Rivaroxaban versus low-molecular weight heparin plus warfarin prevents portal vein system thrombosis after splenectomy and pericardial devascularization: A randomized clinical trial / 西安交通大学学报(医学版)

【Objective】 To evaluate the safety and efficacy of rivaroxaban in preventing portal vein system thrombosis （PVST） in patients with liver cirrhosis after splenectomy and pericardial devascularization. 【Methods】 Totally 76 cirrhotic patients underwent splenectomy and pericardial devascularization were randomly assigned to rivaroxaban treatment group （n=38） or low-molecular weight heparin （LMWH） plus warfarin treatment group （n=38）. The experimental group was given rivaroxaban 10 mg orally， once a day， for 30 days. The control group was given subcutaneous injection of 5000 IU low molecular weight heparin （LMWH） twice a day for 5 days and warfarin （initial dose 2.5 mg） orally once a day for 30 days. Both groups were followed up for 1 year. We compared the two groups in the incidence of PVST， recovery of liver function and coagulation function， decompensation of liver function， incidence of liver cancer， and active bleeding. 【Results】 Totally 18 patients （47.4%） in rivaroxaban group developed PVST， compared with 29 patients （76.3%） in LMWH plus warfarin group （P=0.024）. The incidence of PVST during the first year after operation was significantly lower in rivaroxaban group than in LMWH plus warfarin group （F=7.852， P=0.007）. The intra-group comparisons versus baseline showed that the liver function improved from POD 21 to POM 1， and coagulation function improved from POM 2 in rivaroxaban group. In contrast， the liver function improved from POM 1 to POM 2， and coagulation function improved from POM 4 in LMWH plus warfarin group. The two groups did not significantly differ in liver function decompensation， incidence of liver cancer， or active bleeding （all P>0.05）. 【Conclusion】 The prophylactic use of rivaroxaban significantly decreases the incidence of PVST after splenectomy and pericardial devascularization in cirrhotic patients compared to LMWH plus warfarin treatment. Besides， rivaroxaban treatment is safe and effective and is associated with improved liver and coagulation functions than LMWH plus warfarin treatment.

Risk factors and role of low molecular weight heparin in obstetric complications among women with inherited thrombophilia - a cohort study

ABSTRACT Introduction: Although there is a vast literature regarding the association between inherited thrombophilia, obstetric complications and the effect of low molecular weight heparin (LMWH), these are controversial and we have not found publications related to additional risk factors other than thrombophilia.Our objectives were to assess the prevalence of miscarriage, placenta-mediated pregnancy complications and fetal loss in pregnant women with IT, establishing associated risk factors and the effect of LMWH. Materials and methods: A retrospective cohort of pregnant women with IT was formed. Risk factors considered were: high-risk IT, age ≥35 years, body mass index ≥25 and ≥30, assisted reproductive technology, antiphospholipid antibodies, autoimmune disease, first-degree family history of obstetric complications and personal history of venous or arterial thromboembolic disease, the outcomes being M, FL and PMPC. Results and conclusions: Data from 250 pregnancies in 88 women were obtained.There were 112 (45%) Ms, 13 (5.2%) FLs and 25 (10%) PMPCs.High-risk IT was associated with FL (OR = 4.96; 95% CI, 1.42-17.3). Antiphospholipid antibodies and family history of obstetric complications were associated with PMPC (OR = 7.12; 95% CI, 1.89-26.74, OR = 3.88; 95% CI, 1.18-12.78, respectively). The LMWH presented a benefit in the combined outcome (any obstetric complication, OR = 0.25; 95% CI, 0.12-0.54) and M (OR = 0.41; 95% CI, 0.20-0.82).We conclude that obstetric complications are common in women with IT. Antiphospholipid antibodies, family history of obstetric complications and high-risk IT might be additional risk factors. The LMWH has an apparent protective effect against obstetric complications, which is consistent with some previous studies.

