[Treatment of submasive pulmonary embolism with low-molecular-weight heparin]

[D-dimer levels in venous thromboembolism]

Venous thromboembolism (VTE) is associated with substantial morbidity and mortality. The clinical signs and symptoms are unspecific, widely varying from asymptomatic to sudden death. The diagnostic algorithm of VTE is an evolving field, in which D-dimers (DD) determination has been used as one of the preferred screening tests. Clinical management studies are clarifying the role of DD in the diagnostic paradigm of VTE. Published reports support the use of plasma DD determination in patients with a low clinical probability of VTE. Patients with moderate or high clinical probability of VTE show a higher probability of false negative plasma DD values. This fact forces the clinician to use more complex diagnostic test in order to either confirm or exclude VTE. A variety of different qualitative and semi-quantifiable assays are available for plasma DD determination. There is a wide variation in performance and there are discrepancies in the comparability of the different assays. Therefore, in order to both appropriately incorporate plasma DD determination in the diagnostic strategies of VTE and to reduce unnecessary investigations, clinicians should ensure that they are familiar with the diagnostic performance of the assay used in their own institution allowing a safer and cost-effective procedure.

[Multicenter, prospective study comparing enoxaparin with unfractionated heparin in the treatment of submassive pulmonary thromboembolism]

OBJECTIVE

To compare the safety and efficacy of enoxaparin and unfractionated heparin in the treatment of submassive pulmonary thromboembolism (PTE).

MATERIAL AND METHODS

Fifty-six patients with PTE who did not need fibrinolytic treatment were enrolled prospectively. The patients were randomly assigned to 2 treatment groups: Group A received enoxaparin (1 mg/kg every 12 hours) and Group B received adjusted doses of unfractionated heparin. The oral anticoagulant therapy was started on confirmation of the diagnosis and continued for 6 months. Incidences of recurrence of thromboembolism and of severe bleeding were assessed at the end of this period.

RESULTS

Six patients were withdrawn from the study. Twenty-nine of the 50 remaining patients were in Group A (enoxaparin) and 21 in Group B (unfractionated heparin). A recurrence of thromboembolism was diagnosed in 3 patients from Group A (10.7%) and 2 patients from Group B (9.5%). There were no significant differences. Two patients died, one death being attributed to bleeding secondary to the oral anticoagulant treatment (Group A) and the other to a process unrelated to PTE.

CONCLUSIONS

Enoxaparin seems to be as effective and safe as unfractionated heparin in the initial treatment of PTE.