EFFECTIVENESS AND SAFENESS OF LOW MOLECULAR WEIGHT HEPARINS APPLICATION IN CHILDREN WITH RIGHT ATRIUM THROMBOSES

2018 ◽  
Author(s):  
П.А. Жарков ◽  
Н.М. Ершов ◽  
А.В. Пшонкин
Keyword(s):  
Molecular Weight ◽  
Major Bleeding ◽  
Right Atrium ◽  
Malignant Disease ◽  
Final Analysis ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Complete Lysis ◽  
Electronic Hospital ◽  
Isolated Rat

Введение. Тромбозы правого предсердия (ТПП) являются редкой патологией, которая чаще встречается среди новорожденных и детей, перенесших кардиохирургическое вмешательство. Истинная распространенность, а также подходы к лечению ТПП у детей, получающих терапию по поводу злокачественного заболевания, неизвестны. Цель работы: оценить распространенность ТПП, а также эффективность и безопасность применения низкомолекулярного гепарина (НМГ) у детей с ТПП. Материалы и методы. Проведен анализ электронной базы данных пациентов в возрасте 0-17 лет. Для оценки динамики размеров тромбов в анализ были включены только пациенты с объективно подтвержденным ТПП, у которых имелось не менее двух эхокардиографических исследований, и которым проводилась терапия НМГ. Оценка случаев кровотечений и тромбоэмболии легочной артерии/артерий (ТЭЛА) проводилась по записям в историях болезни пациентов. Результаты. Изолированный ТПП или ТПП в комбинации с тромбозами других локализаций был диагностирован у 13,7%, изолированный ТПП – лишь у 5% детей. При проведении антикоагулянтной терапии НМГ отсутствие динамики со стороны размеров тромба наблюдалось в 1 случае, нарастание размеров тромба – в 1 случае, уменьшение размеров тромба или полный лизис – в 13 случаях. За период наблюдения не было выявлено ни одного случая крупных кровотечений и ТЭЛА. Заключение. ТПП встречаются в 13,7% случаев среди пациентов с тромбозом. Мы считаем применение НМГ эффективным и безопасным методом вторичной антитромботической профилактики у детей с ТПП. Introduction. Right atrium thromboses (RAT) are rare pathology which is more specific for neonates and children undergoing cardiac surgery. True RAT prevalence as well as approaches to its treatment in children receiving therapy for malignant disease are unknown. Aim: to assess RAT prevalence as well as effectiveness and safeness of low molecular weight heparin (LMWH) application in children with RAT. Materials and methods. Electronic hospital database analysis was performed to find patients with objectively confirmed RAT. Children aged 0-17 years old with two or more echocardiographic examinations who received LMWH were included in final analysis. Thrombus size dynamics, the rate of pulmonary embolism (PE) and major bleeding served as effectiveness and safeness endpoints. Results. Isolated RAT or RAT in combination with thromboses of other localizations was found in 13,7%, isolated RAT – only in 5% of children. Under anticoagulant therapy with LMWH we found no dynamics in clot size – in 1 case, clot size increasing – in 1 case, reduction of clot size or its complete lysis – in 13 cases. There were no cases of major bleeding and PE during LMWH treatment. Conclusion. RAT occurs in 13,7% of cases among patients with thrombosis. We consider LMWH treatment to be effective and safe method of secondary antithrombotic prophylaxis in children with RAT.

Safety and efficacy of direct oral anticoagulants for venous thromboembolism and stroke prophylaxis in patients with hematologic malignancies

2019 ◽  
Vol 26 (2) ◽  
pp. 351-360 ◽  
Author(s):  
Stephanie Kim ◽  
Jennifer Namba ◽  
Aaron M Goodman ◽  
Thi Nguyen ◽  
Ila M Saunders
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Hematologic Malignancies ◽  
Low Molecular Weight ◽  
Direct Oral Anticoagulant ◽  
Low Molecular Weight Heparins ◽  
Bleeding Events

Purpose Low-molecular-weight heparins are currently the recommended antithrombotic therapy for treatment and prevention of malignancy-related venous thromboembolism. Currently, the evidence evaluating direct oral anticoagulants versus low-molecular-weight heparins or a vitamin K antagonist in cancer patients with hematologic malignancies is limited. We evaluated the safety and efficacy of direct oral anticoagulants for venous thromboembolism treatment or stroke prevention for non-valvular atrial fibrillation in patients with hematologic malignancies. Methods This was a retrospective evaluation of adult patients with hematologic malignancies who received at least one dose of the Food and Drug Administration-approved direct oral anticoagulant for venous thromboembolism treatment or stroke prevention. We determined the frequency of major bleeding events, non-major bleeding events, stroke, systemic embolism, appropriateness of initial direct oral anticoagulant doses, holding practices prior to procedures, and the rate of all-cause mortality. An analysis was also performed to compare the incidence of bleeding between patients with a history of hematopoietic stem cell transplant to non-transplant patients. Results A total of 103 patients were identified, with the majority of patients receiving rivaroxaban for venous thromboembolism treatment. Major bleeding events occurred in four patients and no fatal bleeding events occurred. Non-major bleeding occurred in 29 patients, most commonly epistaxis and bruising. Two patients experienced a systemic embolism while on direct oral anticoagulant therapy. Conclusion Direct oral anticoagulants may be a safe and effective alternative for anticoagulation therapy in patients with hematologic malignancies. However, larger prospective studies comparing direct oral anticoagulants to low-molecular-weight heparins or vitamin K antagonists are warranted to compare efficacy and safety outcomes in this patient population.

