PMID- 18574264
OWN - NLM
STAT- MEDLINE
DCOM- 20080826
LR  - 20220321
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 133
IP  - 6 Suppl
DP  - 2008 Jun
TI  - Parenteral anticoagulants: American College of Chest Physicians Evidence-Based 
      Clinical Practice Guidelines (8th Edition).
PG  - 141S-159S
LID - S0012-3692(08)60116-6 [pii]
LID - 10.1378/chest.08-0689 [doi]
AB  - This chapter describes the pharmacology of approved parenteral anticoagulants, 
      including the indirect anticoagulants, unfractionated heparin (UFH), 
      low-molecular-weight heparins (LMWHs), fondaparinux, and danaparoid as well as 
      the direct thrombin inhibitors hirudin, bivalirudin, and argatroban. UFH is a 
      heterogeneous mixture of glycosaminoglycans that bind to antithrombin via a 
      unique pentasaccharide sequence and catalyze the inactivation of thrombin factor 
      Xa and other clotting factors. Heparin also binds to cells and other plasma 
      proteins, endowing it with unpredictable pharmacokinetic and pharmacodynamic 
      properties, and can lead to nonhemorrhagic side effects, such as heparin-induced 
      thrombocytopenia (HIT) and osteoporosis. LMWHs have greater inhibitory activity 
      against factor Xa than thrombin and exhibit less binding to cells and proteins 
      than heparin. Consequently, LMWH preparations have more predictable 
      pharmacokinetic and pharmacodynamic properties, have a longer half-life than 
      heparin, and have a lower risk of nonhemorrhagic side effects. LMWHs can be 
      administered once or twice daily by subcutaneous injection, without anticoagulant 
      monitoring. Based on their greater convenience, LMWHs have replaced UFH for many 
      clinical indications. Fondaparinux, a synthetic pentasaccharide, catalyzes the 
      inhibition of factor Xa, but not thrombin, in an antithrombin-dependent fashion. 
      Fondaparinux binds only to antithrombin; therefore, HIT and osteoporosis are 
      unlikely to occur. Fondaparinux has excellent bioavailability when administered 
      subcutaneously, has a longer half-life than LMWHs, and is given once daily by 
      subcutaneous injection in fixed doses, without anticoagulant monitoring. Three 
      parenteral direct thrombin inhibitors and danaparoid are approved as alternatives 
      to heparin in HIT patients.
FAU - Hirsh, Jack
AU  - Hirsh J
AD  - From the Hamilton Civic Hospitals, Henderson Research Centre, Hamilton, ON, 
      Canada. Electronic address: jhirsh@thrombosis.hhscr.org.
FAU - Bauer, Kenneth A
AU  - Bauer KA
AD  - Beth Israel Deaconess Medical Center, Boston, MA.
FAU - Donati, Maria B
AU  - Donati MB
AD  - Centre for High Technology and Education in Biomedical Sciences, Catholic 
      University, C.da Tappino, Campobasso, Italy.
FAU - Gould, Michael
AU  - Gould M
AD  - VA Palo Alto Health Care System, Palo Alto, CA.
FAU - Samama, Meyer M
AU  - Samama MM
AD  - Hotel-Dieu University Hospital, Paris, France.
FAU - Weitz, Jeffrey I
AU  - Weitz JI
AD  - Henderson Research Centre and McMaster University, Hamilton, ON, Canada.
LA  - eng
PT  - Journal Article
PT  - Practice Guideline
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Pipecolic Acids)
RN  - 0 (Polysaccharides)
RN  - 0 (Recombinant Proteins)
RN  - 0 (Sulfonamides)
RN  - 24967-94-0 (Dermatan Sulfate)
RN  - 9005-49-6 (Heparin)
RN  - 9007-28-7 (Chondroitin Sulfates)
RN  - 9050-30-0 (Heparitin Sulfate)
RN  - 94ZLA3W45F (Arginine)
RN  - BI6GY4U9CW (danaparoid)
RN  - IY90U61Z3S (argatroban)
RN  - J177FOW5JL (Fondaparinux)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
EIN - Chest. 2008 Aug;134(2):473
CIN - Chest. 2008 Aug;134(2):474. PMID: 18756611
MH  - Anticoagulants/*administration & dosage/adverse effects/*pharmacokinetics
MH  - Arginine/analogs & derivatives
MH  - Biological Availability
MH  - Chondroitin Sulfates/administration & dosage
MH  - Dermatan Sulfate/administration & dosage
MH  - Fondaparinux
MH  - Heparin/*administration & dosage/adverse effects/pharmacokinetics
MH  - Heparin, Low-Molecular-Weight/*administration & dosage/adverse 
      effects/pharmacokinetics
MH  - Heparitin Sulfate/administration & dosage
MH  - Hirudins/administration & dosage
MH  - Humans
MH  - Infusions, Parenteral
MH  - Injections, Subcutaneous
MH  - Peptide Fragments/administration & dosage
MH  - Pipecolic Acids/administration & dosage
MH  - Polysaccharides/administration & dosage
MH  - Recombinant Proteins/administration & dosage
MH  - Sulfonamides
MH  - Thrombocytopenia/chemically induced
EDAT- 2008/07/24 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/07/24 09:00
PHST- 2008/07/24 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/07/24 09:00 [entrez]
AID - S0012-3692(08)60116-6 [pii]
AID - 10.1378/chest.08-0689 [doi]
PST - ppublish
SO  - Chest. 2008 Jun;133(6 Suppl):141S-159S. doi: 10.1378/chest.08-0689.