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Biomedical subjects

A Kher

Publications and source records attributed to A Kher.

At least 19 recordsLinked to original sources
PubMed1991

[Heparin in the treatment and secondary prevention of myocardial infarction. A critical review of the main trials].

The aim of this article is to assess the therapeutic value of standard heparin in the acute phase and secondary prevention of myocardial infarction. Only clinical trials with an adequate methodology have been analysed. In patients having undergone thrombolytic therapy associated with aspirin, heparin slightly reduces the mortality but only during the period of its administration. In a metaanalysis of approximately twenty clinical trials of patients not receiving thrombolytic or aspirin therapy, heparin was associated with a significant reduction of deep vein thrombosis, pulmonary embolism, recurrent myocardial infarction and cerebrovascular accidents. In the context of secondary prevention of myocardial infarction, the administration of a moderate dose of subcutaneous heparin resulted in a beneficial effect on morbidity and mortality in one published trial. The use of low molecular weight heparins for the prevention of coronary thrombosis merits attention because of the pharmacological and pharmacokinetic properties of these products.

Cerebrovascular Disorders↗
PubMed1989

Effect of standard heparin and a low molecular weight heparin on thrombolytic and fibrinolytic activity of single-chain urokinase plasminogen activator in vitro.

The effect of unfractioned heparin (UH) and low molecular weight heparin (LMWH) (Kabi 2165 - Fragmin) on in vitro scu-PA thrombolytic and fibrinogenolytic activity was investigated. Thrombolytic activity was evaluated by following lysis of radiolabeled plasma clot immersed in plasma in presence of scu-PA alone or with either form of heparin. A 200 IU/ml scu-PA concentration produced clot lysis within 7 hr. UH or LMWH led to a slightly faster clot lysis which was statistically significant only at the 2nd and 3rd hour. No significant difference could be evidenced between UH and LMWH effect. During clot lysis, plasmin, generated within the clot led to a gradual transformation of scu-PA to tcu-PA, specially after a 4-hr incubation. Appearance of tcu-PA activity in the plasma surrounding the clot was significantly inhibited by either form of heparin. This finding contrasts with results observed in purified systems and suggests the presence of heparin-dependent plasma factor(s) inhibiting tcu-PA formation or its activity. Possible candidates might be anti-thrombin III and PAI-3. No fibrinogen breakdown was observed when plasma was incubated for 7 hr at 37 degrees C in presence of scu-PA alone (200 IU/ml) or with either form of heparin. However, in presence of a plasma clot, an important fibrinogen breakdown was observed during clot lysis reflecting the action of plasmin and/or tcu-PA generated within the clot, in the surrounding plasma. Fibrinogenolysis was less pronounced in the presence of both heparin preparations possibly as a consequence of the reduction in the tcu-PA level. These results underline the importance of plasma factors in the interaction of heparin with plasminogen activators such as scu-PA.

Fibrinogen↗
PubMed1989

Randomized trial of a low-molecular-weight heparin (Kabi 2165) versus adjusted-dose subcutaneous standard heparin in the prophylaxis of deep-vein thrombosis after elective hip surgery.

124 patients undergoing total hip replacement were randomly allocated to receive Kabi 2165, 2,500 anti-Xa units twice a day (group A); Kabi 2165, 2,500 anti-Xa units twice a day during the first 48 h postoperatively and then 5,000 anti-Xa units once a day (group B), or adjusted-dose standard heparin, monitored by activated partial thromboplastin time (group C). The first dose was given 2 h before surgery in the three groups. Deep-vein thrombosis (DVT) was detected by radiolabelled fibrinogen uptake and bilateral venography was performed in patients who had a positive scan. In patients who had a negative scan, bilateral venography was performed routinely the day before discharge from hospital. The frequency of DVT demonstrated by venography was 4.9% in group A, 7.3% in group B and 10% in group C. The difference between the three groups was not statistically significant. The incidence of proximal DVT was 2.4, 2.4 and 7.5%, respectively, for the three groups. There was no significant difference between the three groups with respect to mean estimated blood loss, the number of blood units transfused, wound hematoma formation, or hemoglobin and hematocrit levels.

Drug Evaluation↗
PubMed1989

Alpha-fetoprotein in germ cell tumors. An immunohistochemical study.

Total 40 cases of testicular and ovarian germ cell tumors and one case of extragonadal germ cell tumor were studied for the presence of alphafetoprotein (AFP) by indirect immunoperoxidase technique. All seminomas (7 cases) and teratomas (13 cases) were negative for AFP; while 85% of the pure embryonal carcinomas, (E.C.) all pure yolk sac tumors (Y.S.T.) (7 cases) and all embryonal carcinoma and yolk sac components in mixed tumors were AFP positive. Immunostaining of tumor marker appeared to help only in differentiating seminomatous and nonseminomatous tumors and hence does not provide any additional information for classification of these tumors.

Female↗
PubMed1988

Low dose heparin versus low molecular weight heparin (Kabi 2165, Fragmin) in the prophylaxis of thromboembolic complications of abdominal oncological surgery.

