A new plastic collection tube made of polyethylene terephtalate is suitable for monitoring traditional anticoagulant therapy (oral anticoagulant, unfractionated heparin, and low molecular weight heparin)

2007 ◽  
Vol 119 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Pierre Toulon ◽  
Nadine Ajzenberg ◽  
Motalib Smahi ◽  
Marie-Claude Guillin
Keyword(s):  
Molecular Weight ◽  
Unfractionated Heparin ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Polyethylene Terephtalate ◽  
Collection Tube

Bridging with enoxaparin using a half-therapeutic dose regimen: safety and efficacy

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 243-248 ◽  
Author(s):  
Klamroth ◽  
Gottstein ◽  
Essers ◽  
Landgraf
Keyword(s):  
Molecular Weight ◽  
Anticoagulant Therapy ◽  
Therapeutic Dose ◽  
Oral Anticoagulant ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulant Therapy ◽  
Major Surgery ◽  
Low Molecular Weight ◽  
Severe Bleeding ◽  
Thromboembolic Risk

Background: Low molecular weight heparin is widely used during the interruption of long-term oral anticoagulation in patients undergoing surgery. The optimal dose is still a matter of debate. The 8th ACCP Guidelines primarily recommend therapeutic-dose or low-dose low molecular weight heparin after stratification of the thromboembolic risk. We investigated the efficacy and safety of a standardized bridging therapy with enoxaparin in a half-therapeutic dose in patients with a target INR of 2,0 to 3,0. Patients and methods: In our prospective registry we studied 198 consecutive patients receiving oral anticoagulant therapy with phenprocuomon and a planned surgery. Phenprocoumon was stopped 7 days before surgery and after reaching an INR less than 2,0 all patients received enoxaparin in a half-therapeutic dose (1 × 1 mg / kg body weight (bw)/day) until the day before surgery. Enoxaparin was continued with the same dose split into 2 × 0,5 mg / kg bw / day after the procedure. Phenprocoumon was resumed within day 1 to 14 after surgery depending on the bleeding risk as determined by the surgeon. All patients were followed up for 28 days after surgery. Results: Major surgery was performed in 148 patients (75 %). 175 patients (88 % of the total) had an intermediate thromboembolic risk. On average, enoxaparin was administered for 19,5 days. One patient (0,5 %) experienced arterial thrombosis after surgery, and one patient (0,5 %) required a second surgical intervention due to severe bleeding. Conclusions: In patients receiving oral anticoagulant therapy with a target INR of 2,0-3,0 and at an intermediate risk of thromboembolic events who require interruption of oral anticoagulant therapy a half therapeutic dose of enoxaparin seems to be safe and effective for bridging.

scholarly journals Anticoagulant therapy in patients with acute coronary syndrome and COVID-19

2021 ◽  
Author(s):  
Ю.Н. Панина ◽  
В.И. Вишневский
Keyword(s):  
Myocardial Infarction ◽  
Molecular Weight ◽  
Acute Coronary Syndrome ◽  
Unfractionated Heparin ◽  
Anticoagulant Therapy ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

