PREVENTION OF DEEP VEIN THROMBOSIS (DVT) AFTER TOTAL HIP REPLACEMENT (THR) by ENOXAPARINE (LOVENOXR) : ONE DAILY INJECTION OF 40 MG VERSUS TWO DAILY INJECTIONS OF 20 MG

1987 ◽  
Author(s):  
A PLANES ◽  
N VOCHELLZ ◽  
C MANSAT
Keyword(s):  
Lower Limbs ◽  
Daily Injection ◽  
Bleeding Complications ◽  
Double Blind ◽  
Vein Thrombosis ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Significant Difference ◽  
Group B ◽  
Present Trial

Venous thromboembolism is a common complication in patients undergoing THR. In a previous open study, Enoxaparine, a low-molecular-weight-heparin, in a dose of 40 mg/24 hrs by SC injection, had been shown to be efficient in preventing DVT in these patients. This treatment was not associated with an increased risk of bleeding. The present trial compares the efficiency and the risks of bleeding of two regimens : treatment A (2 daily subcutaneous (SC) injections of 20 mg of Enoxaparine) and treatment B (1 daily SC injection of 40 mg of Enoxaparine).118 patients, over 40 years, with a non traumatic hip disease, requiring THR, were included in a randomized, double blind trial. 59 patients received the treatment A. 59 patients received the treatment B. In both groups administration of 40 mg of Enoxaparine was begun 12 hours before operation. Patients were treated for 12-15 days, until bilateral ascending phlebography (BAP) had been completed.Lower limbs BAP were performed in 114 patients. The frequency of DVT is low and is not significantly different between the two regimens : a DVT was detected in 1 of 57 patients who received the treatment A and in 6 of 57 patients who received the treatment B (p = 0.11) . No pumonary embolism occurred in the 114 patients.There was no serious bleeding complication, and the two groups are not significantly different on this point. 3 patients in each group had an important hematoma of the thigh. None required a surgical treatment. Red cell transfusion requirements were 3.88 U ± 1.71 in the group A and 3.5 3 U ± 1.06 in the group B (p = 0.20). There was no significant difference in daily hemoglobin levels between the two groups.One daily injection of 40 mg of Enoxaparine was as effective as two daily SC injections of 20 mg of Enoxaparine in preventing DVT, in patients undergoins THR. The frequencies of bleeding complications were the same in each group.Enoxaparine (LOVENOXR) - PHARMUKA S.F.

PREVENTION OF DEEP VEIN THROMBOSIS (DVT) BY ENOXAPARINE (LOVENOXR) AFTER SURGERY FOR FRACTURE OF FEMORAL NECK. ONE DAILY INJECTION OF 40 MG VERSUS TWO DAILY INJECTIONS OF 20 MG

1987 ◽  
Author(s):  
J BARSOTTI ◽  
B DABO ◽  
J ANDREU ◽  
D ALISON ◽  
J LEROY ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Lower Limbs ◽  
Daily Injection ◽  
Bleeding Complications ◽  
Double Blind Study ◽  
Double Blind ◽  
Significant Difference ◽  
Orthopedic Operation ◽  
Group A ◽  
Group B

