			Home About us Contact

Low Molecular Weight Heparin (low + molecular_weight_heparin)

Distribution by Scientific Domains

Medical Sciences	85%

Selected Abstracts

ANTICOAGULANT EFFECTS OF LOW MOLECULAR WEIGHT HEPARIN IN HEALTHY CATS

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue S1 2004
AJ Alwood
Objectives: 1) Validate a chromogenic assay to measure Factor Xa inhibitory activity (anti-Xa activity) in normal feline plasma and following administration of low molecular weight heparins and unfractionated heparin. 2) Compare the effects of two commercially available low molecular weight heparins (LMWH), unfractionated heparin (UFH), and placebo on TEG, anti-Xa activity, PT/aPTT, PCV/TS and platelet count in healthy cats. Methods: Our study consisted of two phases: 1) the evaluation of a commercially available chromogenic anti-Xa assay (Rotachrom Heparin, Diagnostic Stago) for use in cats, and 2) the evaluation of hemostatic effects of LMWH in healthy cats. Phase 1: The anti-Xa assay was validated for use in cats using feline plasma and serial dilutions of the plasma spiked with UFH, enoxaparin, and dalteparin. Phase 2: Five healthy cats were included in a randomized Latin Squares model crossover-design to compare the effects of UFH and LMWH in cats. The cats then received one of the following subcutaneously: 1) 250 IU/kg UFH QID, 2) 100 IU/kg dalteparin BID, 3) 1 mg/kg enoxaparin BID, 4) 0.25 mL/kg 0.9% saline (placebo) QID. A minimum of a two-week washout period separated each treatment period. Each drug was administered for 5 days. Blood samples were obtained to measure anti-Xa, TEG, PT/aPTT, platelet count, and PCV/TS on Days 1, 3, 5, and 6 of each treatment cycle. Samples were collected at time 0 on each sample day for all parameters and on select days at hours 4, 8, and 12 for anti-Xa and TEG. Results: Preliminary results using the validated anti-Xa assay (from the first part of this study) demonstrate that LMWH treatment results in peak anti-Xa activity at the 4-hour sampling time that returned toward baseline by 8 hours (in 5/6 cats treated with LMWH thus far). Similar anticoagulant effects were noted in the TEG parameters of cats receiving LMWH (i.e., peak effects were noted at 4 hours). Analysis of current data by linear regression identifies a relationship between anti-Xa measurements and TEG parameters for cats treated with all heparin therapies (p<0.001). A similar relationship exists between anti-Xa and aPTT. Conclusions: Preliminary results suggest an anticoagulant effect of LMWH in cats that may not be uniform across individuals. Anti-Xa activity or TEG may provide useful tools for monitoring LMWH. [source]

Long-term Management of an Implantable Left Ventricular Assist Device Using Low Molecular Weight Heparin and Antiplatelet Therapy: A Possible Alternative to Oral Anticoagulants

ARTIFICIAL ORGANS, Issue 5 2007
Bart Meuris
Abstract:, Between January 2004 and December 2005, out of 14 patients with decompensated heart failure who were treated with an INCOR left ventricular assist device (Berlin Heart AG, Berlin, Germany), 10 patients were kept on a long-term regime of low molecular weight heparin (LMWH) and antiplatelet therapy. The treatment objective was bridge-to-transplantation. All patients received LMWH in therapeutic doses according to body weight, in combination with daily aspirin 160 mg, clopidogrel 75 mg, and three times dipyridamole 75 mg. Effectiveness of the low molecular weight regime was monitored through measurement of antifactor Xa activity (base and peak levels). Antiplatelet therapy was monitored through weekly platelet function tests. Within this group of 10 patients, six patients successfully received transplants and four patients died, the latest death after 405 days of INCOR support. Causes of death were sepsis, intestinal hemorrhage, acute right ventricular failure, and one major stroke. Long-term management of INCOR assist devices using a combination of LMWH and antiplatelet therapy is feasible. This treatment strategy can serve as an alternative to oral anticoagulants. [source]

