Background: In spite of using anticoagulant drugs such as unfractionated HEPARIN (UFH) and LOW MOLECULAR WEIGHT HEPARIN (LMWH) in the treatment of acute ischemic stroke, the efficacy of them has not been documented. Regarding to the frequent administration of these drugs, the evaluation of efficacy, advantages, and hazard of them is much important.Methods: We reviewed articles about this type of treatment including randomized clinical trials, meta-analyses, original articles, systematic reviews and review articles published in MEDLINE and EMBASE during 1997-2003.Results: In the short- and long- term folLOW up, UFH and LMWH don't result in considerable decreasing mortality, progression of stroke and early relapse risk. They don't result in considerable improvement in clinical and functional status of patients. In spite of considerable decreasing of deep vein thrombosis (DVT) and pulmonary emboli (PE) by administration of UFH and LMWH, it is established that they increase risk of intra- or hemorrhage. There is no valid document that immediate administration of anticoagulants (particularly intravenous and high dose) has helpful outcome. Conclusion: UFH and LMWH are not recommended in the majority of cases with stroke particularly during the first 24-48 hours of attach. Subcutaneous administration of UFH and LMWH is helpful in preventing DVT and PE, while they increase risk of systemic and intracranial hemorrhages. Immediate treatment is not recommended in any type of cerebrovascular accident (CVA).

Background: LOW MOLECULAR WEIGHT HEPARINs (LMWH) are an important new class of antithrombotic agents. They differ from Unfractionated HEPARIN (UFH) in having relatively more anti-Xa activity, and greater bioavailability at LOW doses. Larger half life alLOWs us to use it as a single dose therapy. Beneficial effect on dyslipidemia of hemodialysis also was noted. In this research we evaluated the efficacy of LMW HEPARIN, fragmin, on Partial Thromboplastin Time (PTT) during hemodialysis anticoagulation in comparison with UFH to recognize the rate of disturbance on PTT and its effect on dialysis adequacy.Subject and methods: This research was done in two steps, first with commercial HEPARIN, on 30 patients, by controlling PTT before, at first half an hour and at the end of dialysis session (three sample). At second step with fragmin and on 35 patients, sampling were the same. Also dialysis adequacy was measured by Urea Reduction Rate (URR) formula, and compared with dialysis adequacy of previous session. The desired URR is over 65%, so we divided the patients into two groups of over 65% and beLOW 65% and then we analysed the datas.Result: Analysing the datas showed that at first half and hour of hemodialysis the result of PTT disturbance with LOW-MOLECULAR WEIGHT HEPARIN was better (better anticoagulation), but at the end of dialysis there were no differences between two methods of anticoagulation. No significant association determined by the chi-square test.Conclusion: Comparing the dialysis adequacy with fragmin and unfractionated HEPARIN showed no difference and as a result, fragmin can induce an equal dialysis adequacy by inducing an adequate anticoagulation.

Background: LOW MOLECULAR WEIGHT HEPARIN (LMWH) is used for the treatment and prevention of coagulative disorders. Few patients receiving therapeutic doses of LMWH develop major hemorrhage. Currently there are few reports in the literature on acute overdose on adults. In this study, clinical profile, treatment and outcome of 21 patients who acutely overdosed enoxaparin are described.Methods: A retrospective chart review of California Poison Control System (CPCS) database: Visual Dot Lab during 1997 to 2007 was obtained. All patients with a definite reported overdose of subcutaneous injection of LMWH were included.Results: In total, 21 patients who were all exposed to enoxaparin were studied. The reasons for overdose included medical miscalculation (3 cases, all infants), intentional misuse (2 patients), accidental overdose (7 cases), suicidal attempt (7 cases) and unknown in 2 patients.7 cases were documented to have overdosed more than 2 times the therapeutic dose. The overdose ranged from 50 mg to 1300mg (0.1-80 times the therapeutic range). No patients were documented to experience bleeding or have thrombocytopenia although complete folLOW-up was only available for 11 patients.Reassurance was given to patients with less than 0.14 times the therapeutic dose. The 2 patients who received protamine were overdosed with more than 2.5 times the therapeutic dose of enoxaparin.Conclusion: Most patients had no complications and were not treated with protamine. This study suggests that a large dosage of LMWH is unlikely to result in any life threatening complications, though further studies are needed to certainly conclude about this. The use of protamine in LMWH overdose seems to remain controversial.

Background – LOW-MOLECULAR-WEIGHT HEPARIN (LMWH) has been shown to reduce the severity of postoperative inflammatory response. We decided to evaluate the specific effect of intraoperative LMWH in reducing the severity of postoperative inflammatory response after standard extracapsular cataract extraction and posterior chamber intraocular lens implantation in cases of phacomorphic glaucoma. Methods . In a randomized, double-blind, clinical trial, 46 eyes (23 case eyes and 23 control eyes) were operated on by a single surgeon. In the first group, 5 IU/mL LMWH (Fragmin) was added to the irrigating fluid. Intraoperative and postoperative hemorrhage, degree of postoperative inflammation, fibrin and posterior synechiae formation, pigment deposits on the intraocular lens surface, visual acuity and intraocular pressure (IOP) were evaluated. The control group underwent a routine conventional surgery. Results – The mean age was 68 years (standard deviation, 8.1; range, 63 . 79 yr). No statistically significant difference in age, sex, duration of operation and hospitalization, preoperative IOP, concurrent ocular and systemic illness, or smoking was found between the cases and controls. There was a statistically significant difference between the two groups in terms of density of cell and flare in anterior chamber, fibrin formation, pigment deposition over intraocular structure, and severity of postoperative inflammation. There was also a statistically significant difference in postoperative visual acuity between cases and controls (20/50 vs 20/125, respectively; p = 0.001). The incidences of intra- and postoperative hemorrhage were similar between the two groups (p = 1.0). Conclusion – LMWH can be used safely in patients with phacomorphic glaucoma. In this study, it was positively correlated with reduced postoperative inflammation and fibrin formation, and gave rise to better visual acuity.

Introduction: The aim of this study was to evaluate the effect of intraoperative LOW MOLECULAR WEIGHT (LMW) HEPARIN in reducing the severity of postoperative inflammatory response after standard extracapsular cataract extraction and PCIOL implantation in cases of phacomorphic glaucoma. Material and Method: In this randomized blind clinical trial 46 eyes (23 cases and 24 controls) were operated on by a single surgeon. In the cases, 5 IU/ml LMW HEPARIN (Fragmin) was added to irrigating fluid. Intraoperative and postoperative hemorrhage, degree of postoperative fibrin and postoperative synechinae formation, pigment deposits on the intraocular lens were evaluated in the both cases and controls. Results: Mean age was 68±8.1years. Male to female ratio was 1/2. Cases and controls were matched regarding age, sex, duration of operation and hospitalization, preoperative IOP, concurrent ocular or systemic disease and smoking. In the cases, there were significantly less cells, flare, fibrin, pigment deposits and inflammation. Final visual acuity was significantly (P< 0.001) better in case than control group (20/50 Vs 201125). Case and control groups were comparable regarding intraoperative and postoperative hemorrhage. Conclusion: the data indicate that adding 5 IU/ml LMW HEPARIN to the irrigating tluid during cataract surgery is safe, reduces postoperative fibrin formation and leads to better visual results in phacomorphic glaucoma.