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Park JW, Jeon OC, Kim SK, Al-Hilal T, Lim KM, Moon HT, Kim CY, Byun Y. Pharmacokinetic evaluation of an oral tablet form of low-molecular-weight heparin and deoxycholic acid conjugate as a novel oral anticoagulant. Thromb Haemost 2017; 105:1060-71. [DOI: 10.1160/th10-07-0484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 02/10/2011] [Indexed: 11/05/2022]
Abstract
SummaryThis study was designed to develop a solid oral dosage form of deoxycholic acid (DOCA)-conjugated low-molecular-weight heparin (LMWH) and to evaluate its oral absorption, distribution, and metabolic stability for the prospect of providing an orally bioavailable LMWH. The LMWH derivative (LHD) was synthesised and then formulated with solubilisers and other pharmaceutical excipients to form a solid tablet. Its absorption and distribution after oral administration were evaluated in mice, rats, and monkeys. The in vitro metabolic stability of LHD was examined by liver microsome assays. More than 80% of LHD was released from the tablet within 60 minutes, guaranteeing rapid tablet disintegration after oral administration. Oral bioavailability of LHD in mice, rats and monkeys were 16.1 ± 3.0, 15.6 ± 6.1, and 15.8 ± 2.5%, respectively. After the oral administration of 131I-tyramine-LHD, most of the absorbed drug remained in the blood circulation and was eliminated mainly through the kidneys. LHD was hardly metabolised by the liver microsomes and showed a stable metabolic pattern similar to that of LMWH. In a rat thrombosis model, 10 mg/kg of orally administered LHD reduced thrombus formation by 60.8%, which was comparable to the antithrombotic effect of the subcutaneously injected LMWH (100 IU/ kg). Solid tablets of LHD exhibited high oral absorption and statistically significant therapeutic effects in preventing venous thromboembolism. Accordingly, LHD tablets are expected to satisfy the unmet medical need for an oral heparin-based anticoagulant as an alternative to injectable heparin and oral warfarin.
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Liebman HA. Current Perspectives on Primary Prophylaxis and Patient Risk Factors for Venous Thromboembolism in the Cancer Patient. Cancer Control 2017; 12 Suppl 1:11-6. [PMID: 16179899 DOI: 10.1177/1073274805012003s03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Howard A Liebman
- Keck School of Medicine, University of Southern California, Los Angeles 90033, USA.
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Kim JY, Jeon OC, Moon HT, Hwang SR, Byun Y. Preclinical safety evaluation of low molecular weight heparin-deoxycholate conjugates as an oral anticoagulant. J Appl Toxicol 2015; 36:76-93. [PMID: 25900269 DOI: 10.1002/jat.3146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/06/2022]
Abstract
The preclinical safety of a newly developed oral anticoagulant, the low molecular weight heparin-deoxycholate conjugate (OH09208), was evaluated by a comprehensive evaluating program in compliance with standard guidelines. The single dose oral toxicity study in rats receiving 2000 and 5000 mg kg(-1) of OH09208 did not reveal any mortality, unusual body weight changes or necropsy findings. The results of the 4-week oral toxicity study with a 4-week recovery program in rats receiving OH09208 in doses of 100, 300 and 1000 mg kg(-1) day(-1) did not reveal any mortality, or indicate any unusual clinical signs, or show any toxicokinetic relationships to the administration of OH09208. Although the increase in liver enzymes in one male dog treated with 300 mg kg(-1) day(-1) and one female dog treated with 1000 mg kg(-1) day(-1) could not be excluded from the effect of the test substance, no other toxicologically significant changes were observed in the 4-week oral toxicity study with a 4-week recovery in beagle dogs. Thus, while the no-observed-adverse-effect level value from the 4-week study in both male and female rats was 1000 mg kg(-1) day(-1), those from the 4-week study in male and female beagle dogs were 300 and 1000 mg kg(-1) day(-1), respectively. Furthermore, OH09208 did not induce anaphylactic reactions in guinea pigs, micronucleated bone marrow cells in male ICR mice, chromosomal aberration in Chinese hamster lung cell lines, bacterial reverse mutation, and any abnormalities in hERG current assay, mouse central nervous system and dog cardiovascular studies. Overall, there were no unexpected toxicities in this preclinical study that might have precluded the safe administration of OH09208 to humans.
