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Latest & greatest articles for heparin
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Heparin-bonded catheters for prolonging the patency of central venous catheters in children. Central venous catheters (CVCs) are a mainstay in the management of critically ill children. However, these catheters are associated with mechanical and infectious complications which reduce their life span. Heparin bonding of catheters has shown promise in animal studies and in adults. This is the first update of a review published in 2007.The primary objective was to determine the effect of heparin (...) -bonded CVCs on the duration of catheter patency in children. Secondary objectives were to determine the effects of heparin-bonded catheters on catheter-related thrombosis, occlusion, blood stream infection and side effects.For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched August 2013) and CENTRAL (2013, Issue 7). The authors searched MEDLINE (1946 to week 3 August 2013).We included randomized and quasi
Citrate Versus Heparin Lock for Hemodialysis Catheters: A Systematic Review and Meta-analysis of Randomized Controlled Trials Citrate solution has been suggested as an effective and safe catheter lock in hemodialysis. However, whether a citrate lock is superior to a heparin lock in preventing catheter-related infections and maintaining catheter patency is inconclusive.A systematic review and meta-analysis was performed by searching in PubMed, EMBASE, Ovid, the Cochrane Library, and Web (...) of Science databases and major nephrology journals.Patients receiving hemodialysis with central venous catheters.Randomized controlled trials comparing citrate locks with heparin locks in hemodialysis patients with central venous catheters.Locking central venous catheters with citrate locks.Primary outcomes include catheter-related bloodstream infection (CRBSI), exit-site infection, catheter removal for poor flow, and thrombolytic treatment.13 randomized controlled trials (1,770 patients, 221,064
Impact of baseline hemorrhagic risk on the benefit of bivalirudin versus unfractionated heparin in patients treated with coronary angioplasty: A meta-regression analysis of randomized trials. Bivalirudin significantly reduces 30-day major and minor bleeding compared with unfractionated heparin (UFH), while resulting in similar or lower rates of ischemic events in both patients with stable and unstable coronary disease undergoing percutaneous coronary intervention. We performed a meta-analysis
[Heparin for treatment of sepsis: a systemic review]. To systemically review the efficacy and safety of heparin for treatment of sepsis.Database search of IM/MEDLINE, Cochrane Library, SCIE, CBM, CNKI, VIP Data, WanFang Data (from January 2000 to June 2012) was conducted. The quality of included randomized controlled trials (RCTs) about heparin for treatment of sepsis was assessed, and relevant data were extracted according to the inclusion and exclusion criteria. Then meta analysis (...) was performed using RevMan 5.1.17 trials with 1 167 participants were included. The results of meta-analysis showed: compared with the control group, heparin significantly decreased 28-day mortality in patients with sepsis [odds ratio (OR)=0.59, 95% confidence interval (95%CI) 0.45-0.77, P=0.0001]; heparin did not deteriorate coagulation disorders, but corrected sepsis-induced platelet (PLT) count reduction [mean difference (MD)=13.94, 95%CI 10.15 to 17.72, P<0.000 01], while it had no significant effect
The cost-effectiveness of oral direct factor Xa inhibitors compared with low-molecular-weight heparin for the prevention of venous thromboembolism prophylaxis in total hip or knee replacement surgery. Major orthopedic surgery is associated with a high risk of venous thromboembolism (VTE). Anticoagulants are recommended to prevent VTE, and recently an oral direct factor Xa inhibitor (FXaI) was approved for this indication. We compared the cost-effectiveness of FXaIs with low-molecular-weight (...) heparin (LMWH) in patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery.A decision-tree model was developed to compare the cost-effectiveness of oral direct FXaIs (rivaroxaban, apixaban, and edoxaban) to subcutaneous LMWHs (enoxaparin and dalteparin), with separate models for THR and TKR. The analysis was conducted over a 180-day postoperative time horizon from the U.S. Medicare perspective. The model was developed using TreeAge Pro 2011 (TreeAge Software Inc
Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions: the randomized VIASTAR trial (Viabahn endoprosthesis with PROPATEN bioactive surface [VIA] versus bare nitinol stent in the treatment of long lesions in sup The hypothesis that endovascular treatment with covered stents has equal risks but higher efficacy than bare-metal stents (BMS) in long femoropopliteal artery disease was tested.Although endovascular treatment of short superficial femoral (...) artery lesions revealed excellent results, efficacy in long lesions remains unsatisfactory.In a prospective, randomized, single-blind, multicenter study, 141 patients with symptomatic peripheral arterial disease were assigned to treatment with heparin-bonded, covered stents (Viabahn 72 patients) or BMS (69 patients). Clinical outcomes and patency rates were assessed at 1, 6, and 12 months.Mean ± SD lesion length was 19.0 ± 6.3 cm in the Viabahn group and 17.3 ± 6.6 cm in the BMS group. Major
