scholarly journals Ultra-low dose estradiol plus dydrogesterone: a role in prevention of the development and progression of atherosclerosis

2021 ◽  
Vol 23 (1) ◽  
pp. 9-14
Author(s):  
Evgeniy V. Kryukov ◽  
Lyudmila V. Popova ◽  
Sergey V. Vasiliev ◽  
Taras S. Panevin ◽  
Anna S. Panevina ◽  
...  
Keyword(s):  
Low Dose ◽  
Vascular Wall ◽  
Control Group ◽  
Protective Mechanism ◽  
Clinical Model ◽  
Beta Alanine ◽  
Natural Estrogens ◽  
Initial Reduction ◽  
Energy Processes

Active development of the "anti-aging medicine", attempts to slow down biological (including vascular) aging led to the creation of new pharmaceuticals including menopausal hormone therapy. The vascular wall protective mechanism of the hormones is not completely clear, but it was shown that natural estrogens are able to control the condition of the vascular wall, prevent platelet adhesion, control a range of metabolic and trophic and energy processes in the endothelium of the vascular wall, producing antithrombogenic factors, namely their inhibition contributes to the development of atherosclerosis. It is known that standard and low-dose estrogen may restore the impaired antithrombogenic potential of the vascular wall, provided its initial reduction does not exceed 20%. The issue of the role and possibilities of correction of the antithrombogenic activity of the vascular wall with ultra-low dose estradiol remained unresolved. As a "clinical model" for the study of this issue, we formed 2 groups of patients: in the study group patients received ultra-low dose estradiol plus dydrogesterone, subjects from the control group received beta-alanine. Three-year follow-up showed a decrease in antithrombogenic activity of the vascular wall in control subjects after 2 and 3 years of follow-up according to the M.V. Baluda's test versus subjects treated with ultra-low dose estrogen plus dydrogesterone. The decrease of the relative risk of reduction of the antithrombogenic activity of the vascular wall with the use of ultra-low dose estrogen plus dydrogesterone during the first two years was 2.3 times, and during the 3 years of follow-up 3.8 times versus control. Thus, prescribing only ultra-low dose estradiol plus dydrogesterone for patients with normal antithrombogenic activity of the vessel wall at baseline reliably lowers the risk of long-term reduction of antithrombogenic potential of the vascular wall.

P2536Protective effects of ultra-low-dose menopausal hormonal therapy on endothelium function in postmenopausal women

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S N Tolstov ◽  
I A Salov ◽  
A P Rebrov
Keyword(s):  
Endothelial Function ◽  
Postmenopausal Women ◽  
Functional State ◽  
Low Dose ◽  
Vascular Wall ◽  
Control Group ◽  
Protective Effects ◽  
Group A ◽  
17Β Estradiol ◽  
Von Willebrand