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Affiliation(s)
- Ji-young Kim
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Ok-Cheol Jeon
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Hyun Tae Moon
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Seung Rim Hwang
- College of Pharmacy, Chosun University, Dong-gu, Gwangju, South Korea
| | - Youngro Byun
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, South Korea.,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
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Nicolaides A, Hull RD, Fareed J. General, vascular, bariatric, and plastic surgical patients. Clin Appl Thromb Hemost 2013; 19:122-33. [PMID: 23529479 DOI: 10.1177/1076029612474840c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Park JW, Jeon OC, Kim SK, Al-Hilal TA, Moon HT, Kim CY, Byun Y. Anticoagulant Efficacy of Solid Oral Formulations Containing a New Heparin Derivative. Mol Pharm 2010; 7:836-43. [DOI: 10.1021/mp900319k] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jin Woo Park
- College of Pharmacy, Seoul National University, 599 Gwanak-ro, Gwanak-gu, Seoul 151-742, South Korea, Amorepacific Corporation R&D Center, 314-1, Bora-dong, Giheung-gu, Yongin-si, Gyeonggi-do 446-729, South Korea, Mediplex Corporation, Guro-dong, Guro-gu, Seoul 135-729, South Korea, Toxicology Research Center, Korea Research Institute of Chemical Technology, 19 Shinseong-ro, Yuseon-gu, Daejeon 305-343, South Korea, and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of
| | - Ok Cheol Jeon
- College of Pharmacy, Seoul National University, 599 Gwanak-ro, Gwanak-gu, Seoul 151-742, South Korea, Amorepacific Corporation R&D Center, 314-1, Bora-dong, Giheung-gu, Yongin-si, Gyeonggi-do 446-729, South Korea, Mediplex Corporation, Guro-dong, Guro-gu, Seoul 135-729, South Korea, Toxicology Research Center, Korea Research Institute of Chemical Technology, 19 Shinseong-ro, Yuseon-gu, Daejeon 305-343, South Korea, and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of
| | - Sang Kyoon Kim
- College of Pharmacy, Seoul National University, 599 Gwanak-ro, Gwanak-gu, Seoul 151-742, South Korea, Amorepacific Corporation R&D Center, 314-1, Bora-dong, Giheung-gu, Yongin-si, Gyeonggi-do 446-729, South Korea, Mediplex Corporation, Guro-dong, Guro-gu, Seoul 135-729, South Korea, Toxicology Research Center, Korea Research Institute of Chemical Technology, 19 Shinseong-ro, Yuseon-gu, Daejeon 305-343, South Korea, and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of
| | - Taslim Ahmed Al-Hilal
- College of Pharmacy, Seoul National University, 599 Gwanak-ro, Gwanak-gu, Seoul 151-742, South Korea, Amorepacific Corporation R&D Center, 314-1, Bora-dong, Giheung-gu, Yongin-si, Gyeonggi-do 446-729, South Korea, Mediplex Corporation, Guro-dong, Guro-gu, Seoul 135-729, South Korea, Toxicology Research Center, Korea Research Institute of Chemical Technology, 19 Shinseong-ro, Yuseon-gu, Daejeon 305-343, South Korea, and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of
| | - Hyun Tae Moon
- College of Pharmacy, Seoul National University, 599 Gwanak-ro, Gwanak-gu, Seoul 151-742, South Korea, Amorepacific Corporation R&D Center, 314-1, Bora-dong, Giheung-gu, Yongin-si, Gyeonggi-do 446-729, South Korea, Mediplex Corporation, Guro-dong, Guro-gu, Seoul 135-729, South Korea, Toxicology Research Center, Korea Research Institute of Chemical Technology, 19 Shinseong-ro, Yuseon-gu, Daejeon 305-343, South Korea, and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of
| | - Choong Yong Kim
- College of Pharmacy, Seoul National University, 599 Gwanak-ro, Gwanak-gu, Seoul 151-742, South Korea, Amorepacific Corporation R&D Center, 314-1, Bora-dong, Giheung-gu, Yongin-si, Gyeonggi-do 446-729, South Korea, Mediplex Corporation, Guro-dong, Guro-gu, Seoul 135-729, South Korea, Toxicology Research Center, Korea Research Institute of Chemical Technology, 19 Shinseong-ro, Yuseon-gu, Daejeon 305-343, South Korea, and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of
| | - Youngro Byun
