A Comparative Review of the Adverse Effect Profiles of Heparins and Heparinoids

Borris, Lars C.; M, Lassen

doi:10.2165/00002018-199512010-00002

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…This occurrence, caused by thrombin release from the thrombus, has necessitated anticoagulant treatment during fibrinolysis [13]. Heparin has been used with fibrinolytic agents as adjunctive therapy, but problems such as thrombocytopenia [14] or bleeding [15] are frequently observed. Other products such as enoxaparin [16] or PEG-hirudin [17] have been given to improve recanalization in dogs using various sequences of bolus and perfusion administrations.…”

Section: Discussionmentioning

confidence: 99%

The Beneficial Effect of a β-D-Xyloside, Iliparcil, in the Prevention of Postthrombolytic Rethrombosis in the Rat

Rademakers²,

Millet³

1998

Pathophysiol Haemos Thromb

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The effect of Iliparcil, a new orally active β-D-xyloside venous antithrombotic, was studied on the rethrombosis following thrombolytic therapy in rats, using a modified Umetsu model. The drug was administered by oral route prior to thrombolytic therapy, which consisted of administering a combination of heparin and urokinase (H/U) at 37.5 and 70,000 IU/kg, respectively. Time to reocclusion increased from 3.9 min with saline to 10.5 min following H/U injection. When Iliparcil (30 mg/kg, oral route) was administered 4 h before H/U injection, the time to reocclusion was increased by 250% compared with H/U alone (p < 0.001). Similarly, dermatan sulfate (DS), administered intravenously (3 mg/kg) 5 min before thrombus induction, also increased the time to reocclusion (300% compared with H/U alone; p < 0.001). It was also shown that times to reocclusion following Iliparcil or DS treatments were still increased even when heparin dosage was decreased. These results suggest that an antithrombotic product derived from the β-D-xyloside family could be advantageously used in combination with thrombolytic treatment instead of heparin, which causes complications and side effects.

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Section: Discussionmentioning

confidence: 99%

The Beneficial Effect of a β-D-Xyloside, Iliparcil, in the Prevention of Postthrombolytic Rethrombosis in the Rat

Rademakers²,

Millet³

1998

Pathophysiol Haemos Thromb

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“…137 Wound hematomas, for example, are of particular concern in major hip and knee surgery because of infection risk associated with bleeding at the surgical site and subsequent septic loosening of the prosthesis, requiring repeat surgery. 110,138 Finally, a cautionary FDA warning regarding the administration of all LMWHs and heparinoids in patients undergoing neuraxial block before surgery has alerted the medical community to anecdotal reports of increased occurrences of spinal hematomas in patients in whom anticoagulation with enoxaparin was combined with regional anesthesia. 139 This warning was extended with the recent FDA mandate that package inserts for all anticoagulants must contain a cautionary note regarding the potential risk of spinal hematoma in patients undergoing anticoagulation in conjunction with neuraxial anesthesia or indwelling catheters for analgesia delivery.…”

Section: Efficacymentioning

confidence: 99%

Selective Factor Xa Inhibition Improves Efficacy of Venous Thromboembolism Prophylaxis in Orthopedic Surgery

Comp

2003

Pharmacotherapy

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Venous thromboembolism is a serious, frequent, and potentially fatal complication of major orthopedic surgery. Currently available pharmacologic agents for the prevention of venous thromboembolism in this high-risk population consist of the oral anticoagulants and the heparin family of antithrombotic agents (unfractionated heparin, low-molecular-weight heparin, heparinoids). These classes of agents interfere with the activity of both thrombin and factor Xa (or their respective zymogens) to varying degrees. Newer antithrombotic agents in various stages of development exert their antithrombotic effect through a more targeted mechanism of action. Direct factor Xa inhibitors and the newest class of antithrombotic agents, the indirect factor Xa inhibitors, the prototype of which is the synthetic pentasaccharide fondaparinux sodium, limit fibrin formation through their exclusive inactivation of factor Xa. Clinical data from venous thromboembolism prophylaxis trials in hip and knee replacement and hip fracture surgeries, including the recently completed fondaparinux phase II and phase III trials, indicate that selective antifactor Xa activity may improve the efficacy:safety ratio of antithrombotic therapies for the prevention of venous thromboembolism in high-risk major orthopedic surgery.

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“…“Nearly two dozen,”5 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 answered Legge ruefully. “And this, Mr Holmes, is where my faith in meta-analysis wavers.…”

Section: Professor Legge's Problemmentioning

confidence: 99%