Low molecular weight heparin given the evening before surgery compared with conventional low-dose heparin in prevention of thrombosis

Abstract

A prospective randomized double-blind trial was performed comparing conventional low-dose heparin with a low molecular weight heparin fragment for thromboprophylaxis in elective general abdominal surgical patients. The first dose of the heparin fragment was given the evening before surgery, and further doses were given thereafter every evening. There were 1002 analysable patients, 826 having received correct prophylaxis. Of these 1002 patients, 64 per cent were operated on for malignant disease. A total of 20 patients died, 10 in each group. The frequency of deep vein thrombosis was significantly reduced among patients with correct prophylaxis with the heparin fragment (9.2-5.0 per cent, P = 0.02) [corrected]. The frequency of bleeding was 6.7 per cent among the heparin fragment patients and 2.7 per cent among the patients given conventional heparin (P = 0.01), but all bleeds were of minor degree and there was no difference in the reoperation rate for bleeding, or in the transfusion requirements. Local pain at the injection site was reported significantly less often among patients given the heparin fragment.

Low molecular weight heparin for the prevention of hepatic veno-occlusive disease (VOD) after hematopoietic stem cell transplantation: a prospective phase II study

“…24 In several large clinical trials, when administered as treatment or prophylaxis of deep venous thrombosis (DVT), it has been found to be as efficacious as UH with a low incidence of bleeding complications. [25][26][27] There are, however, few published reports specifically examining the safety and efficacy of LMWH as VOD prophylaxis. Our centre therefore undertook a prospective pilot study of LMWH as VOD prophylaxis for patients undergoing HDCT and HSCT.…”

“…13,21 LMWH has a number of potential advantages when compared to UH including greater bioavailability and longer plasma half-life because of less plasma protein binding, a more predictable anticoagulant response, no need for laboratory monitoring, a low incidence of HIT and in some studies, a lower incidence of bleeding. [24][25][26][27]30 There have been a number of clinical trials comparing the efficacy and safety of LMWH to UH in the prophylaxis and treatment of DVT in medical and surgical patients. [24][25][26][27] These studies have consistently shown that LMWH is both efficacious and safe with a low incidence of bleeding complications.…”

“…[24][25][26][27]30 There have been a number of clinical trials comparing the efficacy and safety of LMWH to UH in the prophylaxis and treatment of DVT in medical and surgical patients. [24][25][26][27] These studies have consistently shown that LMWH is both efficacious and safe with a low incidence of bleeding complications. All of these qualities potentially make LMWH an attractive anticoagulant agent in the hematopoietic stem cell transplant setting where the majority of patients experience a variable period of thrombocytopenia and increased risk of bleeding.…”

Venous Thromboembolism Prophylaxis in the General Surgical Patient

“…[73][74][75][76][85][86][87] Advantages of LMWHs over UFH include a higher anti-Xa activity compared with antithrombin activity, better bioavailability at low doses, no monitoring required, and a longer half-life (4 hours vs 0.5 to 2 hours), allowing for once-daily dosing in some patients. However, a long half-life can sometimes be a disadvantage in the case of bleeding complications.…”

Venous thromboembolism prophylaxis in cancer patients — guidelines focus on surgical patients

“…The effectiveness of low doses of heparin (low doses of unfractionated heparin -LDUH) in the prevention of VTE in high risk surgical patients has been documented for many years, however, in everyday clinical practice, partly of practical reasons, this method of prophylaxis plays a marginal role in comparison with the very common use of the low molecular weight heparin (LMWH) in this indication [61][62][63][64][65][66][67][68][69][70]. In controlled randomized trials comparing LMWH with LDUH in patients undergoing cancer surgical treatment, both methods of prevention have a high and comparable efficacy [68,71].…”