Original Article

Low-Molecular-Weight Heparin in the Treatment of Patients with Venous Thromboembolism

The Columbus Investigators

N Engl J Med 1997; 337:657-662September 4, 1997

Abstract

Background

Low-molecular-weight heparin is known to be safe and effective for the initial treatment of patients with proximal deep-vein thrombosis. However, its application to patients with pulmonary embolism or previous episodes of thromboembolism has not been studied.

Full Text of Background...

Methods

We randomly assigned 1021 patients with symptomatic venous thromboembolism to fixed-dose, subcutaneous low-molecular-weight heparin (reviparin sodium) or adjusted-dose, intravenous unfractionated heparin. Oral anticoagulant therapy with a coumarin derivative was started concomitantly and continued for 12 weeks. Approximately one third of the patients had associated pulmonary embolism. The outcome events studied over the 12 weeks were symptomatic recurrent venous thromboembolism, major bleeding, and death. We sought to determine whether low-molecular-weight heparin is at least equivalent to unfractionated heparin in patients with venous thromboembolism.

Full Text of Methods...

Results

Twenty-seven of the 510 patients assigned to low-molecular-weight heparin (5.3 percent) had recurrent thromboembolic events, as compared with 25 of the 511 patients assigned to unfractionated heparin (4.9 percent). The difference of 0.4 percentage point indicates that the two therapies have equivalent value according to our predetermined definition of equivalence. Sixteen patients assigned to low-molecular-weight heparin (3.1 percent) and 12 patients assigned to unfractionated heparin (2.3 percent) had episodes of major bleeding (P = 0.63), and the mortality rates in the two groups were 7.1 percent and 7.6 percent, respectively (P = 0.89).

Full Text of Results...

Conclusions

Fixed-dose, subcutaneous low-molecular-weight heparin is as effective and safe as adjusted-dose, intravenous unfractionated heparin for the initial management of venous thromboembolism, regardless of whether the patient has pulmonary embolism or a history of venous thromboembolism.

Full Text of Discussion...

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Media in This Article

Table 1Base-Line Characteristics of the Study Patients.

Table 2Data on the Initial Heparin Treatment, Hospitalization, and Oral Anticoagulant Therapy.

Article Activity

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Article

In Western countries, each year 2 to 4 persons per 1000 require anticoagulant therapy for symptomatic deep-vein thrombosis or pulmonary embolism.1-3 Although deep-vein thrombosis and pulmonary embolism were previously regarded as separate clinical entities, there is good evidence that they are expressions of a single disease process — namely, venous thromboembolism.4-6

Until recently, the standard treatment of patients with venous thromboembolism was hospital admission, with unfractionated heparin given by intravenous infusion for 5 to 10 days, followed by oral anticoagulant therapy for at least 3 months.7,8 Because patients vary widely in their anticoagulant response to unfractionated heparin, frequent laboratory monitoring with appropriate dose adjustment is needed to keep their level of anticoagulation in the therapeutic range. In contrast, the longer half-life of low-molecular-weight heparins and the more predictable anticoagulant response make them suitable for subcutaneous administration without laboratory monitoring.

Initial trials in hospitalized patients with proximal deep-vein thrombosis showed that low-molecular-weight heparin in a dose determined by body weight alone is at least as effective and safe as unfractionated heparin.9,10 Two further recent trials have had similar results when low-molecular-weight heparin was given mainly on an outpatient basis to suitable patients with proximal deep-vein thrombosis.11,12 However, using due caution, these studies excluded patients with symptoms of pulmonary embolism and some patients with a history of venous thromboembolism, because such patients are thought to have more serious thromboembolic disease. Before the widespread use of low-molecular-weight heparin is recommended, the effectiveness of these agents in treating the full spectrum of patients with venous thromboembolism must be confirmed.

We report the results of a large, open, international, randomized clinical trial designed to determine whether fixed-dose, subcutaneous low-molecular-weight heparin and adjusted-dose, continuous intravenous unfractionated heparin have at least equivalent efficacy in unselected patients with symptomatic venous thromboembolism. We studied the clinical outcomes of recurrent venous thromboembolism, hemorrhage, and death during 12 weeks of follow-up, with blinded validation of outcome events by a central adjudication committee.

Methods

Study Patients

Consecutive patients with acute, symptomatic deep-vein thrombosis, pulmonary embolism, or both who were considered to require antithrombotic therapy were eligible for the study. The symptomatic deep-vein thrombosis could be limited to the calf or could involve the popliteal vein or a more proximal vein; the diagnosis had to be documented by ultrasonography or venography. Clinically suspected pulmonary embolism was confirmed by ventilation–perfusion lung scanning that showed a high probability of pulmonary embolism or by pulmonary angiography or, if lung scanning was nondiagnostic, by the demonstration of deep-vein thrombosis on compression ultrasonography or venography.5,6

Patients who met these criteria for inclusion were ineligible for the study if they had received therapeutic doses of low-molecular-weight heparin, unfractionated heparin, or oral anticoagulant therapy for more than 24 hours; if anticoagulant therapy was contraindicated; if thrombolytic therapy was planned; if they had had gastrointestinal bleeding in the preceding 14 days; if they had undergone surgery requiring anesthesia within the previous 3 days; if they had had a stroke in the preceding 10 days; if the platelet count was less than 100,000 per cubic millimeter; if they weighed less than 35 kg; if they were less than 18 years old; if they had a documented pregnancy or had childbearing potential but were not using adequate contraception; or if they were in a location that made follow-up difficult. Patients were enrolled whether venous thromboembolism developed in the hospital or while the patients were outpatients. The feasibility of treatment at home was not considered in assessing eligibility. After the patient gave informed consent, randomization (stratified according to whether the patient presented with deep-vein thrombosis only or with pulmonary embolism, and also stratified according to clinical center) was performed with a computer algorithm and the use of a central 24-hour telephone service that recorded information on the patient before the treatment assignment was disclosed. The study protocol was approved by the institutional review boards of all the clinical centers.

Treatment Regimens

The patients randomly assigned to low-molecular-weight heparin received reviparin sodium (Clivarin, Knoll, Ludwigshafen, Germany), administered subcutaneously in the following fixed doses: 6300 anti–factor Xa units twice daily (according to the first international standard for low-molecular-weight heparin), for patients weighing more than 60 kg; 4200 units twice daily, for patients weighing 46 to 60 kg; and 3500 units twice daily, for patients weighing 35 to 45 kg. Patients could be treated at home, but the decision to do so was left to the treating physician. Patients who received some or all of their treatment at home were instructed by a nurse in the method of self-injection. When self-administration was not feasible, the injections were given by a relative or a nurse.

The patients randomly assigned to unfractionated heparin were treated in the hospital. They received an intravenous bolus injection of 5000 IU (Liquemin, Roche, Basel, Switzerland), followed by a dose of 1250 IU per hour given by continuous intravenous infusion and adjusted according to a nomogram.13 In practice, the clinical centers used an activated partial-thromboplastin time of 60 to 85 seconds as a target value or a fixed ratio of 1.5 to 2.5 times a control value.8 These tests were performed 6 to 12 hours after the start of treatment or 6 to 12 hours after a subtherapeutic activated partial-thromboplastin time was measured, and otherwise daily.

Oral anticoagulant treatment with a derivative of coumarin was begun on the first or second day and continued for a total of 12 weeks. During treatment with the study drug, prothrombin times were measured at least every other day, with the dose adjusted to achieve an international normalized ratio of 2.0 to 3.0. The study drug was discontinued when the international normalized ratio was maintained above 2.0 for two consecutive days and the patient had received the study drug for at least five days.

Surveillance and Follow-up

All the patients were contacted daily during the initial treatment, after 14 days, and after 12 weeks. At each visit, a checklist was used to elicit information on symptoms and signs of recurrent venous thromboembolism and bleeding. All the patients were instructed to report to the clinical center on an emergency basis if any new symptoms developed that were suggestive of deep-vein thrombosis or pulmonary embolism. In cases of suspected deep-vein thrombosis (for example, when there was increased pain or swelling in the leg) or pulmonary embolism (for example, when there was dyspnea or chest pain), the patients underwent appropriate diagnostic tests. The investigators were asked to report all clinically unusual episodes of bleeding.

During the initial treatment, platelet counts were obtained every third day. Hemoglobin and the hematocrit were measured, and platelet counts obtained, at base line and after 14 days.

Assessment of Clinical Outcomes

The principal outcome events were objectively confirmed symptomatic deep-vein thrombosis or pulmonary embolism and major bleeding within 12 weeks of randomization. Information on all suspected outcome events and deaths was reviewed and classified by a central adjudication committee whose members were unaware of the treatment assignments. A training session was held at the start of the study concerning the techniques and interpretation of the diagnostic tests used.

The criteria for the diagnosis of symptomatic deep-vein thrombosis were as follows: an extension of an intraluminal filling defect on a venogram; a new intraluminal filling defect or an extension of the nonvisualization of proximal veins in the presence of a sudden cutoff defect on a venogram that was seen on at least two projections; if no previous venogram was available for comparison, an intraluminal filling defect; if no venogram was available, abnormal results of compression ultrasonography in an area where compression had been normal or a substantial increase in the diameter of the thrombus during full compression at the popliteal or femoral vein11,12; or, if neither a venogram nor an ultrasonographic study was available, a change in the results of impedance plethysmography from normal to abnormal. The criteria for the diagnosis of symptomatic pulmonary embolism were as follows: a new intraluminal filling defect, an extension of an existing defect, or the sudden cutoff of vessels more than 2.5 mm in diameter on a pulmonary angiogram; if no prior angiogram was available, an intraluminal filling defect or a sudden cutoff of vessels more than 2.5 mm in diameter on a pulmonary angiogram; or if no pulmonary angiogram was available, a defect of at least 75 percent of a segment on the perfusion scan, with normal ventilation. If the ventilation–perfusion scan was nondiagnostic (and no pulmonary angiogram was available), satisfaction of the criteria for deep-vein thrombosis was acceptable; or pulmonary embolism could be demonstrated at autopsy. Only if no adequate objective tests had been performed did the adjudication committee base its final decision on the clinical information provided.

Bleeding was defined as major if it was clinically overt and associated with a fall in the hemoglobin level of at least 2.0 g per deciliter or a need for the transfusion of 2 or more units of red cells; if it was retroperitoneal or intracranial; or if it warranted the permanent discontinuation of treatment. Deaths were classified as due to pulmonary embolism (when there was substantive evidence), sudden death, hemorrhage, or another cause.

Statistical Analysis

On the basis of two recent studies comparing low-molecular-weight heparin with unfractionated heparin, we assumed a 7 percent incidence of recurrent venous thromboembolism with unfractionated heparin and a 20 percent reduction in the relative risk of recurrent venous thromboembolism associated with the use of low-molecular-weight heparin.11,12 On the basis of the previously observed absolute risk reduction of 12 percentage points associated with the use of unfractionated heparin as compared with placebo,14 we took an increase of 3 percentage points as the threshold value indicating clinical equivalence. From these assumptions, a study of 1000 patients would provide an 80 percent probability (power) of rejecting, with a one-sided test at a significance level of 0.05, the hypothesis that the rate of recurrence with low-molecular-weight heparin would be more than 3 percentage points higher than that with unfractionated heparin in the entire group of patients with venous thromboembolism.

