocho pacientes (10,1%) reingresaron en nefrología y por empeoramiento clínico hubo 5 (6,3%) reingresos a los 30 días. No se apreció diferencias respecto al resto de los pacientes atendidos en la UHAD al comparar las tasas de intervención asistencial, las altas a domicilio y los reingresos.ConclusionesEl traslado a la UHAD de pacientes con enfermedades nefrológicas es una alternativa segura, eficaz y bien aceptada por el paciente y su familia.Medicina Clínica 03/2006; 126(9):329-331. DOI:10.1157/13085731 · 1.25 Impact Factor
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ABSTRACT: Antithrombotic therapy with heparin plus antiplatelets reduces the rate of ischemic events in patients with coronary heart disease. Low molecular weight heparin has a more predictable anticoagulant effect than standard unfractionated heparin, is easier to administer, does not require monitoring and is associated with less ADRs. The purpose of the present study was to evaluate and compare the clinical and cost outcomes of Enoxaparin with a standard unfractionated heparin in patients with coronary heart disease. This was a noninvasive prospective observational descriptive study carried out at a multi-specialty tertiary care teaching hospital situated in rural Tamil Nadu, India. Male and female coronary heart disease (CHD) patients aged 35-75 years newly diagnosed or those having a history of CHD were included. The intervention group received enoxaparin for 5 days. A series of resting the electrocardiogram, prothrombin time and ADRs were measured in all patients during days 1 and 21 respectively. Compared to unfractionated heparin group of patients, the average prothrombin time was significantly higher (P < 0.0001) whereas hypokalemia was significantly lower (P < 0.02) in enoxaparin group of patients. Even though recurrence of angina and ADRs such as bleeding, nausea, headache and sudden cough occurred less frequently in the enoxaparin group of patients compared to unfractionated heparin group of patients, the differences were not significant. Antithrombotic therapy with enoxaparin plus aspirin was safer and more effective than unfractionated heparin plus aspirin, in reducing the incidence of ischemic events in patients with unstable angina or myocardial infarction in the early phase.Indian Journal of Pharmacology 01/2015; 47(1):91-94.. DOI:10.4103/0253-7613.150360 · 0.68 Impact Factor