Subcutaneous administration of heparin a randomised comparison with intravenous administration of heparin to patients with deep-vein thrombosis

Subcutaneous Heparin Treatment of Deep Venous Thrombosis: A Comparison of Unfractionated and Low Molecular Weight Heparin

“…Monitoring, especially using chromogenic substrate (CS) assays, may increase the efficacy and safety of heparin treatment [1,2]. Continuous intrave nous infusion is preferred by most clinicians, but subcutaneous administration of heparin has also been shown to be useful in the treat ment of DVT and is comparable to intrave nous infusions [3][4][5] in efficacy.…”

Treatment of Proximal Deep-Vein Thrombosis Using Subcutaneously Administered Calcium Heparin: Comparison with Intravenous Sodium Heparin

“…25% developed recur rent venous thromboembolism during the first 12 weeks of anticoagulation therapy. Other authors have noted that patients given SC heparin frequently have a subtherapcutic anticoagulant response at the end of the first day of treatment [7,12], Thus, a major con cern regarding SC dosing of heparin is whether an adequate anticoagulant response can be readily achieved within the first 24 h of therapy.…”

“…A number of randomized, prospective studies have been published that have com pared SC administration of heparin to IV infusion in the treatment of acute DVT [7][8][9][10][11][12], Most of the studies have shown either no clinically significant difference between the two methods of administering heparin [7,12], or evidence favoring SC dosing [9][10][11], Hull et al [8], however, reported that 73% of patients who were given SC sodium heparin using a fixed dosing protocol had a subtherapeutic anticoagulant response by the end of the first 24 h of treatment, and among the subset of patients who failed to achieve a ther apeutic anticoagulant response during the first day of treatment. 25% developed recur rent venous thromboembolism during the first 12 weeks of anticoagulation therapy.…”

“…First, pa tients who were randomized to receive SC cal cium heparin were given 3 injections every day rather than 2 injections every day in order to facilitate more rapid adjustment in the dose; previous studies evaluating SC adminis tration of heparin have generally treated pa tients every 12 h [6][7][8][9][10], Second, empiric dos ing was used, which allows for substantial changes in the dose of heparin administered based on the anticoagulant response.…”

“…Because IV infu sion equipment is not necessary, delivery of the drug is less costly and easier for both the patient and the nursing staff [3]. Once a steady state has been reached, serum levels of heparin and the APTT are steady over an 8-hour time period [4], A major problem with SC heparin admin istration is the wide intersubject variation in the rate and extent of absorption [5][6][7], Thus, when an initial dose in the range of 12,500-15,000 U is given every 12 h, some patients fail to achieve a therapeutic APTT above 1.5 times the laboratory control even after 2-3 days of treatment [7,8]. In a study by Hull et al [8], failure to attain a therapeutic anticoag ulant effect was associated with an unaccepta bly high frequency (25%) of acute venous thromboembolism in a 3-month period fol lowing initiation of therapy.…”