Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism.

The standard initial treatment of hemodynamically stable patients with pulmonary embolism is intravenous unfractionated heparin, requiring laboratory monitoring and hospitalization. We conducted a randomized, open-label trial involving 2213 patients with acute symptomatic pulmonary embolism to compare the efficacy and safety of the synthetic antithrombotic agent fondaparinux with those of unfractionated heparin and to document noninferiority in terms of efficacy. Patients received either fondaparinux (5.0, 7.5, or 10.0 mg in patients weighing less than 50, 50 to 100, or more than 100 kg, respectively) subcutaneously once daily or a continuous intravenous infusion of unfractionated heparin (ratio of the activated partial-thromboplastin time to a control value, 1.5 to 2.5), both given for at least five days and until the use of vitamin K antagonists resulted in an international normalized ratio above 2.0. The primary efficacy outcome was the three-month incidence of the composite end point of symptomatic, recurrent pulmonary embolism (nonfatal or fatal) and new or recurrent deep-vein thrombosis. Forty-two of the 1103 patients randomly assigned to receive fondaparinux (3.8 percent) had recurrent thromboembolic events, as compared with 56 of the 1110 patients randomly assigned to receive unfractionated heparin (5.0 percent), for an absolute difference of -1.2 percent in favor of fondaparinux (95 percent confidence interval, -3.0 to 0.5). Major bleeding occurred in 1.3 percent of the patients treated with fondaparinux and 1.1 percent of those treated with unfractionated heparin. Mortality rates at three months were similar in the two groups. Of the patients in the fondaparinux group, 14.5 percent received the drug in part on an outpatient basis. Once-daily, subcutaneous administration of fondaparinux without monitoring is at least as effective and is as safe as adjusted-dose, intravenous administration of unfractionated heparin in the initial treatment of hemodynamically stable patients with pulmonary embolism.

Büller HR ，Davidson BL ，Decousus H ，Gallus A ，Gent M ，Piovella F ，Prins MH ，Raskob G ，van den Berg-Segers AE ，Cariou R ，Leeuwenkamp O ，Lensing AW ，Matisse Investigators ... -  《-》

Effects of a low-molecular-weight heparin on thrombus regression and recurrent thromboembolism in patients with deep-vein thrombosis.

Breddin HK ，Hach-Wunderle V ，Nakov R ，Kakkar VV ，CORTES Investigators. Clivarin: Assessment of Regression of Thrombosis, Efficacy, and Safety ... -  《NEW ENGLAND JOURNAL OF MEDICINE》

Subcutaneous adjusted-dose unfractionated heparin vs fixed-dose low-molecular-weight heparin in the initial treatment of venous thromboembolism.

Prandoni P ，Carnovali M ，Marchiori A ，Galilei Investigators ... -  《ARCHIVES OF INTERNAL MEDICINE》

Treatment of venous thromboembolism in patients with cancer: subgroup analysis of the Matisse clinical trials.

van Doormaal FF ，Raskob GE ，Davidson BL ，Decousus H ，Gallus A ，Lensing AW ，Piovella F ，Prins MH ，Büller HR ... -  《THROMBOSIS AND HAEMOSTASIS》

Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group.

Koopman MM ，Prandoni P ，Piovella F ，Ockelford PA ，Brandjes DP ，van der Meer J ，Gallus AS ，Simonneau G ，Chesterman CH ，Prins MH ... -  《NEW ENGLAND JOURNAL OF MEDICINE》