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5 results

  • Chapter 29 - Parenteral Anticoagulation

  • from Part 6 - Haematology
  • Edited by Hugh Montgomery, Robert Shulman, Mayur Murali
  • Book:
    Surviving Prescribing
    Published online:
    08 June 2020
    Print publication:
    25 June 2020, pp 119-122

  • Summary

    Successful anticoagulation is a fine balance between clotting and bleeding, which can easily go wrong. The good news is that basic principles can help manage this scenario effectively. The author provides background information on low molecular weight heparins, their use in the treatment and prevention of deep vein thrombosis and pulmonary embolism, its monitoring and reversal, and dose adjustment for body weight and renal function.

  • Chapter 21 - Trophoblast biology and early pregnancy

  • Edited by Roy G. Farquharson, University of Liverpool, Mary D. Stephenson, University of Chicago
  • Book:
    Early Pregnancy
    Published online:
    05 October 2010
    Print publication:
    09 September 2010, pp 227-236

  • Summary

    Venous thromboembolism (VTE) has a multifactorial pathogenesis involving genetic predisposition, acquired diseases and conditions, and lifestyle and environmental factors. Although the level of risk of VTE associated with air travel has been exaggerated through sensationalized reporting in the mass media, it has nevertheless been established now that long-haul flights represent a risk factor for deep vein thrombosis and pulmonary embolism, including fatal events. Potentially effective measures to reduce the risk of travel-related VTE include enhanced mobility, use of graduated compression hosiery and pharmacological interventions. Low molecular weight heparin (LMWH) is effective in reducing the incidence of VTE post-operatively (by 50-60%) as well as in hospitalized subjects more generally, with little increased risk of bleeding. Based on the low absolute risk of travel-related VTE in the overwhelming majority of women during early pregnancy, pharmacological thromboprophylaxis with LMWH can be justified.

  • Chapter 20 - Effects of chemoradiotherapy for hematological malignancy on fertility and pregnancy

  • from Section 7 - Malignant conditions
  • Edited by Sue Pavord, Beverley Hunt
  • Book:
    The Obstetric Hematology Manual
    Published online:
    06 December 2010
    Print publication:
    15 April 2010, pp 243-252

  • Summary

    Successful pregnancy requires trophoblast invasion into the maternal uterine spiral arteries converting them into large dilated vessels. Microthrombi are frequently found in the vessels of the placentas from women who have experienced pregnancy loss and placental infarction has been described in the placentas of some, but not all, women who have a pregnancy loss and who have thrombophilia. Published meta-analyses suggest that factor V Leiden, prothrombin G20210A, and protein S deficiency are associated with an increased risk of recurrent early pregnancy loss and non-recurrent late pregnancy loss. Women with a history of pregnancy loss merit increased surveillance in subsequent pregnancies and should be given folic acid during pregnancy. Despite the lack of evidence from randomized, double-blind, placebo-controlled trials, many clinicians are offering women with a history of pregnancy loss found to have a heritable thrombophilia self-administered prophylactic doses of low molecular weight heparin daily low dose aspirin in subsequent pregnancies.

  • Do neonates, infants and young children need a higher dose of enoxaparin in the cardiac intensive care unit?

  • Joan Sanchez de Toledo, Sriya Gunawardena, Ricardo Munoz, Richard Orr, Donald Berry, Sara Sonderman, Sara Krallman, Dana Shiderly, Li Wang, Peter Wearden, Victor O. Morell, Constantinos Chrysostomou
  • Journal:
    Cardiology in the Young / Volume 20 / Issue 2 / April 2010
    Published online by Cambridge University Press:
    04 March 2010, pp. 138-143
  • Background

    Thromboembolic events are a serious complication occurring in critically ill children admitted to the cardiac intensive care unit. Although enoxaparin is one of the current anticoagulants of choice, dosages in children are extrapolated from adult guidelines. Recent data suggest that this population may need a higher dose than what is currently recommended to achieve target anti-factor Xa levels. The purpose of this study was to evaluate whether children less than 2 years old admitted to the cardiac intensive care unit require a higher enoxaparin dose than that currently recommended to achieve target anti-factor Xa levels.

    Methods

    Retrospective chart review including patients who received enoxaparin for the treatment or prophylaxis of venous thrombosis between January, 2005 and October, 2007. Patients were classified as younger and older as well as prophylactic and therapeutic on the basis of age and enoxaparin dose, respectively. Younger patients were those 2 month old or less and older patients were those older than 2 months of age.

    Results

    A total of 31 patients were identified; 13 (42%) were 2 months or younger and 25 (81%) were postoperative patients. Ten (32%) received prophylactic and 21 (68%) received therapeutic enoxaparin doses. To achieve optimal anti-factor Xa levels, enoxaparin dose was increased in all groups and reached statistical significance in all patients except those older than 2 months who received prophylactic enoxaparin. An average of 2.8 dosage adjustments was needed. No bleeding complications were reported.

    Conclusions

    Young children, infants, and neonates admitted to the cardiac intensive care unit required a significantly higher enoxaparin dose than that currently recommended to achieve target anti-factor Xa levels.