Comparison between commercial heparin, low molecular weight heparin and pentosan polysulfate on hemostasis and platelets in vivo

Esquivel, Carlos O.; Bergqvist, David; Björck, C.-G.; Nilsson, Bo

doi:10.1016/0049-3848(82)90120-7

Cited by 68 publications

(25 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[2][3][4][5][6] Clinical studies in humans have shown that low molecular weight heparins are effective in preventing postoperative venous thromboembolism.7-9 These studies, however, have not clarified whether or not these preparations also prevent extension and embolization of thrombi in patients with overt thrombosis. Furthermore, it still has to be established in humans whether or not low molecular weight heparins produce less bleeding for equivalent antithrombotic efficacy.…”

Section: Treatment Of Acute Venous Thromboembolism With Low Molecularmentioning

confidence: 99%

Treatment of acute venous thromboembolism with low molecular weight heparin (Fragmin). Results of a double-blind randomized study.

Albada¹,

Nieuwenhuis²,

Sixma³

1989

Circulation

161

View full text Add to dashboard Cite

We performed a prospective, randomized, double-blind trial in 194 unselected patients to determine the safety and efficacy of low molecular weight heparin (Fragmin) compared with standard heparin as the initial treatment of acute venous thromboembolism. Ninety-eight patients received continuous intravenous heparin, and 96 patients received Fragmin for 5-10 days. Doses were adjusted to maintain anti-Xa levels between 0.3 and 0.6 unit/ml for patients with a high risk for a bleeding complication and between 0.4 and 0.9 unit/ml for patients with a low risk for bleeding. Treatment was stopped when a therapeutic level of anticoagulation (International Normalized Ratio >3.5) was reached with coumarins. Thirteen patients in the heparin group and 10 patients in the Fragmin group had a major bleeding complication. The incidence of major and minor bleeding complications combined decreased from 48.9% to 38.5% (95% confidence interval for the dilference, -3.5% to +24.2%), corresponding with a relative bleeding risk reduction of 21.2%. There were no significant differences in efficacy as defined by new high-probability defects on repeat ventilation-perfusion scintigraphy of the lung in 80 patients: six of 46 patients in the heparin group and 3 of 34 patients in the Fragmin group had new defects (95% confidence interval for the difference, -9.4% to + 17.8%). We conclude that low molecular weight heparin (Fragmin) given in adjusted, continuous, and intravenous doses is safe and effective as initial treatment of acute venous thromboembolism compared with heparin. There is a trend in risk reduction for bleeding in favor of low molecular weight heparin, a trend, however, that is smaller than expected compared with animal studies. (Circulation 1989;80:935-940) H eparin is used in relatively large doses in the management of thromboembolic disease with the aim of preventing extension and embolization of venous thrombi. The treatment, however, is associated with an appreciable risk of hemorrhage. This has prompted research to improve the benefit to risk ratio of the drug.Heparin acts as an anticoagulant by accelerating the complex formation between antithrombin III and various activated clotting factors, among which factor Xa and thrombin are the most important. Fractionation of the polydisperse heparin according to molecular size has led to the development of low molecular weight heparin preparations with an increased anti-Xa to antithrombin ratio.1 These low molecular weight heparins have been shown to

show abstract

Section: Treatment Of Acute Venous Thromboembolism With Low Molecularmentioning

confidence: 99%

Treatment of acute venous thromboembolism with low molecular weight heparin (Fragmin). Results of a double-blind randomized study.

Albada¹,

Nieuwenhuis²,

Sixma³

1989

Circulation

161

View full text Add to dashboard Cite

show abstract

“…The development of low-molecular weight heparins was accelerated by the discovery that administration of these substances decreases bleeding while maintaining the same antithrombotic efficacy when compared with heparin itself Esquivel et al, 1982;Holmer et al, 1982;Cade et al, 1984;Andriuoli et al, 1985;Bergquist et al, 1985). Clinical studies show that low-molecular weight heparins (LMWH's) are effective especially in the prevention and treatment of venous thrombosis (Hull et al, 1991;Prandoni, 1991;Columbus Investigators, 1997;Klein et al, 1997;Hirsh, 1998).…”

Section: Low Molecular Weight Heparins -Lmwh'smentioning

confidence: 99%

“…The main mode of LMWH metabolism and excretion is through the kidney and urinary system (Palm and Mattsson, 1987;Boneu et al, 1988). LMWH's have a significantly lower affinity to von Wilebrandt factor (vWF) (Sobel et al, 1991) than UFH, which may decrease the probability of excessive bleeding complications at the same dose regimen (Esquivel et al, 1982;Andriuoli et al, 1985).…”

Section: Pharmacokinetics Of Lmwh'smentioning

confidence: 99%

“…In one model, venostasis was achieved by vessel ligation and blood coagulation was induced by injection of serum, factor Xa, thrombin, or tissue factor (Ockelford et al, 1982;Van Ryn-McKenna et al, 1989). In these models, LMWH's are slightly less effective than UFH; however, they cause significantly less systemic bleeding under standardized conditions (Esquivel et al, 1982;Ockelford et al, 1982;Hobbelen et al, 1987). Whenever these sulphated polysaccharides are compared to each other, their effect on platelets (Fabris et al, 1983;Fernandez et al, 1986;Sobel et al, 1991), as well as on blood vessel permeability (Blajchman et al, 1989) should be kept in mind.…”

