TITLE

Hemorrhagic Complications in Patients Treated with Anticoagulant Doses of a Low Molecular Weight Heparin (Enoxaparin) in Routine Hospital Practice

AUTHOR(S)
Ellis, Martin H.; Hadari, Ruth; Tchuvrero, Noa; Shapira, Shirley; Kovlenko, Irena; Kozmìakova, Mariana; Zissin, Rivka; Elis, Avishay
PUB. DATE
April 2006
SOURCE
Clinical & Applied Thrombosis/Hemostasis;Apr2006, Vol. 12 Issue 2, p199
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Low molecular weight heparins (LMWHs) are a rapidly growing class of anticoagulant drug. Their efficacy has been demonstrated in several clinical settings where they are rapidly becoming the anticoagulant of choice. Controlled clinical studies in patients with deep vein thrombosis, pulmonary embolism, and unstable angina have documented that the frequency of major hemorrhage is 0.5-4%. The purpose of the study was to determine the frequency of minor and major hemorrhage occurring in patients receiving anticoagulant doses of an LMWH (enoxaparin) during routine clinical practice. A prospective, observational study of consecutive patients receiving enoxaparin 1 mg/kg twice daily for at least 24 hours in five internal medicine wards of a university teaching hospital was performed. Five hundred forty-nine patients were studied. The mean age was 67.5±15.5 years and the mean duration of enoxaparin therapy was 3.8±1.5 days. Hemorrhage was documented in a total of 94 patients (17.3%). Major hemorrhage occurred in 14 patients (2.6%), injection-site hemorrhage occurred in 55 patients (10%), and minor hemorrhage (noninjection site) was documented in 25 patients (4.7%). There were two deaths attributed to hemorrhage. Patients with major hemorrhage were older than patients with minor or no hemorrhage (75.5±10.4 versus 66.8±15.2 years; p=0.03) and occurred in patients receiving enoxaparin for a longer period (5.14±3.8 days) than those with minor (4±2.5 days) or no hemorrhage (2.9±2.1 days). Major hemorrhage was significantly associated with impaired renal function, chronic liver disease, and concomitant treatment with warfarin or a proton pump inhibitor. Enoxaparin used in anticoagulant doses in unselected medical patients is not associated with more major hemorrhagic complications than observed in controlled clinical trials. Major hemorrhage may be more likely in older patients, in patients with chronic liver disease and impaired renal function, in patients receiving prolonged enoxaparin therapy, and in patients receiving warfarin or proton pump inhibitors.
ACCESSION #
20929795

 

Related Articles

  • Initial management of deep venous thrombosis in the outpatient setting. Groce, James B. // American Journal of Health-System Pharmacy;5/1/2008, Vol. 65 Issue 9, p866 

    The article relates the author's perspective concerning the management of deep venous thrombosis (DVT) with low-molecular-weight heparin (LMWH) in an outpatient setting. He contends that outpatient treatment with LMWH is well tolerated and effective and can result in overall cost savings. He...

  • Differential Effects of Unfractionated Heparin and Low-Molecular-Weight Heparins on Tissue Thromboplastin Inhibition Test. Gerbutavicius, Rolandas; Iqbal, Omer; Messmore, Harry; Hoppensteadt, Debra A.; Demir, Muzaffer; Khan, Erum; Bacher, Peter; Fareed, Jawed // Clinical & Applied Thrombosis/Hemostasis;Oct2000, Vol. 6 Issue 4, p190 

    Circulating anticoagulants are endogenously produced substances that interfere with in vitro tests of coagulation like activated partial thromboplastin time (APTT). and cause prolongation of the clotting times. Evaluation of the abnormal APTT involving various factor assays and mixing studies...

  • Thrombosis during off pump LVAD placement in a patient with heparin induced thrombocytopenia using bivalirudin. Awad, Hamdy; Bryant, Richard; Malik, Obaid; Dimitrova, Galina; Sai-Sudhakar, Chittoor Bhaskar // Journal of Cardiothoracic Surgery;2013, Vol. 8 Issue 1, p1 

    Here we present our attempt at off pump HeartMate II left ventricular assist device (LVAD) implantation using the anticoagulant bivalirudin in a patient with heparin induced thrombocytopenia, which resulted in thrombosis within the LVAD device. This required that our procedure be converted to on...

  • Taming killer clots. Comarow, Avery // U.S. News & World Report;3/10/2003, Vol. 134 Issue 7, p56 

    Focuses on efforts to treat deep vein thrombosis (DVT) a blood clot that lodges itself in patients' legs. Number of people who have died from DVT; Use of the blood thinner heparin in treating the condition.

  • Diagnosis and treatment of deep-vein thrombosis. Scarvelis, Dimitrios; Wells, Philip S. // CMAJ: Canadian Medical Association Journal;10/24/2006, Vol. 175 Issue 9, p1087 

    Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. The approach to the diagnosis of DVT has evolved over the years. Currently an algorithm strategy combining pretest probability, D-dimer testing and...

  • Heparin Reduces DVT with Transvenous Pacemakers. Sadovsky, Richard // American Family Physician;3/1/2002, Vol. 65 Issue 5, p939 

    Presents information on a study by P. Sanders and others to quantitate the risk of lower limb deep venous thrombosis in patients requiring temporary transfemoral pacing and to evaluate the use of heparin in thrombus prevention. Description of the study and its results; Conclusion that deep...

  • Endoluminal Recanalization in a Patient with Phlegmasia Cerulea Dolens Using a Multimodality Approach. Lin, Stephanie C.; Mousa, Albeir; Bernheim, Joshua; Dayal, Rajeev; Henderson, Peter; HoUenheck, Scott; Kent, K. Craig; Faries, Peter L. // Vascular & Endovascular Surgery;May/Jun2005, Vol. 39 Issue 3, p273 

    Phlegmasia cerulea dolens is a limb-threatening form of deep venous thrombosis and should be treated aggressively. The authors report a patient who presented with iliocaval and femoral deep venous thrombosis and posed an additional therapeutic challenge based on a recent history of...

  • Heparin-induced thrombocytopenia: an update. Franchini, Massimo // Thrombosis Journal;2005, Vol. 3, p14 

    Heparin-induced thrombocytopenia (HIT) is the most important and most frequent drug-induced, immune-mediated type of thrombocytopenia. It is associated with significant morbidity and mortality if unrecognized. In this review, we briefly discuss the main features of heparin-induced...

  • Propagation of Tibial Vein Thrombus in Patients Systemically Anticoagulated or Receiving Antiplatelet Therapy. Hirko, Mark K.; Kasirajan, Karthikeshwar; Turner, John J.; Rubin, Jeffrey R. // Vascular Surgery;May/Jun1999, Vol. 33 Issue 3, p351 

    The objective of this study was to evaluate the incidence of infrapopliteal deep vein thrombus propagation in postoperative orthopedic patients. This was a retrospective study of patients undergoing noninvasive venous testing to rule out phlebothrombosis. Venous duplex scans and Doppler studies...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics