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Unfractionated heparin

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https://www.readbyqxmd.com/read/29330739/patterns-and-outcomes-of-prescribing-venous-thromboembolism-prophylaxis-in-hospitalized-older-adults-a-retrospective-cohort-study
#1
Mark Goldin, Jessica Cohen, Alex Makhnevich, Colm Mulvany, Meredith Akerman, Liron Sinvani
Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the United States. Hospitalized, medically ill older adults have increased risk; despite guidelines, data suggest suboptimal pharmacologic prophylaxis rates. Factors influencing provider prescribing non-compliance are unclear. We aimed to describe VTE prophylaxis practices and identify risk factors for, and outcomes of, prescribing non-compliance. A retrospective study was conducted of hospitalized adults aged ≥ 75 years, admitted to the medicine service of a large academic tertiary center from May 1, 2014 to June 30, 2015...
January 12, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29324514/anticoagulant-bridge-comparison-in-mechanical-circulatory-support-patients
#2
Richard H Cosgrove, Robyn L Basken, Richard G Smith, Chiu-Hsieh Hsu, Toshinobu Kazui, Brandon K Martinez, Richard W Burt, Eric S Crawford, Scott D Lick, Zain Khalpey
Maintaining mechanical circulatory support (MCS) device patients in a specified therapeutic range for anticoagulation remains challenging. Subtherapeutic international normalized ratios (INRs) occur frequently while on warfarin therapy. An effective anticoagulant bridge strategy may improve the care of these patients. This retrospective review of MCS patients with subtherapeutic INRs compared an intravenous unfractionated heparin (UFH) strategy with a subcutaneous enoxaparin or fondaparinux strategy. Native thromboelastography (n-TEG) was used to evaluate anticoagulant effect with coagulation index (CI) as the primary outcome measure...
January 10, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29316202/anticoagulant-prophylaxis-and-therapy-in-children-current-challenges-and-emerging-issues
#3
Fiona Newall, Brian Branchford, Christoph Male
This review aims to describe the unique challenges of anticoagulant prophylaxis and treatment in children, and to highlight areas for research for improving clinical outcomes of children with thromboembolic disease. The evidence presented demonstrates the challenges of advancing the evidence-base informing optimal management of thromboembolic disease in children. Recent observational studies have identified risk factors of venous thromboembolism in children, but there are few interventional studies assessing the benefit-risk of using thromboprophylaxis in risk-stratified clinical subgroups...
January 6, 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29315941/thromboembolic-prophylaxis-protocol-with-warfarin-after-radiofrequency-catheter-ablation-of-infarct-related-ventricular-tachycardia
#4
Konstantinos C Siontis, Sina Jamé, Ghaith Sharaf Dabbagh, Rakesh Latchamsetty, Krit Jongnarangsin, Fred Morady, Frank M Bogun
INTRODUCTION: Ablation in the left ventricle (LV) is associated with a risk of thromboembolism. There are limited data on the use of specific thromboembolic prophylaxis strategies post-ablation. We aimed to evaluate a thromboembolic prophylaxis protocol after ventricular tachycardia (VT) ablation. METHODS AND RESULTS: The index procedures of 217 patients undergoing ablation for infarct-related VT with open irrigated-tip catheters were included. Patients with large LV endocardial ablation area (> 3 cm between ablation lesions) were started on low-dose, slowly escalating unfractionated heparin (UFH) infusion 8 hours after access hemostasis, followed by 3 months of anticoagulation...
January 9, 2018: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/29315455/home-versus-in-patient-treatment-for-deep-vein-thrombosis
#5
REVIEW
Richard Othieno, Emmanuel Okpo, Rachel Forster
BACKGROUND: Deep vein thrombosis (DVT) occurs when a blood clot blocks blood flow through a vein, which can occur after surgery, after trauma, or when a person has been immobile for a long time. Clots can dislodge and block blood flow to the lungs (pulmonary embolism (PE)), causing death. DVT and PE are known by the term venous thromboembolism (VTE). Heparin (in the form of unfractionated heparin (UFH)) is a blood-thinning drug used during the first three to five days of DVT treatment...
