scholarly journals Successful Treatment with Bosentan of Lower Extremity Ulcers in a Scleroderma Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Alix Naert ◽  
Petra De Haes
Keyword(s):  
Molecular Weight ◽  
Systemic Sclerosis ◽  
Lower Extremity ◽  
Low Molecular Weight Heparin ◽  
Local Treatment ◽  
Low Molecular Weight ◽  
Digital Ulcers ◽  
Endothelin Receptor ◽  
Vasodilator Therapy ◽  
Scleroderma Patient

Digital ulcers are a well-known problem in patients with systemic sclerosis. Lower extremity ulcers are less prevalent but are also a challenging and underestimated complication of the disease causing important pain and morbidity. Bosentan, an oral dual endothelin receptor antagonist, has been shown to be effective in preventing digital ulcers in patients with systemic sclerosis. A few recent observations showed the efficacy of bosentan for accelerating the healing of nondigital ulcers in scleroderma patients. This report deals with a 48-year-old patient with systemic sclerosis who developed painful ulcers on the left ankle and hallux. The ulcers were refractory to a combination of vasodilator therapy with a calcium antagonist and several courses of intravenous prostanoids, low molecular weight heparin, aspirin, simvastatin, and intensive local treatment. Bosentan treatment showed spectacular healing of the ulcers already after 4 months of therapy. This case supports the previous few observations of accelerating wound healing of lower extremity ulcers in systemic sclerosis patients with bosentan treatment.

scholarly journals Prophylaxis of deep-vein thrombosis after lower extremity amputation: Comparison of low molecular weight heparin with unfractionated heparin

2006 ◽  
Vol 21 (3) ◽  
pp. 184-186 ◽  
Author(s):  
Sidney Lastória ◽  
Hamilton A. Rollo ◽  
Winston Bonetti Yoshida ◽  
Mariangela Giannini ◽  
Regina Moura ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Lower Extremity ◽  
Unfractionated Heparin ◽  
Low Molecular Weight Heparin ◽  
Lower Extremity Amputation ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Extremity Amputation

PURPOSE: To compare the efficacy and safety of a low molecular weight heparin (enoxaparin) with unfractionated heparin (UH) in this prophylaxis. METHODS: Seventy five patients (59 men and 16 women), undergoing major lower extremity amputation (30 above-knee and 45 below-knee), were randomized to be treated with subcutaneous UH (5,000 IU t.i.d.) or enoxaparin (40mg/day) during hospitalization. Prophylaxis was started 12 hours before surgery or, in emergency cases, in the first postoperative day. RESULTS: The two groups were comparable with regard to baseline characteristics. Evaluation of DVT was performed by daily clinical examination and by duplex scanning before and 5 to 8 days after surgery. DVT was documented in the operated limb in 9.75% in patients treated with enoxaparin and in 11.76% in patients treated with UH (p=0.92) and there was one bilateral thrombosis in each group . Bleeding complications were not observed in both groups. CONCLUSION: Enoxaparin and UH were both efficient and safe for the prophylaxis of DVT in patients submitted to lower extremity amputation.

scholarly journals Foot Pump Versus Low-Molecular-Weight Heparin for Preventing Deep Vein Thrombosis Following Surgery for Hip and Knee Replacement

2021 ◽  
Vol 105 (1-3) ◽  
pp. 389-396
Author(s):  
Feng-Fei Lin ◽  
Bin Chen ◽  
Chao-Hui Lin ◽  
Ke Zheng
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Knee Replacement ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
Significant Difference ◽  
Postoperative Drainage ◽  
Deep Vein

Objective To evaluate the comparative efficacy and safety of the use of foot pump versus low-molecular-weight heparin (LMWH) for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in total knee replacement (TKR) and total hip replacement (THR). Summary of background data The use of chemoprophylactic agents in TKR and THR has been shown to result in increased complications like bleeding and wound drainage. Methods Relevant publications indexed in PubMed, Cochrane Library, Embas, Web of Science, Wanfang Data, CNKI, and VIPI were identified. Appropriate articles identified from the reference lists of the above searches were also reviewed. Results No significant difference in the rate of distal in the lower extremity was observed between the 2 groups (OR: 0.99; CI: 0.61–1.61; Z = 0.03; P = 0.97). No significant difference in the rate of proximal DVT in the lower extremity was observed between 2 groups (OR: 1.60, CI: 0.85–3.03, Z = 1.44, P = 0.15). No significant difference in the rate of PE was observed between 2 groups (OR 3.84, CI: 0.42 to 34.80, Z = 1.20, P = 0.23). But we found that postoperative drainage in foot pump group was less than that in LMWH group (OR -68.93, CI: −73.81 to −64.05, Z = 27.68, P < 0.00001), and oozing in foot pump group was less than that in LMWH group (OR: 0.21; CI: 0.10–0.47; Z = 3.86, P = 0.0001). Conclusion The foot pump is a suitable alternative for TKR and THR patients in preventing DVT and PE, and can get less postoperative drainage and oozing side effects that are associated with LWMH.

