Download PDF
Hamostaseologie 1994; 14(01): 25-32
DOI: 10.1055/s-0038-1660340
Übersichtsarbeit/Review Articles
Schattauer GmbH

Klinische Erfahrungen mit niedermolekularen Heparinen bei der primären Thromboembolieprophylaxe

Derzeitiger Stand und offene Fragen
S. Haas
1   Institut für Experimentelle Chirurgie, Technische Universität München (Direktor: Prof. Dr. G. Blümel)
,
P. Haas
1   Institut für Experimentelle Chirurgie, Technische Universität München (Direktor: Prof. Dr. G. Blümel)
› Author Affiliations
Further Information

Publication History

Publication Date:
26 June 2018 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Für die primäre Prophylaxe von thromboembolischen Komplikationen gelten Heparin und niedermolekulare Heparine als Mittel der Wahl, wobei im sogenannten Hochrisikobereich einmal täglich verabreichte pauschalierte Dosierungen von niedermolekularem Heparin sogar wirkungsvoller zu sein scheinen als die mehrfach täglich applizierte Low-dose-Heparinprophylaxe. Im Gegensatz zu herkömmlichem Heparin sollten aber niedermolekulare Heparine als individuelle Substanzen angesehen und nicht unter einem gemeinsamen Generikumsbegriff zusammengefaßt werden. Daraus folgt, daß für jedes Produkt der Wirksamkeits- und Verträglichkeitsnachweis separat erbracht werden muß. Durch die nur einmal täglich notwendige subkutane Injektion und die laborunabhängige Einsatzmöglichkeit hat die Prophylaxe mit niedermolekularen Heparinen auch erfolgreiche Anwendung im Rahmen der ambulanten Patientenversorgung gefunden.

Schlüsselwörter

Primäre Thromboembolieprophylaxe - unfraktioniertes Heparin - niedermolekulare Heparine - Hochrisikobereich - ambulante Patientenversorgung
 

