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Title: Reviparin Safe, Effective in Reducing Deep Vein Thrombosis During Prolonged Immobilization

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N Engl J Med 2002;347:726-730
09/05/2002 11:57:40 AM
By Anne MacLennan

Once daily reviparin appears to be safe and effective in curbing risk of deep-vein thrombosis in people with leg injury requiring prolonged immobilization, a study in Denmark has found. Although deep-vein thrombosis is a well-recognized complication after leg trauma and subsequent immobilization, there are no generally accepted approaches to preventing it. In this randomised, placebo controlled trial, researchers sought to assess the incidence of deep-vein thrombosis and pulmonary embolism in patients immobilized after an isolated leg injury and to evaluate whether reviparin, a low-molecular-weight heparin, is effective and safe for preventing venous thrombosis in these patients. Dr Michael R. Lassen and colleagues from Hillerod Hospital, Hillerod, and Arhus University Hospital, Arhus, both in Denmark, and Knoll, Ludwigshafen, Germany, conducted the study at six Danish hospitals between April 1996 and September 1999. Patients were included if they were 18 years of age or older and had a fracture of the leg or rupture of the Achilles tendon requiring at least five weeks of immobilization in a plaster cast or brace within four days after the injury. Deep-vein thrombosis (in a distal segment, in most cases) was documented by venography in 19 percent of the patients in the placebo group and nine percent of those in the reviparin group, suggesting active therapy halved the risk. Incidence of bleeding and other adverse events did not differ significantly between the groups. Although the study indicates routine use of reviparin for prophylaxis against thrombosis in these patients is beneficial, further evaluation is warranted before such treatment can be recommended for routine use, the authors note. They also suggest it will be important to determine whether this therapy can reduce risk of long-term sequellae of deep-vein thrombosis, such as venous insufficiency.

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