Molecular Weight Heparin Treatment Research Articles

Predictors of recurrent venous thromboembolism and major bleeding in patients with cancer: A secondary analysis of the CANVAS trial

IntroductionPatients with cancer have an increased risk of developing venous thromboembolism (VTE) but also have an increased risk of both recurrent VTE and bleeding with anticoagulation compared to anticoagulated patients without cancer. CANVAS, a randomized pragmatic effectiveness trial, compared the direct oral anticoagulants a class to low molecular weight heparin for treatment of a new VTE in patients with cancer. The aim of this prespecified secondary analysis of the CANVAS trial is to identify predictors of both recurrent VTE and major bleeding in patients with cancer and new VTE. MethodsData from the 671 participants in the analysis population were used to identify predictors of recurrent VTE and bleeding during the 6-month treatment period. Significant predictors identified in the univariable models were carried forward in the multivariable models to identify independent predictors of both risks. ResultsIndependent predictors of recurrent VTE include ECOG performance status ≥2 (HR, 3.19 [95 % CI, 1.45–7.02]; P < .005), presence of metastatic disease (HR, 2.57 [95 % CI, 1.14–5.80]; P = .023), treatment with bevacizumab (HR, 2.50 [95 % CI, 1.04–5.99]; P = .041), and deep vein thrombosis without pulmonary embolus as index VTE (HR, 1.86 [95 % CI, 1.04–3.33]; P = .037). Independent predictors of major bleeding include serum albumin <3.5 g/dL (HR 1.97 [95 % CI, 1.02–3.79]; P = .044) and metastatic disease (HR 2.80 [95 % CI, 1.08–7.22]; P = .034). ConclusionFindings from this pre-specified analysis of the CANVAS trial identified risk factors for recurrent VTE and major bleeding in a population of participants with cancer and new VTE that reflect current oncology clinical practice. Results can be used to identify at risk patients in practice and inform new risk prediction models to improve the care of these patients.

Once daily vs twice daily dose of low molecular weight heparin in treatment of severe acute pancreatitis: A randomized, controlled, open-label, pilot study

Once daily vs twice daily dose of low molecular weight heparin in treatment of severe acute pancreatitis: A randomized, controlled, open-label, pilot study

Abstract 14480: Safety and Efficacy of Direct Oral Anticoagulants vs Low Molecular Weight Heparin for Treatment of Venous Thromboembolism in Patients With Cancer

Introduction: Direct oral anticoagulants (DOACs) have been studied for treatment of venous thromboembolism (VTE) in patients with cancer. However, the trials have shown conflicting results when compared with low molecular weight heparin (LMWH). Therefore, we aimed to conduct an updated meta-analysis of the available studies. Methods: Randomized controlled trials (RCTs) comparing DOAC vs LMWH for VTE treatment in cancer patients were searched from multiple online databases. The primary endpoints of interest were recurrent VTE, major bleeding, clinically relevant non major bleeding (CRNB) and mortality at the longest available follow up. A random-effects model was used to estimate risk ratios (RR) with 95% confidence intervals (CI). Results: Six RCTs, with a total of 3,703 patients - 1,855 in the DOAC group and 1,848 in the LMWH group were included. Around 49% of patients were men and the mean age was 66 years. The follow up duration varied from 3 to 24 months. Patients treated with DOAC, when compared with the LMWH group, had lower risk of recurrent VTE (RR 0.66, 95% CI 0.52-0.83, p = 0.0005) (Figure 1), but a higher risk of CRNB (RR 1.63, 95% CI 1.19-2.23, p = 0.002). No significant differences were found between the two groups with regards to major bleeding (RR 1.19, 95% CI 0.82-1.71, p = 0.36) (Figure 2) or overall mortality (RR 1.02, 95% CI 0.90-1.14, p = 0.78). Conclusions: For treatment of VTE, DOACs as compared with LMWH are associated with significant reduction of recurrent VTE events but with a higher risk of CRNB.

