The Low-Molecular-Weight-Heparin, Tinzaparin, Is Effective and Safe in the Treatment and Prophylaxis of Venous Thromboembolic Disease during Pregnancy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1774-1774 ◽  
Author(s):  
Maja Jorgensen ◽  
Jorn D. Nielsen
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Pregnant Women ◽  
University Hospital ◽  
Individual Risk ◽  
Low Molecular Weight ◽  
Venous Thromboembolic ◽  
Individual Risk Assessment

Abstract During pregnancy the incidence of venous thromboembolism (VTE) is approximately 6 times higher than in age-matched, non-pregnant women and venous thromboembolism remains the most common cause of maternal morbidity and mortality. Low-molecular-weight-heparins are recommended for treatment of VTE during pregnancy and for prophylaxis of VTE in pregnant women with major thromboembolic risk factors. We used tinzaparin for prophylaxis and treatment of VTE in 305 consecutive pregnant women referred to the Thrombosis Centre, Gentofte University Hospital, from 1997 to 2004. In 268 pregnancies the mothers had thrombophilia, 52 women were admitted with acute VTE and 184 had previous VTE. Other clinical risk factors included previous bad obstetric outcome, recurrent miscarriages, cardiac disorders or previous thromboembolic stroke. An individual risk assessment of each pregnant woman was performed. Very high risk females were treated with tinzaparin 90 – 100 IU/kg bid, high risk females were treated with tinzaparin 100 – 125 IU/kg daily and women with moderate risk were treated with 50 – 75 IU/kg daily. 302 of 305 pregnancies (99 %) in 263 females resulted in 310 healthy babies. 306 of 310 babies had appropriate birth weight for gestational week and all babies had normal Apgar score. Two females had miscarriages (week 10 and 20) and 1 female had an elective abortion. No females had pulmonary embolism. Deep venous thrombosis occurred in 4 of 305 pregnancies = 1,3 % (week 6, 11, 27 and one day postpartum). Wound hematoma was observed after cesarean section in two women and postpartum bleeding episodes (700 – 1500 ml) were observed in 7 women (4 had severe vaginal or cervical tearings, 2 had retained placenta and 1 had placental abruption). We found no incidence of thrombocytopenia or symptomatic osteoporosis. We find that individually dosed tinzaparin is safe and seems effective in the prevention of thromboembolic complications during pregnancy. Individual risk stratification is recommended.

scholarly journals Thromboembolism and antithrombotic management in pregnancy

2011 ◽  
Vol 152 (21) ◽  
pp. 815-821 ◽  
Author(s):  
Attila Pajor
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Individual Risk ◽  
Low Molecular Weight ◽  
Pregnancy And Delivery ◽  
Individual Risk Factors ◽  
In Pregnancy

Venous thromboembolism occurs approximately in 1 of 1000 pregnancies. It is one of the leading causes of maternal mortality. Physiologic changes associated with pregnancy and delivery favor for developing venous thromboembolism, and there are individual risk factors, too, contributing to its manifestation. The most frequent risk factors of venous thromboembolism developing during pregnancy are the previous venous thromboembolism and the thrombophilias, furthermore, some other diseases and some unique complications of pregnancy and delivery. Beyond mechanical prevention only heparin preparations can be used for preventing and treating venous thromboembolism in pregnancy and among them the low-molecular-weight heparins are preferred for applying. Dosage of low-molecular-weight heparin preparations is determined by the type and strength of thrombophilia. For treatment of venous thromboembolism presented during pregnancy subcutaneous 100 IU/kg low-molecular-weight heparin is generally used at every 12 hours. Postpartum the oral anticoagulants can be safely applied, too. Orv. Hetil., 2011, 152, 815–821.

scholarly journals Recurrent Venous Thromboembolism (VTE), Major Bleeding (MB), and Associated Cost of Treatment with Low Molecular Weight Heparin (LMWH) or Direct Oral Anticoagulant (DOAC) in High Risk Patients with Gastrointestinal (GI) Malignancies: Retrospective Real-World Analysis at a Comprehensive Cancer Center

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5057-5057 ◽  
Author(s):  
Alejandro Recio Boiles ◽  
Ali McBride ◽  
Hani M. Babiker ◽  
Nimer Alsaid ◽  
Ivo Abraham ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Adverse Events ◽  
Healthcare Costs ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Major Bleed ◽  
Recurrent Vte ◽  
Event Rates

