An Objective Trial of Alternative Methods of Heparin Administration

1979 ◽  
Author(s):  
P.G. Bentley ◽  
V.P. Ward ◽  
V.V. Kakkar
Keyword(s):  
Infusion Pump ◽  
Alternative Methods ◽  
Constant Infusion ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
Heparin Administration ◽  
Life Saving ◽  
The Difference ◽  
Pre Treatment ◽  
Exact Size

Although it ts generally agreed that heparin is truly a life saving drug, the best method of administration remains to be determined. 100 patients with calf vein thrombosis were randomly allocated to receive either subcutaneous (SC) or intravenous (IV) heparin for seven days. Venography was performed in each patient to confirm the exact size and site of thrombus and was repeated at the end of heparin treatment. IV heparin was administered using a constant infusion pump. Platelet count, haemoglobin and haematocrit estimations were performed at the beginning, mid point, and end of hep rin treatment. The dose of heparin to be administered was determined by dally estimation of KCCT. In SC group, thrombi increased in size in 2%. remained unchanged in 50% and decreased in 48%. In IV group, they increased in size in 20%, were unchanged in 62% and decreased in 18%. The difference in decreases in size was significant (P < 0.01). Pre-treatment lung scans corfirmed the presence of emboli in 10 patients in SC and 11 in IV group; post treatmel scan showed improvement in 60% in SC compared to 91% in IV group. The mean daily heparin requirement (±SD) was 36,998 ± 7. 12IU in the SC group and 36,814 ± 6.63 IU in the IV group. The average KCCT fluctuation index in the SC group was 59.08 seconds compared to 64.4 seconds in the IV group. Major bleeding complications occurred in 2 patients on SC heparin and in 4 treated with IV heprin. The clinical signficance of these will be discussed

HAEMOSTASIS CHANGES FOLLOWING TOTAL HIP REPLACEMENT IN A RANDOMIZED TRIAL WITH LMW HEPARIN (KABI 2165) AND ADJUSTED DOSE STANDARD HEPARIN

1987 ◽  
Author(s):  
M Berruyer ◽  
M Dechavanne
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Results ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
No Inhibition ◽  
Heparin Administration ◽  
Group I ◽  
At Iii ◽  
High Level ◽  
Deep Vein

70 patients were randomized to 3 groups. Group I : patients received 5,000 IU calciparineR subcutaneously given 2h before operation, twice a day for 3 days and then, doses were adjusted ty heparin levels. Groups II and III : 2,500 IU Kabi 2165 were given instead of calciparineR, but in group III, a single daily dose of 5,000 IU Kabi 2165 was administered from the third day. Fibrino-peptide A (FPA), FPA generation, D-dimers were measured in plasma by ELISA methods. Anti Xa activity, Xa generation, heparin cofactor II (HC II), antithrombin III (AT III) were assayed in plasma using amidolytic methods. Serial measurements were done : pre-operatively, 2 and 8h after the first heparin injection and on the 7th post-operative day, before heparin administration. Pre-operatively, the mean level of D-dimers was higher (p<0.05) in 9 patients with bleeding complications after surgery (0.83 ± 0.57 pg/ml) compared to other patients (0.42 ± 0.33 pg/ml) 2h after heparin injection : 1) Xa activity was lower (p<0.001) in group I (<0.05 IU/ml) than in groups II and III (0.137 ± 0.1 IU/ml) ; 2) inhibition of Xa generation decreased (p<0.001) in group I (11.7 ± 8%) compared to that in groups II and III (25.8 ± 13%) ; 3) inhibition of FPA generation was lower (p<0.05) in group I (27.1 ± 32.2%) than in groups II and III (45.7 ± 29.2%) ; 4) diminution of D-dimers under heparin (0.37 ± 0.28 pg/ml) was only significant (p<0.05) in groups II and III. 8h after the first heparin injection, in all groups : 1) D-dimers increased (p<0.001) compared to pre-operative values ; 2) AT III and HC II diminished (p<0.001) ; 3) no anti Xa activity and no inhibition of Xa and FPA generation were found. On the 7th day : 1) 4 patiertts with deep vein thrombosis had higher FPA than other patients ; 2) AT III but not HC II fell in group I (p<0.05) ; 3) no anti Xa activity and no inhibition of Xa and FPA generation were observed in all groups. In conclusion : 1) although clinical results are similar in the 3 groups, Xa activity, Xa generation, FPA generation change differently according to the heparin used ; 2) the occurence of deep vein thrombosis is followed by an FPA increase and bleeding complications are correlated with a high level of pre-operative D-dimers.

