Bridging anticoagulation with low-molecular-weight heparin after interruption of warfarin therapy is associated with a residual anticoagulant effect prior to surgery

2005 ◽  
Vol 94 (09) ◽  
pp. 528-531 ◽  
Author(s):  
Karen Woods ◽  
Gary A. Foster ◽  
Mark A. Crowther ◽  
James D. Douketis
Keyword(s):  
Molecular Weight ◽  
Therapeutic Dose ◽  
Odds Ratio ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Warfarin Therapy ◽  
Anticoagulant Effect ◽  
Low Molecular Weight ◽  
Multivariable Regression ◽  
Bridging Anticoagulation

SummaryBridging anticoagulation with low-molecular-weight heparin (LMWH) is common in patients who require temporary interruption of warfarin before surgery or a procedure, but whether such patients have a residual anticoagulant effect just before a procedure is not known. Consecutive patients who received bridging anticoagulation with LMWH had anti-Xa levels measured just before a procedure. The proportion of patients with a residual anticoagulant effect, defined as an anti-Xa level ≥0.10 IU/ml, was determined. Multivariable regression analysis identified predictors of a residual anticoagulant effect, expressed as an odds ratio (OR) and corresponding 95% confidence interval (CI). A pre-procedure residual anticoagulant effect was detected in 12 of 73 (16%) patients overall, in 11 of 37 (30%) patients who received therapeutic-dose LMWH, and in 1 of 36 patients (3%) who received low-dose LMWH. Receiving therapeutic- dose LMWH (OR = 118.8; 95% CI: 5.8, 999.9), and increasing age (OR = 4.0; 95% CI: 1.3, 12.5) were predictors of a residual pre-procedure anticoagulant effect. In patients who require bridging anticoagulation with LMWH, a residual anticoagulant effect from LMWH is detected in 1 of 6 patients, and receiving therapeutic-dose LMWH is the strongest predictor of such an effect.

Pharmacodynamics and Tolerance of Two Nadroparin Formulations (10,250 and 20,500 Anti Xa IU·ml-1) Delivered for 10 Days at Therapeutic Dose

1998 ◽  
Vol 79 (02) ◽  
pp. 338-341 ◽  
Author(s):  
C. Navarro ◽  
J. P. Cambus ◽  
H. Caplain ◽  
P. d’Azemar ◽  
J. Necciari ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Healthy Volunteers ◽  
Total Dose ◽  
Therapeutic Dose ◽  
Low Molecular Weight Heparin ◽  
Dose Effect ◽  
Low Molecular Weight ◽  
High Dose ◽  
Circadian Effect

SummaryVenous thromboembolism may be efficiently treated by once-a-day (o.d.) administration of a high dose of low molecular weight heparin (LMWH) instead of administration of the same total dose in two injections a day (b.i. d.). To reduce the volume of the subcutaneous (s.c.) injection, a more concentrated form of the drug is advisable. This study was designed to compare the bioavailability of 2 formulations of nadroparin containing 10,250 and 20,500 anti-Xa IU·ml-1 respectively. This was an open, randomized, cross-over study where 12 healthy volunteers (age 18-35) were enrolled. They received either 90 anti-Xa IU·kg-1 b.i. d. of the 10,250 IU preparation (treatment A), or 180 anti-Xa IU·kg-1 o.d. of the 20,500 IU preparation (treatment B) for 10 days. On day 1, the subjects were sampled between 0 and 12 h (treatment A) or between 0 and 24 h (treatment B). On day 10, they were sampled between 0 and 12 h and between 12 and 24 h (treatment A) or between 0 and 24 h (treatment B). Anti-Xa and anti-IIa activities were determined by specific chromogenic assays. The main result of the study was that the bioavailability of the anti-Xa activity of the 2 nadroparin formulations was equivalent, as shown by the comparison of the AUC0-12 h plus AUC12-24 h (treatment A) and the AUC0-24 h (treatment B), calculated on day 10. This study also allowed a number of interesting observations to be made. 1) Between day 1 and day 10, there was an accumulation of the anti-Xa activity for treatment A but not for treatment B (accumulation factors: 1.6 and 1.1 respectively); 2) On day 10, the AUC0-12 h were slightly but significantly lower than the AUC12-24 h suggesting a circadian effect for anti-Xa and anti-IIa activities; 3) the clearance of the anti-Xa activity was comparable at the 2-dose regimens, while that of the anti-IIa activity was lower in treatment B than in treatment A, indicating a significant dose effect for the pharmacodynamics of the longer heparin chains; 4) On average, the clearance of the anti-IIa activity was twice as high as that of the anti-Xa activity; 5) For treatment B, significant APTT prolongations were noticed at Tmax (prolongation factor: 1.7 ± 0.25), in relation with the anti-IIa activity (0.3 ± 0.1 IU·ml–1).

