Low molecular weight heparins in clinical practice: unsolved or partially solved problems.
Low molecular weight heparins (LMWH) have been shown, in recent years, to be at least as effective as standard heparin (SH) in the prophylaxis and treatment of venous thrombosis. In spite of several studies there are still some unsolved problems to be dealt with. These may be summarized along the following lines: 1) Side effect; 2) Use in pregnancy; 3) Role in arterial thrombosis; 4) Use in severe deep venous thrombosis; 5) Use for home treatment; 6) Effect on cancer related mortality; 7) Standardization of preparations; 8) Dosage uncertainties; 9) Long term treatment. The two most important aspects are those pertaining to the potential use in arterial thrombosis and the possibility of home treatment of selected patients with venous thromboembolism. A few studies now indicate that LMWH may play an important role in several arterial thrombosis (coronary disease, ischemic stroke, etc). As far as the indications for home treatment are concerned, recent studies have given a positive answer. However, rather than home treatment it would be more appropriate to refer to early discharge from the hospital. The overall impression is that LMWH may represent an important progress in the management and prophylaxis of thrombotic disease.
Girolami
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University of Padua Medical School, II Chair of Internal Medicine, Italy.
D000328:Adult; D002986:Clinical Trials as Topic; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications; D010045:Outpatients; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013923:Thromboembolism / Q000517:prevention & control; D013924:Thrombophlebitis / Q000188:drug therapy; D013927:Thrombosis / Q000188:drug therapy / Q000517:prevention & control; D013997:Time Factors
D006495:Heparin, Low-Molecular-Weight