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LisaMarie Di Pasquale, Elie M Ferneini
For the oral and maxillofacial surgeon, many patients will be on heparin products during surgery. So far, there is no standardized approach to treating anticoagulated patients during oral and maxillofacial surgical procedures. When a patient is on heparin therapy, heparin may be stopped 4 to 6 hours before surgery and resumed once hemostasis is achieved, usually within 24 hours. If low-molecular-weight heparin is administered, the treatment is generally stopped at least 12 hours before surgery and then resumed in a similar fashion...
November 2016: Oral and Maxillofacial Surgery Clinics of North America
Swe Zin Mar Win Htut Oo, Koroush Khalighi, Archana Kodali, Cho May, Thein Tun Aung, Richard Snyder
Wellens' syndrome is characterized by T-wave changes in electrocardiogram (EKG) during pain-free period in a patient with intermittent angina chest pain. It carries significant diagnostic and prognostic value because this syndrome represents a pre-infarction stage of coronary artery disease involving proximal left anterior descending (LAD) artery, which can subsequently lead to extensive anterior myocardial infarctions (MIs) and even death without coronary angioplasty. Therefore, it is crucial for every physician to recognize EKG features of Wellens' syndrome in order to take appropriate immediate intervention to reduce mortality and morbidity for MI...
2016: Journal of Community Hospital Internal Medicine Perspectives
Kara N Radzak, Jennifer J Wages, Kimberly E Hall, Cass K Nakasone
BACKGROUND: Controversy continues regarding the use of powerful anticoagulants for venous thromboembolism prophylaxis in patients undergoing total knee arthroplasty (TKA). To comply with institution-mandated guidelines and pressure from hospitalist intent on complying with conventionally recommended anticoagulation guidelines, we singularly changed our chemoprophylaxis practice from using aspirin to Lovenox and noted that transfusion rates increased substantially. METHODS: A retrospective case review was performed to evaluate transfusion requirement differences in primary TKA patients receiving Lovenox (unilateral TKA: n = 135, bilateral TKA: n = 44) or aspirin (unilateral TKA: n = 153, bilateral TKA: n = 45) for venous thromboembolism prophylaxis...
November 2016: Journal of Arthroplasty
Emilia Calvaresi, Mahesh Swaminathan, Janet Jokela
May-Thurner syndrome is the condition of the left common iliac vein being compressed between the right common iliac artery and the associated vertebral body. This condition has been linked to spontaneous episodes of deep vein thrombosis (DVT), especially in women aged 20-50, and it may contribute to the slightly higher tendency to develop left-sided (~56%) versus right-sided DVTs. A 50-year-old morbidly obese (BMI 42.7 kg/m(2)) female presented to the emergency room with acute left leg pain. Past medical history included asthma...
2016: Carle Sel Pap
Melissa A Herschman, Frank S Rigelsky, Sandra S Axtell
PURPOSE: A pilot study was conducted to determine whether rivaroxaban (Xarelto, Janssen Pharmaceuticals) resulted in a lower 30-day all-cause readmission rate compared with enoxaparin (Lovenox, Sanofi-Aventis) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a community hospital. METHODS: The study was a single-center, retrospective, chart-review investigation involving patients who underwent THA or TKA between May 2013 and May 2014. The study's primary endpoint was the 30-day all-cause readmission rate...
June 2016: P & T: a Peer-reviewed Journal for Formulary Management
Sana R Akbar, Hafiz I Iqbal, Umair Ahmed
BACKGROUND: Chronic kidney disease is an increasingly prevalent health problem with the potential for poor outcome of end-stage renal disease. Hospitalized critically ill patients are prone to acute renal injury from numerous factors such as poor renal perfusion secondary to ischemia and hypotension, nephrotoxin exposure, and intravenous contrast exposure. AIMS: We set to explore resident awareness and knowledge about chronic kidney disease management, timely nephrology referrals, preventing inadvertent acute kidney injury (AKI), and the understanding of basic electrolyte physiology...
November 2015: North American Journal of Medical Sciences
Xia Bai, Hongming Zhuang
A 6-month-old female infant with known left adrenal neuroblastoma and liver metastasis underwent MIBG scan. The images not only revealed elevated activity in the abdomen, but also showed multiple foci of increased activity in the muscles of bilateral upper thighs, which corresponded to the injection sites of LOVENOX.
