Case Report: Spontaneous Intramural Hematoma of the Colon Secondary to Low Molecular Weight Heparin Therapy

Background: Hematoma of the colon is a rare hemorrhagic complication that affects patients accepting low molecular weight heparin (LMWH) therapy. Only scarce cases of colon hematoma have been reported, usually in children or patients accepting warfarin therapy.Case summary: A 76-year-old Chinese man was diagnosed with atrial fibrillation and heart failure, with cardiac function NYHA grade III on March 21, 2018. This patient was given LMWH for anticoagulation therapy and developed a colon hematoma on the third day of hospitalization. Abdominal computed tomography (CT) showed the thickening of areas of the colon up to 110 mm × 78 mm in thickness, which was a symptom of colon hematoma. The patient underwent conservative treatment successfully. On March 27, the patient’s abdominal pain was alleviated, and a CT scan showed that the intestinal hematoma was absorbed.Conclusions: The most frequent minor bleeding events of LMWH anticoagulation are hemorrhage and subcutaneous hematoma. This case demonstrated that bowel hematoma despite its low incidence should be considered as an ADR of LMWH therapy, especially among patients who present with gastrointestinal symptoms.

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Assessment of pregnancy outcome with low molecular weight heparin therapy: a retrospective, single centre observational study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181333 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1446

Author(s):

Ankita Singh ◽

Madhuri Alwani ◽

Nutan Yadav ◽

Priyam Padia

Keyword(s):

Molecular Weight ◽

Deep Vein Thrombosis ◽

Pregnant Women ◽

Pregnancy Outcome ◽

Low Molecular Weight Heparin ◽

Anticoagulation Therapy ◽

Heparin Therapy ◽

Low Molecular Weight ◽

Vein Thrombosis ◽

Deep Vein

Background: The objective of this study was to determine the outcomes of Low Molecular Weight Heparin Therapy (LMWH) given for various indications during pregnancy.Methods: In this context, a detailed retrospective analysis of all the patients who received LMWH for various indications over a period of two years from October 2015 to November 2017 at a single center, Sri Aurobindo Medical College and PG institute in Indore was performed.Results: Total 100 patients were studied, included over the period of 2 years for various indications for which Enoxaparin (1 mg/kg body weight OD/BD subcutaneously) was used. The indications were valvular heart disease with valve replacement and atrial fibrillation (54.0%), chronic deep vein thrombosis (DVT) (13.0%), thrombophilias (9.0%), recurrent pregnancy loses (21.0%) and prophylaxis for deep vein thrombosis (3.0%) in overall patients. Abortion was seen in 8.0 % patients; fetal growth restriction in 13% patients; and oligohydramnios, preeclampsia, gestational hypertension, placenta previa, abruptio placentae, postpartum hemorrhage patients and Stillbirth occurred in 4.0 % patients. No thromboembolic event was noted in any of the patients. None of the patients had any documented thrombocytopenia or clinical fracture.Conclusions: Low Molecular Weight Heparin Therapy (LMWH) used amongst pregnant women with various indications for anticoagulation therapy was associated with successful pregnancy outcome in the vast majority of cases. Further multicenter prospective studies and international registries of pregnant women on LMWH are necessary to broaden our knowledge in optimizing the care of women who require anticoagulation during pregnancy.

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Comparison of Subcutaneous Unfractionated Heparin with a Low Molecular Weight Heparin (Fragmin®) in Patients with Venous Thromboembolism and Contraindications to Coumarin

Thrombosis and Haemostasis ◽

10.1055/s-0038-1642376 ◽

1994 ◽

Vol 71 (01) ◽

pp. 007-011 ◽

Cited By ~ 273

Author(s):

M Monreal ◽

E Lafoz ◽

A Olive ◽

L del Rio ◽

C Vedia

Keyword(s):