Prophylaxis of Deep Vein Thrombosis in Gynecology

1979 ◽  
Author(s):  
M.K. Hohl ◽  
K. P. Lüscher ◽  
U. F. Gruber
Keyword(s):  
Major Bleeding ◽  
Postoperative Bleeding ◽  
Bleeding Complications ◽  
Heparin Group ◽  
Intraoperative Bleeding ◽  
Vein Thrombosis ◽  
Heparin Administration ◽  
Uptake Test ◽  
Deep Vein ◽  
Group 1

There is only scarce data regarding the prevention of DVT in gynecology. Trials using 3x5000 IU/day of Heparin s. c. or 2x2500 IU + 0,5 mg Dihydroergotamine (DHE) s.c./day in gynecological patients have not been published. Therefore we conducted a prospective, randomized trial comparing the two regimens. Methods: Included were patients at the age of 40 or over undergoing major gynecological surgery lasting more than 30 minutes under general anesthesia. The I125-Fibrinogen-uptake test was used in all patients for the diagnosis of DVT. Heparin administration: 5000 IU Na-Heparin (Roche) were given s.c. 2 hours before the operation and 8-hourly thereafter for 7 days. Heparin + DHE administration: 2500 IU Na-Heparin +0,5 mg DHE (Sandoz) were given s. c. 2 hours preop. and 12-hourly thereafter for 7 days. Results: Patients in all groups were well matched for age, bodyweight, duration of anesthesia and type of operation. 2 (31%) of 64 patients receiving Heparin and 4 (6. 6%) of 61 treated with DHE-Heparin developed positive leg scans (p > 0. 3). Major bleeding, complications, massive intraoperative bleeding and reoperation for postoperative bleeding or wound hematoma were found significantly more often in the Heparin group (10.9%) than in the DHE-Heparin-group (1. 6%) (p < 0. 05). Conclusions: One third of the Heparin dosis is as effective as the full dosis when DHE 18 added. The lowering of the Heparin dosis leads to a lower number of major bleeding complications.

scholarly journals Heparin administration by constant infusion pump.

BMJ ◽  
1967 ◽  
Vol 2 (5550) ◽  
pp. 482-484 ◽  
Author(s):  
A. J. Handley
Keyword(s):  
Infusion Pump ◽  
Constant Infusion ◽  
Heparin Administration

Subcutaneous Recombinant Hirudin (HBW 023) Versus Intravenous Sodium Heparin in Treatment of Established Acute Deep Vein Thrombosis of the Legs: a Multicentre Prospective Dose-ranging Randomized Trial

1997 ◽  
Vol 77 (05) ◽  
pp. 0834-0838 ◽  
Author(s):  
François Schiele ◽  
Folke Lindgaerde ◽  
Henry Eriksson ◽  
Jean-Pierre Bassand ◽  
Anders Wallmark ◽  
...  
Keyword(s):  
Bleeding Complications ◽  
Recombinant Hirudin ◽  
Serious Adverse Events ◽  
Sodium Heparin ◽  
Efficacy Analysis ◽  
Vein Thrombosis ◽  
Dose Ranging ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein ◽  
Intravenous Sodium

SummaryThe aim of this multicentre, prospective, randomised, dose-ranging study was to compare the safety and efficacy of subcutaneous recombinant hirudin (HBW 023) against intravenous sodium heparin in acute lower limb deep venous thrombosis (DVT). Patients were randomized to treatment with either HBW 023 or heparin for 5 ±1 days. HBW 023 was given according to body-weight in three dose groups. Thromboembolic disease was assessed by phlebography and ventilation/perfusion (V/Q) scanning on Bay 1 and Day 5±1. One hundred and fifty-five patients were enrolled, of these 121 were evaluable for efficacy analysis. Significantly fewer patients on HBW 023 developed new V/Q abnormalities during the treatment period, (p = 0.006). There was no difference between the groups in thrombus extension or regression, major bleeding complications or serious adverse events. There were significantly fewer findings of new V/Q mismatch after treatment with HBW 023, and anticoagulant control was superior in these patients.

Outcome of Treatment of Deep-Vein Thrombosis with Urokinase: Relationship to Dosage, Duration of Therapy, Age of the Thrombus and Laboratory Changes

1984 ◽  
Vol 51 (02) ◽  
pp. 236-239 ◽  
Author(s):  
A D’Angelo ◽  
P M Mannucci
Keyword(s):  
Degradation Products ◽  
High Rate ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
Treatment Regimens ◽  
Duration Of Therapy ◽  
Laboratory Changes ◽  
Deep Vein ◽  
Dose Dependent ◽  
Higher Doses

