Oral Anticoagulants Controlled by the British Comparative Thromboplastin Versus Low-Dose Heparin in Prophylaxis of Deep Vein Thrombosis

Abstract

cases, but that the general risk of such complications to women in the Netherlands is slight when abortion has been performed by early vacuum aspiration.We thank the participants in GVR for their kind co-operation, W Breur for the statistical evaluation, and B L Huidekoper for gathering obstetric data. References'Wright, C S W, Campbell, S, and Beazley, J, Lancet, 1972Lancet, , 1, 1278 Summary and conclusions The British comparative thromboplastin (BCT) was used to monitor the effectiveness of oral anticoagulants in preventing deep vein thrombosis (DVT) in patients undergoing major gynaecological surgery. All patients were screened for DVT with the use of the 1251-fibrinogen scan.One hundred and forty-five patients aged 40 years or more were randomised into three groups. Group 1 received oral anticoagulant (nicoumalone) treatment, stabilised over five days before surgery and continuing into the second postoperative week. The other patients served as two contrast groups and were managed on a double-blind basis. Group 2 received a subcutaneous low-dose regimen of heparin calcium. Group 3 received subcutaneous saline. Eleven of 48 patients in the saline group, three of 49 patients in the heparin group, and three of 48 patients in the oral anticoagulant group developed DVT as judged by 1251-fibrinogen scanning. The incidences in groups 1 and 2 were significantly lower than in the saline group. The falls in haemoglobin concentration and incidence of haemorrhage were similar in all three groups.The study showed that oral anticoagulant prophylaxis stabilised preoperatively and low-dose heparin were equally effective in preventing deep vein thrombosis in a

American Heart Association/American College of Cardiology Foundation Guide to Warfarin Therapy

“…191,192 The risk of clinically im-portant bleeding at this intensity is modest. A very low fixed dose of warfarin (1 mg daily) prevented subclavian vein thrombosis in patients with malignancy who had indwelling catheters.…”

Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

“…Such comparisons need to be interpreted more cautiously than direct comparisons ( Figure 13) because there is some potential for bias as patients in the trials had different reasons for being at risk of venous thrombosis. Fifteen trials 71,[74][75][76][77][78][79][80][81][82][83][84][85][86][87] had compared an oral anticoagulant regimen versus control, with nine [74][75][76][77][78][79][80][81][82] assessing oral anticoagulant as monotherapy and six 71,[83][84][85][86][87] as adjunctive therapy. Overall, the reduction in DVT appeared similar for moderate and lowintensity regimens, but too few patients had been assessed in trials of very low-intensity regimens for conclusions to be drawn.…”

Experience Always Wins the Day: Measure of Warfarin Anticoagulation Efficiency in the Internal Medicine Clinic

“…The purpose of this study was to determine if a "lower intensity anticoagulation" (INR between 2.0 and 2.3) compared to "moderate intensity anticoagulation" (INR between 2.5 and 4.1) would diminish the bleeding risk without reducing effectiveness for treatment of deep vein thrombosis (DVT). Other studies, done with the same purpose, showed a reduction in bleeding events while maintaining effectiveness for thrombosis prevention and treatment and systemic embolism in tissue heart valves and atrial fibrillation with less intense anticoagulation [13][14][15][16]. One of the earlier studies even showed effectiveness of anticoagulant therapy at range of INR between 1.6 and 2.5 for the treatment of acute myocardial infarction.…”