Anticoagulant effects of two types of low molecular weight heparin administered subcutaneously

Bergqvist, David; Hedner, Ulla; Sjörin, Elsy; Holmer, E.

doi:10.1016/0049-3848(83)90091-9

Cited by 156 publications

(83 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Dalteparin was given after the transoesophageal echocardiography and before cardioversion and was continued until a therapeutic prothrombin level had been reached. The advantage of low molecular weight heparin is the long duration of inhibition of factor Xa; a single dose has a protective effect of 24 h [54] . The inhibition of factor Xa occurs 4 h after a subcutaneous injection at which time the patient is adequately anticoagulated.…”

Section: Thrombus Prophylaxismentioning

confidence: 99%

Transoesophageal echocardiography-guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk group for immediate cardioversion

Roijer

Eskilsson

Olsson

2000

European Heart Journal

View full text Add to dashboard Cite

Aims Despite exclusion of left atrial thrombi by transoesophageal echocardiography, cardioversion-related thromboembolism has been reported in atrial fibrillation or flutter. To define a low-risk group for cardioversion without previous anticoagulation, patients were selected for immediate cardioversion if there were no thrombi, no echo spontaneous contrast and the outflow velocity of the left atrial appendage was greater than 0·25 m . s 1 on transoesophageal echocardiography. Methods and ResultsTwo hundred and forty-two consecutive patients referred for cardioversion of atrial fibrillation or flutter with a duration of more than 2 days and no anticoagulation therapy were examined with transoesophageal echocardiography. After the transoesophageal echocardiography examination, patients who were eligible for immediate cardioversion were anticoagulated with low molecular weight heparin (dalteparin) subcutaneously, together with warfarin prior to cardioversion. Dalteparin treatment was continued until the patient had reached therapeutic prothrombin values.Based on the transoesophageal echocardiographic findings the patients were divided into two groups: immediate cardioversion, group A, with a mean age of 62 13 years (n=162); or conventional warfarin treatment before cardioversion, group B, with a mean age of 67 10 years (P<0·05) (n=80). In group A, lone atrial fibrillation or flutter was more common (53%; 95% CI: 45-61) compared to group B (34%; 95% CI: 23-44, P<0·05), while heart disease was more common in group B (45%; 95% CI: 34-56) compared to group A (31%; 95% CI: 24-39, P<0·05). Echocardiography revealed thrombi in 5% (95% CI: 2·6-8) of the patients, left atrial size was larger, fractional shortening lower, and a higher proportion had impaired left ventricular function in group B. No thromboembolic event occurred at or after cardioversion in any of the patients; however, before planned cardioversion one transitory ischaemic attack, one lethal stroke and one cardiac death occurred in three of the patients with thrombi despite warfarin therapy. One-month follow-up maintenance of sinus rhythm was 75% in group A compared to 45% in group B (P<0·01).Conclusion After using our transoesophageal echocardiographic exclusion criteria (no thrombi, no spontaneous echo contrast and left atrial appendage outflow velocity d0·25 m . s 1 ) cardioversion can safely be performed in 2/3 of patients with atrial fibrillation or flutter without previous anticoagulation therapy. These patients maintained sinus rhythm significantly better after 1 month compared to patients with prolonged warfarin therapy before cardioversion.

show abstract

Section: Thrombus Prophylaxismentioning

confidence: 99%

Transoesophageal echocardiography-guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk group for immediate cardioversion

Roijer

Eskilsson

Olsson

2000

European Heart Journal

View full text Add to dashboard Cite

show abstract

“…Bergqvist et al [19] compared the effects of subcutaneous injections of Fragmin and conventional heparin (see also Aiach et al [20]). The plasma levels of antifactor Xa ac tivity recorded after the administration of Fragmin were about 5 times higher than those obtained with conventional heparin (fig.…”

Section: Pharmacokineticsmentioning

confidence: 99%

Heparin and Its Low Molecular Weight Derivatives: Anticoagulant and Antithrombotic Properties

Holmer

Söderberg

Bergqvist

et al. 1986

Pathophysiol Haemos Thromb

Self Cite

View full text Add to dashboard Cite

The anticoagulant and antithrombotic effect of heparin has been known for many decades. Nevertheless, the knowledge of structure-activity relationships and its mechanisms of action has been rather limited. However, in recent years important progress has been made and our understanding of how heparin works has increased significantly. Based on this information, attempts have been made to modify heparin to get improved pharmacological properties. The present communication summarizes the recent development. It is shown that certain heparin derivatives of low molecular weight are highly interesting compounds from a clinical point of view. Biochemical and pharmacological properties of such a preparation named Fragmin are presented.

show abstract

“…Low-molecular-weight heparins (LMWH) are increasingly used for the prophylaxis of postoperative deep venous thromboses in surgery [1][2][3][4][5]. The mechanism by which un fractionated heparin (UFH) or LMWH pre vent venous thromboses is not yet clear.…”

Section: Introductionmentioning

confidence: 99%

Effect of Low-Molecular-Weight Heparins on Laser-Induced Thrombus Formation in Rat Mesenteric Vessels

Weichert

Breddin²

1988

Pathophysiol Haemos Thromb

View full text Add to dashboard Cite

Laser-induced thrombi have been frequently produced in rat mesenteric vessels to investigate the effect of antithrombotic drugs. We have tested low molecular heparins in comparison to unfractionated heparin. The investigations were carried out on male Wistar rats weighing 200–300 g; the animals were anesthetized with pentobarbital sodium (Nembu-tal®) 60 mg/kg i.p. Vascular lesions were induced with a Coherent CR-2 supergraphite ion laser (argon laser) mounted on a Leitz Orthoplan microscope. An intestinal loop was spread on a self-constructed object stage, mounted on the microscope table. The laser beam was directed through the optical path of the microscope on small mesenteric vessels in the fat-free portion of the mesentery. For the evaluation of thrombus formation the number of laser injuries needed to induce a defined thrombus was used. All low-molecular-weight heparins (preparation B, Braun; BR-Z-0601, Braun; CY 216, Choay; Fragmin, Kabi; low molecular heparin, Sandoz and Org 10172, Organon) or unfractionated heparin (Liquemin®; Hoffmann-La Roche) showed a significant and dose-dependent antithrombotic effect after subcutaneous injection, if venules had been damaged. The effect lasted for 48 h, partly for over 48 h. If thrombus formation was studied after intravenous injection into arterioles as well as into venules 8 h after injection, no antithrombotic effect could be demonstrated under the influence of CY 216 or unfractionated heparin.

show abstract

Anticoagulant effects of two types of low molecular weight heparin administered subcutaneously

Cited by 156 publications

References 21 publications

Transoesophageal echocardiography-guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk group for immediate cardioversion

Transoesophageal echocardiography-guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk group for immediate cardioversion

Heparin and Its Low Molecular Weight Derivatives: Anticoagulant and Antithrombotic Properties

Effect of Low-Molecular-Weight Heparins on Laser-Induced Thrombus Formation in Rat Mesenteric Vessels

Contact Info

Product

Resources

About