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Latest & greatest articles for heparin
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Clinical effectiveness of a Bayesian algorithm for the diagnosis and management of heparin-induced thrombocytopenia Essentials We previously published a diagnostic algorithm for heparin-induced thrombocytopenia (HIT). In this study, we validated the algorithm in an independent large healthcare system. The accuracy was 98%, sensitivity 82% and specificity 99%. The algorithm has potential to improve accuracy and efficiency in the diagnosis of HIT.Background Heparin-induced thrombocytopenia (HIT (...) ) is a life-threatening drug reaction caused by antiplatelet factor 4/heparin (anti-PF4/H) antibodies. Commercial tests to detect these antibodies have suboptimal operating characteristics. We previously developed a diagnostic algorithm for HIT that incorporated 'four Ts' (4Ts) scoring and a stratified interpretation of an anti-PF4/H enzyme-linked immunosorbent assay (ELISA) and yielded a discriminant accuracy of 0.97 (95% confidence interval [CI], 0.93-1.00). Objectives The purpose of this study
Vitamin K antagonists versus low-molecular-weight heparin for the long term treatment of symptomatic venous thromboembolism. People with venous thromboembolism (VTE) generally are treated for five days with intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin (LMWH), followed by three months of vitamin K antagonists (VKAs). Treatment with VKAs requires regular laboratory measurements and carries risk of bleeding; some patients have contraindications to such treatment
Antiangiogenic effects of decorin restored by unfractionated, low molecular weight, and nonanticoagulant heparins Pregnancies affected by preeclampsia (PE) or fetal growth restriction (FGR) display increases in thrombin generation and reductions in angiogenesis and cell growth. There is significant interest in the potential for low molecular weight heparins (LMWHs) to reduce the recurrence of PE and FGR. However, LMWH is associated with an increased risk of bleeding. Therefore, it is of vital (...) importance to determine the exact molecular function of heparins in pregnancy if they are used as therapy for pregnant women. We aimed to determine this using our model for PE/FGR in microvascular endothelial cells. The expression of decorin, a proteoglycan, was reduced to mimic PE/FGR in these cells compared with controls. Four concentrations of unfractionated heparin (UFH), LMWH, and nonanticoagulant heparin (NAC) were added to determine the effect on thrombin generation, angiogenesis, and cell growth
Unfractionated heparin versus low molecular weight heparins for avoiding heparin-induced thrombocytopenia in postoperative patients. Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction presenting as a prothrombotic disorder related to antibody-mediated platelet activation. It is a paradoxical immune reaction resulting in thrombin generation in vivo, which leads to a hypercoagulable state and the potential to initiate venous or arterial thrombosis. A number of factors are thought (...) to influence the incidence of HIT including the type and preparation of heparin (unfractionated heparin (UFH) or low molecular weight heparin (LMWH)) and the heparin-exposed patient population, with the postoperative patient population at higher risk.Although LMWH has largely replaced UFH as a front-line therapy, there is evidence supporting a lack of superiority of LMWH compared with UFH regarding prevention of deep vein thrombosis and pulmonary embolism following surgery, and similar frequencies
Pharmacological Treatments for Type II Heparin-Induced Thrombocytopenia: Clinical Effectiveness Pharmacological Treatments for Type II Heparin-Induced Thrombocytopenia: Clinical Effectiveness | CADTH.ca Find the information you need Pharmacological Treatments for Type II Heparin-Induced Thrombocytopenia: Clinical Effectiveness Pharmacological Treatments for Type II Heparin-Induced Thrombocytopenia: Clinical Effectiveness Published on: April 19, 2017 Project Number: RB1085-000 Product Line (...) : Research Type: Drug Report Type: Summary of Abstracts Result type: Report Question What is the clinical effectiveness the use of fondaparinux to treat patients with type II heparin-induced thrombocytopenia? What is the clinical effectiveness the use of direct oral anticoagulants to treat patients with type II heparin-induced thrombocytopenia? Key Message One systematic review and eight non-randomized studies were identified regarding the clinical effectiveness of fondaparinux and/or direct oral
Serologic characterization of anti-protamine/heparin and anti-PF4/heparin antibodies Anti-protamine (PRT)/heparin antibodies are a newly described class of heparin-dependent antibodies occurring in patients exposed to PRT and heparin during cardiac surgery. To understand the biologic significance of anti-PRT/heparin antibodies, we developed a murine monoclonal antibody (ADA) specific for PRT/heparin complexes and compared it to patient-derived anti-PRT/heparin antibodies, as well as comparing (...) polyclonal and monoclonal antibodies with anti-platelet factor 4 (PF4)/heparin. Using monoclonal antibodies and polyclonal patient-derived antibodies, we show distinctive binding patterns of anti-PRT/heparin antibodies as compared with PF4/heparin antibodies. Whereas heparin-induced thrombocytopenia (HIT) antibody binding to PF4/heparin is inhibited by relatively low doses of heparin (0-1 U/mL), anti-PRT/heparin antibodies, including ADA, retain binding to PRT/heparin over a broad range of heparin
