Low molecular weight heparin

Hirsh, Jack; Mn, Levine

doi:10.1182/blood.v79.1.1.bloodjournal7911

Cited by 275 publications

(9 citation statements)

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“…We did not prespecify any restrictions regarding minimum or maximum length of follow‐up after the ischemic stroke event. The search was limited to records published from the first of January 1990 and onwards because of the extensive introduction of thromboprophylaxis with LMHW in the clinics during the 1990s 19 . In addition, the search was restricted to studies on humans, published in the English language.…”

Section: Methodsmentioning

confidence: 99%

“…The search was limited to records published from the first of January 1990 and onwards because of the extensive introduction of thromboprophylaxis with LMHW in the clinics during the 1990s. 19 In addition, the search was restricted to studies on humans, published in the English language. In Embase, an additional limitation on publication type was applied to exclude conference abstracts from the search, and the focus function was applied on subject heading terms to limit the number of records retrieved.…”

Section: Data Sources and Search Strategymentioning

confidence: 99%

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Risk factors and predictors for venous thromboembolism in people with ischemic stroke: A systematic review

Tøndel

Morelli

Hansen

et al. 2022

Journal of Thrombosis and Haemostasis

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Identification of individuals with ischemic stroke at particularly high risk of venous thromboembolism (VTE) is crucial for targeted thromboprophylaxis. To guide clinical decision‐making and development of risk prediction models, increased knowledge on risk factors and biomarkers is needed. Therefore, we set out to identify risk factors and predictors for VTE in people with ischemic stroke by conducting a systematic review of the literature. Medline and Embase were searched from January 1990 and onwards. Studies investigating demographic, clinical, and/or laboratory factors for stroke‐related VTE were considered. Two reviewers screened all retrieved records, independently and in duplicate. Risk of bias assessments were guided by a structured framework (PROSPERO‐ID: CRD42020176361). Of 4674 identified records, 26 studies were included. Twenty‐six demographic, clinical, and laboratory factors associated with increased risk of stroke‐related VTE after multivariable adjustments were identified. The following factors were reported by ≥2 studies: prior VTE, cancer, prestroke disability, leg weakness, increasing lesion volume of the brain infarct, infection, low Barthel Index, increasing length of hospital stay, biochemical indices of dehydration, as well as elevated levels of D‐dimer, C‐reactive protein, and homocysteine. The majority of the studies were of poor quality with moderate or high risk of bias. In conclusion, this systematic review informs on several potential risk factors and predictors for VTE in people with ischemic stroke. To improve risk stratification and guide development of risk prediction models, further confirmation is needed because there were few high‐quality studies on each factor.

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Section: Methodsmentioning

confidence: 99%

Section: Data Sources and Search Strategymentioning

confidence: 99%

Risk factors and predictors for venous thromboembolism in people with ischemic stroke: A systematic review

Tøndel

Morelli

Hansen

et al. 2022

Journal of Thrombosis and Haemostasis

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“…Despite this fact, UFH has not replaced warfarin for long-term treatment of DVT, probably because it requires twice-daily dosing and monitoring. Subcutaneous low-molecular-weight heparin (LMWH) does not have these restrictions, and compared with UFH it results in more predictable blood levels [6].…”

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confidence: 99%

Low‐Molecular‐Weight Heparin versus Warfarin for Prevention of Recurrent Venous Thromboembolism: A Randomized Trial

et al. 1996

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A group of 105 consecutive patients with venographically proved major acute deep vein thrombosis (DVT) were randomized in an open prospective study to evaluate the comparative efficacy and safety of a fixed dose of subcutaneous low-molecular-weight heparin (LMWH) and warfarin for the prevention of recurrent venous thromboembolism. Four patients developed venographically proved recurrent DVT during the 3 months of treatment: three in the LMWH group and one in the warfarin group. Nonfatal pulmonary embolism occurred in two patients in the LMWH group and in one in the warfarin group. Five of the 55 patients (10%) in the warfarin group and none of the 50 patients in the LMWH developed bleeding complications (two-tailed Fisher exact test, p = 0.06). A preliminary assessment of the costs indicated that treatment with LMWH was less expensive by Pounds 900 per patient than warfarin. In conclusion, the fixed daily dose of LMWH and the adjusted dose of warfarin therapy were of similar efficacy in preventing recurrence of DVT. However, warfarin therapy, despite strict laboratory control, is associated with more frequent side effects and is expensive. Another study with a higher dose of LMWH is recommended.

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“…However, lack of group differences during and after surgery was not anticipated since preoperative administered dalteparin was thought to neutralize thrombin activity [4,19]. An explanation might be that the substantial thrombin generation (F1+2) caused by the operation masked the remaining effect of dalteparin injected 12 hours before surgery due to its bioavailability with a half-life of 3-4 h [26,27].…”

Section: Discussionmentioning

confidence: 99%

Preoperative versus Postoperative Initiation of Dalteparin Thromboprophylaxis in THA

2010

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Chemical thromboprophylaxis in total hip arthroplasty (THA) may increase surgical site bleeding. The drug dose and timing of such therapy is therefore important. We studied two cohorts of 298 and 301 patients undergoing THA. The first group received their first dose of dalteparin sodium 5000 IU subcutaneously the evening before surgery and the second group a half dose six hours postoperatively, followed by 5000 units daily in both groups. Blood loss was reduced by 146 ml from 1230 ml to 1084 ml (p<0.001) with postoperative prophylaxis alone. The number of patients receiving blood transfusion decreased from 53% to 35% (p=0.001), and the use of transfused packed red blood cells was reduced from 1.25 to 0.83 units per patient (p=0.001). The overall rates of non-vascular complications 6 months after surgery were 12% and 11%, bleeding related events 6.0% and 4.0%, and thromboembolic related events were 2.0% and 2.3% in the preoperative and the postoperative cohorts. Two patients died in the preoperative group and one in the postoperative group due to venous and arterial thromboembolism. This study show that 2500 IU dose of dalteparin started 6 hours after surgery significantly reduced blood loss and transfusions compared to 5000 IU dalteparin injected 12 hours before surgery. Few thromboembolic events occurred, and these were equally distributed.

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Low molecular weight heparin

Cited by 275 publications

References 0 publications

Risk factors and predictors for venous thromboembolism in people with ischemic stroke: A systematic review

Risk factors and predictors for venous thromboembolism in people with ischemic stroke: A systematic review

Low‐Molecular‐Weight Heparin versus Warfarin for Prevention of Recurrent Venous Thromboembolism: A Randomized Trial

Preoperative versus Postoperative Initiation of Dalteparin Thromboprophylaxis in THA

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