Deep vein thrombosis heparin

Heparin and warfarin are widely used in the treatment of thrombotic and thromboembolic conditions, such as deep vein thrombosis and pulmonary embolus. Heparin is administered first, because of its prompt onset of action, whereas warfarin takes several days to reach full effect. Their effects are closely monitored by use of appropriate tests of coagulation (see below) because of the risk of producing hemorrhage. 

DVT, deep vein thrombosis HIT, heparin-induced thrombocytopenia PAI-I, plasminogen activator inhibitor PE, pulmonary embolism SERM, selective estrogen receptor modulator VTE, venous thromboembolism. 

Deep vein thrombosis prophylaxis is recommended for septic patients. Low-dose unfractionated heparin or low-molecular-weight heparin may be utilized. Graduated compression stockings or an intermittent compression device is recommended for patients with a contraindication to heparin products (thrombocytopenia, severe coagulopathy, active bleeding, or recent intracerebral hemorrhage).24... 

Eriksson B. I., Kalebo P Anthmyr B. A., et al. Prevention of deep-vein thrombosis and pulmonary embolism after total hip replacement. Comparison of low molecular weight heparin and unfractionated heparin. J Bone Joint Surg [Am] 1991 73A, 484-93. 

Anticoagulant drugs include heparin and warfarin (Coumadin ) —agents used to prevent deep vein thrombosis. They are also used to prevent formation of emboli due to atrial fibrillation, valvular heart disease, and other cardiac disorders. Heparin, which is not absorbed by the gastrointestinal tract, is available only by injection its effect is immediate. 

A 60-year-old female with deep-vein thrombosis (DVT) is given a bolus of heparin, and a heparin drip is also started. Thirty minutes later, she is bleeding profusely from the intravenous site. The heparin is stopped, but the bleeding continues. You decide to give protamine to reverse the adverse effect of heparin. I low does protamine act ... 

Either low-dose unfractionated heparin or low-molecular weight heparin are effective A in preventing deep vein thrombosis Stress ulcer prophylaxis... 

Reviparin - low MW heparin Prevention of deep vein thrombosis and pulmonary embolism following surgery... 

Venous thrombi (red thrombi) are formed mainly from fibrin in simations where vascular stasis exists or in hypercoagulability states. Here the symptoms consist of deep vein thrombosis with the risks of pulmonary embolism and the mainstay of therapy is anti-coagulation with heparin and oral anticoagulants. 

A 23-year old pregnant woman who has been administered IV heparin for treatment of deep vein thrombosis has developed heparin-induced thrombocytopenia. Altering therapy by removing heparin and adding warfarin is not a viable option, because warfarin can cross the placenta and exert an anticoagulant effect in the fetus. Suggest a treatment approach. 

A major focus of drug development has been to develop orally active anticoagulants that do not require monitoring. Rivaroxiban is the first oral factor Xa inhibitor to reach phase III clinical trials. The safety and efficacy of rivaroxiban appears to be at least equivalent, and possibly superior, to LMW heparins for prevention of deep vein thrombosis no routine monitoring is required. This drug is also in clinical trials for treatment of deep vein thrombosis and prevention of stroke in atrial fibrillation. 

The use of traditional (unffactionated) heparin has therefore been replaced by LMWHs to a large extent.18,100 LMWHs are clearly safer and more convenient to their unfractionated counterparts, and these drugs have become the primary method of treating acute venous thrombosis.47,100 LMWHs are now used routinely to prevent or treat deep vein thrombosis (DVT) following various types of surgery or medical conditions (ischemic stroke, cancer).70,127 It has also been suggested that LMWHs will produce optimal effects if they are administered for more than a few days, and some patients who are at high risk for thrombosis may receive LMWHs via subcutaneous injection for several weeks or months.80 Future research will help determine the best way to use LMWHs to prevent or treat venous thrombosis in specific clinical situations. 

Finally, aspirin has also been used to prevent thrombus formation in peripheral veins (deep vein thrombosis [DVT]), and aspirin is sometimes used as an adjunct or alternative to anticoagulants (heparin, warfarin) that are routinely used to treat DVTs.8 Aspirin can likewise be administered to prevent thromboembolism following surgical procedures such as coronary artery bypass, arterial grafts, endarterectomy, and valve replacement 45,78 By preventing platelet-induced thrombogenesis, aspirin helps maintain patency and prevent reocclusion of vessels following these procedures. 