Occurrence of Venous Thromboembolism in Patients with Lung Cancer and Its Anticoagulant Therapy / 中国肺癌杂志

Lung cancer is the first leading cause of morbidity and mortality in the world. Venous thromboembolism (VTE) is a recognized complication in patients with lung cancer, which is one of the leading cause of death in lung cancer patients. The cancer-related, patient-related and treatment-related factors are the main causes of VTE in lung cancer patients. Malignant cells can directly activate blood coagulation by producing tissue factor (TF), cancer procoagulance (CP), inflammatory factors and cytokines; And the one of predominant mechanisms in cancer-related thrombosis is the overexpression of TF. The 10th edition of the antithrombotic therapy guidelines for VTE with cancer patients (AT-10) published in 2016 by American College of Chest Physicians (APCC) recommended that anticoagulant therapy is the basic treatment for patients with lung cancer complicated with VTE; And low molecular-weight-heparin (LMWH) is preferred as an anticoagulant drug, but can be use with caution due to increasing risk of bleeding.
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The Impact of Inherited Thrombophilia Types and Low Molecular Weight Heparin Treatment on Pregnancy Complications in Women with Previous Adverse Outcome

PURPOSE: To assess the distribution of births and spontaneous abortions, first-trimester abortion (FTA) and mid-trimester abortion (MTA), in untreated (n=128) and low molecular weight heparin (LMWH) treated pregnancies (n=50) of the same women with inherited thrombophilias and adverse pregnancy outcome (APO) in previous pregnancies. We particularly investigated the impact of LMWH on reducing the pregnancy complications in two thrombophilia types, "Conventional" and "Novel". MATERIALS AND METHODS: 50 women with inherited thrombophilia (26 Conventional and 24 Novel) and APO in previous pregnancies were included in the study. Conventional group included factor V Leiden (FVL), prothrombin G20210A (PT) mutations and antithrombin (AT), protein S (PS), and protein C (PC) deficiency, while the Novel group included methylentetrahydrofolate-reductase (MTHFR), plasminogen activator inhibitor-1 (PAI-1), and angiotensin converting enzyme (ACE) polymorphism. APO was defined as one of the following: preterm birth (PTB), fetal growth restriction (FGR), preeclampsia (PE), intrauterine fetal death (IUFD), placental abruption (PA) and deep venous thrombosis (DVT). RESULTS: There was no difference in distribution of births and spontaneous abortions between Conventional and Novel thrombophilia in untreated pregnancies (χ2=2.7; p=0.100) and LMWH treated pregnancies (χ2=0.442; p=0.506). In untreaed pregnancies thrombophilia type did not have any impact on the frequency of FTA and MTA (χ2=0.14; p=0.711). In birth-ended pregnancies LMWH treatement reduced the incidence of IUFD (p=0.011) in Conventional and FGR, IUFD, and PTB in Novel thrombophilia group. CONCLUSION: The equal impact of two thrombophilia types on the pregnancy outcomes and a more favorable effect of LMWH therapy on pregnancy complications in Novel thrombophilia group point the need for Novel thrombophilias screening and the future studies on this issue should be recommended.

Technical analysis of low molecule weight heparins patents and R&D suggestions / 中国药科大学学报

@#An analysis of low molecule weight heparins(LMWH)patents throughout China and aroud the world is made. The suggestion, in terms of patent technical solution, is given to the R&D of LMWH, especially the enoxaparin, dalteprin and nadroparin.

GC detection of residual solvents in low molecular weight heparin / 中国药学杂志

OBJECTIVE: To establish a method for determining methanol, ethanol and methylene dichloride residues of low molecular weight heparin(LMWH) by gas chromatography.

The use of routine chemoprophylaxis for deep vein thrombosis in all patients undergoing hip and knee replacements in rural population - whether it is justified.

Background: Deep vein thrombosis (DVT)/ pulmonary embolism (PE) are one of the most feared complications in patients undergoing joint replacements in western literatures. The exact incidence of DVT in Indians particularly rural population remains debatable. Also ways to prevent it in rural population is a dilemma for the orthopedic community. Hence this study was undertaken. Methods: We carried a prospective study of 135 cases of joint replacements i.e. 78 of total hip replacements and 57 of total knee replacements. None of the patients were given any form of chemoprophylaxis like low molecular weight heparin (LMWH). Strict monitoring was done. All patients underwent duplex ultrasonographic doppler assessment of both the lower limbs between the 4th-7th day and on 14th - 16th postoperative day. Only 5 out of 135 cases had DVT. Results: We observed that DVT developed more commonly following total hip replacement surgery (4 cases) as compared to total knee replacement (1 case). There was no mortality in our study. Conclusions: DVT following total joint replacements in rural Indian patients is not as common as reported in the Western literature. A high level of suspicion and close clinical monitoring is mandatory. The use of routine chemoprophylaxis in every patient is perhaps not justified. In future further more trials with a larger number of patients and at multiple centers would be required to confirm the findings of our study and to formulate guidelines to prevent DVT.

