[Treatment and prophylaxis of deep venous thrombosis with low molecular weight heparins (meta-analysis of clinical trials)]

Abstract

Deep-vein thrombosis is a relevant problem of today's medicine, because the risk to fall ill with this pathology is 2-5%; it increases in senior age. Direct and indirect acting thrombin inhibitors are used for treatment and prevention of vein thrombosis. Though great efficiency and safety of new anticoagulants (especially factor Xa inhibitors) were proven in clinical studies, unfractionated heparin and low molecular weight heparins are still most widely used in clinical practice. Low molecular weight heparins are obtained by depolymerizing heparin: its molecular weight is being decreased to 3-7 kDa, or 18-20 monosaccharides. Low molecular weight heparins strongly inhibit Xa coagulation factor and faintly - IIa, that's why their anti-Xa/anti-IIa proportion is >1 (unfractionated heparin = 1); enoxaparine and nadroparine show up the highest proportion. The low weight of these heparins determines good pharmacodynamic characteristics: excellent assimilation from subcutaneous layer, long circulation in plasma, infrequent side effects. Due to these characteristics they are convenient, safe and economically worth using (used by subcutaneous injections, prescribed only 1-2 times per day, coagulation control not required, possibility for patient to be treated at home); therefore low molecular weight heparins are more and more often used in treatment of deep-vein thrombosis and also in primary and secondary prevention. They are one of the most efficacious contemporary anticoagulants, which allow to decrease the deep-vein thrombosis treatment and prevention costs. This article presents literature review about low molecular weight heparins, their appliance in treatment and prophylaxis of deep-vein thrombosis.