scholarly journals A STUDY TO ASSESS THE EFFECT OF SLOW VS FAST SUBCUTANEOUS LOW MOLECULAR WEIGHT HEPARIN (LMWH) ON EXTENT OF BRUISING AND SITE PAIN INTENSITY AMONG PATIENTS RECEIVING LMWH ADMITTED IN SELECTED ICUS OF A TERTIARY CARE HOSPITAL, LUDHIANA, PUNJAB

2021 ◽  
Vol 2 (9) ◽  
pp. 766
Author(s):  
VISHAKHA Anon ◽  
PRABHJOT SAINI ◽  
SHIVANI KALRA
Keyword(s):  
Molecular Weight ◽  
Pain Intensity ◽  
Low Molecular Weight Heparin ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Low Molecular Weight ◽  
Care Hospital ◽  
Site Pain

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.

scholarly journals Adverse drug reactions monitoring of anticoagulant drugs used in cardiac coronary care unit of a tertiary care hospital

2019 ◽  
Vol 8 (11) ◽  
pp. 2512
Author(s):  
Sugandha Kassere ◽  
Juhi Kalra ◽  
Anurag Rawat ◽  
Saurabh Kohli
Keyword(s):  
Molecular Weight ◽  
Adverse Drug Reactions ◽  
Low Molecular Weight Heparin ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Low Molecular Weight ◽  
Care Hospital ◽  
Drug Reactions ◽  
Anticoagulant Drugs

Background: Cardiovascular diseases are one of the leading causes of morbidity and mortality worldwide. Anticoagulants are the most commonly implicated drugs, used in cardiology unit and they are responsible for a majority of adverse drug reactions (ADRs). The objective of the present study was to evaluate the pattern of ADRs reported with anticoagulant drugs used in the cardiology unit of a tertiary care hospital.Methods: This observational prospective study was undertaken from September 2017 to August 2018. Causality assessment of ADRs was assessed using the WHO and Naranjo scale of probability. The severity was assessed by modified Hartwig and Siegel scale, and preventability of ADRs was assessed by Schumock and Thornton scale.Results: Out of the total forty-one ADRs recorded, 40 (97.56%) were mild and 1 (2.44%) was reported as severe on the Hartwig and Siegel severity scale. Hematuria (68.29%) was the most common ADR followed by hemoptysis (14.63%). Among all anticoagulants, low molecular weight heparin was associated with the majority of ADRs (85.37%). The WHO causality and Naranjo Scale revealed that maximum of the ADRs (~80%) were possible. All ADRs reported was Type “A” reactions according to Wills and Brown classification of ADRs. Majority of ADRs (97.56%) were probably preventable.Conclusions: In the present study, hematuria was the most common ADR reported. Among all anticoagulants, Low molecular weight heparin accounted for the majority of ADRs followed by acenocoumarol and heparin. Intensive monitoring and frequent reporting need to be done in cardiac units to improve patient safety.

scholarly journals A STUDY ON THE EFFECT OF LOW MOLECULAR WEIGHT ON POTASSIUM HOMEOSTASIS IN PATIENTS ADMINISTERED HEPARIN FOR THROMBOPROPHYLAXIS IN A TERTIARY CARE HOSPITAL

2017 ◽  
Vol 9 (6) ◽  
pp. 85
Author(s):  
S. Shanmugapriya ◽  
K. Bhuvaneswari ◽  
K. Rashmi
Keyword(s):  
Molecular Weight ◽  
Serum Potassium ◽  
Low Molecular Weight Heparin ◽  
Tertiary Care ◽  
Thrombin Inhibitor ◽  
Low Molecular Weight ◽  
Care Hospital ◽  
Vein Thrombosis ◽  
Potential Risk Factors ◽  
Clinically Significant