- College of Pharmacy, Seoul National University, 599 Gwanak-ro, Gwanak-gu, Seoul 151-742, South Korea, Amorepacific Corporation R&D Center, 314-1, Bora-dong, Giheung-gu, Yongin-si, Gyeonggi-do 446-729, South Korea, Mediplex Corporation, Guro-dong, Guro-gu, Seoul 135-729, South Korea, Toxicology Research Center, Korea Research Institute of Chemical Technology, 19 Shinseong-ro, Yuseon-gu, Daejeon 305-343, South Korea, and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of
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Park JW, Kim SK, Al-Hilal TA, Jeon OC, Moon HT, Byun Y. Strategies for oral delivery of macromolecule drugs. BIOTECHNOL BIOPROC E 2010. [DOI: 10.1007/s12257-009-3058-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Microemulsions are potentially excellent carriers for bioactive molecules. They offer the advantage of spontaneous formation, ease of manufacture, thermodynamic stability, and improved solubilization of bioactive materials. This review explores some of the new trends in microemulsion research through analysis of some representative studies. The solubilization of different classic drugs, peptides, and nutraceuticals in various oral microemulsion compositions and microstructures was reviewed. It was found that even W/O microemulsions, which are expected to break upon dilution in the digestive tract, increase the permeability and bioavailability of drugs. Thus, it seems that component selection (the use of molecules that can act as permeability enhancers) is of great importance. Structures such as self-microemulsifying drug delivery systems (SMEDDS), W/O, bicontinuous, and O/W microemulsions, were closely examined, and their potential to serve as drug carriers was evaluated. It seems that for microemulsion systems to be used as vehicles for bioactive materials, the formulations should be based on SMEEDS, which form O/W upon dilution to a specific water content. U-type microemulsions are actually an improved SMEDDS formulation, capable of being diluted with any given water concentration. Much research is being conducted on microemulsion microstructure since there is an obvious direct connection between the microstructure, solubilization capacity, and bioavailability of the active molecules.
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Affiliation(s)
- Aviram Spernath
- Casali Institute of Applied Chemistry, The Institute of Chemistry, Givat Ram Campus, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
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Motlekar NA, Srivenugopal KS, Wachtel MS, Youan BBC. Evaluation of the Oral Bioavailability of Low Molecular Weight Heparin Formulated With Glycyrrhetinic Acid as Permeation Enhancer. Drug Dev Res 2006; 67:166-174. [PMID: 17710191 PMCID: PMC1948842 DOI: 10.1002/ddr.20087] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Low molecular weight heparin (LMWH) is the agent of choice for anticoagulant therapy and prophylaxis of thrombosis and coronary syndromes. However, its therapeutic use is limited due to poor oral bioavailability. The aim of this study was to investigate the oral delivery of LMWH, ardeparin formulated with 18-beta glycyrrhetinic acid (GA), as an alternative to currently used subcutaneous (sc) delivery. Drug transport through Caco-2 cell monolayers was monitored in the presence and absence of GA by scintillation counting and transepithelial electrical resistance. Regional permeability studies using rat intestine were performed using a modified Ussing chamber. Cell viability in the presence of various concentrations of enhancer was determined by MTT assay. The absorption of ardeparin after oral administration in rats was measured by an anti-factor Xa assay. Furthermore, the eventual mucosal epithelial damage was histologically evaluated. Higher ardeparin permeability (~7-fold) compared to control was observed in the presence of 0.02 % GA. Regional permeability studies indicated predominant absorption in the duodenal segment. Cell viability studies showed no significant cytotoxicity below 0.01 % GA. Ardeparin oral bioavailability was significantly increased (F(relative)/(S.C). = 13.3%) without causing any damage to the intestinal tissues. GA enhanced the oral absorption of ardeparin both in vitro and in vivo. The oral formulation of ardeparin with GA could be absorbed in the intestine. These results suggest that GA may be used as an absorption enhancer for the oral delivery of LMWH.
