scholarly journals Nursing Skill and Responsibility in Administration of Low Molecular Weight Heparin by Prefilled Syringe

2021 ◽  
pp. 85-92
Author(s):  
Vaishali Tembhare ◽  
Gaurav Mujbaile ◽  
Seema Singh ◽  
Achita Sawarkar ◽  
Maduri Shambharkar ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Blood Test ◽  
Low Molecular Weight Heparin ◽  
Occult Blood ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Protamine Sulphate ◽  
Subcutaneous Tissues ◽  
Skin Discoloration ◽  
Medicine Administration

Abstract: Low-molecular-weight heparins (LMWHs) have proven to be effective in the prevention and treatment of thrombotic disorders, as well as   substitute for unfractionated heparin (UFH). LMWHs are a diverse collection of medicines with different biochemical and pharmacological characteristics, despite the fact that they all have antithrombotic actions. Medicine is administered into the subcutaneous tissues with these injections. Small amounts of injections are delivered by the subcutaneous approach, which involves inserting a small thin needle beneath the skin and slowly injecting the medicine. Low molecular weight heparins make up dalteparin and enoxaparin, two anticoagulants. The rights of medicine administration must be followed by nurses. For patients on LMWH medication, the most essential blood test is prothrombin time. Following administration, look for any signs of bleeding, such as occult blood in the stool, malena, bleeding gums, and skin discoloration/hematoma. The antidote for low molecular weight heparin is protamine sulphate. It is effective at counteracting the effects of LMWH. 100 units of LMWH are neutralised by 1 mg of protamine sulphate.If it's been more than 8 hours since you've given LMWH, provide 0.5 mg protamin per 100 units of LMWH.

Neutralisation of Heparan Sulphate and Low Molecular Weight Heparin by Protamine

1985 ◽  
Vol 53 (01) ◽  
pp. 086-089 ◽  
Author(s):  
A R Hubbard ◽  
C A Jennings
Keyword(s):  
Molecular Weight ◽  
Plasma Proteins ◽  
Low Molecular Weight Heparin ◽  
Heparan Sulphate ◽  
Activated Partial Thromboplastin Time ◽  
Weight Basis ◽  
Low Molecular Weight ◽  
Protamine Sulphate ◽  
At Iii ◽  
Reference Preparation

SummaryThe neutralisation by protamine sulphate (PS) of heparan sulphate (HS), a low molecular weight heparin (LMWH), and a reference preparation of unfractionated heparin (UH), was studied by activated partial thromboplastin time (APTT) and anti-Xa clotting assays. UH was most easily neutralised in the APTT assay by PS (on a weight for weight basis), followed by LMWH and HS. The neutralisation of APTT activity by PS closely followed the loss of activity in the anti-Xa clotting assay, when plasma was used as the source of At III. When the anti-Xa clotting assay was carried out using purified At III in place of plasma, HS and LMWH were neutralised by much lower amounts of PS and resembled UH neutralisation more closely. Resistance of HS anti-Xa activity to PS neutralisation decreased with increasing plasma dilution. The presence of bovine albumin with purified At III concentrate increased the resistance of HS to PS neutralisation. It is concluded that PS binding to UH, HS and LMWH is probably related more to their degree of sulphation than molecular weight and that non-specific interactions between PS and plasma proteins inhibit the binding of PS to HS and LMWH.

Pharmacokinetics of Subcutaneous Low Molecular Weight Heparin (Enoxaparin) in Dogs

2009 ◽  
Vol 45 (6) ◽  
pp. 261-267 ◽  
Author(s):  
Kari V. Lunsford ◽  
Andrew J. Mackin ◽  
V. Cory Langston ◽  
Marjory Brooks
Keyword(s):  
Molecular Weight ◽  
Veterinary Medicine ◽  
Low Molecular Weight Heparin ◽  
Patient Monitoring ◽  
Target Range ◽  
Low Molecular Weight ◽  
Close Monitoring ◽  
Low Molecular Weight Heparins ◽  
Pharmacodynamic Profile ◽  
Hemorrhagic Complications

Unfractionated heparin has been the standard heparin used in human and veterinary medicine for its anticoagulation effect; however, it has a complex pharmacodynamic profile that requires close monitoring. Low molecular weight heparins have a more predictable bioavailability, allowing standardized dosing without individual patient monitoring. This project was designed to a) evaluate the pharmacokinetics of the subcutaneous (SC) administration of the low molecular weight heparin, enoxaparin, in dogs using anti-Xa activity as a marker of plasma enoxaparin concentrations and b) to establish the dose necessary to maintain activity within an established target range. Enoxaparin at 0.8 mg/kg SC q 6 hours consistently maintained target levels of anti-Xa activity in normal dogs without evidence of hemorrhagic complications.

