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Alturkmani H, Uretsky B, Patel S, Albadaineh M, Alqaisi O, Alaiwah M, Cross M, Abbasi D, Rollefson W. Safety and Efficacy of Enoxaparin During Low-Risk Elective Percutaneous Coronary Intervention. Am J Cardiol 2024; 218:63-67. [PMID: 38432342 DOI: 10.1016/j.amjcard.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/01/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Intravenous unfractionated heparin (UFH) is the most frequently used anticoagulant for percutaneous coronary intervention (PCI). Intravenous enoxaparin, a low-molecular-weight heparin, has superior pharmacokinetic and pharmacodynamic properties compared with UFH. Multiple trials have shown enoxaparin to be safe and effective in PCI. However, there has not been a contemporary study evaluating its safety and efficacy. To assess its efficacy and safety, intravenous enoxaparin during PCI through radial artery access was evaluated in PCI patients from January 2015 to December 2019. Outcomes included procedural success, all-cause mortality, ischemic complications, and bleeding complications from the time of the procedure until hospital discharge. A total of 1019 consecutive eligible patients were identified. Median age was 63 years, and 70% were men. The indication for PCI was stable and unstable angina in two-thirds of cases (77%). Few patients had myocardial infarction (MI) (2.2%) as the indication for intervention. The procedure was successful in 98.2% of cases. There were no deaths. Procedural MI occurred in 0.3% of patients. Acute stent thrombosis occurred in 0.4%. Urgent revascularization and stroke occurred in 0.1% each. Small wrist hematomas occurred in 0.3% and all were managed conservatively. There was one radial artery pseudoaneurysm. There were no cases of major bleeding. In conclusion, this single-center study showed that intravenous enoxaparin is a reasonable alternative anticoagulant for use in low-risk and elective non-MI PCI through radial artery access.
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Affiliation(s)
- Hani Alturkmani
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Barry Uretsky
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Cardiology, Central Arkansas Veterans Affairs Healthcare System, Little Rock, Arkansas
| | - Swetal Patel
- Department of Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Mu'nes Albadaineh
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Omar Alqaisi
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Malek Alaiwah
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michael Cross
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Danish Abbasi
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - William Rollefson
- Department of Cardiology, Arkansas Heart Hospital, Little Rock, Arkansas
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2
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Mruthunjaya AKV, Chatelier RC, Torriero AAJ. Calibration-free electrochemical sensor to monitor factor-Xa inhibitors at the point-of-care anticoagulation therapy. Talanta 2024; 270:125593. [PMID: 38159356 DOI: 10.1016/j.talanta.2023.125593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
This article presents a novel proof of concept for the blood plasma quantification of clinically relevant concentrations of direct oral anticoagulants, DOACs, including rivaroxaban and edoxaban, as well as low-molecular-weight heparins, LMWHs, such as enoxaparin and dalteparin, utilising a calibration-free disposable electrochemical sensor with co-facing electrodes. A dose-response curve was generated for rivaroxaban and edoxaban to demonstrate the sensor's ability to detect ≥9.00 ng mL-1 rivaroxaban and quantify it in the 11.0-140 ng mL-1 range. Similarly, the lower detection limit for edoxaban was 12.9 ng mL-1, with a quantification range of 16.8-140 ng mL-1. The significance of this sensor lies in its ability to quantify rivaroxaban and edoxaban below 30 ng mL-1, which is crucial in emergency care centres when patients undergoing DOAC therapy require emergency surgery or reversal of DOACs due to bleeding or ischemic stroke. Furthermore, the sensor can detect ≥0.016 IU mL-1 enoxaparin and ≥0.013 IU mL-1 dalteparin and quantify them in the 0.025-0.75 and 0.019-0.75 IU mL-1 range, respectively. Additionally, a dose-response curve was presented to demonstrate the potential ability of this sensor to quantify factor-Xa inhibitors independently of which DOACs or LMWHs are used. With the assay completed in less than 30 s using a minimal volume of 7 μL sample, the possibility to work at physiological pH and under calibration-free format makes this assay an excellent candidate for point-of-care testing.
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Affiliation(s)
- Ashwin K V Mruthunjaya
- School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, 3125, Australia
| | - Ronald C Chatelier
- School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, 3125, Australia
| | - Angel A J Torriero
- School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, 3125, Australia.
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Chilbert MR, Zammit K, Ahmed U, Devlin A, Radparvar S, Schuler A, Woodruff AE. A systematic review of therapeutic enoxaparin dosing in obesity. J Thromb Thrombolysis 2024; 57:587-597. [PMID: 38402505 DOI: 10.1007/s11239-024-02951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/26/2024]
Abstract
Enoxaparin is a hydrophilic drug with obesity having little effect on its apparent volume of distribution, therefore patients with obesity receiving standard 1 mg/kg dosing may be at a higher risk of supratherapeutic dosing. Conversely, dose reducing patients with obesity could place already at risk patients at higher risk of a thrombotic event. Data and recommendations are variable for the most appropriate weight-based dose of therapeutic enoxaparin in obese patients, particularly those a weight > 100 kg or a body mass index (BMI) ≥ 40 kg/m2. The purpose of this systematic review was to globally evaluate these data to surmise optimal dosing recommendations for patients with obesity. A systematic review of English language studies was conducted and identified articles via Pubmed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) searches. Studies were included if they reported therapeutic enoxaparin use in adult patients with a BMI ≥ 40 kg/m2 or body weight > 100 kg and the percentage of patients achieving a therapeutic anti-Xa based on a weight-based dose or the weight-based dose required to produce a therapeutic anti-Xa level. Therapeutic attainment of anti-Xa levels were assessed across enoxaparin weight-based dosing categories including a very low dose group: < 0.75 mg/kg, low dose group: 0.75-0.85 mg/kg, and standard dose group: ≥ 0.95 mg/kg. Rates of bleeding and thrombosis were also evaluated. A total of eight studies were included. For anti-Xa level assessment, 682 patients were included. A total of 62% of anti-Xa levels were therapeutic in the very low dose group, 66% in the low dose group, and 42% in the standard dose group. Overall rates of total bleeding and thrombosis were assessed in 798 patients. A total of 29 bleedings (3.6%) occurred, and 27 reported a relationship to dose. Most bleedings, 85.2% (n = 23/27), occurred with doses in the standard dose group (≥ 0.95 mg/kg). Thrombosis occurred in 5 patients (0.6%). Utilization of a reduced weight-based dosing strategy for therapeutic enoxaparin in obese patients may increase the percentage of patients with a therapeutic anti-Xa level.
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Affiliation(s)
- Maya R Chilbert
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 273 Pharmacy Building, Buffalo, NY, 14214, USA.
- Buffalo General Medical Center, 100 High Street, Buffalo, NY, 14203, USA.
| | - Kimberly Zammit
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 273 Pharmacy Building, Buffalo, NY, 14214, USA
- The Mount Sinai Hospital, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Uzma Ahmed
- Mount Sinai Brooklyn, 3201 Kings Hwy, Brooklyn, NY, 1123, USA
| | - Amanda Devlin
- Mount Sinai Beth Israel, 281 1st Avenue, New York, NY, 10003, USA
| | - Sara Radparvar
- The Mount Sinai Hospital, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Ashley Schuler
- The Mount Sinai Hospital, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Ashley E Woodruff
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 273 Pharmacy Building, Buffalo, NY, 14214, USA
- Buffalo General Medical Center, 100 High Street, Buffalo, NY, 14203, USA
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Chanas T, Gibson G, Langenstroer E, Herrmann DJ, Carver TW, Alexander K, Chui SHJ, Rein L, Ha M, Maynard KM, Bamberg K, O'Keefe M, O'Brien M, Gonzalez MC, Hobbs B, Pajoumand M, Peppard WJ. Multicenter study evaluating target attainment of anti-Factor Xa levels using various enoxaparin prophylactic dosing practices in adult trauma patients. Pharmacotherapy 2024; 44:258-267. [PMID: 38148134 DOI: 10.1002/phar.2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
STUDY OBJECTIVE Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed-dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti-Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single-center study. This study compared BMI-, TBW-, EBV-based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti-Factor Xa (anti-Xa) levels in trauma patients. DESIGN Multicenter, retrospective review. DATA SOURCE Electronic health records from participating institutions. PATIENTS Adult trauma patients who received enoxaparin twice daily for VTE prophylaxis and had at least one appropriately timed anti-Xa level (collected 3 to 6 hours after the previous dose after three consecutive doses) from January 2017 through December 2020. Patients were excluded if the hospital-specific dosing protocol was not followed or if they had thermal burns with > 20% body surface area involvement. INTERVENTION Dosing strategy used to determine initial prophylactic dose of enoxaparin. MEASUREMENTS The primary end point was percentage of patients with peak anti-Xa levels within the target prophylactic range (0.2-0.4 units/mL). MAIN RESULTS Nine hospitals enrolled 742 unique patients. The most common dosing strategy was based on BMI (43.0%), followed by EBV (29.0%). Patients dosed using EBV had the highest percentage of target anti-Xa levels (72.1%). Multiple logistic regression demonstrated EBV-based dosing was significantly more likely to yield anti-Xa levels at or above target compared to BMI-based dosing (adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 2.29-5.62, p < 0.001). EBV-based dosing was also more likely than hybrid dosing to yield an anti-Xa level at or above target (aOR 2.30, 95% CI 1.33-3.98, p = 0.003). Other pairwise comparisons between dosing strategy groups were nonsignificant. CONCLUSIONS An EBV-based dosing strategy was associated with higher odds of achieving anti-Xa level within target range for enoxaparin VTE prophylaxis compared to BMI-based dosing and may be a preferred method for VTE prophylaxis in adult trauma patients.
