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

Abstract

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.

Safety and efficacy of intravenous enoxaparin for carotid endarterectomy: A prospective randomized pilot trial

“…2,7 The current study comparing a single body weight-adjusted bolus of enoxaparin compared with fixed-dose UFH during carotid surgery-to our knowledge the first assessing LMWH in carotid surgery-corroborates these findings. In this pilot study, enoxaparin had comparable efficacy by means of anticoagulant effects and safety by means of occurrence of major bleeding complications.…”

“…Yet, protamine does neutralize antithrombin activities and approximately 60% of antifactor Xa activities in LMWH. 24 This finding is highlighted by the study of Norgren et al, 2 where protamine was used to reverse enoxaparin effects in patients with excessive intraoperative bleeding. Also important was that antagonization was used in the enoxaparin group significantly less than in the UFH group (3% vs 8%; P ϭ .001).…”

“…The first anticoagulant medication used intraoperatively was unfractionated heparin (UFH), 1 a substance that has been almost universally applied until recently. Unfractionated heparin is used either as a standard intravenous bolus before arterial cross-clamping, usually 5000 IU, [2][3][4][5] or as a body weight-adjusted dose. Although UFH is an effective antithrombotic agent, the anticoagulant response it produces in patients is highly variable and unpredictable.…”

“…One prospective, randomized controlled trial for peripheral vascular surgery demonstrated that patients receiving the LMWH enoxaparin had a similar occlusion rate of the reconstructed arterial bed yet statistically significant less blood loss compared with an UFH group. 2 However, carotid endarterectomy was expressively excluded from the study.…”

Investigation of Antithrombotic Drug Effects on Preventing Thrombosis Emerging in Gluteus Maximus Flaps before Anastomosis

“…In 817 patients, Norgren et al (2004), [11] studied that wheather LMWH could be replaced with standard heparin for peripheral artery repair, and they did not found any significant difference between them. In Samama' et al study an intention-to-treat basis (patients who received at least on injection of ENX or UFH and who had at least one end-point evaluation) showed that graft thrombosis occurred in 30 of 199 cases: eight (8%) in the ENX group and 22 (22%) in the UFH group (p = 0.009).…”