scholarly journals Role of Low-Molecular-Weight Heparin in Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: A Prospective Observational Study

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Marco Falcone ◽  
Giusy Tiseo ◽  
Greta Barbieri ◽  
Valentina Galfo ◽  
Alessandro Russo ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Severe Acute Respiratory Syndrome ◽  
Observational Study ◽  
Low Molecular Weight Heparin ◽  
Prospective Observational Study ◽  
Composite Endpoint ◽  
Secondary Endpoint ◽  
Time Dependent ◽  
Low Molecular Weight ◽  
The Impact

Abstract Background This study was conducted to evaluate the impact of low-molecular-weight heparin (LMWH) on the outcome of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Methods This is a prospective observational study including consecutive patients with laboratory-confirmed SARS-CoV-2 pneumonia admitted to the University Hospital of Pisa (March 4–April 30, 2020). Demographic, clinical, and outcome data were collected. The primary endpoint was 30-day mortality. The secondary endpoint was a composite of death or severe acute respiratory distress syndrome (ARDS). Low-molecular-weight heparin, hydroxychloroquine, doxycycline, macrolides, antiretrovirals, remdesivir, baricitinib, tocilizumab, and steroids were evaluated as treatment exposures of interest. First, a Cox regression analysis, in which treatments were introduced as time-dependent variables, was performed to evaluate the association of exposures and outcomes. Then, a time-dependent propensity score (PS) was calculated and a PS matching was performed for each treatment variable. Results Among 315 patients with SARS-CoV-2 pneumonia, 70 (22.2%) died during hospital stay. The composite endpoint was achieved by 114 (36.2%) patients. Overall, 244 (77.5%) patients received LMWH, 238 (75.5%) received hydroxychloroquine, 201 (63.8%) received proteases inhibitors, 150 (47.6%) received doxycycline, 141 (44.8%) received steroids, 42 (13.3%) received macrolides, 40 (12.7%) received baricitinib, 13 (4.1%) received tocilizumab, and 13 (4.1%) received remdesivir. At multivariate analysis, LMWH was associated with a reduced risk of 30-day mortality (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.21–0.6; P < .001) and composite endpoint (HR, 0.61; 95% CI, 0.39–0.95; P = .029). The PS-matched cohort of 55 couples confirmed the same results for both primary and secondary endpoint. Conclusions This study suggests that LMWH might reduce the risk of in-hospital mortality and severe ARDS in coronavirus disease 2019. Randomized controlled trials are warranted to confirm these preliminary findings.

Patients’ experience and compliance with extended low molecular weight heparin prophylaxis post-surgery for gynecological cancer: a prospective observational study

2019 ◽  
Vol 29 (4) ◽  
pp. 802-809 ◽  
Author(s):  
Zibi Marchocki ◽  
Lucy Norris ◽  
Sharon O'Toole ◽  
Noreen Gleeson ◽  
Feras Abu Saadeh
Keyword(s):  
Molecular Weight ◽  
Side Effects ◽  
Observational Study ◽  
Low Molecular Weight Heparin ◽  
Prospective Observational Study ◽  
Patient Choice ◽  
Gynaecological Cancer ◽  
Low Molecular Weight ◽  
Tablet Form ◽  
Heparin Prophylaxis

ObjectiveGynaecological cancer patients have a high risk of developing venous thromboembolism (VTE). There is limited information on patient experience and compliance with an extended low molecular weight heparin prophylaxis in this setting. The aim of this study was to assess patient compliance, satisfaction and experience with the extended low molecular weight heparin prophylaxis after major surgery for gynaecological cancer.MethodsThis was a prospective observational study conducted in a large tertiary center for gynaecological cancer between July 2017-March 2018. Consecutive patients undergoing surgery for gynaecological cancer who received low molecular weight heparin prophylaxis for four weeks following surgery were recruited. All participants received a log book to record all injections, side effects, and questionnaire to be completed at the end of the study.ResultsA total of 106 patients completed and returned the VTE prophylaxis logbook and questionnaire. Sixty-six (62%) patients received low molecular weight heparin for 28 days, twenty-five (24%) for 26-27 days, and 15 (14%) for less than 26 days. The median number of days of therapy was 28 days (range; 12-28 days). Reasons for missed or stopped injections included: forgetfulness(n=12), medical procedures (n=6), pain (n=5), incorrect prescription (n=4), patient choice (n=3), cost (n=2), physician request (n=2), non-availability of person administering the injections (n=1) or unknown (n=5). Sixty-one (58%) patients self-administered the injections. Patients who had the injection performed by a third person were twice as likely to experience pain compared to patients who self-administered (OR 2.81, p=0.003). Eighty-nine (84%) patients self-reported side effects during low molecular weight heparin prophylaxis including: bruising (75%), pain after injections (49%), itchiness (9%), swelling (9%) or other (8%). Although 83 (78%) patients were satisfied with injections, 91 (86%) admitted they would much prefer a tablet form.ConclusionsCompliance with standard recommended regimen of 28-days prophylaxis was completed by 62% of patients. Majority of patients (86%) reported a preference for a tablet form, if one was available.