Eighty patients undergoing pelvic or abdominal surgery for cancer were randomized in two groups for prevention of postoperative thromboembolism: 40 patients received a 15,000 IU day-1 Calciparine prophylaxis and 40 patients a 5000 anti-Xa U/d Fragmin prophylaxis for 10 days. In the Calciparine group, two patients (5%) developed postoperative pulmonary embolism but none developed it in the Fragmin group. Two patients in the Fragmin group (5%) developed isotopic DVT, which was not confirmed by phlebography. There was no deep vein thrombosis of the lower limbs in the two groups. Important postoperative bleeding (one patient in the Calciparine group and two patients in the Fragmin group) was similar in both groups. Moderate and minor bleeding were significantly lower in the Fragmin group. Haemoglobin and haematocrit changes, total blood loss and transfusion requirements were not different in both groups. It is concluded that, over a 10-day period, one daily 5000 U Fragmin prophylaxis was as effective and safe as three daily 5000 IU Calciparine injections.

Abdominal Neoplasms↗
PubMed1987

[Comparison of the efficacy and tolerance of Kabi 2165 and standard heparin in the prevention of deep venous thrombosis in total hip prosthesis].

A series of 80 patients operated for total hip prosthesis under epidural anesthesia was randomly allocated to treatment with Kabi 2165 (n = 40): 2,500 U anti-Xa preoperatively and evening of operation and 2,500 U anti-Xa morning and evening daily up to the 9th or 10th day postoperatively, or standard heparin (n = 40): 3,750 U preoperatively and then 8 hourly, at a dose adjusted with thrombin time and cephalin + activator time, daily up to the 9th or 10th day. Phlebography was performed routinely on the 9th or 10th day. Venous thrombosis occurred in 7 patients (17.5%) in the Kabi 2165 group, including two high, potentially emboligenic, localizations (5%), and in 4 patients (10%) in the standard heparin group, including 2 potentially emboligenic clots (5%). The difference is not statistically significant (total number: p = 0.5; potentially emboligenic: p = 0.33). Pulmonary embolism did not occur. Overall tolerance, evaluated from hemoglobin and hematocrit values, intra- and post-operative bleeding and operation wound hematoma and at injection site was comparable in the two groups.

Aged↗
PubMed1987

[Biological criteria for the evaluation of prophylactic treatment with a low molecular weight heparin (Kabi 2165)].

Efficacy of a low molecular weight heparin (Kabi 2165) was compared with that of non-fractionated heparin in the prevention of abdominal surgery postoperative venous thrombosis by means of a double-blind randomized trial in 79 patients. Determination of D. dimers in these patients allowed assessment of specificity of this assay for detection of postoperative venous thrombosis.

Abdomen↗
PubMed1986

[Low molecular weight heparins].

Heparin is a heterogeneous component consisting of anionic polysaccharides chains of variable molecular weight ranging from 3 000 to 40 000 daltons. It is by potentiating antithrombin III (AT III) a natural inhibitor of coagulation, that heparin exerts its anticoagulant effect. Actually, it has been demonstrated that only 30% of the molecule in commercial heparin preparations are capable of binding to AT III: moreover, several procedures were used to prepare low molecular weight heparin fractions or fragments. These preparations were lacking in ability to prolong the clotting time (APTT) and to inhibit thrombin, but were capable of potentiating the inhibition of factor Xa. The hypothesis that low molecular weight heparins may exhibit antithrombotic effect by inhibition the coagulation cascade system at the initial stages is very attractive. Moreover, on animal models, heparin fractions with molecular weight less than 3 000 had limited ability to prevent experimental thrombosis despite good anti-Xa activity. Thus, the anti-Xa activity did not alone reflect the antithrombotic effect. Experimental studies have shown less bleeding with low molecular weight heparins compared to standard heparin. Some data have suggested other properties of low molecular weight heparins such as enhancement of fibrinolysis and a slighter effect on platelets. The risk of thrombocytopenia induced heparin could be reduced by the use of low molecular weight heparins. The pharmacokinetics of low molecular weight heparins have been studied in human subjects. A higher bioavailability and a longer duration of action were reported compared to heparin. Preliminary clinical trials have shown that one daily injection is sufficient to protect against post-operative thrombosis.

Animals↗
PubMed1986

[Thrombolytic treatment in the acute phase of myocardial infarction. Evaluation in 1986].

Fibrinolytic therapy is effective in reducing the extent of myocardial infarction by lysing intracoronary clots. An overview of twelve trials of prolonged intravenous infusion of SK showed a highly significant reduction in short term mortality. Intra coronary SK infusion achieved reperfusion of the coronary artery in 60 to 90 p. 100 of patients and improvement of left ventricular function was reported. Mortality was also significantly reduced at 6 months. The frequency of bleeding was relatively low and ventricular arrhythmias were not a serious problem. High dose brief duration intravenous SK therapy achieved reperfusion of the occluded coronary artery in 44 to 60 p. 100 of patients. Left ventricular function was also improved. An Italian multicentre trial has shown a significant decrease in the overall hospital mortality of a randomized population. There is no evidence that UK was more effective than SK. New fibrinolytic agents (T-PA, acylated SK-plasminogen activator), with more fibrin specific activity, were successful in inducing coronary thrombolysis in patients with acute myocardial infarction. The rate of reocclusion was about 20 p. 100 and additional stabilising procedure (percutaneous transluminal coronary angioplasty) was necessary in many patients.

Fibrinolytic Agents↗