Monitoring Low-Dose Heparin Administration In Hip Surgery

1981 ◽  
Author(s):  
L Poller ◽  
D A Tabemer
Keyword(s):  
Low Dose ◽  
Factor Xa ◽  
Hip Surgery ◽  
Fixed Dose ◽  
Heparin Group ◽  
Dose Heparin ◽  
Heparin Administration ◽  
Risk Patients ◽  
Calcium Heparin ◽  
Low Dose Heparin

Fifty-five patients requiring selective hip replacement or emergency surgery for hip fractures were randomly given fixed low-dose subcutaneous calcium heparin 5,000 units 8-hourly (30 patients) or monitored subcutaneous calcium heparin (25 patients). The aim was to prolong the activated partial thromboplastin time (APTT), using the NRLARC method, to 5 seconds above the upper limit of normal.Adjusting the dose of heparin was moderately successful in achieving the target value for the APTT (46% of observations) compared to the fixed dose group (27%) p<0.005. In nine patients prophylaxis failed to prevent DVT detected by 125I-fibrinogen scan; three were in the adjusted dose, six in the fixed dose heparin group. In all nine patients the APTT showed less than the desired prolongation the day before the scan became positive although in six patients with positive scans, measurable heparin levels were detected by anti-factor Xa assay. The APTT appears, therefore, to give a better guide during hip surgery to the antithrombotic effect of heparin than the anti-factor Xa assay in low-dose heparin prophylaxis. Maintaining the APTT at or above 50 seconds with the NRLARC method protected these high risk patients from post-operative DVT.

Optimal antithrombotic regimen in patients with cardiogenic shock on ImpellaTM mechanical support: less might be more

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Vandenbriele ◽  
L Dannenberg ◽  
M Monteagudo-Vela ◽  
T Balthazar ◽  
D Metzen ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Low Dose ◽  
Cox Regression ◽  
Mechanical Support ◽  
Bleeding Events ◽  
Heparin Group ◽  
Cox Regression Analysis ◽  
Dose Heparin ◽  
Low Dose Heparin ◽  
Ischemic Events

Abstract Background Bleeding and ischemic complications are the main cause of morbidity and mortality in critically ill cardiogenic shock patients, supported by short-term percutaneous mechanical circulatory support (pMCS) devices. Hence, finding the optimal antithrombotic regimen is challenging. Bleeding not only occurs because of heparin and antiplatelet therapy (both required in the prevention of pump and acute stent thrombosis) but also because of device- and disease related coagulopathy. To prevent clotting-related device failure, most centers target full therapeutic heparin anticoagulation levels in left ventricular (LV) Impella™ supported patients in analogy with Veno-Arterial Extracorporeal Membrane Oxygenation. We aimed to investigate the safety (related to bleeding and thrombotic complications) of targeting low-dose versus therapeutic heparin levels in left Impella™-supported cardiogenic shock patients on dual antiplatelet therapy (DAPT). Methods In this hypothesis generating pilot study, we investigated 114 patients supported for at least two days by LV Impella™ mechanical support due to cardiogenic shock at three tertiary ICUs, highly specialized in mechanical support. Low-dose heparin (aPTT 40–60s or anti-Xa 0.2–0.3) was compared to standard of care (aPTT 60–80s or anti-Xa 0.3–0.5). Major adverse cardio- and cerebrovascular events (MACCE; composite of death, myocardial infarction, stroke/transient ischemic attack) and BARC bleeding (bleeding academic research consortium classification) during 30 day follow-up were assessed. Inverse probability of treatment weighting (IPTW) analysis was calculated with age, gender, arterial hypertension, diabetes mellitus, smoking, chronic kidney disease, previous stroke, previous myocardial infarction, previous coronary arterial bypass grafting, hypercholesterolemia and DAPT as matching variables. COX regression analysis was conducted to test for robustness. Results IPTW revealed 52 patients in the low-dose heparin group and 62 patients in the therapeutic group. Mean age of patients after IPTW was 62±16 years in the intermediate and 62±13 years in the therapeutic group (p=0.99). 25% and 42.2% were male (p=0.92). Overall bleeding events and major (BARC3b) bleeding events were higher in the therapeutic heparin group (overall bleeding: Hazard ratio [HR]=2.58, 95% confidence interval [CI] 1.2–5.5; p=0.015; BARC 3b: HR=4.4, 95% CI 1.4–13.6, p=0.009). Minor bleeding (BARC3a) as well as MACCE and its single components (ischemic events) did not differ between both groups. These findings were robust in the COX regression analysis. Conclusion In this pilot analysis, low-dose heparin in 114 LV Impella™ cardiogenic shock patients was associated with less bleeding without increased ischemic events, adjusted for DAPT. Reducing the target heparin levels in critically ill patients supported by LV Impella™ might improve the outcome of this precarious group. These findings need to be validated in randomized clinical trials. Funding Acknowledgement Type of funding source: None

Low Dose Heparin Versus Oral Anticoagulants in the Prevention of Postoperative Venous Thrombosis in Gynecology

