Comparison of low-molecular-weight-heparin and unfractionated heparin for acute PTE

Abstract

Abstract:Objective: Acute pulmonary thromboembolism (PTE) is a serious high mortality pulmonary vascular disease whose effective treatment decreases morbidity and mortality. To determine if low-molecular-weight-heparin (LMWH) is clinically as efficient and safe as unfractionated heparin (UH) in patients with diagnosis of acute non-massive PTE, our study compares the efficacy, adverse effects and costs of LMWH and UH. Methods: One hundred and fourteen patients with non-massive acute PTE were randomly divided into LMWH (nadroparin calcium) and UH groups. Oxygenation index, D-dimer, fibrinogen (FG), lung ventilation/perfusion (V/Q) scan and computed tomography pulmonary angiography (CTPA) were observed before anticoagulation and on day 14 after anticoagulation. Results: In both groups, the ABG (arterial blood gas) analysis showed PaO 2 and PaCO 2 were elevated, P(A-a)O 2 was decreased and oxygenation index (PaO 2 /FIO 2 ) was elevated, D-dimer and fibrinogen were decreased, lung V/Q and CTPA showed embolized segments reduced (P<0.05). Hemorrhage and thrombocytopenia occurred in 3.5% of the LMWH group. Hemorrhage occurred in 5.3% and thrombocytopenia occurred in 7.0% of the UH group. The average cost in the LMWH group was RMB 1218.60 Yuan and RMB 1541.40 Yuan in the UH group. Conclusion: LMWH and UH are equally effective for treatment of non-massive acute PTE, but LMWH may have a lower prevalence of complications and is less expensive.

Anticoagulation in the Surgical Management of Peripheral Arterial Embolic Disease

“…Our finding of a higher incidence of re-occlusive disease in those receiving UFH is consistent with findings of a study performed by Robinson et al In this study the dose of UFH was found to be subtherapeutic 30% of the time [23]. Unlike some previous studies we found that there was a higher incidence of haematoma and death in the LMWH group than the UFH group [24][25][26]. A recent Cochrane review showed a higher risk of major bleeding in medical patients treated for DVT with UFH than LMWH, in line with our study [9].…”

Thrombin Generation Biomarkers Decline With Parenteral Anticoagulation—An Overlooked Means of Anticoagulation Monitoring?

“…Duplicates from these 2 searches were identified and discarded, leaving 4059 unique articles. Screening and study selection as described above resulted in the identification of 20 articles 20–39 meeting the inclusion criteria (Figure 1). Two articles 29,32 reported data found in other included reports 31,34 and were not included in the final analysis.…”

Should Low-Molecular-Weight Heparin be Preferred Over Unfractionated Heparin After Thrombolysis for Severity Pulmonary Embolism?

“…12 Studies with LMWH have demonstrated that it has similar morbidity and mortality outcomes to UFH in treating DVT and nonmassive PE. 4,14,15 The LMWH and UFH are the most common anticoagulants recommended for treating confirmed nonmassive PE in ACCP guideline in 2012. 3 Many studies showed that LMWH is an effective drug for nonmassive PE; however, the role of LMWH in therapy for patients with massive PE is unclear.…”