The rates of recurrent venous thromboembolism were compared by the method of Blackwelder.15 This statistical test evaluates whether the observed difference excludes the specified threshold for equivalence. For the comparisons of subgroups, the chi-square test (two-sided) was used.

Results

Study Patients

The recruitment of patients began in November 1994 and ended in October 1995. The follow-up of the patients was completed in February 1996. A total of 1745 consecutive patients met the eligibility criteria, among whom 424 (24 percent) met one or more of the criteria for exclusion. The three most common reasons for the exclusion of patients were the use of therapeutic doses of low-molecular-weight heparin, unfractionated heparin, or oral anticoagulant therapy for more than 24 hours (200 patients); contraindications to anticoagulant therapy (68 patients); and difficulty with follow-up because of geographic location (59 patients). Only 12 patients with pulmonary embolism were excluded from the study because thrombolytic therapy was planned. Of the 1321 eligible patients, 1021 (77 percent) gave informed consent and were randomly assigned to low-molecular-weight heparin (510 patients) or unfractionated heparin (511). The base-line characteristics of the patients in the two treatment groups were similar, as Table 1Table 1Base-Line Characteristics of the Study Patients. shows.

Treatment and Follow-up

Data on the initial treatment, hospitalization, and oral anticoagulation are shown in Table 2Table 2Data on the Initial Heparin Treatment, Hospitalization, and Oral Anticoagulant Therapy.. The initial heparin treatment lasted approximately six days in both treatment groups, and the international normalized ratio was in the therapeutic range for similar proportions of time in the two groups. The mean hospital stay was three days less in the group assigned to low-molecular-weight heparin, mainly because 100 of the 372 patients with deep-vein thrombosis assigned to that group (27 percent) were not admitted to the hospital for treatment of their deep-vein thrombosis. Another 56 of the patients with deep-vein thrombosis in that group (15 percent) were discharged during the first three days of treatment. Compliance with treatment and with the study protocol was high, and no patient was lost to follow-up.

Recurrent Venous Thromboembolism

Among the 510 patients treated with low-molecular-weight heparin, 82 patients had a total of 98 episodes of clinically suspected recurrent venous thromboembolism. Of these episodes, 29 (in 27 patients, or 5.3 percent of the total) met the criteria for documented recurrent venous thromboembolism. Among the 511 patients treated with unfractionated heparin, 75 had a total of 88 suspected episodes that were adjudicated, and 30 episodes (in 25 patients, or 4.9 percent) met the criteria. The absolute difference of 0.4 percentage point between these rates indicates equivalence between the treatments, since it rules out an increase of 2.7 percentage points or more with low-molecular-weight heparin as compared with standard heparin at the 95 percent level of confidence (P = 0.030 for the comparison with the preset difference of 3 percentage points).

The majority of the recurrent venous thromboembolic events occurred during the first 14 days, and the risk of recurrence decreased over time (Table 3Table 3Rates of Recurrent Venous Thromboembolism, Major Bleeding, and Death during the Study.). In 17 of the 27 patients assigned to low-molecular-weight heparin who had recurrences, the event was symptomatic deep-vein thrombosis; in the unfractionated-heparin group, the corresponding number was 13 of 25. In all patients except one, recurrent episodes of venous thromboembolism were documented by objective tests or at autopsy. Adjustment by logistic-regression analysis for differences in age and in the frequency of recent surgery at base line did not alter the results of the study.

Bleeding Complications

Among the reported instances of clinically important bleeding, 93 were confirmed by the central adjudication committee, and 28 of them met the criteria for major bleeding. There were 46 events among the patients treated with low-molecular-weight heparin and 47 among those treated with unfractionated heparin; 16 and 12 of these, respectively, involved major bleeding. As Table 3 shows, the majority of instances of bleeding occurred during the first 14 days of the study.

Mortality

During the 12 weeks of follow-up, 75 patients (7.3 percent) died: 36 who were treated with low-molecular-weight heparin (7.1 percent) and 39 who were treated with unfractionated heparin (7.6 percent). The mortality rate remained fairly constant over time (Table 3). Among the 36 deaths of patients treated with low-molecular-weight heparin, 3 (on days 3, 4, and 35) were classified as due to pulmonary embolism and 3 (on days 18, 55, and 73) were considered sudden. There were no instances of fatal bleeding in this group. Among the 39 deaths in the unfractionated-heparin group, there were 3 fatal episodes of pulmonary embolism (on days 3, 24, and 64), 2 sudden deaths (on days 19 and 44), and 2 instances of fatal bleeding (on days 4 and 5). All six fatal episodes of pulmonary embolism occurred in patients who had pulmonary embolism at presentation.

Additional Observations

Among the 271 patients with pulmonary embolism at presentation, 16 had symptomatic recurrent venous thromboembolism (5.9 percent; 8 patients in each treatment group), as compared with 36 of the 750 patients presenting with deep-vein thrombosis only (4.8 percent; 19 patients treated with low-molecular-weight heparin and 17 treated with unfractionated heparin). Among the 16 patients presenting with pulmonary embolism who had recurrent thromboembolism, 11 (69 percent) had recurrences of pulmonary embolism, whereas pulmonary embolism occurred in only 11 of the 36 patients with deep-vein thrombosis at presentation (31 percent, P = 0.023). Among the 232 patients with cancer at base line, 20 (8.6 percent) had symptomatic recurrent venous thromboembolism, as compared with only 32 (4.1 percent) of the remaining 789 patients (P = 0.009). Forty-seven of the patients with cancer (20.3 percent) died, as compared with 28 (3.5 percent) of those without cancer (P<0.001).

The relative effects of low-molecular-weight heparin and unfractionated heparin with respect to the three major clinical outcomes were similar in all these subgroups. They were also similar in other subgroups, such as patients with a history of venous thromboembolism and patients without such a history.

Discussion

Previous randomized trials have shown that subcutaneous, low-molecular-weight heparin is likely to be at least as effective and safe as unfractionated heparin in treating patients with uncomplicated deep-vein thrombosis.16-18 However, because these trials did not include patients with pulmonary embolism and because some patients with a history of venous thromboembolism were excluded, clinicians may legitimately be concerned that the findings may not translate directly to their own clinical practice.19

We studied a broad range of patients, including a large subgroup with pulmonary embolism, in many hospitals in several countries. Unmonitored, subcutaneous low-molecular-weight heparin was shown to be an effective and safe treatment for patients with venous thromboembolism. We observed similar treatment effects in each of various sizable subgroups — patients with pulmonary embolism, cancer, or previous thromboembolism and those without each of these conditions. We also included patients with symptomatic calf-vein thrombosis, who would normally receive anticoagulant therapy, since it has been documented that such patients are at risk for recurrent venous thromboembolism if left untreated.20 Our predetermined criterion for equivalence between the treatments was an absolute increase in the recurrence rate of no more than 3 percentage points with low-molecular-weight heparin. Since our findings showed that there was no such difference, one may conclude that the treatments are equivalent for patients with venous thromboembolism. It should be understood that the study did not have the power to detect differences among subgroups of patients.

Thus, in terms of safety and efficacy, low-molecular-weight heparin offers an appropriate alternative to unfractionated heparin in patients with venous thromboembolism. In addition, low-molecular-weight heparin has several practical advantages. Since there is no need for laboratory monitoring or infusion, suitable patients can be treated at home, either throughout their care or after early discharge from the hospital.11,12 Those requiring hospital admission also benefit because they avoid the inconvenience and hazards of intravenous lines.

Because this was an open trial, care was taken to minimize the potential for bias. We included consecutive patients, used central randomization by telephone, and ensured that follow-up was complete for all randomized patients. Furthermore, all clinically suspected outcome events were assessed by an independent, blinded central adjudication committee on the basis of predetermined criteria.

Meta-analyses of early trials of low-molecular-weight heparins for the treatment of deep-vein thrombosis have suggested that, as compared with unfractionated heparin, these agents may be associated with reductions as large as 50 percent in the relative risk of recurrent thrombosis.16-18 Our findings are inconsistent with a reduction of this magnitude. Explanations for the apparent discrepancy, other than that it occurred by chance, include the possibility that low-molecular-weight heparins are associated with a more modest reduction, if any. This possibility is supported by two recent studies.11,12 It is noteworthy that the rates of recurrent venous thromboembolism with low-molecular-weight heparins in the various treatment trials are consistent, around 4 to 5 percent, whereas the rates among the groups treated with unfractionated heparin vary more widely; the latter variation may be due in part to differences in the regimens of unfractionated heparin in the different trials.9-12,21-24 The incidence of major bleeding reported for both groups in this study is consistent with that reported previously.16-18

Overall, the rates of recurrence we observed were low, whether patients were treated with low-molecular-weight heparin or with unfractionated heparin. In patients with cancer, however, the recurrence rate was doubled in both treatment groups, suggesting that anticoagulant therapy in these patients needs further improvement.

We conclude that low-molecular-weight heparin and unfractionated heparin are equally effective and safe in unselected patients with confirmed deep-vein thrombosis, with or without associated pulmonary embolism. In addition, low-molecular-weight heparin permits treatment regimens to be simplified so that hospital stays can be shortened and suitable patients can be treated outside the hospital.

Supported by a grant from Knoll AG, Ludwigshafen, Germany.

The Writing Committee of the Columbus Study (H.R. Büller, M. Gent, A.S. Gallus, J. Ginsberg, M.H. Prins, and R. Baildon) takes responsibility for the content of this article.

Source Information

Address reprint requests to Professor J.W. ten Cate, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam Zuid-oost, the Netherlands.

The institutions and investigators participating in the study are listed in the Appendix.

