PMID- 15334858
OWN - NLM
STAT- MEDLINE
DCOM- 20041104
LR  - 20190917
IS  - 0277-0008 (Print)
IS  - 0277-0008 (Linking)
VI  - 24
IP  - 8 Pt 2
DP  - 2004 Aug
TI  - Treatment of venous thromboembolism: challenging the unfractionated heparin 
      standard.
PG  - 127S-131S
AB  - Venous thromboembolism (VTE) is a major public health problem leading to high 
      morbidity and mortality in the United States. Since more then 50% of patients 
      with VTE may have asymptomatic disease, the start of appropriate therapy often is 
      delayed. Traditionally, intravenous unfractionated heparin (UFH) has been used to 
      manage the acute phase of VTE. Although an effective agent, numerous limitations 
      are associated with the use of UFH therapy, such as the need for careful 
      monitoring and frequent dosing adjustments. In addition, the assay used to 
      monitor UFH--the activated partial thromboplastin time (aPTT)--does not correlate 
      reliably with plasma heparin levels or antithrombotic activity. In the early 
      1990s, the low-molecular-weight heparins (LMWHs) emerged as alternative 
      anticoagulants to UFH and began to successfully challenge the UFH standard for 
      treatment of VTE. Clinical evidence has consistently demonstrated that LMWHs 
      given subcutaneously are at least as safe and as effective, if not better, than 
      intravenous UFH. This anticoagulant class has a much more predictable 
      dose-response relationship, requires little or no monitoring, and provides 
      cost-saving opportunities for outpatient management of VTE. The LMWHs are now 
      considered the treatment of choice for many patients with VTE and are largely 
      replacing UFH for this indication. In the last decade, additional agents, such as 
      direct thrombin inhibitors and factor Xa inhibitors, have emerged as potential 
      future alternatives for treatment of VTE. As clinical data regarding these new 
      agents for treatment of VTE continue to evolve, their role in clinical practice 
      will be elucidated.
FAU - Nutescu, Edith
AU  - Nutescu E
AD  - Department of Pharmacy Practice, College of Pharmacy, University of Illinois at 
      Chicago, Chicago, Illinois 60612, USA. enutescu@uic.edu
FAU - Singh-Khalsa, Manider
AU  - Singh-Khalsa M
CN  - Heparin Consensus Group
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Clinical Trials as Topic
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Heparin/adverse effects/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects
MH  - Humans
MH  - Injections, Intravenous
MH  - Venous Thrombosis/*drug therapy
RF  - 41
EDAT- 2004/09/01 05:00
MHDA- 2004/11/05 09:00
CRDT- 2004/09/01 05:00
PHST- 2004/09/01 05:00 [pubmed]
PHST- 2004/11/05 09:00 [medline]
PHST- 2004/09/01 05:00 [entrez]
AID - 10.1592/phco.24.12.127s.36112 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2004 Aug;24(8 Pt 2):127S-131S. doi: 
      10.1592/phco.24.12.127s.36112.