ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Low molecular weight heparin versus oral anticoagulants in the long-term treatment of deep venous thrombosis: surveillance of thrombus regression
Mert Dumantepe1, Arif Tarhan1, Tamer Kehlibar2, Azmi Özler1
1Department of Cardiovascular Surgery, Memorial Ataşehir Hospital, İstanbul, Turkey
2Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
DOI : 10.5606/tgkdc.dergisi.2013.7497
Background: This study aims to compare the effects of low molecular weight heparin (LMWH) versus oral anticoagulants on thrombus regression and post-thrombotic syndrome (PTS) in the treatment of long-term acute deep vein thrombosis (DVT).

Methods: One hundred-forty patients with acute, proximal, unilateral DVT of the lower limbs confirmed by Doppler ultrasonography were enrolled to study to receive a-six-month treatment with LMWH or vitamin K antagonist (VKA). Seventy four patients were divided into two groups except excluded patients and noncompleters. Tinzaparin sodium was administered subcutaneously once daily in a weight-adjusted dose of anti Xa 175 IU/Kg bodyweight in LMWH group, while warfarin was administered 5 mg/day for VKA group. Doppler ultrasonography was used to evaluate thrombus regression, recanalization and venous reflux at intervals of 1, 3, 6 and 12 months. All patients were followed up for 12 months.

Results: Comparing ultrasonographic findings derived from both groups, the gradual reduction over time reflecting thrombus regression was more prominent in the LMWH group. A higher reduction in thrombus size in LMWH group was associated with lesser clinical events of recurrence and consequently a lesser rate of PTS. No cases of major bleeding were experienced in LMWH group, while two cases (5%) were observed in the VKA group.

Conclusion: Unmonitored subcutaneous administration of LMWH at a fixed daily dose was more efficient in achieving recanalization of leg veins and safe, at least as much as oral anticoagulant, after long-term administration. These results suggest that LMWHs, compared to other treatment of choices, may represent a real therapeutic advance in the long-term management of DVT.

Keywords : Doppler; low molecular weight heparin; oral anticoagulant; reflux; ultrasonography; venous thromboembolism
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