Patients with cancer are at high risk to develop venous thromboembolism, and they are also more likely to develop complications from anticoagulant treatment. Because little research has focused on the oncology population to date, the optimal methods of prophylaxis and treatment remain uncertain in some clinical situations. Currently, low molecular weight heparin and warfarin are the most freque...

OBJECTIVE To determine the necessity for monitoring of anti-factor Xa levels in pregnant women taking low molecular weight heparin (LMWH). STUDY DESIGN A review of a hematological database with chart review was undertaken to identify patients on LMWH. Levels were drawn monthly. They were considered suboptimal if prophylactic and therapeutic doses of LMWH had an anti-Xa value <0.2 U/mL and 0.6...

Low molecular weight heparins (LMWHs) are the standard agents used for antithrombotic therapy and prophylaxis. Despite their widespread use, reports about adverse effects from LMWHs are very scarce. Heparin-induced skin necrosis at the injection site is a rare adverse effect, more commonly associated with unfractionated heparin (UFH) rather than with LMWH, while its mechanism remains unclear. T...

There is agreement in the literature regarding the pharmacological inequivalence of LMWHs and there is evidence that differences in pharmacological profiles affect clinical outcomes. Unfractionated heparin (UFH) produces its anticoagulation effects by complexing with antithrombin III (AT III) to inactivate both factor IIa (thrombin) and factor Xa. Inhibition of factor IIa requires a polysacchar...

During pregnancy, elevated markers of coagulation and fibrinolytic system activation, such as D-Dimer, indicate increased thrombin activity and increased fibrinolysis following fibrin formation. Testing for D-Dimer during pregnancy could therefore be useful for the diagnosis and prediction of a venous thromboembolic event (VTE) or pregnancy-related complications, and for monitoring antithrombot...

Background/Introduction Management of preoperative antiplatelet therapy in coronary surgery is still variable among surgeons. Guidelines collide with prejudices: replacement of aspirin with low molecular weight heparin (LMWH) is still performed in many Centers due to a presumed minor risk of intraoperative bleeding, even though supporting evidences are weak and detrimental effects are well-desc...

Heparin, a sulfated polysaccharide, has been used as a clinical anticoagulant for over 90 years. Newer anticoagulants, introduced for certain specialized applications, have not significantly displaced heparin and newer heparin-based anticoagulants in most medical procedures. This chapter, while reviewing anticoagulation and these newer anticoagulants, focuses on heparin-based anticoagulants, in...

BACKGROUND Venous thromboembolism is common in patients with cancer and requires anticoagulation with low molecular weight heparin. Current data informs anticoagulation as far as six months, yet guidelines recommend anticoagulation beyond six months in patients who have locally advanced or metastatic cancer. This recommendation, based on expert consensus, has not been evaluated in a clinical st...

We evaluated a simplified algorithm for safely postponing diagnostic imaging for pulmonary embolism (PE). At the index visit, patients were identified as being at high or low risk of PE; the former received full dosage low molecular weight heparin while the latter were left untreated until performance of diagnostic imaging (max 72 hours). During this period, no thromboembolic events occurred in...

Heparins are efficient inhibitors of hepcidin expression even in vivo, where they induce an increase of systemic iron availability. Heparins seem to act by interfering with BMP6 signaling pathways that control the expression of liver hepcidin, causing the suppression of SMAD1/5/8 phosphorylation. The anti-hepcidin activity persists also when the heparin anticoagulant property is abolished or re...