Efficacy of heparinoid supplementation on mortality and disease progression in adults with diabetic kidney disease / Journal of the ASEAN Federation of Endocrine Societies

Methodology. Trials evaluating heparinoid supplementation in DKD were included. Two authors performed a literature search with eligible studies undergoing validity screen, data extraction, and statistical analysis. Results were calculated using the Mantel-Haenszel odds ratio for dichotomous variables and the inverse variance method for continuous variables, and pooled using a random or fixed effects model depending on heterogeneityResults. Twelve trials were included in the analysis. Eight involved sulodexide while two each involved low molecular weight heparin and danaparoid. We found no statistically significant difference between the heparinoid and placebo groups for all-cause mortality (95% CI, HR 0.79 [0.41, 1.53], p=0.49), number of patients reaching therapeutic success (95% CI, OR 0.97 [0.71, 1.33], p=0.87), serum creatinine (95% CI, MD 2.55 umol/L [-0.54, 5.65], p=0.11), and creatinine clearance (95% CI, MD -8.55 mg/min [-18.28, 1.18], p=0.09). We also found no statistically significant difference in urinary albumin excretion rate (UAER) between Type 2 heparinoid-treated DKD patients compared to placebo (95% CI, log transformed MD 0.13 mg/24h [-0.42, 0.68], p=0.65); however, a statistically significant UAER reduction was seen in Type 1 heparinoid-treated DKD patients compared to placebo (95% CI, log-transformed MD -1.5 mg/24h [-2.79, -0.21], p=0.02). This subgroup analysis was performed due to initial heterogeneity (I

Efficacy of heparinoid supplementation on mortality and disease progression in adults with diabetic kidney disease / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#To evaluate the safety and efficacy of heparinoid supplementation on all-cause mortality and disease progression in diabetic kidney disease (DKD). @*Methodology@#Trials evaluating heparinoid supplementation in DKD were included. Two authors performed a literature search with eligible studies undergoing validity screen, data extraction, and statistical analysis. Results were calculated using the Mantel-Haenszel odds ratio for dichotomous variables and the inverse variance method for continuous variables, and pooled using a random or fixed effects model depending on heterogeneity @*Results@#Twelve trials were included in the analysis. Eight involved sulodexide while two each involved low molecular weight heparin and danaparoid. We found no statistically significant difference between the heparinoid and placebo groups for all-cause mortality (95% CI, HR 0.79 [0.41, 1.53], p=0.49), number of patients reaching therapeutic success (95% CI, OR 0.97 [0.71, 1.33], p=0.87), serum creatinine (95% CI, MD 2.55 umol/L [-0.54, 5.65], p=0.11), and creatinine clearance (95% CI, MD -8.55 mg/min [-18.28, 1.18], p=0.09). We also found no statistically significant difference in urinary albumin excretion rate (UAER) between Type 2 heparinoid-treated DKD patients compared to placebo (95% CI, log transformed MD 0.13 mg/24h [-0.42, 0.68], p=0.65); however, a statistically significant UAER reduction was seen in Type 1 heparinoid-treated DKD patients compared to placebo (95% CI, log-transformed MD -1.5 mg/24h [-2.79, -0.21], p=0.02). This subgroup analysis was performed due to initial heterogeneity (I

Efficacy of Heparinoid supplementation on mortality and disease progression in adults with diabetic kidney disease / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#To evaluate the safety and efficacy of heparinoid supplementation on all-cause mortality and disease progression in diabetic kidney disease (DKD). @*Methodology@#Trials evaluating heparinoid supplementation in DKD were included. Two authors performed a literature search with eligible studies undergoing validity screen, data extraction, and statistical analysis. Results were calculated using the Mantel-Haenszel odds ratio for dichotomous variables and the inverse variance method for continuous variables, and pooled using a random or fixed effects model depending on heterogeneity @*Results@#Twelve trials were included in the analysis. Eight involved sulodexide while two each involved low molecular weight heparin and danaparoid. We found no statistically significant difference between the heparinoid and placebo groups for all-cause mortality (95% CI, HR 0.79 [0.41, 1.53], p=0.49), number of patients reaching therapeutic success (95% CI, OR 0.97 [0.71, 1.33], p=0.87), serum creatinine (95% CI, MD 2.55 umol/L [-0.54, 5.65], p=0.11), and creatinine clearance (95% CI, MD -8.55 mg/min [-18.28, 1.18], p=0.09). We also found no statistically significant difference in urinary albumin excretion rate (UAER) between Type 2 heparinoid-treated DKD patients compared to placebo (95% CI, log transformed MD 0.13 mg/24h [-0.42, 0.68], p=0.65); however, a statistically significant UAER reduction was seen in Type 1 heparinoid-treated DKD patients compared to placebo (95% CI, log-transformed MD -1.5 mg/24h [-2.79, -0.21], p=0.02). This subgroup analysis was performed due to initial heterogeneity (I

