BACKGROUND: Unfractionated heparin is used worldwide as a standard anticoagulation therapy for extracorporeal membrane oxygenation (ECMO) machines. However, its use brings about significant bleeding and thrombotic complications for critically ill patients. This case report shows that low molecular weight heparin together with ECMO-produced primary haemostasis pathology can be used as an alternative way of ECMO anticoagulation. CASE PRESENTATION: This paper presents the case of a patient with respiratory failure who subsequently suffered from cardiac failure and spent 94 days on combined V-V and V-A ECMO devices (two ECMO devices running simultaneously on one patient) with intravenous enoxaparin used instead of unfractionated heparin anticoagulation. No life-threatening bleeding/thrombotic events happened during this period, nor did any technical problems with ECMO occur. CONCLUSIONS: In this case report, continuous intravenous low molecular weight heparin anticoagulation was used as a safe alternative to ECMO anticoagulation.

• Klíčová slova
• ECMO, Enoxaparin, Extracorporeal membrane oxygenation, LMWH, PFA 200, Primary haemostasis,
• MeSH
• antikoagulancia škodlivé účinky   MeSH
• enoxaparin MeSH
• heparin nízkomolekulární MeSH
• heparin škodlivé účinky   MeSH
• krvácení etiologie   MeSH
• lidé MeSH
• mimotělní membránová oxygenace * škodlivé účinky   MeSH
• trombóza * etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• antikoagulancia MeSH
• enoxaparin MeSH
• heparin nízkomolekulární MeSH
• heparin MeSH

BACKGROUND: Deep vein thrombosis (DVT) is a serious but preventable complication of critical illness with a reported incidence from 4 to 17%. Anti-Xa activity in critically ill patients achieved with standard dosing of low-molecular-weight heparins (LMWH) is often below the target of 0.2-0.5 IU/mL. However, the clinical significance of this finding is unclear. The quality of thromboprophylaxis also strongly impacts the incidence of DVT. We performed a prospective observational study to evaluate the incidence of DVT in a mixed medical-surgical-trauma intensive care unit (ICU) using a thromboprophylaxis protocol with a fixed dose of enoxaparin. We also explored the relation between DVT incidence and anti-Xa activity. METHOD: All consecutive patients with expected ICU stay ≥72 hours and without evidence of DVT upon admission were included. They underwent ultrasound screening for DVT twice a week until ICU discharge, death, DVT or pulmonary embolism. Peak anti-Xa activity was measured twice a week. Patients received 40 mg of enoxaparin subcutaneously (60 mg in obese, 20 mg in case of renal failure). Graduated compression stockings were used in case of LMWH or another anticoagulant contraindication. RESULTS: A total of 219 patients were enrolled. We observed six cases of DVT (incidence of 2.7%). The agreement between expected and delivered DVT prophylaxis was 94%. Mean peak anti-Xa activity level was 0.24 (SD, 0.13) IU/mL. There was no significant difference in anti-Xa activity in DVT and non-DVT group. CONCLUSION: A low incidence of DVT was achieved with meticulous adherence to the standard prophylactic protocol. The low incidence of DVT was observed despite low levels of anti-Xa activity. Our findings suggest that enoxaparin dose adjustment based on regular monitoring of anti-Xa activity is unlikely to result in further reduction of DVT incidence in a mixed ICU population. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03286985.

• Klíčová slova
• anti-Xa, compression ultrasound test, enoxaparin, pulmonary embolism, thromboprophylaxis intensive care units, venous thrombosis,
• MeSH
• antikoagulancia terapeutické užití   MeSH
• enoxaparin * terapeutické užití   MeSH
• heparin nízkomolekulární MeSH
• jednotky intenzivní péče MeSH
• kritický stav terapie   MeSH
• lidé MeSH
• prospektivní studie MeSH
• žilní tromboembolie * farmakoterapie   etiologie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• antikoagulancia MeSH
• enoxaparin * MeSH
• heparin nízkomolekulární MeSH

Purple toe syndrome is a rare complication of warfarin therapy. It occurs usually after 3 to 8 weeks of therapy and it is caused by cholesterol emboli from atheromatous plaque. Sudden onset of pain in affected area, typically in toes and feet, is the main characteristic of the syndrome. We describe a case of a 65-year-old female with purple toe syndrome after 6 weeks of warfarin. Indication of warfarin was a proximal deep venous thrombosis, which developed after prolonged immobilization. Factor V (FV) Leiden and persistent high FVIII activity were found as additional eliciting factors for venous thromboembolism. After warfarin withdrawal and enoxaparin treatment, symptoms disappeared promptly but a slight discoloration of the toe persists.

