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https://www.readbyqxmd.com/read/28884054/the-role-of-apixaban-in-the-treatment-of-heparin-induced-thrombocytopenia
#1
Sidra Khalid, Hamed Daw
Heparin-induced thrombocytopenia (HIT) can present as arterial and venous thrombosis in adults who are treated with heparin. We present a case of a patient who developed HIT when she was treated for deep venous thrombosis (DVT) and pulmonary embolism with heparin. During the treatment with heparin and while being transitioned to warfarin, she developed arterial thrombosis. A work-up for HIT was sent, and it was positive. She was started on the argatroban drip and her platelet counts stabilized. Since her platelet counts remained stable and were not increasing for three weeks, we decided to transition the patient to an oral anticoagulant...
July 5, 2017: Curēus
https://www.readbyqxmd.com/read/28856946/spontaneous-hit-syndrome-post-knee-replacement-surgery-with-delayed-recovery-of-thrombocytopenia-a-case-report-and-literature-review
#2
Dilli Ram Poudel, Sushil Ghimire, Rashmi Dhital, Daniel A Forman, Theodore E Warkentin
Recently published reports have established a heparin-induced thrombocytopenia (HIT)-mimicking thromboembolic disorder without proximate heparin exposure, called spontaneous HIT syndrome. Although the pathophysiology remains unclear, anti-platelet factor 4 (PF4)/heparin antibodies possibly triggered by exposure to knee cartilage glycosaminoglycans or other non-heparin polyanions found on bacterial surfaces and nucleic acids have been postulated. We present a 53-year-old female receiving antithrombotic prophylaxis with aspirin following right total knee replacement surgery (without perioperative or any previous lifetime heparin exposure) who acutely presented with high-risk pulmonary embolism (PE) and right great saphenous vein thrombophlebitis on postoperative day (POD) 14; her platelet count at presentation was 13 × 10(9)/L...
August 31, 2017: Platelets
https://www.readbyqxmd.com/read/28846826/autoimmune-heparin-induced-thrombocytopenia
#3
REVIEW
A Greinacher, Kathleen Selleng, T E Warkentin
Autoimmune heparin-induced thrombocytopenia (aHIT) indicates patients with anti-PF4/polyanion antibodies that are able to activate platelets strongly even in the absence of heparin (heparin-independent platelet activation). Nevertheless, as seen with serum obtained from patients with otherwise typical HIT, serum-induced platelet activation is inhibited at high heparin concentrations (10-100 IU/mL heparin). Further, upon serial dilution, aHIT serum will usually exhibit heparin-dependent platelet activation. Clinical syndromes associated with aHIT include: delayed-onset HIT, persisting HIT, spontaneous HIT, fondaparinux-associated HIT, heparin "flush"-induced HIT, and severe HIT (platelet count <20×10(9) /L) with associated disseminated intravascular coagulation (DIC)...
August 28, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28830286/anticoagulation-of-percutaneous-ventricular-assist-device-using-argatroban-based-purge-solution-a-case-series
#4
Emily C Blum, Carolyn R Martz, Yelena Selektor, Hassan Nemeh, Zachary R Smith, Long To
Impella devices are percutaneously inserted ventricular assist devices which require a continuous purge solution that contains heparin to prevent pump thrombosis and device failure. We describe 2 patients with heparin-induced thrombocytopenia (HIT) supported with an Impella device utilizing an argatroban-based purge solution. Case 1 involved an 83-year-old female with biventricular failure which resulted in right ventricle Impella support. The purge solution was changed to include argatroban due to concern of device clotting in the setting of HIT...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28818799/an-ultrafiltration-and-high-performance-liquid-chromatography-coupled-with-diode-array-detector-and-mass-spectrometry-approach-for-screening-and-characterizing-thrombin-inhibitors-from-rhizoma-chuanxiong
#5
Qian Zhang, Yu-Xiu Yang, Su-Ying Li, Ya-Li Wang, Feng-Qing Yang, Hua Chen, Zhi-Ning Xia
Thrombin (THR) plays a significant role in thromboembolic diseases, direct THR inhibitors are a class of important clinical anticoagulant drugs. This study established a THR in-solution based biospecific extraction combined with ultrafiltration and high performance liquid chromatography coupled with diode array detector and mass spectrometry analysis (TUA) method to screen and identify ligands for THR in Rhizoma Chuanxiong. After evaluating the reliability of the present TUA method using positive (argatroban) and negative (adenosine, tirofiban, ticagrelor) control drugs, this method was successfully applied to detect eight potential active compounds in Rhizoma Chuanxiong...
