Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A randomized, double-blind multicenter trial was performed to compare the safety and efficacy of a new low-molecular-weight heparin (LMWH) (LU 47311, Clivarine) and standard unfractionated heparin for the prophylaxis of postoperative venous thromboembolism. Altogether 1351 patients scheduled to undergo abdominal surgery were included. Main outcome measures included the incidence of thromboembolic events (deep vein thrombosis, pulmonary embolism, or both) and bleeding complications, including wound hematoma. A total of 655 patients received 1750 anti-Xa IU of LMWH plus a placebo injection daily; 677 patients received 5000 IU of unfractionated heparin (UFH) twice a day. Both drugs were found to be equally effective, as 4.7% of patients in the LMWH group and 4.3% in the UFH group developed postoperative thromboembolic complications. However, the incidence of bleeding complications was significantly reduced in the LMWH group: 55 (8.3%) patients in the LMWH group and 80 (11.8%) in the UFH group developed bleeding complications, a relative risk (RR) of 0.70 (95% CI 0.51-0.97;p = 0.03); wound hematoma occurred in 29 (4.4%) of the LMWH group compared with 55 (7.7%) in those in the UFH group for an RR of 0.57 (95% CI 0.37-0.88;p = 0.01). This study confirmed that a very low dose of 1750 anti-Xa IU daily of this new LMWH is as effective as 10,000 IU of UFH for preventing postoperative deep vein thrombosis. At this dose its administration is associated with a significant reduction in the risk of bleeding including wound hematoma.
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PMID:Efficacy and safety of a low-molecular-weight heparin and standard unfractionated heparin for prophylaxis of postoperative venous thromboembolism: European multicenter trial. 894 70

A prospective, randomised, controlled clinical trial was carried out in order to elucidate the incidence of venous thromboembolism in selected patients undergoing laparoscopic cholecystectomy and other types of minimally invasive surgery, as well as to show safety and efficacy of a low-molecular-weight heparin (LMWH) in the prevention of post-operative venous thromboembolism. Seven hundred and eighteen patients were randomly allocated to one of two groups: One group received physical measures for prevention of deep-vein thrombosis, i.e. graduated elastic stockings (n = 359). The second group also received graduated elastic stockings and, additionally, a LMWH (reviparin sodium, Clivarin) s.c. once daily (n = 359). For safety reasons, with respect to the untreated control group, patients with three or more risk factors for venous thromboembolism were not included into the trial. Diagnosis for DVT was systematically done by duplex scan. In this, rather artificial low-risk selection the overall incidence of thromboembolic events was surprisingly low: five cases of suspected pulmonary embolism, confirmed by scintigraphy in one case only, and one patient with phlebographically confirmed calf vein thrombosis. The use of reviparin for prevention of venous thromboembolism was safe and convenient--the rate of post-operative bleeding complications was 2.3% in the LMWH group, even lower than in the control group (3.2%). The real incidence of venous thromboembolism in patients undergoing laparoscopic cholecystectomy remains unclear. Further trials with unselected patients are needed.
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PMID:[Prevention of thromboembolism in minimal invasive interventions and brief inpatient treatment. Results of a multicenter, prospective, randomized, controlled study with a low molecular weight heparin]. 948 55

Five years ago, we concluded that in patients undergoing major orthopaedic surgery, prophylactic use of a low molecular weight heparin (LMWH) gave greater protection against deep vein thrombosis (DVT) than did conventional unfractionated heparin (UFH). The risk of bleeding appeared to be the same. It was unclear whether the clinical advantages of the LMWHs offset their greater cost. In the UK, four LMWHs ([symbol: see text]certoparin, dalteparin, enoxaparin and tinzaparin) are now licensed for prophylaxis against venous thromboembolism during or after surgery; a fifth (nadroparin) is licensed but not yet marketed in the UK. Dalteparin, enoxaparin and tinzaparin are licensed for the treatment of DVT. Additionally, tinzaparin is licensed for the treatment of pulmonary embolism (PE). Here, we review the use of LMWHs for these indications.
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PMID:Low molecular weight heparins for venous thromboembolism. 968 14

