Hepar Inconcentration, Antithrombin III and Antiplasmin in Elective Surgery with Low Dose Heparin Prophylaxis

Eighty patients underwent abdominal surgery in low dose heparin (Novo) 5.000 units subcutanously 2 hours preoperatively and every 8 hours until full mobilization. Clinical end points were 125J fibrinogen uptake test and venography. Heparin concentrations, antithrombin III(AT III) against IIa and Xa and antiplasmin, were measured on synthetic substrates (Kabi Diagnostica, Sweden). Deep vein thrombosis (DVT) developed in 16 patients. Heparin concentrations were identical in patients ± DVT preoperatively but the concentrations were significantly lower postoperatively on day 1-5 in the patients with DVT, AT III (against IIa)was lower pre- and postoperatively in patients with DVT, but the differences were only significant lower when measuring AT III against Xa, pre- and postoperatively. The antiplasmin level was higher in patients with malignency and in patients with DVT, and the differences were significant postoperatively (p < 0.01).

XaI (Antithrombin III) Activity in Relation to Postoperative Deep Vein Thrombosis (DVT)

10.1055/s-0039-1687423 ◽

1979 ◽

Author(s):

I. Wallenbeck ◽

D. Bergqvist ◽

T. Hallböök ◽

E.T. Yin

Keyword(s):

Low Dose ◽

Antithrombin Iii ◽

Elective Surgery ◽

Specific Test ◽

Vein Thrombosis ◽

Dose Heparin ◽

Comprehensive Test ◽

Deep Vein ◽

Antithrombin Iii Activity ◽

65 patients (21 controls, 20 low-dose heparin, 24 dextran) undergoing hip or elective general surgery were tested for Xal activity with a Differential Xal Assay. The test uses activated F X as substrate for determining the biological activity of Xal in two test systems. 1) Comprehensive test measures the ability of undiluted plasma to neutralize Xa in presence of circulating accelerators or antagonists of Xal. 2) Specific test quantitates total Xal activity in a highly diluted plasma system. For screening of DVT, 125-fibrinogen and/or thermography was used. Classification into minor and major DVT was made. Mean preoperative Xal was 8-10% lower in patients who developed postoperative DVT (both tests). Hip fracture patients had significantly lower initial values than patients undergoing elective surgery (comprehensive test). Postoperatively, Xal activity in patients with minor or no DVT remained constant. In patients with major DVT, Xal activity was significantly lower (20-45% in comprehensive and 15-30% in specific test) on operation and first two postoperative days and then returned to preoperative levels. Patients who developed OVT showed the same pattern of Xal despite prophylaxis. Of 14 major DVT, 10 were diagnosed when Xal activity had normalized. This indicates that a decrease in Xal activityimmediately after trauma, can identify patients disposed to develop major thromboembolic complications.

LOW-DOSE HEPARIN PROPHYLAXIS AGAINST DEEP-VEIN THROMBOSIS AFTER ACUTE STROKE

The Lancet ◽

10.1016/s0140-6736(78)90465-8 ◽

1978 ◽

Vol 311 (8056) ◽

pp. 160-161

Author(s):

O.J.S. Buruma ◽

A.R. Wintzen ◽

E. Briët

Keyword(s):

Deep Vein Thrombosis ◽

Acute Stroke ◽

Low Dose ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Low Dose Heparin ◽

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

British Journal of Surgery ◽

10.1002/bjs.1800760920 ◽

1989 ◽

Vol 76 (9) ◽

pp. 933-935 ◽

Cited By ~ 27

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 ◽

PROPHYLAXIS AGAINST POSTOPERATIVE DEEP VEIN THROMBOSIS (DVT)- A DOUBLE-BLIND MULTICENTER TRIAL COMPARING A HEPARIN FRAGMENT GIVEN ON THE EVENING BEFORE SURGERY WITH CONVENTIONAL LOW DOSE HEPARIN

10.1055/s-0038-1644192 ◽

1987 ◽

Author(s):

D Bergqvist ◽

J Frisel ◽

T Hallböök ◽

A Horn ◽

A Lindhagen ◽

...

