scholarly journals Comparison of Anti-factor Xa Levels in Female and Male Patients with Obesity After Enoxaparin Application for Thromboprophylaxis

2022 ◽  
Author(s):  
Jonas Wagner ◽  
Henrike Wruck ◽  
Anne Lautenbach ◽  
Philipp von Kroge ◽  
Stefan Wolter ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Factor Xa ◽  
Secondary Outcome ◽  
Bleeding Events ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Male Patients ◽  
Group 2 ◽  
Reasonable Choice ◽  
Complications After Bariatric Surgery

Abstract Purpose Venous thromboembolic events (VTEs) are common complications after bariatric surgery, and enoxaparin is commonly used to prevent VTEs. The risk for VTEs is sex-specific. Whether enoxaparin application results in similar anti-factor Xa activities (aFXa) in males and females with obesity remains to be determined. We investigated whether our dosage regimen of enoxaparin resulted in similar serum aFXa levels in female and male patients undergoing bariatric surgery. Materials and Methods We administered enoxaparin twice daily in patients undergoing bariatric surgery. Patients with a body mass index (BMI) > 60 kg/m2 (n = 11) received 60 mg enoxaparin (group 2), and patients with lower BMI (n = 86) received 40 mg per dose (group 1). Peak aFXa levels were measured 3 days after surgery. The primary outcome was the aFXa level. As a secondary outcome, we detected VTEs and major bleeding events and explored the possible influencing factors of aFXa. Results Women had higher aFXa than men, but after matching for anthropometric values, the two groups were similar (females: 0.17 ± 0.08 U/ml; males: 0.18 ± 0.08 U/ml). Linear regression revealed a moderate relationship between weight and aFXa levels. The 3-month follow-up was attended by 94.9%, at which one patient had pulmonary embolism. Conclusion Individual enoxaparin dosage regimens for men and women do not seem to be required. Weight-based dosing regimen seems to be a more reasonable choice. Graphical abstract

scholarly journals Secondary Prevention of Venous Thromboembolic Events in Patients With Active Cancer: Enoxaparin Alone Versus Initial Enoxaparin Followed by Warfarin for a 180-Day Period

2006 ◽  
Vol 12 (4) ◽  
pp. 389-396 ◽  
Author(s):  
Steven R. Deitcher ◽  
Craig M. Kessler ◽  
Geno Merli ◽  
James R. Rigas ◽  
Roger M. Lyons ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
International Normalized Ratio ◽  
Minor Bleeding ◽  
Thromboembolic Events ◽  
Bleeding Events ◽  
Daily Group ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Subcutaneous Enoxaparin ◽  
Group 2

This study evaluated enoxaparin alone versus initial enoxaparin followed by warfarin in secondary prevention of venous thromboembolic events in adults with active malignancy. Cancer patients (n = 122) with acute symptomatic venous thromboembolic events were randomly allocated to receive subcutaneous enoxaparin 1.0 mg/kg every 12 hours for 5 days, followed by 1.0 mg/kg daily (group 1a) or 1.5 mg/kg daily (group 1b) for 175 days, or subcutaneous enoxaparin 1.0 mg/kg every 12 hours for at least 5 days and until a stable international normalized ratio of 2 to 3 was achieved on oral warfarin begun on day 2 and continued to day 180 (group 2). There were no significant differences in major and minor bleeding rates between treatment groups. No bleeding events were intracranial or fatal. Enoxaparin treatment was feasible, generally well tolerated, and effective for a 180-day period in the secondary prevention of venous thromboembolic events in patients with active malignancy.

scholarly journals Vascular Complications in Patients with Hepatocellular Carcinoma Treated with Sorafenib

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2961 ◽  
Author(s):  
Katharina Pomej ◽  
Bernhard Scheiner ◽  
Dabin Park ◽  
David Bauer ◽  
Lorenz Balcar ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cardiovascular Risk ◽  
Treatment Option ◽  
Multivariable Analysis ◽  
Vascular Complications ◽  
Bleeding Complications ◽  
Bleeding Events ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