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Affiliation(s)
- Nusrat A. Motlekar
- Department of Pharmaceutical Sciences, School of Pharmacy,
Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Kalkunte S. Srivenugopal
- Department of Pharmaceutical Sciences, School of Pharmacy,
Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Mitchell S. Wachtel
- Department of Pathology, Divisions of Anatomic Pathology and
Research, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Bi-Botti C. Youan
- Department of Pharmaceutical Sciences, School of Pharmacy,
Texas Tech University Health Sciences Center, Amarillo, Texas
- *Correspondence to: Bi-Botti C. Youan, PhD., Texas
Tech University Health Sciences Center, School of Pharmacy. 1300 Coulter Drive,
Amarillo, TX 79106. E-mail:
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Kim SK, Vaishali B, Lee E, Lee S, Lee YK, Kumar TS, Moon HT, Byun Y. Oral delivery of chemical conjugates of heparin and deoxycholic acid in aqueous formulation. Thromb Res 2006; 117:419-27. [PMID: 15913716 DOI: 10.1016/j.thromres.2005.03.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Revised: 03/14/2005] [Accepted: 03/14/2005] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Heparin, one of the most potent anticoagulants widely used for the treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE), is currently available to patients only by parental administration. In this study, we propose a new oral delivery system of heparin by conjugating it with deoxycholic acid which reformulated by adding dimethyl sulfoxide to increase its bioavailability. MATERIALS AND METHODS The chemical conjugates (LMWH-DOCA) of low molecular weight heparin (4.5 kDa) with deoxycholic acid (DOCA) were synthesized by controlling the conjugation ratio. The absorption of LMWH-DOCA after its oral administration was measured by anti-FXa assay according to the conjugation ratio of DOCA, concentration of DMSO solution and dose of LMWH-DOCA, respectively. Furthermore, the incidences of mucosal damage by LMWH-DOCA in 10% DMSO solution were evaluated using H&E staining and SEM. RESULTS Three kinds of LMWH-DOCA were synthesized according to the DOCA conjugation ratios of LD1, LD2 and LD3, whose anticoagulant activities were 89, 86 and 85 IU/mg, respectively, and the activity of LMWH was 97 IU/mg. LMWH-DOCA was completely dissolved in 10% DMSO solution, and its bioavailability in the oral dose was significantly increased (17.6% for LD2 in 10% DMSO solution) without causing any damages in intestinal tissues. CONCLUSIONS The chemical conjugate of heparin and DOCA in the soluble state could be efficiently absorbed in the intestine. Therefore, we propose this system as a new strategy of oral heparin delivery for the treatment of patients who are at high risk to DVT and PE.
