1
|
Valdes CA, Sharaf OM, Bleiweis MS, Jacobs JP, Mumtaz M, Sharaf RM, Jeng EI, Peek GJ. Heparin-based versus bivalirudin-based anticoagulation in pediatric extracorporeal membrane oxygenation: A systematic review. Front Med (Lausanne) 2023; 10:1137134. [PMID: 36999064 PMCID: PMC10043325 DOI: 10.3389/fmed.2023.1137134] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionOptimal anticoagulation therapy is essential for the prevention of thrombotic and hemorrhagic complications in pediatric patients supported with extracorporeal membrane oxygenation (ECMO). Recent data have demonstrated bivalirudin has the potential to surpass and replace heparin as the anticoagulant of choice.MethodsWe conducted a systematic review comparing the outcomes of heparin-based versus bivalirudin-based anticoagulation in pediatric patients supported on ECMO to identify the preferred anticoagulant to minimize bleeding events, thrombotic complications, and associated mortality. We referenced the PubMed, Cochrane Library, and Embase databases. These databases were searched from inception through October 2022. Our initial search identified 422 studies. All records were screened by two independent reviewers using the Covidence software for adherence to our inclusion criteria, and seven retrospective cohort studies were identified as appropriate for inclusion.ResultsIn total, 196 pediatric patients were anticoagulated with heparin and 117 were anticoagulated with bivalirudin while on ECMO. Across the included studies, it was found that for patients treated with bivalirudin, trends were noted toward lower rates of bleeding, transfusion requirements, and thrombosis with no difference in mortality. Overall costs associated with bivalirudin therapy were lower. Time to therapeutic anticoagulation varied between studies though institutions had different anticoagulation targets.ConclusionBivalirudin may be a safe, cost-effective alternative to heparin in achieving anticoagulation in pediatric ECMO patients. Prospective multicenter studies and randomized control trials with standard anticoagulation targets are needed to accurately compare outcomes associated with heparin versus bivalirudin in pediatric ECMO patients.
Collapse
|
2
|
Khan NZ, Chen LY, Lindenbauer A, Pliquett U, Rothe H, Nguyen TH. Label-Free Detection and Characterization of Heparin-Induced Thrombocytopenia (HIT)-like Antibodies. ACS OMEGA 2021; 6:25926-25939. [PMID: 34660955 PMCID: PMC8515375 DOI: 10.1021/acsomega.1c02496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/16/2021] [Indexed: 05/04/2023]
Abstract
Heparin-induced thrombocytopenia (HIT) antibodies (Abs) can mediate and activate blood cells, forming blood clots. To detect HIT Abs, immunological assays with high sensitivity (≥95%) and fast response are widely used, but only about 50% of these tests are accurate as non-HIT Abs also bind to the same antigens. We aim to develop biosensor-based electrical detection to better differentiate HIT-like from non-HIT-like Abs. As a proof of principle, we tested with two types of commercially available monoclonal Abs including KKO (inducing HIT) and RTO (noninducing HIT). Platelet factor 4/Heparin antigens were immobilized on gold electrodes, and binding of antibodies on the chips was detected based on the change in the charge transfer resistance (R ct). Binding of KKO on sensors yielded a significantly lower charge transfer resistance than that of RTO. Bound antibodies and their binding characteristics on the sensors were confirmed and characterized by complementary techniques. Analysis of thermal kinetics showed that RTO bonds are more stable than those of KKO, whereas KKO exhibited a higher negative ζ potential than RTO. These different characteristics made it possible to electrically differentiate these two types of antibodies. Our study opens a new avenue for the development of sensors for better detection of pathogenic Abs in HIT patients.
