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Low Molecular Weight Heparins

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Pulmonary Embolism
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Summary

A large and growing body of scientific evidence exists which suggests that low molecular weight heparins are at least as effective and safe as other anticoagulants used to treat and prevent venous thromboembolism. Low molecular weight heparins offer important advantages over unfractionated heparin for the treatment of venous thromboembolism. Low molecular weight heparins can be dosed according to the patient’s weight, and monitoring of anticoagulant response is not necessary. For this reason, selected patients with deep vein thrombosis can be managed without hospitalization. The use of low molecular weight heparins to prevent venous thrombosis and pulmonary embolism depends upon costs, relative risks and benefits for specific indications, and additional scientific studies which address unanswered or incompletely answered questions, such as whether preoperative dosing is superior to postoperative dosing.

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References

  1. Fareed J, Walenga JM, Hoppensteadt D et al (1988) Comparative study on the in vitro and in vivo activities of seven low-molecular-weight heparins. Haemostasis 18:Suppl 3: 3–15 [Erratum, Haemostasis 18:389a]

    Google Scholar 

  2. Young E, Prins M, Levine MN et al (1992) Heparin binding to plasma proteins, an important mechanism for heparin resistance. Thromb Haemost 67: 639–643

    PubMed  CAS  Google Scholar 

  3. Young E, Wells P, Holloway S (1994) Ex-vivo and in vitro evidence that low molecular weight heparins exhibit less binding to plasma proteins than unfractionated heparin. Thromb Haemost 71: 300–3004

    PubMed  CAS  Google Scholar 

  4. Barzu T, Molho P, Tobelem G et al (1985) Binding endocytosis of heparin by human endothelial cells in culture. Biochim Biophys Acta 845: 196–203

    Article  PubMed  CAS  Google Scholar 

  5. Bjornsson TO, Wolfram KM, Kitchell BB (1982) Heparin kinetics determined by three assay methods. Clin Pharmacol Ther 31: 104–113

    Article  PubMed  CAS  Google Scholar 

  6. Cadroy Y, Pourrat J, Baladre MF et al (1991) Delayed elimination of enoxaparin in patients with chronic renal insufficiency. Thromb Res 63: 385–390

    Article  PubMed  CAS  Google Scholar 

  7. Carter CJ, Melton JG, Hirsch J et al (1982) The relationship between the hemorrhagic and antithrombotic properties of low molecular weight heparin in rabbits. Blood 59: 1239–1245

    PubMed  CAS  Google Scholar 

  8. Salzman EW, Rosenberg RD, Smith MH et al (1980) Effect of heparin and heparin fractions on platelet aggregation. J Clin Invest 65: 64–73

    Article  PubMed  CAS  Google Scholar 

  9. Prandoni P, Lensing AWA, Buller HR et al (1992) Comparison of subcutaneous lowmolecular-weight heparin with intravenous standard heparin in proximal deep-vein thrombosis. Lancet 339: 441–445

    Article  PubMed  CAS  Google Scholar 

  10. Holm HA, Ly B, Handeland GF et al (1986) Subcutaneous heparin treatment of deep venous thrombosis: a comparison of unfractionated and low-molecular weight heparin. Haemostasis 16: 30–37

    PubMed  Google Scholar 

  11. Albada J, Niewenhuis HK, Sixma JJ (1989) Treatment of acute venous thromboembolism with low-molecular-weight heparin (Fragmin). Results of a double-blind randomized study. Circulation 80: 935–940

    Google Scholar 

  12. Hull RD, Raskob GE, Pineo GF et al (1992) Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. N Engl J Med 326: 975–982

    Article  PubMed  CAS  Google Scholar 

  13. Hull RD, Raskob GE, Rosenbloom D et al (1997) Treatment of proximal vein thrombosis with subcutaneous low-molecular-weight heparin vs. intravenous heparin. An economic perspective. Arch Intern Med 157: 289–294

    CAS  Google Scholar 

  14. Lindmarker P, Holmstrom M, Granqvists S et al (1994) Comparison of once-daily subcutaneous Fragmin with continuous intravenous unfractionated heparin in the treatment of deep vein thrombosis. Thromb Haemost 72: 186–190

    PubMed  CAS  Google Scholar 

  15. Levine M, Gent M, Hirsh J et al (1996) A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 334: 677–681

    Article  PubMed  CAS  Google Scholar 

  16. Koopman MMW, Prandoni P, Piovella F et al (1996) Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. N Engl J Med 334: 682–687

    Article  PubMed  CAS  Google Scholar 

  17. The Columbus Investigators (1997) Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. N Engl J Med 337: 657–662

    Article  Google Scholar 

  18. Lensing AWA, Prins MH, Davidson BL, Hirsh J (1995) Treatment of deep venous thrombosis with low-molecular-weight heparins: a meta-analysis. Arch Intern Med 155: 601–607

    Article  PubMed  CAS  Google Scholar 

  19. Simonneau G, Sors H, Charbonnier B et al (1997) A comparison of low-molecularweight heparin with unfractionated heparin for acute pulmonary embolism. N Engl J Med 337: 663–669

