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Topic: Low molecular weight heparin

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	LMWH
		Low Molecular Weight Heparins are shorter chains of unfractionated heparin.
		Low molecular weight heparin also may cause this, however it is suspected that the risk of this is much less than with unfractionated heparin.
		Even though low molecular weight heparin is administered at home by injection instead of in the hospital by vein, the effect on clotting elements is similar and the risk of bleeding persists.
	www.htcnevada.org /low_molecular_weight_heparin.htm (348 words)

	Low molecular weight heparins in medicine and anaesthesia
		LMWH is produced by either chemical or enzymatic depolymerization of SH and has a mean molecular weight of 4000–6500 Daltons and a chain length of 13–22 sugars.
		Low Molecular Weight Heparins (LMWH) are at least as effective as unfractionated heparin (UFH) in the prevention of deep venous thrombosis and subsequent embolism.
		LMWH are associated with an increasing incidence of spinal haematoma in patients undergoing neuraxial anaesthesia, particularly epidurals.
	www.4um.com /tutorial/currents/lmwh.htm (2719 words)

	Low molecular weight heparin - Wikipedia, the free encyclopedia
		In medicine, low molecular weight heparin (LMWH) is a class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis.
		LMWHs are defined as heparin salts having an average molecular weight of less than 8000 Da and for which at least 60% of all chains have a molecular weight less than 8000 Da.
		Alkaline beta-eliminative cleavage of the benzyl ester of heparin.
	en.wikipedia.org /wiki/Low_molecular_weight_heparin (743 words)

	Low Molecular Weight Protamine (LMWP)as Nontoxic Heparin/Low Molecular Weight Heparin Antidote (II): In Vitro ...
		It is known that thrombin binds heparin directly via an electrostatic interaction, as reflected by the dependency of this binding on the chain length of heparin.
		However, the anti-Xa activity of heparin is mediated by a strong and specific binding of antithrombin III (ATIII) to a pentasaccharide sequence in heparin.
		The weight (ie, μg) concentration was used to represent the ability of the agents (protamine and LMWP) in heparin neutralization, whereas the molar concentration (ie, μM) was used to represent the immunoactivity of the agents.
	www.aapspharmsci.org /view.asp?art=ps030318 (4511 words)

	When should low-molecular- weight heparin be monitored? - College of American Pathologists (Site not responding. Last check: 2007-11-04)
		LMWH is cleared primarily by renal excretion; with normal renal function, the elimination half-life is longer than that of unfractionated heparin and varies from two to six hours, depending on the route of administration.
		The greater sensitivity of the APTT to unfractionated heparin may be due to inhibition of the feedback activation of factors V and VIII by thrombin.
		Patients who are obese or have low body weight may require intermittent monitoring because of possible differences in their pharmacokinetics compared with patients closer to ideal body weight.
	www.cap.org /apps/docs/cap_today/case_study/coag3.html (1400 words)

	An Outpatient Program To Treat Deep Venous Thrombosis with Low-Molecular-Weight Heparin
		The primary care physician referring the patient to the outpatient heparin program verbally relays the clinical history to a nurse in the urgent care department so that the department is ready to care for the patient on arrival.
		To evaluate the impact of the outpatient heparin program, we compared the mean costs for all patients with DVT diagnosed in the 7-month intervals before and after the initiation of the outpatient program (Table 3).
		Two of the patients were treated with unfractionated heparin, and 1 was maintained on LMW heparin during a brief hospitalization.
	www.acponline.org /journals/ecp/sepoct99/pearson.htm (3664 words)

	Where Angels Fear to Tread: DVT & Low Molecular Weight Heparin [Jul 1995; 17-1] (Site not responding. Last check: 2007-11-04)
		One is a study of the use of low molecular weight heparins (LMWH) in the prevention of deep vein thrombosis (DVT) in total hip replacement [1], and the other investigates the effects of LMWH in treating such events [2].
		LMWH resulted in a reduction of total DVT from 149 of 685 patients (22%) to 117 of 735 patients (16%; odds ratio 0.72, 95%CI 0.53 - 0.95) and of proximal DVT from 86 of 685 patients (13%) to 40 of 735 patients (5%; 0.40, 0.28 - 0.59).
		Subcutaneous administration of LMWH was used in 14 studies, in 5 studies of standard heparin.
	www.jr2.ox.ac.uk /bandolier/band17/b17-1.html (1173 words)

