Comparison of efficacy of low molecular weight heparin (parnaparin) with that of unfractionated heparin in the presence of activated platelets in healthy subjects

Melandri, Giovanni; Semprini, Franco; Cervi, Vittorio; Candiotti, N; Branzi, Angelo; Palazzini, E; Magnani, B

doi:10.1016/0002-9149(93)91139-9

Cited by 41 publications

(19 citation statements)

References 18 publications

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“…[2][3][4][5] There are not many studies on the effects and safety of LMWH during PCI, although it is known that LMWH are superior to UFH. [8][9][10][11] However, as mentioned above, because accurate measurement of anticoagulation is required and the anticoagulation state can be simply reflected by activated clotting time (ACT) measurement, LMWH use is still limited in many coronary laboratories, and furthermore, guidelines currently do not exist.…”

Section: Discussionmentioning

confidence: 99%

“…1) However, UFH is associated with various problems, such as unpredictable anticoagulative reactions 2) and intrinsic platelet activation and aggregation, 3,4) which are clinical events that occur due to a reactive response after drug cessation. The use of low molecular weight heparin (LMWH) has gradually increased because of the predictable anticoagulative reaction due to high affinity for factor Xa, resistance to activated platelet, and a decrease in thrombocytopenia.…”

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confidence: 99%

“…The use of low molecular weight heparin (LMWH) has gradually increased because of the predictable anticoagulative reaction due to high affinity for factor Xa, resistance to activated platelet, and a decrease in thrombocytopenia. [3][4][5][6][7] Although there have been few studies on the therapeutic efficacy and safety of LMWH during percutaneous coronary intervention (PCI), it is known that the effect of LMWH is superior to that of UFH due to no intrinsic platelet activation and aggregation, and the favorable clinical results obtained. [8][9][10][11] Also, it is known that LMWH has a more effective and stable anticoagulation effect than UFH.…”

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confidence: 99%

“…The major reason is the superior bioavailability, and the minor causes are the decrease in nonspecific protein binding, and decreases in the responsiveness for neutralization by platelet factor 4 and easy control of release of von Willebrand factor. 1,3,4,12,13) Abciximab (ReoPro ® ), a platelet glycoprotein IIb/IIIa receptor blocker, is a potent antiplatelet agent which blocks the final common pathway of platelet aggregation. Moreover, it has proven to be effective in improving the results of high risk PCIs and in reducing the incidence of major adverse cardiac events (MACE), including short-and long-term mortality.…”

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confidence: 99%

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Comparison of Abciximab Combined With Dalteparin or Unfractionated Heparin in High-Risk Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

et al. 2006

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SUMMARYThe purpose of this study was to determine the clinical outcomes of abciximab combined with the low molecular weight heparin (LMWH), dalteparin, in high-risk percutaneous coronary intervention (PCI) patients with acute myocardial infarction (AMI). A total of 140 high-risk PCI patients with AMI were divided into 2 groups: unfractionated heparin (UFH) with abciximab (group I: 70 patients, 58.7 ± 10.5 years), and dalteparin with abciximab (group II: 70 patients, 59.6 ± 9.8 years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Baseline clinical characteristics, laboratory findings, echocardiography parameters, and baseline angiographic characteristics were not different between the 2 groups. The incidence of thrombotic total occlusion lesions was 62.9% in both groups. Procedural success was achieved in 91.4% in group I and 90.0% in group II. Bleeding and hemorrhagic events were not different between the 2 groups. No significant intracranial bleeding was observed in either group. The incidence of in-hospital MACE was 7 (10.0%) in group I and 4 (5.7%) in group II. Four-year clinical follow-up was performed in 97% of the patients. Four years after PCI, death occurred in 6 (8.6%) patients in group I and in 7 (10.0%) in group II. MI occurred in 4 (5.7%) and 4 (5.7%), target vessel revascularization (TVR) in 23 (32.9%) and 16 (22.9%), and bypass surgery in 3 (4.3%) and 1 (1.4%), respectively. Overall, a MACE occurred in 33 (47.1%) patients in group I and in 26 (35.1%) patients in group II (P = 0.23). The long-term clinical outcome with dalteparin combined with abciximab may be comparable to that of UFH plus abciximab in high risk PCI patients with AMI. (Int Heart J 2006; 47: 821-831)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Comparison of Abciximab Combined With Dalteparin or Unfractionated Heparin in High-Risk Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