The paper deals with fatal pulmonary embolism in patients treated at STOCER after spinal injuries, frequently with neurological impairment. A group of 417 patients treated between 1988 and 1989 has been compared with another one of 350 patients treated between 1995 and 1996. Antyembolic prophylactics has been employed in both groups: an Aspirin in the first group and Clexane in the second one. Forty-seven fatalities (11% of all patients) occurred in the first group (2 females, 44 males, mean age 55.1 years); 40% of them caused by pulmonary embolism (5% of all patients). Twenty-nine fatalities (8% of all patients) occurred in the second group (1 female, 28 males, mean age 60.2 years) 17% of them caused by pulmonary embolism (1.4% of all patients). A comparison between these groups indicates high efficacy of clexane antyembolic prophylactics in patients treated due to spinal injury especially if complicated neurologically.
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PMID:[Pulmonary embolism as one cause of death after spinal injury--the role of clexane]. 968 95

In a prospective, randomized, open study, the therapeutic efficacy of a long-term prophylaxis with standard heparin (SH) was compared with that of low-molecular-weight heparin (LMWH) Dalteparin in 166 patients who had spinal fractures with spinal cord injury. 86 patients were treated with SH 2 x 7500 U s.c. and 80 patients were treated with LMWH 1 x 5000 anti-Xa U s.c. once daily. The screening was implemented by daily bedside-examination. In case of clinical thromboembolism-symptoms patients had confirmatory venography or lung scans. In the SH-group 12 (14.0%) patients had deep vein thrombosis and in the LMWH-group 6 (7.5%). Pulmonary embolism was detected two times in the SH-group (2.33%) and only one time in the LMWH-group (1.25%). A significant difference could not be shown, but is descriptive evident.
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PMID:[Prevention of thromboembolism in spinal fractures with spinal cord injuries. Standard heparin versus low-molecular-weight heparin in acute paraplegia]. 1139 48

Low-Molecular-Weight Heparin (LMWH) fractions are prepared from standard unfractionated heparin (UFH) and are thus similar to it in many aspects. The major advantages of LMWH are improved efficacy and safety, longer half-life and reduced need for laboratory monitoring. In addition, the dangers of UFH administered by continuous infusion in the hospital setting are often not fully appreciated and the necessary monitoring and dosage adjustment poorly carried out resulting in inadequate doses being given. LMWHs are the drug of choice in many clinical situations. Four LMWHs are now licensed in the UK for prophylaxis of venous thrombo-embolism during or after surgery (Certoparin, Dalteparin [Fragmin], Enoxaparin [Lovenox/Clexane] and Tinzaparin [Innohep]; a fifth is licensed but not currently available in the UK. Dalteparin, Enoxaparin and Tinzaparin are licensed for the treatment of Deep Vein Thrombosis (DVT), and Tinzaparin additionally for the treatment of Pulmonary Embolism (PE), but so far none is licensed for use in pregnancy or paediatrics.
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PMID:Haemostasis and Thrombosis: Current Clinical Practice: Low-Molecular-Weight Heparins in The Prophylaxis and Treatment of Thrombo-Embolic Disease. 1139 79

Reviparin sodium (Clivarine), Knoll AG) is a low molecular weight heparin (LMWH) with a mean peak molecular weight of 3900 Da. It is characterised by a narrow molecular weight distribution profile, with an anti-factor Xa (anti-Xa):anti-factor IIa (anti-IIa) ratio of >or=3.6. In healthy human volunteers, plasma anti-Xa activity was up to five times higher and lasted three times longer with reviparin compared with unfractionated heparin (UFH). Unlike UFH, reviparin has negligible effects on global clotting tests. Reviparin has been shown to be as effective as UFH in different prophylactic indications and causes fewer injection-site haematomas. At a daily dose of 1750 IU anti-Xa it was as effective as UFH in preventing deep vein thrombosis (DVT) in moderate risk surgery (general and abdominal) and significantly reduced DVT in patients with brace immobilisation of the legs. At a daily dose of 4200 IU anti-Xa reviparin was as effective as UFH or enoxaparin in preventing DVT in high risk orthopaedic surgery and as effective as UFH in prevention of DVT and/or pulmonary embolism (PE) and/or mortality in high risk orthopaedic surgery. In patients with acute venous thromboembolism (VTE), reviparin was more effective than UFH in thrombus reduction and at least as effective as UFH in the prevention of clinical recurrence of DVT and/or PE. The use of reviparin is associated with a similar or lower incidence of bleeding complications than UFH.
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PMID:Reviparin sodium - a new low molecular weight heparin. 1182 31

