A recent study of 708 patients proved that fixed-dose subcutaneous unfractionated heparin (UFH) was as safe and effective as low-molecular-weight heparin (LMWH) in patients with acute venous thromboembolism (VTE) in the outpatient setting. Patients received either an initial dose of 333 units/kg UFH, followed by 250 units/kg every 12 hours, or 100 IU/kg LMWH (enoxaparin or dalteparin) every 12 hours. The percentage of patients with recurrent VTE was similar in both groups, as were rates of major bleeding, within the first 10 days of treatment. Treatment was administered entirely on an outpatient basis for the majority of patients.
LMWH is commonly used in outpatients to treat acute, uncomplicated episodes of VTE. LMWH is expensive, however, and many patients cannot afford the cost of the drug. The results of this study indicate that UFH may offer a less expensive alternative for treatment. Additional studies are needed to verify these results and further define the role of UFH in outpatient management of VTE.
Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.