Comparison of unfractionated heparin vs low molecular weight heparin in the treatment of acute deep vein thrombosis.

OBJECTIVE: To compare the results of unfractionated heparin (UFH) with low molecular weight heparin in the treatment of acute deep vein thrombosis of lower limb. DESIGN: Randomized control trial. PLACE AND DURATION OF STUDY: Bolan Medical Complex Hospital, Quetta from January 2002 to July 2003. PATIENTS AND METHODS: Thirty patients who presented with acute deep vein thrombosis of lower limb, confirmed by either Doppler ultrasonography or venography, were selected for the study. Patients were divided randomly into two groups for treatment. Group 1 was started with unfractionated heparin while group 2 with low molecular weight heparin. Comparison of two treatments to determine the efficacy was done by certain criteria like pain improvement, reduction in swelling, alteration in bleeding profile, complications of therapy, recurrence, morbidity and mortality. RESULTS: The age of the patients ranged from 16-82 years. There were 15 females (50.00%) and 15 males (50.00%). Pain and swelling were present in all patients (100%), while temperature and superficial vein dilation in 43.3% and 30% respectively. The distribution of DVT in left lower limb was in 13 patients (43.33%), right lower limb involvement in 12 patients (40.00%) and both limbs involvement in 5 patients (16.67%). In group 1 improvement in pain occurred after 4th day in 13 patients, while in group 2 before 4th day in 8 patients (p-value = 0.068). Improvement in swelling was observed after 6th day in 11 patients (group 1), while before 6th day in 8 patients (group 2) (p-value = 0.171). Bleeding time was prolonged in 5 patients in group 1 and statistically found significant (p-value = 0.014), while in group 2 it was normal. Thromboembolism in 3 patients and major bleeding was observed in 2 patients in group 1, while in group 2 it was normal. Recurrence was reported in 2 patients in group 1 and 1 patient in group 2 (p-value 0.0815). The hospital stay was more than 10 days in group 1 (12 patients), and less than 10 days in group 2 (13 patients). It was found statistically significant (p-value = 0.001). Three patients died in group 1, while no mortality was observed in group 2. CONCLUSION: Treatment with low molecular weight heparin (LMWH) has good patient compliance and is easy to administer. LMWH has an advantage over UFH due to its normal bleeding profile and significantly less hospital stay.

Diagnostic yield of color Doppler ultrasonography in deep vein thrombosis.

OBJECTIVE: To see the diagnostic yield of color Doppler ultrasonography in patients who presented with clinical symptoms and signs of acute deep vein thrombosis of lower limb. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The study was carried out in Bolan Medical Complex Hospital, Quetta from January 2002 to December 2002. SUBJECTS AND METHODS: Twenty five patients, who presented with clinical symptoms and signs of acute deep venous thrombosis of lower limb, were selected. In all patients color Doppler ultrasound and venography was performed to compare the results. RESULTS: The age of the patients ranged from 16-82 +/- 20.33 years. The mean was 49.16, median 50.00 and mode 60.00 There were 15 females (60.00%) and 10 males (40.00%). Left lower limb involvement was seen in 12 patients (48.00% +/- 0.51), right lower limb involvement in 10 patients (40.00% +/- 0.50) and both limbs involvement in 3.0 patients (12.00% +/- 0.33). Color Doppler ultrasound was positive in 16 patients (64.00% +/- 0.48) while venography was positive in 21 patients (84.00% +/- 0.37%). Doppler ultrasonography and venography showed that 11 patients (52.38%) had distal DVT, while 10 patients (47.62%) had distal as well as proximal DVT. Ten patients (100.00%) of proximal as well as distal DVT were diagnosed by CDU and later confirmed by venography. Eleven patients (100.00%) of distal DVT only in whom 6 patients (54.54%) were diagnosed by CDU, while 5 patients (45.46%) had inconclusive findings, which were confirmed by venography. Doppler ultrasonography compared venography showed sensitivity 76.1%, specificity 100%, positive predictive value 100%, negative predictive value 44.45% and accuracy 80.00%. CONCLUSION: Color Doppler ultrasonography is a non-invasive, safe, efficient and cost-effective method in diagnosing acute deep venous thrombosis of lower limb but still it has not 100% accuracy. It is better for diagnosing proximal DVT than distal DVT. 7.