Use of Low Molecular Weight Heparin in Pregnancy

1992 ◽  
Vol 68 (06) ◽  
pp. 652-656 ◽  
Author(s):  
Euthemia Melissari ◽  
Christopher J Parker ◽  
Noel V Wilson ◽  
Giovanni Monte ◽  
Chryso Kanthou ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Controlled Study ◽  
Low Molecular Weight ◽  
Placental Barrier ◽  
Fetal Blood ◽  
Blood Samples ◽  
Recurrent Miscarriages ◽  
Heparin Activity ◽  
First Time

SummaryIn a controlled study of 15 pregnant patients undergoing therapeutic termination of pregnancy, seven received subcutaneously 5,000 anti-FXa units of low molecular weight (LMW) heparin 15 and 3 h prior to the termination, and eight patients acted as controls. Paired maternal and fetal blood samples were taken (before or immediately after the termination) for assay of heparin activity by a chromogenic anti-FXa method sensitive to levels of 0.02 anti-FXa U/ml. LMW heparin was detected in all maternal samples of the test patients but was not detected in any of the fetal samples.The use of LMW heparin as a thromboprophylactic agent was then evaluated in 11 patients who were known to have a severe thromboembolic tendency, had suffered recurrent miscarriages and had responded poorly to conventional anticoagulation (oral anticoagulant, conventional heparin). All patients receiving LMW heparin in thromboprophylactic doses completed uneventful pregnancies and gave birth to healthy babies (three for the first time) without complication. Bone density scans performed in all patients shortly after the delivery showed normal mineral mass. We conclude that LMW heparin does not cross the placental barrier, and in addition offers satisfactory antithrombotic protection for both maternal and placental circulation. In addition, this study provides preliminary data from 11 patients suggesting LMWH may not give rise to maternal osteoporosis, a finding that now needs further investigation.

In Vivo Studies On The Inhibition Of Coagulation By Fractionated Heparin

1981 ◽  
Author(s):  
U Schmitz-Huebner ◽  
L Balleisen ◽  
F Asbeck ◽  
J van de Loo
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Gel Filtration ◽  
In Vivo Studies ◽  
Low Molecular Weight ◽  
Chromogenic Substrate ◽  
Serotonin Content ◽  
Heparin Activity ◽  
Heparin Fractions

Recent investigations suggest that low molecular weight heparin may have advantages over conventional heparin with regard to the prevention of venous thrombosis and haemorrhagic side effects.High (HMW) and low (LMW) molecular weight heparin fractions with mean MWs of 16,000 and 8,800 respectively, obtained by gel filtration chromatography of sodium mucosal heparin (B. Braun Melsungen), were injected subcutaneously into six volunteers and compared with the unfractionated substance in a cross-over trial. Doses of 5,000 U were administered twice daily over a period of three days and heparin activity was controlled before injection and 2,4,8 hours afterwards by means of the APTT, the anti-Xa clotting test and a chromogenic substrate assay. In addition, the in vivo effect of fractionated heparin on platelet function was examined. The results show that the LMW fraction induced markedly higher anti-Xa activity than the other preparations. At the same time, APTT results did not significantly differ. Unfractionated heparin and the HMW fraction enhanced ADP-induced platelet aggregation and collagen-mediated MDA-production, while the LMW fraction hardly affected these assays, but potently inhibited thrombin-induced MDA production. All heparin preparations stimulated the release of PF IV, whereas the serotonin content of platelets determined at the same time increased.It is concluded that s.c. injections of LMW heparin induce relatively high levels of anti-Xa activity without leading to sensitive platelet activation or to major effects on overall clotting tests.

Thromboprophylaxis by low-molecular-weight heparin in elective hip surgery. A placebo controlled study

1991 ◽  
Vol 73-B (3) ◽  
pp. 434-438 ◽  
Author(s):  
C Torholm ◽  
L Broeng ◽  
PS Jorgensen ◽  
P Bjerregaard ◽  
L Josephsen ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Hip Surgery ◽  
Controlled Study ◽  
Low Molecular Weight

scholarly journals Cabozantinib and apixaban: an hitherto unreported interaction

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Daniele Santini ◽  
Fabrizio Citarella ◽  
Bruno Vincenzi ◽  
Marco Russano ◽  
Giuseppe Tonini ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Renal Cell Carcinoma ◽  
Oral Anticoagulant ◽  
Low Molecular Weight Heparin ◽  
New Drugs ◽  
Low Molecular Weight ◽  
Direct Oral Anticoagulant ◽  
Anticancer Treatment ◽  
Pharmaceutical Agents ◽  
First Time