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Affiliation(s)
- Tyler Chanas
- ECU Health Medical Center, Greenville, North Carolina, USA
| | | | | | - David J Herrmann
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas W Carver
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kaitlin Alexander
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | | | - Lisa Rein
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael Ha
- UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Kaylee M Maynard
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Mary O'Keefe
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marisa O'Brien
- UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | | | - Brandon Hobbs
- Orlando Regional Medical Center, Orlando, Florida, USA
| | | | - William J Peppard
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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5
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Carter C, Denny K, Carver TW, Jung B, Rein L, Peppard WJ. Evaluation of an Association Between Enoxaparin Dose per Estimated Blood Volume and Clinically Relevant Bleeding in Low-Weight Trauma Patients. Ann Pharmacother 2024; 58:118-125. [PMID: 37138511 DOI: 10.1177/10600280231169523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND The optimal dosing for enoxaparin venous thromboembolism (VTE) prophylaxis in low-weight trauma patients is unknown. Estimated blood volume (EBV) has shown promise as a dose modifier. OBJECTIVE To characterize the association of enoxaparin dose per EBV with the prevalence of VTE and bleeding in low-weight trauma patients. METHODS This was a retrospective study of trauma patients admitted over a 4-year period. Included patients were adults weighing <60 kg who received a minimum of 3 consecutive doses of enoxaparin. The primary endpoint was a comparison of enoxaparin dose per EBV in patients experiencing bleeding and VTE. Secondary endpoints included comparisons of dose per body mass index (BMI) and total body weight (TBW) and the ability of dose per EBV to predict clinical endpoints. Subgroup analyses for patients weighing <50 kg were performed for all endpoints. RESULTS A total of 189 patients were included. Statistical comparisons for VTE were not performed because of low prevalence. The dose of enoxaparin per EBV was not statistically different between patients who did and did not bleed in all analyses. Doses per BMI and TBW were also not statistically different between the groups. In patients weighing <50 kg, numerically higher doses per EBV, BMI, and TBW were noted in patients that bled versus those that did not. Enoxaparin dose per EBV was not a statistically significant predictor of bleeding in logistic regression models. CONCLUSION AND RELEVANCE No significant associations between enoxaparin dose per EBV, BMI, or TBW and bleeding were noted in the study. Future analyses of EBV and other dose modifiers should consider inclusion of patients weighing <50 kg.
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Affiliation(s)
- Chris Carter
- Department of Pharmacy, SSM Health St. Clare Hospital-Fenton, Fenton, MO, USA
| | - Kailey Denny
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas W Carver
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Benjamin Jung
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lisa Rein
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William J Peppard
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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6
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Park G, Dhillon NK, Fierro NM, Drevets P, Stupinski J, Ley EJ. Creatinine clearance predicts the goal enoxaparin dose in traumatic brain injury. J Trauma Acute Care Surg 2024; 96:270-275. [PMID: 37335174 DOI: 10.1097/ta.0000000000004059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Patients with traumatic brain injury (TBI) are at high risk of venous thromboembolism (VTE). Recent guidelines recommend starting TBI patients on enoxaparin 30 mg twice daily and then considering weight-based dosing. Creatinine clearance may be better than weight for patients when considering high and low enoxaparin dose requirements. We hypothesize that creatinine clearance (CrCl) predicts goal enoxaparin dose better than weight-based dosing. METHODS A retrospective review was conducted on patients admitted to an urban, academic Level I trauma center from August 2017 to February 2020. Patients were included if greater than 18 years, admitted longer than 48 hours, and head and neck AIS ≥ 3. Patients were excluded if they did not have TBI, if they received deep vein thrombosis prophylaxis other than enoxaparin 12-hour dosing, if no anti-Xa levels were drawn, or if the goal anti-Xa level was not reached. Patients were grouped into dosing cohorts based on dose of enoxaparin required to reach goal. Pearson's correlation was used to compare mean CrCl and mean weight across dosing cohorts. RESULTS A total of 120 patients met inclusion and exclusion criteria, mean age was 47 years and 68% of patients were male. The mean hospital length of stay was 24 days. There were 5 (4.2%) deep vein thrombosis, no pulmonary embolism, and 5 (4.2%) patients died. Mean CrCl increased significantly with increased dosing of enoxaparin, Pearson's correlation coefficient of 0.484 ( p < 0.001). Weight on admission also increased with increasing enoxaparin dose requirements, with Pearson's correlation coefficient of 0.411 ( p < 0.001). CONCLUSION Creatine clearance predicts goal enoxaparin dose in TBI better than a weight-based dosing strategy. Further research with a larger patient population is required to validate CrCl values to guide enoxaparin dosing. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Greigory Park
- From the Division of Trauma and Critical Care, Department of Surgery (G.P., N.M.F., P.D., J.S., E.J.L.), Cedars-Sinai Medical Center, Los Angeles, California; and R Adams Cowley Shock Trauma Center (N.K.D.), University of Maryland, Baltimore Maryland
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Lyu TY, Li M, He JA, Sun QF, Wang L, Qin H, Yu HP. [Analysis of the experience and procedural complications of trans-radial access versus trans-femoral access for hepatic arterial perfusion chemotherapy in patients with advanced hepatic malignancies:a retrospective study]. Zhonghua Nei Ke Za Zhi 2024; 63:183-191. [PMID: 38326045 DOI: 10.3760/cma.j.cn112138-20230827-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Objective: To analyze the differences between trans-radial access (TRA) and trans-femoral access (TFA) in hepatic arterial perfusion chemotherapy (HAIC) in terms of patient experience, postoperative complications, and patient preferences; explore whether TRA in HAIC is associated with better patient experience and compliance; and determine whether it is safer than TFA. Methods: The study was a retrospective cohort study of patients with advanced hepatocellular carcinoma and liver metastases from colorectal cancer treated with HAIC. We enrolled a total of 91 patients with advanced liver malignancies treated with HAIC from November 2022 to May 2023 in the Department of Interventional Therapy and Hepatobiliary Medicine at Tianjin Medical University Cancer Hospital. The patients were divided into three groups: group TRA (n=20, receiving TRA HAIC only), group TFA (n=33, receiving TFA HAIC only), and crossover group [n=19, receiving TFA HAIC (Cross-TFA group) first, followed by TRA HAIC (Cross-TRA group)]. Meanwhile, to facilitate the expression of partial results, all patients receiving TRA HAIC were defined as the TRA-HAIC group (n=39, TRA+Cross-TRA group), and all patients receiving TFA HAIC were defined as the TFA-HAIC group (n=52, TFA+Cross-TFA group). The primary research index was the Quality of Life (QOL) visualization scale score. The secondary research index included approach-related and catheter-related adverse events, duration of surgery, and mean length of patient stay. We used various statistical methods such as Mann-Whitney U test, t-test, Chi-square test, Fisher's exact test, univariate logistic regression analysis, and multi-factor analysis. Results: TRA patients had significantly lower QOL scores than TFA patients (all P<0.001). The QOL scores of the Cross-TRA group were significantly lower than those of the Cross-TFA group (pain at the puncture site Z=-3.24, P=0.001, others P<0.001). The QOL scores of the Cross-TRA group were compared with those of the TRA group, which showed that the scores of the Cross-TRA group in overall discomfort (Z=-3.07,P=0.002), postoperative toilet difficulty (Z=-2.12, P=0.034), and walking difficulty (Z=-2.58, P=0.010) were significantly lower than those of the TRA group. Satisfaction scores were significantly higher in the Cross-TRA group than in the Cross-TFA group (Z=-3.78, P<0.001), and patients were more likely to receive TRA HAIC as the next procedure (χ2=30.42, P<0.001). In terms of mean length of stay, patients receiving TRA HAIC had a significantly lower mean length of stay than those receiving TFA HAIC (50.1±3.2 h vs. 58.4±6.4 h, t=7.98, P<0.001). The incidence of radial artery occlusion (RAO) as an approach-related adverse event was 15.4% (6/39) in the TRA-HAIC group, which was significantly higher than that in the TFA-HAIC group (15.4% vs. 0, χ2=8.56, P=0.005). Notably, multifactorial analysis of RAO-related factors showed that intraoperative enoxaparin use and patency of radial artery flow during pressure were significantly associated with a reduced risk of postoperative RAO (P=0.037 for enoxaparin use and P=0.049 for pressure). Conclusions: With respect to procedure approach, TRA was significantly better than TFA in terms of patient satisfaction and mean length of stay. Through further process optimization and prevention of adverse reactions, the incidence of adverse reactions can be maintained at a relatively low level, so that patients can benefit from TRA in future operations in terms of cost-effectiveness and medical efficiency.
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Affiliation(s)
- T Y Lyu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China Department Of Oncology of the 983rd Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Tianjin 300142, China
| | - M Li
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - J A He
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Q F Sun
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - L Wang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - H Qin
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - H P Yu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
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Migliorini F, Maffulli N, Velaj E, Bell A, Kämmer D, Hildebrand F, Hofmann UK, Eschweiler J. Antithrombotic prophylaxis following total hip arthroplasty: a level I Bayesian network meta-analysis. J Orthop Traumatol 2024; 25:1. [PMID: 38194191 PMCID: PMC10776533 DOI: 10.1186/s10195-023-00742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Several clinical investigations have compared different pharmacologic agents for the prophylaxis of venous thromboembolism (VTE). However, no consensus has been reached. The present investigation compared enoxaparin, fondaparinux, aspirin and non-vitamin K antagonist oral anticoagulants (NOACs) commonly used as prophylaxis following total hip arthroplasty (THA). A Bayesian network meta-analysis was performed, setting as outcomes of interest the rate of deep venous thrombosis (DVT), pulmonary embolism (PE) and major and minor haemorrhages. METHODS This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. All randomised controlled trials (RCTs) comparing two or more drugs used for the prophylaxis of VTE following THA were accessed. PubMed, Web of Science and Google Scholar databases were accessed in March 2023 with no time constraint. RESULTS Data from 31,705 patients were extracted. Of these, 62% (19,824) were women, with age, sex ratio, and body mass index (BMI) being comparable at baseline. Apixaban 5 mg, fondaparinux, and rivaroxaban 60 mg were the most effective in reducing the rate of DVT. Dabigatran 220 mg, apixaban 5 mg, and aspirin 100 mg were the most effective in reducing the rate of PE. Apixaban 5 mg, ximelagatran 2 mg and aspirin 100 mg were associated with the lowest rate of major haemorrhages, while rivaroxaban 2.5 mg, apixaban 5 mg and enoxaparin 40 mg were associated with the lowest rate of minor haemorrhages. CONCLUSION Administration of apixaban 5 mg demonstrated the best balance between VTE prevention and haemorrhage control following THA. Level of evidence Level I, network meta-analysis of RCTs.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany.