Neonatal cerebral ischaemia with elevated maternal and infant anticardiolipin antibodies

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2000
Gabriel Chow MBBChir BSc DCH MRCPI MRCPCH
A baby girl born by elective lower segment caesarean section was found to have left-sided focal seizures at 48 hours after birth. Her mother had previously had a neonatal death at 26 weeks' gestation and another child born at 32 weeks' gestation had a congenital right hemiplegia with a left middle cerebral artery infarct on CT scan. The mother had raised anticardiolipin IgG antibodies at the time of delivery of her second child, with no thrombotic symptoms. Therefore, during this pregnancy, she had been treated with low molecular weight heparin and aspirin. The baby's mother had raised IgG and IgM anticardiolipin antibodies and the baby had IgG anticardiolipin antibodies at the upper range of normal 4 days after delivery. The seizures were controlled with phenobarbitone and phenytoin. CT and MRI scans showed evidence of cerebral ischaemia. A repeat MRI scan at 4 months of age was normal, anticonvulsants were discontinued, and her latest neurological examination at 5 months was normal. [source]

Relationship between antithrombotic activities of fucans and their structure

DRUG DEVELOPMENT RESEARCH, Issue 4 2000
Catherine Boisson-Vidal
Abstract A low molecular weight fucan fraction extracted from the brown seaweed Ascophyllum nodosum was previously shown to exhibit dose-related venous antithrombotic activity with an ED80 of about 20 mg/kg, 2 h after a single subcutaneous injection HCII (Colliec et al. [1991] Thromb Res 64:143,154; Mauray et al. [1995] Thromb Haemast 74:1280,1285). Its activity was comparable to that of a low molecular weight heparin (Dalteparin®). This fucan fraction is one of several, with a range of different structure parameters, prepared by degradation of the whole native fucan. These low molecular weight fractions were compared using a Wessler stasis thrombosis model in rabbits and by determination of their in vitro and ex vivo anticoagulant activities. Intravenous administrations of these fractions reduced thrombosis in a dose-dependent manner. Partial removal of sulfate groups and/or partial degradation lead to a significant decrease in their anticoagulant and antithrombotic activities. The integrity of the regular pattern of sulphation of the fucoidan is necessary for antithrombotic activity. Drug Dev. Res. 51:216,224, 2000. © 2001 Wiley-Liss, Inc. [source]

A pilot study on systemic thrombolysis followed by low molecular weight heparin in ischemic stroke

EUROPEAN JOURNAL OF NEUROLOGY, Issue 10 2006
R. Mikulík
Low molecular weight heparin (LMWH) administered immediately after intravenous thrombolysis (IT) may reduce the risk of arterial re-occlusion. Its benefit, however, may not outweigh the risk of intracranial hemorrhage (ICH). We sought preliminary data regarding safety of this combined therapy in an open-label, non-randomized study. The patients received either a standard anticoagulation (AC) starting 24 h after IT (the standard AC group) or AC with 2850 IU of nadroparin, given every 12 h immediately after IT (the early AC group). Sixty patients received IT treatment: 25 in the standard AC group [mean age 66, median National Institutes of Health Stroke Scale (NIHSS) 13, 64% men] and 35 in the early AC group (mean age 68, median NIHSS 13, 69% men). Symptomatic ICH occurred in one patient (4%) in the standard AC group and three patients (8.6%) in the early AC group [odds ratio (OR) 1.8; 95%CI 0.2,12.8]. At 3 months, nine patients in the standard AC group (36%) and 16 patients in the early AC group (45.7%) achieved a modified Rankin scale 0 or 1 (OR 1.2; 95%CI 0.5,3.2). Our study suggests that treatment with LMWH could be associated with higher odds of ICH, although it may not necessarily lead to a worse outcome. This justifies larger clinical trials. [source]

