Coronary Disease — Low Molecular Weight Heparin vs Unfractionated Heparin at Cardiac Surgery
Citation(s)
Burger W, Chemnitius JM, Kneissl GD, Rücker G Low-dose aspirin for secondary cardiovascular prevention - cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation - review and meta-analysis. J Intern Med. 2005 May;257(5):399-414. Review.
Clark SC, Vitale N, Zacharias J, Forty J Effect of low molecular weight heparin (fragmin) on bleeding after cardiac surgery. Ann Thorac Surg. 2000 Mar;69(3):762-4; discussion 764-5.
Ferraris VA, Ferraris SP 1988: Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting. Updated in 1995. Ann Thorac Surg. 1995 Apr;59(4):1036-7.
Hirsh J, Raschke R Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):188S-203S.
Jones HU, Muhlestein JB, Jones KW, Bair TL, Lavasani F, Sohrevardi M, Horne BD, Doty D, Lappe DL Preoperative use of enoxaparin compared with unfractionated heparin increases the incidence of re-exploration for postoperative bleeding after open-heart surgery in patients who present with an acute coronary syndrome: clinical investigation and reports. Circulation. 2002 Sep 24;106(12 Suppl 1):I19-22.
Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg. 2004 Aug;78(2):527-34; discussion 534. Review.
Prandoni P Heparins and venous thromboembolism: current practice and future directions. Thromb Haemost. 2001 Jul;86(1):488-98. Review.
Sethi GK, Copeland JG, Goldman S, Moritz T, Zadina K, Henderson WG Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting. Department of Veterans Affairs Cooperative Study on Antiplatelet Therapy. J Am Coll Cardiol. 1990 Jan;15(1):15-20.
Interventional studies are often prospective and are specifically tailored to evaluate direct impacts of treatment or preventive measures on disease.
Observational studies are often retrospective and are used to assess potential causation in exposure-outcome relationships and therefore influence preventive methods.
Expanded access is a means by which manufacturers make investigational new drugs available, under certain circumstances, to treat a patient(s) with a serious disease or condition who cannot participate in a controlled clinical trial.
Clinical trials are conducted in a series of steps, called phases - each phase is designed to answer a separate research question.
Phase 1: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
Phase 2: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.
Phase 3: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
Phase 4: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.
