Hirudins for Prophylaxis and Treatment of Venous Thromboembolism

Prisco, Domenico; Falciani, M.; Antonucci, Emilia; Gensini, Gian Franco

doi:10.1055/s-2001-17965

Cited by 10 publications

(4 citation statements)

References 32 publications

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“…Although the number of observations is small, and caution should be used when extrapolating from baboons to humans, our results fail to support the use of heparin as prophylaxis for HUS in patients with Stx colitis, or as treatment in those with HUS. It is possible, however, that activated protein C (ATC) [32] or the potent direct thrombin inhibitor hirudin [33] could be effective, and these will be the subject of future experiments in our primate model.…”

Section: Discussionmentioning

confidence: 98%

Prophylactic heparinization is ineffective in a primate model of hemolytic uremic syndrome

Siegler

Pysher

Tesh

et al. 2002

Pediatric Nephrology

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The presence of abundant fibrin within the glomerular capillaries of patients with Shiga toxin (Stx)-mediated (post-diarrheal) hemolytic uremic syndrome (HUS) has suggested that heparin anticoagulation might be useful in the treatment of this disease. Although controlled studies have failed to show benefit, this lack of therapeutic efficacy could be due to administration of heparin after the thrombotic microangiopathy (TMA) had developed. If benefit could be demonstrated by giving heparin prior to the onset of the HUS, one could consider prophylactic heparinization of those at high risk of progressing from Stx colitis to HUS. We have developed a baboon model of Stx-mediated HUS, and have used this model to study the effect of prophylactic heparinization on the clinical expression and glomerular TMA of Stx-mediated HUS. A single intravenous infusion of Stx-1 at a dose that uniformly produces clinical and nephropathologic features of HUS was given with and without the prior administration of regular and low molecular weight heparin. Therapeutic levels of anticoagulation were achieved, but this did not reduce the clinical severity or lessen the TMA. Heparin anticoagulation may be ineffective because the rate of coagulation that occurs on the surfaces of dysfunctional endothelial surfaces exceeds the capacity of heparin/antithrombin-III inhibitor complexes to bind and block the factor Xa and thrombin that are generated on these surfaces. Our observations fail to support the use of heparin in preventing Stx-mediated HUS.

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Section: Discussionmentioning

confidence: 98%

Prophylactic heparinization is ineffective in a primate model of hemolytic uremic syndrome

Siegler

Pysher

Tesh

et al. 2002

Pediatric Nephrology

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“…The reduction of fibrinogen can effectively improve the incidence of poor prognosis in AIS patients (Sherman et al, 2000 ). Hirudin can rapidly inhibit blood coagulation through restraining cleavage of fibrinogen by binding with thrombin that improve the viscosity of blood and prevent the formation of thrombosis (Prisco et al, 2001 ). Oxidative stress and inflammation play an important role in the pathophysiology of acute ischemic stroke, the inflammatory biomarkers may be predictive of clinical outcomes (Sardu et al, 2017 ), patients in this study have no difference in the level of CRP, which is a common marker of inflammation.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Human Urinary Kallidinogenase Combined with Maixuekang Capsule Promotes Good Functional Outcome in Ischemic Stroke

Song

Lyu²,

Wang

et al. 2018

Front. Physiol.

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Aims: To evaluate the clinical efficacy of Human Urinary Kallidinogenase (HUK) and Maixuekang capsule in the treatment of acute ischemic stroke (AIS) patients.Methods: In this study, from January 2016 to July 2016, 60 patients with acute ischemic stroke were enrolled and 56 patients with complete information of whom 21 patients received HUK+ basic treatment (HUK group), 16 patients received HUK+ Maixuekang capsule + basic treatment (HUK+ Maixuekang group), 19 patients received basic treatment (control group). 0.15 PNA unit of HUK injection plus 100 ml saline in intravenous infusion was performed in the HUK group and HUK+ Maixuekang group, with once a day for 14 consecutive days. 0.75 g Maixuekang capsules were taken in HUK+ Maixuekang group, with three times a day for 14 consecutive days. The National Institutes of Health Stroke Scale (NIHSS) scores in three groups were analyzed 7 days after treatment. The modified Rankin Scale (mRS) scores in three groups were analyzed 12 month after the treatment.Results: No difference was found in the NIHSS scores, age, gender, and comorbidities between three groups before treatment (p > 0.05). Seven days after treatment, the NIHSS scores in the HUK group and HUK+ Maixuekang group were significantly decreased than before (p HUK = 0.001, p HUK+Maixuekang < 0.001), and lower than that in the control group (p HUK = 0.032; p HUK+Maixuekang < 0.001). Twelve months after treatment, good functional outcome rate (12 month mRS score ≤ 2) in the HUK group and HUK+ Maixuekang group was significantly higher than that in the control group (p HUK = 0.049, p HUK+Maixuekang = 0.032).Conclusion: The treatment of HUK or HUK combined with Maixuekang capsule can effectively improve the neurological function and promote long-term recovery for AIS patients.

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“…Three DTI, hirudin, bivalirudin, and argatroban, have been approved for clinical use in adults. 56,58 In adults, hirudin was found to be more effective for prophylaxis of VTEs after total hip replacement than either UFH or enoxaparin. 59,60 In addition, hirudin was effective as a treatment of VTEs 61 and in the management of adults with HIT who require further anticoagulation.…”

Section: New Anticoagulation Therapymentioning

confidence: 99%

Anticoagulation Therapy in Children

2003

Semin Thromb Hemost

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Thromboembolic events (TEs) in children are rare but are becoming a recognized cause of morbidity and mortality, particularly in children with serious underlying primary conditions such as congenital heart disease, cancer, or prematurity. Neonates, infants, and adolescents are most at risk for developing TEs among children, and the presence of a central venous line or intra-arterial catheter is the most significant risk factor for TEs in children. Hemostatic differences between children and adults affect both the pathophysiology of the thrombotic process and the response to anticoagulant therapy. In this article, we focus on the impact of the developmental hemostatic system on responses to anticoagulants in children. The most commonly used anticoagulants in children are unfractionated heparin, low-molecular-weight heparins, and warfarin. Minimal experience exists with the use of the new antithrombotic agents in children. As the anticoagulant treatment used for TEs in children is largely adopted from clinical trials performed in adult populations, well-designed prospective trials are required to establish the optimal therapy for children with TEs.

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Hirudins for Prophylaxis and Treatment of Venous Thromboembolism

Cited by 10 publications

References 32 publications

Prophylactic heparinization is ineffective in a primate model of hemolytic uremic syndrome

Prophylactic heparinization is ineffective in a primate model of hemolytic uremic syndrome

Treatment of Human Urinary Kallidinogenase Combined with Maixuekang Capsule Promotes Good Functional Outcome in Ischemic Stroke

Anticoagulation Therapy in Children

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