Prevention of perioperative deep vein thrombosis in general surgery: A multicentre double blind study comparing two doses of Logiparin and standard heparin

Abstract

A total of 1290 patients were enrolled in a randomized multicentre double blind study in order to investigate the use of two doses of a new low molecular weight heparin, Logiparin, in the prevention of deep vein thrombosis (DVT) in general surgery. Patients who were included had no contraindication to heparin therapy and had at least one of the recognized risk factors for DVT. Patients were randomized to receive unfractionated heparin (UH) 5000 units b.d., Logiparin 2500 units daily or Logiparin 3500 units daily. Each treatment was given subcutaneously 2 h before surgery and continued for 7-10 days. Daily 125I-labelled fibrinogen uptake tests (FUTs) were performed from day 2 to day 7 to detect DVT, and phleboangiography was used to confirm the diagnosis. The wound was examined on a daily basis to check for haematoma formation, and all patients were followed up for 1 month after operation. All three treatment arms were well matched for age, sex, weight, diagnosis and type of operation performed. The three major inclusion criteria in the trial were malignancy, age over 60 years and a history of varicose veins. Positive FUTs (UH = 4.2 per cent, Logiparin 2500 units daily = 7.9 per cent, Logiparin 3500 units daily = 3.7 per cent) and positive angiograms (UH = 3.0 per cent, Logiparin 2500 units daily = 5.6 per cent, Logiparin 3500 units daily = 2.3 per cent) were significantly more common in the Logiparin 2500 units daily group than in the UH and Logiparin 3500 units daily groups. The rates of major complications (severe haemorrhage, death, pulmonary embolism, reintervention) were similar in the three groups.

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].…”

The Low Molecular Weight Heparin, Tinzaparin, in Thrombosis and Beyond

“…It is more effective than unfractionated heparin in the treatment of DVT and is effective in the treatment of pulmonary embolism and the prevention of DVT in abdominal surgery patients. It is superior to warfarin in the prophylaxis of thromboembolism in subjects undergoing orthopedic joint (hip or knee) replacement surgery (28,29,36,57). It is also an effective anticoagulant for extracorporeal circuits in hemodialysis (55).…”

Factor Xa Inhibition: Correlation between the Plasma Levels of Anti-Xa Activity and Occurrence of Thrombosis and Haemorrhage

“…The inclusion crite ria and the study treatments have been described pre viously [10]. Briefly, the patients were randomised to receive either 5,000 anti-Xa units of U F heparin twice daily, or 2,500 or 3,500 IU of Logiparin, an LMW hep arin, once daily, with a second injection containing only placebo so that a double-blind design could be used.…”

“…A controlled double-blind study compar ing the effects of two different doses of a LMW heparin (Logiparin) and one dose of a UF heparin on the incidence of post-opera tive thrombosis and haemorrhagic events was performed [10], During this study the rela tionship between plasma anti-Xa concentra tion and these clinical events was also evalu ated [11].…”