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Erlis Velaj
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
| | - Daniel Kämmer
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Halle (Saale), Germany
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9
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Peng S, Zhang M, Jin J, MacCormick AD. The effectiveness of venous thromboembolism prophylaxis interventions in trauma patients: A systematic review and network meta-analysis. Injury 2023; 54:111078. [PMID: 37865011 DOI: 10.1016/j.injury.2023.111078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major complication of trauma. Currently, there are few studies summarising the evidence for prophylaxis in trauma settings. This review provides evidence for the use of VTE prophylactic interventions in trauma patients to produce evidence-based guidelines. METHODS A PRISMA-compliant review was conducted from Sep 2021 to June 2023, using Embase, Medline and Google Scholar. The inclusion criteria were: randomized-controlled trials (RCTs) in English published after 2000 of adult trauma patients comparing VTE prophylaxis interventions, with a sample size higher than 20. The network analysis was conducted using RStudio. The results of the pairwise comparisons were presented in the form of a league table. The quality of evidence and heterogeneity sensitivity were assessed. The primary outcome focused on venous thromboembolism (VTE), and examined deep vein thrombosis (DVT) and pulmonary embolism (PE) as separate entities. The secondary outcomes included assessments of bleeding and mortality. PROSPERO registration: CRD42021266393. RESULTS Of the 7,948 search results, 23 studies with a total of 21,312 participants fulfilled screening criteria, which included orthopaedic, spine, solid organ, brain, spinal cord, and multi-region trauma. Of the eight papers comparing chemical prophylaxis medications in patients with hip or lower limb injuries, fondaparinux and enoxaparin were found to be significantly superior to placebo in respect of prevention of DVT, with no increased risk of bleeding. Regarding mechanical prophylaxis, meta-analysis of two studies of inferior vena cava filters failed to provide significant benefits to major trauma patients. CONCLUSION Enoxaparin and fondaparinux are safe and effective options for VTE prevention in trauma patients, with fondaparinux being a cheaper and easier administration option between the two. Inconclusive results were found in mechanical prophylaxis, requiring more larger-scale RCTs.
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Affiliation(s)
- Serena Peng
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland Te Waipapa Taumata Rau, Auckland, New Zealand.
| | - Mandy Zhang
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland Te Waipapa Taumata Rau, Auckland, New Zealand
| | - James Jin
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland Te Waipapa Taumata Rau, Auckland, New Zealand; Department of Surgery, Te Whatu Ora - Counties Manukau, Auckland, New Zealand
| | - Andrew D MacCormick
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland Te Waipapa Taumata Rau, Auckland, New Zealand; Department of Surgery, Te Whatu Ora - Counties Manukau, Auckland, New Zealand
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10
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Kali G, Özkahraman B, Laffleur F, Knoll P, Wibel R, Zöller K, Bernkop-Schnürch A. Thiolated Cellulose: A Dual-Acting Mucoadhesive and Permeation-Enhancing Polymer. Biomacromolecules 2023; 24:4880-4889. [PMID: 37796043 PMCID: PMC10646989 DOI: 10.1021/acs.biomac.3c00577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/25/2023] [Indexed: 10/06/2023]
Abstract
This study aims to design an anionic, thiolated cellulose derivative and to evaluate its mucoadhesive and permeation-enhancing properties utilizing enoxaparin as a model drug. 2-Mercaptosuccinic acid-modified cellulose (cellulose-mercaptosuccinate) was synthesized by the reaction of cellulose with S-acetylmercaptosuccinic anhydride. The chemical structure of the target compound was confirmed by FTIR and 1H NMR spectroscopy. The thiol content was determined by Ellman's test. The conjugate exhibited 215.5 ± 25 μmol/g of thiol groups and 84 ± 16 μmol/g of disulfide bonds. Because of thiolation, mucoadhesion on porcine intestinal mucosa was 9.6-fold enhanced. The apparent permeability (Papp) of the model dye Lucifer yellow was up to 2.2-fold improved by 0.5% cellulose-mercaptosuccinate on a Caco-2 cell monolayer. Enoxaparin permeation through rat intestinal mucosa increased 2.4-fold in the presence of 0.5% cellulose-mercaptosuccinate compared with the drug in buffer only. In vivo studies in rats showed an oral bioavailability of 8.98% using cellulose-mercaptosuccinate, which was 12.5-fold higher than that of the aqueous solution of the drug. Results of this study show that the modification of cellulose with 2-mercaptosuccinic acid provides mucoadhesive and permeation-enhancing properties, making this thiolated polymer an attractive excipient for oral drug delivery.
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Affiliation(s)
- Gergely Kali
- Center for Chemistry
and Biomedicine, Department of Pharmaceutical Technology, Institute
of Pharmacy, University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
| | - Bengi Özkahraman
- Center for Chemistry
and Biomedicine, Department of Pharmaceutical Technology, Institute
of Pharmacy, University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
- Department of Polymer Materials, Faculty of Engineering, Hitit University, 19030 Corum, Turkey
| | - Flavia Laffleur
- Center for Chemistry
and Biomedicine, Department of Pharmaceutical Technology, Institute
of Pharmacy, University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
| | - Patrick Knoll
- Center for Chemistry
and Biomedicine, Department of Pharmaceutical Technology, Institute
of Pharmacy, University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
| | - Richard Wibel
- Center for Chemistry
and Biomedicine, Department of Pharmaceutical Technology, Institute
of Pharmacy, University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
| | - Katrin Zöller
- Center for Chemistry
and Biomedicine, Department of Pharmaceutical Technology, Institute
of Pharmacy, University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
| | - Andreas Bernkop-Schnürch
- Center for Chemistry
and Biomedicine, Department of Pharmaceutical Technology, Institute
of Pharmacy, University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
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11
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Zhou FN, Gellatly RM. Management of an unintentional enoxaparin overdose: A case report and literature review. Am J Health Syst Pharm 2023; 80:1550-1556. [PMID: 37522871 DOI: 10.1093/ajhp/zxad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Indexed: 08/01/2023] Open
Abstract
PURPOSE The aim of this article is to describe a case in which protamine was used for a low-molecular-weight heparin (LMWH) overdose and present an up-to-date review of the literature on the management of LMWH overdose in adults. SUMMARY An unintentional administration of enoxaparin 900 mg occurred in a 73-year-old man with coronavirus disease 2019-related pulmonary embolism. Management of the overdose included a protamine bolus followed by an infusion. Anti-factor Xa levels and activated partial thromboplastin time were monitored. Anti-factor Xa levels declined in a linear fashion irrespective of protamine administration. No bleeding or further thrombotic complications occurred in the patient. A review of the literature revealed that the optimal strategy to treat an LMWH overdose is unknown, with treatment of overdoses ranging from clinical observation to aggressive protamine dosing in reported cases. Although protamine effectively neutralizes unfractionated heparin, it is unable to completely reverse LMWH activity and has variable effects on laboratory measures of LMWH anticoagulant activity. CONCLUSION The current case report provides additional data to previous literature suggesting that protamine may have a limited effect in decreasing anti-factor Xa levels in LMWH overdose. Continued reporting on the management of LMWH overdoses is warranted to clarify the optimal treatment strategy.
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Affiliation(s)
- Florian N Zhou
- Department of Pharmacy, Surrey Memorial Hospital, Surrey, BC
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Rochelle M Gellatly
- Department of Pharmacy, Surrey Memorial Hospital, Surrey, BC, Canada
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
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12
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Jeanroy F, Comby-Zerbino C, Demesmay C, Dugas V. Miniaturized affinity chromatography: A powerful technique for the isolation of high affinity GAGs sequences prior to their identification by MALDI-TOF MS. Anal Chim Acta 2023; 1277:341656. [PMID: 37604620 DOI: 10.1016/j.aca.2023.341656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
Glycosaminoglycans (GAGS) are involved in many biological processes through interactions with a variety of proteins, including proteases, growth factors, cytokines, chemokines and adhesion molecules. Identifying druggable GAG-protein interactions for therapeutic purposes is a challenge for the analytical community. In this context, this work investigates the use of a new miniaturized monolithic affinity column (poly(GMA-co-MBA) grafted with antithrombin III (AT III)) to specifically capture and elute high affinity sequences contained in low molecular weight heparin (enoxaparin) for further on-line characterization. This miniaturized, high binding capacity affinity column allows the specific capture of high-affinity oligosaccharide chains from Enoxaparin, even at low concentrations and with a minimal consumption of AT III. In addition to purification, this elution process enables preconcentration for direct analysis by capillary zone electrophoresis. It was found that many of oligosaccharide chains in enoxaparin were eliminated and that certain chain sequences were retained and enriched. Direct coupling with MALDI-TOF MS was successfully used to further characterize the specifically retained oligosaccharides where nano-ESI-TOF MS failed. After optimization of the sample preparation and ionization parameters, direct on-line analysis was performed by applying the elution volume released from the miniaturized affinity column (≤1 μL) directly to the MALDI plate. Finally, this original miniaturized analytical workflow coupling miniaturized AT III-affinity chromatography to MALDI-TOF MS detection is able to select, enrich and detect and identify high affinity sequences (mainly DP4 in size length with a high degree of sulfation) from low molecular weight heparin samples. A more specific selection of GAG sequences can be achieved by increasing the ionic strength during the washing step of affinity chromatography. This is consistent with the known binding pattern between heparin and AT III.
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Affiliation(s)
- Frédéric Jeanroy
- Université de Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR, 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France
| | - Clothilde Comby-Zerbino
- Université de Lyon, CNRS, Université Claude Bernard Lyon 1, Institut Lumière Matière, UMR 5306, F-69100, Villeurbanne, France
| | - Claire Demesmay
- Université de Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR, 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France
| | - Vincent Dugas
- Université de Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR, 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France.
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13
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Cho YW, Scrushy M, Zhu M, DeAtkine E, Zhu M, Wan B, Fesmire A, Cripps M, Park C. Early administration of high dose enoxaparin after traumatic brain injury. Eur J Trauma Emerg Surg 2023; 49:2295-2303. [PMID: 37405447 DOI: 10.1007/s00068-023-02317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Early enoxaparin 30 mg BID administration at 24 h post-injury has been demonstrated in patients with traumatic brain injury (TBI). However this dose can also yield subtherapeutic anti-Xa levels in 30-50% of trauma patients, suggesting that larger doses may be required for adequate prophylaxis against venous thromboembolism (VTE). The safety of enoxaparin 40 mg BID in trauma patients has previously been shown - however, these studies have largely excluded TBI patients. Therefore, we sought to demonstrate the safety of early enoxaparin 40 mg BID in a low-risk group of TBI patients. METHODS A retrospective review of TBI patients at a Level 1 trauma center was performed. Patients with stable computed tomography (CT) of the head at 6 to 24 h post-injury who received enoxaparin 40 mg BID were included and serial GCS evaluations to identify possible clinical complications. To evaluate the safety of this dosing regimen, data was then compared to patients from our institution with similar TBI profiles who had received 5,000 units (U) of subcutaneous heparin (SQH) prophylaxis. RESULTS 199 TBI patients were identified over a nine month period, 40/199 (19.7%) received DVT prophylaxis after traumatic injury. Of these 40, 19 (47.5%) received enoxaparin 40 mg BID and 21 (52.5%) received 5,000U of SQH. Low risk TBI patients who were either given enoxaparin (n = 7) or SQH (n = 4), demonstrated no clinical decline in mental status during their inpatient stay. CONCLUSION Prior studies have demonstrated that enoxaparin 40 mg BID dosing is superior to traditional VTE prophylaxis in trauma patients. However, TBI patients are often excluded from this dosing due to concern for progression. Our study showed no clinical decline in mental status in a small cohort of low-risk TBI patients who received enoxaparin 40 mg BID.
