A comparison of
low-molecular-weight heparin administered primarily at home
with unfractioned heparin administration in the hospital for
proximal deep-vein thrombosis
M Levine, M Gent, J
Hirsh, J Leclerc, D Anderson, J Weitz.
N Engl J Med 1996;
Background. Patients with acute proximal
deep-vein thrombosis are usually treated first in the
hospital with intravenous standard (unfractionated) heparin.
However, the longer plasma half-life, better bioavailability
after subcutaneous administration, and more predictable
anticoagulant response of low-molecular-weight heparins make
them attractive for possible home use. We compared these two
Methods. Patients with acute proximal
deep-vein thrombosis were randomly assigned to receive
either intravenous standard heparin in the hospital (253
patients) or low-molecular-weight heparin (1 mg of
enoxaparin per kilogram of body weight subcutaneously twice
daily) administered primarily at home (247 patients). The
study design allowed outpatients taking low-molecular-weight
heparin to go home immediately and hospitalized patients
taking low-molecular-weight heparin to be discharged early.
All the patients received warfarin starting on the second
Results. Thirteen of the 247 patients
receiving low-molecular-weight heparin (5.3 percent) had
recurrent thromboembolism, as compared with 17 of the 253
patients receiving standard heparin (6.7 percent; P = 0.57;
absolute difference, 1.4 percentage points; 95 percent
confidence interval, -3.0 to 5.7). Five patient receiving
low-molecular-weight heparin had major bleeding, as compared
with three patients receiving standard heparin. After
randomization, the patients who received
low-molecular-weight heparin spent a mean of 1.1 days in the
hospital, as compared with 6.5 days for the standard-heparin
group; 120 patients in the low-molecular-weight-heparin
group did not need to be hospitalized at all.
Conclusions. Low-molecular-weight heparin can
be used safely and effectively to treat patients with
proximal deep-vein thrombosis at home.