Low Molecular Heparin Research Articles

Comparison of the efficacy of regional perfusion reteplase and alteplase in patients with pulmonary embolism

Objective To compare the therapeutic efficacy of reteplase(r-PA) and alteplase(t-PA) in the high risk patients with pulmonary embolism during a pulmonary artery catheter broken bolt in the interventional treatment, and to evaluate the clinical safety. Methods 54 high risk patients were selected as the research subjects, and they were randomly divided into treatment group(24 patients) and control group(30 patients). Patients in both two groups were given general treatment, low molecular heparin sodium anticoagulation therapy.Besides, the control group was given local perfusion thrombolysis enzyme treatment.While the treatment group was given local perfusion at enzyme thrombolysis treatment. Results Two-way Chi-square test results showed that before treatment, there were no significant differences in HR, RF, PaO2, PaCO2 and SaO2 between the two groups(all P>0.05). After 3-day treatment, in the treatment group, HR[(83.39±14.25)times/min], RF[(17.80±1.65)times/min], PaO2[(87.59±7.34)mmHg], PaCO2[(37.60±7.62)mmHg], SaO2[(97.29±6.72)%] in the treatment group group, which in the control group were (97.7±15.51)times/min, (20.49±1.68)times/min, (81.53±6.42)mmHg, (35.69±4.57)mmHg, (93.91±3.27)%, the differences between the two groups were statistically significant(t=8.01, 7.33, 6.32, all P<0.05). After three days therapy, the total effective rate was 86.67% in the treatment group, which was significantly higher than 75.00% in the control group (χ2=1.21, P=0.55). After thrombolysis treatment, there was no significant difference between the treatment group and control group in hemorrhage rate(χ2=2.24, P=0.53), which were 13.33% and 12.50%, respectively.Besides, the hemorrhage patients were all got effectively treated and their condition was significantly improved, and none of them occurred severe bleeding during the observation periods in the two groups. Conclusion Local perfusion reteplase therapy in high-risk patients with PE through the pulmonary artery catheter broken bolt in the interventional treatment is safe and is worthy of clinical promotion. Key words: Pulmonary embolism; Reteplase; Alteplase

Acute Early Carotid Stent Thrombosis: A Case Series

Acute early carotid stent thrombosis (AcuteCST) is a rare complication after carotid artery stenting (CAS). The purpose of this retrospective study was to investigate the incidence, causes, and optimal management of AcuteCST. Medical records of all patients undergoing CAS between 2008 and 2016 were retrospectively reviewed. The time of thrombosis, grade of stenosis, lesion side, preprocedural and postprocedural anticoagulants, causes, symptoms, treatment, recanalization, and outcome were reviewed. Overall, 674 patients were treated with CAS. Four cases of AcuteCST were identified (0.59%). In the first patient, the stent thrombosis was attributed to dissection caused by filter deployment within a distal internal carotid artery with 360° coiling. Notably, in 3 of the 4 cases of thrombosis a second overlapping stent had been deployed. In total, 41 patients of the cohort under investigation underwent overlapping stent deployment. The use of a second overlapping stent as a bail-out procedure due to dissection or malposition or due to long lesions was correlated with increased rate of thrombosis (3/41 [7.3%] vs. 1/633 [0.002%]). In 2 patients, carotid stents were thrombosed within 2 hr of the procedure. Endovascular thrombus aspiration and subsequent eversion carotid endarterectomy with stent explantation in the first patient and intrathrombus urokinase administration with thromboaspiration and additional stent placement in the second patient were followed. In the other 2 patients having their carotid stents thrombosed 3 and 4days after the procedure, treatment with low weight molecular heparin and antiplatelet regimens was followed. The use of overlapping stents in the carotid artery is a predisposing factor for AcuteCST. Prognostic factors of this potentially devastating complication are the initial clinical presentation expressing the grade of ischemic brain damage, the accurate and timely recognition of the thrombosis, and the prompt restoration of oxygenated blood flow into the viable tissue at risk of infarction.

