Prednosti nizkomolekularnega heparina pred standardnim heparinom = Advantages of low-molecular-weight heparin in comparison with unfractionated heparin
Poredoš, Pavel
Standard - unfractionated heparin (UFH), that until now was used as the only drug in the treatment of acute thrombotic events, exhibits various disadvantages. The most important of these are: an ...unpredictable anticoagulanteffect that depends on binding of the drug to blood proteins, bleeding, thrombocytopenia and osteopenia. Low-molecular-weight heparin (LWMH)is produced by hydrolytic or enzymatic cleavage of UFH. Its anticoagulant effect is predominantly based on inactivation of factor Xa, but its effect on thrombin (IIa) is minimal. In comparison to UFH, pharmacokineticand related pharmacodynamic properties of LMWH are significantly different. LMWH binds to a much lesser extent to plasma proteins, endothelial cells and macrophages. Consequently, the anticoagulationresponse of LMWH is more predictable and is closely related to the dosage of the drug. Further, clearance of LMWH is diminished and its half-life prolonged; therefore, a therapeutic effect is achieved by once-dailyadministration of the drug. Side effects such as thrombocytopenia and osteoporosis appear in patients treated with LMWH less often than in thosetreated with UFH. Recent studies show that LMWH is a safe and effective drug for prevention and treatment of venous thromboembolism, acute pulmonary embolism and for early treatment of patients with stable angina. Therefore, weconclude that LMWH is at least as effective and safe as UFH.
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