February 2016: Clinical Nuclear Medicine
Xiaoqing Tan, Huifei Cui
As per US Food and Drug Administration (FDA) requirement, the study was designed to conduct the fourth and fifth criteria of Abbreviated New Drug Application to demonstrate equivalence of generic and branded Enoxaparin in vivo and vitro.Pharmacodynamic behavior of branded and generic Enoxaparin was compared in a parallel study in rats based upon measurement of anti-FXa and anti-FIIa profiles. Blood samples collected at baseline and at 0.5, 1, 2, 4, 6, 8, 12 and 24 h postsubcutaneous administration of six batches of Lovenox and nine batches of generic Enoxaparin were evaluated for anti-FXa and anti-FIIa using chromogenic substrate method...
October 2015: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Abdelfatah Abou Issa, Richard Simman
Lovenox is a trade name for Enoxaparin. It is a low molecular weight heparin (LMWH) and has other trade names like Clexane and Xaparin. It is an anticoagulant used to prevent and treat venous thromboembolism events (VTE) like deep vein thrombosis or pulmonary embolism, and is given as a subcutaneous injection. General speaking, the most common skin reactions as a result of enoxaparin use are: urticarial, ecchymosis, and even skin necrosis due to vasculitis. These side effects are usually located at the injection site...
December 2013: Journal of the American College of Clinical Wound Specialists
Marco Guerrini, Timothy R Rudd, Lucio Mauri, Eleonora Macchi, Jawed Fareed, Edwin A Yates, Annamaria Naggi, Giangiacomo Torri
The U.S. Food and Drug Administration defines criteria for the equivalence of Enoxaparin with Lovenox, comprising the equivalence of physiochemical properties, heparin source material and mode of depolymerization, disaccharide building blocks, fragment mapping and sequence of oligosaccharide species, biological and biochemical assays, and in vivo pharmacodynamic profile. Chemometric analysis of the NMR spectra, utilizing both (1)H and (1)H-(13)C HSQC NMR experiments, of Lovenox and Enoxaparin, the latter being the generic version of the former, revealed that Lovenox and the four Enoxaparin compounds produced by Sandoz (Enoxaparin and Fibrinox), Winthrop, and Amphastar exhibit dissimilarities in terms of their composition...
August 18, 2015: Analytical Chemistry
Grigoris T Gerotziafas, Aurèlie Rouseau, Elisabeth Mbemba, Amir Khartechi, Patrick Van Dreden, Janine Walenga, Jawed Fareed, Ismail Elalamy
BACKGROUND: The patent protection of low-molecular-weight heparins (LMWHs) expired, so the definition of criteria for the biological similarity between LMWH copies and the original product is a real need. AIM: The present in vitro study compared copies and branded enoxaparin using the specific anti-Xa activity and the calibrated automated thrombogram assay. METHODS: Samples of platelet-poor plasma (PPP) and platelet-rich plasma (PRP) from 15 healthy volunteers were spiked with branded enoxaparin (Lovenox) or its copies (Cutenox, Dilutol, Enoxa, Fibrinox, Loparin, Lupenox, Novex, Noxprin, and Versa)...
November 2015: Clinical and Applied Thrombosis/hemostasis
Vineet Gupta, Naveen Dhawan, Jaya Bahl
A 17-year-old Caucasian male presented with sudden dizziness, ataxia, vertigo, and clumsiness lasting for a couple of hours. He had a subtle trauma during a wrestling match 2 days prior to the presentation. A CT Angiogram (CTA) and MRI showed left vertebral artery dissection (VAD). The patient was treated with anticoagulation with heparin drip in the ICU. The patient was discharged home on the third day on Lovenox-warfarin bridging. This case underscores the importance of considering VAD as a differential diagnosis in patients with sports-related symptoms especially in activities entailing hyperextension or hyperrotation of neck...
2015: Case Reports in Neurological Medicine
Aaron S Kesselheim, Jennifer M Polinski, Lisa A Fulchino, Danielle L Isaman, Joshua J Gagne
BACKGROUND: Generic drugs are approved on the basis of pharmaceutical equivalence and bioequivalence. Some drug products have unique structural or functional attributes, necessitating modified approaches to bioequivalence determinations. OBJECTIVE: The aim of this systematic review was to identify studies that evaluated laboratory or clinical outcomes of six drugs approved via modified bioequivalence approaches. DATA SOURCES: We conducted a systematic review of articles published through February 2014 in MEDLINE, EMBASE, and International Pharmaceutical Abstracts related to six recent drugs subject to modified regulatory approaches: venlafaxine extended release tablet (Effexor XR), acarbose (Precose), enoxaparin (Lovenox), vancomycin capsules (Vancocin), sodium ferric gluconate (Ferrlecit), and calcitonin salmon nasal spray (Miacalcin NS)...