Abstract The use of direct oral anticoagulant in cancer patients is an emerging issue, which seems to be an alternative to low molecular weight heparin. Every year several new drugs are approved as anticancer treatment with possible drug-drug interaction with other drugs such as oral anticoagulant. We describe, for the first time, a case of neutropenia and thrombocytopenia in a patient in treatment with cabozantinib, a novel anticancer treatment used in metastatic renal cell carcinoma, and apixaban with promptly resumption of the toxicity after the interruption of cabozantinib. This case suggest a possible interaction between these two pharmaceutical agents, which merit caution considering the spreading of the two drugs.

scholarly journals http://www.jirb.dormaj.com/issues/Volume%205,%20Issue%204/Anti-Coagulant%20Therapy%20in%20Unexplained%20Recurrent%20Pregnancy%20Loss.pdf

2017 ◽  
Vol 5 (4) ◽  
pp. 15-19
Keyword(s):  
Molecular Weight ◽  
Live Birth ◽  
Low Molecular Weight Heparin ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Recurrent Miscarriage ◽  
Controlled Study ◽  
Low Molecular Weight ◽  
Antiphospholipid Antibody ◽  
History Of

Recurrent pregnancy loss (RPL) is a heterogeneous reproductive problem with multiple aetiologies and contributing factors. It becomes quite challenging to form a work-up to detect the cause of RPL in the early months as a continuation of pregnancy involves many factors. In more than half of all recurrent miscarriage the cause still remains uncertain. Thrombophilia has been identified in about 50% of women with recurrent miscarriage and thromboprophylaxis has been suggested as an option of treatment.. In obstetric APLA Syndrome (Antiphospholipid antibody) the combination of aspirin and heparin has improved outcomes. The use of low molecular weight heparin (LMWH) has become a common practise in women with inherited thrombophilia and also those with unexplained miscarriage to help safeguard the ongoing pregnancy. To evaluate if there is any effectiveness of low molecular weight heparin (enoxaparin) in women with a history of at least two miscarriages without any apparent aetiology for recurrent pregnancy loss. A prospective randomised controlled study held at Vivekananda Institute of Medical Sciences, Kolkata from August 2015- July 2018. The study assessed the effect of anticoagulant treatment on the live-birth rate (primary outcome) in 80 antenatal women with a history of at least two miscarriages without any apparent causes. Interventions included low molecular weight heparin administration in one group and the other one was not given any anti-coagulant therapy. Similar live birth rates were observed with enoxaparin and the patients who did not receive any anti-coagulant, respectively 84% and 82% (RR 0.97, 95% CI 0.81 to 1.16). There were no significant differences in live birth weight and other pregnancy outcomes between the two groups. Therefore, there is no evidence to support any incremental benefit of adding LMWH to the treatment as a routine in unexplained cases of recurrent pregnancy loss.

scholarly journals Low molecular weight heparin prophylaxis for placenta-mediated complications in women with F2G20210A mutation

2021 ◽  
Vol 66 (2) ◽  
pp. 231-241
Author(s):  
M. G. Nikolaeva ◽  
N. N. Yasafova ◽  
A. P. Momot ◽  
M. S. Zainulina ◽  
I. A. Taranenko
Keyword(s):  
Molecular Weight ◽  
Pregnant Women ◽  
Low Molecular Weight Heparin ◽  
Absolute Risk ◽  
Controlled Study ◽  
Low Molecular Weight ◽  
Number Needed To Treat ◽  
Study Cohort ◽  
Mutant Genotype ◽  
Prothrombin Activity

Introduction. A prothrombin-mutant genotype is a known risk factor in gestational complications.Aim — efficacy assessment in pregravid heparin prevention of pre-eclampsia (PE) and foetal growth retardation (FGR) in females with F2G20210A genotype and suprathreshold prothrombin activity.Patients and methods. A single-centre randomised controlled study enrolled 80 pregnant women carrying prothrombin F2G20210A. The inclusion criterion was a pregravid plasma prothrombin activity > 171 %. The study cohort consisted of 50 women (mean age 31.2 ± 3.7 years) receiving low molecular-weight heparin (LMWH) in menstrual cycle at weight-based elevated prevention doses. A comparison group comprised 30 pregnant women (mean age 31.3 ± 2.9 years) not receiving LMWH prophylaxis.Results. A pregravid start of LMWH treatment at high prophylactic doses in F2G20210A genotype carriers with prothrombin activity > 171 % allowed an absolute risk reduction (ARR) of PE by 46.7 % [p = 0.0001; number needed to treat (NNT): 2.1; 95 % confidence interval (CI) 3.4–1.56], severe PE by 30.7 % [p = 0.0001; NTT: 3.3; 95  % CI (6.7–2.2)] and FGR by 30.7 % [p = 0.0001; NTT: 3.3; 95 % CI (6.7–2.2)].Conclusion. Use of LMWH is justified in prevention of placenta-mediated complications in F2G20210A genotype carriers with a suprathreshold-high prothrombin activity.