Rivaroxaban versus Low Molecular Weight Heparin in Treatment of Acute Deep Vein Thrombosis

Abstract Objectives The purpose of this study is to examine the use of low molecular weight heparin, warfarin, and rivaroxban in the treatment of acute deep vein thrombosis. Background A blood clot stops the passage of blood via vein, usually in the legs, causing deep vein thrombosis (DVT). Clots can detach and obstruct blood flow to the pulmonary, which can be deadly (pulmonary embolism (PE). Methodology This prospective study included 250 Patients with acute deep vein thrombosis 20 patients died (9 died due to Pulmonary embolism 1 died due to bleeding – 10 died due to myocardial infarction, stroke and cardiac aresst) during study, 30 patients lack of follow up. 100 Patients are subjected to low molecular weight heparin followed by warfarin and the other 100 subjected to rivaroxban. During the period of the study from Mars 2017 to July 2019 at emergency department in Menofia university. Results The total number of Patient selected for the tests was 200 Patient. The main age was 39 and the Minimum of age was 20 year and the maximum age are 55 year. the disruption of sex are not show any concentration in any groups, the mean BMI in Warfarin Group and Rivaroxban Group are the same with no significant, the age groups shows no statistically significant of data. Conclusion According to this study Warfarin need long term monitoring, Rivaroxaban does not require laboratory surveillance, which makes treatment easier, and there are no medication or dietary interactions with Rivaroxaban.

Prevalence and risk factor of post-operative lower extremities deep vein thrombosis in patients undergoing gynecologic surgery: a single-institute cross-sectional study

Background and aimThe study of prevalence and risk factors of postoperative lower limb deep vein thrombosis (DVT) in Thai gynecologic patients was limited. The present study was conducted to evaluate this issue.MethodsThe patients were age > 15 years old without a history of DVT or pulmonary emboli (PE) scheduled for laparotomy or vaginal gynecologic surgery between May and November 2020 were invited to participate. All of these patients were scheduled for a complete duplex ultrasound to detect lower limb DVT 72 h before and within 14 days after the operation. The patients without DVT were scheduled for an interview by telephone about DVT symptoms 30 days after the operation. The clinical variables were compared using univariate and multivariate analysis to identify the independent factors related to the development of DVT.ResultsOne hundred and twelve patients met the inclusion criteria. Of these patients, 44 cases (39.3%) were diagnosed as malignancy and 102 patients underwent a hysterectomy. Post-operative DVTs were detected in six patients (5.4%) and all except one had a malignancy. Thus, the prevalence of DVT in malignancy cases was five in 44 patients (11.4%). The independent risk factors for postoperative DVT were age > 60-year-old and receiving a perioperative blood transfusion. Five of six DVT patients received low molecular-weight heparin for treatment of DVT and none developed PE. The rest of the participants reported no symptom-related DVTs from the interview 30 days after the operation.ConclusionThe prevalence of postoperative DVT in gynecologic patients was 5%, and the independent risk factors were elderly patients and receiving a perioperative blood transfusion.

Enema based therapy using liposomal formulation of low molecular weight heparin for treatment of active ulcerative colitis: New adjunct therapeutic opportunity

