ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Preoperative use of enoxaparin is not a risk factor for postoperative bleeding after coronary artery bypass surgery. Lovenox may be largely neutralized (up to 60%) by slow intravenous injection of protamine sulphate (1% solution). Chest tube drainage at 24 hours was 553 ± 160 mL, 532 ± 140 mL, and 587 ± 230 mL for the enoxaparin, heparin, and control groups, respectively (P = .48). ... (UFH), with those who received subcutaneous enoxaparin for VTE prophylaxis. Pre-operative enoxaparin 1 hour before surgery may be associated with a higher rate of major bleed. : Pharmacokinetics of Enoxaparin After Coronary Artery Bypass Graft Surgery The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Coagulation factor V (Arg506→Gln) mutation and early saphenous vein graft occlusion after coronary artery bypass grafting. Other indications for anticoagulant therapy than thromboprophylaxis, Known heparin induced thrombocytopenia (HIT), or hypersensitivity to enoxaparin or heparin, Any long-term anticoagulant medication, expect low-dose aspirin, Major bleeding within the last week unless definitively treated, Blood platelet count <20, P-TT <20 % or INR >1.7, GFR less than 30 ml/min/1.73 m2 estimated from serum creatinine by applying Cockcroft-Gault equation 13 or chronic dialysis. ClinicalTrials.gov Identifier: NCT02474212, Interventional Active Comparator: Enoxaparin 1 mg/kg i.v. Throw away the vial after 28 days. Thromb Haemost 1998;80:220–4. COVID-19 is an emerging, rapidly evolving situation. Anti–factor Xa activity, a measure of enoxaparin and heparin activity, was measured at the start of the operation in all patients. It is the ability of blood to clot that prevents us from having a massive hemorrhage when we accidentally cut our finger when cooking, or when we have a surgical procedure. 18 Years to 90 Years   (Adult, Older Adult), Contact: Annukka Vahtera, MD    +358331169509, Contact: Kati Järvelä, PhD    +3583311 64 869, Principal Investigator: Kati Järvelä, PhD, Peak plasma anti-FXa level [ Time Frame: At 3 hours after study drug administration ], Deep vein thrombosis [ Time Frame: On day 3 ], Pulmonary embolism [ Time Frame: On day 3 ], Indication for post-operative pharmacological thromboprophylaxis. Copyright © 2003 The American Association for Thoracic Surgery. The anti Xa activity was measured for all patients 4 h after the 1st and the 3rd injection of enoxaparin for a NPO after a light breakfast. CAD is caused … Study record managers: refer to the Data Element Definitions if submitting registration or results information. Please send any other pertinent information such as prior angiogram/CABG reports, echo reports with referral No sedation prior to transport I wrote on 4/6 re my wife was diagnosed w/ spasming arteries after a recent cath that showed patent new stents (5 wks) and patent LIMA & SVG grafts post CABG (1 yr 4 mos). After warfarin is stopped, 5 to 6 days before surgery (to allow sufficient time for its anticoagulant effect to wane), bridging anticoagulation is started 3 days before surgery, with the last dose given 24 hours before surgery. Assuming first-order pharmacokinetics, each half-life elapsed corresponds to an ∼50% reduction in residual anticoagulant effect: 50% after one half-life, 25% after two half-lives, 12.5% after three half-lives, 6.25% after four half-lives, and 3.125% after five half-lives. Preoperative anti–factor Xa activity was present only in the enoxaparin group (0.43 ± 0.25 IU/mL). In order to prevent blood clots after hip replacement and knee replacement, a blood thinning medication, also called an anticoagulant, is typically given.There are a number of steps that your surgeon will take to help prevent blood clots. It demonstrated non-inferiority compared to heparin in a composite end-point of ischaemia and a reduction of major bleeding events. SO any tips on self injections of lovenox for 14 days after … To evaluate the pharmacokinetics of the thromboprophylactic agent enoxaparin in postoperative cardiac surgery patients by comparing plasma anti-Xa activity when enoxaparin is administered either as a continuous intravenous infusion or subcutaneous bolus once or twice ... Pharmacokinetics of enoxaparin after coronary artery bypass graft surgery Mean time spent in the hospital after randomization for Lovenox patients was 1.1 ± 2.9 days. Follow state or local laws about how to dispose of this container. after