scholarly journals Evaluation and Management of Women who Have Experienced Stillbirth in Their Previous Pregnancies

2019 ◽  
pp. 1
Author(s):  
Erdem Fadiloglu ◽  
Atakan Tanacan ◽  
Canan Unal ◽  
Mehmet Sinan Beksac
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Methylenetetrahydrofolate Reductase ◽  
Post Partum ◽  
Subsequent Pregnancy ◽  
Low Molecular Weight ◽  
Mthfr Polymorphisms ◽  
The Mean

<p><strong>Objective:</strong> To evaluate the subsequent pregnancy outcomes of women who have experienced unexplained stillbirth in their previous gestations.</p><p><strong>Study Design:</strong> This retrospective cohort consisted of 14 pregnancies who had stillbirth (without known risk factors) in their previous pregnancies. These patients had been included in a special preconceptional care program to be evaluated in terms of etiological risk factors for stillbirth. At least one of the risk factors, such as methylenetetrahydrofolate reductase (MTHFR) polymorphisms, hereditary thrombophilias and autoimmune problems, were defined in this study population. After detection of pregnancy, the patients were administered low-dose low-molecular-weight heparin (LMWH) (enoxaparin, 1×2000 Anti-XA IU/0.2 mL/day), low-dose salicylic acid (100 mg/day) and low-dose corticosteroid (methylprednisolone, 1×4 mg/day orally) in necessary cases.</p><p><strong>Results:</strong> Out of 14 pregnancies, 4 (28.5%) ended up with miscarriages at 9, 11, 11 and 15 gestational weeks, respectively. The remaining 10 pregnancies ended up with alive deliveries. The mean gestational week at birth was 36.4±0.51, while the mean birthweight was 2882±381.01 g. Out of 10 pregnancies, only one was diagnosed as IUGR. Only two newborn necessitated hospitalization in the neonatal intensive care unit (NICU) due to respiratory problems. Both newborns were discharged from the NICU without any further complication at the post-partum 5th day. </p><p><strong>Conclusion:</strong> Patients with a prior stillbirth should be screened for MTHFR polymorphisms, autoimmune problems and hereditary thrombophilias, especially in case of absence of any etiological factor. Management of these patients with low-dose aspirin, low-dose low molecular weight heparin and corticosteroids seemed to be beneficial for increasing live birth rates and avoiding obstetric complications.</p>

A RANDOMIZED, DOUBLE BLIND STUDY OF A LOW MOLECULAR WEIGHT HEPARIN (KABI 2165) ONCE DAILY AND LOW DOSE STANDARD HEPARIN TWICE DAILY, IN THE PREVENTION OF POST OPERATIVE DEEP VEIN THROMBOSIS IN GENERAL SURGERY. A French Multicenter Trial

1987 ◽  
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Multicenter Trial ◽  
Low Molecular Weight ◽  
Double Blind ◽  
Once Daily ◽  
Vein Thrombosis ◽  
Deep Vein

