Academic literature on the topic 'Subcutaneous heparin injection'
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Journal articles on the topic "Subcutaneous heparin injection"
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Baer, CL, WM Bennett, DA Folwick, and RS Erickson. "Effectiveness of a jet injection system in administering morphine and heparin to healthy adults." American Journal of Critical Care 5, no. 1 (January 1, 1996): 42–48. http://dx.doi.org/10.4037/ajcc1996.5.1.42.
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BACKGROUND: Jet injection eliminates the risk of contaminated needlestick injuries when giving intramuscular or subcutaneous medications. Clinical efficacy of the Biojector System was equivalent to that of needle and syringe injection in unpublished trials with vaccines, but had not been studied using other drugs. OBJECTIVE: To compare the effectiveness of the Biojector with conventional needle and syringe injection in administering intramuscular morphine and subcutaneous heparin to healthy adults, as measured by plasma drug concentration. METHODS: Intramuscular injections of morphine 8 mg (5 mg if weight < or = 65 kg) were given 24 hours apart with the jet injector and with a needle and syringe to 30 subjects at the deltoid site and 10 subjects at the dorsogluteal site. Blood samples for plasma concentrations of free morphine were drawn at 15, 30, 45, 60, 120, and 240 minutes and were analyzed using radioimmunoassay. Abdominal subcutaneous injections of heparin 3500 U were given every 8 hours for 5 days with both injection methods to 29 subjects, with 48 hours between the two series. Daily blood samples for plasma heparin were analyzed by colorimetric assay for antifactor Xa activity. RESULTS: Mean free morphine concentration, peak value, and area under the curve did not differ significantly between the deltoid and dorsogluteal sites or between the jet injector and needle and syringe. Values of mean daily heparin concentrations and area under the curve were low and did not differ between the two injection methods. CONCLUSION: Plasma drug concentrations provided by the Biojector were equivalent to those provided by conventional needle and syringe when administering intramuscular morphine and low-dose subcutaneous heparin.
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Hadley, SA, M. Chang, and K. Rogers. "Effect of syringe size on bruising following subcutaneous heparin injection." American Journal of Critical Care 5, no. 4 (July 1, 1996): 271–76. http://dx.doi.org/10.4037/ajcc1996.5.4.271.
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BACKGROUND: Bruising and induration associated with subcutaneous heparin injection often result in sustained tenderness and severe ecchymosis at the injection site. Research-based practice guidelines for subcutaneous heparin administration are needed to reduce these adverse effects. OBJECTIVES: The purpose of this study was to investigate the effect of syringe size (1-mL vs 3-mL) on postinjection-site bruising and induration following the administration of subcutaneous heparin. METHODS: A convenience sample of 29 subjects receiving 5000 units of subcutaneous heparin at least twice a day was recruited from a large urban hospital. Subjects received their regularly scheduled subcutaneous heparin injections with a 3-mL or a 1-mL syringe in a randomized sequence using a standardized procedure. Injection sites were assessed for bruises and induration at 24, 48, and 72 hours after injection. RESULTS: The incidence of injection site bruising with 1- and 3-mL syringes was 79% and 69%, respectively. The use of a 3-mL vs 1-mL syringe resulted in significantly smaller bruises at 48 and 72 hours after injection. Induration at the injection site occurred in three patients. CONCLUSIONS: Findings suggest that 3-mL syringes are preferable to 1-mL syringes for heparin administration. The effect of other injection-related variables should be studied with the use of the 3-mL syringe, and tested on various populations.
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Morrison, F. S. "Site for subcutaneous heparin injection." Archives of Internal Medicine 152, no. 1 (January 1, 1992): 202a—202. http://dx.doi.org/10.1001/archinte.152.1.202a.
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Inwood, M. J. "Site for subcutaneous heparin injection." Archives of Internal Medicine 153, no. 2 (January 25, 1993): 263. http://dx.doi.org/10.1001/archinte.153.2.263.