	Low Molecular Weight Heparin - New Treatments, May 2, 2006
		Standard unfractionated heparin (UH) is a heterogeneous mixture of highly sulfated polysaccharide chains ranging in MW from 3000 to 30,000 daltons.
		Low molecular weight heparins are fragments of unfractionated heparin
		The pharmacokinetic differences between LMWH and UH is explained by the decreased binding of LMWH to plasma proteins, endothelial cells and macrophages, whereas UH binds to proteins.
	www.ccspublishing.com /journals2a/Low_Molecular_Weight_Heparin.HTM (612 words)

	ClotCare: Low Molecular Weight Heparin Preferred for Pulmonary Embolism?
		Despite the number of publications indicating efficacy of LMWH for treatment of PE, many consider the data inconclusive because the small numbers of patients in the study (over half with less than 100 patients) leads to a lack of statistical power.
		The results of this study are consistent with those seen in LMWH treatment of deep vein thrombosis, and present reasonable assurance that LMWHs are safe and effective in the treatment of non-massive pulmonary embolism.
		While none of the differences were statistically significant, the absolute rates of complications suggest that LMWH is at least as safe and effective as unfractionated heparin in the treatment of PE.
	www.clotcare.com /clotcare/lmwhforpe.aspx (771 words)

	Low Molecular Weight Heparin Primer- CareInternet.net
		Low molecular weight heparins are smaller pieces of the heparin molecule that inhibit clotting factor Xa more than factor IIa (thrombin).
		Once-daily subcutaneous dalteparin, a low molecular weight heparin, for the initial treatment of acute deep vein thrombosis.
		A multicentre comparison of once-daily subcutaneous dalteparin (low molecular weight heparin) and continuous intravenous heparin in the treatment of deep vein thrombosis.
	www.careinternet.com /caregiver/lmwh.php (699 words)

	Heparin and Low-Molecular-Weight Heparin: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy -- ...
		Low doses of heparin clear rapidly from plasma through a saturable (cellular) mechanism and the slower, nonsaturable, dose-independent mechanism of renal clearance.
		anticoagulant response to heparin and to the phenomenon of heparin
		LMWHs are derived from UFH by chemical or enzymatic depolymerization.
	www.chestjournal.org /cgi/content/full/126/3_suppl/188S (7081 words)

	Novel concatameric heparin-binding peptides reverse heparin and low-molecular-weight heparin anticoagulant activities ...
		Partial reversal of low molecular weight heparin (PK 10169) anti-Xa activity by protamine sulfate: in vitro and in vivo study during cardiac surgery with extracorporeal circulation.
		Low molecular weight protamine (LMWP) as nontoxic heparin/low molecular weight heparin antidote (II): in vitro evaluation of efficacy and toxicity.
		Low molecular weight protamine as nontoxic heparin/low molecular weight heparin antidote (III): preliminary in vivo evaluation of efficacy and toxicity using a canine model.
	www.bloodjournal.org /cgi/content/full/103/4/1356 (4651 words)

	Home treatment of DVT with low-molecular-weight heparin (Site not responding. Last check: 2007-11-04)
		In previous studies, subcutaneous administration of low-molecular-weight heparin has been shown to compare favorably to intravenous heparin for the in-hospital treatment of proximal deep-vein thrombosis of the legs.
		Because of the ease of subcutaneous administration, and particularly because LMW heparin is administered at a fixed, weight-based dosage, without adjustment based on blood tests, it should be well suited to treatment of DVT at home, either as initial therapy or after a shortened hospital stay.
		Low molecular weight heparins seem to be better drugs in some settings and are easier to use, but are more expensive than unfractionated heparin.
	www.journalclub.org /vol1/a17.html (1471 words)

