Therapeutic Use of Low Molecular Weight Heparins: Knowledge to Date and Their Application to Therapy

Abstract

Indeed, the accumulating evidence indicates that certain LMW heparins administered subcutaneously may replace classic intravenous heparin therapy. Certain of these subcutaneously administered LMW heparins do not require monitoring. The simplified care offered by LMW heparin therapy offers the possibility of transferring care from in to out of hospital in uncomplicated patients with deep vein thrombosis. The advantages to the patient of avoiding in-hospital care and its associated hazards are obvious. Outpatient LMW heparin therapy will likely prove to be highly cost effective. It is uncertain at present whether the findings associated with an individual LMW heparin preparation can be extrapolated to a different LMW heparins. For this reason, the findings of clinical trials apply only to the particular LMW heparin evaluated and cannot be generalized to the LMW heparins at large.

Heparin Therapy in Pediatric Patients

“…LMWH pharmacokinetics have been extensively compared with standard heparin in animal models 182,[189][190][191][192][193] and adults. 179,180,190,[210][211][212][213] In contrast to heparin, LMWH follows a linear nonsaturable clearance mechanism mediated by the kidneys. 12,15,16 The decreased binding of LMWH to endothelial cells likely explains the lack of a saturable clearance mechanism.…”

Outcome Analysis for Treatment in 100 Patients with Deep Vein Thrombosis

“…Recently, an increasing number of clinical studies have confirmed the efficacy, safety, convenience, and cost-effectiveness of fixed-dose subcutaneous low-molecular-weight heparin for posthospital anticoagulation and even long-term therapy (72,(75)(76)(77)(78)(95)(96)(97)(98). Although 39% of the deceased patients in our study had received heparin, in only one patient, with antithrombin deficiency, was death clearly related to a new thrombotic event.…”

Comparison of Unfractionated Versus Low Molecular Weight Heparin for Deep Vein Thrombosis Prophylaxis During Breast and Pelvic Cancer Surgery: Efficacy, Safety, and Follow-up

“…The high incidence of major and minor bleeding in UFH may have also resulted from our stringent criteria for bleeding events and our careful daily examination of all patients. Some studies suggest that the risk of death after discharge from hospital decreases with use of LMWH for treatment of established DVT (27)(28)(29)(30). Since LMWH might exert an antitumor effect by various mechanisms including inhibition of cell proliferation angiogenesis (30), and cell adhesion required for metastasis (31 ), our data are being analyzed for long-term cancer mortality as well as the development of late DVT.…”

“…Deep vein thrombosis was diagnosed in 10 (6.3%) of 160 patients taking low molecular weight heparin and 10 (6.1 %) of 164 patients treated with unfractionated heparin (relative risk: 1.03; 95% confidence interval 0.44-2.39; p = 1.0). Major bleeding events occurred in 27 (16.8%) patients in the low molecular weight heparin group and 47 (28.7%) in the unfractionated heparin group (relative risk: 0.59; 95% confidence interval: 0.39-0.89; p = .01). Severe intraoperative bleeding was observed in three patients in the unfractionated heparin group and in none of the patients in the low molecular weight heparin group.…”