equipoise definition

Possible symptoms of hemorrhagic syndrome. Treatment . Minor bleeding rarely require special treatment, a significant (at the risk of thrombosis) – may require the assignment of protamine sulfate..

Interaction with other drugs
bemiparin sodium should not be mixed in the same container with other drugs for parenteral administration.
Do not co-administration of sodium bemiparin is recommended with vitamin K antagonists and other anticoagulants, acetyl salicylic acid and other salicylates and equipoise definition, ticlopidine, clopidogrel and other aggregation inhibitors platelets, and systemic glucocorticosteroids dextran due to potentiation of the pharmacological action of bemiparin sodium and increased risk of bleeding. In the case of inevitability appropriate combination therapy bemiparin sodium should be used under close clinical and laboratory control.
Concomitant use of drugs that increase the concentration of potassium in serum, also need to be carried out only under careful medical supervision.
The use of sodium bemiparin, as well as other drugs heparin, together with nitroglycerin intravenous reduces the efficiency of the anticoagulant.

 

special instructions

Bemiparin sodium can not be administered intramuscularly.
In order to avoid the risk of hematoma during therapy with  not be used by the intramuscular route of administration other drugs.
Various low molecular weight heparins do not always have equivalent activity, so for each drug in this class is necessary to observe specific dosage regimen and the method of application.
bemiparin sodium, as well as other low molecular weight heparins can suppress adrenal secretion of aldosterone, which may cause hyperkalemia, especially in patients with diabetes mellitus, chronic renal insufficiency prior metabolic acidosis, increased concentration of potassium in plasma or in patients taking potassium-sparing drugs. The risk of hyperkalemia is increased in proportion to the duration of therapy, but such hyperkalemia is usually reversible. In high-risk patients before starting therapy with equipoise definition is necessary to determine plasma electrolytes and regular monitoring of the relevant indicators in the course of treatment, especially if the duration of therapy with more than seven days.
In rare cases at the beginning of heparin therapy, observed a light transient thrombocytopenia type I , associated with temporary platelet activation.

Side effect:

). This reaction generally occurs between 5 and 21 th days of therapy. In patients with heparin-induced thrombocytopenia in the history of this complication can develop at an earlier date.
It is recommended that platelet counts before starting therapy with equipoise definition the first day of therapy, then – on a regular basis with 3-4 day intervals and at the end of therapy with . In the event of a significant reduction in the number of platelets (from 30 to 50%), coupled with positive or unknown results of studies in vitro for the presence of anti-platelet antibody in the presence of sodium bemiparin or other low molecular weight heparins and / or heparins, you should immediately discontinue therapy drug equipoise definitionand assign alternative treatment.
As with other heparins appointment, the application of sodium bemiparin cases of skin necrosis have been observed, sometimes preceded by redness or painful erythematous patches.

equipose

General surgical intervention with a moderate risk of venous thromboembolism in surgery day is introduced in  antifactor-Ha 2 hours before or 6 hours after surgery. In the days that followed introduced by antifactor Ha every 24 hours. To complete this dosing regimen is necessary to use the drug equipose. Orthopaedic surgery with high risk of venous thromboembolism in surgery day administered antifactor  before or after 6 hours after surgery. In the days that followed introduced . Preventive treatment should be carried out by a physician for at least 7-10 days, and after surgery until the reduce the risk of thromboembolic complications or to complete patient mobilization.

Thromboembolism prophylaxis in patients without surgery The recommended daily intake of sodium bemiparin -. 2500 or 3500 IU, depending on the degree of risk of thromboembolism Prophylactic treatment should be carried out by a physician during the risk period of thromboembolism, or to complete patient mobilization. Secondary prevention of recurrence of venous thromboembolism in patients with deep vein thrombosis and transient risk factors sodium Bemiparin can be administered in a daily dose of  to patients receiving anticoagulant therapy against deep vein thrombosis with pulmonary embolism or without, as a therapeutic alternative to oral anticoagulation treatment, or in cases where past contraindicated. Duration of treatment – no more than 3 months. prevention of clotting in the extracorporeal circulation system during hemodialysis in patients undergoing repeated hemodialysis sessions lasting no more than 4 hours, provided there is no risk of bleeding, blood clotting prevention in the extracorporeal blood circulation system dialysis process is achieved by a single dose in the form of a bolus injection into the arterial tree at the beginning of the dialysis session. A single dose for patients weighing less  equipose, for patients weighing  Correction dose for elderly patients is not required. The data allows us to give recommendations for correction doses of sodium bemiparin for patients with hepatic impairment and kidney are not available. Dosing (technique of subcutaneous injection) syringes ready for immediate use and does not require sterilization. The drug is injected into the subcutaneous layer of the abdomen anterolateral or posterolateral lumbar region (waist), alternately with the right and left sides. The needle is inserted to the full depth perpendicularly (vertically), rather than at an angle in the skin fold formed by the thumb and forefinger. Folds of skin do not straighten, holding it up to completion of the injection. Injection site does not rub!