In a previous open study, a low-molecular-weight-heparinEnoxa-parine in a dose of 40 mg/24 hrs by subcutaneous (SC) injection, had been shown to be efficient and safe in preventing DVT after total hip replacement (THR), for a non traumatic hip disease. 103 patients (mean age : 82 years ± 10, mean weight : 52 kg ± 10) undergoing an orthopedic operation for fracture of femoral neck were included ina randomized, double blind study. These patients receivedSC Enoxaparine according to two different regimens : 54 patients received the treatment A (2 daily injections of 20 mg), 49 patients received the treatment B (1 daily injection of 40 mg).In both groups, administration of 40 mg of Enoxaparine was begun 12 hours before operation.Patients weretreated for 10-15 days, until bilateral ascending phlebography (BAP) had been completed.Lower limbs BAP were performed in 97 patients. The incidence of DVT is low and not significantly different betweenthe two regimens :a proximal DVT was detected in 6 patients of the group A and in 2 patients of the group B. This differenceis not significant(p = 0.28).3 patients of each group hada distal DVT. No clinical pulmonary embolism occurred.There was no serious bleeding complication, and the two groups are not significantly different on this point; 2 patients in each group had an important hematoma of the thigh.One hematoma, in a patient who received the treatment B, required a surgical treatment.Red cell transfusion requirementswere 2.6U+1.8 in the group A and 2.5 U ±1.4 in the group B (p = 0.84)There was no significant difference in the daily hemoglobinlevels between the two groups.This study shows that one daily SC injection of 40 mg of Enoxaparine is as efficient as two daily SC injections of20 mg of Enoxaparine in preventing DVT, in very elderly patients undergoing orthopedic operation for fracture of the femoral neck. The frequencies of bleeding complications in each group were not significantly different.Enoxaparine (LOVENOXR) - PHARMUKA S.F.

scholarly journals Adequate timing of thromboembolic prophylaxis in colorectal cancer surgery

2018 ◽  
Vol 5 (2) ◽  
pp. 576
Author(s):  
Ghada Morshed ◽  
Nader Zaki
Keyword(s):  
Colorectal Cancer ◽  
Venous Thromboembolism ◽  
Prospective Study ◽  
Bleeding Complications ◽  
Thromboembolic Prophylaxis ◽  
Colorectal Cancer Surgery ◽  
Increased Risk ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: It has been found that patients with colorectal cancer are at increased risk for postoperative venous thromboembolism. The aim of this prospective study is to evaluate the incidence of venous thromboembolism and major bleeding complications in patients undergoing colorectal cancer who are treated with preoperative or postoperative venous thromboprophylaxis.Methods: This prospective study included 30 patients from September 2013 to November 2017. There were 22 males and 8 females; mean age was 66.7±5.5 years (range 44-78). Author divided the patients randomly into two groups (group A=15 cases with preoperative and group B = 15 cases with postoperative venous thromboprophylaxis).Results: There was no significant difference in preoperative versus postoperative thromboembolic prophylaxis regarding postoperative DVT 0/15(0%) vs 1/15 (6.6%), P=0.69, no bleeding complications and no pulmonary embolism.Conclusions: Preoperative and postoperative thromboembolic prophylaxis are equally safe in venous thromboembolism protection. 

ENOXAPARINE (LOVENOXR), VERSUS STANDARD HEPARIN IN PROPHYLAXIS OF DEEP VEIN THROMBOSIS (DVT) AFTER TOTAL HIP REPLACEMENT (THR)

1987 ◽  
Author(s):  
T LE BALC’H ◽  
a LANDAIS ◽  
T BUTEL ◽  
D WEILL ◽  
J C PASCARIELLO ◽  
...  
Keyword(s):  
Bleeding Risk ◽  
Lower Limbs ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Heparin Group ◽  
Double Blind ◽  
Vein Thrombosis ◽  
Hip Disease ◽  
Group A ◽  
Deep Vein