Efficacy and safety of the use of heparin as thromboprophylaxis in patients with liver cirrhosis: a systematic review and meta-analysis. Venous thromboembolism is a common cause of morbidity and mortality. Although cirrhosis has classically been considered as an acquired bleeding diathesis, there is increasing evidence that rejects the traditional belief that these patients are naturally protected against venous thromboembolism. However, antithrombotic prophylaxis in this setting is still (...) underused. The aim of this review is to assess if the use of heparin in cirrhotic patients is effective in the prevention of venous thromboembolism and whether its use is related to an increase in bleeding episodes.We searched in MEDLINE and EMBASE, using the terms "liver cirrhosis", "heparin", "low molecular weight heparin," "venous thrombosis", "deep venous thrombosis", "hemorrhage" and "bleeding". We sought for clinical trials and observational studies performed in patients with liver cirrhosis
Heparin thromboprophylaxis in medical-surgical critically ill patients: a systematic review and meta-analysis of randomized trials. Venous thromboembolism prevention during critical illness is a widely used quality metric. The objective of this systematic review was to systematically review the efficacy and safety of heparin thromboprophylaxis in medical-surgical patients in the ICU.We searched EMBASE, MEDLINE, the Cochrane Controlled Trials Register, Clinicaltrials.gov, and personal files (...) through May 2012.Randomized trials in adult medical-surgical ICU patients comparing any heparin (unfractionated heparin or low-molecular-weight heparin) with each other or no anticoagulant prophylaxis, evaluating deep vein thrombosis, pulmonary embolism, major bleeding, or mortality.Independently, in duplicate, we abstracted trial characteristics, outcomes, and risk of bias.Seven trials involved 7,226 patients. Any heparin thromboprophylaxis compared with placebo reduced rates of deep vein thrombosis
Heparin for assisted reproduction. Heparin as an adjunct in assisted reproduction (peri-implantation heparin) is given at or after egg collection or at embryo transfer during assisted reproduction. Heparin has been advocated to improve embryo implantation and clinical outcomes. It has been proposed that heparin enhances the intra-uterine environment by improving decidualisation with an associated activation of growth factors and a cytokine expression profile in the endometrium (...) that is favourable to pregnancy.To investigate whether the administration of heparin around the time of implantation (peri-implantation heparin) improves clinical outcomes in subfertile women undergoing assisted reproduction.A comprehensive and exhaustive search strategy was developed in consultation with the Trials Search Co-ordinator of the Cochrane Menstrual Disorders and Subfertility Group (MDSG). The strategy was used in an attempt to identify all relevant studies regardless of language or publication
Adjunct low-molecular-weight heparin to improve live birth rate after recurrent implantation failure: a systematic review and meta-analysis. BACKGROUND Poor fertility outcomes in women with recurrent implantation failure (≥ RIF) present significant challenges in assisted reproduction, and various adjuncts, including heparin, are used for potential improvement in pregnancy rates. We performed this systematic review and meta-analysis to evaluate the effect of low-molecular-weight heparin (LMWH
Low Molecular Weight Heparins Versus Unfractionated Heparin for Thromboprophylaxis in Surgery, Cancer and General Medicine: A Review of the Cost-effectiveness and Safety TITLE: Low Molecular Weight Heparins Versus Unfractionated Heparin for Thromboprophylaxis in Surgery, Cancer and General Medicine: A Review of the Cost-effectiveness and Safety DATE: 02 July 2013 CONTEXT AND POLICY ISSUES Low molecular weight heparins (LMWH) have emerged as an important alternative to unfractionated heparin (...) . LMWH are at least as effective antithrombotic drugs as UFH, however, it is still unclear whether the safety profiles of LMWH and UFH differ. 12 The important adverse events of heparin includes heparin-induced thrombocytopenia (HIT), an adverse drug reaction presenting as a prothrombotic disorder related to antibody-mediated platelet activation, 13 and bleeding. In 2009, CADTH published a review on the cost-effectiveness of LMWH compared with UFH. 11 It was reported in that review that LMWH appeared
Once versus twice daily low molecular weight heparin for the initial treatment of venous thromboembolism. In the initial treatment of venous thromboembolism (VTE) low molecular weight heparin (LMWH) is administered once or twice daily. A once daily treatment regimen is more convenient for the patient and may optimise home treatment. However, it is not clear whether a once daily treatment regimen is as safe and effective as a twice daily treatment regimen. This is the second update of a review
Low molecular weight heparin for prevention of microvascular occlusion in digital replantation. The success of digital replantation is highly dependent on the patency of the repaired vessels after microvascular anastomosis. Antithrombotic agents are frequently used for preventing vascular occlusion. Low molecular weight heparin (LMWH) has been reported to be as effective as unfractionated heparin (UFH) in peripheral vascular surgery, but with fewer adverse effects. Its benefit in microvascular
