scholarly journals Advisory Board conclusion following the discussion "Controversial issues of low molecular weight heparins use in obstetrics"

2021 ◽  
Vol 15 (4) ◽  
pp. 461-469
Author(s):  
Article Editorial
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight ◽  
Controversial Issues ◽  
Systemic Embolism ◽  
Low Molecular Weight Heparins ◽  
Maternal Complications ◽  
Treatment And Prevention ◽  
Increased Risk ◽  
Low Incidence ◽  
Valve Prostheses

Antithrombotic therapy is often used during pregnancy for the treatment and prevention of venous thromboembolism, systemic embolism in patients with heart valve prostheses, for prevention of foetal loss in patients with antiphospholipid syndrome, placenta-mediated complications. In common, low molecular weight heparins (LMWHs) have largely replaced unfractionated heparin as the anticoagulant. However, in case of placenta-mediated complications it has off-label status. The effectiveness and safety of the LMWHs in pregnant women at an increased risk of placenta-mediated complications is discussed in this review. LMWH is effective, safety, easy to administer and associated with a low incidence of foetal and maternal complications.

Effect of concomitant diseases on the hemostasis system in the perioperative period of non-cardiac surgery

2021 ◽  
Author(s):  
И.С. Пряхин ◽  
С.С. Мурашко ◽  
С.А. Бернс ◽  
И.Н. Пасечник
Keyword(s):  
Molecular Weight ◽  
Cardiac Surgery ◽  
Antithrombotic Therapy ◽  
Perioperative Period ◽  
Low Molecular Weight ◽  
Clinical Factors ◽  
Low Molecular Weight Heparins ◽  
Global Test ◽  
Thrombotic Risk ◽  
Increased Risk

В данном исследовании изучалось влияние клинических факторов и антитромботической терапии на свертывающую систему крови пациентов в периоперационном периоде. В исследование включено 80 пациентов, которым проводилось плановое некардиальное хирургическое вмешательство. Лабораторный контроль осуществлялся с использованием рутинных методов исследования гемостаза (АЧТВ, МНО) и глобального теста исследования гемостаза (тест тромбодинамики). Использование теста тромбодинамики в данном исследовании оказалось более чувствительным методом по сравнению с рутинными тестами и позволило выявить клинические факторы, ассоциированные с гиперкоагуляционными состояниями и снижением эффективности низкомолекулярных гепаринов в послеоперационном периоде: возраст старше 60 лет, фибрилляция предсердий, хроническая ишемическая болезнь сердца, стентирование коронарных артерий в анамнезе, предшествующий прием антитромботической терапии до оперативного вмешательства. У больных с тромбозом глубоких вен нижних конечностей отмечалась гиперкоагуляция в первые сутки после проведения операции по сравнению с остальными пациентами. Использование теста тромбодинамики за сутки до оперативного вмешательства позволило спрогнозировать увеличение объема интраоперационной кровопотери. Назначение периоперационной мост-терапии низкомолекулярными гепаринами у больных с высоким тромботическим риском достоверно ассоциировалось с увеличением трансфузии эритромассы практически в 2 раза по сравнению с остальными пациентами и было связано с повышением риска геморрагических осложнений. Результаты исследования показали, что тест тромбодинамики потенциально может быть применен в дальнейших исследованиях с целью персонификации ведения пациентов в периоперационном периоде при некардиальной хирургии, а также способен прогнозировать возникновение геморрагических и тромботических осложнений. This study examined the effect of clinical factors and antithrombotic therapy on the blood coagulation system of patients in the perioperative period. The study included 80 patients who underwent elective noncardiac surgery. Laboratory control of hemostasis was carried out using routine tests for studying hemostasis (APTT, INR) and a global test for hemostasis (thrombodynamics test). Usage of the thrombodynamics test in this study was more sensitive compared to routine tests and made it possible to identify clinical factors associated with hypercoagulable states and «decreasing in the effectiveness» of low molecular weight heparins in the postoperative period. These factors are: age over 60 years, chronic ischemic heart disease, a history of coronary artery stenting, prior antithrombotic therapy before surgery. Hypercoagulability was found on the first day after surgery in patients with deep vein thrombosis of the lower extremities compared to other patients. The use of a thrombodynamics test a day before surgery allowed to predict an increase of intraoperative blood loss volume. Perioperative bridge therapy with low molecular weight heparins in high thrombotic risk patients was significantly associated with an increase in packed red blood cells transfusion of almost two times compared with other patients and is associated with an increased risk of hemorrhagic complications. The results of the study showed that thrombodynamics test can potentially be used further with the aim of personalizing patients’ management in the non-cardiac surgery perioperative period. It also helps to predict the occurrence of hemorrhagic and thrombotic complications.