THR is associated with a high risk of thromboembolic complications. Enoxaparine, LovenoxR, a low-molecular-weight-heparin, and standard heparin were compared in their abilities to prevent DVT in patients undergoing THR. The efficiency and the bleeding risk of each treatment were studied.237 patients, with a non traumatic hip disease, requiringTHR, were included in a multicentric, randomized, double blind trial. Mean age:65.8 years ± 9.2; mean weight :67.3kg ± 1.3.113 patients received standard heparin, 5000 UI/8 hrs, by"subcutaneous (SC) injection. 124 patients received Enoxaparine, 40 mg/24 hrs, by SC injection. Administration of drugs was begun 2 hours before operation for standard heparin, 12 hours before operation for Enoxaparine. Patientswere treated for 10-15 days, until bilateral ascending phlebography (BAP) had been completed.Lower limbs BAP were performed in 228 patients. The incidence of DVT was significantly lower in the Enoxaparine group : a DVT was detected in 15(12.5 %) of 120 patients who received Enoxaparine and in 27(25%) of 108 patients who received standard heparin (p=0.014).A pulmonary embolism occurred in 1 patient of the heparin group, in none of the Enoxaparine group.The frequency of bleeding complications was significantly lower in the Enoxaparine group. A post operative wound hematoma occurred in 1 patient of the Enoxaparine group and in 3 patients of the heparin group. Red cell transfusions requirements were significantly lower in the Enoxaparine group (3.37 U ± 1.81) than in the heparin group (3.84U ± 1.70)(p=0.03). The hemoglobin level was significantly higher, on the 3rd, 4th post operative day, in the Enoxaparine group.Subcutaneous Enoxaparine (40 mg/24 hrs) was significantlymore efficient than subcutaneous heparin (5000 UI/8 hrs) in preventing DVT, in patients undergoing THR. The incidence of bleeding complications was significantly lower in the Enoxaparine group.Enoxaparine (LOVENOXR) - PHARMUKA S.F.

Risk of Damaging Anatomical Structures During Minimally Invasive Hallux Valgus Correction (Bösch Technique): An Anatomical Study

2018 ◽  
Vol 39 (11) ◽  
pp. 1355-1359 ◽  
Author(s):  
Martin Kaipel ◽  
Lukas Reissig ◽  
Lukas Albrecht ◽  
Stefan Quadlbauer ◽  
Joachim Klikovics ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Complication Rate ◽  
Metatarsal Osteotomy ◽  
Anatomical Structures ◽  
Intensive Training ◽  
Increased Risk ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Percutaneous, transverse distal metatarsal osteotomy with K-wire fixation (the Bösch technique) is an established technique for hallux valgus correction. Nevertheless, the risk of damaging the anatomical structures during the operation is unknown. Methods: Forty fresh-frozen anatomical foot specimens with hallux valgus deformity underwent a percutaneous corrective procedure. Specimens of group A (n = 20) were operated by an experienced surgeon while specimens of group B (n = 20) were done by untrained residents. Results: The dorsal cutaneous nerve was injured in 1 of 20 cases in group A and 6 of 20 cases in group B ( P = .037). There was a significant difference in overall complication rate between specimens of group A and group B ( P = .043). Conclusions: The results show an increased risk of perioperative injury of the dorsal cutaneous branch of the deep peroneal nerve as well as a significant effect of the surgeon’s experience on the overall complication rate. Clinical Relevance: Results of this study are highly relevant for all surgeons who perform percutaneous, minimally invasive hallux valgus surgery to avoid damage to the peripheral nerves. In addition, the data suggest an intensive training for surgeons before minimally invasive hallux valgus surgery is performed without supervision.

scholarly journals Effects of Dexmedetomidine on Intraoperative Hemodynamic Responses in Patients Undergoing Laparoscopic Cholecystectomy: A Randomised Double Blind Trial

2021 ◽  
Author(s):  
Dhanashree Dongare ◽  
Smita Gharde
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Base Line ◽  
Loading Dose ◽  
Double Blind Trial ◽  
Hemodynamic Responses ◽  
Double Blind ◽  
Significant Difference ◽  
Group A ◽  
American Society ◽  
Group B