Collapse
Affiliation(s)
- Nida Zaman Khan
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
- Institute
for Chemistry and Biotechnology, Faculty of Mathematics and Natural
Sciences, Technische Universität
Ilmenau, 98694 Ilmenau, Germany
| | - Li-Yu Chen
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
- Institute
of Microbiology, Friedrich Schiller University, 07745 Jena, Germany
| | - Annerose Lindenbauer
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
| | - Uwe Pliquett
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
| | - Holger Rothe
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
| | - Thi-Huong Nguyen
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
- Institute
for Chemistry and Biotechnology, Faculty of Mathematics and Natural
Sciences, Technische Universität
Ilmenau, 98694 Ilmenau, Germany
| |
Collapse
|
3
|
Di Micco P, Camporese G, Cardillo G, Lodigiani C, Carannante N, Annunziata A, Fiorentino G, Russo V, Imbalzano E. Pathophysiology of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) and Vaccine-Induced Thrombocytopenic Thrombosis (VITT) and Their Diagnostic Approach in Emergency. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:997. [PMID: 34684034 PMCID: PMC8539999 DOI: 10.3390/medicina57100997] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022]
Abstract
SARS-CoV-2 induced a pandemic that is reported to have started in Asia and was then extended to other countries in the world. Main clinical aspects of this viral infection have been lung injuries with severe pneumonia requiring prolonged hospitalization and associated morbidities such as venous thromboembolism and/or superinfection by bacteria, fungus or other pests. Immediately there was a need to develop a sustainable therapeutic strategy, such as vaccination. Vaccines against Covid-19, in fact, exert a protective action for common people and reduce viral diffusion. Yet, vaccination of a large number of people raises the question of a well-known complication of several types of vaccines; this complication is immune thrombocytopenia, which is sometimes associated with thrombosis as well. In this short review, we summarized mechanisms involved in the pathogenesis of vaccine-induced prothrombotic immune thrombocytopenia and vaccine-induced thrombocytopenic thrombosis.
Collapse
Affiliation(s)
- Pierpaolo Di Micco
- UOC Medicina, Ospedale Buon Consiglio Fatebenefratelli, 80122 Napoli, Italy
| | | | | | - Corrado Lodigiani
- Thrombosis and Haemorragic Diseases Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | | | - Anna Annunziata
- Department of Cardiology, OspedaleMonaldi, 80131 Napoli, Italy; (A.A.); (G.F.)
| | - Giuseppe Fiorentino
- Department of Cardiology, OspedaleMonaldi, 80131 Napoli, Italy; (A.A.); (G.F.)
| | - Vincenzo Russo
- Head of Cardiology, University of Campania “Luigi Vanvitelli”, 80100 Napoli, Italy;
| | - Egidio Imbalzano
- Department of Cardiology, University of Messina, 98100 Messina, Italy;
| |
Collapse
|
4
|
Lee HW, An JN, Lee HS, Song YR, Kim HJ, Kim SG, Kim JK. Neutrophil extracellular traps and heparin-induced antibodies contribute to vascular access thrombosis in hemodialysis patients. Kidney Res Clin Pract 2021; 40:712-723. [PMID: 34370931 PMCID: PMC8685352 DOI: 10.23876/j.krcp.21.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/03/2021] [Indexed: 11/05/2022] Open
Abstract
Background Anti-heparin/platelet factor 4 (PF4) antibodies may trigger severe thrombotic complications in hemodialysis (HD) patients. Tetrameric PF4 has a high affinity for extracellular DNA, which is a key component of neutrophil extracellular traps (NETs); therefore, the interactions between anti-heparin/PF4 antibodies and NETs can contribute to prothrombotic events. Methods Anti-heparin/PF4 antibody levels were measured by enzyme-linked immunosorbent assay and an optical density > 1.8 was regarded as clinically significant. We additionally measured serum nucleosome levels as representative markers of NETs, and the contributions of anti-heparin/PF4 and increased serum nucleosome levels to the primary functional patency loss of vascular access was assessed. Results The frequency of anti-heparin/PF4 antibodies was significantly higher in incident HD patients compared to prevalent HD patients (23.6% vs. 7.7%). Serum nucleosome levels, as well as the white blood cell counts, neutrophil counts, and high- sensitivity C-reactive protein levels, were significantly higher in anti-heparin/PF4 antibody-positive patients compared to the control. Platelet counts tended to be lower in the patients with anti-heparin/PF4 of >1.8 than in the controls. Relative risk calculations showed that the presence of anti-heparin/PF4 antibodies increased the risk of primary functional patency failure by 4.28-fold, and this risk increased further with higher nucleosome levels. Furthermore, in the anti-heparin/PF4 antibody-positive group, the time to first vascular intervention was much shorter, and the risk of repeated intervention was higher, compared to the controls. Conclusion In incident HD patients, the presence of anti-heparin/PF4 antibodies was associated with increased NET formation; this could be a strong predictor of vascular access complications