Bara L, Planes A, Samama M-M Occurrence of thrombosis and haemorrhage, relationship with anti-Xa, anti-I la activities, and D-dimer plasma levels in patients receiving low molecular weight heparin, en-oxaparin or tinzaparin, to prevent deep vein thrombosis after hip surgery. Br. J. Haematol. (1999) 304 230-240. 

Kakkar VV Hoppensteadt DA, Fareed J, et al. Randomized trial of different regimens of heparins and in vivo thrombin generation in acute deep vein thrombosis. Blood 2002 99(6) 1965-1970. 

Fiessinger JN, Huisman MV Davidson BL, etal. Ximelagatran vs low-molecular-weight heparin and warfarin for the treatment of deep vein thrombosis a randomized trial. J Am Med Assoc 2005 293 681-689. 

Fondaparinux is a chemically synthesized pentasaccharide that mimics the antithrombin-binding site of heparin and LMWH. Its molecular size (1728Da) is too small to bind to thrombin molecules while it is bound to antithrombin, Therefore, it is a pure anti-Xa inhibitor. It binds very little to platelets, proteins, or endothelium and is excreted in the urine, It does not form a complex with PF4 or other positively charged molecules. It is not neutralizable by protamine sulfate, Recent clinical trials have resulted in FDA approval for prophylaxis of deep vein thrombosis in orthopedic surgery, It has been shown to be effective and safe for the treatment of pulmonary embolism (20,21) and ACS (non-ST-elevation Ml) (OASIS 5—Michelangelo Trial) (17). 

The composition of the cotton threaded thrombus shows a composition of fibrin together with tightly aggregated and distorted erythrocytes, thus being in accordance with human deep vein thrombosis structure. Non-occlusive thrombus formation has been successfully inhibited by heparins, prothrombinase complex inhibitors and thrombin inhibitors (Hollenbach et al. 1994,1995). 

Mobilization may reduce complications, including pneumonia, deep vein thrombosis, pulmonary embolism and pressure ulcers. At present, there are no reUable data to recommend the use of compression stockings or low-dose heparin for deep vein thrombosis prohylaxis (Andre et al. 2007) but trials are ongoing (Dermis 2004). 

Prandoni P, Lensing A, BuDer H, Carta M, Cogo A, Vigo M, Casara D, Ruol A, ten Cate JW Comparism of subcutaneous standard low-molecular wrigbt heparin wifii intravenous standard heparin in proximal deep-vein thrombosi Lancet (1992) 339 441-445. 

Caen JP A randomized double-blind study between a low molecular weight heparin Kabi 2165 and standard heparin in the prevention of deep vein thrombosis in general surgery. A French multicenter trial. IhrombHaemost (19SS) 59(2) 216-220. 

LeyvrazPF, Richard J, BadmaonF, Van Melle O, Treyvaud JM, Livio JJ, Candardjis G Adjusted versus ficed suhcitaneous heparin in the i -evention of deep vein thrombosis after total hip replacement. N Eng JMed (1983) 309 954-958. 

The convenience (and cost-effectiveness) of LMW heparin therapy has resulted in widespread changes in practice. Patients with acute venous thromboembolism can be treated safely and effectively with LMW heparin as outpatients. Large-scale studies have demonstrated that outpatient treatment of acute deep vein thrombosis (DVT) with unmonitored body-weight adjusted LMW heparin is as safe and effective as inpatient treatment with adjusted dose intravenous standard heparin. Further trials have confirmed the safety and efficacy of LMW heparin therapy in acute pulmonary embolism and that 80% of imselected patients with acute thromboembolism can be safely treated as outpatients. ... 

Heparinoids. Danaparinoid sodium is a mixture of several types of non-heparin glycosaminoglycans extracted from pig intestinal mucosa (84% heparan sulphate). It is an effective anticoagulant for the treatment of deep vein thrombosis (DVT) prophylaxis in high-risk patients and treatment of patients with heparin-associated thrombocytopenia. 

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