scholarly journals Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding

2017 ◽  
Vol 13 (2) ◽  
pp. 751-758 ◽  
Author(s):  
Guoping Chen ◽  
Wangyin Shi ◽  
Xu He ◽  
Wensheng Lou ◽  
Liang Chen ◽  
...  
Keyword(s):  
At Risk ◽  
Molecular Weight ◽  
Venous Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Low Molecular Weight ◽  
Risk Of Bleeding ◽  
Catheter Directed Thrombolysis ◽  
Patients At Risk

scholarly journals Low-dose low–molecular-weight heparin is anti-inflammatory during venous thrombosis

1998 ◽  
Vol 28 (5) ◽  
pp. 848-854 ◽  
Author(s):  
L.Joseph Downing ◽  
Robert M. Strieter ◽  
Amy M. Kadell ◽  
Carol A. Wilke ◽  
Lazar J. Greenfield ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Low Molecular Weight ◽  
Anti Inflammatory

Thromboprophylaxis in Multiple Myeloma: Indian Perspective

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5207-5207
Author(s):  
Velu Nair ◽  
Satyaranjan Das ◽  
Ajay Sharma ◽  
Deepak Kumar Mishra ◽  
Shilajit Bhattacharya ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Multiple Myeloma ◽  
Developing Countries ◽  
Adverse Effects ◽  
Venous Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Low Molecular Weight ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Abstract Background: Hypercoagulability has been observed in patients of multiple myeloma and has been associated with deep venous thrombosis (DVT). There is growing evidence of increased rate of venous thromboembolism associated with use of thalidomide, an anti angiogenesis drug, especially when combined with other agents such as dexamethasone and doxorubicin. Currently there is no consensus on the most appropriate prophylactic approach for thrombotic episodes in patients of multiple myeloma treated with thalidomide containing regimen. Although newer thalidomide derivatives with less thrombogenic adverse effects are being used in the developed countries, in developing countries like India due to financial constraints thalidomide remains the 1st line drug for multiple myeloma. Further there are scant reports of multiple myeloma related thrombosis and thrombo prophylactic regimen from developing countries. Objectives: To evaluate the incidence of symptomatic as well as asymptomatic thrombosis at onset of the disease as well as during treatment, the efficacy of low dose aspirin and low molecular weight heparin as thromboprophylaxis and their adverse effects in multiple myeloma patients treated with thalidomide and dexamethasone regimen. Patients and Methods: 30 patients of multiple myeloma reporting to our centre from May 2006 to March 2008 comprised the study group. Patient with past history of bleeding, thrombocytopenia and deranged coagulation parameters were excluded from the study. The male to female ratio was 3:2. The median age was 56 years (39–70). 23 patients were de-novo and 7 patients were relapse cases. Before starting therapy in addition to diagnostic and prognostic work up, all patients were evaluated for symptomatic as well as asymptomatic DVT with the help of Color Doppler Flow Index (CDFI) study and d-dimer estimation. Patients were randomized to low dose aspirin (Aspirin 150 mg once a day) and low molecular weight heparin (Enoxapirin 40 mg once a day). All patients were administered dexamethasone pulses of 40 mg once a day from day 1 to 4 in each cycle of 28 days. Thalidomide was started at a dose of 100mg once a day and increased to maximum of 400 mg depending on tolerability (median dose 200 mg). None of the patients received erythropoietin. All patients were evaluated for DVT at the beginning of each cycle during the first three cycles. Thromboprophylaxis was administered for first three cycles only. The response to therapy was evaluated at completion of 3rd and 6th cycles. Criteria for response were as previously reported by Blade et al. Results: The overall response (OR) after 3 cycles was 18/30 (60%), complete response (CR)-10/30(33.3%), partial response (PR)-8/30(26.7%) and after 6 cycles was 22/28 (78.5%), CR-16/28(57.1%), PR-6/28(21.4%). 2 patients who had progressive disease after 3 cycles were changed to Bortezumib containing regimen. Out of 30 patients only one patient (3.3%) a 70 yr old male had deep vein thrombosis at diagnosis which was asymptomatic and the diagnosis was based on CDFI findings. One patient on low dose aspirin had one episode of upper GI bleed on 5th day of the first cycle and thromboprophylaxis was stopped. During the follow up, none of the patient had any evidence of symptomatic as well as asymptomatic DVT. Conclusion: This study suggests that the incidence of venous thrombosis in our cohort of patients were much lower than reported from the west. Both low doses Aspirin as well as low molecular weight heparin are effective agents for thromboprophylaxis. The adverse effects were acceptable. Larger trials would be required to confirm these findings.