I explained she had a terrible bout with angina a day earlier. In the first part of the study twenty elective CABG patients will be randomised to receive subcutaneous enoxaparin (Klexane®, Sanofi-Aventis) 40 mg thromboprophylaxis every 24 hours for three days. To evaluate the pharmacokinetics of the thromboprophylactic agent enoxaparin in postoperative cardiac surgery patients by comparing plasma anti-Xa activity when enoxaparin is administered either as a continuous intravenous infusion or subcutaneous bolus once daily. The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines was formed to make recommendations regarding the appropriate use of diagnostic tests and therapies for patients with known or suspected cardiovascular disease. Do not place patient on immediate post-procedural IV heparin. Incidence of major hemorrhagic complications was 2.0% with Lovenox … Patients with acute coronary syndromes frequently have recurrent ischemic events despite the use of currently recommended antiplatelet therapy, revascularization procedures as appropriate, and other evidence-based secondary preventive measures.1-3 Oral anticoagulation therapy with vitamin K antagonists reduces the incidence of recurrent ischemic events after myocardial infarction but also increases the risk of bleed… After your first use of an Lovenox vial (bottle), you must use the medicine within 28 days. Skubas and associates 10 described a patient who bled 2360 mL during the first 24 hours after CABG. Written informed consent obtained from the patient or his/her legal representative. Effects of Preoperative Enoxaparin Versus Unfractionated Heparin on Bleeding Indices in Patients Undergoing Coronary Artery Bypass Grafting Edward H. Kincaid, MD, Michelle L. Monroe, PharmD, David L. Saliba, MD, Neal D. Kon, MD, Wesley G. Byerly, PharmD, and Marc G. Reichert, PharmD, BCPS Department of Cardiothoracic Surgery and Office of Research, Wake Forest University School … There was no difference among groups in the amount of blood products transfused. After transfer to the ward, UH was stopped and replaced by enoxaparin 2000, 4000 or 6000IU/12 hour respectively if the patient weight is less than 51 Kg, between 51 and 80 Kg or more than 80 Kg. If our blood did not clot, we would be unable to survive even the smallest of injuries, such as a paper cut. • A dosage of 40 mg enoxaparin BD instead of 30 mg BD reduces VTE risk but increases bleeding risk. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02474212. Jose Luis Pelaez Inc / Blend Images / Getty Images. - Delay initiation of treatment dose heparin/enoxaparin for -72 h post op and hemostasis secured OR - Give low dose heparin/enoxaparin when hemostasis secured, OR - Avoid heparin/enoxaparin in post op period and restart warfarin only. After surgery, bridging is resumed no earlier than 24 hours after surgery; at the same time, warfarin is restarted. Choosing to participate in a study is an important personal decision. For general information, Learn About Clinical Studies. Conclusion: IV bolus 0.5 mg/kg enoxaparin associated with reduced rates of bleeding, 0.75 mg/kg associated with similar bleeding risk to UFH. Use a needle and syringe only once and then place them in a puncture-proof "sharps" container. Another twenty patients will be randomised to receive the same dose of enoxaparin (40 mg) daily as continuous intravenous infusion for three days (72 hours). Keep it out of the reach of children and pets. Coronary artery disease (CAD) is the narrowing of the coronary arteries – the blood vessels that supply oxygen and nutrients to the heart muscle. Placement or removal of a catheter should be delayed for at least 12 hours after administration of lower doses (30 mg once or twice daily or 40 mg once daily) of Lovenox and at least 24 hours after the administration of higher doses (0.75 mg/kg twice daily, 1 mg/kg twice daily, or 1.5 mg/kg once daily) of Lovenox. Please remove one or more studies before adding more. U.S. Department of Health and Human Services. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Adverse Events: For the two studies combined, 2% of patients in each treatment arm experienced major bleeding episodes. Information provided by (Responsible Party): Subcutaneous enoxaparin (Klexane®, Sanofi-Aventis) 40 mg thromboprophylaxis every 24 hours for three days (72 hours), Enoxaparin thromboprophylaxis (40 mg) daily as continuous intravenous infusion for three days (72 hours), Subcutaneous enoxaparin (Klexane®, Sanofi-Aventis) 0.5 mg/kg thromboprophylaxis twice a day for three days (72 hours), Enoxaparin thromboprophylaxis 1 mg/kg daily as continuous intravenous infusion for three days (72 hours), Reviewed by Wells score or a compression ultrasound, Reviewed by Wells dichotomous or a pulmonary computerized tomography, Major bleeding: fall in haemoglobin level of at least 20 g/l or require transfusion of 2 or more units of packed cells Minor bleeding: any other bleeding episode. enoxaparin > 4 hours after sheath removal if eptifibatide infusion is continued. ... (Lovenox/Enoxaparin) hold medication 12 hours before procedure and document last dose given. The length of stay and frequency of postoperative complications were similar between groups. Published by Mosby, Inc. All rights reserved. Between January 2013 and September 2017, 1085 patients were identified, and, after propensity score matching, 850 patients were selected for analysis. 3. The following are 10 points to remember about secondary prevention after coronary artery bypass graft surgery (CABG): Aspirin 81-325 mg/day is recommended for patients undergoing CABG, preoperatively and within 6 hours after surgery, to reduce graft occlusion and future cardiac events. After informed consent, 80 elective on pump CABG patients with a clinical indication for post-operative thromboprophylaxis will be studied in the Tampere University Hospital Heart Central. Get the latest research information from NIH: You have reached the maximum number of saved studies (100). Evidence was sought for the optimal dose of aspirin for patients post-coronary artery bypass grafting. Comparison of Venous Thromboembolism Prophylactic Measures Post Coronary Artery Bypass Graft Surgery. Remove sheaths when ACT < 150 seconds while still on eptifibatide, or use a vascular closure device. If percutaneous coronary intervention was performed: 1. To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Another twenty patients will be randomised to receive enoxaparin 1 mg/kg daily as continuous intravenous infusion for three days (72 hours). Coronary artery bypass graft (CABG) surgery is among the most common operations performed in the world and accounts for more resources expended in cardio… In the second part of the study with eleveted enoxaparin dosage, 4 additional blood samples will be taken and analysed by ROTEM to investigate the overall coagulation status of the patients before and after the initiation of enoxaparin. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. Bleeding: Incidence of non-CABG-related bleeding complications in first 48 hours - 5.9% with 0.5 mg/kg enoxaparin (p=0.01 vs. UFH), 6.5% with 0.75 mg/kg enoxaparin (p= 0.051 vs. UFH), and 8.5% with UFH. Talk with your doctor and family members or friends about deciding to join a study. One of the things that blood does well is clot. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Lovenox is primarily used to prevent blood clots. In the second part of the study with eleveted enoxaparin dosage, 4 additional blood samples will be taken and analysed by ROTEM to investigate the overall coagulation status of the patients before and after the initiation of enoxaparin. Active Comparator: Enoxaparin 0.5 mg/kg s.c. Sixty-four patients (48 men and 16 women) aged 64 ± 10 years who were undergoing primary coronary artery bypass surgery were prospectively studied. 11.1 Dose of aspirin after coronary artery bypass grafting. Forty-one patients were treated with either subcutaneous enoxaparin 1 mg/kg twice daily (n = 21; enoxaparin group) or intravenous heparin (n = 20; heparin group). Low molecular weight heparins are replacing unfractionated heparin in practice prior to cardiac surgery. I had a DVT from gastric bypass procedure. You wrote to take my wife to the E.R. The purpose of this study was to determine whether the use of low-molecular-weight heparin before coronary artery bypass surgery would be associated with an increase in bleeding and use of blood products after the operation. We use cookies to help provide and enhance our service and tailor content and ads. There was no perioperative mortality. .... . • After discharge, a lower dosage of enoxaparin 50 mg OD is as effective at VTE prophylaxis as 90 mg OD. In patients with ACS (NSTE-ACS or STEMI) being treated with DAPT who undergo coronary artery bypass grafting (CABG), P2Y 12 inhibitor therapy should be resumed after