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Unfractionated heparin

Mikkel M Schoos, Giuseppe De Luca, George D Dangas, Peter Clemmensen, Girma Minalu Ayele, Roxana Mehran, Gregg W Stone
AIMS: In the HORIZONS-AMI trial, bivalirudin compared to unfractionated heparin (UFH) plus a glycoprotein IIb/IIIa inhibitor (GPI) improved net clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) at the cost of an increased rate of acute stent thrombosis. We sought to examine whether these effects are dependent on time to treatment. METHODS AND RESULTS: The interaction between anticoagulation regimen and symptom onset to first balloon inflation time (SBT) on the 30-day and three-year rates of major adverse cardiac events (MACE) was examined in 3,199 randomised patients according to SBT ≤3 hours versus >3 hours...
October 20, 2016: EuroIntervention
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
Ramona Nicolau-Raducu, Elise Occhipinti, Thomas Marshall, Joseph Koveleskie, Donald Ganier, Brian Evans, William Daly, Brian Fish, Ari J Cohen, Trevor W Reichman, David Bruce, Humberto Bohorquez, John Seal, Emily Ahmed, Ian Carmody, George Loss, Jonathan Rayburn, Bobby Nossaman
OBJECTIVES: The purpose of this study was to compare the agreement between two heparin assays, Hepcon HMS plus/Kaolin-ACT and Anti-Xa, and their predictive power in detecting circulating heparin levels post-reperfusion of the liver graft when compared with thromboelastogram (TEG) r time ratio in patients undergoing orthotopic liver transplantation (OLT). DESIGN: Prospective, observational cohort study design. SETTING: Single center, university hospital...
August 2, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Dirk Wackernagel, Sami Obaya, Per Nydert
Drug fever caused by dalteparin-sodium (DS), a low-molecular-weight derivative of heparin, is neither listed in the official drug information and nor published as a case report until today. A preterm infant, born at 26 weeks of gestation, developed fever 2 days after starting a treatment with DS for an intracardial thrombus. The fever reverses soon after changing the treatment to unfractionated heparin and reappeared after reintroduction of DS. Once again, after discontinuing DS, the infant regained normothermia...
October 13, 2016: BMJ Case Reports
Andreas Hanslik, Erwin Kitzmüller, Ulrich S Tran, Katharina Thom, Hratsch Karapetian, Nicole Prutsch, Jasmin Voitl, Ina Michel-Behnke, Fiona Newall, Christoph Male
BACKGROUND: Unfractionated heparin (UFH) is used for prophylaxis and treatment of thrombosis in children. Laboratory monitoring of UFH is needed to prevent over- or under-anticoagulation. OBJECTIVES: Study objectives were to investigate i) the association between UFH dose and UFH effect as monitored by anti-IIa, ii) the relationship of anti-IIa and anti-Xa effects, and iii) the influence of patients' age and other factors on UFH effect. PATIENTS AND METHODS: Randomized controlled trial in children during cardiac catheterization, comparing high-dose UFH (100 units/kg bolus) versus low-dose UFH (50 units/kg bolus)...
October 13, 2016: Journal of Thrombosis and Haemostasis: JTH
Jin Han Lim, Kyung Pyo Kang, Sik Lee, Sung Kwang Park, Won Kim
Heparin has remained the most commonly used anticoagulant for patients undergoing hemodialysis. It is usually safe to use but can have severe adverse effects in some cases. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. It results from an autoantibody directed against endogenous platelet factor 4 (PF4) in complex with heparin, which activates platelets and can cause catastrophic arterial and venous thromboses. Here, we present the case of an 80-year-old woman with a recent diagnosis of chronic renal failure who developed acute HIT (platelet count nadir, 15 × 10(9) /L) on day 7 of hemodialysis performed with routine heparin anticoagulation, who despite subsequent heparin-free hemodialysis (with argatroban and warfarin) developed recurrent HIT (complicated by acute cerebral infarction) on day 11 that we attributed to "rinsing" of the circuit with heparin-containing saline (3,000 units of unfractionated heparin, with subsequent saline washing) performed pre-dialysis as per routine...