Background: Dexmedetomidine is selective alpha 2 agonist with sedative sympatholytic, analgesic properties and is used as an anaesthetic adjuvant. We have evaluated the effect of dexmedetomidine on various hemodynamic responses to incidences such as laryngoscopy, endotracheal intubation, exubation and pneumoperitoneum in patients who were undergoing surgeries like laparoscopic cholecystectomy. We have used loading dose of 0.5mcg/kg of inj. Dexmedetomidine given over 10 minutes followed by infusion of a dose of 0.3mcg/kg/hour for the control of hemodynamic response to laparoscopy. Methods: Patient of either sex aged between 18-50 yrs, belongs to ASA I and II (AMERICAN SOCIETY OF ANAESTHESIOLOGY) posted for laparoscopic cholecystectomy were included. Institutional ethical committee clearance was obtained prior to study. After enrolment and valid written consent was taken. 60 patients were enrolled written valid informed consent was taken. Patients were divided into two groups 30 each with computerized randomization. Base line parameters were noted. Observer and patient was blinded for the content of syringe. Group A received injection dexmedetomidine and group B received bolus and infusion of normal saline at same rate. Routine general anaesthesia was instituted. Parameters were noted after induction, after intubation, after co2 insufflation, after 20 min, after 40 min, after co2 deflation, after extubation, after 1 and 2 hrs post-extubation. Results: Group A showed significantly less rise in HR and MAP than Group B. Requirement of intraoperative propofol was more in Group B. There was no significant difference for time taken to awakening in both groups. Conclusion: We found Injection Dexmedetomidine in given doses gave good hemodynamic control with minimal undesired effects during laparoscopy.

scholarly journals A double-blind randomized placebo-controlled study of low dose mirtazapine once daily in patients of major depressive disorders on escitalopram

2019 ◽  
Vol 8 (5) ◽  
pp. 1067
Author(s):  
Mallikarjuna Rao I. ◽  
Usha Kiran Prayaga ◽  
Dharma Rao Uppada ◽  
Ramachandra Rao E. ◽  
B. L. Kudagi
Keyword(s):  
Depressive Disorders ◽  
Low Dose ◽  
Rating Scale ◽  
Controlled Study ◽  
P Value ◽  
Chi Square ◽  
Double Blind ◽  
Increased Risk ◽  
Significant Difference ◽  
Chi Square Test

Background: The SSRIs being used as 1st line therapy in treatment of depression have delayed therapeutic effect which makes the patient vulnerable to an increased risk of suicide and decreased adherence to the treatment and will prematurely discontinue the therapy. The present study was conducted to evaluate if low dose mirtazapine-escitalopram combination therapy has any add on benefit over monotherapy with escitalopram.Methods: In a single-centered, comparative study involving patients with depression attending the out-patient after screening and exclusion, 60 eligible patients were randomly assigned to receive tablet mirtazapine 7.5 mg plus tablet escitalopram 10 mg intervention or tablet escitalopram 10 mg plus placebo intervention in a double-blind 6-week treatment phase. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline. Participants were evaluated at baseline, 1st, 2nd,4th and 6th week. Results were analyzed using Chi-Square test for adverse effects and independent t-test analysis for efficacy parameter.Results: In the analysis of results at 6th week the numbers of patients achieved remission in mirtazapine group are more with a p-value of 0.018 which is significant and the numbers of responders in mirtazapine group are also more which is statistically significant on chi-square test. There is no significant difference was observed between the two groups with reference to occurrence of adverse effect.Conclusions: Adding low dose mirtazapine has an added benefit in terms of efficacy and getting remission early with more number of responders in the treatment of major depression.

The role of tolvaptan in prevention of hyponatremia in patients undergoing transurethral resection of prostate surgery- A randomized double blind study

2021 ◽  
Vol 8 (2) ◽  
pp. 321-325
Author(s):  
Dinesh Kumar Singh ◽  
B B Baj ◽  
Vipin Goyal
Keyword(s):  
Transurethral Resection ◽  
Blind Study ◽  
Transurethral Resection Of Prostate ◽  
Double Blind Study ◽  
Double Blind ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

