ClotCare: Blood Clots, Stroke, Heart Attack
Friday, September 22, 2017
Home   |   DVT/PE   |   Blood Clots   |   Coumadin/Warfarin   |   New Patients   |   Self Testing   |   Email List   |   Donate

Pick a Topic:

Find info on a:

We subscribe to the HONcode principles of the HON Foundation. Click to verify.
ClotCare complies with the HONcode standard for trustworthy health
information:
verify here.

ClotCare is a member of the Coalition to Prevent Deep Vein Thrombosis (DVT Coalition)  ClotCare is a member organization of the Coalition to Prevent Deep Vein Thrombosis. Click here to learn more about the Coalition to Prevent Deep Vein Thrombosis and DVT Awareness Month, which is held each March.

Weight-based, fixed-dose, unmonitored subcutaneous unfractionated heparin administered twice daily found to be equivalent to low molecular weight heparin for treatment of DVT and PE

Henry I. Bussey, Pharm.D.
August, 2006

Reference: Kearon C, Ginsberg JS, Julian JA, et al. Comparison of fixed-dose weight-adjusted unfractionated heparin and low-molecular-weight heparin for acute treatment of venous thromboembolism. JAMA 2006; 296:935-942.

Investigators in Canada and New Zealand randomized a total of 708 DVT and/or PE patients to twice daily, fixed dose unfractionated heparin (333 U/Kg load followed by 250 U/kg q 12 hrs) or twice daily subcutaneous LMWH (100 U/kg q 12 hrs - approximately 75% received dalteparin and 25% enoxaparin). Most patients (approx. 70% in each group) - including PE patients - were treated as outpatients. The trial was open-label but end points were adjudicated by a board that was blinded to treatment. There was no significant difference in recurrent VTE (3.8% with UFH vs. 3.4% with LMWH), major bleed (1.1% with UFH vs. 1.4% with LMWH), and deaths (18 in UFH vs 22 with LMWH).

Blood samples for aPTT determination were collected at the midpoint of the dosing interval on day 3 of dosing in the UFH group, but the samples were not analyzed until after the study was completed. Subsequently, aPTT values were found to be above the therapeutic range more than within or below the range, but low aPTT values did not correlate with an increase in VTE, and high aPTT values did not correlate with increased bleeding. Platelet counts were not monitored but the mean length of UFH and LMWH treatment was approximately 6 days.

The estimated cost of medication for 6 days of treatment for an 80 kg patient was calculated to be $37 for UFH vs. $712 for LMWH (enoxaparin). It should be noted that the cost of enoxaparin would be about 25% less if the once daily regimen (1.5mg/kg daily) were used, and that other LMWHs may be less expensive in the U.S. An additional consideration could be unpredictable absorption of UFH when given subcutaneously, but this concern did not appear to influence clinical outcomes in this study population. Lastly, whether the choice of LMWH (dalteparin in 75% vs. enoxaparin in 25%) may have influenced results is a potential issue for debate. Interestingly, the recurrent VTE rates at 10 and 30 days of follow-up was 0.7% and 3.3% with dalteparin vs. 0% and 3.2% with enoxaparin. Similarly, major bleeding rates at 10 and 30 days were 1.9% and 3.8% for dalteparin vs. 0% and 2.2% for enoxaparin.

Ask a question about blood clots or anticoagulant medications Have questions? Ask ClotCare. Send questions by email to webmaster@clotcare.org.

ClotCare is a 501(c)(3) non-profit organization generously supported by your tax-deductible donations and grants from our industry supporters.

Blood Clot Activities Calendar

New Postings:

Rivaroxaban or Warfarin in Stable Coronary Artery Disease – Should the COMPASS Study Lead Us Back to the Future?

Rivaroxaban or Warfarin in Stable Coronary Artery Disease – Should the COMPASS Study Lead Us Back to the Future?

Click here to view full list of new postings
ClotCare Home | New Postings | Patient Postings | Clinician Postings | Join Our Email List | Useful Web Links
CE Opportunities | Training Programs | DVT & PE Stories | Editorial Board | Financial Support
About ClotCare | DVT Coalition | Donate to ClotCare | Contact Us
Key topics discussed on ClotCare include: Blood Clots | Deep Vein Thrombosis (DVT) | Pulmonary Embolism (PE) | Atrial Fibrillation (A. Fib or AF) | Heart Attack | Stroke | Transient Ischemic Attack (TIA) | Mini Stroke | Bleeding Complications | Vascular Surgery | Surgical Blood Clot Removal | Warfarin | Coumadin | Lovenox | Low Molecular Weight Heparin (LMWH) | Heparin | Anticoagulants | Plavix | Aspirin | Antiplatelets | Blood Thinners
Copyright 2000-2014 by ClotCare. All rights reserved.
Terms, Conditions, & Privacy | Image Copyright Information
19260 Stone Oak Parkway, Suite 101 | San Antonio, TX 78258 | 210-495-4335
Send comments to webmaster@clotcare.org.
Friday, September 22, 2017