Guidelines on the use and monitoring of heparin

Baglin, Trevor; Barrowcliffe, T W; Cohen, Aloni; Greaves, Michael

doi:10.1111/j.1365-2141.2005.05953.x

Cited by 219 publications

(123 citation statements)

References 116 publications

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“…As already discussed, monitoring of UFH has long relied on clot-based assays (APTT and ACT) which have significant limitations. Furthermore, although LMWHs require less laboratory monitoring due to their predictable pharmacokinetics, monitoring is recommended in populations where pharmacokinetic parameters are altered, including obesity, renal insufficiency, pregnancy, in underweight patients, elderly patients and children [7,26].…”

Section: Discussionmentioning

confidence: 99%

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Development of a fluorescent anti-factor Xa assay to monitor unfractionated and low molecular weight heparins

Harris

Castro-López

Hammadi

et al. 2010

Talanta

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Fluorogenic assays have many potential advantages over traditional clot-based and chromogenic assays such as the absence of interference from a range of factor deficiencies as well as offering the possibility of assays in platelet rich plasma or whole blood. A fluorogenic anti-factor Xa (anti-FXa) assay has been developed for the determination of heparin-like anticoagulants including unfractionated heparin (UFH), low-molecular weight heparins (LMWHs), namely enoxaparin and tinzaparin, and the synthetic heparinoid danaparoid, in commercial human pooled plasma. The assay was based on the complexation of heparinspiked plasmas with exogenous FXa at a concentration of 4 nM in the presence of 0.9 µM of the fluorogenic substrate methylsulfonyl-D-cyclohexylalanyl-glycyl-arginine-7-amino-4-methylcoumarin acetate (Pefafluor FXa). Pooled plasma samples were spiked with concentrations of anticoagulants in the range 0 to 1.6 U/ml. The assay was capable of the measurement of UFH and danaparoid in the range 0-1 U/ml, and enoxaparin and tinzaparin in the range 0-0.8 U/ml and 0-0.6 U/ml, respectively. Assay percentage coefficients of variation were typically below 7 %.3

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Section: Discussionmentioning

confidence: 99%

“…LMWHs demonstrate better bioavailability, have significantly longer half-lives compared to UFH [1], and are also associated with reduced incidence of significant complications [7].…”

Section: Introductionmentioning

confidence: 99%

Development of a fluorescent anti-factor Xa assay to monitor unfractionated and low molecular weight heparins

Harris

Castro-López

Hammadi

et al. 2010

Talanta

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“…Some authors suggest that the preparations of LMWH can be considered a family of closely related drugs (i.e., class effect) despite their in vitro differences. 80 Our analysis also suggests that the amount of LMWH may be more important than the LMWH preparation. Consequently, future studies need to explore whether there is a threshold effect with LMWH when it comes to the dose and duration of LMWH treatment.…”

Section: Strengths and Weaknessesmentioning

confidence: 72%

Effects of Long-Term Low-Molecular-Weight Heparin on Fractures and Bone Density in Non-Pregnant Adults: A Systematic Review With Meta-Analysis

et al. 2016

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BACKGROUND: Adults who require long-term anticoagulation with low-molecular-weight heparin (LMWH) such as cancer patients or the elderly may be at increased risk of fractures. OBJECTIVE: To determine the effects of LMWH therapy of at least 3 months' duration on fractures and bone mineral density (BMD) in non-pregnant adult populations. METHODS: We systematically reviewed electronic databases (e.g., MEDLINE, EMBASE), conferences and bibliographies until June 2015 and included comparative studies in non-pregnant adult populations that examined the effects of LMWH (≥3 months) on fractures and BMD. We synthesized evidence qualitatively and used random-effects meta-analysis to quantify the effect of LMWH on fractures. RESULTS: Sixteen articles reporting 14 studies were included: 10 clinical trials (n = 4865 participants) and four observational cohort studies (3 prospective, n = 221; 1 retrospective, n = 30). BMD and fractures were secondary outcomes in the majority of trials, while they were primary outcomes in the majority of observational studies. In participants with venous thromboembolism and underlying cardiovascular disease or cancer (5 RCTs, n = 2280), LMWH for 3-6 months did not increase the relative risk of all fractures at 6-12 months compared to unfractionated heparin, oral vitamin K antagonists or placebo [pooled risk ratio (RR) = 0.58, 95 % CI: 0.23-1.43; I 2 = 12.5 %]. No statistically significant increase in the risk of fractures at 6-12 months was found for cancer patients (RR = 1.08, 95 % CI: 0.31-3.75; I 2 = 4.4 %). Based on the data from two prospective cohort studies (n = 166), LMWH for 3-24 months decreased mean BMD by 2.8-4.8 % (depending on the BMD site) compared to mean BMD decreases of 1.2-2.5 % with oral vitamin K antagonists. CONCLUSIONS: LMWH for 3-6 months may not increase the risk of fractures, but longer exposure for up to 24 months may adversely affect BMD. Clinicians should consider monitoring BMD in adults on long-term LMWH who are at increased risk of bone loss or fracture.

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“…Para tal utiliza-se a heparina não fracionada ou a heparina de baixo peso molecular (HBPM) [7]. A heparina consiste num proteoglicano ácido sulfatado (mucopolissacárideo) com peso molecular variável de 3000 a 30000 dáltons [8], extraída de vísceras de suínos e bovinos [9]. Parte da molécula de heparina é responsável por seu efeito anticoagulante principal.…”

Section: Antitrombóticosunclassified

“…Parte da molécula de heparina é responsável por seu efeito anticoagulante principal. Um sítio ativo de sua molécula contém uma unidade de glicosamina com uma seqüência específica de pentassacarídeos que se liga à antitrombina III (AT III) [1,9,10]. A AT III é um inibidor lento da trombina e outras serino-proteases, incluindo calicreína, plasmina e fatores de coagulação (IXa, Xa, XIa e XIIa).…”

Section: Antitrombóticosunclassified

Avaliação da tromboflebite jugular experimental em equinos tratados com heparina

Borghesan¹

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Guidelines on the use and monitoring of heparin

Cited by 219 publications

References 116 publications

Development of a fluorescent anti-factor Xa assay to monitor unfractionated and low molecular weight heparins

Development of a fluorescent anti-factor Xa assay to monitor unfractionated and low molecular weight heparins

Effects of Long-Term Low-Molecular-Weight Heparin on Fractures and Bone Density in Non-Pregnant Adults: A Systematic Review With Meta-Analysis

Avaliação da tromboflebite jugular experimental em equinos tratados com heparina

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