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Low molecular weight heparin or unfractionated heparin in the treatment of patients with uncomplicated deep vein thrombosis
  1. Beverley Lane,
  2. Magnus Harrison
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road,Manchester M13 9WL

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    Report by Beverley Lane, Research Nurse Search checked by Magnus Harrison, Research Fellow

    Clinical scenario

    A 60 year old man presents with a three day history of pain in his left calf. You suspect an above knee deep vein thrombosis (DVT), which is later confirmed by ultrasound. You are considering admitting this man for treatment with unfractionated heparin (UH), when one of your colleagues mentions that low weight molecular weight heparins (LMWH) have been proven to be as good at treating thromboembolic disease and its complications. You wonder whether this is true.

    Three part question

    In [patients with deep vein thrombosis] is [low molecular weight heparin as good as unfractionated heparin} at {treating uncomplicated proximal DVT]?

    Search strategy

    Medline 1966–07/00 using the OVID interface. (Exp venous thrombosis OR deep vein OR OR [(exp thrombosis or AND (exp veins OR Vein$.mp)] AND (exp. heparin, low molecular weight OR low molecular weight NOT ( OR primary LIMIT to human AND english language.

    Search outcome

    Altogether 373 papers identified of which 369 were irrelevant or of insufficient quality for inclusion. The remaining four papers are shown in table 2.

    Table 2


    There are four well designed trials in this area. All come to the same conclusion.

    Clinical bottom line

    Low molecular weight heparin is as effective and safe as unfractionated heparin and should be the form of treatment for patients with uncomplicated proximal deep vein thrombosis.

    Report by Beverley Lane, Research Nurse Search checked by Magnus Harrison, Research Fellow