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In this well-designed study, Hull et al¹ showed 7 new episodes (6.8%) of venous thromboembolism in 103 patients who received intravenous heparin. None of the patients in the low-molecular-weight heparin (LMWH) group had a recurrence. Out of 7 patients, 1 patient had a subtherapeutic activated partial thromboplastin time while receiving heparin, and 2 patients had subtherapeutic prothrombin times before or at the time of a recurrent thromboembolic event. This may be a potential confounder.

Four more patients died of abrupt metastatic carcinoma in the intravenous heparin group. Were the patients who experienced a higher incidence of recurrence of thromboembolic disease more likely to have advanced cancer? It is not clear if the recurrence of venous thromboembolism was confined only to the patients with cancer. Venous thrombosis has a more aggressive course in patients with cancer. In patients with acute calf vein thrombosis, progression to proximal deep vein thrombosis (DVT) was . . . [Full Text of this Article]