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Affiliation(s)
- Young-Woo Cho
- Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Marinda Scrushy
- Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Michelle Zhu
- Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Elizabeth DeAtkine
- Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Michelle Zhu
- Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Bingchun Wan
- Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Alyssa Fesmire
- Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Michael Cripps
- Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Caroline Park
- Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
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14
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Vaughn AE, Hall JK, Harrison ML, Klein G, Diaz-Miron J, Yi JA, Acker SN. Practice patterns in the management of pediatric iliofemoral arterial thrombosis. Surgery 2023; 174:940-945. [PMID: 37507305 DOI: 10.1016/j.surg.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/03/2023] [Accepted: 06/18/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Acute arterial thrombosis can be life- and limb-threatening. Most pediatric patients with iliofemoral arterial thrombosis are treated successfully with medical therapy; however, expert consensus is limited, and many recommendations are based on the extrapolation of adult data. We aim to understand treatment patterns and long-term outcomes after pediatric acute iliofemoral arterial thrombosis, from which management recommendations can be informed. METHODS A single-institution retrospective study of pediatric patients diagnosed with iliofemoral arterial thrombosis from 2009 to 2018 was performed. Multiple parameters of management and follow-up were evaluated. Children anticoagulated for ≤28 days versus >28 days were compared. Data analysis used Fisher exact and Mann-Whitney U tests. RESULTS Two hundred thirty-six children were included. Median age at diagnosis was 65 days (interquartile range 17-163), with 207 diagnosed as infants, 15 diagnosed between 1 to 2 years, and 14 diagnosed between 2 to 16 years. The median treatment duration was 28 days (interquartile range 13-42); patients treated for >28 days had a longer time for thrombus resolution, and more follow-up ultrasounds were performed. Limb length discrepancy did not differ between the groups (1.0% vs 6.3%, P = .06), and no patients were documented to have developed peripheral arterial disease over a median 6.5-year follow-up. Multiple treatment strategies were employed, the most common being heparin bridged to enoxaparin (25.0%) and enoxaparin monotherapy (21.6%). Eight patients (3.4%) underwent surgical intervention. CONCLUSION Pediatric iliofemoral arterial thrombosis is primarily a disease of infants treated adequately with heparin or enoxaparin, infrequently requires surgical intervention, and is rarely associated with long-term complications. When guided by thrombus resolution on ultrasound, a four-week or shorter course of anticoagulation does not increase the need for surgical intervention or long-term complications.
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Affiliation(s)
- Alyssa E Vaughn
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
| | - Jessica K Hall
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Madison L Harrison
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Glendalyn Klein
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Jose Diaz-Miron
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Jeniann A Yi
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO. https://twitter.com/nnainej
| | - Shannon N Acker
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO. https://twitter.com/ShannonAcker12
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Palmieri A, Hicks V, Aikman N, Borowsky M, Haggerty A, ElSahwi K. Extended Venous Thromboembolism Prophylaxis after Robotic Staging for Endometrial Cancer. South Med J 2023; 116:790-794. [PMID: 37788812 DOI: 10.14423/smj.0000000000001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Our objectives were to estimate the incidence of venous thromboembolism (VTE) after robotic staging for endometrial cancer and to compare the incidence of VTE in patients who received a single dose of preoperative prophylaxis of enoxaparin with those who received extended postoperative prophylaxis. METHODS This study is a retrospective chart review of patients who underwent robot-assisted surgical staging for endometrial cancer. Patients were categorized into two groups: preoperative prophylaxis (PP), patients who received a single dose of enoxaparin preoperatively, and extended prophylaxis (EP), patients who received 28 days of enoxaparin postoperatively. RESULTS In total, 148 patients were included, with 117 patients in the PP group and 31 patients in the EP group. The overall incidence of VTE within 30 days postoperatively was 0.67%. No significant difference was found between the PP and the EP groups (0.9% and 0%, respectively; P = 1.00). Most patients in the cohort had endometrioid adenocarcinoma (78%) with low-grade disease (70%), although there were a greater number of patients in the PP group with uterine serous carcinoma compared with the EP group (17% vs 10%; P = 0.034). The PP group had higher estimated blood loss (106 vs 81 mL; P = 0.009) and longer operative times (178 vs 151 min; P = 0.028) compared with the EP group. Significantly more patients in the PP group underwent lymph node dissection compared with the EP group (32% vs 7%; P = 0.008). CONCLUSIONS The incidence of VTE following robot-assisted surgical staging for endometrial cancer in this study was 0.67%. No significant difference was found in VTE incidence between the PP group compared with the EP group. Mechanical prophylaxis plus a single dose of preoperative pharmacologic prophylaxis may suffice for low-risk patients following robotic surgical staging for endometrial cancer.
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Affiliation(s)
| | | | | | | | | | - Karim ElSahwi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Jersey Shore University Medical Center, Neptune, New Jersey
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Tsai SW, Chang WL, Pai FY, Chou TFA, Chen CF, Wu PK, Chen WM. Combination of enoxaparin and low-dose aspirin for thromboprophylaxis in selective patients after primary total joint arthroplasty in a Taiwanese population. J Chin Med Assoc 2023; 86:923-929. [PMID: 37563769 DOI: 10.1097/jcma.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND The incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after total joint arthroplasty (TJA) procedures are lower in Asian populations than in Caucasian populations. Therefore, the need for thromboprophylaxis in Asian patients undergoing TJA remains inconclusive. The aim of this study was to validate the clinical outcomes of thromboprophylaxis in selective TJA patients in a Taiwanese population. METHODS We retrospectively reviewed records of patients who underwent TJA procedures performed by a single-surgeon between January 2010 through December 2019. Patients received thromboprophylaxis with a combination of enoxaparin and low-dose aspirin if they fulfilled any of the following criteria: 1) body mass index >30 (kg/m 2 ), 2) presence of varicose veins, 3) history of DVT or PE, or 4) simultaneous bilateral TJA procedure. We assessed the incidence of DVT and PE, 90-day postoperative complications, length of stay, in-hospital mortality, 30-day and 90-day readmission, and 1-year reoperation. RESULTS Of the 7511 patients included in this study, 2295 (30.6%) patients received thromboprophylaxis. For patients who received thromboprophylaxis(N = 2295), the incidence of DVT and PE were 0.44% and 0%, respectively. For patients who did not receive thromboprophylaxis (N = 5216), the incidence of DVT and PE was 0.46% and 0.04%, respectively. The overall rates of 90-day postoperative complications (2.3%), 30-day (1.8%) and 90-day readmission (2.3%), and 1-year reoperation (1.1%) were low. CONCLUSION Providing thromboprophylaxis for selective TJA patients within the Taiwanese population was effective, as indicated by the low incidence of DVT and PE. Complications, such as surgical site infection, should be carefully weighed and managed.
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Affiliation(s)
- Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Lin Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Fu-Yuan Pai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Marc TB, Michel TP, Florence M, Tousaint M, Serge K, Chadrack B, Roly K, Gédéon D, Brady MM, Erick KN. "Hospital survival of patients with pulmonary embolism in a country with limited resources case of the city of Kinshasa". BMC Cardiovasc Disord 2023; 23:439. [PMID: 37667172 PMCID: PMC10476371 DOI: 10.1186/s12872-023-03467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Pulmonary embolism is a frequent cause of intra-hospital mortality. The survival of patients depends not only on the speed of diagnosis but also on the treatment initiated. OBJECTIVE to evaluate the intra-hospital survival of patients with pulmonary embolism in the city of Kinshasa. METHODOLOGY analytical cross-sectional study based on non-probability convenience sampling carried out in the city of Kinshasa; three hospitals selected for convenience on the basis of their technical platforms. The patients were judged to have had a pulmonary embolism after a chest CT angiography proved it. The data recorded on the Kobocollect site were exported in Excel format and analyzed with SPSS software version 23. The comparison of the means was made using the Student test and that frequencies with the Yates Chi-square test. The association was attributed by the calculation of the odds ratio and the survival presented according to the Cox regression. RESULTS Eighty-nine cases or 63 women and 26 men were analyzed, the mean age was 64.4 ± 15.6 years. Individuals over 65 died more (ß=0.043 and p-Value of 0.01) the female sex multiplied by 1.38 the risk of death (DNS, p-Value = 0.478). Approximately 80% of patients were classified as PESI stage II or III. Starting Rivaroxaban from the outset does not show any difference with enoxaparin in terms of intra-hospital survival. CONCLUSION Pulmonary embolism is a real problem in our environment, the age of more than 65 years and the female sex are factors of poor prognosis and predicted survival.
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Affiliation(s)
- Tshilanda Balekelayi Marc
- Department of Internal Medicine, Faculty of Medicine, Notre-Dame du Kasayi University, Kananga, Congo.
- Department of Internal Medicine, Center Hospitalier Mère-Enfant Monkole, Kinshasa, Congo.
