scholarly journals Heparin and its contribution to the treatment of COVID-19

2021 ◽  
Vol 10 (12) ◽  
pp. e331101220274
Author(s):  
Tamíres Hillesheim Mittelmann ◽  
Juliana Baldissera Dors ◽  
Victória Galletti dos Santos Arraes ◽  
Graciela Soares Fonseca ◽  
Cesar Andres Diaz Arias
Keyword(s):  
Low Molecular Weight Heparin ◽  
Statistical Data ◽  
Study Groups ◽  
Experimental Models ◽  
Hospitalized Patients ◽  
Low Molecular Weight ◽  
Construction Of Knowledge ◽  
Prophylactic Dose ◽  
Multiple Variables ◽  
The Subject

The infection caused by SARS-CoV-2 presents changes in the coagulation processes such as venous thromboembolism (VTE) and disseminated intravascular coagulation (DIC) and it has been shown that this coagulopathy is associated by some means with the mortality. Studies suggest that these anticoagulants reduced the mortality of hospitalized patients. However, the studies for this point are not demonstrative, since they are evaluated as multiple variables and the results obtained are not the answer to experimental designs with controlled variables. In most of the cases, the obtained responses are the result of isolated cases or experimental models that do not differentiate statistical data, probably because of the differences related to the study groups. However, in models adjusted for age and sex, the reduction in mortality was statistically significant in patients who were treated with heparins, even when other variables were added to the model. In view of this, there is no consensus regarding the dose and type of anticoagulant, between different countries and entities, but what is most often cited is the use of low molecular weight heparin (LMWH) in a prophylactic dose for all hospitalized patients with the disease. The use of anticoagulants such as heparins has suggested results applicable to the treatment of coagulopathy caused by COVID-19, which makes the subject important for the centralization and analysis of the results. In order to continue with the construction of knowledge around this theme, the objective of this work was to review the use of heparins in the treatment of COVID-19.

Neutralization of a Low Molecular Weight Heparin (LHN-1) and Conventional Heparin by Protamine Sulfate in Rats

1986 ◽  
Vol 56 (03) ◽  
pp. 318-322 ◽  
Author(s):  
V Diness ◽  
P B Østergaard
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Thrombus Formation ◽  
Experimental Models ◽  
Protamine Sulfate ◽  
Low Molecular Weight ◽  
Antithrombotic Effect ◽  
Higher Doses

SummaryThe neutralization of a low molecular weight heparin (LHN-1) and conventional heparin (CH) by protamine sulfate has been studied in vitro and in vivo. In vitro, the APTT activity of CH was completely neutralized in parallel with the anti-Xa activity. The APTT activity of LHN-1 was almost completely neutralized in a way similar to the APTT activity of CH, whereas the anti-Xa activity of LHN-1 was only partially neutralized.In vivo, CH 3 mg/kg and LHN-1 7.2 mg/kg was given intravenously in rats. The APTT and anti-Xa activities, after neutralization by protamine sulfate in vivo, were similar to the results in vitro. In CH treated rats no haemorrhagic effect in the rat tail bleeding test and no antithrombotic effect in the rat stasis model was found at a protamine sulfate to heparin ratio of about 1, which neutralized APTT and anti-Xa activities. In LHN-1 treated rats the haemorrhagic effect was neutralized when APTT was close to normal whereas higher doses of protamine sulfate were required for neutralization of the antithrombotic effect. This probably reflects the fact that in most experimental models higher doses of heparin are needed to induce bleeding than to prevent thrombus formation. Our results demonstrate that even if complete neutralization of APTT and anti-Xa activities were not seen in LHN-1 treated rats, the in vivo effects of LHN-1 could be neutralized as efficiently as those of conventional heparin. The large fall in blood pressure caused by high doses of protamine sulfate alone was prevented by the prior injection of LHN-1.

