Small Doses Of Heparin Research Articles

997-P: Testing a Novel Infusion Set for Extended Wear Duration

This was a randomized double blinded study of a novel infusion set with and without heparin, hypothesizing that small doses of heparin would decrease thrombosis and subcutaneous inflammation. The MiniMed™ Quick-set™ infusion set was modified with a new tubing connector from current P-Cap. The P-Cap was modified to contain a foam (F) or a foam with heparin (F+H) connector. Visibly the sets appeared identical. Each participant wore two F and two F + H sets for 7 days or until set failure. The order of infusion set wear was randomly assigned. Infusion set failure was determined by unexplained hyperglycemia >250mg/dL with a failed correction dose, ketones >0.6mmol/L, evidence of infection, occlusion alarms, or adhesive failure. Infused set survival was compared to similar published 1-week studies using standard Quick-sets. There were 20 participants (mean age 29.5±8 years). Each set was worn 40 times. Length of wear and causes of failure are shown below. Length of wear was not different between the F and F+H groups, but both had improved length of wear compared to historical Quick-sets (p<0.05). There was no significant increase in insulin requirements or mean glucose values throughout the seven days of wear in any group. There was no difference in overall duration of wear between the F and F+H groups. Both infusion set groups intended for extended wear had significantly better survival than the historical Quick-Set™ group. Further studies are planned with the F group. Disclosure B.A. Buckingham: Advisory Panel; Self; ConvaTec Inc., Medtronic. Research Support; Self; Beta Bionics, Inc., Dexcom, Inc., Insulet Corporation, Medtronic, Tandem Diabetes Care. T. Marcal: None. L. Hoffman: None. G. Musolino: None. L. Ekhlaspour: None. G. Zhang: None. S. Chattaraj: Employee; Self; Medtronic. Funding Medtronic Diabetes

ЭФФЕКТЫ ГЕПАРИНА ПРИ ПОСТТРАВМАТИЧЕСКОМ СТРЕССОВОМ РАССТРОЙСТВЕ В ЭКСПЕРИМЕНТЕ, "Российский физиологический журнал им. И.М. Сеченова"

Используя модель воздействия предаторного стресса на половозрелых самцах крыс линии Вистар воспроизводили посттравматическое стрессовое расстройство (ПТСР). Базовые признаки ПТСР определяли по поведению животных в приподнятом крестообразном лабиринте. Зарегистрировано ПТСР-индуцированное снижение уровня циркулирующего кортикостерона, дистрофические изменения в печени, нарушение состояния гематологического баланса. Обнаруженные психосоматические нарушения не проявлялись у крыс, которым после стрессирования внутрибрюшинно вводили малые дозы гепарина (64 МЕ/кг). Полученные результаты могут послужить обоснованием для расширения клинического применения гепарина в малых дозах с целью предупреждения и лечения психосоматической патологии при ПТСР.

Dosage and medication method and time of heparin for neonatal disseminated intravascular coagulation

Objective To explore the dosage and medication method and time of heparin for neonatal disseminated intravascular coagulation(DIC).Methods 40 newborns with DIC chosen from our hospital from October 2010 to April 2013 were randomly divided into an experimental group and a control group,20 for each group.All patients underwent comprehensive treatment.The experimental group were intravenously injected a micro-dose of heparin,while the control group intravenously took a conventional dose of heparin.The cure rates,mortalities,hospitalization cost,length of hospital stay,and adverse occurrences of both groups were observed.Results There were statistical differences in cure rate,mortality,length of hospital stay,hospitalization cost,and mortality between the experimental group and the control group(P＜ 0.05).Conclusions Intravenous injection of a small dose of heparin for newborn DIC is safe and effective and has fewer adverse reactions,and is worth being clinically generalized. Key words: Heparin; Neonate; Disseminated intravascular coagulation; Intravenous injection; Micro-metering

A controlled study on the treatment of acute progressive cerebral infarction by continuous anticoagulation with small doses of heparin