• MeSH
• antikoagulancia aplikace a dávkování   škodlivé účinky   MeSH
• ateroembolie * chemicky indukované   farmakoterapie   patologie   MeSH
• aterosklerotický plát patologie   MeSH
• enoxaparin aplikace a dávkování   MeSH
• faktor V * MeSH
• fibrinolytika aplikace a dávkování   MeSH
• lidé MeSH
• prsty nohy * krevní zásobení   patologie   MeSH
• senioři MeSH
• syndrom MeSH
• warfarin aplikace a dávkování   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antikoagulancia MeSH
• enoxaparin MeSH
• factor V Leiden MeSH Prohlížeč
• faktor V * MeSH
• fibrinolytika MeSH
• warfarin MeSH

BACKGROUND: Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled warfarin therapy. Few safety data about edoxaban in patients undergoing electrical cardioversion are available. METHODS: We did a multicentre, prospective, randomised, open-label, blinded-endpoint evaluation trial in 19 countries with 239 sites comparing edoxaban 60 mg per day with enoxaparin-warfarin in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. The dose of edoxaban was reduced to 30 mg per day if one or more factors (creatinine clearance 15-50 mL/min, low bodyweight [≤60 kg], or concomitant use of P-glycoprotein inhibitors) were present. Block randomisation (block size four)-stratified by cardioversion approach (transoesophageal echocardiography [TEE] or not), anticoagulant experience, selected edoxaban dose, and region-was done through a voice-web system. The primary efficacy endpoint was a composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular mortality, analysed by intention to treat. The primary safety endpoint was major and clinically relevant non-major (CRNM) bleeding in patients who received at least one dose of study drug. Follow-up was 28 days on study drug after cardioversion plus 30 days to assess safety. This trial is registered with ClinicalTrials.gov, number NCT02072434. FINDINGS: Between March 25, 2014, and Oct 28, 2015, 2199 patients were enrolled and randomly assigned to receive edoxaban (n=1095) or enoxaparin-warfarin (n=1104). The mean age was 64 years (SD 10·54) and mean CHA2DS2-VASc score was 2·6 (SD 1·4). Mean time in therapeutic range on warfarin was 70·8% (SD 27·4). The primary efficacy endpoint occurred in five (<1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin-warfarin group (odds ratio [OR] 0·46, 95% CI 0·12-1·43). The primary safety endpoint occurred in 16 (1%) of 1067 patients given edoxaban versus 11 (1%) of 1082 patients given enoxaparin-warfarin (OR 1·48, 95% CI 0·64-3·55). The results were independent of the TEE-guided strategy and anticoagulation status. INTERPRETATION: ENSURE-AF is the largest prospective randomised clinical trial of anticoagulation for cardioversion of patients with non-valvular atrial fibrillation. Rates of major and CRNM bleeding and thromboembolism were low in the two treatment groups. FUNDING: Daiichi Sankyo provided financial support for the study.

• MeSH
• antikoagulancia škodlivé účinky   terapeutické užití   MeSH
• cévní mozková příhoda prevence a kontrola   MeSH
• elektrická defibrilace * MeSH
• enoxaparin škodlivé účinky   terapeutické užití   MeSH
• fibrilace síní terapie   MeSH
• inhibitory faktoru Xa škodlivé účinky   terapeutické užití   MeSH
• krvácení chemicky indukované   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• pyridiny škodlivé účinky   terapeutické užití   MeSH
• senioři MeSH
• thiazoly škodlivé účinky   terapeutické užití   MeSH
• tromboembolie prevence a kontrola   MeSH
• warfarin škodlivé účinky   terapeutické užití   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• antikoagulancia MeSH
• edoxaban MeSH Prohlížeč
• enoxaparin MeSH
• inhibitory faktoru Xa MeSH
• pyridiny MeSH
• thiazoly MeSH
• warfarin MeSH

INTRODUCTION: The aim of the study was to evaluate and compare the efficacy of standard unfractionated heparin (UFH) and low-molecular weight heparins (LMWH's). MATERIALS AND METHODS: We modified a previously published rabbit model of arterial thrombosis prevention [1,2] to compare unfractionated heparin and two different doses of two low-molecular weight heparin fragments--nadroparin and enoxaparin. Thrombosis in the distal aorta was triggered by vessel wall injury and critical stenosis. Blood flow in the damaged arterial segment was monitored by a flow probe placed distal to the constrictor. The primary endpoints of the study were: (1) cumulative flow, (2) time to occlusion and (3) residual clot weight. Thirty six animals were split into 6 groups with six animals in each group. Control groups were given saline or heparin and four more groups were used to compare LMWH's at 2 different doses. RESULTS: In our study, all treatments were superior to the saline control group (alpha

• MeSH
• arterie MeSH
• enoxaparin terapeutické užití   MeSH
• heparin nízkomolekulární terapeutické užití   MeSH
• heparin terapeutické užití   MeSH
• klinické zkoušky jako téma MeSH
• králíci MeSH
• nadroparin terapeutické užití   MeSH
• trombóza farmakoterapie   prevence a kontrola   MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• enoxaparin MeSH
• heparin nízkomolekulární MeSH
• heparin MeSH
• nadroparin MeSH

