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This Week in JAMA
August 23/30, 2006

This Week in JAMA

JAMA. 2006;296(8):899. doi:10.1001/jama.296.8.899

Patients with acute venous thromboembolism (VTE) are often hospitalized for initial treatment with intravenous unfractionated heparin and coagulation monitoring by activated partial thromboplastin time (APTT). Subcutaneously administered low-molecular-weight heparin can be used in the outpatient setting and does not require APTT monitoring, which reduces costs. The Fixed-Dose Heparin trial compared the safety and efficacy of 2 treatment regimens intended for acute inpatient or outpatient treatment of VTE: fixed-dose weight-adjusted unfractionated heparin and fixed-dose weight-adjusted low-molecular-weight heparin, each combined with warfarin therapy for 3 months. In this randomized adjudicator-blinded trial reported by Kearon and colleagues,Article similar low rates of recurrent VTE and major bleeding and comparable rates (about 70%) of outpatient treatment were achieved with either treatment. In an editorial, CarsonArticle discusses the importance of assessing these treatment protocols in a double-blinded trial to ensure that safety and efficacy are not compromised by cost concerns.