To discuss the treatment of acute progressive cerebral infarction by continuous anticoagulation with small doses of heparin. A prospective, randomized, and controlled clinical research was conducted. Three hundred and fifty-one patients were randomly divided into three groups. Group A (n=119) was treated with heparin, which was controlled by an infusion pump with a speed of 18 U×kg(-1)×h(-1) for 24 hours, and the dosage was regulated according to the changes in activated partial thromboplastin time (APTT) which was determined every 8 hours. Group B (n=115) was treated with intravenous drip of 12,500 U of heparin with a speed of 18 U×kg(-1)×h(-1) once a day. Group C (n=117) was treated with 5000 U of low-molecular-weight heparin calcium injection twice a day. After 14 days, nerve function defect according to the National Institutes of Heath stroke scale (NIHSS) score was determined, the adverse events (e.g. intracranial hemorrhage, subcutaneous ecchymosis, gingival bleeding, hematuria and occult blood in stools) were observed. After 6 months, the recurrence rate and Barthel index (BI) would be determined. The total efficiency in group A (95.80%) was significantly higher than that in group B (85.22%) and group C (85.47%). Recurrence rate in group A (1.68%) was significantly lower than group B (8.70%) and group C (8.33%) with significant differences (P<0.05 or P<0.01), while there was no significant difference between group B and group C (both P>0.05). The BI of group A (89.27±8.56) was significantly higher than group B (72.57±9.77) and group C (71.66±9.37) with significant difference (both P<0.01), while there was no significant difference between group B and group C (P>0.05). Adverse event rate in group A (5.88%) was slightly higher than that of group B (3.48%) and group C (4.27%), but the difference was not significant (both P>0.05). Continuous infusion of low dosage of heparin could significantly reduce neurologic impairment score in patients with progressive cerebral infarction, increase cure rate, reduce the recurrence rate, and raise the BI of patients, and it dose not increase the risk of intracranial and extracranial hemorrhage.

Post-TACE Combination Therapy of Heparin and Octreotide Results in Decreased Tumor Metastasis in Extrahepatic Tumorigenesis

Primary hepatocarcinoma is the most common type of malignant tumor and a leading cause of cancer mortality. Standard treatment for patients with advanced primary hepatocarcinoma for whom surgery is not recommended includes transcatheter arterial chemoembolization (TACE). Within these patients 44% develop metastasis within 1 year. Thus, understanding the events underlying the recurrent tumors and developing therapies in conjunction with TACE would be of great benefit. Reducing tumor angiogenesis by combining the somatostatin analog octreotide with small doses of heparin is one approach in decreasing metastasis rates by targeting VEGF and heparinase, respectively. Given this, we investigated whether a heparin and octreotide combination treatment administered post-TACE would decrease the tumor metastasizing rate in primary hepatocarcinoma. A total of 147 patients diagnosed with primary hepatocarcinoma were admitted to the study and received 2-4 TACE treatments and were monitored for 1 year. Of these 84 received the heparin plus octreotide combination treatment and 63 did not (control group). All patients were monitored for adverse reactions, coagulation ability, and tumor metastasis. We found a significant decrease in the incidence of tumor metastasis in patients receiving the combination treatment post-TACE for up to 1 year with no significant toxic or adverse effects. Thus, we propose using the combination treatment of heparin and octreotide post-TACE in the treatment of recurrent tumorigenesis in primary hepatocarcinoma.

