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https://www.readbyqxmd.com/read/28057945/ismp-medication-error-report-analysis-aggrastat-argatroban-mix-ups-don-t-expect-radiofrequency-identification-stock-systems-to-be-perfect-paralyzed-by-mistakes-reassess-the-safety-of-neuromuscular-blockers-in-your-facility
#1
Michael R Cohen, Judy L Smetzer
These medication errors have occurred in health care facilities at least once. They will happen again-perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program...
December 2016: Hospital Pharmacy
https://www.readbyqxmd.com/read/28052306/laboratory-monitoring-of-parenteral-direct-thrombin-inhibitors
#2
Elizabeth M Van Cott, A Joshua Roberts, William E Dager
Argatroban and bivalirudin are parenteral direct inhibitors of the activity of thrombin, but, unlike heparin, can inhibit both soluble as well as clot-bound thrombin. These agents do not require antithrombin as a cofactor for activity. The parenteral direct thrombin inhibitors (DTIs) can be used in a variety of settings, including heparin-induced thrombocytopenia (HIT) or an allergy to heparin, and patients requiring anticoagulation for an invasive cardiovascular intervention. Both agents have a relatively short half-life in patients without organ system failure and are typically administered by continuous infusion...
January 4, 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28031678/a-case-of-heparin-induced-thrombocytopenia-type-2-after-repair-of-juxtarenal-abdominal-aortic-aneurysm
#3
Jun Watanabe, Kengo Nishimura, Shigeto Miyasaka, Keisuke Morimoto, Takafumi Hamasaki, Shingo Ishiguro
Heparin-induced thrombocytopenia (HIT) is still a relatively uncommon condition and it is not well known how to administer argatroban during continuous hemodiafiltration (CHDF). A 72-year-old man required CHDF with heparin because of the oliguria and hyperpotassemia directly after the open repair of a juxtarenal abdominal aortic aneurysm. As the postoperative blood platelet count dropped and there was a thrombus in the CHDF circuit, HIT was suspected and nafamostat mesilate, but not heparin, was immediately administered for CHDF...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/28005139/-heparin-induced-thrombocytopenia-type%C3%A2-ii-hit%C3%A2-ii-a%C3%A2-medical-economic-view
#4
R Riedel, A Schmieder, A Koster, S Kim, G Baumgarten, J C Schewe
BACKGROUND: In the context of inpatient and increasingly ambulatory thrombosis prophylaxis, heparins have been recognised as standard therapy for decades. In addition to the therapeutic benefit, therapy with heparins also entails the risk of undesirable side effects, such as bleeding and thrombocytopenia. Heparin-induced thrombocytopenia (HIT II) is deemed a serious side effect. AIM: In the following work, HIT II is subjected to a medico-economic consideration (treatment, pharmaceuticals, subsequent costs due to possible complications) and, with regard to a possible HIT II prophylaxis, aspects of increasingly respected patient safety are also considered...
December 22, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/27986695/acute-oxygenator-failure-a-new-presentation-of-heparin-induced-thrombocytopenia-in-a-patient-undergoing-venovenous-extracorporeal-membrane-oxygenation-support
#5
Robert A Ratzlaff, Juan G Ripoll, Lena L Kassab, Jose L Diaz-Gomez
A 58-year-old man with medical history of thrombocytopenia was admitted to an outside hospital for a 6-day history of worsening dyspnoea requiring mechanical ventilator support. He was transferred to our institution for extracorporeal membrane oxygenation (ECMO) given his refractory hypoxaemia. On arrival, H1N1 influenza virus was confirmed and all measures to improve oxygenation were ineffective. Thus, the decision was made to start venovenous (VV)-ECMO. Although a low baseline platelet count was recognised (60-70×10(9)/L), a sudden further decrease occurred (30×10(9)/L) and platelet transfusion was initiated...
December 16, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27970391/tct-216-bivalrudin-vs-argatroban-for-treatment-of-heparin-induced-thrombocytopenia-a-meta-analysis
#6
Poonam Velagapudi, Mohit Turagam, Mayank Mittal, Natraj Katta, Harsh Agrawal, Kul Aggarwal, J Dawn Abbott
No abstract text is available yet for this article.
