PMID- 10549724
OWN - NLM
STAT- MEDLINE
DCOM- 19991208
LR  - 20071115
IS  - 0094-6176 (Print)
IS  - 0094-6176 (Linking)
VI  - 25 Suppl 3
DP  - 1999
TI  - Low molecular weight heparins in the prevention of venous thromboembolism in 
      nonsurgical patients.
PG  - 101-5
AB  - Hospitalized nonsurgical patients are at risk of developing venous thromboembolic 
      disease (VTED) but, in contrast to surgical patients, only a limited number of 
      prevention trials have been performed. Guidelines for optimal prophylaxis, 
      particularly with respect to low molecular weight heparins (LMWHs), are not 
      definitive. The Fifth American College of Chest Physicians' (ACCP) Consensus on 
      Antithrombotic Therapy makes limited recommendations on the use of LMWH in 
      patients. Recommendations are made for ischemic stroke and general medical 
      patients, but there are insufficient clinical trial data to produce firm 
      recommendations on the use of LMWHs in acute myocardial infarction, pregnancy, 
      and cancer patients. Patients with acute ischemic stroke are at high risk for 
      VTED. The ACCP Consensus recommends employing either low-dose UFH or LMWH. A 
      recent comparison between enoxaparin and UFH revealed an incidence of 
      thromboembolic events in 20% of patients randomized to enoxaparin, compared with 
      35% in the UFH-treated group. Although the ACCP Consensus states that both 
      low-dose unfractionated heparin (UFH) and LMWH provide effective prophylaxis in 
      general medical patients, particularly those with congestive heart failure and/or 
      pulmonary infections, no specific LMWH or dose is specified. The recently 
      completed Thromboembolism Prevention in Cardiopulmonary Diseases with Enoxaparin 
      (PRINCE) trial compared once-daily enoxaparin with three times daily UFH. 
      Enoxaparin was at least as effective as UFH in reducing the risk of 
      thromboembolic events by 19%. In high-risk pre-defined subgroups with heart 
      failure, enoxaparin was significantly more effective. It is not possible to 
      recommend a specific LMWH for prophylaxis in medical patients, but the recent 
      position adopted by the United States Food and Drug Administration and the World 
      Health Organization that LMWHs are noninterchangeable drugs suggests that 
      thromboprophylaxis guidelines should be strengthened to reflect the level of 
      evidence for each individual LMWH.
FAU - Haas, S
AU  - Haas S
AD  - Institut fur Experimentelle Onkologie und Therapieforschung, Technical University 
      of Munich, Germany.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Semin Thromb Hemost
JT  - Seminars in thrombosis and hemostasis
JID - 0431155
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Breast Neoplasms/complications
MH  - Clinical Trials as Topic
MH  - Drug Evaluation
MH  - Female
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Male
MH  - Myocardial Infarction/complications/drug therapy
MH  - Pregnancy
MH  - Pregnancy Complications, Cardiovascular/prevention & control
MH  - Stroke/complications/drug therapy
MH  - Thromboembolism/*prevention & control
MH  - Venous Thrombosis/*prevention & control
RF  - 23
EDAT- 1999/11/05 00:00
MHDA- 1999/11/05 00:01
CRDT- 1999/11/05 00:00
PHST- 1999/11/05 00:00 [pubmed]
PHST- 1999/11/05 00:01 [medline]
PHST- 1999/11/05 00:00 [entrez]
PST - ppublish
SO  - Semin Thromb Hemost. 1999;25 Suppl 3:101-5.