Low-molecular Weight Heparins in Venous and Arterial Thrombotic Disease

1999 ◽  
Vol 82 (S 01) ◽  
pp. 139-147 ◽  
Author(s):  
Rohan Hettiarachchi ◽  
Ron Peters ◽  
Martin H. Prins ◽  
Marcel Levi ◽  
Harry R. Büller ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Molecular Weight ◽  
Ischemic Stroke ◽  
Major Bleeding ◽  
Odds Ratio ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Coronary Syndromes

Summary Introduction: Since the introduction of low-molecular-weight heparins (LMWHs) in the early 1980's, the use of these compounds has been extensively investigated as a substitute for unfractionated heparin (UFH) in patients with venous and arterial thrombotic diseases. LMWHs have several advantages as compared to UFH, such as the subcutaneous route of administration, the predictable anticoagulant response and the lack of the need for laboratory monitoring. The present systematic review evaluates randomised clinical trials which investigated the efficacy and safety of LMWH in the acute treatment of venous thromboembolims, myocardial infarction, unstable coronary syndromes and ischemic stroke. Methods: A computerised and manual search was performed to identify all relevant clinical trials. All randomised studies, with an a priori defined study population, clinical outcome measurement and adequate follow-up, were reviewed by two independent assessors. Whenever possible a common effect estimate of the included studies was calculated. Results: Thirteen studies in approximately 4000 patients with acute venous thromboembolism revealed an odds ratio for the 3-month recurrent thromboembolism rate and major bleeding complications during exposure of 0.77 (C.I. 0.57-1.04) and 0.61 (C.I. 0.39-0.95), respectively, in favour of LMWH as compared to UFH. In patients with acute myocardial infarction, one study suggested a reduction in the incidence of reinfarction and cardiac death in LMWH recipients compared to UFH, while a placebo-controlled study revealed no beneficial effect of LMWH on these outcomes. In six studies including over 7000 patients with acute unstable coronary syndromes, there was an odds ratio for recurrent angina, myocardial infarction, urgent revascularisation and major bleedings of 0.88 (C.I. 0.76-1.01), 0.84 (C.I. 0.69-1.01), 0.83 (C.I. 0.70-0.99), 1.09 (C.I. 0.70-1.70), respectively, in favour of LMWH compared to UFH. The three studies comparing LMWH treatment with placebo in approximately 1000 patients with acute ischemic stroke revealed an odds ratio for the 10-day recurrent stroke, death or disability after 3 months and major bleeding complications of 0.68 (C.I. 0.41-1.13), 0.94 (C.I. 0.78-1.15), 2.92 (C.I. 1.88-4.55), respectively. Conclusion: Fixed-dose subcutaneous LMWH appears to be a safe and effective alternative for dose-adjusted intravenous heparin in the treatment of patients with acute venous thrombotic disease as well as in patients with acute unstable coronary syndromes. The effectiveness of LMWH in patients with acute myocardial infarction remains unclear. There seems to be no beneficial effect of LMWH treatment as compared to placebo in patients with acute ischemic stroke, while the risk of major bleeding was clearly increased.

scholarly journals The Risk of Major Bleeding with Low-Molecular-Weight-Heparins for Venous Thromboembolism in Dialysis Patients: The Q-VTE Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 89-89
Author(s):  
Adi J. Klil-Drori ◽  
Janie Coulombe ◽  
Sharon J. Nessim ◽  
Vicky Tagalakis
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Proportional Hazards Model ◽  
Conflicts Of Interest ◽  
Cox Proportional Hazards Model ◽  
Low Molecular Weight ◽  
Dialysis Patients ◽  
Low Molecular Weight Heparins ◽  
Bleeding Events

