| Enoxaparin monotherapy without oral anticoagulation to treat acute symptomatic pulmonary embolism. | |
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MedLine Citation:
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PMID: 12783106 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Conventional anticoagulation for symptomatic pulmonary embolism consists of continuous intravenous unfractionated heparin as a "bridge" to oral anticoagulation. This strategy requires 5 days or more of intravenous heparin while oral vitamin K antagonists gradually achieve a therapeutic effect. Oral vitamin K antagonists require frequent blood testing to optimize dosing, and their interactions with other medications and foods make regulation difficult. Therefore we tested a different approach to therapy: long-term enoxaparin monotherapy. We randomized 60 symptomatic pulmonary embolism patients in a 2:1 ratio to 90 days of enoxaparin as monotherapy without warfarin (N=40) or to intravenous unfractionated heparin as a "bridge" to warfarin, target INR 2.0-3.0 (N=20). Enoxaparin patients received 1 mg/kg twice daily for 14 days during the acute phase followed by randomized assignment during the chronic phase to 1.0 mg/kg vs. 1.5 mg/kg once daily. In an intention-to-treat analysis, 3 of the 40 enoxaparin patients developed recurrent venous thromboembolism compared with 0 of 20 standard therapy patients (p = 0.54). One of the 40 enoxaparin patients had a major hemorrhagic complication compared with 2 of the 20 standard therapy patients (p = 0.26). Median hospital length of stay was shorter with enoxaparin compared to standard therapy (4 vs. 6 days) (p = 0.001). Following our study we can conclude that extended 3-month treatment with enoxaparin as monotherapy for symptomatic, acute pulmonary embolism is feasible and warrants further study in a large clinical trial. |
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Authors:
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Joshua A Beckman; Kelly Dunn; Arthur A Sasahara; Samuel Z Goldhaber |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Thrombosis and haemostasis Volume: 89 ISSN: 0340-6245 ISO Abbreviation: Thromb. Haemost. Publication Date: 2003 Jun |
Date Detail:
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Created Date: 2003-06-03 Completed Date: 2004-03-24 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 7608063 Medline TA: Thromb Haemost Country: Germany |
Other Details:
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Languages: eng Pagination: 953-8 Citation Subset: IM |
Affiliation:
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Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. sgoldhaber@partners.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adult Aged Enoxaparin / administration & dosage*, toxicity Feasibility Studies Female Hemorrhage / chemically induced Heparin / administration & dosage Humans Length of Stay Male Middle Aged Pulmonary Embolism / complications, drug therapy* Recurrence / prevention & control Venous Thrombosis / prevention & control Ventricular Dysfunction, Right / chemically induced |
| Grant Support | |
ID/Acronym/Agency:
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K23 HL-04169/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Enoxaparin; 9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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