Weight-Based Low-Molecular-Weight Heparin versus Weight-Based Intravenous Unfractionated Heparin

Letters18 September 2007Weight-Based Low-Molecular-Weight Heparin versus Weight-Based Intravenous Unfractionated HeparinCraig A. Umscheid, MD, MSCE, Rajender Agarwal, MPH, and Gene Gibson, PharmDCraig A. Umscheid, MD, MSCEFrom the University of Pennsylvania Health System Center for Evidence-Based Practice and Hospital of the University of Pennsylvania, Philadelphia, PA 19104.Search for more papers by this author, Rajender Agarwal, MPHFrom the University of Pennsylvania Health System Center for Evidence-Based Practice and Hospital of the University of Pennsylvania, Philadelphia, PA 19104.Search for more papers by this author, and Gene Gibson, PharmDFrom the University of Pennsylvania Health System Center for Evidence-Based Practice and Hospital of the University of Pennsylvania, Philadelphia, PA 19104.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-147-6-200709180-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In regard to the systematic review evaluating the management of venous thromboembolism (VTE) by Segal and colleagues (1), we are concerned that the analyses comparing the efficacy and safety of low-molecular-weight heparin (LMWH) with unfractionated heparin (UFH) are biased against UFH. In 1993, Raschke and colleagues (2) demonstrated the superior efficacy and safety of the weight-based UFH dosing nomogram compared with the traditional non–weight-based UFH dosing nomogram for the treatment of VTE. But of the approximately 45 studies included in Segal and colleagues' review, only 6 (13%) compared weight-based LMWH with weight-based intravenous UFH. Comparing weight-based LMWH ...References1. Segal JB, Streiff MB, Hofmann LV, Hoffman LV, Thornton K, Bass EB. Management of venous thromboembolism: a systematic review for a practice guideline. Ann Intern Med. 2007;146:211-22. [PMID: 17261856] LinkGoogle Scholar2. Raschke RA, Reilly BM, Guidry JR, Fontana JR, Srinivas S. The weight-based heparin dosing nomogram compared with a “standard care” nomogram. A randomized, controlled trial. Ann Intern Med. 1993;119:874-81. [PMID: 8214998] LinkGoogle Scholar3. Simonneau G, Charbonnier B, Decousus H, Planchon B, Ninet J, Sie P, et al. Subcutaneous low-molecular-weight heparin compared with continuous intravenous unfractionated heparin in the treatment of proximal deep vein thrombosis. Arch Intern Med. 1993;153:1541-6. [PMID: 8391792] CrossrefMedlineGoogle Scholar4. Simonneau G, Sors H, Charbonnier B, Page Y, Laaban JP, Azarian R, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l'Embolie Pulmonaire. N Engl J Med. 1997;337:663-9. [PMID: 9278462] CrossrefMedlineGoogle Scholar5. Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. 1998;338:409-15. [PMID: 9459643] CrossrefMedlineGoogle Scholar6. Merli G, Spiro TE, Olsson CG, Abildgaard U, Davidson BL, Eldor A, et al. Subcutaneous enoxaparin once or twice daily compared with intravenous unfractionated heparin for treatment of venous thromboembolic disease. Ann Intern Med. 2001;134:191-202. [PMID: 11177331] LinkGoogle Scholar7. A randomised trial of subcutaneous low molecular weight heparin (CY 216) compared with intravenous unfractionated heparin in the treatment of deep vein thrombosis. A collaborative European multicentre study. Thromb Haemost. 1991;65:251-6. [PMID: 1646490] CrossrefMedlineGoogle Scholar8. Meyer G, Brenot F, Pacouret G, Simonneau G, Gillet Juvin K, Charbonnier B, et al. Subcutaneous low-molecular-weight heparin fragmin versus intravenous unfractionated heparin in the treatment of acute non massive pulmonary embolism: an open randomized pilot study. Thromb Haemost. 1995;74:1432-5. [PMID: 8772215] CrossrefMedlineGoogle Scholar9. Snow V, Qaseem A, Barry P, Hornbake ER, Rodnick JE, Tobolic T, et al. Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2007;146:204-10. [PMID: 17261857] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the University of Pennsylvania Health System Center for Evidence-Based Practice and Hospital of the University of Pennsylvania, Philadelphia, PA 19104.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Weight-based Heparin Dosing Nomogram Compared with a Standard Care Nomogram Robert A. Raschke , Brendan M. Reilly , James R. Guidry , Joseph R. Fontana , and Sandhya Srinivas Subcutaneous Enoxaparin Once or Twice Daily Compared with Intravenous Unfractionated Heparin for Treatment of Venous Thromboembolic Disease Geno Merli , Theodore E. Spiro , Carl-Gustav Olsson , Ulrich Abildgaard , Bruce L. Davidson , Amiram Eldor , Darlene Elias , Andrew Grigg , Dominique Musset , George M. Rodgers , Arthur A. Trowbridge , Roger D. Yusen , Krystyna Zawilska , and Management of Venous Thromboembolism: A Systematic Review for a Practice Guideline Jodi B. Segal , Michael B. Streiff , Lawrence V. Hofmann , Katherine Thornton , and Eric B. Bass Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians Vincenza Snow , Amir Qaseem , Patricia Barry , E. Rodney Hornbake , Jonathan E. Rodnick , Timothy Tobolic , Belinda Ireland , Jodi B. Segal , Eric B. Bass , Kevin B. Weiss , Lee Green , Douglas K. Owens , and Weight-Based Low-Molecular-Weight Heparin versus Weight-Based Intravenous Unfractionated Heparin Jodi B. Segal , Michael B. Streiff , and Eric B. Bass Metrics Cited ByEfficacy and safety of high-dose thromboprophylaxis in morbidly obese inpatients 18 September 2007Volume 147, Issue 6Page: 433-434KeywordsConflicts of interestHemorrhageHeparinSafetySystematic reviewsVenous thromboembolism ePublished: 18 September 2007 Issue Published: 18 September 2007 CopyrightCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...