et al. 2006

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“…24 Unfractionated heparin inactivates thrombin by forming a complex with thrombin and antithrombin, and inactivates factor Xa through antithrombin. Limitations to unfractionated heparin use include the need for frequent laboratory monitoring, neutralization of heparin's activity by activated platelets, 25 thrombocytopenia, 26 platelet aggregation, 26 a dose-dependent risk of bleeding, 27 and rebound ischemia following its discontinuation. [28][29][30] Moreover, since unfractionated heparin is heterogenous in structure (about one-third of heparin chains contain the high-affinity pentasaccharide required for anticoagulant activity) it is also heterogeneous in its pharmacologic activity.…”

Section: Indirect Thrombin Inhibitorsmentioning

confidence: 99%

Selecting the optimal antithrombotic regimen for patients with acute coronary syndromes undergoing percutaneous coronary intervention

Parikh

Keeley

2009

VHRM

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Abstract:The wide variety of anticoagulant and antiplatelet agents available for clinical use has made choosing the optimal antithrombotic regimen for patients with acute coronary syndromes undergoing percutaneous coronary intervention a complex task. While there is no single best regimen, from a risk-benefit ratio standpoint, particular regimens may be considered optimal for different patients. We review the mechanisms of action for the commonly prescribed antithrombotic medications, summarize pertinent data from randomized trials on their use in acute coronary syndromes, and provide an algorithm (incorporating data from these trials as well as risk assessment instruments) that will help guide the decision-making process.

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Efficacy and tolerability of a very low molecular weight heparin compared with standard heparin in patients with unstable angina: A pilot study

Mattioli

Castellani

Goedecke

et al. 1999

Clinical Cardiology

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SummaryBuckground: Unstable angina is an active thrombotic process that involves thrombus formation and platelets. It requires a rapid and intensive treatment with anticoagulants and antiplatelets.Hypothesis: The aim of the present study was to compare the efficacy of a very low molecular weight heparin, OP 2000, with standard heparin in the treatment of unstable angina. Tolerance and safety were also assessed.Methocls: The study population included 120 consecutive hospitalized patients with unstable angina randomized for treatment with very low molecular weight heparin or with standard heparin. The dosage of the study drug was 200 mg intramuscular (IM) the first day followed by 150 mg M d a y . The control drug was standard heparin starting at a dosage of 5,000 UVml intravenously (IV) and followed by continuous infusion at an activated partial thromboplastin time-adjusted dosage. The primary end points were death, acute myocardial infarction, urgent revascularization, and recurrence of angina. Tolerability was assessed using bleeding parameters, thrombocytopenia, and allergic reactions.Results: Fourteen clinical events were reported in the study group compared with 25 events in the control group (p < 0.05).No adverse events were reported in either group. Conclusion: During the acute phase of unstable angina, treatment with a very low molecular weight heparin plus aspirin was more effective than treatment with standard heparin plus aspirin.

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Comparison of efficacy of low molecular weight heparin (parnaparin) with that of unfractionated heparin in the presence of activated platelets in healthy subjects

Cited by 41 publications

References 18 publications

Comparison of Abciximab Combined With Dalteparin or Unfractionated Heparin in High-Risk Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

Comparison of Abciximab Combined With Dalteparin or Unfractionated Heparin in High-Risk Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

Selecting the optimal antithrombotic regimen for patients with acute coronary syndromes undergoing percutaneous coronary intervention

Efficacy and tolerability of a very low molecular weight heparin compared with standard heparin in patients with unstable angina: A pilot study

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