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.

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 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 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.

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.

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