Keyword(s):

Low Dose ◽

Factor Xa ◽

Multicenter Trial ◽

Double Blind ◽

Vein Thrombosis ◽

Intention To Treat ◽

Dose Heparin ◽

Uptake Test ◽

Deep Vein ◽

Bergen, Halmstad, Goteborg and KabiVitrum AB Stockholm, Sweden and Norway. At the Xth Int. Congress on Thrombosis and Haemostasis in San Diego results from a multicenter trial on 432 patients were presented, comparing a low molecular weight heparin (LMWH) fragment (Fragmin, Kabi) once daily with low dose heparin twice daily. Prophylaxis started 2 hours preoperatively. The frequency of postoperative DVT did notdiffer (6.4 % v. 4.3 %) but the onset of thrombosis was delayed in the LMWH group. Haemorrhagic complications occurred significantly more often in the LMWH group (11.6 % v. 4.6 ?o). The results were similar independent whether the analysis was made according to the intention to treat principle or based on patients with correct prophylaxis. On the basis of these data and newer knowledge regarding the pharmacokinetics of LMWH a second prospective randomized double-blind multicenter trial on patients.older than 40 years undergoing elective abdominal surgery was started. The only difference was that the first dose of 5000 ariti-factor Xa units of LMWH was given on the evening before surgery. Only conventional low dose heparin was given 2 h before surgery. The study is designed to include 1000patients, a number which will be obtained during the spring 1987. At the time of abstract deadline 799 patients have been included. The over-all frequency of DVT (fibrinogen uptake test) is 6.8 %, the frequency of haemorrhagic complications 3.6 % and mortality 1.8 % (one fatal pulmonary embolism). These frequencies remained unaltered after inclusion of 336, 576, 655 and 799 patients. Although the code has not been broken yet, it can be concluded that the new regimen with start of prophylaxis the evening before surgery has not altered the frequency of DVT or mortality whereas the frequency of haemorrhagic side effects has decreased considerably.

Prevention of Deep-Vein-Thrombosis (DVT) in Hysterectomy Patients by Low-Dose-Heparin, Heparin-Dihydroergotamin and Acenocoumarol

10.1055/s-0039-1687247 ◽

1979 ◽

Author(s):

S. Kunz ◽

R. C. Briel

Keyword(s):

Low Dose ◽

Vein Thrombosis ◽

Dose Heparin ◽

Common Operation ◽

Uptake Test ◽

Deep Vein ◽

Mean Time ◽

Low Dose Heparin ◽

Calf Vein ◽

Group 1

In major gynecological surgery an incidence of 15 - 35% DVT is found. However there are no data concerning the incidence of DVT following hysterectomy, the most common operation in gynecology. Therefore, in 288 patients undergoing elective hysterectomy a 125-J-fibrinogen uptake test was carried out, starting 2 hours postop and repeated every 24 hours for 8 days. Results: Of the 97 patients who received heparin alone (2 x 5000 IU/24 h) 15, 5% developed DVT. In the heparin-dihydroergotamin group (101 patients, 2 x 5000 IU heparin + 0 . 5 mg DHE) only 5, 9% positive scans were found (2p <0.05). In the acenocoumarol group (prophylaxis was begun 36 hrs. postop. in 90 patients) the frequency was 11.1%. Mean time for the onset in the heparin and heparin-DHE group was 4 and 3 days resp., in the acenocoumarol group 1 day. Duration of positive scans: 98, 53 and 50 hours. Localisation: 65 - 72 % calf-vein thrombosis;14 % bilateral in the heparin, 0 in the heparin-DHE and 9 % in the acenocoumarol group. No differences were registered in complications, side effects, blood volume insuction drainages, postop. fall of hemoglobin, standard morbidity and hematoma.

Effect of Low-Dose heparin and dihydroercotamine prophylaxis on incidence of postoperative deep-vein thrombosis in patients undergoing hip surgery

10.1055/s-0039-1684783 ◽

1979 ◽

Author(s):

G. Lahnborg ◽

B. Beerman

Keyword(s):

Low Dose ◽

Prospective Trial ◽

Favourable Effect ◽

Control Group ◽

Heparin Group ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Low Dose Heparin ◽

The favourable effect of low-dose heparin prophylaxis in preventing postoperative deep-vain thrombosis (DVT) in patients undergoing surgical treume has bean shown in several investigations. However, there are still some patients sustaining DVT in spite of heparin prophylaxis. In an attempt to improve the prophylaxis, dihydroergotamine (DHE) has been added to the heparin.In a prospective trial the effect of low-dose heparin and DHE prophylaxis was studied in 190 patients undergoing nailing of fractured femoral neck. The patients were divided into 3 groups and were randomly given heparin or a combination of heparin and DHE and the third group was given only saline.The frequency of DVT, detected by the 125-I-fibrinogen method was 167. in the group given heparin and DHE, 20%, in the heparin group and 39% in the control group.Preliminary results. Completed evaluation will be presented during the congress.