The effect of LMWH on Oligohydramnios at mid and late trimester of pregnancy / 中国基层医药

ObjectiveTo detect the effect of LMWH on Oligohydramnios at mid and late trimester of pregnancy.MethodsPatients were divided into two groups.Control group was given Compound amino acids 500ml,5％glucose solution 500ml by intravenous infusion and water 1000ml per oral per day,and rest in bed with left lateral position for 10 days.Test group was given the same treatments as control group,plus Flagmin 5000U by subcutaneous injection per day.Amniotic fluid index was retest after treatment.Delivery mode,newborn birth weight,neonatal asphyxia and amount of postpartum hemorrhage were compared between two groups.ResultsAmniotic fluid index and newborn birth weight of test group was significantly higher than control group( P ＜ 0.05).Cesarean section rate,mild neonatal asphyxia rate was significantly lower than control group( P ＜ 0.05).Severe neonatal asphyxia rate and amount of postpartum hemorrhage had no significant differences (all P＞0.05).ConclusionLMWH treatment could increase amniotic fluid volume and newborn birth weight on Oligohydramnios at mid and late trimester of pregnancy,improve pregnancy outcome,without increase of postpartum hemorrhage.

SUBCUTANEOUS INJECTION OF FIXED-DOSE WEIGHT ADJUSTED UNFRACTIONATED HEPARIN TO PREVENT DEEP VENOUS THROMBOSIS AFTER HIP OPERATION / 现代医院

Objective To investigate safety and efficacy of fixed-dose weight adjusted unfractionated heparin to prevent deep venous thrombosis (DVT) after hip operation.Methods 56 patients were randomly divided into control group and experimental group.27 cases in control group were treated with subcutaneous low-molecular heparin, while 29 cases in experimental group treated with subcutaneous unfractionated heparin, and both were given twice daily 12 to 24 hours after operation for 7 days.The daily doses were adjusted to patients’ weight.The volume of blood transfused and postoperative blood loss was recorded, and levels of hemoglobin, platelet, prothrombin time and APTT were tested.Incidences of DVT were obtained.Results There was no significant difference in the volume of blood transfused and postoperative blood loss between two groups (p>0.05).There was no significant change of hemoglobin, platelet, prothrombin time and APTT on the first and seventh day after surgery (p>0.05).There was no significant difference in incidences of DVT in two groups (p>0.05).Conclusion Subcutaneous unfractionated heparin can effectively reduce the incidence of DVT after hip operation, and has a good result in treating DVT with low incidence of side effects.

Influence of Low Molecular Weight Heparin on Perioperative Bleeding after Rear Operation of Thoracolumbar Spinal Bursting Fracture / 中国康复理论与实践

@#Objective To study the influence of bleeding after using low molecular weight heparin （LMWH） to prevent deep vein thrombosis (DVT) in patients with thoracolumbar spinal bursting fracture and spinal cord injury operated by rear internal fixation. Methods 120 cases were divided into the observation group (64 cases) and control group (56 cases). The observation group accepted hypodermic injection of LMWH to prevent DVT, while the control group did not. Results The volume of bleeding and blood transfusion, the change of red blood cell count (RBC) and hemoglobin were compared between two groups before and after operation. There is no statistical significance. Conclusion During the period of the operation of rear internal fixation, low molecular weight heparin cannot increase the bleeding and is safe to prevent deep vein thrombosis.

