Consider The Evidence: Med/Peds Journal Roundup

August 24, 2006

Can UF Heparin replace LMWH as subcu anticoagulation?

Filed under: JAMA, VTE — medblog @ 8:30 pm

JAMA 8/23 – Will Lovenox and Fragmin share the same fate as New Coke? A study by Kearon et al. investigated the use of Classic unfractionated heparin as a subcutaneous treatment without APTT monitoring. The study protocol treated DVT and PE with a twice daily subQ injection of UFH in much the same way Low Molecular Weigh Heparin is used currently, except for a weight adjustment. The results essentially show that UFH was equally effective as LMWH in preventing recurrent thromboembolism. Appparently the crazy unpredictable pharmacokinetics are not a big issue with the subcutaneous route. And the fact that UFH is about 50 times cheaper is a big plus.
The study was an open-label RCT and the outcome analysis was done by blinded investigators. About 70% of subjects were treated as outpatients. Apparently there were some problems with recruitment but the power was adequate to provide reliable results.

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