• 제목/요약/키워드: Low molecular weight heparin

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Respiratory Review of 2013: Pulmonary Thromboembolism

  • Hwang, Hun Gyu;Schulman, Sam
    • Tuberculosis and Respiratory Diseases
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    • 제75권3호
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    • pp.89-94
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    • 2013
  • Pulmonary embolism (PE), which can originate as a consequence of deep vein thrombosis (DVT), is the most frequent and potentially fatal venous thromboembolic event. Despite the fact that the incidence of venous thromboembolism (VTE) in Asians is lower than that in the Western populations, a recent epidemiologic study demonstrates an increasing incidence of VTE in the Korean population. Anticoagulants, including low molecular weight heparin (LMWH) and vitamin K antagonist (VKAs), have been the main treatments for PE, however, recently new oral anticoagulants (NOACs) were introduced. We will review how well patients with PE can be managed with the existing anticoagulants and NOACs along with the time span of treatment, which still pose some challenges for clinicians.

Isolated Cortical Vein Thrombosis with Long Cord Sign

  • Ban, Seung Pil;Chung, Young Seob;Park, Sung Bae;Son, Young-Je
    • Journal of Korean Neurosurgical Society
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    • 제58권5호
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    • pp.476-478
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    • 2015
  • Isolated cortical vein thrombosis (ICVT) is a rare disease, accounting for less than 1% of strokes. A 46-year-old woman presented with progressive left side weakness. Magnetic resonance (MR) imaging with $T2^*$-gradient echo ($T2^*$-GE) sequence showed long cord sign at the right frontal cortex. The patient was treated with low molecular weight heparin, followed by oral warfarin for 6 months. The 3-month follow-up MR imaging showed recanalization of the previously thrombosed cortical vein. She was completely recovered without neurological deficits after 6 months. This provides that MR imaging with $T2^*$-GE sequence can help to diagnosis the ICVT and outcomes of the ICVT are generally favorable.

대마 부위별 추출물의 항혈전 활성 (Evaluation of Anti-thrombosis Activities of Different Parts of Cannabis sativa L.)

  • 강덕경;김영민;손호용
    • 생명과학회지
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    • 제31권6호
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    • pp.581-586
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    • 2021
  • COVID-19 (Corona Virus Disease 2019) 감염증에 의한 주요 사망원인은 급성폐렴과 신체 전체에 나타나는 혈전증이며, 증가된 면역반응에 의한 사이토카인 폭풍(cytokine storm)은 고염증 상태와 함께 비정상적인 혈전생성을 더욱 활성화시키는 것으로 알려져 있다. 최근 혈전 생성을 억제하는 low molecular weight heparins의 사용이 사망률을 감소시키며, 대마 추출물이 COVID-19 증상의 완화 및 치료에 효과적임이 보고되었다. 본 연구에서는 대마 성분이 항혈전 활성에 기여하는지를 확인하고자, 대마 잎, 줄기, 뿌리, 미성숙 꽃 및 종실 추출물을 각각 조제하고 이를 대상으로 혈전 생성 억제활성을 평가한 결과, 모든 부위 추출물에서 우수한 항혈전 활성을 확인하였으며, 특히 대마 꽃 추출물에서 강력한 혈액응고인자 저해에 의한 혈전 생성 억제활성을 확인하였다. 그러나 대마꽃 추출물은 적혈구 용혈활성도 강력하여 향후 항혈전 활성물질의 분리가 필요하였다. 본 연구는 대마 부위별 추출물의 항응고 활성에 대한 최초 보고이며, 향후 국내에서 연구 및 사용이 제한된 대마를 이용한 고부가가치 생물소재 개발이 필요함을 제시하고 있다.

둔상성 외상 후 양측 간내 담관에서 담즙 누출의 치료 사례 1례 (Management of Bile Leaks from Bilateral Intrahepatic Ducts after Blunt Trauma)

  • 김동훈;최석호;고승제
    • Journal of Trauma and Injury
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    • 제27권3호
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    • pp.89-93
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    • 2014
  • Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low-grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82.

Cavernous sinus thrombosis following dental extraction: a rare case report and forgotten entity

  • Aggarwal, Karun;Rastogi, Sanjay;Joshi, Atul;Kumar, Ashish;Chaurasia, Archana;Prakash, Rajat
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제43권5호
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    • pp.351-355
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    • 2017
  • Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive antibiotic treatment can prevent future mortality resulting from CST.

