DiseasesChemicals and DrugsAnalytical, Diagnostic and Therapeutic Techniques and EquipmentPhenomena and ProcessesHealth Care
HeparinAntibiotic ProphylaxisHeparin, Low-Molecular-WeightPost-Exposure ProphylaxisHeparin AntagonistsHeparin LyaseAnticoagulantsHeparin Cofactor IIDental ProphylaxisAntithrombin IIIChemopreventionPremedicationAntithrombinsEnoxaparinTrimethoprim-Sulfamethoxazole CombinationVenous ThromboembolismPartial Thromboplastin TimeVenous ThrombosisSurgical Wound InfectionThromboembolismGlycosaminoglycansThrombophlebitisDalteparinHemorrhageTreatment OutcomeFibrinolytic AgentsPneumonia, PneumocystisWhole Blood Coagulation TimeFactor XaMycosesPlatelet Factor 4Dermatan SulfateProtaminesPulmonary EmbolismAnti-Bacterial AgentsCefazolinAntiviral Agents
LMWHThrombosisAnticoagulationObserved with pharmacologic prophylaxisPharmacologicMolecular weightThrombocytopeniaAnticoagulantsAdministration of heparinAntithrombinAnticoagulant effectDosesPatientsIntravenousHeterogeneousVersusClots1930sApixabanSodiumMechanicalVitaminAdministerBleedingVitroBenefitTreatmentAmountsClinicalSubstanceTrialsTherapyDosageUnitsEarly
LMWH15
  • [ 112 ] Other anticoagulation drugs have subsequently been added to the treatment armamentarium over the years, such as vitamin K antagonists and low-molecular-weight heparin (LMWH). (medscape.com)
  • Admitted patients may be treated with a LMWH, fondaparinux, or unfractionated heparin (UFH). (medscape.com)
  • Early prophylaxis in surgical patients with low-molecular-weight heparin (LMWH) has been associated with significant reductions in postoperative venous thrombosis. (medscape.com)
  • As COVID-19 is associated with an increased risk of thromboembolic complications, the question arises as to whether intervention with prophylactic-dose low-molecular-weight heparin (LMWH) during the early stages of COVID-19 might prevent later complications in at-risk outpatients. (bjh.be)
  • These results suggest that LMWH prophylaxis should not be used routinely in this setting. (bjh.be)
  • Low-molecular-weight heparin (LMWH) has been validated for its efficacy and safety in preventing venous thromboembolic disease in patients at high risk in both the acute hospitalised and post-discharge settings. (bjh.be)
  • This case represents a "near miss," in that a pregnant woman received neuraxial anesthesia only four hours after her last dose of prophylactic low molecular weight heparin (LMWH). (ahrq.gov)
  • The purpose of this study is to evaluate the effect of Low Molecular Weight Heparin (LMWH) (Fragmin, dalteparin) versus Unfractionated Heparin (UFH) on the primary outcome of proximal leg Deep Vein Thrombosis (DVT) diagnosed by compression ultrasound, and the secondary outcomes of Pulmonary Embolism (PE), bleeding, Heparin-Induced Thrombocytopenia (HIT), and objectively confirmed venous thrombosis at any site. (drugpatentwatch.com)
  • Preferred initial therapy for VTE in patients with cancer is low-molecular-weight heparin (LMWH)-based therapy over warfarin-based therapy or vitamin K antagonists (VKAs), according to guidelines from the American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO), the American College of Chest Physicians (ACCP), and the National Cancer Comprehensive Network (NCCN). (oncologynurseadvisor.com)
  • Low-molecular-weight heparin (LMWH) is preferred as an effective and safe means for prophylaxis and treatment of VTE. (oncologynurseadvisor.com)
  • Low molecular weight heparin (LMWH) has better absorption after subcutaneous administration, and reduced protein binding results in improved bioavailability. (gponline.com)
  • When it is being used for prophylaxis or treatment, routine monitoring is not required with LMWH. (gponline.com)
  • Only 16% of patients in whom LMWH prophylaxis was not prescribed lacked a contraindication. (unav.edu)
  • Despite current recommendations in clinical guidelines, thromboprophylaxis with low molecular weight heparin (LMWH) is underused. (unav.edu)
  • Prophylaxis of venous thromboembolism (VTE) with low molecular weight heparin (LMWH) is now common for hospitalized non-surgical patients in British Columbia and much of North America. (ubc.ca)
Thrombosis8
  • Small amounts of heparin in combination with antithrombin III (heparin cofactor) can inhibit thrombosis by inactivating activated Factor X and inhibiting the conversion of prothrombin to thrombin. (nih.gov)
  • The same drugs are used for thrombosis as for prophylaxis. (mediservice.ch)
  • In such cases, a heparin injection may prevent thrombosis. (mediservice.ch)
  • Based on high-quality evidence, the Cochrane review showed that combining IPC with pharmacologic prophylaxis was more effective than a single preventative measure for preventing deep venous thrombosis (DVT), and more effective than IPC alone for preventing pulmonary embolism (PE). (aafp.org)