Low-molecular-weight and unfractionated heparins are frequently used to treat venous thromboembolism, but it is not known whether they are equally effective in inhibiting in vivo generation of thrombin. In this multicenter trial, 1048 patients were randomized to intravenous unfractionated heparin (group A), twice daily low-molecular-weight heparin (reviparin) for 1 week (group B), or once daily reviparin for 4 weeks (group C). All patients received vitamin K antagonists. Blood samples withdrawn at the baseline and at weeks 1 and 3 were analyzed using markers of in vivo thrombin generation and other coagulation parameters. During the first 3 weeks symptomatic recurrent deep vein thrombosis-pulmonary embolism (DVT/PE) occurred in 17 (4.5%) of 375 patients in group A compared with 4 (1.0%) of 388 patients in group B, and 9 (2.4%) of 374 patients in group C. Forty percent of patients in group A, 53.4% in group B, and 53.5% in group C showed 30% or greater reduction in thrombus size assessed by venography. Patients in group B had significantly greater reduction in D-dimer, prothrombin fragments 1 and 2 (F1 + 2), endogenous thrombin potential (ETP), and thrombin-antithrombin (TAT) complexes compared to groups A and C. Greater release of tissue factor pathway inhibitor (TFPI) and reduction in levels of thrombin activatable fibrinolysis inhibitor (TAFI) and fibrinogen were significantly more pronounced in group C patients. Reviparin administered twice daily plus vitamin K antagonist is more effective in inhibiting in vivo thrombin generation compared to intravenous unfractionated heparin plus vitamin K antagonist, and reviparin once daily produced significantly higher TFPI release and greater reduction in TAFI and fibrinogen levels.
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PMID:Randomized trial of different regimens of heparins and in vivo thrombin generation in acute deep vein thrombosis. 1187 67

The paper reviews occurrence, diagnostic tools venous thromboembolic complications. Cost effectiveness of preventive measures for venous thrombosis and pulmonary embolism in general surgery is analysed. The study included 45 patients who underwent elective (21) and urgent (24) abdominal and pelvic interventions. Each patient was examined with ultrasonic with color Doppler imaging before and 8-10 days after surgery. Deep venous thrombosis of lower limbs was diagnosed in 11.1%, most of cases being asymptomatic. Ultrasonic angioscanning appeared to be an acute and reliable diagnostic tool for this pathology. Various approaches to the management of patients at thrombotic risk are reviewed. Cost effectiveness analysis of anticoagulation prevention for postoperative venous thromboembolic complications must address the problem: is prevention outcome worth those extra efforts? Surveillance of 500 patients at high thrombotic risk has shown that preventive use of low weight heparin (Clexane) is economically beneficial then conventional Heparin, the more in the absence of special preventive strategy. Targeted prevention in patients with different risk of postoperative venous thromboembolic complications can yield more then 3-fold reduction in occurrence of these complications.
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PMID:[The problem of postoperative venous thromboembolic complications in general surgery]. 1281 94

Bemiparin sodium (Hibor, Ivor, Zivor, Badyket, Laboratorios Farmaceuticos Rovi SA) is a new second-generation low molecular weight heparin (LMWH). Bemiparin has the lowest mean molecular weight (3600 Da), the longest half-life (5.3 h) and the largest antifactor Xa:antifactor IIa ratio (8:1) of all LMWHs. Bemiparin promotes a greater release of tissue factor pathway inhibitor than unfractionated heparin (UFH) or dalteparin. These properties could result in a more favourable efficacy:safety ratio than the currently marketed LMWHs. Bemiparin 2500 IU/day was as effective as UFH for preventing venous thromboembolism (VTE) in moderate risk abdominal surgery. Bemiparin 3500 IU/day significantly reduced VTE compared to UFH in high-risk hip replacement surgery. Bemiparin 3500 IU/day started postoperatively was as effective as enoxaparin 4000 IU/day started preoperatively in total knee arthroplasty, with a trend towards a lower rate of proximal deep vein thrombosis (DVT), pulmonary embolism and symptomatic VTE. In patients with acute DVT, bemiparin was more effective than UFH in thrombus mass reduction and at least as effective as UFH for the prevention of clinical recurrence. Bemiparin was as effective as UFH for clot prevention during haemodialysis. The use of bemiparin was associated with a lower incidence of major and minor bleeding as compared to UFH in abdominal surgery. When compared with enoxaparin in orthopaedic surgery, a lower rate of complications at injection site was observed.
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PMID:Review of bemiparin sodium--a new second-generation low molecular weight heparin and its applications in venous thromboembolism. 1294 85


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