scholarly journals Low Molecular Weight Heparin versus Aspirin plus Intermittent Compression Devices for Thromboprophylaxis in Indian Patients Undergoing Total Hip and Knee Arthroplasty

2014 ◽  
Vol 3 (2) ◽  
pp. 26-32
Author(s):  
Sushil Paudel
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Knee Arthroplasty ◽  
Low Molecular Weight Heparin ◽  
Color Doppler ◽  
Low Molecular Weight ◽  
Bleeding Events ◽  
Heparin Group ◽  
Total Hip ◽  
Indian Patients

Introduction: Thromboembolic complications is common after arthroplasty. The purpose of this study was to find out the incidences of deep vein thrombosis, symptomatic, and fatal pulmonary embolism in Indian patients undergoing arthroplasties and to compare the effectiveness and safety of thromboprophylaxis with low molecular weight heparin versus aspirin plus intermittent pneumatic compression device. Methods: Patients who had a total hip and knee arthroplasty were randomized to receive prophylaxis with LMWH or aspirin plus intermittent pneumatic compression device. After four to six days, all patients underwent bilateral lower-extremity color Doppler ultrasonography to screen for deep venous thrombi in the calf and thigh. Any clinical symptoms of pulmonary embolism were evaluated with pulmonary CT angiography. Bleeding events in both groups were documented. The patients were followed up at 6 week and 3 months with Color Doppler to look for the evidence of deep venous thrombi. Results: 300 patients (409 joints) were randomized into 2 groups and studied regarding the incidence of deep vein thrombosis, pulmonary embolism, safety of the thromboprophylaxis in regard to its efficacy. Demographics were similar clinically between the groups. The rate of major bleeding events was 0.67% in the aspirin and compression group and 6% in the low-molecular-weight heparin group. Overall, prevalence of DVT and PE in Indian patients who underwent total hip or knee arthroplasty was 0.67% and 0.33% respectively. The rates of deep venous thrombosis were 1.33%, in the aspirin plus compression group compared 0% in the LMWH group. The rates of pulmonary embolism were 0.67% in the Aspirin plus compression group and 0% in the heparin group, and there were no fatal pulmonary emboli. Within the six week and three month follow-up period, no events occurred. There was no difference between the groups with regard to the prevalence of venous thromboembolism. Conclusions: An inexpensive multimodal protocol, consisting of aspirin, exercises, and the use of intermittent compression devices, was associated with relatively higher thromboembolic complications. However, major bleeding events were significantly lower in Aspirin group. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9525   NOAJ July-December 2013, Vol 3, Issue 2, 26-32

THROMBOSIS PROPHYLAXIS WITH LOW MOLECULAR WEIGHT HEPARIN (KABI 2165) AND CALCIUM HEPARIN IN PATIENTS WITH TOTAL HIP REPLACEMENT

1987 ◽  
Author(s):  
G Potron ◽  
J Barre ◽  
C Droulle ◽  
J C Baudrillard ◽  
P Barbie ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Low Molecular Weight Heparin ◽  
Thrombosis Prophylaxis ◽  
Low Molecular Weight ◽  
Thrombin Time ◽  
Heparin Group ◽  
Total Hip ◽  
Calcium Heparin