Impact of rehabilitation training combined with low molecular heparin calcium on functional recovery and venous thrombosis of postoperative period of hip fracture in the elderly

Objective To study the impact of rehabilitation training combined with low molecular heparin calcium on functional recovery and venous thrombosis of postoperative period of hip fracture in the elderly. Methods 86 elderly patients with hip fracture surgery were divided into the control group(43 cases) and observation group(43 cases) according to random number table method.The control group was given low molecular heparin calcium, and the observation group was given rehabilitation training combined with low molecular heparin calcium.After four weeks, the hip functional recovery and venous thrombosis occurrence were observed in the two groups.The levels of blood rheology indicators such as blood high shear viscosity, shear viscosity, low shear viscosity, erythrocyte aggregation index and coagulant function index of thrombin time and D-dimer were detected. Results The scores of hip joint pain, joint function, joint mobility, deformity and Harris score in the observation group were higher than those in the control group, the differences were statistically significant(t=3.713, 3.224, 3.345, 1.861 and 8.087, all P<0.05). The incidence rate of venous thrombosis in the observation group was 6.89%, which was lower than 23.26% in the control group, the difference was statistically significant (χ2=4.440, P=0.035). After 4 weeks treatment, the levels of the whole blood high shear viscosity, shear viscosity, low shear viscosity and erythrocyte aggregation index in the observation group were lower than those in the control group, the differences were statistically significant (t=2.092, 2.590, 1.716 and 2.590, all P<0.05). After treatment, the level of D-dimer in the observation group was lower than that in the control group, and the prothrombin time in the observation group was higher than that in the control group, the differences were statistical significance(t=7.510 and 2.151, all P<0.05). Conclusion The rehabilitation training combined with low molecular heparin calcium can promote hip joint function recovery of postoperative period of hip fracture in the elderly, reduce the incidence of venous thrombosis, improve blood rheology and blood coagulation function indicators. Key words: Rehabilitation training; Low molecular heparin calcium; Hip fracture; Venous thrombosis; Blood rheology; Blood coagulation function

Real-life practices for preventing venous thromboembolism in multiple myeloma patients: a cohort study from the French health insurance database.

The risk of venous thromboembolic event (VTE) in multiple myeloma is particularly increased. Current guidelines recommend systematic VTE prophylaxis with vitamin K antagonists (VKA) or low weight molecular heparin (LWMH) or unfractionated heparin (UFH) in high-risk patients, based on treatment received [e.g. use of IMiDs (thalidomide, lenalidomide and pomalidomide), alkylating agents or erythropoietin] and individual risk factors (e.g. history of VTE). The aim of this study was to describe strategy of VTE prophylaxis and prescribing of other antithrombotic agents during the first 6months of multiple myeloma therapy, with stratification on IMiD-based regimens and drug and disease-related risk factors. A retrospective cohort study of French beneficiaries from the health insurance database (SNIIRAM, Système National d'Information Inter-Régime de l'Assurance Maladie) was designed in the Midi-Pyrénées area (South West France). Patients starting a treatment for multiple myeloma in the period 2011-2014 were identified through hospital and chronic disease diagnoses. Among the 236 incident multiple myeloma patients, 56% male (n=133), 67% >65years (n=159) and 47% (n=110) patients received an IMiD-based regimen. In these patients, 63% (n=69) were identified as high-risk patients with indication for low molecular weight heparin or equivalent, and 37% (n=41) were identified as low-risk with aspirin recommended. Among the high-risk IMiDs patients, 43% (30/69) currently received a VTE prophylaxis after starting their first regimen: 70% LWMH (21/30), 40% VKA (12/30), 10% UFH (3/30) and 13% (4/30) other drugs (rivaroxaban and fondaparinux); 33% of the patients (23/69) received an antiplatelet drug only, and 23% (16/69) did not receive any antithrombotic drug. These results revealed lack of implementation of VTE prophylaxis in one out of high-risk multiple myeloma patients with IMiD. Copyright © 2017 John Wiley & Sons, Ltd.

EHIT after thermoablation

SummaryAim: After 10 years of experience, we evaluated the incidence and management of endothermal heat-induced-thrombosis (EHIT), i.e. saphenous vein thrombosis following endothermic treatment of saphenous vein re-flux.Methods: From 2006 to 2016 data were retrospectively collected on 840 patients undergoing saphenous vein treatment by laser and radiofrequency technique. All patients were treated with tumescent local anaesthesia in an ambulatory setting to promote early mobilization. Class II compression stockings and heparin were recommended for 5 days post-operatively.Results: EHIT was observed in 15 patients from a total of 992 saphenous veins which were evaluated (1,5 %). 14 patients treated by EVLA had EHIT 1, one patient by RFA had EHIT 2, complicated by pulmonary embolism. All EHIT patients were treated by low weight molecular heparin. 980 nm laser and bare-tip fibres had been used in EVLA-EHIT patients. EHIT was not observed in patients treated by 1470 nm laser and radial fibres.Conclusions: Latest generation technology, the ambulatory setting and local anaesthesia probably contributed to the low incidence of EHIT reported. Further studies are necessary for a better acquaintance of these complications and to facilitate the development of specific guidelines.