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Morrison, Francis S. "Site for Subcutaneous Heparin Injection." Archives of Internal Medicine 152, no. 1 (January 1, 1992): 202. http://dx.doi.org/10.1001/archinte.1992.00400130192027.
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Inwood, Martin J. "Site for Subcutaneous Heparin Injection." Archives of Internal Medicine 153, no. 2 (January 25, 1993): 263. http://dx.doi.org/10.1001/archinte.1993.00410020105014.
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Mar, Adrian W.-Y., Barry Dixon, Kamal Ibrahim, and John D. Parkin. "Skin necrosis following subcutaneous heparin injection." Australasian Journal of Dermatology 36, no. 4 (November 1995): 201–3. http://dx.doi.org/10.1111/j.1440-0960.1995.tb00974.x.
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Tsapatsaris, Nicholas P. "Site for Subcutaneous Heparin Injection-Reply." Archives of Internal Medicine 152, no. 1 (January 1, 1992): 202. http://dx.doi.org/10.1001/archinte.1992.00400130192028.
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Tsapatsaris, Nicholas P. "Site for Subcutaneous Heparin Injection-Reply." Archives of Internal Medicine 153, no. 2 (January 25, 1993): 263. http://dx.doi.org/10.1001/archinte.1993.00410020105015.
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Tonn, Michael E., Robyn A. Schaiff, and Marin H. Kollef. "Enoxaparin-Associated Dermal Necrosis: A Consequence of Cross-Reactivity with Heparin-Mediated Antibodies." Annals of Pharmacotherapy 31, no. 3 (March 1997): 323–26. http://dx.doi.org/10.1177/106002809703100310.
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Objective To describe a patient with enoxaparin-induced dermal necrosis and to review previously reported cases of skin manifestations associated with low-molecular-weight heparins. Case Summary A 43-year-old white woman with adult respiratory distress syndrome developed localized dermal necrosis and thrombocytopenia secondary to subcutaneous administration of unfractionated heparin. Upper extremity thrombi that had developed after administration of subcutaneous heparin at an outside hospital were treated with subcutaneous enoxaparin. Although platelet counts remained stable during enoxaparin therapy, dermal necrosis developed at the injection site. Parenteral anticoagulant therapy was discontinued and the necrotic lesions secondary to enoxaparin resolved with minimal local care. Discussion Numerous cases of dermal necrosis secondary to heparin administration have been reported while this reaction secondary to enoxaparin use has been reported only briefly. It has been postulated that dermal necrosis secondary to heparin is associated with heparin-induced thrombocytopenia and is a result of heparin-mediated thrombosis in the microvasculature. Antibodies to heparin have cross-reactivity with enoxaparin; therefore, dermal necrosis secondary to enoxaparin may occur by a similar mechanism. Conclusions Although enoxaparin-associated dermal necrosis appears to be a rare occurrence, we advise against the use of enoxaparin or other low-molecular-weight heparins in patients with a previous history of heparin-associated thrombocytopenia or heparin-induced dermal necrosis.
Dissertations / Theses on the topic "Subcutaneous heparin injection"
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Chan, Harriet S. C. "Duration of subcutaneous heparin injections : effect on bruising and pain." Thesis, Curtin University, 2000. http://hdl.handle.net/20.500.11937/460.