SummaryForty-one patients with phlebographically proven DVT of the popliteal, femoral or iliac veins were treated with different regimens of urokinase (UK) given by continuous intravenous infusion. The four groups were comparable with respect to localization, extension and estimated age of the thrombi. Another phlebographic picture was taken within 48 hr after the end of UK infusion. Substantial lysis had occurred in 2 of 10 patients treated with 1500 U/kg/h for 2 days, in 4 of 11 treated with 2500/U/kg/h for 3 days, in 2 of 10 treated with 2500 U/kg/h for 7 days and in 4 of 10 treated with 4000 U/kg/h for 4 days. Only thrombi younger than 8 days could be lysed, with 61% (8/13) rate of lysis for thrombi less than 5 days old. Bleeding complications were observed more frequently with the higher doses and longer durations of therapy. The four treatment regimens all induced dose-dependent changes in fibrinogen, fibrin(ogen) degradation products, plasminogen and antiplasmin. Neither pre- nor postinfusion values of these parameters could differentiate patients with lysis from those without lysis. It is concluded that UK can provoke a high rate of thrombolysis of DVT treated early after the appearance of symptoms but that there is no relationship between UK-induced modifications of fibrinolysis and the outcome of therapy.

Heparin Assays and Bleeding Complications in Treatment of Deep Venous Thrombosis with Particular Reference to Retroperitoneal Bleeding

1985 ◽  
Vol 53 (02) ◽  
pp. 278-281 ◽  
Author(s):  
H Asbjørn Holm ◽  
Ulrich Abildgaard ◽  
Sigmund Kalvenes
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Major Bleeding ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Thrombin Time ◽  
Heparin Infusion ◽  
Retroperitoneal Bleeding ◽  
Heparin Activity ◽  
The Difference

SummaryBleeding complications occurred in 30 (11%) out of 280 patients who received continuous heparin infusion for deep venous thrombosis (DVT). 22 (8%) had minor while 8 patients (3%) had major bleeding complications (1 intrathoracic [fatal], 2 gastrointestinal and 5 retroperitoneal). Heparin activity, in daily drawn blood samples, was determined by four assays (chromogenic substrate [CS] assay, activated partial thromboplastin time [APTT], thrombin time with citrated plasma [CiTT] and thrombin time with recalcified plasma [CaTT]). The differences in median heparin activity between patients with minor bleeding and patients with no bleeding did not reach significance for any of the tests. In patients with major bleeding, the differences were significant with the CS (p = .011) and the CaTT (p = .030) assays. Patients with retroperitoneal bleeding had significantly increased median activity judged by all four assays: CS (p = .002), CaTT (p = .003), APTT (p = .010), CiTT (p = .029). The difference was most pronounced after four days of heparin treatment, but there was a considerable overlap with patients without bleeding.

scholarly journals Influence of the Bottom Color Modification and Material Color Modification Process on the Performance of Modified Poplar

Coatings ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 660
Author(s):  
Qingqing Liu ◽  
Di Gao ◽  
Wei Xu
Keyword(s):  
Chemical Properties ◽  
Target Color ◽  
Modification Process ◽  
Red Color ◽  
The Difference ◽  
Pre Treatment ◽  
Physical And Chemical ◽  
Surface Differentiation ◽  
Color Modification ◽  
And Chemical Properties

According to the old surface coating process of European and American furniture, the surface of modified poplar is first differentiated pre-treatment, and then the bottom color modification and material color modification are respectively applied to the modified poplar after the surface differentiation treatment. The visual physical quantity and physical and chemical properties were measured and compared with mahogany, which is commonly used in old furniture in Europe and America to explore the effect of colorants and coloring steps, as well as different surface pretreatments on the coloring effect. Finally, it is concluded that continuous coloring operations can narrow the difference in brightness and red color value in the coloring layer of modified poplar and mahogany. Continuous coloring operations increase the difference between the yellow-green color values of modified poplar and mahogany. Therefore, the coloring difference between modified poplar and mahogany was affected by the colorant and coloring steps. Through color accumulation, the gap between the two in the target color coloring effect can be reduced, thereby reducing the difference between the coloring effect of modified poplar and mahogany.

scholarly journals Home Mechanical Ventilation: A Patient’s Perspective Survey Study

2021 ◽  
Vol 18 (8) ◽  
pp. 4048
Author(s):  
Magdalena Kwiatosz-Muc ◽  
Bożena Kopacz
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
Alternative Methods ◽  
Survey Study ◽  
Home Mechanical Ventilation ◽  
Patient’S Satisfaction ◽  
Satisfaction Index ◽  
Number Of Patients ◽  
The Difference