October 13, 2016: Hemodialysis International
Christopher M McLaughlin, Steven L Marks, David C Dorman, Alison Motsinger-Reif, Rita M Hanel
OBJECTIVE: To characterize the correlation between thromboelastography (TEG) variables using strong activators and anti-Xa (AXa) activity in healthy dogs administered subcutaneous unfractionated heparin (UFH). DESIGN: Prospective experimental study. SETTING: University research facility. ANIMALS: Eight adult random-source male dogs. INTERVENTION: Dogs were randomized to receive subcutaneous UFH at 200, 250, or 300 IU/kg every 8 hours for a total of 10 injections...
October 12, 2016: Journal of Veterinary Emergency and Critical Care
Jung-Hyun Byun, In-Seok Jang, Jong Woo Kim, Eun-Ha Koh
BACKGROUND: Unfractionated heparin (UFH) has unstable pharmacokinetics and requires close monitoring. The activated partial thromboplastin time (aPTT) test has been used to monitor UFH therapy for decades in Korea, but its results can be affected by numerous variables. We established an aPTT heparin therapeutic range (HTR) corresponding to therapeutic anti-Xa levels for continuous intravenous UFH administration, and used appropriate monitoring to determine if an adequate dose of UFH was applied...
September 2016: Blood Research
Yuman Yu, Qun Lv, Bin Zhang, Fen Lan, Yifan Dai
BACKGROUND: The effect of heparin in improving cancer survival has gained increasing attention over the past decades. Several clinical trials have evaluated the role of heparin on survival outcome and its safety profile in lung cancer patients. Thus, we performed a systematic review and meta-analysis from the results of randomized controlled trials (RCTs) to assess the efficacy and safety of heparin in patients with lung cancer without indication for anticoagulants. METHODS: We searched PubMed, Embase, and The Cochrane Central Register of Controlled Trials databases for relevant studies...
October 2016: Journal of Cancer Research and Therapeutics
Neil J Turco
I would like to thank Joy et al for their recent article, "Safety and Efficacy of High-dose Unfractionated Heparin for Prevention of Venous Thromboembolism in Overweight and Obese Patients," which contributed more to the body of literature in VTE prophylaxis for patients with obesity.(1) This study provided evidence against the use of high-dose unfractionated heparin (UFH) thromboprophylaxis for obese patients. These results differ from those of a previous study by Wang et al, which found a lower incidence of VTE for patients on high-dose UFH...
October 7, 2016: Pharmacotherapy
Joseph Zaia, Kshitij Khatri, Joshua A Klein, Chun Shao, Yuewei Sheng, Rosa Viner
Low molecular weight heparins (LMWH) prepared by partial depolymerization of unfractionated heparin are used globally to treat coagulation disorders on an outpatient basis. Patent protection for several LMWH has expired and abbreviated new drug applications have been approved by the Food and Drug Administration. As a result, reverse engineering of LMWH for biosimilar LMWH has become an active global endeavor. Traditionally, the molecular weight distributions of LMWH preparations have been determined using size exclusion chromatography (SEC) with optical detection...
October 6, 2016: Analytical Chemistry
Jonghanne Park, Joo Myung Lee, Jeong Seok Lee, Young Jae Cho
Thromboprophylaxis for venous thromboembolism is widely used in critically ill patients. However, only limited evidence exists regarding the efficacy and safety of the various thromboprophylaxis techniques, especially mechanical thromboprophylaxis. Therefore, we performed meta-analysis of randomized controlled trials (RCTs) that compared the overall incidence of deep vein thrombosis (DVT) for between unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and intermittent pneumatic compression (IPC) in critically ill patients...
November 2016: Journal of Korean Medical Science
Rohan D'Souza, Candice K Silversides, Claire McLintock
The prothrombotic state of pregnancy increases the risk of thromboembolic complications and death in women with mechanical heart valves (MHVs). Although it is accepted that these women must be on therapeutic anticoagulation throughout pregnancy, competing maternal and fetal risks, as well as the lack of high-quality data from prospective studies, make the choice of the optimal method of anticoagulation challenging. Vitamin K antagonists (VKAs) are associated with fewer maternal complications, but conversely also the lowest live birth rates as well as warfarin-related embryopathy and fetopathy...