September 1, 2017: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
https://www.readbyqxmd.com/read/28776204/efficacy-and-safety-of-argatroban-in-patients-with-acute-respiratory-distress-syndrome-and-extracorporeal-lung-support
#6
Mario Menk, Philipp Briem, Björn Weiss, Martina Gassner, David Schwaiberger, Anton Goldmann, Christian Pille, Steffen Weber-Carstens
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist (pECLA) requires effective anticoagulation. Knowledge on the use of argatroban in patients with acute respiratory distress syndrome (ARDS) undergoing ECMO or pECLA is limited. Therefore, this study assessed the feasibility, efficacy and safety of argatroban in critically ill ARDS patients undergoing extracorporeal lung support. METHODS: This retrospective analysis included ARDS patients on extracorporeal lung support who received argatroban between 2007 and 2014 in a single ARDS referral center...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28771571/optical-sensing-of-anticoagulation-status-towards-point-of-care-coagulation-testing
#7
Diane M Tshikudi, Markandey M Tripathi, Zeinab Hajjarian, Elizabeth M Van Cott, Seemantini K Nadkarni
Anticoagulant overdose is associated with major bleeding complications. Rapid coagulation sensing may ensure safe and accurate anticoagulant dosing and reduce bleeding risk. Here, we report the novel use of Laser Speckle Rheology (LSR) for measuring anticoagulation and haemodilution status in whole blood. In the LSR approach, blood from 12 patients and 4 swine was placed in disposable cartridges and time-varying intensity fluctuations of laser speckle patterns were measured to quantify the viscoelastic modulus during clotting...
2017: PloS One
https://www.readbyqxmd.com/read/28766891/influences-of-argatroban-on-five-fibrinogen-assays
#8
L Zhang, J Yang, X Zheng, Q Fan, Z Zhang
INTRODUCTION: Argatroban, as a direct thrombin inhibitor, prolongs the clotting time. However, detection of clotting time is the base of routine fibrinogen assays, including Clauss method and derived method. The influences of argatroban on fibrinogen assays are still unclear. METHODS: Normal pooled plasma (NPP) from 20 healthy subjects was spiked with increasing argatroban concentrations (0-3.2 μg/mL). Then the NPP samples were analyzed by five fibrinogen assays: HemosIL Fibrinogen-C XL reagent (Clauss method) on ACL-TOP; STA-Fibrinogen reagent (Clauss method) on STA-R Evolution; Siemens Thrombin reagent (Clauss method) on CS-5100; SynthASil RecombiPlasTin 2G reagent (PT-derived method) on ACL-TOP; and N Antiserum to Human Fibrinogen reagent (NAHF, Immunoassay) on BN2 nephelometer analyzer...
August 2, 2017: International Journal of Laboratory Hematology
https://www.readbyqxmd.com/read/28764988/argatroban-in-thrombocytopenic-patients-sensitized-to-circulating-protamine-heparin-complexes
#9
Patricia Pia Wadowski, Alessia Felli, Arno Schiferer, Simon Panzer, Philipp Opfermann, Martin Dworschak, Caroline Holaubek, Arezu Aliabadi-Zuckermann, Barbara Steinlechner
No abstract text is available yet for this article.