VEGF(R)-targeted therapies are associated with an increased risk of thromboembolism and bleeding, which might be pronounced in patients with increased cardiovascular risk. Nevertheless, sorafenib represents an important treatment option in patients with hepatocellular carcinoma (HCC). We retrospectively investigated the risk of arterial/venous thromboembolic and bleeding events in 252 patients treated with sorafenib for HCC between 05/2006 and 03/2020 at the Medical University of Vienna. Cardiovascular risk was assessed using Framingham score. Eight patients (3.2%) experienced 11 arterial/venous thromboembolic events. Only two patients (0.8%) developed arterial thromboembolism even though cardiovascular risk was low, intermediate, and high in 15 (8.7%), 104 (60%), and 54 (31.2%) of 173 assessable patients. Median overall survival (OS) was shorter in the high risk vs. low/intermediate risk group 7.4 (95% CI: 3.4–11.3) vs. 10.0 (95% CI: 6.8–13.2 months) and independently associated with OS in multivariable analysis HR: 1.53 (95% CI: 1.07–2.19; p = 0.019). Forty-eight (19%) patients experienced a bleeding, most commonly gastrointestinal bleeding (14%) followed by epistaxis (4.7%). Advanced liver dysfunction was not associated with an increased incidence of bleeding/venous thromboembolism. Sorafenib represents a safe treatment option even in patients with increased cardiovascular risk. Bleeding complications were comparable with previous reports, even though patients with more advanced liver disease were included.

scholarly journals The Impact of COVID-19 Disease on Platelets and Coagulation

Pathobiology ◽  
2020 ◽  
pp. 1-13 ◽  
Author(s):  
Geoffrey D. Wool ◽  
Jonathan L. Miller
Keyword(s):  
Degradation Products ◽  
Severe Bleeding ◽  
Bleeding Events ◽  
Current State ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Intravascular Coagulopathy ◽  
Vascular Beds ◽  
The Impact ◽  
D Dimer

Coronavirus disease 2019 (COVID-19) causes a spectrum of disease; some patients develop a severe proinflammatory state which can be associated with a unique coagulopathy and procoagulant endothelial phenotype. Initially, COVID-19 infection produces a prominent elevation of fibrinogen and D-dimer/fibrin(ogen) degradation products. This is associated with systemic hypercoagulability and frequent venous thromboembolic events. The degree of D-dimer elevation positively correlates with mortality in COVID-19 patients. COVID-19 also leads to arterial thrombotic events (including strokes and ischemic limbs) as well as microvascular thrombotic disorders (as frequently documented at autopsy in the pulmonary vascular beds). COVID-19 patients often have mild thrombocytopenia and appear to have increased platelet consumption, together with a corresponding increase in platelet production. Disseminated intravascular coagulopathy (DIC) and severe bleeding events are uncommon in COVID-19 patients. Here, we review the current state of knowledge of COVID-19 and hemostasis.

Peak and baseline concentrations of fondaparinux during prophylactic therapy

Phlebologie ◽  
2011 ◽  
Vol 40 (04) ◽  
pp. 187-194 ◽  
Author(s):  
R. Kanagendran ◽  
J. Scheuermann ◽  
H. Ackermann ◽  
R. Kaufmann ◽  
W.-H. Boehncke ◽  
...  
Keyword(s):  
Inverse Correlation ◽  
Life Time ◽  
High Rate ◽  
Secondary Outcome ◽  
Bleeding Events ◽  
Skin Reactions ◽  
Venous Thromboembolic Events ◽  
Baseline Concentrations ◽  
Allergic Skin ◽  
Baseline Levels

SummaryFondaparinux is widely approved for prophylaxis and treatment of venous thromboembolic events (VTE). However, its longer half-life time compared to heparins limits its peri-procedural use. Aim: To investigate 3h peak and 24h baseline concentrations of fondaparinux when administered for prophylaxis (1 x 2.5 mg qd). Secondary outcome measures: incidences of VTE, bleedings, HIT, allergic skin reactions, 30 days mortality. Patients, methods: Between 02/2010 and 03/2011, 3h peak and 24h baseline levels of fondaparinux were measured with a chromogenic anti-FXa method in 75 consecutive patients. Medical data were obtained from patients' records. Results: The 5% and 95% percentile of the 3h peak level were 0.20 μg/ml and 0.83 μg/ml (median: 0.53 μg/ml), and of the 24h baseline level 0.08 μg/ml and 0.53 μg/ml (median 0.21 μg/ml), respectively. An inverse correlation was found between fondaparinux levels and GFRs (rho=-0.617 (3h); rho=-0.648 (24h); p=0.01). Shorter (≤5 days) or longer (≥8 days) duration of prior fondaparinux exposure showed no significantly different 3h peak/24h baseline levels (p>0.6). One progressive thrombosis occurred but no major bleedings, HIT, allergic skin reactions or fatalities. Conclusions: After fondaparinux exposure, >75% of the patients still had relevant prophylactic 24h baseline levels. This did not coincide with a high rate of bleeding events. Due to the low patient number in this study undergoing surgery or interventions, it remains to be investigated whether or at which concentrations the bleeding risk is increased when baseline levels are within prophylactic ranges.

