PMID- 15210403
OWN - NLM
STAT- MEDLINE
DCOM- 20040729
LR  - 20061115
IS  - 0949-2321 (Print)
IS  - 0949-2321 (Linking)
VI  - 9
IP  - 4
DP  - 2004 Apr 30
TI  - Low-molecular-weight heparin (LMWH) in the treatment of thrombosis.
PG  - 225-39
AB  - Thromboembolic complications are a common and costly medical problem, associated 
      with significant morbidity and mortality, especially in postoperative patients. 
      There have been reports of death due to thromboembolic complications even after 
      short procedures, e.g. arthroscopy. Low-molecular-weight heparins (LMWHs) (e.g., 
      certoparin, dalteparin, enoxaparin, nadroparin, reviparin, tinzaparin) have been 
      tested for treatment of deep vein thrombosis in comparison to unfractionated 
      heparin (UFH) in many patients being effective and safe alternative for treatment 
      of deep vein thrombosis (DVT) and venous thromboembolism (VTE). Fixed-dose 
      subcutaneous LMWH once daily is in most cases of equivalent efficacy and safety 
      compared to conventional UFH therapy. There may be less risk for bleeding, less 
      platelet activation together with a control of markers of haemostatic system 
      activation, and either no progression or regression of thrombus size in patients 
      treated with LMWH. The handling of LMWH is more comfortable for patients and less 
      time consuming for nurses and laboratories compared to UFH. The 
      cost-effectiveness analysis showed that LMWH are more cost effective than UFH. It 
      has been calculated that outpatient treatment with LMWH may save 1641 dollars per 
      patient in comparison to hospital treatment. This economic benefit of outpatient 
      treatment of DVT seems to be realized in different health systems. Women with 
      antiphospholipid antibodies and a history of either prior thrombotic events or 
      pregnancy loss are at high risk during pregnancy for either another fetal death 
      or thrombosis and may benefit from treatment with LMWH. In patients with 
      malignant tumors secondary prophylaxis or long-term treatment with LMWH is 
      successful. Patients with a contraindication for oral anticoagulants may benefit 
      from treatment with LMWH as do patients on chronic anticoagulation treatment 
      scheduled for an operative intervention. In most instances LMWH (dalteparin, 
      enoxaparin, nadroparin) treatment for DVT may be given once daily at a fixed dose 
      without any harm, based on a prolonged antithrombin activity. Effectiveness and 
      safety of LMWH (dalteparin, enoxaparin, nadroparin, tinzaparin) in comparison to 
      UFH treatment on outpatient basis has been demonstrated in several studies. In 
      summary, LMWHs have an established role in the treatment of DVT and pulmonary 
      embolism (PE), on an in- and outpatient basis and could realize substantial 
      savings. Most studies were performed with dalteparin, enoxaparin and nadroparin. 
      There is evidence that LMWHs may help to prolong survival in cancer patients and 
      to avoid complications of the acute coronary syndrome.
FAU - Holzheimer, Rene G
AU  - Holzheimer RG
AD  - University Halle-Wittenberg, Germany. Gresser.holzheimer@t-online.de
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Review
PL  - England
TA  - Eur J Med Res
JT  - European journal of medical research
JID - 9517857
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Animals
MH  - Anticoagulants/adverse effects/economics/*therapeutic use
MH  - Female
MH  - Heparin, Low-Molecular-Weight/adverse effects/economics/*therapeutic use
MH  - Humans
MH  - Pregnancy
MH  - Thrombosis/*drug therapy/economics
MH  - Treatment Outcome
RF  - 198
EDAT- 2004/06/24 05:00
MHDA- 2004/07/30 05:00
CRDT- 2004/06/24 05:00
PHST- 2004/06/24 05:00 [pubmed]
PHST- 2004/07/30 05:00 [medline]
PHST- 2004/06/24 05:00 [entrez]
PST - ppublish
SO  - Eur J Med Res. 2004 Apr 30;9(4):225-39.