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Injection site-pain and bruising are common side effects of subcutaneous heparin injections. These adverse outcomes are problematic for both the patient and the nurse. Specifically, site-pain causes the patient discomfort and bruising limits possible sites for subsequent injections. It is important that nurses use an injection technique that minimises the incidence of adverse outcomes when administering subcutaneous heparin injections. This study examines the effect of duration of subcutaneous heparin injection on site-pain intensity and bruise size experienced by a group of patients being treated with heparin for ischaemic stroke or transient ischaemic attacks.A quasiexperimental design with subjects serving as their own control was used to address the study objectives. The independent variable was the duration of the injection and the dependent variables were site-pain and bruise size. A convenience sample of 34 subjects receiving 5000 units of a subcutaneous Fragmin injection twice a day were recruited from a large teaching hospital. Subjects rated the level of perceived site-pain intensity during injection using the vertical Visual Analogue Scale. Injection-site bruising was measured at 48 and 60 hours after injection. Data were analysed using the Wilcoxon Sign-Rank test. Results indicated that injection technique B (30-second injection duration) resulted in significantly less intense site-pain during administering the injection and fewer and smaller bruises.The findings of this study indicate that injecting subcutaneous heparin over a longer duration may reduce injection site-pain and bruising.
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Chan, Harriet S. C. "Duration of subcutaneous heparin injections : effect on bruising and pain." Curtin University of Technology, School of Nursing, 2000. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=9868.
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Injection site-pain and bruising are common side effects of subcutaneous heparin injections. These adverse outcomes are problematic for both the patient and the nurse. Specifically, site-pain causes the patient discomfort and bruising limits possible sites for subsequent injections. It is important that nurses use an injection technique that minimises the incidence of adverse outcomes when administering subcutaneous heparin injections. This study examines the effect of duration of subcutaneous heparin injection on site-pain intensity and bruise size experienced by a group of patients being treated with heparin for ischaemic stroke or transient ischaemic attacks.A quasiexperimental design with subjects serving as their own control was used to address the study objectives. The independent variable was the duration of the injection and the dependent variables were site-pain and bruise size. A convenience sample of 34 subjects receiving 5000 units of a subcutaneous Fragmin injection twice a day were recruited from a large teaching hospital. Subjects rated the level of perceived site-pain intensity during injection using the vertical Visual Analogue Scale. Injection-site bruising was measured at 48 and 60 hours after injection. Data were analysed using the Wilcoxon Sign-Rank test. Results indicated that injection technique B (30-second injection duration) resulted in significantly less intense site-pain during administering the injection and fewer and smaller bruises.The findings of this study indicate that injecting subcutaneous heparin over a longer duration may reduce injection site-pain and bruising.
Book chapters on the topic "Subcutaneous heparin injection"
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Keeling, David. "Therapeutic anticoagulation." In Oxford Textbook of Medicine, 3018–22. Oxford University Press, 2010. http://dx.doi.org/10.1093/med/9780199204854.003.161602_update_002.
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Low molecular weight heparins (LMWH) have largely replaced unfractionated heparin. Their much more predictable anticoagulant response combined with high bioavailability after subcutaneous injection means that the dose can be calculated by body weight and given subcutaneously without any monitoring or dose adjustment. Their widespread use resulted in most patients with deep vein thrombosis being managed as outpatients, and this is also increasingly the case for uncomplicated pulmonary embolism....
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Keeling, David. "Therapeutic anticoagulation." In Oxford Textbook of Medicine, edited by Jeremy Dwight, 3729–34. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198746690.003.0376.
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The main indications for therapeutic anticoagulation are venous thromboembolism, deep vein thrombosis, and pulmonary embolism, and the prevention of stroke in patients with atrial fibrillation or mechanical heart valves. Low-molecular-weight heparins have largely replaced unfractionated heparin in its treatment. Their much more predictable anticoagulant response combined with high bioavailability after subcutaneous injection means that the dose can be calculated by body weight and given subcutaneously without any monitoring or dose adjustment. Their widespread use resulted in most patients with deep vein thrombosis being managed as outpatients, and this is also increasingly the case for uncomplicated pulmonary embolism. Oral direct inhibitors of anticoagulation that specifically target thrombin or factor Xa are increasingly used to treat acute venous thromboembolism and for stroke prevention in atrial fibrillation.
Conference papers on the topic "Subcutaneous heparin injection"
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Hara, T., M. Iwamoto, H. Ogawa, and M. Tamikawa. "PROPHYLACTIC EFFECT OF ARGIPIDINE (MD-805) ON DEVELOPMENT OF LESIONS IN RAT PERIPHERAL ARTERIAL OCCLUSION MODEL." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644802.