November 1, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27943368/rapid-and-durable-response-to-intravenous-immunoglobulin-in-delayed-heparin-induced-thrombocytopenia-a-case-report
#7
Brandon Z Lei, Joseph J Shatzel, Merav Sendowski
BACKGROUND: Heparin-induced thrombocytopenia (HIT) results in platelet consumption and a virulent thrombotic state, which generally responds to cessation of heparin and initiation of anticoagulation. Rarely, delayed HIT can occur and/or persist after heparin is discontinued. STUDY DESIGN AND METHODS: A 47-year-old male developed delayed HIT with severe thrombocytopenia and thrombosis after cardiac surgery. Thrombocytopenia developed and persisted after heparin cessation and did not improve despite sequential use of argatroban followed by bivalirudin...
December 9, 2016: Transfusion
https://www.readbyqxmd.com/read/27866136/biodegradable-polymer-based-argatroban-eluting-cobalt-chromium-stent-jf-04-for-treatment-of-native-coronary-lesions-final-results-of-the-first-in-man-study-and-lessons-learned
#8
Yoshihiro Morino, Tetsuya Tobaru, Satoshi Yasuda, Kazuaki Kataoka, Kengo Tanabe, Atsushi Hirohata, Ken Kozuma, Takeshi Kimura
AIMS: The aim of the study was to investigate the six-month angiographic and nine-month clinical follow-up outcomes in a first-in-man study using the biodegradable polymer-based cobalt-chromium argatroban-eluting stent (JF-04) for treatment of native coronary atherosclerotic lesions. METHODS AND RESULTS: A total of 31 patients with either stable or unstable angina, or silent myocardial ischaemia, exhibiting de novo coronary lesions were enrolled at seven Japanese sites...
November 20, 2016: EuroIntervention
https://www.readbyqxmd.com/read/27848915/heparin-monitoring-clinical-outcome-and-practical-approach
#9
Noémie Despas, Anne-Sophie Larock, Hugues Jacqmin, Jonathan Douxfils, Bernard Chatelain, Marc Chatelain, François Mullier
Traditional anticoagulant agents such as unfractionated heparin (UFH), low molecular weight heparins (LMWHs), fondaparinux, danaparoid and bivalirudine are used in the prevention and treatment of thromboembolic diseases. However, these agents have limitations: their constraining parenteral route of administration and the need for regular coagulation monitoring for HNF. The LMWHs, with their more predictable anticoagulant response, don't require a systematic monitoring. The usefulness of LMWHs monitoring in several clinical situations such as pregnancy, obesity and renal insufficiency is a matter of debate...
December 1, 2016: Annales de Biologie Clinique
https://www.readbyqxmd.com/read/27793877/cost-effectiveness-of-anticoagulants-for-suspected-heparin-induced-thrombocytopenia-in-the-united-states
#10
Ahmed Aljabri, Yvonne Huckleberry, Jason H Karnes, Mahdi Gharaibeh, Hussam I Kutbi, Yuval Raz, Seongseok Yun, Ivo Abraham, Brian Erstad
Despite the availability of multiple nonheparin anticoagulants for the treatment of heparin-induced thrombocytopenia (HIT), few data are available comparing the cost-effectiveness of these agents. This analysis is particularly important when considering differences in the risk of adverse effects, routes of administration, requirements for phlebotomy and laboratory monitoring, and overall drug costs. We conducted a cost-effectiveness analysis of argatroban, bivalirudin, and fondaparinux for the treatment of suspected HIT from the institutional perspective...
