TREATMENT OF PROXIMAL DEEP VENOUS THROMBOSIS WITH LOW MOLECULAR WEIGHT HEPARIN (ENOXAPARIN) (EARLY RESULTS)
MEHMET KURTOĞLU, KEMAL DOLAY, RECEP GÜLOĞLU, CEMALETTİN ERTEKİN, AHMET NECEFLİ
İstanbul Üniversitesi İstanbul Tıp Fakültesi, Genel Cerrahi ABD İSTANBUL
The aim of the study is to evaluate the efficacy and safety of low molecular weight heparin (LMWH) in the initial treatment of deep venous thrombosis. Despite heparin and oral anticoagualant therapy, pulmonary embolism (PE) which can result in death and chronic venous insufficiency as a result of recurrent deep venous thrombosis (DVT) can develop in patients with DVT. Furthermore, high dose unfractionated heparin (UFH) and oral anticoagulant therapy causes major bleeding and rarely, severe thrombocytopenia. Recently, many studies suggested the use of LMWH in the treatment of DVT. One hundred patients with DVT were included in this study between October 1996 and April 1998. The diagnoses were established by means of dupplex sonography. Enoxaparin was initiated with a dose of 2 mg/kg/day (200 anti-factor Xa units) subcutaneously divided equally into two injections and was continued 5 days. On the second day of the treatment, warfarin sodium was initiated with a dose of 10 mg. twice a day and was continued three months so that the INR would be 2.5-3. The patients were examined daily for symptoms and signs of PE and bleeding. Anti-thrombin III (AT-III), protein C, protein S, antikardiolipin antibodies (ACA) were assessed in every patient. Patients were released from the hospital using elastic socks covering below the knee and INR assays were performed every ten days. Forty-eight (48%) of the patients were male, 52 (52%) of them were female and the mean age was 51 (range; 16-82 ).The thrombus was located in iliofemoral or iliofemoropopliteal veins in 89 (89%) patients and solely in the popliteal vein in 11 (11%) patients. AT-III was found to be low in 11 cases, Protein C in 13 cases. Despite venous thromboembolectomy, limited amputation was necessary in one patient with phlegmia cerulae dolens. No thrombus extention was detected in control dupplex sonography performed at 7th day and thrombus regression was detected in 17 patients. All patients except 1 improved clinically. No bleeding due to enoxaparin was seen, however bleeding due to warfarin were observed in 5 (5%) patients. Non-fatal PE developed in 2 (2%) patients. One patient with dilated cardiomyopathy died. We believe that the use of LMWH (enoxaparin) in the treatment of DVT does not require daily laboratory monitoring and it is easy to administer, safe and efficient.
Keywords: DEEP VENOUS THROMBOSIS, LOW MOLECULAR WEIGHT HEPARINS, ENOXAPARIN