Ulcerative colitis (UC) is an idiopathic bowel disease involving chronic inflammation and ulcers in colon and implicates severe epithelial damage with disruption in colon homeostasis. Presently existing treatments possess serious concerns like off target effects and adverse reactions, drug inactivation, poor absorption and other complications resulting in poor bioavailability. In context of high risk of thrombotic events in UC patients, heparin can offer appreciable benefits in UC management due to its remarkable anti-coagulating properties, its ability to intervene inflammatory pathways and acceleration of wound healing process. However, oral administration of heparin being impractical due to harsh gastric acidic environment and heparin degradation, conventional heparin administration is done via intravenous route. Present study was designed to formulate, characterize and evaluate sustained release heparin formulation in mice model of experimental colitis. Heparin liposomes (HLp) were formulated by solvent evaporation and extrusion process and possessed hydrodynamic diameter of 242 ± 4.3 nm. Size, shape and surface morphology was confirmed by TEM, SEM and AFM micrographs while encapsulation efficiency and loading of heparin in optimized HLp were 59.61% and 12.27%, respectively. HLp enema administration ameliorated gross disease indices like body weight, colon length, stool consistency, fecal occult blood. Further, anti-inflammatory efficacy of HLp was established in histopathological analysis where HLp appreciably restored protective mucin layer, colon epithelial mucosal histoarchitecture and considerably attenuated mast cell infiltration in colon epithelia. Overall, results of this study indicate that HLp demonstrated an appreciable therapeutic efficacy in experimental colitis and these results are attributed to their ability to suppress inflammation.

Clinical Value of Low Molecular Weight Heparin in Treatment of Pulmonary Heart Disease Complicated With Respiratory Failure

It is aimed to investigate the clinical value of low-molecular-weight heparin in treatment of pulmonary heart disease complicated with respiratory failure. Between January 2018 and April 2019, we included 120 pulmonary heart disease patients complicated with respiratory failure in this study and divided them into two groups using the double-blind, random method, i.e. the control group and the observation group, with 60 patients in each group. After admission, patients in two groups undertook the regular treatment, while those in the observation group additionally took low molecular weight heparin at 5000 U via subcutaneous injection, twice per d. Before and after treatment, arterial blood-gas indicators [partial pressure of carbon dioxide, partial pressure of oxygen and pH value] and the indicators of hemorheology (high blood viscosity, hematocrit and fibrinogen) and clinical efficacy were evaluated for patients in two groups. Prior to the treatment, comparison of the levels of partial pressure of carbon dioxide, partial pressure of oxygen, pH value, high blood viscosity, hematocrit and fibrinogen between two groups showed no significant differences, while after treatment, significant improvement was demonstrated in these indicators in the observation group as compared to those in the control group (p 0.05). In the observation group, patients had an effectiveness rate of 88.33 % (53/60), significantly higher than 63.33 % (38/60) in the control group (p 0.05), while patients in the observation group had shorter hospitalization time [(14.7±0.4) d] than that [(16.9±0.3) d] in the control group (p<0.05). For pulmonary heart disease patients complicated with respiratory failure, medication of low-molecular-weight heparin gained promising efficacy, with significant improvement in the blood performance, ventilation, and heart and lung functions of patients, thereby increasing the survival rate and shortening the hospitalization time of patients. Thus, it is worthy of being promoted in clinical practice.

Safety and Effectiveness of Rivaroxaban Versus Low Molecular Weight Heparin for Treatment of Cancer-Associated Venous Thrombosis: A SEER-Medicare-Linked Data Analysis

