Secondary prophylaxis of deep venous thromboembolism. When is the application of low-molecular-weight heparins advisable? Review of the literature

Abstract

Deep vein thrombosis of the lower limbs is a frequent therapeutic problem, and additionally makes hemodynamic functioning of the venous system worse for a long time. Treatment and primary prophylaxis does not arouse controversies today. The secondary prevention of the deep vein thombosis lets one effectively counteract post-thrombotic syndrome. Low molecular weight heparins have nearly completely substituted nowadays unfracted heparins in primary prophylaxis. In secondary prophylaxis it is generally accepted to administer oral anticoagulants, but there are numerous contraindications for administered oral anticoagulants. Also many side effects are caused by these medicines. In this paper, the authors wanted to answer the following question: in which patients does the administration of LMWH in secondary prophylaxis bring benefits? They analysed over 50 articles and found some conclusions. There are many advantages for pregnant patients and those suffering from a cancer who should be treated with low-molecular-weight heparins. Many authors have noticed that LMWH and oral anticoagulants have a similar efficacy and a comparable amount of serious haemorrhagic complications. Except for the groups of patients who need long-term prophylaxis, the physician together with the patient should decide on what method of treatment to choose.