January 9, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29314514/non-immediate-heparin-and-heparinoid-cutaneous-allergic-reactions-a-role-for-fondaparinux
#6
Elina Tan, Grace Thompson, Charlotta Ekstrom, Michaela Lucas
Non-immediate allergic cutaneous reactions to heparins have been increasingly reported, typically manifesting as large, eczematous plaques at sites of subcutaneous injection. Patients may demonstrate cross-reactivity between unfractionated heparin, low molecular weight heparin and semi-synthetic heparinoids, making finding an alternative difficult. Fondaparinux has been identified as a useful alternative in such patients; here we present the first two documented cases in Australia and a literature review.
January 2018: Internal Medicine Journal
https://www.readbyqxmd.com/read/29309315/predicting-heparin-responsiveness-in-children-before-cardiopulmonary-bypass-a-retrospective-cohort-study
#7
Sayaka Nakamura, Osami Honjo, Lynn Crawford-Lean, Celeste Foreman, Minako Sano, James D O'Leary
BACKGROUND: Inadequate or excess administration of unfractionated heparin for cardiopulmonary bypass (CPB) can cause significant harm. Age-dependent differences in the pharmacodynamics and pharmacokinetics of heparin contribute to increased variability of heparin responsiveness in children. The aims of the current study were to (1) examine the correlation between predicted and observed heparin responsiveness in children before CPB measured using the Hemostasis Management System (HMS) Plus (Medtronic, Minneapolis, MN), (2) describe age-specific reference intervals for heparin sensitivity index (HSI) observed in children, and (3) test predictive models of HSI using preoperative clinical and laboratory data...
January 5, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29296764/antiangiogenic-effects-of-decorin-restored-by-unfractionated-low-molecular-weight-and-nonanticoagulant-heparins
#8
Amy K L Chui, Tilini N Gunatillake, Vera Ignjatovic, Paul T Monagle, Padma Murthi, Shaun P Brennecke, John M Whitelock, Joanne M Said
Pregnancies affected by preeclampsia (PE) or fetal growth restriction (FGR) display increases in thrombin generation and reductions in angiogenesis and cell growth. There is significant interest in the potential for low molecular weight heparins (LMWHs) to reduce the recurrence of PE and FGR. However, LMWH is associated with an increased risk of bleeding. Therefore, it is of vital importance to determine the exact molecular function of heparins in pregnancy if they are used as therapy for pregnant women. We aimed to determine this using our model for PE/FGR in microvascular endothelial cells...
July 11, 2017: Blood Advances
https://www.readbyqxmd.com/read/29285085/unfractionated-heparin-protects-the-protein-c-system-against-lipopolysaccharide-induced-damage-in-vivo-and-in-vitro
#9
Dongmei Zhao, Renyu Ding, Yina Liu, Xiaohan Yin, Zhidan Zhang, Xiaochun Ma
Activation of protein C is greatly enhanced by the presence of thrombomodulin (TM) and endothelial protein C receptor (EPCR) on the endothelial surface. Impairment of the anticoagulant protein C system occurs during endotoxemia and contributes to sepsis-associated hypercoagulability. Previous studies have demonstrated that unfractionated heparin (UFH) can attenuate coagulation in endotoxemic mice. However, whether UFH has an effect on the protein C system remains to be elucidated. The current study evaluated the therapeutic effect of UFH on the protein C system in a mouse model of lipopolysaccharide (LPS)-induced sepsis, and further investigated the effect of UFH on the expression of TM and EPCR in vitro using human umbilical vein endothelial cells (HUVECs)...
December 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29282776/synthetic-glycans-and-glycomimetics-a-promising-alternative-to-natural-polysaccharides
#10
Xinshan Ye
A large quantity of polysaccharide-derived conjugate vaccines have been developed to combat various pathogenic infections. Another prominent polysaccharide, heparin, is listed as an essential drug by World Health Organization (WHO) to treat the thrombus. One of their common problems is that they all derive from natural polysaccharides. Specifically, capsular polysaccharides are mainly obtained from bacterial fermentation and unfractionated heparin is extracted from animal tissues such as porcine mucosa. The quality of natural polysaccharides is inconsistent and traces of contamination would cause a disaster...
