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Deep vein thrombosis

Prevalence
Clinical features
Differential diagnosis
Investigations
Therapy
Prevention
Prognosis
Therapy

Give a low molecular weight heparin (LMWH) a (e.g. tinzaparin 175 units/kg subcutaneously) whilst waiting for the results of investigations. 
No monitoring is necessary for LMWH. d  

Why?

  • It is more effective than unfractionated heparin. a
  • It causes fewer bleeds than unfractionated heparin. a
  • It is as more cost-effective than intravenous unfractionated heparin. a

LMWH and warfarin reduces death and causes less bleeding than heparin and warfarin

Patient Treatment Comparison Outcome CER OR
(95% CI)
NNT
(95% CI)
venous thromboembolism a LMWH and warfarin heparin and warfarin death
at 3-6 months
5.7% 0.74
(0.57 to 0.98)
59
(35 to 780)
      major bleed
at 3-6 months
2.0% 0.55
(0.34 to 0.89)
115
(78 to 472)
cancer and venous thromboembolism a LMWH and warfarin heparin and warfarin death
at 3-6 months
24% 0.53
(0.33 to 0.85)
10
(7 to 35)
 

 

Expiry date: January 2004
Levels of Evidence used in grading these guides

Author   C   Ball
Reviewer   J   Ginsberg
CAT Writers   C   Ball , B   Phillips