Abstract Background: Low-molecular weight heparins (LMWH) are not traditionally used to treat venous thromboembolism (VTE) among dialysis patients because their renal clearance may lead to less predictability in the degree of anticoagulation for a given dose. We determined the risk of major bleeding with LMWH compared with vitamin K antagonist (VKA) use in dialysis patients diagnosed with VTE in a real world setting. Methods: Using the linked administrative healthcare databases of the province of Quebec, Canada, we identified all patients with incident VTE between 2000 and 2009 and pre-existing dialysis status (hemodialysis or peritoneal dialysis). We included patients dispensed VKA or LMWH for the first time within 30 days of their VTE. Monotherapy was successive dispensation of LMWH in the absence of VKA, or vice versa. Combination therapy was LMWH and VKA on the same day. For each patient, we determined average daily dose and duration of continuous use. Patients were followed from VKA or LMWH initiation until a switch or discontinuation of anticoagulation, or major bleeding (emergency room visit or hospital admission for gastrointestinal bleeding or bleeding into a critical organ). Using a Cox proportional hazards model, we determined the incidence of major bleeding associated with LMWH monotherapy, compared with VKA monotherapy. The risk estimate was adjusted for deciles of a propensity score for LMWH use, which included comorbidities-, dialysis-, and VTE-related covariates, as well as calendar year. Results: In all, 647 dialysis patients with VTE were identified: 467 started VKA, 82 started LMWH, and 96 started both. Initiators of LMWH were 35 dalteparin, 26 tinzaparin, 19 enoxaparin, and 2 nadroparin. Median (interquartile range, IQR) daily doses were 12,500 (7,500-17,570) IU dalteparin, 16,080 (13,540-20,000) IU tinzaparin, 100 (70-120) mg enoxaparin, and 15,910 (15,200-16,625) IU nadroparin. Median (IQR) duration of LMWH monotherapy was 37 (22-87) days, and 132 (65-235) for VKA monotherapy. More than 90% of LMWH monotherapy was from 2004 and onwards, and 80% of LMWH users had cancer (Table). There were 22 major bleeding events (86% gastrointestinal), 20 in VKA and 2 in LMWH users. No fatal bleeding occurred. Compared with VKA monotherapy, LMWH monotherapy was not associated with major bleeding (adjusted HR, 1.21; 95% CI: 0.20-7.37). Conclusions: To our knowledge, this is the first population-based cohort reporting LMWH use in dialysis patients with VTE. We observed LMWH monotherapy mostly in cancer patients and from 2004 and onwards. This may reflect the evidence supporting improved effectiveness of LMWH compared with VKA for cancer-associated VTE. Further, daily doses of LMWH were generally halved. Overall, LMWH alone in dialysis patients was not associated with an increased major bleeding risk. If replicated, these findings indicate LMWH use is feasible in this clinical setting. Disclosures No relevant conflicts of interest to declare.

Clinical Rationale of Low Molecular Weight Heparins with Special Emphasis on Their Advantages

1993 ◽  
Vol 13 (S 01) ◽  
pp. S21-S23
Author(s):  
V. V. Kakkar
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Malignant Disease ◽  
Meta Analysis ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Risk Of Bleeding ◽  
Perioperative Bleeding ◽  
Male Patients ◽  
Haematoma Formation

SummaryA multicenter study was undertaken to evaluate the risk of perioperative bleeding after the administration of either low molecular weight heparin or unfractionated heparin. To assess the risk of bleeding objectively, a severity score was developed, based on objective criteria. Results indicated that the frequency of serious bleeding was markedly reduced when low molecular weight heparins were used. Elder and male patients bled more often than young and female patients. Malignant disease and the administration of nonsteroidal antiinflammatory compounds also increased the risk of perioperative bleeding. In this study as well as in a meta analysis it could be shown that wound haematoma formation represents the most significant indicator of defective haemostasis.

Retrospective comparison of low molecular weight heparin vs. warfarin vs. oral Xa inhibitors for the prevention of recurrent venous thromboembolism in oncology patients: The Re-CLOT study

2017 ◽  
Vol 24 (7) ◽  
pp. 494-500 ◽  
Author(s):  
Saeed K Alzghari ◽  
Susan E Seago ◽  
Jessica E Garza ◽  
Yasmeen F Hashimie ◽  
Kimberly A Baty ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Factor Xa ◽  
Factor Xa Inhibitors ◽  
First Episode ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Oncology Patients ◽  
Recurrent Venous Thromboembolism

Background There is increasing evidence indicating oral factor Xa inhibitors can be used for secondary prevention of venous thromboembolism. Studies are needed to compare oral factor Xa inhibitors, low molecular weight heparins, and warfarin in the oncology population. The purpose of this study is to evaluate the recurrent venous thromboembolism incidence in oncology patients utilizing oral Xa inhibitors, low molecular weight heparins, or warfarin. Methods Using retrospectively collected data, we compared the recurrent venous thromboembolism incidence in oncology patients taking rivaroxaban/apixaban, enoxaparin, or warfarin with at least three months of follow-up. Patients were included if they had an active cancer, venous thromboembolism, and taking warfarin, enoxaparin, or rivaroxaban/apixaban. The primary endpoint was the first episode of recurrent venous thromboembolism at three months. Secondary endpoints included recurrent venous thromboembolism after six months, major bleeding, and mortality. Results Of 127 venous thromboembolism patients, 48 received rivaroxaban or apixaban, 23 received enoxaparin, and 56 received warfarin. The three most common cancer diagnoses were lung (21%), colorectal (14%), and breast (14%). There was no difference in venous thromboembolism recurrence at three months between the rivaroxaban/apixaban (0%), warfarin (3.6%), and the enoxaparin cohorts (4.4%) (p = 0.8319). Major bleeding at three months was only seen in one patient in the enoxaparin arm (4.2%). Mortality at three months was 0%, 3.6%, and 17.4% in the rivaroxaban/apixaban, warfarin, and enoxaparin cohorts, respectively. Conclusion The results of this retrospective study suggest that oral factor Xa inhibitors are potential options for cancer patients with venous thromboembolism. However, randomized, controlled trials are needed to confirm these results.

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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