Molecular Weight ◽

Venous Thromboembolism ◽

Low Molecular Weight Heparin ◽

Spinal Fracture ◽

Heparin Therapy ◽

Laboratory Animals ◽

Low Molecular Weight ◽

Consecutive Series ◽

Minor Bleeding ◽

Promising Alternative

SummaryIntravenous heparin followed by oral anticoagulant therapy (e. g. with coumarin) is still the most widely used treatment for deep venous thromboembolism. Self-administered subcutaneous injections of heparin have been thought of as a promising alternative to coumarin, but the high doses required for ongoing prophylaxis have raised concerns about the possible development of bone disease. Certainly, long-term heparin therapy has been reported to cause osteoporosis in both laboratory animals and humans.This study aimed to compare the efficacy and safety of unfractionated (UF) heparin with that of a low molecular weight heparin (Fragmin®, Kabi Pharmacia) in the prevention of recurrent deep venous thrombosis (DVT) and pulmonary embolism (PE) in a consecutive series of patients with contraindications to coumarin therapy. The patients comprised 40 men and 40 women, aged between 19 and 92 years (mean age, 68 years). They had all previously been diagnosed as having acute DVT and had been treated with conventional doses of heparin while in hospital. All patients had at least one of the following conditions: recent blood loss (either spontaneous or during admission while receiving heparin therapy); active gastroduodenal ulcer disease; psychological or physical inability or unwillingness to understand and accept the need for regular laboratory monitoring during coumarin treatment; chronic alcoholism; dementia; pregnancy; recent neurosurgery, and pericardial effusion; or were over 80 years of age. They were randomly allocated to receive either UF heparin, 10,000 IU s.c. b.d., or Fragmin®, 5000 IU anti-Factor Xa s. c. b. d., for a period of 3-6 months.Two patients taking UF heparin were readmitted to hospital 2 and 3 months after discharge, owing to symptomatic, scintigraphically proven recurrent PE. No patients receiving Fragmin® had recurrent PE. There were 10 reports of minor bleeding: six in patients receiving UF heparin and four in patients on Fragmin®. Furthermore, there were seven cases of spinal fracture: six in patients on UF heparin, and one in a patient taking Fragmin®.We conclude that fixed doses of both UFH and Fragmin® appear to be quite effective and safe for use in patients with a high risk of bleeding. In our experience, however, UF heparin is associated with an unacceptably high incidence of spinal fracture.

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Feasibility of Anticoagulation using Low Molecular‑weight Heparin during Catheter-directed Thrombolysis for Lower Extremity Deep Venous Thrombosis

10.21203/rs.3.rs-42400/v1 ◽

2020 ◽

Author(s):

Yonghui Li ◽

Junwei Wang ◽

Rongzhou He ◽

Junmeng Zheng ◽

Zhibo Chen ◽

...

Keyword(s):

Molecular Weight ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Therapeutic Dose ◽

Low Molecular Weight Heparin ◽

Anticoagulation Therapy ◽

Low Molecular Weight ◽

Minor Bleeding ◽

Catheter Directed Thrombolysis ◽

Significant Difference

Abstract Background: The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. The present study is performed to evaluate the effectiveness and safety of anticoagulation therapy using low molecular‑weight heparin (LMWH) during CDT for DVT.Methods: The clinical data of DVT patients underwent CDT during the past 6 years were retrospectively collected and reviewed. According to LMWH dose, patients were divided into therapeutic-dose anticoagulation (TPDA) group and sub therapeutic-dose anticoagulation (sub-TPDA) group.Results: A total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloon, stent and thrombectomy were provided for 9 (14.8%), 4 (6.6%) and 1 (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rates was 2.5 (0.83 to 5) x 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 240 (60 to 1080) x 104 U. During CDT, 5 (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolism or death occurred. Complete (>90%) and partial thrombolysis (50~90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant difference in baseline characteristics, clinical improvement, thrombolysis results and complications.Conclusions: Anticoagulation therapy using low molecular‑weight heparin during CDT for DVT is effective and safe. In comparison with sub-therapeutic-dose anticoagulation, therapeutic-dose did not improve the thrombolytic effect or increase the rate of complication.

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