Collapse
Affiliation(s)
- Hoi Woul Lee
- Department of Clinical Immunology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jung Nam An
- Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hyung Seok Lee
- Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Young Rim Song
- Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hyung Jik Kim
- Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Sung Gyun Kim
- Department of Clinical Immunology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.,Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jwa-Kyung Kim
- Department of Clinical Immunology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.,Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| |
Collapse
|
5
|
Zhou CZ, Feng DJ, Fang Y, Zha FY, Wang EH, Li YZ, Wei MX, Wen JM. Research on clinical characteristics and prognostic analysis of heparin-induced thrombocytopenia after surgery for acute type a aortic dissection. J Cardiothorac Surg 2021; 16:96. [PMID: 33879210 PMCID: PMC8056691 DOI: 10.1186/s13019-021-01482-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/06/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The present study aimed to explore the clinical characteristics of heparin-induced thrombocytopenia (HIT) after surgery for acute type A aortic dissection and perform a relevant prognostic analysis. Methods After continuous observation and analysis of 204 patients who underwent acute type A aortic dissection, we found that blood platelets decreased significantly after surgery and that these patients can be suspected to suffer HIT based on relevant 4Ts scores. For these suspected HIT patients, a latex particle-enhanced immunoturbidimetric assay was conducted to detect heparin-induced antibodies. Perioperative clinical data of patients in HIT and non-HIT groups were recorded as were blood platelet counts, HIT antibody test results, 4Ts scores, thromboembolic complications, clinical prognosis and outcomes. Results In the present study, 38 suspected HIT patients, 16 HIT patients and 188 non-HIT patients were selected in the clinical setting. Among them, HIT patients were found to have prolonged cardiopulmonary bypass time (223 min on average vs. 164 min) and delayed aortic cross-clamp time (128 min on average vs. 107 min), and these differences between HIT patients and non-HIT patients were significant (P < 0.05). Additionally, the HIT group required longer operation time and higher dose of heparin, but showing no statistical differences (P > 0.05). The transfusions of blood platelets in the HIT group and non-HIT group were 18.7 ± 5.0u and 15.6 ± 7.34 u, respectively. In the HIT group, the mechanic ventilation time and the length of ICU stay were longer comparing the non-HIT group(P < 0.05), though no significant differences in total length of stay or In-hospital mortality were observed (P > 0.05). The incidence of continuous renal replacement therapy in HIT group was higher than the non-HIT group (P < 0.05). Additionally,there were no significant differences in 24-h postoperative drainage or reoperation for bleeding in both group(P > 0.05). However, the HIT antibody titer in the HIT group was significantly higher than that in the Suspected HIT group (2.7 ± 0.8 U/mL vs. 0.3 ± 0.2 U/mL) (P < 0.05). Among patients diagnosed with HIT, the incidence of thromboembolism reached 31.5%.For example, two HIT patients newly developed thromboembolism in both lower extremities,and three patients experienced cerebral infarction. Conclusions After surgery for acute type A aortic dissection, HIT patients developed postoperative complications, the duration of ventilatory support and length of ICU stay were extended, and the incidence of thromboembolism increased. HIT antibody detection and risk classification should be implemented for high-risk patients showing early clinical characteristics.