- Department of Internal Medicine, Faculty of Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa, Congo.
| | - Tshiasuma Pipo Michel
- Department of Internal Medicine, Faculty of Medicine, Notre-Dame du Kasayi University, Kananga, Congo
| | - Mpembe Florence
- Department of Internal Medicine, Faculty of Medicine, Notre-Dame du Kasayi University, Kananga, Congo
| | - Mujijo Tousaint
- Department of Internal Medicine, Faculty of Medicine, Simon-Kimbangu University, Kinshasa, Congo
| | - Kazadi Serge
- Department of Internal Medicine, Faculty of Medicine, Notre-Dame du Kasayi University, Kananga, Congo
| | - Bosenedje Chadrack
- Department of Internal Medicine, Center Hospitalier Mère-Enfant Monkole, Kinshasa, Congo
| | - Kokusa Roly
- Department of Internal Medicine, Faculty of Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa, Congo
| | - Dizolele Gédéon
- Department of Internal Medicine, Faculty of Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa, Congo
| | - Makanzu Madioko Brady
- Department of Internal Medicine, Faculty of Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa, Congo
| | - Kamangu Ntambue Erick
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo
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Mottier D, Girard P, Couturaud F, Lacut K, Le Moigne E, Paleiron N, Guellec D, Sanchez O, Cogulet V, Laporte S, Marhic G, Mismetti P, Presles E, Robert-Ebadi H, Mahé I, Plaisance L, Reny JL, Darbellay Farhoumand P, Cuvelier C, Le Henaff C, Lambert Y, Danguy des Deserts M, Rousseau Legrand C, Boutreux S, Bleher Y, Decours R, Trinh-Duc A, Armengol G, Benhamou Y, Daumas A, Guyot SL, De Carvalho H, Lamia B, Righini M, Meyer G, Le Gal G. Enoxaparin versus Placebo to Prevent Symptomatic Venous Thromboembolism in Hospitalized Older Adult Medical Patients. NEJM Evid 2023; 2:EVIDoa2200332. [PMID: 38320142 DOI: 10.1056/evidoa2200332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Enoxaparin to Prevent Venous Thromboembolism in Older AdultsThis trial of thromboprophylaxis in medically ill, hospitalized older adults did not demonstrate that enoxaparin reduced the risk of symptomatic VTE after 1 month. Because the trial was prematurely discontinued, larger trials are needed to definitively address this question.
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Affiliation(s)
- Dominique Mottier
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, INSERM UMR 1304-GETBO, CIC INSERM 1412, F-CRIN INNOVTE, Brest, France
| | - Philippe Girard
- Institut du Thorax Curie-Montsouris, Département de Pneumologie, Institut Mutualiste Montsouris, Paris; F-CRIN INNOVTE, France
| | - Francis Couturaud
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, INSERM UMR 1304-GETBO, CIC INSERM 1412, F-CRIN INNOVTE, Brest, France
| | - Karine Lacut
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, INSERM UMR 1304-GETBO, CIC INSERM 1412, F-CRIN INNOVTE, Brest, France
| | - Emmanuelle Le Moigne
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, INSERM UMR 1304-GETBO, CIC INSERM 1412, F-CRIN INNOVTE, Brest, France
| | - Nicolas Paleiron
- Service de Pneumologie, Hôpital d'Instruction des Armées Saint Anne, Toulon, France
| | - Dewi Guellec
- Service de Rhumatologie, Centre d'Investigation Clinique INSERM UMR 1412, LBAI 37613, Centre Hospitalo-Universitaire de Brest, Brest, France
| | - Olivier Sanchez
- Université Paris Cité; Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, APHP Centre Université Paris Cité, INSERM UMRS 1140, Paris; F-CRIN INNOVTE, France
| | - Virginie Cogulet
- Service de la Pharmacie, Centre Hospitalo-Universitaire de Brest, Brest, France
| | - Silvy Laporte
- Unité de Recherche Clinique, Innovation, Pharmacologie, Centre Hospitalo-Universitaire de Saint-Etienne, Hôpital Nord, SAINBIOSE INSERM U1059, Université Jean Monnet, Saint-Etienne, France; F-CRIN INNOVTE, Saint-Etienne, France
| | - Gisèle Marhic
- Centre d'Investigation Clinique, INSERM 1412, Centre Hospitalier Universitaire, Brest, France
| | - Patrick Mismetti
- Service de Médecine et Thérapeutique, Unité de Pharmacologie Clinique, Centre Hospitalo-Universitaire de Saint-Etienne, Hôpital Nord, SAINBIOSE INSERM U1059, Université Jean Monnet, Saint-Etienne, France; F-CRIN INNOVTE, Saint-Etienne, France
| | - Emilie Presles
- Unité de Recherche Clinique, Innovation, Pharmacologie, Centre Hospitalo-Universitaire de Saint-Etienne, Hôpital Nord, SAINBIOSE INSERM U1059, Université Jean Monnet, Saint-Etienne, France; F-CRIN INNOVTE, Saint-Etienne, France
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva
| | - Isabelle Mahé
- Université Paris Cité, Service de Médecine Interne, Hôpital Louis Mourier, AP-HP, Colombes, France; Innovative Therapies in Haemostasis, INSERM UMR S1140, Paris; F-CRIN INNOVTE, Saint-Etienne, France
| | - Ludovic Plaisance
- Service de Médecine Interne, Hôpital Louis Mourier, AP-HP, Colombes, France
| | - Jean-Luc Reny
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Thônex, Switzerland
| | - Pauline Darbellay Farhoumand
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Thônex, Switzerland
| | - Clémence Cuvelier
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Thônex, Switzerland
| | - Catherine Le Henaff
- Service de Médecine Interne, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Yannick Lambert
- Service de Médecine Interne, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Marc Danguy des Deserts
- Unité de Recherche Clinique, Hôpital d'Instruction des Armées Clermont Tonnerre, Université de Bretagne Occidentale, INSERM UMR 1304-GETBO, F-CRIN INNOVTE, Brest, France
| | - Claire Rousseau Legrand
- Service de Médecine Interne, Hôpital d'Instruction des Armées Clermont Tonnerre, Brest, France
| | | | - Yves Bleher
- Service Médecine Post Urgence-Infectiologie, Hôpital La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Romain Decours
- Service Court Séjour Gériatrique, Hôpital La Roche-sur-Yon, La Roche-sur-Yon, France
| | | | - Guillaume Armengol
- Département de Médecine Interne, Centre Hospitalo-Universitaire de Rouen, Normandie Université, UNIROUEN 1096, Rouen, France
| | - Ygal Benhamou
- Département de Médecine Interne, Centre Hospitalo-Universitaire de Rouen, Normandie Université, UNIROUEN 1096, Rouen, France
| | - Aurélie Daumas
- Service de Médecine Interne, Gériatrie et Thérapeutique, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix Marseille Université, INSERM, INRAE, C2VN, Marseille, France
| | - Sarah-Lou Guyot
- Service de Médecine Polyvalente Urgence, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Hugo De Carvalho
- Service de Médecine Polyvalente Urgence, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Bouchra Lamia
- Département de Pneumologie, Centre Hospitalier du Havre, Université de Normandie, UNIROUEN EU 3830, Le Havre, France
| | - Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva
| | - Guy Meyer
- Université Paris Cité; Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, APHP Centre Université Paris Cité, INSERM UMRS 1140, Paris; F-CRIN INNOVTE, France
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa
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Abstract
BACKGROUND Guidelines for enoxaparin dosing after trauma recommend an initial dose of 40 mg twice daily for most patients and then adjusting by anti-Xa levels. Previous studies indicated higher enoxaparin doses are necessary with higher levels of creatinine clearance (CrCl). We sought to determine if the goal enoxaparin dose correlates with the admission CrCl to reduce the reliance on measuring anti-Xa levels. STUDY DESIGN A retrospective review was conducted of patients admitted to an urban, academic Level 1 trauma center from April 2017 to February 2020. Patients started on enoxaparin who reached goal anti-Xa trough levels were included, and patients were excluded if they did not reach goal anti-Xa levels. Data collection included patient demographics, injury characteristics, admission CrCl, and final enoxaparin dose. CrCl was then correlated with the final enoxaparin dose. RESULTS Of 421 patients included, the mean age was 46.6 years and 73% were male. The median goal enoxaparin dose was 40 mg twice daily. The mean CrCl significantly increased with increasing twice-daily doses of enoxaparin (20 mg: 69.2 mL/min; 30 mg: 89 mL/min; 40 mg: 112.8 mL/min; 50 mg: 140.5mL/min; 60 mg: 147.4 mL/min; and 70 mg: 140 mL/min; p < 0.01). CONCLUSIONS Admission CrCl may predict the enoxaparin dose required to achieve adequate anti-Xa levels. Our data indicate that CrCls of approximately 70, 90, 110, 140, and 150 mL/min may predict the twice-daily enoxaparin doses of 20, 30, 40, 50, and 60 mg, respectively. CrCl dosing guidance may reduce the time to goal anti-Xa levels and the frequency of anti-Xa measurements. Further research is necessary, and enoxaparin dosing should continue to be monitored by anti-Xa levels.
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Affiliation(s)
- Greigory Park
- From the Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA (Park, Fierro, Drevets, Stupinski, Ley)
| | - Navpreet K Dhillon
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD (Dhillon)
| | - Nicole M Fierro
- From the Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA (Park, Fierro, Drevets, Stupinski, Ley)
| | - Peter Drevets
- From the Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA (Park, Fierro, Drevets, Stupinski, Ley)
| | - John Stupinski
- From the Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA (Park, Fierro, Drevets, Stupinski, Ley)
| | - Eric J Ley
- From the Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA (Park, Fierro, Drevets, Stupinski, Ley)
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Gibson A, Montanez N, Addy K, Hashmi SS, Brown D, Rodriguez N, Menon N, Srivaths L. Once-daily Compared With Twice-daily Enoxaparin Maintenance Therapy Appears Safe and Efficacious in Pediatric Venous Thromboembolism. J Pediatr Hematol Oncol 2023; 45:e655-e659. [PMID: 36449733 DOI: 10.1097/mph.0000000000002601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/16/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Once-daily enoxaparin (ODE), considered standard of care for venous thromboembolism (VTE) treatment in adults, has been infrequently assessed in children. To contribute available data to a limited field, we reviewed our center's experience with ODE in treating pediatric VTE compared with twice-daily enoxaparin (TDE). MATERIALS AND METHODS A retrospective analysis of children and adolescents 18 years of age or below diagnosed with VTE and treated at our institution with ODE or TDE maintenance therapy between April 2015 and December 2020 was performed. Patient demographics, clinical and laboratory data pertaining to VTE diagnosis, and management were gathered from electronic medical records and compared between the 2 cohorts. RESULTS Seventy-one children met the eligibility criteria. All patients were initially treated with TDE for 2 weeks before transitioning to ODE maintenance therapy (n=39; 55%) or continuing with TDE dosing (n=32; 45%).Extremity VTE was more common in ODE ( P =0.051) versus pulmonary/intracardiac sites in TDE ( P =0.002) when compared with other sites. Median enoxaparin dosing was 1.5 and 1.1 mg/kg/dose in ODE and TDE cohorts, respectively. Bleeding episodes were rare without any difference between the cohorts. Two patients (6%) were lost to follow up in TDE cohort. All evaluable patients in both cohorts had either complete/partial response (ODE n=35 [90%]; TDE n=24 [75%] or stable thrombus ODE n=4 [10%]; TDE n=6 [19%]). CONCLUSIONS Our results indicate that ODE, used after the initial TDE treatment period, is as safe and efficacious as TDE maintenance for the treatment of pediatric VTE. The difference in VTE sites may have contributed to the equal efficacy of both the cohorts. Future prospective studies in pediatric VTE are needed to validate these results.
