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[Fractionated heparins. The clinician's viewpoint]
1Service d'Urgence et de Réanimation, C.H.R. de Nancy.
Currently the rapid development of low molecular weight heparins offers the following questions: assessment of such heparins in prophylaxis of thrombo-embolic disease in surgical or medical procedures; comparison with prior, double-blinded, randomized methods of reference like Kakkar's in general, abdominal, genital, neoplastic and especially orthopedic surgery; search of the most effective standardized dose with no reliable biologic data (usual assays are rather complex and concern more activity than efficacy); respect of absolute contraindication but usefulness of these treatments in relative contraindication of high molecular weight heparin; duration, regimen and outcome measures. The most important standpoint concerns the standardized dosage with few or no reliable biologic tests; thus these dosages cannot be adjusted to coagulation assays.
Currently the rapid development of low molecular weight heparins offers the following questions: assessment of such heparins in prophylaxis of thrombo-embolic disease in surgical or medical procedures; comparison with prior, double-blinded, randomized methods of reference like Kakkar's in general, abdominal, genital, neoplastic and especially orthopedic surgery; search of the most effective standardized dose with no reliable biologic data (usual assays are rather complex and concern more activity than efficacy); respect of absolute contraindication but usefulness of these treatments in relative contraindication of high molecular weight heparin; duration, regimen and outcome measures. The most important standpoint concerns the standardized dosage with few or no reliable biologic tests; thus these dosages cannot be adjusted to coagulation assays.