Complications of heparin administration in normal individuals

Schwartz, Kenneth A.; Royer, George; Kaufman, Donald B.; Penner, John A.

doi:10.1002/ajh.2830190406

Cited by 50 publications

(15 citation statements)

References 21 publications

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“…The present studies evidenced the effi ciency of r-hirudin in preventing thrombus formation in experimental hemodialysis and hence its suitability as anticoagulant in such extracorporeal circulation [9].…”

Section: Discussionsupporting

confidence: 59%

Hirudin as Anticoagulant in Experimental Hemodialysis

Markwardt¹,

Nowak²,

Bucha³

1991

Pathophysiol Haemos Thromb

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After genetically engineered recombinant DNA desulfatohirudin (r-hirudin) had been investigated as to its pharmacokinetic behavior and blood level course in nephrectomized dogs, the compound was studied for its capability to prevent thrombus formation in the extracorporeal circulation. Beagle dogs underwent bilateral functional nephrectomy followed by experimental hemodialysis. r-Hirudin content in blood, fibrinogen level as well as platelet count were determined before and during the dialysis. Furthermore, the blood loss during the experiment was measured as well as the mean arterial pressure and the pressure in the blood line system. Intravenous administration of the thrombin inhibitor resulted in initial distribution in the extracellular space (distribution phase 90 min) followed by retarded decrease of the r-hirudin blood level (t_½β ∼ 6–8 h) which is due to the missing renal excretion of the inhibitor. This caused a long-lasting, dose-dependent anticoagulant effect, which is not only characterized by the prevention of increasing pressure before the capillary dialyzer but also by the reduced drop in fibrinogen and platelets during hemodialysis. The required dose of r-hirudin (0.5 mg/kg) is within a range where bleeding complications will not occur yet.

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Section: Discussionsupporting

confidence: 59%

Hirudin as Anticoagulant in Experimental Hemodialysis

Markwardt¹,

Nowak²,

Bucha³

1991

Pathophysiol Haemos Thromb

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“…This is a known complication of UFH and LMWH treatment (30), and is possibly caused by a direct toxic effect of heparins on the hepatocytes (31,32). In two patients who continued LMWH treatment, they normalized spontaneously.…”

Section: Discussionmentioning

confidence: 99%

Low Molecular Weight Heparin Treatment in Steroid Refractory Ulcerative Colitis: Clinical Outcome and Influence on Mucosal Capillary Thrombi

Vrij

Jansen

Schoon

et al. 2001

Scandinavian Journal of Gastroenterology

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Vrij AA, Jansen JM, Schoon EJ, de Bruṏne A, Hemker HC, Stockbrügger RW. Low molecular weight heparin treatment in steroid refractory ulcerative colitis: clinical outcome and influence on mucosal capillary thrombi. Scand J Gastroenterol 2001;36 Suppl 234:41-47. Background: In ulcerative colitis, a state of hypercoagulation has frequently been observed. Unfractionated heparin has shown bene cial effects as an adjuvant treatment of steroid refractory ulcerative colitis in open trials and in one placebo-controlled trial. Low molecular weight heparin (LMWH) offers advantages in the method of administration, but it has not been evaluated in severe ulcerative colitis. We therefore assessed the tolerability, safety and potential therapeutical effects of LMWH in hospitalized patients with steroid refractory ulcerative colitis. Methods: Twenty-ve patients with severely active ulcerative colitis were included in an open-labelled trial. All patients had a are-up of disease under glucocorticosteroid treatment. Nadroparine calcium 5.700 IE anti-Xa/0.6 mL s.c. was self-administered twice daily for 8 weeks. Patients were monitored for possible adverse events, and changes in clinical symptoms and in laboratory, endoscopical and histological results were analysed. Results: Tolerability and compliance were excellent and no serious adverse events occurred. In 20 of 25 patients, a good clinical and laboratory response was observed. Also, the endoscopic and histological signs of in ammation were found to be signi cantly improved. However, this was not accompanied by a signi cant reduction in the number of mucosal microvascular thrombi after 8 weeks of LMWH treatment. Conclusion: LMWH may be a safe adjuvant therapy for patients with active, glucocorticosteroid refractory ulcerative colitis.

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“…Other predefined reasons for discontinuation were heparin-induced thrombocytopenia (HIT) type 2 [27,28] and/or severe bleeding (defined as Hb < 5.0 mmol/l, Hb > 2.0 mmol/l below baseline value, blood loss with blood pressure <80/50 mmHg and/or need for blood transfusion). In patients in whom the study treatment was discontinued, a treatment with corticosteroids was initiated.…”

Section: Methodsmentioning

confidence: 99%

Thrombin generation in mesalazine refractory ulcerative colitis and the influence of low molecular weight heparin

Vrij

Oberndorff-Klein-Woolthuis

Dijkstra

et al. 2007

J Thromb Thrombolysis

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Background In ulcerative colitis (UC), a state of hypercoagulation has frequently been observed. Low molecular weight heparin (LMWH) has shown beneficial effects as an adjuvant treatment of steroid refractory UC in open trials. We assessed potential therapeutic effects of the LMWH reviparin in hospitalised patients with mesalazine refractory UC, as well as its influence on haemostasis factors. Methods Twentynine patients with mild-to-moderately active UC were included in a double-blind placebo controlled trial. All patients had a flare-up of disease under mesalazine treatment. Reviparin (Clivarin Ò ) 3,436 IU anti-Xa/0.6 ml or placebo s.c. was added, and self-administered twice daily for 8 weeks. Patients were monitored for possible adverse events and changes in clinical symptoms. Endoscopical, histological, biochemical and haemostasis parameters were analysed. Results Tolerability and compliance were excellent and no serious adverse events occurred. No significant differences were observed on the clinical, endoscopical and histological outcome, as compared to placebo. A high intrinsic and extrinsic thrombin potential was found before LMWH therapy. However, the significant reduction in the thrombin generation by LMWH was not related to the reduction in disease activity. Conclusion The LMWH reviparine reduces thrombin generation in patients with mild-to-moderately active, mesalazine refractory UC, but is not associated with a reduction in disease activity.

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Complications of heparin administration in normal individuals

Cited by 50 publications

References 21 publications

Hirudin as Anticoagulant in Experimental Hemodialysis

Hirudin as Anticoagulant in Experimental Hemodialysis

Low Molecular Weight Heparin Treatment in Steroid Refractory Ulcerative Colitis: Clinical Outcome and Influence on Mucosal Capillary Thrombi

Thrombin generation in mesalazine refractory ulcerative colitis and the influence of low molecular weight heparin

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