December 29, 2016: Blood
https://www.readbyqxmd.com/read/27734602/recurrent-heparin-induced-thrombocytopenia-due-to-heparin-rinsing-before-priming-the-machine-in-a-hemodialysis-patient-a-case-report
#11
Jin Han Lim, Kyung Pyo Kang, Sik Lee, Sung Kwang Park, Won Kim
Heparin has remained the most commonly used anticoagulant for patients undergoing hemodialysis. It is usually safe to use but can have severe adverse effects in some cases. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. It results from an autoantibody directed against endogenous platelet factor 4 (PF4) in complex with heparin, which activates platelets and can cause catastrophic arterial and venous thromboses. Here, we present the case of an 80-year-old woman with a recent diagnosis of chronic renal failure who developed acute HIT (platelet count nadir, 15 × 10(9) /L) on day 7 of hemodialysis performed with routine heparin anticoagulation, who despite subsequent heparin-free hemodialysis (with argatroban and warfarin) developed recurrent HIT (complicated by acute cerebral infarction) on day 11 that we attributed to "rinsing" of the circuit with heparin-containing saline (3,000 units of unfractionated heparin, with subsequent saline washing) performed pre-dialysis as per routine...
October 13, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27734072/identifying-patients-at-high-risk-of-heparin-induced-thrombocytopenia-associated-thrombosis-with-a-platelet-activation-assay-using-flow-cytometry
#12
Takuma Maeda, Katsura Nakagawa, Kuniko Murata, Yoshiaki Kanaumi, Shu Seguchi, Shiori Kawamura, Mayumi Kodama, Takeshi Kawai, Isami Kakutani, Yoshihiko Ohnishi, Koichi Kokame, Hitoshi Okazaki, Shigeki Miyata
To diagnose heparin-induced thrombocytopenia (HIT), detection of platelet-activating antibodies (HIT antibodies) is crucial. However, serum platelet activation profiles vary across patients and depend on test conditions. We evaluated the association between clinical outcomes and platelet-activating profiles assessed by a platelet microparticle assay (PMA), which detects activation of washed platelets induced by HIT antibodies, in 401 consecutive patients clinically suspected of having HIT. We made modifications to the assay, such as donor selection for washed platelets that increased sensitivity...
October 13, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27628460/monitoring-anticoagulation-with-argatroban-in-critically-ill-patients-activated-partial-thromboplastin-time-versus-diluted-thrombin-time
#13
Cornelius Keyl, Cornelius Lehane, Emanuel Zimmer, Dietmar Trenk
No abstract text is available yet for this article.
November 30, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27599353/photodegradation-of-aqueous-argatroban-investigated-by-lc-ms-n-photoproducts-transformation-processes-and-potential-implications
#14
Philippe-Henri Secrétan, Maher Karoui, Mélisande Bernard, Noureddine Ghermani, Fathi Safta, Najet Yagoubi, Bernard Do
Argatroban (ARGA), used as intravenous anticoagulant drug, has been reported to photodegrade under light exposure, requiring specific precautions at handling, storage and administration. Thus, for the first time, aqueous ARGA photodegradation under aerobic conditions has been described in terms of photoproducts, phototransformation processes and potential implications. ARGA significant photoproducts were successfully separated and characterized by gradient reversed-phase liquid chromatography coupled with high-resolution multistage mass spectrometry (LC/HR-MS(n))...
November 30, 2016: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/27588950/dual-functionalized-poly-vinylidene-fluoride-membrane-with-acryloylmorpholine-and-argatroban-to-improve-antifouling-and-hemocompatibility
#15
Rui Xu, Qianqian Feng, Yang He, Fanyong Yan, Li Chen, Yiping Zhao
The present work aims to improve the antifouling properties and anticoagulation of poly(vinylidene fluoride) (PVDF) membrane by dual modification. An amphiphilic copolymer of PVDF-g-(polyacryloylmorpholine-(polyacrylic acid)) [PVDF-g-(PACMO-PAA)] was first prepared by the free radical copolymerization. Then argatroban, a commonly used anticoagulant, was successfully grafted to PVDF-g-(PACMO-PAA). Finally the obtained copolymer was casted into a flat membrane via immersion phase inversion. The as-prepared copolymer membranes show improved hydrophilicity, higher water flux and lower protein adsorption...
