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Thromb Haemost 1995; 74(06): 1432-1435
DOI: 10.1055/s-0038-1649960
Original Articles
Clinical Studies
Schattauer GmbH Stuttgart

Subcutaneous Low-Molecular-Weight Heparin Fragmin Versus Intravenous Unfractionated Heparin in the Treatment of Acute Non Massive Pulmonary Embolism: An Open Randomized Pilot Study

G Meyer
1   The Service de Pneumologie et Réanimation, Hôpital Laennec, Paris, France
,
F Brenot
2   The Service de Pneumologie et Réanimation, Hôpital Antoine Béclère, Clamart, France
,
G Pacouret
3   The Service de Cardiologie D, Hôpital Trousseau, Tours, France
,
G Simonneau
2   The Service de Pneumologie et Réanimation, Hôpital Antoine Béclère, Clamart, France
,
K Gillet Juvin
1   The Service de Pneumologie et Réanimation, Hôpital Laennec, Paris, France
,
B Charbonnier
3   The Service de Cardiologie D, Hôpital Trousseau, Tours, France
,
H Sors
1   The Service de Pneumologie et Réanimation, Hôpital Laennec, Paris, France
› Author Affiliations
Further Information

Publication History

Received: 08 June 1995

Accepted after revision 12 September 1995

Publication Date:
10 July 2018 (online)

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Summary

Low-molecular-weight heparins have been extensively investigated in the treatment of deep venous thrombosis but limited data are available concerning their use in pulmonary embolism. In an open, pilot, randomized study, we compare the safety and efficacy of Fragmin, a low-molecular-weight heparin with those of unfractionated heparin in 60 patients with non massive pulmonary embolism (Miller Index < 20). Thirty one patients received unfractionated heparin intravenously and 29 received a fixed dose of 120 Anti-Xa IU/kg of Fragmin administered subcutaneously twice a day for 10 days. There was no pulmonary embolism recurrence nor major bleeding in either group during the treatment period. The decrease in pulmonary vascular obstruction on perfusion lung scan between day 0 and day 10 was 17 ± 13% in the Fragmin group and 16 ± 13% in the heparin group (NS). These results indicate that Fragmin may be a safe and effective treatment of submassive pulmonary embolism.

 

