Low Molecular Weight Heparin: Current Evidence for Its Application in Orthopaedic Surgery

Kalyani, Bharati S.; Roberts, Craig S.

doi:10.2174/157016111793744661

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…Enoxaparin is the LMWH that is commonly used for both VTE prophylaxis and treatment. Enoxaparin has the largest body of clinical evidence supporting its use across the spectrum of VTE management and has been used as the reference standard comparator anticoagulant in trials of new anti-coagulants Bharathi Kalyani et al [16] conducted a systematic review of literature using Medline database and showed that Enoxaparin was found to be more cost effective in orthopedic surgeries. [17] .…”

Section: Resultsmentioning

confidence: 99%

Efficacy of enoxaparin as athromboprophylactic agent in major lower limb orthopaedic surgeries

Reddy¹,

Kamal²,

Gadigar³

et al. 2019

Int. J. Orthop. Sci.

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Venous Thromboembolism (VTE) which consists of Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE) is a potentially fatal & common complication following major lower limb orthopaedic surgeries like Hip, Knee Arthroplasty & Hip fracture surgeries which fall under highest risk category for VTE stratification. Analysis of selected Indian articles show that rates of DVT with prophylaxis is 8% and without prophylaxis 14%. Therefore VTE prophylaxis is essential to prevent the mortality and morbidity associated with it. Low Molecular weight heparins like Enoxaparin is one of the leading anticoagulants registered for use worldwide and has a long track record of over several years for safety and efficiency in orthopaedic surgeries. 180 patients undergoing Surgeries for fracture around Hip, Femur fracture surgery, patients undergoing Hip and Knee Arthroplasty were given prophylaxis for DVT in the form of Inj. Enoxaparin 40 Mg S/C once a day for 10 days starting 12 hours after epidural catheter removal. Three Bilateral lower limb venous Doppler scans were done in all the patients, one at the time of admission, one on eleventh post op day and another on thirtieth post-operative day to look for development or progression of deep vein thrombosis. Only One Patient (0.55%) showed ultrasonographic evidence of proximal asymptomatic Deep Vein Thrombosis on the eleventh post-operative day. Patient was treated for the same and the thrombus resolved while on treatment as shown by repeat Doppler scan done on twentieth day following detection. No cases of Fatal Pulmonary embolism or major complications were noted in the study. Enoxaparin is a safe and effective thromboprophylactic agent when used for the duration of 10 days post operatively in Major lower Limb orthopaedic Surgeries.

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Section: Resultsmentioning

confidence: 99%

Efficacy of enoxaparin as athromboprophylactic agent in major lower limb orthopaedic surgeries

Reddy¹,

Kamal²,

Gadigar³

et al. 2019

Int. J. Orthop. Sci.

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“…In another study, even a reduction of MMP-9 concentration and activity has been reported in the plasma of LMWH-treated patients with abdominal aortic aneurysm [57], an effect which might be connected to the LMWH-dependent downregulation of IL-8 as shown in enoxaparin-treated epithelial cells [48]. Accordingly, LMWH is increasingly used as an anticoagulant, e.g., for VTE prevention [58,59].…”

Section: Discussionmentioning

confidence: 99%

Cellular and Molecular Effects of High-Molecular-Weight Heparin on Matrix Metalloproteinase 9 Expression

Huber

Attili

Abedalkhader

et al. 2019

IJMS

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Blood sampling with different anticoagulants alters matrix metalloproteinase (MMP-) 9 expression, thus influencing its concentration and diagnostic validity. Here, we aimed to evaluate the effects of different anticoagulants on MMP-9 regulation. MMP-9 expression was assessed in response to ethylenediaminetetraacetic acid, citrate, and high-/low-molecular-weight heparin (HMWH, LMWH) in co-culture experiments using THP-1, Jurkat, and HT cells (representing monocytes, T, and B cells). Triple and double cell line co-culture experiments revealed that HMWH treatment of THP-1 and Jurkat led to a significant MMP-9 induction, whereas other anticoagulants and cell type combinations had no effect. Supernatant of HMWH-treated Jurkat cells also induced MMP-9 in THP-1 suggesting monocytes as MMP-9 producers. HMWH-induced cytokine/chemokine secretion was assessed in co-culture supernatant, and the influence of cytokines/chemokines on MMP-9 production was analyzed. These experiments revealed that Jurkat-derived IL-16 and soluble intercellular adhesion molecule (sICAM-) 1 are able to induce MMP-9 and IL-8 production by THP-1. As a consequence, the increased MMP-9 expression found in HMWH blood samples may be influenced by HMWH-dependent secretion of IL-16 and sICAM-1 by T cells resulting in an increased production of MMP-9 and IL-8 by monocytes. IL-8, in turn, may support MMP-9 and its own expression in a positive autocrine feedback loop.

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“…In this patient group, up to 40-60% of the patients have asymptomatic, objectively confirmed DVT (38). Research during the past ten years has shown that prophylactic treatment with low molecular weight heparin (LMWH) can reduce the incidence of postoperative VTE (38,39). Patients undergoing general surgery such as abdominal, urological, gynaecological surgery have about 20 % risk of VTE whereas the same kind of surgery in cancer patients is associated with a risk of almost 40%.…”

Section: Surgery and Plaster Cast Treatmentmentioning

confidence: 99%

Thrombin generation and activated protein C resistance in the absence of factor V Leiden correlates with the risk of recurrent venous thromboembolism in women aged 18–65 years

Sonnevi¹,

Tchaikovski²,

Holmström³

et al. 2011

Thromb Haemost

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Identification of patients at high risk of recurrence after a first event of venous thromboembolism (VTE) remains difficult. Resistance to activated protein C (APC) is a known risk factor for VTE, but data on the risk of recurrence is controversial. We wanted to investigate whether APC resistance in the absence of factor V Leiden, determined with global coagulation test such as the thrombin generation assay, could be used as a marker for increased risk of recurrent VTE among women 18-65 years old after a first event of VTE. In a cohort of 243 women with a first event of VTE, plasma was collected after discontinuation of anticoagulant treatment and the patients were followed up for 46 months (median). Thrombin generation was measured via calibrated automated thrombography, at 1 pM and 10 pM of tissue factor (TF). In women without factor V Leiden (n=117), samples were analysed in the absence and in the presence of APC. Increase in ETP (endogenous thrombin potential) and peak height analysed in the presence of APC correlated significantly with higher risk of recurrence. At 1 pM, peak height correlated with increased risk of recurrence. In conclusion, high thrombin generation in the presence of APC, in women after a first event of VTE is indicative for an increased risk of a recurrence. We also found that thrombin generation at low TF (1 pM) is correlated with the risk of recurrence. Our data suggest that APC resistance in the absence of factor V Leiden is a risk factor for recurrent VTE.

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Low Molecular Weight Heparin: Current Evidence for Its Application in Orthopaedic Surgery

Cited by 9 publications

References 16 publications

Efficacy of enoxaparin as athromboprophylactic agent in major lower limb orthopaedic surgeries

Efficacy of enoxaparin as athromboprophylactic agent in major lower limb orthopaedic surgeries

Cellular and Molecular Effects of High-Molecular-Weight Heparin on Matrix Metalloproteinase 9 Expression

Thrombin generation and activated protein C resistance in the absence of factor V Leiden correlates with the risk of recurrent venous thromboembolism in women aged 18–65 years

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