Introduction

Several components of the haemostatic system are altered in sickle cell anaemia(SCA). The sum of these alterations is manifested as a state of hypercoagulability. Many therapeutic approaches including anticoagulants has been tried in managing the acute painful crisis of SCA along with the analgesics.

Aim

This trial aimed at assessing the efficacy and safety of low molecular weight heparin Tinzaparine (innohep®) as an adjuvant therapy in the management of acute painful vaso-occlusive crisis.

Material and Methods

This two arm pilot, randomised multi-centre controlled prospective trial has incorporated 253 patients admitted through emergency in acute painful crisis, with no other complications of SCA. Subjects were consecutively randomized to the study or control group. In the study group 127 patients (mean age 22,83 years) received tinzaparine 175 i.u, s.c once daily along with analgesics, while in the control group 126 patients (mean age 21,64 years) received placebo and the same analgesics. Subjects were followed for improvement using the numerical pain scale (NMS), assessing the number of days in which the patient experienced the severest degree of pain on the NMS, the hospitalization period, the duration of painful crisis, and the rate at which the pain intensity declined over time. The maximal treatment period was seven days. The complications encountered are treated and estimated in both groups. The results were analysed using “SSPS-V10” statistical tests

Results

The results displayed in the table.1 showed statistically significant reduction in the duration of morbidity in the study group. The drop in the pain intensity is sharper, and the complications experienced in the study group were two events of minor bleeding treated conservatively.

PatientControl
No. of days with severest pain score on the NMS (Days) 1,28 1,74 
Duration of painful crisis(Days) 2,57 4,35 
Total duration of hospitalization(Days) 7.08 12,06 
PatientControl
No. of days with severest pain score on the NMS (Days) 1,28 1,74 
Duration of painful crisis(Days) 2,57 4,35 
Total duration of hospitalization(Days) 7.08 12,06 
View Large

Conclusion

The results indicate a favourable outcome in the study group compared to the control group. The use of tinzaparine in the acute painful crisis of SCA as an adjuvant to the strong analgesics is recommended due to its proven efficacy and safety in shortening the period of the agonizing pain at presentation, the period of painful crisis and the hospital stay.

Topics:
pain, sickle cell anemia, vaso occlusive crisis, analgesics, adjuvant therapy, anticoagulants, hemorrhage, hemostatics, immunologic adjuvants, length of stay

Author notes

Corresponding author

2005, The American Society of Hematology
2005
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