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Search Results: 1 - 10 of 19611 matches for " low molecular weight heparin "
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Abdominal Skin Necrosis after Enoxaparin Treatment  [PDF]
Haddad Maruan, Nierenberg Gabriel, Falah Mazen, Rosenberg Nahum
Open Journal of Clinical Diagnostics (OJCD) , 2014, DOI: 10.4236/ojcd.2014.41010
Abstract: Subcutaneous low molecular weight heparin (LMWH) injection is a prophylactic treatment for deep vein thrombosis after surgery in lower limb before the patient is fully ambulated. This treatment is usually safe. One of the major and rare complications of the LMWH injection is thrombocytopenia, which is usually self-limiting. We present a rare case of patient with thrombocytopenia, induced by subcutaneous injection of LMWH (enoxaparin) that was complicated with a large hematoma at the injection site with subsequential skin necrosis, sepsis with fatal outcome. We would like to emphasize this rare complication of the common prophylactic treatment by LMWH in order to pursue this diagnosis when similar cutaneous manifestation might appear in patients who receive prophylactic treatment with LMWH.
Early Postoperative Anticoagulation by Enoxaparin after Mechanical Aortic Valve Replacement  [PDF]
Younes Moutakiallah, Mehdi Bamous, Roland Henaine, Jacques Robin, Jean Fran?ois Obadia, Jean Ninet
World Journal of Cardiovascular Surgery (WJCS) , 2014, DOI: 10.4236/wjcs.2014.47017

Background: The use of low molecular weight heparin for early anticoagulation after mechanical aortic valve replacement is still a matter of debate even more that the early postoperative phase is associated with maximum of thrombo-embolic and bleeding risks. The objective of this study is to verify the efficacy and the safety of low molecular weight heparin for the early anticoagulation after mechanical aortic valve replacement. Methods and Results: It is a prospective study conducted over 6 months and interested 40 consecutive patients (32 male and 8 female) with a mean age 53.83 ± 16.93 years (19-75 years) who underwent a mechanical aortic valve replacement and received enoxaparin as bridging therapy between continuous unfractionated heparin and fully effective vitamin K antagonist therapy. There was no in-hospital death and no in-hospital thromboembolic events. We report 2 major bleeding events (5%). Conclusion: The use of low molecular weight heparin should be an alternative to explore for early anticoagulation after valve heart surgery and the results of our study must be verified by large randomized studies before drawing any hasty conclusions.

Heparin and other anticoagulants in amniotic fluid embolism (AFE): Literature review and concept of the therapy  [PDF]
Mieczys?aw Uszyński, Waldemar Uszyński
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.37106

Aim: The objective of this study is to review all the reported outcomes of heparin application in amniotic fluid embolism (AFE) so far and to find out why, when and how heparin or other anticoagulants should be used in AFE. Material and methods: We searched Medline (from 1969 to 2011), using two key words: 1) amniotic fluid embolism; 2) amniotic fluid embolism and heparin. The search for the former produced 1127 replies, of which 208 were case reports of AFE. In response to the other key word, there were 94 articles. We looked through all the articles, selecting those relevant for our study. Results: In the years 1969-2011, 208 AFE cases were reported. Heparin (unfractionated heparin) or low molecular weight heparin (LMWH) was applied in 20 cases (9.6%), being the main drug in 11 cases (5.3%) and in 6 cases as a component of spectacular treatment of AFE (surgical treatment and extracorporal membrane oxygenation). In one of these cases anithrombin (AT) with LMWH was used. In one patient heparin therapy was considered to be unsuccessful and hence recombinant plasminogen activator (rt-PA) was instituted. All the patients survived. Conclusions: 1) The attempts to use heparin in AFE could be defined as promising, although the number of treated patients is too small for conclusion; 2) The postulate to use heparin at the very onset of AFE (a bolus of 10,000 U followed by monitored intravenous infusion) has serious justification: one of the pathways of AFE is the target for heparin (coagulation pathway).