March 22, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28743779/treatment-of-pulmonary-embolism-with-argatroban-and-ultrasound-assisted-catheter-directed-thrombolysis-with-alteplase-in-a-patient-with-heparin-induced-thrombocytopenia
#10
Brittany T Bethea, John W Elliot, John B Richardson, Mustafa I Ahmed
PURPOSE: Successful ultrasound-assisted catheter-directed thrombolysis (USAT) with low-dose alteplase and argatroban in a patient with bilateral pulmonary embolism (PE) secondary to heparin-induced thrombocytopenia (HIT) is reported. SUMMARY: HIT is a life-threatening complication associated with a high risk of thromboembolism. Systemic anticoagulation for the treatment of thrombosis may not be sufficient in the presence of PE. Catheter-directed treatment may be indicated in patients with PE and associated right ventricular dysfunction...
August 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28725494/apixaban-for-treatment-of-confirmed-heparin-induced-thrombocytopenia-a-case-report-and-review-of-literature
#11
Daniel E Ezekwudo, Rebecca Chacko, Bolanle Gbadamosi, Syeda Batool, Sussana Gaikazian, Theodore E Warkentin, Jo-Ann I Sheppard, Ishmael Jaiyesimi
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a life and limb-threatening condition caused by the binding of platelet-activating antibodies (IgG) to multimolecular platelet factor 4 (PF4)/heparin complexes because of heparin exposure. The by-product of this interaction is thrombin formation which substantially increases the risk of venous and/or arterial thromboembolism. Currently, only one anticoagulant, argatroban, is United States Food and Drug Administration-approved for management of HIT; however, this agent is expensive and can only be given by intravenous infusion...
2017: Experimental Hematology & Oncology
https://www.readbyqxmd.com/read/28695302/argatroban-attenuates-diabetic-cardiomyopathy-in-rats-by-reducing-fibrosis-inflammation-apoptosis-and-protease-activated-receptor-expression
#12
Yogesh Bulani, Shyam Sunder Sharma
PURPOSE: Chronic diabetes is associated with cardiovascular dysfunctions. Diabetic cardiomyopathy (DCM) is one of the serious cardiovascular complications associated with diabetes. Despite significant efforts in understanding the pathophysiology of DCM, management of DCM is not adequate due to its complex pathophysiology. Recently, involvement of protease-activated receptors (PARs) has been postulated in cardiovascular diseases. These receptors are activated by thrombin, trypsin, or other serine proteases...
July 10, 2017: Cardiovascular Drugs and Therapy
https://www.readbyqxmd.com/read/28694001/safety-and-effectiveness-of-argatroban-versus-heparin-for-preventing-venous-thromboembolism-after-lumbar-decompressive-surgery
#13
Ying Guo, Zhongwen Zou, Lianshun Jia, Zhi Huang, Xiong Yun, Guo Xing
BACKGROUND: To evaluate the safety and effectiveness of argatroban for the prevention of venous thromboembolism (VTE) after posterior lumbar decompressive surgery. METHODS: Included in this retrospective study were 556 patients who underwent posterior lumbar decompressive surgery for trauma and degenerative diseases. They were divided into two groups: argatroban group (n = 274), and low molecular weight heparin (LMWH) group (n = 282). The occurrence of postoperative venous thrombosis and complications including hemorrhage and allergic reaction was compared between the two groups...