Pulmonary embolism in a patient with severe congenital deficiency for factor V during treatment with fresh frozen plasma

HAEMOPHILIA, Issue 3 2005
A. García-Noblejas
Summary., Thrombosis is a rare complication in patients with congenital clotting factor deficiencies. In most cases, it is related to inherited procoagulant factors, use of central venous catheters or administration of coagulation factor concentrates. There are only a few case reports about thrombotic events during treatment with fresh frozen plasma (FFP). We report the case of a patient with homozygous inherited factor V deficiency, who developed a pulmonary embolism at a time of treatment with methylene blue treated FFP (MBFFP). The patient had only two other factors predisposing to thrombosis and both were acquired: obesity and bed rest. He started anticoagulant treatment with low molecular weight heparin (LMWH) while the deficient factors were replaced with MBFFP. After 8 days of treatment the patient developed a severe respiratory insufficiency. Pulmonary haemorrhage was considered among the differential diagnosis and LMWH was stopped. An inferior vena cava filter was placed without any further thrombotic complications. To our knowledge, there are no reports about patients with clotting factor deficiencies who developed a thrombotic event during treatment with MBFFP. [source]

Randomized, placebo-controlled trial of low molecular weight heparin in active ulcerative colitis

INFLAMMATORY BOWEL DISEASES, Issue 6 2007
M.A. de Bièvre MD
Abstract Background: In several open and 1 controlled trial, unfractionated heparin was effective in the treatment of active ulcerative colitis (UC). Low molecular weight heparin (LMWH) had a similar effect in several open studies. Methods: We studied the efficacy, safety, and tolerability of LMWH in mild to moderately active UC in a randomized, double-blind, placebo-controlled trial. In all, 29 patients with a mild or moderate recurrence of UC during salicylate treatment were randomized to receive either reviparin 3,436 IU (n = 15) subcutaneously twice daily or placebo (n = 14). The study period was 8 weeks. Treatment was discontinued if there was no improvement at 4 weeks or at any disease progression. Primary outcome measure was clinical improvement at 8 weeks measured by the Colitis Activity Index (CAI) and the Clinical Symptoms Grading (CSG, based on the CAI). Endoscopic and histologic grading and quality of life as measured by the Inflammatory Bowel Disease Questionnaire (IBDQ) were secondary outcome measures. Patients were closely monitored for adverse events. Results: Twenty of 29 patients finished the 8-week treatment period (reviparin versus placebo: 11 versus 9; P = 0.70). There was no difference in CSG, CAI, endoscopic and histologic grading, or IBDQ. Treatment was well tolerated and no serious adverse events occurred. Conclusion: In this study, treatment with LMWH showed no significant clinical advantage compared to placebo in mild to moderately active UC. (Inflamm Bowel Dis 2007) [source]

Delayed Presentation of Low Molecular Weight Heparin Treatment Failure in a Patient With Mitral Valve Prosthesis

JOURNAL OF CARDIAC SURGERY, Issue 1 2007
Sotiris C. Stamou M.D.
The patient did not develop the embolic complication from the thrombosis until almost 4 months after the bridging sequence with low molecular weight heparin. The patient underwent thrombectomy of the mitral valve. At least 16 similar cases with mechanical valve prostheses and treatment failure of low molecular weight heparin have been reported. [source]

