Low-Dose Heparin Equal to Low-Molecular-weight Heparin For DVT Prophylaxis
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WESTPORT, CT (Reuters Health) Mar 30 - In patients undergoing colorectal surgery, low-dose heparin and low-molecular-weight heparin (LMWH) are equally effective in preventing deep vein thrombosis (DVT), but the former therapy is currently less expensive than the latter.
In a study reported in the March issue of the Annals of Surgery, Dr. Robin S. McLeod from the University of Toronto and colleagues randomized 936 patients who underwent colorectal surgery to receive a subcutaneous injection of either 5000 units of calcium heparin (low-dose heparin) every 8 hours or 40 mg of enoxaparin (LMWH) once daily. Contrast venography was performed between postoperative day 5 and 9 or earlier if DVT was clinically suspected.
The researchers found that both groups had a DVT rate of 9.4%. No deaths from pulmonary embolism or bleeding complications occurred in either group, but bleeding events were more common in the enoxaparin group. The rates of major bleeding and bleeding that required reoperation, however, were similar between the groups.
"LMWHs have been advocated for prophylaxis in surgical patients because they are potentially more effective and safer, and with once-daily dosing they are more convenient to administer," the authors point out. The findings of the current study, however, support those of smaller studies that have failed to show that LMWHs are superior to low-dose heparin.
"Currently in North America, the costs of the LMWHs are substantially higher than for unfractionated heparin," the investigators note. "Not surprisingly, given the efficacy and safety results of this trial, the strategy of prophylaxis with low-dose heparin [is] the more cost-effective option."
Ann Surg 2001;233:438-444. |