Objective: Low molecular weight heparin (LMWH) is an indirect thrombin inhibitor used clinically as an anticoagulant for thromboprophylaxis of patients at risk of deep vein thrombosis. The study was done to assess the magnitude of rise in serum potassium after administration of low molecular weight heparin comparing enoxaparin with dalteparin and to evaluate the frequency of clinically significant hyperkalemia in the population studied.Methods: The study was done as a prospective non-randomized observational study in a population of 32 patients started on heparin for thromboprophylaxis for deep venous thrombosis, pulmonary thromboembolism or stroke.Results: A statistically significant elevation in serum potassium was seen in patients treated with LMWH (p = 0.007). The magnitude of rise in potassium was significantly higher in enoxaparin (p = 0.008) than the dalteparin group (p = 0.447). A clinically relevant hyperkalemia of>5 mEq/l was seen in 25% of the population studied. Other important associations detected from the study were that the advancing age and increasing dose could be potential risk factors contributory to an accentuated rise in serum potassium which may culminate in clinically significant hyperkalemia.Conclusion: The study has highlighted that the likelihood of rise in potassium levels during LMWH therapy necessitates monitoring of serum potassium.

“A TRUE EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF XYLOCAINE 2% GEL ON PAIN INTENSITY DURING INTRAVENOUS CANNULATION AMONG PATIENTS AT SELECTED TERTIARY CARE HOSPITAL BELAGAVI”

2021 ◽  
pp. 22-23
Author(s):  
Mounesh Badiger ◽  
Honnagouda Patil
Keyword(s):  
Pain Intensity ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Adult Patients ◽  
Control Group ◽  
Care Hospital ◽  
Intravenous Cannula ◽  
Cannulation Site ◽  
Post Test ◽  
Experimental Group

A true experimental, post test only control group design was used to nd out the effectiveness of Xylocaine 2% gel on pain intensity reduction during intravenous cannulation among the adult patients tertiary care hospital of Belagavi, Karnataka. Quantitative approach was used for the study. The study was done on 80 adult patients using standardized pain numerical scale. (Based on pilot study the prevalence rates in both group calculated p1=82% p2=100%, q1=18 q2=0, d=18% , Z= 1.96 (at 5% α error), Z= 0.842 (at 80% power) n=38 40). Simple random (lottery method) technique was used .in this study the patients, who have a patent intravenous cannula in place and who are unable perceive and responds for pain (unconscious patient). Demographical variables analyzed for the study Age, Gender, Education, Occupation, Previous experience, duration of pain during intravenous cannulation, site of cannulation and size of intravenous Cannula (Variables Independent variable: Xylocaine 2% gel. Dependent variable: Pain intensity experience during intravenous cannulation). Total 21 reviews were taken under the title of the above study (Indian- 03, International- 18). The conceptual framework used for this study is based on General Systems Theory introduced by Ludwig Von Bertalanffy in 1968. The obtained data was analyzed by using descriptive and inferential statistics. The mean of post test pain intensity during IV cannulation in experimental group was 1.93 and 4.30 in control group and SD of 0.60 in experimental group, 0.61 in control group. In this study 62.50% of participants have mild pain and 15% have moderate pain in experimental group as compared to 55% have severe pain followed by 37.50% have worst pain in control group. The difference is found to be statistically signicant

Low molecular weight heparin (LMWH) usage for cancer patients under palliative care.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 1-1
Author(s):  
Ahmed Ali ◽  
Amani Zayir ◽  
Adel Hamody ◽  
Shakeel Ahmed
Keyword(s):  
Molecular Weight ◽  
Palliative Care ◽  
Cancer Patients ◽  
Survival Benefit ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Care Hospital ◽  
Significant Survival Benefit ◽  
Significant Survival ◽  
Clinically Significant

1 Background: Cancer patients are at increased risk of thromboembolic complications. Studies show that prophylactic low molecular weight heparin (LMWH) can successfully reduce incidence of venous thromboembolic events; however, a survival benefit for patients with advanced cancer who receive LMWH in a palliative setting has not been confirmed. Methods: We evaluated the survival of cancer patients undergoing palliative treatment in a tertiary care hospital in Saudi Arabia during 2016. Patients were followed from the day of palliative care initiation until the day of death, and we compared the survival of patients who received LMWH (enoxaparin) with those who did not. Gender, diagnosis (site of cancer), and date of diagnosis were considered for subgroup analysis. Results: Of the 209 patients included in this study, enoxaparin was administered to 91(about 44%), while 117 (about 56%) did not receive any LMWH, and the treatment of one patient was not clearly defined. Male and female patients are equally distributed (104 and 105 patients, respectively). Cancer sites included breast, brain, gastrointestinal, genitourinary, lung, hematological malignancies, bone, and others. Although there was generally no statistical difference in survival time between treated and untreated groups (approximately 48 days each), subgroup analyses showed a statistically significant but not clinically significant survival benefit for patients with genitourinary cancers, such as uterine, urinary bladder, ovarian, or prostatic carcinomas who received LMWH (14.15 to 63.85 Days, P=0.0046). Conclusions: Prophylactic treatment with LMWH provided no clinically significant survival benefit to terminally ill cancer patients when administered in conjunction with other medications. Further prospective trials are warranted. Clinical trial information: ONC0329.

