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Briefing Therapeutic Approaches in Anticoagulant, Thrombolytic, and Antiplatelet Therapy
Published in Debarshi Kar Mahapatra, Sanjay Kumar Bharti, Medicinal Chemistry with Pharmaceutical Product Development, 2019
The molecular weight (MW) of LMWHs is lesser than the MW of UFHs. To inactivate thrombin, heparin molecule must form a ternary complex as a bridge between antithrombin and thrombin, which requires minimum 18 saccharide units and thus smaller heparin molecules, cannot facilitate the interaction between antithrombin and thrombin. The implication of the minimum size requirement is that there must be at least 13 saccharides next to the pentasaccharide for thrombin binding. Therefore, LMWHs have greater affinity towards factor Xa, but lesser to thrombin as shown in Figure 7.3. If the MW of LMWHs is greater than 5000 Da, the anti-IIa specific activity of LMWH is drastically reduced and selectivity increased towards the inhibition of factor X. Enoxaparin, dalteparin, tinzaparin, parnaparin, nadroparin, certoparin, bemiparin, reviparin are the approved LMWHs. Tinzaparin is withdrawn from the market. These agents have improved subcutaneous bioavailability; dose-independence clearance; longer biological half-life; lower incidence of thrombocytopenia; and a reduced need for routine laboratory monitoring in comparison to UFH [38–41].
Drug Therapy in Laryngology and Head and Neck Surgery
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Low molecular weight heparins (certoparin, dalteparin, enoxaparin, reviparin and tinzaparin) are also effective in the prophylaxis of venous thromboembolism and their once daily subcutaneous administration is more convenient. These can also be used to treat deep vein thrombosis and monitoring is not required.
Stenting of the Femoropopliteal Artery
Published in Richard R Heuser, Giancarlo Biamino, Peripheral Vascular Stenting, 1999
Andrej Schmidt, Dierk Scheinert, Giancarlo Biamino
There are two major problems after stenting the femoropopliteal tract: acute or subacute thrombosis, and restenosis induced either by intimal hyperplasia or by progressive atherosclerosis. The acute thrombosis risk was recognized by Rousseau et al19 who reported that 25% of patients had thrombosis of the stented SFA segment within the first month after implantation. Thus, many investigators recommend anticoagulation for patients with infrainguinal stents. The early thrombosis rate could be reduced to 6% with peri-procedural heparin followed by warfarin for several months.4 In contrast, White et al,20 using Wallstents™ and Strecker™ stents for short segment (3.7 cm) disease without warfarin, noted only two cases with acute thrombosis in 32 patients; it was also noted that acute stent thrombosis occurred more frequently in long lesions. According to our experience, acute occlusion after stenting can be reduced below 1% by an anticoagulation regimen, including aspirin 100 mg and clopidogrel 75 mg once daily and low molecular weight heparin for 4 weeks. This procedure is confirmed by the results of Strecker et al21 who observed no early stent thrombosis after administration of reviparin in a high dosage over a period of 3 weeks after intervention, and is also supported by the results of Becquemin et al22 who found that ticlopidine significantly improved long-term patency of infrainguinal saphenous vein bypass grafts compared to placebo.
Current approaches in the treatment of catheter-related deep venous thrombosis in children
Published in Expert Review of Hematology, 2020
Julie Jaffray, Neil Goldenberg
The REVIVE trial was an international RCT comparing the efficacy and safety of the LMWH reviparin versus UFH during the acute phase of VTE treatment, prior to the transition to warfarin [48]. Seventy-six subjects completed the study, and 50% of the subjects in the UFH arm and 80% of the subjects in the LMWH arm had CVC-related VTE. The trial was terminated early due to poor accrual and was thus underpowered. Of note, the study did show a major bleeding event rate of 5.6% (2/36) in the reviparin group versus 12.5% (5/40) for UFH. Recurrent VTE within 3 months after completing treatment was seen in 5.6% (2/36) of the reviparin group versus 10% (4/40) for the UFH group [48].