The disorders of hemostasis system and thrombotic complications in oncologic patients having liver operation.

The surgical interventions in patients with malignant tumors of liver cause a development of various forms of syndrome of disseminated intravascular coagulation (DIC) with significant increasing of concentration of markers of intravascular blood coagulation against the background of dramatic decreasing of activity of factors of prothrombin complex, level of natural anti-coagulants and components of fibrinolytic system. The thrombosis of veins of various localization developed in 12 patients with subacute form of DIC. The application of low-molecular heparin in combination with concentrate of anti-thrombin III and freshly frozen plasma decreases intensity of intra-vascular blood coagulation and results in reduction of factors of coagulation and is an efficient and adequate method of treatment of thrombosis and thromboembolism of pulmonary artery in oncologic patients. The significant increasing of level of D-dimer, von Willebrand factor against the background of dramatic decreasing of prothrombin activity, content of antithrombin III and level of plasminogen are hemostasiologic factors of development of severe liver insufficiency. The corresponding timely diagnostic and correction permits to ameliorate results of surgical treatment of patients with malignant tumors of liver.

Effect of low-molecular heparin on therapeutic effect and renal function in patients with gastric cancer

Effect of low-molecular heparin on therapeutic effect and renal function in patients with gastric cancer

VTE-Related Healthcare Resource Utilization and Costs Associated with Venous Thromboembolism in Cancer Patients Treated with Anticoagulants

Introduction: The standard of care for treatment of cancer-related venous thromboembolism (VTE) is a low molecular heparin (LMWH). In our previous claimsbased analysis, we showed that besides LMWH oral anticoagulants, warafrin and rivaroxaban are widely prescribed in clinical practice (Khorana, 2015). The objective of this study is to compare VTE-related healthcare resource utilization and costs of cancer patients treated with anticoagulant therapies.Methods: Medical and pharmacy claims from the Humana Database between 1/1/2013 and 05/31/2015 were analyzed. Newly diagnosed cancer patients with a first VTE diagnosis occurring after their first cancer diagnosis and with ≥1 dispensing of an anticoagulant agent within 7 days after their VTE diagnosis, were selected. Based on the first anticoagulant agent received, patients were classified into one of the following cohorts: LMWH, warfarin, and rivaroxaban. Inverse probability of treatment weights based on propensity score was used to adjust for differences between treatment cohorts. Baseline characteristics were evaluated during the 6 month period prior to the index VTE. VTE-related resource utilization and costs were identified with a primary or secondary diagnosis of deep vein thrombosis or pulmonary embolism and were evaluated for the entire follow up period, starting from the initiation of the anticoagulant therapy until the earliest either end of enrollment or end of data availability (05/31/2015). Resource utilization components included: number of hospitalizations, hospitalization days, emergency room (ER) visits, and outpatient visits. Comparisons between the different treatment cohorts were performed using rate ratios (RR) and statistical differences between groups as well as 95% confidence intervals [95% CI] were calculated using Poisson regression models. Healthcare costs were evaluated in per-patient-per-year (PPPY) and compared using mean cost difference.Results: A total of 2,428 patients (LMWH: n=660; warfarin; n=1,061; rivaroxaban: n=707) were included. Baseline demographic and clinical characteristics were well balanced across the treatment cohorts including hospitalizations, emergency room (ER) visits, and outpatient visits. Compared to patients treated with LMWH, patients treated with rivaroxaban had significantly fewer VTE-related hospitalizations, hospitalization days, ER visits, and outpatient visits (Figure 1). This resulted in significantly higher VTE-related health care cost difference of $12,000 for LMWH relative to rivaroxaban treatment cohort (Table 1).Patients treated with rivaroxaban had significantly lower VTE-related resource utilization compared to patients treated with warfarin (Figure 1). The total VTE-related costs were however similar between two cohorts (Table 1). The higher drug costs ($1,519) were offset by significantly lower outpatient (-$1,039) and hospitalization costs (-$522) in rivaroxaban relative to warfarin cohort.Conclusion: Healthcare resource use and costs associated with VTE treatment in cancer patients are the highest with LMWH relative to warfarin and rivaroxaban treatments. Healthcare resources use and costs are significantly higher in warfarin relative to rivaroxaban cohort but these resource costs were offset by higher drug costs of rivaroxaban. These results are in line with previous study in cancer patients that found fewer re-hospitalizations related to VTE recurrences in patients treated with rivaroxaban compared to patient treated with LMWH or warfarin (Streiff, 2016). [Display omitted] [Display omitted] DisclosuresStreiff:Roche: Research Funding; Portola: Research Funding; Janssen: Consultancy, Research Funding; CSL Behring: Consultancy, Research Funding. Milentijevic:Janssen Scientific Affairs: Employment, Equity Ownership. McCrae:Janssen: Membership on an entity’s Board of Directors or advisory committees. Fortier:Janssen Pharmaceuticals: Research Funding. Laliberté:Janssen Scientific Affairs: Research Funding. Lefebvre:Janssen Scientific Affairs: Research Funding. Schein:Johnson & Johnson: Employment, Equity Ownership, Other: Own in excess of $10,000 of J&J stock. Khorana:Sanofi: Consultancy, Honoraria; Leo: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria; Halozyme: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Janssen Scientific Affairs, LLC: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria.