Abstract Introduction This is the first pilot study to assess the functional state of the vascular wall in postmenopausal women on the background of ultra low-dose menopausal hormone therapy (MHT). Purpose To evaluate the protective effects on endothelial function of ultra-low-dose MHT 0.5 mg of 17β-estradiol (E2) and 0.25 mg of drospirenone (DRSP) in postmenopausal women. Methods The study included 115 previously examined postmenopausal women. Group 1 (n=25) included patients who started receiving MGT with DRSP during the menopausal transition; in the 2nd group (n=31), women who started receiving MGT with DRSP in the early postmenopausal period. Women of the 1st and 2nd groups made the transition to a combination of 0.5 mg E2/0.25 mg DRSP. The control group (n=59) of women not taking MGT. The duration of therapy is 1.0 (0.9; 1.2) years. The age of women was 56.8±1.6 years, 57.1±2.8 years and 57.3±1.7 years (p>0.05). Endothelium-dependent vasodilation (EDV) of the brachial artery, levels of endothelin-1 (ET-1), metabolites of nitric oxide (NO), asymmetric dimethylarginine (ADMA), von Willebrand factor antigen (vWF: Ag) in plasma were evaluated. Results In the control group EDV 8.6±5.1% of the original and 7.4±4.5% by the end of the study (p=0.08); in women of the 1st group 12.5±3.8% and 12.2±4.4; in women of the 2nd group11.1±8.5% and 10.5±0.2% (p=0.07 between women of the 1st and 2nd groups by the end of the study). The level of NO metabolites in women of the 1st group 43.4 (28.6; 45.9) at baseline and 40.7 (34.4; 41.5) μmol/l by the end of the study, in women of the 2nd group 38.8 (36.5; 44.9) and 35.2 (32.8; 38.9) μmol/l (p=0.04 between the women of the 1st and 2nd groups). In the control group 34.6 (30.4; 38.2) and 27.8 (24.5; 34.9) μmol/l (p<0.001 for women of the 1st and 2nd groups). In women of the 1st group a significant increase in ET-1 was detected from 1.02±0.26 initially to 1.18±0.24 fMol/ml by the end of the study; levels of vWF:Ag with 0.839 (0.695; 0.940) and 0.900 (0.782; 0.925) U/ml. The level of ADMA did not change significantly 0.43±0.10 and 0.45±0.10 μmol/L. In women of the 2nd group a significant increase ET-1 was detected from 1.08±0.42 to 1.29±0.59 fMol ml; vWF:Ag from 0.841 (0.718; 0.960) to 0.829 (0.811; 0.984) U/ml and ADMA from 0.43±0.10 to 0.48±0.15 μmol/l (p>0.05). In the the control group a significant increase in the level of ET-1 was observed from 1.40±0.43 to 1.74±0.34 fMol/ml by the end of the study; vWF levels:Ag 0.860 (0.743; 0.941) and 0.960 (0.850; 1.025) U/ml, ADMA 0.48±0.16 and 0.60±0.18 μmol/l (p<0.01 compared with women of the 1st and 2nd groups). Conclusions Revealed protective effects on endothelial function of ultra low-dose MHT in postmenopausal women. Early and prolonged MHT has an additional positive effect on the functional state of the vascular wall. Acknowledgement/Funding None

scholarly journals FRI0171 THE CHANGES OF IMMUNE FUNCTION AND CLINICAL INDEXES WITH SYSTEMIC LUPUS ERYTHEMATOSUS AFTER IMMUNOREGULATORY COMBINATION THERAPIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 670.3-670
Author(s):  
X. Liu ◽  
X. Liu ◽  
H. Hou ◽  
X. LI
Keyword(s):  
Systemic Lupus Erythematosus ◽  
T Cells ◽  
Lupus Erythematosus ◽  
Low Dose ◽  
Remission Rate ◽  
Treg Cells ◽  
Control Group ◽  
Combination Therapies ◽  
Systemic Lupus

Background:Recent studies have reported that some drugs such as low-dose interleukin-2, rapamycin, metformin, retinoic acid and coenzyme Q10 could promote the proliferation and functional recovery of regulatory T cells (Treg) in patients with autoimmune diseases. However, the effects on the balance of Treg cells and pro-inflammatory lymphocytes and long-term efficacy have rarely been reported.Objectives:To evaluate the changes of peripheral lymphocyte subsets, conventional drugs and remission rate in patients with systemic lupus erythematosus (SLE) after immunomodulatory combination therapies.Methods:A total of 189 patients with SLE from the Second Affiliated Hospital of Shanxi Medical University from January 2016 to October 2019 were enrolled, who were divided into well-controlled group and untargeted control group taking a full consideration of the patient’s symptoms, signs and related laboratory findings. We measured the absolute counts of B, NK, CD8+T and helper T 1 (Th1), helper T 2 (Th2), helper T 17 (Th17) and Treg cells in peripheral blood of patients before immunomodulatory combination therapies and during the 3 months and 6 months of follow-up and 190 sex- and age- matched control individuals using flow cytometry. Moreover, the ratios of various cells to Treg cells were calculated.Results:Compared with healthy controls, Treg cells in SLE patients were significantly lower before the treatment with immunomodulator, while the ratios of various pro-inflammatory lymphocytes to Treg cells (such as Th2/Treg, Th17/Treg, CD8+T/Treg, etc.) were higher. After 3 months and 6 months with immunomodulatory therapy, the absolute number of Treg cells in peripheral blood of SLE patients increased obviously reaching to normal level. Accordingly, the ratios of various pro-inflammatory lymphocytes to Treg cells recovered. At the same time, the dose of glucocorticoid and disease-modifying antirheumatic drugs (DMARDs) decreased distinctly. Additionally, the well-controlled group was able to maintain a high remission rate, and the untargeted control group could achieve a higher response rate after immunomodulatory treatment.Conclusion:The imbalance between pro-inflammatory lymphocytes and Treg cells caused by the significant decrease of Treg cells may be the main cause of SLE. And immunomodulatory combination therapies we came up with may reverse the imbalance of proinflammatory lymphocytes and Treg cells, which is an potential and effective treatment for SLE.References:[1]Noack M, Miossec P. Th17 and regulatory T cell balance in autoimmune and inflammatory disease[J]. Autoimmun Rev, 2014, 13(6): 668-677.[2]Yu A, Snowhite I, Vendrame F, et al. Selective IL-2 responsiveness of regulatory T cells through multiple intrinsic mechanisms supports the use of low-dose IL-2 therapy in type 1 diabetes. Diabetes. 2015;64: 2172–2183.[3]Schuiveling M, Vazirpanah N, Radstake TRDJ, Zimmermann M, Broen JCA. Metformin, A New Era for an Old Drug in the Treatment of Immune Mediated Disease?[J]. Curr Drug Targets, 2017;18:1-15.Table 1.The changes of remission rate in the no-remission group during follow-up.Follow-up periodTotal patientsRemissionNo-remissionRemission rate(%)Baseline9209203 Months72333945.8a6 Months74423256.8aa: Compared with baseline; b: Compared with 3 months.Acknowledgments:We would like to express our sincere gratitude to all our coworkers and collaborators, Jing Luo, Xiangcong Zhao, Chen Zhang, Qi Wu, Congcong Liang, and Rui Fu for their technical support.Disclosure of Interests:None declared