Periprocedural Anticoagulation for Atrial Fibrillation Ablation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2008
M. EYMAN MORTADA M.D.
Background: Catheter ablation for atrial fibrillation (AF) can increase risk of left atrial (LA) thrombi and stroke. Optimal periprocedural anticoagulation has not been determined. Objective: We report the role of administering warfarin and aspirin without low molecular weight heparin in patients undergoing AF ablation. Methods: A total of 207 patients underwent ablation for AF. Transesophageal echocardiography (TEE) guided transseptal puncture and ruled out clot in the LA. After first puncture, the sheath was flushed with heparin (5,000 Units/mL). After second puncture, a bolus of 80 units/kg of heparin was given, followed by an infusion to maintain activated clotting time (ACT) around 300,350 seconds. Warfarin was stopped and aspirin was started (325 mg/day) 3 days preprocedure. Warfarin was restarted on the day of the procedure. Both medications were continued for 6 weeks postablation. Warfarin was continued for 6 months in patients with prior history of persistent or recurrent AF. Thirty-seven patients who showed smoke in the LA on TEE were given low molecular weight heparin postprocedure until international normalized ratio (INR) was therapeutic. Results: Thirty-two patients had persistent and 175 had paroxysmal AF; 87 were cardioverted during ablation. Two patients had transient ischemic attack (TIA) on the sixth and eighth days, respectively, following ablation, with complete recovery. Both had subtherapeutic INRs. Conclusion: In patients without demonstrable clot or smoke in the LA, starting aspirin 3 days prior and warfarin immediately post-radiofrequency ablation, without low molecular weight heparin, with meticulous anticoagulation during the procedure, appears to be a safe mode of anticoagulation. [source]

Inhalable liposomes of low molecular weight heparin for the treatment of venous thromboembolism

JOURNAL OF PHARMACEUTICAL SCIENCES, Issue 11 2010
Shuhua Bai
Abstract This study tests the feasibility of inhalable pegylated liposomal formulations of low molecular weight heparin (LMWH) for treatment of two clinical manifestations of vascular thromboembolism: deep vein thrombosis (DVT) and pulmonary embolism (PE). Conventional distearoyl- sn -glycero-3-phosphoethanolamine (DSPE) and long-circulating pegylated (DSPE,PEG-2000 and DSPE,PEG-5000) liposomes were prepared by hydration method. Formulations were evaluated for particle size, entrapment efficiency, stability, pulmonary absorption, anticoagulant, and thrombolytic effects in rats. Pulmonary absorption was monitored by measuring plasma antifactor Xa activity; anticoagulant and thrombolytic effects were studied by measuring reduction in thrombus weight and amount of dissolved radioactive clot in the blood, respectively. Pegylated liposomal were smaller and showed greater drug entrapment efficiency than conventional liposomes. All formulations produced an increase in pulmonary absorption and circulation time of LMWH upon first dosing. Three repeated dosings of conventional liposomes resulted in decreased half-life and bioavailability; no changes in these parameters were observed with pegylated liposomes. PEG-2000 liposomes were effective in reducing thrombus weight when administered every 48,h over 8 days. In terms of thrombolytic effects and dosing frequency, PEG-2000 liposomes administered via the pulmonary route at a dose of 100,U/kg were as effective as 50,U/kg LMWH administered subcutaneously. This paper suggests that inhalable pegylated liposomes of LMWH could be a potential noninvasive approach for DVT and PE treatment. © 2010 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 99:4554,4564, 2010 [source]

Nasal administration of low molecular weight heparin

JOURNAL OF PHARMACEUTICAL SCIENCES, Issue 7 2002
John Arnold
Abstract The main objective of this study was to determine if the systemic absorption of therapeutic amounts of heparin was possible following nasal administration. Sprague-Dawley rats received nosedrops containing a low molecular weight heparin (LMWH) or unfractionated heparin (UFH) formulated with or without tetradecylmaltoside (TDM). TDM is a nonionic surfactant that has been previously shown to be a potent absorption enhancer in studies with peptide drugs. LMWH/UFH absorption was determined by measuring plasma anti-Factor Xa activity. The inclusion of 0.25% TDM in nasal formulations containing LMWH resulted in a significant increase in the Cmax and area under the curve (AUC) of anti-Factor Xa activity when compared to LMWH formulated in saline alone. The addition of TDM to a nasal formulation containing UFH resulted in a much smaller increase in the Cmax and the AUC of anti-Factor Xa activity. The absolute bioavailability of LMWH was increased from 4.0,±,0.4% in the absence of TDM to 19,±,0.3% in the presence of TDM. The reversibility of the absorption enhancing effect of TDM was studied by applying LMWH nasally 60 or 120 min after the enhancer. The effect of TDM on the nasal epithelia appeared to be rapidly reversible. In conclusion, nasal delivery of LMWH, but not UFH, was successful when an absorption enhancer was included to increase nasal permeability. © 2002 Wiley-Liss Inc. and the American Pharmaceutical Association J Pharm Sci 91:1707,1714, 2002 [source]

