NEW DEVELOPMENTS IN THE TREATMENT OF DEEP VENOUS THROMBOSIS

An initial course of standard heparin (SH) or low-molecular-weight hep arins (LMWH) is regarded as the treatment of choice for patients with deep venous thrombosis (DVT). LMWH have better bioavailability after s ubcutaneous administration, have a longer half-life, and show higher a nd more predictable anticoagulant activity. As a result they can be gi ven subcutaneously and without laboratory control, using a dose that i s determined by bodyweight. Because of these multiple advantages of LM WH they will replace SH in the future and subsequently home treatment with LMWH oi selected patients seems feasible. The currently accepted approach is to start with SH ur LMWH therapy combined with oral antico agulant therapy (OAT) at the time of diagnosis. The course of SH or LM WH should continue for at least 5 days, provided that international no rmalized ratio (WR) is in the therapeutic range on 2 consecutive days. OAT should be continued for at least 3 months to prolong the prothrom bin time to an INR of 2-3. When oral anticoagulants are either contrai ndicated or inconvenient, SH or LMWH can be used at the middosing inte rval. The role of anti-platelet treatment is not yet established and s hould be compared with coumarin therapy in the future.