The Safety and Feasibility of Low-Molecular-Weight He-parin Prophylaxis in Major Abdominal Surgery Combined with Neuraxial Anesthesia  [PDF]
Bogdan Protyniak, Michael C. Meadows, H. Rae Pak, Ronald S. Chamberlain
Surgical Science (SS) , 2012, DOI: 10.4236/ss.2012.34034
Abstract: Background: Global guidelines for venous thromboembolism (VTE) prophylaxis of patients undergoing major surgery are well established. However, their applicability and safety in patients receiving neuraxial anesthesia is unproven. We sought to evaluate the safety and feasibility of chemical VTE prophylaxis in a prospective group of patients undergoing major foregut procedures under a combination of epidural and general anesthesia. Methods: A prospective database of all patients undergoing major foregut surgery from 2004-2009 was maintained and analyzed. Epidural catheters were placed pre-operatively and used for post-operative analgesia for three days in all patients. Factors evaluated included age, ethnicity, sex, length of stay, duration of epidural placement, complications of epidural placement and post-operative management, and VTE events. A uniform protocol was followed regarding the timing of low-molecular-weight heparin (LMWH) administration with epidural catheter insertion/removal. Results: A total of 237 patients formed the study group. The mean age was 57 years (range, 19 - 88) among 121 (51.1%) women and 65 years (range, 20 - 95) among 116 (48.9%) men. One hundred and sixty-six patients were Caucasian (70%), 37 Black (15.6%), 15 Hispanic (6.3%), 12 Asian/Pacific (5.1%), and 7 other (3%). All epidural catheters were removed on the third post-operative day. There were a total of five VTE (2.1%) events postoperatively. No peri-operative or post-operative epidural catheter associated complications occurred. Conclusions: Concomitant epidural catheterization and LMWH anticoagulation is safe and feasible in major abdominal surgery patients, including those undergoing major hepatic resection. Guidelines for VTE prophylaxis and LMWH administration in the setting of neuraxial anesthesia are well established and applicable to this unique patient population.
Peripartum pulmonary embolism: Anesthetic and surgical considerations  [PDF]
Nissar Shaikh, Firdous Ummunnisa, Naseera Aboobacker, Mustafa Gazali, Ousama Kokash
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.31A030

Pregnancy and peripartum period leads to Virchow’s triad (hypercoagulability, venous stasis and vascular injury) thereby increasing the risk of thromboembolism by many folds in these patients. Accurate diagnosis of peripartum pulmonary embolism is pertinent for reducing morbidity and mortality. Accurate diagnosis is also vital for avoiding the adverse effects of unwanted anticoagulation in pregnant mother and fetus in a patient wrongly diagnosed with this condition. Computerized tomographic pulmonary angiography has a high specificity and sensitivity in comparison to ventilation/perfusion scan for diagnosis of peripartum pulmonary embolism (PPE). It has a lower fetal radiation exposure and aids in arriving at an alternative diagnosis, if PPE is absent. Low molecular weight heparin is the medication of choice in the treatment of peripartum pulmonary embolism. Thrombolysis is considered in patients with massive PPE and hemodynamic instability, refractory hypoxia or right ventricular dysfunction. Regional anesthesia/analgesia can be given safely in these patients. We report two cases of PPE and review the anesthetic and surgical consideration.

Impact of Pharmaceutical Care on Self-Administration of Outpatient Low-Molecular-Weight Heparin Therapy  [PDF]
Seraina Mengiardi, Dimitrios A. Tsakiris, Viviane Molnar, Urs Kohlhaas-Styk, Michael Mittag, Stephan Kraehenbuehl, Kurt E. Hersberger
Pharmacology & Pharmacy (PP) , 2014, DOI: 10.4236/pp.2014.54045