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Argipidine ((2R,4R)-4-methyl-1-(N2-[(RS)-3-methyl-l,2,3,4-tetrahydroquinolinesulfonyl)-L-arginyl]-2-piperidinecarboxylie acid hydrate) is a potent and specific inhibitor of thrombin(Ki=0.039μM). We tested the effect of argipidine on a new animal model of peripheral arterial occlusion (PA0).PA0 was prepared by injection of 5% lactic acid into rat femoral artery. Macroscopic changes of legs progressed asfollows; change to violet color around whole paw (3-24hr), edema (3-24hr), gangrene of fingers (after 24hr) and mummification of whole paw (after 7 days). Pathological examination demonstrated partial deletion of arterial endotherial cells and subsequent occlusive arterial thrombosis. Coagulo-parameters in circulating blood did not change 3 hours after lactic acid injection. To evaluate the effect of tested antithrombotic drugs, sum of lesion grade of five fingers is used as an index of severity of. PA0.Single subcutaneous injection of argipidine 30 minutes before lactic acid injection, inhibited significantly development of lesions of the lower limb at doses lOmg/kg and 30mg/kg in a dose-dependent manner. The number of rats which showed moderate or severe lesion on their legs at 14 days after lactic acid injection was decreased to 2/8 in argipidine treated (30mg/kg) rats from 7/8 in control rats. But argipidine injected simultaneously with lactic acid showed weak inhibitory effect (not significant) and argipidine injected three hours after lactic acid injection did not showany inhibitory activity. Slight prophylactic effect was also found by subcutaneous injection of heparin at a dose of 900U/kg, but its effect were not significant.In a separate experiment, PT and APTT were assayed after subcutaneous injection of argipidine or heparin. Heparin (900U/kg) prolonged APTT much greater than argipidine (30mg/kg), but as for prolongation of PT, argipidine was more effective than heparin.These results suggest that extrinsic coagulation system plays an important role in initiation of lesions of this model.
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Johnston, R. V., M. Orr, A. Rumley, J. McLachalan, and C. D. Forbes. "A STUDY OF THE ANTI-THROMBOTIC POTENTIAL OF LOW MOLECULAR WEIGHT HEPARIN LHN-1 (NOVO) IN NORMAL VOLUNTEERS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643225.
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Studies of low molecular weight heparin have shown a molecular sized dependency of the anti-coagulant activity. We studied the effects of a low molecular weight heparin LHN-1 (Novo) with a mean molecular weight of 5-7000 daltons on the coagulation mechanism and platelet function of normal volunteers. The heparin was given for 5 days on a once daily dose of 2500, 5000 or 7500 anti-Xa units to 3 groups of volunteers and in a twice daily regime of 2500 and 5000 anti-Xa units in 2 further groups of volunteers. After subcutaneous injection LHN-1 produced a significant (p<0.01) increase in anti-Xa activity which peaked between 3-4 hours after subcutaneous injection on both once and twice daily regime. On once daily regime there was no significant measure able anti-Xa activity 24 hours after the last injection. There was a small but significant increase in both KCCT and thrombin time (p<0.01) following injection, which was also dose related. Bleeding time did not change and there was no effect on platelet function. There was a significant (p<0.01) increase in fibrinolysis as measured by the fibrin plate method. There were no bleeding problems. These findings would suggest that LHN-1 merits further clinical evaluation to confirm its anti-thrombotic and profibrinolytic potential.
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LE BALC’H, T., a. LANDAIS, T. BUTEL, D. WEILL, J. C. PASCARIELLO, and A. PLANES. "ENOXAPARINE (LOVENOXR), VERSUS STANDARD HEPARIN IN PROPHYLAXIS OF DEEP VEIN THROMBOSIS (DVT) AFTER TOTAL HIP REPLACEMENT (THR)." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643691.