Long-duration therapy with low molecular weight heparin in patients with antiphospholipid antibody syndrome resistant to warfarin therapy

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 9 2005
F. DENTALI
[source]

Coagulation effects of low molecular weight heparin compared with heparin in dogs considered to be at risk for clinically significant venous thrombosis

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2009
Kielyn C. Scott DVM
Abstract Objective , Compare the effects of 3 anticoagulation protocols on anti-factor Xa activity (AXa). Design , Prospective, randomized, double-blind study. Setting , University veterinary teaching hospital. Animals , Eighteen dogs considered to be at risk for venous thrombosis. Interventions , Each dog was randomly assigned to 1 of the following 3 groups (n=6/group) and was treated for 24 hours: low-dose heparin (LDH), high-dose heparin (HDH), and dalteparin (DP). Dogs in the LDH group received a constant rate infusion (CRI) of unfractionated heparin (UFH) at 300 U/kg/d, the HDH group received a bolus of 100 U/kg of UFH IV, then a CRI of 900 U/kg/day, and the DP group received 100 U/kg DP SC at 0, 12, and 24 hours. Measurements and Main Results , A total of 54 samples for activated partial thromboplastin time (aPTT) and AXa assays were collected at 0, 4, and 28 hours. Six samples had an AXa >0.1 U/mL, 5 of those were from the HDH group at hour 4. Two samples from the HDH group at hour 4 had a prolonged aPTT (93 and 200 seconds) and the highest AXa (0.6 and 1.0 U/mL, respectively). Four additional dogs in the HDH group did not complete the study due to hemorrhage; none of the dogs completing the study showed signs of hemorrhage. Conclusions: Neither DP nor LDH increased AXa to values considered therapeutic in humans (0.5,1 and 0.35,0.75 U/mL, respectively), and both protocols appear to be inadequate to increase AXa in dogs with clinical illness. HDH increased AXa to this range in 2 of 6 dogs, but had unpredictable effects on aPTT and resulted in hemorrhage in some dogs. [source]

An Analysis of Early Renal Transplant Protocol Biopsies , the High Incidence of Subclinical Tubulitis

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2001
Ron Shapiro
To investigate the possibility that we have been underestimating the true incidence of acute rejection, we began to perform protocol biopsies after kidney transplantation. This analysis looks at the one-week biopsies. Between March 1 and October 1, 1999, 100 adult patients undergoing cadaveric kidney or kidney/pancreas transplantation, or living donor kidney transplantation, underwent 277 biopsies. We focused on the subset of biopsies in patients without delayed graft function (DGF) and with stable or improving renal function, who underwent a biopsy 8.2 ± 2.6 d (range 3,18 d) after transplantation (n = 28). Six (21%) patients with no DGF and with stable or improving renal function had borderline histopathology, and 7 (25%) had acute tubulitis on the one-week biopsy. Of the 277 kidney biopsies, there was one (0.4%) serious hemorrhagic complication, in a patient receiving low molecular weight heparin; she ultimately recovered and has normal renal function. Her biopsy showed Banff 1B tubulitis. In patients with stable or improving renal allograft function early after transplantation, subclinical tubulitis may be present in a substantial number of patients. This suggests that the true incidence of rejection may be higher than is clinically appreciated. [source]

The effect of low molecular weight heparin (enoxaparin) on enhanced coagulation induced by crystalloid haemodilution,