Influence of Low Molecular Weight Heparin on Perioperative Bleeding after Rear Operation of Thoracolumbar Spinal Bursting Fracture / 中国康复理论与实践

@#Objective To study the influence of bleeding after using low molecular weight heparin （LMWH） to prevent deep vein thrombosis (DVT) in patients with thoracolumbar spinal bursting fracture and spinal cord injury operated by rear internal fixation. Methods 120 cases were divided into the observation group (64 cases) and control group (56 cases). The observation group accepted hypodermic injection of LMWH to prevent DVT, while the control group did not. Results The volume of bleeding and blood transfusion, the change of red blood cell count (RBC) and hemoglobin were compared between two groups before and after operation. There is no statistical significance. Conclusion During the period of the operation of rear internal fixation, low molecular weight heparin cannot increase the bleeding and is safe to prevent deep vein thrombosis.

Clinical Study on Ttreatment of Acute Cerebral Infarction with Xuesetong Injection combined with Low Molecular Weight Heparin / 国际中医中药杂志

Ubjective To evaluate the clinical effects of Xuesetong injecfion combined with Low-molecular-weight Heparin (LMWH) on the treatment of acute cerebral infarction (ACI).Methotis 101 cases of ACI pafiens were randomly divided into three groups:a group one with thirty-three patients were treated only with 5000 IU LMWH twice daily subcutaneously;a group two with thirty-four patients were treated with only 400 mg Xuesetong injection,one daily by intravenous drip;and a group thtee with thirty-four patients were treated with enoxaparin and Xuesetong injection.All the three groups were treated for 14 days.Impaired neurological function score,blood routine,functions of liver and kidney,blood coagulating funcfion were examined before and after the treatment.Results Significant effective rate and the effective rate of the group three were 71%and 91%respectively,higher than the other two groups(P＜0.05 or P＜0.01).No severe adverse reactions were found after the treatment.Conclusion Enoxaparin combined with Xuesetong injection is an effective regimen for the treatment of acute cerebral infarction.

Clinical Observation of Low Molecular Weight Heparin in Prevention of Acute Pulmonary Embolism in Patients Following General Surgery / 药物流行病学杂志

Objective:To study the perioperative anticoagulant therapy for patients in prevention of moderate or high risk of pulmonary embolism(PE)after general surgery.Method:1146 patients who had undergone major general surgery were divided into a non-anticoagulant therapy group and an anticoagulant therapy group.There were 743 patients without the anticoagulant therapy during Jan.2005 to Aug.2008,a preventive anticoagulant therapy was performed on 403 patients who recived 5 000IU(142 patients at moderate risk of PE)or 10 000IU(261 patients at high risk of PE)low molecular weight heparin(LWMH)subcutaneous injection after major general surgery during Jan.2006 to Nov.2008.Result: Five cases died and 2 survived among 7 PE patients.Hemorrhage occurred in 3 out of 403 cases(0.7%),but no PE occurred among 403 patients administered with the LWMH anticoagulant therapy.The incidence of PE in the patients reciving LWMH decreased from 0.9%to 0(P

Antioxidant and protective effects of LWMH-SOD on neurocytes / 中国药理学通报

Aim To investigate the protective effects of LMWH-SOD(Low molecular weight heparin- Superoxide dismutase Conjugate)on the injuries induced by oxygen and glucose deprivation in cultured neurons. Methods The cortical neurons of fetal rat were cultured in vitro. The antioxidant and protective effects of LMWH-SOD were observed by treating neurons with oxygen and glucose deprivation. Results LMWH-SOD reduced the number of cell death and the efflux of LDH and the content of NO,MDA and increased the membrane fluidity after the injuries of cells. Conclusion LMWH-SOD has protective effects on cerebral cortical neurons through its action of scavenging free radicals.

Two Cases of Term Pregnancy Associated with Thrombophilia / 대한산부인과학회잡지

These are natural inhibitors of coagulation, and deficiencies of any of these factors is referred to as thrombophilia. The identified main causes of thrombophilia are deficiencies of antithrombin III, protein C, or protein S, resistance to actived protein C associated with Factor V Leiden mutation, and inherited hyperhomocystinemia. Inherited and acquired thrombophilias may also contribute to pathophysiological processes involved in recurrent pregnancy loss, fetal death, intrauterine growth restriction, placental abruption, placental infarction, and pre-eclampsia. Various therapeutic protocols with low-molecular-weight heparin (LMWH) were used. because it is associated with a low incidence of osteoporosis and thrombocytopenia. We experienced the two cases of successful deliveries by Cesarean section following a successful pregnancy maintenance in thrombophilia. we administered LMWH to prevent thromboembolism. one patient was the primi-gravidarum, with inherited thrombophilia, who has the familial history of pulmonary embolism and deep vein thrombosis. the other was the multi-gravidarum, with acquired thrombophilia, who has the past medical history of pulmonary embolism.

