scholarly journals Is Low Molecular Weight Heparin the Treatment of choice for Neonatal Thrombosis?

2020 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Caesarean Section ◽  
Low Molecular Weight Heparin ◽  
Inferior Vena ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Emergency Caesarean Section ◽  
Low Molecular Weight ◽  
Preterm Baby

A borderline preterm baby is born with an emergency caesarean section. The baby is found to have an unprovoked occlusive thrombosis in the left renal vein and inferior vena cava. There are no obvious risk factors for thrombosis. The baby is commenced on un-fractionated heparin (UFH) followed by a prolonged course of low molecular weight heparin (LMWH) based on the guidelines adopted from adult evidence. You wonder if this is reasonable to treat neonates as per adult guidelines given the great differences between adult and neonatal clotting parameters.

scholarly journals Efficacy, Safety, and Timing of Anticoagulant Thromboprophylaxis for the Prevention of Venous Thromboembolism in Patients With Acute Spinal Cord Injury: A Systematic Review

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 138S-150S ◽  
Author(s):  
Paul M. Arnold ◽  
James S. Harrop ◽  
Geno Merli ◽  
Lindsay G. Tetreault ◽  
Brian K. Kwon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Lower Risk ◽  
Low Molecular Weight Heparin ◽  
Inferior Vena Cava Filter ◽  
Inferior Vena ◽  
Vena Cava ◽  
Low Molecular Weight ◽  
Mechanical Prophylaxis ◽  
Cord Injury

Study Design: Systematic review. Objectives: The objective of this study was to answer 5 key questions: What is the comparative effectiveness and safety of (1a) anticoagulant thromboprophylaxis compared to no prophylaxis, placebo, or another anticoagulant strategy for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) after acute spinal cord injury (SCI)? (1b) Mechanical prophylaxis strategies alone or in combination with other strategies for preventing DVT and PE after acute SCI? (1c) Prophylactic inferior vena cava filter insertion alone or in combination with other strategies for preventing DVT and PE after acute SCI? (2) What is the optimal timing to initiate and/or discontinue anticoagulant, mechanical, and/or prophylactic inferior vena cava filter following acute SCI? (3) What is the cost-effectiveness of these treatment options? Methods: A systematic literature search was conducted to identify studies published through February 28, 2015. We sought randomized controlled trials evaluating efficacy and safety of antithrombotic strategies. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine studies satisfied inclusion criteria. We found a trend toward lower risk of DVT in patients treated with enoxaparin. There were no significant differences in rates of DVT, PE, bleeding, and mortality between patients treated with different types of low-molecular-weight heparin or between low-molecular-weight heparin and unfractionated heparin. Combined anticoagulant and mechanical prophylaxis initiated within 72 hours of SCI resulted in lower risk of DVT than treatment commenced after 72 hours of injury. Conclusion: Prophylactic treatments can be used to lower the risk of venous thromboembolic events in patients with acute SCI, without significant increase in risk of bleeding and mortality and should be initiated within 72 hours.

scholarly journals Antithrombin III Supplementation in a Premature Infant: Is There a Target Antithrombin Level?

2021 ◽  
Vol 26 (8) ◽  
pp. 850-856
Author(s):  
Ankit Shukla ◽  
Chi Braunreiter
Keyword(s):  
Molecular Weight ◽  
Premature Infant ◽  
Critically Ill ◽  
Premature Infants ◽  
Low Molecular Weight Heparin ◽  
Inferior Vena ◽  
Antithrombin Iii ◽  
Vena Cava ◽  
Low Molecular Weight ◽  
Optimal Target

The optimal antithrombin (AT) activity for low-molecular-weight heparin efficacy and the benefits of antithrombin III (ATIII) supplementation in premature infants diagnosed with venous thromboembolism are unknown. Currently, there are no neonatal-specific guidelines directing the appropriate target AT activity during supplementation. This case report describes a critically ill premature infant with a progressive, occlusive inferior vena cava thrombus who received supplemental ATIII during enoxaparin treatment. The patient did not achieve therapeutic anti-Xa levels despite increasing enoxaparin dosing to 3 mg/kg every 12 hours. ATIII supplementation sufficient to attain an AT activity of >40%, in combination with an enoxaparin dosing of >2 mg/kg every 12 hours, was needed to achieve therapeutic anti-Xa levels. Future large studies are needed to determine if there is an optimal target AT activity for critically ill premature infants.

