Treatment of Symptomatic Venous Thromboembolism: Improving Outcomes

Abstract

Antithrombotic therapy with unfractionated heparin (UFH) and warfarin for the treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE) became widely accepted in the early 1960s. Subsequent clinical trials have focused on the importance of early intravenous UFH in the treatment of venous thromboembolic events, the method of heparin administration, the importance of rapid anticoagulation to prevent recurrent venous thromboembolism (VTE), and the optimal duration of UFH administration. Low-molecular-weight heparin (LMWH) represents a significant advance over UFH therapy for VTE. Developed in the late 1980s, LMWH has become an excellent alternative to UFH because it offers superior efficacy and safety, improved pharmacokinetics, longer half-life, and once- or twice-daily subcutaneous administration without the need for laboratory monitoring. Fondaparinux is the first of a new class of antithrombotic agents that targets factor Xa. Based on studies of the heparin binding site of antithrombin, this novel pentasaccharide has superior pharmacokinetics and bioavailability when compared with LMWH and can be administered once daily. Studies in patients undergoing major orthopedic surgery and in those with proximal DVT indicate that the efficacy and safety of fondaparinux may represent an improvement over those of LMWH.

Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents

“…Developed in the late 1980s, LMWH differs in its mechanism of action from unfractionated heparin by its inhibitory effect against factor Xa and thrombin. Since its development, LMWH has become an excellent alternative to unfractionated heparin because it offers superior efficacy and safety, has improved pharmacokinetics, and permits once-or twice-daily administration, without the need for laboratory monitoring (Büller, 2002). Unfortunately, LMWH therapy is not without risk.…”

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

“…Therapy with UH for PTE became widely accepted in the early 1960s while LMWH was used more often in the late 1980s (Buller, 2002). Clinically, LMWH and UH are the most common anticoagulants used for acute PTE nowadays (Valiukiene et al, 2003).…”

Emergency reversal of antithrombotic treatment

“…This means that idraparinux can be administered once weekly, which renders the subcutaneous route of administration less cumbersome. Pentasaccharides are effective in the prophylaxis and treatment of venous thromboembolism, and are currently being evaluated in other types of thrombosis [18]. The (very) long half-life of pentasaccharides necessitates the availability of a suitable antidote if major bleeding complicates the treatment, which may especially occur in patients who are treated with therapeutic doses of this type of anticoagulation.…”