scholarly journals Role of Low Molecular Weight Heparin in the Management of Acute Pancreatitis – A Prospective Study in a Tertiary Care Hospital, Tirupati

2021 ◽  
Vol 8 (23) ◽  
pp. 1977-1981
Author(s):  
Venkata Prakash Gandikota ◽  
Srikanth Reddy Challapalli ◽  
Keerthinmayee Karimaddela ◽  
Anupama Chinni
Keyword(s):  
Molecular Weight ◽  
Acute Pancreatitis ◽  
Mortality Rate ◽  
Severe Acute Pancreatitis ◽  
Recovery Rate ◽  
Standard Care ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Care Hospital ◽  
Age Group

BACKGROUND Acute pancreatitis (AP) runs a moderately severe and severe course in around 20 % - 30 % of cases. It can progress into severe acute pancreatitis (SAP) and pancreatic necrosis if not appropriately intervened. This study aims to study the effect of low molecular weight heparin in treating acute pancreatitis. METHODS This was a prospective hospital-based study. Patients presenting to the emergency ward in our hospital with acute pancreatitis features with a duration of 72 hours or less and fulfilling the inclusion and exclusion criteria were included. They were randomly divided into those receiving standard care alone, and standard care low molecular weight heparin in addition to routine management, and results were calculated using the chi-square test. RESULTS The number of patients in the present study was 100. The most common age group affected was 30 - 40 years. Out of 100, 94 were male patients, and 6 were female patients. There is no notable difference in the mean age group between the groups. The recovery percentage is 98 % in patients with low molecular weight heparin. The recovery rate is 86 % in patients without low molecular weight heparin. The mortality rate is 2 % in patients with low molecular weight heparin. The mortality rate is 14 % in patients without low molecular weight heparin. It was found that the low molecular weight heparin usage has brought a significant difference in the patients. Outcome affected with acute pancreatitis had a significant P - value of 0.02. CONCLUSIONS The low molecular weight heparin by its property of improving the micro circulations relieves the abdominal pain, prevents the disease's further progression, and hence reduces the duration of hospital stay, morbidity, and mortality associated with the disease and enhances the recovery rate. KEYWORDS Acute Pancreatitis, Severe Acute Pancreatitis, Low Molecular Weight Heparin, Microcirculation, Systemic Inflammatory Response

scholarly journals To study the effectiveness of self-instructional module on knowledge and selected outcome among women undergoing hysterectomy in a tertiary care hospital in South India

2016 ◽  
Vol 6 (1) ◽  
pp. 100
Author(s):  
Elgi MC ◽  
Lekha Viswanath
Keyword(s):  
Test Score ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Control Group ◽  
Care Hospital ◽  
Instructional Module ◽  
Post Test ◽  
The Mean ◽  
Experimental Group ◽  
Site Pain

