Clinical application of enoxaparin

Efficacy and safety of salvianolate and enoxaparin in the prevention of perioperative deep venous thrombosis in gastrointestinal surgery

OBJECTIVE

In this study, the efficacy and safety of salvianolate were compared with enoxaparin in the prevention of perioperative deep vein thrombosis in gastrointestinal surgery.

METHODS

From October 2017 to September 2019, 563 patients who underwent gastrointestinal surgery were collected. Based on the inclusion and exclusion criteria, 119 patients were divided into two groups: enoxaparin group (n = 65) and salvianolate group (n = 54). Comparisons were made regarding the outcomes: prothrombin time (PT), prothrombin activity (PTA), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D-dimer level (D-D), platelet count (PLT), hematokrit (HCT), and incidence of deep vein thrombosis (DVT).

RESULTS

The main outcomes showed no significance between enoxaparin group and salvianolate group (p > .05). The incidence of DVT in salvianolate group was 1.85%, significantly lower than that in enoxaparin group (12.3%) (p < .05). No serious adverse reactions occurred in the two groups during treatment.

CONCLUSION

Compared with enoxaparin, salvianolate has an advantage in the prevention of perioperative thrombosis in gastrointestinal surgery with a lower incidence of DVT.

Comprehensive structural assignment of glycosaminoglycan oligo- and polysaccharides by protein nanopore

Glycosaminoglycans are highly anionic functional polysaccharides with information content in their structure that plays a major role in the communication between the cell and the extracellular environment. The study presented here reports the label-free detection and analysis of glycosaminoglycan molecules at the single molecule level using sensing by biological nanopore, thus addressing the need to decipher structural information in oligo- and polysaccharide sequences, which remains a major challenge for glycoscience. We demonstrate that a wild-type aerolysin nanopore can detect and characterize glycosaminoglycan oligosaccharides with various sulfate patterns, osidic bonds and epimers of uronic acid residues. Size discrimination of tetra- to icosasaccharides from heparin, chondroitin sulfate and dermatan sulfate was investigated and we show that different contents and distributions of sulfate groups can be detected. Remarkably, differences in α/β anomerization and 1,4/1,3 osidic linkages can also be detected in heparosan and hyaluronic acid, as well as the subtle difference between the glucuronic/iduronic epimers in chondroitin and dermatan sulfate. Although, at this stage, discrimination of each of the constituent units of GAGs is not yet achieved at the single-molecule level, the resolution reached in this study is an essential step toward this ultimate goal.

A Case of Thrombocytosis Associated with Enoxaparin Therapy in an Adolescent

Secondary thrombocytosis, often referred to as a reactive thrombocytosis, is more common than primary thrombocytosis and has many potential etiologies including anemia, infection, inflammation, medications, and post-splenectomy. When considering the critically ill patient in the ICU setting potential medication-related etiologies of thrombocytosis should be included in the differential diagnosis. We present a 15-year-old adolescent with a traumatic brain injury who developed thrombocytosis that was temporally related to the administration of enoxaparin. There was a prompt return of the platelet count to normal following the discontinuation of enoxaparin therapy which led to the probable diagnosis of enoxaparin-induced thrombocytosis.

Heparin concentration is critical for cell culture with human platelet lysate

BACKGROUND AIMS

Culture media for mesenchymal stromal cells (MSCs) are generally supplemented with fetal bovine serum. Human platelet lysate (hPL) has been proven to be a very effective alternative without the risk of xenogeneic infections or immune reactions. In contrast to fetal bovine serum, hPL comprises plasma, and anticoagulants-usually unfractionated heparin (UFH)-need to be added to prevent gel formation.

METHODS

Cultures of MSCs in hPL media with various concentrations of UFH and enoxaparin, a low-molecular-weight heparin (LMWH), were systematically compared with regard to proliferation, fibroblastoid colony-forming unit frequency, immunophenotype and in vitro differentiation.

RESULTS

At least 0.61 IU/mL UFH or 0.024 mg/mL LMWH was necessary for reliable prevention of coagulation of hPL pools used in this study. Higher concentrations impaired cellular proliferation in a dose-dependent manner even without benzyl alcohol, which is commonly added to heparins as a bacteriostatic agent. Colony-forming unit frequency was also reduced at higher heparin concentrations, particularly with LMWH, whereas no significant effect was observed on cellular morphology or immunophenotype. High concentrations of heparins reduced the in vitro differentiation toward adipogenic and osteogenic lineages.