Appendix

In addition to the members of the Writing Committee, the following institutions and investigators participated in the study. Executive Committee: J.W. ten Cate, H.R. Büller, M. Gent, J. Hirsh, M.H. Prins, and R. Baildon; Adjudication Committee: A.W.A. Lensing, D.R. Anderson, and E.J.R. van Beek; Safety Committee: J.N. Fiesinger and J.G.P. Tijssen; Coordination and Data Management Centers: Academic Medical Center, University of Amsterdam, Amsterdam — A. van Barneveld, L.T. Eimers, Y.P. Graafsma, R. Hettiarachchi, B. Hutten, and K. Redekop; Hamilton Civic Hospitals Research Center, Hamilton, Ont., Canada — S. Haley, L. Liberale, T. Finch, S. Whittaker, and L. Wilkinson; Participating Centers (the number of patients contributed by the center follows the name of the center): Institute of Medical Semiotics, Padua, Italy (96) — P. Prandoni, S. Villalta, B. Girolami, P. Bagatella, L. Rossi, and A. Girolami; Medicina Interna e Oncologia Medica, Policlinico “San Matteo,” Pavia, Italy (81) — F. Piovella, M. Barone, C. Beltrametti, S. Serafini, S. Siragusa, and E. Ascari; Victoria Hospital and University of Western Ontario, London, Ont., Canada (75) — M.J. Kovacs, B. Morrow, and J. Kovacs; Academic Medical Center, University of Amsterdam, Amsterdam (71) — P.M.M. Kuijer, M.M.W. Koopman, and H. Jagt; Hamilton Civic Hospitals, Henderson General Division, Hamilton, Ont., Canada (53) — J. Weitz, C. Kearon, and L. Biagioni; Krankenhaus Bogenhaussen–Medizinische Poliklinik, Munich, Germany (52) — S. Haas, F. Lössner, F.A. Spengel, and M. Berger; Hôpital du Saint-Sacrement, Quebec, Que., Canada (51) — C. Demers and J. Poulin; University Hospital Groningen, Groningen, the Netherlands (41) — J. van der Meer, G.T.H. Que, and W.M. Smid; Victoria General Hospital, Halifax, N.S., Canada (38) — D.R. Anderson, K.S. Robinson, and E. Boyle; Montreal General Hospital, Montreal (35) — J.R. Leclerc, B. St. Jacques, and S. Finkenbine; Flinders Medical Centre, Adelaide, Australia (33) — A.S. Gallus, D. Cohlan, and C. Rich; Slotervaart Hospital, Amsterdam (33) — D.P.M. Brandjes, C.A. Hoefnagel, M. de Rijk, and F. Turkstra; Centre Hospitalier de l'Université Laval, Quebec, Que., Canada (30) — L. Desjardins, J. Cote-Desjardins, L. Couture, M. Ruel, and J. Villeneuve; Sunnybrook Health Science Centre, Toronto (29) — W.H. Geerts, R.M. Jay, and K.I. Code; Hamilton Civic Hospitals, Hamilton General Division, Hamilton, Ont., Canada (29) — A.G.G. Turpie and J. Johnson; Hôtel Dieu, Montreal (28) — P. Nguyen, J.R. Cusson, and S. Roy; Ottawa Civic Hospital, Ottawa, Ont., Canada (28) — P.S. Wells, J. Bormanis, and D. Goudie; University Hospital, London, Ont., Canada (26) — M. Cruickshank and M. von Lewinski; Hospital Germans Trias i Pujol, Barcelona, Spain (24) — M. Monreal, J.C. Sahuquillo, and E. Lafoz; Hôpital Antoine Béclère, Clamart, France (20) — G. Simonneau, F. Parent, and J. Jagot; St. Joseph's Hospital, Hamilton, Ont., Canada (19) — J.D. Douketis and K. Kinnon; McMaster University Medical Centre, Hamilton, Ont., Canada (19) — J.S. Ginsberg, P. Brill-Edwards, and D. Donovan; Auckland Hospital, Auckland, New Zealand (18) — P.A. Ockelford; Hôpital Maisonneuve-Rosemount, Montreal (18) — J. Kassis and S. Bornais; Centre Hospitalier Universitaire Hôtel Dieu, Nantes, France (17) — B. Planchon, D. El Kouri, and M.A. Pistorius; Hospital de 12 Octubre, Madrid (13) — M. Escribano and G. Garrido; Prince of Wales Hospital, Sydney, Australia (13) — C.N. Chesterman, B.H. Chong, and S. Pritchard; Royal Melbourne Hospital, Melbourne, Australia (10) — J.F. Cade, T. Bynon, and J. Stanford; St. Joseph's Health Centre, London, Ont., Canada (9) — W.M. Brien and B. Palmer; Clinique Saint Vincent, Besançon, France (9) — R. Faivre and P.Y. Petiteau; Hemophilia and Thrombosis Center A. Bianchi Bonomi, Maggiore Hospital, Milan, Italy (5) — P.M. Manucci, M. Moia, and P. Bucciarelli.

References

References

1. 1

   Kierkegaard A. Incidence of acute deep vein thrombosis in two districts: a phlebographic study. Acta Chir Scand 1980;146:267-269
   Medline

2. 2

   Nordstrom M, Lindblad B, Bergqvist D, Kjellstrom T. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med 1992;232:155-160
   CrossRef | Web of Science | Medline

3. 3

   van Beek EJR, Büller HR, ten Cate JW. Epidemiology of venous thromboembolism. In: Tooke JE, Lowe GD, eds. A textbook of vascular medicine. London: Arnold, 1996:471-88.
   

4. 4

   Huisman MV, Buller HR, ten Cate JW, et al. Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest 1989;95:498-502
   CrossRef | Web of Science | Medline

5. 5

   Hull RD, Hirsh J, Carter CJ, et al. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med 1983;98:891-899
   Web of Science | Medline

6. 6

   Kruit WHJ, de Boer AC, Sing AK, van Roon F. The significance of venography in the management of patients with clinically suspected pulmonary embolism. J Intern Med 1991;230:333-339
   CrossRef | Web of Science | Medline

7. 7

   Clark S. Current issues in management of thrombosis. Lancet 1995;346:113-114
   CrossRef | Web of Science | Medline

8. 8

   Hirsh J. Heparin. N Engl J Med 1991;324:1565-1574
   Full Text | Web of Science | Medline

9. 9

   Prandoni P, Lensing AWA, Buller HR, et al. Comparison of subcutaneous low-molecular-weight heparin with intravenous standard heparin in proximal deep-vein thrombosis. Lancet 1992;339:441-445
   CrossRef | Web of Science | Medline

10. 10

    Hull RD, Raskob GE, Pineo GF, et al. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. N Engl J Med 1992;326:975-982
    Full Text | Web of Science | Medline

11. 11

    Levine M, Gent M, Hirsh J, et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 1996;334:677-681
    Full Text | Web of Science | Medline

12. 12

    Koopman MMW, Prandoni P, Piovella F, et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. N Engl J Med 1996;334:682-687
    Full Text | Web of Science | Medline

13. 13

    Cruickshank MK, Levine MN, Hirsh J, Roberts R, Siguenza M. A standard heparin nomogram for the management of heparin therapy. Arch Intern Med 1991;151:333-337
    CrossRef | Web of Science | Medline

14. 14

    Brandjes DPM, Heijboer H, Buller HR, de Rijk M, Jagt H, ten Cate JW. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis. N Engl J Med 1992;327:1485-1489
    Full Text | Web of Science | Medline

15. 15

    Blackwelder WC. “Proving the null hypothesis“ in clinical trials. Control Clin Trials 1982;3:345-353
    CrossRef | Medline

16. 16

    Lensing AWA, Prins MH, Davidson BL, Hirsh J. Treatment of deep venous thrombosis with low-molecular-weight heparins: a meta-analysis. Arch Intern Med 1995;155:601-607
    CrossRef | Web of Science | Medline

17. 17

    Siragusa S, Cosmi B, Piovella F, Hirsh J, Ginsberg JS. Low-molecular-weight heparins and unfractionated heparin in the treatment of patients with acute venous thromboembolism: results of a meta-analysis. Am J Med 1996;100:269-277
    CrossRef | Web of Science | Medline

18. 18

    Leizorovicz A, Simonneau G, Decousus H, Boissel JP. Comparison of efficacy and safety of low molecular weight heparins and unfractionated heparin in initial treatment of deep venous thrombosis: a meta-analysis. BMJ 1994;309:299-304
    CrossRef | Web of Science | Medline

19. 19

    Schafer AI. Low-molecular-weight heparin -- an opportunity for home treatment of venous thrombosis. N Engl J Med 1996;334:724-725
    Full Text | Web of Science | Medline

20. 20

    Lagerstedt CI, Olsson CG, Fagher BO, Oqvist BW, Albrechtsson U. Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis. Lancet 1985;2:515-518
    CrossRef | Web of Science | Medline

21. 21

    Lopaciuk S, Meissner AJ, Filipecki S, et al. Subcutaneous low molecular weight heparin versus subcutaneous unfractionated heparin in the treatment of deep vein thrombosis: a Polish multicenter trial. Thromb Haemost 1992;68:14-18
    Web of Science | Medline

22. 22

    Simonneau G, Charbonnier B, Decousus H, et al. Subcutaneous low-molecular-weight heparin compared with continuous intravenous unfractionated heparin in the treatment of proximal deep vein thrombosis. Arch Intern Med 1993;153:1541-1546
    CrossRef | Web of Science | Medline

23. 23

    Lindmarker P, Holmstrom M, Granqvist S, Johnsson H, Lockner D. Comparison of once-daily subcutaneous Fragmin with continuous intravenous unfractionated heparin in the treatment of deep vein thrombosis. Thromb Haemost 1994;72:186-190
    Web of Science | Medline

24. 24

    Albada J, Nieuwenhuis HK, Sixma JJ. Treatment of acute venous thromboembolism with low molecular weight heparin (Fragmin): results of a double-blind randomized study. Circulation 1989;80:935-940
    CrossRef | Web of Science | Medline

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Citing Articles

1. 1

   Jeffrey B Geske, Sean B Smith, Timothy I Morgenthaler, Sunil V Mankad. (2012) Care of patients with acute pulmonary emboli: a clinical review with cardiovascular focus. Expert Review of Cardiovascular Therapy 10:2, 235-250
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   Elie A Akl, Nawman Labedi, Irene Terrenato, Maddalena Barba, Francesca Sperati, Elena V Sempos, Paola Muti, Deborah Cook, Holger Schünemann, Elie A Akl. 2011. Low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer. .
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   Shervin Farahmand, Morteza Saeedi, Hooman Haji Seyed Javadi, Patricia Khashayar. (2011) High doses of warfarin are more beneficial than its low doses in patients with deep vein thrombosis. The American Journal of Emergency Medicine 29:9, 1222-1226
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4. 4

   Cormac Farrelly, Nicholas Fidelman, Jeremy C. Durack, Eugene Hagiwara, Robert K. Kerlan. (2011) Transcatheter Arterial Embolization of Spontaneous Life-Threatening Extraperitoneal Hemorrhage. Journal of Vascular and Interventional Radiology 22:10, 1396-1402
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5. 5

   Paul D. Stein, Fadi Matta. (2011) Epidemiology and Incidence: The Scope of the Problem and Risk Factors for Development of Venous Thromboembolism. Critical Care Clinics 27:4, 907-932
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   Claire MCLINTOCK, Tim BRIGHTON, Sanjeev CHUNILAL, Gus DEKKER, Nolan MCDONNELL, Simon MCRAE, Peter MULLER, Huyen TRAN, Barry N.J. WALTERS, Laura YOUNG. (2011) Recommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period. Australian and New Zealand Journal of Obstetrics and Gynaecologyno-no
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   N. FALVO, C. BONITHON-KOPP, K. RIVRON GUILLOT, J. A. TODOLI, M. JIMéNEZ-GIL, P. DI MICCO, M. MONREAL, . (2011) Heparin-associated thrombocytopenia in 24 401 patients with venous thromboembolism: findings from the RIETE Registry1. Journal of Thrombosis and Haemostasis 9:9, 1761-1768
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   Karen T Schultz, Tammy J Bungard. (2011) Dosing Options for Decreasing the Time to Achieve Therapeutic Anticoagulation When Reinitiating Warfarin: A Case Series. Pharmacotherapy 31:8, 793-805
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9. 9