Functional state of the vascular wall and plasma hemostasis in women of early postmenopausal period under long-term menopausal hormone therapy

2020 ◽  
Author(s):  
С.Н. Толстов ◽  
И.А. Салов ◽  
А.П. Ребров
Keyword(s):  
Hormone Therapy ◽  
Functional Activity ◽  
Low Dose ◽  
Vascular Wall ◽  
Menopausal Hormone Therapy ◽  
Control Group ◽  
Coronary Syndrome ◽  
Postmenopausal Period ◽  
Increased Risk

Цель исследования: оценка изменений функциональной активности сосудистой стенки и плазменного звена гемостаза у женщин раннего постменопаузального периода на фоне длительной низкодозовой менопаузальной гормональной терапии (МГТ). Материалы и методы: Обследовано 162 женщины в ранней постменопаузе. В основную группу вошли 84 пациентки, которым была назначена низкодозовая МГТ: 1 мг 17β-эстрадиола (E2) и 2 мг дроспиренона (ДРСП) — препарат Анжелик® (Байер Фарма, Германия). Контрольную группу составили 78 женщин, не получавших МГТ. Длительность наблюдения составила 5,2 [4,8; 5,7] лет. Исследовали антитромбогенную активность сосудистой стенки, лабораторные маркеры эндотелиальной дисфункции. Результаты: Несмотря на увеличение агрегационной активности тромбоцитов и более низкие значения активности антитромбина III у женщин на фоне МГТ, не было отмечено увеличения риска развития венозного тромбоза и эмболий, ишемического инсульта и случаев острого коронарного синдрома. К окончанию наблюдения установлено снижение антиагрегационного потенциала сосудистой стенки, более выраженное у женщин группы кон-троля. У женщин, принимавших МГТ, выявлено снижение концентрации фибриногена крови к окончанию исследования. На фоне МГТ отмечено значимое возрастание уровня метаболитов оксида азота, снижение уровней эндотелина-1 и асимметричного диметиларгинина к 12 мес наблюдения, но в дальнейшем отмечено повышение их уровней, не достигшее исходных значений. Заключение: Изменения функциональной активности эндотелия свидетельствуют об отсутствии негативного влияния на эндотелий сосудов длительной низкодозовой МГТ (1 мг E2/2 мг ДРСП). Objectives: to assess changes in the functional activity of the vascular wall and plasma hemostasis in women of early postmenopausal period under long-term low-dose menopausal hormone therapy (MHT). Patients/Methods: We examined 162 women in early postmenopause. The main group included 84 patients; they were prescribed a low-dose MHT: 1 mg of 17β-estradiol (E2) and 2 mg of drospirenone (DRSP) — Angelique® (Bayer Pharma, Germany). The control group consisted of 78 women did not taking MHT. The duration of observation was 5.2 [4.8; 5.7] years. Antithrombogenic activity of the vascular wall and laboratory markers of endothelial dysfunction were examined. Results: In women taking MHT we found increasing of platelet aggregation activity and lower antithrombin III activity, but did not reveal increased risk of venous thrombosis and embolism, ischemic stroke, and cases of acute coronary syndrome. By the end of observation decreasing of antiplatelet potential of the vascular wall, more expressed in women of the control group, was noted. In women taking MHT, blood fi brinogen concentration decreased by the end of the study. After 12 months of observation in women taking MHT we revealed significant increasing of nitric oxide metabolites, decreasing of endothelin-1 and asymmetric dimethylarginine; later their levels increased but did not reach the initial values. Conclusions: Changes in endothelial functional activity showed no adverse effect of long-term low-dose MHT (1 mg E2/DRSP 2 mg) on the vascular endothelium.