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Affiliation(s)
- Sang Kyoon Kim
- Center for Cell and Macromolecular Therapy, Department of Materials Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Korea
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10
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Kim SK, Kim K, Lee S, Park K, Park JH, Kwon IC, Choi K, Kim CY, Byun Y. Evaluation of absorption of heparin-DOCA conjugates on the intestinal wall using a surface plasmon resonance. J Pharm Biomed Anal 2005; 39:861-70. [PMID: 16143485 DOI: 10.1016/j.jpba.2005.06.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Revised: 06/07/2005] [Accepted: 06/09/2005] [Indexed: 11/24/2022]
Abstract
We validated the application of the surface plasmon resonance (SPR) technique to reliably determine adhesion of drugs to the intestinal wall using heparin-DOCA conjugates, developed to enhance the oral absorption of poorly absorbed heparin. In this study, heparin conjugates, or deoxycholyl-heparin (H-DOCA) and bisdeoxycholyl-heparin (H-bis-DOCA), were synthesized by covalently coupling the synthesized succinimido deoxycholate (DOCA-NHS) or succinimido bis-deoxycholyl-L-lysine (DOCA-bis-NHS) to amine groups of heparin, and their physicochemical and biological properties were evaluated. To mimic the duodenal and ileal surfaces, duodenal and ileal brush border membrane (BBM) vesicles isolated from Sprauge-Dawley (SD) rats were immobilized onto a biosensor chip composed of dextran derivatives with modified lipophilic residues. The adhesion of heparin conjugates on the BBM surface was evaluated by measuring the SPR response signal. The adhesion of heparin conjugates was significantly dependent on the conjugated DOCA molecules: that is, they showed higher adhesion signal on the ileal BBM surface than that on the duodenal BBM surface. In particular, the solubilized heparin conjugates in DMSO solution presented significantly increased adhesion affinity on the ileal BBM surface. The adhesion of heparin conjugates on the intestinal surfaces was successfully assayed using the surface plasmon resonance technique with the sensor chip on which BBM vesicles were immobilized.
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Affiliation(s)
- Sang Kyoon Kim
- Department of Materials Science and Engineering, Gwangju Institute of Science and Technology, 1 Oryong-dong Buk-gu, Gwangju 500-712, Republic of Korea
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Kim SK, Lee EH, Vaishali B, Lee S, Lee YK, Kim CY, Moon HT, Byun Y. Tricaprylin microemulsion for oral delivery of low molecular weight heparin conjugates. J Control Release 2005; 105:32-42. [PMID: 15925422 DOI: 10.1016/j.jconrel.2005.03.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Revised: 03/08/2005] [Accepted: 03/18/2005] [Indexed: 11/18/2022]
Abstract
Heparin is available to patients only by parenteral administrations due to its low oral bioavailability. For the oral delivery of low molecular weight heparin (LMWH), LMWH-DOCA was synthesized by chemical conjugation of LMWH and deoxycholic acid (DOCA) and this conjugate was formulated in a microemulsion system. The coupling ratios of DOCA to LMWH for LD1 and LD2 were 1.33 and 2.37, respectively. The microemulsion was composed of tricaprylin, surfactant mixture (Tween 80 and Span 20) and LMWH-DOCA in water, and their volume ratio was 5:3:1:1. Pharmacokinetic parameters of LMWH were not significantly changed by conjugation with DOCA; however, when LMWH-DOCA in tricaprylin microemulsion was orally administered in mice, its bioavailability was increased up to 1.5%. Furthermore, the enhancing effect of the conjugated DOCA in the tricaprylin microemulsion on the absorption of LMWH in the intestine was more significantly increased in monkey than in mice. Since the tricaprylin microemulsion could dissolve LMWH-DOCA, this formulation could maximize the enhancing effect of the conjugated DOCA on the absorption of LMWH in the intestine. Finally, it was expected that 20 mg/kg of LMWH-DOCA in the tricaprylin microemulsion was enough to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
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Affiliation(s)
- Sang Kyoon Kim
- Center for Cell and Macromolecular Therapy, Department of Materials Science and Engineering, Gwangju Institute of Science and Technology, 1 Oryong-dong, Buk-gu, Gwangju 500-712, South Korea
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Moriau M, Lavenne-Pardonge E, Crasborn L, von Frenckell R, Col-Debeys C. The treatment of severe or recurrent deep venous thrombosis. Beneficial effect of the co-administration of antiplatelet agents with or without rheological effects, and anticoagulants. Thromb Res 2005; 78:469-82. [PMID: 15714749 DOI: 10.1016/0049-3848(95)00081-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Deep venous thromboses can be divided into two groups according to their pathogenesis, anatomical features and differing responses to therapy. The first and most frequent consists of so-called simple venous thrombosis while the second group, which is less common, comprises severe or recurrent venous thrombosis characterised by a multifactorial pathogenesis, a mixed thrombus rich in platelets and by an incomplete response to both prophylactic and therapeutic treatment with anticoagulants (heparin or vitamin K antagonist). In a randomized, prospective blind study in patients with severe or recurrent venous thrombosis, which included 6 groups each of 100 patients, co-administration of anticoagulants with various types of antiplatelet agent, either with rheological effects (piracetam, buflomedil, pentoxifylline) or without them (dipyridamole), has shown a beneficial potentiating antithrombotic effect with those drugs possessing rheological effects and the absence of this effect with dipyridamole.