Economic Evaluation of Unfractionated Heparin Versus Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in General Medical and Non Orthopedic Surgical Patients Economic Evaluation of Unfractionated Heparin Versus Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in General Medical and Non Orthopedic Surgical Patients | CADTH.ca CADTH Document Viewer Economic Evaluation of Unfractionated Heparin Versus Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism (...) in General Medical and Non Orthopedic Surgical Patients Table of Contents Search this document Economic Evaluation of Unfractionated Heparin Versus Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in General Medical and Non Orthopedic Surgical Patients April 2017 Key Finding: Economic Evaluation The price of low-molecular-weight heparin (LMWH) has decreased since it was marketed in the mid‑1990s in Canada, while unfractionated heparin (UFH) has recently become more costly because of changes
Low-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischaemic stroke. Low-molecular-weight heparins (LMWHs) and heparinoids are anticoagulants that may have more powerful antithrombotic effects than standard unfractionated heparin (UFH) but a lower risk of bleeding complications. This is an update of the original Cochrane Review of these agents, first published in 2001 and last updated in 2008.To determine whether antithrombotic therapy with LMWHs
Prospective Study of Routine Heparin Avoidance Hemodialysis in a Tertiary Acute Care Inpatient Practice Extracorporeal circuit (EC) anticoagulation with heparin is a key advance in hemodialysis (HD), but anticoagulation is problematic in inpatients at risk of bleeding. We prospectively evaluated a heparin-avoidance HD protocol, clotting of the EC circuit (CEC), impact on dialysis efficiency, and associated risk factors in our acute care inpatients who required HD (January 17, 2014 to May 31 (...) , 2015).HD sessions without routine EC heparin were performed using airless dialysis tubing. Patients received systemic anticoagulation therapy and/or antiplatelets for non-HD indications. We observed patients for indications of CEC (interrupted HD session, circuit loss, or inability to return blood). The primary outcome was CEC. Logistic regression with generalized estimating equations assessed associations between CEC and other variables.HD sessions (n = 1200) were performed in 338 patients (204
Evaluating the safety and efficacy of regional citrate compared to systemic heparin as anticoagulation for continuous renal replacement therapy in critically ill patients: A service evaluation following a change in practice Following the implementation of citrate anticoagulation for continuous renal replacement therapy, we evaluate its first year of use and compare it to the previously used heparin, to assess whether our patients benefit from the recently reported advantages of citrate. We (...) retrospectively analysed 2 years of data to compare the safety and efficacy of citrate versus heparin. The results have shown that 43 patients received continuous renal replacement therapy with heparin, 37 patients with citrate. We found no significant difference in metabolic control of pH, urea and creatinine after 72 h. Filters anticoagulated with citrate had significantly longer median lifespan (33 h vs 17 h; p = 0.001), shorter downtime (0 h vs 5 h; p = 0.015) and less filter sets per patient day (0.37 vs
One-Year Mortality for Bivalirudin vs Heparins Plus Optional Glycoprotein IIb/IIIa Inhibitor Treatment Started in the Ambulance for ST-Segment Elevation Myocardial Infarction: A Secondary Analysis of the EUROMAX Randomized Clinical Trial. Uncertainty exists regarding potential survival benefits of bivalirudin compared with heparin with routine or optional use of glycoprotein IIb/IIIa inhibitors (GPIs) in patients with ST-segment elevation myocardial infarction (STEMI). Few data are available (...) regarding long-term mortality in the context of contemporary practice with frequent use of radial access and novel platelet adenosine diphosphate P2Y12 receptor inhibitors.To assess the effect of bivalirudin monotherapy compared with unfractionated or low-molecular-weight heparin plus optional GPIs on 1-year mortality.This international, randomized, open-label clinical trial (EUROMAX [European Ambulance Acute Coronary Syndrome Angiography]) included 2198 patients with STEMI undergoing transport
Subcutaneous unfractionated heparin for the initial treatment of venous thromboembolism. Venous thromboembolism (VTE) is a prevalent and serious condition. Its medical treatment requires anticoagulation, usually with either unfractionated or low molecular weight heparin (LMWH). Administration of unfractionated heparin (UFH) is usually intravenous (IV) but can be subcutaneous as well. This is an update of a review first published in 2009.To assess the effects of subcutaneous UFH versus
Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for the initial treatment of venous thromboembolism. Low molecular weight heparins (LMWHs) have been shown to be effective and safe in preventing venous thromboembolism (VTE). They may also be effective for the initial treatment of VTE. This is the third update of the Cochrane Review first published in 1999.To evaluate the efficacy and safety of fixed dose subcutaneous low molecular weight heparin (...) compared to adjusted dose unfractionated heparin (intravenous or subcutaneous) for the initial treatment of people with venous thromboembolism (acute deep venous thrombosis or pulmonary embolism).For this update the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (15 September 2016). In addition the CIS searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 15 September 2016) and trials
Comparative effectiveness of bivalirudin versus heparin monotherapy for percutaneous coronaryintervention (PCI) Comparative effectiveness of bivalirudin versus heparin monotherapy for percutaneous coronary intervention (PCI) Comparative effectiveness of bivalirudin versus heparin monotherapy for percutaneous coronary intervention (PCI) HAYES, Inc. Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been (...) made for the HTA database. Citation HAYES, Inc.. Comparative effectiveness of bivalirudin versus heparin monotherapy for percutaneous coronary intervention (PCI) Lansdale: HAYES, Inc.. Directory Publication. 2016 Authors' objectives Anticoagulation is recommended for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Two commonly employed options include heparin and bivalirudin. Heparin is an indirect thrombin inhibitor; it binds and activates
Meta-analysis of aspirin-heparin therapy for un-explained recurrent miscarriage. Objective This study was designed to evaluate the efficacy and safety of aspirin-heparin treatment for un-explained recurrent spontaneous abortion (URSA). Methods Literatures reporting the studies on the aspirin-heparin treatment of un-explained recurrent miscarriage with randomized controlled trials (RCTs) were collected from the major publication databases. The live birth rate was used as primary indicator (...) publications of RCTs were included in this study. There were a total of 907 pregnant women with diagnosis of URSA, 367 of them were pooled in the study group with aspirin-heparin therapy and 540 women in the control group with placebo, aspirin or progesterone therapy. Meta-analysis showed that the live birth rate in the study group was significantly different from that in the control group [RR = 1.18, 95% CI (1.00-1.39), P=0.04]. Considering the clinical heterogeneity among the six studies, subgroup
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Heparin Flushing of IV Lines Rapid Review 1 Heparin flushing of IV lines Citation Centre for Clinical Effectiveness. 2017. Heparin flushing of IV lines: Rapid Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia. Executive Summary Background Monash Health are working on improving procedural and maintenance documentation as a result of the dramatic increase in the size of the lines service with the opening of the new Children’s Hospital. As part of this, they are re (...) - considering the use of heparin for flushing paediatric lines which is common practice around the world. Changing practice from heparin to saline at Monash Health would be a significant change in practice. Anaesthetics have engaged the Centre for Clinical Effectiveness to undertake a rapid review of current literature about the use of heparin for flushing paediatric lines. Objective The purpose of this Rapid Review was to synthesise recent evidence pertaining to the use of heparin versus saline flushing
Heparin flush for central and peripheral venous access devices Heparin flush for central and peripheral venous access devices Heparin flush for central and peripheral venous access devices Mitchell MD, Wilck MB, Zborowski K, Mull, N Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Mitchell MD, Wilck MB, Zborowski K, Mull, N. Heparin flush (...) for central and peripheral venous access devices. Philadelphia: Center for Evidence-based Practice (CEP). 2017 Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Catheterization, Central Venous; Heparin; Humans Language Published English Country of organisation United States English summary An English language summary is available. Address for correspondence Center for Evidence-based Practice, University of Pennsylvania Health System, 3535 Market St. Suite 50, Philadelphia PA
Low molecular weight heparin in one or two doses for the initial treatment of venous thromboembolic disease? The preferred dosification for low molecular weight heparins is in two doses for most patients with venous thromboembolic disease. A daily dose would make treatment simpler, less expensive and more comfortable while retaining a similar benefit and safety. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including (...) five randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded it is not clear whether the risk of recurrence differs between the two alternatives because the certainty of the evidence is very low, and that administering low molecular weight heparin in two doses might be associated to little or no difference in the risk of major bleeding and mortality.