Clinical Studies with Low Molecular Weight Heparins in the Prevention and Treatment of Venous Thromboembolism

Samama, M; Boissel, Jean-Pièrre; Combe-Tamzali, S; Leizorovicz, Alain

doi:10.1111/j.1749-6632.1989.tb22520.x

Cited by 19 publications

(19 citation statements)

References 25 publications

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“…CY216 has a higher anti factor Xa/antithrombin ratio than the other LMW heparins currently licensed for routine clinical use in Europe. Unlike unfraction ated heparins, similar blood levels of LMW heparins are obtained in vivo, whether LMW heparins are given subcutaneously or intravenously [19]. The catalytic effects of LMW heparins also survive in the circula tion for a longer time than those of unfrac tionated heparins.…”

Section: Potential Pitfalls Associated With Current Laboratory' Testsmentioning

confidence: 73%

“…The catalytic effects of LMW heparins also survive in the circula tion for a longer time than those of unfrac tionated heparins. This greater bioavailabil ity and longer half-life of LMW heparins have clearly made them more convenient to use than unfractionated heparin to prevent thrombosis after surgery [19]. When used at the right dose, LMW heparins do not poten tiate postsurgical bleeding complications [19].…”

Section: Potential Pitfalls Associated With Current Laboratory' Testsmentioning

confidence: 99%

“…Several LM W heparins have subsequently been shown to be effective in reducing the incidence of postsurgical thrombosis [10][11][12][13][14][15][16]. Recent studies suggest that LMW heparins will be highly effective in reducing the growth of established thrombi [18,19]. The potential of CY216 and other LMW heparins in prevent ing the recurrence of idiopathic deep-vein thrombosis has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

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In vitro and ex vivo Activities of CY216: Comparison with Other Low Molecular Weight Heparins

Ofosu

1990

Pathophysiol Haemos Thromb

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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 thereof.

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Section: Potential Pitfalls Associated With Current Laboratory' Testsmentioning

confidence: 73%

Section: Potential Pitfalls Associated With Current Laboratory' Testsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

In vitro and ex vivo Activities of CY216: Comparison with Other Low Molecular Weight Heparins

Ofosu

1990

Pathophysiol Haemos Thromb

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“…Earlier studies have shown that neither the APTT nor the thrombin clotting time (TCT) method can be used for monitoring LMWH [1,6,14,15]. The Heptest clotting assay is much more sensitive to LMWH than is APTT.…”

Section: Discussionmentioning

confidence: 99%

“…Although the antithrom botic effect of various LMWH probably is not directly related to the anti Xa effect mea sured in the patient's plasma, this test princi ple is at present the most convenient [12]. Accordingly, LMWH therapy has mainly been monitored with factor-Xa-based chromogenic substrate (CS) assays [6,7,9,13,14], Preliminary data have suggested that the therapeutic range for some LMWH prepara tions is between 0.2 and 1.0 anti FXa U/ml [15].…”

Section: Introductionmentioning

confidence: 99%

Monitoring Therapy with LMW Heparin: A Comparison of Three Chromogenic Substrate Assays and the Heptest Clotting Assay

Abildgaard¹,

Norrheim²,

Larsen³

et al. 1990

Pathophysiol Haemos Thromb

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Three LMW heparins (LMWH), one unfractionated heparin (UH), and international standards of LMWH and UH were compared in three chromogenic substrate (CS) assays and the ‘Heptest’ clotting assay. With a two-stage CS assay, linear standard curves were obtained in the 0.1–1.0 U/ml range, nearly coinciding for all preparations. With the one-stage CS assays, standard curves were curvilinear and similar for UH and the LMWH groups. In the Heptest assay, standard curves were linear for UH but not for LMWH. Mean recovery of LMWH, added to patients’ plasma samples was 70–98% for the four assays. Variation between individual recoveries was much greater with Heptest (coefficient of variation (CV) 35–44%) than with one-stage CS assays (CV 14–21 %) or two-stage CS assays (CV 7–8 %). For monitoring LMW heparin therapy, CS assays seem preferable to Heptest. The two-stage CS assay had superior accuracy, but the one-stage CS assays were easier to perform.

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Postoperative Pulmonary Embolism After Hospital Discharge

Huber¹

1992

Arch Surg

272

113

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During a 10-year period (1980 through 1989), 28,953 patients were admitted to our Clinic of Digestive Surgery, Geneva, Switzerland. Two thirds of them were operated on, and one third were treated conservatively. Symptomatic pulmonary embolism (PE) was recorded in 90 patients (0.31%; 95% confidence interval, 0.25% to 0.38%) during their hospital stay. Within 30 days of hospital discharge, 29 patients were readmitted because of PE (incidence of delayed PE, 0.10%; 95% confidence interval, 0.07% to 0.14%; total incidence of PE, 0.41%; 95% confidence interval, 0.34% to 0.49%). In the operated-on group, the delayed embolic events occurred a median of 6 days (range, 2 to 25 days) after discharge and 18 days (range, 6 to 35 days) after surgery. Delayed PEs were more frequent after so-called low-risk surgery. Thus, the rate of postoperative PE increased by 30% when PEs occurring within 30 days of hospital discharge were considered, and this provides a useful basis for prolonged prophylactic measures after hospital stay.

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Clinical Studies with Low Molecular Weight Heparins in the Prevention and Treatment of Venous Thromboembolism

Cited by 19 publications

References 25 publications

In vitro and ex vivo Activities of CY216: Comparison with Other Low Molecular Weight Heparins

In vitro and ex vivo Activities of CY216: Comparison with Other Low Molecular Weight Heparins

Monitoring Therapy with LMW Heparin: A Comparison of Three Chromogenic Substrate Assays and the Heptest Clotting Assay

Postoperative Pulmonary Embolism After Hospital Discharge

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