Low‐Molecular‐Weight Heparins: Are they all the Same?

White, Richard; Ginsberg, Jeffrey S.

doi:10.1046/j.1365-2141.2003.04196.x

Cited by 92 publications

(40 citation statements)

References 55 publications

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“…9 In the absence of trials directly comparing different LMWH preparations, it is unclear whether differences among the various preparations are clinically important. 37 Standard meta-analysis 30 and multivariate regression analysis 38 techniques have been used to compare results obtained with different LMWH preparations in 2 separate studies, both of which failed to draw definite conclusions with regard to comparative efficacy or safety because of the relatively small number of patients available.…”

Section: Comparative Efficacy and Safety Of Ufh And Lmwhmentioning

confidence: 99%

Initial Treatment of Venous Thromboembolism

McRae

Ginsberg

2004

Circulation

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Abstract-Adequate initial anticoagulant therapy of deep venous thrombosis (DVT) is required to prevent thrombus growth and pulmonary embolism (PE). Intravenous unfractionated heparin (UFH) is being replaced by low-molecular-weight heparin (LMWH) as the anticoagulant of choice for initial treatment of venous thromboembolism (VTE). Both agents are relatively safe and effective when used to treat VTE, with LMWH suitable for outpatient therapy because of improved bioavailability and more predictable anticoagulant response. Serious potential complications of heparin therapy, such as heparin-induced thrombocytopenia (HIT) and osteoporosis, seem less common with LMWH. The potential for fetal harm and changes in maternal physiology complicate the treatment of VTE during pregnancy. Although systemic thrombolysis is used in patients with massive PE and in some patients with proximal DVT, controversy persists with respect to appropriate patient selection for this intervention. Key Words: venous thromboembolism Ⅲ pulmonary embolism Ⅲ deep venous thrombosis Ⅲ anticoagulants Ⅲ thrombosis Ⅲ heparin

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Section: Comparative Efficacy and Safety Of Ufh And Lmwhmentioning

confidence: 99%

Initial Treatment of Venous Thromboembolism

McRae

Ginsberg

2004

Circulation

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“…On this treatment regimen, our patient developed no further thrombotic complications. It is well recognised that different LMWH products demonstrate different pharmacokinetic and pharmacodynamic properties in-vivo [5]. Although these LMWH products and treatment regimens demonstrate comparable efficacy in the treatment of VTE occurring with cancer, there is some evidence to 340 suggest that higher doses and twice-daily administration may be important in order to confer maximal anticoagulant effect in patients with cancer [2].…”

Section: Discussionmentioning

confidence: 99%

Management of refractory venous thrombosis associated with malignancy using a supra-therapeutic enoxaparin regimen

et al. 2008

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For many years, it has been recognised that venous thrombo-embolism (VTE) represents a common complication of malignancy. Moreover, VTE in the form of pulmonary embolism (PE) is life-threatening, and constitutes the second leading cause of death in patients with cancer. Consequently, overall survival is significantly reduced in cancer patients who develop thrombosis. In addition, treatment of VTE with anticoagulation is often difficult to manage in the context of cancer. Studies have shown that the risk of recurrent VTE, and the risk of major bleeding are both increased significantly in cancer patients on therapeutic anticoagulant therapy. In this case report, we describe a patient with metastatic carcinoma of the cervix, who developed recurrent thrombotic complications despite being maintained on standard therapeutic doses of both warfarin, and subsequently low molecular weight heparin. However, her refractory VTE was successfully managed using a supra-therapeutic dose low-molecular-weight-heparin (LMWH) regimen, together with close monitoring of plasma anti-Xa levels.

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“…Despite this, a second recurrent VTE event occurred in 8.6% of patients [102]. Switching to a different brand of LWMH might be considered as they have different pharmacokinetic and pharmacodynamic properties in vivo [103], but one of the only RCTs to directly compare two LMWH formulations in the treatment of deep vein thrombosis (DVT) and PE did not show any significant differences in efficacy [104]. Recently Pillai et al [105] reported the use of LMWH and VKA in combination to treat two patients with recurrent thrombosis despite increased doses of LMWH.…”

Section: Warfarin Failurementioning

confidence: 94%

Practical issues with vitamin K antagonists: elevated INRs, low time-in-therapeutic range, and warfarin failure

Lee

Crowther

2011

J Thromb Thrombolysis

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Millions of patients worldwide are prescribed vitamin K antagonists for a variety of medical conditions annually. Despite widespread and long-standing experience with these medications, medical care providers are often confronted with challenging clinical situations. Vitamin K antagonists have a narrow therapeutic index secondary to intrinsic patient characteristics and extrinsic factors including a propensity for drug-drug interactions. Clinicians are required to titrate doses according to the measured international normalized ratio for each individual, balancing the risk of bleeding with preventing thrombosis. The risk of major bleeding associated with vitamin K antagonists has been reported to range from 1 to 3% per year. This narrative review will provide an overview of the most commonly used vitamin K antagonists and discuss the importance of assessing quality of anticoagulation with respect to clinical outcomes. Practical approaches to managing excessive anticoagulation, variable anticoagulation, and anticoagulation failure will be provided, drawing on evidence where applicable and expert opinion where evidence is limited.

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Low‐Molecular‐Weight Heparins: Are they all the Same?

Cited by 92 publications

References 55 publications

Initial Treatment of Venous Thromboembolism

Initial Treatment of Venous Thromboembolism

Management of refractory venous thrombosis associated with malignancy using a supra-therapeutic enoxaparin regimen

Practical issues with vitamin K antagonists: elevated INRs, low time-in-therapeutic range, and warfarin failure

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