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Bleeding reversal

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https://www.readbyqxmd.com/read/28919071/validation-of-the-retrieve-reverse-triage-events-criteria-for-same-day-return-of-non-st-elevation-acute-coronary-syndrome-patients-to-referring-non-pci-centres
#1
Sonya N Burgess, Vu Huynh Nguyen, James Xu, Yoshio Hinde, Anoop Dharmadmajan, Xavier Brennan, Karen Owen, Karen Lintern, Craig Juergens, Sidney Lo, Phong Nguyen, Krishna K Kadappu, John K French, Rohan Rajaratnam
BACKGROUND: There are continuing bed constraints in percutaneous coronary intervention centres (PCI) so efficient patient triage from referral hospitals is pivotal. To evaluate a strategy of PCI centre (PCIC) bed-sparing we examined return of patients to referral hospitals screened by the RETRIEVE (REverse TRIage EVEnts) criteria and validated its use as a tool for screening suitability for same day transfer of non-ST-elevation acute coronary syndrome (NSTEACS) patients post PCI to their referring non-PCI centre (NPCIC)...
August 19, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28913708/emergency-neurological-life-support-intracerebral-hemorrhage
#2
J Claude Hemphill, Arthur Lam
Intracerebral hemorrhage (ICH) is a subset of stroke due to spontaneous bleeding within the parenchyma of the brain. It is potentially lethal, and survival depends on ensuring an adequate airway, proper diagnosis, and early management of several specific issues such as blood pressure, coagulopathy reversal, and surgical hematoma evacuation for appropriate patients. ICH was chosen as an Emergency Neurological Life Support (ENLS) protocol because intervention within the first hours may improve outcome, and it is critical to have site-specific protocols to drive care quickly and efficiently...
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28913672/reversal-of-dabigatran-associated-bleeding-using-idarucizumab-review-of-the-current-evidence
#3
REVIEW
Michela Giustozzi, Melina Verso, Giancarlo Agnelli, Cecilia Becattini
Major bleeding occurs in about 4% of patients while on treatment with direct oral anticoagulants (DOACs). The case-fatality rate associated with these events is estimated to be about 5%. The specific roles of antidotes, when used with DOACs in reducing the case fatality or improving the overall clinical course of these events, are not thoroughly understood. To this regard, the US Food and Drug Administration as well as European Medicines Agency have recently licensed idarucizumab for the management of patients with life-threatening bleeding or the need for urgent surgery/procedures while on treatment with dabigatran...
September 14, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28904343/engineered-factor-xa-variants-retain-procoagulant-activity-independent-of-direct-factor-xa-inhibitors
#4
Daniël Verhoef, Koen M Visscher, C Ruben Vosmeer, