Comparison of Subcutaneous Unfractionated Heparin with a Low Molecular Weight Heparin (Fragmin®) in Patients with Venous Thromboembolism and Contraindications to Coumarin

1994 ◽  
Vol 71 (01) ◽  
pp. 007-011 ◽  
Author(s):  
M Monreal ◽  
E Lafoz ◽  
A Olive ◽  
L del Rio ◽  
C Vedia
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Spinal Fracture ◽  
Heparin Therapy ◽  
Laboratory Animals ◽  
Low Molecular Weight ◽  
Consecutive Series ◽  
Minor Bleeding ◽  
Promising Alternative

SummaryIntravenous heparin followed by oral anticoagulant therapy (e. g. with coumarin) is still the most widely used treatment for deep venous thromboembolism. Self-administered subcutaneous injections of heparin have been thought of as a promising alternative to coumarin, but the high doses required for ongoing prophylaxis have raised concerns about the possible development of bone disease. Certainly, long-term heparin therapy has been reported to cause osteoporosis in both laboratory animals and humans.This study aimed to compare the efficacy and safety of unfractionated (UF) heparin with that of a low molecular weight heparin (Fragmin®, Kabi Pharmacia) in the prevention of recurrent deep venous thrombosis (DVT) and pulmonary embolism (PE) in a consecutive series of patients with contraindications to coumarin therapy. The patients comprised 40 men and 40 women, aged between 19 and 92 years (mean age, 68 years). They had all previously been diagnosed as having acute DVT and had been treated with conventional doses of heparin while in hospital. All patients had at least one of the following conditions: recent blood loss (either spontaneous or during admission while receiving heparin therapy); active gastroduodenal ulcer disease; psychological or physical inability or unwillingness to understand and accept the need for regular laboratory monitoring during coumarin treatment; chronic alcoholism; dementia; pregnancy; recent neurosurgery, and pericardial effusion; or were over 80 years of age. They were randomly allocated to receive either UF heparin, 10,000 IU s.c. b.d., or Fragmin®, 5000 IU anti-Factor Xa s. c. b. d., for a period of 3-6 months.Two patients taking UF heparin were readmitted to hospital 2 and 3 months after discharge, owing to symptomatic, scintigraphically proven recurrent PE. No patients receiving Fragmin® had recurrent PE. There were 10 reports of minor bleeding: six in patients receiving UF heparin and four in patients on Fragmin®. Furthermore, there were seven cases of spinal fracture: six in patients on UF heparin, and one in a patient taking Fragmin®.We conclude that fixed doses of both UFH and Fragmin® appear to be quite effective and safe for use in patients with a high risk of bleeding. In our experience, however, UF heparin is associated with an unacceptably high incidence of spinal fracture.

scholarly journals Case Report: Spontaneous Intramural Hematoma of the Colon Secondary to Low Molecular Weight Heparin Therapy

2021 ◽  
Vol 12 ◽  
Author(s):  
Ye Zhu ◽  
Chao Wang ◽  
Chao Xu ◽  
Jia Liu
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Gastrointestinal Symptoms ◽  
Intramural Hematoma ◽  
Heparin Therapy ◽  
Low Molecular Weight ◽  
Hemorrhagic Complication ◽  
Minor Bleeding ◽  
Bleeding Events

Background: Hematoma of the colon is a rare hemorrhagic complication that affects patients accepting low molecular weight heparin (LMWH) therapy. Only scarce cases of colon hematoma have been reported, usually in children or patients accepting warfarin therapy.Case summary: A 76-year-old Chinese man was diagnosed with atrial fibrillation and heart failure, with cardiac function NYHA grade III on March 21, 2018. This patient was given LMWH for anticoagulation therapy and developed a colon hematoma on the third day of hospitalization. Abdominal computed tomography (CT) showed the thickening of areas of the colon up to 110 mm × 78 mm in thickness, which was a symptom of colon hematoma. The patient underwent conservative treatment successfully. On March 27, the patient’s abdominal pain was alleviated, and a CT scan showed that the intestinal hematoma was absorbed.Conclusions: The most frequent minor bleeding events of LMWH anticoagulation are hemorrhage and subcutaneous hematoma. This case demonstrated that bowel hematoma despite its low incidence should be considered as an ADR of LMWH therapy, especially among patients who present with gastrointestinal symptoms.

