A Case against Heparin Therapy of Intravascular Coagulation

1975 ◽  
Vol 33 (01) ◽  
pp. 107-112 ◽  
Author(s):  
P. W Straub
Keyword(s):  
Clinical Benefit ◽  
Serum Proteins ◽  
Case Reports ◽  
Critical Evaluation ◽  
Heparin Therapy ◽  
Controlled Clinical Trials ◽  
Intravascular Coagulation ◽  
Therapeutic Procedures ◽  
Proteolytic Action ◽  
Theoretical Considerations

SummaryAdministration of a potentially dangerous drug like heparin should not be based on theoretical considerations and innumerable case reports but 1) on a firm diagnosis and 2) on a critical evaluation of the clinical benefit.The validity of criteria for the diagnosis of intravascular coagulation (IC) is discussed. It is emphasized in particular that loss of fibrinogen into extravascular spaces can only be excluded by assays of the level and disappearance rate of serum proteins not subject to the proteolytic action of thrombin or plasmin.Even when the diagnosis can be reasonably established, heparin therapy in a particular condition should only be advocated if its clinical benefit has been demonstrated in controlled clinical trials.Our conviction that heparin has as yet a small if any place in the management of patients with so-called intravascular coagulations is based mainly on two sets of arguments, one stemming from a critique of the diagnosis of IC, the other from a general attitude in the evaluation of therapeutic procedures.

scholarly journals Improved clinical symptoms and mortality among patients with severe or critical COVID-19 after convalescent plasma transfusion

Blood ◽  
2020 ◽  
Vol 136 (6) ◽  
pp. 755-759 ◽  
Author(s):  
Xinyi Xia ◽  
Kening Li ◽  
Lingxiang Wu ◽  
Zhihua Wang ◽  
Mengyan Zhu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Benefit ◽  
Clinical Symptoms ◽  
Case Series ◽  
Plasma Transfusion ◽  
Controlled Clinical Trials ◽  
Early Administration ◽  
The Impact

Two case series examining the impact of convalescent plasma on patients with COVID-19 suggest some clinical benefit from early administration and modest impact on parameters of inflammation. Further assessment of the impact of this intervention awaits controlled clinical trials.

The Use of Anti-Xa Assay to Monitor Intravenous Unfractionated Heparin Therapy

2010 ◽  
Vol 23 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Amy Fann Rosenberg ◽  
Marc Zumberg ◽  
Lisa Taylor ◽  
Aimée LeClaire ◽  
Neil Harris
Keyword(s):  
Clinical Trials ◽  
Unfractionated Heparin ◽  
Pediatric Population ◽  
Factor Xa ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Controlled Clinical Trials ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Heparin Activity

Continuous infusion unfractionated heparin (UH) has traditionally been monitored using the activated partial thromboplastin time (aPTT). The use of this test to monitor heparin therapy is not based on randomized controlled clinical trials, and the test is associated with significant intra- and inter-patient variability that is not related to circulating blood heparin activity. Due to these and other limitations, the use of aPTT alone to monitor UF has been questioned. Many laboratories are now transitioning to monitoring actual heparin activity (by anti-factor Xa analysis). In this review, we discuss the limitations of using the aPTT to monitor UH therapy and additionally the limitations of solely using heparin activity to monitor therapy. We also include a discussion of the challenges with monitoring heparin therapy in the pediatric population.

Hypnosis in the Treatment of Depression: Research and Theory

1986 ◽  
Vol 58 (3) ◽  
pp. 923-929 ◽  
Author(s):  
Joseph Deltito ◽  
Lee Baer
Keyword(s):  
Clinical Trials ◽  
Cognitive Therapy ◽  
Case Reports ◽  
Unipolar Depression ◽  
Controlled Clinical Trials ◽  
Treatment Of Depression

The literature contains several case reports demonstrating the successful use of hypnosis in nonpsychotic, unipolar depression; controlled studies however are lacking. In an attempt to substantiate theoretically the anecdotal literature on hypnotic treatments of depression, we advance the following theory: hypnotic treatment can be viewed as both an antianxiety technique and as a facilitator of restructuring nihilistic cognitions in depression. Hypnosis, both theoretically and anecdotally, appears to facilitate the process of cognitive therapy. The importance of moderate to high hypnotic ability of patients is commented on, and the need for controlled clinical trials is noted.

