scholarly journals Efficacy, Safety, and Timing of Anticoagulant Thromboprophylaxis for the Prevention of Venous Thromboembolism in Patients With Acute Spinal Cord Injury: A Systematic Review

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 138S-150S ◽  
Author(s):  
Paul M. Arnold ◽  
James S. Harrop ◽  
Geno Merli ◽  
Lindsay G. Tetreault ◽  
Brian K. Kwon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Lower Risk ◽  
Low Molecular Weight Heparin ◽  
Inferior Vena Cava Filter ◽  
Inferior Vena ◽  
Vena Cava ◽  
Low Molecular Weight ◽  
Mechanical Prophylaxis ◽  
Cord Injury

Study Design: Systematic review. Objectives: The objective of this study was to answer 5 key questions: What is the comparative effectiveness and safety of (1a) anticoagulant thromboprophylaxis compared to no prophylaxis, placebo, or another anticoagulant strategy for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) after acute spinal cord injury (SCI)? (1b) Mechanical prophylaxis strategies alone or in combination with other strategies for preventing DVT and PE after acute SCI? (1c) Prophylactic inferior vena cava filter insertion alone or in combination with other strategies for preventing DVT and PE after acute SCI? (2) What is the optimal timing to initiate and/or discontinue anticoagulant, mechanical, and/or prophylactic inferior vena cava filter following acute SCI? (3) What is the cost-effectiveness of these treatment options? Methods: A systematic literature search was conducted to identify studies published through February 28, 2015. We sought randomized controlled trials evaluating efficacy and safety of antithrombotic strategies. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine studies satisfied inclusion criteria. We found a trend toward lower risk of DVT in patients treated with enoxaparin. There were no significant differences in rates of DVT, PE, bleeding, and mortality between patients treated with different types of low-molecular-weight heparin or between low-molecular-weight heparin and unfractionated heparin. Combined anticoagulant and mechanical prophylaxis initiated within 72 hours of SCI resulted in lower risk of DVT than treatment commenced after 72 hours of injury. Conclusion: Prophylactic treatments can be used to lower the risk of venous thromboembolic events in patients with acute SCI, without significant increase in risk of bleeding and mortality and should be initiated within 72 hours.

scholarly journals Is Low Molecular Weight Heparin the Treatment of choice for Neonatal Thrombosis?

2020 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Caesarean Section ◽  
Low Molecular Weight Heparin ◽  
Inferior Vena ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Emergency Caesarean Section ◽  
Low Molecular Weight ◽  
Preterm Baby

A borderline preterm baby is born with an emergency caesarean section. The baby is found to have an unprovoked occlusive thrombosis in the left renal vein and inferior vena cava. There are no obvious risk factors for thrombosis. The baby is commenced on un-fractionated heparin (UFH) followed by a prolonged course of low molecular weight heparin (LMWH) based on the guidelines adopted from adult evidence. You wonder if this is reasonable to treat neonates as per adult guidelines given the great differences between adult and neonatal clotting parameters.

scholarly journals Antithrombin III Supplementation in a Premature Infant: Is There a Target Antithrombin Level?

2021 ◽  
Vol 26 (8) ◽  
pp. 850-856
Author(s):  
Ankit Shukla ◽  
Chi Braunreiter
Keyword(s):  
Molecular Weight ◽  
Premature Infant ◽  
Critically Ill ◽  
Premature Infants ◽  
Low Molecular Weight Heparin ◽  
Inferior Vena ◽  
Antithrombin Iii ◽  
Vena Cava ◽  
Low Molecular Weight ◽  
Optimal Target

The optimal antithrombin (AT) activity for low-molecular-weight heparin efficacy and the benefits of antithrombin III (ATIII) supplementation in premature infants diagnosed with venous thromboembolism are unknown. Currently, there are no neonatal-specific guidelines directing the appropriate target AT activity during supplementation. This case report describes a critically ill premature infant with a progressive, occlusive inferior vena cava thrombus who received supplemental ATIII during enoxaparin treatment. The patient did not achieve therapeutic anti-Xa levels despite increasing enoxaparin dosing to 3 mg/kg every 12 hours. ATIII supplementation sufficient to attain an AT activity of >40%, in combination with an enoxaparin dosing of >2 mg/kg every 12 hours, was needed to achieve therapeutic anti-Xa levels. Future large studies are needed to determine if there is an optimal target AT activity for critically ill premature infants.

Intermediate doses of low-molecular-weight heparin for the long-term treatment of pregnancy thromboembolism. A systematic review

2014 ◽  
Vol 111 (03) ◽  
pp. 559-561 ◽  
Author(s):  
Esteban Gándara ◽  
Marc Carrier ◽  
Marc Rodger
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Term Treatment ◽  
Low Molecular Weight ◽  
Contact Information ◽  
Long Term Treatment ◽  
E Mail

Note: The contact information for Drs. Gandara and Carrier is the same as for Dr. Rodger. Their e-mail addresses are [email protected] and [email protected], respectively.

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