PubMed · 9813554
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M K Davies, A Hollman. 1998. Heparin.. https://doi.org/10.1136/hrt.80.2.120
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Heparin induced thrombocytopenia has remained the major complication of therapy or prophylaxis with heparin. Although low molecular weight heparins seem to confer much lesser chance to induce thrombocytopenia, the danger is still considerable, and the fatal outcome is not rare. A lot of new data have been published about the origin, binding, physicochemical properties of the antibodies, the responsive platelet membrane receptors, and laboratory diagnosis in particular, however, many issues are still unresolved. The anticoagulant treatment of cases, in which heparin induced thrombocytopenia in associated with progressive, frequently arterial thrombosis still needs great skills, experience and the use of new generation antithrombotic agents. This review summarizes briefly the internationally accepted standard diagnostic and therapeutic protocols with heparin induced thrombocytopenia.
It is difficult to draw conclusions from published meta-analysis on the treatment of proximal deep vein thrombosis by low molecular weight heparins in view of methodological problems related to selection of the studies and the addition of early and late complications. To determine the efficacy and safety of subcutaneous low molecular weight heparins in the initial treatment of proximal deep vein thrombosis we reviewed all published randomised controlled studies comparing this treatment to the standard intravenous unfractionated heparin regimen. Adverse events were taken into account up to 48 hours after cessation of heparin treatment. Results point towards equivalent or greater efficacy, with reduction in thrombosis size, and safety of low molecular weight heparin. The mortality rate was low (0-1.2%). Incidence of recurrent venous thromboembolism (0-2%) or major bleeding (0-2.4%) was also low, though such events were linked to a high mortality rate (9-16%). Thrombocytopenia occurred in 0 to 2.5% of cases.
The 80th anniversary of the best known glycosaminoglycan, a mixture of mucopolysaccharides, named heparin by Howell and Holt in 1918 is celebrated this year. It was widely used during the last six decades in prevention and treatment of venous thromboembolism causing a significant decrease of death from pulmonary embolism and the morbidity of deep venous thrombosis. Conventional, unfractionated heparin is also administered on many other topics. Some more than ten years ago the fractionated, low-molecular-weight heparins were introduced into clinical practice and it seems increasingly likely that the fractionated preparations of this classic drug will take over the dominating role. The present study intends to summarize the today's possibilities of prevention and treatment of thromboembolism mostly on the venous side of circulation.