Incidence of Bleeding Complications in Patients on Intermittent IV Heparin Therapy

1975 ◽  
Vol 9 (10) ◽  
pp. 560-565
Author(s):  
Robert J. Ignoffo
Keyword(s):  
Heparin Therapy ◽  
University Hospital ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Intravenous Heparin ◽  
Bleeding Episodes ◽  
Deep Vein ◽  
High Degree ◽  
Apparent Association

The incidence of bleeding from heparin therapy in patients with diagnosed pulmonary embolism and deep vein thrombosis was evaluated in a university hospital. Major or minor bleeding episodes occurred in 32 percent of patients and of these 50 percent were major episodes requiring cessation of therapy and blood transfusion. Activated clotting times were not excessively prolonged during bleeding episodes nor was there any apparent association with the age or sex of the patient. It is felt that bleeding secondary to intermittent intravenous heparin therapy may be the result of the high degree of clotting inhibition from 15 minutes to 2 hours after injection. It is suggested that continuous intravenous infusion of heparin is as effective as intermittent heparin injections and yet appears to produce a lower incidence of both major and minor bleeding episodes.

Defibrination During Warfarin Therapy in a Man with Protein C Deficiency

1985 ◽  
Vol 53 (02) ◽  
pp. 249-251 ◽  
Author(s):  
Robert B Francis ◽  
William G McGehee
Keyword(s):  
Protein C ◽  
Warfarin Therapy ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Functional Protein ◽  
Protein C Deficiency ◽  
Vein Thrombosis ◽  
Oral Warfarin ◽  
Intravenous Heparin ◽  
Deep Vein

SummaryA 57 year old man presented with apparently spontaneous lower extremity deep vein thrombosis and pulmonary embolism. He was treated in conventional fashion with intravenous heparin and oral warfarin. After 4 daily doses of warfarin the prothrombin and proconvertin (P+P) time was within therapeutic range, and heparin was stopped. Over the next six hours complete defibrination occurred, associated with severe bleeding complications. Functional protein C measured after normalization of routine coagulation tests averaged 40% of normal, and was only 3.5% of normal immediately prior to the episode of defibrination. We conclude that the very low functional protein C levels seen immediately prior to defibrination were caused by a combination of pre-existent protein C deficiency and warfarin therapy, and directly predisposed to defibrination once heparin was stopped, despite “therapeutic” warfarin anticoagulation. Exacerbation of intravascular coagulation should be considered a potential prothrombotic effect of warfarin therapy in protein C deficient individuals.

Postoperative Versus Preoperative Initiation of Deep-Vein Thrombosis Prophylaxis with a Low-Molecular-Weight Heparin (Nadroparin) in Elective Hip Replacement

1996 ◽  
Vol 2 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Gualtiero Palareti ◽  
Battista Borghi ◽  
Sergio Coccheri ◽  
Nicoletta Leali ◽  
Rita Golfieri ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Hip Replacement ◽  
Low Molecular Weight Heparin ◽  
Bleeding Complications ◽  
Thrombosis Prophylaxis ◽  
Low Molecular Weight ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Deep Vein

The aim of this multicenter, randomized, dou ble-blind study performed in patients undergoing elective hip surgery was to compare the efficacy and safety of prophylaxis with low-molecular-weight heparin (LMWH) (Nadroparin, 7,500 anti-Xa IC units for the first 3 days and 10,000 from the fourth day on, s.c. o.i.d.) begun in one group shortly after surgery and in the other 12 h before operation, as is usually recommended. Preopera tive administration (drug or placebo) was the only differ ence between the two groups. Deep vein thrombosis (DVT) was detected by bilateral venography 10-15 days after surgery. The study investigated 179 patients (55 men), 40-80 years old, in seven Italian orthopedic cen ters. In 131 patients efficacy analysis was possible be cause of adequate bilateral venography. All 179 patients were evaluated for bleeding complications. The preva lence of thrombotic complications was similar in the two groups. Proximal DVT was found in 8.4% of patients (10.8% and 6.1% in the preop and postop groups, respec tively ; difference not statistically significant). Distal DVT was recorded in 30.5% of patients (30.8% and 30.3% in the pre- and postop groups, respectively). DVTs were more common in patients ≥65 years old (54.2% versus 28.4%, p < 0.05); no significant differences were detected in terms of other characteristics. No significant differ ences were recorded in the number or type of bleeding complications: major (nonfatal) bleeding episodes were reported in five patients (2.8%, two and three in the pre- and postop groups); minor bleeding was noted in 25 (13.9%, 14 and 11 in the pre- and postop groups). In con clusion, the present study suggests that a LMWH regi men started postoperatively is no less effective in pre venting DVT in elective hip replacement than the classi cal regimen started preoperatively. Surprisingly, postoperative commencement offered no significant ad vantage in terms of bleeding complications.

Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

1998 ◽  
Vol 79 (03) ◽  
pp. 517-519 ◽  
Author(s):  
Stephane Heymans ◽  
Raymond Verhaeghe ◽  
Luc Stockx ◽  
Désiré Collen
Keyword(s):  
Deep Vein Thrombosis ◽  
Continuous Infusion ◽  
High Speed ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Long Term Follow Up ◽  
Valve Function ◽  
Rotating Impeller ◽  
Deep Vein

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

Low Molecular Weight Heparin Therapy: Is Monitoring Needed?

1994 ◽  
Vol 72 (03) ◽  
pp. 330-334 ◽  
Author(s):  
B Boneu
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Plasma Proteins ◽  
Bleeding Risk ◽  
Heparin Therapy ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
Meta Analyses ◽  
Deep Vein ◽  
Initial Check

SummaryRecent meta-analyses indicate that low molecular weight heparins (LMWH) are more effective than unfractionated heparin (UH) in preventing and treating deep vein thrombosis. This article presents the arguments for and against the need for laboratory monitoring. At the present time, the only tests currently available for monitoring LMWH therapy are those which measure the anti Xa activity in the plasma. Due to lower binding to plasma proteins and to cell surfaces,the plasma anti Xa activity generated by a given dose of LMWH is more predictable than for UH.Some clinical trials suggest that LMWH delivered at the recommended dose expose the patient to less bleeding risk than UH. Several . meta-analyses indicate comparable risk while any overdose unaccept-ably increases the haemorrhagic risk. The lowest dose of LMWH still effective in treating established DVT is presently unknown; some reports indicate that inadequate doses of LMWH are associated with a lack of efficacy for prevention. An overview of the published clinical trials indicates that the LMWH dose has never been monitored for prevention of DVT. In the treatment of established DVT, several trials have been performed without any monitoring, while in others the dose was adapted to target a given anti Xa activity. These considerations suggest that in prevention of DVT, monitoring the dose is not required. In the treatment of established DVT, considering the haemorrhagic risk of LMWH, the risk of undertreating the patient and the absence of large clinical trials comparing the advantages of monitoring the dose or not, it might be useful to check anti Xa activity at least once at the beginning of the treatment but the need for this initial check remains to be established. Because a large proportion of patients will be in the desired range, dose adjustments will be far less frequent than for UH.

Subcutaneous Recombinant Hirudin (HBW 023) Versus Intravenous Sodium Heparin in Treatment of Established Acute Deep Vein Thrombosis of the Legs: a Multicentre Prospective Dose-ranging Randomized Trial

1997 ◽  
Vol 77 (05) ◽  
pp. 0834-0838 ◽  
Author(s):  
François Schiele ◽  
Folke Lindgaerde ◽  
Henry Eriksson ◽  
Jean-Pierre Bassand ◽  
Anders Wallmark ◽  
...  
Keyword(s):  
Bleeding Complications ◽  
Recombinant Hirudin ◽  
Serious Adverse Events ◽  
Sodium Heparin ◽  
Efficacy Analysis ◽  
Vein Thrombosis ◽  
Dose Ranging ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein ◽  
Intravenous Sodium

SummaryThe aim of this multicentre, prospective, randomised, dose-ranging study was to compare the safety and efficacy of subcutaneous recombinant hirudin (HBW 023) against intravenous sodium heparin in acute lower limb deep venous thrombosis (DVT). Patients were randomized to treatment with either HBW 023 or heparin for 5 ±1 days. HBW 023 was given according to body-weight in three dose groups. Thromboembolic disease was assessed by phlebography and ventilation/perfusion (V/Q) scanning on Bay 1 and Day 5±1. One hundred and fifty-five patients were enrolled, of these 121 were evaluable for efficacy analysis. Significantly fewer patients on HBW 023 developed new V/Q abnormalities during the treatment period, (p = 0.006). There was no difference between the groups in thrombus extension or regression, major bleeding complications or serious adverse events. There were significantly fewer findings of new V/Q mismatch after treatment with HBW 023, and anticoagulant control was superior in these patients.