Outcomes of Venous Thromboembolism (VTE) Treatment in Thrombocytopenic Leukemic Patients

BACKGROUNDThe current standard of care for the treatment of cancer-related VTE is low molecular heparin. Treatment of VTE in leukemia is complicated as patients suffer severe thrombocytopenia during the different phases of their malignant disease. The optimal treatment of cancer-related VTE in this population has still not been widely studied. Therefore, there is a dire need for research to provide evidence-based guidance on the optimal management of cancer related-VTE in leukemia population.OBJECTIVESThe primary objective of the study was to estimate the recurrence rate of VTE (proximal lower extremity, pulmonary embolism or both) at 6 months from the institution of VTE-related treatment. Secondary objectives included overall survival, recurrent VTE event-free survival, and rate of complications attributed to therapies for VTE.METHODSA retrospective chart review of adult patients with thrombocytopenic leukemia patients who suffered VTE and were treated at MD Anderson Cancer Center between January 2002 and March 2016. Demographic, clinical, and VTE treatment-related data were collected. Primary and secondary outcomes were compared among the different VTE treatment-modalities using non-parametric methods. Kaplan-Meier curves were calculated and compared between the groups of VTE-treatment modalities using Log-Rank test. All comparisons were performed with a test significance of 0.05.RESULTS:At the time of abstract submission, a total of 101 patient-data have been analyzed. The most common type of leukemia was AML (2/3 of all cases). Study outcomes were compared between three groups: anticoagulation only, inferior vena cava filter only and no VTE-treatment intervention. We found no statistically significant differences in the demographic and clinical characteristics between the three groups, except for a lower median platelet count in the patients in whom no VTE-treatment intervention was performed (p<0.05). The VTE recurrence rate was low (<5%) and not different between the intervention groups. The median overall survival of the general population was poor (< 6 months) and significantly worse in patients who did not receive anticoagulation therapy for the management of VTE (p<0.01).CONCLUSION:Our study is the largest cohort reported to date on management of VTE in thrombocytopenic leukemia patients. Our preliminary data indicated that anticoagulation therapy and non-pharmacologic interventions for the management of VTE seemed to be safe and equivalent for the secondary prevention of recurrent VTE in that population. Future prospective cohort studies will likely confirm these findings. DisclosuresNo relevant conflicts of interest to declare.

Intra Bone Route of Donor Lymphocyte Infusions May Result with an Anti-Leukemic Effect Associated with an Accumulation of CD279+ Lymphocytes in the Marrow

