Subcutaneous Low-Molecular-Weight Heparin Compared with Continuous Intravenous Heparin in the Treatment of Proximal-Vein Thrombosis

Hull, R. D.; Ge, Ruigang; Gf, Pineo; Green, D; Aa, Trowbridge; Cg, Elliott; Rg, Lerner; Hall, Jeffrey; Sparling, Terence G.; Hr, Brettell

doi:10.1056/nejm199204093261502

Cited by 670 publications

(189 citation statements)

References 57 publications

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“…First, the change in thrombus size was assessed by repeating venography at the end of the course of treatment [33][34][35][36][37]: LMWH were as effective as SH. Second, most studies used the occurrence of the symptomatic recurrent DVT as end-point; there was a strong trend for LMWH to be more effective and safer than SH [38][39][40][41]. Two meta-analyses of these trials found similar trends indicating improved efficacy and safety with LMWH [42,43], It is uncertain if the favorable outcomes of treatment with different LMWH can be extrapolated to ail other types of LMWH [24,42,44], Also it is not certain whether there is bioequivalence between all products.…”

Section: Low Molecular Weight Heparins (Lmwh)mentioning

confidence: 99%

“…As a consequence similar studies with different types of LMWH should be performed. Fi nally it should be noted that only a few studies used a once-daily regimen of LMWH [39,41,45], the other studies twice daily. Currently LMWH once versus twice daily are being compared.…”

Section: Low Molecular Weight Heparins (Lmwh)mentioning

confidence: 99%

“…The risk of bleeding is increased with an increased heparin dose, but also other factors such as recent surgery, trauma, peptic ulcer, malignancy or an haemostatic abnormality are important. Most tri als comparing SH to LMWH suggest that LMWH 40 Medicine 50(19971 36-45 cause fewer bleeding complications [20,[39][40][41], This embolism despite anticoagulation [8,62,63]. No data is probably due to a lower anti-IIa/anti-Xa ratio of LMWH than of SH.…”

Section: Side-effectsmentioning

confidence: 99%

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New developments in the treatment of deep venous thrombosis

Janssen¹,

Nováková²,

Verbruggen³

et al. 1997

The Netherlands Journal of Medicine

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An initial course of standard heparin (SH) or low-molecular-weight heparins (LMWH) is regarded as the treatment of choice for patients with deep venous thrombosis (DVT). LMWH have better bioavailability after subcutaneous administra tion, have a longer half-life, and show higher and more predictable anticoagulant activity. As a result they can be given subcutaneously and without laboratory control, using a dose that is determined by body weight. Because of these multiple advantages of LMWH they will replace SH in the future and subsequently home treatment with LMWH of selected patients seems feasible. The currently accepted approach is to start with SH or LMWH therapy combined with oral anticoagulant therapy (OAT) at the time of diagnosis. The course of SH or LMWH should continue for at least 5 days, provided that international normalized ratio (INR) is in the therapeutic range on 2 consecutive days. OAT should be continued for at least 3 months to prolong the prothrombin time to an INR of 2 -3 . When oral anticoagulants are either contraindicated or inconvenient, SH or LMWH can be used at the middosing interval. The role of anti-platelet treatment is not yet established 4 and should be compared with coumarin therapy in the future.

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Section: Low Molecular Weight Heparins (Lmwh)mentioning

confidence: 99%

Section: Low Molecular Weight Heparins (Lmwh)mentioning

confidence: 99%

Section: Side-effectsmentioning

confidence: 99%

See 1 more Smart Citation

New developments in the treatment of deep venous thrombosis

Janssen¹,

Nováková²,

Verbruggen³

et al. 1997

The Netherlands Journal of Medicine

View full text Add to dashboard Cite

show abstract

“…5 Several studies have shown that LMWHs are at least as effective as intravenous (IV) UFH in the in-hospital treatment of DVT. [6][7][8] Furthermore, the ability to administer LMWHs subcutaneously makes it feasible to treat patients in their home, rather than in the hospital. Although treatment in an outpatient setting offers the benefits of convenience for the patient and the potential to reduce hospital costs, 9-13 many physicians may be reluctant to use this approach, possibly because of a belief that the controlled conditions of clinical trials are not representative of the real-world clinical situation.…”

mentioning

confidence: 99%

A Pilot Study of Home Treatment of Deep Vein Thrombosis With Subcutaneous Once-Daily Enoxaparin Plus Warfarin

