scholarly journals Management of heparin resistance due to antithrombin deficiency in a Chinese pregnant woman: a case report

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110583
Author(s):  
Xiaoxin Zhang ◽  
Feng Guo ◽  
Qiaohong Wang ◽  
Wenxin Bai ◽  
Aimin Zhao
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Fresh Frozen Plasma ◽  
Low Molecular Weight ◽  
Antithrombin Deficiency ◽  
Heparin Resistance ◽  
Fresh Frozen ◽  
At Deficiency ◽  
Frozen Plasma

Untreated individuals with antithrombin (AT) deficiency are at higher risk of thrombosis and adverse pregnancy outcomes. The present recommendations are mostly empirical for treating patients with AT deficiency during pregnancy because of the absence of guidelines. We report a rare case of heparin resistance due to AT deficiency in a pregnant 32-year-old Chinese woman. We also reviewed the English medical literature for AT deficiency and its association with thromboembolism and treatment. This patient suffered two early miscarriages because of thrombosis due to AT deficiency. The patient was administered the combination of adequate low molecular weight heparin with fresh frozen plasma and warfarin because of her heparin resistance. She delivered a healthy female newborn without any adverse effects of the anticoagulation therapy. Our findings suggest that the combination of adequate low molecular weight heparin with fresh frozen plasma and warfarin is effective for preventing thrombus during pregnancy.

scholarly journals A young COVID-19 patient with mild symptoms and disseminated intravascular coagulation

2020 ◽  
Vol 8 (11) ◽  
pp. 4130
Author(s):  
Abhishek Kumar ◽  
Piyush Kumar ◽  
Ajit Dungdung
Keyword(s):  
Inflammatory Markers ◽  
Low Molecular Weight Heparin ◽  
Fresh Frozen Plasma ◽  
Low Molecular Weight ◽  
Major Contributor ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Mild Fever ◽  
Acquired Thrombophilia ◽  
D Dimer

Covid-19 pandemic in recent times has emerged as a major contributor to multisystemic thrombosis and related complications. Covid-19 leads to a syndrome of generalised systemic coagulopathy and acquired thrombophilia which manifests itself in the form of arterial, venous and microvascular thrombosis. The pathological mechanisms for covid-19 induced coagulopathy are yet to be clear however extensive research is underway and multiple insights have emerged recently. Here we report a case of young Covid-19 patient who presented with mild fever but severely deranged coagulation parameters and inflammatory markers. He was managed conservatively with Low molecular weight heparin, Fresh frozen plasma, Tab HCQS, Tab Doxycycline, Tab Ivermectin, Tab Zinc, Tab Vitamin C and responded well to treatment. He was later discharged after testing covid-19 negative. Screening of all confirmed cases for coagulopathy like D-dimer, FDP, platelet count, Prothrombin time may be done to identify high risk asymptomatic/mild cases which may cause further decrease in mortality.

Should Anticoagulation Therapy Be Withheld in Patients With Active Cancer After 6 Months of Low–Molecular Weight Heparin?

2015 ◽  
Vol 33 (15) ◽  
pp. 1713-1713 ◽  
Author(s):  
Edgar Gerardo Urrego ◽  
Alberto Carmona-Bayonas ◽  
Enrique González-Billalabeitia ◽  
Francisco Ayala de la Peña
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Low Molecular Weight ◽  
Active Cancer

scholarly journals Assessment of pregnancy outcome with low molecular weight heparin therapy: a retrospective, single centre observational study

2018 ◽  
Vol 7 (4) ◽  
pp. 1446
Author(s):  
Ankita Singh ◽  
Madhuri Alwani ◽  
Nutan Yadav ◽  
Priyam Padia
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Heparin Therapy ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
Deep Vein

Background: The objective of this study was to determine the outcomes of Low Molecular Weight Heparin Therapy (LMWH) given for various indications during pregnancy.Methods: In this context, a detailed retrospective analysis of all the patients who received LMWH for various indications over a period of two years from October 2015 to November 2017 at a single center, Sri Aurobindo Medical College and PG institute in Indore was performed.Results: Total 100 patients were studied, included over the period of 2 years for various indications for which Enoxaparin (1 mg/kg body weight OD/BD subcutaneously) was used. The indications were valvular heart disease with valve replacement and atrial fibrillation (54.0%), chronic deep vein thrombosis (DVT) (13.0%), thrombophilias (9.0%), recurrent pregnancy loses (21.0%) and prophylaxis for deep vein thrombosis (3.0%) in overall patients. Abortion was seen in 8.0 % patients; fetal growth restriction in 13% patients; and oligohydramnios, preeclampsia, gestational hypertension, placenta previa, abruptio placentae, postpartum hemorrhage patients and Stillbirth occurred in 4.0 % patients. No thromboembolic event was noted in any of the patients. None of the patients had any documented thrombocytopenia or clinical fracture.Conclusions: Low Molecular Weight Heparin Therapy (LMWH) used amongst pregnant women with various indications for anticoagulation therapy was associated with successful pregnancy outcome in the vast majority of cases. Further multicenter prospective studies and international registries of pregnant women on LMWH are necessary to broaden our knowledge in optimizing the care of women who require anticoagulation during pregnancy.