  • References

  • 1 Hirsh J, Fuster V. Guide to anticoagulant therapy. Part I: Heparin. American Heart Association Circulation 1994; 89: 1449-1468
    CrossrefPubMedSearch in Google Scholar
  • 2 Hyers TM, Hull RD, Weg JG. Antithrombotic therapy for venous thromboembolic disease. Chest 1992; 102 suppl 408S-425S
    CrossrefPubMedSearch in Google Scholar
  • 3 Dalen JE, Hirsh J. American College of Chest Physicians and the National Heart, Lung and Blood Institute-National conference on antithrombotic therapy. Arch Intern Med 1986; 146: 462-472
    CrossrefPubMedSearch in Google Scholar
  • 4 Kelton JG, Hirsh J. Bleeding associated with antithrombotic therapy. Semin Heniatol 1980; 17: 259-295
    PubMedSearch in Google Scholar
  • 5 Bratt G, Törnebohm E, Granqvist S, Aberg W, Lockner D. A comparison between low-molecular-weight heparin (Kabi 2165) and standard heparin in the intravenous treatment of deep venous thrombosis. Thromb Haemost 1985; 54: 813-817
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Holm HA, Ly B, Handeland GE, Abildgaard U, Arnesen KE, Gottschalk P, Hoeg V, Aandahl M, Haugen K, Loerum F, Scheel B, Sortland O, Vinje B. Subcutaneous heparin treatment of deep venous thrombosis. A comparison of unfractionated and low-molecular-weight heparin Haemostasis 1986; 16 suppl (Suppl. 02) 30-37
    PubMedSearch in Google Scholar
  • 7 Albada J, Nieuwenhuis HK, Sixma JJ. Treatment of acute venous thromboembolism with low-molecular-weight heparin (Fragmin): Results of a double-blind randomized study. Circulation 1989; 80: 935-940
    CrossrefPubMedSearch in Google Scholar
  • 8 Haddeland GF, Abildgaard U, Holm HA, Arnesen KE. Dose-adjusted heparin treatment of deep venous thrombosis : A comparison of unfractionated and low-molecular-weight heparin. Eur J Clin Pharmacol 1990; 39: 107-112
    CrossrefPubMedSearch in Google Scholar
  • 9 Prandoni P, Vigo M, Cattelan AM, Ruol A. Treatment of deep venous thrombosis by fixed doses of a low-molecular-weight heparin (CY 216). Haemostasis 1990; 20 suppl (Suppl. 01) 220-223
    PubMedSearch in Google Scholar
  • 10 Bratt G, Aberg W, Johansson M, Törnebohm E, Granqvist S, Loekner D. Two daily subcutaneous injections of Fragmin as compared with intravenous standard heparin in the treatment of deep venous thrombosis (DVT). Thromb Haemost 1990; 64: 506-510
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Duroux P. A randomized trial of subcutaneous low-molecular-weight heparin (CY 216) compared with intravenous unfractionated heparin in the treatment of deep vein thrombosis : A collaborative european mullieenter study. Thromb Haemost 1991; 65: 251-256
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Hull RD, Raskob GE, Pineo GF, Green D, Trowbridge AA, Elliott CG, Lerner RG, Hall J, Sparling T, Brettell HR, Norton J, Carter CJ, George R, Merli G, Ward J, Mayo W, Koscnhloom D, Brant R. Subcutanenous low-molecular-weight heparin compared with continous intravenous heparin in the treatment of proximal vein thrombosis. N Engl J Med 1992; 326: 975-982
    CrossrefPubMedSearch in Google Scholar
  • 13 Simonneau G, Charbonnier B, Decousus H, Planchon B, Ninet J, Sié P, Silsiguen M, Combe S. Subcutaneous low-molecular-weight heparin compared with continous intravenous unfractionated heparin in the treatment of proximal deep vein thrombosis. Arch Intern Med 1993; 153: 1541-1546
    CrossrefPubMedSearch in Google Scholar
  • 14 Théry C, Simonneau G, Meyer G, Hélénon O, Bridey F, Armagnae C, d’Azémar P, Coquart JP. Randomized trial of subcutaneous low-molecular-weight heparin CY 216 (Fraxiparine) compared with intravenous unfractionated heparin in the curative treatment of submassive pulmonary embolism. A dose-ranging study Circulation 1992; 85: 1380-1389
    CrossrefPubMedSearch in Google Scholar
  • 15 Miller GA H, Sutton GC, Kerr IH, Gibson RV, Honey M. Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. Br Med J 1971; 2: 681-684
    CrossrefPubMedSearch in Google Scholar
  • 16 Meyer G, Collignon AM, Guinet F, Jeffrey AA, Barritault L, Sors H. Comparison of perfusion lung scanning and angiography in the estimation of vascular obstruction in acute pulmonary embolism. Eur J Nucl Med 1990; 17: 315-319
    CrossrefPubMedSearch in Google Scholar
  • 17 Hirsh J. Heparin. N Engl J Med 1991; 324: 1565-1574
    CrossrefPubMedSearch in Google Scholar
  • 18 Hirsh J. Low molecular weight heparin. Thromb Haemost 1993; 70: 204-207
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Leizorovicz A, Simonneau G, Decousus H, Boissel JP. Comparison of the efficacy and safety of low molecular weight heparins and unfractionated heparin in the initial treatment of deep venous thrombosis: a meta-analysis. Br Med J 1994; 309: 299-304
    CrossrefPubMedSearch in Google Scholar
  • 20 Green D, Hirsh J, Heit J, Prins M, Davidson B, Lensing AW A. Low Molecular Weight Heparin: A Critical Analysis of Clinical Trials. Pharmacol Rev 1994; 46: 89-109
    PubMedSearch in Google Scholar