摘要:

Low molecular weight (LMW) heparins achieve their anticoagulant effects by inhibiting prothrombin activation, catalyzing endogenous thrombin inhibition, and binding thrombin. The extent to which each of the three actions of LMW heparins contributes to the antithrombotic effectiveness of LMW in man has not been defined. Several studies have reported that ex vivo anti-factor Xa activities of LMW heparins correlate with efficacy and potential haemorrhagic complications. However, critical review of the data suggests that anti-factor Xa assays are basically surrogate tests for the mass of LMW heparins in patients’ plasmas rather than reliable estimates of total catalytic concentrations of LMW heparins. Antithrombotic effectiveness of LMW heparins probably reflects their ability to inhibit coagulation in vivo. If the last concept proves correct, then results of tests which directly assess the extents to which LMW heparins have suppressed in vivo coagulation may provide more reliable markers for their antithrombotic effectiveness or lack thereo

ISSN:1424-8832    

DOI:10.1159/000216177

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Deep venous thrombosis is very frequent after general surgery, and its major complication, pulmonary embolism, is today the most frequent cause of postoperative death. The reduction of this cause of mortality is mainly based on its prevention rather than its therapy. This purpose was achieved by using physical and pharmacological means. During

ISSN:1424-8832    

DOI:10.1159/000216178

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Fifty patients presenting with acute deep-vein thrombosis were randomized in a prospective, controlled study to determine the safety and efficacy of a treatment with low-molecular-weight (LMW) heparin compared with unfractionated heparin. LMW heparin (n = 24) was administered twice daily subcutaneously at a dose of 2 × 150 anti-Xa units/kg body weight, and unfractionated heparin (n = 26) was given intravenously by continuous infusion at a dose of 450 anti-Xa units/kg body weight daily for 10 days. Doses were adjusted to maintain peak anti-Xa levels between 0.5 and 1.0 anti-Xa units per milliliter. One patient in the unfractionated heparin group and 2 patients in the LMW heparin group suffered from bleeding complications. Two patients on LMW heparin and on unfractionated heparin had high evidence of pulmonary embolism based on defects on ventilation-perfusion scintigraphy. Control phlebography and duplex sonography demonstrated a significant improvement during both treatment regimens. Reperfusion of the deep-vein system was 70% with LMW heparin and 75 % with unfractionated heparin. The anti-Xa levels were significantly higher in the LMW heparin group, and activated partial thromboplastin and thrombin clotting times were significantly higher in the group receiving unfractionated heparin. Thrombin-anti-thrombin III complexes and D-dimer concentration decreased during the treatment, but did not differ between the two regimens. At the end of the treatment period with LMW heparin, protein C and antithrombin III were significantly higher

ISSN:1424-8832    

DOI:10.1159/000216179

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Ninety consecutive outpatients with acute proximal and/or distal deep-vein thrombosis (DVT), as shown by phlebography, were entered into a prospective randomized trial comparing intravenous adjusted unfractionated heparin (UFH) with subcutaneous fixed doses of a low-molecular-weight heparin (CY216; 225 IC anti-Xa U/kg 12 hourly) for 10 days. The incidence of pulmonary embolism did not differ in the two groups (one episode per group). The comparison between pre- and posttreatment venograms and perfusion lung scans showed a statistically significant improvement (p < 0.01 and p < 0.05, respectively) only in the CY216-treated group. The incidence of major adverse reactions (major hemorrhages, relevant hemoglobin fall, and serious thrombocytopenia) was significantly higher (22 vs. 4.5%; p = 0.01) in the UFH-treated group. After a mean follow-up period of 2 years, the incidence of thromboembolic recurrences and that of post-thrombotic manifestations did not differ in the two groups. It is concluded that subcutaneous fixed doses of CY216 are more effective and safer than intravenous adjusted UFH in the treatment of acute DVT.

ISSN:1424-8832    

DOI:10.1159/000216180

出版商:S. Karger AG    

年代:1990

数据来源: Karger

ISSN:1424-8832    

DOI:10.1159/000216181

出版商:S. Karger AG    

年代:1990

数据来源: Karger

ISSN:1424-8832    

DOI:10.1159/000216182

出版商:S. Karger AG    

年代:1990

数据来源: Karger

ISSN:1424-8832    

DOI:10.1159/000216158

出版商:S. Karger AG    

年代:1990

数据来源: Karger