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

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.

Management of ascending aorta perforation during transseptal puncture for left atrial appendage closure: a case report

Background An 82-year-old female with a history of atrial fibrillation and repeated episodes of major bleeding on direct oral anticoagulant therapy, with a high risk for thromboembolism and was referred for left atrial appendage closure. Case summary During the procedure, an unrecognized puncture of the aorta by the transseptal puncture (TSP) needle and inadvertent advancement of the sheath resulted in ascending aorta perforation. This perforation was closed percutaneously using an Amplatzer™ Duct Occluder (ADO). Reversal of heparinization with protamine sulphate was given to avoid intractable bleeding. However, this resulted in thrombus formation and subsequent embolization causing an ST-elevation myocardial infarction. This was treated with balloon dilatation and thrombus aspiration with subsequent Thrombolysis in Myocardial Infarction 3 flow. Discussion Inadvertent ascending aorta perforation is a rare yet serious complication that can occur during TSP. Percutaneous closure using an ADO is a viable management option. The reversal of heparin carries a risk of thrombus formation and should be avoided in cases where there is no evidence of overt bleeding.

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

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.

The effects of goutweed (Aegopodium Podagraria L.) preparations and their combinations with metformin in rats with the disorders of the lipid and carbohydrate metabolism induced by protamine sulphate

The improvement of the therapy of the metabolic syndrome, obesity, and type 2 diabetes is an important task which may be realized through the co-administration of herbal and synthetic medicines. The tincture and extract obtained from the aerial part of goutweed (Aegopodium podagraria L.) have been shown to possess antidiabetic and organoprotective properties. Goutweed tincture exerts a permissive effect on the action of metformin in dexamethasone-treated diabetic rats. Aim. The objective of this study is to determine the efficacy of the combined use of goutweed tincture and extract with metformin on the model of the primary disorder of the lipid metabolism. Materials and Methods. The model was used that presupposed administration of protamine sulfate to rats (10 mg/kg per day intramuscularly) against the background of atherogenic diet with the additional administration of cholestrol. Goutweed extract and tincture (1 g/kg and 1 ml/kg intragastrically, respectively), metformin (50 mg/kg intragastrically) and their combinations were administered during the whole period of model development. The lipid composition of the liver and blood plasma, as well as the content of glycogen in the liver were studied, and, as this model is accompanied with insulin resistance, glucose tolerance test was carried out. Results. It has been shown that all studied drugs and their combinations normalize the lipid composition of the liver, reducing the content of cholesterol and triglycerides and increasing the level of phospholipids. They do not significantly influence on the lipid spectrum of the blood plasma, tend to elevate the level of liver glycogen, their efficacy does not change in combined use. Goutweed tincture and metformin in combination, but not per se, completely normalize area under glucose curve that is significantly increased in the untreated group, the extract does not change this value. Conclusions. Goutweed extract and tincture normalize the lipid composition of the liver in rats with lipid and carbohydrate metabolism disorders caused by protamine sulfate and atherogenic diet, the tincture also exerts a permissive effect on the action of metformin on glucose metabolism, but not on lipid metabolism. (For citation: Tovchiga OV, Gorbatch TV, Shtrygol’ SYu, et al. The effects of goutweed (Aegopodium podagraria L.) preparations and their combinations with metformin in rats with the disorders of the lipid and carbohydrate metabolism induced by protamine sulphate. Reviews on Clinical Pharmacology and Drug Therapy. 2017;15(2):31-41. doi: 10.17816/RCF15231-41).