Low-molecular-weight heparins and unfractionated heparin in the treatment of patients with acute venous thromboembolism: Results of a meta-analysis

1996 ◽  
Vol 100 (3) ◽  
pp. 269-277 ◽  
Author(s):  
Sergio Siragusa ◽  
Benilde Cosmi ◽  
Franco Piovella ◽  
Jack Hirsh ◽  
Jeffrey S. Ginsberg
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Unfractionated Heparin ◽  
Meta Analysis ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Acute Venous Thromboembolism

scholarly journals Evaluation of costs and outcomes associated with pharmacological thromboprophylaxis (unfractionated heparin and low molecular weight heparins) of venous thromboembolism at orthopedic ward in Clinical Hospital Stip

2017 ◽  
Vol 63 (01) ◽  
pp. 25-34
Author(s):  
Biljana Lazarova ◽  
Aleksandra Kapedanovska Nestorovska ◽  
Zoran Sterjev ◽  
Ljubica Suturkova
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Unfractionated Heparin ◽  
Orthopedic Surgery ◽  
Low Molecular Weight ◽  
First Line ◽  
Low Molecular Weight Heparins ◽  
Clinical Hospital ◽  
Orthopedic Department ◽  
Major Orthopedic Surgery

Clinical trials have shown Low-molecular weight heparins (LMWHs) to be at least as safe and efficacious as unfractionated heparin (UFH) for preventing venous thromboembolism (VTE) in patients undergoing major orthopedic surgery who are at highest risk of developing VTE. The retrospective study was conducted at orthopedic department in Clinical Hospital – Stip for period of 12 months (January-December 2013), where LMWHs and UFH are accepted thromboprophylaxis options. 320 patients (144 males and 157 females, medium age 58 years and 70 years, respectively) were hospitalized for various types of major orthopedic surgical interventions. 212 (66%) patients were admitted because of hip or knee fractures, 26 (8%) had conditions after hip or knee fractures and 82 (26%) were hospitalized for removal or implanting of osteosynthetic devices. After the surgical intervention, patients were subjected to anticoagulant prophylaxis (UFH or LMWHs). Which type of prophylaxis will be used depended exclusively on the surgeon’s decision. VTE complications resulting death were observed in 8 (2.5%) out of 13 patients. Death because of PE occurred in 2 (25%) out of 8 patients, compared to 6 (75%) patients who had fatal DVT complications. The average hospital cost for patients treated with LMWHs prophylaxis as first line thromboprophylaxis option was 52831.92 MKD/patient compared to 70082.24 MKD/patient for UFH first line thromboprophylaxis option. We observed that LMWHs thromboprophylaxis, applied in recommended doses subcutaneously once a day, is potentially more effective and cost saving option compared to UFH and should be considered as pharmacological treatment of first choice for the prevention of VTE (DVT and PE) in patients recovering from major orthopedic surgery at the orthopedic department in Clinical Hospital Stip. Keywords: Thromboprophylaxis, major orthopedic surgery, LMWHs, UFH

Low-molecular-weight heparins: Pharmacoeconomic decision modeling based on meta-analysis data

2010 ◽  
Vol 26 (3) ◽  
pp. 272-279 ◽  
Author(s):  
Edmundas Kadusevicius ◽  
Gabriele Kildonaviciute ◽  
Birute Varanaviciene ◽  
Danguole Jankauskiene
Keyword(s):  
Molecular Weight ◽  
Unfractionated Heparin ◽  
Fixed Effects ◽  
Cost Minimization ◽  
Meta Analysis ◽  
Analysis Data ◽  
Low Molecular Weight ◽  
Decision Modeling ◽  
Low Molecular Weight Heparins ◽  
Reference Pricing

Objectives: The aim of this study was to compare efficacy, safety, and consumption of low-molecular-weight heparins with unfractionated heparin, and to develop a pharmacoeconomic decision model based on meta-analysis data.Methods: Review and meta-analysis were performed of published randomized control trials directly comparing the safety and efficacy of low-molecular-weight heparins (LMWHs)—that is, nadroparin, enoxaparin, and dalteparin—and unfractionated heparin (UFH) was performed by two reviewers using inclusion/exclusion criteria based on the research objectives. The value of fixed effects and random effects odds ratio (95 percent confidence interval) was calculated for each trial for the composite end point. Subsequently, a pharmacoeconomic decision modeling based on reference pricing methodology was implemented.Results: In comparison to UFH, all LMWHs have independently demonstrated greater safety and effectiveness. None of the LMWHs demonstrated a significant superiority over each other; therefore, the group of LMWHs was interchangeable and suitable for cost minimization analysis and reference price implementation. Being the least expensive option, dalteparin single DDD price was set as the reference. Introduction of reference pricing for LMWHs would decrease the total expenditure on LMWHs of approximately 30 percent and would result in total savings of 1.830–2.070 thousand LTL in the country of Lithuania (approximately 0.8 million USD) per year.Conclusions: The meta-analysis results of LMWHs could be used to support a policy on reference-based pricing and pharmacoeconomic decision modeling in healthcare institutions, which would allow a decrease in healthcare expenditures.

scholarly journals Are All Low Molecular Weight Heparins Equivalent in the Management of Venous Thromboembolism?

2007 ◽  
Vol 14 (4) ◽  
pp. 385-392 ◽  
Author(s):  
Jawed Fareed ◽  
Walter Jeske ◽  
Daniel Fareed ◽  
Melaine Clark ◽  
Rakesh Wahi ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Unfractionated Heparin ◽  
Low Molecular Weight Heparin ◽  
Randomized Clinical Trials ◽  
Safety Data ◽  
Low Molecular Weight ◽  
Efficacy And Safety ◽  
Low Molecular Weight Heparins

Low molecular weight heparins are replacing unfractionated heparin in a number of clinical indications because of their improved subcutaneous bioavailability and more predictable antithrombotic response. Clinical trials have demonstrated that low molecular weight heparins are at least as safe and effective as unfractionated heparin for the initial treatment of venous thromboembolism, and unfractionated heparin and warfarin for primary and secondary thromboprophylaxis. The mechanism behind the antithrombotic action of low molecular weight heparins is not fully understood but is likely to involve inhibition of coagulation factors Xa and IIa (thrombin), release of tissue-factor-pathway inhibitor, and inhibition of thrombin activatable fibrinolytic inhibitor. Different low molecular weight heparins have been shown to have various effects on coagulation parameters. Seven low molecular weight heparins are currently marketed worldwide, each demonstrated distinct chemical entities with unique pharmacokinetic and pharmacodynamic profiles. Each low molecular weight heparin is approved for specific indications based on the available efficacy and safety data for that product. The relative efficacy and safety of the low molecular weight heparins are unclear because there have been very few direct comparisons in randomized clinical trials. While recommending low molecular weight heparins for the prevention and treatment of venous thromboembolism, clinical guidelines have not specified individual agents. National and international organizations recognize that low molecular weight heparins are distinct entities and that they should not be used interchangeably in clinical practice. Each low molecular weight heparin should be used at the recommended dose when efficacy and safety data exist for the condition being treated. When these data are not available, the dosing and administration of low molecular weight heparins must be adapted from existing data and recommendations.

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