Background: An increasing number of patients included in home mechanical ventilation (HMV) care has been under observation for many years. The study aimed to assess the patients opinion concerning the expected and perceived quality of care in an HMV system and a patient’s satisfaction with care. Methods: In 2017, patients treated with HMV were surveyed in Poland with the modified SERVQUAL questionnaire. Results: One hundred correctly completed surveys were analyzed. Patient Satisfaction Index was high. In every examined area, the expectations were statistically significant larger than the perception of the services. The biggest gap was in the tangibility dimension and the smallest gap was in the empathy dimension. Perceived respect and understanding for a patient’s needs are close to the expectations. Conclusions: The level of satisfaction with health care among patients treated with HMV in majority of investigated components is high. Moreover, the difference between perceived and expected quality of health care in the HMV system was relatively small in the opinion of the patients themselves. Further investigations with alternative methods are needed.

scholarly journals Higher anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-center cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Julie Helms ◽  
◽  
François Severac ◽  
Hamid Merdji ◽  
Maleka Schenck ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Bleeding Risk ◽  
Tertiary Hospital ◽  
Biological Data ◽  
Bleeding Complications ◽  
Therapeutic Group ◽  
Vein Thrombosis ◽  
Icu Stay ◽  
Thrombotic Complications

Abstract Background Thromboprophylaxis of COVID-19 patients is a highly debated issue. We aimed to compare the occurrence of thrombotic/ischemic events in COVID-19 patients with acute respiratory distress syndrome (ARDS) treated with either prophylactic or therapeutic dosage of heparin. All patients referred for COVID-19 ARDS in two intensive care units (ICUs) from two centers of a French tertiary hospital were included in our cohort study. Patients were compared according to their anticoagulant treatment to evaluate the risk/benefit of prophylactic anticoagulation versus therapeutic anticoagulation. Medical history, symptoms, biological data and imaging were prospectively collected. Results One hundred and seventy-nine patients (73% men) were analyzed: 108 in prophylactic group and 71 in therapeutic group. Median age and SAPS II were 62 [IQR 51; 70] years and 47 [IQR 37; 63] points. ICU mortality rate was 17.3%. Fifty-seven patients developed clinically relevant thrombotic complications during their ICU stay, less frequently in therapeutic group (adjusted OR 0.38 [0.14–0.94], p = 0.04). The occurrences of pulmonary embolism (PE), deep vein thrombosis (DVT) and ischemic stroke were significantly lower in the therapeutic group (respective adjusted OR for PE: 0.19 [0.03–0.81]; DVT: 0.13 [0.01–0.89], stroke: 0.06 [0–0.68], all p < 0.05). The occurrence of bleeding complications was not significantly different between groups, neither were ICU length of stay or mortality rate. D-dimer levels were significantly lower during ICU stay, and aPTT ratio was more prolonged in the therapeutic group (p < 0.05). Conclusion Increasing the anticoagulation of severe COVID-19 patients to a therapeutic level might decrease thrombotic complications without increasing their bleeding risk.

Mortality rates and risk factors for asymptomatic deep vein thrombosis in medical patients

2005 ◽  
Vol 93 (01) ◽  
pp. 76-79 ◽  
Author(s):  
Alain Leizorovicz ◽  
Alexander Cohen ◽  
Alexander Turpie ◽  
Carl-Gustav Olsson ◽  
Samuel Goldhaber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Mortality Rates ◽  
Hazard Ratio ◽  
Group Iii ◽  
Vein Thrombosis ◽  
Group I ◽  
Compression Ultrasound ◽  
The Difference ◽  
Deep Vein

SummaryThe clinical importance of asymptomatic proximal and distal deep vein thrombosis (DVT) remains uncertain and controversial. The aim of this retrospective,post-hoc analysis was to examine mortality and risk factors for development of proximal DVT in hospitalized patients with acute medical illness who were recruited into a randomized, prospective clinical trial of thromboprophylaxis with dalteparin (PREVENT).We analyzed 1738 patients who had not sustained a symptomatic venous thromboembolic event by Day 21 and who had a complete compression ultrasound of the proximal and distal leg veins on Day 21. We examined the 90-day mortality rates in patients with asymptomatic proximal DVT (Group I, N = 80), asymptomatic distal DVT (Group II, N = 118) or no DVT (Group III, N = 1540).The 90-day mortality rates were 13.75%, 3.39%, and 1.92% for Groups I–III, respectively. The difference in mortality between Group I and Group III was significant (hazard ratio 7.63, 95% CI = 3.8–15.3;p < 0.0001),whereas the difference between Groups II and III did not reach significance (hazard ratio 1.36, 95% CI = 0.41–4.45).The association of asymptomatic proximal DVT with increased mortality remained highly significant after adjusting for differences in baseline demographics and clinical variables. Risk factors significantly associated with the development of proximal DVT included advanced age (p = 0.0005), prior DVT (p = 0.001), and varicose veins (p = 0.04). In conclusion, the high mortality rate in patients with asymptomatic proximal DVT underscores its clinical relevance and supports targeting of asymptomatic proximal DVT as an appropriate endpoint in clinical trials of thromboprophylaxis.

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