Bishop¹,

Wilson²,

Post³

et al. 2006

JMCP

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“…Previous work has demonstrated the efficacy and safety of low molecular weight heparin (LMWH) for deep venous thrombosis prophylaxis and treatment. 15,16 A small prospective study comparing LMWH to placebo revealed a shorter duration of VOD-related symptoms after BMT in the LMWH treated patients. 17 In our retrospective study, we analyzed three VOD prophylactic regimens in 462 patients undergoing allogeneic or autologous BMT.…”

mentioning

confidence: 99%

Retrospective multivariate analysis of hepatic veno-occlusive disease after blood or marrow transplantation: possible beneficial use of low molecular weight heparin

Simon

Hahn

et al. 2001

Bone Marrow Transplant

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Summary:This retrospective cohort study of 462 consecutive adult allogeneic and autologous blood or marrow transplantation (BMT) patients compared the incidence of hepatic veno-occlusive disease (VOD) after BMT with three prophylactic regimens. Patients receiving heparin (Hep), heparin + prostaglandin E1 (Hep + PGE1) or low molecular weight heparin (LMWH) as a prophylactic VOD regimen were compared to a historical cohort receiving no VOD prophylaxis. Of 462 BMT patients, VOD was diagnosed in 22% (31 of 142) of the no prophylaxis group, 11% (11 of 104) of the Hep, 12% (13 of 110) in the Hep + PGE1 and 4% (four of 106) of the LMWH group (P = 0.0002). VOD was the primary cause of death in 20% (12 of 59). By multivariate logistic regression, independent risk factors for developing VOD were: no VOD prophylactic regimen, unrelated allogeneic BMT, Karnofsky performance score (KPS) Ͻ80 and aspartate aminotransferase (AST) у50 U/l. There was no increase in the rate of death due to hemorrhagic events or VOD in any prophylaxis group compared to the control group. Prospective randomized trials of Hep vs LMWH vs placebo are warranted to assess the efficacy of heparin compounds in the prevention of VOD. Bone Marrow Transplantation (2001) 27, 627-633. Keywords: veno-occlusive disease; prophylaxis; heparin; blood and marrow transplantation Veno-occlusive disease (VOD) of the liver is a clinical syndrome, characterized by hyperbilirubinemia, painful hepatomegaly and fluid retention. 1 It occurs in up to 54% of patients and is a leading cause of blood or marrow transplantation (BMT)-related death with a mortality rate up to 3 The etiology of VOD is not clearly defined, however, drug-induced hepatocellular damage occurs in the centrilobular zones of the liver. The coagulation cascade may have a role in VOD pathophysiology due to clotting factor activation leading to fibrin deposition in the central veins. It has been postulated that anticoagulant therapy could prevent fibrin deposition and subsequent hepatic damage. 5,6 Several clinical trials of prophylactic heparin (Hep) during BMT have shown contradictory results. [7][8][9][10][11][12] Nevertheless, these studies demonstrated that low doses of Hep could be safely administered to BMT patients. Prostaglandin E1 (PGE1) was used as a VOD prophylactic regimen by Gluckman et al, 13 who found a decreased incidence of VOD in patients treated with PGE1, whereas Bearman et al, 14 concluded that PGE1 was too toxic. Previous work has demonstrated the efficacy and safety of low molecular weight heparin (LMWH) for deep venous thrombosis prophylaxis and treatment. 15,16 A small prospective study comparing LMWH to placebo revealed a shorter duration of VOD-related symptoms after BMT in the LMWH treated patients. 17 In our retrospective study, we analyzed three VOD prophylactic regimens in 462 patients undergoing allogeneic or autologous BMT. The VOD preventive effects of Hep, Hep + PGE1 and LMWH were compared to each other and to a historical control group. This is the first retrospective mul...

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Subcutaneous Low-Molecular-Weight Heparin Compared with Continuous Intravenous Heparin in the Treatment of Proximal-Vein Thrombosis

Cited by 670 publications

References 57 publications

New developments in the treatment of deep venous thrombosis

New developments in the treatment of deep venous thrombosis

A Pilot Study of Home Treatment of Deep Vein Thrombosis With Subcutaneous Once-Daily Enoxaparin Plus Warfarin

Retrospective multivariate analysis of hepatic veno-occlusive disease after blood or marrow transplantation: possible beneficial use of low molecular weight heparin

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