당뇨병성 케톤산증에서 발생한 폐혈전색전증 (Diabetic ketoacidosis with pulmonary thromboembolism)

  • 김동민;이정훈;남수민;이연선;문희;이강우;장인욱
    • Journal of Yeungnam Medical Science
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    • 제31권2호
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    • pp.99-102
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    • 2014
  • Diabetic ketoacidosis (DKA), a fatal acute diabetic complication, is characterized by severe metabolic decompensation and intravascular volume depletion. These conditions may result in hypercoagulability and prothrombic state. Pulmonary thromboembolism (PTE) could be presented as an uncommon and life-threatening complication of DKA. Reported herein is a case involving a 54-year-old male patient who was admitted with DKA due to chronic alcohol consumption and stopping the intake of oral antidiabetic drugs. After low-molecular-weight heparin and warfarin treatment because of PTE during the DKA treatment, the patient's condition improved over the week that he was discharged on insulin and warfarin.

Anticoagulation after pancreatic surgery with venous resection (TIGRESS): What should we do? Results from an international survey

  • Thomas B. Russell;Debora Ciprani;Somaiah Aroori
    • 한국간담췌외과학회지
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    • 제27권4호
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    • pp.423-426
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    • 2023
  • Backgrounds/Aims: Patients who undergo pancreatic surgery with venous resection have high rates of morbidity/mortality. Also, they are high-risk for postoperative venous thromboembolism. Whether this group should be routinely anticoagulated is unknown. This study aimed to establish current anticoagulation practices. Methods: A survey (https://form.jotform.com/220242489107048) was sent out to pancreatic surgeons. Questions covered center volume, venous resection/reconstruction techniques and anticoagulation policies. Results: Sixty-five centers from 17 countries responded. Following a "side-bite" venous resection with a patch repair, 40% used an autologous vein patch, 27% used peritoneum, and 27% used a bovine patch. After formally resecting a segment of vein, 17% of centers used an interposition graft (IG). Left renal vein (41%) and polytetrafluoroethylene (73%) grafts were the most commonly used autologous and prosthetic IGs, respectively. Following a prosthetic IG, an autologous IG, and a "side-bite" resection, 59%, 28%, and 19% of centers provided therapeutic anticoagulation, respectively (66% used low molecular-weight heparin). The duration of therapy provided varied from inpatient stay only (14%) to six months (32%). Conclusions: Our global survey indicates that anticoagulation practices are highly variable. Centers do not agree on when to anticoagulate, how to anticoagulate, or the duration of therapy. A robust trial is required to provide clarity.

인공승모판막 혈전의 용해 치료 - 3례 보고 - (Thrombolysis for Prosthetic Mitral Valve Thrombosis - 3 cases report -)

  • 백만종;김형묵;이인성;선경;김광택;김학제
    • Journal of Chest Surgery
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    • 제32권1호
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    • pp.70-74
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    • 1999
  • 승모판의 기계판막치환술 후 판막이나 좌심방 내 혈전증은 판막 기능장애나 혈전색전증을 일으킨다. 조기 진단과 적절한 치료는 중요하지만 임상에서 쉽지 않다. 혈전용해 치료는 혈전증으로 인한 재수술의 위험성을 줄일 수 있어 혈전증 치료에 적절한 한 방법이 될 수 있다. 본 보고는 저분자량 헤파린과 와파린으로 혈전용해 치료를 한 3명의 환자를 보고하고자 하였다. 한 명의 임산부를 포함한 2명의 환자는 판막 혈전증으로 인한 판막폐쇄와 개폐운동 장애가 있었고 다른 한 명은 내원 5일전 혈전색전증으로 뇌경색이 발생한 좌심방내 혈전증 환자였다. 환자들은 프락시파린 0.3cc (7,500 ICU AXa)을 하루에 2∼3번씩 피하로 투여하여 치료를 받았다. 퇴원 당시 판막과 좌심방 내 혈전은 완전히 혹은 거의 완전히 용해되었고 판막의 개폐운동은 정상이었다. 혈전용해 때부터 외래 추적 기간동안 특별한 부작용은 없었다.

