Abstract
Objective: Acute pulmonary thromboembolism (PTE) is a serious high mortality pulmonary vascular disease whose effective treatment decreases morbidity and mortality. To determine if low-molecular-weight-heparin (LMWH) is clinically as efficient and safe as unfractionated heparin (UH) in patients with diagnosis of acute non-massive PTE, our study compares the efficacy, adverse effects and costs of LMWH and UH. Methods: One hundred and fourteen patients with non-massive acute PTE were randomly divided into LMWH (nadroparin calcium) and UH groups. Oxygenation index, D-dimer, fibrinogen (FG), lung ventilation/perfusion (V/Q) scan and computed tomography pulmonary angiography (CTPA) were observed before anticoagulation and on day 14 after anticoagulation. Results: In both groups, the ABG (arterial blood gas) analysis showed PaO2 and PaCO2 were elevated, P(A-a)O2 was decreased and oxygenation index (PaO2/FIO2) was elevated, D-dimer and fibrinogen were decreased, lung V/Q and CTPA showed embolized segments reduced (P<0.05). Hemorrhage and thrombocytopenia occurred in 3.5% of the LMWH group. Hemorrhage occurred in 5.3% and thrombocytopenia occurred in 7.0% of the UH group. The average cost in the LMWH group was RMB 1218.60 Yuan and RMB 1541.40 Yuan in the UH group. Conclusion: LMWH and UH are equally effective for treatment of non-massive acute PTE, but LMWH may have a lower prevalence of complications and is less expensive.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Buller, H.R., 2002. Treatment of symptomatic venous thromboembolism: improving outcomes. Semin. Thromb. Hemost., 28(Suppl 2):41–48. doi:10.1055/s-2002-32315.
Buller, H.R., Agnelli, G., Hull, R.D., Hyers, T.M., Prins, M.H., Raskob, G.E., 2004. Antithrombotic therapy for venous thromboembolic disease: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest., 126(3 Suppl):401S–428S.
Chinese Medical Association (Respiratory Branch), 2001. The guideline of diagnosis and treatment of PTE (draft). Chin. J. Tuberc. Respir. Dis., 24(5):273–275 (in Chinese).
Davis, R., Faulds, D., 1997. Nadroparin calcium. A review of its pharmacology and clinical use in the prevention and treatment of thromboembolic disorders. Drugs Aging., 10(4):299–322.
Deitcher, S.R., Carman, T.L., 2002. Deep venous thrombosis and pulmonary embolism. Curr. Treat Options Cardiovasc. Med., 4(3):223–238.
Eikelboom, J.W., Hankey, G.J., 2002. Low molecular weight heparins and heparinoids. Med. J. Aust., 177(7):379–383.
Estrada, C.A., Mansfield, C.J., Heudebert, G.R., 2000. Cost-effectiveness of low-molecular-weight heparin in the treatment of proximal deep vein thrombosis. J. Gen. Intern. Med., 15(2):108–115. doi:10.1046/j.1525-1497.2000.03349.x.
Gylys, K.H., 2001. Pharmacology department. J. Cardiovasc. Nurs., 15(4):91–95.
Holzheimer, R.G., 2004. Low-molecular-weight heparin (LMWH) in the treatment of thrombosis. Eur. J. Med. Res., 9(4):225–239.
Manganaro, A., Giannino, D., Lembo, D., Bruni, F., Consolo, F., 2000. Evolution in the pharmacological treatment of venous thrombosis according to evidence-based medicine. Minerva Cardioangiol., 48(12 Suppl 1):41–51 (in Italian).
Marbet, G.A., 2003. Heparins. Ther. Umsch., 60(1):10–13 (in German).
McRae, S.J., Ginsberg, J.S., 2004. Initial treatment of venous thromboembolism. Circulation, 110(9 Suppl 1):13–19. doi:10.1161/01.CIR.0000140904.52752.0c.
Messmore, H.L., Covne, E., Wehrmacher, W.H., Demir, A.M., Fareed, J., 2004. Studies comparing low molecular weight heparin with heparin for the treatment of thromboembolism: a literature review. Curr. Pharm. Des., 10(9):1001–1010. doi:10.2174/1381612043452802.
Moreno-Palomares, J.J., Fisac-Herrero, R.M., Herrero-Domingo, A., Ferreira-Pasos, E.M., Grasa, J., Reverte-Cejudo, D., 2001. Low molecular weight heparin versus unfractionated heparin in the treatment of deep vein thrombosis. An. Med. Interna., 18(7):364–368 (in Spanish).
Ng, H.J., Lee, L.H., 2003. Heparin-induced thrombocytopenia: acknowledging its presence in low-molecular weight heparin therapy. Int. J. Hematol., 77(2):185–187.
Nicolaides, A.N., Breddin, H.K., Fareed, J., 2001. Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence. Int. Angiol., 20(1):1–37.
Pineo, G.F., Hull, R.D., 1998. Heparin and low-molecularweight heparin in the treatment of venous thromboembolism. Baillieres. Clin. Haematol., 11(3):621–637.
Valiukiene, L., Naudziunas, A., Unikauskas, A., 2003. Treatment and prophylaxis of deep venous thrombosis with low molecular weight heparins (meta-analysis of clinical trials). Medicina (Kaunas), 39(4):352–358 (in Lithuanian).
Wells, P.S., 2001. Outpatient treatment of patients with deep-vein thrombosis or pulmonary embolism. Curr. Opin. Pulm. Med., 7(5):360–364. doi:10.1097/00063198200109000-00019.
Wells, P.S., Buller, H.R., 2001. Outpatient treatment of patients with pulmonary embolism. Semin. Vasc. Med., 1(2):229–234. doi:10.1055/s-2001-18492.
Author information
Authors and Affiliations
Corresponding author
Additional information
Project supported by the Hi-Tech Research and Development Program (863) of China (No. 2003BA703B13) and the Fund of Health Bureau of Zhejiang Province, China (No. 2003A058)
Rights and permissions
About this article
Cite this article
Chen, Ly., Ying, Kj., Hong, Wj. et al. Comparison of low-molecular-weight-heparin and unfractionated heparin for acute PTE. J. Zhejiang Univ. - Sci. B 6, 1195–1199 (2005). https://doi.org/10.1631/jzus.2005.B1195
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1631/jzus.2005.B1195