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)

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

During a 22-month period, 555 consecutive patients at seven hospitals in the western part of Sweden with an acute deep vein thrombosis (DVT) not involving the iliac vein and not having pulmonary embolism were included in a study testing the efficacy of implementing out-patient treatment. For all patients with a confirmed diagnosis of acute DVT, a folder was used that contained two checklists with detailed instructions for further treatment, one for the doctor and one for the nurse, an information pamphlet for the patient and prepared prescriptions for low-molecular-weight heparin (LMWH) tinzaparin (Innohep) of 175 anti-Xa IU/kg body weight subcutaneously once daily and warfarin. Patients not requiring hospitalisation, according to strict guidelines, were then eligible for treatment as out-patients. Prior to release from the emergency department for home treatment, a nurse provided detailed information to the patient and administered the first tinzaparin injection. In 194 (35.0%) out of 555 patients, the DVT was localised only in the lower leg not reaching the popliteal vein. Factors predisposing to venous thromboembolism were identified in 35.0% of the patients. 332 (59.8%) out of the 555 patients studied did not require hospitalisation and were therefore treated as out-patients. 140 of these patients (42.2%) injected themselves, the injection was given by a relative in 63 (19.0%) patients and by the community nurse in 129 (38.9%). Six (1.8%) patients reported a worsening of the DVT condition during the LMWH treatment period. No major bleedings were observed during the injection treatment period. Except for local minor skin bleedings at the injection site, only 3 (0.9%) patients reported minor bleedings during the injection treatment period. Recurrences of venous thromboembolism during the first 2 months were reported in 9 patients (2.7%) out of 332 patients who were sent home from the emergency department. Five (2.2%) patients out of the 223 who were admitted to the hospital had an increased tendency to bleeding. Twelve patients (5.4%) were hospitalised because of a pronounced local status, 26 (11.7%) were senile, social factors were the reason for hospitalisation in 76 (34.1%) and lack of time of the physician in 39 (17.5%) of the patients. A pharmacoeconomic analysis found a cost reduction of 69% with the present model for home treatment compared with traditional in-hospital treatment of DVT patients. We conclude that tinzaparin can be safely used at home by patients with DVT below the inguinal region and that the model used in the present study is cost-effective.
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PMID:Home treatment of deep vein thrombosis. An out-patient treatment model with once-daily injection of low-molecular-weight heparin (tinzaparin) in 555 patients. 1221 50

Low molecular weight heparin (LMWH) is widely regarded as the anticoagulant treatment of choice for the prevention and treatment of venous thromboembolism during pregnancy. However, previous studies have demonstrated that the pharmacokinetic profiles of LMWH vary significantly with increasing gestation. Consequently, it remains unclear whether LMWH regimens recommended for use in nonpregnant individuals can be safely extrapolated to pregnant women. The aims of this study were to assess the safety and the efficacy of tinzaparin sodium (Innohep) administered only once daily during pregnancy. A systematic retrospective review identified a cohort of 37 high-risk pregnancies which had been managed using tinzaparin 175 IU/kg once daily. In 26 cases, the index pregnancy had been complicated by development of an acute venous thromboembolism (17 deep vein thrombosis and nine pulmonary embolism). For each individual, case notes were examined and data extracted using a predetermined questionnaire. No episodes of recurrent venous thromboembolism were identified amongst this cohort of pregnancies managed using once daily LMWH administration. However, two unusual thrombotic complications were observed, including a parietal infarct in one patient, and a postpartum cerebral venous thrombosis in another. Once daily tinzaparin was well tolerated, with no cases of heparin-induced thrombocytopaenia, symptomatic osteoporosis, or foetal malformations. Tinzaparin dose modification based upon peak anti-Xa levels occurred in 45% of the cases examined. The present study is the largest study to have examined the clinical efficacy of once daily LMWH for use in pregnant women at high risk of venous thromboembolism. Our data support the safety and efficacy of antenatal tinzaparin at a dose of 175 IU/kg. In order to determine whether this once daily regimen provides equivalent (or indeed greater) thromboprophylaxis to twice daily LMWH regimens during pregnancy will require highly powered direct comparative studies.
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PMID:Efficacy and safety of once daily low molecular weight heparin (tinzaparin sodium) in high risk pregnancy. 1883 11

Tinzaparin sodium (Innohep) is a low molecular weight heparin (LMWH) that is effective in the prevention and treatment of deep vein thrombosis (DVT) and/or pulmonary embolism (PE), and in maintaining the patency of haemodialysis circuits in adult patients. In terms of preventing DVT and/or PE, therapy with subcutaneous tinzaparin sodium was more effective than oral warfarin and equivalent to subcutaneous enoxaparin sodium in patients undergoing orthopaedic surgery, and did not significantly differ from that of subcutaneous unfractionated heparin (UFH) in patients undergoing general surgery. In the initial therapy of adult patients with DVT and/or PE, subcutaneous tinzaparin sodium was at least as effective as intravenous UFH and did not significantly differ from subcutaneous dalteparin sodium. Various other studies have demonstrated that the long-term efficacy of subcutaneous tinzaparin sodium in the treatment of patients with DVT and/or PE was sustained for a total period of up to 12 months. Tinzaparin sodium was also demonstrated to be effective in maintaining the patency of haemodialysis circuits in adult patients with end-stage renal failure. In clinical studies, tinzaparin sodium was generally well tolerated in the prevention and treatment of DVT and/or PE in adult patients, including in elderly patients, and in patients undergoing haemodialysis. As expected, bleeding complications were the most frequently occurring adverse event. Thus, available data indicate that tinzaparin sodium is a useful option in the prevention and treatment of DVT and/or PE, and in maintaining the patency of haemodialysis circuits in adult patients.
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PMID:Tinzaparin sodium: a review of its use in the prevention and treatment of deep vein thrombosis and pulmonary embolism, and in the prevention of clotting in the extracorporeal circuit during haemodialysis. 2056 36