The American College of Chest Physicians recommends therapeutic doses of intravenous unfractionated heparin, low-molecular-weight
heparin, or fondaparinux for initial treatment of UEVT, followed by at least 3 months of treatment with a vitamin K antagonist.
A group of cardiologists and cardiovascular medicine specialists from the US, Europe, and Canada discuss therapies individually and in combination, including fibrinolytic agents; antiplatelet therapies like aspirin, thieneopyridines, and glycoprotein IIb/IIIa inhibitors; anticoagulant therapies such as unfractionated heparin, low-molecular-weight
heparins, direct thrombin inhibitors, and synthetic factor X inhibitors; and therapies for non-ST-segment elevation ACS and ST-segment elevation myocardial infarction.
As expected, the new guidelines reaffirm the position of the American College of Chest Physicians that aspirin alone is not sufficient therapy to prevent venous thromboembolism in any patient population, because more effective alternatives are available, including heparin, low-molecular-weight
heparin, and a synthetic, selective factor Xa inhibitor, fondaparinux, which was approved by the FDA in 2001.
Compared with unfractionated heparin, low-molecular-weight
heparin (LMWH) is associated with a reduced risk of major bleeding and mortality in the treatment of DVT, and as such "should be used whenever possible for the initial inpatient treatment" of these patients, according to the treatment guidelines (Ann.
The drugs examined were heparin, low-molecular-weight
heparin and glycoprotein lib-Ilia blockers (superaspirins).
Further analysis determined that only half of these at-risk patients (17,732) received ACCP-recommended types of prophylaxis, which include low-dose unfractionated heparin, low-molecular-weight
heparin, graduated compression stockings, and/or intermittent pneumatic compression devices.
In 10 trials directly comparing low-molecular-weight with unfractionated heparin, low-molecular-weight
heparin reduced risk of DVT (RR=0.
These important questions are answered in a guideline developed by a committee of the American College of Chest Physicians, which considered the following prophylaxis recommendations: early ambulation, aspirin, graduated compression stockings, intermittent pneumatic compression, low-dose unfractionated heparin, low-molecular-weight
heparin, or oral antithrombotic agents.