Low molecular weight heparins and their clinical applications

Hao, Cui; Sun, Mojian; Wang, Hongmei; Zhang, Lijuan; Wang, Wei

doi:10.1016/bs.pmbts.2019.02.003

Cited by 83 publications

(52 citation statements)

References 97 publications

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“…As cohort studies suggest a high rate of thromboembolic complications among hospitalised patients [13] , prophylactic administration with LMWH for hospitalised COVID-19 patients is recommended [14] , whereas some experts recommend higher doses for critically ill patients. LMWH is preferred over unfractionated heparin due to the decreased risk of bleeding, good predictability, dose-dependent plasma levels and longer half-life [ 15 , 16 ]. Data from retrospective studies suggest that the use of heparin/LMWH may improve outcome in COVID-19, although evidence of prospective trials is needed before more firm conclusions can be drawn [17] , [18] , [19] .…”

Section: Introductionmentioning

confidence: 99%

Beneficial non-anticoagulant mechanisms underlying heparin treatment of COVID-19 patients

et al. 2020

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Coronavirus disease-2019 (COVID-19) is associated with severe inflammation in mainly the lung, and kidney. Reports suggest a beneficial effect of the use of heparin/low molecular weight heparin (LMWH) on mortality in COVID-19. In part, this beneficial effect could be explained by the anticoagulant properties of heparin/LMWH. Here, we summarise potential beneficial, non-anticoagulant mechanisms underlying treatment of COVID-19 patients with heparin/LMWH, which include: (i) Inhibition of heparanase activity, responsible for endothelial leakage; (ii) Neutralisation of chemokines, and cytokines; (iii) Interference with leukocyte trafficking; (iv) Reducing viral cellular entry, and (v) Neutralisation of extracellular cytotoxic histones. Considering the multiple inflammatory and pathogenic mechanisms targeted by heparin/LMWH, it is warranted to conduct clinical studies that evaluate therapeutic doses of heparin/LMWH in COVID-19 patients. In addition, identification of specific heparin-derived sequences that are functional in targeting non-anticoagulant mechanisms may have even higher therapeutic potential for COVID-19 patients, and patients suffering from other inflammatory diseases.

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Section: Introductionmentioning

confidence: 99%

Beneficial non-anticoagulant mechanisms underlying heparin treatment of COVID-19 patients

et al. 2020

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“…Compared with heparin, it has been shown to be safe and effective, with reduced incidence of heparin-induced thrombocytopenia (HIT) complication. LMWH molecular weight around 5000 Da is considerably variable in the chemical structure and has anti-factor Xa and anti-factor IIa activities (Hao et al, 2019). LMWH has a lower anti-factor IIa activity and a relatively higher anti-factor Xa activity.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Spontaneous Intramural Hematoma of the Colon Secondary to Low Molecular Weight Heparin Therapy

Zhu

Wang

et al. 2021

Front. Pharmacol.

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Background: Hematoma of the colon is a rare hemorrhagic complication that affects patients accepting low molecular weight heparin (LMWH) therapy. Only scarce cases of colon hematoma have been reported, usually in children or patients accepting warfarin therapy.Case summary: A 76-year-old Chinese man was diagnosed with atrial fibrillation and heart failure, with cardiac function NYHA grade III on March 21, 2018. This patient was given LMWH for anticoagulation therapy and developed a colon hematoma on the third day of hospitalization. Abdominal computed tomography (CT) showed the thickening of areas of the colon up to 110 mm × 78 mm in thickness, which was a symptom of colon hematoma. The patient underwent conservative treatment successfully. On March 27, the patient’s abdominal pain was alleviated, and a CT scan showed that the intestinal hematoma was absorbed.Conclusions: The most frequent minor bleeding events of LMWH anticoagulation are hemorrhage and subcutaneous hematoma. This case demonstrated that bowel hematoma despite its low incidence should be considered as an ADR of LMWH therapy, especially among patients who present with gastrointestinal symptoms.

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“…For example, nitrous acid depolymerization was used in the preparation of nadroparin and dalterparin characteristerized by the presence of 2,5-anhydro-D-mannose at reducing terminus [ 15 ]. By constrast, benzylation followed by alkaline depolymerization was used in the manufacture of enoxaparin characterized by the presence of 4,5 unsaturated uronic acid at non-reducing terminus [ 20 ]. These subtle differences in chemical structure might have an influence on the physicochemical properties of the LMWHs, which might account for the observed difference in the performance of the three LMWHs [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of low-molecular-weight heparins on anti-Xa peak levels and adverse reactions in Chinese patients with recurrent spontaneous abortion: a single-center, observational study

Bai

Zhang

Sun

et al. 2021

BMC Pregnancy Childbirth

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Objective To compare three commonly used low-molecular-weight heparins (LWMHs) in the treatment of recurrent spontaneous abortion (RSA) by evaluating the anti-Xa peak levels and adverse reactions. Methods In this single-center, observational study, we enrolled 310 patients with RSA in whom anti-Xa levels were measured during pregnancy. Patients were divided into three groups according to the LMWH they used: the nadroparin group, enoxaparin group and dalteparin group. We compared the peak anti-Xa levels and the coagulation status of each group, and analyzed the incidence of adverse reactions, including local allergy, liver and renal dysfunction, and the impact on platelet. Results Patients in the enoxaparin group had a higher anti-Xa peak level than those in the nadroparin group (0.80 ± 0.22 IU/ml vs. 0.61 ± 0.24 IU/ml; P < 0.0001), although most patients in the three groups reached the target concentration of anti-Xa. Furthermore, patients in the enoxaparin group had a more stable anti-Xa levels during pregnancy. In addition, patients in the nadroparin group had a higher rate of local allergy than those in the enoxaparin group (60.5% vs. 42.5%; P = 0.004) and those in the dalteparin group (60.5% vs. 33.3%; P = 0.002). Further examination by the type of local allergy indicated a dramatic difference in pruritus and induration between the nadroparin group and the other two groups. No difference was found in the incidence of liver and renal dysfunction and thrombocytopenia. Conclusion Compared with nadroparin and daltepatin, enoxaparin showed a better performance regarding anti-Xa levels and the incidence of adverse reactions in the treatment of RSA.

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Low molecular weight heparins and their clinical applications

Cited by 83 publications

References 97 publications

Beneficial non-anticoagulant mechanisms underlying heparin treatment of COVID-19 patients

Beneficial non-anticoagulant mechanisms underlying heparin treatment of COVID-19 patients

Case Report: Spontaneous Intramural Hematoma of the Colon Secondary to Low Molecular Weight Heparin Therapy

Effect of low-molecular-weight heparins on anti-Xa peak levels and adverse reactions in Chinese patients with recurrent spontaneous abortion: a single-center, observational study

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