Introduction: Venous thromboembolism (VTE) affects ~20% of patients with cancer prior to death and may be present in up to half of cancer patients upon autopsy. International Society of Thrombosis and Haemostasis (ISTH) guidelines recommend oral factor Xa inhibitors for the acute treatment and secondary prevention of cancer-associated thrombosis (CAT) in patients considered low risk of bleeding and without a potential for drug-drug interactions with current systemic therapy. We sought to evaluate the effectiveness and safety of rivaroxaban versus a low molecular weight heparin (LMWH) for the treatment of CAT in routine practice. Methods: Using United States Surveillance, Epidemiology and End Results (SEER)-Medicare-linked data from 2013 to 2015, we identified adults diagnosed with lung, breast, pancreatic, prostate or ovarian cancer, having at ≥1 hospitalization or emergency department admission (index event) with a primary discharge diagnosis code for VTE (indicating VTE was the foremost reason for admission) , ≥12-months of continuous medical and prescription benefits prior to the index CAT and who received rivaroxaban or a LMWH as their first outpatient anticoagulant. Patients with primary or metastatic gastrointestinal cancers, stage 4 or worse chronic kidney disease or liver failure were excluded. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the composite outcome of recurrent VTE or major bleeding, each of these outcomes alone as well as all-cause mortality in the subsequent 12-months were calculated using a multivariable Fine-Gray (competing risk) Cox regression model adjusted for baseline covariates and propensity score decile (c-index=0.76) estimated using generalized boosted models on the basis of 10,000 regression trees. Results: We included 259 rivaroxaban- and 559 LMWH-managed patients with CAT. The median age (25%, 75% range) of patients was 73 (68, 79) years, 62.5% were men and 43.6% had pulmonary embolism. The incident cancer diagnosis was made between 2010 and 2013 in 87.8% of patients. Primary cancer locations included lung (41.8%), breast (21.8%), pancreatic (12.1%), prostate (11.9%), ovarian (5.3%) and other (7.1%). Nearly all patients (96.5%) were diagnosed with stage 2 or 3 disease. During the 12-month follow-up period, the incidence of the composite of recurrent VTE or major bleeding was 13.8%, recurrent VTE alone occurred in 11.4% and major bleeding alone in 2.9% of patients and all-cause mortality occurred in 48.4%. No significant difference in patients' relative hazard of the experiencing the composite outcome (HR=0.86, 95%CI=0.52-1.41), recurrent VTE (HR=0.91, 95%CI=0.51-1.62), major bleeding (HR=0.90, 95%CI=0.29-2.83) or all-cause mortality (HR=0.86, 95%CI=0.62-1.21) were observed between the rivaroxaban and LMWH-managed cohorts. Conclusions: In this real-world study of rivaroxaban- and LMWH-managed CAT patients, no significant difference in patients' relative hazard of experiencing the composite outcome, recurrent thrombosis, major bleeding or all-cause mortality were observed between the two cohorts. These data are consistent with recommendation that the oral factor Xa inhibitor, rivaroxaban, is a reasonable alternative to LMWH for the treatment of CAT and prevention of recurrent thrombosis. Disclosures Lyman: Amgen Inc.: Other: Research support, Research Funding; Janssen Scientific Affairs, LLC: Research Funding; Generex Biotechnology: Membership on an entity's Board of Directors or advisory committees; G1 Therapeutics, Halozyme Therapeutics, Partners Healthcare, Hexal, Bristol-Myers Squibb, Helsinn Therapeutics, Amgen Inc., Pfizer, Agendia, Genomic Health, Inc.: Consultancy. Kuderer:Mylan: Consultancy, Other: Travel, Accommodations, Expenses; Celldex: Consultancy; Myriad Genetics: Consultancy; Coherus Biosciences: Consultancy, Other: Travel, Accommodations, Expenses; Pfizer: Consultancy; Halozyme: Consultancy; Janssen Scientific Affairs, LLC: Consultancy, Other: Travel, Accommodations, Expenses. Coleman:Bayer AG: Consultancy, Honoraria, Research Funding; Janssen Scientific Affairs LLC: Consultancy, Honoraria, Research Funding.

Low Molecular Weight Heparin (LMWH) treatment does not increase the risk of bleeding after prophylactic endoscopic variceal band ligation in patients with cirrhosis

Low Molecular Weight Heparin (LMWH) treatment does not increase the risk of bleeding after prophylactic endoscopic variceal band ligation in patients with cirrhosis

Reduced Emergency Room Utilization for Initiation of Anticoagulation with Rivaroxaban Versus Low Molecular Weight Heparin for Treatment of Cancer-Associated Thrombosis

