Low Molecular Weight Heparin: A Better Drug?

Thomas, Duncan P.; Barrowcliffe, T W; Curtis, A. D. M.

doi:10.1159/000215278

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…Protamine sulfate has been used as an antidote to neutralize heparin following cardiovascular surgery, and to reverse heparin associated bleeding (1)(2)(3). Whether protamine sulfate is as useful an antidote to neutralize the effects of low molecular weight heparins (LMWH) which are presently being used clinically (4)(5)(6)(7)(8), however, is unclear. A number of investigators measured the ability of protamine sulfate to neutralize the anticoagulant properties of various LMWHs, assessed both in vitro and ex vivo (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Neutralization of Enoxaparine-lnduced Bleeding by Protamine Sulfate

et al. 1990

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SummaryIt has been suggested that protamine sulfate is a poor antidote for the bleeding side-effeets of low molecular weight heparins (LMWHs) in vivo, since protamine sulfate does not completely neutralize the anti-factor Xa activity of LMWHs in vitro or ex vivo. Therefore, we performed experiments to compare directly the abilities of protamine sulfate to neutralize the anticoagulant activities of the LMWH, enoxaparine, and unfractionated heparin ex vivo, with its ability to neutralize the bleeding side-effeets of both compounds in vivo. Bleeding was measured as the amount of blood lost from 5 cuts made in rabbits ears before and after treatment with enoxaparine or unfractionated heparin ± protamine sulfate. Plasma anti-factor Xa and anti-thrombin activities ex vivo, were measured chromogenically. Doses of 400 and 1,500 anti-factor Xa U/kg of heparin and enoxaparine, respectively, were required to enhance blood loss to the same extent. Protamine sulfate completely neutralized blood loss induced by both compounds, but did not neutralize the anti-factor Xa nor antithrombin activities ex vivo. We conclude that protamine sulfate is an effective antidote for the bleeding side-effeets of enoxaparine and unfractionated heparin, despite its inability to completely neutralize their anticoagulant activities.

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Section: Introductionmentioning

confidence: 99%

Neutralization of Enoxaparine-lnduced Bleeding by Protamine Sulfate

et al. 1990

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“…The question of whether to use a common standard for LMWHs, however, is being strongly debated. 3,4,90,[144][145][146][147][148][149][150][151] The data presented here suggest that standardization practices for unfractionated heparin are not valid in the case of LMWHs. The key issue on the standardization of LMWHs can be summarized in the following: There is considerable concern over the current use of the first LMWH standard.…”

Section: Standardization Of Low Molecular Weight Heparinsmentioning

confidence: 99%

Chemical and Biological Heterogeneity in Low Molecular Weight Heparins: Implications for Clinical Use and Standardization

Fareed¹,

Walenga²,

Hoppensteadt³

et al. 1989

Semin Thromb Hemost

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“…Ideally plasma should be prepared from blood collected in the laboratory into 0.109 M trisodium citrate, centrifuged at high speed (e.g. 5 min at 50,000 g) immediately after collection to remove platelets, aliquoted, snap-frozen and stored at -40 oC.…”

Section: Appendixmentioning

confidence: 99%

An International Standard for Low Molecular Weight Heparin

et al. 1988

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SummaryAn international collaborative study has been carried out with the aim of establishing an international standard for low molecular weight (LMW) heparin. Three preparations of LMW heparin were assayed against the International Standard for unfractionated heparin (UFH) by 25 laboratories in 13 countries, using nine different assay methods. The results confirmed previous findings of non-parallel assays, wide interlaboratory variability and differences between methods when LMW heparins are assayed against a UFH standard. Use of one of the LMW heparins as a standard for the other two gave parallel assays and much closer agreement between laboratories. The preparation in ampoules coded 85/600 was selected as likely to give the best agreement with the largest number of LMW heparins; potencies were assigned by taking the mean of all the anti-Xa assays, and the mean of the thrombin and APTT assays, to represent the two major groups of activities. Preparation 85/600 has been established by WHO as the 1st International Standard for LMW heparin, with potencies of 1,680 iu/ampoule by anti-Xa assays and 665 iu/ampoule by thrombin inhibition and APTT assays.

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Low Molecular Weight Heparin: A Better Drug?

Cited by 5 publications

References 16 publications

Neutralization of Enoxaparine-lnduced Bleeding by Protamine Sulfate

Neutralization of Enoxaparine-lnduced Bleeding by Protamine Sulfate

Chemical and Biological Heterogeneity in Low Molecular Weight Heparins: Implications for Clinical Use and Standardization

An International Standard for Low Molecular Weight Heparin

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