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THR is associated with a high risk of thromboembolic complications. Enoxaparine, LovenoxR, a low-molecular-weight-heparin, and standard heparin were compared in their abilities to prevent DVT in patients undergoing THR. The efficiency and the bleeding risk of each treatment were studied.237 patients, with a non traumatic hip disease, requiringTHR, were included in a multicentric, randomized, double blind trial. Mean age:65.8 years ± 9.2; mean weight :67.3kg ± 1.3.113 patients received standard heparin, 5000 UI/8 hrs, by"subcutaneous (SC) injection. 124 patients received Enoxaparine, 40 mg/24 hrs, by SC injection. Administration of drugs was begun 2 hours before operation for standard heparin, 12 hours before operation for Enoxaparine. Patientswere treated for 10-15 days, until bilateral ascending phlebography (BAP) had been completed.Lower limbs BAP were performed in 228 patients. The incidence of DVT was significantly lower in the Enoxaparine group : a DVT was detected in 15(12.5 %) of 120 patients who received Enoxaparine and in 27(25%) of 108 patients who received standard heparin (p=0.014).A pulmonary embolism occurred in 1 patient of the heparin group, in none of the Enoxaparine group.The frequency of bleeding complications was significantly lower in the Enoxaparine group. A post operative wound hematoma occurred in 1 patient of the Enoxaparine group and in 3 patients of the heparin group. Red cell transfusions requirements were significantly lower in the Enoxaparine group (3.37 U ± 1.81) than in the heparin group (3.84U ± 1.70)(p=0.03). The hemoglobin level was significantly higher, on the 3rd, 4th post operative day, in the Enoxaparine group.Subcutaneous Enoxaparine (40 mg/24 hrs) was significantlymore efficient than subcutaneous heparin (5000 UI/8 hrs) in preventing DVT, in patients undergoing THR. The incidence of bleeding complications was significantly lower in the Enoxaparine group.Enoxaparine (LOVENOXR) - PHARMUKA S.F.
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Boneu, B., G. Houin, M. Rostin, J. L. Montastructure, P. d’Azemar, and B. Bayrou. "INTER-INDIVIDUAL PHARMACOKINETIC VARIATIONS AFTER INTRAVENOUS (IV) AND SUBCUTANEOUS (SC) INJECTION OF CY 216 IN HEALTHY SUBJECTS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643235.
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We investigated the pharmacokinetic parameters and their inter individual variations of a low molecular weight heparin (LMWH) derivative (CY 216, Fraxiparine R, Choay). In a cross-over study, 100 anti Xa IC u/kg were injected in 12 healthy volunteers, either by IV or SC route, at one week interval. The pharmacological effects were followed on 12 serial citrated samples for 24h: - anti factor Xa (AXa) activity (chromogenic assay calibrated against CY 216); - APTT and thrombin clotting time prolongation. The main pharmacokinetic parameters (elimination half-life (T|); clearance (cl); distribution volume (Vd); bioavailability F (SC/ IV)) were calculated from the anti Xa activity curves using con-, ventional methods. The results (mean, range) indicated below confirm some classical properties of CY 216: poor anticoagulant effect (APTT-TT), even after IV injection, longer half-life than . standard Heparin (SH), distribution volume similar to plasma volume, excellent bioavailability of the drug.We also emphasize important inter-individual variations between volunteers, as known for the pharmacological effects of SH in vitro and ex-vivo. From those results it could be assumed that, as for SH, close monitoring of treatment with LMWH would be suitable with higher dosages, after validation of the correlations between those biological tests and clinical results.* anti Xa IC u : anti factor X activated Institut Choay unit.
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Arnesen, K. E., G. F. Handeland, U. Abildgaard, P. Gottschalk, G. Stene-Larsen, and D. W. T. Nilsen. "WHAT IS THE OPTIMAL DOSAGE OF LMW HEPARIN IN THE SC TREATMENT OF DEEP VENOUS THROMBOSIS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643593.