Background: Hysterectomy is a one of the major operations of surgical treatment in Gynecology. The purpose of the study was to assess the effectiveness of Self -Instructional Module (SIM) on knowledge and selected outcome among women undergoing hysterectomy at a tertiary care hospital Kochi.Methods: An experimental approach with a pretest-posttest control group design was used for the study. Forty women posted for hysterectomy were selected by convenience sampling technique. First 20 samples were allotted to experimental group and second 20 to the control group to avoid data contamination. SIM was given to the women in the experimental group after the pretest and post-test of both group was done on the fourth post-operative day. The socio-demographic and clinical data were collected by a semi-structured interview. A semi structured questionnaire was used to assess the pretest and posttest knowledge. The selected outcomes were measured using a ten point visual analogue scale in the fourth postoperative day. Data analysis was done by using descriptive and inferential statistics.Results: The findings of the study revealed that the pre-test level of knowledge among experimental group was average for 13 (65%), and poor for seven (35%), whereas in post-test 12 (60%) subjects had good knowledge and eight (40%) had average knowledge. The mean post-test score of knowledge in the experimental group (19.95 + 3.268) is higher than the mean pre-test score of knowledge (10.80 + 3.847) and the post-test score of control group (9.5+4.2). These differences in the means were significant at P<0.001. The mean score of all the selected outcomes were less in the experimental group than the control group. The difference in mean score was significant at p <0.001 in variable like pain, head ache, abdominal discomfort, insomnia, fatigue, anxiety and at P <0.05 level in variables like pain on surgical site, pain on back, pain on abdomen.Conclusions: Based on the major findings of the study, it was concluded that the self-instructional module on hysterectomy was effective in improving the knowledge of subjects and they felt it more useful in identifying the possible post-operative problems like pain on abdomen, surgical site pain, head ache, abdominal discomfort, insomnia, fatigue and anxiety. And take necessary steps to prevent it. SIM was effective as they could read and clear their doubts at their own place. More over the subjects experienced minimal problems associated with the surgery and subjects verbalized that they felt more comfortable to ask their doubts during the time of post assessment.

Can We Do Better? Identifying Orthopedic Surgery Patients at High Risk for Venous Thromboembolism Despite Thromboprophylaxis.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1782-1782
Author(s):  
Susan R. Kahn ◽  
Renee L. Schiff ◽  
Ian Shrier ◽  
Wahbi Hammouda ◽  
David Zukor
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Orthopedic Surgery ◽  
Low Molecular Weight Heparin ◽  
Patient Characteristics ◽  
Low Molecular Weight ◽  
Care Hospital ◽  
Major Orthopedic Surgery

Abstract Background Routine administration of thromboprophylaxis is the standard of care for patients undergoing major orthopedic surgery due to the very high rate of postoperative venous thromboembolism (VTE). However, because prophylaxis is not 100% effective, a significant proportion of patients who receive thromboprophylaxis develop post-operative VTE (“breakthrough VTE”). Clinical and surgical characteristics that are associated with the development of VTE in orthopedic surgery patients who receive standard thromboprophylaxis have not been well characterized. Objectives To evaluate the incidence of and risk factors for breakthrough VTE in patients who underwent major orthopedic surgery at a tertiary care hospital in Montreal, Canada. Methods Charts from consecutive patients who underwent total hip arthroplasty (THA), total knee arthroplasty (TKA) or hip fracture surgery (HFS) (hip pinning or hemiarthroplasty) from August 1, 1999 to April 30, 2000 were abstracted using standardized case report forms. Data were collected on patient characteristics (including VTE risk factors and postoperative complications), surgical characteristics (including type of surgery, operative factors, type of anesthetic) and thromboprophylaxis regimen. The results of any tests performed for clinically suspected VTE were documented, and associations between potential risk factors and objectively confirmed VTE were examined. Results Over the 9 month study period, 310 patients underwent major orthopedic surgery (34% THA, 30% TKA, and 36% HFS) and received standard thromboprophylaxis with either dalteparin or enoxaparin (mean duration of prophylaxis: 7 days). Of 83 suspected VTE, 44 (7 proximal DVTs and 37 distal DVTs; 14% of study population; median onset 6 days post-op) were confirmed with objective testing (compression ultrasonography). Multivariate analyses showed that knee surgery (odds ratio [OR] 4.8, 95% confidence interval 2.3, 10.1) and type of low molecular weight heparin (enoxaparin: protective) (OR 0.39, 95% confidence interval 0.20, 0.80) independently predicted VTE. Patient characteristics such as previous VTE, malignancy, hormonal therapy or varicose veins were not associated with VTE. Conclusion Despite receiving standard thromboprophylaxis, 14% of patients undergoing major orthopedic surgery developed symptomatic breakthrough VTE. Factors that independently predicted VTE in our population were TKR surgery and type of low molecular weight heparin. Our results suggest that TKR patients may warrant more aggressive post-operative physiotherapy and ambulation and adjunctive prophylactic measures such as pneumatic compression. In addition, due to the heterogeneity of different low molecular weight heparin compounds, direct comparison of the effectiveness of enoxaparin with dalteparin for orthopedic prophylaxis in prospective, randomized trials seems warranted.

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