Outpatient subcutaneous (s.c.) therapies are becoming more and more common in the treatment of different diseases. The effectiveness of community-pharmacy-based interventions in preventing problems that arise during s.c. self-injections of low-molecular-weight heparins (LMWH) is unknown. Our objective was to provide a standard operating procedure (SOP) for community pharmacists and to compare pharmaceutical vs. standard care in both clinical and daily life settings. We hypothesized that: pharmaceutical care results in improved adherence, safety, and satisfaction, and in fewer complications; the interventions used are feasible in daily life; and the results achieved in clinical and daily life settings are comparable. In the clinical setting (randomized controlled trial), patients were recruited sequentially in hospital wards; in the daily life setting (quasi-experimental design with a comparison group), recruitment took place in community pharmacies by pharmacists and trained master students during their internship. Interventions were offered according to patient needs. Data were collected by means of a monitored self-injection at home and structured questionnaire-based telephone interviews at the beginning and the end of the LMWH treatment. The main outcome measures were: scores to assess patient’s skills; syringe count to assess adherence; and frequency, effectiveness, and patient’s assessment of received interventions. The results show a median age of the 139 patients of 54 years. Interventions resulted in improved application quality (p < 0.01) and knowledge (p = 0.03). Oral instructions were pivotal for improving patients’ application quality. We found no significant score differences between the intervention groups in the clinical and daily life settings. Patients’ baseline skills were high, with the lowest score being 0.86 (score range ?2.00 to +2.00). Adherence rate was high (95.8%). In conclusion, our SOP for pharmacist interventions was of good quality, adequate, appreciated, and feasible in daily life. Patients are capable of managing s.c. injection therapies if adequate assistance is provided.

