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Thromb Haemost 1994; 71(05): 698-702
DOI: 10.1055/s-0038-1642507
Review Article
Schattauer GmbH Stuttgart

Adjusted Versus Fixed Doses of the Low-Molecular-Weight Heparin Fragmin in the Treatment of Deep Vein Thrombosis

M Alhenc-Gelas
1   Laboratoire d’Hémostase, Hôpital Broussais, Paris
,
C Jestin-Le Guernic
2   Laboratoires Kabi, St. Quentin en Yvelines, Hôpital Broussais, France
,
J F Vitoux
3   Centre Claude Bernard de Recherche sur les Maladies Vasculaires, Service de Médecine Vasculaire, Hôpital Broussais, France
,
A Kher
2   Laboratoires Kabi, St. Quentin en Yvelines, Hôpital Broussais, France
,
M Aiach
1   Laboratoire d’Hémostase, Hôpital Broussais, Paris
,
J N Fiessinger
3   Centre Claude Bernard de Recherche sur les Maladies Vasculaires, Service de Médecine Vasculaire, Hôpital Broussais, France
,
Fragmin-Study Group › Author Affiliations
Further Information

Publication History

Received: 17 September 1993

Accepted after revision 06 February 1994

Publication Date:
06 July 2018 (online)

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Summary

Treatment monitoring based on a laboratory parameter increases the efficacy and safety of standard heparin therapy, but it is not known if this also applies to low-molecular-weight heparin (LMWH) therapy of acute deep vein thrombosis (DVT). In a prospective randomized trial involving 122 consecutive patients, group A (58 patients) received a weight adjusted dose of Fragmin (100 IU/kg) subcutaneously twice a day throughout the treatment period (10 days ± 1), while in group B (64 patients) the dosage was based on the results of an anti factor Xa (anti Xa) amidolytic assay to obtain a target concentration from 0.5 to 1 IU/ml. AntiXa and antithrombin activities were also measured retrospectively on frozen plasma from all patients. The two regimens were comparable in terms of hemorrhagic complications (4 in group A and 3 in group B). Bilateral ascending phlebography was performed before inclusion and at the end of LMWH treatment. Treatment efficacy, based on Marder’s score, did not differ between the two groups (p = 0.3). Dosage adjustment to between 0.5 to 1IU anti-Xa/ml does not therefore appear to improve the efficacy or safety of LMWH tieatment. However, correlations between the change in Marder’s score and both anti-Xa (p <0.001) and antithrombin activity (p <0.001) were observed, suggesting a relationship between the degree of FXa or thrombin inhibition and antithrombotic activity.

 

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