Effects of Nadroparin, Enoxaparin, and Unfractionated Heparin on Endogenous Formation of Factor Xa and IIa and on Thrombelastometry Profiles in Cord versus Adult Blood

Cvirn, Gerhard; Hörl, Gerd; Tafeit, Erwin; Heinl, Nikolaus; Wodrig, Kathrin; Koestenberger, Martin; Juergens, Guenther

doi:10.1159/000320164

Cited by 3 publications

(2 citation statements)

References 59 publications

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“…However, no difference was noted between these two formulations in terms of bleeding and preventing thrombelastometry. 38 39 40 Due to small sample size, enoxaparin and nadroparin were not individually analyzed.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Safety between Different Kinds of Heparins in Patients Receiving Intra-Aortic Balloon Counterpulsation

Guan

Chen

et al. 2020

Thorac Cardiovasc Surg

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Background The present study aimed to compare the effectiveness and safety of low molecular-weight-heparin (LMWH) and unfractionated heparin (UFH) in acute myocardial infarction (AMI) patients receiving intra-aortic balloon counterpulsation (IABP). Materials and Methods We retrospectively analyzed a total of 344 patients receiving IABP for cardiogenic shock, severe heart failure, ventricular septal rupture, or mitral valve prolapse due to AMI. A total of 161 patients received UFH (a bolus injection 70 U/kg immediately after IABP, followed by infusion at a rate of 15 U/kg/hour and titration to for 50 to 70 seconds of activated partial thromboplastin time. A total of 183 patients received LMWH (subcutaneous injection of 1.0 mg/kg every 12 hours for 5 to 7 days and 1.0 mg/kg every 24 hours thereafter). Events of ischemia, arterial thrombosis or embolism, and bleeding during IABP were evaluated. Major bleeding was defined as a hemoglobin decrease by >50 g/L (vs. prior to IABP) or bleeding that caused hemodynamic shock or life-threatening or requiring blood transfusion. Results Subjects receiving UFH and LMWH did not differ in baseline characteristics. Ischemia was noted in five (3.1%) and two (1.1%) subjects in UFH and LMWH groups, respectively. Arterial thromboembolism occurred in three (1.9%) subjects in the UFH group, but not in the LMWH group. Logistic regression analysis failed to reveal an association between ischemia or bleeding with heparin type. Major bleeding occurred in 16 (9.9%) and six (3.3%) patients in the UFH and LWMH groups, respectively (p = 0.014). Regression analysis indicated that LMWH is associated with less major bleeding. Conclusion LMWH could reduce the risk of major bleeding in patients receiving IABP. Whether LMWH could reduce arterial thromboembolism needs further investigation.

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Section: Discussionmentioning

confidence: 99%

Comparison of Safety between Different Kinds of Heparins in Patients Receiving Intra-Aortic Balloon Counterpulsation

Guan

Chen

et al. 2020

Thorac Cardiovasc Surg

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“…It is well known that the infants’ hemostatic system differs from that of adults, maturing until the age of 6 months [6]. The pharmacokinetics and pharmacodynamics of LMWHs are likely to differ from older children and adults, suggesting a higher dose for neonates and younger infants [7, 8]. This difference in coagulation physiology emphasizes the need to evaluate the efficacy of (starting) doses of LMWH in neonates of different gestational ages (GAs).…”

Section: Introductionmentioning

confidence: 99%

Dalteparin in Newborn Thrombosis, Time for a New Starting Dose

et al. 2021

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Background: Neonatal thrombosis is a frequently encountered complication in a neonatal intensive care unit. Dalteparin can be used to treat thrombosis in newborn infants. Objectives: In this study, we evaluate the current recommended starting dose of 129 ± 43 U/kg/24 h, hypothesizing that this dose is too low to reach therapeutic anti-Xa levels. Methods: From 2008 until 2017, all infants treated with dalteparin in the University Medical Centre Utrecht were included in this study. In this retrospective cohort study, the correlation between dose and anti-Xa level was observed. Results: Sixty-six infants were included. The most common thrombus types were catheter-related (29 patients, 44%) and venous sinus thrombosis (28 patients, 43%). The mean dalteparin dose needed for the first adequate anti-Xa level (0.5–1.0 IU/mL) was 297.6 U/kg/12 h. Two infants developed a first bleeding episode under dalteparin therapy; they both had anti-Xa levels in the therapeutic range. Conclusion: The increase of the starting dose of dalteparin will lead to earlier therapeutic levels of anti-Xa in the studied population and appears to be safe. However, this needs to be evaluated in further study.

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In-vitro assessment of the effect of dabigatran on thrombosis of adult and neonatal plasma

Nossair

Chan²,

Gantioqui³

et al. 2017

Blood Coagulation &Amp; Fibrinolysis

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: Thromboelastography (TEG) is a global assay used for evaluating features of clot formation in vitro. Dabigatran is a reversible direct inhibitor of thrombin that has not been studied in neonates using a sophisticated global assay, such as TEG. Neonatal hemostasis differs from adult hemostasis in both quantitative and qualitative characteristics. Our aim was to compare the TEG clotting profile of neonatal and adult platelet-poor plasma when exposed to different concentrations of dabigatran. We used commercially collected adult pooled plasma and neonatal cord blood collected from placentas of healthy full term newborns. Platelet-poor plasma was isolated, pooled, and frozen. Prior to experiment, plasma was thawed and filtered. A reaction mixture of CaCl2, corn trypsin inhibitor, tissue factor, and dabigatran in imidazole buffer was mixed with plasma in a TEG cup. Time to clot initiation (R-time), speed of clot strengthening (α-angle), and maximum clot strength (maximal amplitude) were measured. Scanning electron microscopy was performed to evaluate fibrin clot structure. Without dabigatran, there was no significant difference in TEG measurements between neonatal and adult samples. However, neonatal plasma clotting with dabigatran had slower onset, slower speed, and weaker clots that were more porous with thicker fibers, compared with adult plasma clotting. Thus, neonatal plasma may be more sensitive to dabigatran as assessed by our in-vitro TEG study.

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Effects of Nadroparin, Enoxaparin, and Unfractionated Heparin on Endogenous Formation of Factor Xa and IIa and on Thrombelastometry Profiles in Cord versus Adult Blood

Cited by 3 publications

References 59 publications

Comparison of Safety between Different Kinds of Heparins in Patients Receiving Intra-Aortic Balloon Counterpulsation

Comparison of Safety between Different Kinds of Heparins in Patients Receiving Intra-Aortic Balloon Counterpulsation

Dalteparin in Newborn Thrombosis, Time for a New Starting Dose

In-vitro assessment of the effect of dabigatran on thrombosis of adult and neonatal plasma

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