   Mariette J. Agterof, Roger E.G. Schutgens, Noureddine Moumli, M.J.C. Eijkemans, René van der Griend, Ellen A.M. Tromp, Douwe H. Biesma. (2011) A prognostic model for short term adverse events in normotensive patients with pulmonary embolism. American Journal of Hematology 86:8, 646-649
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10. 10

    G. AGNELLI, M. VERSO. (2011) Management of venous thromboembolism in patients with cancer. Journal of Thrombosis and Haemostasis 9, 316-324
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11. 11

    Drahomir Aujesky, Pierre-Marie Roy, Franck Verschuren, Marc Righini, Joseph Osterwalder, Michael Egloff, Bertrand Renaud, Peter Verhamme, Roslyn A Stone, Catherine Legall, Olivier Sanchez, Nathan A Pugh, Alfred N'gako, Jacques Cornuz, Olivier Hugli, Hans-Jürg Beer, Arnaud Perrier, Michael J Fine, Donald M Yealy. (2011) Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. The Lancet 378:9785, 41-48
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12. 12

    Salim Surani, Barbara Estement, Subham Manchandan, Sivakumar Sudhakaran, Joseph Varon. (2011) Spontaneous Extraperitoneal Lumbar Artery Hemorrhage. The Journal of Emergency Medicine 40:6, e111-e114
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13. 13

    Masaki Ogino, Seiji Fukui, Yoshihisa Nakada, Ryosuke Tokunoh, Shigekazu Itokawa, Yuichi Kakoi, Satoshi Nishimura, Tsukasa Sanada, Hiromitsu Fuse, Kazuki Kubo, Takeo Wada, Shogo Marui. (2011) Discovery of a Potent and Orally Available Acyl-CoA: Cholesterol Acyltransferase Inhibitor as an Anti-atherosclerotic Agent: (4-Phenylcoumarin)acetanilide Derivatives. CHEMICAL & PHARMACEUTICAL BULLETIN 59:10, 1268-1273
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14. 14

    Paul D. Stein, Fadi Matta. (2010) Epidemiology and Incidence: The Scope of the Problem and Risk Factors for Development of Venous Thromboembolism. Clinics in Chest Medicine 31:4, 611-628
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15. 15

    D. Soonawala, R. A. Middelburg, M. Egger, J. P. Vandenbroucke, O. M. Dekkers. (2010) Efficacy of experimental treatments compared with standard treatments in non-inferiority trials: a meta-analysis of randomized controlled trials. International Journal of Epidemiology 39:6, 1567-1581
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16. 16

    M. J. KOVACS, J. D. HAWEL, J. F. REKMAN, A. LAZO-LANGNER. (2010) Ambulatory management of pulmonary embolism: a pragmatic evaluation. Journal of Thrombosis and Haemostasis 8:11, 2406-2411
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17. 17

    Petra MG Erkens, Martin H Prins, Martin H Prins. 2010. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. .
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18. 18

    M. J. KOVACS, S. R. KAHN, P. S. WELLS, D. A. ANDERSON, I. CHAGNON, G. LE GAL, S. SOLYMOSS, M. CROWTHER, A. PERRIER, T. RAMSAY, M. T. BETANCOURT, R. H. White, L. Vickars, M. A. RODGER. (2010) Patients with a first symptomatic unprovoked deep vein thrombosis are at higher risk of recurrent venous thromboembolism than patients with a first unprovoked pulmonary embolism. Journal of Thrombosis and Haemostasis 8:9, 1926-1932
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19. 19

    John Winters, David Garcia. (2010) Cancer-Associated Thrombosis. Hematology/Oncology Clinics of North America 24:4, 695-707
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20. 20

    Remedios Otero, Fernando Uresandi, David Jiménez, Miguel Ángel Cabezudo, Mikel Oribe, Dolores Nauffal, Francisco Conget, Consolación Rodríguez, Aurelio Cayuela. (2010) Home treatment in pulmonary embolism. Thrombosis Research 126:1, e1-e5
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21. 21

    Paul D. Stein, Fadi Matta. (2010) Acute Pulmonary Embolism. Current Problems in Cardiology 35:7, 314-376
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22. 22

    C. Lindow, A. Mumme, G. Asciutto, B. Strohmann, T. Hummel, B. Geier. (2010) Long-term Results after Transfemoral Venous Thrombectomy for Iliofemoral Deep Venous Thrombosis. European Journal of Vascular and Endovascular Surgery 40:1, 134-138
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23. 23

    M. J. AGTEROF, R. E. G. SCHUTGENS, R. J. SNIJDER, G. EPPING, H. G. PELTENBURG, E. F. M. POSTHUMA, J. A. HARDEMAN, R. VAN DER GRIEND, T. KOSTER, M. H. PRINS, D. H. BIESMA. (2010) Out of hospital treatment of acute pulmonary embolism in patients with a low NT-proBNP level. Journal of Thrombosis and Haemostasis 8:6, 1235-1241
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24. 24

    J. A. NIETO, R. SOLANO, M. D. RUIZ-RIB, N. RUIZ-GIMENEZ, P. PRANDONI, C. KEARON, M. MONREAL, . (2010) Fatal bleeding in patients receiving anticoagulant therapy for venous thromboembolism: findings from the RIETE registry. Journal of Thrombosis and Haemostasis 8:6, 1216-1222
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25. 25

    Vibhu Sharma, Charles Koczka, Conrad Fischer. (2010) Underutilization of evidence-based strategies in the diagnosis and treatment of venous thromboembolism among trainees. Journal of Hospital Medicine 5:1, E26-E30
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26. 26

    Stephen M. Pastores, Louis P. Voigt. (2010) Acute Respiratory Failure in the Patient with Cancer: Diagnostic and Management Strategies. Critical Care Clinics 26:1, 21-40
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27. 27

    Lars J. Petersen. (2009) Anticoagulation therapy for prevention and treatment of venous thromboembolic events in cancer patients: A review of current guidelines. Cancer Treatment Reviews 35:8, 754-764
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28. 28

    Ricky Medel, Stephen J. Monteith, R. Webster Crowley, Aaron S. Dumont. (2009) A review of therapeutic strategies for the management of cerebral venous sinus thrombosis. Neurosurgical FOCUS 27:5, E6
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29. 29

    Davide Imberti, Marcello Di Nisio, Maria Benedetta Donati, Anna Falanga, Angelo Ghirarduzzi, Daniele Guarneri, Franco Piovella, Rita Carlotta Santoro, Edoardo Baldini, Stefania Zampogna. (2009) Treatment of venous thromboembolism in patients with cancer: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thrombosis Research 124:5, e32-e40
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30. 30

    A. LAZO-LANGNER, K. MONKMAN, M. J. KOVACS. (2009) Predicting warfarin maintenance dose in patients with venous thromboembolism based on the response to a standardized warfarin initiation nomogram. Journal of Thrombosis and Haemostasis 7:8, 1276-1283
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31. 31

    Katherine Monkman, Alejandro Lazo-Langner, Michael J. Kovacs. (2009) A 10 mg warfarin initiation nomogram is safe and effective in outpatients starting oral anticoagulant therapy for venous thromboembolism. Thrombosis Research 124:3, 275-280
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32. 32

    Stephen M. Pastores. (2009) Management of venous thromboembolism in the intensive care unit. Journal of Critical Care 24:2, 185-191
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33. 33

    Martha L. Louzada, Habeeb Majeed, Philip S. Wells. (2009) Efficacy of Low- molecular- weight- heparin versus Vitamin K antagonists for long term treatment of cancer-associated venous thromboembolism in adults: A systematic review of randomized controlled trials. Thrombosis Research 123:6, 837-844
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34. 34

    Agnes Y.Y. Lee. (2009) Treatment of venous thromboembolism in cancer patients. Best Practice & Research Clinical Haematology 22:1, 93-101
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35. 35

    Kenneth E. Wood. (2009) A History of Pulmonary Embolism and Deep Venous Thrombosis. Critical Care Clinics 25:1, 115-131
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36. 36

    LAUREN D. VAZQUEZ, EMILY A. KUHL, JULIE BISHOP SHEA, ANN KIRKNESS, JIM LEMON, DAVID WHALLEY, JAMIE B. CONTI, SAMUEL F. SEARS. (2008) Age-Specific Differences in Women with Implantable Cardioverter Defibrillators: An International Multi Center Study. Pacing and Clinical Electrophysiology 31:12, 1528-1534
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37. 37

    BEATRICE BREMBILLA-PERROT, FRANÇOIS ALLA, CHRISTINE SUTY-SELTON, OLIVIER HUTTIN, HUGUES BLANGY, NICOLAS SADOUL, FRÉDÉRIC CHOMETON, LAURENT GROBEN, JEAN D. LUPORSI, NOURA ZANNAD, ETIENNE ALIOT, JUANICO CEDANO, SONIA AMMAR, AHMED ABDELAAL, YVES JUILLIÈRE. (2008) Nonischemic Dilated Cardiomyopathy: Results of Noninvasive and Invasive Evaluation in 310 Patients and Clinical Significance of Bundle Branch Block. Pacing and Clinical Electrophysiology 31:11, 1383-1390
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38. 38

    Ricardo Guijarro, Julio Montes, Carlos Sanromán, Manuel Monreal. (2008) Venous thromboembolism in Spain. Comparison between an administrative database and the RIETE registry. European Journal of Internal Medicine 19:6, 443-446
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39. 39

    Elie A. Akl, Sandeep Rohilla, Maddalena Barba, Francesca Sperati, Irene Terrenato, Paola Muti, Fadi Bdair, Holger J. Schünemann. (2008) Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer. Cancer 113:7, 1685-1694
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    Guy Meyer, Benjamin Planquette, Olivier Sanchez. (2008) Long-term outcome of pulmonary embolism. Current Opinion in Hematology 15:5, 499-503
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41. 41

    Andrew Walden, Richard Levison, Sudir Singh, David Keeling. (2008) A case of fatal pulmonary embolism raising questions about the dosing regimen for dalteparin in the very obese. British Journal of Haematology 142:3, 487-489
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42. 42

    Elie A Akl, Maddalena Barba, Sandeep Rohilla, Irene Terrenato, Francesca Sperati, Paola Muti, Holger Schünemann, Elie A Akl. 2008. Anticoagulation for the long term treatment of venous thromboembolism in patients with cancer. .
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43. 43

    A.J. Burge, K.D. Freeman, P.J. Klapper, L.B. Haramati. (2008) Increased diagnosis of pulmonary embolism without a corresponding decline in mortality during the CT era. Clinical Radiology 63:4, 381-386
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    Tapson, Victor F., . (2008) Acute Pulmonary Embolism. New England Journal of Medicine 358:10, 1037-1052
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    Guy Meyer, Benjamin Planquette, Olivier Sanchez. (2008) Long-term outcome of pulmonary embolism. Therapy 5:2, 159-167
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46. 46