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Postmastectomy Breast Reconstruction is Safe in Patients on Chronic Anticoagulation

  • Yan, Maria;Kuruoglu, Doga;Boughey, Judy C.;Manrique, Oscar J.;Tran, Nho V.;Harless, Christin A.;Martinez-Jorge, Jorys;Nguyen, Minh-Doan T.
    • Archives of Plastic Surgery
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    • 제49권3호
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    • pp.346-351
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    • 2022
  • Background Postmastectomy breast reconstruction (PMR) increases patient satisfaction, quality of life, and psychosocial well-being. There is scarce data regarding the safety of PMR in chronic anticoagulated patients. Perioperative complications can reduce patient satisfaction; therefore, it is important to elucidate the safety of PMR in these patients. Methods A retrospective case-control study of patients who underwent PMR with implants and were on chronic anticoagulation was performed at our institution. Inclusion criteria were women ≥ 18 years old. Exclusion criteria included autologous reconstructions, lumpectomy, and oncoplastic procedures. Two controls for every one patient on anticoagulation were matched by age, body mass index, radiotherapy, smoking history, type of reconstruction, time of reconstruction, and laterality. Results From 2009 to 2020, 37 breasts (20 patients) underwent PMR with implant-based reconstruction and were on chronic anticoagulation. A total of 74 breasts (40 patients) who had similar demographic characteristics to the cases were defined as the control group. Mean age for the case group was 53.6 years (standard deviation [SD] = 16.1), mean body mass index was 28.6 kg/m2 (SD = 5.1), and 2.7% of breasts had radiotherapy before reconstruction and 5.4% after reconstruction. Nine patients were on long-term warfarin, six on apixaban, three on rivaroxaban, one on low-molecular-weight heparin, and one on dabigatran. The indications for anticoagulation were prior thromboembolic events in 50%. Anticoagulated patients had a higher risk of capsular contracture (10.8% vs. 0%, p = 0.005). There were no differences regarding incidence of hematoma (2.7% vs. 1.4%, p = 0.63), thromboembolism (5% vs. 0%, p = 0.16), reconstructive-related complications, or length of hospitalization (1.6 days [SD = 24.2] vs. 1.4 days [SD = 24.2], p = 0.85). Conclusion Postmastectomy implant-based breast reconstruction can be safely performed in patients on chronic anticoagulation with appropriate perioperative management of anticoagulation. This information can be useful for preoperative counseling on these patients.

유경횡복직근피판을 이용한 유방복원술시 폐색전증의 발병률과 위험인자 (Incidence and Risk Factors of Pulmonary Thromboembolism in Pedicled TRAM Breast Reconstruction)

  • 이상혁;이택종;엄진섭;손병호;안세현;이상도
    • Archives of Plastic Surgery
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    • 제33권2호
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    • pp.193-197
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    • 2006
  • Pulmonary thromboembolism is often clinically silent and difficult to diagnose, and can be fatal to patients with belated treatment. This complication is seen in patients who underwent TRAM breast reconstruction. Multiple factors are involved in this disease such as the presence of malignancy itself, major surgery and therapy-related interventions. TRAM surgery is a lengthy procedure involving mastectomy, flap surgery and abdominoplasty. The purpose of this study is to evaluate the incidence and the correlation between presurgical risk factors(BMI and age) of symptomatic pulmonary thromboembolism after TRAM surgery and the incidence. From July 2001 to March 2005 a total of 384 pedicled TRAM reconstruction of breast was performed in 382 patients at Asan Medical Center. The average of Body mass index was $21.9kg/m^2$ and mean age of the patients was 37.9 years old. We diagnosed symptomatic pulmonary thromboembolism using ventilation/perfusion lung scan and pulmonary embolism computed tomography. Incidence of in-hospital symptomatic pulmonary thromboembolism was 1.3%. BMI and age showed no significant statistical relationship to pulmonary thromboembolism. But the incidence of symptomatic pulmonary thromboembolism in obese patients (BMI > 25) was 3.75%. According to the guideline of the 7th American College of Chest Physicians Consensus Conference on Antithrombotic and Thrombolytic Therapy, the incidence of 3.75% was classified as high risk group. The prevention of pulmonary thromboembolism should be considered in cases of obese patients with low molecular weight heparin(BMI > 25).