[Prevention of venous thromboembolism: unfractionated heparins and low-molecular weight heparins. Analysis of these 2 options].
Traditionally, it has been recommended that the prevention of venous thromboembolic disease (VTD) be treated, subcutaneously, with heparins, be they fractionated (UH) or low molecular weight (LMWH). While it has been expected that the latter would prove the more effective, numerous clinical studies have confirmed that there are no appreciable differences between either, given the results obtained in the prevention of VTD, or of bleeding, or of death. It therefore appears logical to think that the moment has arrived to consider substituting the old, conventional heparins, for the new LMWH. In order to attempt to answer this question, we have undertaken a revision of the main meta-analysis published, wherein both heparins have been comparatively employed; thus we analyze their mechanisms of action, their pharmacokinetics differences, and their adverse effects, as well as the type of patients, both at the time of initiation and continuation of tromboprophylaxis with heparins. Using currently available data, it can be inferred that LMWH are as safe and effective as the UH in the prevention of VTD. Moreover, there are a series or added advantages, such as no unnecessary laboratory controls, and the easy dosification and administration, both to patient as well as nursing staff.
Gabriel Botella
F
F
Servicio de Medicina Interna, Hospital Clínico Universitario, Valencia.
Labiós Gomez
M
M
Balaguer Martínez
J V
JV
Fernández Llopez
A
A
D005544:Forecasting; D006493:Heparin / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D012959:Socioeconomic Factors; D013923:Thromboembolism / Q000517:prevention & control*; D013997:Time Factors
D006493:Heparin