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Affiliation(s)
| | | | | | - S Shahrukh Hashmi
- Department of Pediatrics, McGovern Medical School, University of Texas Health and Science Center of Houston, Houston, TX
| | - Deborah Brown
- University of Texas MD Anderson Cancer Center
- Gulf States Hemophilia and Thrombophilia Center
- Department of Pediatrics, McGovern Medical School, University of Texas Health and Science Center of Houston, Houston, TX
| | - Nidra Rodriguez
- University of Texas MD Anderson Cancer Center
- Gulf States Hemophilia and Thrombophilia Center
- Department of Pediatrics, McGovern Medical School, University of Texas Health and Science Center of Houston, Houston, TX
| | - Neethu Menon
- University of Texas MD Anderson Cancer Center
- Gulf States Hemophilia and Thrombophilia Center
- Department of Pediatrics, McGovern Medical School, University of Texas Health and Science Center of Houston, Houston, TX
| | - Lakshmi Srivaths
- Gulf States Hemophilia and Thrombophilia Center
- Department of Pediatrics, McGovern Medical School, University of Texas Health and Science Center of Houston, Houston, TX
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21
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Chang CK, Higgins RM, Rein L, Peppard WJ, Herrmann DJ, Kindel T. Effectiveness of Body Mass Index-Based Prophylactic Enoxaparin Dosing in Bariatric Surgery Patients. J Surg Res 2023; 287:168-175. [PMID: 36933548 DOI: 10.1016/j.jss.2023.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/03/2023] [Accepted: 01/27/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Enoxaparin is administered for venous thromboembolic (VTE) prophylaxis in bariatric surgery patients. There is concern whether body mass index (BMI)-based enoxaparin dosing consistently achieves prophylactic targets in patients with severe obesity. METHODS This retrospective study included patients who underwent bariatric surgery at an academic medical center from Jan 2015-May 2021 and had an anti-Xa level drawn 2.5-6 h after ≥3 doses of BMI-based prophylactic enoxaparin. The primary outcome was the percentage of patients who achieved a target anti-Xa level. Secondary outcomes were prevalence of venous thromboembolic and bleeding events within 30 d post-operatively. RESULTS Overall, 137 patients were included. Mean BMI was 59.1 ± 10.4 kg/m2, mean age was 43.9 ± 13.3 y and 110 patients (80.3%) were female. Target anti-Xa levels were achieved in 116 patients (84.7%); 14 (10.2%) were above target and 7 (5.1%) were below target. Patients with above target anti-Xa levels were significantly shorter in height than those within target range (167.1 versus 159.8 cm, P = 0.003). Five patients (3.6%) had a bleeding event; no thromboembolisms occurred. Anti-Xa levels correlated more strongly with enoxaparin dose per unit estimated blood volume (EBV) than dose per unit BMI (Rho = 0.54 versus Rho = 0.33). CONCLUSIONS Target range anti-Xa levels were achieved in 85% of patients using BMI-based enoxaparin dosing. Patients with above target anti-Xa levels were significantly shorter by nearly 3 inches, suggesting an increased risk of overdosing enoxaparin in shorter, obese patients. An EBV-based dosing regimen may better account for patient height and is supported by a greater correlation with anti-Xa levels with dosing based on EBV than BMI.
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Affiliation(s)
- Catherine K Chang
- Medical College of Wisconsin School of Medicine, Milwaukee, Wisconsin
| | - Rana M Higgins
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lisa Rein
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William J Peppard
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Pharmacy, Froedtert Hospital, Milwaukee, Wisconsin
| | - David J Herrmann
- Department of Pharmacy, Froedtert Hospital, Milwaukee, Wisconsin
| | - Tammy Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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22
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Spiegelburg DT, Mannes M, Schultze A, Scheibenberger F, Müller F, Klitzing A, Messerer DAC, Nilsson Ekdahl K, Nilsson B, Huber-Lang M, Braun CK. Impact of surface coating and systemic anticoagulants on hemostasis and inflammation in a human whole blood model. PLoS One 2023; 18:e0280069. [PMID: 36634087 PMCID: PMC9836312 DOI: 10.1371/journal.pone.0280069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Surface compatibility with blood is critical both for scientific investigations on hemostasis and clinical applications. Regarding in vitro and ex vivo investigations, minimal alteration in physiological hemostasis is of particular importance to draw reliable conclusions on the human coagulation system. At the same time, artificial coagulation activation must be avoided, which is relevant for the patient, for example to prevent stent graft occlusion. The aim was to evaluate the advantages and disadvantages of antithrombotic and antifouling surface coatings in the context of their suitability for ex vivo incubation and the study of coagulation properties. METHODS We investigated the impact of different protocols for surface coating of synthetic material and different anticoagulants on hemostasis and platelet activation in ex vivo human whole blood. Blood samples from healthy donors were incubated in coated microtubes on a rotating wheel at 37°C. Two protocols for surface coating were analyzed for hemostatic parameters and metabolic status, a heparin-based coating (CHC, Corline Heparin Conjugate) without further anticoagulation and a passivating coating (MPC, 2-methacryloyloxethyl phosphorylcholine) with added anticoagulants (enoxaparin, ENOX; or fondaparinux, FPX). Employing the MPC-based coating, the anticoagulants enoxaparin and fondaparinux were compared regarding their differential effects on plasmatic coagulation by thrombelastometry and on platelet activation by flowcytometry and platelet function assays. RESULTS Using the CHC coating, significant coagulation cascade activation was observed, whereas parameters remained mostly unchanged with MPC-based protocols. Extended incubation caused significantly elevated levels of the soluble membrane attack complex. Neither ENOX nor FPX caused a relevant impairment of platelet function or activation capacity and thrombelastometric parameters remained unchanged with both protocols. For translational purposes, we additionally modeled endotoxemia with the MPC-based protocols by incubating with lipopolysaccharide plus/minus thrombin. While coagulation parameters remained unchanged, elevated Interleukin 8 and Matrix Metalloproteinase 9 demonstrated preserved immune cell responsiveness. CONCLUSIONS The MPC-based protocols demonstrated better hemocompatibility compared to CHC, and ENOX and FPX proved useful for additional anticoagulation. Furthermore, this simple-to-use whole blood model may be useful for experimental analyses of the early coagulatory and immunological response without decalcification.
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Affiliation(s)
- Doreen Tabea Spiegelburg
- Institute for Clinical and Experimental Trauma Immunology, University Hospital of Ulm, Ulm, Germany
| | - Marco Mannes
- Institute for Clinical and Experimental Trauma Immunology, University Hospital of Ulm, Ulm, Germany
| | - Anke Schultze
- Institute for Clinical and Experimental Trauma Immunology, University Hospital of Ulm, Ulm, Germany
| | - Frieder Scheibenberger
- Institute for Clinical and Experimental Trauma Immunology, University Hospital of Ulm, Ulm, Germany
| | - Frederik Müller
- Institute for Clinical and Experimental Trauma Immunology, University Hospital of Ulm, Ulm, Germany
| | - Amadeo Klitzing
- Institute for Clinical and Experimental Trauma Immunology, University Hospital of Ulm, Ulm, Germany
| | - David Alexander Christian Messerer
- Institute for Clinical and Experimental Trauma Immunology, University Hospital of Ulm, Ulm, Germany
- Department of Transfusion Medicine and Hemostaseology, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Kristina Nilsson Ekdahl
- Centre of Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala, Sweden
| | - Bo Nilsson
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala, Sweden
| | - Markus Huber-Lang
- Institute for Clinical and Experimental Trauma Immunology, University Hospital of Ulm, Ulm, Germany
| | - Christian Karl Braun
- Institute for Clinical and Experimental Trauma Immunology, University Hospital of Ulm, Ulm, Germany
- * E-mail:
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Derbalah A, Duffull S, Sherwin CM, Job K, Al‐Sallami H. Optimal dosing of enoxaparin in overweight and obese children. Br J Clin Pharmacol 2022; 88:5348-5358. [PMID: 35816401 PMCID: PMC9795990 DOI: 10.1111/bcp.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/17/2022] [Accepted: 07/01/2022] [Indexed: 12/30/2022] Open
Abstract
AIM Current enoxaparin dosing guidelines in children are based on total body weight. This is potentially inappropriate in obese children as it may overestimate the drug clearance. Current evidence suggests that obese children may require lower initial doses of enoxaparin, therefore the aim of this work was to characterise the pharmacokinetics of enoxaparin in obese children and to propose a more appropriate dosing regimen. METHODS Data from 196 unique encounters of 160 children who received enoxaparin treatment doses were analysed. Enoxaparin concentration was quantified using the chromogenic anti factor Xa (anti-Xa) assay. Patients provided a total of 552 anti-Xa samples. Existing published pharmacokinetic (PK) models were fitted and evaluated against our dataset using prediction-corrected visual predictive check plots (pcVPCs). A PK model was fitted using a nonlinear mixed-effects modelling approach. The fitted model was used to evaluate the current standard dosing and identify an optimal dosing regimen for obese children. RESULTS Published models of enoxaparin pharmacokinetics in children did not capture the pharmacokinetics of enoxaparin in obese children as shown by pcVPCs. A one-compartment model with linear elimination best described the pharmacokinetics of enoxaparin. Allometrically scaled fat-free mass with an estimated exponent of 0.712 (CI 0.66-0.76) was the most influential covariate on clearance while linear fat-free mass was selected as the covariate on volume. Simulations from the model showed that fat-free mass-based dosing could achieve the target anti-Xa activity at steady state in 77.5% and 78.2% of obese and normal-weight children, respectively, compared to 65.2% and 75.5% for standard total body weight-based dosing. CONCLUSIONS A population PK model that describes the time course of anti-Xa activity of enoxaparin was developed in a paediatric population. Based on this model, a unified dosing regimen was proposed that will potentially improve the success rate of target attainment in overweight/obese patients without the need for patient body size categorisation. Therefore, prospective validation of the proposed approach is warranted.
