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Heparin, monitoring

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https://www.readbyqxmd.com/read/28741848/pharmacologic-considerations-in-the-management-of-patients-receiving-left-ventricular-percutaneous-mechanical-circulatory-support
#1
J Erin Allender, Brent N Reed, Jenna L Foster, Jeremy D Moretz, Carrie S Oliphant, Douglas L Jennings, Robert J DiDomenico, James C Coons
Percutaneous mechanical circulatory support (MCS) devices, including the intra-aortic balloon pump, Impella, and TandemHeart, are often used for hemodynamic support in the setting of refractory cardiogenic shock. The thrombotic and bleeding complications associated with these devices is well recognized, and the Impella and TandemHeart devices have unique anticoagulation considerations that may influence patient outcomes. Both devices typically require use of a heparinized purge solution in combination with intravenous unfractionated heparin, thereby providing multiple sources of heparin exposure...
July 25, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28735423/the-anticoagulant-effect-of-heparin-during-radiofrequency-ablation-rfa-in-patients-taking-apixaban-or-rivaroxaban
#2
L C Brendel, F Dobler, G Hessling, J Michel, S L Braun, A L Steinsiek, P Groha, R Eckl, I Deisenhofer, A Hyseni, M Roest, I Ott, B Steppich
PURPOSE: Measuring the anticoagulant effect of heparin during radiofrequency ablation (RFA) in patients taking apixaban and rivaroxaban is challenging, since the activated coagulation time (ACT) does not seem to reflect the true anticoagulant activity of these drugs. We therefore evaluated coagulation properties of apixaban and rivaroxaban during RFA by different coagulation assays to better monitor periprocedural hemostasis. METHODS: The study included 90 patients (61 ± 12 years) with atrial fibrillation who underwent RFA procedures...
July 22, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28727723/analytical-sensitivity-and-specificity-of-a-loop-mediated-isothermal-amplification-lamp-kit-prototype-for-detection-of-trypanosoma-cruzi-dna-in-human-blood-samples
#3
Susana A Besuschio, Mónica Llano Murcia, Alejandro F Benatar, Severine Monnerat, Israel Cruz Mata, Albert Picado de Puig, María de Los Ángeles Curto, Yutaka Kubota, Diana P Wehrendt, Paula Pavia, Yasuyoshi Mori, Concepción Puerta, Joseph M Ndung'u, Alejandro G Schijman
This study aimed to assess analytical parameters of a prototype LAMP kit that was designed for detection of Trypanosoma cruzi DNA in human blood. The prototype is based on the amplification of the highly repetitive satellite sequence of T.cruzi in microtubes containing dried reagents on the inside of the caps. The reaction is carried out at 65°C during 40 minutes. Calcein allows direct detection of amplified products with the naked eye. Inclusivity and selectivity were tested in purified DNA from Trypanosoma cruzi stocks belonging to the six discrete typing units (DTUs), in DNA from other protozoan parasites and in human DNA...
July 20, 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/28725329/ticagrelor-associated-conduction-disorder-a-case-report-and-review-of-the-literature
#4
Mustafa Yurtdas, Mahmut Ozdemir
A 47-year-old female presented to emergency clinic due to non-ST-elevation myocardial infarction (NSTEMI). After receiving acetylsalicylic acid, a loading dose of ticagrelor 180 mg and intravenous unfractionated heparin, she underwent successful placement of drug eluting stent on the distal part of non-dominant left circumflex artery. The patient had no pre-existing atrioventricular (AV) block and did not use AV blocking agent. Approximately 10 h after taking a loading dose of ticagrelor, baseline normal rhythm degenerated to the first and then complete AV block, with mild dizziness...
June 2017: Cardiology Research
https://www.readbyqxmd.com/read/28722442/sensing-active-heparin-by-counting-aggregated-quantum-dots-at-single-particle-level
#5
Suli Dong, Xiaojun Liu, Qingquan Zhang, Wenfeng Zhao, Chenghua Zong, Aiye Liang, Hongwei Gai
Developing highly sensitive and highly selective assays for monitoring heparin levels in blood is required during and after surgery. In previous studies, electrostatic interactions are exploited to recognize heparin and changes in light signal intensity are used to sense heparin. In the present study, we developed a quantum dot (QD) aggregation-based detection strategy to quantify heparin. When cationic micelles and fluorescence QDs modified with anti-thrombin III (AT III) are added into heparin sample solution, the AT III-QDs, which specifically bind with heparin, aggregate around the micelles...