Treatment of AML Relapse After Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) Using Low-Dose Azacitidine (AZA).

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3445-3445
Author(s):  
Alexandre Chiattone ◽  
Rima M Saliba ◽  
Borje S. Andersson ◽  
Sergio Giralt ◽  
Manish R Sharma ◽  
...  
Keyword(s):  
Low Dose ◽  
Conflicts Of Interest ◽  
Disease Free Survival ◽  
Control Group ◽  
Hematopoietic Stem ◽  
Dismal Prognosis ◽  
Baseline Characteristics ◽  
And Control

Abstract Abstract 3445 Background: Relapsing AML/MDS after HSCT has a dismal prognosis, with few patients achieving long-term control of the malignancy. AZA is a hypomethylating agent that is moderately active against AML/MDS, and may have beneficial immunomodulatory effects after HSCT. We have shown that a significant minority of patients with recurrent disease respond to this drug. Here, we present long-term follow-up after salvage treatment regimens that included AZA, to treat AML/MDS that recurred after HSCT. Patients and Methods: Twenty-three patients received low-dose AZA for recurrence. Decision to use AZA was based on clinical assessment of slow progression of disease and relatively slower disease ‘tempo' and relatively small AML bulk. AZA cohort preparative regimens for 1st HSCT were myeloablative in 12 cases, and of reduced intensity in 11 cases. AZA was used prior to or without a 2nd HSCT (n=17), or after a 2nd HSCT (n=6). Outcomes were compared to controls (n=18) that relapsed ≥ 8 months after HSCT, and did not receive AZA (8 months representing the median disease free survival (DFS) for AZA-treated patients). The control group included all patients that relapsed ≥ 8 months after allogeneic HSCT using myeloablative busulfan 130 mg/m2 and fludarabine 40 mg/m2 for 4 days. AZA was studied as a time dependent variable. AZA and controls had similar baseline characteristics as described in the Table, although median DFS after the first HSCT was 8 (range: 2–51) and 17 (range: 7–59) months, favoring the control group (p=0.08). AZA was administered outpatient, with good tolerance. Fatigue and nausea were commonly observed toxicities. Doses were 8 mg/m2 (n=1), 16 mg/m2 (n=3), 24 mg/m2 (n=10), 32 mg/m2 (n=5), 40 mg/m2 (n=2), and 75 mg/m2 (n=2), administered subcutaneously for 5 days, in 28–32-day cycles. Results: Median number of cycles was 4 (range, 1–44). With a median follow-up of 18 months for AZA and control patients, median survival after relapse was 17 versus 6 months, respectively for AZA and control patients. 11 (48%) AZA patients are alive, while 2 (11%) control patients are alive. Two-year overall survival (OS) for AZA and control groups was 40% and 10%, respectively. AZA and controls had similar baseline characteristics as described in the Table. Conclusion: Low-dose AZA was a well tolerated outpatient treatment that may improve survival after AML/MDS recurrence in selected cases. Major determinants of survival in this setting, however, were remission duration after HSCT, and use of a 2nd HSCT. Disclosures: No relevant conflicts of interest to declare.