	Does Low Molecular Weight Heparin Prolong Cancer Patient Survival?
		Regular heparin effectively prevents VT. The newer heparin fragments also prevent VT, are easier to administer, and may inhibit tumor growth.
		LMWHs, fragments about one third the size of heparin, have average molecular weights of 4,000 to 6,000 daltons.
		LMWH is probably best suited for long-term therapy by having an extended half-life to allow once daily dosing, no significant effect on platelet aggregation, fibrinolysis, or global clotting tests, and a reduced risk for causing hemorrhage.
	www.meds.com /conrad/ash/kakkar.html (862 words)

	Warfarin Versus Low-Molecular-Weight Heparin Therapy in Cancer Patients -- Zacharski et al. 10 (1): 72 -- The Oncologist
		Low molecular weight heparin versus warfarin in the prevention of recurrences after deep vein thrombosis.
		Low molecular weight heparin versus acenocoumarol in the secondary prophylaxis of deep vein thrombosis.
		Low molecular weight heparin (enoxaparin) versus oral anticoagulant therapy (acenocoumarol) in the long-term treatment of deep vein thrombosis in the elderly: a randomized trial.
	theoncologist.alphamedpress.org /cgi/content/full/10/1/72 (4461 words)

	Heparin and Low-Molecular-Weight Heparin Mechanisms of Action, Pharmacokinetics, Dosing, Monitoring, Efficacy, and ...
		Low doses of heparin clear rapidly from plasma through saturable (cellular) mechanism of clearance.
		Therapeutic doses of heparin are cleared by a combination of the rapid, saturable mechanism and the slower, nonsaturable dose-independent mechanism of renal clearance.
		heparin increases the affinity of thrombin for fibrin, and by occupying
	www.chestjournal.org /cgi/content/full/119/1_suppl/64S (4165 words)

	Prevention of symptomatic thrombosis with short term (low molecular weight) heparin in patients with rheumatoid ...
		Prevention of symptomatic thrombosis with short term (low molecular weight) heparin in patients with rheumatoid arthritis after hip or knee replacement -- van Heereveld et al.
		Prevention of symptomatic thrombosis with short term (low molecular weight) heparin in patients with rheumatoid arthritis after hip or knee replacement
		Low molecular weight versus standard heparin for prevention of venous thromboembolism after major abdominal surgey.
	ard.bmjjournals.com /cgi/content/full/60/10/974 (1946 words)

	Innohep (Tinzaparin) Low Molecular Weight Heparin, Now Available In US (Site not responding. Last check: 2007-11-04)
		Mortality with Innohep was 4.6 percent (10 patients) and with heparin 9.6 percent (21 patients).
		Importantly, clinical studies in the treatment of DVT with or without PE also demonstrated a low incidence of bleeding (0.8 percent of 519 patients treated with subcutaneous Innohep as compared to 2.7 percent of 524 patients treated with intravenous heparin).
		Innohep cannot be used interchangeably (unit for unit) with heparin or other low molecular weight heparins as they differ in manufacturing process, molecular weight distribution, anti-Xa and anti-IIa activities, units and dosage.
	www.pslgroup.com /dg/1E7A9E.htm (1085 words)

	Low Molecular Weight Heparin for DVT
		After eligibility for outpatient management or early discharge is established, a discussion with the patient of this possibility and a determination of the feasibility of treatment with LMWH should occur.
		Some experts prescribe a dose somewhere between the lean body weight and actual weight, monitor with measurements of anti Factor Xa activity, and instruct patients to administer the drug in the deltoid (rather than in the more fatty areas of the buttock or abdomen).
		However, because protein C has a short plasma half-life of 6 hours, heparin should initially be administered before Coumadin when clot is already present to avoid propagation due to an induced hypercoagulable state.
	www.brighamandwomens.org /hospitalist/dvt.asp (1250 words)

	Cost effectiveness of extended treatment with low molecular weight heparin (dalteparin) in unstable coronary artery ...
		Cost effectiveness of extended treatment with low molecular weight heparin (dalteparin) in unstable coronary artery disease: results from the FRISC II trial -- Janzon et al.
		Comparison of low-molecular-weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease.
		Low-molecular weight heparin reduces the generation and activity of thrombin in unstable coronary artery disease.
	heart.bmjjournals.com /cgi/content/full/89/3/287 (2994 words)