January 27, 2017: ACS Sensors
https://www.readbyqxmd.com/read/28710245/abciximab-induced-acute-profound-thrombocytopenia-postpercutaneous-coronary-intervention
#6
Todd Golden, Sehem Ghazala, Rita Wadeea, Shilpa Junna
Abciximab (c7E3 Fab) is one of the three potent intravenous glycoprotein IIb/IIIa receptor inhibitors (along with eptifibatide and tirofiban) that have shown significant positive outcomes when used in patients with intracoronary thrombus. However, major side effects have been reported with its use including hypotension, major bleeding and thrombocytopenia. This case is a 53-year-old man presenting with acute chest pain diagnosed with non-ST-elevation myocardial infarction, who underwent percutaneous coronary intervention with abciximab and heparin infusion and developed acute profound thrombocytopenia (platelet count <20,000/L) within 9 hours of infusion...
July 14, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28698538/warfarin-should-not-be-used-for-thromboprohylaxis-in-elective-major-orthopaedic-surgery-a-croatian-perspective
#7
Robert Kolundžić, Marijana Šimić Jovičić, Maja Ðinkić, Tadija Petrović, Tomislav Crnković, Vladimir Trkulja
Aim To identify modes of venous thromboembolism (VTE) prophylaxis in patients undergoing elective major orthopaedic surgery (total hip or knee arthroplasty, THA/TKA) at a single university-associated hospital in Croatia. Methods A retrospective analysis of consecutive patients subjected to THA or TKA over a two-year period (2014-2015) with a focus on anticoagulation during the first 15 post-surgical days (period of highest VTE risk). Results Of 603 identified patients three (0.5%) were not anticoagulated (haemophilia) and others received perioperative doses of low molecular weight heparins (LMWH)...
August 1, 2017: Medicinski Glasnik
https://www.readbyqxmd.com/read/28698456/combining-nmr-spectroscopy-and-chemometrics-to-monitor-structural-features-of-crude-hep-arin
#8
Lucio Mauri, Maria Marinozzi, Giulia Mazzini, Richard E Kolinski, Michael Karfunkle, David A Keire, Marco Guerrini
Because of the complexity and global nature of the heparin supply chain, the control of heparin quality during manufacturing steps is essential to ensure the safety of the final active pharmaceutical ingredient (API). For this reason, there is a need to develop consistent analytical methods able to assess the quality of heparin early in production (i.e., as the crude heparin before it is purified to API under cGMP conditions). Although a number of analytical techniques have been applied to characterize heparin APIs, few of them have been applied for crude heparin structure and composition analyses...
July 8, 2017: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
https://www.readbyqxmd.com/read/28693359/coagulation-monitoring-correlation-with-heparin-dose-in-pediatric-extracorporeal-life-support
#9
Katie Moynihan, Kerry Johnson, Lahn Straney, Christian Stocker, Ben Anderson, Prem Venugopal, John Roy
OBJECTIVES: Extracorporeal Life Support (ECLS) risks thrombotic and hemorrhagic complications. Optimal anti-coagulation monitoring is controversial. We compared coagulation tests evaluating the heparin effect in pediatric ECLS. METHODS: A retrospective study of children (<18yrs) undergoing ECLS over 12 months in a tertiary pediatric intensive care unit (PICU). Variables included anti-Factor Xa activity (anti-Xa), activated partial thromboplastin time (aPTT), activated clotting time (ACT) and thromboelastogram (TEG(®)6s) parameters: ratio and delta reaction (R) times (the ratio and difference, respectively, between R times in kaolin assays with and without heparinase)...
July 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28678046/coagulation-profile-is-not-a-predictor-of-acute-cerebrovascular-events-in-pediatric-extracorporeal-membrane-oxygenation-patients
#10
Pilar Anton-Martin, Janna Journeycake, Vinai Modem, Sailaja Golla, Lakshmi Raman, Jefferson Tweed, Cindy Darnell-Bowens
We performed a retrospective matched case-control study evaluating whether the traditional coagulation profile predicts cerebrovascular events in children on extracorporeal membrane oxygenation (ECMO) in a 71 bed intensive care unit at a tertiary children's hospital. Between 2009 and 2014, 241 neonates and children were initiated on ECMO. The cumulative 5 year incidence of intracranial hemorrhage and infarct was 9.2% and 7.9%, respectively. Thirty-six cases were individually matched 1:1 with control subjects based on age, primary diagnosis, ECMO type, cannulation site, and the presence of pre-ECMO coagulopathy...