    Marieke JHA Kruip, Frank WG Leebeek. (2008) Advances in the detection of pulmonary embolism. Expert Opinion on Medical Diagnostics 2:2, 171-181
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    Elie A Akl, Sandeep Rohilla, Maddalena Barba, Francesca Sperati, Irene Terrenato, Paola Muti, Holger Schünemann, Elie A Akl. 2008. Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer. .
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    Arina J. ten Cate-Hoek, Martin H. Prins. (2008) Low molecular weight heparins in cancer. Thrombosis Research 122:5, 584-598
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    Christer Gottfridsson, Britta Nyström, Thomas Karlsson, Johan Herlitz, Nils Edvardsson. (2008) Sex difference and factors associated with outcome in patients with sustained ventricular arrhythmias. Scandinavian Cardiovascular Journal 42:3, 182-191
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    L. Pérard, A. Hot, M. Cucherat, M. Simon, H. Desmurs, B. Coppéré, M.-H. Girard-Madoux, J.-P. Boissel, J. Ninet. (2007) Essais de non-infériorité dans la maladie thromboembolique veineuse. Une lecture critique est nécessaire!. La Revue de Médecine Interne 28:11, 731-736
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    The van Gogh Investigators. (2007) Idraparinux versus Standard Therapy for Venous Thromboembolic Disease. New England Journal of Medicine 357:11, 1094-1104
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    I. A. NÆSS, S. C. CHRISTIANSEN, P. ROMUNDSTAD, S. C. CANNEGIETER, F. R. ROSENDAAL, J. HAMMERSTRØM. (2007) Incidence and mortality of venous thrombosis: a population-based study. Journal of Thrombosis and Haemostasis 5:4, 692-699
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    Jacob P. Deerhake, Julie C. Merz, Jeanna V. Cooper, Kim A. Eagle, William P. Fay. (2007) The duration of anticoagulation bridging therapy in clinical practice may significantly exceed that observed in clinical trials. Journal of Thrombosis and Thrombolysis 23:2, 107-113
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    Thomas C. Krivak, Kristin K. Zorn. (2007) Venous Thromboembolism in Obstetrics and Gynecology. Obstetrics & Gynecology 109:3, 761-777
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    Lauren A. Stutts, Natalie J. Cross, Jamie B. Conti, Samuel F. Sears. (2007) Examination of Research Trends on Patient Factors in Patients with Implantable Cardioverter Defibrillators. Clinical Cardiology 30:2, 64-68
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    Jeanne Jacoby, Mark Cesta, Jennifer Axelband, Scott Melanson, Michael Heller, James Reed. (2007) Can emergency medicine residents detect acute deep venous thrombosis with a limited, two-site ultrasound examination?. The Journal of Emergency Medicine 32:2, 197-200
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    Russell D. Hull, Graham F. Pineo, Rollin F. Brant, Andrew F. Mah, Natasha Burke, Richard Dear, Turnly Wong, Roy Cook, Susan Solymoss, Man-Chiu Poon, Gary Raskob. (2007) Self-Managed Long-Term Low-Molecular-Weight Heparin Therapy: The Balance of Benefits and Harms. The American Journal of Medicine 120:1, 72-82.e3
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    Frederick R. Rickles, Mark Levine. 2007. Thrombosis and Cancer. , 389-403.
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    B. Brembilla-Perrot, O. Marçon, F. Chometon, J. Bertrand, A. Terrier de la Chaise, P. Louis, H. Belhakem, H. Blangy, O. Claudon, O. Selton, E. Khaldi, N. Sadoul, D. Beurrier, M. Abbas, M. Andronache, M. Abbas, N. Zhang. (2006) Supraventricular tachyarrhythmia as a cause of sudden cardiac arrest. Journal of Interventional Cardiac Electrophysiology 16:2, 97-104
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    A. Sánchez Rodríguez, M. Sánchez Ledesma, I. Cruz González. (2006) Aspectos actuales y perspectivas de futuro del tratamiento de la enfermedad tromboembólica. Medicine - Programa de Formación Médica Continuada Acreditado 9:69, 4421-4428
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    Gregory Piazza, Samuel Z. Goldhaber. (2006) Venous Thromboembolism Guidebook. Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine 5:4, 211-227
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    Patrick Y. Wen, David Schiff, Santosh Kesari, Jan Drappatz, Debra C. Gigas, Lisa Doherty. (2006) Medical management of patients with brain tumors. Journal of Neuro-Oncology 80:3, 313-332
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    Y.-Y. Wang, H. L. Po. (2006) Enoxaparin-induced alopecia in patients with cerebral venous thrombosis. Journal of Clinical Pharmacy and Therapeutics 31:5, 513-517
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    M. Mandalà, A. Falanga, A. Piccioli, P. Prandoni, E.M. Pogliani, R. Labianca, S. Barni. (2006) Venous thromboembolism and cancer: Guidelines of the Italian Association of Medical Oncology (AIOM). Critical Reviews in Oncology/Hematology 59:3, 194-204
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    Ramón Lecumberri, Jesús Feliu, Eduardo Rocha. (2006) Tromboembolia venosa en pacientes con cáncer. Medicina Clínica 127:1, 22-32
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    Juan Ruiz Manzano. (2006) Tratamiento ambulatorio de la tromboembolia pulmonar. Medicina Clínica 127:1, 11-12
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    M. Pavic, P. Debourdeau, M. Aletti, D. Farge-Bancel, H. Rousset. (2006) Maladie veineuse thromboembolique et cancer. La Revue de Médecine Interne 27:4, 313-322
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    Daigo Nagahara, Mamoru Hase, Kazufumi Tsuchihashi, Nobuaki Kokubu, Seiichiro Sakurai, Takuji Yoshioka, Kimio Nishizato, Noriyuki Fujii, Kikuya Uno, Tetsuji Miura, Nobuyuki Ura, Yasufumi Asai, Kazuaki Shimamoto. (2006) Long-Term Outcome of Implanted Cardioverter Defibrillators in Survivors of Out-of-Hospital Cardiac Arrest of Cardiac Origin. Circulation Journal 70:9, 1128-1132
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    John T. Wiernikowski, Uma H. Athale. (2006) Thromboembolic complications in children with cancer. Thrombosis Research 118:1, 137-152
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    Daniel F. Hogan. 2006. Prevention and Management of Thromboembolism. , 331-345.
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    Regina S. Cunningham. (2005) Therapeutic Options for the Treatment of Cancer-Associated Thrombosis. Seminars in Oncology Nursing 21:4, 21-40
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    Rajesh S. Mangrulkar. (2005) Targeting and structuring information resource use: A path toward informed clinical decisions. Journal of Continuing Education in the Health Professions 24:S1, S13-S21
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    A. T. Cohen, C. Hirst, B. Sherrill, P. Holmes, D. Fidan. (2005) Meta-analysis of trials comparing ximelagatran with low molecular weight heparin for prevention of venous thromboembolism after major orthopaedic surgery. British Journal of Surgery 92:11, 1335-1344
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    Joseph A. Caprini, Victor F. Tapson, Thomas M. Hyers, Albert L. Waldo, Ann K. Wittkowsky, Richard Friedman, Kevin J. Colgan, Alicia C. Shillington. (2005) Treatment of venous thromboembolism: Adherence to guidelines and impact of physician knowledge, attitudes, and beliefs. Journal of Vascular Surgery 42:4, 726-733
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    Filippo Luca Fimognari, Lazzaro Repetto, Leo Moro, Walter Gianni, Raffaele Antonelli Incalzi. (2005) Age, cancer and the risk of venous thromboembolism. Critical Reviews in Oncology/Hematology 55:3, 207-212
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    Marc Lémann, Jean-Yves Mary, Jean-Frédéric Colombel, Bernard Duclos, Jean-Claude Soule, Eric Lerebours, Robert Modigliani, Yoram Bouhnik. (2005) A Randomized, Double-Blind, Controlled Withdrawal Trial in Crohn’s Disease Patients in Long-term Remission on Azathioprine. Gastroenterology 128:7, 1812-1818
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    D. George Wyse. (2005) Conflict of Interest—Draining the Swamp Means Confronting Alligators. Journal of Interventional Cardiac Electrophysiology 13:1, 5-7
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    Jorge Cervantes, Guillermo Rojas. (2005) Virchow’s Legacy: Deep Vein Thrombosis and Pulmonary Embolism. World Journal of Surgery 29:S1, S30-S34
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    Beng H. Chong, Tim A. Brighton, Ross I. Baker, Peter Thurlow, Choon H. Lee, . (2005) Once-Daily Enoxaparin in The Outpatient Setting Versus Unfractionated Heparin in Hospital for the Treatment of Symptomatic Deep-Vein Thrombosis. Journal of Thrombosis and Thrombolysis 19:3, 173-181
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    C. J. J. DONGEN, P. PRANDONI, M. FRULLA, A. MARCHIORI, M. H. PRINS, B. A. HUTTEN. (2005) Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. Journal of Thrombosis and Haemostasis 3:5, 939-942
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    J. D. DOUKETIS, O. LEEUWENKAMP, P. GROBARA, M. JOHNSTON, M. SOHNE, M. TEN WOLDE, H. BULLER. (2005) The incidence and prognostic significance of elevated cardiac troponins in patients with submassive pulmonary embolism. Journal of Thrombosis and Haemostasis 3:3, 508-513
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    S. Lange, G. Freitag. (2005) Special Invited Papers Section: Therapeutic Equivalence – Clinical Issues and Statistical Methodology in Noninferiority Trials. Biometrical Journal 47:1, 12-27
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    Paolo Prandoni. (2005) Emerging strategies for treatment of venous thromboembolism. Expert Opinion on Emerging Drugs 10:1, 87-94
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    Agnes Y. Y. Lee. (2005) Management of thrombosis in cancer: primary prevention and secondary prophylaxis. British Journal of Haematology 128:3, 291-302
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    Daniel Most, Jeffrey Kozlow, Jennifer Heller, Michele A. Shermak. (2005) Thromboembolism in Plastic Surgery. Plastic and Reconstructive Surgery 115:2, 20e-30e
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    F.F. Syed. (2005) Lower-limb deep-vein thrombosis in a general hospital: risk factors, outcomes and the contribution of intravenous drug use. QJM 98:2, 139-145
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    Mamoru Hase, Kazufumi Tsuchihashi, Noriyuki Fujii, Kimio Nishizato, Nobuaki Kokubu, Satoshi Nara, Yoshihiko Kurimoto, Akiyoshi Hashimoto, Kikuya Uno, Tetsuji Miura, Nobuyuki Ura, Yasufumi Asai, Kazuaki Shimamoto. (2005) Early Defibrillation and Circulatory Support Can Provide Better Long-Term Outcomes Through Favorable Neurological Recovery in Patients With Out-of-Hospital Cardiac Arrest of Cardiac Origin. Circulation Journal 69:11, 1302-1307
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    Nathan I. Shapiro, Jeffrey Spear, Susan Sheehy, Jeremy Brown, Jonathan A. Edlow. (2005) Barriers to the use of outpatient enoxaparin therapy in patients with deep venous thrombosis. The American Journal of Emergency Medicine 23:1, 30-34
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    Timothy A. Morris, Alan Jacobson, James J. Marsh, James R. Lane. (2005) Pharmacokinetics of UH and LMWH are similar with respect to antithrombin activity. Thrombosis Research 115:1-2, 45-51
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    Darlene J. Elias. (2004) Pulmonary Embolism in Orthopaedic Patients: Diagnosis and Treatment. Techniques in Orthopaedics 19:4, 317-326
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    H. Lévesque, C. Belizna, P. Michel, C. Pfister. (2004) Traitement de la maladie thromboembolique veineuse chez les patients souffrant de cancers. La Revue de Médecine Interne 25:12, 906-914
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    Antonio Basile, Jos Garcia Medina, Elena Mundo, Vicente Garcia Medina, Rafael Leal. (2004) Transcatheter Arterial Embolization of Concurrent Spontaneous Hematomas of the Rectus Sheath and Psoas Muscle in Patients Undergoing Anticoagulation. CardioVascular and Interventional Radiology 27:6, 659-662
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    Carlo J van Dongen, Angelique GM van den Belt, Martin H Prins, AWA Lensing, Martin H Prins. 2004. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. .
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    David Bergqvist. (2004) Bleeding profiles of anticoagulants, including the novel oral direct thrombin inhibitor ximelagatran: definitions, incidence and management. European Journal of Haematology 73:4, 227-242
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    Edith A. Nutescu, Alex C. Spyropoulos, Kerry W. Cranmer. (2004) Oral Anticoagulation: Preparing for Change. Journal of the American Medical Directors Association 5:5, 2-10
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    A. Gómez-Outes, R. Lecumberri, A. Lafuente-Guijosa, J. Martínez-González, P. Carrasco, E. Rocha. (2004) Correlation between thrombus regression and recurrent venous thromboembolism. Examining venographic and clinical effects of low-molecular-weight heparins: a meta-analysis. Journal of Thrombosis and Haemostasis 2:9, 1581-1587
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    Mehmet Kurtoglu, Hakan Yanar, Yilmaz Bilsel, Recep Guloglu, Sevda Kizilirmak, Dincay Buyukkurt, Volkan Granit. (2004) Venous Thromboembolism Prophylaxis after Head and Spinal Trauma: Intermittent Pneumatic Compression Devices Versus Low Molecular Weight Heparin. World Journal of Surgery 28:8, 807-811
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    Vincent J. Willey, Michael F. Bullano, Ole Hauch, Matthew Reynolds, Gail Wygant, Lauren Hoffman, George Mayzell, Alex C. Spyropoulos. (2004) Management patterns and outcomes of patients with venous thromboembolism in the usual community practice setting. Clinical Therapeutics 26:7, 1149-1159
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    M. Monreal, A. W. A. Lensing, M. H. Prins, M. Bonet, J. Fernandez-Llamazares, J. Muchart, P. Prandoni, J. Angel Jimenez. (2004) Screening for occult cancer in patients with acute deep vein thrombosis or pulmonary embolism. Journal of Thrombosis and Haemostasis 2:6, 876-881
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     S SRIVASTAVA. (2004) Diagnosis of pulmonary embolism with various imaging modalities. Seminars in Vascular Surgery 17:2, 173-180
     CrossRef