Pulmonary Embolism in Children.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2606-2606
Author(s):  
Madhvi Rajpurkar ◽  
Indira Warrier ◽  
Meera Chitlur ◽  
Cynthia Sabo ◽  
Mary Jane Frey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Lower Extremity ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Low Molecular Weight ◽  
D Dimer

Abstract Pulmonary embolism (PE) is rare in children and optimal methods for diagnosis, management and treatment for children with PE are unknown. We report a case series of 13 patients (pts) with PE managed at the Thrombosis Treatment Center at Children’s Hospital of Michigan in the last 48 months and discuss their clinical characteristics. Demographics: 13 pts (7 males, 6 females; 6 African - American, 7 Caucasian) were followed for a duration of 1– 43 months (mean 16 months). Average age at presentation was 16.3 years (range 9–29 years; 11 pts were less than 18 years of age). One patient had a previous documented PE but had been lost to follow-up. Average time to diagnosis of PE was 7.7 days (1–21 days) after onset of first symptom. 3 pts diagnosed at the onset of symptoms were in the hospital at the time of the event. 1 patient was diagnosed almost a year after onset of symptoms. 8 patients (61.5%) received treatment for other respiratory illness prior to the accurate diagnosis of PE. All pts were symptomatic and had chest pain (69 %) or dyspnea on exertion (76.9%). Diagnostic Studies: Chest radiography was performed in 10 pts and was abnormal in 7 (70 %). D-Dimer was normal in 30 % of patients. All pts were diagnosed with a spiral CT. Additional clots were present in 10 pts (1 upper extremity, 1 cortical sinus, 2 superior vena caval, 6 lower extremity)and were diagnosed by ultrasonography (2), venography (5), echocardiography (2) and magnetic resonance venography (1). Risk factors: Antithrombin III, protein C and protein S were normal in all patients.1 patient was heterozygous for prothrombin G20210A mutation. None of the pts had Factor V Leiden. Six (46%) pts were heterozygous for the MTHFR C677T mutation but only one had an elevated homocysteine level. Seven (53.8 %) patients were obese. Other risk factors were systemic lupus erythematosus in 2 (15.4 %), ventriculo-atrial shunt in 3 (23.1%), inflammatory bowel disease (IBD) in 2 (23.1%) and immobilization in 4 (30.8 %) patients. No identifiable risk factor was found in one patient. A central venous line was present in one pt (7.7%). Anticardiolipin antibodies were elevated in 23.1 % and lupus anticoagulant was positive in 46.2 % Treatment: Pts received unfractionated heparin (76.9 %), catheter-directed thrombolysis (15.4%) or low molecular weight heparin (7.7 %) as initial treatment. 5 pts (38.4%) had undergone a recent (within 14 days) surgical procedure and could not receive thrombolytic therapy. 11 pts (84.6 %) received low molecular weight heparin (LMWH) and 2 (15.4%) received warfarin as follow-up treatment. 5 pts received therapy for a minimum of 12 months following the episode and none had a recurrence. 8 other pts are still on anticoagulation therapy (mean duration 4.75 months, range1–11 months) and have no recurrence. Therapy was well tolerated in pts treated with LMWH; 1 patient with IBD on warfarin had recurrent gastrointestinal bleeding necessitating blood transfusion. Summary: PE is often missed in children and should be included as a differential diagnosis in pts with chest pain or dyspnea on exertion. As diagnosis is delayed, a normal D-Dimer may not exclude the presence of PE in children. Acquired risk factors appear to play a major role in the pathogenesis of pediatric PE. As in adults, PE in children is often associated with lower extremity venous clots. Specific treatment protocols need to be developed for children with PE as most patients either cannot or do not receive thrombolyis.

Low-molecular-weight heparin in the prevention and treatment of thromboembolic disorders

1998 ◽  
Vol 1 (5) ◽  
pp. 166-174 ◽  
Author(s):  
Evelyn R Hermes De Santis ◽  
Betsy S Laumeister ◽  
Vidhu Bansal ◽  
Vandana Kataria ◽  
Preeti Loomba ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Prevention And Treatment
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