Background: Venous thromboembolism (VTE) is a leading cause of mortality and morbidity in cancer patients. The current standard of care is to treat cancer-associated VTE with Low Molecular Weight Heparin (LMWH), which is more effective than vitamin K antagonists, such as warfarin. However, LMWH injections are painful, expensive, and a burden in healthcare resource utilization. Further, many of these patients are referred to an emergency room for education on self-injection techniques, an added health care cost. The Hematology/Anticoagulation Management Service at Memorial Sloan Kettering Cancer Center is developing rivaroxaban as a safe and effective alternative to LMWH for cancer-associated VTE. In this report, we demonstrate a significant reduction in the referral of patients to the MSKCC Urgent Care Center (UCC), our in-house emergency room, to initiate anticoagulation, resulting in a significant reduction in resource utilization.Methods: As a Quality Assessment Initiative, we track all patients with cancer-associated VTE at MSKCC receiving rivaroxaban since January 2014, and have a similar database of cancer-associated VTE from June through December 2013, treated with enoxaparin. For this utilization of resources study we evaluated where anticoagulation was initiated for treatment of a new pulmonary embolism or lower extremity deep vein thrombosis, specifying either a single outpatient visit, two outpatient visits on the same day, a telephone call, or a visit to the UCC. When patients had a second outpatient visit on the same day as diagnosis of the VTE, the second visit was for patient education on injection technique and insurance authorization. The site of anticoagulation initiation was by the judgment and discretion of the physician managing the patient's cancer. Patients who developed a VTE during a hospital stay or were managed at an outside emergency room were not included in this analysis, as our program has no influence in those settings. Statistical analysis was with the Chi-square test. Comparison of safety and efficacy of rivaroxaban and LMWH is the subject of a separate study.Results: As anticipated, changing from a parenteral anticoagulant to rivaroxaban (an oral agent) resulted in significant changes in practice (Table). Significantly fewer rivaroxaban patients required visits to the UCC than with enoxaparin (p=0.009). Fewer patients required a second outpatient, as well. When viewed in the aggregate of UCC or second outpatient visit, 82% of patients treated with enoxaparin required additional medical resources for initiation of anticoagulation, beyond a single outpatient visit, which decreased to 59% with rivaroxaban (p<0.001). Of note, 11% of rivaroxaban patients were initiated with a phone call only, typically after a recent medical visit and outpatient imaging. The reduction in UCC utilization was confined to weekday hours when the outpatient clinics are open. In all cases with enoxaparin and rivaroxaban, initiation of anticoagulation was in the UCC on weekends and between the hours of 6 PM and 8 AM on weekdays.Discussion: In addition to the burden of morbidity and mortality, management of cancer-associated VTE with LMWH is painful to the patient and expensive to the healthcare system. In our QAI we have been developing rivaroxaban as an oral alternative. Safety and efficacy are being analyzed separately. In addition to the markedly lower cost of rivaroxaban compared with enoxaparin, and patient quality of life preference, we also demonstrate a significant reduction in the healthcare resources associated with initiation of anticoagulation. Cancer patients tend to be higher risk and more complex than general medical patients and it remains appropriate for some to be evaluated in an emergency room for diagnosis and management. Despite this, we observed a reduction in emergency room visits for patients in this setting. One limitation to our findings is that our study was within a single institution, with a devoted Hematology/Anticoagulation Management Service. It would be appropriate to perform a similar analysis in other institutions, including non-cancer patients, to confirm these findings.Table 1Sites of Initiation of AnticoagulationEnoxaparinRivaroxabanUCC/Emergency Room (p=0.009)127 (71%)101 (57%)Two Outpatient Visits On The Same Day20 (11%)4 (2%)Outpatient, Single Visit32 (18%)53 (30%)Telephone019 (11%)Total179177 DisclosuresNo relevant conflicts of interest to declare.

1619 Low molecular weight heparin (LMWH) treatment in cancer patients with low risk venous thromboembolism - results of Turkish Observational Study (TREBECA)

1619 Low molecular weight heparin (LMWH) treatment in cancer patients with low risk venous thromboembolism - results of Turkish Observational Study (TREBECA)

Low molecular weight heparin (LMWH) and low-dose aspirin treatment in patients with pre-existing high-risk conditions improves pregnancy outcomes when such pregnancies are complicated in addition by unexplained low maternal serum PAPP-A (LPAPP-A).