A Human Pharmacological Study Comparing Conventional Heparin and a Low Molecular Weight Heparin Fragment

1985 ◽  
Vol 53 (02) ◽  
pp. 208-211 ◽  
Author(s):  
G Bratt ◽  
E Törnebohm ◽  
D Lockner ◽  
G Bergströ
Keyword(s):  
Molecular Weight ◽  
Half Life ◽  
Low Molecular Weight Heparin ◽  
Pharmacological Study ◽  
Low Molecular Weight ◽  
Dose Dependency ◽  
First Order ◽  
First Order Kinetics ◽  
Heparin Activity ◽  
Different Doses

SummaryThe pharmacokinetics of a heparin fragment of low molecular weight (LMWH) of 4000-5000 D and unfractioned standard heparin (UFH) have been studied after i. v. injections of different doses and infusions in 8 humans.The heparin activity was significantly higher and the effect on APTT lower after LMWH fragment as compared to UFH in the same doses.The half-life of heparin activity was about 1 hr for UFH and about 2 hr for LMWH. LMWH was found to be eliminated according to first order kinetics and there were no signs of dose dependency.

scholarly journals Cartridge-Based Thromboelastography Can Be Used to Monitor and Quantify the Activity of Unfractionated and Low-Molecular-Weight Heparins

TH Open ◽  
2019 ◽  
Vol 03 (03) ◽  
pp. e295-e305 ◽  
Author(s):  
João D. Dias ◽  
Carlos G. Lopez-Espina ◽  
Mauro Panigada ◽  
Heidi J. Dalton ◽  
Jan Hartmann ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Maximum Amplitude ◽  
Low Molecular Weight ◽  
Strongly Correlated ◽  
Mixed Effect ◽  
Blood Samples ◽  
Nonlinear Mixed Effect ◽  
Healthy Donors ◽  
Thrombotic Complications ◽  
Heparin Activity

AbstractThromboelastography is increasingly utilized in the management of bleeding and thrombotic complications where heparin management remains a cornerstone. This study assessed the feasibility of the cartridge-based TEG® 6s system (Haemonetics Corp., Braintree, Massachusetts, United States) to monitor and quantify the effect of unfractionated and low-molecular-weight heparin (UFH and LMWH). Blood samples from healthy donors were spiked with UFH (n = 23; 0–1.0 IU/mL) or LMWH (enoxaparin; n = 22; 0–1.5 IU/mL). Functional fibrinogen maximum amplitude (CFF.MA), RapidTEG activated clotting time (CRT.ACT), and kaolin and kaolin with heparinase reaction time (CK.R and CKH.R) were evaluated for their correlation with heparin concentrations, as well as the combination parameters ΔCK.R − CKH.R, ratio CK.R/CKH.R, and ratio CKH.R/CK.R. Nonlinear mixed-effect modelling was used to study the relationship between concentrations and parameters, and Bayesian classification modelling for the prediction of therapeutic ranges. CK.R and CRT.ACT strongly correlated with the activity of LMWH and UFH (p < 0.001). Using combination parameters, heparin activity could be accurately quantified in the range of 0.05 to 0.8 IU/mL for UFH and 0.1 to 1.5 IU/mL for LMWH. CRT.ACT was able to quantify heparin activity at higher concentrations but was only different from the reference range (p < 0.05) at >0.5 IU/mL for UFH and >1.5 IU/mL for LMWH. Combination parameters classified blood samples into subtherapeutic, therapeutic, and supratherapeutic heparin ranges, with an accuracy of >90% for UFH, and >78% for LMWH. This study suggests that TEG 6s can effectively monitor and quantify heparin activity for LMWH and UFH. Additionally, combination parameters can be used to classify blood samples into therapeutic ranges based on heparin activity.

Sign in / Sign up

Export Citation Format

Share Document