Bioavailability of subcutaneous low-molecular-weight heparin to patients on vasopressors

Dörffler‐Melly, Janine; Jonge, Evert de; Pont, Anne-Cornélie de; Meijers, Joost C. M.; Vroom, Margreet B; Büller, Harry R.; Levi, Marcel

doi:10.1016/s0140-6736(02)07920-5

Cited by 199 publications

(150 citation statements)

References 4 publications

Supporting

Mentioning

133

Contrasting

Unclassified

Order By: Relevance

“…In our population, the risk of DVT occurrence associated with neuromuscular block was stronger than that of vasopressors, which was also reported by Cook et al [23]. These drugs can contribute to the occurrence of DVT by the vasoconstriction of peripheral blood vessels and the reduction in skin blood flow with decreased absorption of subcutaneous heparin used for prophylaxis [31]. In our patients, we have not assayed concentration of anti-Xa activity, and therefore, decreased adsorption of subcutaneous heparin cannot be excluded.…”

Section: Discussionsupporting

confidence: 84%

Reduction in deep vein thrombosis incidence in intensive care after a clinician education program

Boddi

Barbani

Abbate

et al. 2010

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Summary.Background: Deep vein thrombosis (DVT) is a major complication in intensive care units (ICU) but dedicated guidelines on its management are still lacking. Objectives and Methods: This study investigated the effect of a 1-year educational program for the implementation of DVT prophylaxis on the incidence of inferior limb DVT in a mixed-bed ICU that admits high-risk surgical and trauma patients, investigated during a first retrospective phase [126 patients, SAPS II score 42 (28-54)] and a following prospective phase [264 patients, SAPS II score II 41 (27-55)]. The role of baseline and time-dependent DVT risk factors in DVT occurrence was also investigated during the prospective phase. Results: The educational program on implementation of DVT prophylaxis was associated with a significant decrease in DVT incidence from 11.9% to 4.5% (P < 0.01) and in the mean length of ICU stay (P < 0.01). Combined with pharmacological prophylaxis, the use of elastic compressive stockings significantly also increased in the prospective phase (P < 0.01). The duration of mechanical ventilation, vasopressor administration and neuromuscular block were significantly different between DVT-positive and DVT-negative patients (P < 0.01). Multivariate analysis identified neuromuscular block as the strongest independent predictor for DVT incidence. Conclusion: One-year ICU-based educational programs on implementation of DVT prophylaxis were associated with a significant decrease in the incidence of DVT and also in the length of stay in ICU.

show abstract

Section: Discussionsupporting

confidence: 84%

Reduction in deep vein thrombosis incidence in intensive care after a clinician education program

Boddi

Barbani

Abbate

et al. 2010

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…There is an ongoing debate regarding the bioavailability of LMWH administered s.c. in critically ill patients receiving vasopressors and/or high amounts of fluids [5,6]. Robinson et al [16] have recently suggested that the dose of s.c. enoxaparin should be increased to achieve anti-Xa activities in the recommended range [17].…”

Section: Discussionmentioning

confidence: 99%

“…anticoagulants [5,6]. The size of the respective hospital and the number of beds in the ICU as well as the medical discipline (anaesthesia, internal medicine, surgery, neurosurgery, neurology) were also documented.…”

Section: Questionnaire Itemsmentioning

confidence: 99%

“…Despite prophylaxis, more than 15 % of critically ill patients suffer from VTE [2]. This alarming prevalence of VTE in critical illness may in part be caused by the simultaneous occurrence of multiple risk factors such as age, immobilization, sepsis, trauma and/or decreased bioavailability of subcutaneous (s.c.) low molecular weight heparins (LMWH) [3][4][5][6]. VTE is lifethreatening and DVT, even if initially asymptomatic, may provoke post-thrombotic syndrome as an irreversible lifelong consequence [4,7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Coagulation Day 2010: an Austrian survey on the routine of thromboprophylaxis in intensive care