scholarly journals Anticoagulation in Patients with Liver Cirrhosis (Literature Review)

2019 ◽  
Vol 4 (2) ◽  
pp. 23-28
Author(s):  
E. S. Eniseeva
Keyword(s):  
Atrial Fibrillation ◽  
Molecular Weight ◽  
Liver Cirrhosis ◽  
Venous Thrombosis ◽  
Vitamin K Antagonists ◽  
Coagulation Cascade ◽  
Low Molecular Weight ◽  
Thromboembolic Complications ◽  
Low Molecular Weight Heparins ◽  
Increased Risk

Liver cirrhosis is accompanied by complex hemostatic disorders with an increase in the risk of both hemorrhagic and thrombotic complications. Reduced coagulation protein synthesis, such as factors II, VII, IX, X and thrombocytopenia are associated with an increased risk of bleeding. Reducing the synthesis of such anticoagulants as protein C, protein S, antithrombin III is accompanied by increased generation of thrombin, which leads to procoagulant status, increased risk of venous thrombosis, pulmonary embolism, and portal vein thrombosis. Activation of the coagulation cascade increases the risk of thrombosis, and also plays an important role in liver damage, contributing to the progression of fibrosis. Cirrhosis increases the risk of thromboembolic complications of atrial fibrillation.Anticoagulants are necessary for the prevention of thrombosis and thromboembolic complications. However, there are no large prospective studies. There is insufficient data on the safety of anticoagulant therapy in cirrhosis. There are difficulties in monitoring anticoagulation in the application of vitamin K antagonists and low molecular weight heparins.The review presents the available data on the use of warfarin, unfractionated heparin, low molecular weight heparins and direct oral anticoagulants in patients with liver cirrhosis, indicating the need for prevention of venous thrombosis in patients with risk factors, the possibility of preventing decompensation of cirrhosis, reducing the frequency of cardioembolic strokes in patients with atrial fibrillation.

Low incidence of heparin-induced skin lesions in orthopedic surgery patients with low-molecular-weight heparins

2018 ◽  
Vol 48 (8) ◽  
pp. 1016-1024 ◽  
Author(s):  
M. Schindewolf ◽  
M. Paulik ◽  
H. Kroll ◽  
R. Kaufmann ◽  
M. Wolter ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Orthopedic Surgery ◽  
Skin Lesions ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Low Incidence

scholarly journals Fatal Retroperitoneal Hematoma in a Patient Receiving Enoxaparin for Bilateral Pulmonary Emboli

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Jordan Sexe ◽  
Robin McCarthy ◽  
Navid Dara ◽  
Lyon Brown ◽  
Gaurav Dutta
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Retroperitoneal Hematoma ◽  
Morbidity And Mortality ◽  
Low Molecular Weight ◽  
Pulmonary Emboli ◽  
Low Molecular Weight Heparins ◽  
Vein Thrombosis ◽  
Treatment And Prevention ◽  
Rare Side Effect

Venous thromboembolism occurs when a deep vein thrombosis travels to the lungs and forms a pulmonary embolism. Low-molecular-weight heparins are a mainstay in the treatment and prevention of venous thromboembolism and should be initiated promptly due to substantial morbidity and mortality. A rare side effect of low-molecular-weight heparins is major bleeding, which also carries a significant morbidity and mortality rate. Here, we present a case of a fatal retroperitoneal hematoma in a patient being treated with enoxaparin for bilateral pulmonary emboli.