Section: Efficacy and Safety Of Lmwh's In An Animal Modelmentioning

confidence: 99%

“…Standard (unfractionated) heparin has been compared with low-molecular weight heparins, ORG heparinoid and dermatan sulphate on various experimental animal models with regard to their antithrombotic and hemorrhagic responses (Esquivel et al, 1982;Ockelford et al, 1982;Andriuoli et al, 1985;Hobbelen et al, 1987;Van Ryn-McKenna et al, 1989;Currier et al, 1991). In one model, venostasis was achieved by vessel ligation and blood coagulation was induced by injection of serum, factor Xa, thrombin, or tissue factor (Ockelford et al, 1982;Van Ryn-McKenna et al, 1989).…”

Section: Efficacy and Safety Of Lmwh's In An Animal Modelmentioning

confidence: 99%

See 2 more Smart Citations

Heparin and its derivatives in the treatment of arterial thrombosis: a review

Dvořák¹,

Vlašín²,

Dvorakova³

et al. 2010

Vet. Med. - Czech

View full text Add to dashboard Cite

Arterial occlusion due to thrombosis caused by ruptured atherosclerotic plaques (Baba et al., 1975) has been recognized as a major cause of morbidity and mortality in western populations. Thrombosis may occur in various sections of arterial circulation, peripheral arteries of the limbs, coronary arteries, brain arteries, or both major and minor vessels within the abdominal cavity. The ultimate consequence is varying degrees of organ failure, mostly of ischemic origin. Arterial thrombosis represents a continuous problem, debilitating patients and decreasing their quality of life. Moreover, along with chronic heart failure, it can significantly decrease patient life expectancy. Arterial thrombosis results in ischemia, with serious systemic consequences, such as metabolic breakdown. The major goal of treatment remains fast and efficient recanalization -surgical, interventional or thrombolytic. To be able to prevent acute reocclusion with severe consequences (rhabdomyolysis, compartment syndrome, excessive tissue necrosis leading to limb amputation, etc.), several adjunctive treatment regimens have been advocated. Among others, thrombin inhibitors and platelet inhibitors have been widely used for both prophylaxis and adjunctive treatment. Direct thrombin inhibitors and antithrombin stimulators have been recognized as typical antithrombotic drugs. Direct (antithrombin-independent) thrombin inhibitors can be divided into two main categories: monovalent, active site inhibitors (argatroban, efegatran, inovastan, melagatran) and bivalent (hirudin, hirugen, hirulog, bivalirudin), while antithrombin stimulators represent standard (unfractionated) heparin (UFH) and its depolymerizing products -low molecular weight heparins (LMWH's). Recently, a clear change in the main use of heparin, as well as low-molecular weight heparins has been advocated representing a shift from treatment and prophylaxis of deep vein thrombosis to prophylaxis of thromboembolic disease following vascular, cardiovascular or orthopedic surgery, treatment of unstable angina and prevention of acute myocardial infarction. The main effect of heparins lies in their anticoagulant activity. Heparins are involved in different pathways of the coagulation cascade with anticoagulant, antithrombotic, profibrinolytic, anti-aggregative, as well as anti-inflammatory effects. Moreover, there is a little doubt about their anti-proliferative and anti-ischemic activity (Penka and Bulikova, 2006). Unlike standard heparin, low-molecular weight heparins do not affect the patient's general coagulation profile. Obviously, the difference in molecular weight results in different pharmacokinetic and pharmacodynamic properties of the agents.Key words: coagulation; arterial thrombosis; standard heparin; low-molecular weight heparins List of abbreviations ABI = axillary/...index, t-PA = tissue-type plasminogen activator, ADP = adenosin diphosphate, AG = angiography, AMI = acute myocardial infarction, APSAC = acylated plasminogen streptokinase activator complex, APTT = acti...

show abstract

Inhibition of Intraocular Fibrin Formation Following Infusion of Low-Molecular-Weight Heparin During Vitrectomy

Iverson

Katsura²,

Hartzer³

et al. 1991

Arch Ophthalmol

View full text Add to dashboard Cite

Comparison between commercial heparin, low molecular weight heparin and pentosan polysulfate on hemostasis and platelets in vivo

Cited by 68 publications

References 12 publications

Treatment of acute venous thromboembolism with low molecular weight heparin (Fragmin). Results of a double-blind randomized study.

Treatment of acute venous thromboembolism with low molecular weight heparin (Fragmin). Results of a double-blind randomized study.

Heparin and its derivatives in the treatment of arterial thrombosis: a review

Inhibition of Intraocular Fibrin Formation Following Infusion of Low-Molecular-Weight Heparin During Vitrectomy

Contact Info

Product

Resources

About