101. 101

     Pengo, Vittorio, Lensing, Anthonie W.A., Prins, Martin H., Marchiori, Antonio, Davidson, Bruce L., Tiozzo, Francesca, Albanese, Paolo, Biasiolo, Alessandra, Pegoraro, Cinzia, Iliceto, Sabino, Prandoni, Paolo, . (2004) Incidence of Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism. New England Journal of Medicine 350:22, 2257-2264
     Full Text

102. 102

     Samuel Z Goldhaber. (2004) Pulmonary embolism. The Lancet 363:9417, 1295-1305
     CrossRef

103. 103

     Shuwei Gao, Carmen Escalante. (2004) Venous thromboembolism and malignancy. Expert Review of Anticancer Therapy 4:2, 303-320
     CrossRef

104. 104

     Timothy Jang, Martin Docherty, Chandra Aubin, Greg Polites. (2004) Resident-performed Compression Ultrasonography for the Detection of Proximal Deep Vein Thrombosis: Fast and Accurate. Academic Emergency Medicine 11:3, 319-322
     CrossRef

105. 105

     Ajay K Kakkar. (2004) Low- and ultra-low-molecular-weight heparins. Best Practice & Research Clinical Haematology 17:1, 77-87
     CrossRef

106. 106

     S. R. Deitcher. (2004) Undue Extension of Hospital Stay Associated With Anticoagulation. Mayo Clinic Proceedings 79:2, 157-158
     CrossRef

107. 107

     Edith A. Nutescu, Alex C. Spyropoulos, Kerry W. Cranmer. (2004) Oral Anticoagulation: Preparing for Change. Journal of the American Medical Directors Association 5:suppl, 2
     CrossRef

108. 108

     Agnes YY Lee. (2003) Anti-thrombotic therapy in cancer patients. Expert Opinion on Pharmacotherapy 4:12, 2213-2220
     CrossRef

109. 109

     S. Dunkley. (2003) Heparin nomograms: time for change. Internal Medicine Journal 33:12, 623-624
     CrossRef

110. 110

     Edwin J.R. van Beek, Jim M. Wild, Christian Fink, Alan R. Moody, Hans-Ulrich Kauczor, Matthijs Oudkerk. (2003) MRI for the diagnosis of pulmonary embolism. Journal of Magnetic Resonance Imaging 18:6, 627-640
     CrossRef

111. 111

     R. Vink, R. A. Kraaijenhagen, M. Levi, H. R. Buller. (2003) Individualized duration of oral anticoagulant therapy for deep vein thrombosis based on a decision model. Journal of Thrombosis and Haemostasis 1:12, 2523-2530
     CrossRef

112. 112

     The Matisse Investigators. (2003) Subcutaneous Fondaparinux versus Intravenous Unfractionated Heparin in the Initial Treatment of Pulmonary Embolism. New England Journal of Medicine 349:18, 1695-1702
     Full Text

113. 113

     Cheryl Nadeau, Jerry Varrone. (2003) Treat DVT with Low Molecular Weight Heparin. The Nurse Practitioner 28:10, 22-29
     CrossRef

114. 114

     Lee, Agnes Y.Y., Levine, Mark N., Baker, Ross I., Bowden, Chris, Kakkar, Ajay K., Prins, Martin, Rickles, Frederick R., Julian, Jim A., Haley, Susan, Kovacs, Michael J., Gent, Michael, . (2003) Low-Molecular-Weight Heparin versus a Coumarin for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer. New England Journal of Medicine 349:2, 146-153
     Full Text

115. 115

     M. N. Levine, A. Y. Lee, A. K. Kakkar. (2003) From Trousseau to targeted therapy: new insights and innovations in thrombosis and cancer. Journal of Thrombosis and Haemostasis 1:7, 1456-1463
     CrossRef

116. 116

     Alan K. Berger. (2003) Thrombolysis in Elderly Patients With Acute Myocardial Infarction. The American Journal of Geriatric Cardiology 12:4, 251-258
     CrossRef

117. 117

     Matthias Pross, Hans Lippert, Frank Misselwitz, Gerd Nestler, Sabine Krüger, Harald Langer, Walter Halangk, Hans-Ulrich Schulz. (2003) Low-molecular-weight heparin (reviparin) diminishes tumor cell adhesion and invasion in vitro, and decreases intraperitoneal growth of colonadeno-carcinoma cells in rats after laparoscopy. Thrombosis Research 110:4, 215-220
     CrossRef

118. 118

     Mark N. Levine. (2003) Can we optimise treatment of thrombosis?. Cancer Treatment Reviews 29, 19-22
     CrossRef

119. 119

     Andrew D. Feingold, David DeNofrio. (2003) Management issues for patients with coronary artery disease and heart failure. Current Cardiology Reports 5:3, 216-222
     CrossRef

120. 120

     U. Priglinger, G. Delle Karth, A. Geppert, C. Joukhadar, S. Graf, R. Berger, M. Hülsmann, S. Spitzauer, I. Pabinger, G. Heinz. (2003) Prophylactic anticoagulation with enoxaparin: Is the subcutaneous route appropriate in the critically ill?*. Critical Care Medicine 31:5, 1405-1409
     CrossRef

121. 121

     Janet A Rowan, Claire McLintock, Rennae S Taylor, Robyn A North. (2003) Prophylactic and therapeutic enoxaparin during pregnancy: Indications, outcomes and monitoring. The Australian and New Zealand Journal of Obstetrics and Gynaecology 43:2, 123-128
     CrossRef

122. 122

     Ana T Rocha, Victor F Tapson. (2003) Venous thromboembolism in intensive care patients. Clinics in Chest Medicine 24:1, 103-122
     CrossRef

123. 123

     Roger D Yusen, Brian F Gage. (2003) Outpatient treatment of acute venous thromboembolic disease. Clinics in Chest Medicine 24:1, 49-61
     CrossRef

124. 124

     Michel Boucher, Marc Rodger, Jeffrey A. Johnson, Mike Tierney. (2003) Shifting from Inpatient to Outpatient Treatment of Deep Vein Thrombosis in a Tertiary Care Center: A Cost-Minimization Analysis. Pharmacotherapy 23:3, 301-309
     CrossRef

125. 125

     Rodger L Bick, Sylvia Haas. (2003) Thromboprophylaxis and thrombosis in medical, surgical, trauma, and obstetric/gynecologic patients. Hematology/Oncology Clinics of North America 17:1, 217-258
     CrossRef

126. 126

     Sheila A Doggrell. (2003) Reviparin as prophylaxis for thromboembolism after leg injury and hip replacement. Expert Opinion on Pharmacotherapy 4:2, 285-288
     CrossRef

127. 127

     Kirk Magee, William W Sevcik, David Moher, Brian H Rowe, Kirk Magee. 2003. Low molecular weight heparins versus unfractionated heparin for acute coronary syndromes. .
     CrossRef

128. 128

     H. Eriksson, K. Whlander, D. Gustafsson, L.t Welin, L. Frison, S. Schulman, . (2003) A randomized, controlled, dose-guiding study of the oral direct thrombin inhibitor ximelagatran compared with standard therapy for the treatment of acute deep vein thrombosis: THRIVE I. Journal of Thrombosis and Haemostasis 1:1, 41-47
     CrossRef

129. 129

     D. Haverkamp, B. A. Hutten, H. R. Bller, A. S. Gallus, A. W. A. Lensing, M. H. Prins. (2003) The use of specific antidotes as a response to bleeding complications during anticoagulant therapy for venous thromboembolism. Journal of Thrombosis and Haemostasis 1:1, 69-73
     CrossRef

