Post-surgical deep vein thrombosis prevention: Evaluation of the risk/ benefit ratio of fractionated and unfractionated heparin

Garcea, Domenico; Martuzzi, Federica; Santelmo, Nicola; Savoia, Marinella; Casertano, Maria Grazia; Furno, A.; Ruggeri, Valter

doi:10.1185/03007999209111524

Cited by 14 publications

(4 citation statements)

References 18 publications

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“…Because of the paucity of studies related to TURP, data across all major general, urological, and gynecological surgical procedures were pooled. Thirty-one studies reported the effect of LMWH vs UFH on risk of mortality, 305,307,308,[310][311][312]314,[317][318][319]321,322,[325][326][327][329][330][331][332][333][334][335][336][337][338][339]341,342,346,347,374 and 36 studies reported on development of symptomatic PEs. 295,[305][306][307][310][311][312][314][315][316][317][318][319]321,322,324,[326]…”

Section: Recommendation 22mentioning

confidence: 99%

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

et al. 2019

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Background:Venous thromboembolism (VTE) is a common source of perioperative morbidity and mortality.Objective:These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about preventing VTE in patients undergoing surgery.Methods:ASH formed a multidisciplinary guideline panel balanced to minimize bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic reviews. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.Results:The panel agreed on 30 recommendations, including for major surgery in general (n = 8), orthopedic surgery (n = 7), major general surgery (n = 3), major neurosurgical procedures (n = 2), urological surgery (n = 4), cardiac surgery and major vascular surgery (n = 2), major trauma (n = 2), and major gynecological surgery (n = 2).Conclusions:For patients undergoing major surgery in general, the panel made conditional recommendations for mechanical prophylaxis over no prophylaxis, for pneumatic compression prophylaxis over graduated compression stockings, and against inferior vena cava filters. In patients undergoing total hip or total knee arthroplasty, conditional recommendations included using either aspirin or anticoagulants, as well as for a direct oral anticoagulant over low-molecular-weight heparin (LMWH). For major general surgery, the panel suggested pharmacological prophylaxis over no prophylaxis, using LMWH or unfractionated heparin. For major neurosurgery, transurethral resection of the prostate, or radical prostatectomy, the panel suggested against pharmacological prophylaxis. For major trauma surgery or major gynecological surgery, the panel suggested pharmacological prophylaxis over no prophylaxis.

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Section: Recommendation 22mentioning

confidence: 99%

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

et al. 2019

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“…Subsequently, 16 studies 67–82 and 9 meta-analyses compared LMWH with LDUH. 83–91 Six studies compared different doses of LDUH or LMWH.…”

Section: Prophylactic Methods and Recommendationsmentioning

confidence: 99%

General, Vascular, Bariatric, and Plastic Surgical Patients

Nicolaides¹,

Fareed²,

Kakkar³

et al. 2013

Clin Appl Thromb Hemost

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“…In tutti questi studi [2,5,10,11] parnaparin, alle dosi di 3.200 o 6.400 UI/die, ha dimostrato una tendenza alla superiorità rispetto a ENF, somministrata alle dosi di 10.000 o 15.000 unità/die, senza tuttavia raggiungere una superiorità statisticamente significativa, in parte per la ridotta dimensione dei campioni esaminati (50-140 pazienti).…”

Section: Trombosi Venosa Profonda: Profilassi E Terapiaunclassified

Parnaparin: review of the literature

Pradelli

2008

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Sodium parnaparin is a low molecular weight heparin (LMWH). The introduction of this drug class has represented a medical advancement in the prevention and therapy of thromboembolic pathologies, as they maintain the same efficacy of unfractionated heparin, but with simplified dosing regimens and reduced side effects. Parnaparin has demonstrated its thromboprophylactic efficacy on both high-and moderate risk surgical patients, besides resulting effective in treating established deep vein thromboses and thrombosis-associated phlebopathies. Besides and independently from its antithrombotic activity, parnaparin possesses modulating effects on cells involved in inflammatory processes, which may explain its reported utility in phlebopathies other than DVT; among LMWHs available in Italy, parnaparin is the only approved for these indications. Alongside these clinical advantages, parnaparin and other LMWHs allow outpatient or home-based therapy of a large number of subjects that should otherwise be treated in hospital, with important savings of health resources and enhanced quality of life for the patients. In Italy, parnaparin drug acquisition cost is among the lowest in its class, permitting marginal savings in health costs at the same efficacy level. In summary, the use of parnaparin in thrombotic pathologies has very good efficacy and safety profiles, and has positive clinical and economical outcomes for patients, health system and society as a whole. Keywords: parnaparin, low molecular weight heparin (LMWH), health costs, ItalyParnaparin: review della letteratura Lorenzo Pradelli (1) Farmeconomia e percorsi terapeutici 2008; 9(1): 27-40 composta da piastrine e da fibrina, nella quale restano inglobate cellule ematiche.Il primo evento è generalmente rappresentato dall'adesione delle piastrine alla parete del vaso e dalla loro aggregazione; l'attivazione dei fattori plasmatici porta intanto alla produzione di una rete di fibrina che si estende progressivamente trattenendo emazie nel suo contesto. Nella costituzione del trombo debbono quindi essere considerate come fasi fondamentali l'adesione delle piastrine alla superficie del vaso, l'aggregazione delle piastrine fra di loro, l'attivazione della coagulazione del sangue, che ha come fenomeno finale la formazione della fibrina. Le piastrine aderiscono all'endotelio danneggiato o al subendotelio esposto dalla lesione, modificano la loro forma, manifestano i recettori per i vari attivatori, preparano la loro superficie per il coinvolgimento dei fattori coagulativi.Per la concomitante attivazione dei fattori di contatto (meccanismo "intrinseco") si scatena il meccanismo coagulativo plasmatico, che si svolge attraverso le attivazioni progressive dei fattori XII, XI, IX (con la mediazione del fattore VIII) ed infine X. Più importante però è l'intervento del Fattore Tissutale, il quale, assieme al fattore VII (meccanismo "estrinse- INTRODUZIONEL'eparina è stata introdotta nella terapia e nella prevenzione delle patologie trombotiche da circa 70 anni, contribuendo a ...

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Post-surgical deep vein thrombosis prevention: Evaluation of the risk/ benefit ratio of fractionated and unfractionated heparin

Cited by 14 publications

References 18 publications

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

General, Vascular, Bariatric, and Plastic Surgical Patients

Parnaparin: review of the literature

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