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Sukhdeep Bhogal, Uttam Verma
No abstract text is available yet for this article.
October 18, 2016: American Journal of Therapeutics
Katherine J Hahn, Shannon J Morales, James H Lewis
Anticoagulants are a well known cause of drug-induced liver injury (DILI). We recently encountered a 45-year-old male who developed DILI during treatment with enoxaparin, a low-molecular-weight heparin (LMWH), for dural venous thrombosis. The man received enoxaparin 80 mg subcutaneously, twice daily. After 4 days, the patient was asymptomatic but he developed liver aminotransferase elevations: AST 340 U/L and ALT 579 U/L. Investigation revealed an R ratio of 19.9 by day 5 and a Roussel Uclaf Causality Assessment Method score of 10, giving a high probable likelihood that enoxaparin was the cause of hepatic injury...
December 2015: Drug Saf Case Rep
Bassam Haddad, Norbert Winer, Yvon Chitrit, Véronique Houfflin-Debarge, Céline Chauleur, Karine Bages, Vassilis Tsatsaris, Alexandra Benachi, Florence Bretelle, Jean-Christophe Gris, Sylvie Bastuji-Garin
OBJECTIVE: To evaluate whether daily enoxaparin, added to low-dose aspirin, started before 14 weeks of gestation reduces placenta-mediated complications in pregnant women with previous severe preeclampsia diagnosed before 34 weeks of gestation. METHODS: In this open-label multicenter randomized trial, we enrolled consenting pregnant women with previous severe preeclampsia diagnosed before 34 weeks of gestation, gestational age at randomization of 7-13 weeks, singleton pregnancy, and no plan for anticoagulation...
October 6, 2016: Obstetrics and Gynecology
Mary E Westerman, Joseph A Scales, Vidit Sharma, Derek J Gearman, Johann P Ingimarsson, Amy E Krambeck
OBJECTIVE: To analyze bleeding related complications among patients on long term anticoagulation (AC) undergoing ureteroscopy (URS). Current AUA/ICUD guidelines state it is safe to continue AC in routine URS; however, these recommendations are based on small case series. PATIENTS AND METHODS: 4,799 URS procedures performed at our institution between June 2009 and February 2016 were identified. Records were then retrospectively reviewed to confirm AC use and identify periprocedural complications...
October 5, 2016: Urology
Pierre-Antoine Moulin, Anne Dutour, Patricia Ancel, Pierre-Emmanuel Morange, Thierry Bege, Olivier Ziegler, Stéphane Berdah, Corinne Frère, Bénédicte Gaborit
BACKGROUND: Venous thromboembolism (VTE) is a leading cause of death in obese patients undergoing bariatric surgery (BS), but there is neither consensus nor high-level guidelines yet on VTE prophylaxis in this specific population. OBJECTIVE: We aimed to evaluate patterns of BS perioperative thromboprophylaxis practices. SETTING: French obesity specialized care centers (CSO), which are tertiary care referral hospitals for the most severe cases of obesity METHODS: A detailed questionnaire survey (11 opened, 15 closed questions) investigating their prophylactic schemes of anticoagulation (molecule, dose, weight-adjustment, duration, associated measures, follow-up) was sent to the 37 CSO...
September 1, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Brady S Moffett, Kimberly Dinh, Jennifer Placencia, Gregory Pelkey, Shiu-Ki Rocky Hui, Jun Teruya
BACKGROUND: Enoxaparin is often diluted to accurately deliver doses to neonatal and infant patients. Current recommendations for dilutions may not be adequate for the smallest patients. METHODS: Review of dosing at our institution occurred, and an 8 mg/mL concentration of enoxaparin was chosen. A concentration of 8 mg/mL was compounded by diluting 0.4 mL of enoxaparin (100 mg/mL) into 4.6 mL of sterile water for injection into an empty sterile vial. Four syringes of the 8 mg/mL concentration were prepared by 5 technicians (20 total syringes)...
July 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Christopher J Pannucci, Matthew T Rondina
No abstract text is available yet for this article.
October 3, 2016: Surgery
Surachai Kotirum, Bunchai Chongmelaxme, Nathorn Chaiyakunapruk
To analyze the cost-utility of oral dabigatran etexilate, enoxaparin sodium injection, and no intervention for venous thromboembolism (VTE) prophylaxis after total hip or knee replacement (THR/TKR) surgery among Thai patients. A cost-utility analysis using a decision tree model was conducted using societal and healthcare payers' perspectives to simulate relevant costs and health outcomes covering a 3-month time horizon. Costs were adjusted to year 2014. The willingness-to-pay threshold of THB 160,000 (USD 4926) was used...
