Warfarin Sodium versus Low-Dose Heparin in the Long-Term Treatment of Venous Thrombosis

Authors:
  • RHRussell Hull
    Russell Hull
  • TDTerry Delmore
    Terry Delmore
  • EGEdward Genton
    Edward Genton
  • JHJack Hirsh
    Jack Hirsh
  • MGMichael Gent
    Michael Gent
  • DSDavid Sackett
    David Sackett
  • DMDermot McLoughlin
    Dermot McLoughlin
  • PAPeter Armstrong
    Peter Armstrong
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Abstract
Acute deep-vein thrombosis is usually treated with intravenous heparin for a number of days, then with oral anticoagulants for weeks to months. We have compared adjusted-dose warfarin sodium with fixed low-dose subcutaneous heparin in the prevention of recurrent deep-vein thrombosis. Sixty-eight patients with acute deep-vein thrombosis confirmed by venography were treated with intravenous heparin and then randomized to secondary prophylaxis. Nine of 35 patients receiving subcutaneous heparin, but none of 33 receiving warfarin sodium, had new episodes of objectively documented venous thromboembolism (P = 0.001). Seven patients on warfarin sodium experienced bleeding complications (of which four were major), as compared with no patients receiving subcutaneous heparin (P<0.005). Thus, adjusted-dose warfarin sodium is more effective than low-dose subcutaneous heparin in preventing recurrent venous thromboembolism, but its use is accompanied by a significant risk of bleeding. (N Engl J Med 301:855–858, 1979)