Immunologic surveillance of leukemia is employed for the prevention and treatment of relapse post alloHSCT. The rate of success depends on the characteristics of leukemia which is more beneficial if the cells are recognized in the way of alloreactivity. Intra venous DLI is associated with a high risk of aGvHD and we believe that this route of administration may not make the direct contact between infused cells and blasts the optimal one. The previous reports documented a lower risk of aGvHD if the transplant material was given to the bone marrow cavity which at relapse is usually infiltrated by the blasts.To address these issues, we started delivering donor lymphocytes directly to the bone marrow cavity (IB-DLI) in patients post alloHSCT at relapse.This technique was employed in 4 patients, 3 with AML and one with CLL, all relapsed post alloHSCT: 3 alloSIB: 50-year-old female AML patient with normal karyotype (relapsed 2 years post HSCT) and 22-year-old AML male 7q31 del (relapsed at 3 years post HSCT) and 64-year-old CLL male, TP53 del, recurrent EBV reactivation with vasculitis (progressed 7 years), and 25-year-old male AML FLT3 ITD+ received MUD HSCT (relapsed 9 months).Two patients with a proportion of 26% and 12% blasts in the marrow respectively received IB-DLI up-front and two others due to the excess (52.50%, 57.70% (CD5+CD19+)) of leukemic cells received either FLAG (AML case) or anti-CD20 MoAB (CLL case) followed by IB-DLI.The patients received from 3 to 5 IB-DLIs according to the escalating dose regimen starting from 10E6 and ending with a dose of 10E8 of CD3+ cells/kg b. w. (blood MNC were harvested with use of Spectra Optia (Terumo BTC) for SIB transplantation, in MUD HSCT they were taken from the PBPC material (J Hasskarl et al. 2012). The intervals between IB DLI varied from 1 to 2 months. One patient received azacitidine between the DL infusions (Schroeder T et al. 2013) which was associated with longer intervals.The cells were injected directly to the bone marrow cavity under local anaesthesia with a low molecular Heparin prophylaxis. The blood and marrow specimens were taken prior each IB-DLI for: cytology, cytometry (including CD8, CD279, CD26, CD28 MoAb in addition to the routine staining used for blast cells), genetic work (chimerism, mutations associated with the disease).Clinical outcome:No side effects were noticed (including GvHD).The patients are alive.Anti-leukemic effect:3.1 Responding AML ITD+ case was free of blasts 6 months after the initiation of the treatment. However, after the third IB-DLI blasts appeared in the marrow but the patient responded favorably to the Sorafenib treatment and the following course of IB-DLI.3.2 Partial remission (stable proportion of blasts and sustained hematopoiesis); the patient (22-year-old AML male) was transplanted a second time but blasts at the range of 38% were still observed in the marrow without progression after 9 months.3.3 One case which failed to respond to IB-DLI (female AML patient) was transplanted a second time but this approach also failed and this patient now has full blown leukemia.The laboratory work up:Proportions of lymphocytes in the marrows tended to increase after completion of each IB-DLI (32.0 ± 4.6% vs 37.1 ± 3.7%, Wilcoxon test for pairs, p=0.078).Collectively CD279+ cells contributed to the lymphocyte pool in the marrow to a greater extent than it was seen in the blood at the same time (16.6 ± 2.9% vs 33.1 ± 4.0%, p<0.001); this was also valid for CD8+CD279+ cells (12.4 ± 3.2% vs 27.1 ± 4.5%, p<0.001).Microarray analysis of the transcriptome in the marrows of patients who received three IB-DLI courses revealed that in the patients responded favorably (CR or PR) their transcriptome profiles formed a cluster together with the transcriptomes of normal individuals in contrast to the patients who failed to respond, whose transcriptome profiles clustered separately.IB-DLI was safe and not associated with GvHD. In all cases the infusion was associated with an increase in the marrow of lymphocytes being CD8+CD279+. The response may result in CR or PR and the patients were in a good physical shape during the treatment, which makes it possible to consolidate the treatment with a second alloHSCT if required. A lack of any response after the first courses of IB-DLI was associated with a failure to respond, even if the second transplant is performed.Supported by The National Centre for Research and Development grant (INNOMED/I/1/NCBR/2014) DisclosuresNo relevant conflicts of interest to declare.

Influence of heparin molecular size on the induction of C- terminal unfolding in β2-microglobulin.