Collapse
Affiliation(s)
- Chu-Zhi Zhou
- Graduate School of Tianjin Medical University, No. 22 Qixiangtai Road, Tianjin, 300070, China.,Department of Critical Care Medicine ICU, Fu Wai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518057, Guangdong, China
| | - Dong-Jie Feng
- Department of Critical Care Medicine ICU, Fu Wai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518057, Guangdong, China
| | - Yuan Fang
- Department of Critical Care Medicine ICU, Fu Wai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518057, Guangdong, China
| | - Feng-Yan Zha
- Department of Critical Care Medicine ICU, Fu Wai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518057, Guangdong, China
| | - Er-Hui Wang
- Department of Critical Care Medicine ICU, Fu Wai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518057, Guangdong, China
| | - Yan-Zhen Li
- Graduate School of Tianjin Medical University, No. 22 Qixiangtai Road, Tianjin, 300070, China
| | - Min-Xin Wei
- Graduate School of Tianjin Medical University, No. 22 Qixiangtai Road, Tianjin, 300070, China.
| | - Jun-Min Wen
- Department of Critical Care Medicine ICU, Fu Wai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518057, Guangdong, China.
| |
Collapse
|
6
|
Sahu KK, Jindal V, Anderson J, Siddiqui AD, Jaiyesimi IA. Current Perspectives on Diagnostic Assays and Anti-PF4 Antibodies for the Diagnosis of Heparin-Induced Thrombocytopenia. J Blood Med 2020; 11:267-277. [PMID: 32884385 PMCID: PMC7443028 DOI: 10.2147/jbm.s232648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022] Open
Abstract
Heparin-induced thrombocytopenia (HIT) is a recognized clinical entity in patients receiving unfractionated heparin and low–molecular weight heparin. Currently, diagnosing HIT includes the combination of a physician’s clinical suspicion based on a clinical scoring system and a series of laboratory tests. In the present article, we discuss challenges in suspecting and diagnosing HIT in consideration of the turnaround time of available tests and recent advances in techniques and methodologies of newer immunoassays and functional assays.
Collapse
Affiliation(s)
- Kamal K Sahu
- Hemato-oncology Division, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA
| | - Vishal Jindal
- Department of Hematology and Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, USA
| | - Joseph Anderson
- Department of Hematology and Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, USA
| | - Ahmad D Siddiqui
- Hemato-oncology Division, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA
| | - Ishmael A Jaiyesimi
- Department of Hematology and Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, USA
| |
Collapse
|
7
|
Song JC, Liu SY, Zhu F, Wen AQ, Ma LH, Li WQ, Wu J. Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China. Mil Med Res 2020; 7:15. [PMID: 32241296 PMCID: PMC7118900 DOI: 10.1186/s40779-020-00244-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 01/14/2023] Open
Abstract
Thrombocytopenia is a common complication of critical care patients. The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia. Therefore, the Critical Care Medicine Committee of Chinese People's Liberation Army (PLA) worked with Chinese Society of Laboratory Medicine, Chinese Medical Association to develop this consensus to provide guidance for clinical practice. The consensus includes five sections and 27 items: the definition of thrombocytopenia, etiology and pathophysiology, diagnosis and differential diagnosis, treatment and prevention.
Collapse
Affiliation(s)
- Jing-Chun Song
- Department of Critical Care Medicine, the 908th Hospital of Joint Logistics Support Forces of Chinese PLA, Nanchang, 360104, China.
| | - Shu-Yuan Liu
- Emergency Department, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Feng Zhu
- Burns and Trauma ICU, Changhai Hospital, Naval Medical University, Shanghai, 200003, China
| | - Ai-Qing Wen
- Department of Blood Transfusion, Daping Hospital of Army Medical University, Chongqing, 400042, China
| | - Lin-Hao Ma
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Wei-Qin Li
- Surgery Intensive Care Unit, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China.
