Skip to main content

Ultra Low Molecular Weight Heparins



Depolymerization of LMWHs has resulted in the development of ultra low LMWHs.

Several ultra-LMWHs have recently become available and are currently in development for specific indications.

Bemiparin  is one such product that is efficacious in the management of DVT. Bemiparin represents a lower low molecular weight heparin which is derived from the same depolymerization process as enoxaparin.

Bemiparin has been evaluated in the management of venous thrombosis in both the medical and surgical settings. Additional clinical development of bemiparin is planned in both arterial and venous thrombosis.

Semuloparin represents an ultra low molecular weight heparin with a higher anti-Xa activity than enoxaparin and much lower anti-IIa activity. The molecular weight of octaparin is 2.4 KDA which is nearly half of enoxaparin, while the specific anti-Xa activity is 140 U/mg .

In a double-blind, multicenter trial, evaluated the efficacy and safety of the ultra-low-molecular-weight heparin semuloparin for prevention of venous thromboembolism in patients receiving chemotherapy for cancer.The authors  concluded Semuloparin reduces the incidence of thromboembolic events in patients receiving chemotherapy for cancer, with no apparent increase in major bleeding.(N Engl J Med 2012; 366:601-609)

The implications of these agents on the perioperative course is not yet well defined and there is an new room for further research.

Chapman TM, Goa KL. Bemiparin: a review of it’s use in the prevention of venous thromboembolism and treatment of deep vein thrombosis.
 Drugs 2003; 63: 2357-2377.
Laux V, Just M, Rosenburg R et al. and Viskov C.The new anticoagulant octaparin displays high antithrombotic action in venous thrombosis in rabbits and rats without impairment of hemostasis. J Thromb Hemost. 2005; 3: P0601
Labels:

Comments

Post a Comment

Popular posts from this blog

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

Lumbar and thoracic epidural in Pediatrics-Technical aspect

The midline approach is most commonly used. The ligamentum   flavum is considerably thinner and less dense in infants than in older children and adults. This makes recognition of engagement in the ligament more difficult and requires both extra care and slower, more deliberate passage of the needle to avoid subarachnoid puncture. The angle of approach to the epidural space is slightly more perpendicular to the plane of the back than in older children and adults, owing to the orientation of the spinous   processes in infants and small children. The loss of resistance technique should be used, but only with saline, not air. There are several reports of venous air embolism in infants and children when air was used to test for loss of resistance Use a short (5 cm) 18-gauge Tuohy needle and a 20- or 21-gauge catheter in infants and children. Epidural kits specifically for infants and children are available Maximum of 0.4 mg/kg/hr of bupivacaine after the initial block is estab...
Post a Comment
Read more