1975 ◽  
Author(s):  
A. E. Schaer ◽  
L. Huber ◽  
P. Bader ◽  
U. Baertschi ◽  
P. Morf
Keyword(s):  
Low Dose ◽  
Oral Anticoagulants ◽  
Randomised Trial ◽  
Postoperative Hemorrhage ◽  
Heparin Group ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Severe Hemorrhage ◽  
Fibrinogen Test ◽  
Low Dose Heparin

In a randomised trial involving 458 patients low dose heparin, peri- and postoperatively given subcutaneousely (Liquemin subcutan Roche) 2 × 5000 U twice daily for one week, was compared with oral anticoagulants. Deep vein thrombosis, diagnosed clinically and by the 125-J-fibrinogen test, was less frequent in the heparin group (2,3%/4,6%). However, the incidence of pulmonary embolism was rather high (6 cases in the heparin group, only one with oral anticoagulants). Mild postoperative hemorrhage occured more often with heparin, but the incidence of severe hemorrhage remained the same (4,5%).These results suggest to examine a combination of the two methods: low dose heparin perioperatively, oral anticoagulants in the postoperative course.

Prophylactic, Low-Dose Heparin Administration Inhibits Pulmonary Growth and Development

2020 ◽  
Vol 231 (4) ◽  
pp. S209-S210
Author(s):  
Victoria H. Ko ◽  
Lumeng J. Yu ◽  
Duy T. Dao ◽  
Jordan D. Secor ◽  
Amy Pan ◽  
...  
Keyword(s):  
Growth And Development ◽  
Low Dose ◽  
Dose Heparin ◽  
Heparin Administration ◽  
Low Dose Heparin

Drcg Phopllylaxis of Thromboehbolic Complicatioxs, Lituts and Facilities in Hip Surgery

1979 ◽  
Author(s):  
K. Westermann ◽  
O. Trentz ◽  
P. Pretschmer
Keyword(s):  
Hip Replacement ◽  
Low Dose ◽  
Lung Perfusion ◽  
Pulmonary Emboli ◽  
Thromboembolic Complications ◽  
Heparin Group ◽  
Dose Heparin ◽  
Before And After ◽  
Perfusion Scan ◽  
Low Dose Heparin

In 1973 we started prospective, controlled trials on prophylactic efficiency of 5 drugs: combination of aspirin and dipyridaMol (95 patients), deXtran 60 (43 patients), Clihydroergotarnin (61patients), Iml-dose-heparin (63 patients) and a combination of dihydroergotamin and low-dose-heparin two times (61patients), three times (63 patients) a day. The 386 patients undergoing total hip replacement were screened with the 125-J-fibrinogenuptake- test, phlebography and a careful clinical evaluation before and after surgery. A lung perfusion scan was performed in the last 4 groups. In cases of established DVT simultaneous anticoagulation with heparin and coumarin was started. In the group with aspirin/dipyridamol prophylaxis 32 (34 %) DVT and 3 pulmonary emboli were detected. In the dextran group 24 (56 %) got DVT and one non fatal PE. The dihydroergotamin showed 33 DVT (54 %) and 7 PE. In the low dose heparin group we had 29 (46 %) DVT and 3 PE. Only the combination of low dose heparin and dihydroergotamin reduced the incidence of thromboembolic complications significantly: no PE, 15 DVT (25%). The last group showed no further reduction but more hemorrhagic complications

Randomized study of adjusted versus fixed low dose heparin prophylaxis of deep vein thrombosis in hip surgery

1989 ◽  
Vol 76 (9) ◽  
pp. 933-935 ◽  
Author(s):  
D. A. Taberner ◽  
L. Poller ◽  
J. M. Thomson ◽  
G. Lemon ◽  
F. J. Weighill
Keyword(s):  
Deep Vein Thrombosis ◽  
Low Dose ◽  
Randomized Study ◽  
Hip Surgery ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Deep Vein ◽  
Low Dose Heparin ◽  
Heparin Prophylaxis

scholarly journals Failure of Low Dose Heparin to Prevent Pulmonary Embolism After Hip Surgery Or Above The Knee Amputation

1978 ◽  
Vol 188 (4) ◽  
pp. 468-474 ◽  
Author(s):  
JAMES W. WILLIAMS ◽  
EDWARD A. EIKMAN ◽  
STEPHEN H. GREENBERG ◽  
J. CARLISLE HEWITT ◽  
ENRIQUE LOPEZ-CUENCA ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Low Dose ◽  
Hip Surgery ◽  
Knee Amputation ◽  
Dose Heparin ◽  
Low Dose Heparin

Postoperative Hypercoagulability, Detection And Measurement Using A Modified Recalcification Time System, Effects Of Low Dose Heparin And Types Of Surgery

1981 ◽  
Author(s):  
P B Lundquist ◽  
J Swedenborg
Keyword(s):  
Healthy Volunteers ◽  
Low Dose ◽  
Factor Xa ◽  
Inhibition Test ◽  
Time System ◽  
Arterial Grafts ◽  
Dose Heparin ◽  
Factor Xa Inhibition ◽  
Recalcification Time ◽  
Low Dose Heparin