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LMW heparin (LMWH) is better suited for subcutaneous (sc) administration than is UF heparin due to higher bioavailability and slower elimination. Optimal dosage for sc treatment of DVT has not been defined. Our previous study suggested that LMWH should be given in doses according to bodyweight (bw), and that sc injection of 100 anti-Xa U/kg bw/12 hrs might result in therapeutic plasma levels (Holm et al. Haemostasis 16, supl 2,30-37, 1986). This dosage is now being evaluated in an open study including patients with venographically proven DVT. Excluded were patients with pulmonary embolism, thrombosis in the IIiacal vein and females beyond 70 yrs of age. LMWH (Fragmin) is administered sc for at least 5 days. Venography is repeated the last day of treatment and evaluated blindly (Marder score). Compared to the previous study in which doses were given according to age and sex, the present protocol results in more uniform and predictable heparin plasma concentrations : Peak concentration day 2 now ranged 0.40-0.75 U/ml (mean 0.58) (n = ll) as compared to the three-fold wider range (0.261.20 U/ml)(mean 0.57)(n = 29) in the previous study. The 12 hrs plasma heparin profile was determined on day 3. Peak concentrations in the 0.44-0.72 U/ml range were found 2.5-4 hrs after injection. The plasma heparin activity was subtherapeutic (< 0.2 U/ml) the last 3-6 hrs of the 12 hrs period. The heparin activity at the next injection averaged 0.05 U/ml (range 0-0.ll). Day to day variation of peak heparin activity in the individual patient, expressed as CV, ranged 11-22% and there was no heparin accumulation.Conclusions: SC treatment of DVT with LMWH 100 anti-Xa U/kg bw/12 hrs results in peak plasma heparin activity in the 0.40-0.75 U/ml range. The plasma heparin activity was below therapeutic level 3-6 hrs of the 12 hrs period indicating that a larger dose (250 U/kg bw/ 24 hrs divided into 2 or perhaps 3 injections) is preferable.
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Cornelli, U., J. M. Welena, J. Fareed, X. Huan, and D. Hoppensteadt. "ANTITHROMBOTIC ACTIONS OF A SULFOMUCOPOLYSACCHARIDE MIXTURE (ATERIOD) IN ANIMAL MODELS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644160.
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Ateriod obtained from beef mucosal lining is a sulfomuco-polysaccharide mixture of various glycosaminoglycans which contains derma tans, heparatans and traces of heparin. It has been used in the treatment ofatherosclerosis and related vaso-oclusive disorders. Ateriod is standardized in terms of its lipoprotein lipase activation actions. Ateriod contains signfi-cant in vitro anticoagulant and antiprotease (anti-factor Xa and anti-factor Ila) activities as measured by clot-based and chromr ogenic substrate methods. However, this in vitro activity is 7-10 times lesser than heparin. In order to study the antithrombotic actions of this agent in subcutaneous, intravenous and oral routes, we utilized a rabbit stasis thrombosis model with a prothrombin complex concentrate/Russell's viper venom thrombogenic challenge and prolonged stasis. The apparent ED50 for the antithrombotic action were found to be: IV (75-100 ug/ kg), SC (0.8-1.3 mg/kg) and oral (20-30 mg/kg). In both the IV- and SC studies, sustained anticoagulant and antiprotease actions were evident. The observed antithrombotic actions did not relate to the anti-factor IIa or anti-factor Xa actions. Pretreatment of Ateriod with equigravimetric amounts of protamine and platelet factor 4 did not neutralize the antithrombotic actions of this agent in the rabbit model. In a primate (Macaca mulatta) model of pharmacokinetics, ex vivo analysis following subcutaneously administered Ateriod showed sustained anticoagulant and antiprotease effects. The time course of the subcutaneously administered Ateriod was markedly different than heparin and a low molecular weight heparin. Treated animals were shown to resist induced hypercoagulability following injection of homologous serum as measured by FPA generation for extended periods. These studies suggest that Ateriod produces a strong antithrombotic action and that it has highly sustained pharmacokinetics. The antithrombotic activity appears to be primarily mediated via non-antithrombin - HI dependent events which may be related to heparin cofactor II and vascular/ cellular modifications.
