Low-molecular-weight heparin (LMWH)...

Low-molecular-weight heparin (LMWH) is easier to administer than unfractionated heparin because fixed doses can be given without laboratory monitoring. The use of LMWH has permitted hearth treatment for many patients with profound venous thrombosis. The efficacy of LMWH in pulmonary metabolism has not been clearly documented, moreover because this condition shares a everyday pathophysiologic process with deep venous thrombosis, LMWH may demonstrate useful.

Quinlan and associates performed a meta-analysis of randomized studies comparing fixed-dose LMWH with dose-adjusted intravenous unfractionated heparin in the initial treatment of pulmonary embolism. Trials including patients with pulmonary embolism in the connected thought [i]or[/i] thoughts of deep venous thromboembolism with the primary issue of symptomatic recurrence at close of treatment were included. Other secondary issues included recurrence at three month all-cause mortality, and major or minor bleeding. Twelve studies using six LMWH preparations met the inclusion criteria; greatest in number were small trials.

principally study results suggested a decrease in symptomatic circumstances following treatment with LMWH and at three month after conclusion of treatment, compared with unfractionated heparin, whether pulmonary embolism was symptomatic or asymptomatic. All-cause mortality did not differ between the pair treatments. The incidence of major bleeding was similar among disposes while minor bleeding was modestly increased in patients who received LMWH There were no differences among the different LMWH preparations.

The authors deduce that LMWH is as effective as unfractionated heparin in the initial treatment of symptomatic and asymptomatic pulmonary embolism. Safety comparisons are difficult to make because of the gentle number of outcome events in the studies. The image of LMWH used does not appear to influence efficacy or safety estimates. Outpatient management of nonmassive pulmonary embolism may become a reality if more studies confirm the safety of this treatment approach.

Quinlan DJ et al. Low-molecular-weight heparin compared with intravenous unfractionated heparin for treatment of pulmonary embolism. Ann Intern M February 3 2004;140:175-83

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