Purpose: To compare the effect of Dalteparin (Low molecular weight heparin) versus Aspirin on recent-onset central retinal vein occlusion (CRVO). Patients & Methods: A randomized controlled clinical trial was conducted on patients with definite CRVO of less than 21 days duration. Patients in the Dalteparin group received subcutaneous Dalteparin (100 IU/kg bid for 10 days and 100 IU/kg daily for another 10 days); patients in the aspirin group were given Aspirin (100 mg daily). Results: Thirty-eight patients were enrolled, 18 in the Dalteparin group and 20 in the Aspirin group. The duration of follow-up was 6 months. Visual outcome was compared between two groups and no significant difference was found (P=0.74). All 3 patients who received Dalteparin within 7 days of onset of CRVO had dramatic improvement in visual acuity (mean change in logMAR=1.16). NVI occurred significantly less frequently in Dalteparin treated cases as compared with Aspirin (0.55% vs. 30%, P=0.006). Conclusion: Patients treated with Dalteparin within 21 days of onset of CRVO were less likely to develop NVI. There was no significant difference in visual acuity between the two groups at 6 months.  

Low molecular weight heparin-modified isoliquiritigenin-loaded solid lipid nanoparticle (LMWH-ISL-SLN) was developed for injective application. The morphological observation, particle diameter and zeta potential of LMWH-ISL-SLN were characterized using transmission electron microscopy (TEM) and a Malvern Zetasizer. Its entrapment efficiency (EE) and drug loading (DL) were determined by ultracentrifuge. The in-vitro release experiments were performed by dialysis technique. The cytotoxic effects of LMWH-ISL-SLN on Hep-G2 cell lines were determined using an MTT assay. Pharmacokinetic and tissue distribution studies were conducted in kunming mice after intravenous administration of LMWH-ISL-SLN. The average drug entrapment efficiency for LMWH-ISL-SLN was (99. 80 ± 3. 27)%, drug loading was (18. 68 ± 1. 51)%, mean particle size was (217. 53 ± 4. 86) nm and zeta potential was (– 18. 24 ± 2. 47) mV. The in-vitro release experiments demonstrated isoliquiritigenin release from LMWH-ISL-SLN was in line with Weibull’ s distribution law. Hemolysis test and doserelated toxic effects proved that LMWH-ISL-SLN was a safe and non toxic product when given by intravenous injection. The pharmacokinetics results of LMWH-ISL-SLN showed that the area under the concentration-time curve (AUC0→ ∞ )of LMWH-ISL-SLN was greater than that for the isoliquiritigenin solution in plasma. Tissue distribution study indicated that ISL were mainly distributed in the liver and lung. In conclusion, low molecular weight heparin-modified SLN system is a promising carrier for the intravenous delivery of ISL.

Introduction: Deep Vein thrombosis (DVT) is one of the most common vascular diseases, which affects millions of people around the world annually. The important complication of DVT, pulmonary emboli, can cause various dangers as well as mortality. Therefore correct and on time treatment helps patient’s life greatly. From time ago, standard or unfractionated heparin (UFH) has been the chosen treatment, but in recent years with the production of low molecular weight heparin (LMWH) and its specific advantages as compared to UFH, treating patients with LMWH instead of UFH has been presented.Objective: This study aims to compare the cost of LMWH and UFH in treatment of DVT. Materials and Methods: This cross- sectional study was conducted on 125 DVT hospitalized patients with DVT admitted to cardiac ward of Imam Reza Hospital in Mashhad between 2002 to 2004. Mean hospitalization days and hospital costs, nursing care, venous heparin prescription, routine tests and PTT test and also other costs such as serum therapy and … were extracted from patients’ medical files along with LMWH. Data was analyzed with SPSS software.Results: Mean hospital stay was 8.48±2.57 days. The average occupied bed was nearly 500 nights annually. Treatment cost with intravenous UFH and LMWH for each patient was 942080 Rials and 760000 Rials respectively.Conclusion: In attention to advantages of LMWH including economic benefits, decreased bed occupation, better personal and social function of patient, decreased complication and simple use, LMWH can be used in low risk patients instead of hospitalizing and treating with intravenous heparin.