Tromboseprofylaxe na doorgemaakte Covid-19: een onopgelost raadsel

2021 ◽  
Author(s):  
V. WOUTERS ◽  
A. GADISSEUR ◽  
C. KENYON
Keyword(s):  
Molecular Weight ◽  
Ct Scan ◽  
Low Molecular Weight Heparin ◽  
Epigastric Pain ◽  
Abrupt Onset ◽  
Splenic Infarction ◽  
Low Molecular Weight ◽  
Prophylactic Dose

Thromboprophylaxis after discharge for COVID-19: an unsolved puzzle Whilst recovering from severe COVID-19, a 61-year-old man was admitted to the hospital with abrupt onset epigastric pain, nausea and constipation for 2 days. Four days earlier, he had been released from the hospital after 2 weeks of hospitalization for severe bilateral COVID-19 pneumonia. A CT scan of the abdomen revealed a splenic infarction despite treatment with a prophylactic dose of low-molecular-weight heparin (LMWH). The incidence, pathophysiology and prevention of COVID-19-associated coagulopathy are discussed.

Low molecular weight heparin (tinzaparin) therapy for moderate risk thromboprophylaxis during pregnancy

2004 ◽  
Vol 92 (10) ◽  
pp. 791-796 ◽  
Author(s):  
John Bonnar ◽  
Mark Smith ◽  
Philip Steer ◽  
Geoff Savidge ◽  
Lucy Norris
Keyword(s):  
Molecular Weight ◽  
Pregnant Women ◽  
Low Molecular Weight Heparin ◽  
Dose Adjustment ◽  
Pregnant Patient ◽  
Low Molecular Weight ◽  
Moderate Risk ◽  
Once Daily ◽  
Prophylactic Dose ◽  
Starting Dose

SummaryLow molecular weight heparin (LMWH) is used increasingly for prophylaxis and treatment of venous thromboembolism during pregnancy. However, the prophylactic dose for patients at moderate risk varies between centers, and the recommended LMWH dose for the non pregnant patient is frequently used in pregnant women. The aim of this study was to investigate the effects of pregnancy on the pharmacokinetics of anti-Xa levels during moderate risk thromboprophylaxis with the LMWH, tinzaparin. In 24 pregnant women, one of three doses of tinzaparin (50, 75 or 100 IU/kg) were given according to the treating physician’s assessment of their risk profile. Four-hour peak anti-Xa levels were measured throughout pregnancy and 24-hour profiles were measured at 28 and 36 weeks gestation. Doses were adjusted when peak anti-Xa levels fell below 0.1 IU/ml and, in some cases, when levels at 10 and 18 hours post injection were undetectable (<0.05 IU/ml). Our results showed that women receiving tinzaparin (50 IU/kg) frequently had peak (4 hour) anti-Xa levels below 0.1IU/ml and that 46% of these patients required dose adjustment. Similarly anti-Xa levels were also found to be low over the 24-hour period. A starting dose of 75 IU/kg, once daily, gave greater anti-Xa cover over the 24-hour period and may avoid the need for dose adjustment. The results suggest that the pharmacokinetics of tinzaparin are affected by pregnancy. Larger studies are required to determine whether an increased tinzaparin dose (75 IU/kg) would be more effective in the prevention of thrombosis during pregnancy than 50 IU/kg

scholarly journals Therapeutic dosing of low-molecular-weight heparin may decrease mortality in patients with severe COVID-19 infection

2020 ◽  
Vol 40 (6) ◽  
pp. 462-468
Author(s):  
Kadir Canoglu ◽  
Bengu Saylan
Keyword(s):  
Molecular Weight ◽  
Therapeutic Dose ◽  
Low Molecular Weight Heparin ◽  
Tertiary Care ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Care Hospital ◽  
Coagulation Parameters ◽  
Icu Admission ◽  
Prophylactic Dose