Estudo comparativo para avaliar a tolerabilidade e segurança da enoxaparina na profilaxia da trombose venosa profunda em pacientes internados em Hospital Universitário e submetidos a operações abdominais e abdômino-pélvicas / Comparative study to evaluate the tolerability and security of the enoxaparin in the prophylaxis of venous thromboembolism in patients interned in University Hospital and submitted the abdominal and abdomino-pelvic operations

A tolerabilidade e a segurança da enoxaparina usada na profilaxia da trombose venosa profunda(TVP)foi avaliada num estudo aberto comparativo que incluiu 97 pacientes de ambos os sexos,com idade variando de 40a86 anos(média= 60,9a),no Grupo Teste(GT)e 30 pacientes,de ambos os sexos com idade variando de 42a80 anos(média=60a),no Grupo Controle(GC),submetidos a operações abdominais e/ou pélvicas de médio e grande porte.A enoxaparina foi aplicada,profilaticamente,via subcutânea,em todos os pacientes do GT,na dose de 20 mg/dia,iniciada duas horas antes do ato operatório e mantida ao longo do pós-operatório,enquanto o paciente esteve acamado,no máximo por 7 dias.Os pacientes do GC,com a mesma técnica usada para os pacientes do GT,receberam injeções subcutâneas de soro fisiológico.A tolerabilidade foi avaliada pela observação de aparecimento ou não de hematomas no local de aplicação do medicamento,comparada com aqueles formados pela simples injeção de soro fisiológico. Quarenta pacientes(41,2por cento)do GT apresentaram hematomas no local da injeção,83por cento deles menor que 1 cm.Cinco pacientes(16,6por cento)do GC apresentaram 7 hematomas no local da aplicação do soro fisiológico(p= 0,025).A segurança foi testada pela avaliação do sangramento ocorrido no intra-operatório e pelas alterações sangüíneas dos valores de hemoglobina e contagem de plaquetas.A perda sangüínea intra-operatória foi semelhante nos dois grupos(p=0,36).Observou-se...do GC.Houve queda significativa da hemoglobina de...e 3ºdia do pós-operatório,entre os pacientes do GT,e de 12,8 g/100 ml para 10,9 g/100 ml,entre os pacientes do GC (p<0,0001).Houve variação significativa no número de plaquetas contadas ao longo do estudo dentre os pacientes do GT(p<0,0001),às custas de elevação ocorrida no 3ºdia do pós-operatório.Entre os pacientes do GC foi observada diminuição do nºde plaquetas contadas no 3ºdia do pós-operatório,com variação não significativa dentro do grupo (p=0,5)As alterações dos valores de hemoglobina e contagem de plaquetas observadas nos pacientes do GT não foram acompanhadas de manifestações clínicas que justificassem observação ou medida terapêutica de qualquer natureza.A enoxaparina foi bem tolerada pelos pacientes,o que ficou evidenciado pela ausência de reações locais ou sistêmicas relevantes e mostrou-se segura,na dose empregada,por não ter provocado eventos adversos que pudessem ter sido atribuídos a seu uso ou que exigissem a suspensão de sua administração profilática.

Novas visões sobre estrutura, ações farmacológicas e degradação enzimática de heparina e heparonóides de diferentes origens / New vision about structure, pharmacologic action and enzimatic degradation of heparin and heparinoide of origin differents

Uma heparina de baixa massa molecular (8,5 kDa) com atividade anticoagulante de 95 UI/mg pelo ensaio da "'United States Pharmacopea" foi isolada do camarão Penaeus brasiliensis. A heparina do crustáceo foi degradada por heparinase e heparitinase II isoladas da Flavobacterium heparinum formando dissacarídeos dissulfatados e dissacarídeo trissulfatado. Ressonância magnética nuclear de 13C e 1H mostraram que a heparina do camarão apresenta grandes quantidades de ácido glucurônico e ácido idurônico não sulfatado. Ensaios in vitro mostraram que as atividades anticoagulantes da heparina de camarão são exercidas principalmente através da inibição do Fator Xa e do co-fator II da heparina. A heparina do camarão apresenta uma potente atividade antitrombótica in vivo comparável com heparina de baixa massa molecular produzida por métodos químicos ou enzimáticos a partir da heparina de mamífero. Estes resultados juntamente com as observações anteriores da presença de heparina em moluscos nos levaram a buscar esse composto em outros fitos de invertebrados. Glicosaminoglicanos sulfatados foram isolados de 23 espécies de 13 fila de invertebrados e caracterizados pela migração eletroforética em três tampões diferentes combinado à degradação enzimática por heparinase, heparitinases e condroitinase AC. Heparam sulfato foi encontrado em todas as espécies analisadas enquanto que condroitim sulfato foi encontrado em 20 espécies e compostos relacionados com a heparina em 12 espécies. Um composto semelhante a heparina foi isolado do equinoderma Mellita quinquisperforata e do caranguejo Ucides cordatus com atividades anticoagulantes de 60 e 52 U.I./mg, respectivamente. Degradação dessas heparinas por heparinase produziu significantes quantidades de dissacarídeo trissulfatado, típico de heparina de mamíferos. Esta observação foi confirmada por espectroscopia de ressonância magnética nuclear de 13C da heparina de caranguejo. Baseado nestes resultados foi feita uma nova árvore filogenética da distribuição dos glicosaminoglicanos em invertebrados…(au)