По мере того как пандемия COVID-19 продолжает разворачиваться, растет и уровень понимания этиопатогенеза, диагностики и лечения данного заболевания. На сегодняшний день становится ясным, что инфекция, вызванная SARS-CoV-2, предрасполагает к состоянию гиперкоагуляции с некоторыми тромботическими событиями, включая острый коронарный синдром. Однако несмотря на то, что пандемия началась более года назад, неопределенность в отношении антикоагулянтной терапии у пациентов с COVID-19 продолжает преобладать. Учитывая, что в настоящее время нет стандартизированного подхода к антикоагулянтной терапии у пациентов с острым коронарным синдромом и COVID-19, нами был проведен обзор научной литературы по данной проблеме. В результате исследования было выявлено, что тактика ведения пациентов с острым коронарным синдромом и COVID-19 в целом не отличается от стандартно принятой. Однако следует уделять особое внимание лекарственным взаимодействиям между антитромбоцитарными препаратами, антикоагулянтами и терапией COVID-19. Также мы отметили, что помимо антикоагулянтных и противовоспалительных свойств гепарины обладают прямым противовирусным эффектом. Все пациенты с инфарктом миокарда с подъемом сегмента ST должны получать стандартную медикаментозную терапию, которая включает нефракционированный гепарин. У пациентов с инфарктом миокарда без подъема сегмента ST с ранней инвазивной стратегией рекомендуется использовать нефракционированный гепарин вместо низкомолекулярного гепарина в качестве антикоагулянта выбора. При этом использование у пациентов с инфарктом миокарда без подъема сегмента ST и COVID-19 низкомолекулярного гепарина предпочтительнее, чем нефракционированного гепарина. As the COVID-19 pandemic continues to unfold, the level of understanding of the etiopathogenesis, diagnosis and treatment of this disease is also growing. To date, it is becoming clear that infection caused by SARS-CoV-2 is a predisposition to a state of hypercoagulation with some thrombotic events, including acute coronary syndrome. However, despite the fact that the pandemic began 1 year ago, uncertainty about anticoagulant therapy in patients with COVID-19 continues to prevail. Given that there is currently no standardized approach to anticoagulation in patients with ACS and COVID-19, we conducted a review of the scientific literature on this problem. As a result of the study, it was found that the management tactics of patients with ACS and COVID-19 generally do not differ from the standard accepted ones. However, special attention should be paid to drug interactions between antiplatelet drugs, anticoagulants, and COVID-19 therapy. We also noted that in addition to anticoagulant and anti-inflammatory properties, heparins have a direct antiviral effect. All patients with ST-segment elevation myocardial infarction should receive standard medical therapy, which includes unfractionated heparin. In patients with non-ST-elevation myocardial infarction with an early invasive strategy, it is recommended to use heparin instead of low-molecular-weight heparin as the anticoagulant of choice. At the same time, the use of low-molecular-weight heparin in patients with myocardial infarction without ST-segment elevation and COVID-19 is preferable to unfractionated heparin.

Abstract 349: Variability of Anticoagulant Dosing Among Hospitals for Patients Presenting with Acute Coronary Syndrome in the VA

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Meg Plomondon ◽  
Xuefei Jennewein ◽  
Anne Lambert-Kerzner ◽  
Thomas Tsai ◽  
Michael Ho
Keyword(s):  
Molecular Weight ◽  
Creatinine Clearance ◽  
Unfractionated Heparin ◽  
Anticoagulant Therapy ◽  
Test Performance ◽  
Low Molecular Weight Heparin ◽  
Performance Measure ◽  
Low Molecular Weight ◽  
Factors Associated ◽  
Va Hospitals