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Affiliation(s)
- M Moriau
- Department of Internal Medicine, Haematology Division, Haemostasis and Thrombosis Unit, University of Louvain (UCL), St.-Luc University Clinics, Brussels, Belgium
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Abstract
Macromolecules comprise a growing group of new drugs with great clinical promise. To date, the therapeutic application of these drugs has been limited, because they are effective only when administered parenterally. Unfortunately, macromolecular drugs are not absorbed following nonparenteral dosing, because the mechanisms of the human body are designed to degrade and/or exclude them. To overcome the numerous obstacles to the noninvasive delivery of these drugs, various approaches are under investigation including the use of delivery agents to promote drug absorption. This review provides a summary of the novel approaches currently in progress in the areas of transdermal, transmucosal, and oral delivery of macromolecular drugs facilitated by delivery agents. We review our own novel work in this area in some detail, including the methods developed for the synthesis of the delivery agents, in vitro screening techniques developed to select compounds for in vivo testing, and the results of in vivo screening in both rats and primates, including preliminary safety and efficacy studies. Finally, the results of Phase I clinical studies showing the oral delivery of heparin are presented.
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Affiliation(s)
- A Leone-Bay
- Emisphere Technologies, Inc., Tarrytown, NY 10591, USA
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Leone-Bay A, Paton DR, Freeman J, Lercara C, O'Toole D, Gschneidner D, Wang E, Harris E, Rosado C, Rivera T, DeVincent A, Tai M, Mercogliano F, Agarwal R, Leipold H, Baughman RA. Synthesis and evaluation of compounds that facilitate the gastrointestinal absorption of heparin. J Med Chem 1998; 41:1163-71. [PMID: 9544216 DOI: 10.1021/jm970811m] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A family of novel compounds (delivery agents) that promote the gastrointestinal absorption of USP heparin in rats and primates has been discovered. The delivery agents in combination with heparin were administered either orally or intracolonically in an aqueous propylene glycol solution and caused dramatic increases in both plasma heparin concentrations (anti-Factor Xa) and clotting times (APTT). Using one of the most effective delivery agents in this series, an estimated relative bioavailability of 8% can be achieved following oral administration to cynomolgus monkeys. To establish a correlation between the in vivo data and an in vitro parameter, immobilized artificial membrane (IAM) chromatography was performed. Log relative k' values were correlated to the efficiency of oral heparin delivery.
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Affiliation(s)
- A Leone-Bay
- Emisphere Technologies, Inc., Hawthorne, New York 10532, USA
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15
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Van de Perre JP, Stoelinga PJ, Blijdorp PA, Brouns JJ, Hoppenreijs TJ. Perioperative morbidity in maxillofacial orthopaedic surgery: a retrospective study. J Craniomaxillofac Surg 1996; 24:263-70. [PMID: 8938506 DOI: 10.1016/s1010-5182(96)80056-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The data of 2049 patients, who underwent maxillofacial orthopaedic surgery, were retrospectively analysed for major intra- and immediate postoperative complications. Immediate life-threatening complications were very rare. They can in most cases be avoided by good anaesthetic and surgical techniques and adequate postoperative care. The most frequently encountered problem in maxillary surgery is excessive blood loss, whilst a compromised airway due to swelling is the most frequent complication in mandibular surgery. Good co-operation between anaesthetist and surgeon is essential to prevent major intraoperative and immediate postoperative problems.