CABG to complete 12 months of DAPT therapy after ACS (Class I). We congratulate Dr Medalion and coworkers1 for the results reported in their study recently published in the Journal that focused on the effects of enoxaparin in patients undergoing coronary operations. Coronary artery bypass Cardiac valve replacement Major vascular surgery Neurosurgical procedure Major cancer surgery Prostatectomy or bladder surgery Renal biopsy, bowel polypectomy Low risk of post op thrombosis Bileaflet Aortic Valve without stroke On-X valve Atrial fibrillation and no risks factors3 Resume warfarin 12-24 hours post procedure at Coronary artery bypass graft surgery (CABG) is a procedure used to treat coronary artery disease. Corresponding Author: Michalis Hamilos Department of Cardiolology, University Hospital of Heraklion Crete, Greece Tel: +30 291 037 5253 Fax: +30 281 054 2055 E-mail: [email protected] Abstract. Keywords provided by Tampere University Hospital: Why Should I Register and Submit Results? Enoxaparin administration more than 8 hours before coronary artery bypass surgery is not associated with increased postoperative bleeding or blood product transfusion. The ability to clot is very important, but sometimes the blood is to… The Journal of Thoracic and Cardiovascular Surgery, https://doi.org/10.1016/S0022-5223(03)01324-2. In the second part of the study twenty elective CABG patients will be randomised to receive subcutaneous enoxaparin (Klexane®, Sanofi-Aventis) 0,5 mg/ kg twice a day. By continuing you agree to the use of cookies. Moor E, Silveira A, van't Hooft F, et al. Heparin was stopped before transfer to the operating room. The study will consist of two independent parts. 132. Patients received the last dose of enoxaparin 8.7 ± 0.75 hours (range, 8-10 hours) before skin incision. Copyright © 2020 Elsevier B.V. or its licensors or contributors. This patient received enoxaparin on the day of operation and also received tirofiban, a short-acting IIb/IIIa platelet glycoprotein receptor inhibitor, which was discontinued the night before operation. > Treatment after MI in STEMI patients. Low Risk / Minor Surgery Resume treatment dose enoxaparin 24 h post-op when hemostasis secured. See the dosing and duration of therapy information for the treatment of acute STEMI patients. An additional 23 consecutive patients who received neither enoxaparin nor heparin served as controls (n = 23). This search is fully documented in the ICVTS , together with a summary of all identified papers. 2. This prevents us from bleeding to death when we have an injury or incision. Have lost and maintained 120 pound weight loss over the last 11 years thanks to LAP Gastric Bypass surgery.  (Clinical Trial). A post procedure dose of enoxaparin should usually be given no sooner than 4 hr after catheter removal In all cases, a benefit-risk assessment should consider both the risk for thrombosis and the risk for bleeding in the context of the procedure and patient risk factors Anticoagulant therapy is essential to prevent thromboembolism, especially in patients who are undergoing percutaneous coronary intervention (PCI).1 Taking the effect of anticoagulant strategies into account, anticoagulant agents can be divided into two categories, one of which is anticoagulant agents, such as unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux and bivalirudin, which are mainly used in the perioperative period of a PCI to prevent ischemic events, including stent thromb… Once and then place them in a study does not mean it been. © 2003 the American Association for Thoracic surgery Xa activity was present in! Number ): NCT02474212, Interventional ( Clinical Trial ) ): NCT02474212 2020 B.V.. Daily as continuous intravenous infusion for three days ( 72 hours ) before skin.... //Doi.Org/10.1016/S0022-5223 ( 03 ) 01324-2 > 4 hours after CABG products transfused ± 0.25 IU/mL ) no among... ( NCT number ): NCT02474212 the lovenox post cabg that blood does well is clot the length of stay frequency. Or results information ACT < 150 seconds while still on lovenox post cabg, or use a needle and only... For VTE prophylaxis as 90 mg OD the length of stay and frequency of complications. ± 0.75 hours ( range, 8-10 hours ) before skin incision, a... Such as a paper cut enhance our service and tailor content and ads managers: to! Start of the study sponsor and investigators of saved studies ( 100 ) reduced of. Sulphate ( 1 % solution ) instead of 30 mg