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.

Subcutaneous Heparin Therapy In Renal Insufficiency

1981 ◽  
Author(s):  
W Salzmann ◽  
K Andrassy ◽  
E Ritz ◽  
J Koderisch
Keyword(s):  
Low Dose ◽  
Factor Xa ◽  
Repeated Administration ◽  
Heparin Therapy ◽  
Thrombin Time ◽  
Amidolytic Activity ◽  
Dose Heparin ◽  
Heparin Activity ◽  
Uremic Patients ◽  
Low Dose Heparin

It is often necessary to treat uremic patients with low dose heparin therapy,e.g. for prophylaxis of Cimino-fistula thrombosis. However, little information is available on heparin pharmacokinetics and heparin action in uremic patients. In the present study, plasma activity time profiles during low dose heparin therapy were investigated in control individuals (CO) and in uremic patients (UP). Patients and methods: Heparin levels 0;3;8;10;12;24;27;32;34 and 36 h after s.c. injection of various doses of heparin (2×7.500 IU/day for 2 days; 3×5.000 IU and 2×5.000 IU each for 2 days) were measured in 9 control individuals and in 11 uremic patients (Ccr < 10 ml/min.). Heparin activity was determined by measurements of (1) neutralisation of factor Xa-activity (Denson and Bonnar); (2) neutralisation of Xa measuring amidolytic activity (Teien and Lie); (3) PTT and thrombin time. Heparin cofactor concentrations were measured with immuno-diffusion and by measuring amidolytic activity. Results: With the dose of 2×5.000 IU heparin s.c. no difference between CO and UP was found; in contrast, peak concentrations of heparin were significantly lower in UP after 7.500 IU heparin s.c. With the dose of 3×5.000 IU heparin s.c.there was a significant (p<0.05) difference of heparin levels between CO and UP. This difference was even more pronounced after repeated administration of heparin; heparin levels in UP were markedly lower than in controls. The antithrombin III levels did not change significantly during the study. Conclusion : The results show that in order to reach a given profile of heparin activity, higher s.c. doses of heparin must be administered in uremic patients than in non-uremic controls.

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.

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

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 ◽  
Low Dose Heparin

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.

Antithrombin III and Low-Dose Heparin in Acute Cardioembolic Stroke

1995 ◽  
Vol 5 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Masahiro Yasaka ◽  
Takenori Yamaguchi ◽  
Hideki Moriyasu ◽  
Jiro Oita ◽  
Tohru Sawada ◽  
...  
Keyword(s):  
Low Dose ◽  
Antithrombin Iii ◽  
Cardioembolic Stroke ◽  
Dose Heparin ◽  
Low Dose Heparin

Problems In Measuring Low Dose Heparin

1981 ◽  
Author(s):  
R Róka
Keyword(s):  
Low Dose ◽  
Plasma Sample ◽  
Antithrombin Iii ◽  
Platelet Factor 4 ◽  
Platelet Factor ◽  
Individual Control ◽  
Dose Heparin ◽  
The Difference ◽  
Antithrombin Iii Activity ◽  
Low Dose Heparin

In order to assess the influence of low dose heparin on the reaction between thrombin and antithrombin, an individual control is needed, if heparin levels below 0,05 U/ml are to be measured. This allows discrimination between progressive antithrombin and heparin cofactor activity. The concentration of low dose heparin is calculated as the difference between spontaneous antithrombin III activity and progressive antithrombin III activity in a given sample. The plasma sample to be assayed also serves as individual control after heparin has been inactivated by binding to platelet factor 4. Purified platelet factor 4 can either be added to the sample or liberated from platelets contained in the sample by platelet sonification. The activity of progressive antithrombin in the control depends on the ratio of thrombin to antithrombin in the reaction mixture. This ratio and the activity of progressive antithrombin increase proportionally and thus influence the calculation of low dose heparin concentration. Comparable results are obtained only if this ratio is kept constant.

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

1989 ◽  
Vol &NA; (248) ◽  
pp. 152???157 ◽  
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 ◽  
Low Dose Heparin
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