scholarly journals Modern low-molecular-weight heparins in the prevention and treatment of venous thromboembolic complications in oncourologic patients

2018 ◽  
pp. 106-112
Author(s):  
N. V. Vorobyev ◽  
S. V. Popov
Keyword(s):  
Molecular Weight ◽  
Impaired Renal Function ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Efficacy And Safety ◽  
Thromboembolic Complications ◽  
Antithrombotic Effect ◽  
Low Molecular Weight Heparins ◽  
Prevention And Treatment ◽  
Venous Thromboembolic

Oncourologic diseases are accompanied by a risk for subsequent venous thromboembolic complications, which are rated the most dangerous in terms of thrombogenic effect. The article presents a review of the clinical studies of efficacy and safety, and the experience in using of modern low-molecular-weight heparins in clinical practice - drugs of choice for the prevention of venous thromboembolic complications in cancer patients. Particular attention is paid to Bemiparin - a new second-generation low-molecular-weight heparin with a significant antithrombotic effect and improved pharmacological parameters that allow it to be successfully used in patients with impaired renal function in oncourological practice.

PHARMACOKINETICS OF A LOW MOLECULAR WEIGHT HEPARIN (KABI 2165, FRAGMIN) ATFER INTRAVENOUS AND SUBCUTANEOUS ADMINISTRATION IN HUMAN VOLUNTEERS AND ITS IN VIVO NEUTRALIZATION BY PROTAMINE SULFATE

1987 ◽  
Author(s):  
J Albada ◽  
K K Nieuwenhuis ◽  
J J Sixma
Keyword(s):  
Molecular Weight ◽  
Healthy Volunteers ◽  
Half Life ◽  
Low Molecular Weight Heparin ◽  
Subcutaneous Administration ◽  
Low Molecular Weight ◽  
Protamine Sulphate ◽  
Original Curve ◽  
Rebound Phenomenon

Pharmacokinetics of a low molecular weight heparin (LMWH) were studied in healthy volunteers. After an intravenous bolus injection of 5000 anti-Xa U in 5 healthy volunteers anti Xa activity disappeared according to the combination of saturable and a linear mechanism, preceded by a rapid initial disappearance. The apparent half-life of the anti Xa activity is about twice as long as that of standard heparin. In another set of experiments 5000 anti Xa U of LMWH were immediately followed by 50 mgr of Protamine Sulphate (PS). The curve of the anti Xa-activity parallelled the original curve at a level of about 30-40%. No rebound phenomenon was observed. The same dose of the LMWH followed by 100 mg of PS resulted in an anti Xa disappearance curve at an obvious higher level of about 50%. Also at this dose no rebound phenomenon was noticed.A continuous infusion of 10.000 anti Xa U/24 h during 10 hours was followed by 15.000 anti Xa U/24 h for another 10 hours after which the dose was raised to 20.000 anti Xa U/24 h for another 10 hours. Only the first infusion period resulted in a plateau fase. At the end of these experiments anti Xa activity was neutralized by 50 mg P.S. i.v. resulting in the disappearance of less than 50% of anti Xa activity. After subcutaneous administration of 15.000 anti Xa U (corresponding to the dose for i.v. treatment per day with this LMWH) peak levels of 1,1-1,8 anti Xa were reached after 3-4 hours. Supra-optimal anti Xa levels (higher than 0.9) were observed in all volunteers during a period of 5 hours. After 24 hours in none of the volunteers any anti Xa-activity could be detected.Conclusions:In contrast to previous reports pharmacokinetics of this LMWH do not essentially differ from those of standard heparin apart from its longer half-life and its high bioavialability after subcutaneous injection.

Heparin and low-molecular-weight heparin

2008 ◽  
Vol 99 (11) ◽  
pp. 807-818 ◽  
Author(s):  
Barbara Mulloy ◽  
Trevor Barrowcliffe ◽  
Elaine Gray
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Unfractionated Heparin ◽  
Low Molecular Weight Heparin ◽  
Clinical Status ◽  
Mechanisms Of Action ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Prevention And Treatment

SummaryHeparin is one of the oldest biological medicines, and has an established place in the prevention and treatment of venous thrombosis. Low-molecular-weight heparins (LMWH) have been developed by several manufacturers and have advantages in terms of pharmacokinetics and convenience of administration. They have been shown to be at least as effective and safe as unfractionated heparin and have replaced the latter in many indications. In this article the chemistry, mechanisms of action, measurement of anticoagulant activities, and clinical status of heparin and LMWH are reviewed.