Severe thrombosis and acute thrombocytopenia in a cancer patient

A 62-year-old Caucasian female who had recently been diagnosed with multiple myeloma with a sacral plasmacytoma received induction treatment with bortezomib, cyclophosphamide, and dexamethasone. She had a significant response to therapy and had just begun the process of mobilization and collection of peripheral blood progenitor cells for autologous stem cell transplantation when she presented to the emergency center (EC) with pain and swelling of the left upper extremity. Her blood pressure on presentation was 114/69 mmHg with a heart rate of 98 beats per minute. Serum sodium was 136 mEq/L, potassium 4.3 mEq/L, chloride 98 mEq/L, carbon dioxide 24 mEq/L, blood urea nitrogen 9 mg/dL, serum creatinine 0.6 mg/dL, glucose 119 mg/dL, calcium 8.6 mg/dL, albumin 3.9 mg/dL, phosphorus 2.5 mg/dL, and magnesium 2.1 mg/dL. Liver function tests were within normal limits, with the exception of lactate dehydrogenase that was elevated at 728 IU/L. Prothrombin time (PT) was 16.5 sec (normal 12.7―15 sec), international normalized ratio (INR) 1.24, and activated PTT (aPTT) was 38.3 sec (normal 24.7―35.9 sec). D-dimer was >20 μg/mL (normal 0―0.4 μg/dL) and fibrinogen was 424 mg/dL. A complete blood count (CBC) showed a white blood cell (WBC) count of 11,400/μL, hemoglobin of 11.6 g/dL, and platelet count of 14,000/μL. Review of the peripheral smear revealed the presence of anisocytosis and ovalocytes, and the absence of fragmented red blood cells (schistocytes). The platelet count had dropped from 316,000/μL to 14,000/μL in a 7-day period (see Fig. 1). Home medications included zolpidem, lorazepam, duloxetine, famotidine, fentanyl, hydromorphone, and ondansetron. Doppler ultrasound study showed a completely occlusive thrombus within the left internal jugular vein extending to the subclavian, axillary, brachial, and basilic veins. The patient had recently had a left subclavian central venous catheter (CVC) placed 11 days prior to presenting to the EC. The CVC was removed, but no anticoagulation was started secondary to severe thrombocytopenia.

Heparin-Induced Thrombocytopenia Induced by Small Doses of Heparin during Burn Treatment

Heparin-Induced Thrombocytopenia Induced by Small Doses of Heparin during Burn Treatment

Intravenous or Intra-Arterial Thrombolysis?

See related article, pages 2191–2195. Intravenous recombinant tissue plasminogen activator (rt-PA) given within 3 hours of stroke onset is considered the standard treatment of stroke and is approved by the health authorities of most countries. It increases the rate of favorable outcomes from the range of 20% to 38% to 31% to 50%.1 Patients with mild or moderate strokes, persons younger than 75 years, and patients treated very early have the best chance for a favorable outcome to treatment.2,3 Nevertheless, more than half of stroke victims face a bleak outlook. Therefore, better means to treat stroke are needed. Intra-arterial thrombolysis (IAT) with pro-urokinase and a small dose of heparin has been tested in a phase III trial to treat stroke patients of <6 hours duration because of middle cerebral artery (MCA) main stem (M1 segment) and main branch (M2 segment) occlusion.4 Recanalization rates were 66% when treated with pro-urokinase and 18% with placebo ( P <0.001). At 90 days, 40% of patients treated with pro-urokinase but only 25% assigned to placebo had regained independency (modified Rankin scale of 0, 1, or 2; P =0.04). The FDA has not approved pro-urokinase for stroke treatment. Nevertheless, IAT mostly with rt-PA or urokinase is used increasingly at stroke centers by interventionalists. Since the FDA granted approval of the MERCI retriever for arterial embolectomy, mechanical recanalization has gained popularity as well.5 Forty-five percent of occluded MCAs and 53% of occluded intracranial internal carotid arteries were recanalized successfully with the MERCI retriever. Vessel recanalization rose to …

The effect of small doses of heparin on platelet adhesiveness and lipoprotein-lipase activity before and after operation.