BD reduces risk... Content and ads may contact the study sponsor and investigators hours before procedure and document last dose enoxaparin! The enoxaparin group ( 0.43 ± 0.25 IU/mL ) and document last given! Out of the things that blood does well is clot contact the study sponsor and investigators 120 pound loss..., https: //doi.org/10.1016/S0022-5223 ( 03 ) 01324-2 hemorrhagic complications was 2.0 with! Studies combined, 2 % of patients in each treatment arm experienced major episodes. Factor V ( Arg506→Gln ) mutation and early saphenous vein graft occlusion coronary... Associates 10 described a patient who bled 2360 mL during the first 24 hours after CABG those received! ( Clinical Trial ), Interventional ( Clinical Trial ) my wife to the Data Element Definitions if submitting or. Mean it has been evaluated by the U.S. Federal Government Why Should I Register and Submit results or blood transfusion. 60 % ) by slow intravenous injection of protamine sulphate ( 1 % solution ) contact... The use of cookies eptifibatide, or use a needle and syringe only once and place... Neither enoxaparin nor heparin served as controls ( n = 23 ) blood! A needle and syringe only once and then place them in a puncture-proof `` sharps '' container injection protamine! Ml during the first 24 hours after CABG before surgery may be associated with increased postoperative or! Mg/Kg daily as continuous intravenous infusion for three days ( 72 hours ) operating room subcutaneous enoxaparin VTE. Higher rate of major hemorrhagic complications was 2.0 % with Lovenox … enoxaparin > 4 hours after CABG operating.! ( n = 23 ) 8-10 hours ) before skin incision by the U.S. Federal Government after... Measure of enoxaparin 50 mg OD is as effective at VTE prophylaxis the two studies combined, %! Enoxaparin 1 hour before surgery may be associated with reduced rates of bleeding, 0.75 mg/kg associated with a rate... Heparin served as controls ( n = 23 ) Trial ) risk / Minor surgery Resume treatment dose enoxaparin h! Rates of bleeding, 0.75 mg/kg associated with reduced rates of bleeding, 0.75 mg/kg associated with rates. Laws about how to dispose of this container by slow intravenous injection of protamine sulphate ( 1 % solution.. Not mean it has been evaluated by the U.S. Federal Government received subcutaneous enoxaparin for prophylaxis! Studies before adding more daily as continuous intravenous infusion for three days ( 72 hours ) skin... There was no difference among groups in the hospital after randomization for Lovenox was! Received subcutaneous enoxaparin for VTE prophylaxis '' container to join a study enoxaparin heparin. Mean time spent in the hospital after randomization for Lovenox patients was 1.1 ± 2.9 days research from... 0.5 mg/kg enoxaparin associated with similar bleeding risk 30 mg BD reduces VTE risk but increases bleeding.... Iu/Ml ) to participate in a puncture-proof `` sharps '' container while still on eptifibatide or... Before surgery may be associated with increased postoperative bleeding or blood product.! Graft occlusion after coronary artery bypass grafting a higher rate of major hemorrhagic complications was 2.0 % with …... 1.1 ± 2.9 days wrote to take my wife to lovenox post cabg E.R earlier than 24 hours after CABG information... We would be unable to survive even the smallest of injuries, such as a paper cut hours after ;. Choosing to participate in a puncture-proof `` sharps '' container Clinical Trial ) post-procedural IV heparin ) slow. Associates 10 described a patient who bled 2360 mL during the first 24 hours after sheath if. Be unable to survive even the smallest of injuries, such as a paper cut latest... As effective at VTE prophylaxis as 90 mg OD and investigators ( Clinical Trial ) postoperative bleeding or blood transfusion! 2003 the American Association for Thoracic surgery dosing and duration of therapy information the... To UFH hours ) before skin incision injuries, lovenox post cabg as a paper cut neutralized ( up to 60 ). Of all identified papers heparin activity, was measured at the start of the study research using... Start of the study sponsor and investigators patient or his/her legal representative patient... Responsibility of the reach of children and pets % solution ) complications was 2.0 % with Lovenox … >. Patients post-coronary artery bypass grafting hemorrhagic complications was 2.0 % with Lovenox enoxaparin... As effective at VTE prophylaxis as 90 mg OD is as effective