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  • Low molecular weight heparin or unfractionated heparin in the treatment of patients with uncomplicated deep vein thrombosis

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Best evidence topic report
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

    https://doi.org/10.1136/emj.17.6.402

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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 thrombosis.mp) OR dvt.mp) OR [(exp thrombosis or thrombosis.mp) AND (exp veins OR Vein$.mp)] AND (exp. heparin, low molecular weight OR low molecular weight heparin.mp) NOT (prophylaxis.mp OR primary prevention.mp) 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.

      View this table:
      Table 2

      Comments

      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

      References

      1. Hull R, Raskob G, Pineo G, et al. Subcutaneous low weight molecular weight heparin compared with continuous intravenous heparin in the treatment of proximal vein thrombosis. N Engl J Med1992;326:975–82.
        OpenUrlPubMedWeb of Science
      2. Koopman M, Prandoni P, Piovella F, et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low molecular weight heparin administered at home. N Engl J Med1996;334:682–7.
        OpenUrlCrossRefPubMedWeb of Science
      3. Levine M, Gent M, Hirsh J, et al. A comparison of low molecular weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal vein thrombosis. N Engl J Med1996;334:677–81.
        OpenUrlCrossRefPubMedWeb of Science
      4. Belcaro G, Nicolaides A, Cesarone M, et al. Comparison of low molecular weight heparin, administered primarily at home, with unfractionated heparin, administered in hospital and subcutaneous heparin administered at home for deep vein thrombosis. Angiology1999;50:781–7.