130. 130

     Laura Magee, Lelia Duley, Laura Magee. 2003. .
     CrossRef

131. 131

     Enrico Bernardi, Paolo Prandoni. (2003) Safety of low molecular weight heparins in the treatment of venous thromboembolism. Expert Opinion on Drug Safety 2:1, 87-94
     CrossRef

132. 132

     Douglas E. Sutherland, Ilene C. Weitz, Howard A. Liebman. (2003) Thromboembolic complications of cancer: Epidemiology, pathogenesis, diagnosis, and treatment. American Journal of Hematology 72:1, 43-52
     CrossRef

133. 133

     (2002) Pharmacotherapy of pulmonary embolism. Expert Opinion on Pharmacotherapy 3:12, 1719-1725
     CrossRef

134. 134

     Stuart J. Pocock, Susan E. Assmann, Laura E. Enos, Linda E. Kasten. (2002) Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practiceand problems. Statistics in Medicine 21:19, 2917-2930
     CrossRef

135. 135

     K. T. Tan, E. J. R. van Beek. (2002) Diagnosis and Treatment of Pulmonary Embolism: An Overview. Imaging Decisions MRI 6:3, 3-10
     CrossRef

136. 136

     N. Cook, D. M. Thomas. (2002) Retrospective survey of unselected hospital patients with and without cancer comparing outcomes following venous thromboembolism. Internal Medicine Journal 32:9-10, 437-444
     CrossRef

137. 137

     Thach Nguyen, THACH NGUYEN, SHIGERU SAITO, PHAM HOAN TIEN, CINDY L. GRINES. (2002) Fibrinolytic and Mechanical Intervention Trials in ST Elevation Acute Myocardial Infarction. Journal of Interventional Cardiology 15:4, 321-334
     CrossRef

138. 138

     Susan I O'Shea, Thomas L Ortel. (2002) Issues in the utilization of low molecular weight heparins. Seminars in Hematology 39:3, 172-178
     CrossRef

139. 139

     RODERICK NAZARIO, LAWRENCE J. DELORENZO, GEORGE P. MAGUIRE. (2002) Treatment of Venous Thromboembolism. Cardiology in Review 10:4, 249-259
     CrossRef

140. 140

     Mark N Levine. (2002) Managing thromboembolic disease in the cancer patient: efficacy and safety of antithrombotic treatment options in patients with cancer. Cancer Treatment Reviews 28:3, 145-149
     CrossRef

141. 141

     DEEPAK P. VIVEKANANTHAN, VASANT B. PATEL, DAVID J. MOLITERNO. (2002) Glycoprotein IIb/IIIa Antagonism and Fibrinolytic Therapy for Acute Myocardial Infarction. Journal of Interventional Cardiology 15:2, 131-139
     CrossRef

142. 142

     William O. McKinley, Michelle S. Gittler, Steven C. Kirshblum, Steven A. Stiens, Suzanne L. Groah. (2002) 2. Medical complications after spinal cord injury: Identification and management. Archives of Physical Medicine and Rehabilitation 83:3, S58-S64
     CrossRef

143. 143

     Hans Klaus Breddin. (2002) Reviparin sodium – a new low molecular weight heparin. Expert Opinion on Pharmacotherapy 3:2, 173-182
     CrossRef

144. 144

     Yerem Yeghiazarians, Peter H. Stone. (2002) ST-segment elevation myocardial infarction. Current Treatment Options in Cardiovascular Medicine 4:1, 3-23
     CrossRef

145. 145

     N. Meneveau, J.P. Bassand. (2002) Quand suspecter une embolie pulmonaire chez un malade ayant une thrombose veineuse profonde ?. Annales de Cardiologie et d'Angéiologie 51:3, 139-145
     CrossRef

146. 146

     J. Jaime Caro, Denis Getsios, Ingrid Caro, Judith A. O??Brien. (2002) Cost Effectiveness of Tinzaparin Sodium Versus Unfractionated Heparin in the Treatment of Proximal Deep Vein Thrombosis. PharmacoEconomics 20:9, 593-602
     CrossRef

147. 147

     Kewal K. Talwar, Nitish Naik, Rajnish Juneja. (2001) Are drugs and catheter ablation effective for treating ventricular arrhythmias in populations that cannot afford implantable cardioverter defibrillators?. Current Cardiology Reports 3:6, 459-466
     CrossRef

148. 148

     DK Cundiff, J Manyemba, David Cundiff. 2001. Anticoagulants versus non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism.. .
     CrossRef

149. 149

     P. Di Micco, M. Romano, A. Niglio, P. Nozzolillo, A. Federico, P. Petronella, L. Nunziata, B. Di Micco, R. Torella. (2001) Alteration of haemostasis in non-metastatic gastric cancer. Digestive and Liver Disease 33:7, 546-550
     CrossRef

150. 150

     E VANBEEK, E BROUWERS, B SONG, P STEIN, M OUDKERK. (2001) Clinical Validity of a Normal Pulmonary Angiogram in Patients with Suspected Pulmonary Embolism?A Critical Review. Clinical Radiology 56:10, 838-842
     CrossRef

151. 151

     Andrew F. Shorr, Anthony S. Ramage. (2001) Enoxaparin for thromboprophylaxis after major trauma: Potential cost implications. Critical Care Medicine 29:9, 1659-1665
     CrossRef

152. 152

     James D. Douketis. (2001) Prognosis in pulmonary embolism. Current Opinion in Pulmonary Medicine 7:5, 354-359
     CrossRef

153. 153

     Samuel Z Goldhaber. (2001) Unsolved Issues in the Treatment of Pulmonary Embolism. Thrombosis Research 103:6, V245-V255
     CrossRef

154. 154

     Philip S. Wells. (2001) Outpatient treatment of patients with deep-vein thrombosis or pulmonary embolism. Current Opinion in Pulmonary Medicine 7:5, 360-364
     CrossRef

155. 155

     M DESANCHO, J RAND. (2001) BLEEDING AND THROMBOTIC COMPLICATIONS IN CRITICALLY ILL PATIENTS WITH CANCER. Critical Care Clinics 17:3, 599-622
     CrossRef

156. 156

     S PASTORES. (2001) ACUTE RESPIRATORY FAILURE IN CRITICALLY ILL PATIENTS WITH CANCERDiagnosis and Management. Critical Care Clinics 17:3, 623-646
     CrossRef

157. 157

     Christopher R May. (2001) Management of venous thromboembolic disease in the lower limb. Emergency Medicine Australasia 13:2, 211-223
     CrossRef

158. 158

     Graham F. Pineo. (2001) New Developments in the Prevention and Treatment of Venous Thromboembolism. Pharmacotherapy 21:6 Part 2, 51S-55S
     CrossRef

159. 159

     Wee S. Chan, Sanjeev D. Chunilal, Jeffrey S. Ginsberg. (2001) Antithrombotic therapy during pregnancy. Seminars in Perinatology 25:3, 165-169
     CrossRef

160. 160

     Agnes Y.Y Lee. (2001) Treatment of Venous Thromboembolism in Cancer Patients. Thrombosis Research 102:6, V195-V208
     CrossRef

161. 161

     Giancarlo Agnelli, Cecilia Becattini. (2001) Clinical and economic aspects of managing venous thromboembolism in the outpatient setting. Seminars in Hematology 38, 58-66
     CrossRef

162. 162

     Alexander G.G Turpie. (2001) Looking forward in the treatment of deep-vein thrombosis. Seminars in Hematology 38, 49-57
     CrossRef

163. 163

     Breddin, Hans Klaus, Hach-Wunderle, Viola, Nakov, Roumen, Kakkar, Vijay V., . (2001) Effects of a Low-Molecular-Weight Heparin on Thrombus Regression and Recurrent Thromboembolism in Patients with Deep-Vein Thrombosis. New England Journal of Medicine 344:9, 626-631
     Full Text

164. 164

     Nitin B. Chandramouli, George M. Rodgers. (2001) Management of Thrombosis in Women With Antiphospholipid Syndrome. Clinical Obstetrics and Gynecology 44:1, 36-47
     CrossRef

165. 165

     E Pautas, V Siguret, M d’Urso, M Laurent, P Gaussem, M Février, B Durand-Gasselin. (2001) Surveillance d’un traitement par la tinzaparine à dose curative pendant dix jours chez le sujet âgé. La Revue de Médecine Interne 22:2, 120-126
     CrossRef

166. 166

     Beth A. Duplaga, Christina W. Rivers, Edith Nutescu. (2001) Dosing and Monitoring of Low-Molecular-Weight Heparins in Special Populations. Pharmacotherapy 21:2, 218-234
     CrossRef

167. 167

     Ermanno Attanasio, Pierluigi Russo, Gabriella Carunchio, Luciano Caprino. (2001) Dermatan Sulfate versus Unfractionated Heparin for the Prevention of Venous Thromboembolism in Patients Undergoing Surgery for Cancer. PharmacoEconomics 19:1, 57-68
     CrossRef

168. 168

     Keri Wellington, Karen McClellan, Blair Jarvis. (2001) Reviparin. Drugs 61:8, 1185-1209
     CrossRef

169. 169

     John A. Heit. (2001) Current Management of Acute Symptomatic Deep Vein Thrombosis. American Journal of Cardiovascular Drugs 1:1, 45-50
     CrossRef

170. 170

     Ian D. Timms. (2001) Low-Molecular-Weight Heparins: Overview and Potential Uses in Interventional Radiology. Journal of Vascular and Interventional Radiology 12:1, P33-P39
     CrossRef

171. 171

     M. F. Loreto, Massimo Martinis, M. P. Corsi, M. Modesti, L. Ginaldi. (2000) Coagulation and cancer: Implications for diagnosis and management. Pathology & Oncology Research 6:4, 301-312
     CrossRef

172. 172

     Hugo Partsch, Werner Blättler. (2000) Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. Journal of Vascular Surgery 32:5, 861-869
     CrossRef

173. 173

     Jeroen F van der Heijden, Martin H Prins, Harry R Büller. (2000) For the Initial Treatment of Venous Thromboembolism. Thrombosis Research 100:2, 121-130
     CrossRef

174. 174

     Rodger L. Bick. (2000) Proficient and Cost-Effective Approaches for the Prevention and Treatment of Venous Thrombosis and Thromboembolism. Drugs 60:3, 575-595
     CrossRef

175. 175

     Oscar M Aguilar, Neal S Kleiman. (2000) Low molecular weight heparins. Expert Opinion on Pharmacotherapy 1:6, 1091-1103
     CrossRef

176. 176

     Francis Couturaud, Clive Kearon. (2000) Long-term treatment for venous thromboembolism. Current Opinion in Hematology 7:5, 302-308
     CrossRef

177. 177

     G Agnelli, R Rossi, M.G Santamaria. (2000) Management of thromboembolism in the outpatient setting. Seminars in Hematology 37, 23-26
     CrossRef