The Effectiveness of a Fixed Low Dose of Erythropoietin (EPO) in Anemic Solid Tumor Patients Receiving Concomitant Chemotherapy: A Prospective, Randomized, Controlled Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2092-2092
Author(s):  
Lama A Youssef ◽  
Dilman Haj Hussien ◽  
Siham Sulaiman
Keyword(s):  
Solid Tumor ◽  
Low Dose ◽  
Controlled Study ◽  
Control Group ◽  
Concomitant Chemotherapy ◽  
Tumor Patients ◽  
Randomized Controlled ◽  
Starting Dose ◽  
Ecog Ps

Abstract Abstract 2092 Background: Erythropoiesis-stimulating agents (ESAs) are indicated for the management of chemotherapy induced anemia in oncology. However, increased risks of cardiovascular events, inferior survival, and poorer tumor outcomes are linked to ESAs when used to achieve a target hemoglobin ≥12 g/dL. Due to these serious safety concerns, the FDA has recommended more conservative dosing guidelines whereby the lowest possible dose of ESAs should be used to gradually increase hemoglobin concentration to the lowest level sufficient to avoid blood transfusion. The currently ASCO/ASH recommended and FDA approved starting dose for epoetin is 150 U/kg three times weekly (TIW) or 40,000 U weekly, and the dose should be increased to 300 U/kg or 60,000 U in nonresponsive patients. Objectives: This study evaluated the effectiveness of a fixed lower dose (4000 unit, TWI) of Epoetin alfa (Epo a) in comparison with transfusion support alone in anemic solid tumor patients (Hb< 9 g/dl) who were administered concomitant chemotherapy. Methods: This was a prospective, single-centered, randomized, controlled study. The period of enrollment began in June 2009 and ended in December 2010. A total of a hundred and two solid tumor patients with chemotherapy induced anemia (Hb < 9 g/dl) and Eastern Cooperative Oncology Group performance status (ECOG PS) score of 0–3 were enrolled and randomized into two groups; forty five patients (treatment arm) received 4000 unit of Epo a three times weekly plus oral iron, whereas fifty seven patients were randomized to control group (control arm). Both groups received RBC transfusion when needed. Epo dose was not increased in patients deemed nonresponsive. The primary endpoints were the changes in hemoglobin (Hb) concentrations, transfusion needs, and QoL. The follow-up period was twelve weeks. Results: Mean age of 102 patients was 53.6 ±12.7 years (mean ± SD), mean weight was 63.86 ±12.05 kg (mean ± SD), mean hemoglobin was 8.22 ± 0,55 g/dl (mean ± SD), 32.4% were male, and 60.8% were on platinum based chemotherapy. After excluding patients who died, were lost to follow up, withdrew consent, or were ineligible, 81, 59, and 50 patients were assessed at weeks 4, 8, and 12 respectively. At each of these time points, Epo at low dose (4000 unit, TWI) significantly decreased transfusion needs, increased hemoglobin concentrations, and improved QoL. At week 12, the mean hemoglobin increase was 2.4 g/dL in the EPO group (n=28) versus 0.97 g/dL in the control group (n=22) (P < 0.001). In Epo-responders (17/28), Hb increase was 2.87 g/dl, and Hb concentrations were > 12 g/dl in 5/17 (29.4%), 11–12 g/dl in 3/17 (17.64%), and 10–10.9 in 3/17 (17.64%). EPO evaded blood transfusion in 19/28 patients (67.87%) in the EPO arm. 9/28 (32.14%) of patients in the EPO arm were transfused a total of 18 units (0.65 unit per patient), versus 21/22 (95.45%) in the control group who received a total of 53 units, resulting in a significantly higher average transfused units per patient (2.41 units per patient) (p < 0.001). Based on ECOG PS score, QoL was significantly better in Epo treatment group in comparison with control group (p< 0.05). Conclusions: Administration of EPO in a low dose (4000 U, TIW) is effective in alleviating anemia, evading RBC transfusions, and improving QoL in a considerable proportion of anemic cancer patients receiving chemotherapy. Our findings highlight a great variation in responsiveness to low dose of EPO in anemic cancer patients and suggest the existence of high EPO responders. Lowering the starting dose of Epo may represent a more physiologic and effective alternative that better corresponds to FDA recommendations. Disclosures: No relevant conflicts of interest to declare.

