Low molecular weight versus standard heparin for prevention of venous thromboembolism after major abdominal surgery

Kakkar, Vijay V.; Cohen, A.T.; Edmonson, R.A.; Phillips, M.; Das, Sunit; Maher, K.T.; Sanderson, Ruth; Kakkar, S.; Cooper, Derek

doi:10.1016/0140-6736(93)92614-y

Cited by 315 publications

(64 citation statements)

References 23 publications

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“…Low molecular weight heparin (LMWH) is safer than UH for DVT (13)(14)(15), and is regarded as the first choice for patients with contraindications to thrombolysis. Use of LMWH alone is unable to clear the clots completely and is associated with a high risk of developing postthrombotic syndrome, thus compromising the quality of life.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding

Chen

Shi

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The present study aimed to examine the feasibility of catheter-directed thrombolysis (CDT) using continuous infusion of low-dose urokinase in combination with low molecular weight heparin (LMWH) for acute iliofemoral venous thrombosis. This retrospective analysis included patients with symptomatic acute iliofemoral venous thrombosis who received CDT using continuous infusion of low-dose urokinase in combination with LMWH within the past four years. Urokinase was administered at 1x10 4 U/h and 2x10 4 U/h in patients at high-risk and low-risk of bleeding, respectively. Measurements included urokinase dosage, duration, clinical outcomes and CDT-related complications. A total of 46 patients were included (high-risk, n=17; low-risk, n=29). In the high-risk patients, 64.7% experienced dissolution of ≥50% thrombi after a median CDT duration of 8 days (range, 6-10 days) and median total urokinase dose of 1.92x10 6 units (range, 1.44-2.4x10 6 units). In the low-risk patients, 82.8% achieved dissolution of ≥50% thrombi after a median CDT duration of 7 days (range, 4-10 days) and a median total urokinase dose of 3.36x10 6 units (range, 1.92-4.80x10 6 units). Remission of clinical symptoms after CDT was achieved in 15 (88.2%) and 28 (96.6%) cases in high-risk and low-risk patients, respectively. No treatment-associated pulmonary embolism or major bleeding was observed. Three (6.5%) subjects (high-risk, n=1; low-risk, n=2) experienced minor bleeding. In conclusion, continuous infusion of low-dose urokinase via CDT in combination with LMWH is effective and safe for acute iliofemoral venous thrombosis in patients with one or more risk factor for bleeding.

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Section: Introductionmentioning

confidence: 99%

Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding

Chen

Shi

et al. 2017

Experimental and Therapeutic Medicine

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“…Following major elective orthopedic surgery, more than 50% of patients will develop DVT, and approximately 3%-5% develop symptomatic PE, which remains the major cause of postoperative death (0.5%-2%) [3,4]. A considerable risk for DVT still remains (12%-30%), despite prophylaxis treatment [5][6][7][8]. To date, the factors contributing to the higher DVT incidence after orthopedic compared with abdominal surgery are not well established.…”

Section: Introductionmentioning

confidence: 99%

Hemostatic markers in surgery: a different fibrinolytic activity may be of pathophysiological significance in orthopedic versus abdominal surgery

López¹,

*²,

Pardo³

et al. 1998

International Journal of Clinical & Laboratory Research

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Without prophylaxis, patients subjected to major abdominal surgery have a risk of deep vein thrombosis of approximately 30%, while the rate varies between 40% and 60% in orthopedic surgery. The reasons for this discrepancy are not completely understood. The present study was designed to compare the pre-and postoperative behavior of different coagulation and fibrinolysis parameters in patients undergoing both types of surgery, receiving low molecular weight heparin prophylaxis. Samples were taken before operation and on postoperative days 1,3, and 7. The following parameters were assessed: prothrombin fragment 1+2, thrombin-antithrombin III complexes, fibrinopeptide A, tissue plasminogen activator, plasminogen activator inhibitor, plasmin-c~__-antiplasmin complexes, and fibrin degradation products. We found a significant increase in the clotting markers postoperatively compared with preoperative values (P<0.05), both in abdominal and orthopedic surgery, indicating a marked hemostatic activation which remained until postoperative day 7. A significant increase in plasminogen activator inhibitor (P<0.01) and a decrease in tissue plasminogen activator and plasmin-%-antiplasmin complexes was also observed early