scholarly journals USE OF BEMIPARIN IN PATIENTS UNDERGOING MAJOR SURGERY FOR ESOPHAGEAL AND GASTRIC CANCER

2017 ◽  
pp. 104-111
Author(s):  
R. A. Khvavstunov ◽  
S. E. Tolstopyatov
Keyword(s):  
Gastric Cancer ◽  
Molecular Weight ◽  
Major Surgery ◽  
Low Molecular Weight ◽  
Thromboembolic Events ◽  
Low Molecular Weight Heparins ◽  
Short Term ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

The purpose of our study is to evaluate our own experience in the use of low molecular weight heparins, in particular bemiparin, in a group of patients with an increased risk of venous thromboembolic events undergoing major surgery for esophageal and gastric cancer. The study presents a comparative analysis of these groups and short-term results of the use of bemiparin in cancer patients.

scholarly journals Controversial Issues in Thromboprophylaxis with Low-Molecular Weight Heparins in Palliative Care

2008 ◽  
Vol 36 (2) ◽  
pp. e3-e4 ◽  
Author(s):  
Davide Tassinari ◽  
Carlotta Santelmo ◽  
Emanuela Scarpi ◽  
Paola Tombesi ◽  
Sergio Sartori
Keyword(s):  
Molecular Weight ◽  
Palliative Care ◽  
Low Molecular Weight ◽  
Controversial Issues ◽  
Low Molecular Weight Heparins

scholarly journals Mechanisms of the Antitumor Activity of Low Molecular Weight Heparins in Pancreatic Adenocarcinomas

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 432 ◽  
Author(s):  
Alexandros Bokas ◽  
Pavlos Papakotoulas ◽  
Panagiotis Sarantis ◽  
Adriana Papadimitropoulou ◽  
Athanasios G Papavassiliou ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Molecular Weight ◽  
Tumor Microenvironment ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Combined Treatment ◽  
Resistance Mechanisms ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Treatment And Prevention

Immune checkpoint inhibitors have revolutionized cancer treatment in the last decade. Despite the progress in immunotherapy, most pancreatic cancer patients still do not derive benefit when receiving immune-based therapies. Recently, resistance mechanisms to immune therapies have been mainly focused on tumor microenvironment properties. Pancreatic cancer is considered one of the most lethal and difficult to treat tumors due to its highly immunosuppressive and desmoplastic microenvironment. Low molecular weight heparins (LMWHs) have been used for the treatment and prevention of thromboembolic disease in these patients. However, many nonanticoagulant properties attributed to LMWHs have been described. Exploiting LMWH properties in a combined treatment modality with immune checkpoint inhibition and chemotherapy could provide a new approach in the management of pancreatic adenocarcinoma patients. The ability of LMWH to interfere with various aspects of the tumor microenvironment could result in both the alleviation of immunosuppression and improvement in drug delivery within the tumor, leading to higher cancer cell destruction rates and more potent immune system activity that would, ultimately, lead to better patient outcomes.

A Perspective on Low Molecular Weight Heparins in the Management of Thrombosis

1993 ◽  
Vol 13 (S 01) ◽  
pp. S5-S11 ◽  
Author(s):  
Debra Hoppensteadt ◽  
Jeanine Walenga ◽  
A Ahsan ◽  
O Iqbal ◽  
W Jeske ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Mechanism Of Action ◽  
Manufacturing Process ◽  
Laboratory Tests ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Pharmacological Management

SummaryThe introduction of low molecular weight heparins has added a new dimension to the pharmacological management of thrombotic disorders. Because of different chemical and pharmacological characteristics, due to the manufacturing process, each LMWH should be considered as a distinct entitity and only be used for its given indication. A list of commercially available LMWHs is included. The mechanism of action of the LMWHs and their use in various disorders are discussed. Available laboratory tests for monitoring LMWHs are presented and their limitations pointed out.

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