scholarly journals Cancer and Thrombosis: New Treatments, New Challenges

2021 ◽  
Vol 9 (2) ◽  
pp. 41
Author(s):  
Anders Erik Astrup Dahm
Keyword(s):  
Cancer Patients ◽  
Arterial Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Current Article ◽  
New Challenges ◽  
New Guidelines ◽  
Direct Acting ◽  
New Treatments ◽  
Urogenital Cancers

The direct-acting oral anticoagulant (DOAC) has become an alternative to low-molecular-weight heparin (LMWH) for treatment and prophylaxis of venous thromboembolism (VTE) in cancer patients. The clinicians are, however, faced with difficult decisions regarding DOAC treatment: Which patients cannot use DOACs? Should incidental VTE be treated similar to symptomatic VTE? Is it safe to give DOACs to patients with gastrointestinal or urogenital cancers? How about drug–drug interactions? Should all cancer patients receive thromboprophylaxis? Is arterial thrombosis a problem? The current article reviews the available literature regarding these questions and aims to provide practical solutions based on data from the clinical trials and new guidelines.

scholarly journals Direct acting oral anticoagulants versus low molecular weight heparin for primary thromboprophylaxis in cancer patients

Medwave ◽  
2021 ◽  
Vol 21 (04) ◽  
pp. e8178-e8178
Author(s):  
Natalia Méndez ◽  
Constanza Norambuena ◽  
Symón Silva ◽  
Valentín López
Keyword(s):  
Molecular Weight ◽  
Cancer Patients ◽  
Systematic Reviews ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Thromboembolic Disease ◽  
Low Molecular Weight ◽  
Sources Of Information ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

Introduction Low molecular weight heparin is currently the standard therapy for the primary prevention of thromboembolic disease in cancer patients. The use of direct-acting anticoagulants could be an alternative, but its efficacy and safety profile in these types of patients remains unclear. Methods We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from identified reviews, analyzed data from primary studies, performed a meta-analysis, and prepared a summary table of results using the GRADE method. Results and conclusions We identified four systematic reviews that together included two primary studies, of which both correspond to trials. We conclude that the use of direct-acting oral anticoagulants probably increases the outcome of major bleeding and likely slightly increases the risk of thromboembolic disease. No studies were found that evaluated the outcome of quality of life or mortality.

Heparin-Induced Thrombocytopenia during Obstetric Hospital Admissions

2018 ◽  
Vol 35 (09) ◽  
pp. 898-903 ◽  
Author(s):  
Deepika Sagaram ◽  
Zainab Siddiq ◽  
Andrew Eisenberger ◽  
Cande Ananth ◽  
Jason Wright ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arterial Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Hospital Admissions ◽  
The United States ◽  
Limb Amputation ◽  
Administrative Database ◽  
Low Molecular Weight ◽  
Heparin Induced Thrombocytopenia ◽  
Pharmacologic Prophylaxis

Introduction The rate of heparin-induced thrombocytopenia (HIT) on a population basis is unknown. The objective of this study was to characterize the risk for HIT during antepartum, delivery, and postpartum hospitalizations in the United States. Materials and Methods A large administrative database was used to determine the risk of HIT in hospitalized obstetric patients who received unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were presumed to have HIT if they were exposed to UFH or LMWH, received a diagnosis of HIT, and were administered a medication for the treatment of HIT including bivalirudin, argatroban, fondaparinux, or lepirudin. We queried severe complications of HIT including arterial thrombosis, limb amputation, heart failure, and death. Results We identified 66,468 antepartum hospitalizations, 66,741 delivery hospitalizations, and 16,325 postpartum readmissions where women received pharmacologic prophylaxis. Of these, 10 antepartum admissions, 1 delivery admission, and 14 postpartum readmissions involved a diagnosis of HIT with treatment of bivalirudin, argatroban, fondaparinux, or lepirudin. There were no deaths and no diagnoses of arterial thrombosis, limb amputation, heart failure, and death. Conclusion Risk for HIT among hospitalized obstetric patients is low. In this cohort, no cases of death or severe complications were noted in relation to the diagnosis.

scholarly journals Validation of the Antifactor Xa and Antifactor IIa Assays for the Potency Assessment of Nadroparin in Pharmaceutical Formulations

