Unfractionated heparin versus low molecular weight heparins for avoiding heparin-induced thrombocytopenia in postoperative patients

Abstract

This updated review demonstrated low-quality evidence of a lower incidence of HIT, and HIT complicated by venous thromboembolism, in postoperative patients undergoing thromboprophylaxis with LMWH compared with UFH. Similarily, the risk of HIT in people undergoing major surgical procedures was lower when treated with LMWH compared to UFH (low-quality evidence). The quality of the evidence was downgraded due to concerns about the risk of bias in the included studies and imprecision of the study results. These findings may support current clinical use of LMWH over UFH as front-line heparin therapy. However, our conclusions are limited and there was an unexpected paucity of RCTs including HIT as an outcome. To address the scarcity of clinically-relevant information on HIT, HIT must be included as a core harmful outcome in future RCTs of heparin.

Effects of Low Molecular Weight Heparin on Alveolar Bone Loss in Wistar Rats

“…The main function is blood clot formation, participation in the immune response and in the inflammatory response (21). Low molecular weight heparin is fractions of unfractionated heparin obtained by enzymatic depolarization with molecular weight of 1000 to 10,000 daltons (2). Studies have demonstrated the great advantages of using LMWH in the treatment of thromboembolism (3) and against deep venous thrombosis (22).…”

“…Low molecular weight heparins (LMWH) are the most widely used drugs worldwide for the prophylactic treatment of thromboembolic disorders (2). These are complex drugs that play the role of inhibiting the blood clotting cascade, acting on the inhibition of antithrombin (3).…”

Biosimilars of low molecular weight heparins: Relevant background information for your drug formulary

“…Pharmacodynamic tests for LMWHs are available to test the equivalence and some aspects of safety and efficacy. In HIT, anti‐PF4/heparin antibodies play a dominant role in unfractionated heparin and to a lesser extent in LMWHs . The incidence of HIT is low (<1%) in LMWHs and valuable comparative data on LMWH biosimilars are lacking in the registry files because of the low incidence of this serious complication.…”

“…HIT is a thrombotic disorder caused by immune complexes containing platelet factor 4 antibodies (PF4) and heparin or cellular glycoseaminoglycans. From clinical studies with UFH and LMWHs the incidence of clinical relevant HIT is respectively <1 and 5% . PF4‐heparin antibodies are detected in 2–8% of the LMWH treated patients .…”

“…From clinical studies with UFH and LMWHs the incidence of clinical relevant HIT is respectively <1 and 5%. 31 PF4-heparin antibodies are detected in 2-8% of the LMWH treated patients. 32 The reason for only some patients with antibodies acquiring HIT has not been clarified.…”