To review and analyze the current knowledge about the effectiveness and safety of use of LMWH for the treatment and prevention of acute coronary syndrome. They are obtained by various methods of depolymerization of UFH, resulting in fractions with a lower molecular weight (from 4000 to 6500 daltons).Īim. The low molecular weight fractions of heparin obtained during the polymerization process have new pharmacodynamic properties. LMWH is a product of enzymatic or chemical depolymerization of conventional heparin. Significant advantages over UFH are low molecular weight heparins or low molecular weight heparins (LMWH). However, despite its high efficiency, UFH has a number of disadvantages and side effects. For a long time, the main medication for treating and preventing of thrombotic complications was unfractionated heparin (UFH).
There was no difference in postdischarge bleeding rates between the groups.Įxtended prophylaxis likely prevents postdischarge venous thromboembolism after major abdominal surgery without an increased risk of bleeding. All postdischarge venous thromboembolism occurred in the Johns Hopkins group, and this difference was statistically significant (p = 0.0498). Seven patients developed in-hospital venous thromboembolism and seven developed venous thromboembolism postdischarge. Fourteen patients developed postoperative venous thromboembolism. We determined the proportion of patients in each cohort that developed venous thromboembolism within 30 days of surgery.įour hundred and eighty-nine patients underwent abdominal surgery for cancer and inflammatory bowel disease 181 (37.0%) patients from Brigham and Women’s Hospital and 308 (63.0%) patients from Johns Hopkins Hospital. Brigham and Women’s Hospital patients received four weeks supply of extended/outpatient venous thromboembolism prophylaxis, while Johns Hopkins Hospital patients did not. We retrospectively analyzed data from the Brigham and Women’s Hospital and the Johns Hopkins Hospital’s American College of Surgeons, National Surgical Quality Improvement Program registries from 1 August 2014 to 30 June 2015. This study aimed to evaluate the impact of postdischarge prophylaxis practices at two academic medical centers on the rate of postdischarge venous thromboembolism. Despite these guidelines, extended venous thromboembolism prophylaxis is not used uniformly at all institutions. This meta-analysis, based on the pooling of data available for several heparins, shows that heparins are beneficial in the prevention of venous thromboembolism in internal medicine.Ĭurrent guidelines recommend in-hospital venous thromboembolism prophylaxis for many patients and extended/outpatient prophylaxis in high-risk patients undergoing abdomino-pelvic surgery for cancer. However LMWH reduced by 52% the risk of major haemorrhage (p = 0.049). No significant effect was observed on either DVT, clinical PE or mortality. Nine trials comparing LMWH to UFH (4,669 patients) were also included. A significant decrease in DVT and in clinical PE were observed with heparins as compared to control (risk reductions = 56% and 58% respectively, p <0.001 in both cases), without significant difference in the incidence of major bleedings or deaths. Seven trials comparing a prophylactic heparin treatment to a control (15,095 patients) were selected. Deep-vein thrombosis (DVT) systematically detected at the end of the treatment period, clinical pulmonary embolism (PE), death and major bleeding were recorded.
We performed a meta-analysis of randomised trials studying prophylactic unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) in internal medicine, excluding acute myocardial infarction or ischaemic stroke. The prevention of venous thromboembolic disease is less studied in medical patients than in surgery.
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