Hull R, Delmore T, Carter C, Hirsh J, Genton E, Gent M, Turpie G, McLaughlin D
N Engl J Med. 1982 Jan 28;306(4):189-94. doi: 10.1056/NEJM198201283060401.
Previously, we compared fixed low doses of heparin with adjusted doses of warfarin for the long-term treatment of venous thrombosis; in that study low-dose heparin was ineffective in preventing recurrence in patients with proximal-vein thrombosis. We have now completed a randomized trial comparing adjusted doses of heparin and of warfarin for prevention of recurrent venous thromboembolism in patients with proximal-vein thrombosis. One hundred six consecutive patients with acute proximal-vein thrombosis confirmed by venography were treated with intravenous heparin and then randomized to secondary prophylaxis. Two of 53 patients receiving heparin, as compared with one of 53 receiving warfarin, had new episodes of objectively documented venous thromboembolism. Nine patients taking warfarin had bleeding complications (which were major in three patients), as compared with one patient taking heparin (P = 0.008). Our data indicate that adjusted-dose subcutaneous heparin therapy provides an effective alternative to warfarin sodium and is associated with a lower risk of bleeding.
此前，我们比较了固定低剂量肝素与调整剂量华法林对静脉血栓形成的长期治疗效果；在该研究中，低剂量肝素对预防近端静脉血栓形成患者的复发无效。我们现已完成一项随机试验，比较调整剂量的肝素与华法林对近端静脉血栓形成患者预防复发性静脉血栓栓塞的效果。106例经静脉造影确诊为急性近端静脉血栓形成的连续患者先接受静脉注射肝素治疗，然后随机接受二级预防。接受肝素治疗的53例患者中有2例发生客观记录的新的静脉血栓栓塞事件，而接受华法林治疗的53例患者中有1例发生。服用华法林的9例患者出现出血并发症（3例为严重出血），而服用肝素的患者有1例（P = 0.008）。我们的数据表明，调整剂量的皮下肝素治疗是华法林钠的有效替代方案，且出血风险较低。
