Adjusted Subcutaneous Heparin versus Warfarin Sodium in the Long-Term Treatment of Venous Thrombosis

TLDR

The study randomized patients with proximal‑vein thrombosis to compare adjusted‑dose subcutaneous heparin versus warfarin for preventing recurrent venous thromboembolism. One hundred six patients with confirmed proximal‑vein thrombosis were treated with intravenous heparin and then randomized to receive either adjusted‑dose subcutaneous heparin or warfarin for secondary prophylaxis. Adjusted‑dose subcutaneous heparin was as effective as warfarin in preventing recurrence (2/53 vs 1/53) and was associated with a markedly lower bleeding risk (1 vs 9 events).

Abstract

Previously, we compared fixed low doses of heparin with adjusted doses of warfarin for the long-term treatment of venous thrombosis; in that study low-dose heparin was ineffective in preventing recurrence in patients with proximal-vein thrombosis. We have now completed a randomized trial comparing adjusted doses of heparin and of warfarin for prevention of recurrent venous thromboembolism in patients with proximal-vein thrombosis. One hundred six consecutive patients with acute proximal-vein thrombosis confirmed by venography were treated with intravenous heparin and then randomized to secondary prophylaxis. Two of 53 patients receiving heparin, as compared with one of 53 receiving warfarin, had new episodes of objectively documented venous thromboembolism. Nine patients taking warfarin had bleeding complications (which were major in three patients), as compared with one patient taking heparin (P = 0.008). Our data indicate that adjusted-dose subcutaneous heparin therapy provides an effective alternative to warfarin sodium and is associated with a lower risk of bleeding.