This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (31)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Thrombolysis  • Venous Thromboembolism  • Cardiovascular System  • Randomized Controlled Trial  • Alert me on articles by topic  Social Bookmarking   What's this?

Philip S. Wells, MD, MSc; David R. Anderson, MD; Marc A. Rodger, MD, MSc; Melissa A. Forgie, MD, MSc; Peggy Florack, RN; Donna Touchie, RN; Beverly Morrow, RN; Lisa Gray, RN; Keith O’Rourke, MSc; George Wells, PhD; Judy Kovacs, RN; Michael J. Kovacs, MD

Arch Intern Med. 2005;165:733-738.

Background  Low-molecular-weight heparins (LMWHs) are now standard therapy for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). No published trials have compared LMWHs, and few studies have examined outpatient therapy for PE. Only tinzaparin sodium has demonstrated superiority to unfractionated heparin in a clinical trial.

Methods  We compared 2 LMWH products, tinzaparin and dalteparin sodium, for the treatment of acute DVT and PE in a randomized, controlled clinical trial of consecutive outpatients presenting to a venous thromboembolism service at 4 tertiary-care hospitals. Patients were treated with subcutaneous tinzaparin sodium, 175 IU/kg every 24 hours, or subcutaneous dalteparin sodium, 200 IU/kg every 24 hours, for at least 5 days. Warfarin sodium therapy was started simultaneously and continued for 90 days. The primary end point was efficacy (recurrence of venous thromboembolism); safety (bleeding) was a composite end point.

Results  Two hundred fifty-four patients received tinzaparin (39 with PE and 215 with DVT) and 251 received dalteparin (51 with PE and 200 with DVT). Most patients had an active malignancy or idiopathic DVT/PE. The outcome events occurred in 11 (4.4%; 95% confidence interval [CI], 2.2%-7.7%) and 15 patients (5.9%; 95% CI, 3.3%-9.5%) in the dalteparin and tinzaparin groups, respectively, including 9 and 10 recurrences, respectively, and 2 and 5 major hemorrhages, respectively (P = .44). The 95% CI on the difference of –1.5% was –5.3% to 2.4%.

Conclusions  Tinzaparin and dalteparin are safe and effective for the outpatient treatment of DVT or PE. Our finding of no differences between the LMWHs based on major clinical end points means that practical issues can be the deciding factor on which drug to use.

Author Affiliations: Departments of Medicine, University of Ottawa, Ottawa Health Research Institute, Ottawa, Ontario (Drs P. S. Wells, Rodger, Forgie, and G. Wells; Mss Florack and Touchie; and Mr O’Rourke); Dalhousie University, Halifax, Nova Scotia (Dr Anderson and Ms Gray); and University of Western Ontario, London (Mss Morrow and Kovacs and Dr Kovacs).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review
Squizzato et al.
Eur Respir J 2009;33:1148-1155.
ABSTRACT | FULL TEXT  

Are All Low Molecular Weight Heparins Equivalent in the Management of Venous Thromboembolism?
Fareed et al.
CLIN APPL THROMB HEMOST 2008;14:385-392.
ABSTRACT  

Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Schulman et al.
Chest 2008;133:257S-298S.
ABSTRACT | FULL TEXT  

Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Kearon et al.
Chest 2008;133:454S-545S.
ABSTRACT | FULL TEXT  

Length of Stay and Mortality in Pulmonary Embolism: High Time for Evidence-Based Discharge Criteria
Brotman and Lindenauer
Arch Intern Med 2008;168:683-684.
FULL TEXT  

Length of Hospital Stay and Postdischarge Mortality in Patients With Pulmonary Embolism: A Statewide Perspective
Aujesky et al.
Arch Intern Med 2008;168:706-712.
ABSTRACT | FULL TEXT  

Clinical Predictors for Fatal Pulmonary Embolism in 15 520 Patients With Venous Thromboembolism: Findings From the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry
Laporte et al.
Circulation 2008;117:1711-1716.
ABSTRACT | FULL TEXT  

Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?
Otero et al.
Eur Respir J 2007;30:1111-1116.
ABSTRACT | FULL TEXT  

Home at last? Early discharge for acute pulmonary embolism
Tapson and Huisman
Eur Respir J 2007;30:613-615.
FULL TEXT  

There's No Place Like Home
Moores
Chest 2007;132:7-8.
FULL TEXT  

Fixed-Dose Unfractionated Heparin vs Low-Molecular-Weight Heparin for Venous Thromboembolism--Reply
Kearon et al.
JAMA 2007;297:263-263.
FULL TEXT  

Choosing the Appropriate Antithrombotic Agent for the Prevention and Treatment of VTE: A Case-Based Approach
Nutescu et al.
The Annals of Pharmacotherapy 2006;40:1558-1570.
ABSTRACT | FULL TEXT  

Validation of a model to predict adverse outcomes in patients with pulmonary embolism
Aujesky et al.
Eur Heart J 2006;27:476-481.
ABSTRACT | FULL TEXT  

A Prediction Rule to Identify Low-Risk Patients With Pulmonary Embolism
Aujesky et al.
Arch Intern Med 2006;166:169-175.
ABSTRACT | FULL TEXT  

How I treat venous thromboembolism in patients with cancer
Prandoni
Blood 2005;106:4027-4033.
ABSTRACT | FULL TEXT  

Derivation and Validation of a Prognostic Model for Pulmonary Embolism
Aujesky et al.
Am. J. Respir. Crit. Care Med. 2005;172:1041-1046.
ABSTRACT | FULL TEXT  

Comparison of Two Low-Molecular-Weight Heparins for DVT and PE
JWatch General 2005;2005:2-2.
FULL TEXT  

Low-Molecular-Weight Heparins: Do We Have the GUSTO to Identify Differences Between Alternative Formulations?
Zakarija and Bennett
Arch Intern Med 2005;165:722-723.
FULL TEXT