178. 178

     P. de Moerloose, G. Reber, A. Perrier, T. Perneger, H. Bounameaux. (2000) Prevalence of factor V Leiden and prothrombin G20210A mutations in unselected patients with venous thromboembolism. British Journal of Haematology 110:1, 125-129
     CrossRef

179. 179

     Karen Campbell Betten. (2000) The Use of Low Molecular Weight Heparin in the Initial Management of Patients with Deep Vein Thrombosis. Journal of the American Academy of Nurse Practitioners 12:7, 267-272
     CrossRef

180. 180

     Manuel Monreal. (2000) Long-term treatment of venous thromboembolism with low-molecular-weight heparin. Current Opinion in Pulmonary Medicine 6:4, 326-329
     CrossRef

181. 181

     Spiros G Frangos, Alan H Chen, Bauer Sumpio. (2000) Vascular drugs in the new millennium11No competing interests declared.. Journal of the American College of Surgeons 191:1, 76-92
     CrossRef

182. 182

     Lauren B. Gerson, Brian F. Gage, Douglas K. Owens, George Triadafilopoulos. (2000) Effect and outcomes of the ASGE guidelines on the periendoscopic management of patients who take anticoagulants. The American Journal of Gastroenterology 95:7, 1717-1724
     CrossRef

183. 183

     Christopher J. Dunn, Blair Jarvis. (2000) Dalteparin. Drugs 60:1, 203-237
     CrossRef

184. 184

     Mark A Crowther, Karen Spitzer, Jim Julian, Jeff Ginsberg, Marilyn Johnston, Roberta Crowther, Carl Laskin. (2000) Pharmacokinetic Profile of a Low-Molecular Weight Heparin (Reviparin) in Pregnant Patients. Thrombosis Research 98:2, 133-138
     CrossRef

185. 185

     Susan F Assmann, Stuart J Pocock, Laura E Enos, Linda E Kasten. (2000) Subgroup analysis and other (mis)uses of baseline data in clinical trials. The Lancet 355:9209, 1064-1069
     CrossRef

186. 186

     Thomas W Wakefield. (2000) Treatment options for venous thrombosis. Journal of Vascular Surgery 31:3, 613-620
     CrossRef

187. 187

     Carlos A. Estrada, Christopher J. Mansfield, Gustavo R. Heudebert. (2000) Cost-effectiveness of Low-Molecular-Weight Heparin in the Treatment of Proximal Deep Vein Thrombosis. Journal of General Internal Medicine 15:2, 108-115
     CrossRef

188. 188

     Michael Blaivas, Michael J. Lambert, Robert A. Harwood, Joseph P. Wood, John Konicki. (2000) Lower-extremity Doppler for Deep Venous Thrombosis—Can Emergency Physicians Be Accurate and Fast?. Academic Emergency Medicine 7:2, 120-126
     CrossRef

189. 189

     Samuel Z. Goldhaber. (2000) Medical Management of Venous Thromboembolic Disease. Journal of Vascular and Interventional Radiology 11:2, 160-162
     CrossRef

190. 190

     Ian D. Timms. (2000) Low-Molecular-Weight Heparins. Journal of Vascular and Interventional Radiology 11:2, 392-396
     CrossRef

191. 191

     Walter Ageno. (2000) Treatment of Venous Thromboembolism. Thrombosis Research 97:1, V63-V72
     CrossRef

192. 192

     Peter J. Zed. (2000) Low molecular weight heparins and coronary artery disease. Current Cardiology Reports 2:1, 61-68
     CrossRef

193. 193

     William E. Wade, Bradley C. Martin, Jeffrey A. Kotzan, William J. Spruill, Marie A. Chisoholm, Matthew Perri. (2000) Formulary Management of Low Molecular Weight Heparins. PharmacoEconomics 17:1, 1-12
     CrossRef

194. 194

     THIERRY LEFÈVRE, MARIE-CLAUDE MORICE. (1999) Interventional Treatment of Acute Myocardial Infarction: Is The Thrombolysis Era Coming to an End?. Journal of Interventional Cardiology 12:6, 477-486
     CrossRef

195. 195

     Ville Pettilä, Risto Kaaja, Pekka Leinonen, Ulla Ekblad, Matti Kataja, Eero Ikkala. (1999) Thromboprophylaxis with Low Molecular Weight Heparin (Dalteparin) in Pregnancy. Thrombosis Research 96:4, 275-282
     CrossRef

196. 196

     Davendra Mehta. (1999) Redefining the role of antiarrhythmic drugs in the management of ventricular arrhythmias. Current Cardiology Reports 1:4, 265-267
     CrossRef

197. 197

     AGM van den Belt, MH Prins, AWA Lensing, AA Castro, OAC Clark, AN Atallah, E Burihan. 1999. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. .
     CrossRef

198. 198

     Wee Shian Chan, Joel G. Ray. (1999) Low Molecular Weight Heparin Use During Pregnancy: Issues of Safety and Practicality. Obstetrical & Gynecological Survey 54:10, 649-654
     CrossRef

199. 199

     Stavros Konstantinides. (1999) Aktuelle Diagnostik und Therapie der akuten Lungenembolie. Herz 24:6, 411-420
     CrossRef

200. 200

     John H. Reeves, Alison R. Cumming, Leanne Gallagher, Jennifer L. O'Brien, John D. Santamaria. (1999) A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration. Critical Care Medicine 27:10, 2224-2228
     CrossRef

201. 201

     Paolo Prandoni, Pier Mannuccio Mannucci. (1999) Deep-vein thrombosis of the lower limbs: diagnosis and management. Best Practice & Research Clinical Haematology 12:3, 533-554
     CrossRef

202. 202

     Jose A. Joglar, Mohamed H. Hamdan. (1999) Symptomatic ventricular tachycardia. Current Treatment Options in Cardiovascular Medicine 1:2, 145-152
     CrossRef

203. 203

     Gary E. Raskob. (1999) Heparin and low molecular weight heparin for treatment of acute pulmonary embolism. Current Opinion in Pulmonary Medicine 5:4, 216
     CrossRef

204. 204

     Brian M. Legere, Raed A. Dweik, Alejandro C. Arroliga. (1999) VENOUS THROMBOEMBOLISM IN THE INTENSIVE CARE UNIT. Clinics in Chest Medicine 20:2, 367-384
     CrossRef

205. 205

     Carsten Ranke, Hans-Joachim Trappe. (1999) Update Angiologie. Medizinische Klinik 94:5, 251-263
     CrossRef

206. 206

     John Blebea, Todd K. Kihara, Marsha M. Neumyer, Judy S. Blebea, Karla M. Anderson, Robert G. Atnip. (1999) A national survey of practice patterns in the noninvasive diagnosis of deep venous thrombosis. Journal of Vascular Surgery 29:5, 799-806
     CrossRef

207. 207

     Jack Hirsh, Shannon M Bates. (1999) Prognosis in acute pulmonary embolism. The Lancet 353:9162, 1375-1376
     CrossRef

208. 208

     Edward C. Grendys, James V. Fiorica. (1999) Advances in the prevention and treatment of deep vein thrombosis and pulmonary embolism. Current Opinion in Obstetrics and Gynaecology 11:1, 71-79
     CrossRef

209. 209

     Gregory A. Schmidt. (1999) Pulmonary embolism. Current Opinion in Critical Care 5:1, 61
     CrossRef

210. 210

     Anthonie WA Lensing, Paolo Prandoni, Martin H Prins, HR Büller. (1999) Deep-vein thrombosis. The Lancet 353:9151, 479-485
     CrossRef

211. 211

     Max P. Rosen. (1999) Spiral CT angiography for suspected pulmonary embolism: A cost-effectiveness analysis. Academic Radiology 6:1, 72-74
     CrossRef

212. 212

     Arian R. van Erkel, Peter M.T. Pattynama. (1999) Authors' response. Academic Radiology 6:1, 74-75
     CrossRef

213. 213

     James N. Huang, Akiko Shimamura. (1998) LOW-MOLECULAR-WEIGHT HEPARINS. Hematology/Oncology Clinics of North America 12:6, 1251-1281
     CrossRef

214. 214

     Mohammed A Quader, Lisa S Stump, Bauer E Sumpio. (1998) Low molecular weight heparins: current use and indications. Journal of the American College of Surgeons 187:6, 641-658
     CrossRef

215. 215

     (1998) Pulmonary Embolism. New England Journal of Medicine 339:21, 1555-1557
     Full Text

216. 216

     John W. Eikelboom, Ross I. Baker. (1998) Low-molecular-weight Heparin for the treatment of venous thrombosis in patients with adenocarcinoma. American Journal of Hematology 59:3, 260-261
     CrossRef

217. 217

     Paolo Prandoni, Anthonie WA Lensing, Andrea Piccioli, Paola Bagatella, Antonio Girolami. (1998) Ultrasonography of contralateral veins in patients with unilateral deep-vein thrombosis. The Lancet 352:9130, 786
     CrossRef

218. 218

     Goldhaber, Samuel Z., . (1998) Pulmonary Embolism. New England Journal of Medicine 339:2, 93-104
     Full Text

219. 219

     David Bergqvist. (1998) MODERN ASPECTS OF PROPHYLAXIS AND THERAPY FOR VENOUS THROMBO-EMBOLIC DISEASE. ANZ Journal of Surgery 68:7, 463-468
     CrossRef

220. 220

     Yu, David R., Miller, Redonda, Bray, Paul F., . (1998) Through Thick and Thin. New England Journal of Medicine 338:23, 1684-1687
     Full Text

221. 221

     P.E. Rose, D. Fitzmaurice. (1998) New approaches to the delivery of anticoagulant services. Blood Reviews 12:2, 84-90
     CrossRef

222. 222

     S C Litin, J A Heit, K A Mees. (1998) Use of low-molecular-weight heparin in the treatment of venous thromboembolic disease: answers to frequently asked questions. The Thrombophilia Center Investigators.. Mayo Clinic Proceedings 73:6, 545-550
     CrossRef

223. 223

     Sylvia K. Haas. (1998) TREATMENT OF DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM. Medical Clinics of North America 82:3, 495-510
     CrossRef

224. 224

     Decousus, Hervé, Leizorovicz, Alain, Parent, Florence, Page, Yves, Tardy, Bernard, Girard, Philippe, Laporte, Silvy, Faivre, René, Charbonnier, Bernard, Barral, Fabrice-Guy, Huet, Yann, Simonneau, Gérald, . (1998) A Clinical Trial of Vena Caval Filters in the Prevention of Pulmonary Embolism in Patients with Proximal Deep-Vein Thrombosis. New England Journal of Medicine 338:7, 409-416
     Full Text

225. 225

     Jules A Shafer. (1998) Cardiovascular chemotherapy: anticoagulants. Current Opinion in Chemical Biology 2:4, 458-465
     CrossRef

226. 226

     Wood, Alastair J.J., , Weitz, Jeffrey I., . (1997) Low-Molecular-Weight Heparins. New England Journal of Medicine 337:10, 688-699
     Full Text