Risk factors and prevention of placenta-associated diseases

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (3) ◽  
pp. 236-240
Author(s):  
Ekaterina A. Minaeva ◽  
Roman G. Shmakov
Keyword(s):  
Molecular Weight ◽  
Early Stage ◽  
Heparin Therapy ◽  
Cochrane Library ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Previous Pregnancy ◽  
Associated Diseases ◽  
The Cochrane Library ◽  
To Receive

The review presents modern data on the preventive effect of antiplatelet and anticoagulant therapy of placenta-associated diseases. The review includes data from foreign and Russian articles published over the past 15 years on the Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, CyberLeninka, Pubmed databases. In recent years, there have been reports of the effectiveness of low molecular weight heparins in the prevention of placenta-associated complications. M. Rodger et al. In their study (2016), report on the effect of low molecular weight heparins on the development of placenta-associated complications. Patients whose previous pregnancy was complicated by preeclampsia or fetal growth restriction were randomized into 2 groups. The first group of pregnant women began to receive injections of low molecular weight heparins at an early stage of pregnancy (before 12 weeks), the second group did not receive low molecular weight heparins. Thus, only 19% of women receiving low molecular weight heparin therapy and 43% of women not receiving it developed placenta-associated complications, which may indicate the effectiveness of low molecular weight heparins. This data shows the urgency of the problem of placenta-associated complications, and the development of effective methods of early prevention of these diseases can improve the outcomes of the pregnancy.

Effects of Unfractionated and Low Molecular Weight Heparins on Platelet Thromboxane Biosynthesis “In Vivo”

1994 ◽  
Vol 72 (06) ◽  
pp. 942-946 ◽  
Author(s):  
Raffaele Landolfi ◽  
Erica De Candia ◽  
Bianca Rocca ◽  
Giovanni Ciabattoni ◽  
Armando Antinori ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Unfractionated Heparin ◽  
Low Molecular Weight Heparin ◽  
Primary Source ◽  
In Vivo Studies ◽  
Low Molecular Weight ◽  
Heparin Administration ◽  
To Receive

SummarySeveral “in vitro” and “in vivo” studies indicate that heparin administration may affect platelet function. In this study we investigated the effects of prophylactic heparin on thromboxane (Tx)A2 biosynthesis “in vivo”, as assessed by the urinary excretion of major enzymatic metabolites 11-dehydro-TxB2 and 2,3-dinor-TxB2. Twenty-four patients who were candidates for cholecystectomy because of uncomplicated lithiasis were randomly assigned to receive placebo, unfractionated heparin, low molecular weight heparin or unfractionaed heparin plus 100 mg aspirin. Measurements of daily excretion of Tx metabolites were performed before and during the treatment. In the groups assigned to placebo and to low molecular weight heparin there was no statistically significant modification of Tx metabolite excretion while patients receiving unfractionated heparin had a significant increase of both metabolites (11-dehydro-TxB2: 3844 ± 1388 vs 2092 ±777, p <0.05; 2,3-dinor-TxB2: 2737 ± 808 vs 1535 ± 771 pg/mg creatinine, p <0.05). In patients randomized to receive low-dose aspirin plus unfractionated heparin the excretion of the two metabolites was largely suppressed thus suggesting that platelets are the primary source of enhanced thromboxane biosynthesis associated with heparin administration. These data indicate that unfractionated heparin causes platelet activation “in vivo” and suggest that the use of low molecular weight heparin may avoid this complication.

Low Molecular Weight Heparin Therapy: Is Monitoring Needed?

1994 ◽  
Vol 72 (03) ◽  
pp. 330-334 ◽  
Author(s):  
B Boneu
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Plasma Proteins ◽  
Bleeding Risk ◽  
Heparin Therapy ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
Meta Analyses ◽  
Deep Vein ◽  
Initial Check

SummaryRecent meta-analyses indicate that low molecular weight heparins (LMWH) are more effective than unfractionated heparin (UH) in preventing and treating deep vein thrombosis. This article presents the arguments for and against the need for laboratory monitoring. At the present time, the only tests currently available for monitoring LMWH therapy are those which measure the anti Xa activity in the plasma. Due to lower binding to plasma proteins and to cell surfaces,the plasma anti Xa activity generated by a given dose of LMWH is more predictable than for UH.Some clinical trials suggest that LMWH delivered at the recommended dose expose the patient to less bleeding risk than UH. Several . meta-analyses indicate comparable risk while any overdose unaccept-ably increases the haemorrhagic risk. The lowest dose of LMWH still effective in treating established DVT is presently unknown; some reports indicate that inadequate doses of LMWH are associated with a lack of efficacy for prevention. An overview of the published clinical trials indicates that the LMWH dose has never been monitored for prevention of DVT. In the treatment of established DVT, several trials have been performed without any monitoring, while in others the dose was adapted to target a given anti Xa activity. These considerations suggest that in prevention of DVT, monitoring the dose is not required. In the treatment of established DVT, considering the haemorrhagic risk of LMWH, the risk of undertreating the patient and the absence of large clinical trials comparing the advantages of monitoring the dose or not, it might be useful to check anti Xa activity at least once at the beginning of the treatment but the need for this initial check remains to be established. Because a large proportion of patients will be in the desired range, dose adjustments will be far less frequent than for UH.

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.

How Useful is the Monitoring of (Low Molecular Weight) Heparin Therapy by Anti-Xa Assay? A Laboratory Perspective

2005 ◽  
Vol 11 (3) ◽  
pp. 157-162 ◽  
Author(s):  
EMMANUEL J. FAVALORO ◽  
ROSLYN BONAR ◽  
MARGARET ABOUD ◽  
JOYCE LOW ◽  
JOHN SIOUFI ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Heparin Therapy ◽  
Low Molecular Weight

Barriers and facilitators to conducting research by early career psychiatrists: a literature review

2019 ◽  
Vol 2 (2) ◽  
pp. 135-154
Author(s):  
Katja Koelkebeck ◽  
Maja Pantovic Stefanovic ◽  
Dorota Frydecka ◽  
Claudia Palumbo ◽  
Olivier Andlauer ◽  
...  
Keyword(s):  
Research Participation ◽  
Early Career ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Research Career ◽  
Hand Search ◽  
Electronic Search ◽  
Conducting Research ◽  
The Cochrane Library ◽  
To Receive

AbstractObjectivesTo understand and identify factors that promote and prevent research participation among early career psychiatrists (ECPs), in order to understand what would encourage more ECPs to pursue a research career.MethodsWe conducted an electronic search of databases (PubMed and the Cochrane library) using the keywords ‘doctors’, ‘trainees’, ‘residents’, ‘physicians’ and ‘psychiatric trainees’ as well as ‘research’ (MeSH) and ‘publishing’ (MeSH). This search was complemented by a secondary hand search.ResultsWe identified 524 articles, of which 16 fulfilled inclusion criteria for this review. The main barriers included lack of dedicated time for research, lack of mentoring and lack of funding. The main facilitators were opportunities to receive mentorship and access to research funding.ConclusionsAction is needed to counteract the lack of ECPs interested in a career in research. Specific programs encouraging ECPs to pursue research careers and having access to mentors could help increase the current numbers of researching clinicians in the field.

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