Abstract
There is ample evidence from clinical trials to justify giving certain low-molecular-weight
heparins (LMWHs) subcutaneously rather than administering continuous intravenous unfractionated
heparin for the initial treatment of venous thromboembolic disease. The LMWHs given
by subcutaneous injection have a predictable anticoagulant response and prolonged
duration of action. They can, therefore, be administered once or twice daily to treat
venous thrombosis. Furthermore, treatment with these agents does not require laboratory
monitoring. Eliminating the need for intravenous therapy and for laboratory monitoring
should allow patients to be discharged earlier, and eventually lead to the outpatient
treatment of venous thromboembolism. Studies to date indicate that LMWH is safer and
as effective as continuous intravenous heparin in the treatment of venous thrombosis.
The decreased mortality rates seen in two clinical trials, particularly in patients
with metastatic cancer, were an unexpected but intriguing finding. This requires further
confirmation, in larger prospective randomized trials.
Keywords:
Heparin - low-molecular-weight heparin (LMWH) - venous thrombosis - treatment - metastatic
cancer - laboratory monitoring