The efficacy and safety of a low molecular weight heparin (Kabi 2165) in preventing postoperative deep vein thrombosis (D.V.T.), was assessed in a double blind randomly allocated multicenter trial. 385 patients were included and analysed on a intention to treat basis. Kabi 2165 was given S.C. 24 hourly in 2 500 anti-factor Xa units and compared with standard low dose calcium heparin 5 000 i.u. S.C. 12 hourly in patients undergoing major abdominal or gynaecological surgery. The first dose was administered two hours before operation in both groups. The relevant characteristics of the patients in the two treatment groups were similar. The two groups were well matched for risk factors which could predispose to D.V.T.DVT was detected by the radioactive fibrinogen test. Venography was performed whenever a positive scan developed in a patient. Six (3,1 96) of 195 patients receiving Kabi 2165 and seven (3,7 96) of 190 patients in the standard heparin group developed D.V.T. No pulmonary embolism we re detected during the prophylactic regimens. There was no significant difference between the two groups in terms of blood loss during surgery, postoperative drainage, blood transfusion, wound haematoma. Mean hemoglobin levels and mean hematocrit values preoperatively and postoperatively (day 1 and 6) were :There were no statistically significant differences in both groups. No thrombocytopenia was reported in this study. The antifactor Xa activity was significantly higher in the Kabi 2165 group.In conclusion, Kabi 2165 once daily is as effective and safe as standard heparin twice daily in preventing postoperative D.V.T. in general surgery.

INDUCTION OF OSTEOPOROSIS IN RATS BY STANDARD HEPARIN AND LOW MOLECULAR WEIGHT HEPARIN

1987 ◽  
Author(s):  
T Mätzsch ◽  
D Berggvist ◽  
U Hedner ◽  
B Nilsson ◽  
P Østergaard
Keyword(s):  
Molecular Weight ◽  
Bone Mass ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Term Treatment ◽  
Ash Content ◽  
Low Molecular Weight ◽  
High Dose ◽  
Degree Of Reduction ◽  
Long Term Treatment

Long-term treatment with heparin can induce osteoporosis. This complication is suspected to be related to the dosage of heparin rather than to duration of therapy, but the mechanism by which heparin induces osteoporosis is unknown. In a previous study we reported the same degree of reduction in mineral bone mass in rats after treatment with 2 IU heparm/g bw for 33 and 65 days (Thromb Haemostas 1986,56:293-4). Using the same animal model we compared the effect of a high-dose standard heparin (SH) and a low molecular weight heparin (LMWH) in a high and a low dose on the mineral bone mass in the femur of rats. Method: 60 female Wistar rats (207±1.8 g) were randomly allocated to treatment with either 2 Xal U/g bw of standard heparin (SH), 2 Xal U/g bw of LMWH ("high-dose"), 0.4 Xal U/g bw LMWH ("low-do-se") or placebo (saline). A standard sodium salt heparin of porcine origin was used, and the LMWH was an enzymatically depolymerized pork mucosal heparin (LHN-1, mean MW 4900 D). Treatment with s.c. injections was continued for 34 days. 24 hours after the last injection the rats were sacrificed and the carefully cleaned femora weighed in air and in water under standardized conditions. Volumes and densities were calculated from the weights. The bones were then incinerated for 48 hours at 600°C and weighed again to determine the ash content (expressed as ash weight per ml of unashed femur volume). Results: There was a significant decrease in ash content (p<0.01) and density (p<0.01) of the femora in all heparin treated groups as compared with controls. High-dose LMWH caused the same reduction in bone mineral mass as standard heparin. Treatment with low-dose LMWH resulted in a significantly less pronounced reduction in ash content (p<0.001) and density (p<0.05) of the femora when compared with high-dose standard heparin and high-dose LMWH. CONCLUSION: Daily injections of 2 Xal U/g body weight of standard heparin or low molecular weight heparin for 34 days causes the same degree of reduction of mineral bone mass in rats. The reduction of mineral bone mass in rats by treatment with low molecular weight heparin is dose dependent.

scholarly journals Low-dose low–molecular-weight heparin is anti-inflammatory during venous thrombosis

1998 ◽  
Vol 28 (5) ◽  
pp. 848-854 ◽  
Author(s):  
L.Joseph Downing ◽  
Robert M. Strieter ◽  
Amy M. Kadell ◽  
Carol A. Wilke ◽  
Lazar J. Greenfield ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Low Molecular Weight ◽  
Anti Inflammatory
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