Low molecular weight heparin (LMWH) and low-dose aspirin treatment in patients with pre-existing high-risk conditions improves pregnancy outcomes when such pregnancies are complicated in addition by unexplained low maternal serum PAPP-A (LPAPP-A).

HIV-complicated meningovascular syphilis: Atypical symptoms with promising result using low molecular weight heparin

Both WHO and the CDC of Taiwan have reports indicating a dramatic increase in incidence of both syphilis and HIV. With their co-infection, neurosyphilis will become a major issue, and meningovascular insults may become more complex to these Sexually Transmitted Diseases (STD). We are reporting a young individual presented with quadriparesis and initial National Institutes of Health Stroke Scale (NIHSS) greater than 20 points after having flu-like symptoms and diarrhea for a couple of days. The patient was later diagnosed as HIV-complicated meningovascular syphilis by positive blood and CSF laboratory tests. After seven-days of low molecular weight heparin (LMWH) treatment, the patient improved dramatically with NIHSS score of 2 before being transferred to HIV center for further treatment. In contrary, there is case report that demonstrates mortality after treated meningovascular syphilis with rtPA and recanalization. As the world faltten and population of HIV spreads worldwide, the prevalence of stroke in young people may increase in the upcoming century. Only scattered case reports have been presented worldwide discussing the treatment of HIV complicated with meningovascular syphilis. We are the first to rescue the stroke in the patient of HIV with syphilis by LMWH. This case report may contribute to a better treatment for infectious patient with stroke.

Inhalable Liposomes of Low Molecular Weight Heparin for the Treatment of Venous Thromboembolism

This study tests the feasibility of inhalable pegylated liposomal formulations of low molecular weight heparin (LMWH) for treatment of two clinical manifestations of vascular thromboembolism: deep vein thrombosis (DVT) and pulmonary embolism (PE). Conventional distearoyl-sn-glycero-3-phosphoethanolamine (DSPE) and long-circulating pegylated (DSPE-PEG-2000 and DSPE-PEG-5000) liposomes were prepared by hydration method. Formulations were evaluated for particle size, entrapment efficiency, stability, pulmonary absorption, anticoagulant, and thrombolytic effects in rats. Pulmonary absorption was monitored by measuring plasma antifactor Xa activity; anticoagulant and thrombolytic effects were studied by measuring reduction in thrombus weight and amount of dissolved radioactive clot in the blood, respectively. Pegylated liposomal were smaller and showed greater drug entrapment efficiency than conventional liposomes. All formulations produced an increase in pulmonary absorption and circulation time of LMWH upon first dosing. Three repeated dosings of conventional liposomes resulted in decreased half-life and bioavailability; no changes in these parameters were observed with pegylated liposomes. PEG-2000 liposomes were effective in reducing thrombus weight when administered every 48 h over 8 days. In terms of thrombolytic effects and dosing frequency, PEG-2000 liposomes administered via the pulmonary route at a dose of 100 U/kg were as effective as 50 U/kg LMWH administered subcutaneously. This paper suggests that inhalable pegylated liposomes of LMWH could be a potential noninvasive approach for DVT and PE treatment.

Clinical observation of low molecular weight heparin combined with magnesium sulfate treatment on patients with pregnancy-induced hypertension

Objective To observe the clinical effect and safety of low molecular weight heparin in treatment of pregnancy-induced hypertension. Methods 40 patients included were randomly divided into two groups. 20 patients of treatment group were treated with low molecular weight heparin combined with magnesium sulfate. 20 patients of control group were treated with magnesium sulfate. Results The blood pressure and D-dimer of treatment group were significantly lower than control group ( P ＜ 0. 05 ). The platelet count, prothrombin time and bleeding of two groups were not significant different ( P ＞ 0. 05 ). Conclusion Low molecular weight heparin used in the treatment of severe pre-eclampsia pregnancy-induced hypertension are effeclive,safe and reliable, worthy of popularization. Key words: Pregnancy-induced hypertension; Low molecular weight heparin; Magnesium sulfate

