Background: After a short initial course of heparin therapy, patients with venous thrombo-embolism (VTE) require continuing anticoagulant therapy for several months after hospital discharge. At present, two small-scale studies have compared the efficacy and safety of low-molecular-weight heparin (LMWH) with warfarin in the secondary prevention of VTE. Patients and Methods: We studied 654 consecutive patients, 202 with pulmonary embolism (PE) and 452 patients with deep vein thrombosis (DVT) of the lower limbs. 220/654 patients (34%) were considered to have some contraindications to coumarin, and were discharged on LMWH (dalteparin, Fragmin®, 10,000 IU s.c. once daily). The remaining 434/654 patients were asked to choose between either coumarin or LMWH: 190 patients preferred LMWH and 244 coumarin. Patients were followed up for a 3-month (DVT patients) or 6-month (PE patients) period. Results: 14/654 patients (2%) developed recurrent VTE while on anticoagulant therapy. One in every three recurrent episodes was PE (which was fatal in 2/5 patients), and half of the recurrent DVT were located in the contralateral leg. We failed to find any differences between patients receiving LMWH and those on coumarin therapy, but recurrences were more common in patients with cancer (hazard ratio: 17.15; 95% CI: 4.0–73.5; p < 0.001). 21 patients (3.3%) bled (major bleeding 5 patients; minor bleeding 16). Bleeding was more common in patients on coumarin therapy (hazard ratio: 3.14; 95% CI: 1.20–8.22; p = 0.02). Conclusions: Long-term LMWH therapy proved to be both effective and safe in the long-term treatment of VTE. Thus, we suggest long-term LMWH therapy should be considered for patients with contraindications to coumarin, or those with difficulties in coming to laboratory control.
Prof. Manuel Monreal
Servicio de Medicina Interna
Hospital Universitari Germans Trias i Pujol
E–08916 Badalona (Spain)
Fax +34 93 3952229, E-Mail email@example.com
Received: Received: March 27, 1998
Accepted in revised form: February 1, 1999
Number of Print Pages : 8
Number of Figures : 0, Number of Tables : 4, Number of References : 19
Haemostasis (International Journal on Haemostasis and Thrombosis Research)
Official Journal of the ‘Mediterranean League against Thromboembolic Diseases’
Vol. 28, No. 5, Year 1998 (Cover Date: September-October 1998 (Released July 1999))
Journal Editor: H.C. Hemker, Maastricht; V.V. Kakkar, London
ISSN: 0301–0147 (print), 1423–0038 (Online)
For additional information: http://www.karger.com/journals/hae
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