ISCHAEMIC HEART DISEASE

Low molecular weight heparin to treat pulmonary embolism ▸ In a meta-analysis of 12 trials, low molecular weight heparin was associated with a non-significant decrease in recurrent symptomatic venous thromboembolism at the end of treatment (1.4% v 2.4%; odds ratio (OR) 0.63, 95% confidence interval (CI) 0.33 to 1.18) and at three months (3.0% v 4.4%; OR 0.68, 95% CI 0.42 to 1.09) compared to unfractionated heparin. Similar estimates were obtained for patients who presented with symptomatic pulmonary embolism (1.7% v 2.3%; OR 0.72, 95% CI 0.35 to 1.48) or asymptomatic pulmonary embolism (1.2% v 3.2%; OR 0.53, 95% CI 0.15 to 1.88). For major bleeding complications, the odds ratio favouring low molecular weight heparin (1.3% v 2.1%; OR 0.67, 95% CI 0.36 to 1.27) was also not significant. This suggests that low molecular weight heparin is probably a safer alternative for the treatment of pulmonary as well as deep vein thrombosis.

▴Quinlan DJ, McQuillan A, Eikelboom JW. Low-molecular-weight heparin compared with intravenous unfractionated heparin for treatment of pulmonary embolism: a meta-analysis of randomized, controlled trials. Ann Intern Med2004;140:175–83.OpenUrlCrossRefPubMedWeb of Science

Warfarin for six months removes atrial appendage thrombus in 25% ▸ Among 219 candidates for percutaneous mitral commissurotomy (PTMC) with left atrial thrombus (mean age 39.6 (7.4) years) complete resolution of thrombus was demonstrated in 53 patients (24.2%), who subsequently underwent successful PTMC. In another 166 patients, the thrombus size was reduced by 24% (p < 0.001). No thrombus resolution was observed in the 27 patients with a left atrial body thrombus. Eighteen patients had minor bleeding. The significant predictors of thrombus resolution were a New York Heart Association functional class ⩽ II, a left atrial appendage thrombus size …