    Article  PubMed  CAS  Google Scholar 

  20. Clagett GP, Anderson FA, Heit J et al (1995) Prevention of venous thromboembolism. Chest 108:Supp1: 312S - 3345

    Article  Google Scholar 

  21. Hull R, Raskob G, Pineo G et al (1993) A comparison of subcutaneous lowmolecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med 329: 1370–1376

    Article  PubMed  CAS  Google Scholar 

  22. Planes A, Vochelle N, Darman JY et al (1996) Risk of deep venous thrombosis after hospital discharge in patients having undergone total hip replacement: double blind randomized comparison of enoxaparin versus placebo. Lancet 348: 224–228

    Article  PubMed  CAS  Google Scholar 

  23. Bergqvist D, Benoni G, Bjorgell O et al (1996) Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med 335: 696–700

    Article  PubMed  CAS  Google Scholar 

  24. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP (1994) A prospective study of venous thromboembolism after major trauma. N Engl J Med 331: 1601–1606

    Article  PubMed  CAS  Google Scholar 

  25. Geerts WH, Jay RN, Code KI et al (1996) A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med 335: 701–707

    Article  PubMed  CAS  Google Scholar 

  26. Green D, Lee MY, Lim AC et al (1990) Prevention of thromboembolism after spinal cord injury using low-molecular-weight heparin. Ann Intern Med 113: 571–574

    PubMed  CAS  Google Scholar 

  27. Bergmann JF, Neuhart E (1996) A multicenter randomized double-blind study of enoxaparin compared with unfractionated heparin in the prevention of venous thromboembolic disease in elderly in-patients bedridden for an acute medical illness. Thromb Haemost 76: 529–534

    PubMed  CAS  Google Scholar 

  28. Harenberg J, Kallenbach B, Martin U et al (1990) Randomized controlled study of heparin and low molecular weight heparin for prevention of deep-vein thrombosis in medical patients. Thromb Res 59: 639–650

    Article  PubMed  CAS  Google Scholar 

  29. Fiessinger JN, Lopez-Fernandez M, Gatterer E et al (1996) Once-daily subcutaneous dalteparin, a low-molecular-weight heparin, for the initial treatment of acute deep vein thrombosis. Thromb Haemost 76: 195–199

    PubMed  CAS  Google Scholar 

  30. Caen JP (1988) A randomized double-blind study between a low molecular weight heparin Kabi 2165 and standard heparin in the prevention of deep vein thrombosis in general surgery: a French multicenter trial. Thromb Haemost 59: 216–220

    PubMed  CAS  Google Scholar 

  31. Bergqvist D, Matzsch T, Burmark US et al (1988) Low molecular weight heparin given the evening before surgery compared with conventional low-dose heparin in prevention of thrombosis. Br J Surg 75: 888–891

    Article  PubMed  CAS  Google Scholar 

  32. Encke A, Breddin K (1988) Comparison of a low-molecular-weight heparin and unfractionated heparin for the prevention of deep vein thrombosis in patients undergoing abdominal surgery. Br J Surg 75: 1058–1063

    Article  Google Scholar 

  33. Kakkar VV, Boeckl O, Boneu B et al (1997) Efficacy and safety of a low-molecularweight heparin and standard unfractionated heparin for prophylaxis of postoperative venous thromboembolism: European multicenter trial. World J Surg 21: 2–8

    Article  PubMed  CAS  Google Scholar 

  34. Boneu B (1993) An international multicenter study: clivarin in the prevention of venous thromboembolism in patients undergoing general surgery. Blood Coagul Fibrinolysis 4:Suppl 1: S21 - S22

    Google Scholar 

  35. Nurmohamed MT, Verhaeghe R, Haas S et al (1995) A comparative trial of a lowmolecular-weight heparin (enoxaparin) versus standard heparin for the prophylaxis of postoperative deep vein thrombosis. Am J Surg 169: 567–571

    Article  PubMed  CAS  Google Scholar 

  36. RD Heparin Arthroplasty Group (1994) RD heparin compared with warfarin for prevention of venous thromboembolic disease following total hip or knee arthroplasty. J Bone Joint Surg Am 76: 1174–1185

    Google Scholar 

  37. Leclerc JR, Geerts WH, Desjardins L et al (1996) Prevention of venous thromboembolism after knee arthroplasty: a randomized, double-blind trial comparing enoxaparin with warfarin. Ann Intern Med 124: 619–626

    PubMed  CAS  Google Scholar 

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© 1999 Springer Japan

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Elliott, C.G. (1999). Low Molecular Weight Heparins. In: Nakano, T., Goldhaber, S.Z. (eds) Pulmonary Embolism. Springer, Tokyo. https://doi.org/10.1007/978-4-431-66893-0_12

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  • DOI: https://doi.org/10.1007/978-4-431-66893-0_12

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-66895-4

  • Online ISBN: 978-4-431-66893-0

  • eBook Packages: Springer Book Archive

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