[Practical use of low molecular weight heparins in angiology]

The recent development of low molecular weight heparins (LMWH), obtained by the depolymerization of standard non-fractioned heparin (NFH), considerably simplifies the course of anticoagulant treatments. They now allow effectively and safely dealing with the risks of thrombosis, both in hospital and at the patient's home. Their effectiveness for both the prevention and the treatment of thromboembolic accidents has been proved by many clinical trials. In comparison to standard heparin, the LMWHs still have a high anti-Xa activity, but their anti-IIa action is much reduced, thus preserving their antithrombotic power while reducing the hemorrhagic risks. Owing to their better bioavailability and longer half-life, they allow using in priority the subcutaneous route, reducing the frequency of the injections and simplifying surveillance, without impairing the effectiveness of the treatment. The prevention of thrombosis with LMWHs requires one daily subcutaneous dose. The control of the anti-Xa activity is not necessary for the doses used. Prior to initiating a curative treatment, it is essential to confirm the existence of thrombosis. When the diagnosis is definitive, the three LMWHs currently known are used after reconversion, at a dosage of 100 IU/kg/12 hrs. The anti-Xa activity, in samples taken 3 to 4 hours after the injection, must be maintained between 0.5 and 1 IU anti-Xa/ml. It is prudent to control the platelet level at D5 and D10, although thrombocytopenia is exceptional. The changeover treatment with antivitamins K (AVK), which is essential to prevent the recurrence of venous thrombosis, is initiated very early (2nd or 3rd day).(ABSTRACT TRUNCATED AT 250 WORDS)