Dialysis-related amyloidosis (DRA) is characterized by accumulation of amyloid β2- microglobulin (β2m) in the interstitial matrix. Matrix substances such as heparin have reportedly been strongly implicated in the pathogenesis of dialysis-related amyloidosis. In clinical setting of hemodialysis, two types of heparin, i.e., high and low molecular heparin (H.M.H. and L.M.H.) have been routinely used. Still commonly used is H.M.H., followed by L.M.H. preparations with distinct advantages. Here, we studied that the interaction of native and two amyloidogenic β2m variants: ΔN6β2m and D76N β2m with H.M.H. and L.M.H. We also investigated whether heparin could induce β2m to have an amyloidogenic conformation. Biolayer interferometry revealed that ΔN6β2m had a strong reaction and D76N β2m had a moderate reaction with H.M.H.. Furthermore,H.M.H. induced the C-terminal unfolding in a native β2m. By contrast, L.M.H. showed no reaction even with ΔN6β2m. This study showed firstly a direct binding of β2m with H.M.H.. H.M.H. would provoked a C-terminal unfolding of β2m, which indicated production of an amyloidogenic intermediate, i.e., β2m92-99. In addition, our findings also suggest that L.M.H. may provide beneficial effects against the development of the DRA.

Effect of continuous pulse injection of urokinase on thrombosis of arteriovenous fistulas

Objective To investigate the curative effect and safety of continuous pulse injection of urokinase for the treatment of arteriovenous internal fistula thrombosis. Methods During the period from Jan. 2011 to Dec. 2014, 40 patients with arteriovenous internal fistula thrombosis were collected. They were randomly assigned to the improved group (continuous pulse urokinase injection) and control group (traditional urokinase application) according to the table of random digit. Thrombin time, prothrombin time, D-dimer, fibrinogen, hemoglobin, platelet, lipid and colored doppler ultrasonography of arteriovenous internal fistula before thrombolysis were recorded. All the patients used the 18 G venous indwelling needles. In the improved group, continuous pulse injection of urokinase (200 000 units) was performed. The same dose of urokinase were injected by micro-pump at the speed of 20 000 U/min in the control group. After that all the patients still received micro-pump injection of 300 000 units urokinase at the speed of 20 000 U/min, subcutaneous injection of low molecular heparin (4 000 U), intravenous injection of papaverine (30 mg), oral administration of aspirin (150 mg) for 3 days, respectively. We recorded the internal fistula recanalization, vital signs, bleeding, and the dose of urokinase every hour. The end points of our study were internal fistula recanalization, severe bleeding and pulmonary thromboembolism. The treatment could be repeated during the three days after admission. We compared the time and incidence of recanalization, dose of urokinase, incidence of bleeding and pulmonary thromboembolism between two groups. Results A total of 28 cases (93.33%) showed successful results in (30.33±27.23)hours an average, with (20 000±12 000)units urokinase in the improved group. Whereas, 22 cases (75.86%) showed successful results in an average of (50.15±22.18)hours, with (25 000±18 000)units urokinase in the control group. There was significant difference in the time and incidence of recanalization, dose of urokinase between two groups (P 0.05). Conclusions Compared to traditional urokinase application, continuous pulse urokinase injection achieves higher recanalization rate, shorter recanalization time, and less dose of urokinase. It does not increase the risk of bleeding as well. For the treatment of arteriovenous internal fistula thrombosis, continuous pulse urokinase injection is an effective and safe way, with great clinical value. Key words: Urinary plasminogen activator/TU; Injections, jet; Arteriovenous fistula/CO/DT; Thrombosis/CO/DT; Thrombolytic therapy

Relationship between Warfarin and Thrompocytosis : A Case Report Study

This report is point to patient admitted to our hospital as case of G6PD and dilated cardiomyopathy, with congestive heart failure started on anti-failure and aspirin and need to be admitted on ICU for inotropic support, then on the 2nd day the patient developed thrombocytopenia then we stopped aspirin and warfarin started after using of warfarin by one-day patient developed sever thrombocytosis so we consider to start low molecular heparin which improved the platelets count then started to decreased to normal range in 5 days duration after LMH started.

Meta-analysis on the effectiveness of intermittent pneumatic compression device on preventing deep vein thrombosis after spinal operation