66 Anticoagulant treatment in a hypercoagulable woman with mechanical prosthetic mitral valve – failure of high-dose low molecular weight heparin (LMWH) treatment

66 Anticoagulant treatment in a hypercoagulable woman with mechanical prosthetic mitral valve – failure of high-dose low molecular weight heparin (LMWH) treatment

Clinical Research of Low Molecular Weight Heparins in Treatment of Chronical Pulmonary Heart Diseases

目的 探讨子肝素(LMWH)治疗慢性肺源性心脏病的疗效和安全性.方法98性肺源性心脏病患者随机分为LMWH组与对照组两组,对照组常规治疗,LMWH组在常规治疗基础上加用低分子肝素(法安明,Fragmin)5000U皮下注射,2次/d,疗程7 d.结果LMWH组与对照组总有效率分别为89.6%和74.0%,具有显著性差异(P＜0.05);LMWH组治疗后全血比粘度、血浆粘度、纤维蛋白原、血沉较治疗前有明显下降,P＜0.05;而对照组,治疗前后相比,无显著差异,P＞0.05.结论低分子肝素能明显改善高凝状态,防治肺动脉血栓的形成,改善微循环并减少红细胞粘附,减轻和防止肺动脉高压的增加,改善心、肺功能。

The initial phase of oral anticoagulation with warfarin in outpatients with deep venous thrombosis

Patients with deep venous thrombosis (DVT) treated out of hospital usually start warfarin with the recommended 5 mg loading dose and have their International Normalized Ratio (INR) test performed every 2-3 days. Thus, achievement of the therapeutic range may be more difficult than for inpatients, possibly resulting in extended duration of low molecular weight heparin (LMWH) treatment. We retrospectively examined the charts of 55 DVT outpatients (mean age, 61.4 years; 30 males) to assess the actual duration of LMWH treatment and to identify predictors of a slow achievement of the INR range. Thirty patients (54.4%) reached the therapeutic INR range and stopped LMWH within 7 days, and 25 patients (45.6%) had to continue for an average of 10.5 days. The latter group was significantly younger than the former (57 and 65 years, respectively; P = 0.039). Patients younger than 60 years old had an odds ratio for an extended treatment of 4.92 (P = 0.0057). Algorithms with different loading doses of warfarin according to age should be proposed for outpatient treatment of DVT.

Mucosal capillary thrombi in steroid refractory ulcerative colitis: Influence of low molecular weight heparin (LMWH) treatment

Mucosal capillary thrombi in steroid refractory ulcerative colitis: Influence of low molecular weight heparin (LMWH) treatment

Heparin and low molecular weight heparin for treatment of acute pulmonary embolism.

Pulmonary embolism occurs in more than 175,000 patients each year in the United States. The objectives of treatment are to prevent death from the existing embolus, to prevent death and morbidity from recurrent pulmonary embolism, and to prevent morbidity from recurrent deep-vein thrombosis. For patients with adequate cardiorespiratory reserve, the primary objective is to prevent recurrent pulmonary embolism. Anticoagulant therapy with intravenous unfractionated heparin or subcutaneous low molecular weight heparin followed by oral anticoagulant treatment for at least 3 months is the treatment of choice for most of these patients. Clinical trials indicate that the effectiveness of intravenous heparin depends on achieving an adequate heparin effect (activated partial thromboplastin time above lower limit) during the initial 24 hours. A validated protocol for intravenous heparin should be used to lessen the likelihood of delayed heparinization. Low molecular weight heparin given subcutaneously either once or twice daily is as effective as intravenous heparin for the treatment of patients with deep-vein thrombosis and submassive pulmonary embolism. Low molecular weight heparin enables many patients with uncomplicated deep-vein thrombosis to be treated in an outpatient setting.