October 4, 2016: Journal of Thrombosis and Thrombolysis
James Coelho, David Izadi, Sameer Gujral
No abstract text is available yet for this article.
2016: Eplasty
Christopher J Pannucci, Thomas K Varghese, Kencee K Graves, Ann Marie Prazak
INTRODUCTION: Enoxaparin prophylaxis prevents venous thromboembolism in surgical patients. Real time anti-Factor Xa monitoring for surgical patients on enoxaparin prophylaxis is increasingly common. PRESENTATION OF CASES: We report on three cancer patients with therapeutic or supratherapeutic anti-Factor Xa levels while on prophylactic doses of enoxaparin after surgical procedures. In all cases, elevated anti-Factor Xa levels were the result of blood specimens being removed from a heparinized chemoport...
September 25, 2016: International Journal of Surgery Case Reports
Ožbej Zupančič, Julia Anita Grießinger, Julia Rohrer, Irene Pereira de Sousa, Lukas Danninger, Alexandra Partenhauser, Nadine Flavia Elli Sündermann Laffleur, Andreas Bernkop-Schnürch
AIM: It was the aim of this study to develop SEDDS for oral enoxaparin administration and evaluate it in vitro and in vivo. METHODS: The emulsifying properties of SEDDS composed of long chain lipids (LC-SEDDS), medium chain lipids (MC-SEDDS), short chain lipids (SC-SEDDS) and no lipids (NL-SEDDS) were evaluated. Thereafter, enoxaparin was incorporated via hydrophobic ion pairing in the chosen SEDDS, which were evaluated regarding their mucus permeating properties, stability towards pancreatic lipase, drug release profile and cytotoxicity...
September 28, 2016: European Journal of Pharmaceutics and Biopharmaceutics
Christopher J Pannucci, Ann Marie Prazak, Melody Scheefer
BACKGROUND: Between 2% and 10% of the highest risk surgery, patients have a "breakthrough" venous thromboembolism (VTE) event despite receipt of chemoprophylaxis. The goals of this review are to summarize how patient-level factors may predict enoxaparin metabolism and how alterations in enoxaparin dose magnitude and frequency affect both anti-factor Xa (aFXa) levels and downstream VTE events. DATA SOURCES: Relevant articles were identified on PubMed. Fixed-dose prophylaxis provides inadequate enoxaparin prophylaxis for most surgical patients based on anti-factor Xa levels...
September 2, 2016: American Journal of Surgery
Eduardo Vilanova, Bianca F Glauser, Stephan-Nicollas M C G Oliveira, Ana M F Tovar, Paulo A S Mourão
Brazil is among the first countries approving the commercialization and clinical use of biosimilar enoxaparins. Our research group has performed quality control assessments of these drugs over the last decade. Areas covered: We have not found noticeable differences between Brazilian biosimilar enoxaparins and the original product regarding their physicochemical properties, disaccharide composition, anticoagulant activity, bioavailability and safety. Expert commentary: In spite of clinical and pharmacological advantages of enoxaparin, subcutaneous formulations of unfractionated heparin are employed by the Brazilian public health system for prevention and treatment of thromboembolism...
October 17, 2016: Expert Review of Hematology
Juan Jesús Fernández-Alba, Carmen González-Macías, Angel Vilar Sánchez, Pilar Tajada Cepero, Raquel Garrido Teruel, María José García-Cabanillas, Luis Javier Moreno-Corral, Rafael Torrejón Cardoso
OBJECTIVE: To determine the risk of small-for-gestational-age (SGA) and intrauterine growth retardation (IUGR) in pregnant women with protein S (PS) deficiency who received low-molecular-weight heparin (LMWH). METHODS: Retrospective cohort study of pregnant women seen from January 2002 to December 2011. The study cohort comprised a total of 328 patients with PS deficiency, who received prophylactic enoxaparin during pregnancy. The control cohort included 11 884 pregnant women without significant past medical history...