  • LITERATUR

  • 1 Adolf J, Knee H, Roder JD, van de Flierdt E, Siewert RJ. Thromboembolieprophylaxe mit niedermolekularem Heparin in der Abdominalchirurgie. Dtsch Med Wochenschr 1989; 114: 48-53.
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Barre J, Pfister G, Potron G, Droulle C, Baudrillard JC, Barbier P, Kher A. Efficacité et tolérance comparée du Kabi 2165 et de l’héparine standard dans la prévention des thromboses profondes au cours des prothèses totales de hanche. J Mal Vase 1987; 12: 90-5.
    PubMedSearch in Google Scholar
  • 3 Baumgartner A, Jacot N, Moser G, Krähenbühl B. Prevention of postoperative deep vein thrombosis by one daily injection of low molecular weight heparin and dihydroergotamine. Vasa 1989; 18: 152-6.
    PubMedSearch in Google Scholar
  • 4 Bergqvist D, Burmark US, Frisell J, Hallböök T, Lindblad B, Risberg B, Törngren S, Wallin G. Low molecular weight heparin once daily compared with conventional lowdose heparin twice daily. A prospective double-blind multicentre trial on prevention of postoperative thrombosis. Br J Surg 1986; 73: 204-8.
    CrossrefPubMedSearch in Google Scholar
  • 5 Bergqvist D, Mätzsch T, Burmark US, Frisell J, Guilbaud O, Hallböök T, Horn A, Lindhagn A, Ljungner H, Ljungström KG, Onarheim H, Risberg B, Törngren S, Örtenwall P. Low molecular weight heparin given the evening before surgery compared with conventional low-dose heparin in prevention of thrombosis. Br J Surg 1988; 75: 888-91.
    CrossrefPubMedSearch in Google Scholar
  • 6 Caen JP. A randomized double-blind study between a low molecular weight heparin (Kabi 2165) and standard heparin in the prevention of deep vein thrombosis in general surgery - A French multicentre trial. Thromb Haemost 1988; 59: 216-20.
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients - Results of meta-analysis. Ann Surg 1988; 208: 227-40.
    CrossrefPubMedSearch in Google Scholar
  • 8 Colditz GA, Tuden RL, Oster G. Rates of venous thrombosis after general surgery - Combined results of randomized clinical trials. Lancet 1986; II: 143-5.
    PubMedSearch in Google Scholar
  • 9 Collins R, Scrimgeour A, Yusuf S, Petro R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. N Engl J Med 1988; 318: 1162-72.
    CrossrefPubMedSearch in Google Scholar
  • 10 Dechavanne M, Ville D, Berruyer M, Trepo F, Dalery F, Clermont N, Lerat JL, Moyen B, Fischer LP, Kher A, Barbier P. Randomized trial of low-molecular-weight heparin (Kabi 2165) versus adjusted-dose subcutaneous standard heparin in the prophylaxis of deep vein thrombosis after elective hip surgery. Haemostasis 1989; 01: 5-12.
    PubMedSearch in Google Scholar
  • 11 Encke A, Breddin HK. Comparison of a low molecular weight heparin for the prevention of deep vein thrombosis in patients undergoing abdominal surgery. Br J Surg 1988; 75: 1058-63.
    CrossrefPubMedSearch in Google Scholar
  • 12 Encke A, Breddin HK, Haas S. Gegenwärtiger Stand der Thromboembolieprophylaxe in der Chirurgie. Akt Chir 1992; 27: 109-16.
    PubMedSearch in Google Scholar
  • 13 Eriksson BI, Kälebo P, Anthmyr BA, Wadenwik H, Tengborn L, Risberg B. Prevention of deep vein thrombosis and pulmonary embolism after total hip replacement. J Bone Joint Surg 1991; 73A: 484-93.
    PubMedSearch in Google Scholar
  • 14 European Consensus Statement: Prevention of venous thromboembolism. Int Angiol 1992; 11: 151-9.
    PubMedSearch in Google Scholar
  • 15 Fareed J, Walenga JM, Hoppensteadt D, Racanelli A, Coyne E. Chemical and biological heterogeneity in low molecular weight heparins: Implications for clinical use and standardization. Semin Thromb Hemost 1989; 15 (04) 440-63.
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Freick H, Haas S. Prevention of deep vein thrombosis by low molecular weight heparin and dihydroergotamine in patients undergoing total hip replacement. Thromb Res 1991; 63: 133-43.
    CrossrefPubMedSearch in Google Scholar
  • 17 Fricker JP, Vergnes Y, Schach R, Heitz A, Eber M, Grunebaum L, Wiesel ML, Kher A, Barbier P, Cazenave HP. Low dose heparin versus low molecular weight heparin (Kabi 2165, Fragmin) in the prophylaxis of thromboembolic complications of abdominal oncological surgery. Eur J Clin Invest 1988; 18: 561-7.
    CrossrefPubMedSearch in Google Scholar
  • 18 The German Hip Arthroplasty Trial (GHAT) Group. Prevention of deep vein thrombosis with low molecular weight heparin in patients undergoing total hip replacement. A randomized trial. Arch Orthop Trauma Surg 1992; 111: 110-20.
    CrossrefPubMedSearch in Google Scholar
  • 19 Haas S, Fritsche HM, Stemberger A, Otto J, Lechner F, Blümel G. Antithrombotic efficacy of Embolex NM in total hip replacement under various schedules of administration. Haemostasis 1988; 18 (Abstr) 20.
    PubMedSearch in Google Scholar
  • 20 Haas S, Haas P. Thromboembolieprophylaxe in der Unfallchirurgie und Orthopädie. Chirurg 1992; 63: 271-5.
    PubMedSearch in Google Scholar
  • 21 Harenberg J, Weuster B, Pfitzer M, Dempfle CE, Stehle G, Kübler W, Schlierf G. Prophylaxis of embolic events in patients with atrial fibrillation using low molecular weight heparin. Semin Thromb Hemost 1993; 19: 116-21.
    PubMedSearch in Google Scholar
  • 22 Harenberg J, Siegele M, Dempfle CE, Stehle G, Heene DL. Protamine neutralization of the release of tissue factor pathway inhibitor activity by heparins. Thromb Haemost 1993; 70: 942-5.