Background: Venous thromboembolism (VTE) increases patientchr('39')s morbidity and mortality after orthopedic surgeries, and as such, prophylaxis is a routine practice after total joint replacement. Although there are many effective and safe prophylactic agents, clinical results are suboptimal. The aim of this study was to compare clinical and ultrasonographic results for the use of low molecule weight heparin (LMWH) and Rivaroxaban in patients undergoing total knee replacement. Methods: In a prospective cross-sectional study 325 patients were enrolled in receiving Enoxaparin or Rivaroxaban as thromboprophylaxis in their total knee replacement surgery. They had pre and post-operative doppler ultrasonography for diagnosis of thromboembolism. They were followed for a minimum of two years. The status and occurrence of VTE was evaluated. Patients were compared in terms of gender, body mass index (BMI), smoking, diabetes mellitus (DM) and previous VTE history. Results: The 325 eligible patients provided a sample of 130 (40%) male and 195 (60%) female. The average patient age (SD) was 63. 2 (14. 3). A total of 40 (12. 3%) patients (27 on LMWH, and 13 on Rivaroxaban), had DVT at the lower extremity. 15 (4. 6 %) patients-11from LMWH and 4 from Rivaroxaban group had pulmonary embolism (PE). 5 patients (1. 5%)-4 on LMWH, 1 on Rivaroxaban-had cerebrovascular thromboembolism. The incidence of thromboembolism was found to be similar in both prophylactic regimes. On the other hand, 2 patients (0. 6%) had spontaneous retroperitoneal bleeding from LMWH group. The PE patients had history of DVT. DVT occurred in patients with risk factors of obesity, diabetes or smoking. Conclusion: There was no difference between the use of rivaroxaban and enoxaparin for thromboembolic prophylaxis in total knee replacement in terms of occurrence of venous thrombosis and PE. Long-term thromboembolic prophylactic is preferred in cases with smoking, diabetes and obesity. Patients with previous venous thromboembolism are at a high risk for pulmonary and cerebrovascular embolism. Progressive hematocrit drop should alert the surgeon towards spontaneous retroperitoneal bleeding in the patients taking enoxaparin for thromboprophylaxis after total knee replacement surgery.

BACKGROUND AND OBJECTIVE: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder that is associated with thrombosis in both arteries and veins as well as pregnancy-related complications. The aim of this study was to compare the relative efficacy and safety of low molecular weight heparin (LMWH) with unfractionated heparin (UFH) in the treatment of pregnant women with a history of recurrent abortion secondary to antiphospholipid syndrome (APS).METHODS: In this prospective study, 83 women with a history of 3 or more consecutive spontaneous abortions before 10th weeks of pregnancy and positive antiphospholipid antibodies were received either UFH (5000 units, twice daily), or LMWH (enoxaparin 40 mg, once daily) as soon as pregnancy was diagnosed. Information regarding these women was obtained from comprehensive medical records system of Social Security Corporation, Qom, Iran. Then pregnancy outcome was compared in two groups.FINDINGS: Forty-two women in the LMWH group (95.5%) and 34 women in the UFH group (87.2%) delivered a viable infant (p>0.05). There were no significant differences in age and birth weight between the two groups. The mean±SD of apgar score in LMWH was 8.4±1.2 and in UFH was 7.7±1.2. Apgar score was higher in LMWH group (p<0.05) that was statistically significant.CONCLUSION: Both UFH and LMWH were effective in the treatment of pregnant women with a history of recurrent abortion secondary to APS. UFH was successfully used as an alternative to LMWH in the treatment of recurrent abortion secondary to APS.

Skin necrosis is a rare but serious side-effect of warfarin treatment. With the increase in the number of patients anticoagulated to prevent thromboembolic events, it is necessary to consider this serious complication in appropriate settings. Although the exact mechanism is not clear, some conditions have been described in association with warfarin-induced skin necrosis. We present the case of a 48-year-old man treated with warfarin following mitral valve replacement. The patient developed full thickness skin necrosis in the second month of warfarin therapy. He was investigated for known conditions associated with this complication. He received LMWH (Enoxaparin) until healing of the wounds and warfarin was then re-instituted for him by a low-dose schedule.

Dear Sir: The practice of preemptively administering therapeutic doses of low‑, molecular‑, weight heparin (LMWH) to prevent the dreaded complication of venous thromboembolism in COVID‑, 19 cases is practiced globally. [1, 2] LMWH increases the chances of bleeding, but since COVID‑, 19 causes a relative prothrombotic state, it is needed to administer LMWH in such cases. Chronic subdural hematoma (cSDH) is one of the most common surgical interventions in daily neurosurgical procedures in which mortality and morbidity vary with urgency and postoperative complications. The risk of recurrent hematoma after cSDH is 5%–, 30% within a span of 2–, 3 months. [3] An anticoagulant drug like LMWH is a known risk factor for cSDH. The use of anticoagulants in severe COVID‑, 19 patients in postoperative cSDH is controversial. Here, we present a clinical dilemma to initiate LMWH in a patient suffering from severe COVID‑, 19 infection in postoperative cSDH surgery.

Background: Deep venous thrombosis (DVT) is a fast-growing disease which is being dedicated significant human and financial resources. The objective of the current study was to compare the cost of current methods of heparin therapy; unfractioned heparin (UFH) and low molecular weight heparin (LMWH), in the treatment of deep venous thrombosis.Methods: This was a cross-sectional study on 146 patients with DVT which was carried out at the cardiology ward between 2002 and 2004. The number of admission days and the total inpatient and out-patient costs of therapy were evaluated.Results: The results revealed that in-patient treatment with standard heparin (UFH) cost US $240.with a mean 8.5 days of hospital stay, while treatment with LMWH (Enoxaparin) cost US $80.Conclusion: Considering all the benefits of LMWH including desired efficacy, greater ease of administration, fewer laboratory monitoring requirements, earlier hospital discharge, feasibility of using LMWH safely on an outpatient basis instead of an in-patient basis, cost effectiveness and better individual and social activities during the treatment period, it is suggested that LMWH at least be used in low-risk patients instead of intravenous heparin, also sparing them hospital admission.