Adjusted versus Fixed-Dose Subcutaneous Heparin in the Prevention of Deep-Vein Thrombosis after Total Hip Replacement

Leyvraz, P. F.; Richard, J; Bachmann, Fédor; Melle, Guy van; Treyvaud, Jean-Michel; Livio, Jean-Jacques; Candardjis, G

doi:10.1056/nejm198310203091605

Cited by 280 publications

(64 citation statements)

References 16 publications

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“…In the presence of heparin, the rates of inhibition of thrombin, factor IXa, and factor Xa by antithrombin are increased ~1000-fold (4), so that inhibition is essentially instantaneous. Heparin has been used clinically for almost 70 years for the prevention of thromboembolic events frequently observed after surgery, especially pelvic and orthopedic surgery (5,6).…”

Section: Introductionmentioning

confidence: 99%

In vivo antithrombotic properties of a heparin from the oocyte test cells of the sea squirt Styela plicata(Chordata-Tunicata)

Cardilo-Reis

Cavalcante

Silveira

et al. 2006

Braz J Med Biol Res

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In the ascidian Styela plicata, the oocytes are surrounded by two types of accessory cells named follicle cells and test cells. A heparin-like substance with an anticoagulant activity equivalent to 10% of mammalian heparin and about 5% as potent as the mammalian counterpart for the inhibition of thrombin by antithrombin was isolated from the oocyte test cells. In the present study, we compared the antithrombotic and hemorrhagic effects of sea squirt oocyte test cell heparin with those of porcine heparin in rat models of venous thrombosis and blood loss. Intravenous administration of the oocyte test cell heparin to Wistar rats (both sexes, weighing ~300 g, N = 4 in each group) at a dose of 5.0 mg/kg body weight, which produced a 1.8-fold increase in plasma activated partial thromboplastin time, inhibited thrombosis by 45 ± 13.5% (mean ± SD) without any bleeding effect. The same dose of porcine heparin inhibited thrombosis by 100 ± 1.4%, but produced a blood loss three times greater than that of the saline-treated control. However, 10-fold reduction of the dose of porcine heparin to 0.5 mg/ kg body weight, which produced a 5-fold increase in plasma-activated partial thromboplastin time, inhibited thrombosis by 70 ± 13% without any bleeding effect. The antithrombotic properties of a new heparin isolated from test cells of the sea squirt S. plicata, reported here for the first time, indicate that, although sea squirt oocyte test cell heparin was a poor anticoagulant compared to porcine heparin, it had a significant antithrombotic effect without causing bleeding.

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Section: Introductionmentioning

confidence: 99%

In vivo antithrombotic properties of a heparin from the oocyte test cells of the sea squirt Styela plicata(Chordata-Tunicata)

Cardilo-Reis

Cavalcante

Silveira

et al. 2006

Braz J Med Biol Res

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“…/r\ -π. · * ·* c ι static system are now available, such as the measuremajor orthopaedic surgery (6). The intensity of oral ' , .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Markers of Coagulation Activation in Patients Under Oral Anticoagulation at Different Levels

Wersch

Mourik-Alderliesten²,

Coremans³

1992

Clinical Chemistry and Laboratory Medicine

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Summary:Three groups of patients receiving oral anticoagulation treatment were evaluated. The groups consisted of patients with mechanical heart valve prosthesis (n = 60), patients after coronary bypass graft surgery (n = 60) and patients using oral anticoagulation after deep venous thrombosis or pulmonary embolism (n = 60).The patient groups were subdivided into three groups of 20 patients, each group receiving different levels of oral anticoagulation as indicated by the international normalized ratio (INR). Prothrombin fragment 1+2, thrombin-antithrombin III complexes and fibrin monomers were determined as coagulation activation makers. The prothrombin fragments 1+2 were INR dependent in all groups whereas the thrombin-antithrombin III values were only INR dependent in the group of patients with mechanical heart valve prosthesis. For fibrin monomers no correlation with the INR levels could be found.These results indicate that prothrombin fragment 1 + 2 is the only laboratory quantity of the three, which provides a suitable index of low thrombin activity during anticoagulation therapy.

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“…It is an important therapeutic agent in the treatment of patients with thrombosis or patients at risk to develop it. Heparin is highly used in the prevention of thromboembolic events frequently observed after some kind of surgery, especially pelvic and orthopedics (Leyvraz et al 1983, Poller 1985. How-ever, the unrestricted use of heparin as an antithrombotic agent is limited due to its various side effect, such as thrombocytopenia, osteoporosis, and hemorrhagic complications (Ockelford et al 1982, Carreras 1980, Mätzsch et al 1986).…”

Section: Antithrombotic Use Of Mammalian Glycosaminoglycansmentioning

confidence: 99%

Structure and anticoagulant properties of sulfated glycosaminoglycans from primitive Chordates

Pavão

2002

An. Acad. Bras. Ciênc.

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Dermatan sulfates and heparin, similar to the mammalian glycosaminoglycans, but with differences in the degree and position of sulfation were previously isolated from the body of the ascidian Styela plicata and Ascidia nigra. These differences produce profound effects on their anticoagulant properties. S. plicata dermatan sulfate composed by 2-O-sulfated α-L-iduronic acid and 4-O-sulfated N-acetyl-β-D-galactosamine residues is a potent anticoagulant due to a high heparin cofactor II activity. Surprisingly, it has a lower potency to prevent thrombus formation on an experimental model and a lower bleeding effect in rats than the mammalian dermatan sulfate. In contrast, A. nigra dermatan sulfate, also enriched in 2-O-sulfated α-Liduronic acid, but in this case sulfated at O-6 of the N-acetyl-β-D-galactosamine units, has no in vitro or in vivo anticoagulant activity, does not prevent thrombus formation but shows a bleeding effect similar to the mammalian glycosaminoglycan. Ascidian heparin, composed by 2-O-sulfated α-L-iduronic acid, N-and 6-O-sulfated glucosamine (75%) and α-L-iduronic acid, N-and 6-O-sulfated glucosamine (25%) disaccharide units has an anticoagulant activity 10 times lower than the mammalian heparin, is about 20 times less potent in the inhibition of thrombin by antithrombin, but has the same heparin cofactor II activity as mammalian heparin.

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Adjusted versus Fixed-Dose Subcutaneous Heparin in the Prevention of Deep-Vein Thrombosis after Total Hip Replacement

Cited by 280 publications

References 16 publications

In vivo antithrombotic properties of a heparin from the oocyte test cells of the sea squirt Styela plicata(Chordata-Tunicata)

In vivo antithrombotic properties of a heparin from the oocyte test cells of the sea squirt Styela plicata(Chordata-Tunicata)

Comparison of Markers of Coagulation Activation in Patients Under Oral Anticoagulation at Different Levels

Structure and anticoagulant properties of sulfated glycosaminoglycans from primitive Chordates

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