December 28, 2017: Chemistry: a European Journal
https://www.readbyqxmd.com/read/29279638/prophylaxis-and-incidence-of-symptomatic-deep-vein-thrombosis-in-indian-patients-with-sepsis-detect-deep-vein-thrombosis-registry
#11
Nagarajan Ramakrishnan, Detect-Dvt Investigators
Purpose: To assess thromboprophylaxis rate and incidence of symptomatic deep vein thrombosis (DVT) in Indian patients with acute sepsis. Materials and Methods: Adult patients with sepsis, within 48 h of sepsis onset/hospital admission were included. DVT was assessed using Doppler ultrasonography if clinical signs were present. Data were collected at inclusion, discharge, and 30 ± 7 days (if discharged before 30 days). Results: The study included 278 patients (men: 69...
November 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29277101/incidence-and-management-of-thrombotic-and-thromboembolic-complications-following-the-superior-cavopulmonary-anastomosis-procedure-a-literature-review
#12
Arnav Agarwal, Mohammed Firdouse, Nishaan Brar, Andy Yang, Panos Lambiris, Anthony K Chan, Tapas Kumar Mondal
The objective of this literature review was to estimate the incidence of thrombosis and thromboembolism associated with the superior cavopulmonary anastomosis (SCPA) procedure and its variants and to examine current thromboprophylaxis regimens utilized. MEDLINE and EMBASE were searched from inception to August 2017 for all prospective and retrospective cohort studies explicitly reporting incidence of thrombosis, thromboembolism, or shunt occlusion in neonates, infants, and children undergoing 1 or more variants of the SCPA procedure...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29276299/safety-and-efficacy-of-enoxaparin-compared-with-unfractionated-heparin-for-venous-thromboembolism-prophylaxis-in-hemodialysis-patients
#13
Melissa S Green, Katie B Tellor, Amanda R Buckallew
Background: Enoxaparin, a low-molecular-weight heparin approved for prophylaxis in patients at risk for venous thromboembolism (VTE), offers several advantages compared with unfractionated heparin (UFH). Enoxaparin is primarily excreted through renal elimination and is currently not recommended in patients receiving hemodialysis (HD) due to potential increased bleeding complications. To date, there are limited safety and efficacy data supporting the use of enoxaparin in this patient population for VTE prophylaxis...
October 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/29274443/gynecologic-bleeding-complications-in-post-menarchal-adolescent-females-on-anti-thrombotic-medications
#14
Heather Soni, Jennifer Kurkowski, Danielle Guffey, Jennifer E Dietrich, Lakshmi V Srivaths
INTRODUCTION: The prevalence, clinical features and management of gynecologic bleeding complications and health care provider awareness of these in post-menarchal adolescents on anti-thrombotic medications has rarely been addressed in the literature. We sought to review our experience in a pediatric tertiary care center addressing these issues. MATERIALS AND METHODS: A retrospective chart review was conducted with Institutional Review Board approval from 2004-2014, on eligible post-menarchal adolescents on antithrombotic medications...
December 20, 2017: Journal of Pediatric and Adolescent Gynecology
https://www.readbyqxmd.com/read/29248145/renal-replacement-therapy-and-anticoagulation
#15
REVIEW
Timo Brandenburger, Thomas Dimski, Torsten Slowinski, Detlef Kindgen-Milles
Today, up to 20% of all intensive care unit patients require renal replacement therapy (RRT), and continuous renal replacement therapies (CRRT) are the preferred technique. In CRRT, effective anticoagulation of the extracorporeal circuit is mandatory to prevent clotting of the circuit or filter and to maintain filter performance. At present, a variety of systemic and regional anticoagulation modes for CRRT are available. Worldwide, unfractionated heparin is the most widely used anticoagulant. All systemic techniques are associated with significant adverse effects...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29247268/-anticoagulation-strategies-in-patients-with-deep-vein-thrombosis-and-pulmonary-artery-embolisms
#16
P W Radke, M Möckel
Deep vein thrombosis and pulmonary artery embolisms share pathophysiological features and are therefore collectively referred to as venous thromboembolisms (VTE). While the incidence of VTE has been increasing for years as a result of demographic changes and improved diagnostics, the morbidity and mortality are decreasing. This is particularly due to more sensitive diagnostics, improvements in risk stratification and more effective anticoagulation strategies. The aim of effective anticoagulation therapy is the avoidance of early events up to death and prevention of recurrent events...