In a group of male surgical patients platelet adhesiveness increased on the second postoperative day. 10 minutes after the intravenous injection of 10 I.U. heparin per kg. body-weight platelet adhesiveness had fallen significantly, but at 1 and 2 hours adhesiveness was back at preheparin levels. Lipoprotein-lipase activity rose 10 minutes after injection of heparin both preoperatively and postoperatively, but on the second postoperative day activity had returned towards preheparin levels 1 and 2 hours after the injection. When the platelet-adhesiveness experiments were repeated in a second group of patients given only 1 I.U. heparin per kg. body-weight, the response was similar to that observed with the higher dose, high postoperative platelet adhesiveness falling significantly 10 minutes after the administration of heparin. Although it is not certain that a reduction in platelet adhesiveness would affect the incidence of deep-vein thrombosis after surgery, a clinical trial of the smaller dose of heparin would seem worth while for, in respect of effect on coagulability, 1 I.U. per kg. heparin is truly a small dose.

Anesthetic Considerations for Bariatric Surgery

According to the National Institutes of Health, obesity is a major health problem with clearly established health implications, including an increased risk for coronary artery disease, hypertension, dyslipidemia, diabetes mellitus, gallbladder disease, degenerative joint disease, obstructive sleep apnea, and socioeconomic and psychosocial impairment (1). The risk of developing one or more of these obesityrelated conditions is based on body mass index (BMI), with 25–30 kg/m 2 being low risk and 40 kg/m 2 being very high risk (2). The prevalence of obesity in the 18- to 29-yr-old group increased from 12% in 1991 to 18.9% in 1999 (3). Bariatric surgery encompasses a variety of surgical weight loss procedures used to treat morbid obesity. Obesity is clinically expressed in terms of BMI or Quetelet’s index (4), which is derived by dividing weight by the square of height to estimate the degree of obesity. Thus, BMI body weight (kg)/height 2 (m 2 ). Morbid obesity is a BMI more than 35 kg/m 2 , and super morbid obesity is BMI more than 55 kg/m 2 . The indications for surgical treatment of severe obesity, as outlined in the 1991 National Institutes of Health Consensus Development Conference Panel, include an absolute BMI more than 40 kg/m 2 or BMI more than 35 kg/m 2 in combination with lifethreatening cardiopulmonary problems or severe diabetes mellitus (1). Patients seeking surgical weight loss must have proven attempts at medically supervised weight loss. Documentation of loss of 5% to 10% excess body weight or weight gain after at least 6 mo of diet modification, exercise, and medical therapy or nonimprovement in comorbid conditions during this period indicates failure. Studies have shown that weight loss of 5%–10% of initial body weight improves glucose intolerance and Type II diabetes, hypertension, and dyslipidemia (5–7). The average expenditure is approximately $7000 per year per patient on weight loss programs and equipment. Unfortunately, long-term weight loss is the exception, and most patients regain weight, sometimes more than they initially lost.

Targeted chemoembolization of tumors with poly(2-hydroxyethyl methacrylate) particles.

Thirty-four patients suffering from various kinds of tumors, including metastasis, were treated by selective embolization with both spherical and cylindrical poly(2-hydroxyethyl methacrylate) [poly(HEMA)] particles and topical chemotherapy. Treatment of a patient with carcinoid metastases in the liver is discussed. Immediately after embolization, 5-fluorouracil, and later, doxorubicin and Lipiodol, were selectively infused into the tumorous tissue for approximately 1 week. Patient received four cycles of this infusion. Chemoembolization proceeded against the background of anticoagulant therapy using small doses of heparin or its low-molecular-weight analogue, dalteparin. This was followed by transcutaneous transhepatic portography and embolization. Finally, the tumor-feeding artery and portal vein were sealed by a hydrogel. After 1.5 months, the affected liver lobe was resected. Although 4 years from the beginning of treatment, the patient is still alive. Embolization with poly(HEMA) hydrogel particles in conjunction with an anticancer drug infusion via catheter is recommended as an efficient method of tumor treatment. The therapeutic effect has been shown to be a function of ischemia and slow local infusion of drug into the tumor, and systemic drug levels can be kept low.

The in vitro effects of antithrombin III on the activated coagulation time in patients on heparin therapy.