	Readmission after hysterectomy and prophylactic low molecular weight heparin: retrospective case-control study -- Cook ...
		Readmission after hysterectomy and prophylactic low molecular weight heparin: retrospective case-control study -- Cook et al.
		A prospective randomized trial of low molecular weight heparin-DHE and conventional heparin-DHE (with acenocoumarol) in patients undergoing gynaecological surgery.
		Levine MN, Hirsh J. An overview of clinical trials of low molecular weight heparin fractions.
	bmj.bmjjournals.com /cgi/content/full/332/7545/819 (891 words)

	Treatment of Acute Ischemic Stroke With the Low-Molecular-Weight Heparin Certoparin : Results of the TOPAS Trial -- ...
		Low molecular weight heparinoid, ORG 10172 (danaparoid), and outcome after acute ischemic stroke.
		Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety.
		Low-molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation: a double-blind randomised study.
	stroke.ahajournals.org /cgi/content/full/32/1/22 (4164 words)

	Clinical Trial: ABRIDGE: Low Molecular Weight Heparin in Bridging Patients After Mechanical Valve Replacement
		This is started in the hospital with intravenous unfractionated heparin; patients must remain in the hospital while on unfractionated heparin.
		This is a single center, non-randomized pilot study using twice a day enoxaparin injections in place of unfractionated heparin as a bridge to warfarin therapy.
		Contraindication or sensitivity to unfractionated heparin/ low molecular weight heparin: history of heparin associated thrombocytopenia, heparin induced thrombocytopenia, or heparin induced thrombotic thrombocytopenia syndrome;
	www.clinicaltrials.gov /ct/show/NCT00298285 (674 words)

	Unfractionated and Low Molecular Weight Heparin Affect Fibrin Structure and Angiogenesis in Vitro -- Collen et al. 60 ...
		Unfractionated and Low Molecular Weight Heparin Affect Fibrin Structure and Angiogenesis in Vitro -- Collen et al.
		Unfractionated and Low Molecular Weight Heparin Affect Fibrin Structure and Angiogenesis in Vitro
		was retarded with matrices polymerized in the presence of LMWH
	cancerres.aacrjournals.org /cgi/content/abstract/60/21/6196 (603 words)

	NEJM -- A Comparison of Low-Molecular-Weight Heparin with Unfractionated Heparin for Acute Pulmonary Embolism
		Hirsh, J., Raschke, R. Heparin and Low-Molecular-Weight Heparin: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
		Mousa, S. A., Bozarth, J., Barrett, J. Pharmacodynamic Properties of the Low Molecular Weight Heparin, Tinzaparin: Effect of Molecular Weight Distribution on Plasma Tissue Factor Pathway Inhibitor in Healthy Human Subjects.
		Effects of a Low-Molecular-Weight Heparin on Thrombus Regression and Recurrent Thromboembolism in Patients with Deep-Vein Thrombosis.
	content.nejm.org /cgi/content/abstract/337/10/663 (1988 words)

	Low-Molecular-Weight Heparin Compared with Intravenous Unfractionated Heparin for Treatment of Pulmonary Embolism: A ...
		Low-Molecular-Weight Heparin Compared with Intravenous Unfractionated Heparin for Treatment of Pulmonary Embolism: A Meta-Analysis of Randomized, Controlled Trials -- Quinlan et al.
		heparin is uncertain and unfractionated heparin remains widely
		heparin may be a safe and efficacious alternative to unfractionated
	www.annals.org /cgi/content/abstract/140/3/175 (853 words)

	LOVENOX®: Antithrombotic LMWH (low-molecular-weight heparin)
		is the only low-molecular-weight heparin in the United States approved by the Food and Drug Administration in 7 approved indications for the prophylaxis and treatment of thromboembolic disease.
		Certain procedures, called "epidural/spinal anesthesia" and "spinal puncture," may be used as a normal part of hospitalization.
		or other low-molecular-weight heparins are at risk of developing a blood clot in or around the spine.
	www.lovenox.com /consumer/aboutLovenox/main.aspx (432 words)

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