Abstract Introduction: Cancer patients who experienced a venous thromboembolism (VTE) are at high risk for poor clinical outcomes; hence VTE recurrence prevention is salient. Low molecular weight heparin (LMWH) has been the preferred treatment for cancer-related VTE; however, direct oral anticoagulants (DOACs) have been prescribed empirically in cancer due to patient convenience. Although the recent HOKUSAI and SELECT-D trials have confirmed the non-inferiority of DOACs to LMWH in the management of recurrent VTE in cancer patients, there remain a continued safety concern for major bleeds (MB). Recurrent VTE and MB complications during anticoagulation treatment of GI cancer (GICA) patients are increased as compared to other cancer types. The incremental health care costs associated with VTE recurrences and MB episodes are significant and steadily increasing. In this retrospective analysis, we aimed (1) to evaluate for differences in the VTE recurrence rate and MB events based on anticoagulation therapy (LMWH or DOAC) prescribed with a prior VTE and (2) to calculate the associated healthcare costs for six months of treatment. Methods: We reviewed the medical records of patients with biopsy-proven GICA and imaging documented VTE treated with DOAC or LMWH from November 2013 to February 2017. Patients were excluded if anticoagulation was given for another treatment indication or cancer diagnosis. Adverse events of recurrent VTE and MB criteria were defined per the Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Costs of LMWH and DOAC t was sourced from Medicare Reimbursement 2018. Hospital admission and adjusted 6-month ambulatory cots were sourced from Economic Evaluations of Anticoagulation Outcomes in the U.S. by Amin et al 2015. Costs were inflation-adjusted to 2018 cost levels using the Medical Care component of the Consumer Price Index. The Chi-squared test was used for overall and the Fisher exact test for pairwise comparisons of the proportions of patients experiencing VTE and MB events. Results: Our analysis included 106 patients on enoxaparin (N=40), rivaroxaban (N=37) and apixaban (N=29). Recurrent VTE outcomes at 6 months were 3 (7.5%) for enoxaparin, 1 (2.7%) for rivaroxaban, and 2 (6.8%), for apixaban (all p=n.s.) (Table 1). Major bleeding events at 6 months were 2 (5%) for enoxaparin, 2 (6.8%) for apixaban, and a significantly higher 8 (21.6%) for rivaroxaban (overall p=0.048; v. LMWH pairwise p=0.042; all other p=n.s.). The estimated composite costs associated with the observed recurrent VTE event rates were $173,130 for enoxaparin, $57,710 for rivaroxaban, and $115,420 for apixaban. The estimated composite costs associated with the observed MB event rates were $117,146 for enoxaparin and apixaban, versus $468,558 for rivaroxaban. The estimated total 6-months healthcare costs for recurrent VTE, MB and prescriptions were $293,784 for enoxaparin, $529,336 for rivaroxaban, and $235,634 for apixaban. Conclusion: Our real-world retrospective analysis corroborates a non-inferiority of DOACs to LMWH in preventing recurrent VTE in GICA patients at 6 months but a higher incidence of MB in rivaroxaban v. LMWH treated patients. The higher MB rate for rivaroxaban mainly accounts for the higher overall costs of this DOAC v. LMWH and apixaban. In absolute total costs, apixaban prevails over LMWH and rivaroxaban, and LMWH prevails over rivaroxaban in cost-efficiency in this analysis of anticoagulation in selected high-risk GICA patients. Rivaroxaban significantly increases medical costs, mainly driven by the total number of major bleed adverse events in GICA patients, confirming previously published evidence. The subpopulation of GICA patients at high risk of VTE/MB warrants an additional prospective clinical trial for primary safety major bleed outcomes of DOACs with an accompanying cost-effectiveness analysis. This may eventually reduce the healthcare economic burden. Disclosures Abraham: Sandoz: Consultancy.

scholarly journals New anticoagulant therapy aspects to the COVID-19 patients: From prophylaxis to complications treatment therapy

2021 ◽  
Vol 26 (81) ◽  
pp. 33-51
Author(s):  
Aleksandar Đenić
Keyword(s):  
Molecular Weight ◽  
Body Weight ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Bleeding Events ◽  
Risk Of Bleeding ◽  
Therapeutic Doses ◽  
D Dimer

