title: Efficacy of low-molecular-weight heparin in the management of intermittent claudication.
abstract: Treating chronic arterial occlusive disease with heparin is controversial because of the risks associated with long-term anticoagulant therapy. Low molecular weight (LMW) heparin (mw about 5000 Dalton), which selectively inhibits the Xa factor with minimal risk of hemorrhage, seems to offer new possibilities in the prevention and treatment of both venous and acute arterial thromboembolism. Therefore, 44 patients with intermittent claudication were recruited to a randomized, double-blind, controlled study. Twenty-two were treated for six months with a single daily subcutaneous dose (15,000 UaXa) of LMW heparin and 22 with placebo administered in the same way over the same period of time. After six months, LMW heparin treatment not only improved walking capacity (by lengthening the pain-free walking time by 25%) but also significantly modified the hemorrheologic pattern (by reducing fibrinogen concentrations and whole blood viscosity at low shear rates). LMW heparin also exerted an antithrombotic and profibrinolytic effect by significantly increasing both the anti-Xa factor and plasminogen activity without markedly modifying activated partial thromboplastin time (+20%). No LMW heparin-treated patient hemorrhaged or reported other noteworthy side effects. These results suggest LMW heparin might be a useful drug in the long-term treatment of chronic arterial occlusive disease of the limbs.
authors.affiliation: 2nd Department of Internal Medicine, University of Perugia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mannarino
authors.forename: L
authors.initials: L
authors.lastname: Pasqualini
authors.forename: S
authors.initials: S
authors.lastname: Innocente
authors.forename: U
authors.initials: U
authors.lastname: Orlandi
authors.forename: V
authors.initials: V
authors.lastname: Scricciolo
authors.forename: R
authors.initials: R
authors.lastname: Lombardini
authors.forename: G
authors.initials: G
authors.lastname: Ciuffetti
mesh_terms: D000368:Aged; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007383:Intermittent Claudication / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow
chemical_list: D006495:Heparin, Low-Molecular-Weight