July 3, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28676032/anticoagulation-in-tuberculosis-patients-not-achieving-a-therapeutic-range-with-vitamin-k-antagonists-a-systematic-review
#11
Marco Fiore, Alberto Enrico Maraolo, Paolo Chiodini, Claudio Cerchione, Ivan Gentile, Guglielmo Borgia, Maria Caterina Pace
Background Approximaly 3% of Tuberculosis (TB) patients have a venous thromboembolic events (VTE). The use of Vitamin K antagonists (VKAs), as anticoagulant, in patients receiving anti TB antimicrobials is often complicated by drug interactions, especially rifampicin. These patients require frequent monitoring of the International Normalized Ratio (INR), and it is reported that warfarin can not achieve a therapeutic INR. In such cases, abruptly stopping the rifampicin once the course of anti TB antimicrobials is not completed is potentially hazardous...
July 3, 2017: Cardiovascular & Hematological Disorders Drug Targets
https://www.readbyqxmd.com/read/28675265/-direct-oral-anticoagulants-some-practical-considerations
#12
Stéphanie Bornet, Christodoulos Dolapsakis, Pierre-Auguste Petignat, Niels Gobin
Prevention and management of thromboembolic events are historically based on the use of anti-vitamines K (AVK) and heparins. Since 2009, emerging direct oral anticoagulants (DOAC) with successive validated indications, changed progressively the way of managing oral anticoagulation. The main advantages of this new generation of medication are a better safety profile and the lack of need for monitoring anticoagulation activity. However, a number of situations in clinical practice still require careful use of these DOAC...
September 7, 2016: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28672421/-acute-coronary-syndrome-what-should-the-general-practitioner-do
#13
Stefan Stadler, Dierk Endemann, Lars S Maier
Acute myocardial infarction is the second most common cause of mortality in Germany after chronic ischemic cardiac disease. It is essential to think of acute coronary syndrome also in patients who do not present with typical signs (pressure, tightness, pain, or a squeezing or aching sensation in the chest or arms that may spread to the neck, jaw or back) in the general practitioner's practice. Vital signs (blood pressure, heart rate and oxygen saturation) must be measured; an ECG should be recorded and analyzed within ten minutes of first medical contact...
July 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28667866/a-case-that-illustrates-the-challenges-of-managing-pregnant-patients-with-antithrombin-deficiency-more-questions-than-answers
#14
Leslie Skeith, Andrew Aw, Julia Hews-Girard, Natalia Rydz
Using an illustrative case of a patient with antithrombin (AT) deficiency who developed a recurrent venous thromboembolism (VTE) in pregnancy despite therapeutic low-molecular-weight heparin (LMWH), we highlight what is known in the literature and address areas of controversy through a series of questions around the case. The questions we address include the role of anti-Xa monitoring for patients with past VTE on antepartum LMWH, what treatment regimen is recommended for pregnant patients who develop a recurrent VTE while on therapeutic anticoagulation, the role of antepartum AT concentrate prophylaxis, and the management of labor/delivery, epidural anesthesia and postpartum anticoagulation...
June 24, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28662704/thrombocytopenia-induced-by-dabigatran-two-case-reports
#15
Hyun Goo Kang, Seung Jae Lee, Ji Yeon Chung, Jin Sung Cheong
BACKGROUND: Vitamin K inhibitors (e.g. warfarin) and indirect thrombin inhibitors (e.g. heparin) are widely used to prevent thromboembolic disorders (e.g. myocardial infarction, venous thromboembolism, and stroke). These agents have been mainstays of anticoagulation for people older than 60 years. However, their administration is associated with a risk of bleeding and requires careful monitoring of patients. Novel oral anticoagulants (NOACs), such as dabigatran, are significantly safer in preventing thromboembolism than warfarin and heparin (sporadically causes thrombocytopenia) and are more specific for their target protein, thrombin...
