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Low-Molecular-Weight Heparin for Treating Venous Thromboembolism
- Maria M.W. Koopman, MD; and
- Harry R. Büller, MD
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IN RESPONSE:
We concluded that LMWH is the preferred therapy for patients with deep venous thrombosis on the basis of its demonstrated efficacy, ease of administration, lack of need for laboratory monitoring, and decreased risk for bleeding. This conclusion was based on a pooled analysis of the results of all the studies mentioned in our review (1) and the data from the THESEE (2) and Columbus Investigators (3) trials. In this pooled analysis, currently in press (4), major hemorrhage was observed in 1.1% of the patients allocated to LMWH and in 2.0% of the patients who received unfractionated heparin (odds ratio, 0.55; P < 0.02).
We agree with Drs. Mahoney and Kahn that in only one of the individual studies (4) was the incidence of major hemorrhage significantly lower in LMWH recipients than in patients who received unfractionated heparin. In addition, the pooled analysis of the 13 studies described earlier (1) showed no significant difference in bleeding between the two treatments. The results of the most recent analysis, however, which included about 4300 patients, indicated that the risk for bleeding with both LMWH and unfractionated heparin is small but that this risk is even smaller in patients treated with LMWH. This, in our opinion, justifies our conclusion that when judged by safety, LMWH is the preferred therapy for patients with deep venous thrombosis.
Maria M.W. Koopman, MD
Harry R. Büller, MD
University of Amsterdam
Amsterdam, 1100 DE, the Netherlands
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