Heparin requires antithrombin III (AT) to achieve anticoagulation, and patients on continuous small-dose heparin preoperatively experience decreased levels of AT-causing heparin resistance. When this occurs, 2-4 units of fresh frozen plasma ( approximately 1000 units of AT) are often administered to increase AT levels and restore heparin responsiveness. We evaluated purified human AT concentrate (Thrombate III; Bayer, Inc., Elkhart, IN) to restore in vitro anticoagulation responses in patients receiving heparin. Blood samples were obtained from cardiac surgery patients including 22 patients receiving heparin and 21 patients not receiving heparin preoperatively. Heparin was added to blood in final concentrations of 4.1, 5.4, and 6.8 U/mL (equivalent to 300, 400, and 500 U/kg), and kaolin-activated clotting times (ACTs) were determined with and without AT at a final concentration of 0.2 units/mL to mimic fresh frozen plasma administration. The mean duration of preoperative heparin therapy was 4.0 days (range 2-10 days). AT activity was 69% +/- 9% in patients receiving heparin and 92% +/- 8% in patients not receiving heparin (P < 0.01). Heparin >4.1 U/mL failed to further increase ACT values in all patients. Attempts to increase ACT in patients receiving heparin may require supplemental AT administration. Purified AT even in small doses significantly prolongs the ACT response to heparin. In vitro addition of antithrombin III (0.2 U/mL) to heparinized blood samples (4.1-6.8 units of heparin/mL) from patients on previous heparin therapy increases sensitivity to supplemental heparin as reflected by significantly prolonged activated clotting time.

A heparin bonding of the extracorporeal circuit reduces clot formation during prolonged lung assist in goats

Purpose of Study: This study investigated whether heparin bonded artificial lungs with non-microporous polyolefin hollow fibber combined with low dose systemic heparinization could reduce the thrombus formation during prolonged, veno-arterial extracorporeal lung assist (V-A ECLA) in goats. Methods Used: We compared heparin-bonded (HB, 5 goats) and non-heparin bonded circuits (NHB, 5 goats) in ECLA of one week. ACT was kept below 130 s by systemic infusion with a small dose of heparin in the HB group, and 180 to 230 s in the NHB group. Clot formation was assessed by both microscopic and visual examination the circuit after the experiments, and the incidence of systemic complications. Summarize Results: The mean heparin dose give during ECLA was 20.4 ± 3.6U/kg/hr iin HB group, 50.9 ± 14.2 U/kg/hr in NHB group, significantly less in HB group than in NHB group (P < 0.01). The bypass flow rate, platelet aggregation activity, platelet counts, and fibrin monomer test, antithrobin - III activity did not differ between two groups. Macroscopic examinations revealed a lot of clot in all the oxygenators of the NHB group. A goat of NHB group of NHB group developed convulsions and cerebral hemorrhage. The HB artificial membrane lung consisted of those fibers showed a good anticoagulation advantage to decrease clot formations nevertheless a small dose of heparin in ECLA of 7 in goats.

Cardiopatía, embarazo y tratamiento anticoagulante

Pregnancy is a hypercoagulable state. Some women with cardiac disease and mechanical valve prosthesis are at increased risk of arterial thromboembolic phenomena. These women are maintained on oral anticoagulants and require effective permanent prophylaxis during pregnancy. The use of oral anticoagulants during pregnancy is controversial because of the risks of embriopathy (Chondrodysplasia punctata) in fetuses who are exposed to coumarin between the 6th and 9th week of gestation, the risk of neurological disorders all through pregnancy, and a higher incidence of abortion and stillbirths. The exact incidence of these complications is unknown. Most of this information comes from North American reports, when much higher mean daily doses of coumarin were administered, and they were probably overemphasised. Reports from Europe, Asia and our own, show that both embriopathy and central nervous system malformations are probably dose-related and that the risks of abnormality to the fetus are small. The ACC Antithrombotic Consensus (1998) recommends the use of subcutaneous heparin all through pregnancy or until the 13th week of gestation. Heparin does not cross the placenta, however there is a higher risk of maternal bleeding, abortion and stillbirths. With the use of small dose of heparin and of therapeutic heparin doses there is a risk of prosthesis thrombosis. Anticoagulant treatment of patients with prosthetic heart valves during pregnancy remains controversial. Subcutaneous heparin prophylaxis is feasible but the use of well controlled oral anticoagulants appear to offer lower risks of maternal and fetal complications.

