Low-molecular-weight heparin for the treatment of acute XXXX .

@entity1 @entity1188 @entity1031 @entity204 @entity385
BACKGROUND: Despite doubts about their efficacy and concern about their safety, antithrombotic agents are often used to treat acute @entity385 . Recent experience in @entity1 with other @entity1031 suggests that low-molecular-weight heparin, which requires only subcutaneous administration once or twice daily, may be more effective and safer than standard (unfractionated) heparin. METHODS: We conducted a randomized, double-blind, placebo-controlled trial comparing two dosages of low-molecular-weight heparin with placebo in the treatment of @entity385 . @entity1 were randomly assigned within 48 hours of the onset of symptoms to receive high-dose nadroparin (4100 anti-factor Xa IU twice daily), low-dose nadroparin (4100 IU once daily), or placebo subcutaneously for 10 days. The primary measure of outcome was @entity204 or dependency regarding activities of daily living six months after randomization. Secondary outcomes were @entity204 , hemorrhagic transformation of the @entity1188 , and other complications at 10 days, and @entity204 or dependency at 3 months. RESULTS: A total of 2750 @entity1 were screened for the study. Among 312 @entity1 randomized, 306 had outcomes that were analyzed at six months. Forty-five @entity1 (45 percent) in the high-dose group, 53 @entity1 (52 percent) in the low-dose group, and 68 @entity1 (65 percent) in the placebo group died or became dependent. There was a significant dose-dependent effect among the three study groups in favor of low-molecular-weight heparin (P = 0.005 by the chi-square test for trend). No significant differences among the groups in the occurrence of secondary outcomes were observed at 10 days. CONCLUSIONS: For @entity1 with @entity385 treated within 48 hours of the onset of symptoms, low-molecular-weight heparin was effective in improving outcomes at six months.
