Drugs

Baglin, Trevor

doi: 10.2165/00003495-199600527-00003pmid: 9042554

Venous thromboembolism is a potentially fatal complication of surgery. The use of graded pressure stockings in combination with unfractionated heparin (UFH) or a low molecular weight heparin (LMWH) appears to be the safest and most effective method of prevention. With some LMWHs, the risk of venous thromboembolism appears to be lower than that associated with the use of standard UFH.

Samama, M.; Bara, L.; Gouin-Thibault, I.

doi: 10.2165/00003495-199600527-00004pmid: 9042555

Studies on the pharmacological and pharmacodynamic properties of heparins are complicated by the heterogeneity of heparin preparations. It is important to consider the molecular weight distribution, which may differ from one preparation to another. Molecules with a molecular weight ranging from about 2000 to 5000D are abundant in low molecular weight heparins (LMWHs), while they are present at a very low concentration in standard heparin. The clinical relevance of this difference is not fully understood.

Bouthier, Jean

doi: 10.2165/00003495-199600527-00005pmid: 9042556

The risk of venous thromboembolism is not restricted to surgical situations: previous surgery is encountered in less than one-third of fatal pulmonary embolism cases, and less than 30% of patients hospitalised because of venous thromboembolic events are surgical patients.

Leizorovicz, A.

doi: 10.2165/00003495-199600527-00006pmid: 9042557

The aim of this study was to determine whether treatment with low molecular weight heparin (LMWH) reduces the incidence of recurrent thromboembolic events, death, haemorrhages, and extension of thrombus more than treatment with unfractionated heparin (UFH) in patients with established deep vein thrombosis (DVT).

McLeod, Robin

doi: 10.2165/00003495-199600527-00007pmid: 9042558

Patients undergoing colorectal surgical procedures are at a moderately high risk for the development of thromboembolic events. Possible reasons may be that the procedures tend to be long in duration, patients are often placed in the lithotomy position, a pelvic dissection may be performed, and the indication is often inflammatory bowel disease or cancer. While prophylaxis with low dose heparin is effective at reducing this risk, approximately 10% of patients may still develop a thromboembolic event. Results on the effectiveness of low molecular weight heparin in this cohort of patients are pending.

Borris, Lars; Lassen, Michael

doi: 10.2165/00003495-199600527-00008pmid: 9042559

The objective of this analysis was to evaluate the socioeconomic consequences of routine administration of low molecular weight heparin (LMWH) as thromboprophylaxis in patients undergoing total hip arthroplasty, on the basis of data from a number of clinical studies. Despite the higher direct costs associated with LMWH, this regimen was more cost effective per thromboembolic complication prevented than no prophylaxis, dextran 70, or low dose un-fractionated heparin. A sensitivity analysis was performed to address the outcome when the main factors in the economic analysis were changed; this had no significant effect on the conclusions of the study.

Planes, André; Vochelle, Nicole; Darmon, Jean-Yves; Fagola, Michel; Bellaud, Michel; Compan, Delphine; Saliba, Eric; Weisslinger, Nadine; Huet, Yann

doi: 10.2165/00003495-199600527-00009pmid: 9042560

Although venous thromboembolism has occasionally been reported after hospital discharge in patients who have undergone total hip replacement (THR), this risk has not been fully quantified and the usefulness of a prophylactic treatment has not been evaluated.

Bergqvist, David

doi: 10.2165/00003495-199600527-00010pmid: 9042561

This review deals with the problems of delayed thrombosis after hip arthroplasty and the possible need for prolonged prophylaxis. These problems have been considered key questions in the European Consensus Statement on venous thromboembolism. There are several factors, such as long immobilisation, venous trauma and decreased venous emptying, which all may contribute to the development of late postoperative thrombosis. There are data on frequencies of venous thromboembolism supporting the occurrence of such late complications. In 4 recent studies on prolonged prophylaxis, it was consistently shown that prophylaxis with low molecular weight heparins for 1 month significantly reduced the frequency of deep venous thrombosis compared with conventional prophylaxis during hospitalisation in patients undergoing elective hip arthroplasty.

&NA;;

doi: 10.2165/00003495-199600527-00011pmid: N/A

Lowe, G.

doi: 10.2165/00003495-199600527-00012pmid: N/A