scholarly journals Evaluation and Management of Women who Have Experienced Stillbirth in Their Previous Pregnancies

2019 ◽  
pp. 1
Author(s):  
Erdem Fadiloglu ◽  
Atakan Tanacan ◽  
Canan Unal ◽  
Mehmet Sinan Beksac
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Methylenetetrahydrofolate Reductase ◽  
Post Partum ◽  
Subsequent Pregnancy ◽  
Low Molecular Weight ◽  
Mthfr Polymorphisms ◽  
The Mean

<p><strong>Objective:</strong> To evaluate the subsequent pregnancy outcomes of women who have experienced unexplained stillbirth in their previous gestations.</p><p><strong>Study Design:</strong> This retrospective cohort consisted of 14 pregnancies who had stillbirth (without known risk factors) in their previous pregnancies. These patients had been included in a special preconceptional care program to be evaluated in terms of etiological risk factors for stillbirth. At least one of the risk factors, such as methylenetetrahydrofolate reductase (MTHFR) polymorphisms, hereditary thrombophilias and autoimmune problems, were defined in this study population. After detection of pregnancy, the patients were administered low-dose low-molecular-weight heparin (LMWH) (enoxaparin, 1×2000 Anti-XA IU/0.2 mL/day), low-dose salicylic acid (100 mg/day) and low-dose corticosteroid (methylprednisolone, 1×4 mg/day orally) in necessary cases.</p><p><strong>Results:</strong> Out of 14 pregnancies, 4 (28.5%) ended up with miscarriages at 9, 11, 11 and 15 gestational weeks, respectively. The remaining 10 pregnancies ended up with alive deliveries. The mean gestational week at birth was 36.4±0.51, while the mean birthweight was 2882±381.01 g. Out of 10 pregnancies, only one was diagnosed as IUGR. Only two newborn necessitated hospitalization in the neonatal intensive care unit (NICU) due to respiratory problems. Both newborns were discharged from the NICU without any further complication at the post-partum 5th day. </p><p><strong>Conclusion:</strong> Patients with a prior stillbirth should be screened for MTHFR polymorphisms, autoimmune problems and hereditary thrombophilias, especially in case of absence of any etiological factor. Management of these patients with low-dose aspirin, low-dose low molecular weight heparin and corticosteroids seemed to be beneficial for increasing live birth rates and avoiding obstetric complications.</p>

scholarly journals Risk factors and role of low molecular weight heparin in obstetric complications among women with inherited thrombophilia – a cohort study

2019 ◽  
Vol 41 (4) ◽  
pp. 303-309
Author(s):  
María Manuela Clavijo ◽  
Carolina Valeria Mahuad ◽  
María de los Angeles Vicente Reparaz ◽  
María Florencia Aizpurua ◽  
Adriana Ventura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Cohort Study ◽  
Low Molecular Weight Heparin ◽  
Obstetric Complications ◽  
Low Molecular Weight ◽  
Inherited Thrombophilia

scholarly journals Thromboembolism and antithrombotic management in pregnancy

2011 ◽  
Vol 152 (21) ◽  
pp. 815-821 ◽  
Author(s):  
Attila Pajor
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Individual Risk ◽  
Low Molecular Weight ◽  
Pregnancy And Delivery ◽  
Individual Risk Factors ◽  
In Pregnancy

Venous thromboembolism occurs approximately in 1 of 1000 pregnancies. It is one of the leading causes of maternal mortality. Physiologic changes associated with pregnancy and delivery favor for developing venous thromboembolism, and there are individual risk factors, too, contributing to its manifestation. The most frequent risk factors of venous thromboembolism developing during pregnancy are the previous venous thromboembolism and the thrombophilias, furthermore, some other diseases and some unique complications of pregnancy and delivery. Beyond mechanical prevention only heparin preparations can be used for preventing and treating venous thromboembolism in pregnancy and among them the low-molecular-weight heparins are preferred for applying. Dosage of low-molecular-weight heparin preparations is determined by the type and strength of thrombophilia. For treatment of venous thromboembolism presented during pregnancy subcutaneous 100 IU/kg low-molecular-weight heparin is generally used at every 12 hours. Postpartum the oral anticoagulants can be safely applied, too. Orv. Hetil., 2011, 152, 815–821.

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