Uso delle eparine a basso peso molecolare in chirurgia generale e d'urgenza

La Motta, B; Madonia, S

Research output: Contribution to conferencePaperpeer-review

Abstract

[automatically translated] Heparin is a mucopolysaccharide extracted from certain organs such as the lung, liver and intestinal mucosa and binds to the surface of endothelial cells. Its biological activity requires the presence of a plasma cofactor for protease inhibitory activity [Antithrombin III], which inhibits the protease coagulation factors forming with them equimolar stable complexes. In the absence of heparin, such reactions are slow, while on the contrary are accelerated by almost 1000 times. The heparin molecules are highly active and bind strongly to antithrombin, determining conformational alterations of the inhibitor: these changes expose its active site for faster interaction with the protease (activated by coagulation factors). Heparin catalyses antithrombin-protease reaction without being consumed, and after the formation of the complex, is made available again to bind to new Antithrombin. To better understand the action is necessary to know the genesis of the thrombus. The low molecular weight heparins are used for the prevention and treatment of thromboembolic disease, are administered by injection subcutaneously in specific areas of the body in a lying position preferibilmente.Tutte the low molecular heparins are not equal, however, at the Company Associated Hospitals Villa Sofia-Cervello for a corporate issue and manageability of the following molecules were purchased: nadroparin, enoxaparin, parnaparin, bemiparin. (Figure 2) in view of the opinion expressed by the Commission Technical - Scientific (CTS) of ' AIFA its meeting on 14 to 15 May 2013, which, after re-evaluated the pharmacokinetic and pharmacodynamic characteristics of heparins, limits the application of the PHT for heparins and low molecular weight heparin calcium to the sun signs: "Prophylaxis of thrombosis deep vein (DVT) and continuation of therapy is initiated in hospital after major orthopedic surgery who after major general surgery, "excluding from the PHT all other indications; Low molecular weight heparins are used for the prevention and treatment of thromboembolic disease, they are administered by subcutaneous inezione in specific areas of the body while lying down instead. In a sample of 80 patients; aged between 35-80anni, 50 are female and 30 are male sex; It was administered the low molecular weight heparin prophylactically to 22.00 on the day before the surgery in order to set up the best mode of treatment with fewer possible side effects. Below shows the annual average of vials used per molecule which shows that two of them are the most used: Nadro and enoxaparin; through direct observation of patients the following side effects have been highlighted regarding parnaparin and Bemiparin; bleeding gums when brushing teeth greater in elderly subjects, particularly heavy periods; excessive bleeding from cuts or minor injuries; hematomas in place of inezione. There were no side effects for the other two molecules (Table 1). The evidence found in this study show that with the administration of nadroparin and enoxaparin have never registered alterations of AP and PTT, with the administration rather than parnaparin and Bemiparin observe behavior of fibrinolytic kind by these heparins , decreased the AP and an increase in PTT
Original languageItalian
Publication statusPublished - 2013

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