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.

Apparent Lack of Synergism between Heparin and Dihydroergotamine in Prevention of Deep Vein Thrombosis after Elective Hip Replacement: a Randomised Double-Blind Trial Reported in Conjunction with an Overview of Previous Results

1992 ◽  
Vol 68 (03) ◽  
pp. 238-244 ◽  
Author(s):  
Alexander S Gallus ◽  
John F Cade ◽  
K W Mills ◽  
Wendy Murphy
Keyword(s):  
Confidence Interval ◽  
Hip Replacement ◽  
Low Dose ◽  
Randomised Trial ◽  
Double Blind ◽  
Apparent Lack ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Published Evidence ◽  
Low Dose Heparin

SummaryWe report the results of a double-blind, randomised trial of venous thrombosis (VT) prevention in 117 patients having elective hip replacement where low dose heparin alone (5,000 IU sodium heparin given subcutaneously [sc] 8 hourly until the seventh postoperative day) was compared with low dose heparin plus dihydroergotamine (DHE; 0.5 mg, given 8 hourly by sc injection). The trial end point consisted of VT discovered through bilateral ascending venography done routinely on the seventh postoperative day. VT developed in 34% of patients given heparin/DHE (95% confidence interval = 22% – 47%) compared with 24% in those given low dose heparin alone (95% confidence interval = 14% – 37%; p = 0.34), difference = 10% (95% confidence interval = –7% to +26%). Corresponding figures for the incidence of proximal (above-knee) thrombosis were 17% and 14% (95% confidence intervals = 8% – 29% and 6% – 25% respectively). These results are discussed in the context of a detailed overview of published evidence concerning VT prevention with heparin/DHE after hip replacement and we conclude it is unlikely that heparin/DHE is markedly superior to low dose heparin alone in this clinical setting.

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

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 ◽  
Heparin Prophylaxis

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.

Low Molecular Weight Heparin and Prevention of Postoperative Thrombosis in Abdominal Surgery

1992 ◽  
Vol 67 (06) ◽  
pp. 627-630 ◽  
Author(s):  
K Koppenhagen ◽  
J Adolf ◽  
M Matthes ◽  
E Tröster ◽  
J D Roder ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Abdominal Surgery ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Low Molecular Weight ◽  
Heparin Group ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Deep Vein ◽  
Low Dose Heparin

SummaryIn a prospective, double-blind, randomized multicenter trial the efficacy and safety of low molecular weight heparin and unfractionated heparin were compared for the prevention of postoperative deep vein thrombosis in patients undergoing abdominal surgery. Six hundred and seventy-three patients were randomly allocated to the two prophylaxis groups; 20 of these, however, did not undergo surgery and did not receive any prophylaxis. Of the remaining 653 patients 323 received one subcutaneous injection of 3,000 anti-Xa units of low molecular weight heparin and 330 received subcutaneously 5,000 U heparin three times a day. Treatment was initiated 2 h preoperatively and continued for 7 to 10 days. The occurrence of DVT was determined by the 125I-labelled fibrinogen uptake test and phlebography. Venous thrombosis was diagnosed in 24 of 323 patients (7.4%) treated with low molecular weight heparin and in 26 of 330 patients (7.9%) treated with low-dose heparin. DVT of proximal veins was detected in four patients of the low molecular weight heparin group and in three patients of the low-dose heparin group. During the observation period three pulmonary emboli - one fatal and two non-fatal - occurred in patients receiving prophylaxis with low-dose heparin. No pulmonary embolism was found in patients treated with low molecular weight heparin. Both prophylactic schemes were well tolerated. Intra-and postoperative blood loss, incidence of wound hematoma, frequency and volume of intra- and postoperative blood transfusion were similar in both groups with a slight advantage for the low molecular weight heparin group. The results of this trial show that the investigated low molecular weight heparin is at least as effective and safe as low-dose heparin in preventing deep vein thrombosis in patients undergoing elective abdominal surgery.

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

1978 ◽  
Vol 49 (3) ◽  
pp. 378-381 ◽  
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 ◽  
Heparin Prophylaxis

✓ 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.

Low-Dose Heparin and Deep-Vein Thrombosis after Total Hip Replacement

1976 ◽  
Vol 36 (01) ◽  
pp. 157-164 ◽  
Author(s):  
P. M Mannucci ◽  
Luisa E. Citterio ◽  
N Panajotopoulos
Keyword(s):  
Deep Vein Thrombosis ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Low Dose ◽  
Control Group ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Deep Vein ◽  
Low Dose Heparin

SummaryThe effect of subcutaneous low-dose heparin on postoperative deep-vein thrombosis (D. V. T.) (diagnosed by the 125I-labelled fibrinogen test) has been investigated in a trial of 143 patients undergoing the operation of total hip replacement. Two randomized studies were carried out: in one the scanning for D.V.T. was carried out daily for 7 days post operatively and in the other for 15 days. In both, the incidence of D.V.T. was significantly lower in the heparin-treated patients (P<0.005). Bilateral D.V.T. was also prevented (P<0.05), through the extension of D.V.T. to the distal veins of the thigh was not significantly reduced. Heparin treatment was, however, followed by a higher incidence of severe postoperative bleeding (P< 0.02) and wound haematoma formation (P< 0.005), and the postoperative haemoglobin was significantly lower than in the control group (P<0.005). A higher number of transfused blood units was also needed by the heparin treated patients (P<0.001).

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

The Prophylaxis of Deep Vein Thrombosis with Low-Dose Heparin: A Trial

1974 ◽  
Vol 44 (3) ◽  
pp. 289-291 ◽  
Author(s):  
J. Propsting ◽  
O. Williams ◽  
M. Stathis ◽  
J. F. Mccaffrey
Keyword(s):  
Deep Vein Thrombosis ◽  
Low Dose ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Deep Vein ◽  
Low Dose Heparin
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