A Case of Embolism of Left Posterior Tibial Artery after Successful Pregnancy and Delivery in a Patient with a Mechanical Valve Replacement Using Subcutaneous Injection of Low Molecular Weight Heparin

Low molecular weight heparin (LMWH) demonstrated the safety and efficacy in patients with valve prosthesis and successfully prevented or treated venous thromboembolic events in large series of pregnant women. Subcutaneous injection of LMWH at home was done for whole gestational period (39 weeks) in 29 year-old female patient with mechanical prosthetic valves in the aortic (St. Jude 21 mm) and mitral (St. Jude 29 mm) position. aPTT and echocardiography were regularly monitored once a month. Dosage of LMWH was used in a steady state. On delivery day, use of LMWH was stopped and full-term vaginal delivary of a healthy baby could be obtained without fetal loss, thromboembolic episodes. Warfarin was combined with LMWH for 3 days after delivery. One week later, left posterior tibial artery embolism developed.

Randomized study of low molecular weight heparin (LMWH) plus chemtherapy in advanced non-small cell lung cancer / 中国癌症杂志

Purpose: To evaluate the efficacy, safety and survival of low molecular weight heparin ( LMWH) plus chemotherapy in patients with advanced non-small cell lung cancer. Methods: 46 patients with NSCLC were randomized into chemotherapy plus LMWH. (study group) and chemotherapy only( control group). Both groups received two cycles of MVP regimen (MMC 6 mg/m2, YDS 3 mg/m2 x 2, DDP 90 mg/m2). Patients in the study group were treated with LMWH 5000u twice daily from the third day before chemtherapy up to 7 days. Results: The response rate was 56. 5% (13/23) for the study group and 39. l%(9/23) for the control group. Median survival time( MST) and 1-year survival rate were 12, 1 months(95%CI:8.52~14.64) and 52.2% for the study group compare 8.4 months(95%CI:6.15 ~ 10. 85) and 34. 8% for the control group. There were significant differences for MST( 12. 1 vs 8. 4) and 1 year survival rate(52. 2% vs 34. 8%) in the study group as compared to the control group. No difference in response rate and toxicities were found between the two groups. Conclusions: Chemotherapy( MVP regimen) plus LMWH is effective and safe. Prolonged survival was observed in patients who received MVP regimen plus LMWH.

Low molecular weight heparin (LMWH) protect vascular endothelial cells in hypoxia-reoxygenation condition / 重庆医科大学学报

Objective:To investigate whether LMWH can protect the function of umbilical cells in hypoxia and hypoxia-reoxygenation conditions.Methods:Human umbilical vein endothelial cells,—ECV304,were planted into 6-well dishes,then cultivated respectively in three conditions:normal,hypoxia and hypoxia-reoxygenation conditions.Cells were grown for 1 hour in hypoxia condition;reoxygenated for 6 or 24 hours after 1 hour hypoxia,respectively.Cells in hypoxia and hypoxia-reoxygenation conditions were divided into two subgroups:LMWH group (5IU/ml) and control group.At each end of incubation time the medium was removed from each well.NO and MDA were measured by chromatometry.ET were measured by radioimmunoassay.Results:There was a decrease in the biosythesis and release of NO,while an increase of MDA and ET in hypoxia and hypoxia-reoxygenation conditions.The effect in hypoxia-reoxygenation condition was more remarkable than in hypoxia condition.But in both conditions LMWH could inhibit the productions of MDA and ET,increase the productions of NO.Conclusion:In hypoxia and hypoxia-reoxygenation conditions,LMWH can inhibit the production of MDA,and protect endothelial cells from oxygen free radicals.