Low-molecular-weight heparin therapy for venous thromboembolism

VASA ◽  
2000 ◽  
Vol 29 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Sylvia Haas ◽  
Haas ◽  
Creutzig
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Heparin Therapy ◽  
Low Molecular Weight ◽  
Niedermolekulare Heparine

Niedermolekulare Heparine, deren Einsatz zur Thromboseprophylaxe heute praktisch zum Standard geworden ist, können seit kurzem auch für die Behandlung von tiefen Venenthrombosen verwendet werden. In dieser Übersichtsarbeit wird dargelegt, welche Gründe es dafür gibt und insbesondere welche Vorteile sich daraus im klinischen Alltag ergeben. Nach einer Beschreibung der verschiedenen prinzipiellen Ansätze zum therapeutischen Einsatz niedermolekularer Heparine werden die wesentlichen Ergebnisse bisher durchgeführter Studien angeführt. Sie zeigen, daß das bisher übliche Schema der initialen Behandlung mit intravenös gegebenem unfraktioniertem Heparin durch subkutane Gaben niedermolekularer Heparine ersetzt werden kann, wobei eine mindestens gleich gute Wirksamkeit bei besserer Verträglichkeit zu erwarten ist. Außerdem ermöglicht die Einfachheit dieses therapeutischen Regimes die ambulante Durchführung, die sowohl aus Sicht des Patienten als auch aus Kostengründen beträchtliche Vorteile bietet.

Transaminase Elevation in Patients Treated with Unfractionated Heparin or Low Molecular Weight Heparin for Venous Thromboembolism

1998 ◽  
Vol 4 (2) ◽  
pp. 126-128 ◽  
Author(s):  
Bruno Girolami ◽  
Paolo Prandoni ◽  
Laura Rossi ◽  
Antonio Girolami
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Unfractionated Heparin ◽  
Low Molecular Weight Heparin ◽  
Statistical Significance ◽  
Heparin Therapy ◽  
Low Molecular Weight ◽  
Transaminase Elevation ◽  
End Of Treatment ◽  
The Difference

The purpose of this study was to evaluate the in cidence of transaminase elevation in patients treated with un fractionated (UFH) or low molecular weight heparin (LMWH). Patients receiving UFH, nadroparin, or reviparin for venous thromboembolism and with normal baseline transaminase val ues were evaluated for serum transaminase levels 10-14 days after the start of heparin therapy or at the end of treatment. The incidence of high transaminase was 4.7% overall (95% CI, 2.2 to 7.3), while it was 2.9% (95% CI, 0.1 to 5.6) and 6.7% (95% CI, 2.5 to 11.0) with UFH and LMWH treated patients, respec tively. The difference was equal to -3.8% (95% CI, -8.9 to 1.2) and the common odds ratio was equal to 0.38 (95% CI, 0.12 to 1.16, p = .09). Nadroparin treated patients showed a 5.7% (95% CI, 1.3 to 10.2) incidence of high transaminase levels, while reviparin treated patients presented a 10.3% incidence (95% CI, -0.7 to 21.4). The comparison with UFH showed a mild trend in favor of UFH when compared with nadroparin, but not with reviparin. In conclusion, the incidence of trans aminase increase during heparin treatment for a venous throm boembolic event is equal to 3%, 6%, and 10% in UFH-, na droparin-, and reviparin-treated patients, respectively. LMWHs showed a slightly higher average incidences of hypertransami nasemia as compared with UFH. Differences did not reach statistical significance. Key Words: Unfractionated heparin— Low molecular weight heparin—Hypertransaminasemia.

How Useful is the Monitoring of (Low Molecular Weight) Heparin Therapy by Anti-Xa Assay? A Laboratory Perspective

2005 ◽  
Vol 11 (3) ◽  
pp. 157-162 ◽  
Author(s):  
EMMANUEL J. FAVALORO ◽  
ROSLYN BONAR ◽  
MARGARET ABOUD ◽  
JOYCE LOW ◽  
JOHN SIOUFI ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Heparin Therapy ◽  
Low Molecular Weight

scholarly journals Safety and efficacy of direct oral anticoagulants (DOACs) vs low molecular weight heparin (LMWH) in malignancy induced venous thromboembolism-a systematic review and meta analysis

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
N Hussain ◽  
S Adeel Hassan ◽  
S Mandava ◽  
F Yasmin ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Efficacy And Safety ◽  
Dichotomous Data ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Background- Low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) have been proven to be more effective in the management of venous thromboembolism (MVTE). The efficacy and safety of LMWH or DOACs in treatment of recurrent or malignancy induced VTE is not studied in literature. Objective To compare the efficacy and safety of LMWH and  DOACs in the management of malignancy induced  VTE Methods- Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to November  28th, 2020. Dichotomous data was extracted for prevention of VTE and risk of major bleeding in patients taking either LMWH or DOACs. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05.  Results- Three studies with 2607 patients (DOACs n = 1301 ; LMWH n = 1306) were included in analysis. All the study population had active cancer of any kind diagnosed within the past 6 months. Average follow-up period for each trial was 6 months. Patients receiving DOACs have a lower odds of recurrence of MVTE as compared to LMWH( OR 1.56; 95% CI 1.17-2.09; P = 0.003, I2 = 0). There was no significant difference in major bleeding among patients receiving LMWH or DOACs  (OR-0.71, 95%CI 0.46-1.10, P = 0.13, I2 = 22%) (Figure 1). We had no publication bias in our results (Egger’s regression p > 0.05). Conclusion- DOACs are superior to LMWH in prevention of MVTE and have similar major bleeding risk as that of LMWH. Abstract Figure. A)VTE Recurrence B)Major Bleeding events

Sign in / Sign up

Export Citation Format

Share Document