April 2015: Drugs
Bruce B Garber, Michael Bickell
INTRODUCTION: Infrequent but serious postoperative complications following inflatable penile prosthesis (IPP) insertion include infection, malfunction, and bleeding. Although prior publications report methods to reduce immediate postoperative bleeding, there is little in the literature concerning the etiology, diagnosis, imaging, and management of delayed bleeding after IPP insertion. AIM: The aim of the study was to review cases of delayed postoperative bleeding following IPP insertion in a large single-surgeon series...
January 2015: Journal of Sexual Medicine
Dhaval Raval, Hisashi Tsukada, Samaan Rafeq
SESSION TITLE: Bronchology/Interventional Procedures Cases ISESSION TYPE: Affiliate Case Report SlidePRESENTED ON: Sunday, October 26, 2014 at 10:45 AM - 12:00 PMINTRODUCTION: Endobronchial lipoma is a rare cause of airway obstruction with variable presentation. There are only 130 cases reported worldwide. We present a case of hemoptysis from endobronchial lipoma which was resected with electrocautery snare.CASE PRESENTATION: A 62 year old smoker with COPD and prior pulmonary embolism on Warfarin, presented with 3 days of productive cough, exertional dyspnea and low grade fever...
October 1, 2014: Chest
Jad Bou Monsef, Friedrich Boettner
BACKGROUND: The steady rise in demand for total hip arthroplasty constitutes a significant and increasing burden on health care resources. The biggest contributors to the total cost of hip replacement procedures other than the price of the implant are hospital stay and postoperative rehabilitation. Blood management is one of the most adjustable factors that can impact length of stay and cost-efficiency while improving patient safety. QUESTIONS/PURPOSES: The primary purpose of this retrospective study was to assess the potential impact of blood management interventions on length of hospital stay after primary unilateral total hip arthroplasty...
July 2014: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Bin Liu, Sherwin Chan, Sabah Servaes, Hongming Zhuang
An initial staging FDG PET/CT scan in a 15-year-old female patient with lymphoma revealed FDG-avid tumor in the mediastinum and the neck. After chemotherapy, a restaging PET/CT scan was performed. Although mediastinal and cervical lesions were not visualized, multiple new foci of activity were noted in the bilateral anterior thighs, which corresponded to soft tissue nodules in the subcutaneous tissue on the low-dose CT. On the third PET/CT study, multiple new foci appeared in the subcutaneous tissue in the anterior abdomen...
March 2014: Clinical Nuclear Medicine
Joseph Hannon, Craig Garrison, John Conway
BACKGROUND AND PURPOSE: Accurate diagnosis of deep vein thrombosis in an outpatient setting is difficult; however, proper screening and prompt referral can be lifesaving. The purpose of this case report is to present the unusual findings of a Deep Vein Thrombosis (DVT) in an otherwise healthy young male following an upper extremity surgery. CASE DESCRIPTION: An 18 year-old male high school baseball pitcher presented to the clinic for his four month follow up visit after Ulnar Collateral Ligament (UCL) reconstruction surgery...
August 2013: International Journal of Sports Physical Therapy
Ali Farooqui, Bradley Hiser, Stephen L Barnes, N Scott Litofsky
OBJECT: Patients with traumatic brain injury (TBI) are at risk for development of thromboembolic disease. The use of chemoprophylaxis in this patient group has not fully been characterized. The authors hypothesize that early chemoprophylaxis in patients with TBI is safe and efficacious. METHODS: In May 2009, a protocol was instituted for patients with TBI where chemoprophylaxis for thromboembolic disease (either 30 mg of Lovenox twice daily or 5000 U of heparin 3 times a day) was initiated 24 hours after an intracranial hemorrhage (ICH) was demonstrated as stable on head CT image...
December 2013: Journal of Neurosurgery
Céline Martinez, Adama Savadogo, Christophe Agut, Pascal Anger
Enoxaparin is a widely used subcutaneously administered antithrombotic agent comprising a complex mixture of glycosaminoglycan chains. Owing to this complexity, its antithrombotic potency cannot be defined by physicochemical methods and is therefore evaluated using an enzymatic assay of anti-Xa and anti-IIa activity. Maintaining consistent anti-Xa activity in the final medicinal product allows physicians to ensure administration of the appropriate dosage to their patients. Bioassays are usually complex and display poorer reproducibility than physicochemical tests such as HPLC assays...
July 2013: Journal of Pharmaceutical and Biomedical Analysis
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