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Affiliation(s)
| | | | - Catherine M. Sherwin
- Department of PediatricsWright State University Boonshoft School of Medicine/Dayton Children's Hospital. DaytonOHUSA
| | - Kathleen Job
- School of MedicineUniversity of UtahSalt Lake CityUTUSA
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Bruno AM, Allshouse AA, Campbell HM, Branch DW, Lim MY, Silver RM, Metz TD. Weight-Based Compared With Fixed-Dose Enoxaparin Prophylaxis After Cesarean Delivery: A Randomized Controlled Trial. Obstet Gynecol 2022; 140:575-583. [PMID: 36075079 PMCID: PMC10473241 DOI: 10.1097/aog.0000000000004937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/14/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate fixed compared with weight-based enoxaparin dosing to achieve prophylactic anti-Xa levels after cesarean delivery. METHODS Individuals meeting institutional criteria for enoxaparin thromboprophylaxis after cesarean delivery were randomly allocated to fixed (40 mg daily for body mass index [BMI, calculated as weight in kilograms divided by height in meters squared] lower than 40; 40 mg every 12 hours for BMI 40 or higher) or weight-based (0.5 mg/kg every 12 hours) enoxaparin dosing. Enoxaparin was initiated during inpatient hospitalization and continued at discharge for 14 days. Those with contraindication to anticoagulation, plan for therapeutic anticoagulation, or known renal impairment were excluded. The trial was unmasked. The primary outcome was prophylactic (0.2-0.6 international units/mL) peak anti-Xa level 4-6 hours after at least the third enoxaparin dose (at steady state). Secondary outcomes included subprophylactic and supraprophylactic peaks, outpatient peak, and venous thromboembolism (VTE) and wound complications in the first 6 weeks postpartum. Sample size of 121 per group was planned. At interim analysis with 50% enrollment, the trial was stopped early for efficacy. Primary analyses followed intention-to-treat principle with worst-case imputation for missing outcomes. Secondary analyses were complete case. RESULTS From June 2020 to November 2021, 74 individuals were randomized to weight-based enoxaparin and 72 to fixed-dose enoxaparin. Those who received weight-based dosing were more likely to achieve prophylactic anti-Xa levels than those who received fixed dosing in primary analysis (49/74 [66%] vs 32/72 [44%], relative risk [RR] 1.49, 95% CI 1.10-2.02) and secondary analysis (49/60 [82%] vs 32/57 [56%], RR 1.45, 95% CI 1.12-1.88). Subprophylactic levels occurred more frequently with fixed dosing; supraprophylactic levels did not differ significantly by dosing. At the outpatient postoperative visit, 52% of participants (15/29) with weight-based dosing compared with 15% (5/33) with fixed dosing achieved prophylactic peak anti-Xa level (RR 3.41, 95% CI 1.42-8.24). There were no VTEs in either group. Wound complications occurred in five individuals (7%) with weight-based enoxaparin dosing compared with one individual (1%) with fixed enoxaparin dosing (RR 4.86, 95% 0.58-40.63). CONCLUSION Weight-based dosing was more effective than fixed enoxaparin dosing in achieving prophylactic peak anti-Xa levels after cesarean delivery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04305756.
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Affiliation(s)
- Ann M. Bruno
- University of Utah Health, Salt Lake City, UT
- Intermountain Healthcare, Murray, UT
| | | | - Heather M. Campbell
- University of Utah Health, Salt Lake City, UT
- Intermountain Healthcare, Murray, UT
| | - D. Ware Branch
- University of Utah Health, Salt Lake City, UT
- Intermountain Healthcare, Murray, UT
| | - Ming Y. Lim
- University of Utah Health, Salt Lake City, UT
| | - Robert M. Silver
- University of Utah Health, Salt Lake City, UT
- Intermountain Healthcare, Murray, UT
| | - Torri D. Metz
- University of Utah Health, Salt Lake City, UT
- Intermountain Healthcare, Murray, UT
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25
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Husain SA. Is Blood Thicker Than Water? Perhaps Not Always…. Ann Thorac Surg 2022; 114:889. [PMID: 34166636 DOI: 10.1016/j.athoracsur.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/01/2022]
Affiliation(s)
- S Adil Husain
- University of Utah School of Medicine, 100 N Mario Capecchi Dr, Ste 220, Salt Lake City, UT 84113.
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Calabretta F, Preti PS, Russo M, Klersy C, Di Sabatino A. The role of heparin in reducing in-hospital complications and three-month mortality rates in hospitalized COVID-19 patients. Eur J Intern Med 2022; 101:124-127. [PMID: 35307245 PMCID: PMC8923898 DOI: 10.1016/j.ejim.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Affiliation(s)
- F Calabretta
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.
| | - P S Preti
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - M Russo
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - C Klersy
- Clinical Epidemiology and Biometry Service. IRCCS Policlinico San Matteo Foundation. Pavia, Italy
| | - A Di Sabatino
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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Di Micco P, Imbalzano E, Russo V, Attena E, Mandaliti V, Orlando L, Lombardi M, Di Micco G, Camporese G, Annunziata S, Piccinocchi G, Pacelli W, Del Guercio M. Heparin and SARS-CoV-2: Multiple Pathophysiological Links. Viruses 2021; 13:v13122486. [PMID: 34960754 PMCID: PMC8705068 DOI: 10.3390/v13122486] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 12/22/2022] Open
Abstract
Low molecular weight heparin, enoxaparin, has been one of most used drugs to fight the SARS-CoV-2 pandemic. Pharmacological properties of heparin recognize its specific ability, as with other oligosaccharides and glycosaminoglycan, to bind several types of viruses during their pass through the extracellular matrix of the respiratory tract, as well as its anticoagulant activity to prevent venous thromboembolism. Antithrombotic actions of enoxaparin have been testified both for inpatients with COVID-19 in regular ward and for inpatients in Intensive Care Units (ICUs). Prophylactic doses seem to be able to prevent venous thromboembolism (VTE) in inpatients in the regular ward, while intermediate or therapeutic doses have been frequently adopted for inpatients with COVID-19 in ICU. On the other hand, although we reported several useful actions of heparin for inpatients with COVID-19, an increased rate of bleeding has been recorded, and it may be related to several conditions such as underlying diseases with increased risks of bleeding, increased doses or prolonged administration of heparin, personal trend to bleed, and so on.
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Affiliation(s)
- Pierpaolo Di Micco
- Department of Medicine, Buon Consiglio Fatebenefratelli Hospital of Naples, 80122 Naples, Italy
- Correspondence:
| | - Egidio Imbalzano
- Dipartimento Di ClinicaMedica E Farmacologia, University of Messina, 98100 Messina, Italy; (E.I.); (L.O.)
| | - Vincenzo Russo
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, Piazzale Ettore Ruggeri, 80131 Naples, Italy;
| | - Emilio Attena
- Division of Cardiology, San Giuliano Hospital, 80014 Giugliano in Campania, Italy;
| | | | - Luana Orlando
- Dipartimento Di ClinicaMedica E Farmacologia, University of Messina, 98100 Messina, Italy; (E.I.); (L.O.)
| | - Maurizio Lombardi
- Cardiocenter Outpatients Clinic, 80121 Naples, Italy; (M.L.); (W.P.)
| | - Gianluca Di Micco
- Division of Cardiology, Ospedale Buon Consiglio, Fatebenefratelli, 80122 Naples, Italy;
| | - Giuseppe Camporese
- Unit of Angiology, Department of Cardiac, Thoracic and Vascular Sciences, Padua University, 35100 Padua, Italy;
| | | | | | - Walter Pacelli
- Cardiocenter Outpatients Clinic, 80121 Naples, Italy; (M.L.); (W.P.)
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Ali Hasan M, Azeez Alsaadi M, Tahseen Mehsen J. Effectiveness of apixaban versus enoxaparin in preventing wound complications and deep venous thrombosis following total knee replacement surgery: A retrospective study. Int J Clin Pract 2021; 75:e14552. [PMID: 34145954 DOI: 10.1111/ijcp.14552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Enoxaparin, a thromboprophylactic drug that is widely used for preventing deep venous thrombosis (DVT) and surgical wound complications after total knee replacement surgery, can only be administered subcutaneously. Apixaban, a novel factor Xa inhibitor that could be comparable to enoxaparin, is an oral formulation and thus would be easier to manage. OBJECTIVE To compare the thromboprophylactic effectiveness of apixaban and enoxaparin in patients receiving total knee replacements. METHODS In this retrospective, single-institution study, the records of 200 patients who underwent elective total knee replacement surgery were reviewed. Of those, 120 patients had received enoxaparin 4000 IU daily (initiated 6 hours before surgery), whereas 80 had received apixaban 2.5 mg twice daily (initiated 12 hours after surgery), for 21 days. All patients were examined for major and minor surgical wound complications and DVT incidence during their hospital stay and 7-21 days after surgery. RESULTS No statistically significant differences (P ≥ .005) were found between the apixaban and enoxaparin groups with regard to minor and major surgical wound complications and DVT incidence. Patients in both groups were comparable in terms of age, hospital stay, and required blood transfusion units. Two enoxaparin-treated patients and one apixaban-treated patient developed DVT (1.5%) during the study period. CONCLUSION Oral apixaban is an effective alternative to enoxaparin as a thromboprophylactic drug for patients undergoing elective total knee replacement surgery.
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Chong MJ, Chiam C. Commentary on: Efficacy and safety of short-term (3 days) enoxaparin in preventing venous thromboembolism after gastric cancer surgery: A single-center, prospective cohort study [Int J Surg 021 Epub ahead of Print]. Int J Surg 2021; 92:106026. [PMID: 34280562 DOI: 10.1016/j.ijsu.2021.106026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Marcus Jw Chong
- The Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, United Kingdom.
| | - Carolyn Chiam
- School of Medicine, Dentistry & Nursing, University of Glasgow, United Kingdom
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30
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Puspitasari AD, Salean DDC, Hasmono D, Hartono R, Ardiana M. A study of anticoagulant therapy in patients with coronary artery disease. J Basic Clin Physiol Pharmacol 2021; 32:473-478. [PMID: 34214300 DOI: 10.1515/jbcpp-2020-0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES One of the methods used to treat coronary artery disease (CAD) is anticoagulant therapy, which involves administering anticoagulants to patients that inhibit the arrangement and actuation of clotting factors. Anticoagulant therapy in patients with CAD must be monitored and evaluated because its greatest side effect is the risk of bleeding. The research aimed to analyze anticoagulants used in therapy for CAD patients and identify potential adverse drug reactions and adverse drug interactions. METHODS This was an observational study which collected data retrospectively at Bhayangkara Hospital Surabaya. Patient data had to meet the requirements for inclusion, which were patients treated for a diagnosis of CAD with anticoagulant therapy and were in conditions with or without complications and comorbid diseases. Data were obtained from 40 patient medical records. The data were then processed descriptively. RESULTS Most patients were male (80%) and aged 61-70 years old (37.5%). Fondaparinux was administered to 18 patients at a dose of 1 × 2.5 mg SC. Furthermore, enoxaparin was administered to 15 patients at a dose of 2 × 60 mg SC, and seven patients received warfarin at a dose of 1 × 2-4 mg per oral. CONCLUSIONS The anticoagulants used in this study were fondaparinux 1 × 2.5 mg SC (45%), enoxaparin 2 × 60 mg SC (37.5%), and warfarin 1 × 2-4 mg PO (17.5%). Side effects of the anticoagulants were absent. However, drug interactions with aspirin, clopidogrel, and allopurinol increased the risk of bleeding.