| | - Jun Wu
- Department of Clinical Laboratory, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | | |
Collapse
|
8
|
Patriarcheas V, Pikoulas A, Kostis M, Charpidou A, Dimakakos E. Heparin-induced Thrombocytopenia: Pathophysiology, Diagnosis and Management. Cureus 2020; 12:e7385. [PMID: 32337112 PMCID: PMC7179984 DOI: 10.7759/cureus.7385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/24/2020] [Indexed: 01/16/2023] Open
Abstract
Heparin-induced thrombocytopenia (HIT), even rare, is a life-threatening, immune-mediated complication of heparin exposure. It is considered the most severe non-bleeding adverse reaction of heparin treatment and one of the most important adverse drug reactions. The pathophysiological basis of HIT results from the formation of an immunocomplex consisting of an auto-antibody against platelet factor 4 (PF4) - heparin complex, which binds to the surface of platelets and monocytes, provoking their activation by cross-linking FcgIIA receptors. Platelets and monocyte activation, leads to the generation of catastrophic arterial and venous thrombosis, with a mortality rate of 20%, without early recognition. The definitive diagnosis of HIT i.e., clinical and laboratory evidence, can not be done at the onset of symptoms because laboratory results may not be available for several days. Thus, the initial approach is to predict the likelihood of HIT, because in highly suspected patients immediate heparin cessation and initiation of alternative anticoagulation treatment are crucial for the prevention of the devastating thrombotic sequelae. Herein, we describe the pathophysiology, the clinical manifestations, the diagnostic approach, and the management of patients with HIT.
Collapse
Affiliation(s)
| | | | - Minas Kostis
- Internal Medicine, University Hospital of Patras, Patras, GRC
| | - Andriani Charpidou
- Internal Medicine, Thoracic Diseases General Hospital Sotiria, Athens, GRC
| | | |
Collapse
|
9
|
Suljevic I, Basic S, Surkovic I, Turan M, Musija E. The Effect of Prophylactic Doses of Reviparin on the Postoperative Value of Platelets. Med Arch 2020; 73:404-407. [PMID: 32082009 PMCID: PMC7007632 DOI: 10.5455/medarh.2019.73.404-407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Low molecular weight heparin (LMWH) is used as anticoagulant in diseases characterized by possible thrombosis, as well as for thromboprophylaxis in surgery. The administration of LMWH preoperatively and postoperatively allows satisfactory thromboprophylaxis of patients undergoing surgery. Their application can reduce the number of platelets. Aim To determine what effect Reviparin has on platelet values postoperatively in patients undergoing open cholecystectomy. Methods The study was conducted at the Clinic for Anesthesia and Resuscitation of the Clinical Center of the University of Sarajevo. A retrospective study was performed that included data analysis for 33 patients undergoing open cholecystectomy over a two-year period. There were 22 male and 11 female patients out of a total of 33 patients. Platelet values from laboratory findings of patient's medical history were monitored for 5 days. The values found were recorded in a table containing the patient's first and last name, gender, age and platelet value. All patients had the same endotracheal anesthesia with Propofol, Fentanyl, and Atracurium supplemented with oxygen and nitric oxide at the appropriate dose. All of the patients received same dose of 0.25ml (1432 IU) Reviparin (Clivarin) from Abbott GmbH & Co.KG, preoperatively and postoperatively. Patients undergoing laparoscopic surgery as well as patients receiving other low-molecular-weight heparin or receiving higher doses of Reviparin were excluded from the study. Statistical analysis was performed using the MedCalc v12.7 statistical package for biomedical research. Results An analysis of gender representation in the total sample shows that there was 22 or 66.7% of males while there was 11 or 33.3% of female patients. Analysis of platelet values indicates that there is no statistically significant correlation with gender, but that there is a statistically significant correlation between platelet values between samples, ie. that patients who had higher preoperative values retained more platelet values even during postoperative measurements. Conclusion Platelet values do not change significantly postoperatively with the use of prophylactic doses of Reviparin, after an open cholecystectomy.
Collapse
Affiliation(s)
- Ismet Suljevic
- Clinic for Anesthesia and Resuscitation, Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Suad Basic
- Public Health institution, Institute for Addiction Diseases of Zenica-Doboj Canton, Zenica, Bosnia and Herzegovina
| | - Ismana Surkovic
- Clinic for Nuclear Medicine and Endocrinology, Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Maida Turan
- Acibadem Health Group, Representative Office in Sarajevo, Bosnia and Herzegovina
| | - Ehlimana Musija
- Clinic for Heart and Blood vessel Diseases and Rheumatism, Clinical Center Sarajevo, Bosnia and Herzegovina
| |
Collapse
|