The efficacy and safety of low-molecular-weight heparin use for cancer treatment: a meta-analysis. Low-molecular-weight heparin (LMWH) has an anti-tumour effect in-vitro and in animal models of malignancy; however, the evidence from clinical trials is controversial. Thus, we performed a meta-analysis from the results of randomised controlled trials (RCTs) to assess LMWH efficacy and safety in cancer patients who had no venous thromboembolism (VTE).We searched the MEDLINE, EMBASE and CENTRAL
Low-molecular-weight heparins for managing vaso-occlusive crises in people with sickle cell disease. Sickle cell disease is one of the most common and severe genetic disorders in the world. It can be broadly divided into two distinct clinical phenotypes characterized by either haemolysis or vaso-occlusion. Pain is the most prominent symptom of vaso-occlusion, and hypercoagulability is a well-established pathogenic phenomenon in people with sickle cell disease. Low-molecular-weight heparins (...) might control this hypercoagulable state through their anticoagulant effect.To assess the effects of low-molecular-weight heparins for managing vaso-occlusive crises in people with sickle cell disease.We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register comprising references identified from comprehensive electronic database searches. We also searched abstract books of conference proceedings and several online trials registries for ongoing
Heparin-bonded central venous catheters do not reduce thrombosis in infants with congenital heart disease: a blinded randomized, controlled trial PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Targeted use of heparin, heparinoids, or low-molecular-weight heparin to improve outcome after acute ischaemic stroke: an individual patient data meta-analysis of randomised controlled trials. Many international guidelines on the prevention of venous thromboembolism recommend targeting heparin treatment at patients with stroke who have a high risk of venous thrombotic events or a low risk of haemorrhagic events. We sought to identify reliable methods to target anticoagulant treatment and so (...) improve the chance of avoiding death or dependence after stroke.We obtained individual patient data from the five largest randomised controlled trials in acute ischaemic stroke that compared heparins (unfractionated heparin, heparinoids, or low-molecular-weight heparin) with aspirin or placebo. We developed and evaluated statistical models for the prediction of thrombotic events (myocardial infarction, stroke, deep vein thrombosis, or pulmonary embolism) and haemorrhagic events (symptomatic
Safety and efficacy of bridging with low molecular weight heparins: a systematic review and partial meta-analysis. Surgical interventions in patients on long term vitamin K antagonist (VKA) treatment create a dilemma; periprocedural interruption of anticoagulation raises the risk of thrombosis, while continuation raises the risk of bleeding. The anticoagulation- free interval is minimized by "bridging" with parenteral anticoagulants. The efficacy and safety of bridging with low molecular weight (...) heparins (LMWH) has however not been unequivocally established.We performed an EMBASE and MEDLINE search for studies that compared bridging anticoagulation with continuation or cessation of VKA without bridging; with thromboembolism (TE) and bleeding as outcomes. We identified 878 articles and finally selected 17. Results of individual studies were pooled.None of the included studies reported significant differences in incidence of TEs between the bridging group and the comparator group; 4 out of 13
Deep venous thrombosis and pulmonary embolism. Part 1. Initial treatment: usually a low-molecular-weight heparin. Patients with deep venous thrombosis are at a short-term risk of symptomatic or even life-threatening pulmonary embolism, and a long-term risk of post-thrombotic syndrome, characterised by lower-limb pain, varicose veins, oedema, and sometimes skin ulcers. What is the best choice of initial antithrombotic therapy following deep venous thrombosis or pulmonary embolism, in terms (...) of mortality and short-term and long-term complications? How do the harm-benefit balances of the different options compare? To answer these questions, we reviewed the available literature using the standard Prescrire methodology. Unfractionated heparin has documented efficacy in reducing mortality and recurrent thromboembolic events in patients with pulmonary embolism or symptomatic proximal (above-knee) deep venous thrombosis. The authors of a systematic review selected 23 trials of low-molecular-weight
Low-Dose Heparin Use and the Patency of Peripheral IV Catheters in Children: A Systematic Review To assess evidence from randomized controlled trials (RCTs) on the efficacy of low-dose heparin for prolonging patency of peripheral intravenous (PIV) catheters in the pediatric population.We searched Medline, Embase, CINAHL, and Cochrane Central Register of Controlled Trials to identify studies up to June 6, 2012. Additional citations were retrieved from the bibliography of selected articles (...) . The eligible studies were RCTs of low-dose heparin used in PIV catheters as compared with control and measured any one of the following outcomes: duration of catheter patency, infusion failure rates, or phlebitis. Data were extracted by 1 reviewer by using a standardized form and checked for accuracy by a second reviewer. Discrepancies were resolved by consensus.Thirteen RCTs were identified (3 RCTs of continuous infusion and 10 RCTs of intermittent flush). Catheters using heparin had longer patency (mean