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.

Venous Thromboembolism Treatment with Low-Molecular-Weight Heparin during Pregnancy: A Systematic Review.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1780-1780
Author(s):  
Ian A. Greer ◽  
Catherine Nelson-Piercy
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Case Reports ◽  
Safety Data ◽  
Case Series ◽  
Low Molecular Weight ◽  
Efficacy And Safety ◽  
Vein Thrombosis

Abstract Introduction Low-molecular-weight heparin (LMWH) has become the standard therapy for managing acute venous thromboembolism (VTE) during pregnancy. In the UK, Europe and Australasia, LMWH is widely used for the treatment of both deep-vein thrombosis and pulmonary embolism occurring during pregnancy, and this practice is endorsed by a peer-reviewed Royal College of Obstetricians and Gynaecologists (RCOG) guideline. However, there are currently no LMWHs licensed for use during pregnancy, and efficacy and safety data are derived mostly from small case series. Our aim was to evaluate the efficacy and safety of LMWH for VTE treatment during pregnancy by performing a systematic review of data from published literature. Methods Data from published studies included in this systematic review were identified by searching MEDLINE and EMBASE up to the end of 2003. The reference lists from identified articles were also hand searched. Data on the LMWH treatment regime, VTE recurrence, and side effects of VTE treatment were extracted and entered into pre-piloted forms. Results Sixteen studies (including six case reports) reporting 177 patients were included. One hundred and eight (61%) women were treated with enoxaparin, 49 (28%) with dalteparin and 20 (11%) with nadroparin. In 31 (18%) cases, VTE was initially treated with unfractionated heparin for two days to two weeks after diagnosis. LMWH was administered twice daily in 154 (87%) cases. Recurrent VTE was reported in three (1.7%) women: one receiving dalteparin 10,000 IU od, one receiving enoxaparin 40 mg bd, and one receiving enoxaparin 1mg/kg bd. There were no maternal deaths. Severe maternal bleeding occurred in three (1.7%) women. In two cases, the LMWH could have contributed to the extent of bleeding originating primarily from obstetric causes, and in the other from epistaxis. Minor allergic reactions occurred in two (1.1%) women, thrombocytopenia (unrelated to LMWH) in one (0.6%) woman, and osteoporosis in none. Conclusion Our findings are consistent with LMWH being both effective and safe in the treatment of acute VTE during pregnancy.

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

scholarly journals Modern low-molecular-weight heparins in the prevention and treatment of venous thromboembolic complications in oncourologic patients

2018 ◽  
pp. 106-112
Author(s):  
N. V. Vorobyev ◽  
S. V. Popov
Keyword(s):  
Molecular Weight ◽  
Impaired Renal Function ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Efficacy And Safety ◽  
Thromboembolic Complications ◽  
Antithrombotic Effect ◽  
Low Molecular Weight Heparins ◽  
Prevention And Treatment ◽  
Venous Thromboembolic

Oncourologic diseases are accompanied by a risk for subsequent venous thromboembolic complications, which are rated the most dangerous in terms of thrombogenic effect. The article presents a review of the clinical studies of efficacy and safety, and the experience in using of modern low-molecular-weight heparins in clinical practice - drugs of choice for the prevention of venous thromboembolic complications in cancer patients. Particular attention is paid to Bemiparin - a new second-generation low-molecular-weight heparin with a significant antithrombotic effect and improved pharmacological parameters that allow it to be successfully used in patients with impaired renal function in oncourological practice.

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