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November 4, 1988

Low-Molecular-Weight Heparin for Deep Venous Thrombosis

Author Affiliations

Centre Hospitalier Regional de Besancon Besancon, France

Centre Hospitalier Regional de Besancon Besancon, France

JAMA. 1988;260(17):2507. doi:10.1001/jama.1988.03410170055022

To the Editor.—  It has been observed recently that venous thrombus extension occurs more frequently in patients with acute deep venous thrombosis (DVT) treated with intravenous standard heparin compared with subcutaneous standard heparin.1,2 Moreover, venous thrombolysis was achieved more frequently with subcutaneous heparin therapy. Previous reports on the use of low-molecular-weight heparin (LMWH) in the initial treatment of DVT have shown an efficacy similar to subcutaneous heparin treatment.1,3,4 Data reported by Vitoux and colleagues,5 while confirming that heparin therapy did not prevent thrombus extension in some cases, did not give evidence for the real efficacy of LMWH.Furthermore, the study by Vitoux et al fails to comment on certain clinical aspects of LMWH use in acute DVT. For example, the high incidence of thrombus extension and the absence of thrombus reduction on phlebography performed on the eighth day may have been different if subcutaneous LMWH had been