ANAESTHESIA, Issue 10 2010
R. L. Llewellyn
Summary The purpose of this study was to establish whether a low molecular weight heparin (enoxaparin) attenuated or abolished the enhanced coagulation induced by crystalloid fluid therapy. Twenty young, healthy male volunteers were injected subcutaneously with either enoxaparin 40 mg or saline on two separate occasions one week apart, in a randomised, blinded study. Twelve hours later, a blood sample was taken for thrombelastography analysis and haematocrit. Saline 14 ml.kg,1 was then infused over thirty minutes and thrombelastography and haematocrit measurements repeated. There was a significant post-dilutional difference in the alpha angle (p = 0.002) and k -time (p = 0.001) between the two groups. There was a trend towards reduced shortening of r -time in the enoxaparin group compared to the saline control (p = 0.18). The findings suggest that enoxaparin diminished acceleration of clot formation due to haemodilution. [source]

Thrombelastometer and low molecular weight heparin

ANAESTHESIA, Issue 8 2009
J. Harenberg
No abstract is available for this article. [source]

An audit of the use of low molecular weight heparin and epidural anaesthesia

ANAESTHESIA, Issue 3 2002
G. A. Matthews
No abstract is available for this article. [source]

Long-term Management of an Implantable Left Ventricular Assist Device Using Low Molecular Weight Heparin and Antiplatelet Therapy: A Possible Alternative to Oral Anticoagulants

Aplasia cutis congenita and low molecular weight heparin

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2005
Saba Sharif
No abstract is available for this article. [source]

Methylenetetrahydrofolate reductase polymorphism associated with moderate hyperhomocysteinaemia in a patient with livedo vasculopathy: treatment with vitamin supplementation and low molecular weight heparin

BRITISH JOURNAL OF DERMATOLOGY, Issue 4 2006
J. Rampf
No abstract is available for this article. [source]

A risk score for the management of pregnant women with increased risk of venous thromboembolism: a multicentre prospective study

BRITISH JOURNAL OF HAEMATOLOGY, Issue 6 2009
Yesim Dargaud
Summary Patients with thrombophilia and/or a history of venous thromboembolism (VTE) exhibit a high risk of thrombosis during pregnancy. The present multicentre study prospectively assessed a prophylaxis strategy, based on a risk score, in pregnancies with increased risk of VTE. Among 286 patients included in the study, 183 had a personal history of VTE (63·98%) and 191 patients (66·8%) had a thrombophilia marker. Eighty nine (46·6%) thrombophilic women had a personal history of VTE. Patients were assigned to one of three prophylaxis strategies according to the risk scoring system. In postpartum, all patients received low molecular weight heparin (LMWH) prophylaxis for at least 6 weeks. In antepartum, LMWH prophylaxis was prescribed to 61·8% of patients with high risk of VTE. Among them, 37·7% were treated in the third trimester only and 24·1% were treated throughout pregnancy. In this cohort, one antepartum-related VTE (0·35%) and two postpartum-related VTE (0·7%) occurred. No case of pulmonary embolism was observed during the study period. The rate of serious bleeding was 0·35%. There was no evidence of heparin-induced thrombocytopenia or osteoporosis. The use of a risk score may provide a rational decision process to implement safe and effective antepartum thromboprophylaxis in pregnant women at high risk of VTE. [source]

Letter 2: meta-analysis of trials comparing ximelagatran with low molecular weight heparin for prevention of venous thromboembolism after major orthopaedic surgery (Br J Surg 2005; 92: 1335-1344)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2006
M. J. D. Tangelder
No abstract is available for this article. [source]

Letter 3: Meta-analysis of trials comparing ximelagatran with low molecular weight heparin for prevention of venous thromboembolism after major orthopaedic surgery (Br J Surg 2005; 92: 1335-1344)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2006
G. Agnelli
No abstract is available for this article. [source]