 

Side effect:

The most frequently reported side effect is hematoma and / or ecchymosis at the injection site (about 15% of patients).
The long-term heparin therapy can lead to the development of osteoporosis.
The frequency of side effects in the appointment of sodium bemiparin corresponds to that reported for other low molecular weight heparins, and is given below : Very frequent equipose). ecchymosis at the injection site frequent ( > 1/100 <1/10) pain and hematoma at the injection site bleeding (in the skin, mucous membranes, wounds, gastrointestinal tract , urinary tract), a slight transient increase in transaminases  and equipose.

 

boldenone undecylenate

Reduced blood clotting influenced bemiparin sodium due to the fact that it enhances the inhibitory effect of antithrombin III to several blood clotting factors boldenone undecylenate.

Pharmacokinetics
Absorption and elimination kinetics of the drug described by a linear 1st order. Absorption : after subcutaneous injection of bemiparin sodium is rapidly absorbed, bioavailability of 96%. Maximum antifactor-Xa activity in plasma upon administration of the drug in prophylactic with peak activity of the order / ml, respectively. Antifactor-IIa activity when administered at the above doses of the drug can not be detected. Maximum  activity in plasma of the drug when administered at therapeutic  and  is achieved in 3-4 hours with peak activity of the order  and , respectively. Antifactor-IIa activity of about was detected upon administration of the drug at the following doses:.  and boldenone undecylenate Elimination : when administered at a dose of bemiparin sodium  is approximately 5-6 hours, and the drug administered 1 time per day. currently, the data describing the ability of sodium bemiparin bind to plasma proteins, its metabolism and excretion in humans is not available.

 

Indications for use:

  • Prevention of thromboembolism in patients undergoing general surgical interventions and orthopedic surgery;
  • thromboembolism prophylaxis in patients with high or moderate risk of thrombosis (without surgery);
  • secondary prevention of venous thromboembolism recurrence in patients with deep vein thrombosis and transient risk factors;
  • prevention of clotting in boldenone undecylenate the extracorporeal circulation system during hemodialysis.

 

Contraindications:

  • Hypersensitivity to bemiparin sodium, heparin or processed products organs of pigs;
  • thrombocytopenia confirmed or suspected of thrombocytopenia caused by heparin immunologically with a history;
  • active bleeding or bleeding disorder;
  • severe liver and pancreas;
  • trauma or surgery in the central nervous system, organs of vision and hearing;
  • syndrome, disseminated intravascular coagulation heparin induced within thrombocytopenia;
  • Acute bacterial endocarditis and endocarditis protracted;
  • organic disorders with increased risk of bleeding (active peptic ulcer, haemorrhagic stroke, cerebral aneurysm or cerebral neoplasms);
  • childhood.

Precautions :

  • hepatic or renal failure;
  • uncontrolled hypertension;
  • gastric ulcer and duodenal ulcer in the anamnesis;
  • urolithiasis disease;
  • iris and retina disease;
  • during spinal or epidural anesthesia and / or lumbar puncture.

Pregnancy and lactation
In the absence of reliable clinical boldenone undecylenate evidence supporting the safety of drugs in pregnancy, use pregnancy should only be if the expected benefit to the mother outweighs the potential risk to the fetus.
It is not known whether breast drug is released milk, so if you must  lactation, breast-feeding for a period of the drug should be discontinued.

 

eq steroid

This reaction generally occurs between 5 and 21 th days of therapy. In patients with heparin-induced thrombocytopenia in the history of this complication can develop at an earlier date.
It is recommended that platelet counts before starting therapy with eq steroid, the first day of therapy, then – on a regular basis with 3-4 day intervals and at the end of therapy with . In the event of a significant reduction in the number of platelets (from 30 to 50%), coupled with positive or unknown results of studies in vitro for the presence of anti-platelet antibody in the presence of sodium bemiparin or other low molecular weight heparins and / or heparins, you should immediately discontinue therapy  and assign alternative treatment.
As with other heparins appointment, the application of sodium bemiparin cases of skin necrosis have been observed, sometimes preceded by redness or painful erythematous patches.