December 15, 2017: Herz
https://www.readbyqxmd.com/read/29227173/changes-in-platelet-function-with-inflammation-in-patients-undergoing-vascular-surgery
#17
Bartosz Olechowski, Vikram Khanna, Mark Mariathas, Alexander Ashby, Richard T Dalton, Ian Nordon, Nicola Englyst, Scott Harris, Zoe Nicholas, Kala Thayalasamy, Michael Mahmoudi, Nick Curzen
The role of platelets in ischaemic events is well established. Aspirin represents the default antiplatelet and blocks the metabolism of arachidonic acid (AA) at the cyclo-oxygenase enzyme (COX). AA is commonly used as a test of response to aspirin, but recent data raise uncertainty about the validity of this approach. Specifically, in some patients AA-induced clotting is not suppressed, but the level of COX-dependent AA metabolite, thromboxane B2 (TXB2) is negligible. Furthermore, AA-induced whole blood clotting varies dynamically in individuals, who are aspirin responsive according to TXB2 levels...
December 11, 2017: Platelets
https://www.readbyqxmd.com/read/29222429/case-report-ischemic-priapism-secondary-to-tinzaparin
#18
Jennifer Purnell, Alym N Abdulla
Low-molecular-weight heparin (LMWH) therapy has recently been proposed as a cause of ischemic priapism. The evidence, however, remains scarce, as there are very few published cases of LMWH-induced priapism to date. The implications of such events are significant as ischemic priapism is a medical emergency. In current clinical practice we are seeing a trend towards LMWH therapies replacing unfractionated heparin (UFH). As LMWH therapies continue to gain favor, we will potentially see more cases of LMWH-induced priapism...
December 8, 2017: International Journal of Impotence Research
https://www.readbyqxmd.com/read/29216941/-impact-of-unfractionated-heparin-on-serum-and-liver-tissue-expression-of-heparanase-in-the-liver-injury-of-mice-with-sepsis
#19
Ziwei Hu, Xiaojuan Zhang, Song Chen, Ran Zhu, Xiaochun Ma
OBJECTIVE: To investigate the effect of unfractionated heparin on the expression of serum and liver tissue heparanase (HPA) in mice with liver injury induced by sepsis. METHODS: Forty-eight healthy male C57BL/6 mice aged 6-8 weeks were divided into groups according to random number table method. Twenty-four septic mice models (CLP group) were established by cecal ligation and puncture (CLP); the other 24 mice underwent sham operation (sham group), only laparotomy and abdominal closure were performed without ligation...
December 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29205487/the-impact-of-unfractionated-heparin-or-bivalirudin-on-patients-with-stable-coronary-artery-disease-undergoing-percutaneous-coronary-intervention
#20
Fabio V Lima, Luis Gruberg, Usman Aslam, Melissa Ramgadoo, Kydanis Clase, Alessandra Trevisan, Allen Jeremias
OBJECTIVES: To compare bleeding and clinical events of patients with stable angina or silent ischemia undergoing percutaneous coronary intervention (PCI) treated with unfractionated heparin (UFH) or bivalirudin. BACKGROUND: Few direct comparisons between UFH monotherapy versus bivalirudin exist for patients with stable ischemic heart disease undergoing PCI. METHODS: A prospective, investigator-initiated, single-center, single-blinded, randomized trial of UFH versus bivalirudin was conducted...
December 4, 2017: Journal of Interventional Cardiology
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