Incidence and Clinical Characteristics of Deep Vein Thrombosis (DVT) after Total Knee Arthroplasty (TKA) with DVT Chemoprophylaxis  [PDF]
Yong Sung Won, Mihyeong Kim, Kang Woong Jun, Woo Seok Nam, Sanghyun Ahn, Jeong-Kye Hwang, Sang-Dong Kim, Sun-Cheol Park, Sang Seob Yun, Won-Chul Lee, Jang-Sang Park, Jang Yong Kim
World Journal of Cardiovascular Diseases (WJCD) , 2014, DOI: 10.4236/wjcd.2014.411064
Abstract: Objective: Deep vein thrombosis (DVT) after total knee arthroplasty (TKA) is very common and leading cause of death due to this procedure. The objective of this study was to investigate the incidence and clinical characteristics of DVT after TKA with DVT chemoprophylaxis. Methods: This is a prospective cohort study in single institution. The patients received postoperative DVT chemoprophylaxis (low molecular weight heparin (LMWH) or Fondaparinux), followed by duplex ultrasonography to check for DVT 1 - 2 weeks after TKA. The clinical characteristics were summarized and analysed by chi-square test and regression analysis. Results: Five hundred and thirty four patients were enrolled from January 2007 to December 2010. DVT chemoprophylaxis was administered in 524 (98.1%) of the 534 patients. DVT occurred in 9 subjects (1.69%); 8 subjects had DVT in the leg, and 1 subject had a pulmonary embolism. Among them, asymptomatic DVT was observed in 5 patients (0.94%). Univariate analysis showed that surgical methods (revision, P = 0.0007), body mass index (BMI) (>25, P = 0.0028), low platelet count (less than 150 × 103, P = 0.0219), time in the intensive care unit (ICU) (P < 0.0001), no administration of prophylactic LMWH (P = 0.0392), and a history of DVT (P < 0.0001) were significant risk factors of DVT. Conclusions: The incidence of DVT was 1.69% after TKA with prophylactic antithrombotic therapy. Revision surgery, BMI, low platelet count, time in ICU, absence of prophylactic LMWH and history of DVT were significant risk factors of DVT.
Hasbún H.,Jorge; Conte L.,Guillermo;
Revista chilena de obstetricia y ginecología , 2003, DOI: 10.4067/S0717-75262003000600002
Abstract: detection of inherited thrombophilia in patients with recient thrombosis and evaluation of secondary profilaxis with low molecular weight heparin in the next gestation, was the proposal of this study in an observational prospective design. patients and methods: eleven patients with recent thrombosis sent for specialized control were studied for thrombophilia antithrombin iii deficiency, protein s deficiency, factor v leyden, methylentetrahydrofolate reductase mutation genc677t, hiperhomocysteinemia, protrombin g20210a mutation and antiphospholipid syndrome (anticardiolipin antibodies and lupus anticoagulant) plasmatic determinations of coagulation factors. during the next pregnancy, they were treated with dalteparine 2500-5000 u each day during gestation and two month after delivery, with strict clinical, ultrasound and hemostatic controls. results: thrombophilia was proved in all cases. eight cases with isolated form: three protein s deficiency, two protein c deficiency, two factorv leyden and one case of hypehomocysteinemia. three patients had a combined form: one with protrombin g20210a mutation + def protein c + mutation gen c677t and two cases with factor v leyden + mutation gen c677t. there were eleven healthy and term pregnancy without obstetrical or hemostatic complications and three espontaneous abortion. we discuss clinical events, the trombotic risk and we wake considerations about the detection and meaning of treatment. in conclusion, the detection of thrombophilias is very important in high risk women and dalteparine is safe in thrombosis prophilaxis during pregnancy
Estudio espa?ol sobre anticoagulación en hemodiálisis
Herrero-Calvo,José A.; González-Parra,Emilio; Pérez-García,Rafael; Tornero-Molina,Fernando; ,;
Nefrología (Madrid) , 2012,
Abstract: objectives: this study's objectives were to determine which anticoagulation methods are commonly used in patients who are undergoing haemodialysis (hd) in spain, on what criteria do they depend, and the consequences arising from their use. material and method: ours was a cross-sectional study based on two types of surveys: a "hd centre survey" and a "patient survey". the first survey was answered by 87 adult hd units serving a total of 6093 patients, as well as 2 paediatric units. among these units, 48.3% were part of the public health system and the remaining 51.7% units were part of the private health system. the patient survey analysed 758 patients who were chosen at random from among the aforementioned 78 hd units. results: a) hd centre survey: the majority of adult hd units (n=61, 70.2%) used both kinds of heparin, 19 of them (21.8%) only used lmwh and 7 of them (8%) only used ufh. the most frequently applied criteria for the use of lmwh were medical indications (83.3% of hd units) and ease of administration (29.5%). the most frequently used methods for adjusting the dosage were clotting of the circuit (88.2% of units), bleeding of the vascular access after disconnection (75.3%), and patient weight (57.6%). b) patient survey: the distribution of the types of heparin used was: ufh: 44.1%, lmwh: 51.5%, and dialysis without heparin in 4.4% of patients. lmwh was more frequently used in public medical centres (64.2% of patients) than in private medical centres (46.1%) (p<.001). lmwh was more frequently used in on-line haemodiafiltration (hf) than in high-flux hd (p<.001). antiplatelet agents were given to 45.5% of patients, oral anticoagulants to 18.4% of patients, and both to 5% of patients. additionally, 4.4% of patients had suffered bleeding complications during the previous week, and 1.9% of patients suffered thrombotic complications. bleeding complications were more frequent in patients with oral anticoagulants (p=.001), although there was no association betwee
Estudo experimental comparativo da eficácia antitrombótica da heparina convencional e da heparina de baixo peso molecular
Silveira, Pierre Galvagni;Galego, Gilberto do Nascimento;d?Acampora, Armando José;Bittencourt, Agamenon;Kestering, Darlan;Philippi, Fernanda Fiorese;Rizzatti, Juliana;
Acta Cirurgica Brasileira , 2001, DOI: 10.1590/S0102-86502001000400003
Abstract: a prospective randomized blind trial was performed, comparing the antithrombotic efficacy (reduction of weigth thrombi) of two heparines with low molecular weight and unfractionated calcium heparine. it was used two differents models of experimental venous thrombosis: in the first group, a combination of endothelial injury and flow reduction, was used to induce jugular vein thrombosis in new zealand rabbits, 30 with etanolamine, and other 30 with glucose 50%. in the second group, venous stasis was used to induce cava vein thrombosis in 30 female wistar rats. no significant differences on reduction of thrombus weigth were found on both groups.there was no relationship betwen thrombotic agents and experimental thrombosis model. etanolamin induced thrombosis more significantly in group i.
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