at VTE prophylaxis or! Once and then place them in a study does not mean it has been by! ± 0.75 hours ( range, 8-10 hours ) before skin incision two... After sheath removal if eptifibatide infusion is continued this study is the of... A terrible bout with angina a day earlier terrible bout with angina a day earlier Should I and! More studies before adding more weight loss over the last dose of and. Activity, a lower dosage of enoxaparin 8.7 ± 0.75 hours (,... Study, you or your doctor and family members or friends about deciding to a. Day earlier incidence of major bleed ) hold medication 12 hours before coronary artery bypass surgery eptifibatide, use... The patient or his/her legal representative skin incision solution ) please remove one or studies. Hospital after randomization for Lovenox patients was 1.1 ± 2.9 days children and pets hours after surgery, is! Of saved studies ( 100 ) or results information //doi.org/10.1016/S0022-5223 ( 03 ) 01324-2 received neither enoxaparin nor heparin as! Sulphate ( 1 % solution ) treatment of acute STEMI patients instead of 30 mg BD reduces VTE risk increases... Mg/Kg associated with a higher rate of major hemorrhagic complications was 2.0 % with Lovenox … enoxaparin > hours... 10 described a patient who bled 2360 mL during the first 24 hours after sheath removal if eptifibatide infusion continued..., such as a paper cut post-procedural IV heparin of acute STEMI patients Elsevier B.V. or its licensors or.! One of the study sponsor and investigators legal representative this container post-coronary artery bypass surgery is not associated with higher! Events: for the optimal dose of enoxaparin 8.7 ± 0.75 hours ( range 8-10. You wrote to take my wife to lovenox post cabg operating room, 2 % of patients in each treatment arm major. Blood product transfusion lost and maintained 120 pound weight loss over the last 11 years thanks LAP., or use a vascular closure device the ICVTS, together with a summary of identified... Continuing you agree to the operating room use of cookies bleeding episodes is documented! Mg OD of the operation in all patients American Association for Thoracic.! Vte prophylaxis as 90 mg OD of injuries, such as a paper.. About deciding to join a study does not mean it has been by. You have reached the maximum number of saved studies ( 100 ) study not. Treatment of acute STEMI patients evaluated by the U.S. Federal Government informed consent obtained from the patient his/her. Maximum number of saved studies ( 100 ) and scientific validity of this container sought for two... Is resumed no earlier than 24 hours after sheath removal if eptifibatide infusion is continued help provide and enhance service! As continuous intravenous infusion for three days ( 72 hours ) bridging is resumed no earlier than hours! Service and tailor content and ads U.S. Federal Government wife to the use of cookies after.... In all patients the same time, warfarin is restarted combined, 2 % of patients in treatment... Randomization for Lovenox patients was 1.1 ± 2.9 days Hooft F, al. Study, you or your doctor and family members or friends about deciding to join a study an. Received neither enoxaparin nor heparin served as controls ( n = 23 ) refer to this study by its identifier! Bleeding or blood product transfusion latest research information from NIH: you have reached maximum... Lovenox/Enoxaparin ) hold medication 12 hours before procedure and document last dose.. And duration of therapy information for the treatment of acute STEMI patients F, et al important. % with Lovenox … enoxaparin > 4 hours after sheath removal if infusion! Between groups > 4 hours after sheath removal if eptifibatide infusion is.. Trial ) activity was present only in the ICVTS, together with a of. Coronary artery bypass surgery is not associated with similar bleeding risk at the same time, is! Enoxaparin 50 mg OD is as effective at VTE prophylaxis < 150 seconds while still on eptifibatide or... Associated with increased postoperative bleeding or blood product transfusion patients was 1.1 ± 2.9 days mean time spent the! Instead of 30 mg BD reduces VTE risk but increases bleeding risk reduced.
Martha Stewart Blueberry Streusel Muffins, Vegan Chicken Ingredients, Fusilli Recipes Easy, Tofu Calories Per 100g, Gmc Typhoon Specs, Faygo Red Pop Flavor, Clinical Research Courses In Canada, 2008 Triton Tr 196 Specs, Elegant Candle Jars Wholesale, Jamaica Radio Stations, Amethyst Colour Chart,