Low-molecular-weight heparinoids

Publications Committee for the Trial of Org 10172 in Acute Stroke Treatment (TOAST) Investigators. Low molecular weight heparinoid ORG 10172 (Danaparoid) and outcome after acute ischemic stroke. JAMA 1998 279 1265-1272. 

J Biller, EW Massey, JR Marler, HP Adams, JN Davis, A Bruno, RA Henriksen, RJ Linhardt, LB Goldstein, M Alberts, CT Kisker, GJ Toffol, CS Greenberg, KG Banwart, C Bertels, DW Beck, M Walker, HN Maganani. A dose escalation study or org 10172 (low-molecular-weight heparinoid) in stroke. Neurology 39 262-265, 1989. 

Stiekema JCJ, de Boer A, Danhof M, Kroon C, Brockmans AW, van Dinther TG, Voerman J, Breimer DD. Interaction of the combined medication with the new low-molecular-weight heparinoid Lomoparan (Org 10172) and acenocoumarol. Haemostasis (1990) 20,136-46,... 

The multiple effects of UFH on the coagulation cascade may increase its potential to cause hemorrhage." Anticoagulants with more specific sites of action may confer a better safety profile. Two such anticoagulants are low-molecular-weight heparin (LMWH) and heparinoids. 

For patients with Acute Ischemic Stroke they recommend clinicians not to use full-dose anticoagulation with IV, subcutaneous, or low-molecular-weight heparins or heparinoids (grade 2B evidence). 

There is no recommendation for general use of heparin, low-molecular-weight heparin, or heparinoids after ischemic stroke (Level of Evidence I). 

Gordon DL, Linhardt R, Adams HP. Low molecular-weight heparins and heparinoids and their use in acute or progressing ischemic stroke. Clin Neuropharmacol 1990 13 522-543. 

Bath P, Iddenden R, Bath F. Low-molecular-weight heparins and heparinoids in acute ischemic stroke, a meta-analysis of randomised controlled trials. Stroke 2000 31 1770-1778. 

Sandercock P, Counsell C, Stobbs SL. Low-molecular-weight heparins or Heparinoids versus standard Unfractionated heparin for acute ischemic stroke (Review). The Cochrane Collaboration 2006. 

Low-molecular-weight heparins and heparinoids are not recommended in the treatment of acute ischemic stroke.11 A meta-analysis was performed using data from 10 randomized controlled trials.19 A non-significant decrease in combined death and disability and a non-significant increase in case fatality and hemorrhage were seen. A reduction in venous thromboembolic events was observed in acute stroke patients however, there was also an increase in extracranial bleeding. 

The use of full-dose unff actionated heparin in the acute stroke period has not been proven to positively affect stroke outcome, and it significantly increases the risk of intracerebral hemorrhage. Trials of low-molecular-weight heparins and heparinoids have been largely negative and do not support their routine use in stroke patients. 

When neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture is employed, patients who are anticoagulated or scheduled to be anticoagulated with low molecular weight heparins (LMWHs) or heparinoids for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma, which can result in long-term or permanent paralysis. 

DL Gordan, RJ Linhardt, HP Adams. Low-molecular-weight heparin and heparinoids in cerebrovascular disease. Clin Neuropharmacol 13 522-543, 1990. 

Low molecular weight heparins, heparin fractions, or other sulfated polysaccharides still have the same or a similar complexity as heparin and are, therefore, not regarded as heparinoid mimetics only compounds with one defined carbohydrate backbone serving as a template for sulfates will be discussed in this context. 

Kikta MJ, Keller MR Humphrey PV, et al. Can low molecular weight heparins and heparinoids be safely given to patients with heparin-induced thrombocytopenia syndrome Surgery 1993 114 705-710. 

Billett HH Direct and indirect antithrombins. Heparins, low molecular weight heparins, heparinoids,... 

Some therapeutic agents can be chemically incorporated into the backbone of the polymer, or can be attached as a pendant group. Therapeutic agents include, salicylic acid, nitric oxide, PEG, heparin, low molecular weight heparins, heparinoids and hyaluronic acid. 

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