Sefer USTA, Ergün HALİLOĞLU, Özgür SAYIL, Mehmet ÖZKAN

Akut derin ven trombozunun uzun süreli tedavisinde düşük molekül ağırlıklı heparin ile oral antikoagülanların karşılaştırılması

Amaç: Bu çalışmada kiloya göre ayarlanmış dozlarda subkütan düşük molekül ağırlıklı heparin (DMAH) uygulanmasının, sekonder derin ven trombozu (DVT) profilaksisinde oral antikoagülan (OA) ile karşılaştırarak etkinlik ve güvenirliliği belirlendi. Çalışma planı: Alt ekstremite akut DVT’si objektif olarak belgelenen ardışık semptomatik 40 hasta çalışmaya dahil edildi. Hastalar DMAH ve OA grubu olarak ayrıldı. Her iki grupta da ilk yedi gün DMAH tedavisi kullanıldı. Bundan sonra, bir grup, sadece DMAH almaya devam ederken, diğer grup OA eklenmesi ile tedaviye devam etti. Bulgular: Her iki grupta da ölümcül kanama komplikasyonu yoktu. Kırk hastanın hiçbirinde mortalite görülmedi. DMAH grubunda dört hastada (%20), OA grubunda altı hastada (%30) venöz yetmezlik gelişti. Altı aylık izlem sürecinde DMAH grubunda 20 hastadan ikisinde, OA grubunda 20 hastadan dördünde tekrarlayan tromboz gelişti. Bu durum istatistiksel olarak anlamlı bulunmadı. Sonuç: Çalışmamızda akut DVT’nin sekonder profilaksisinde, laboratuvar takibi yapmadan subkütan DMAH kullanımının etkili ve güvenli olduğu gösterildi.

A comparison of low-molecular-weight heparin and oral anticoagulants in the long-term treatment of acute deep venous thrombosis

Background: In this study, the efficacy and safety of weight-adjusted doses of subcutaneous low-molecularweight heparin (LMWH) in the secondary prophylaxis of deep vein thrombosis (DVT) were determined in comparison with oral anticoagulants (OA). Methods: Forty consecutive symptomatic patients with objectively documented acute DVT of the lower extremities were included in the study. The patients were divided into LMWH and OA groups. Both groups used LMWH during the first seven days of treatment. Thereafter, one group continued to receive only LMWH while the other group continued that treatment with the addition of OA. Results: There were no fatal bleeding complications in either group. Mortality was not observed in any of the 40 patients. Venous insufficiency developed in four (20%) patients in the LMWH group and in six (30%) patients in the OA group. During the six-month follow-up, recurrent thrombosis developed in two patients in the LMWH group and in four patients in the OA group. This was not found to be statistically significant. Conclusion: In our study, the use of subcutaneous LMWH without laboratory monitoring has been shown to be effective and safe for the secondary prophylaxis of acute DVT.

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