  • In patients at high risk of acute thrombosis, once the indication has been confirmed, the traditional method of initiating therapy is administration of warfarin, with or without concurrent administration of heparin. (gponline.com)
  • Ultimately, ten Cate concluded the data do not support use of heparin to prevent thrombosis in critically ill patients, but that "other thrombotic or even profibrinolytic strategies may be warranted. (medpagetoday.com)
  • Arixtra is approved in the United States (U.S.) for the prevention of venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), in patients undergoing surgery for hip fracture (including extended prophylaxis), knee replacement, hip replacement, and in abdominal surgery patients who are at risk for thromboembolic complications. (webwire.com)
  • If you have been classified as a high-risk patient or have already been diagnosed with thrombosis, heparin injections are the safest means of prophylaxis. (alemape-tours.com)
Anticoagulation4
  • The mainstay of medical therapy has been anticoagulation since the introduction of heparin in the 1930s. (medscape.com)
  • Heparin is generally used for anticoagulation for the following conditions: Acute coronary syndrome, e.g. (wikipedia.org)
  • In the non-critically ill cohort, therapeutic dose anticoagulation with heparin was superior to usual care prophylaxis, with higher odds of increasing organ support-free days in patients hospitalized with moderate COVID-19 (adjusted odds ratio [aOR] 1.27, 95% credible interval [CrI] 1.03-1.58), reported Ryan Zarychanski, MD, of the University of Manitoba in Winnipeg, Canada, and colleagues. (medpagetoday.com)
  • They were randomized to receive either therapeutic-dose anticoagulation with heparin or usual-care thromboprophylaxis, and were stratified by D-dimer level: high, low, or unknown. (medpagetoday.com)
Observed with pharmacologic prophylaxis1
  • This finding may lead to a false sense of security because although the total number of deep venous thrombi may be similar to the numbers observed with pharmacologic prophylaxis, the proportion of the relatively more dangerous proximal clots is increased (see Table 1 below). (medscape.com)
Pharmacologic10
  • The timing and duration of pharmacologic prophylaxis have also been determined to exert a significant effect the development of DVT. (medscape.com)
  • For high-risk patients, does prophylaxis against venous thromboembolism (VTE) with the combined modalities of leg intermittent pneumatic compression (IPC) and pharmacologic prophylaxis provide more protection than either treatment alone? (aafp.org)
  • The studies were not powered to detect a difference between combined and pharmacologic prophylaxis alone for the prevention of PE. (aafp.org)
  • To assess the effectiveness of intermittent pneumatic compression (IPC) combined with pharmacologic prophylaxis versus single modalities in preventing DVT in high-risk patients. (aafp.org)
  • Compared with pharmacologic prophylaxis alone, combined modalities significantly reduced the incidence of DVT, but the effect on PE is unknown. (aafp.org)
  • More studies are needed on their role in PE prevention compared with pharmacologic prophylaxis alone. (aafp.org)
  • Therefore, we recommend pharmacologic prophylaxis for patients with COVID-19 when hospitalized. (springer.com)
  • We recommend that dosing of VTE pharmacologic prophylaxis be evidence-based, whenever possible. (springer.com)
  • We recommend that post-hospital pharmacologic prophylaxis be used selectively for patients at highest risk for VTE based on existing evidence from randomized trials. (springer.com)
  • Modern VTE prophylaxis, which consists of pharmacologic therapy or mechanical compression devices, can reduce the incidence of symptomatic VTE to approximately 0.5%–1% during the hospitalization. (cdc.gov)
Molecular weight5
  • Semuloparin is a hemisynthetic ultra-low-molecular-weight heparin. (medscape.com)
  • There are no low-molecular-weight heparins or other anticoagulants approved for use in cancer patients undergoing chemotherapy, according to the FDA. (medscape.com)
  • A fractionated version of heparin, known as low molecular weight heparin, is also available. (wikipedia.org)
  • Two methods of thromboembolic prophylaxis were utilized: continuous intravenous heparin infusion, n=208, and low molecular weight heparin, n=2720. (sages.org)
  • 6] Some guidelines advocate the use of low molecular weight heparin for both prophylaxis and treatment. (jcadonline.com)
Thrombocytopenia3
  • Serious side effects include heparin-induced thrombocytopenia. (wikipedia.org)