Side effect:

). In such cases, drug therapy eq steroid should be discontinued immediately.
Prophylactic use of heparin in combination with epidural or spinal anesthesia or lumbar puncture, in rare cases can lead to the development of an epidural or spinal hematoma, resulting in prolonged or sustained paralysis may develop (see.

Side effect:

The risk of hematomas is increased by using the epidural or spinal catheter for anesthesia, with the concomitant use of drugs affecting coagulability of blood such as nonsteroidal anti-inflammatory drugs (NSAIDs), platelet aggregation inhibitors or the anticoagulants (see. Interaction with other drugs ), and in traumatic or repeated puncture.
when deciding on the time interval between the last heparin administration at prophylactic doses and the introduction or removal of an epidural or spinal catheter should be considered characteristic of the drug and the patient’s profile. After removal of the catheter following the dose of sodium bemiparin may be administered no earlier than 4 hours and only after completion of the surgical procedure.
The decision on the appointment of anticoagulant therapy in the context of epidural or spinal anesthesia is necessary to use extreme caution, including frequent monitoring to detect signs and symptoms of neurological disorders such as back pain, violation of sensitivity eq steroid and motility (numbness and weakness of the lower limbs) and bowel dysfunction and bladder. Nursing staff should be trained to identify these signs and symptoms. Patients should be instructed as to the need for immediate information nurses or doctors in the event of these symptoms.
If you suspect the presence of an epidural or spinal hematoma is urgently needed to establish a diagnosis of the adoption of therapeutic measures, up to the medullary decompression.

Effects on ability to drive vehicles and management mechanisms
The drug does not affect the ability to drive vehicles and management mechanisms.

boldenone

Possible symptoms of hemorrhagic syndrome. Treatment . Minor bleeding rarely require special treatment, a significant (at the risk of thrombosis) – may require the assignment of protamine sulfate (protamine sulfate leads to a partial reduction in boldenone activity bemiparin sodium 2 hours after intravenous administration at a dose of 1.4 mg / 100 IU ).

Interaction with other drugs
bemiparin sodium should not be mixed in the same container with other drugs for parenteral administration.
Do not co-administration of sodium bemiparin is recommended with vitamin K antagonists and other anticoagulants, acetyl salicylic acid and other salicylates  ticlopidine, clopidogrel and other aggregation inhibitors platelets, and systemic glucocorticosteroids dextran due to potentiation of the pharmacological action of bemiparin sodium and increased risk of bleeding. In the case of inevitability appropriate combination therapy should be used under close clinical and laboratory control sodium bemiparin.
Concomitant use of drugs that increase the concentration of boldenone potassium in serum, also need to be carried out only under careful medical supervision.
The use of sodium bemiparin, as well as other drugs heparin, together with nitroglycerin intravenous reduces the efficiency of the anticoagulant.

 

special instructions

Bemiparin sodium can not be administered intramuscularly.
In order to avoid the risk of hematoma during therapy  not be used by the intramuscular route of administration other drugs.
Various low molecular weight heparins do not always have equivalent activity, so for each drug in this class is necessary to observe specific dosage regimen and the method of application.
bemiparin sodium, as well as other low molecular weight heparins can suppress adrenal secretion of aldosterone, which may cause hyperkalemia, especially in patients with diabetes mellitus, chronic renal insufficiency prior metabolic acidosis, increased concentration of potassium in plasma or in patients taking potassium-sparing drugs. The risk of hyperkalemia is increased in proportion to the duration of therapy, but such hyperkalemia is usually reversible. In high-risk patients before starting therapy with boldenone is necessary to determine plasma electrolytes and regular monitoring of the relevant indicators in the course of treatment, especially if the duration of therapy with more than seven days.
In rare cases at the beginning of heparin therapy, observed a light transient thrombocytopenia type I (number of platelet – 100000-150000 / mm 3 ), associated with temporary platelet activation (see.

Side effect:

As a rule, such a condition does not cause complications and does not require discontinuation of therapy with boldenone
In the rare cases when heparin therapy is observed the development of severe immune thrombocytopenia type II with platelet counts significantly below.