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A Journal on Phlebology
Acta Phlebologica 2005 December;6(3):129-36
Low molecular weight heparins in the long term reatment of deep vein thrombosis
de Franciscis S., Serra R., Luongo A., Perziano A.
Department of Experimental and Clinical Medicine, Surgical Clinical Methodology, University Magna Graecia of Catanzaro, Italy
AIM: Oral anticoagulation is the strategy of choice for the long-term treatment (secondary prophylaxis) of venous thromboembolism. However the inherent side effects hamper its use in some patients.
METHODS: We have evaluated the use of a low molecular weight heparin (Parnaparin) in the long term treatment of venous thromboembolism in patients with contraindications to oral anticoagulants. METHODS: 10 patients with documented deep venous thrombosis (6 with proximal DVT, 4 with distal DVT), were treated with a low molecular weight heparin (Parnaparin). The 6 patients with proximal DVT received Parnaparin for 9 months (6,400 IU subcutaneously, twice daily for 6 months, and then once a day for 3 months); the 4 patients with distal DVT received Parnaparin for 6 months (6,400 IU subcutaneouslyt wice daily for 3 months, and then once a day for the following 3 months). All patients were also treated with compression stockings. Clinical examination, compression ultrasonography, D-dimer test, platelet count , liver enzymes were performed at the baseline and after 1, 3, 6 and 9 months.
RESULTS: A marked improvement in symptoms was observed in all cases, and no new thromboembolic event recurred. A significant, progressive decrease in D-dimer values was observed during treatment. Platelet count and liver enzymes were in the normal range throughout the study., and no minor or major bleedings were reported during the administration of Parnaparin. No pathological fractures, , nor back pein indirect indices of osteoporosis, were associated ith the prolonged low-molecular weight heparin treatment.
CONCLUSION: These data suggest that low molecular weight heparins may represent a safe and effecive alternative to oral anticoagulation in the long-term treatment of venous thromboembolism in subjects with major contraindications to the later drugs.