Heparin in the prevention

Serruys PW, Herrman J-PR, Simon R, et al. A comparison of hirudin with heparin in the prevention of restenosis after coronary angioplasty. N Engl J Med 1995 333 757-763,... 

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. 

Unlabeled uses As an adjunct in treatment of coronary occlusion with acute Ml. Although there is some controversy regarding the efficacy of heparin therapy with concurrent antiplatelet therapy (eg, aspirin) in the prevention of rethrombosis/reocclusion after primary thrombolysis with thrombolytics during acute Ml, it is recommended by the American College of Cardiology and the American Heart Association. Generally, administer heparin IV immediately after thrombolytic... 

For the past few decades, heparin has been widely used for the prevention of postoperative thiomboemboUsm (6,7). However, there are several adverse side-effects associated with the use of heparin such as bleeding, heparin induced thrombocytopenia, heparin induced thrombosis (8,9) and osteoporosis (10). In addition, the regimen of pioph actic heparin used in the prevention of deep venous thrombosis (DVT) is tedious, requiring 2 to 3 daily injections because of the limited bioavailability and short half-life of heparin when administered subcutaneously. 

Low-molecular-weight heparin (LMWH) has been shown to reduce fibrin formation after vitrectomy (61-63). Fibrin has the potential to serve as a scaffold for attachment and proliferation of RPE with subsequent membrane formation (64). Treatment with heparin can prevent fibrin formation but has the potential to increase intraoperative bleeding (62,65). Because LMWH has been shown to produce less hemorrhage for an equivalent antithrombotic effect, a number of investigators have chosen to use it instead of heparin in the infusion (66). 

Other chemical inducers, such as pyran copolymers, tilorone, diethylaminoethyl dextran, and heparin, also have been used. Tilorone is an effective inducer of interferon in mice, but it is relatively ineffective in humans. Initial use of interferon and its inducers instilled intranasally after rhinovirus exposure was successful in the prevention of respiratory diseases. The clinical success of interferon and its inducers has not yet been established, although they may play a significant role in cell-mediated immunity to viral infections and cancer. Disadvantages of interferon use include unacceptable side effects, such as fever, headache, myalgias, leukopenia, nausea, vomiting, diarrhea, hypotension, alopecia, anorexia, and weight loss. 

Fluxum. Opocrin. OP 21-23 Low MW heparin (see Heparin, H-5). Prepd. by H2O2 and Cu(//) acetate degradation of heparin obt. from the intestinal mucosa of pigs. Anticoagulant. Used in the prevention and treatment of thromboembolic and other vascular disorders. Launched 1993 (Italy)... 

Published guidelines on the management of catheter-related infections are in favor of the use of ALT for the treatment of catheter-related infections [24]. The in vitro stability of antibiotic-heparin combinations in CVCs was studied by Vercaigne et al. [25]. While ciprofloxacin produced immediate precipitation with heparin, cefazolin, vancomycin and ceftazidime at 10 mg/ml and gentamycin at 5 mg/ml were successfully incubated with heparin (5,000 U/ml) for 72 h in the central venous catheter lumen. Although free antibiotic in CVC solution was reduced, the final concentration was still sufficient for an effective antibiotic-heparin lock [25]. Good evidence is available to support ALT in the prevention of catheter-related bacteremia in patients on hemodialysis [26,27]. However, others have reported that the use of ALT may be limited due to antibiotic toxicity and the appearance of antibiotic-resistant microbial isolates [28, 29]. 

A variety of clinical states are associated with thrombosis. The present discussion is limited to a few of the more prominent thromboembolic diseases further Information on this subject may be found in several reviews.3,7-9 The most common clinical states which Involve clot-like, venous thrombi are deep vein thrombosis, particularly as a postsurgical complication, and pulmonary embolism. Anticoagulants such as heparin and the coumarins have been known for years to be effective in the prevention of these types of thrombi and more recent experience has demonstrated the efficacy of fibrinolytic agents such as streptokinase for their dissolution.3,9 Platelet aggregation Inhibitors have only recently been evaluated clinically in the prevention of venous thrombosis. These studies are crucial to the resolution of the controversy as to whether platelets play a vital role in the initiation of venous thrombi.10 There is persistent histological evidence that indicates venous thrombi begin as platelet aggregates.H Myocardial infarction and stroke are... 

The comprehensive review by Douglas provides a recent discussion of the clinically useful anticoagulants. Recent studies have shown heparin to be clearly effective in clinical states In which disseminated Intravascular coagulation was Indicated to be a pathologic factor.75 xhe most commonly employed oral anticoagulants are of the coumarin type such as warfarin and nicoumalone. The oral anticoagulants appear to be of value in the prevention of thromboembolic complications after myocardial infarction.9 76 However, anticoagulation therapy has been found to have no effect on death-rate in these patients.77 Warfarin has been shown to be effective in the prevention of postoperative venous thrombosis. 

One drawback of thrombolytic therapy is a high incidence of reocclusion. In a report using a canine model, inclusion of heparin [9005-49-6] (anticoagulant therapy) in the treatment prevented this side effect (158). The combination of aspirin [50-78-2] (antiplatelet therapy) and streptokinase (thrombolytic therapy) has also shown significant therapeutic advantages (78). Although additional work is needed to estabUsh the thrombolytic advantage of various combinations, preliminary results in this area indicate promise in terms of increased efficacy and reduced side effects. 

Heparin inhibits the formation of fibrin clots, inhibits the conversion of fibrinogen to fibrin, and inactivates several of the factors necessary for the clotting of blood. Heparin cannot be taken orally because it is inactivated by gastric acid in the stomach therefore, it must be given by injection. Heparin has no effect on clots that have already formed and aids only in preventing the formation of new blood clots (thrombi). The LMWHs act to inhibit clotting reactions by binding to antithrombin HI, which inhibits the synthesis of factor Xa and the formation of thrombin. 

Ms. Jackson, age 56years, is hospitalized with a venous thrombosis. The primary health care provider orders SC heparin. In developing a care plan for Ms. Jiekson, discuss the nursing interventions that would be most important to prevent complications while administering heparin. Provide a rationale for each intervention. 

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