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Thromboembolic disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
Some women (1%–2%) develop a local allergic reaction to LMWH. If this occurs, women usually develop a similar localized pruritic urticarial skin eruption to all forms of UFH and LMWH. In these unusual cases, heparinoids such as danaparoid or fondaparinux (see next) have been used successfully and seem safe during pregnancy and breastfeeding.
Atherosclerosis
Published in George Feuer, Felix A. de la Iglesia, Molecular Biochemistry of Human Disease, 2020
George Feuer, Felix A. de la Iglesia
During the development of atheroma sulfated mucopolysaccharides and glycoproteins are increased.687 These substances interact with plasma lipoproteins and extract lipoproteins from the arterial wall, especially sulfate-rich mucopolysaccharides which react with LDL. Based on these observations heparin, chondroitin sulfate, and different heparinoids were suggested for in vivo studies. These substances may saturate LDL binding sites that lipoproteins cannot bind and become incorporated into smooth muscle cells. Sulfated mucopolysaccharides may enhance the release of lipoprotein lipase from the arterial endothelium and increase LDL release and degradation. The major problem of application of heparin and heparinoids in therapy is due to their great expense, requirement of prolonged parenteral administration which may cause long-term side effects.
Pharmacokinetics of drug transfer into breastmilk
Published in Amy Brown, Wendy Jones, A Guide to Supporting Breastfeeding for the Medical Profession, 2019
Research has shown that more drugs are prescribed for breastfeeding mothers in the immediate postpartum period than at any other time. We prescribe analgesics, laxatives and low-molecular-weight heparinoids without concern because this is a familiar situation on the maternity ward. However, at this time drugs are able to pass freely through the intercellular gaps and reach higher levels in the baby than at any other time during lactation (Figures 8.1–8.3). However, the absolute volume of colostrum is low and hence the level of the drug lower than when lactation is fully established.
Exploring the pathways of inflammation and coagulopathy in COVID-19: A narrative tour into a viral rabbit hole
Published in International Reviews of Immunology, 2022
Nitsan Landau, Yehuda Shoenfeld, Liat Negru, Gad Segal
AT, synthesized by the liver, is the most potent endogenous coagulation inhibitor of thrombin and factor Xa [34]. During severe inflammation, AT levels are reduced due to impaired synthesis and increased clearance [31, 35]. AT function is impaired due to the reduced availability of glycosaminoglycans, acting as physiological, heparin-like cofactor of AT. Under the influence of pro-inflammatory cytokines the synthesis of glycosaminoglycans by endothelial cells is reduced, thus impairing the inhibitory potential of AT [31]. Investigations of AT in COVID-19 to date are limited, but should be of great importance as heparinoids, one of the cornerstones for treatment, might render ineffective in face of AT depletion [36]. Indeed, AT reduction was related to increased mortality in hospitalized COVID-19 patients [37]. One study reported AT levels below the lower limit of the normal range, in one third of hospitalized COVID-19 patients; among them, two thirds died. Among survivors with low AT levels, 80% required mechanical ventilation. Interestingly, obesity, a risk factor for worse prognosis in COVID-19, is also associated with reduction in AT levels in COVID-19 [38]. Providing AT supplementation for critically ill COVID-19 patients using FFP may therefore improve prognosis but such reports are currently sporadic [39]. Potentially, AT supplementation may contribute to the positive effect of convalescent plasma.
A Case of COVID-19 Vaccine-Induced Thrombotic Thrombocytopenia
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Abhinandan Chittal, Shiavax Rao, Pallavi Lakra, Natalia Nacu, Christopher Haas
Upon presentation to our facility, she remained hemodynamically stable. Physical examination was notable for a petechial rash localized to the dorsal surface of the bilateral hands with multiple bruises. Laboratory diagnostics demonstrated a further decline in the platelet count to 29,000 platelets/mcL without evidence of clumping, with a preserved white blood cell count and hemoglobin. Additional diagnostics (Table 1) were largely unremarkable, except for a mildly elevated aPTT (59.3 seconds; reference range 23.4–36.2 seconds), a positive lupus anticoagulant, and a mildly prolonged Dilute Russell’s Viper Venom screen (57.7 seconds; reference range 36.1–50.8 seconds). Additional serologies including hepatitis panel, Human Immunodeficiency Virus, COVID-19 PCR, vitamin B12, folic acid, and morning cortisol were unremarkable. Intriguingly, heparin-induced thrombocytopenia (HIT) antibodies (anti-Platelet factor 4; anti-PF4), as measured by enzyme-linked immunosorbent assay, were positive with an optical density of 0.505 (reference range 0.00–0.349), despite her lack of heparinoid exposure. She was managed conservatively with dexamethasone for presumed VITT and was ultimately discharged in stable condition with stable thrombocytopenia (35,000/mcL). On follow-up, the patient continued to remain asymptomatic without further episodes of petechiae or bleeding. Her platelet count recovered to 118,000/mcL, 6 weeks after discharge.
Efficacy and tolerability of orally administered tramadol/dexketoprofen fixed-dose combination compared to diclofenac/thiocolchicoside in acute low back pain: experience from an Italian, single-centre, observational study
Published in Current Medical Research and Opinion, 2020
Stefano Meloncelli, Marco Divizia, Giorgio Germani
In order to be eligible to participate, patients met all of the following criteria: (1) Adult aged between 18 and 80 years; (2) diagnosis of LDH as assessed by magnetic resonance imaging; (3) Acute radicular pain with onset no more than 7 days prior to the screening visit and moderate to severe intensity (≥4 on 11-point NRS). The following conditions did not permit participation in the study: known allergy or hypersensitivity to study treatments, active cervical/dorsal disc herniation, active or suspected aesophageal, gastric, pyloric channel or duodenal ulceration or bleeding in the last 30 days, uncontrolled blood pressure, use for more than 7 days of analgesics (different from study medication like weak opioids or acetaminophen or other NSAIDs such as ketorolac, nimesulide, naproxen, ibuprofen, indometacin or ketoprofen) in the weeks before the study. Moreover, patients with BMI <18.5 and >35 were not enrolled as well as patients unable to sign the consent agreement were excluded. Lastly, use of other analgesics, drugs acting on pain perception (e.g. opioids, psychotropic agents, anti H1 agents or analgesics like gluco-corticosteroids, NSAIDs) or anticoagulants (e.g. heparinoids, warfarin) were not permitted.