July 8, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28680640/argatroban-for-an-alternative-anticoagulant-in-hit-during-ecmo
#14
Alain Rougé, Felix Pelen, Michel Durand, Carole Schwebel
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) have become more frequently used in daily ICU practice, heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication while on extracorporeal membrane oxygenation (ECMO). HIT confirmation directly impacts on anticoagulant strategy requiring no delay unfractionated heparin discontinuation to be replaced by alternative systemic anticoagulant treatment. CASE PRESENTATION: We report two clinical cases of HIT occurring during ECMO in various settings with subsequent recovery with argatroban and provide literature review to help physicians treat HIT during ECMO in clinical daily practice...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28672052/direct-acting-oral-anticoagulants-for-the-treatment-of-suspected-heparin-induced-thrombocytopenia
#15
Kyle A Davis, Daphne O Davis
OBJECTIVE: To evaluate the efficacy and safety of direct oral anticoagulant (DOAC) therapy in hospitalized patients with suspected heparin induced thrombocytopenia (HIT). METHODS: Retrospective cohort study of adult patients prescribed apixaban, dabigatran, or rivaroxaban for the treatment of acute HIT from January 1 2013 to January 1 2017. Eligibility requirements included an intermediate or high pretest probability for HIT (4T score ≥ 4) and a positive IgG-specific anti-PF4/ heparin complex assay...
July 3, 2017: European Journal of Haematology
https://www.readbyqxmd.com/read/28638161/argatroban-for-heparin-induced-thrombocytopenia-during-venovenous-extracorporeal-membrane-oxygenation-with-continuous-venovenous-hemofiltration
#16
Jonathan H Sin, Natasha D Lopez
Patients receiving extracorporeal membrane oxygenation (ECMO) are at risk of circuit thrombosis due to constant contact between blood and the extracorporeal components. Unfractionated heparin has traditionally been used in this setting as a systemic form of anticoagulation to prevent thrombosis of the circuit. However, if a patient develops heparin-induced thrombocytopenia (HIT), an alternative anticoagulant would be required while the patient is maintained on ECMO. Unfortunately, the pharmacokinetic changes induced by ECMO and critical illness may potentially affect optimal drug dosing...
June 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28637375/anticoagulant-therapy-for-recurrent-in-stent-thrombosis-following-carotid-artery-stenting-a-case-report
#17
Akinori Miyakoshi, Hiroki Toda, Makoto Hayase, Takeshi Kawauchi, Yuki Oichi, Etsuko Hattori
We report a case in which strict anticoagulant therapy management was useful for a recurrent in-stent thrombosis after carotid artery stenting (CAS). An 84-year-old man presented with cognitive decline that progressed rapidly over two months. Head magnetic resonance imaging showed an acute-stage infarct occurring frequently in the right cerebral hemisphere, and he underwent hospitalization and treatment. On neck magnetic resonance angiography (MRA), severe stenosis was found at the origin of the right internal carotid artery...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28621461/the-use-of-eptifibatide-alone-or-in-combination-with-heparin-or-argatroban-for-suspected-thrombosis-in-patients-with-left-ventricular-assist-devices
#18
Abbas Bitar, Rajakrishnan Vijayakrishnan, Andrew Lenneman, Emma Birks, Todd Massey, Mark Slaughter, Dmitry Abramov
Pump thrombosis and hemolysis in patients with left ventricular assist devices (LVADs) are associated with significant morbidity and mortality. Intensification of anticoagulation has been suggested as potential therapy, with mixed results. The aim of this study is to assess the safety and efficacy of adding eptifibatide with or without an anticoagulation agent in managing patients with LVAD presenting with hemolysis and suspected pump thrombosis. This retrospective single center study included all patients who presented with their first episode of suspected pump thrombosis and were treated with eptifibatide with or without an anticoagulant between March 1, 2011 and July 30, 2015...
June 16, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28618436/more-on-the-limitations-of-the-activated-partial-thromboplastin-time-for-monitoring-argatroban-therapy
#19
Susan Guy, Joost Van Veen, Steve Kitchen
No abstract text is available yet for this article.
September 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28609797/response-to-more-on-the-limitations-of-the-aptt-for-monitoring-argatroban-therapy
#20
Elizabeth M Van Cott, A Joshua Roberts, William E Dager
No abstract text is available yet for this article.
September 2017: Seminars in Thrombosis and Hemostasis
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