October 17, 2016: Journal of Maternal-fetal & Neonatal Medicine
Junxin Wang, Fang Chen, Santiago J Arconada-Alvarez, James Hartanto, Li-Peng Yap, Ryan Park, Fang Wang, Ivetta Vorobyova, Grant Dagliyan, Peter S Conti, Jesse V Jokerst
Heparin anticoagulation therapy is an indispensable feature of clinical care yet has a narrow therapeutic window and is the second most common intensive care unit (ICU) medication error. The active partial thromboplastin time (aPTT) monitors heparin but suffers from long turnaround times, a variable reference range, limited utility with low molecular weight heparin, and poor correlation to dose. Here, we describe a photoacoustic imaging technique to monitor heparin concentration using methylene blue as a simple and Federal Drug Administration-approved contrast agent...
September 28, 2016: Nano Letters
Katie Ann Pivarnik, Fred Schiffman, James Sullivan, Arkadiy Finn
Low-molecular-weight heparins including enoxaparin are commonly used for anticoagulation as prophylaxis and treatment for deep vein thrombosis (DVT). Prescribers of enoxaparin monitor for common side effects, such as bleeding and thrombocytopenia, but hepatotoxicity, a less common and under-reported adverse effect, may be overlooked. This report describes a case of enoxaparin-induced hepatotoxicity in a 57-year-old man who was started on the drug for a DVT. Within 3 days of taking enoxaparin, elevated transaminases were noted, and the drug was discontinued after 6 days...
2016: BMJ Case Reports
Sunniva Leer-Salvesen, Eva Dybvik, Ola E Dahl, Jan-Erik Gjertsen, Lars B EngesæTer
Background and purpose - Controversies exist regarding thromboprophylaxis in orthopedic surgery. Using data in the nationwide Norwegian Hip Fracture Register (NHFR) with postoperative death and reoperation in the first 6 months after surgery as endpoints in the analyses, we determined whether the thromboprophylaxis in patients who undergo hemiarthroplasty for femoral neck fracture should start preoperatively or postoperatively. Patients and methods - After each operation for hip fracture in Norway, the surgeon reports information on the patient, the fracture, and the operation to the NHFR...
September 23, 2016: Acta Orthopaedica
S Hartmann, K Biliouris, L J Lesko, U Nowak-Göttl, M N Trame
Warfarin is the anticoagulant of choice for venous thromboembolism (VTE) treatment, although its suppression of the endogenous clot-dissolution complex APC:PS may ultimately lead to longer time-to-clot dissolution profiles, resulting in increased risk of re-thrombosis. This detrimental effect might not occur during VTE treatment using other anticoagulants, such as rivaroxaban or enoxaparin, given their different mechanisms of action within the coagulation network. A quantitative systems pharmacology model was developed describing the coagulation network to monitor clotting factor levels under warfarin, enoxaparin, and rivaroxaban treatment...
September 20, 2016: CPT: Pharmacometrics & Systems Pharmacology
Kari Kurtzhalts, Megan E Gee, Lindsey Feuz, Kristin C Krajewski
PURPOSE: A case of supratherapeutic International Normalized Ratio (INR) values and hematomas subsequent to concomitant administration of warfarin and intravesical gemcitabine is reported. SUMMARY: A 90-year-old man with bladder cancer refractory to bacillius Calmette-Guérin was diagnosed with deep vein thrombosis (DVT) and started on warfarin one month before starting treatment with intravesical gemcitabine 2 g (one dose per week for six weeks). Before intravesical gemcitabine was started, the patient reached consecutive therapeutic INR values...
October 1, 2016: American Journal of Health-system Pharmacy: AJHP
Abolfazl Jangholi, Mohammad Reza Ashrafi-Kooshk, Seyed Shahriar Arab, Gholamhossein Riazi, Farzad Mokhtari, Mansour Poorebrahim, Hamid Mahdiuni, Boris I Kurganov, Ali Akbar Moosavi-Movahedi, Reza Khodarahmi
In many neurodegenerative diseases, formation of protein fibrillar aggregates has been observed as a major pathological change. Neurofibrillary tangles, mainly composed of fibrils formed by the microtubule-associated protein; Tau, are a hallmark of a group of neurodegenerative diseases such as Alzheimer's disease. Tau belongs to the class of natively unfolded proteins and partially folds into an ordered β-structure during aggregation. Polyanionic cofactors such as heparin are commonly used as inducer of Tau aggregation in vitro...
November 1, 2016: Archives of Biochemistry and Biophysics
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