Hirudin is one of the new synthetic antithrombin agents, which is most commonly used in patients with type II heparin-induced thrombocytopenia and in patients with hypersensitivity reactions to unfractionated heparin
as well as low-molecular-weight heparins.
The most commonly used anticoagulants in clinical practice are warfarin, unfractionated heparin
(UFH), and low molecular weight heparins (LMWH) (see Table 1).
To determine anti-Xa activity of unfractionated heparin
(expressed in IU/mL), we performed the Berichrom Heparin assay (Behring) in the same instrument.
Assess each patient for thromboembolism potential; use pneumatic compression, unfractionated heparin
, or low-molecular-weight heparin as indicated.
Both groups will receive open label enoxaparin or unfractionated heparin
for at least five days and up to 12 days, followed by double-blind warfarin or edoxaban 60 mg once-daily.
For women with high-risk mechanical heart valves, the guidelines cite some studies that have documented an "unacceptably high risk of maternal stroke, valve thrombosis, and death" when LMWH or unfractionated heparin
is substituted for warfarin.
1) The use of low-molecular-weight heparin (LMWH) is preferred to unfractionated heparin
(UFH) as it is associated with a lower risk of bleeding, osteoporosis, heparin-induced thrombocytopenia (HIT) and hypersensitivity reactions.
6) While evidence was insufficient to recommend 1 agent over another, both were found to significantly decrease the incidence of lower-extremity DVT over placebo (for unfractionated heparin
, relative risk [RR]=0.
Other notable updates to the guidelines include a suggestion to use a formal scoring system to assess patient risk and help guide the choice between the two management options; longer use of the antiplatelet drug clopidogrel (for up to 1 year in all patients); and a broadening of anticoagulant drug options to include two newer agents, fondaparinux and bivalirudin, in addition to the older drugs low-molecular-weight heparin and unfractionated heparin
3) Standard unfractionated heparin
(UFH) has been used for decades to support coronary artery bypass graft (CABG) surgery and PCI because it is effective, inexpensive, and reversible, although it has been replaced by LMWH in therapeutic circumstances where rapid reversal is not a consideration.