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Affiliation(s)
- J P Van de Perre
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, The Netherlands
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16
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Baglin T. Unresolved issues in the prevention of venous thromboembolism. Drugs 1996; 52 Suppl 7:1-6; discussion 6-7. [PMID: 9042554 DOI: 10.2165/00003495-199600527-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Venous thromboembolism is a potentially fatal complication of surgery. The use of graded pressure stockings in combination with unfractionated heparin (UFH) or a low molecular weight heparin (LMWH) appears to be the safest and most effective method of prevention. With some LMWHs, the risk of venous thromboembolism appears to be lower than that associated with the use of standard UFH. A comparison of heparin given before versus after surgery (with all patients receiving graded pressure stockings) is justified. More information on the benefit-risk ratio of minidose warfarin is also required. The risk of pulmonary embolism (PE) following discharge from hospital after general surgery is relatively low and the extended use of heparin may not be justified. The value of graded pressure stockings and minidose warfarin for the prevention of PE should be determined. The risk of late PE after orthopaedic surgery is unknown and also needs to be determined.
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Affiliation(s)
- T Baglin
- Department of Clinical Haematology, Addenbrooke's NHS Trust, Cambridge, England
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Pangrazzi J, Donati MB, Romero M, Scroccaro G, Colombo F, Terzian E, Tognoni G. Is there still an avoidable fraction of post-operative thromboembolic complications with heparin prophylaxis? The results of a case-control surveillance. Collaborative Group on Heparin Prophylaxis in Surgery (S.E.P.E.C.). J Clin Epidemiol 1993; 46:371-7. [PMID: 8483002 DOI: 10.1016/0895-4356(93)90152-q] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A case-control multicenter study was set up in 68 general and specialistic wards in Italian regional hospitals in order to assess whether underuse of heparin prophylaxis may account for at least a fraction of the thromboembolic events still occurring in surgical patients. 100 cases with clinically relevant thromboembolic or hemorrhagic events occurring during hospitalization for major surgery and 200 controls were identified. Controls were selected among patients not presenting any of the events under study during the same period of observation and were matched with cases for age, sex, and type of surgery. The results of the study suggest that heparin use in routine conditions of care closely reflects the "consensus" knowledge, patients at higher risk (specifically orthopedic surgical patients, those with varicose veins or with preoperative bed rest longer than 3 days) being treated more frequently with heparin. Absence of heparin prophylaxis does not appear to represent a specific risk factor for the occurrence of index events (OR 0.73, 95% CI = 0.42-1.26). Despite the higher rates of heparin exposure, the presence of varicose veins is associated with a statistically significant increase in the risk of postoperative complications (OR 2.23, 95% CI = 1.07-4.65). This study indicates that among known pre- and peri-operative risk factors only varicose veins may be unprotected by the current prophylaxis practice.
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Affiliation(s)
- J Pangrazzi
- Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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Risk of and prophylaxis for venous thromboembolism in hospital patients. Thromboembolic Risk Factors (THRIFT) Consensus Group. BMJ (CLINICAL RESEARCH ED.) 1992; 305:567-74. [PMID: 1298229 PMCID: PMC1883249 DOI: 10.1136/bmj.305.6853.567] [Citation(s) in RCA: 386] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Dale C, Gallus A, Wycherley A, Langlois S, Howie D. Prevention of venous thrombosis with minidose warfarin after joint replacement. BMJ (CLINICAL RESEARCH ED.) 1991; 303:224. [PMID: 1884060 PMCID: PMC1670507 DOI: 10.1136/bmj.303.6796.224] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- C Dale
- Adelaide University, South Australia
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