Jamula Erin, Woods Karen, Verhovsek Madeleine, Douketis James D, McDonald Ellen
Department of Medicine, McMaster University, Hamilton, Canada.
J Thromb Thrombolysis. 2009 Oct;28(3):266-8. doi: 10.1007/s11239-009-0312-8. Epub 2009 Feb 14.
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.
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.
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.
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.
皮下注射低分子量肝素（LMWH）或普通肝素（UFH）在华法林中断后的桥接抗凝治疗中安全有效。尽管超过90%的患者自行注射LMWH和UFH，但对于患者可能重要的因素，如疼痛和瘀斑的差异尚未进行探索。
我们将24例患者随机分组，在围手术期每天两次皮下注射LMWH或皮下注射UFH。使用视觉模拟量表记录注射相关疼痛，并在手术当天通过对注射部位进行数码拍照测量瘀斑面积。
UFH组的瘀斑面积比LMWH组高2倍（19.4平方厘米对8.98平方厘米；P = 0.33），两种治疗的疼痛情况相似（115毫米对171毫米；P = 0.25），但两项结果均未达到统计学显著性。
这项探索性研究的效能不足以检测出两组之间的差异。需要进一步研究以可靠地比较LMWH和UFH在疼痛和瘀斑方面的情况。
