Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis
Deep-vein thrombosis refers to the development of a blood clot (thrombus) in a deep vein, such as are in the legs. If such a clot remains in the location where it developed, it can cut off blood supply to the body part, such as a leg or foot, which can lead to gangrene (death of the tissue) and ultimately to the necessity for amputation. If the clot breaks away, becoming an embolus, it may travel to and block another blood vessel such as one in the lung, and such a blockage can be fatal. Treatment for deep-vein thrombosis, also referred to as venous thromboembolism, typically involves intravenous (IV) infusion of heparin, an anticoagulant that is used to keep the clot from getting bigger and prevent recurrences. Heparin is given in the hospital, and part-way through the course of heparin, an oral anticoagulant (warfarin) is begun, which is continued over the long term. Traditionally, IV heparin has been given for 10 days, but it has recently been suggested that five days would be adequate, which would allow earlier discharge from the hospital with a substantial cost savings. A study was performed to compare the effectiveness of 5- and 10-day courses of heparin in the treatment of acute proximal venous thrombosis. One hundred subjects received the long course, while 99 received the short course. Warfarin therapy was initiated on day 1 in the group that was given 5 days of IV heparin, and on day 5 in the group that was given 10 days of IV heparin. Results showed that the short course of heparin was just as effective as the long course, and offered the expected advantage of earlier discharge of the patient. The rate of recurrence of thromboembolism was equivalent in the two groups (7 percent), as was the rate of major bleeding reactions, a known side effect of anticoagulant therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Effectiveness of intermittent pneumatic leg compression for preventing deep vein thrombosis after total hip replacement
After patients undergo surgery for total hip replacement, between 40 and 60 percent suffer deep vein thrombosis (blood clots in deep veins). This can lead to fatal pulmonary embolism in a small percentage of such patients. While it is known that external pneumatic leg compression can help prevent thrombosis after general surgery, its role after hip replacement surgery has not been determined. To this end, a randomized trial was performed to study the effects of calf and thigh compression in 310 patients (152 leg compression patients, 158 controls) who had undergone total hip replacement surgery. Patients received sequential intermittent compression of calf and thigh by pneumatic cuffs containing four chambers each. A diagram of the apparatus is provided. Cuff compression began in the recovery room and continued for an average of 10 days. Venography (X-ray imaging of a vein) and noninvasive tests to determine the health of the veins were performed on day 14 after surgery, or earlier. Results showed that deep vein thrombosis was present in 24 percent of the patients who wore compression cuffs and in 49 percent of the control group. Proximal vein thrombosis (clotting in a different location) was present in 14 percent of those treated with compression cuffs and in 27 percent of controls. Venography proved a more accurate method of detecting thrombosis in the group as a whole, as noninvasive tests failed to detect clots in 54 percent of the patients who developed them. It appears that prophylactic use of intermittent cuff compression is a useful, cost-effective approach to treating patients who have undergone hip replacement surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis
Treating patients with deep-vein thrombosis with low-molecular-weight heparin, an anti-coagulant, may be safer and more effective than treatment with intravenous heparin. Deep-vein thrombosis occurs when a blood clot gets lodged in the large veins of the legs. Of 432 patients with deep-vein thrombosis, 213 were treated with a subcutaneous injection of low-molecular-weight heparin once a day, and 219 were treated with continuous intravenous heparin. Six patients (2.8%) treated with low-molecular weight heparin, and 15 patients (6.9%) treated with intravenous heparin had a recurrence of deep-vein thrombosis. One patient (0.5%) treated with low-molecular-weight heparin, and 11 patients (5.0%) treated with intravenous heparin had major bleeding associated with treatment. Ten patients (4.7%) treated with low-molecular weight heparin, and 21 patients (9.6%) treated with intravenous heparin died.
Publication Name: The New England Journal of Medicine
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