Ramucirumab (Ram) and durvalumab (Durva) treatment of metastatic non-small cell lung cancer (NSCLC), gastric/gastroesophageal junction (G/GEJ) adenocarcinoma, and hepatocellular carcinoma (HCC) following progression on systemic treatment(s).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 2528-2528 ◽  
Author(s):  
Yung-Jue Bang ◽  
Talia Golan ◽  
Chia-Chi Lin ◽  
Laetitia Dahan ◽  
Siqing Fu ◽  
...  
Keyword(s):  
Gastroesophageal Junction ◽  
Primary Objective ◽  
Bleeding Events ◽  
Venous Thromboembolic Events ◽  
Common Grade ◽  
Venous Thromboembolic ◽  
Previously Treated ◽  
Grade 3 ◽  
Ecog Ps ◽  
Tumor Biopsies

2528 Background: A Phase 1b study (NCT02572687) was conducted to examine the combined effects of Ram (anti VEGFR2) and Durva (anti PD-L1). Methods: Patients (pts) with previously-treated, advanced NSCLC (Cohort [CH] A), G/GEJ adenocarcinoma (CH B), HCC (CH C), ECOG PS 0-1, and no prior Ram or IO therapy, received Ram (10 mg/kg) + Durva (1125 mg) Q3W (CH A) or Ram (8 mg/kg) + Durva (750 mg) Q2W (CH B, C). Primary objective was to assess safety; efficacy was also examined. PD-L1 expression of tumor cells (TC) +/- immune cells (IC) in pretreatment tumor biopsies were assessed using SP263 immunohistochemistry. “High” PD-L1 is ≥25% TC for NSCLC and ≥25% TC or IC for G/GEJ, HCC. Results: CH A, B and C enrolled pts with ECOG PS 1 (%) of 43, 66, 68; and average of 2, 2, 1 prior regimens, respectively. The most common grade 3/4 treatment-emergent adverse events (AE) are hypertension (HTN) (14.3, 17.2, 17.9%), anemia (3.6, 24.1, 21.4%), and fatigue (10.7, 10.3, 10.7%). Grade 3/4 AEs of special interest ( > 5% total pts) for Ram: HTN, bleeding events (3.6, 10.3, 10.7%), Venous thromboembolic events (0, 10.3, 7.1%); for Durva: increase in lipase (10.7, 3.4, 10.6%) and AST (3.6, 3.4, 17.9 %). Data from CH B,C suggest a trend toward increased efficacy in pts with high PD-L1 expressing tumors. Conclusions: Ram + Durva generated no unexpected toxicities and demonstrated antitumor activity. Results in pts with high PD-L1 HCC and G/GEJ cancer warrant further evaluation. Clinical trial information: NCT02572687. [Table: see text]

scholarly journals Efficacy and safety of Xa factor antagonists in patients with nonvalvular atrial fibrillation

2021 ◽  
Vol 30 (2) ◽  
pp. 59-66
Author(s):  
V.N. Drozdovа ◽  
E.K. Kochetkovaа
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Reactions ◽  
Factor Xa ◽  
Current Data ◽  
Individual Characteristics ◽  
Thromboembolic Events ◽  
Efficacy And Safety ◽  
Nonvalvular Atrial Fibrillation ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Factor Xa antagonists are used increasingly frequently for prevention and treatment of venous thromboembolic events and for prevention of stroke and systemic emboli in patients with non-valvular atrial fibrillation. Individual characteristics of patient, a need in prolonged or life-long treatment, concomitant diseases, the use of other drugs interacting with anticoagulants increase the risk of side effects of anticoagulation. We analyzed the current data on the efficacy and safety of Xa factor antagonists, as well as the features of their use in the event of adverse reactions, particularly bleedings. The possibilities of monitoring the efficacy and safety of treatment with these drugs were evaluated.

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