Effect of low molecular weight heparin (dalteparin) and fondaparinux (Arixtra®) on human osteoblasts in vitro,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2005
A. E. Handschin
Background: The prolonged administration of heparin for prevention and treatment of venous thromboembolism has been associated with a risk of heparin-induced osteoporosis. Fondaparinux is a new antithrombotic drug that specifically inhibits factor Xa. Because of the known interactions of other antithrombotic agents with bone remodelling, the effects of fondaparinux on human osteoblasts were analysed in vitro. Methods: Primary human osteoblast cell cultures were incubated with either the low molecular weight heparin dalteparin at concentrations of 30, 300 and 900 µg/ml or with fondaparinux at concentrations of 25, 50, 100, 150, 200 and 250 µg/ml. Cellular proliferation rate and protein synthesis were measured. Expression of genes encoding osteocalcin, collagen type I and alkaline phosphatase was examined by reverse transcriptase,polymerase chain reaction. Results: Incubation with dalteparin led to a significant, dose-dependent inhibition of osteoblast proliferation, inhibition of protein synthesis, and inhibited expression of phenotype markers (osteocalcin and alkaline phosphatase genes) after 3 and 7 days. No inhibitory effects were observed in the fondaparinux-treated cells. Conclusion: Fondaparinux did not inhibit osteoblast proliferation in vitro and may reduce the risk of heparin-induced osteoporosis associated with long-term heparin administration. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Predictors of anticoagulation in hospice patients with lung cancer,

CANCER, Issue 20 2010
Holly M. Holmes MD
Abstract BACKGROUND: Guidelines recommend lifelong anticoagulation in patients with cancer and a history of thromboembolism, but the use of anticoagulation in hospice has not been described. A retrospective study of medication data was conducted to determine patterns of anticoagulant use and predictors of type of anticoagulant prescribed for hospice patients with lung cancer. METHODS: Medication data were evaluated for 16,896 hospice patients with lung cancer in 2006 to determine patient and hospice characteristics that predicted anticoagulant prescription. Independent predictors of warfarin versus low molecular weight heparin (LMWH) prescription were identified using a logistic regression model. RESULTS: One of every 11 patients was prescribed an anticoagulant, most commonly warfarin. Compared with patients prescribed LMWH, patients prescribed warfarin were older (71.6 vs 65.8 years, P<.001), were more likely white (81.2% vs 74.3%, P = .03), had a longer stay in hospice (median 21 days vs 17 days, P = .001), and were more likely to have ,3 comorbid illnesses (37.5% vs 25.0%, P<.001). The strongest independent predictor of type of anticoagulant prescribed was geographic region, with hospices in the Northeast more likely to prescribe LMWH. CONCLUSIONS: Anticoagulant use is prevalent in patients with lung cancer enrolled in hospice. This study highlights the need to understand the benefits and risks of anticoagulation at the end of life. Cancer 2010. © 2010 American Cancer Society. [source]

Macroscopic thrombus formation on angioplasty equipment following antithrombin therapy with enoxaparin

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2007
A. Dana
Abstract Increasing evidence suggests that treatment with the low molecular weight heparin enoxaparin during percutaneous coronary intervention (PCI) is safe and effective. We evaluated the incidence and consequences of periprocedural macroscopic thrombus formation on PCI equipment following antithrombin therapy with enoxaparin. Between April 2003 and December 2004, all patients undergoing cardiac catheterization following antithrombin therapy with enoxaparin were evaluated. All patients had blood sampled at the onset of procedure for subsequent measurement of anti-factor-Xa levels. Of the 4,504 patients who underwent PCI during this period, in 122 (3%) the procedure was performed within 8 hr of treatment with subcutaneous enoxaparin and no additional unfractionated heparin (UFH) was used periprocedurally. Of these, macroscopic thrombus was observed on PCI equipment in 6 patients (5%) necessitating withdrawal of all catheters and wires. All patients had therapeutic anti-factor-Xa levels at the time of PCI, and had been treated with double antiplatelet therapy with aspirin and clopidogrel. No periprocedural thrombus was observed in 356 patients who were ,12 hr of the last dose of enoxaparin and received UFH at the time of PCI. Following observation of thrombus, additional anticoagulation with UFH resulted in significant epistaxis in one patient. In another patient, the procedure was complicated by distal coronary embolization. Percutaneous coronary intervention following antithrombin therapy with enoxaparin is associated with a 5% incidence of macroscopic thrombus formation on PCI equipment. The necessity for subsequent exchange of all equipment and/or the need for additional anticoagulation may have disastrous consequences for the patient. Our findings suggest that the safety of antithrombin therapy with low molecular weight heparin during PCI requires further evaluation. © 2007 Wiley-Liss, Inc. [source]

