Background: Low Molecular Weight HEPARINs (LMWH) are an important new class of antithrombotic agents. They differ from UNFRACTIONATED HEPARIN (UFH) in having relatively more anti-Xa activity, and greater bioavailability at low doses. Larger half life allows us to use it as a single dose therapy. Beneficial effect on dyslipidemia of hemodialysis also was noted. In this research we evaluated the efficacy of LMW HEPARIN, fragmin, on Partial Thromboplastin Time (PTT) during hemodialysis anticoagulation in comparison with UFH to recognize the rate of disturbance on PTT and its effect on dialysis adequacy.Subject and methods: This research was done in two steps, first with commercial HEPARIN, on 30 patients, by controlling PTT before, at first half an hour and at the end of dialysis session (three sample). At second step with fragmin and on 35 patients, sampling were the same. Also dialysis adequacy was measured by Urea Reduction Rate (URR) formula, and compared with dialysis adequacy of previous session. The desired URR is over 65%, so we divided the patients into two groups of over 65% and below 65% and then we analysed the datas.Result: Analysing the datas showed that at first half and hour of hemodialysis the result of PTT disturbance with low-molecular weight HEPARIN was better (better anticoagulation), but at the end of dialysis there were no differences between two methods of anticoagulation. No significant association determined by the chi-square test.Conclusion: Comparing the dialysis adequacy with fragmin and UNFRACTIONATED HEPARIN showed no difference and as a result, fragmin can induce an equal dialysis adequacy by inducing an adequate anticoagulation.

Background: In spite of using anticoagulant drugs such as UNFRACTIONATED HEPARIN (UFH) and low molecular weight HEPARIN (LMWH) in the treatment of acute ischemic stroke, the efficacy of them has not been documented. Regarding to the frequent administration of these drugs, the evaluation of efficacy, advantages, and hazard of them is much important.Methods: We reviewed articles about this type of treatment including randomized clinical trials, meta-analyses, original articles, systematic reviews and review articles published in MEDLINE and EMBASE during 1997-2003.Results: In the short- and long- term follow up, UFH and LMWH don't result in considerable decreasing mortality, progression of stroke and early relapse risk. They don't result in considerable improvement in clinical and functional status of patients. In spite of considerable decreasing of deep vein thrombosis (DVT) and pulmonary emboli (PE) by administration of UFH and LMWH, it is established that they increase risk of intra- or hemorrhage. There is no valid document that immediate administration of anticoagulants (particularly intravenous and high dose) has helpful outcome. Conclusion: UFH and LMWH are not recommended in the majority of cases with stroke particularly during the first 24-48 hours of attach. Subcutaneous administration of UFH and LMWH is helpful in preventing DVT and PE, while they increase risk of systemic and intracranial hemorrhages. Immediate treatment is not recommended in any type of cerebrovascular accident (CVA).

Introduction: Administration of UNFRACTIONATEDHEPARIN (UFH) is associated with rising of serum potassium, particularly in patients with renal failure.As an anticoagulant during hemodialysis, it is not yet clear whether Low Molecular Weight HEPARIN (LMWH) could reduce the risk of hyperkalemia in chronic hemodialysis patients.Methods: We performed a randomized case-control study at Shahid Faghihi hemodialysis center. A total of 40 patients with at least 6 months duration on hemodialysis were selected and were randomized to case and control groups with 20 patients in each group. The case group received UFH 5000 unit intravenously (IV) and control group Enoxaparin 40 milligram IV, both as single bolus without any additional dosages, for intradialytic anticoagulation.Serum levels of potassium, BUN, and phosphate were measured at the beginning and after 4 weeks.Results: As rough indices of nutritional status and hemodialysis efficacy, there was no significant difference between two groups in terms of BUN and phosphate level, at the beginning and the end of the study. Of those receiving UFH and LMWH, 6 (30%) and 7 (35%) had diabetes mellitus, respectively (P=.500).The serum level of potassium decreased significantly after 4 weeks of Enoxaparin (4.5 ± 0.5 versus 4.3 ± 0.4, P=.001) while it remained unchanged in those receiving UFH (4.6 ± 0.6 versus 4.6 ± 0.5, P=.486). The reduction of serum potassium was also significant in diabetic patients receiving Enoxaparin (4.8 ± 0.5 versus 4.6 ± 0.6, P=.006), but not in UFH group with diabetes (4.8 ± 0.6 versus 4.7 ± 0.6, P=.876).Conclusions: For anticoagulation during hemodialysis, replacing UFH by LMWH can reduce serum potassium level in chronic hemodialysis patients.

