BACKGROUND:Subcutaneous (SC) low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) are safe and efficacious for bridging anticoagulation after warfarin interruption. Although LMWH and UFH are self-administered by >90% of patients, factors that may be important to patients such as differences in pain and ecchymosis have not been explored. METHODS: We randomized 24 patients to receive SC LMWH or SC UFH twice-daily during the perioperative period. Injection associated pain was recorded using a visual analogue scale and area of ecchymosis was measured by digital photography of the injection site on the day of the procedure. RESULTS: The area of ecchymosis was 2-fold higher with UFH than LMWH (19.4 cm(2) vs. 8.98 cm(2); P = 0.33) and pain was similar with both treatments (115 mm vs. 171 mm; P = 0.25), though neither finding attained statistical significance. CONCLUSIONS: This exploratory study was underpowered to detect differences between the groups. Further studies are needed to reliably compare pain and ecchymosis in LMWH vs. UFH.
RCT Entities:
BACKGROUND: Subcutaneous (SC) low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) are safe and efficacious for bridging anticoagulation after warfarin interruption. Although LMWH and UFH are self-administered by >90% of patients, factors that may be important to patients such as differences in pain and ecchymosis have not been explored. METHODS: We randomized 24 patients to receive SC LMWH or SC UFH twice-daily during the perioperative period. Injection associated pain was recorded using a visual analogue scale and area of ecchymosis was measured by digital photography of the injection site on the day of the procedure. RESULTS: The area of ecchymosis was 2-fold higher with UFH than LMWH (19.4 cm(2) vs. 8.98 cm(2); P = 0.33) and pain was similar with both treatments (115 mm vs. 171 mm; P = 0.25), though neither finding attained statistical significance. CONCLUSIONS: This exploratory study was underpowered to detect differences between the groups. Further studies are needed to reliably compare pain and ecchymosis in LMWH vs. UFH.
Authors: Clive Kearon; Jeffrey S Ginsberg; Jim A Julian; James Douketis; Susan Solymoss; Paul Ockelford; Sharon Jackson; Alexander G Turpie; Betsy MacKinnon; Jack Hirsh; Michael Gent Journal: JAMA Date: 2006-08-23 Impact factor: 56.272
Authors: A C Spyropoulos; A G G Turpie; A S Dunn; J Spandorfer; J Douketis; A Jacobson; F J Frost Journal: J Thromb Haemost Date: 2006-06 Impact factor: 5.824
Authors: James D Douketis; Peter B Berger; Andrew S Dunn; Amir K Jaffer; Alex C Spyropoulos; Richard C Becker; Jack Ansell Journal: Chest Date: 2008-06 Impact factor: 9.410