  • Heparin is contraindicated for suspected cases of vaccine-induced pro-thrombotic immune thrombocytopenia (VIPIT) secondary to SARS-CoV-2 vaccination, as heparin may further increase the risk of bleeding in an anti-PF4/heparin complex autoimmune manner, in favor of alternative anticoagulant medications (such as argatroban or danaparoid). (wikipedia.org)
  • Heparin-induced thrombocytopenia is an immune mediated reaction, which may be secondary to heparin and causing platelet aggregation. (gponline.com)
Anticoagulants1
Administration of heparin2
  • In acute situations, concurrent administration of heparin and daily monitoring of INR for the first few days are recommended. (gponline.com)
  • Given the concerns regarding the administration of heparin in recent stroke, stockings (and other forms of mechanical/non-pharmacological) prophylaxis was an alluring route out of this dilemma, but given the inescapable conclusion from CLOTS, that stockings were ineffective in reducing DVT and were actively harmful, the position had to be reconsidered. (bmj.com)
Antithrombin1
  • SVTLE are not repressed by heparin and therefore used for assaying antithrombin in heparin-containing testers. (ukessays.com)
Anticoagulant effect2
  • In 2020, several studies demonstrated the efficacy of heparin in mitigating severe disease progression, as its anticoagulant effect counteracted the formation of immunothrombosis. (wikipedia.org)
  • The dose-response relationship is not linear and the anticoagulant effect increases disproportionately as doses are increased, so heparin therapy requires intensive monitoring. (gponline.com)
Doses4
  • It is sensible to use warfarin in low doses and gradually increase once every few weeks while concomitant administration with heparin is continued. (gponline.com)
  • The activated partial thromboplastin time (APTT) has been used to monitor therapeutic doses of unfractionated heparin. (gponline.com)
  • In an accompanying editorial , Hugo ten Cate, MD, PhD, of Gutenberg University Medical Center in Mainz, Germany, speculated that "the underlying thrombotic and inflammatory damage may have been too advanced to be influenced by higher doses of heparin" in the critically ill group. (medpagetoday.com)
  • The only thing I'd add to your chapter is the importance of VTE prophylaxis (some places still advocating therapeutic doses of LMW heparin? (emcrit.org)
Patients13
  • June 20, 2012 - The Oncologic Drugs Advisory Committee of the US Food and Drug Administration (FDA) voted overwhelmingly to reject the use of semuloparin sodium injection (sanofi-aventis) for the prophylaxis of venous thromboembolism (VTE) in some cancer patients receiving chemotherapy. (medscape.com)
  • Specifically, the vote was related to the use of semuloparin for VTE prophylaxis in patients with locally advanced or metastatic pancreatic or lung cancer and in patients with locally advanced or metastatic solid tumors and a VTE risk score of at least 3. (medscape.com)
  • The indication for semuloparin originally proposed was for "prophylaxis of venous thromboembolism in patients receiving chemotherapy for locally advanced or metastatic solid tumors. (medscape.com)
  • Between 1933 and 1936, Connaught Medical Research Laboratories, then a part of the University of Toronto, perfected a technique for producing safe, nontoxic heparin that could be administered to patients, in a saline solution. (wikipedia.org)
  • prolonged prophylaxis use in hip-replacement patients. (the-hospitalist.org)
  • A therapeutic dose of heparin was associated with increased probability of survival for non-critically ill COVID-19 patients versus usual-care thromboprophylaxis, but not for the most severe patient population, peer-reviewed results from the REMAP-CAP, ACTIV-4a, and ATTACC multi-platform trial showed. (medpagetoday.com)
  • We recommend the use of anti-Xa assay rather than aPTT to monitor unfractionated heparin dosing due to potential baseline abnormlaities in aPTT for patients with COVID-19. (springer.com)
  • The routine use of VTE prophylaxis is recommended for patients who undergo these types of orthopedic surgery.1 All anti-thrombotics carry some risk for bleeding, however, and the timing of administration of the first dose following orthopedic surgery has been shown to influence both tolerability and efficacy. (webwire.com)
  • At the current time, betrixaban is the only anticoagulant that has demonstrated clinical benefit and has been FDA-approved for postdischarge extended VTE prophylaxis in acute medically ill patients. (ajmc.com)
  • An unmet medical need exists for improving the quality of VTE prophylaxis during hospitalization and after discharge in acute medically ill patients, decreasing thromboembolic disease burden and improving long-term patient outcomes. (ajmc.com)
  • Best Evidence Webinar: VTE prophylaxis in medical patients: is it worth it? (ubc.ca)
