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Low molecular weight heparin and mechanical valve prostheses


Sang Thrombose Vaisseaux. Volume 19, Number 5, 261-7, Mai 2007, Mini-revue

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Author(s) : Philippe Meurin, Pierre Jean Esmieu-Fournel

Summary : Several recent observational studies have evaluated the use of low molecular weight heparin (LMWH) in patients with mechanical valve prostheses. This issue is particularly raised in three high risk situations : (i) the early post operative period, (ii) as a bridging therapy in patients on long term oral anticoagulants and (iii) during pregnancy. All these studies showed LMWH to be as efficient and safe as unfractionated heparin (UH). However, as all these studies are only surveys and there is no authorisation of the use of for LMWH in this particular setting, which raises medico-legal issues.Misuse of LMWH in this setting is the key issue given the easy of use of LMWH. It must not be forgotten that the platelet count must be regularly checked, that LMWH is contraindicated in patients with renal failure, and that in all these studies, LMWH was administered twice (not once) daily, and at a higher dose (100 IU/kg twice daily).

Keywords : low molecular weight heparin, unfractionated heparin, valve prostheses

 

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