scholarly journals Low Molecular Weight Heparin Induced Skin Necrosis without Platelet Fall Revealing Immunoallergic Heparin Induced Thrombocytopenia

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Thomas Godet ◽  
Sébastien Perbet ◽  
Aurélien Lebreton ◽  
Guillaume Gayraud ◽  
Sophie Cayot ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Adverse Event ◽  
Differential Diagnosis ◽  
Renal Replacement Therapy ◽  
Skin Necrosis ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Functional Tests ◽  
Low Molecular Weight Heparins ◽  
Heparin Induced Thrombocytopenia

Low molecular weight heparins (LMWH) are commonly used in the ICU setting for thromboprophylaxis as well as curative decoagulation as required during renal replacement therapy (RRT). A rare adverse event revealing immunoallergic LMWH induced thrombopenia (HIT) is skin necrosis at injection sites. We report the case of a patient presenting with skin necrosis witnessing an HIT after RRT, without thrombocytopenia. The mechanism remains unclear. Anti-PF4/heparin antibodies, functional tests (HIPA and/or SRA), and skin biopsy are of great help to evaluate differential diagnosis with a low pretest probability 4T’s score.

scholarly journals The anti-factor Xa range for low molecular weight heparin thromboprophylaxis

2015 ◽  
Vol 7 (4) ◽  
Author(s):  
Matthew Y. Wei ◽  
Salena M. Ward
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Dose Adjustment ◽  
Factor Xa ◽  
Research Data ◽  
Target Range ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Therapeutic Doses ◽  
Venous Thromboses

Low molecular weight heparins (LMWHs) are now the mainstay option in the prevention and treatment of venous thromboembolism. In some patients receiving therapeutic doses of LMWH, activity can be measured by quantifying the presence of Anti-factor Xa (AFXa) for dose adjustment. However, currently there are no guidelines for LMWH monitoring in patients on thromboprophylactic, doses, despite certain patient populations may be at risk of suboptimal dosing. This review found that while the AFXa ranges for therapeutic levels of LMWHs are relatively well defined in the literature, prophylactic ranges are much less clear, thus making it difficult to interpret current research data. From the studies published to date, we concluded that a reasonable AFXa target range for LMWH deep venous thromboses prophylaxis might be 0.2-0.5 IU/mL.

scholarly journals Protamine Sulfate Neutralization Profile of Various Dosages of Bovine, Ovine and Porcine UFHs and Their Depolymerized Derivatives in Non-Human Primates

2021 ◽  
Vol 27 ◽  
pp. 107602962110055
Author(s):  
Ahmed Kouta ◽  
Walter Jeske ◽  
Lee Cera ◽  
Azarfrooz Farshid ◽  
Richard Duff ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Intestinal Mucosa ◽  
Mammalian Species ◽  
Low Molecular Weight ◽  
Effective Inhibitor ◽  
Low Molecular Weight Heparins ◽  
Primate Model ◽  
Protamine Sulphate ◽  
Mucosal Tissues ◽  
Human Primate

Introduction: Currently used unfractionated heparins (UFHs) and low molecular weight heparins (LMWHs) are derived from porcine intestinal mucosa. However, heparins have also been manufactured from tissues of other mammalian species such as cow (Bovine) and sheep (Ovine). Protamine sulphate (PS) is an effective inhibitor of heparin and is used clinically to neutralize both LMWH and UFH. In this study, we determined the PS neutralization profile of these agents in non-human primate model using anti-Xa and anti-IIa methods. Material and Methods: UFHs obtained from bovine, ovine and porcine mucosal tissues and their respective depolymerized LMWHs were administered at both, gravimetric (0.5 mg/kg) and potency adjusted (100 U/kg) dosages regimen intravenously to individual groups of primates in cross over studies. PS was administered at a fixed dosage and the relative neutralization of these anticoagulants was measured utilizing amidolytic anti-Xa and anti-IIa methods. Results: These studies have demonstrated that, the equi-gravimetric dosages of BMH, PMH and OMH have comparable PS neutralization profiles. At potency adjusted dosages, all UFHs were completely neutralized by PS. Although comparable, the LMWHs were not fully neutralized by PS in both the anti-Xa and anti-IIa assays. PS was more efficient in neutralizing the anti-IIa effects of LMWHs. Conclusion: Heparins of diverse origins showed comparable neutralization profiles by PS in the amidolytic anti-Xa and anti-IIa assays.

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