It's All in the Mind! Or is It? Positive Acupuncture Responses in Patients with Dementia: A Series of Case Reports

2014 ◽  
Vol 32 (2) ◽  
pp. 186-189 ◽  
Author(s):  
Nicolette Williams ◽  
Duncan Lawler ◽  
Peter Dilworth
Keyword(s):  
Case Studies ◽  
Placebo Effect ◽  
Clinical Benefit ◽  
Major Element ◽  
Case Reports ◽  
Real Effect ◽  
Impaired Cognition ◽  
The Mind

Controversy continues over whether or not there is any real effect from acupuncture over and above that of placebo. However, this series of case studies may provide us with evidence from an unlikely source. Anticipation of clinical benefit is a major element of placebo, and clearly cognition is needed to experience this. This raises the question of how much placebo effect is experienced by a patient with dementia. These cases document reliably witnessed responses to acupuncture in patients with impaired cognition, which have been reproducible and maintained. Given the similarity of responses, it could be argued that these reports provide evidence of a ‘real’ effect of acupuncture, and raise the possibility of including patients with dementia in formal studies from which they might routinely be excluded.

A Comprehensive Review of Potential Warfarin-Fruit Interactions

2014 ◽  
Vol 28 (6) ◽  
pp. 561-571 ◽  
Author(s):  
Daryl A. Norwood ◽  
Crystal K. Parke ◽  
Leonard R. Rappa
Keyword(s):  
Clinical Trials ◽  
Grapefruit Juice ◽  
Fruit Juice ◽  
Case Reports ◽  
Scientific Evidence ◽  
International Normalized Ratio ◽  
Pomegranate Juice ◽  
Controlled Clinical Trials ◽  
Dietary History ◽  
Search Terms

Purpose: The aim of this review is to discuss possible interactions that may occur between warfarin and fruit products. Methods: A literature search was conducted using the search terms: “warfarin (Coumadin®) and fruit interactions, warfarin and fruit, warfarin and fruit juice, case reports and clinical trials”. Results: A total of 23 citations (15 case reports and 7 controlled clinical trials) were reviewed. The majority of cases involved cranberry products, while pomegranate juice, avocado, grapefruit juice, mango, and papain were also implicated in reports of suspected warfarin-fruit interactions. Cranberry juice was also the most frequently studied fruit product. Other fruit products evaluated with warfarin in controlled clinical trials were cranberry concentrate and grapefruit juice. Conclusion: Although a number of case reports have been published that suggest warfarin has the potential to interact with several fruit products, it is difficult to determine their relevance, as scientific evidence is scarce. Until further information is available, clinicians may want to encourage patients to consume cranberry products and grapefruit juice in small to moderate quantities and to inquire about the recent consumption of mangos, pomegranate juice, and avocados when taking a dietary history or when assessing possible causes for international normalized ratio (INR) instability.

scholarly journals Serum protein concentrations, including acute phase proteins, in calves with hepatogenous photosensitization

2007 ◽  
Vol 59 (6) ◽  
pp. 1355-1358 ◽  
Author(s):  
J.J. Fagliari ◽  
M. Passipieri ◽  
H.T. Okuda ◽  
S.L. Silva ◽  
P.C. Silva
Keyword(s):  
Serum Protein ◽  
Acute Phase ◽  
Serum Proteins ◽  
Acute Phase Proteins ◽  
Polyacrylamide Gel Electrophoresis ◽  
Sodium Dodecyl ◽  
Clinical Signs ◽  
Control Group ◽  
Molecular Weights ◽  
Therapeutic Procedures