State-of-the-Art Review : Activated Partial Thromboplastin Time in Heparinized Plasma: Influence of Reagent, Acute-Phase Reaction, and Interval Between Sampling and Testing

Plasma samples from 10 healthy persons and 10 patients with acute-phase reaction were heparinized in vitro to obtain up to 0.70 U/ml. Activated partial throm boplastin time (APTT) was then determined using an op tical method (Automated Coagulation Laboratory or ACL Machine) and four different reagents (Actin, Ceph otest, Platelin, and Thrombosil). Heparin sensitivity var ied between individuals, and it was lower in acute-phase plasma than in healthy plasma. There was also a marked difference in heparin sensitivity among the different re agents; Actin was the least sensitive reagent, while Plate lin was the most sensitive reagent in healthy plasma and Thrombosil the most sensitive reagent in acute-phase plasma. Delay in testing prolonged the APTT values both in acute-phase and healthy heparinized plasma. With Ac tin and Cephotest, a delay of 90 min at 22°C resulted in 30-50% prolongation of APTT. A delay of 150 min caused a prolongation of 75-110% with Actin. Cephotest, Plate lin, and Thrombosil were less prolonged. Ex vivo samples from heparinized plasma showed similar degrees of pro longation. Storage at 4°C resulted in less prolongation. Assuming a therapeutic range of 0.35-0.70 U/ml of hep arin, the therapeutic APTT ratios in heparinized acute- phase plasma were 1.5-3.0 for Actin and 2.5-4.5 for Cephotest, Platelin, and Thrombosil. These results un derscore certain limitations in monitoring heparin therapy with the APTT system. Unless the assay is performed within 30 min after sampling, unduly prolonged APTT values will be recorded, which may lead to giving the patient an inappropriately small dose of heparin.

Control and Treatment of Hemostasis in Cardiovascular Surgery.

The hemostasis protocol applied at the Cardiovascular Surgery Dept. of La Pitié Hospital has greatly reduced thromboembolic accidents and excessive bleeding, with consequent benefits for patients as well as cost reduction. Protocol also has been adopted for patients implanted with a circulatory assist device or a TAH. This paper presents our criteria on supervision and treatment of coagulation with such patients, who reflect all the acquired pathology in clinical hemostasis. From 04/86 to 07/94, 82 patients underwent TAH as a bridge to transplantation. Mean age: 38. Overall duration of mechanical support: 1930 days (mean: 23), of which 137 and 603 for 2 patients. Average duration of CPB: 150 min. Systematic approach to complex TAH-blood interaction and pre-operative multiple organ dysfunction used to control bleeding and/or thromboembolism after CPB. In addition to routine tests, specific regular testing was carried out at least once a day for platelet functions, for thrombin formation and its regulatory pathways, and for the fibrinolytic system. Patients were treated with small doses of Heparin, large doses of Dypyridamole, small doses of Aspirin, modulated doses of Aprotinin, Ticlopidine, Pentoxifylline, FFP, as well as Fibrinogen and AT III concentrates. Dosage was adapted to patient's clinical profile as well as to test interpretation criteria to provide personalized treatment. DIC, widely present in its different phases, was thus diagnosed and treated. All DIC bleeding was controlled, making it possible to detect other causes of post-operatory bleeding and use blood derivates rationally. There were no thromboembolic complications and no iatrogenic bleeding. TAH explanation shows no evidence of macroscopic clots in high risk sites, confirmed by microscopic analysis.

