Nonhemorrhagic Complications of Anticoagulant Therapy

Levine, Mark

doi:10.1055/s-2007-1003535

Cited by 27 publications

(4 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several trials have demonstrated that subcutaneous heparin, at doses of up to 10,000 IU b. d., may be an acceptable alternative to coumarin (11,12). However, the high doses required for continu ing prophylaxis have raised concerns about the risks of develop ment of osteoporosis and bone fracture (13)(14)(15)(16)(17)(18)(19)(20). The recent development of low-molecular weight heparins (LMWH) has stimulated our interest in the possible role of such drugs in patients for whom oral anticoagulant therapy is contraindicated.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Subcutaneous Unfractionated Heparin with a Low Molecular Weight Heparin (Fragmin®) in Patients with Venous Thromboembolism and Contraindications to Coumarin

et al. 1994

View full text Add to dashboard Cite

SummaryIntravenous heparin followed by oral anticoagulant therapy (e. g. with coumarin) is still the most widely used treatment for deep venous thromboembolism. Self-administered subcutaneous injections of heparin have been thought of as a promising alternative to coumarin, but the high doses required for ongoing prophylaxis have raised concerns about the possible development of bone disease. Certainly, long-term heparin therapy has been reported to cause osteoporosis in both laboratory animals and humans.This study aimed to compare the efficacy and safety of unfractionated (UF) heparin with that of a low molecular weight heparin (Fragmin®, Kabi Pharmacia) in the prevention of recurrent deep venous thrombosis (DVT) and pulmonary embolism (PE) in a consecutive series of patients with contraindications to coumarin therapy. The patients comprised 40 men and 40 women, aged between 19 and 92 years (mean age, 68 years). They had all previously been diagnosed as having acute DVT and had been treated with conventional doses of heparin while in hospital. All patients had at least one of the following conditions: recent blood loss (either spontaneous or during admission while receiving heparin therapy); active gastroduodenal ulcer disease; psychological or physical inability or unwillingness to understand and accept the need for regular laboratory monitoring during coumarin treatment; chronic alcoholism; dementia; pregnancy; recent neurosurgery, and pericardial effusion; or were over 80 years of age. They were randomly allocated to receive either UF heparin, 10,000 IU s.c. b.d., or Fragmin®, 5000 IU anti-Factor Xa s. c. b. d., for a period of 3-6 months.Two patients taking UF heparin were readmitted to hospital 2 and 3 months after discharge, owing to symptomatic, scintigraphically proven recurrent PE. No patients receiving Fragmin® had recurrent PE. There were 10 reports of minor bleeding: six in patients receiving UF heparin and four in patients on Fragmin®. Furthermore, there were seven cases of spinal fracture: six in patients on UF heparin, and one in a patient taking Fragmin®.We conclude that fixed doses of both UFH and Fragmin® appear to be quite effective and safe for use in patients with a high risk of bleeding. In our experience, however, UF heparin is associated with an unacceptably high incidence of spinal fracture.

show abstract

Section: Introductionmentioning

confidence: 99%

Comparison of Subcutaneous Unfractionated Heparin with a Low Molecular Weight Heparin (Fragmin®) in Patients with Venous Thromboembolism and Contraindications to Coumarin

et al. 1994

View full text Add to dashboard Cite

show abstract

“…This treatment reduces the risk of thromboembolic complications caused by the prosthesis: a weighted rnean of eight series comprising 552 valves showed 6.6% thromboembolic events per patient-year without anticoagulation, as compared with 2.1% (aortic valves) and 4.4% (mitral valves) or lower with anticoagulation (2). Pharmacologic anticoagulation does, however, in itself, entail a certain risk of complications (3)(4)(5)(6)(7)(8). The most important of these is bleeding, which is easily provoked by invasive procedures, and which occurs spontaneously as well.…”

mentioning

confidence: 99%

Views of cardiac‐valve prosthesis patients and their dentists on anticoagulation therapy

Lippert

Gutschik

1994

European J Oral Sciences

View full text Add to dashboard Cite

By administering a questionnaire to 253 patients with cardiac‐valve prostheses (89.3% responding), and another to 136 of their attending dentists (79% responding), the level of knowledge among both groups of anticoagulant therapy in connection with dental treatment was investigated. The cardiothoracic department monitored all anticoagulation therapies. Of the anticoagulated patients, 96.6% were able to state their medication (94.1% received phenprocoumon); and of 86 dentists with patients on anticoagulation treatment, 94% were aware of their patients' medication. All 20 dentists stating that their patients did not receive anticoagulants were correct. The great majority (98%) of the dentists employed a special measure to reduce the risk of bleeding associated with invasive dental procedures, most commonly (86%) referring patients to their general practitioner or hospital department for adjustment of the anticoagulant therapy. Around 60% of the dentists considered extractions and operations to require measures to reduce the risk of bleeding complications. We recommend referral of patients to the attending physician for adjustment of anticoagulation to a target International Normalized Ratio (INR) of 4.0 or possibly 3.0 before undergoing dental procedures involving the risk of bleeding. Additional reduction of the bleeding risk can be obtained by local application of an inhibitor of fibrinolysis (tranexamic acid).

show abstract

“…61 Aside from its well-known hemorrhagic risks, warfarin has been associated with fetal mal formations, especially when it is used during the first trimester of pregnancy [53]. On the other hand, heparin, which is safe for the fetus, can cause maternal thrombocytopenia and rarely, osteoporosis [54][55][56].…”

Section: Diagnosis Of Dvt In Pregnancymentioning

confidence: 99%

Diagnostic Problems with Venous Thromboembolic Disease in Pregnancy

Douketis

Ginsberg²

1995

Pathophysiol Haemos Thromb

View full text Add to dashboard Cite

In the pregnant patient with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE), accurate diagnosis is required to identify patients with DVT or PE who would benefit from appropriate anticoagulant therapy, and to exclude DVT and PE in the majority of patients so they are not exposed to the risks of anticoagulants. The diagnosis of DVT and PE during pregnancy is problematic. The use of invasive diagnostic tests, such as venography and pulmonary angiography, is limited because of the potential risks to the fetus of radiation exposure. Due to hemodynamic changes associated with pregnancy, noninvasive diagnostic tests such as impedance plethysmography and venous Doppler may be falsely abnormal. Diagnostic approaches for DVT and PE will be outlined that can accurately and safely confirm or exclude suspected DVT and PE during pregnancy.

show abstract

Nonhemorrhagic Complications of Anticoagulant Therapy

Cited by 27 publications

References 19 publications

Comparison of Subcutaneous Unfractionated Heparin with a Low Molecular Weight Heparin (Fragmin®) in Patients with Venous Thromboembolism and Contraindications to Coumarin

Comparison of Subcutaneous Unfractionated Heparin with a Low Molecular Weight Heparin (Fragmin®) in Patients with Venous Thromboembolism and Contraindications to Coumarin

Views of cardiac‐valve prosthesis patients and their dentists on anticoagulation therapy

Diagnostic Problems with Venous Thromboembolic Disease in Pregnancy

Contact Info

Product

Resources

About