Objective To evaluate the application value of intermittent pneumatic compression (IPC) in preventing deep vein thrombosis (DVT) after spinal operation. Methods Randomized controlled trails (RCTs) on ICP in preventing DVT were searched in the Cochrane Library, PubMed, CNKI, Wanfang data and so on. Quality of RCTs was evaluated strictly. Data were extracted by two researchers. Literature was selected and extracted according to inclusion and exclusion criteria. And then, Meta-analysis was used to analyze the data with the software Stata 12.0. Results Meta-analysis results revealed much on the incidences comparison of DVT between the IPC group and the blank control group [RR=0.11, 95% CI(0.04, 0.34), P=0.921], among the ICP group and low-molecular-weight heparin group with the low molecular heparin group [RR=0.27, 95% CI(0.12, 0.61), P=0.97], among the ICP group and graduated compression stocking group with the group using graduated compression stocking alone (χ2=3.871, P 0.05). The use of IPC was safe by the confirmation of research report. Conclusions IPC can effectively prevent DVT and reduce the incidence of DVT of postoperative patients in department of spine surgery. However, the clinical RCTs with large sample size and high quality are needed to validate since the included studies with low quality and small sample size. Key words: Prevent; Deep vein thrombosis; Spinal surgery; Intermittent pneumatic compression device; Air pressure; Meta-analysis

Incidence of Deep Vein Thrombosis and Its Natural History Following Unilateral Primary Total Knee Replacement in Local Chinese Patients—A Prospective Study: 本地中國籍患病者接受單側全膝關節置換後出現深部靜脈栓塞的發病率和自然史 – 一個前瞻性研究

PurposeThis prospective study was to investigate the incidence and the fate of deep vein thrombosis (DVT) among Chinese patients following unilateral primary total knee replacement (TKR). The influence of tourniquet time and the mode of anaesthesia on DVT were evaluated. Method390 patients who underwent unilateral cemented primary TKR were investigated. Patients whose body-mass- index (BMI) exceeded 30kg/m2 were given chemoprophylaxis with low molecular heparin postoperatively. DVT was diagnosed using duplex ultrasonography on 4th to 7th days after operation. DVT was classified into two groups, distal and proximal. Patients who had DVT on the first scan were assigned two follow-up scans. ResultThe incidence of DVT was 25.7%. 97 patients (24.9%) had distal DVT, whereas 3 had proximal DVT (0.8%). Among patients with DVT, 18 (18%) of them resolved at first follow up scan, 82 persisted, and there were no proximal progression. At the 6th week scanning, 57 patients (57%) were free from DVT, while 42 patients (42%) had persistent DVT. There was one (1%) case which the distal DVT had proximal migration, but there was no pulmonary embolism. Tourniquet time and mode of anaesthesia did not reveal any statistical significance on the incidence of DVT. ConclusionThis prospective study showed that the incidence of DVT after unilateral primary TKR in Hong Kong Chinese patient was high. However, most of them are distal to popliteal vein with low risk of proximal migration. More than half of them resolved at about two months after the operation.

The role of comprehensive geriatric assessment and functional status in evaluating the patterns of antithrombotic use among older people with atrial fibrillation

Aim of the study is to investigate the use of antithrombotic drugs in older patients with atrial fibrillation (AF) at the time of hospital discharge. We enrolled 399 ≥65 years old patients with AF consecutively admitted to our acute geriatric unit from September 2012 to February 2014. Utilization of antithrombotic drugs, comorbidities, functional, mental and nutritional status were evaluated through a comprehensive geriatric assessment (CGA). A Logistic regression model was used to assess variables associated with antithrombotic use. On admission, 198 patients (49.6%) used oral anticoagulants (OAC), 125 (21.3%) antiplatelets, 32 (8%) low weight molecular heparin (LMWH) and 44 (11%) none of them. At discharge the proportion of patients on OAC increased to 55.7%. Age>90years (OR=2.57, CI=1.28–5.16, p-value=0.008), severe functional impairment (OR=3.38, CI=1.63–7.01, p-value=0.001), polypharmacy (OR=2.07, CI=1.1–3.86, p-value=0.023), HAS-BLED score (OR=1.64, CI=1.09–2.47, p-value=0.019) and ≥1 OAC contraindication (OR=5.01, CI=2.68–9.34, p-value<0.001) were all associated with OAC underuse.In conclusion, OAC is underused in geriatric patients with AF, while antiplatelet, LMWH and no antithrombotic therapy are relatively overused. Factors associated with the decision to not prescribe OAC lie on a mix of clinical and geriatric variables, among which functional status is particularly relevant.

