PMID- 1662941
OWN - NLM
STAT- MEDLINE
DCOM- 19920218
LR  - 20220408
IS  - 0003-9683 (Print)
IS  - 0003-9683 (Linking)
VI  - 84
IP  - 11 Suppl
DP  - 1991 Nov
TI  - [Therapeutic indications of low molecular weight heparins].
PG  - 1733-43
AB  - The depolymerisation of the various chains of unfractionated heparin (UFH) by 
      chemical or enzymatic reactions provides so-called low molecular weight heparin 
      (LMWH), with an average molecular weight of approximately 5000 daltons. The 
      specific biological and pharmacokinetic properties of LMWH with greater 
      inhibition of factor Xa than of thrombin activity, less interaction with 
      platelets, better bioavailability and a longer half life of anti-Xa activity, 
      suggest possible new therapeutic applications. The hypothesis of reducing the 
      risk of haemorrhage related to the antithrombin activity and the incidence of 
      heparin-induced thrombocytopenia whilst preserving effective antithrombotic 
      action has stimulated clinical and biological research. Clinical trials of 
      prophylaxis of venous thrombo-embolism have been undertaken mainly in surgical 
      patients. The results have shown identical if not better efficacy of LMWH 
      compared to UFH in general surgical and above all orthopedic patients in whom 
      subcutaneous heparin is only effective with a strict protocol which is difficult 
      to adhere to in routine practice (adaptation of dosage to activated partial 
      thromboplastin time). The risk of bleeding was not significantly lower using LMWH 
      at the specified dosage, which in the latter indication, is twice that used in 
      general surgery. There are many indications of prophylaxis of thromboembolism in 
      the medical specialties but, paradoxically, LMWH has not been widely studied 
      because of the difficulties in performing the therapeutic trials. Except in rare 
      cases (extreme body weights, renal failure, haemorrhagic disease, thrombotic or 
      haemorrhagic complications) the evaluation of amidolytic anti-Xa activity does 
      not seem to be necessary. More recently, LMWH has been studied in a small number 
      of trials for the treatment of deep venous thrombosis (DVT). The therapeutic 
      efficacy is identical if not better than that of UFH without increasing the risk 
      of bleeding. Biological monitoring seems to be necessary in this indication for 
      evaluating amidolytic anti-Xa activity, which, though not a true marker of 
      antithrombotic activity is a relatively sensitive investigation. The therapeutic 
      values are 0.5 IU/ml to 1.0 IU/ml, 3 to 4 hours after subcutaneous injection. The 
      conclusions of all these trials are: LMWH is relatively simple to use and, 
      compared with UFH, has a more stable anticoagulant effect due to its 
      pharmacokinetic properties; the therapeutic efficacy is as good as, if not 
      better, than that of UFH; the risk of bleeding remains, therefore, the specified 
      dosages should be respected and treatment should be monitored by anti-Xa activity 
      when indicated; the decreased interaction with platelet function should not mask 
      the risk of thrombocytopoenia.(ABSTRACT TRUNCATED AT 400 WORDS)
FAU - Samama, M M
AU  - Samama MM
AD  - Laboratoire central d'hematologie, Hotel-Dieu, Paris.
FAU - Michaut-Paterno, F
AU  - Michaut-Paterno F
LA  - fre
PT  - Clinical Trial
PT  - English Abstract
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Review
TT  - Les indications therapeutiques des heparines de bas poids moleculaire.
PL  - France
TA  - Arch Mal Coeur Vaiss
JT  - Archives des maladies du coeur et des vaisseaux
JID - 0406011
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Clinical Protocols
MH  - Disseminated Intravascular Coagulation/drug therapy
MH  - Factor Xa Inhibitors
MH  - Heparin, Low-Molecular-Weight/pharmacokinetics/*therapeutic use
MH  - Humans
MH  - Platelet Count
MH  - Renal Dialysis
MH  - Surgical Procedures, Operative
MH  - Thrombosis/*drug therapy/prevention & control
RF  - 35
EDAT- 1991/11/01 00:00
MHDA- 1991/11/01 00:01
CRDT- 1991/11/01 00:00
PHST- 1991/11/01 00:00 [pubmed]
PHST- 1991/11/01 00:01 [medline]
PHST- 1991/11/01 00:00 [entrez]
PST - ppublish
SO  - Arch Mal Coeur Vaiss. 1991 Nov;84(11 Suppl):1733-43.