Outcome of Treatment of Deep-Vein Thrombosis with Urokinase: Relationship to Dosage, Duration of Therapy, Age of the Thrombus and Laboratory Changes

1984 ◽  
Vol 51 (02) ◽  
pp. 236-239 ◽  
Author(s):  
A D’Angelo ◽  
P M Mannucci
Keyword(s):  
Degradation Products ◽  
High Rate ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
Treatment Regimens ◽  
Duration Of Therapy ◽  
Laboratory Changes ◽  
Deep Vein ◽  
Dose Dependent ◽  
Higher Doses

SummaryForty-one patients with phlebographically proven DVT of the popliteal, femoral or iliac veins were treated with different regimens of urokinase (UK) given by continuous intravenous infusion. The four groups were comparable with respect to localization, extension and estimated age of the thrombi. Another phlebographic picture was taken within 48 hr after the end of UK infusion. Substantial lysis had occurred in 2 of 10 patients treated with 1500 U/kg/h for 2 days, in 4 of 11 treated with 2500/U/kg/h for 3 days, in 2 of 10 treated with 2500 U/kg/h for 7 days and in 4 of 10 treated with 4000 U/kg/h for 4 days. Only thrombi younger than 8 days could be lysed, with 61% (8/13) rate of lysis for thrombi less than 5 days old. Bleeding complications were observed more frequently with the higher doses and longer durations of therapy. The four treatment regimens all induced dose-dependent changes in fibrinogen, fibrin(ogen) degradation products, plasminogen and antiplasmin. Neither pre- nor postinfusion values of these parameters could differentiate patients with lysis from those without lysis. It is concluded that UK can provoke a high rate of thrombolysis of DVT treated early after the appearance of symptoms but that there is no relationship between UK-induced modifications of fibrinolysis and the outcome of therapy.

Predicting recurrences or major bleeding in cancer patients with venous thromboembolism

2008 ◽  
Vol 100 (09) ◽  
pp. 435-439 ◽  
Author(s):  
Javier Trujillo-Santos ◽  
José Nieto ◽  
Gregorio Tiberio ◽  
Andrea Piccioli ◽  
Pierpaolo Micco ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Major Bleeding ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
Recurrent Pulmonary Embolism ◽  
Acute Venous Thromboembolism ◽  
Deep Vein

SummaryCancer patients with acute venous thromboembolism (VTE) have an increased incidence of recurrences and bleeding complications while on anticoagulant therapy. Methods RIETE is an ongoing registry of consecutive patients with acute VTE. We tried to identify which cancer patients are at a higher risk for recurrent pulmonary embolism (PE), deep vein thrombosis (DVT) or major bleeding. Up to May 2007, 3, 805 cancer patients had been enrolled in RIETE. During the first three months of follow-up after the acute, index VTE event, 90 (2.4%) patients developed recurrent PE, 100 (2.6%) recurrent DVT, 156 (4.1%) had major bleeding. Forty patients (44%) died of the recurrent PE,46 (29%) of bleeding. On multivariate analysis, patients aged <65 years (odds ratio [OR]: 3.0; 95% confidence interval [CI]: 1.9–4.9), with PE at entry (OR: 1.9; 95% CI: 1.2–3.1), or with <3 months from cancer diagnosis to VTE (OR: 2.0; 95% CI: 1.2–3.2) had an increased incidence of recurrent PE. Those aged <65 years (OR: 1.6; 95% CI: 1.0–2.4) or with <3 months from cancer diagnosis (OR: 2.4; 95% CI: 1.5–3.6) had an increased incidence of recurrent DVT. Finally, patients with immobility (OR: 1.8; 95% CI: 1.2–2.7), metastases (OR: 1.6; 95% CI: 1.1–2.3), recent bleeding (OR: 2.4; 95% CI: 1.1–5.1), or with creatinine clearance <30 ml/ min (OR: 2.2; 95% CI: 1.5–3.4), had an increased incidence of major bleeding. With some variables available at entry we may identify those cancer patients withVTE at a higher risk for recurrences or major bleeding.