Bioengineering of Human Heparin: A Next Generation Anti‐coagulant

Heparin used clinically is manufactured by extraction from porcine and bovine tissues. Recently, contaminating oversulfated chondroitin sulfates found in batches of porcine heparin led to the deaths of approximately 100 people in the US, which was caused by an uncontrolled anaphylactoid‐type response. This has led researchers to explore alternative methods of producing heparin including chemical synthesis, chemoenzymatic synthesis and metabolic engineering of cells to express high levels of the enzymes involved in heparin biosynthesis. However, these approaches are yet to produce heparins with anticoagulant activity similar to heparin used in the clinic. The aim of this research was to recombinantly express serglycin in human cells as an alternative approach to producing anticoagulant heparin.The serglycin recombinantly expressed in human embryonic kidney (HEK‐293) cells was decorated with heparin, heparan sulfate and chondroitin sulfate. The disaccharide composition of the recombinantly expressed heparin was analysed by fluorophore assisted carbohydrate electrophoresis and contained 15% tri‐sulfated disaccharides as well as 40% di‐sulfated, 25% monosulfated and 20% unsulfated disaccharides. The disaccharide composition of low molecular weight heparin was also analysed and contained a higher proportion of sulfated disaccharides than the recombinantly expressed heparin being 40% trisulfated, 45% disulfated, 10% monosulfated and 5% unsulfated disaccharides.The activated partial clotting time assay is used clinically to monitor heparin levels in patients after its administration and was used in this study to determine the anticoagulant activity of the recombinant human heparin and to compare this to the activity of low molecular weight porcine heparin. In this assay porcine heparin was approximately 20 times more potent in its anticoagulant activity than the recombinant human heparin on a weight basis.These data demonstrate for the first time the successful production of human heparin from cells transfected with the human serglycin gene. This is a significant step towards alternative sources of heparin that has distinct advantages for patient safety due to the use of production methods with a lower inherent risk of contamination. Human cell‐derived heparin will also provide an alternative source to animal‐derived heparin that will enable its use by patients who, due to religious beliefs and/or dietary choices, have so far been excluded from heparin treatment.Support or Funding InformationFunding provided by the Australian Research Council.

Perioperative Management of Anticoagulation-Review of Latest Evidence.

Periprocedural anticoagulation bridging is recommended to reduce the risk of thromboembolic events in patients at a higher risk of developing thromboembolism during the perioperative period. The optimal periprocedural anticoagulation strategy has not been established. Unfractionated heparin and low molecular heparin are used in preventing thromboembolism in the special population. Novel oral anticoagulants that directly inhibit thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban) are shown as effective anticoagulants in preventing thromboembolism (venous thromboembolism) in various medical conditions. They have the advantage of having a faster onset, shorter half-lives, easier monitoring, and predicable doses. But there are disadvantages to newer anticoagulants such as the unavailability of definitive reversal agents and lack of data in patients with renal insufficiency. We review the latest evidence on the effects of newer oral anticoagulants in preventing thromboembolism and its bleeding risks.

EXTENDED THERAPY OF VENOUS THROMBOSIS BY ORAL ANTICOAGULANTS: FOCUS AT SAFETY

Study objective: to evaluate safety of prolonged therapy of venous thrombosis by rivarixaban compared to the standard scheme of therapy by low-molecular heparins (LMH) with subsequent transfer to warfarin administration. Materials and methods. Prospective observation comparative study was conducted that included 243 patients with verified venous thrombosis. The control group included 96 patients to whom therapy by LMH/warfarin was prescribed. The major group included 147 patients to whom rivaroxaban was prescribed. Results. The frequency of major hemorrhages reached 0% in the major group versus 2% in the control group (р = 0.32). The total frequency of hemorrhagic complications development amounted to 10.2% in the major group and 12.5% in the control one (p = 0.73). 86.7% of patients of the major group and only 50% of the control group (р = 0.049) continued the anticoagulant therapy after development of hemorrhagic complications. Conclusions: the results obtained by us confirm higher safety of rovaroxaban use compared to warfarin within prolonged therapy of venous thrombosis. These data correspond to the results of the previously published studies EINSTEIN and XALIA.

PREVENTION OF VENOUS THROMBOEMBOLIC COMPLICATIONS IN TRAUMAS OF LOCOMOTOR SYSTEM

Therapy of patients with disturbances of the locomotor system requires use of drugs to prevent venous thromboembolic complications. In addition to non-drug measures low-molecular heparins are the drugs of choice among coagulants at conservative therapy of traumas and in the post- operative period. The second generation low-molecular heparin – bemirin sodium – demonstrates high effectiveness and safety and might be applied by patients with medium and high degree of development of venous thromboembolic complications (VTEC).