Evaluation of the Relationship between the Patient's Severity and the Presence of Heparin Effects with the Use of Heparinase-Guided TEG in Liver Transplantation / 대한마취과학회지

BACKGROUND: Endogenous heparinoid substances have been mentioned as one of the causes of coagulopathy during liver transplantation. Some reported that heparin effects after reperfusion increase with decreasing liver function, as assessed by the Child-Pugh classification. Comparisons of native and heparinase TEG can assess the quantity of heparin effects and distinguish the cause of coagulopathy. We investigated the heparin effects before reperfusion by heparinase-guided TEG and the correlation between heparin effects and the UNOS and Child-Pugh score. METHODS: 67 liver transplanted patients were studied and divided two groups. Two groups were control group that exist heparin effect and experimental group that does not exist heparin effect during preanhepatic period. Native and heparinase TEG are performed simultaneously after anesthetic induction. Present heparin effects were defined as coagulation time (gamma + kappa) differs more than 20% between native and heparinase TEG showing the native TEG's index is out of the normal range. RESULTS: Heparin effects were present before reperfusion in 29.8% of liver transplantation cases and these were related more with the Child-Pugh classification than UNOS (gamma = 0.31, P = 0.012). There were many transfusions of packed red cells and a large infusion amount through RIS in the group with heparin effects but there was no statistical significance. CONCLUSIONS: We could confirm that heparin effects appear already before reperfusion in 29.8% of the cases using heparinase-guided TEG and this correlates with the Child-Pugh classification

Clinical Observation of Postreperfusion Heparine Effects with a Heparinase Guided Thromboelastogram in a Liver Transplanted Patient / 대한마취과학회지

Orthotopic liver transplantation is frequently associated with severe bleeding, especially after reperfusion of the grafted liver. Heparin or heparinoids are released from the grafted liver and cause additional blood coagulation disorders. Recently many investigators have used a heparinase guided thromboelastogram (TEG) to control and confirm heparin effects not only on liver transplantation but also cardiac surgery. We reported a clinical case using a heparinase guided TEG to observe the duration of postreperfusion heparin effects.

Autoradiography reveals regional metabolic differences in the endometrium of pregnant and nonpregnant mice

The rodent endometrium undergoes remarkable modifications during pregnancy, resulting from a redifferentiation of its fibroblasts. During this modification (decidualization), the fibroblasts transform into large, polyhedral cells that establish intercellular junctions. Decidualization proceeds from the subepithelial stroma towards the deep stroma situated next to the myometrium and creates regions composed of cells in different stages of differentiation. We studied by autoradiography whether cells of these different regions have different levels of macromolecular synthesis. Radioactive amino acids or radioactive sulfate were administered to mice during estrus or on different days of pregnancy. The animals were killed 30 min after injection of the precursors and the uteri were processed for light microscope autoradiography. Silver grains were counted over cells of different regions of the endometrium and are reported as the number of silver grains per area. Higher levels of incorporation of amino acids were found in pregnant animals as compared to animals in estrus. In pregnant animals, the region of decidual cells or the region of fibroblasts transforming into decidual cells showed the highest of synthesis. Radioactive sulfate incorporation, on the other hand, was generally higher in nonpregnant animals. Animals without decidual cell transformation (nonpregnant and 4th day of pregnancy) showed a differential incorporation by subepithelial and deep stroma fibroblasts. This study shows that regional differences in synthetic activity exist in cells that are in different stages of transformation into decidual cells as well as in different regions of the endometrium of nonpregnant mice.

Inhibidor heparinoide en un paciente con mieloma múltiple

Se describe una paciente con mieloma múltiple tipo IgA con un inhibidor de la coagulación de tipo heparinoide, no inmune ni relacionada con la paraproteina. Fue identificado por pruebas de neutralización con sulfato de protamina, con una concentración plasmatica menor de 0.3 U/mL. Se discute la naturaleza de este tipo de inhibidores y su relación con las neoplasias

Comparative study of the action of topical heparinoids on the evolution of experimental thrombophlebitis

The action of threem different topical heparinoids on the evolution of experimental thrombophlebitis was studies. Thrombophlebitis was induced in the marginal vein of the ear of rabbits by stasis and inection of hypertonic glucose solution. Forty-eight hours later animals were allocated to three treatment groups and a control group. The substances were applied over the affected vein three times a day for 6 days and the ears inspected daily by transillumination. After 7 days, the animals were killed and anatomopathological studies performed. No difference in thrombus frequency or inflamatory reaction was observed between the animals treated with heparinoids and the control group, or among the treated groups