scholarly journals Essay for the CIHR/CMAJ award: the role of low-molecular-weight heparin therapy venous thromboembolism

2011 ◽  
Vol 183 (6) ◽  
pp. E344-E346
Author(s):  
R. Hull
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Heparin Therapy ◽  
Low Molecular Weight

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.

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.

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.

scholarly journals Covid-19 and low molecular weight heparin therapy: retrospective study of 257 patients.

2020 ◽  
Author(s):  
Marco Stabile ◽  
Daniela Aschieri ◽  
Cristina Maestri ◽  
Luca Rosato ◽  
Paola Novara ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Hospital Mortality ◽  
Low Molecular Weight Heparin ◽  
Invasive Mechanical Ventilation ◽  
Heparin Therapy ◽  
Low Molecular Weight ◽  
Non Invasive ◽  
Therapeutic Doses ◽  
Stratified Analysis

Abstract Objective To evaluate the role of low molecular weight heparin in COVID-19 treatment.Design Retrospective cohort studySetting Patients with COVID-19 pneumonia consecutively admitted to Castel San Giovanni COVID- Hospital from February 29, to April 7, 2020.Main outcome measure Hospital mortality and safety in patients treated with low molecular weight hep- arin.Results Of the 257 patients enrolled, 49 (19.1%) died during the hospitalization. Hospital mortality was significantly lower in patients treated with therapeutic dose of low molecular weight heparin (T-LMWH) (17/126, 13.5%), compared with patients treated with prophylactic dose (P-LMWH) (32/131, 24.4%; χ²=4.98, p = 0.02). Crude and adjusted odds ratios of mortality for patients treated with T-LMWH were OR=0.483, 95% CI 0.252-0.923 and OR=0.374, 95% CI 0.177-0.792. In a stratified analysis by ventila- tion type, the only subgroup of patients who benefited from therapeutic doses of heparin were those re- ceiving non-invasive mechanical ventilation (OR=0.099, 95% CI 0.028-0.354, p<0.001). No fatal bleed- ings were observed.Conclusion Treatment with therapeutic doses of T-LMWH is safe and seems to reduce mortality in COVID-19 patients with pneumonia, especially among those who need non-invasive mechanical ventila- tion. We look forward to prospective studies to confirm this observation and evaluate the appropriate dose of LMWH in the treatment of COVID-19 patients.

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