CONCLUSIONS

Heparin concentration is critical for culture of MSCs in hPL media; this is of particular relevance for cellular therapy where cell culture procedures need to be optimized and standardized.

Thromboprophylaxis in medically ill patients at risk for venous thromboembolism

PURPOSE

According to guidelines from the American College of Chest Physicians, low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) should be prescribed to medical (nonsurgical) patients at high risk of venous thromboembolism. Thromboprophylaxis and mortality rates were determined in medical inpatients with indications for thromboprophylaxis. Cost differences between patient groups were investigated and are discussed.

SUMMARY

Using Solucient's ACTracker Inpatient Database, medical discharges between January 2001 and December 2004 were extracted and patients who had indications for thromboprophylaxis (acute myocardial infarction, ischemic stroke, cancer, heart failure, or severe lung disease) were identified. Patients < 40 years or with deep-vein thrombosis or pulmonary embolism, active peptic ulcer, malignant hypertension, blood disease, HIV infection, or intubation of gastrointestinal or respiratory tract were excluded. Rates of thromboprophylaxis and mortality were compared between groups. Mean total drug costs and hospital costs per patient discharge were compared between patient groups. Of 12,887,080 medical discharges extracted from 330 hospitals, there were 2,367,362 patients with indications for thromboprophylaxis. Patients were subdivided on the basis of whether they received thromboprophylaxis (n = 717,850) or not (n = 1,649,512). The thromboprophylaxis rate was low, despite increasing from 26% to 33% over the study period. Patients receiving thromboprophylaxis had significantly lower risk-adjusted mortality rates than those who did not (p < 0.001), except those with ischemic stroke. The mean total drug cost per patient receiving LMWH and UFH ($791 and $569, respectively) was higher than for patients not receiving thromboprophylaxis ($372) (p < 0.001). The mean total hospital cost per patient receiving UFH ($7615) was higher than for LMWH ($6866, p < 0.001).

CONCLUSION

The thromboprophylaxis rate among medical patients was low, with no significant improvement between 2001 and 2004. Thromboprophylaxis can impact patient mortality rates. Economic evaluation revealed that the use of LMWH for thromboprophylaxis in at-risk medical patients was associated with higher total drug costs but lower total hospital costs than UFH. Efforts should be made to increase clinicians' awareness of clinical guidelines.

Nursing interventions in the management of patients with cancer-associated thrombosis

OBJECTIVES

To provide oncology nurses with an overview of the clinical trial evidence and to help them apply the data to patient management to optimize care and ensure the best possible outcomes.

DATA SOURCES

Primary and tertiary literature and the authors' clinical experience.

CONCLUSION

Nursing interventions for patients with cancer-associated thrombosis involve such key areas as the need for careful and continuing risk assessment, close monitoring of laboratory values, evaluation of patients as candidates for outpatient management, patient and caregiver education, and monitoring of patient compliance.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses provide critical oversight and coordination in the treatment and prevention of venous thromboembolism. These interventions are essential to reducing venous thromboembolism-associated morbidity and mortality.

Comparison of the Vasodilatory Effect of Nadroparin, Enoxaparin, Dalteparin, and Unfractioned Heparin in Human Internal Mammary Artery

The aim of this study was to investigate whether the low-molecular-weight heparins (LMWHs) (eg, nadroparin, enoxaparin, and dalteparin) cause a vasodilatory effect in human internal mammary artery (IMA) and to further compare its effect with unfractioned heparin (UFH). Samples of redundant IMA obtained from 20 patients undergoing a coronary artery bypass graft surgery were cut into 3-mm-wide rings and suspended in 20-mL organ baths. Isometric tension was continuously measured with an isometric force transducer connected to a computer-based data acquisition system. LMWHs (0.5-6 U/mL) caused a concentration-dependent relaxation in the endothelium-intact human IMA rings, which were precontracted with Phe (10(-6) M) (P < 0.05). The vasodilator potency of LMWHs seems to be nearly similar while the maximal effect produced by LMWHs was less pronounced compared with that produced by UFH. Removal of endothelium totally abolished the responses of human IMA to LMWHs as well as UFH (P < 0.05). LMWHs-induced vasodilator effect was significantly attenuated by Nomega-nitro-L-arginine methyl ester (L-NAME, 10(-4) M) but not indomethacin (10(-5) M). Our results have shown that LMWHs cause a dose-dependent relaxation in human IMA but are less effective than that produced by UFH. The vasorelaxant effects induced by each of LMWH are nearly similar and seem to be via endothelium-dependent mechanisms, including generation of nitric oxide.