Acetaminophen: Neonatal hepatotoxicity due to late pregnancy exposure

1987 ◽  
Vol 45 ◽  
pp. 718-719
Author(s):  
G.A. Miranda ◽  
M.A. Arroyo ◽  
C.A. Lucio ◽  
M. Mongeotti ◽  
S.S. Poolsawat
Keyword(s):  
Low Dose ◽  
Fetal Liver ◽  
Late Pregnancy ◽  
Toxic Chemicals ◽  
Control Group ◽  
High Dose ◽  
Over The Counter ◽  
Liver And Kidney ◽  
Neonatal Liver ◽  
Childbearing Women

Exposure to drugs and toxic chemicals, during late pregnancy, is a common occurrence in childbearing women. Some studies have reported that more than 90% of pregnant women use at least 1 prescription; of this, 60% used more than one. Another study indicated that 80% of the consumed drugs were not prescribed, and of this figure, 95% were “over-the-counter” drugs. Acetaminophen, the safest of all over-the-counter drugs, has been reported to induce fetal liver necrosis in man and animals and to have abortifacient and embryocidal action in mice. This study examines the degree to which acetaminophen affects the neonatal liver and kidney, when a fatty diet is simultaneously fed to the mother during late pregnancy.Timed Swiss Webster female mice were gavaged during late pregnancy (days 16-19) with fat suspended acetaminophen at a high dose, HD = 84.50 mg/kg, and a low dose, LD = 42.25 mg/kg; a control group received fat alone.

1172: Improved Recovery of Erectile Function with Nightly Low dose Sildenafil - 18 Months Follow-Up After Nerve-Sparing Radical Prostatectomy

2007 ◽  
Vol 177 (4S) ◽  
pp. 386-387
Author(s):  
Andreas Bannowsky ◽  
Heiko Schulze ◽  
Christof van der Horst ◽  
Stefan Hautmann ◽  
Klaus P. Juenemann
Keyword(s):  
Radical Prostatectomy ◽  
Erectile Function ◽  
Low Dose ◽  
Nerve Sparing

Audio Stories as Incidental Language Teachers

2020 ◽  
pp. 1-12 ◽  
Author(s):  
Ute Ritterfeld ◽  
Timo Lüke
Keyword(s):  
Language Learning ◽  
Low Socioeconomic Status ◽  
Language Teachers ◽  
Control Group ◽  
Low Socioeconomic ◽  
Migrant Families ◽  
Populations At Risk ◽  
Grammatical Skills ◽  
Entertainment Value

Abstract. Audio stories offer a unique blend of narrative entertainment with language learning opportunities as a user’s enjoyment is dependent on their processing of the linguistic content. A total of 138 third- and fourth-graders from low socioeconomic status and migrant families recruited from a metropolitan area in Germany participated in a randomized pre–post follow-up intervention study with a control group. Children listened to a tailored crime story of approximately 90 min over a period of 3 days within the classroom setting. Entertainment value for the age group was established in a pilot study. Outcome variables included semantic and grammatical skills in German and were administered before (pretest), shortly after intervention (posttest), and 2 weeks later (follow-up). We used nonverbal intelligence, reading, comprehension skills, age and sex as control variables. Results indicate a strong positive effect of media reception on language skills. The effectiveness of the intervention is discussed with reference to different linguistic domains, entertainment value, and compensatory effects in populations at risk of language learning deficits.

Low-Dose Heparin and Deep-Vein Thrombosis after Total Hip Replacement

1976 ◽  
Vol 36 (01) ◽  
pp. 157-164 ◽  
Author(s):  
P. M Mannucci ◽  
Luisa E. Citterio ◽  
N Panajotopoulos
Keyword(s):  
Deep Vein Thrombosis ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Low Dose ◽  
Control Group ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Deep Vein ◽  
Low Dose Heparin

SummaryThe effect of subcutaneous low-dose heparin on postoperative deep-vein thrombosis (D. V. T.) (diagnosed by the 125I-labelled fibrinogen test) has been investigated in a trial of 143 patients undergoing the operation of total hip replacement. Two randomized studies were carried out: in one the scanning for D.V.T. was carried out daily for 7 days post operatively and in the other for 15 days. In both, the incidence of D.V.T. was significantly lower in the heparin-treated patients (P<0.005). Bilateral D.V.T. was also prevented (P<0.05), through the extension of D.V.T. to the distal veins of the thigh was not significantly reduced. Heparin treatment was, however, followed by a higher incidence of severe postoperative bleeding (P< 0.02) and wound haematoma formation (P< 0.005), and the postoperative haemoglobin was significantly lower than in the control group (P<0.005). A higher number of transfused blood units was also needed by the heparin treated patients (P<0.001).

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