ABSTRACT BACKGROUND: Venous thromboembolism or extensive thrombosis is relatively common in patients with severe COVID-19 infection and has been associated with increased mortality. During the current COVID-19 pandemic, several prophylactic doses and types of low-molecular-weight heparin (LMWH) are being used worldwide; however, there are no high-quality studies or recommendations for an optimal prophylactic LMWH dose. OBJECTIVES: Investigate the relationship between coagulation parameters and the LMWH dose, and mortality and ICU admission in hospitalized patients with severe COVID-19 pneumonia. DESIGN: Retrospective. SETTING: Tertiary care hospital. PATIENTS AND METHODS: Data on clinical features, coagulation parameters and anticoagulant medications of inpatients with severe COVID-19 were collected for the period between 11 March 2020 and 31 April 2020. MAIN OUTCOME MEASURES: Mortality and ICU admission for prophylactic dose LMWH (0.5 mg/kg twice daily) and therapeutic dose LMWH (1 mg/kg twice daily). SAMPLE SIZE: 154 cases. RESULTS: Ninety-eight (63.6%) patients were treated with the LMWH prophylactic dose and 56 (36.4%) patients were treated with the therapeutic dose. Forty-four (44.9%) of 98 patients using the prophylactic dose LMWH died, while 10 (17.9%) of 56 patients using the therapeutic dose LMWH died ( P =.001). Mortality was 6.4-fold higher in the prophylactic dose LMWH users than in the therapeutic dose LMWH users (OR=6.5, 95% CI: 2.4–17.6, P <.001). CONCLUSIONS: Therapeutic dosing of LMWH may decrease mortality in patients with severe COVID-19 infected pneumonia. More aggressive thromboprophylaxis regimens using higher doses of heparin should be evaluated in prospective studies. LIMITATIONS: Lack of information about bleeding complications. LMWH was not compared with other anticoagulant therapies. There was no comparison between our two groups on the APACHE score. Used different doses of LMWH in different clinics in our hospital. Single-center, retrospective study. CONFLICT OF INTEREST: None.

Hypercoagulability and Venous Thromboembolism in Burn Patients

2015 ◽  
Vol 41 (01) ◽  
pp. 043-048 ◽  
Author(s):  
Jonathan Meizoso ◽  
Juliet Ray ◽  
Casey Allen ◽  
Robert Van Haren ◽  
Gabriel Ruiz ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Burn Patients ◽  
Comprehensive Review ◽  
Factors Associated ◽  
Prospective Trials ◽  
The Subject ◽  
Antifactor Xa ◽  
Using Data

To our knowledge, this is the first comprehensive review on the subject of venous thromboembolism (VTE) and hypercoagulability in burn patients. Specific changes in coagulability are reviewed using data from thromboelastography and other techniques. Disseminated intravascular coagulation in burn patients is discussed. The incidence and risk factors associated with VTE in burn patients are then examined, followed by the use of low-molecular-weight heparin thromboprophylaxis and monitoring techniques using antifactor Xa levels. The need for large, prospective trials in burn patients is highlighted, especially in the areas of VTE incidence and safe, effective thromboprophylaxis.

scholarly journals The effect of prophylactic dose of a low molecular weight heparin on skin wound healing of rats

2009 ◽  
Vol 24 (6) ◽  
pp. 471-475 ◽  
Author(s):  
Ozdamar Fuad Oken ◽  
Ahmet Ozgur Yildirim ◽  
Murat Gulcek ◽  
Vuslat Sema Unal ◽  
Akin Karakuyu ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Wound Healing ◽  
Tensile Strength ◽  
Low Molecular Weight Heparin ◽  
Skin Wound ◽  
Control Group ◽  
Low Molecular Weight ◽  
Skin Wound Healing ◽  
Prophylactic Dose ◽  
Experimental Group

PURPOSE: To investigate the effect of prophylactic dose of a low molecular weight heparin, enoxaparin, on skin wound healing of rats. METHODS: Forty rats were used for the study. Rats were randomly assigned to two equal groups. Experimental group received prophylactic dose of enoxaparin. Physiologic saline was administered to the control group. Parameters of wound healing of experimental and control groups were compared. For comparison of the groups in terms of fibrosis, vascularization, inflammation, epithelization, and tensile strength test (Newton). Mann-Whitney-U test was used because variables were categorical data (fibrosis, vascularization, inflammation and epithelization). Differences between groups were analyzed with independent samples t-test (tensile strength). Significance was set at p<0.05. RESULTS: Skin wound of the experimental group presented tensile strength significantly decreased (p<0.001), histopathologic examination revealed a significant (p<0.001) delayed epithelization and decreased in fibrosis, vascularization, inflammation (p<0.001) in the experimental group. CONCLUSION: Enoxaparin delay wound healing by decreased inflammatory cells, fibroblast contents and their products (growth factors), and by promoted hemorrhage.

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