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Briel, R. C., P. C. Hermann, and P. Doller. "LOW MOLECULAR WEIGHT HEPARIN (FRAGMIN) PROPHYLAXIS IN GYNECOLOGIC SURGERY." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643223.
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In a prospective, randomized study patients undergoing hysterectomy were treated either by the low molecular weight heparin Fragmin or by the combination of unfractionated sodium heparin + dihydroergotamin (HDHE). The dosage in the Fragmin group was 2× 2500 anti Xa-U on day 1 = day of surgery, from day 2-8: 1× 5000 anti Xa-U, in the HDHE-group from day 1-8: 2× 5000 IU heparin + 0.5 mg DHE. 99 patients were randomly allocated to prophylaxis with Fragmin, 101 to HDHE prophylaxis. 95 and 96 respectively were evaluated, the others excluded for different reasons. The 2 groups were comparable for general data and risk factors. Duration of surgery, intraoperative blood loss, transfusion rates and postoperative hemoglobin levels were identical. Blood volumes in subcutaneous and subfascial drainages were slightly but not significantly higher in the Fragmin group. In patients with an additional Marshall-Marchetti-operation, blood volumes in the drainages of the spatium retzii were significantly higher in patients on Fragmin. No differences were observed in the incidence of minor and major wound hematoma. Painful injections and sugillations at the injection sites were more frequently observed in the HDHE-group. The thermographic DeVeTherm test, which was carried out daily for diagnosis of DVT, gave positiv results (= temperature difference 1°C) on one day only in 14 patients of each group. The test was positive on 2 or more consecutive days in 4 patients on Fragmin and 2 patients on HDHE. Phlebography, which was carried out in the latter patients, gave a positive result in 1 patient of each group. Localization of DVT was mainly the lower limb. Plasma anti-Xa activity (S-2222) 4 hrs. after injection of 5000 anti-Xa IU Fragmin was 0.45 IU/ml being 10 fold higher than after HDHE. aPTT was slightly prolonged in both groups, thrombin time and thrombelastogramm gave even more pronounced changes in the Fragmin group. The present data indicate that Fragmin dosage should be further decreased to avoid bleeding complications.
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Albada, J., K. K. Nieuwenhuis, and J. J. Sixma. "PHARMACOKINETICS OF A LOW MOLECULAR WEIGHT HEPARIN (KABI 2165, FRAGMIN) ATFER INTRAVENOUS AND SUBCUTANEOUS ADMINISTRATION IN HUMAN VOLUNTEERS AND ITS IN VIVO NEUTRALIZATION BY PROTAMINE SULFATE." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1642866.
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Pharmacokinetics of a low molecular weight heparin (LMWH) were studied in healthy volunteers. After an intravenous bolus injection of 5000 anti-Xa U in 5 healthy volunteers anti Xa activity disappeared according to the combination of saturable and a linear mechanism, preceded by a rapid initial disappearance. The apparent half-life of the anti Xa activity is about twice as long as that of standard heparin. In another set of experiments 5000 anti Xa U of LMWH were immediately followed by 50 mgr of Protamine Sulphate (PS). The curve of the anti Xa-activity parallelled the original curve at a level of about 30-40%. No rebound phenomenon was observed. The same dose of the LMWH followed by 100 mg of PS resulted in an anti Xa disappearance curve at an obvious higher level of about 50%. Also at this dose no rebound phenomenon was noticed.A continuous infusion of 10.000 anti Xa U/24 h during 10 hours was followed by 15.000 anti Xa U/24 h for another 10 hours after which the dose was raised to 20.000 anti Xa U/24 h for another 10 hours. Only the first infusion period resulted in a plateau fase. At the end of these experiments anti Xa activity was neutralized by 50 mg P.S. i.v. resulting in the disappearance of less than 50% of anti Xa activity. After subcutaneous administration of 15.000 anti Xa U (corresponding to the dose for i.v. treatment per day with this LMWH) peak levels of 1,1-1,8 anti Xa were reached after 3-4 hours. Supra-optimal anti Xa levels (higher than 0.9) were observed in all volunteers during a period of 5 hours. After 24 hours in none of the volunteers any anti Xa-activity could be detected.Conclusions:In contrast to previous reports pharmacokinetics of this LMWH do not essentially differ from those of standard heparin apart from its longer half-life and its high bioavialability after subcutaneous injection.
