Comparison of unfractionated heparin vs low molecular weight heparin in the treatment of acute deep vein thrombosis

ABSTRACT

To compare the results of unfractionated heparin [UFH] with low molecular weight heparin in the treatment of acute deep vein thrombosis of lower limb. Randomized control trial. Bolan Medical Complex Hospital, Quetta from January 2002 to July 2003. Thirty patients who presented with acute deep vein thrombosis of lower limb, confirmed by either Doppler ultrasonography or venography, were selected for the study. Patients were divided randomly into two groups for treatment. Group 1 was started with unfractionated heparin while group 2 with low molecular weight heparin. Comparison of two treatments to determine the efficacy was done by certain criteria like pain improvement, reduction in swelling, alteration in bleeding profile, complications of therapy, recurrence, morbidity and mortality. The age of the patients ranged from 16-82 years. There were 15 females [50.00%] and 15 males [50.00%]. Pain and swelling were present in all patients [100%], while temperature and superficial vein dilation in 43.3% and 30% respectively. The distribution of DVT in left lower limb was in 13 patients [43.33%], right lower limb involvement in 12 patients [40.00%] and both limbs involvement in 5 patients [16.67%]. In group 1 improvement in pain occurred after 4th day in 13 patients, while in group 2 before 4th day in 8 patients [p-value=0.068]. Improvement in swelling was observed after 6th day in 11 patients [group 1], while before 6th day in 8 patients [group 2] [p-value=0.171]. Bleeding time was prolonged in 5 patients in group1and statistically found significant [p-value=0.014], while in group 2 it was normal. Thromboembolism in 3 patients and major bleeding was observed in 2 patients in group 1, while in group 2 it was normal. Recurrence was reported in 2 patients in group 1 and 1 patient in group 2 [p-value 0.0815]. The hospital stay was more than 10 days in group1 [12 patients], and less than 10 days in group 2 [13 patients]. It was found statistically significant [p-value=0.001]. Three patients died in group 1, while no mortality was observed in group 2. Treatment with low melecular weight heparin [LMWH] has good patient compliance and is easy to administer. LMWH has an advantage over UFH due to its normal bleeding profile and significantly less hospital stay