Low-Molecular-Weight Heparins in the Treatment of Deep-Vein Thrombosis

1998 ◽  
Vol 32 (5) ◽  
pp. 588-601 ◽  
Author(s):  
Pierre Martineau ◽  
Nadine Tawil
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Clinical Efficacy ◽  
Total Mortality ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Laboratory Monitoring ◽  
Low Molecular Weight Heparins ◽  
Vein Thrombosis ◽  
Deep Vein

OBJECTIVE: To compare the characteristics and clinical efficacy of low-molecular-weight heparins (LMWHs) and unfractionated heparin (UFH) in the treatment of deep-vein thrombosis (DVT). Adverse effects, dosing, and cost issues are also discussed. DATA SOURCES: A MEDLINE search (January 1984–October 1997) was used to identify pertinent French and English literature, including clinical trials and reviews on LMWHs and their use in DVT. STUDY SELECTION: Trials comparing dalteparin, enoxaparin, tinzaparin, and nadroparin with UFH were selected. As studies were numerous, only randomized trials including more than 50 patients were reviewed. Moreover, all patients studied had a first episode of symptomatic DVT confirmed by objective tests (i.e., venography, duplex ultrasonography, impedance plethysmography). Clinical efficacy and safety of LMWHs were assessed in these trials. DATA EXTRACTION: Results pertaining to venographic assessment, recurrent thromboembolism, total mortality, and bleeding complications were extracted from the selected studies. DATA SYNTHESIS: Compared with UFH, LMWHs have a longer plasma half-life, better subcutaneous bioavailability, more predictable anticoagulant response, and require less intense laboratory monitoring. Most trials demonstrate comparable effects on thrombus extension and incidence of recurrent thromboembolism. Compared with UFH, LMWHs do not alter total mortality. Although animal trials predict a lower hemorrhagic potential for LMWHs, the incidence of bleeding complications is generally similar to that observed with UFH. Outpatient management of DVT with LMWHs has shown comparable safety and efficacy with inpatient UFH use but a shorter hospital stay. CONCLUSIONS: Because LMWHs are as safe and as effective as UFH, and because of their more convenient method of administration, they can be considered valuable alternatives for the treatment of DVT. Savings generated by less intensive laboratory monitoring and the possibility of early hospital discharge and outpatient therapy may outweigh the higher acquisition cost of LMWHs.

Postoperative Versus Preoperative Initiation of Deep-Vein Thrombosis Prophylaxis with a Low-Molecular-Weight Heparin (Nadroparin) in Elective Hip Replacement

1996 ◽  
Vol 2 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Gualtiero Palareti ◽  
Battista Borghi ◽  
Sergio Coccheri ◽  
Nicoletta Leali ◽  
Rita Golfieri ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Hip Replacement ◽  
Low Molecular Weight Heparin ◽  
Bleeding Complications ◽  
Thrombosis Prophylaxis ◽  
Low Molecular Weight ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Deep Vein

The aim of this multicenter, randomized, dou ble-blind study performed in patients undergoing elective hip surgery was to compare the efficacy and safety of prophylaxis with low-molecular-weight heparin (LMWH) (Nadroparin, 7,500 anti-Xa IC units for the first 3 days and 10,000 from the fourth day on, s.c. o.i.d.) begun in one group shortly after surgery and in the other 12 h before operation, as is usually recommended. Preopera tive administration (drug or placebo) was the only differ ence between the two groups. Deep vein thrombosis (DVT) was detected by bilateral venography 10-15 days after surgery. The study investigated 179 patients (55 men), 40-80 years old, in seven Italian orthopedic cen ters. In 131 patients efficacy analysis was possible be cause of adequate bilateral venography. All 179 patients were evaluated for bleeding complications. The preva lence of thrombotic complications was similar in the two groups. Proximal DVT was found in 8.4% of patients (10.8% and 6.1% in the preop and postop groups, respec tively ; difference not statistically significant). Distal DVT was recorded in 30.5% of patients (30.8% and 30.3% in the pre- and postop groups, respectively). DVTs were more common in patients ≥65 years old (54.2% versus 28.4%, p < 0.05); no significant differences were detected in terms of other characteristics. No significant differ ences were recorded in the number or type of bleeding complications: major (nonfatal) bleeding episodes were reported in five patients (2.8%, two and three in the pre- and postop groups); minor bleeding was noted in 25 (13.9%, 14 and 11 in the pre- and postop groups). In con clusion, the present study suggests that a LMWH regi men started postoperatively is no less effective in pre venting DVT in elective hip replacement than the classi cal regimen started preoperatively. Surprisingly, postoperative commencement offered no significant ad vantage in terms of bleeding complications.

scholarly journals Prevalence of thromboembolic complications depending upon compliance and preventive care after endoprosthetics of large joints

2020 ◽  
pp. 46-48
Author(s):  
G. A. Palshin ◽  
S. S. Pavlov ◽  
M. Yu. Markovchina ◽  
A. N. Komissarov ◽  
P. V. Markov ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Preventive Care ◽  
Lower Extremities ◽  
Low Molecular Weight ◽  
Thromboembolic Complications ◽  
Low Molecular Weight Heparins ◽  
Study Objective ◽  
Vein Thrombosis ◽  
Deep Vein

Objective. The study objective is to assess the efficacy of preventive care for thromboembolic complications after endoprosthetics of large joints depending on patients’ compliance.Methods: Prospective clinical examination of 686 patients aged 50–70 years, who underwent the endoprosthetics of knee and hip joints. Preventive care for thrombosis and embolism was performed according to three regimens: 1) monotherapy with parenteral low molecular weight heparins, 2) therapy with low molecular weight heparins converted to indirect anticoagulants, 3) administration of oral anticoagulants.Results: 376 patients (54.8%) fully complied with the medical recommendations. The rest 310 patients (45.2%), non-compliant patients, ignored medical prescriptions: refusal to take anticoagulants, spontaneous replacement of anticoagulants with antiplatelet agents, not taking medications as prescribed. Among compliant patients, deep vein thrombosis of lower extremities was registered in 9 cases (2.4%); among non-compliant patients, it was registered in 13 cases (4.2%).Conclusions: Deep vein thrombosis of lower extremities was registered significantly more often in non-compliant patients. To increase the efficacy of the prevention care for thromboembolic complications after endoprosthetics of large joints, more attention should be paid to explanatory work, explaining to patients the nature and negative consequences of compliance violations. 

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