Enoxaparin monotherapy without oral anticoagulation to treat acute symptomatic pulmonary embolism

Joshua A. Beckman, Kelly Dunn, Arthur A. Sasahara, Samuel Z. Goldhaber

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Conventional anticoagulation for symptomatic pulmonary embolism consists of continuous intravenous unfractionated heparin as a "bridge" to oral anticoagulation. This strategy requires 5 days or more of intravenous heparin while oral vitamin K antagonists gradually achieve a therapeutic effect. Oral vitamin K antagonists require frequent blood testing to optimize dosing, and their interactions with other medications and foods make regulation difficult. Therefore we tested a different approach to therapy: long-term enoxaparin monotherapy. We randomized 60 symptomatic pulmonary embolism patients in a 2:1 ratio to 90 days of enoxaparin as monotherapy without warfarin (N=40) or to intravenous unfractionated heparin as a "bridge" to warfarin, target INR 2.0-3.0 (N=20). Enoxaparin patients received 1 mg/kg twice daily for 14 days during the acute phase followed by randomized assignment during the chronic phase to 1.0 mg/kg vs. 1.5 mg/kg once daily. In an intention-to-treat analysis, 3 of the 40 enoxaparin patients developed recurrent venous thromboembolism compared with 0 of 20 standard therapy patients (p = 0.54). One of the 40 enoxaparin patients had a major hemorrhagic complication compared with 2 of the 20 standard therapy patients (p = 0.26). Median hospital length of stay was shorter with enoxaparin compared to standard therapy (4 vs. 6 days) (p = 0.001). Following our study we can conclude that extended 3-month treatment with enoxaparin as monotherapy for symptomatic, acute pulmonary embolism is feasible and warrants further study in a large clinical trial.

Original languageEnglish (US)
Pages (from-to)953-958
Number of pages6
JournalThrombosis and Haemostasis
Issue number6
StatePublished - Jun 1 2003
Externally publishedYes


  • Anticoagulation
  • Enoxaparin
  • Low molecular weight heparin
  • Pulmonary embolism
  • Thrombosis

ASJC Scopus subject areas

  • Hematology


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