  • For admitted patients treated with UFH, the activated partial thromboplastin time (aPTT) or heparin activity level must be monitored every 6 hours while the patient is taking intravenous (IV) heparin until the dose is stabilized in the therapeutic range. (medscape.com)
  • At the time the CLOTS Trial Collaboration was reported, work was near completion on NICE guidance for venous thromboembolism (VTE) prophylaxis in all hospitalised patients. (bmj.com)
Intravenous1
  • Erik Jorpes at Karolinska Institutet published his research on the structure of heparin in 1935, which made it possible for the Swedish company Vitrum AB to launch the first heparin product for intravenous use in 1936. (wikipedia.org)
Heterogeneous1
  • Heparin is a heterogeneous group of straight-chain anionic mucopolysaccharides, called glycosaminoglycans, having anticoagulant properties. (nih.gov)
Versus1
  • The comparison of compression plus anticoagulant prophylaxis versus compression plus aspirin showed a nonsignificant reduction in PE and DVT in favor of the former group. (aafp.org)
Clots2
  • Heparin acts as an anticoagulant, preventing the formation of clots and extension of existing clots within the blood. (wikipedia.org)
  • While heparin itself does not break down clots that have already formed (unlike tissue plasminogen activator), it allows the body's natural clot lysis mechanisms to work normally to break down clots that have formed. (wikipedia.org)
1930s1
Apixaban1
  • To date, several clinical trials have evaluated the use of extended-duration VTE prophylaxis with enoxaparin, apixaban, rivaroxaban, and betrixaban compared with standard-duration VTE prophylaxis with enoxaparin. (ajmc.com)
Sodium2
  • In heparin sodium, the acidic protons of the sulfate units are partially replaced by sodium ions. (nih.gov)
  • Heparin Sodium Injection, USP is a sterile solution of heparin sodium derived from porcine intestinal mucosa, standardized for anticoagulant activity, in water for injection. (nih.gov)
Mechanical1
  • [ 16 ] However, the use of mechanical means of prophylaxis alone is not effective in moderate or high-risk cases. (medscape.com)
Vitamin1
Administer1
  • Treatment strategies are to withhold heparin and to administer protamine sulphate for severe bleeds. (gponline.com)
Bleeding1
Vitro1
  • In vitro studies of factors potentially affecting Plasmodium falciparum infection (Heparin and anti-P. falciparum immune responses) / Asli Kulane. (who.int)
Benefit1
  • 120] Routine VTE prophylaxis: Is there a net health benefit? (ubc.ca)
Treatment3
  • [ 10 ] The 2016 updates for the 10th edition of the ACCP guidelines did not contain significant changes with regard to VTE prophylaxis (as distinct from treatment) in orthopedic surgery. (medscape.com)
  • In less affluent countries, the resulting heparin shortage also led to worsened health care beyond the treatment of covid, for example through the cancellation of cardiac surgeries. (wikipedia.org)
  • Effective prophylaxis and treatment of VTE reduced morbidity and mortality, and improved quality of life. (oncologynurseadvisor.com)
Amounts1
  • Prior to 1933, heparin was available in small amounts, was extremely expensive and toxic, and, as a consequence, of no medical value. (wikipedia.org)
Clinical1
  • Heparin was discovered by Jay McLean and William Henry Howell in 1916, although it did not enter clinical trials until 1935. (wikipedia.org)
Substance2
  • As a result, global heparin production became increasingly concentrated in China, where the substance was now procured from the expanding industry of breeding and slaughtering hog. (wikipedia.org)
  • Usually, the active substance heparin is injected under the skin or given intravenously. (mediservice.ch)
Trials1
  • The first human trials of heparin began in May 1935, and, by 1937, it was clear that Connaught's heparin was safe, easily available, and effective as a blood anticoagulant. (wikipedia.org)
Therapy1
  • The use of international reference materials for designating the activity of biological substances used in prophylaxis or therapy, or for ensuring the reliability of quality control or diagnostic procedures, allows comparability of data worldwide. (who.int)
Dosage1
  • Study results demonstrated that delayed initiation of Arixtra prophylaxis may provide an alternative dosage regimen for preventing VTE after total joint arthroplasty. (webwire.com)
Units1
  • The potency is determined by a biological assay using a USP reference standard based on units of heparin activity per milligram. (nih.gov)
Early1
  • In the early 1920s, Howell isolated a water-soluble polysaccharide anticoagulant, which he also termed 'heparin', although it was different from the previously discovered phosphatide preparations. (wikipedia.org)