Randomized Phase II Trial of Docetaxel Plus Thalidomide in Androgen-Independent Prostate Cancer

2004 ◽  
Vol 22 (13) ◽  
pp. 2532-2539 ◽  
Author(s):  
William L. Dahut ◽  
James L. Gulley ◽  
Philip M. Arlen ◽  
Yinong Liu ◽  
Katherine M. Fedenko ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Molecular Weight ◽  
Phase Ii ◽  
Low Molecular Weight Heparin ◽  
Phase Ii Trial ◽  
Low Molecular Weight ◽  
Randomized Phase Ii ◽  
The Impact ◽  
Docetaxel Group ◽  
Androgen Independent

Purpose Both docetaxel and thalidomide have demonstrated activity in androgen-independent prostate cancer (AIPC). We compared the efficacy of docetaxel to docetaxel plus thalidomide in patients with AIPC. Methods Seventy-five patients with chemotherapy-naïve metastatic AIPC were randomly assigned to receive either docetaxel 30 mg/m2 intravenously every week for 3 consecutive weeks, followed by a 1-week rest period (n = 25); or docetaxel at the same dose and schedule, plus thalidomide 200 mg orally each day (n = 50). Prostate-specific antigen (PSA) consensus criteria and radiographic scans were used to determine the proportion of patients with a PSA decline, and time to progression. Results After a median potential follow-up time of 26.4 months, the proportion of patients with a greater than 50% decline in PSA was higher in the docetaxel/thalidomide group (53% in the combined group, 37% in docetaxel-alone arm). The median progression-free survival in the docetaxel group was 3.7 months and 5.9 months in the combined group (P = .32). At 18 months, overall survival in the docetaxel group was 42.9% and 68.2% in the combined group. Toxicities in both groups were manageable after administration of prophylactic low-molecular-weight heparin in the combination group. Conclusion In this randomized phase II trial, the addition of thalidomide to docetaxel resulted in an encouraging PSA decline rate and overall median survival rate in patients with metastatic AIPC. After the prophylactic low-molecular-weight heparin was instituted to prevent venous thromboses, the combination regimen was well tolerated. Larger randomized trials are warranted to assess the impact of this combination.

scholarly journals Role of Low Molecular Weight Heparin (LMWH) in the Treatment of Recurrent Missed Abortion

2016 ◽  
Vol 29 (2) ◽  
pp. 94-101
Author(s):  
Mosammat Rashida Begum ◽  
Mariya Ehsan ◽  
Nazia Ehsan ◽  
Iftekhar Amin ◽  
Farhana Sharmin ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Observational Study ◽  
Low Molecular Weight Heparin ◽  
Late Pregnancy ◽  
Live Birth Rate ◽  
Heparin Therapy ◽  
Fertility Treatment ◽  
Low Molecular Weight ◽  
Missed Abortion ◽  
Satisfactory Outcome

Objective (s): The aim of this study was to explore the outcome of treatment of low molecular weight heparin (LMWH) in recurrent missed abortion cases.Method: This prospective observational study was done between January 2005 and July 2014 in Infertility Care and Research Center, Dhaka, Bangladesh. Two hundred and ten (210) patients who were able to give clear history of missed abortion, who had no endocrine and hypertensive disorders and who conceived spontaneously or after fertility treatment were the target population for this study. After positive pregnancy test all patients started taking oral progesterone (Dydrogesterone 10 mg bd), folic acid and aspirin 75 mg daily. Patients were advised to come for ultrasonography at 6 weeks of pregnancy. After confirming intrauterine viable pregnancy by ultrasonography we started injection enoxaparin (LMWH) 40 mg sc daily to all patients and continued till 34 completed weeks. The primary end point was the live birth rate and secondary end points were the side effects, late pregnancy complications and neonatal outcome in the study population.Results: One hundred and nine (52.39%) patients had antiphospholipid syndrome. Among them antiphospholipid subgroup antibody found in 40.37% cases, ACLA found in 27.52% cases, LA found in 18.34% cases and both ACLA and LA found in 13.77% cases. Antinuclear antibody was positive in 10% cases. No abnormality was identified in 38.09% cases. Pregnancy continued successfully in 96.66% cases. There were no maternal and foetal complications. Except failed cases there was no need to discontinue the treatment.Conclusion: This observational study dealt only with recurrent missed abortion and found satisfactory outcome with low dose heparin therapy. Large, well-designed randomized trials are needed to establish the heparin therapy in recurrent missed abortion.Bangladesh J Obstet Gynaecol, 2014; Vol. 29(2) : 94-101

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