PURPOSE: The objective of our study was to identify changes in the coagulation and serum concentration of soluble P-selectin (sP-sel) after i.v. bolus of 0.75 mg/kg enoxaparin in a group of 33 patients during PCI. METHODS AND RESULTS: As compared to baseline, i.v. enoxaparin increased anti -Xa activity and FIIa inhibition together with APTT and thrombin time tests within 20 min, that persisted for 60 min. At 6 h, the results of all tests had returned to baseline. In contrast, the level of prothrombin fragments (F1 + 2) decreased persistingly for a period of 6 h (baseline 1.19 ± 0.42 nmol/l, after 20 min 1.03 ± 0.46 nmol/l, after 60 min 1.06 ± 0.43 nmol/l, after 6 h 0.95 ± 0.40 nmol/l, p < 0.001 vs. baseline for all values). In addition, i.v. enoxaparin decreased serum sP-sel level (baseline 111.80 ± 37.05 ng/ml, after 20 min 87.80 ± 33.17 ng/ml, after 60 min 86.45 ± 29.15 ng/ml, after 6 h 92.24 ± 31.34 ng/ml, p < 0.001 vs. baseline value for all). sP-sel level mildly correlated with both F Xa inhibition (r = -0.275, p < 0.05) and F1 + 2 level (r = 0.274, p < 0.05). CONCLUSION: Intravenous enoxaparin induced target F Xa inhibition (>0.6 IU/ml) for 60 min in 82% of study patients. During the 6 h of monitoring, a decrease of thrombin generation (F1 + 2) and sP-selectin levels were observed.

• MeSH
• antikoagulancia farmakologie   MeSH
• balónková koronární angioplastika metody   MeSH
• časové faktory MeSH
• enoxaparin farmakologie   MeSH
• inhibitory faktoru Xa MeSH
• injekce intravenózní MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen terapie   MeSH
• P-selektin účinky léků   metabolismus   MeSH
• parciální tromboplastinový čas MeSH
• protrombin antagonisté a inhibitory   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• thrombin účinky léků   metabolismus   MeSH
• trombinový čas MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• Názvy látek
• antikoagulancia MeSH
• enoxaparin MeSH
• Factor IIa MeSH Prohlížeč
• inhibitory faktoru Xa MeSH
• P-selektin MeSH
• protrombin MeSH
• thrombin MeSH

The objective of our study was to examine the changes in coagulation parameters and inflammatory reaction over the course of 15 days in patients with severe sepsis. We tried to identify mechanisms by which sepsis-induced pathophysiological changes may influence the effectiveness of subcutaneously (SC) administered enoxaparin 40 mg once daily. A total of 16 patients (8 men, 8 women; age 35-83 years) meeting the inclusion criteria of severe sepsis were enrolled in this study. The follow-up was performed on days 1, 2, 3, 6, 9, 12, and 15 of hospitalization at the intensive care unit (ICU). Blood coagulation (activated partial thromboplastin time [aPTT], prothrombin time [PT], fibrinogen, antithrombin (AT), protein C [PC], D-dimer, fragment 1.2 [F1.2], factor Xa [FXa] inhibition) and inflammatory reactants (interleukin 6 [IL-6], C-reactive protein [CRP], orosomucoid, alpha-1-antitrypsin) were tested. The mean FXa inhibition was 0.17 (+ or - 0.17) IU/mL. The arbitrarily established range of FXa inhibition for prophylaxis, 0.2 to 0.4 IU/mL, was reached in 22 cases (20%), while in 74 cases (68%), it was below and in 13 cases (12%) above the aforementioned range. Factor Xa inhibition positively correlated with AT (r = .42; P < .001) and PC (r = .45; P < .001) activities. A negative correlation was found between the FXa inhibition and alpha-1-antitrypsin concentrations (r = -.33; P = .01) but only in the subgroup with alpha-1-antitrypsin concentrations > or = 2.2 g/L. We confirmed that in most patients with sepsis, the prophylaxis with enoxaparin did not lead to the required FXa inhibition. The inhibition of FXa by enoxaparin depends mainly on the AT and PC activities.