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Hartl P, Brücke P, Dienstl E, Vinazzer H. Prophylaxis of thromboembolism in general surgery: Comparison between standard heparin and Fragmin. Thromb Res 1990; 57: 577-84.
    CrossrefPubMedSearch in Google Scholar
  • 24 Kakkar VV, Murray WJG. Efficacy and safety of low-molecular weight-heparin (CY 216) in preventing postoperative venous thromboembolism: A cooperative study. Br J Surg 1985; 71: 786-91.
    PubMedSearch in Google Scholar
  • 25 Kim YS, Linhardt RL. Structural features of heparin and their effect on heparin cofactor II mediated inhibition of thrombosis. Thromb Res 1989; 53: 55-9.
    CrossrefPubMedSearch in Google Scholar
  • 26 Klein G. Thromboseprophylaxe mit niedermolekularen Heparinen aus der Sicht des Anästhesisten. In: Thrombosen und Embolien - Arzthaftung. Husfeld KJ, Raschke R. (Hrsg). Berlin, Heidelberg, New York: Springer; 1993: 101-4.
    Search in Google Scholar
  • 27 Koller M, Schoch U, Buchmann B, Largiadèr F, von Felten A, Frick PG. Low molecular weight heparin (Kabi 2165) as thromboprophylaxis in elective visceral surgery. A randomized, double-blind study versus unfractionated heparin. Thromb Haemost 1986; 56: 243-6.
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Koppenhagen K, Matthes M, Häring R, Tröster E, Wolf H, Welzel D. Thromboembolieprophylaxe in der Abdominalchirurgie. Vergleich der Wirksamkeit und Verträglichkeit von niedermolekularem Heparin und unfraktioniertem Heparin. Münch Med Wochenschr 1990; 132: 677-80.
    PubMedSearch in Google Scholar
  • 29 Koppenhagen K, Adolf J, Matthes M, Tröster E, Roder JD, Haas S, Fritsche HM, Wolf H. Low molecular weight heparin and prevention of postoperative thrombosis in abdominal surgery. Thromb Haemost 1992; 67: 627-30.
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Lassen MR, Borris LC, Christiansen HM, Schott P, Olsen AD, Sörensen JV, Rahr H, Jensen HP. Clinical trials with low molecular weight heparins in the prevention of postoperative thromboembolic complications: A meta analysis. Semin Thromb Hemost 1991; 17: 284-90.
    PubMedSearch in Google Scholar
  • 31 Leizorovicz A, Haugh MC, Chapuis FR, Samama M, Boissel JP. Low molecular weight heparin in the prevention of perioperative thrombosis. Br Med J 1992; 305: 913-20.
    CrossrefPubMedSearch in Google Scholar
  • 32 Levine MN, Hirsh J, Gent M, Turpie AG, Leclerc J, Powers P, Jay RM, Neemeh J. Prevention of deep vein thrombosis after elective hip surgery. A randomized trial comparing low molecular weight heparin with standard unfractionated heparin. Ann Intern Med 1991; 114: 545-51.
    CrossrefPubMedSearch in Google Scholar
  • 33 Leyvraz PF, Bachmann F, Hoek H, Büller HR, Postel M, Samama M, Vandenbroek MD. Prevention of deep vein thrombosis after hip replacement: randomised comparison between unfractionated heparin and low molecular weight heparin. Br Med J 1991; 303: 543-8.
    CrossrefPubMedSearch in Google Scholar
  • 34 Lindahl AK, Abildgaard U, Staalesen R. The anticoagulant effect in heparinized blood and plasma resulting from interactions with extrinsic pathway inhibitor. Thromb Res 1991; 64: 155-68.
    CrossrefPubMedSearch in Google Scholar
  • 35 Nurmohamed MT, Rosendaal FR, Büller HR, Dekker E, Hommes DW, Vandenbroucke JP, Briet E. Low molecular weight heparin versus standard heparin in general and orthopaedic surgery: a meta-analysis. Lancet 1991; 340: 152-6.
    PubMedSearch in Google Scholar
  • 36 Nurmohamed MT, Verhaege R, Haas S, Iriarte JA, Vogel G, van Rij AM, Prentice C, ten Cate JW. Comparative trial of a low molecular weight heparin (Enoxaparin) for the prophylaxis of deep vein thrombosis in general surgery. Thromb Haemost 1993; 69: 384 (Abstr).
    PubMedSearch in Google Scholar
  • 37 Onarheim H, Lund T, Heimdal A, Arnesjo B. A low molecular weight heparin (Kabi 2165) for prophylaxis of postoperative deep venous thrombosis. Acta Chir Scand 1986; 152: 593-6.
    PubMedSearch in Google Scholar
  • 38 Planes A, Vochelle N, Mazas F, Mansat C, Zucman J, Landais A, Pascariello JC, Weill D, Butel J. Prevention of postoperative venous thrombosis: A randomized trial comparing unfractionated heparin with low molecular weight heparin in patients undergoing total hip replacement. Thromb Haemost 1988; 60: 407-10.
    Thieme ConnectPubMedSearch in Google Scholar
  • 39 Samama M, Bernard P, Bonnardot JP, Combe-Tamzali A, Lanson Y, Tissot E. Low molecular weight heparin compared with unfractionated heparin in prevention of postoperative thrombosis. Br J Surg 1988; 75: 128-31.
    CrossrefPubMedSearch in Google Scholar
  • 40 Sasahara AA, Koppenhagen K, Häring R, Welzel D, Wolf H. Low molecular weight heparin plus dihydroergotamine for prophylaxis of postoperative deep vein thrombosis. Br J Surg 1986; 73: 697-700.
    CrossrefPubMedSearch in Google Scholar
  • 41 Weber U, Koppenhagen K, Mälzer L, Matthes M. Unterschiedliche Wirksamkeit von zwei Präparaten mit niedermolekularen Heparinen bei Patienten mit elektivem Hüftgelenksersatz. Langenbecks Arch Chir 1991; 376: 147-51.
    PubMedSearch in Google Scholar
  • 42 Welzel D, Stringer MD, Hedges AR, Parker CJ, Kakkar VV, Ward VP, Sanderson RM, Cooper D, Kakkar S. Fixed combinations of low molecular weight or unfractionated heparin plus dihydroergotamine in the prevention of postoperative deep vein thrombosis. Thromb Haemost 1989; 62 (Abstr): 523.
    PubMedSearch in Google Scholar