A Low-Molecular-Weight Heparinoid Compared with Unfractionated Heparin in the Prevention of Deep Vein Thrombosis in Patients with Acute Ischemic Stroke

Turpie, Alexander G. G.; Gent, Michael; Côté, Robert; Levine, Mark; Ginsberg, Jeffrey S.; Powers, P.; Leclerc, Jean‐Mathieu; Geerts, W.; Jay, RichardM; Neemeh, Jean

doi:10.7326/0003-4819-117-5-353

Cited by 111 publications

(38 citation statements)

References 16 publications

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“…Limited data are available for prophylaxis of thromboembolism with LMW heparin in bedridden medical inpatients [19][20][21][22], The present paper describes the results of a dou ble-blind prospective randomized study in al most 2,000 patients, comparing the efficacy and safety of one daily subcutaneous adminis tration of LMW heparin with low-dose hepa rin for prophylaxis of thromboembolism in hospitalized bedridden patients with an in creased risk of thromboembolism. Deep-vein thrombosis and pulmonary embolism were detected by repeated compression sonography in all patients and pulmonary scintigraphy in symptomatic patients, respectively, because the performance of invasive diagnostic meth ods in asymptomatic patients was ethically not acceptable.…”

Section: Introductionmentioning

confidence: 99%

Subcutaneous Low-Molecular-Weight Heparin versus Standard Heparin and the Prevention of Thromboembolism in Medical Inpatients

Harenberg¹,

Roebruck

Heene³

1996

Pathophysiol Haemos Thromb

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In a multicenter, double-blind clinical trial in 1,968 inpatients 1 daily subcutaneous administration of LMW heparin plus 2 placebo injections or 3 × 5,000 IU unfractionated (UF) heparin was given for 10 (8-11) days. The primary end point was the incidence of proximal deep-vein thrombosis or pulmonary embolism. Patients were assessed during the study period for development of proximal deep-vein thrombosis by compression sonography at days 1 and 10 and for pulmonary embolism by scintigraphy in symptomatic patients. Aim of the study was to demonstrate the equivalence of both treatment regimens. A total of 1,968 patients were randomized to receive UF or LMW heparin. Of these, 378 patients were excluded during the study period, so that 780 patients on UF and 810 on LMW heparin were included in the efficacy analysis. Four primary end points were observed with UF and 6 with LMW heparin, demonstrating the equivalence of treatments (p = 0.012). Additionally, pulmonary embolism was suspected as the cause of death in 6 patients who died during the study (3 per treatment group). A higher frequency of death (n = 32) was observed in the LMW-heparin group (p = 0.02) particularly documented in a part of the centers. Safety analysis showed a higher frequency of local pruritus, local erythema and subcutaneous hematoma, a higher increase in plasma levels of triglycerides, total cholesterol, alanine aminotransferase and aspartate aminotransferase, and a decrease of antithrombin III in patients receiving UF heparin. A decrease in platelet count (values ranging between 40,000 and 80,000/μl) was observed in 4 patients with UF and in none with LMW heparin. No severe thrombocytopenia was observed. Subcutaneous LMW heparin is as effective as UF heparin for prophylaxis of thromboembolism in bedridden, hospitalized medical patients.

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Section: Introductionmentioning

confidence: 99%

Subcutaneous Low-Molecular-Weight Heparin versus Standard Heparin and the Prevention of Thromboembolism in Medical Inpatients

Harenberg¹,

Roebruck

Heene³

1996

Pathophysiol Haemos Thromb

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“…253,254 Compared with placebo, LMWHs reduce the risk of venous thrombosis between 40% and 86% without an increase in clinically important bleeding. In studies comparing LMWHs with heparin, patients randomized to receive LMWH showed a statistically significant Ͼ70% relative risk reduction in thrombosis.…”

Section: Medical Patientsmentioning

confidence: 99%

Guide to Anticoagulant Therapy: Heparin

Hirsh¹,

Anand²,

Halperin³

et al. 2001

ATVB

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“…Studies have suggested that a low-molecular-weight heparinoid is superior and equally safe to placebo [16] and to UFH [17] for prevention of venographic thrombosis in patients with acute stroke. But only one [18] of several trials demonstrated superiority of LMWH over placebo for improving long-term outcome in acute stroke.…”

Section: Studies Of Vte In Acutely And/or Critically Ill Patientsmentioning

confidence: 99%

Risk Assessment and Prophylaxis of Venous Thromboembolism in Acutely and/or Critically Ill Patients

Davidson¹

2000

Pathophysiol Haemos Thromb

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Both undetected and clinically evident venous thrombosis and venous thromboembolism (VTE) can seriously impact the prognosis of acutely and/or critically ill patients. Pulmonary embolism (PE) is harder to diagnose in the acutely and/or critically ill, many of whom also have developed respiratory failure for other reasons. Deep vein thrombosis (DVT) of the upper and lower extremities can subsequently complicate insertion of central venous catheters, leading to PE, sepsis and septic shock. Recovery from the original critical illness (e.g. weaning from mechanical ventilation) can be adversely affected by these complications. There are recent data suggesting that, for prophylaxis, low-molecular-weight heparin (LMWH) is more effective than unfractionated heparin (UFH) in critically ill trauma patients, and that high-dose LMWH is more effective than placebo or low-dose LMWH in seriously ill medical patients. In both populations, LMWH appeared safe. While LMWH appears superior to UFH in acute stroke patients to prevent venographically-proven lower-extremity DVT, whether it provides a superior long-term outcome after acute stroke is uncertain. One study found that a high dosage of the LMWH dalteparin was more effective than placebo in preventing left ventricular thrombi after acute myocardial infarction, but there was a significant safety cost. Current questions surrounding prophylaxis of VTE and the use of LMWH in acutely and/or critically ill patients include whether monitoring levels and dosage adjustment in some of these patients would improve outcome, and whether the diagnosis of VTE can be improved so that treatment can be instituted when prophylaxis has failed.

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A Low-Molecular-Weight Heparinoid Compared with Unfractionated Heparin in the Prevention of Deep Vein Thrombosis in Patients with Acute Ischemic Stroke

Abstract: Low-molecular-weight heparinoid, given in a fixed dose of 750 anti-factor Xa units subcutaneously twice daily, is more effective than subcutaneous low-dose heparin for the prevention of deep vein thrombosis in patients with acute ischemic stroke.

Cited by 111 publications

References 16 publications

Subcutaneous Low-Molecular-Weight Heparin versus Standard Heparin and the Prevention of Thromboembolism in Medical Inpatients

Subcutaneous Low-Molecular-Weight Heparin versus Standard Heparin and the Prevention of Thromboembolism in Medical Inpatients

Guide to Anticoagulant Therapy: Heparin

Risk Assessment and Prophylaxis of Venous Thromboembolism in Acutely and/or Critically Ill Patients

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