Background: Despite the overwhelming progress that has been accomplished in the prevention of mortality due to cardiovascular disease, coronary artery disease (CAD) is the leading cause of death in the world.The aim of this study was to compare of the effects of enoxaparin versus UNFRACTIONATED HEPARIN (UFH) on major clinical events, including mortality, myocardial infarction (MI), and recurrent angina, as well as bleeding in patients with non ST elevation acute coronary syndrome (NSTEACS). We also studied the need for coronary angiography and revascularization (PCI or CABG) in these patients.Method: Two-hundred patients were enrolled in this study, 100 of whom received intravenous UFH (an initial bolus of 5000 U followed by continuous infusion of 1000 U/h) and 100 received enoxaparin subcutaneous injections of 1mg/kg twice daily for a minimum of 72 h. During their admission we recorded data regarding death, MI, recurrent angina, need for angiography and revascularization, and major and minor bleeding.Results: The incidence of recurrent angina, total mortality and the need for revascularization were significantly lower in patients receiving enoxaparin compared to those receiving UFH, at 17% vs. 39% (p=0.002), 0% vs. 3% (p=0.035), 14% vs. 33% (p=0.001), respectively. However, there was no significant difference regarding the incidence of MI, major bleeding and cardiac death between the two groups.Conclusions: This study showed that, in patients with NSTEACS, enoxaparin was superior to UFH regarding the prevention of major in-hospital clinical events, especially recurrent angina and the need for revascularization. We therefore recommend enoxaparin as an alternative antithrombotic agent to UFH in patients with NSTEACS.

BACKGROUND AND OBJECTIVE: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder that is associated with thrombosis in both arteries and veins as well as pregnancy-related complications. The aim of this study was to compare the relative efficacy and safety of low molecular weight HEPARIN (LMWH) with UNFRACTIONATED HEPARIN (UFH) in the treatment of pregnant women with a history of recurrent abortion secondary to antiphospholipid syndrome (APS).METHODS: In this prospective study, 83 women with a history of 3 or more consecutive spontaneous abortions before 10th weeks of pregnancy and positive antiphospholipid antibodies were received either UFH (5000 units, twice daily), or LMWH (enoxaparin 40 mg, once daily) as soon as pregnancy was diagnosed. Information regarding these women was obtained from comprehensive medical records system of Social Security Corporation, Qom, Iran. Then pregnancy outcome was compared in two groups.FINDINGS: Forty-two women in the LMWH group (95.5%) and 34 women in the UFH group (87.2%) delivered a viable infant (p>0.05). There were no significant differences in age and birth weight between the two groups. The mean±SD of apgar score in LMWH was 8.4±1.2 and in UFH was 7.7±1.2. Apgar score was higher in LMWH group (p<0.05) that was statistically significant.CONCLUSION: Both UFH and LMWH were effective in the treatment of pregnant women with a history of recurrent abortion secondary to APS. UFH was successfully used as an alternative to LMWH in the treatment of recurrent abortion secondary to APS.

Background: This study was designed to examine a unique and low dose use of intravenous enoxaparin in elective percutaneous coronary intervention (PCI) that would be applicable to an unselected population regardless of age, weight, and renal function. There is limited experience in anticoagulation using intravenous low-molecular-weight HEPARIN in PCI. Methods: A total of 100 consecutive patients undergoing elective PCI were treated with a single IV bolus of enoxaparin (0.5mg/kg) in group A of patients (n=50) or with UNFRACTIONATED HEPARIN in group B of patients (n=50). Sheaths were removed immediately after the procedure in patients treated with enoxaparin and some hours later in those treated with UNFRACTIONATED HEPARIN. Results: In group A, ACT was 124.6±9.3 before PCI and 149.2±17.1 after that (P<0.05). In group B, one patient (2.9%) developed groin hematoma. No deaths, MI, or urgent target vessel revascularization were reported.Conclusion: Low- dose (0.5 mg/kg) IV enoxaparin allows a target level of anticoagulation in patients undergoing PCI, appears to be safe and effective, allows immediate sheath removal, and does not require dose adjustment.