In a prospective controlled randomized trial efficacy and safety of a low molecular weight heparin (Kabi 2165) and calcium heparin were compared in 80 patients with total hip replacement. 40 patients were given Kabi 2165 : 2,500 anti-Xa Units S.C. 2 hours before operation and then every 12 hours for 10 days. 40 patients received calcium heparin : 5,000 iu S.C. 2 hours before operation, then every 8 hours during the first post operative day and then heparin doses were adjusted according to the activated partial thromboplastin time and the thrombin time for 10 days. Bilateral venography was performed routinely on all patients between the ninth and tenth post operative day. The two groups were well matched for risk factors which could predispose to risk of developing venous thrombosis. 7 patients in Kabi 2165 group (17,5 96) and 4 patients in calcium heparin group (10 %) developed D.V.T. (p = 0.33). In 3 patients (7,5 96) of Kabi 2165 group and in 2 patients (5 96) of calcium heparin group, the thrombi extented to the popliteal-femoral vein. The incidence is not significantly different (p = 0,50). There were no significant differences in postoperative mean estimated blood losses, and mean blood units transfused. Mean hemoglobin levels and mean hematocrit values at the day before operation, the 1st, 5th, and 10th day after operation were :These differences were not statistically significant. Incidence of wound hematomas was similar in both groups No thrombocytopenia was reported in this study. In conclusion, Kabi 2165 2,500 anti Xa Units twice daily seems as efficient as adjusted-dose of calcium heparin thrice daily.

Subcutaneous Low-Molecular-Weight Heparin Fragmin Versus Intravenous Unfractionated Heparin in the Treatment of Acute Non Massive Pulmonary Embolism: An Open Randomized Pilot Study

1995 ◽  
Vol 74 (06) ◽  
pp. 1432-1435 ◽  
Author(s):  
G Meyer ◽  
F Brenot ◽  
G Pacouret ◽  
G Simonneau ◽  
K Gillet Juvin ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Unfractionated Heparin ◽  
Low Molecular Weight Heparin ◽  
Randomized Study ◽  
Massive Pulmonary Embolism ◽  
Fixed Dose ◽  
Low Molecular Weight ◽  
Heparin Group ◽  
Submassive Pulmonary Embolism

SummaryLow-molecular-weight heparins have been extensively investigated in the treatment of deep venous thrombosis but limited data are available concerning their use in pulmonary embolism. In an open, pilot, randomized study, we compare the safety and efficacy of Fragmin, a low-molecular-weight heparin with those of unfractionated heparin in 60 patients with non massive pulmonary embolism (Miller Index < 20). Thirty one patients received unfractionated heparin intravenously and 29 received a fixed dose of 120 Anti-Xa IU/kg of Fragmin administered subcutaneously twice a day for 10 days. There was no pulmonary embolism recurrence nor major bleeding in either group during the treatment period. The decrease in pulmonary vascular obstruction on perfusion lung scan between day 0 and day 10 was 17 ± 13% in the Fragmin group and 16 ± 13% in the heparin group (NS). These results indicate that Fragmin may be a safe and effective treatment of submassive pulmonary embolism.

scholarly journals Experimental pulmonary embolism: Effects of the thrombus and attenuation of pulmonary artery injury by low-molecular-weight heparin

2006 ◽  
Vol 43 (4) ◽  
pp. 800-808 ◽  
Author(s):  
John E. Rectenwald ◽  
K. Barry Deatrick ◽  
Pasu Sukheepod ◽  
Erin M. Lynch ◽  
Andrea J. Moore ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Artery Injury

Comparison of a once Daily with a twice Daily Subcutaneous Low Molecular Weight Heparin Regimen in the Treatment of Deep Vein Thrombosis

1998 ◽  
Vol 79 (05) ◽  
pp. 897-901 ◽  
Author(s):  
Bernard A. Charbonnier ◽  
Jean-Noël Fiessinger ◽  
J. D. Banga ◽  
Ernst Wenzel ◽  
Pascal d’Azemar ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Daily Regimen ◽  
Once Daily ◽  
Daily Group ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryBackground: Clinical trials have been performed to compare with standard heparin a once or a twice daily regimen of low-molecular-weight heparin but no direct comparison has been done between these two low-molecular-weight heparin regimens in terms of efficacy and safety with a long-term clinical evaluation.Methods: Patients with proximal deep vein thrombosis, confirmed by venography were randomly assigned to either nadroparin (10,250 AXa IU/ml) twice daily or nadroparin (20,500 AXa IU/ml) once daily for at least 5 days. Regimens were adjusted to bodyweight. Oral anticoagulants were started on day 1 or 2 and continued for 3 months. Patients were followed up for 3 months. The composite outcome of venous thromboembolism and death possibly related to pulmonary embolism was the primary measure of efficacy. Major bleeding was the principal measure of safety. The study was designed to show equivalence between the two regimens.Results: Recurrent thromboembolic events or death possibly related to pulmonary embolism were reported in 13 patients in the once daily group (4.1%) and in 24 patients of the twice daily group (7.2%): (absolute difference 3.1% in favor of the once daily regimen; 95% confidence interval -6.6%, +0.5%). Major bleeding episodes during nadroparin treatment occurred in 4 (1.3%) and 4 patients (1.2%) in the once and twice daily groups, respectively.Conclusions: A nadroparin regimen of one injection per day is at least as effective and safe as the same total daily dose divided over two injections for the treatment of acute deep vein thrombosis.