• MeSH
• antikoagulancia terapeutické užití   MeSH
• dospělí MeSH
• enoxaparin terapeutické užití   MeSH
• hemokoagulace účinky léků   MeSH
• inhibitory faktoru Xa * MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sepse krev   MeSH
• žilní trombóza krev   prevence a kontrola   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antikoagulancia MeSH
• enoxaparin MeSH
• inhibitory faktoru Xa * MeSH

This is a first descriptive, retrospective, observational study aiming to evaluate the changes in bone turnover markers in pregnant women and to assess the effect of a long-term treatment with low-molecular-weight heparin (LMWH), specifically, enoxaparin. Study involved 50 pregnant Caucasian women with thrombophilia. The patients either received prophylactic enoxaparin once daily subcutaneously (N = 35) or were observed without treatment (N = 15). Concentrations of total serum alkaline phosphatase (total AP), bone alkaline phosphatase (bone AP), osteoprotegerin (OPG), and the receptor activator of nuclear factor κB ligand (RANKL) were measured at 15, 25, and 35 weeks of gestation. Total serum AP increased with gestational age. In the group treated with enoxaparin, the percentage of bone AP concentration was lower (P < .05) than in the control group. Serum OPG also increased with gestational age, but no significant difference was found between the groups with- and without treatment. Despite the OPG increased, RANKL did not change.

• MeSH
• alkalická fosfatasa krev   MeSH
• antikoagulancia aplikace a dávkování   škodlivé účinky   MeSH
• dospělí MeSH
• enoxaparin aplikace a dávkování   škodlivé účinky   MeSH
• gestační stáří MeSH
• hematologické komplikace těhotenství krev   prevence a kontrola   MeSH
• kosti a kostní tkáň metabolismus   MeSH
• lidé MeSH
• ligand RANK krev   MeSH
• osteoprotegerin krev   MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• trimestry těhotenství krev   MeSH
• trombofilie krev   prevence a kontrola   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• alkalická fosfatasa MeSH
• antikoagulancia MeSH
• enoxaparin MeSH
• ligand RANK MeSH
• osteoprotegerin MeSH
• TNFRSF11B protein, human MeSH Prohlížeč
• TNFSF11 protein, human MeSH Prohlížeč

BACKGROUND: Clinical studies have clearly revealed that low-molecular-weight heparins (LMWHs) are an effective alternative to unfractionated heparin in the therapy of acute coronary syndrome (ACS); however, data on the comparison of different LMWHs are sparse. AIM: To compare the inhibition of coagulation factor Xa by enoxaparin and nadroparin in the therapy of ACS. METHODS: Thirty-eight consecutive patients with ACS were randomly assigned to enoxaparin (group E, n=18) or nadroparin (group N, n=20) in the recommended dose. Anti-Xa activity was measured 3 h after administering the first dose of LMWH. RESULTS: Baseline demographics (age, sex) and clinical (type of ACS, pain-to-door time, elevation of troponin, percutaneous coronary intervention performed, smoking status, and history of diabetes, hypertension and hyperlipoproteinemia) characteristics were similar in both groups. Anti-Xa activity was significantly higher in group E than in group N (0.65+/-0.05 U/mL versus 0.30+/-0.03 U/mL; P<0.001). Moreover, the therapeutic target (0.5 U/mL to 0.8 U/mL) was achieved in 66.7% of patients in group E; on the other hand, effective therapy was observed in 10.0% of patients in group N (P<0.001). CONCLUSIONS: The results of the present study demonstrate a highly significant difference in anti-Xa activity of enoxaparin and nadroparin in their recommended dosing regimens, in the therapy of ACS 3 h after subcutaneous administration; the anticoagulant effect of enoxaparin was markedly stronger than that of nadroparin.

• Klíčová slova
• Acute coronary syndrome, Enoxaparin, Factor Xa, Heparin, Nadroparin,
• Publikační typ
• časopisecké články MeSH

Prospective study implicates problems of heparin-induced thrombocytopenia (HIT). This is one of the most important complications in heparin treatment and prophylaxis. The set was formed of patients with severe diagnosis and larger intra-abdominal operation that was associated with relative high risk of thrombotic event. That's why there was need of heparin prophylaxis. We used Enoxaparin in dose 0.2-0.4 ml subcutaneously. The controlled parameters were platelet counts, detection of antibodies using ELISA Assay method (GTI-PFA), indirect platelet immunofluorescent test for monitoring platelet disorders. We had no known case of clinical symptoms of HIT. The change in platelet counts was due to postoperative course, or binding on blood transfer or basic haematological disease. The test detecting antibodies was positive in eight percent without clinical correlation, without important thrombocytopenia. Low-molecular-weight heparin has certain advantages over unfractionated heparin, as well know from clinical and laboratory monitoring in other studies, including larger safety (in relationship with HIT) with very effective prophylaxis.

• MeSH
• antikoagulancia škodlivé účinky   terapeutické užití   MeSH
• břicho chirurgie   MeSH
• dospělí MeSH
• enoxaparin terapeutické užití   MeSH
• heparin škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace prevence a kontrola   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trombocytopenie chemicky indukované   MeSH
• trombóza prevence a kontrola   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antikoagulancia MeSH
• enoxaparin MeSH
• heparin MeSH