scholarly journals Feasibility of Anticoagulation Using Low Molecular‑Weight Heparin During Catheter-Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis 

2020 ◽  
Author(s):  
Yonghui Li ◽  
Junwei Wang ◽  
Rongzhou He ◽  
Junmeng Zheng ◽  
Zhibo Chen ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Therapeutic Dose ◽  
Infusion Rate ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Catheter Directed Thrombolysis

Abstract Background: The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular‑weight heparin (LMWH) during CDT for DVT.Methods: The clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage.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 the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (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 rate 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 2.4 (0.6 to 10.80) x 106 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, 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 with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.

scholarly journals Feasibility of Anticoagulation Using Low Molecular‑Weight Heparin During Catheter-Directed Thrombolysis for  Lower Extremity Deep Venous Thrombosis

2021 ◽  
Author(s):  
Yonghui Li ◽  
Junwei Wang ◽  
Rongzhou He ◽  
Junmeng Zheng ◽  
Zhibo Chen ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Therapeutic Dose ◽  
Infusion Rate ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Catheter Directed Thrombolysis

Abstract Background: The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular‑weight heparin (LMWH) during CDT for DVT.Methods: The clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage.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 the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (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 rate 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 2.4 (0.6 to 10.80) x 106 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, 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 differences in baseline characteristics, clinical improvement, thrombolysis results, and complications. Conclusions: Anticoagulation therapy using low molecular‑weight heparin during CDT with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.

Preoperative Low Molecular Weight Heparin as Venous Thromboembolism Prophylaxis in Patients at Risk for Prosthetic Infection After Knee Arthroplasty

2005 ◽  
Vol 26 (12) ◽  
pp. 903-909 ◽  
Author(s):  
Angel Asensio ◽  
Antonio Ramos ◽  
Elena Múñez ◽  
José L. Vilanova ◽  
Pedro Torrijos ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Low Molecular Weight Heparin ◽  
Surgical Site Infections ◽  
Low Molecular Weight ◽  
Site Infection ◽  
Prosthetic Infection ◽  
Patients At Risk

AbstractObjective:To investigate the effect of preoperative initiation of low molecular weight heparin as prophylaxis for deep venous thrombosis in patients at risk of developing surgical-site infections after knee arthroplasty.Design:Case–control study nested in a cohort. The incidence of surgical-site infection in the cohort was calculated. With the use of data extracted from medical histories and after adjustment for other risk factors, the effect of preoperative heparinization on the risk of incisional and prosthetic infection among case-patients and control-patients (1:3 ratio) was assessed.Setting:Orthopedic department in a tertiary-care referral hospital.Patients:A cohort of 160 consecutive patients who had received prosthetic knee implants between October 1, 2001, and November 30, 2003.Results:Eighteen patients with surgical-site infections were identified, yielding an incidence of incisional and prosthetic infection of 6.9 (95% confidence interval [CI95], 3.5 to 12.0) and 4.4 (CI95,1.8 to 8.8) cases per 100 patients undergoing surgery, respectively. Surgical-site infection was associated with preoperative use of low molecular weight heparin (odds ratio [OR], 6.2 after adjustment for medical and surgical factors; CI95, 1.5 to 23). Prosthetic infection was strongly associated with preoperative use of prophylaxis (OR, undetermined [100% exposure in case-patients vs 35% exposure in control-patients]; P = .002), but incisional surgical-site infection was not.Conclusion:The use of low molecular weight heparins immediately before knee arthroplasty as prophylaxis for deep venous thrombosis should be questioned because of probable increased risk of prosthetic infection.

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

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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