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Treatment of venous thrombosis with standard intravenous heparin in hospital versus subcutaneous low-molecular-weight heparin at home
Notes
Treatment of venous thrombosis with standard intravenous heparin in hospital versus suhcutaneous low-molecular-weight heparin at home In this multicenter study we randomly assigned patients with deep-vein thrombosis to adjusted-dose intravenous standard heparin administered in the hospital (198 patients) or fixed-dose subcutaneous low-molecularweight heparin administered at home. when feasible (202 patients). We compared the treatments with respect to efficacy, defined as recurrent venous thromboemholism, safety. defined as the occurence of major bleeding, quality of life and costs. Of the standard heparin treated patients 8.6 percent had recurrent thromboembolism and 6.9% of the patients who received lowmolecular-weight heparin (difference 1.7 percent; 95% CI, -3.6 to 6.9). Major bleeding occurred in 2.0 percent of patients assigned to standard heparin and in 0.5 percent of patients assigned to low-molecular-weight heparin (difference 0.5%; 95% CI, -0.7 to 2.7). Quality of life improved in both groups. Physical activity and social functioning were better in the low-molecularweight heparin treated patients. The low-molecularweight heparin treatment was associated with a mean reduction in hospital days of 67 percent. In conclusion, the treatment of patients with deep-vein thrombosis with low-molecular-weight heparin at home is feasible, effective and safe. MMW Koopman (4) University of Amsterdam 1105 AZ Amsterdam, The Netherlands (4) N Engl .I Med
1996;334:682-7
469 New risk factor in Down’s syndrome? Down’s syndrome (DS), the most common chromosomal abnormality among children, is usually caused by an extra chromosome 21 due to errors in meiosis in the mother (about 95% of cases) or in the father (about 5%). Except for advanced maternal age, there is no well documented risk factor in DS, thus remaining one of the major unanswered questions of human genetics. Our results demonstrate an increase in the frequency of apolipoprotein E (apoE) allele ~4 in young mothers where the error took place in the second meiotic divison of the oocyte, as determined by DNA analysis in a population-based study of DS. This finding supports the reported increased risk of Alzheimer’s disease (AD) in young mothers of DS individuals, as apoE allele ~4 has been established as the major genetic susceptibility factor in AD. The biological role of apoE in oocytes remains to be investigated, but a direct function in relation to chromosomal segregation is hypothesised. MB Petersen (5) Institute of Child Health, GR-115 (5) Lancet
1996;347:862-5
27 Athens,
Greece
Treatment of venous thrombosis with standard intravenous heparin in hospital versus suhcutaneous low-molecular-weight heparin at home In this multicenter study we randomly assigned patients with deep-vein thrombosis to adjusted-dose intravenous standard heparin administered in the hospital (198 patients) or fixed-dose subcutaneous low-molecularweight heparin administered at home. when feasible (202 patients). We compared the treatments with respect to efficacy, defined as recurrent venous thromboemholism, safety. defined as the occurence of major bleeding, quality of life and costs. Of the standard heparin treated patients 8.6 percent had recurrent thromboembolism and 6.9% of the patients who received lowmolecular-weight heparin (difference 1.7 percent; 95% CI, -3.6 to 6.9). Major bleeding occurred in 2.0 percent of patients assigned to standard heparin and in 0.5 percent of patients assigned to low-molecular-weight heparin (difference 0.5%; 95% CI, -0.7 to 2.7). Quality of life improved in both groups. Physical activity and social functioning were better in the low-molecularweight heparin treated patients. The low-molecularweight heparin treatment was associated with a mean reduction in hospital days of 67 percent. In conclusion, the treatment of patients with deep-vein thrombosis with low-molecular-weight heparin at home is feasible, effective and safe. MMW Koopman (4) University of Amsterdam 1105 AZ Amsterdam, The Netherlands (4) N Engl .I Med
1996;334:682-7
469 New risk factor in Down’s syndrome? Down’s syndrome (DS), the most common chromosomal abnormality among children, is usually caused by an extra chromosome 21 due to errors in meiosis in the mother (about 95% of cases) or in the father (about 5%). Except for advanced maternal age, there is no well documented risk factor in DS, thus remaining one of the major unanswered questions of human genetics. Our results demonstrate an increase in the frequency of apolipoprotein E (apoE) allele ~4 in young mothers where the error took place in the second meiotic divison of the oocyte, as determined by DNA analysis in a population-based study of DS. This finding supports the reported increased risk of Alzheimer’s disease (AD) in young mothers of DS individuals, as apoE allele ~4 has been established as the major genetic susceptibility factor in AD. The biological role of apoE in oocytes remains to be investigated, but a direct function in relation to chromosomal segregation is hypothesised. MB Petersen (5) Institute of Child Health, GR-115 (5) Lancet
1996;347:862-5
27 Athens,
Greece