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Affiliation(s)
- Arina D Puspitasari
- Clinical Pharmacy Department, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
- Universitas Airlangga Hospital, Surabaya, Indonesia
| | | | - Didik Hasmono
- Clinical Pharmacy Department, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
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Tardy B, Buchmuller A, Bistervels IM, Ni Ainle F, Middeldorp S. Thromboprophylaxis in pregnant women: For whom and which LMWH dosage? J Thromb Haemost 2019; 17:1401-1403. [PMID: 31368223 DOI: 10.1111/jth.14547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Bernard Tardy
- Inserm CIC 1408, FCRIN-INNOVTE, CHU de Saint Etienne, Saint Etienne, France
| | - Andrea Buchmuller
- Inserm CIC 1408, FCRIN-INNOVTE, CHU de Saint Etienne, Saint Etienne, France
| | - Ingrid M Bistervels
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Fionnuala Ni Ainle
- Department of Haematology, Mater Misericordiae University Hospital and Rotunda Hospital, Dublin, Ireland
| | - Saskia Middeldorp
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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32
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Solt I, Ben David C, Carp H. Enoxaparin (or plus aspirin) for the prevention of recurrent miscarriage: a meta-analysis of randomized controlled studies. Eur J Obstet Gynecol Reprod Biol 2019; 239:67-68. [PMID: 31000143 DOI: 10.1016/j.ejogrb.2019.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/27/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Ido Solt
- Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
| | - Chen Ben David
- Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel.
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Bertoletti L, Murgier M, Stelfox HT. Direct oral anticoagulants for venous thromboembolism prophylaxis in critically ill patients: where do we go from here? Intensive Care Med 2019; 45:549-551. [PMID: 30911805 DOI: 10.1007/s00134-019-05605-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, 42055, Saint-Etienne, France
- INSERM, CHU Saint-Etienne, CIC-1408, 42055, Saint-Etienne, France
| | - Martin Murgier
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, 42055, Saint-Etienne, France
- Service de Médecine Intensive et Réanimation, CHU de St-Etienne, Saint-Etienne, France
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Alberta Health Services, Calgary, AB, Canada.
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34
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Affiliation(s)
- Ahmed Ibrahim
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
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35
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Stensland KD, Katz EG, Canes D. Re: Extended Duration Enoxaparin Decreases the Rate of Venous Thromboembolic Events after Radical Cystectomy Compared to Inpatient Only Subcutaneous Heparin: J. J. Pariser, S. M. Pearce, B. B. Anderson, V. T. Packiam, V. N. Prachand, N. D. Smith and G. D. Steinberg J Urol 2017;197:302-307. J Urol 2017; 198:707-708. [PMID: 28577378 DOI: 10.1016/j.juro.2017.04.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Kristian D Stensland
- Lahey Hospital and Medical Center, Burlington, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eric G Katz
- Lahey Hospital and Medical Center, Burlington, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David Canes
- Lahey Hospital and Medical Center, Burlington, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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36
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Beyer-Westendorf J. Letter to the Editor "Gender related aspects of bleeding with rivaroxaban in venous thromboembolism - Potential for pitfalls": A comment to "Impact of gender on safety and efficacy of rivaroxaban in adolescents & young adults with venous thromboembolism" by Manuela Krause et al. (Thrombosis Research 2016, published online). Thromb Res 2016; 148:152-153. [PMID: 28029382 DOI: 10.1016/j.thromres.2016.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Jan Beyer-Westendorf
- Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital "Carl Gustav Carus", Fetscherstrasse 74, 01307 Dresden, Germany; Kings Thrombosis Service, Department of Hematology, Kings College London, UK.
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37
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Vijayan V, Rachel T. Pregnancy outcomes compared in women with mechanical heart valve replacements anticoagulated with warfarin and enoxaparin in pregnancy. Med J Malaysia 2012; 67:591-594. [PMID: 23770951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The anticoagulation of choice for mechanical heart valves is the oral anticoagulant warfarin. Warfarin is associated with increased risk of miscarriage, intrauterine fetal deaths and warfarin embryopathy. This longitudical cross-over study of 5 women observed all 5 having livebirths of healthy infants after heparin-managed pregnancies. Their earlier 8 pregnancies had all resulted in perinatal losses or miscarriages when on regimes based on warfarin.
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Affiliation(s)
- V Vijayan
- Sabah Women & Children Hospital, Kota Kinabalu, Sabah, Malaysia.
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38
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Deal EN, Hollands JM. Contraindicated medication use in dialysis patients. JAMA 2010; 303:1481-2; author reply 1482. [PMID: 20407055 DOI: 10.1001/jama.2010.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Garrick BJ. Interval analysis versus probabilistic analysis. Risk Anal 2010; 30:369-370. [PMID: 20487396 DOI: 10.1111/j.1539-6924.2010.01360.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Maslovitz S, Many A, Landsberg JA, Varon D, Lessing JB, Kupferminc MJ. The safety of low molecular weight heparin therapy during labor. J Matern Fetal Neonatal Med 2009; 17:39-43. [PMID: 15804785 DOI: 10.1080/14767050400028626] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Current recommendations are to discontinue low molecular weight heparin (LMWH) at least 24 hours prior to labor induction or administering epidural anesthesia. We assessed the safety of discontinuing LMWH 12-24 hours before delivery. METHODS We evaluated the prevalence of hemorrhagic complications during labor, cesarean or epidural catheter placement in 284 women treated with enoxaparin during pregnancy as compared with 16132 untreated women. Treated participants were divided into subgroups by the various intervals between last LMWH dose hemorrhage-prone events (vaginal delivery,epidural, cesarean etc.). The rate of hemorrhagic complications and hemoglobin values were compared between the study and control groups. RESULTS Postpartum hemorrhage was uncommon and occurred in 2.1% and 1.9% in study and control groups, respectively (p=0.13). Antenatal as well as postnatal hemoglobin values were very similar for treated and untreated women. No differences were noted between women who discontinued enoxaprin 12-24 hours before labor and those who discontinued treatment later with regard to maternal hemorrhagic complications. No spinal hematomas were report among 12792 treated and un-treated women who had epidural or spinal block. No hemorrhagic neonatal complications were encountered. CONCLUSION Discontinuing LMWH more than 12 hours before delivery is safe in relation to maternal hemorrhagic complications.
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Affiliation(s)
- Sharon Maslovitz
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Imberti D, Pierfranceschi MG. Successful Protein C Concentrate Administration during Initiation of Oral Anticoagulation in Adult Patients with Severe Congenital Protein C Deficiency: Report of Two Cases. Pathophysiol Haemos Thromb 2009; 36:53-7. [PMID: 19127082 DOI: 10.1159/000173721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 02/15/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Davide Imberti
- Thrombosis and Haemostasis Center, Emergency Department, Piacenza Hospital, Piacenza, Italy.
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Mitome J, Yamamoto H. [Anticoagulant]. Nihon Rinsho 2004; 62 Suppl 5:368-73. [PMID: 15197947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Jun Mitome
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine
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Gratsianskiĭ NA, Alesh De Konto A, Zuniga MA, Enar R, Akhmed Sheĭkh C, Makarie K. [ Enoxaparin for the Treatment of Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: the ENO-INT Study]. Kardiologiia 2004; 44:4-7. [PMID: 15211341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
UNLABELLED AIM. To assess safety and efficacy of enoxaparin in patients with UA/NSTEMI in an open-label, multi-centre, non-comparative study and to compare the results with data from large-scale randomized trials ESSENCE and TIMI-11B. METHODS Patients hospitalized with a diagnosis of recent UA/NSTEMI were treated with 1 mg/kg enoxaparin every 12 hours for 2-8 days. The composite endpoint of the study was death, myocardial infarction (MI) or recurrent angina at day 15 (or hospital discharge). Minor and major bleedings were recorded. RESULTS A total of 1902 patients were enrolled in 109 centers across 24 countries, of which 1901 received at least one injection of enoxaparin and 1785 (93.8%) completed the study (follow-up). Throughout the study (day 180) 21.4% of patients underwent at least one revascularization, of which 4.4% were urgent. The incidence of the composite efficacy endpoint was 16.3% after 15 days and 27.9% on day 180, which was comparable with the enoxaparin arm of the ESSENCE/TIMI 11B studies, and lower than the incidence found in the UFH arm of those studies. At day 15 or hospital discharge the occurrence of major and minor haemorrhages was 1.1 and 6.6%, respectively, which was lower than in ESSENCE/TIMI 11B. More bleeding complications (major and minor) were noted in patients aged </= 75 years (11.2%) versus those of <75 years (7.1%). Independent predictors of 180-day adverse outcome (death, MI, recurrent angina) were: age (OR 1.02, 95% DI: 1.01-1.03), prior aspirin treatment (OR 1.33, 95% DI: 1.15-1.47) and previous PTCA (OR 1.4, 95% DI: 1.11-1.59). CONCLUSION These results which are highly consistent with those previously reported from ESSENCE and TIMI 11B trials evidence for safety and effectiveness of enoxaparin in the treatment of UA and NSTEMI.
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Affiliation(s)
- N A Gratsianskiĭ
- Research Institute for Physicochemical Medicine; ul. Malaya Pirogovskaya 1a, 119828 Moscow, Russia
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Dolenska S. Neuroaxial blocks and LMWH thromboprophylaxis. Hosp Med 1998; 59:940-3. [PMID: 10696357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
In the last 12 months, the Food and Drug Administration issued two documents warning the medical profession about the concurrent use of low molecular weight heparins (LMWHs) and neuroaxial blocks. This article summarizes the American and European experiences with LMWH thromboprophylaxis that could help with risk assessment.
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Affiliation(s)
- S Dolenska
- Department of Anaesthetics, Guy's Hospital, London
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