Background: Anticoagulant therapy for ACS patients is recommended by clinical practice guidelines. Further, appropriate dosing of anticoagulant therapy is necessary to ensure effectiveness and safety and is a current ACC/AHA STEMI/NSTEMI test performance measure. This study describes the variability in excess dosing of unfractionated heparin (UFH), low-molecular weight heparin (LMWH), and glycoprotein IIb/IIIa inhibitors among all VA hospitals and the association between patient, provider and facility characteristics with excessive dosing. Methods: This was a national cohort of 53,489 patients admitted for ACS at 135 VA hospitals between FY09-FY11 and administered anticoagulation therapy during their hospital stay. Excess dosing was defined based on the ACC/AHA test performance measures: unfractionated heparin > 70U/kg or infusion >15U/kg per hour, low molecular weight heparin (LMWH) >1.05mg/hr and glycoprotein IIb/IIa inhibitors, epifibitide: >180ug/kg and infusion of >2.0 ug/kg per minute among patients with creatinine clearance <50ml/min; tirofiban >0.4ug/kg and infusion of >0.1ug/kg among patients with creatinine clearance <30ml/min. Results: Dosing information was available in 39,873 (~75%) patients. Among these patients, 62.7% (25003) were prescribed unfractionated heparin, 34.9% (13919) were prescribed LMWH, and 2.4% (951) were prescribed glycoprotein IIb/IIIa. The average (standard deviation) percentage of patients receiving excess dosing of any anticoagulant at a hospital was 10.1% (12.2%); and 10.7% (20.9%) for unfractionated heparin, 12.9% (8.4%) for LMWH and 0.54% (1.9%) for glycoprotein IIb/IIIa. In general, common factors associated with excess dose across the three types of anticoagulants included older age, lower BMI, and higher serum creatinine. Among the provider and facility characteristics, anticoagulant dose ordered by an emergency department physician versus hospitalist, and first administered anticoagulant occurring in ICU versus not ICU were also associated with reduced risk of excessive dosing. Conclusions: There is wide hospital variability in excess dosing of anticoagulants for patients treated for ACS. Next steps include conducting qualitative interviews at sites to further understand reasons for variation in anticoagulant dosing. It will be important to incorporate both the identified factors associated with excessive dosing and the qualitative interview findings into future interventions to ensure appropriate dosing of anticoagulants for ACS patients.

Markers of Hemostatic System Activation in Acute Deep Venous Thrombosis-Evolution during the First Days of Heparin Treatment

1993 ◽  
Vol 70 (06) ◽  
pp. 0909-0914 ◽  
Author(s):  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Unfractionated Heparin ◽  
Low Molecular Weight Heparin ◽  
Factor Xa ◽  
Low Molecular Weight ◽  
Dose Adaptation ◽  
Heparin Treatment ◽  
Lung Scan

SummaryFibrin D-Dimer (D-Di), prothrombin activation fragment (F 1+2) and thrombin-antithrombin III complexes (TAT) were measured using ELISA procedures in the plasma of patients with an acute deep venous thrombosis (DVT), at presentation and on days 2, 6 and 10 after initiation of heparin treatment. Patients were randomly allocated into two treatment groups: 44 patients received adapted doses of continuous intravenous unfractionated heparin (UH) whereas 47 received 1 mg/kg every twelve hours of a low molecular weight heparin (enoxaparin) subcutaneously. A phlebography and a perfusion lung scan were performed before inclusion and on day 10. Failure of therapy (n = 9) was defined by venogram worsening or confirmed pulmonary embolism. Improvement (n = 44) or stationary state (n = 38) were defined by venogram evolution in the absence of new leg scan defects.At presentation, D-Di, F 1 + 2 and TAT were above cut-off values in 97, 66 and 89% of patients respectively. D-Di levels correlated with the extent of venous thrombosis whereas TAT and F 1 + 2 did not. Mean levels of D-Di decreased sharply during the first days of treatment but were still abnormal on day 10. A secondary increase of D-Di on days 6 or 10 by more than 3 μg/ml occurred in 4 of the 9 patients who developed a thromboembolic recurrence but in none of the 72 patients who had a more favorable outcome. F 1 + 2 and TAT time-courses were not related to clinical evolution. In the Enoxaparin group, there was no relationship between antifactor Xa activities and any biological markers. TAT and F 1 + 2 levels fell on day 2 and remained stable until day 10. In contrast, in the UH group, TAT and F 1 + 2 did not significantly decrease on day 2, probably due to a delay in dose adaptation, but they declined slowly until day 10.In conclusion, D-Di displays a higher sensitivity than F 1 + 2 or TAT for the diagnosis of D\T. D-Di, but not TAT or F 1 + 2, follow-up seems to be of potential value for early detection of recurrency. Hemostatic activation is controlled earlier by fixed doses of a low molecular weight heparin, irrespective of the plasma anti-factor Xa activities, than by unfractionated heparin at adapted doses.

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