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Forestier, F., F. Daffos, M. Rainaut, P. Cornu, A. Deschamps, and F. Toulemonde. "MAY LMW (CY 216) BE ADMINISTERED DURING PREGNANCY ?" In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643598.
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One of the main problems related to the use of fractionated heparin during pregnancy concerns its transplacental passage.Previous studies showed LMW heparin fraction CY 216 has no teratogenic effects, and when labelled, does not cross the placental barrier in animal, and does not appear into the milk.We studied the transplacental passage following subcutaneous administration of large dosage (17.500 AXa IC u) in 7 women who where going to have an abortion during the third trimester of gestation because of severe fetal malformation, after informed consent.Blood samples were taken before and 3 h after injection from che mother , from the fetuses 3 h after mother injection -using ultrasound guidance of the needle and aspiration of blood in the umbilical vein.Biological assays showed that the effects are clearly observable in mother, whereas no change was observed from the fetus.Thus, it was justifiable to treat, for several reasons, 22 patients using CY 216 during a period of 2 to 5 weeks before delivery. Treatments were successful and no complication has been observed. The cord blood samples at birth never showed any biological activity.These data seem to clearly indicate that there is no passage through the placental barrier of CY 216 which offers a new possibility of treatment during pregnancy.
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LE GAGNEUX, F., A. STEG, and M. LE GUILLOU. "SUBCUTANEOUS ENOXAPARINE (LOVENOXR) VERSUS PLACEBO FOR PREVENTING DEEP VEIN THROMBOSIS (DVT) AFTER TRANSURETHRAL PROSTATECTOMY (TUP)." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643212.
Full textAbstract:
The aim of this study was mainly to evaluate the risk of bleeding, and the efficiency of Enoxaparine, a low-molecular-weight-heparin, in preventing DVT in patients undergoing TUP.89 patients (mean age : 67.5 years + 1.3), undergoing TUP, were included in a randomized, double blind study. Patients with a major risk of thromboembolism were excluded. 44 patients received one daily subcutaneous (SC) injection of 60 mg of Enoxaparine ; 45 patients received placebo. All the patients received the first injection 12 hours before operation.Red cell transfusions requirements were not significantly different between the two groups : 18 % of patients in the Enoxaparine group and 13 % of patients in the placebo group received red cell transfusions (p = 0.57). The amount of red cell units required was 3.3 units ± 0.9 in the Enoxaparine group and 2.5 U ± 0.8 in the placebo group (p = 0.51). The urethral catheters were removed on the 4th post operative day in each group.There was no significant difference in daily hemoglobin levels between the two groups.No DVT occurred : 125I fibrinogen scanning was negative in all patients but two : in these two patients (one in each group), DVT was not confirmed by a radiographic phlebography. No pulmonary embolism occurred.Enoxaparine, begun 12 hours before operation, however injected at high dose (60 mg/24 hrs), is safe in patients undergoing TUP. No significant bleeding complication occurred in the Enoxaparine group comparing with the placebo group. Red cell transfusions requirements were the same in both groups. There was no DVT in our patients.Enoxaparine (LOVENOXR) - PHARMUKA S.F.