Antithrombin III/Low-Dose Heparin in the Prevention of Deep-Vein Thrombosis After Total Knee Arthroplasty

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-198911000-00024 ◽

1989 ◽

Vol &NA; (248) ◽

pp. 152???157 ◽

Cited By ~ 1

Author(s):

B. N. STULBERG ◽

C. W. FRANCIS ◽

V. D. PELLEGRINI ◽

M. L. MILLER ◽

S. SHULL ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Low Dose ◽

Antithrombin Iii ◽

Vein Thrombosis ◽

Dose Heparin ◽

Total Knee ◽

Deep Vein ◽

Heparin and Venous Thrombo-Embolism

10.1055/s-0039-1680690 ◽

1977 ◽

Author(s):

V.V. Kakkar

Keyword(s):

Pulmonary Embolism ◽

Low Dose ◽

Subcutaneous Administration ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Kinetics Of ◽

Low Dose Heparin ◽

Total Elimination ◽

Venous thromboembolism represents a serious hazard in patients confined to bed in hospital. Though the search for an effective method of prophylaxis has been going on for nearly the last 90 years, a method which is effective in the total elimination of this condition has yet to be developed. One promising approach is the use of low-dose heparin given subcutaneously.In this review: (a) the rationale for low-dose heparin will be considered in the context of present concepts of pathogenesis of venous thrombosis; (b) factors which govern the kinetics of clearance of heparin from the circulation will be compared following its intravenous and subcutaneous administration; (c) the recently published studies, where the efficacy of this form of prophylaxis against deep vein thrombosis and pulmonary embolism has been assessed, will be analysed, and (d) further possible developments in heparin prophylaxis includingthe use of semi-synthetic heparin analogue will be discussed.

Deep vein thrombosis and low-dose heparin prophylaxis in neurosurgical patients

Journal of Neurosurgery ◽

10.3171/jns.1978.49.3.0378 ◽

1978 ◽

Vol 49 (3) ◽

pp. 378-381 ◽

Cited By ~ 160

Author(s):

Dario Cerrato ◽

Cesare Ariano ◽

Folco Fiacchino

Keyword(s):

Deep Vein Thrombosis ◽

Low Dose ◽

Motor Deficit ◽

Control Group ◽

Heparin Group ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Low Dose Heparin ◽

✓ By the use of 125I-labeled fibrinogen test, the incidence of postoperative deep vein thrombosis (DVT) and the effectiveness of prophylactic low-dose heparin treatment were investigated in 110 patients who underwent elective neurosurgical procedures. Fifty patients were appointed randomly to a control group and 50 to a heparin group (10 patients were excluded since they had DVT before surgery). The incidence of DVT was reduced from 34% in the control group to 6% in the heparin group (p < 0.005). No statistically significant differences were observed in transfusion requirements, postoperative hemoglobin concentration, and the occurrence of postoperative hematomas between the two groups. Positive correlation was observed between DVT and motor deficit (p < 0.05). Preoperative assessment of patients' sensitivity to the standard 5000-unit dose of heparin was performed in all treated patients and is thought an important factor in improving the safety of heparin prophylaxis.

Combined Administration of Low Dose Heparin and Aspirin Versus low Dose Heparin Alone as Prophylaxis of Deep Vein Thrombosis (D.V.T.) After Total Hip Replacement. A Preliminary Report

10.1055/s-0039-1680611 ◽

1977 ◽

Author(s):

A. Kher ◽

H. Flicoteaux ◽

N. Jean ◽

M. Blery ◽

T. Judet ◽

...

Keyword(s):

Low Dose ◽

Treatment Groups ◽

Vein Thrombosis ◽

Dose Heparin ◽

Group I ◽

Significant Difference ◽

Group Ii ◽

Uptake Test ◽

Deep Vein ◽

In a prospective randomized trial, the efficacy of a prophylaxis of D.V.T. by low dose heparin alone (t.i.d.-group I-18 patients) and by low dose heparin (t.i.d.) combined with aspirin (500 mg b.i.d.-group II-15 patients) was investigated using both radioactive fibrinogen uptake test and venography. The treatment groups were comparable for all pretreatment characteristics. The incidence of isotopic D.V.T. between group I (22.2%) and group II (26.6%) was not statistically significant. There was also no significant difference in the frequency of popliteal vein thrombosis between the two groups. One non fatal pulmonary embolism occurred in group I. Correlation of phlebography with radioactive fibrinogen uptake test is 87.5%. The combination of low dose heparin and aspirin does not improve the results obtained with low dose heparin alone in the prevention of post operative D.V.T. and a tendency in increased bleeding and wound haematomas were observed with such a combination.