RT info:eu-repo/semantics/article
T1 Venographic comparison of subcutaneous low-molecular weight heparin with oral anticoagulant therapy in the long-term treatment of deep venous thrombosis
A1 González Fajardo, José Antonio
A1 Arreba, Emilio
A1 Castrodeza Sanz, José Javier
A1 Pérez Castrillon, José Luis
A1 Fernández, Leopoldo
A1 Agundez, Ignacio
A1 Mateo, Antonio M.
A1 Carrera, Santiago
A1 Gutíerrez Alonso, Vicente
A1 Vaquero Puerta, Carlos
K1 Trombosis-Tratamiento
AB Purpose: The primary objective of this study was to evaluate with venography the rate ofthrombus regression after a fixed dose of low–molecular weight heparin (LMWH) perday for 3 months compared with oral anticoagulant therapy for deep venous thrombosis(DVT). Secondary endpoints were the comparisons of the efficacy and safety of bothtreatments.Methods: This study was designed as an open randomized clinical study in a university hospitalsetting. Of the 165 patients finally enrolled in the study, 85 were assigned LMWHtherapy and 80 were assigned oral anticoagulant therapy. In the group randomized to oralanticoagulant therapy, the patients first underwent treatment in the hospital with standardunfractionated heparin and then coumarin for 3 months. Doses were adjusted withlaboratory monitoring to maintain the international normalized ratio between 2.0 and3.0. Patients in the LMWH group were administered subcutaneous injections of fixeddoses of 40 mg enoxaparin (4000 anti-Xa units) every 12 hours for 7 days, and after dischargefrom the hospital, they were administered 40 mg enoxaparin once daily at fixeddoses for 3 months without a laboratory control assay. A quantitative venographic score(Marder score) was used to assess the extent of the venous thrombosis, with 0 points indicatingno DVT and 40 points indicating total occlusion of all deep veins. The rate ofthrombus reduction was defined as the difference in quantitative venographic scores aftertermination of LMWH or coumarin therapy as compared with the scores obtained on theinitial venographic results. The efficacy was defined as the ability to prevent symptomaticextension or recurrence of venous thromboembolism (documented with venograms orserial lung scans). The safety was defined as the occurrence of hemorrhages.Results: After 3 months of treatment, the mean Marder score was significantly decreasedin both groups in comparison with the baseline score, although the effect of therapy wassignificantly better after LMWH therapy (49.4% reduction) than after coumarin therapy(24.5% reduction; P < .001). LMWH therapy and male gender were independentlyassociated with an enhanced resolution of the thrombus. A lower frequency of symptomaticrecurrent venous thromboembolism was also shown in patients who underwenttreatment with LMWH therapy (9.5%) than with oral anticoagulant therapy (23.7%; P< .05), although this difference was entirely a result of recurrence of DVT. Bleedingcomplications were significantly fewer in the LMWH group than in the coumarin group(1.1% vs 10%; P < .05). This difference was caused by minor hemorrhages. Coumarintherapy and cancer were independently associated with an enhanced risk of complications.Subcutaneous heparin therapy was well tolerated by all patients.Conclusion: The patients who were allocated to undergo enoxaparin therapy had a significantlygreater improvement in their quantitative venographic score, a significantly
SN 0741-5214
YR 1999
FD 1999
LK http://uvadoc.uva.es/handle/10324/3443
UL http://uvadoc.uva.es/handle/10324/3443
LA eng
NO Journal of Vascular Surgery, August, vol.30, n.2. p.283-292
NO Producción Científica
DS UVaDOC
RD 22-dic-2024