June 29, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28638004/modification-of-the-hcmv-specific-ifn-%C3%AE-release-test-quantiferon-cmv-and-a-novel-proposal-for-its-application
#16
Takahiro Kobayashi, Jun-Ichi Sato, Kazufumi Ikuta, Ryoko Kanno, Kyoko Nishiyama, Tetsuo Koshizuka, Ken Ishioka, Tatsuo Suzutani
Human cytomegalovirus (HCMV) is universally distributed among humans without any adverse effects; however, it induces severe diseases in immunocompromised patients such as organ transplant recipients and AIDS patients. To manage these immunocompromised patients, an easy clinical examination for the monitoring of disease risk is required. In this study, we modified the interferon-γ (IFN-γ) release test (QuantiFERON(®)-CMV) using HCMV immediate early-1 (IE-1) or pp65 whole proteins, or UV-inactivated HCMV particles as an antigen...
June 22, 2017: Fukushima Journal of Medical Science
https://www.readbyqxmd.com/read/28632418/therapeutic-monitoring-of-unfractionated-heparin-trials-and-tribulations
#17
Israfil Baluwala, Emmanuel J Favaloro, Leonardo Pasalic
Heparin is one of the oldest biological medicines with an established role in prevention and treatment of arterial and venous thromboembolism. Published therapeutic ranges for unfractionated heparin (UFH) mostly precede the large increase in the number of activated partial thromboplastin time (APTT) reagent/instrument combinations that now show wide variability. Areas covered: This paper explores the use of UFH, the development of heparin therapeutic ranges (HTRs), and the strengths and limitations of the methods used to monitor heparin's anticoagulant effect...
July 2017: Expert Review of Hematology
https://www.readbyqxmd.com/read/28620756/preliminary-data-on-utility-of-subcutaneous-unfractionated-heparin-in-patients-with-deep-cerebral-venous-thrombosis
#18
Girish Baburao Kulkarni, Abbas Masoom Mirza, Subasree Ramakrishnan, Veerendrakumar Mustare
Subcutaneous unfractionated heparin (SCUFH) has been proved effective in puerperal cerebral venous thrombosis (CVT), but its efficacy in the more serious form of the disease such as deep CVT patients (DCVT) unreported. We describe the outcomes of 37 (isolated:combined: 11:26) patients of DCVT diagnosed by MRI, treated with SCUFH in a tertiary care stroke unit. It was a prospective observational cohort study using 5000 U of SCUFH every 6 hourly for 10 days with oral Acenocoumarol started on day 7, with monitoring...
August 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28599392/the-laboratory-control-of-anticoagulant-thromboprophylaxis-during-the-early-postpartum-period-after-cesarean-delivery
#19
Ekaterina M Koltsova, Anna N Balandina, Konstantin I Grischuk, Margarita A Shpilyuk, Elena A Seregina, Natalia M Dashkevich, Alexander V Poletaev, Alexey V Pyregov, Gennady T Sukhih, Ilya I Serebriyskiy, Fazly I Ataullakhanov
INTRODUCTION: The incidence of venous thromboembolism (VTE) after cesarean section is up to 0.6%, and the widespread use of cesarean section draws attention to this group. The dosage and duration of low-molecular-weight heparin (LMWH) prophylaxis after delivery is estimated by anamnestic risk-scales; however, the predictive potency for an individual patient's risk can be low. Laboratory hemostasis assays are expected to solve this problem. The aim of this study was to estimate the potency of tests to reflect the coagulation state of patients receiving LMWH in the early postpartum period...
May 25, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28594426/new-developments-in-anticoagulants-past-present-and-future
#20
Jeffrey I Weitz, Job Harenberg
Thrombosis is a leading cause of death and disability worldwide, and anticoagulants are the mainstay of its prevention and treatment. Starting with unfractionated heparin (UFH) and vitamin K antagonists (VKAs) such as warfarin, the choices of anticoagulants have exploded in the past 20 years. With over 90 % subcutaneous bioavailability, no need for coagulation monitoring and dose adjustment, and a lower risk of heparin-induced thrombocytopenia, low-molecular-weight heparin and fondaparinux have replaced UFH for prevention and initial treatment of venous thromboembolism and for secondary prevention in cancer patients...
June 28, 2017: Thrombosis and Haemostasis
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