et al. 2012

View full text Add to dashboard Cite

Purpose: Venous thromboembolism (VTE) is a common but often overlooked lifethreatening complication of critical illness. The aim of this cross-sectional survey was to assess current practice of thromboprophylaxis as well as adherence to international guidelines. Methods: After ethics committee approval, all intensive care units in Austrian hospitals treating adult patients were invited to participate in this web-based survey. Anonymized data on each patient treated at the participating intensive care units on Coagulation Day 2010 were collected using an electronic case report form. Risk assessment, choice and monitoring of anticoagulants, means of mechanical prophylaxis, and demographic data were recorded. Results: Data from 325 critically ill patients were collected. Patients had a median of four risk factors for thrombosis and 6 % suffered from VTE. Of the 325 patients, 80 % received low molecular weight heparins subcutaneously, 10 % received unfractionated heparin intravenously, 1 % received alternative anticoagulants and 9 % received no pharmacological prophylaxis. Mechanical prophylaxis was used in 49 % with a predominant use of graduated compression stockings. In 39 % a combination of pharmacological and mechanical prophylaxis was applied and 5 % received no prophylaxis at all. Overall guideline adherence was 40 % on Coagulation Day 2010. Conclusion: Current practice of thromboprophylaxis is predominantly based on the administration of low molecular weight heparins prescribed at rather arbitrary doses without a discernible relationship to drug monitoring, thromboembolic risk factors, vasopressor use or fluid balance. The use of mechanical prophylaxis, evaluation of risk scores and overall guideline adherence must be further encouraged by education, training and communication.

show abstract

“…Patients with DIC may benefit from prophylaxis to prevent venous thromboembolism, which may not be prevented with standard low-dose subcutaneous heparin. 33 Theoretically, the most logical anticoagulant agents to use in DIC would be those directed against tissue factor activity. Potential agents include recombinant tissue factor pathway inhibitor, inactivated factor VIIa, and recombinant NAPc2, a potent and specific inhibitor of the ternary complex between tissue factor/factor VIIa and factor derived from the family of Nematode Anticoagulant Proteins (NAPs).…”

Section: Anticoagulantsmentioning

confidence: 99%

Disseminated Intravascular Coagulation

Levi

2003

Transfus Alt Transfus Med

Self Cite

View full text Add to dashboard Cite

Disseminated Intravascular Coagulation ) (Transfusion Alternatives in Transfusion Medicine VOLUME 4 NUMBER 6 MARCH 2003( Pa ge 21 2 ) isseminated intravascular coagulation (DIC) in a patient may lead to considerable confusion among physicians, in particular concerning its proper management. In fact, the syndrome is often viewed differently depending on the specialist. Surgeons, for example, may consider DIC a severe bleeding disorder whereas intensive care specialists may focus on the role of disseminated fibrin deposition in multiple organ failure (MOF). This variable perception is also reflected by the many names for the syndrome, ranging from disseminated intravascular fibrin formation to consumptive hemorrhagic coagulopathy.The reason for this confusion is not because DIC is a new syndrome. The medical literature of the 1950s includes precise accounts of what we would now call DIC.1 Even centuries earlier, Celsus described diffuse hemorrhage from several sites after a snake bite and Dupuy, in 1834, noted that the injection of brain material resulted in widespread intravascular clotting in dogs. DIC is also not a syndrome that has been altogether ignored in the medical literature. A search of the MEDLINE database from 1966 to 2002 using the search term "disseminated intravascular coagulation" and related text words yields an impressive number of manuscripts -some 1400. Most are case reports and studies dealing with the pathophysiology of disseminated intravascular coagulation, which, in its main features, is indeed well understood now. Very few of the published papers -only about 1.5% -report on clinical studies that may be helpful in guiding the clinician to appropriate and "evidence-based" management strategies applicable to patients with DIC. The lack of useful literature can probably be explained by the fact that DIC is a poorly defined syndrome whose intensity varies widely. It often occurs with a broad range of severe disorders, which, individually, are associated with extensive morbidity and mortality, thus complicating them even further. Definition, Relevance, and Clinical Setting of DICDIC is not a disease or a symptom, but a syndrome that is always secondary to an underlying disorder. The syndrome is characterized by a systemic activation of the blood coagulation system, which results in the generation and deposition of fibrin, leading to microvascular thrombi in various organs and contributing to the development of MOF. Consumption and subsequent depletion of coagulation proteins and platelets, due to the ongoing activation of the coagulation system, may induce severe bleeding complications, although microclot formation may occur in the absence of severe clotting factor depletion and bleeding. 4 Hence, a patient with DIC can present with a simultaneously occurring thrombotic and bleeding problem (Figure 1) The clinical importance of severe platelet and coagulation factor depletion in patients with diffuse widespread bleeding or requiring an invasive procedure is obviously indisputable. However, i...

show abstract

Bioavailability of subcutaneous low-molecular-weight heparin to patients on vasopressors

Cited by 199 publications

References 4 publications

Reduction in deep vein thrombosis incidence in intensive care after a clinician education program

Reduction in deep vein thrombosis incidence in intensive care after a clinician education program

Coagulation Day 2010: an Austrian survey on the routine of thromboprophylaxis in intensive care

Disseminated Intravascular Coagulation

Contact Info

Product

Resources

About