The aim of our study to determine the role of tolvaptan in prevention of hyponatremia in transurethral resection of prostate surgery. This is randomized double-blind study conducted in 60 ASA grade status 1 and 2 patients age group between 45-80 yrs undergoing TURP under spinal anaesthesia in urology operation theatre in Mahatma Gandhi hospital Jaipur after receiving permission from hospital ethical committee. A detailed history, complete physical examination and routine investigation were done for all patients followed by informed written consent was obtained. Patients are randomly divided into 2 groups. In group A -30 patients who received orally tab tolvaptan 15 mg and group B-30 patients who received orally tab multivitamin 2 hrs before surgery after doing electrolytes of the patients in the morning. In both groups age (in yrs), wt (in kg), ASA grade, volume of irrigating fluid (in litres), volume of prostate resected (in gm) and duration of surgery (in minutes) all demographic and surgical details data were compared. Electrolytes were compared in both groups pre and post-operatively and statistical analysis was done.There was significant difference in post-operative sodium level between the two groups (A and B). The mean level of sodium significantly reduced post-operatively in group –B (control grp). The mean level of sodium significantly increased post-operatively in group –A (tolvaptan grp). We conclude single dose of tolvaptan -15 mg found to effective in prevention of hyponatremia in patients undergoing TURP.

scholarly journals Graft and patient survival in portal vein thrombosis in living donor liver transplantation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Ramadan ◽  
N M Hytham ◽  
K K Mamdouh ◽  
A M Fathy
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Lower Survival Rate ◽  
Donor Liver Transplantation ◽  
Vein Thrombosis ◽  
Life Saving ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Stay Hospital

Abstract Background and Rational To date, only few studies have evaluated the benefits of anticoagulation in individuals with cirrhosis. An obvious goal of anticoagulation is PV recanalization: when cirrhotic individuals with PVT are treated with anticoagulation, complete recanalization has been described in 33–45% while partial PV recanalization is observed in 15–35% of cases. LDLT has emerged as the alternative life-saving treatment to DDLT. Over the past 2 decades, the number of LDLTs has steadily increased in many transplant centers, especially in Asia. The separation between occlusive and non-occlusive thrombosis is very important; in patients with partial PVT, post-transplant mortality outcomes are no different from non-PVT patients but it is significantly increased in patients with complete PVT. Patients and Methods This randomized prospective study will include 79 patients who will undergo LDLT in Ain Shams Specialized and Egypt Air hospitals, there are two groups of patients according to presence of portal vein thrombosis or not group A 39 patients of non PVT and group B 40 patient of PVT including different grades of PVT according Yerdel classification. Results In this study, there is no significant difference between groups regard age but Males were significantly associated with group B. In this study, there is no significant difference between groups regard CHILD and MELD scores and this findings. In our study there is no significantly difference between groups A and B regarding ICU stay, hospital stay and cell saver. In this study, comparisons of the PVT patients and controls showed no statistical significant differences regard HA thrombosis, post operative pulmonary embolism and biliary leak but PV rethrombosis is significantly associated with PVT patients, mortality sig associated with PVT patients. Conclusion The outcomes of patients with PVT who underwent LDLT are inferior to those without PVT. Patients with PVT has lower survival rate, higher postoperative PV rethrombosis.

scholarly journals Role of Immediate Release and Delayed Release Omeprazole in Patients with Gastro Esophageal Reflux Disease

2017 ◽  
Vol 11 (2) ◽  
pp. 67-73
Author(s):  
Mahabub Rahman ◽  
Dewan Saifuddin Ahmed ◽  
Syeda Nur E Jannat ◽  
MM Shahin Ul Islam ◽  
Abu Ahmed Abdullah
Keyword(s):  
Reflux Disease ◽  
Immediate Release ◽  
Esophageal Reflux ◽  
Double Blind ◽  
Delayed Release ◽  
End Of Treatment ◽  
Significant Difference ◽  
Group A ◽  
Group B