Antithrombin Concentrates in Heparin-Resistant Cardiopulmonary Bypass Patients

1996 ◽  
Vol 2 (2) ◽  
pp. 103-106 ◽  
Author(s):  
Mehraboon S. Irani
Keyword(s):  
Cardiopulmonary Bypass ◽  
Serine Protease Inhibitor ◽  
Fresh Frozen Plasma ◽  
Clotting Time ◽  
Activated Clotting Time ◽  
Heparin Resistance ◽  
Resis Tance ◽  
Fresh Frozen ◽  
Blood Transfu ◽  
Frozen Plasma

Antithrombin, a serine protease inhibitor, plays an important role in the regulation of the coagula tion cascade. It inhibits thrombin as well as factors Xa, IXa, XIa, and XIIa. Heparin markedly accelerates the rate at which antithrombin inhibits these enzymes. To prevent the formation of clots in the extracorporeal cir cuit, heparin is used during cardiopulmonary bypass sur gery (CPB). However, in a small proportion of patients, adequate anticoagulation, defined as an activated clotting time (ACT) of >400 s after an intravenous bolus of hep arin in a dose of 300 U/kg, is not achieved. Conventional treatment of heparin resistance includes fresh frozen plasma or large doses of heparin. Antithrombin concen trates were given to 12 patients who were considered to be heparin resistant at our institution. All patients had received >300 U/kg of heparin before antithrombin con centrates were infused. In all patients, the ACT pro longed to >400 s after concentrates were infused, and in nine of 12 cases to >600 s. Of these nine patients, six (67%) did not receive any allogeneic transfusions, whereas three (33%) required allogeneic blood transfu sions. In nine of 12 patients, no more heparin was given after infusing antithrombin concentrate. It appears that antithrombin concentrate, which is a fractionated, pas teurized plasma product, is a possible safer alternative to excessive heparin doses or fresh frozen plasma for CPB patients who are heparin resistant. Key Words: An tithrombin—Cardiopulmonary bypass—Heparin resis tance.

scholarly journals Case Report: Spontaneous Intramural Hematoma of the Colon Secondary to Low Molecular Weight Heparin Therapy

2021 ◽  
Vol 12 ◽  
Author(s):  
Ye Zhu ◽  
Chao Wang ◽  
Chao Xu ◽  
Jia Liu
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Gastrointestinal Symptoms ◽  
Intramural Hematoma ◽  
Heparin Therapy ◽  
Low Molecular Weight ◽  
Hemorrhagic Complication ◽  
Minor Bleeding ◽  
Bleeding Events

Background: Hematoma of the colon is a rare hemorrhagic complication that affects patients accepting low molecular weight heparin (LMWH) therapy. Only scarce cases of colon hematoma have been reported, usually in children or patients accepting warfarin therapy.Case summary: A 76-year-old Chinese man was diagnosed with atrial fibrillation and heart failure, with cardiac function NYHA grade III on March 21, 2018. This patient was given LMWH for anticoagulation therapy and developed a colon hematoma on the third day of hospitalization. Abdominal computed tomography (CT) showed the thickening of areas of the colon up to 110 mm × 78 mm in thickness, which was a symptom of colon hematoma. The patient underwent conservative treatment successfully. On March 27, the patient’s abdominal pain was alleviated, and a CT scan showed that the intestinal hematoma was absorbed.Conclusions: The most frequent minor bleeding events of LMWH anticoagulation are hemorrhage and subcutaneous hematoma. This case demonstrated that bowel hematoma despite its low incidence should be considered as an ADR of LMWH therapy, especially among patients who present with gastrointestinal symptoms.

scholarly journals Feasibility of Anticoagulation Using Low Molecular‑Weight Heparin During Catheter-Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis 

2020 ◽  
Author(s):  
Yonghui Li ◽  
Junwei Wang ◽  
Rongzhou He ◽  
Junmeng Zheng ◽  
Zhibo Chen ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Therapeutic Dose ◽  
Infusion Rate ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Catheter Directed Thrombolysis

Abstract Background: The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular‑weight heparin (LMWH) during CDT for DVT.Methods: The clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage.Results: A total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rate was 2.5 (0.83 to 5) x 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 2.4 (0.6 to 10.80) x 106 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, or death occurred. Complete (>90%) and partial thrombolysis (50~90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant difference in baseline characteristics, clinical improvement, thrombolysis results, and complications. Conclusions: Anticoagulation therapy using low molecular‑weight heparin during CDT with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.

scholarly journals Feasibility of Anticoagulation Using Low Molecular‑Weight Heparin During Catheter-Directed Thrombolysis for  Lower Extremity Deep Venous Thrombosis

2021 ◽  
Author(s):  
Yonghui Li ◽  
Junwei Wang ◽  
Rongzhou He ◽  
Junmeng Zheng ◽  
Zhibo Chen ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Therapeutic Dose ◽  
Infusion Rate ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Catheter Directed Thrombolysis

Abstract Background: The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular‑weight heparin (LMWH) during CDT for DVT.Methods: The clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage.Results: A total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rate was 2.5 (0.83 to 5) x 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 2.4 (0.6 to 10.80) x 106 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, or death occurred. Complete (>90%) and partial thrombolysis (50~90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant differences in baseline characteristics, clinical improvement, thrombolysis results, and complications. Conclusions: Anticoagulation therapy using low molecular‑weight heparin during CDT with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.

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