Glycosaminoglycans in prophylaxis against venous thromboembolism.

Abstract

Ever since the 1930’s when Jorpes and Crafoord in Stockholm started using heparin to prevent postoperative venous thromboembolism, a tremendous amount of basic as well as clinical research has been performed on heparin and related compounds to create effective means of prophylaxis, which at the same time is safe. This research is continuously progressing, several new substances being evaluated in animal experiments but so far without clinical documentation. Today it is a rather common view that it is possible to reduce the risk of developing deep vein thrombosis (DVT) and its acute consequence in the form of fatal pulmonary embolism (FPE) by various prophylactic modalities. Which risk factor definitions to use to determine the volume of patients needing prophylaxis is, however, still a matter for discussion. Heparin is world wide the dominating prophylactic method (Bergqvist, 1990) but in recent years low molecular weight heparins have gained a widespread interest and several of them are approved for clinical use by European health authorities. This chapter will review heparin and other glycosaminoglycans as pharmacological agents to diminish the frequency of postoperative venous thromboembolism. The discussion is mostly based on overviews, compilations and metaanalyses as the number of individual studies by now is very large, especially concerning low dose heparin and low molecular weight heparin and there is little meaning in this context to repeat the results of every single study. The original studies are all randomized and controlled with objective diagnostic methods for the detection of DVT. Relative risk reduction has been calculated according to Gent and Roberts (1986).KeywordsRelative Risk ReductionDermatan SulfateFatal Pulmonary EmbolismPatient Deep Vein ThrombosisPostoperative Venous ThromboembolismThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.