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“…However, data from meta-analyses and doubleblind, randomized, placebo-controlled studies have shown that the administration of low doses of heparin (unfractionated heparin or, especially, low-molecular-weight heparin) does not significantly increase the incidence of intraoperative bleeding. (29) Another possible explanation for not prescribing prophylactic medication is its allegedly high cost. However, the correct use of pharmacological prophylaxis presents a favorable cost-benefit ratio.…”

Section: Discussionmentioning

confidence: 99%

Fatores de risco e profilaxia para tromboembolismo venoso em hospitais da cidade de Manaus

et al. 2009

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Objective: To identify and classify risk factors for venous thromboembolism (VTE) in hospitalized patients, as well as to evaluate medical practices regarding prophylaxis for the disease. Methods: An observational crosssectional study, carried out between January and March of 2006, involving inpatients at three hospitals in the city of Manaus, Brazil. Risk stratification for VTE was based on the criteria established by the Brazilian Society of Angiology and Vascular Surgery and by the International Union of Angiology. Clinical, surgical and medicationrelated risk factors were analyzed. The statistical analysis of the data obtained was conducted, adopting an alpha error of 5% and 95% CI. Qualitative data were analyzed using the chi-square test, whereas quantitative data were analyzed using Student's t-test. Results: Of the 1,036 patients included (total number of admissions, 1,051), 515 (49.7%) were male, and 521 (50.3%) were female. A total of 23 risk factors for VTE were identified (total number of occurrences, 2,319). The stratified risk for VTE was 50.6%, 16.6% and 30.8% among the admissions of high-, moderate-and low-risk cases, respectively. In 73.3% of the admissions, nonpharmacological prophylaxis was not employed at any point during the study period. In 74% of those classified as high-or moderate-risk cases, no prophylactic medications were administered. Conclusions: This study showed that, in the population studied, risk factors were common and that prophylactic measures were not employed in patients prone to developing VTE and its complications.Keywords: Venous thromboembolism; Risk factors; Venous thrombosis/prevention & control. ResumoObjetivo: Identificar e classificar os fatores de risco para tromboembolismo venoso (TEV) em pacientes internados, avaliando as condutas médicas adotadas para a profilaxia da doença. Métodos: Estudo observacional, de corte transversal no período de janeiro a março de 2006, envolvendo uma população de pacientes internados em três hospitais na cidade de Manaus (AM). A estratificação do risco para TEV foi feita com base nos critérios da Sociedade Brasileira de Angiologia e Cirurgia Vascular e da International Union of Angiology. Foram avaliados variáveis sobre os fatores de risco clínicos, cirúrgicos e medicamentosos, assim como os métodos profiláticos para TEV. Os dados foram analisados estatisticamente, adotando-se um alfa de 5% e IC95%. Os dados qualitativos foram analisados pelo teste do qui-quadrado e os dados quantitativos pelo teste t de Student. Resultados: Foram estudados 1.036 pacientes num total de 1.051 internações, sendo 515 (49,7%) homens e 521 (50,3%) mulheres. Um total de 23 de fatores de risco para TEV foram identificados (número total de eventos, 2.319). O risco estratificado para TEV foi de 50,6%, 18,6% e 30,8% das internações para risco alto, moderado e baixo, respectivamente. Em 73,3% das internações, não foram adotadas medidas profiláticas não-medicamentosas durante o período do estudo, e em 74% das internações que apresentavam risco moderado ...

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Low molecular weight versus standard heparin for prevention of venous thromboembolism after major abdominal surgery

Cited by 315 publications

References 23 publications

Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding

Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding

Hemostatic markers in surgery: a different fibrinolytic activity may be of pathophysiological significance in orthopedic versus abdominal surgery

Fatores de risco e profilaxia para tromboembolismo venoso em hospitais da cidade de Manaus

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