The purpose of the study was to demonstrate postoperative hypercoagulability and its possible prevention by low dose heparin (LDH). Healthy volunteers (with LDH), patients undergoing cholecystectomy (with & without LDH) and patients undergoing arterial reconstructive surgery with synthetic grafts (with LDH), were tested. All were tested 1, 3 & 5 hrs after LDH.Overall coagulability was determined by using platelet free plasma and a modified recalcification time system with a nefelometer to detect first fibrin formation. Recalcification times were measured before (T0) and after (TA) plasma activation against glass, in vitro. Heparin levels were determined with the Factor Xa inhibition test using a chromogenic substrate (CoatestR, Kabi).T0 and TA were prolonged after LDH in healthy volunteers. Cholecystectomy caused shortening of T0 and TA. This could be prevented by LDH, raising T0 to level recorded after LDH in normals. Patients receiving synthetic arterial grafts showed no prolongation of T0 and TA after surgery with LDH, but rather a shortening. These patients showed hypercoagulability in spite of LDH.It is concluded that postoperative hypercoagulability can be traced with the presented method and counteracted by LDH in patients undergoing cholecystectomy but not in patients receiving synthetic arterial grafts. All patients on LDH had similar heparin levels, determined with the Factor Xa inhibition test. Vascular surgery with synthetic grafting and Cholecystectomy seem to induce two different kinds of hypercoagulability, where the former is thought to be induced by the foreign surface. Subcutaneous heparin therapy (LDH) results in poor inhibition of surface induced coagulation, in vivo.

Results in Preventing Thrombosis By Low-Dose Heparin in Consideration of Heparin Concentration and Antithrombin III in

1979 ◽  
Author(s):  
V. Tilsner ◽  
U. Müller
Keyword(s):  
Low Dose ◽  
Antithrombin Iii ◽  
Factor Xa ◽  
Coagulation Factors ◽  
Optimal Dosage ◽  
Thrombin Time ◽  
Normal Limits ◽  
Dose Heparin ◽  
Treatment Plans ◽  
Low Dose Heparin

The antithrombotic effect of low-dose heparin has been ascertained clinically. The postoperative activation of the coagulation factors must be decreased, without increasing any bleeding tendencies. In order to determine the optimal dosage in low-dose heparin prophylaxis we examined the RCT, PTT, TT, Factor Xa, AT III and heparin concentrations in 400 patients prior to and following emergency surgery. Any thrombotic or haemorrhagic complication was registered. All 100 cases received one of the following treatment plans: 1) 5000 U heparin s.c. TID, 2) 7500 U heparin s.c. TID, 3) 100 U heparin/kg s.c. BID, 4) 150 U heparin/kg s.c. BID. Only plans 2 and 4 achieved a measureable heparin effect without increasing the risk of bleeding. The PTT did not shorten in either of these 2 groups and the thrombin time rose only occasionally to the upper normal limits. All other values remained within normal limits. The thrombo-embolic incidence amounted to 1% in groups 2 and 4, 2% in groups 3 and 5% in the first group.

scholarly journals Prevention of hepatic veno-occlusive disease after bone marrow transplantation by continuous infusion of low-dose heparin: a prospective, randomized trial [see comments]

Blood ◽  
1992 ◽  
Vol 79 (11) ◽  
pp. 2834-2840 ◽  
Author(s):  
M Attal ◽  
F Huguet ◽  
H Rubie ◽  
A Huynh ◽  
JP Charlet ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Randomized Trial ◽  
Continuous Infusion ◽  
Marrow Transplantation ◽  
Low Dose ◽  
Control Group ◽  
Heparin Group ◽  
Dose Heparin ◽  
Low Dose Heparin

Abstract Hepatic veno-occlusive disease (VOD) is a major regimen-related toxicity after bone marrow transplantation (BMT). Endothelial injury, leading to deposition of coagulation factors within the terminal hepatic venules, is believed to be the key event in the pathogenesis of VOD. To evaluate the benefit and the safety of a VOD prophylaxis with anticoagulants, we conducted a prospective randomized trial of continuous infusion of low-dose heparin among 161 patients under-going either allogeneic (n = 79) or autologous BMT (n = 81). Patients were randomized to receive (n = 81) or not receive (n = 80) prophylactic heparin 100 U/kg/d by continuous infusion from day -8 until day +30 post-BMT. Heparin was found to be highly effective in preventing VOD, which occurred in 11 of 80 patients (13.7%) in the control group versus 2 of 81 (2.5%) in the heparin group (P less than .01). Furthermore, none of the 39 patients in the heparin group developed VOD after allogeneic BMT, versus 7 of 38 (18.4%) in the control group (P less than .01). This prophylactic effect was achieved without added risk of bleeding. Indeed, the low-dose heparin we used did not prolong the partial thromboplastin time and did not increase the red blood cell and platelet requirements. It is therefore recommended that heparin prophylaxis be part of early mortality prevention programs after BMT.

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