2006 ◽  
Vol 89 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Sérgio Luiz Dalmora ◽  
Maximiliano da Silva Sangoi ◽  
Thiago Barth ◽  
Liberato Brum ◽  
Silvana Ferreira Vaccari
Keyword(s):  
Molecular Weight ◽  
Arterial Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Pharmaceutical Formulations ◽  
Pharmaceutical Products ◽  
Low Molecular Weight ◽  
Nadroparin Calcium ◽  
Prevention And Treatment ◽  
Antifactor Xa ◽  
Routine Quality Control

Abstract The low-molecular weight heparin nadroparin calcium is used clinically for the prevention and treatment of venous and arterial thrombosis. The antifactor Xa and antifactor IIa assays were validated by investigating the parameters of range, linearity (r2 0.9905 and r2 0.9914, respectively) precision, accuracy, and robustness. The 2 methods incorporated a chromogenic endpoint and detection at 405 nm, yielding good results with detection limits of 0.004 and 0.01 IU/mL and quantitation limits of 0.01 and 0.03 IU/mL, respectively, for the antifactor Xa and antifactor IIa assays. Nadroparin calcium pharmaceutical products were evaluated by the antifactor Xa assay and the antifactor IIa assay, giving potencies between 93.86 and 109.88%, with an antifactor Xa/antifactor IIa ratio between 3.2 and 3.7. The results demonstrated the validity of the assays that are useful methodologies for the routine quality control of nadroparin in pharmaceutical formulations.

The effects of low-molecular-weight heparin at two different dosages on thrombin generation in cancer patients.

2010 ◽  
Vol 104 (07) ◽  
pp. 92-99 ◽  
Author(s):  
Ludwig Traby ◽  
Alexandra Kaider ◽  
Rainer Schmid ◽  
Alexander Kranz ◽  
Peter Quehenberger ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Cancer Patients ◽  
Low Molecular Weight Heparin ◽  
Thrombin Generation ◽  
Low Molecular Weight ◽  
Prothrombotic State ◽  
Coagulation Activation ◽  
Thrombotic Risk ◽  
Baseline Levels ◽  
D Dimer

SummaryNon-surgical cancer patients are at high thrombotic risk. We hypothesised that the prothrombotic state is reflected by elevated thrombin generation and can be mitigated by increasing the low-molecularweight heparin (LMWH) dose. Non-surgical cancer patients were randomised to enoxaparin 40 or 80 mg. D-dimer, prothrombin fragment F1+2 (F1+2) and peak thrombin (PT) were measured 2, 4, 6 hours (h) after LMWH (day 1) and daily for 4 days. A total of 22 and 27 patients received enoxaparin 40 and 80 mg, respectively. D-dimer and F1+2 moderately decreased after 6 h in both groups. After enoxaparin 80 mg, D-dimer baseline levels [median (quartiles)] decreased from day 1 to 4 [1054.9 (549.5, 2714.0) vs. 613.0 (441.1, 1793.5) ng/ml] (p<0.0001), while no difference was seen after 40 mg. Baseline PT levels [median (quartiles)] were 426.2 nM (347.3, 542.3) (40 mg) and 394.0 nM (357.1, 448.8) (80 mg). After 80 mg, PT significantly decreased to 112.4 nM (68.5, 202.4), 57.1 nM (38.0, 101.2) and 43.6 nM (23.4, 112.8) after 2, 4 and 6 h, which was lower than after 40 mg (p=0.003). After 80 mg, PT decreased from day 1 to 4 [358.6 nM (194.2, 436.6); p=0.06] while no difference was seen after 40 mg. In conclusion, in cancer patients coagulation activation and thrombin generation is substantially increased. Peak thrombin levels are sensitive to the anticoagulant effects of LMWH at different dosages. The prothrombotic state is substantially attenuated by higher LMWH doses.

scholarly journals Effect of Low Molecular Weight Fucoidan and Low Molecular Weight Heparin in a Rabbit Model of Arterial Thrombosis

2008 ◽  
Vol 45 (6) ◽  
pp. 529-537 ◽  
Author(s):  
Eric Durand ◽  
Dominique Helley ◽  
Ayman Al Haj Zen ◽  
Céline Dujols ◽  
Patrick Bruneval ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Arterial Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Rabbit Model ◽  
Low Molecular Weight
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