ANTICOAGULANT-THERAPY IN DEEP VENOUS THROMBOSIS - A RANDOMIZED CONTROLLED-STUDY

Ninety patients with venographically proven deep venous thrombosis(DVT ) but without clinical signs of pulmonary embolism(PE) were randomized into two different treatment regimes to compare the safety and effica cy of continuous intravenous heparin and oral anticoagulant(AC) treatm ent versus non-AC treatment. All patients in the two treatment groups were actively mobilized from the day of admission and wore graduated c ompressing stockings. In the non-AC-group the patients were treated wi th phenylbutazone for ten days. Treatment with heparin was maintained for 6 days and oral AC treatment was given from the third day and cont inued for 3 months. Venography was repeated after 30 days. A perfusion -ventilation lung scan was performed on day 1-2, 10 and 60. In fifty-n ine patients a revenography was performed, twentynine in the AC-group and thirty in the non-AC group. For distal veins regression was found in nine and eight respectively (4,4% in favour of AC,95% confidence li mit 27,5% to - 18,7%) and in proximal veins regression was found in fi ve and eight, respectively (10,9% in favour of AC, 95% confidence limi t 32,0% to -1O,1%). No difference in lung scans was found after 10 day s (0.8% in favour of AC, 95% confidence limit 21,5% to -19,9%) or afte r 60 days (3,3% in favour of non-AC treatment, 95% confidence limit 21 ,8% to -28,5%). In the AC group the incidence of bleeding complication s was 8,3%. No side-effects of phenylbutazone was found. The present c ontrolled clinical study demonstrated no effect of AC-treatment on DVT progression in actively mobilized patients wearing graduated compress ing stockings when compared to a non-AC treated group receiving analge tic therapy with phenylbutazone, However, the patient population of th e study is relatively small with wide confidence intervals for differe nces between groups. Before more general recommendations can be made, a large scale placebo-controlled study is needed to evaluate the possi ble effect of AC-treatment in DVT patients, who can be mobilized from the first day.