Two studies have been done to establish recommendations for dosage and dose adjustment in the treatment of deep vein thrombosis (DVT) with low molecular weight heparin (LMWH). In the first, 56 patients were randomized in a double blind study to be treated either with unfractionated heparin (UFH) or LMWH s.c. every 12 h. Initial doses were given according to age and sex, disregarding bodyweight, and the dose was then adjusted when the peak plasma heparin concentration fell outside the desired range of 0.5-0.8 anti-FXa U/ml. There were fewer dose adjustments in the LMWH group. The correlation between injected dose (U/kg bodyweight) and the heparin concentration was higher in the LMWH group (r = 0.59) than in the UFH group (r = 0.38). The results suggest that, in order to obtain the desired heparin concentration, the initial dose of LMWH should be about 100 U/kg bodyweight every 12 h. In the second, open study, this dosage plan was followed in 15 patients. The peak heparin concentration on Day 2 ranged from 0.40 to 0.75 anti-FXa U/ml and adjustment was only required in 3 patients. Day to day variation in peak heparin activity in the individual patient varied little (CV 11-22%), and there was no accumulation. The results indicate that plasma heparin concentration is more predictable using LMWH than UFH, and they point to definite advantages in the use of LMWH in a bodyweight adjusted dosage.
In a double-blind study, patients with phlebographically proven deep venous thrombosis (DVT) were treated with subcutanous injections twice a day of either unfractionated heparin (UH; n = 27) or low molecular weight heparin (LH; n = 29) for 7 days, and the dose was adjusted until therapeutic range was reached, according to a chromogenic substrate anti-Xa assay. Forty-eight percent of the LH group did not need dose adjustment as compared to 24% of the UH group. During the course of heparin administration, deviation from initial heparin activity was frequent in both groups, but mean activity did not indicate a cumulative effect in either group. There was 1 incidence of pulmonary embolism (LH) and only 1 minor bleeding episode (UH). Half of the patients in both groups were phlebographically improved. We conclude that subcutaneous heparin treatment with UH or LH appears safe and convenient.
The prevalence of post-prostatectomy incontinence varied considerably according to the definition applied. In our opinion incontinence may be reported as any leakage and not only as pad use with grading done on a symptom scale. Preoperative sexual dysfunction and urinary incontinence were the strongest predictors of post-prostatectomy incontinence at 12-month followup.
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