Proton pump inhibitors are widely used for Gastro Esophageal Reflux Disease (GERD) treatment. This prospective double blind randomized cross over study was carried out in the Department of Gastroenterology, BSMMU from June 2007 to May 2008 to assess the efficacy of Immediate-release omeprazole (IR-OMEP) & Delayed-release Omeprazole (DR-OMEP) in relieving symptoms & healing of oesophagitis in GERD. All patients who fulfilled the inclusion criteria underwent upper gastrointestinal (UGI) endoscopy to be lebelled as nonerosive and erosive GERD. Among total 69 patients, 43 (62.3 %) had nonerosive and 26 (37.7 %) had erosive GERD. Patients were divided into group A (35) and group B (34) who received group A drugs (20 mg IR-OMEP bd) and group B drugs (20 mg DROMEP bd) from day 1-14 respectively. Then drugs were crossed over (group A: 20mg DR-OMEP bd; group B: 20 mg IR-OMEP bd) from day 15-28. Improvement of heartburn, regurgitation in each group were assessed in every week, during drug cross over and at the end and then compared between two groups. There was no significant difference in relieving heartburn and regurgitation between IR-OMEP and DR-OMEP either in erosive or nonerosive GERD (P>0.50). Patients with erosive GERD underwent UGI endoscopy at the end of treatment to see healing of esophagitis. Study showed significant healing of oesophagitis in group A after 4 weeks than group B (14%) (P<0.05) but there is no superiority of IR-OMEP over DR-OMEP in relieving symptoms of GERD.Faridpur Med. Coll. J. Jul 2016;11(2): 67-73

Residual Vein Thrombosis Improves Screening for Occult Cancer: Results On 537 Patients with Idiopathic Deep Vein Thrombosis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3999-3999
Author(s):  
Sergio Siragusa ◽  
Alessandra Malato ◽  
Fabio Fulfaro ◽  
Giorgia Saccullo ◽  
Domenica Caramazza ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Early Detection ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Occult Cancer ◽  
Group A ◽  
Group B ◽  
Deep Vein ◽  
Related Mortality

Abstract Abstract 3999 Poster Board III-935 Background Clinical advantage of extensive screening for occult cancer in patients with idiopathic Deep Vein Thrombosis (DVT) is unknown. We have demonstrated that the Residual Vein Thrombosis (RVT)-based screening for occult cancer improves early detection as well as cancer-related mortality (Siragusa S et al. Blood 2007;110(699):OC). Here we report on final analysis of 537 patients over a period of 8 years. Objective of the study We conducted a prospective study evaluating whether a RVT-based screening for cancer is sensitive and influences cancer-related mortality. Study design Prospective with two cohorts of DVT patients: the first cohort was monitored for clinical overt cancer only (Group A), while the second (Group B) received complete screening for occult neoplasm and subsequent surveillance. Materials and methods Consecutive patients with a first episode of DVT who presented RVT after 3 month of anticoagulation and without signs and/or symptoms for overt cancer. Screening for occult cancer was based on: ultrasound and/or CT scan of the abdomen and pelvis, gastroscopy, colonoscopy or sigmoidoscopy, hemoccult, sputum cytology and tumor markers. These tests were extended with mammography and Pap smear for women and ultrasound of the prostate and total specific prostatic antigen (PSA) for men. All investigations had to be completed within four-weeks from the assessment of RVT. All patients were followed-up for at least 2 years. Incidence and cancer-related mortality was compared between the two groups by survival curves (Kaplan-Mayer) and related Breslow test for statistics. Results Over a period of 8 years, 537 patients were included in the analysis: first cohort included 346 patients (Group A), second cohort 191 (Group B). Clinical characteristics between groups were homogenous. During the follow-up, 8.3% of patients developed overt cancer in group A; in group B, 7.8% of patients had diagnosed cancer at the moment of extensive screening while 2 new cases (0.7%) occurred during the follow-up (Table). The sensitivity of this approach was 92.1% (95% confidence intervals 75.2-104.2). Cancer-related mortality was 7.5% in group A and 3.6% in group B (p< 0.001). Conclusions The RVT-based screening for occult cancer is highly effective for improving early detection as well as cancer-related mortality in a cohort of 537 patient with DVT of the lower limbs. Disclosures: Off Label Use: Hydroxyurea use in myelofibrosis.

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