LOW-MOLECULAR-WEIGHT HEPARIN FOR THE TREATMENT OF VENOUS THROMBOEMBOLISM

There is ample evidence from clinical trials tojustify giving certain low-molecular-weight heparins subcutaneously rather than administering continuous iv unfractionated heparin for the initial treatment of thr omboembolism. Given subcutaneously, the low-molecular-weight heparins have a predictably high absorption rate and a prolonged duration of ac tion, They can, therefore, be administered once or twice daily by inje ction to prevent or treat venous thrombosis, Furthermore, treatment do es not require laboratory monitoring. Eliminating the need for continu ous iv infusion and for laboratory monitoring should allow patients to be discharged earlier, and eventually lead to the outpatient treatmen t of venous thromboembolism. Studies to date indicate that low-molecul ar-weight heparin is more cost-effective than unfractionated heparin a nd the cost-effectiveness will be increased by out-of-hospital treatme nt, The information to date is that low-molecular-weight heparin is sa fer and more effective than continuous iv unfractionated heparin in th e treatment of proximal venous thrombosis, The decreased mortality rat e seen in two clinical trials, particularly in patients with metastati c cancer, was quite unexpected, This requires further confirmation in larger prospective randomized trials.