Treatment of Deep Vein Thrombosis with Low-Molecular-Weight Heparins: A Consensus Statement of the Gesellschaft für Thrombose-und Hämostaseforschung (GTH)

Abstract

Recent studies have led to a new concept for the management of deep vein thrombosis. The German Society on Thrombosis and Haemostasis decided to work up the clinical studies in this field published until June 1996 for a consensus statement. The consensus group concluded that (1) high-dose, APTT-controlled subcutaneous administration of unfractionated heparin is as effective as high-dose, APTT-controlled continuous intravenous infusion of unfractionated heparin (grade B recommendation); (2) the anticoagulation with heparin may start at day 1 or 2, overlapping with oral anticoagulants for 7 to 10 days (grade C recommendation); (3) high-dose subcutaneous low-molecular-weight heparins are almost as effective and safe as continuous intravenous infusion of unfractionated heparins (grade B recommendation); (4) no agreement was obtained for the other concomitant treatments of DVT, such as duration of bed rest, use of antiphlogistic drugs, whether LMW heparins are comparable, and whether outpatient treatment can be recommended using LMW heparins.

Dosing and Monitoring of Low‐Molecular‐Weight Heparins in Special Populations

“…18 Although controversial, special circumstances that may warrant anti-Xa activity monitoring include renal or hepatic insufficiency, extremes of body weight (< 40 kg, > 150 kg), newborns and children, pregnancy, prolonged therapy (> 7-10 days), and the presence of other factors that may increase the risk of bleeding complications such as recent trauma or surgery. 5,10,[22][23][24] Although appropriate timing, frequency, and desired therapeutic range of anti-Xa activity are not clearly defined and remain controversial, peak anti-Xa activity (4 hrs after subcutaneous injection) generally is considered a more useful predictor of LMWH safety and efficacy than trough (just before dose) activity. 18 For prevention of venous thromboembolism (VTE), a peak anti-Xa level of 0.1-0.2 U/ml 4 hours after subcutaneous injection of an LMWH is recommended.…”

“…102 Several authors suggested that patients with extremes of body weight, often stated as total body weight below 40 kg or above 150 kg, should have periodic monitoring of anti-Xa activity during prophylactic or therapeutic treatment with LMWHs. 5,18,23,24 Unfortunately, few randomized, controlled trials evaluating the effect of weight, height, body surface area (BSA) or body mass index (BMI) and the occurrence of clinically significant bleeding complications or thrombotic events are found in the literature.…”

Evidence‐based medicine: a Kuhnian perspective of a transvestite non‐theory

“…While it is conceivably true that some (or even many) patients with DVT can be safely treated at home with LMWH, we remain ignorant about which particular patients they are. Last, but not least, the conclusions of Levine and Koopman are not corroborated by pathophysiological principles and are clearly rejected by expert opinion, expressed in consensus reports (Harenberg 1997).…”

Notf�lle in der Phlebologie

“…Standardtherapie der TVT ist heute die Behandlung mit niedermolekularem Heparin (NMH) in einer körpergewichtsad-aptierten Dosis, je nach Präparat 1-mal oder 2-mal täglich subkutan [15,26,27,39] (⊡ Tabelle [39]. Nach stabilem Erreichen eines therapeutischen INR-Wertes kann Heparin abgesetzt werden.…”