Are Low-Molecular-Weight Heparins Useful for the Prophylaxis and Treatment of Arterial Thrombi?

Samama, Charles Marc; Combe, S.; Ill, Patrick; Barré, Éric; Dreux, Sophie; Viars, P.

doi:10.1159/000217273

Cited by 9 publications

(5 citation statements)

References 36 publications

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“…On the basis that LMWH is effective in prevention of deep venous thrombosis after vascular surgery and after general surgery 4 and that LMWH is useful also to prevent arterial thrombi, both clinically 5 and experimentally, 6 we compared a single dose of LMWH during vascular surgery before vascular clamping with the same regimen using UFH. Further, the better bioavailability and longer plasma half-life of LMWH would be of benefit.…”

Section: Discussionmentioning

confidence: 99%

Can low molecular weight heparin replace unfractionated heparin during peripheral arterial reconstruction? An open label prospective randomized controlled trial

Norgren¹

2004

Journal of Vascular Surgery

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The mortality rate at 30 days was 2.7%, with no difference between groups. The patency rate at 1 day was 91.2% to 98.4%, depending on diagnosis and type of reconstruction. No difference was recorded between study groups (0.6 < P < 1.0). At 30 days the patency rate was 83.1% to 100% (0.2 < P <.9). Median blood loss was 350 mL (interquartile range [IQR], 200-800 mL) in the LMWH group and 425 mL (IQR, 200-900 mL) in the UFH group (P =.02). Protamin was given to significantly fewer patients in the LMWH group (P =.001). LMWH was comparable to UFH during peripheral vascular reconstruction in terms of 1-day and 30-day graft patency, operative blood loss, and hemorrhagic complications. Protamine was required less often after LMWH. In this randomized trial LMWH was as effective as UFH in preventing thrombosis without excess bleeding or hemorrhagic complications.

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Section: Discussionmentioning

confidence: 99%

Can low molecular weight heparin replace unfractionated heparin during peripheral arterial reconstruction? An open label prospective randomized controlled trial

Norgren¹

2004

Journal of Vascular Surgery

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“…4 LMWHs have a number of pharmacodynamic and pharmacokinetic advantages over UH that would favor the use of LMWH instead of heparin for arterial indications. 7 For example, LMWHs are more resistant than heparin to neutralization by platelet factor 4, 8 which is released from activated platelets present at the site of arterial thrombus formation. In addition, reliable anticoagulation can be achieved with LMWHs by subcutaneous dosing without monitoring, 9 thereby providing convenient antithrombotic therapy that can be easily maintained for a prolonged time.…”

mentioning

confidence: 99%

“…11 However, recent evidence indicates that LMWHs are safe and effective antithrombotic agents for arterial thrombotic diseases. 7 For example, preclinical studies have demonstrated that LMWHs improve reflow after thrombolysis in canine models of thrombosis. 12,13 Clinically, a small trial provided evidence to support the potential use of enoxaparin instead of heparin as adjunctive therapy during thrombolysis with streptokinase.…”

mentioning

confidence: 99%

Inhibition of Repetitive Thrombus Formation in the Stenosed Canine Coronary Artery by Enoxaparin, But Not by Unfractionated Heparin

Leadley¹,

Kasiewski²,

Bostwick³

et al. 1998

ATVB

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Abstract-Experiments were designed to compare the antithrombotic efficacy of enoxaparin and unfractionated heparin (UH) in a model of platelet-dependent cyclic flow reductions (CFRs) in the stenosed canine circumflex coronary artery. Low-molecular-weight heparins (LMWHs) are safe and effective in the prevention and treatment of venous thromboembolism. The present experiments were designed to evaluate the potential use of LMWHs in arterial thrombotic indications by comparing the antithrombotic effect of an LMWH with that of UH in an animal model of unstable angina. After establishment of consistent CFRs by experimentally induced vascular stenosis and damage, vehicle (saline), enoxaparin, or UH was administered intravenously as a loading dose plus a continuous infusion for 1 hour. The inhibition of CFRs was taken as an indicator of antithrombotic efficacy. Enoxaparin inhibited repetitive platelet thrombus formation in a dose-dependent manner, with significant inhibition of CFRs achieved at 0.5 mg/kgϩ5 g/kg per minute. This dose of enoxaparin resulted in anti-Xa levels of 0.9 to 1.0 IU/mL, anti-IIa levels of 0.2 to 0.3 IU/mL, activated partial thromboplastin time (APTT) of 1.3-fold over baseline, and a 1.4-fold increase (NS) in template bleeding time. Near-complete abolishment of CFRs was achieved with enoxaparin at 1.0 mg/kgϩ10 g/kg per minute. This dose of enoxaparin produced anti-Xa levels of 2 to 2.2 IU/mL, anti-IIa levels of 0.5 to 0.6 IU/mL, an increase in APTT of 1.4-to 1.5-fold over baseline, and a 1.9-fold increase (PϽ0.05) in template bleeding time. In contrast, UH had no significant effect on CFRs at a dose (100 U/kgϩ10 U/kg per minute) that resulted in anti-Xa levels of 1.2 to 1.6 IU/mL, anti-IIa levels of 1.8 to 2.4 IU/mL, an increase in APTT greater than 10-fold over baseline, and a 2.

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“…This has most frequently been accomplished with oral coumadin, but the hypercoagulable state in some patients is resistant to this agent. Recent reports indicate low molecular weight heparins are as effective as unfractionated heparin in preventing and treating thrombotic states, but there are few reports of their use in patients with Trousseau's syndrome or for arterial thrombosis [9,10]. Because of convenient dosing schedules and ease of administration) low molecular weight heparin may provide an attractive alternative long-term prophylactic treatment.…”

Section: Discussionmentioning

confidence: 99%

Trousseau's Syndrome and Acute Arterial Thrombosis

Rigdon

2000

Cardiovascular Surgery

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This report describes three patients treated for acute arterial thrombosis due to malignancy-related hypercoagulability (Trousseau's syndrome). The average age was 59 yr. There were two women and one man. The cancers were breast, lung, and pancreas. Atherosclerosis or nonneoplastic hypercoagulable states did not appear to be a factor in any patient. One patient who presented with irreversible arm ischemia and Stage IV breast cancer underwent primary amputation. The other two patients underwent immediate surgical thrombectomy and thrombolytic therapy, and malignancy was discovered during postoperative workup for hypercoagulable states. Both ultimately required amputation. All three patients died due to cancer less than one year after presentation. When a hypercoagulable state is suspected as the cause of acute arterial thrombosis, an evaluation for occult malignancy is indicated. Although aggressive revascularization attempts may be appropriate, the prognosis for limb salvage and long-term survival is poor.

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Are Low-Molecular-Weight Heparins Useful for the Prophylaxis and Treatment of Arterial Thrombi?

Cited by 9 publications

References 36 publications

Can low molecular weight heparin replace unfractionated heparin during peripheral arterial reconstruction? An open label prospective randomized controlled trial

Can low molecular weight heparin replace unfractionated heparin during peripheral arterial reconstruction? An open label prospective randomized controlled trial

Inhibition of Repetitive Thrombus Formation in the Stenosed Canine Coronary Artery by Enoxaparin, But Not by Unfractionated Heparin

Trousseau's Syndrome and Acute Arterial Thrombosis

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