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Fixed-Dose Dalteparin Effective For Deep Vein Thrombosis Alone
A DGReview of :"Should Patients with Deep Vein Thrombosis Alone be Treated as Those with Concomitant Asymptomatic Pulmonary Embolism? A Prospective Study"
Thrombosis and Haemostasis
12/11/2002
By Anne MacLennan
A fixed dose of 10,000 IU low-molecular weight heparin (LMWH) dalteparin once daily is both effective and safe in patients with deep vein thrombosis (DVT) alone, researchers in Europe have found.
The recurrence rate of 0.5 percent in DVT patients in this study compares favourably with the 3.5 percent rate in patients with silent pulmonary embolism (PE), says this report from the Hospital Universitari Germans Trias i Pujol, Badalona, Spain and the Academic Medical Centre, Amsterdam, The Netherlands.
DVT patients in the study who weighed more than 70 kg saw a significant decrease in rate of major bleeding and no compensatory increase in rate of recurrent PE, add Dr Manuel Monreal and colleagues.
This study prospectively evaluated 1,000 consecutive patients with acute, proximal DVT. All underwent ventilation-perfusion lung scan on admission and stayed in hospital for a minimum of seven days.
Those patients with silent PE were given once daily 10,000 to 15,000 IU subcutaneous LMWH dalteparin according to their body weight for seven days and then received vitamin K antagonists.
Patients with DVT alone received LMWH in a fixed dose of 10,000 IU once daily for at least five days and were then given vitamin K antagonists.
Thirteen patients (1.3 percent) developed recurrent PE (one died), and 16 (1.6 percent) developed major bleeding (seven died).
Recurrent PE was significantly more common in silent PE patients (9 of 258, 3.5 percent) than in those with DVT alone (4/742, 0.5 percent). Odds ratio (OR) was 6.5 (p < 0.001).
No significant differences in bleeding rate were observed between patients with silent PE and those with DVT alone.
However, the fixed-dose 10,000 IU in patients with DVT alone led to a significantly lower bleeding rate in those weighing over 70 kg: one of 349 patients (0.3 percent) versus nine of 393 patients (2.3 percent) in those weighing less than 70 kg (OR: 0.12; p = 0.018).
Thrombosis and Haemostasis 2002; 88: 938-942.
"Should Patients with Deep Vein Thrombosis Alone be Treated as Those with Concomitant Asymptomatic Pulmonary Embolism? A Prospective Study"
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