Low-molecular Weight Heparin for Treatment of Pulmonary Embolism in a Pregnant Woman

1999 ◽  
Vol 82 (10) ◽  
pp. 1361-1362 ◽  
Author(s):  
Robert Stiller ◽  
Gina Dunston-Boone ◽  
John Whetham ◽  
Steven Laifer
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Pregnant Woman ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight

scholarly journals Enoxaparin-Induced Liver Injury

2020 ◽  
Vol 14 (2) ◽  
pp. 315-319 ◽  
Author(s):  
Shehriyar Mehershahi ◽  
Nikhitha Mantri ◽  
Aneesh Kumar ◽  
Shaikh Danial ◽  
Patel Harish
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Liver Injury ◽  
Low Molecular Weight Heparin ◽  
Liver Enzymes ◽  
Low Molecular Weight ◽  
Dramatic Improvement ◽  
Hepatocellular Injury

Enoxaparin, a form of low-molecular-weight heparin, can cause a rare, underreported, and often reversible form of hepatocellular injury. This report describes a case of enoxaparin-induced hepatotoxicity in a 61-year-old male diagnosed with pulmonary embolism. Elevations of liver enzymes were noted within 1 week of starting the drug, followed by a dramatic improvement upon its discontinuation, with subsequent normalization in the following days.

Low Molecular Weight Heparin Decreases Proximal and Distal Deep Venous Thrombosis Following Total Knee Arthroplasty

1998 ◽  
Vol 79 (05) ◽  
pp. 902-906 ◽  
Author(s):  
Andrew W. Howard ◽  
Shawn D. Aaron
Keyword(s):  
Molecular Weight ◽  
Total Knee Arthroplasty ◽  
Relative Risk ◽  
Venous Thrombosis ◽  
Knee Arthroplasty ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Dose Heparin ◽  
Total Knee ◽  
Adjusted Dose

SummaryObjectives: To assess the efficacy and safety of low molecular weight heparin (LMWH) as deep venous thrombosis (DVT) prophylaxis following total knee arthroplasty. Data sources: Medline 1986 to June 1997, Embase, and manufacturers were used to identify randomized controlled trials. Review methods: Trials included were randomized studies of LMWH with routine radiological screening for DVT. Placebo or active controls were included. Two reviewers independently screened trials for inclusion, and assessed their quality. Pooled relative risk estimates of DVT and proximal DVT rates were calculated using a DerSimonian and Laird random effects model. Sensitivity of the results to the type of control used and the quality of the trial was assessed. Results: The relative risk of DVT for a patient given LMWH is 0.73 (95% CI 0.66 to 0.80) when compared with patients treated with adjusted dose heparin or warfarin controls. The relative risk for proximal DVT is 0.58 (95% CI 0.38 to 0.90). The relative risk of pulmonary emboli in the LMWH group was 0.55 (95% C.I. 0.20 to 1.57). No excess of bleeding was recorded in the LMWH group. Conclusions: Low molecular weight heparin is more efficacious than either adjusted dose heparin or adjusted dose warfarin, when used to prevent DVT and proximal DVT following total knee arthroplasty.

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