title: [Value of a fraction of low molecular weight heparin, enoxaparine, in patients at high risk of hemorrhage and thrombosis].
abstract: Treatment of patients with both thromboembolic manifestations and acute bleeding episodes is poorly defined. The use of low molecular weight heparin fractions has been shown to provide prophylactic antithrombotic activity in humans, with the possibility of fewer hemorrhagic complications because of their low anticoagulant activity and weaker action on platelets. An open trial was carried out in 50 patients. 47 of whom had a recent history of thromboembolic accident (34 venous thrombosis, including 13 with pulmonary embolism, 9 systemic arterial episodes, 4 cardiac emboli) and 3 who required prophylaxis. Conventional heparin therapy was contraindicated in all patients: 30 because of major digestive or muscle hemorrhage and 20 with high hemorrhagic risk (neurosurgery, deep thrombocytopenia). Enoxaparine (Laboratoire Pharmuka, Gennevilliers) was administered as 1 mg/kg/24 hours as 2 divided injections with adjustment to maintain an anti-Xa activity of 0.1 to 0.4 IU/ml. Antithrombotic efficacy as function of type of pathology was rated excellent in all patients, while tolerance, evaluated similarly by tests chosen as a function of type of hemorrhage, was good: one patient had moderate bleeding after accidental overdose and 4 patients minor bleeding. Enoxaparine by subcutaneous injection could represent a new therapeutic approach by improving the efficacy/risk ratio in this type of patients.
authors.affiliation: Policlinique, Hôpital Henri Mondor, Créteil.
authors.forename: Y
authors.initials: Y
authors.lastname: Huet
authors.forename: T
authors.initials: T
authors.lastname: Gadelha-Parente
authors.forename: C
authors.initials: C
authors.lastname: Benvenutti
authors.forename: E
authors.initials: E
authors.lastname: Melon
authors.forename: A
authors.initials: A
authors.lastname: Salvat
authors.forename: C
authors.initials: C
authors.lastname: Cordonnier
authors.forename: A
authors.initials: A
authors.lastname: Schaeffer
authors.forename: J L
authors.initials: JL
authors.lastname: Portos
mesh_terms: D001780:Blood Coagulation Tests; D006470:Hemorrhage / Q000517:prevention & control*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D013927:Thrombosis / Q000517:prevention & control*
chemical_list: D006495:Heparin, Low-Molecular-Weight
vernacular_title: Intérêt d'une fraction d'héparine de bas poids moléculaire, l'énoxaparine, chez des patients à hauts risques hémorragique et thrombotique.