One hundred 6- to 12-month-old Nelore calves were allotted into control group (G1; 50 healthy calves) and photosensitization group (G2; n= 50). Blood samples were collected 12 to 24 hours after the onset of dermatitis (M1), and 15 to 30 days after that (M2), at time of resolution of clinical signs. Serum protein electrophoresis was performed by means of sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Eighteen serum proteins with molecular weights ranging from 16,000 to 189,000 daltons (Da) were identified in all calves. In M1 and M2 serum concentrations of proteins with molecular weights of 115,000Da (ceruloplasmin), 61,000Da (a1-antitrypsin), 45,000Da (haptoglobin), and 40,000Da (acid glycoprotein) were significantly increased in calves. In conclusion, measurement of serum acute phase protein concentrations may be useful in monitoring the progression of bovine hepatogenous photosensitization, including guide probable alteration on therapeutic procedures.

Fibrinolytic Therapy Of Subclavian-Axillary Vein Thrombosis With Urokinase

1981 ◽  
Author(s):  
R Zimmermann ◽  
H Mörl ◽  
J Harenberg ◽  
E Janssen ◽  
H M Kuhn ◽  
...  
Keyword(s):  
Fibrinolytic Therapy ◽  
Heparin Therapy ◽  
Maintenance Dosage ◽  
Axillary Vein ◽  
Vein Thrombosis ◽  
Therapeutic Results ◽  
Therapeutic Procedures ◽  
System 2 ◽  
Axillary Vein Thrombosis ◽  
Trauma Stress

Acute vein thrombosis of the upper extremity occurs in consequence of trauma,stress,effort or spontaneously. The management was often performed conservatively,including anticoagulation and elevation of the involved arm. But the incidence of chronic residual edema,pain or disability in 6895 % of the cases suggests that active therapeutic procedures should be considered.In 18 cases with recent and older thrombosis of the suclavian and axillary veins fibrinolytic therapy was performed with urokinase in combination with heparin. Urokinase and heparin therapy was adjusted to attain an anticoagulant effect not exceeding that aimed at usually by heparin alone.7 of 11 patients with recently developed (8 days or less) thrombosis showed a complete recanalization of the venous system.2 cases demonstrated a partial success. In 2 patients no phlebogra- phic alteration could be stated. These 2 patients had received urokinase at the lowest maintenance dosage of only 970 and 1000 IU/kg/h,respectively. In addition 7 patients with thromboses more than 10 days old showed no alteration of the thrombotic occlusions. Relevant side effects were not observed.The therapeutic results unequivocally depended on the thrombus age,the dosage of urokinase applied and the duration of the fibrinolytic therapy. Under treatment with an median,initial maintenance dosage of urokinase 1300-2000 IU/kg/h in combination with heparin excellant therapeutic results could be attained. Our data suggest that the here presented therapeutic procedure has to be considered in serious cases of recently developed subclavian-axillary vein thrombosis.

Possible Interaction of Indomethacin and Warfarin

1978 ◽  
Vol 12 (10) ◽  
pp. 580-581 ◽  
Author(s):  
Timothy H. Self ◽  
Mark S. Soloway ◽  
Don Vaughn
Keyword(s):  
Clinical Trials ◽  
Case Report ◽  
Prothrombin Time ◽  
Case Reports ◽  
Controlled Clinical Trials ◽  
Low Incidence

A case report of a possible interaction between indomethacin and warfarin is presented. The effect of warfarin on the prothrombin time (PT) was enhanced while indomethacin was given concurrently. Substitution of Ibuprofen for indomethacin resulted in the desired control of the prothrombin time. Based on the results of controlled clinical trials and on the rarity of case reports, there is probably an extremely low incidence of enhancement of warfarin-induced hypoprothrombinemia by indomethacin.

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