October 5, 2016: Seminars in Thrombosis and Hemostasis
Peter Bentzer, Jane Fisher, HyeJin Julia Kong, Mattias Mörgelin, John H Boyd, Keith R Walley, James A Russell, Adam Linder
BACKGROUND: Elevated plasma levels of heparin-binding protein (HBP) are associated with risk of organ dysfunction and mortality in sepsis, but little is known about causality and mechanisms of action of HBP. The objective of the present study was to test the hypothesis that HBP is a key mediator of the increased endothelial permeability observed in sepsis and to test potential treatments that inhibit HBP-induced increases in permeability. METHODS: Association between HBP at admission with clinical signs of increased permeability was investigated in 341 patients with septic shock...
December 2016: Intensive Care Medicine Experimental
Marijan Bosevski, Elizabeta Srbinovska-Kostovska
BACKGROUND: Pulmonary embolism and deep venous thrombosis, known as venous thromboembolism (VTE), are associated with a high proportion of morbidity and mortality. AIM: Aim of this review is to emphasise current diagnostic and therapeutic modalities for VTE. RESULTS: No differences have been noticed in European and American guidelines in diagnostic approach of this disorder. Today there is enough clinical information for the use of heparin (either, unfractionated or low molecular) and vitamin K antagonists in the treatment of acute and chronic phases of VTE...
September 15, 2016: Open Access Macedonian Journal of Medical Sciences
Duaa Alsulaiman, Katelyn Sylvester, Craig Stevens, Danielle Carter
Background: For patients on continuous IV unfractionated heparin (UFH), failing to achieve a therapeutic aPTT by 24 hours can be associated with increased morbidity. A pharmacy clinical surveillance system (PCSS) subtherapeutic aPTT alert was implemented at our institution to improve achievement of therapeutic aPTT goals by 24 hours. Objective: The primary objective was the time to achieve the minimum goal aPTT before and after the alert implementation. The secondary objectives were to examine the percentage of patients who achieved the minimum goal aPTT by 24 hours and the number of dose changes to achieve the minimum goal aPTT...
September 2016: Hospital Pharmacy
Jerrold H Levy
Patients taking direct oral anticoagulants (DOACs) who then need an emergency invasive procedure require specialized management strategies. Appropriate patient evaluation includes assessment of the current anticoagulation state, including timing of the last dose. DOACs require particular coagulation assays to measure anticoagulation levels accurately, although standard coagulation screening tests may provide qualitative guidance. Specialty societies have endorsed general recommendations for patient management to promote hemostasis in anticoagulated patients requiring surgery or other invasive procedures...
September 29, 2016: American Journal of Emergency Medicine
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
S Vilasagar, M Towner, K Congelosi, S J Caveglia, D Kumar, B Bhagavath
No abstract text is available yet for this article.
November 2015: Journal of Minimally Invasive Gynecology
Sergio Leonardi, Enrico Frigoli, Martina Rothenbühler, Eliano Navarese, Paolo Calabró, Paolo Bellotti, Carlo Briguori, Marco Ferlini, Bernardo Cortese, Alessandro Lupi, Salvatore Lerna, Dennis Zavallonito-Parenti, Giovanni Esposito, Simone Tresoldi, Antonio Zingarelli, Stefano Rigattieri, Cataldo Palmieri, Armando Liso, Fabio Abate, Marco Zimarino, Marco Comeglio, Gabriele Gabrielli, Alaide Chieffo, Salvatore Brugaletta, Ciro Mauro, Nicolas M Van Mieghem, Dik Heg, Peter Jüni, Stephan Windecker, Marco Valgimigli
OBJECTIVE:  To test the optimal antithrombotic regimen in patients with acute coronary syndrome. DESIGN:  Randomised controlled trial. SETTING:  Patients with acute coronary syndrome with and without ST segment elevation in 78 centres in Italy, the Netherlands, Spain, and Sweden. PARTICIPANTS:  7213 patients with acute coronary syndrome and planned percutaneous coronary intervention: 4010 with ST segment elevation and 3203 without ST segment elevation...
September 27, 2016: BMJ: British Medical Journal
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