PORTAL THROMBOSIS OCCURRING AFTER ESOPHAGEAL TRANSECTION

We examined three patients with portal thrombosis occurring after esophageal transection. Two of them whose condition developed in the early stage after surgery developed hepatic failure, indicating poor prognosis. The most probable cause of portal thrombosis was considered to be damage to the intravascular tunica intima by manipulation of a catheter during the intraoperative measurement of pylic pressure, but there were various problems regarding the pathogenesis. In terms of prophylaxis and countermeasures, it is necessary to carefully manipulate catheters in the portal vein during operation and to administer a small dose of heparin immediately after surgery. Because of the possible development of portal thrombosis immediately after surgery for portal hypertension, early diagnosis and treatment, mainly including ultrasonic examination of the abdomen, are necessary.

Increased fibrinolytic activity after surgery induced by low dose heparin

Forty women undergoing surgery under general anaesthesia for hyperplasia mammae were randomized to treatment with low dose heparin (5000 IU twice daily) or not. Preoperatively, and repeated on the 3. postoperative day, assays of euglobulin clot lysis time (ELT) after venous stasis, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) were performed. Compared to the control group heparin was found to give a significant rise in t-PA antigen before (24.0 vs. 11.2 ng/ml, p=0.02), and especially after venous stasis (104.8 vs. 47.3 ng/ml, P=0.007). t-PA activity was also significantly more increased after venous stasis in the heparin group than among the controls (4.2 vs. 1.4 U/ml, p=0.04). This was also reflected in the ELT after venous stasis which was significantly shorter in the heparin group (p=0.01). No differences in PAI were found between the groups. The present results point to a heparin-induced increase of t-PA synthesis in the endothelium, also giving rise to an increased level of circulating t-PA as measured immunologically. This effect of small dose heparin may play an important role in the prophylaxis against thrombo-emboli, in addition to the anticoagulant effect.

Effectiveness of leg compression in preventing venous stasis

To compare the ability of intermittent calf compression with that of sequential leg compression to prevent venous stasis, the clearance times of radiopaque dye, as determined by sequential phleborheograms performed on anesthetized patients, were compared. Calf compression was superior to no compression in clearing the dye from the calf alone, but did not aid clearance from the rest of the leg. Sequential leg compression was superior to intermittent calf compression in clearing dye from the calf and popliteal areas. Since intermittent leg compression has been as effective as small-dose heparin therapy in preventing postoperative deep venous thrombosis [7], the use of sequential leg compression may prove to be more effective and have less complications than heparin administration.

Prevention of Fatal Pulmonary Thromboembolism by Small Dose Heparin Prophylaxis in Acute Hip Fracture Surgery

International Journal of Clinical PracticeVolume 35, Issue 11-12 p. 390-427 Clinical Studies Prevention of Fatal Pulmonary Thromboembolism by Small Dose Heparin Prophylaxis in Acute Hip Fracture Surgery J. G. Sharnoff MD, J. G. Sharnoff MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorR. L. Rosen MD, R. L. Rosen MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorP. J. Palazzo MD, P. J. Palazzo MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorD. A. Fethiere MD, D. A. Fethiere MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorS. Sotudeh MD, S. Sotudeh MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorE. V. Alvarez MD, E. V. Alvarez MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorC. Rosen, C. Rosen Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this author J. G. Sharnoff MD, J. G. Sharnoff MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorR. L. Rosen MD, R. L. Rosen MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorP. J. Palazzo MD, P. J. Palazzo MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorD. A. Fethiere MD, D. A. Fethiere MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorS. Sotudeh MD, S. Sotudeh MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorE. V. Alvarez MD, E. V. Alvarez MD Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this authorC. Rosen, C. Rosen Department of Pathology, The Mount Vernon Hospital, Mt. Vernon, N.Y.Search for more papers by this author First published: 01 November 1981 https://doi.org/10.1111/j.1742-1241.1981.tb08322.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume35, Issue11-12November/December 1981Pages 390-427 RelatedInformation