Risk Factors for Post-Thrombotic Syndrome in Patients With a First Proximal Deep Venous Thrombosis Treated With Direct Oral Anticoagulants

Angiology ◽  
2022 ◽  
pp. 000331972110708
Author(s):  
Luca Spiezia ◽  
Elena Campello ◽  
Chiara Simion ◽  
Anna Poretto ◽  
Fabio Dalla Valle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
University Hospital ◽  
First Episode ◽  
Minimum Period ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Age Range ◽  
Deep Vein

The incidence of post-thrombotic syndrome (PTS) in patients with deep vein thrombosis (DVT) treated with direct oral anticoagulants (DOACs) remains a matter of debate. Hence, our endeavor to investigate a large cohort of patients with a first episode of proximal DVT treated with DOACs to ascertain the incidence and predisposing risk factors for PTS. All consecutive patients referred to the Thrombotic and Haemorrhagic Diseases Unit of Padova University Hospital (Italy) between January 2014 and January 2018 for a first episode of proximal DVT were considered for enrollment. Participants received DOACs for a minimum period of 3 months. PTS was assessed using the Villalta score up to 36 months after DVT diagnosis. Among 769 enrolled patients (M/F 353/416, age range 26–87 years), 152 (19.8%) developed PTS and 30 (3.9%) developed severe PTS. The adjusted hazard ratio was significant for obesity (1.64, 95% CI 1.28–2.39) and DVT site (femoral and/or iliac veins vs popliteal vein) (1.23, 95% CI 1.15–3.00). The incidence of PTS is not negligible in patients with proximal DVT despite the use of DOACs. We identified obesity and iliofemoral DVT as possible risk factors for PTS. Larger prospective studies are needed to confirm our findings and optimize therapeutic strategies.

Diagnosis Of Deep Vein Thrombosis - “The Case for NonInvasive Testing”

1981 ◽  
Author(s):  
R Hull ◽  
J Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
High Sensitivity ◽  
Cost Effective ◽  
Impedance Plethysmography ◽  
Noninvasive Testing ◽  
Vein Thrombosis ◽  
Non Invasive ◽  
Long Term Follow Up ◽  
Deep Vein ◽  
High Degree

Ascending venography, although the diagnostic standard for deep vein thrombosis (DVT), has important clinical pitfalls and shortcomings. It is invasive and thus not readily repeated: its use is associated with significant discomfort in many patients and in 3-4% of patients post-veno- graphic phlebitis is induced. A high degree of technical and interpretive skill is required and in up to 20% of patients routine ascending venography fails to visualize the external and common iliac veins. In many hospitals, outpatient access is not readily available necessitating admission to hospital for elective venography. Non-invasive testing with impedance plethysmography (IPG) is gaining increasing acceptance and use because it is objective, versatile and free of morbidity. IPG is sensitive and specific for symptomatic proximal DVT, but has the potential limitation that it is insensitive to calf DVT. Because of this, two different non-invasive approaches are currently advocated: a) serial IPG’s to detect calf vein thrombi which extend proximally (advocates of this approach suggest that calf DVT rarely lead to symptomatic pulmonary emboli unless proximal extension occurs) and b) addition of leg scanning to detect calf DVT. The effectiveness of serial IPG’s is uncertain and to resolve this issue we are currently performing a randomized trial. Multiple large studies however demonstrate that because of both high sensitivity and specificity, the combined approach of IPG and leg scanning provides a replacement for venography in the majority of symptomatic patients. Furthermore, the safety of witholding anticoagulant therapy in patients negative by combined IPG and leg scanning has been confirmed by long-term follow-up. Combined IPG and leg scanning is more cost-effective than elective venography because these non-invasive tests are readily performed in the emergency room or clinic, thus preventing unnecessary admission to hospital of patients with clinically suspected DVT who are negative by testing.

Sign in / Sign up

Export Citation Format

Share Document