January 2017: Journal of Biomedical Materials Research. Part A
https://www.readbyqxmd.com/read/27513970/successful-anticoagulation-using-argatroban-during-transcatheter-aortic-valve-implantation-in-a-patient-with-heparin-induced-thrombocytopenia
#16
Toru Naganuma, Satoru Mitomo, Nobuhide Kin, Sunao Nakamura
We report the first case of transfemoral transcatheter aortic valve implantation with a history of heparin-induced thrombocytopenia that was successfully managed with perioperative argatroban.
October 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27513533/overtreatment-of-heparin-induced-thrombocytopenia-in-the-surgical-icu
#17
Megan Y Harada, David M Hoang, Andrea A Zaw, Jason S Murry, Oksana Volod, Beatrice J Sun, Miriam Nuño, Russell Mason, Daniel R Margulies, Eric J Ley
OBJECTIVE: Recent studies reveal a high occurrence of overdiagnosis of heparin-induced thrombocytopenia in surgical patients with critical illness. The optimal criteria for diagnosis of heparin-induced thrombocytopenia remain unclear, contributing to unnecessary treatment. We reviewed patients who were admitted to surgical ICUs and were suspected of heparin-induced thrombocytopenia to identify how often patients were correctly treated. DESIGN: In this clinical prospective study, data were collected including age, sex, antiplatelet factor 4/heparin enzyme-linked immunosorbent assay, serotonin release assay, and Warkentin 4Ts scores...
January 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/27464495/heparin-induced-thrombocytopenia-presenting-with-deep-venous-thrombosis-and-pulmonary-embolism-successfully-treated-with-rivaroxaban-clinical-case-report-and-review-of-current-experiences
#18
Matej Samoš, Tomáš Bolek, Jela Ivanková, Lucia Stančiaková, František Kovář, Peter Galajda, Peter Kubisz, Ján Staško, Marián Mokáň
Heparin induced thrombocytopenia (HIT) is a life or limb threatening thrombotic thrombocytopenia. HIT is traditionally treated with factor-IIa inhibitors such as bivalirudin, lepirudin or argatroban. However, these agents usually require parenteral administration and are not generally available in all countries. Recently, several experiences with novel oral anticoagulants (NOACs) administration to treat HIT had been reported. NOACs generally offer advantages such as consistent and predictable anticoagulation, oral administration with good patient compliance and a good safety profile...
July 16, 2016: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/27458521/the-immobilization-of-a-direct-thrombin-inhibitor-to-a-polyurethane-as-a-nonthrombogenic-surface-coating-for-extracorporeal-circulation
#19
Jane Yu, Elizabeth Brisbois, Hitesh Handa, Gail Annich, Mark Meyerhoff, Robert Bartlett, Terry Major
A biomaterial with both antithrombin and antiplatelet properties is the ideal surface for use in extracorporeal circulation (ECC) as it targets both fibrin generation and platelet adhesion. A hemocompatible surface coating avoids the need for systemic anticoagulation by providing a local anticoagulant effect at the polymer-blood interface. Previous work has demonstrated the potential use of argatroban, a direct thrombin inhibitor, as a nonthrombogenic material for extracorporeal devices. The work reported here focuses on the characterization of argatroban linked to a polyurethane-silicone polymer, CarboSil®...
April 7, 2016: Journal of Materials Chemistry. B, Materials for Biology and Medicine
https://www.readbyqxmd.com/read/27439480/a-novel-rapid-method-to-compare-the-therapeutic-windows-of-oral-anticoagulants-using-the-hill-coefficient
#20
Jeremy B Chang, Kayla M Quinnies, Ronald Realubit, Charles Karan, Jacob H Rand, Nicholas P Tatonetti
A central challenge in designing and administering effective anticoagulants is achieving the proper therapeutic window and dosage for each patient. The Hill coefficient, nH, which measures the steepness of a dose-response relationship, may be a useful gauge of this therapeutic window. We sought to measure the Hill coefficient of available anticoagulants to gain insight into their therapeutic windows. We used a simple fluorometric in vitro assay to determine clotting activity in platelet poor plasma after exposure to various concentrations of anticoagulants...
2016: Scientific Reports
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