The challenge of ST-segment elevation myocardial infarction

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2007
M. Cohen
Summary Background/introduction:, Acute coronary syndromes (ACS) represent a spectrum of ischaemic myocardial events that share a similar pathophysiology. ST-segment elevation myocardial infarction (STEMI), the most severe form of ACS short of sudden cardiac death, is a significant public health problem with an estimated 500,000 STEMI events every year in the United States. Treatment/therapy:, The mortality and morbidity associated with STEMI is significant. Early reperfusion therapy is the most important aspect of the treatment of STEMI. There are two main methods of reperfusion therapy: percutaneous coronary intervention (PCI) and fibrinolytic therapy, with PCI being the preferred method. In addition to standard reperfusion therapy, antithrombotics (unfractionated heparin and low molecular weight heparins) and antiplatelet agents (aspirin, clopidogrel and glycoprotein IIb/IIIa inhibitors) are critical adjuncts, effective in the treatment of acute STEMI. Conclusions:, The survival of patients with STEMI depends on rapid diagnosis and optimal early treatment. Guidelines for the management of patients with STEMI recommend PCI within 90 min of presentation and that fibrinolytics are administered within 30 min. However, only a fraction of patients undergo reperfusion within the recommended time. Improvements in protocols for identifying STEMI cases are therefore required to allow reperfusion therapy to be initiated sooner. Secondary prevention is another important aspect of STEMI management, and patients should be encouraged to adopt strategies that reduce the risk of subsequent ischaemic events. [source]

Choice of low molecular weight heparins

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 3 2003
C. Cimminiello
No abstract is available for this article. [source]

ANTICOAGULANT EFFECTS OF LOW MOLECULAR WEIGHT HEPARIN IN HEALTHY CATS

Investigation of Direct Toxic and Teratogenic Effects of Anticoagulants on Rat Embryonic Development Using In Vitro Culture Method and Genotoxicity Assay

ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 2 2006
I. I. Uysal
Summary Heparin and low molecular weight heparins (LMWHs) are used to reduce the incidence of venous thromboembolism in pregnancy. Although, these agents have been shown to be safe when used during pregnancy, the studies about direct toxic and teratogenic effects of these drugs on embryonic development are limited. In this study, the effects of heparin and LMWHs on rat embryonic development were investigated by using in vitro embryo culture and micronucleus (MN) assay methods. Rat embryos were cultured in vitro in the presence of different concentrations of heparin (5,40 IU/ml), dalteparin (2.5,20 IU/ml), enoxaparin (25,100 ,g/ml) and nadroparin (1,4 IU/ml). Effects of anticoagulants on embryonic developmental parameters were compared and embryos were evaluated for the presence of any malformations. After culturing the embryos, classic MN assay was performed. Anticoagulants significantly decreased all growth and developmental parameters dose-dependently. Dalteparin and enoxaparin were found to cause more developmental toxicity than heparin and nadroparin. Along with haematoma in general, heparin and nadroparin caused maxillary deformity, situs inversus and oedema most frequently, while neural tube defects were observed with dalteparin and enoxaparin. All agents also significantly induced MN formation in rat embryonic blood cells. These results indicate the possible genotoxic effects of anticoagulant agents on the developing rat embryo when applied directly. [source]