COVID-19 patients have a high risk of thrombosis of the arterial and venous systems due to extensive systemic inflammation, platelet activation, endothelial dysfunction, and stasis. D-dimer is an important prognostic marker of mortality caused by COVID-19 patients and its increased values indicate tissue damage and inflammation. The incidence of venous thromboembolism (VTe) is between 16 and 49% as a complication of more severe forms of COVID-19 infection in patients hospitalized in intensive care units. Prophylactic doses of low molecular weight heparin (lMWH) should be given to all hospitalized patients with COVID-19 infection in the absence of active bleeding. The safest way is to adjust the low molecular weight heparin (lMWH) dose according to body weight, especially in obese patients. Unfractionated heparin (UFH) is used in patients with a creatinine clearance of less than 30 ml/min. The therapeutic dose of anticoagulation should be discontinued if the platelet count is <50 × 109 /l or fibrinogen <1.0 g/l. Clinically significant bleeding events are higher in those who received therapeutic doses compared to those with standard thromboprophylaxis doses. Thrombolytic therapy is recommended in patients with proven pulmonary embolism (Pe) and hemodynamic instability or signs of cardiogenic shock, who are not at high risk of bleeding. In hospitalized COVID-19 patients with a high clinical risk of developing venous thromboembolism (VTe) and D-dimer values greater than 2600 ng/ml, the use of therapeutic doses of lMWH in doses adjusted to the patient's body weight should be considered, in the absence of a higher risk of bleeding.

Thrombosis prophylaxis prior to surgery

2003 ◽  
Vol 18 (3) ◽  
pp. 106-109
Author(s):  
D Bergqvist
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Review Article ◽  
Thrombosis Prophylaxis ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Thrombin Inhibition ◽  
New Methods

This review article provides an update on risk factors of venous thromboembolism and methods for preventing its occurrence following surgery. A summary of the prophylactic methods that are currently available is provided, with particular attention given to low molecular weight heparins, which are the most popular. The new methods of Xa inhibition and oral thrombin inhibition are also mentioned. Finally, the most appropriate times to start prophylaxis and the necessary duration are discussed, along with some of the risks of prophylaxis.

scholarly journals Low Molecular Weight Heparin Improves Endothelial Function in Pregnant Women at High Risk of Preeclampsia

Hypertension ◽  
2017 ◽  
Vol 69 (1) ◽  
pp. 180-188 ◽  
Author(s):  
Kelsey McLaughlin ◽  
Dora Baczyk ◽  
Audrey Potts ◽  
Michelle Hladunewich ◽  
John D. Parker ◽  
...  
Keyword(s):  
Molecular Weight ◽  
High Risk ◽  
Endothelial Function ◽  
Pregnant Women ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Risk Of Preeclampsia

Venous Thromboembolism Prevention with LMWHs in Medical and Orthopedic Surgery Patients

2003 ◽  
Vol 37 (3) ◽  
pp. 402-411 ◽  
Author(s):  
Steven B Deitelzweig ◽  
Gordon J Vanscoy ◽  
Cynthia S Niccolai ◽  
Thomas L Rihn
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Orthopedic Surgery ◽  
Low Molecular Weight ◽  
Medical Patients ◽  
Efficacy And Safety ◽  
Consensus Guidelines ◽  
Medline Search ◽  
Vte Prophylaxis

OBJECTIVE: To discuss the role of low-molecular-weight heparins (LMWHs) in the prevention of venous thromboembolism (VTE) in medical and orthopedic surgery patients. VTE prophylaxis trials in these practice settings establishing the current use of LMWHs marketed in the US are included. An overview is also provided of VTE incidence, risk factors, and prophylaxis consensus guidelines. DATA SOURCES AND STUDY SELECTION: Clinical trials, review articles, and meta-analyses for Food and Drug Administration–approved LMWHs were identified from a MEDLINE search (1980–March 2002). Search terms included dalteparin, enoxaparin, internal medicine, low-molecular-weight heparin, orthopedic surgery, risk factors, tinzaparin, and venous thromboembolism. DATA SYNTHESIS: Consensus guidelines are useful as an initial guide to appropriate VTE prophylaxis; however, a review of the primary literature is needed to identify optimal agents, regimens, or interventions. LMWHs have demonstrated sound efficacy in VTE prevention; however, the quantity and quality of literature are not always comparable for the available agents. CONCLUSIONS: Enoxaparin has demonstrated efficacy and safety in VTE prevention in medical patients, whereas information is limited or lacking for dalteparin and tinzaparin. Total hip replacement (THR) trials have been conducted with all US-marketed LMWHs and have demonstrated the efficacy and safety of each agent. Trials specifically establishing the efficacy of an LMWH in total knee replacement surgery (TKR) have been published for enoxaparin. One combination THR and TKR trial has been published for tinzaparin. These trial outcomes have positioned the LMWHs as key alternatives to adjusted-dose warfarin for VTE prophylaxis in orthopedic surgery. Inherent differences between LMWHs prevent the extrapolation of clinical outcomes from 1 trial to another.

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