LOW-MOLECULAR-WEIGHT HEPARIN VERSUS WARFARIN FOR PREVENTION OF RECURRENT VENOUS THROMBOEMBOLISM - A RANDOMIZED TRIAL

A group of 105 consecutive patients with venographically proved major acute deep vein thrombosis (DVT) were randomized in an open prospectiv e study to evaluate the comparative efficacy and safety of a fixed dos e of subcutaneous low-molecular-weight heparin (LMWH) and warfarin for the prevention of recurrent venous thromboembolism. Four patients dev eloped venographically proved recurrent DVT during the 3 months of tre atment: three in the LMWH group and one in the warfarin group, Nonfata l pulmonary embolism occurred in two patients in the LMWH group and in one in the warfarin group, Five of the 55 patients (10%) in the warfa rin group and none of the 50 patients in the LMWH developed bleeding c omplications (two-tailed Fisher exact test, p = 0.06), A preliminary a ssessment of the costs indicated that treatment with LMWH was less exp ensive by pound 900 per patient than warfarin. In conclusion, the fixe d daily dose of LMWH and the adjusted dose of warfarin therapy were of similar efficacy in preventing recurrence of DVT, However, warfarin t herapy, despite strict laboratory control, is associated with more fre quent side effects and is expensive, Another study with a higher dose of LMWH is recommended.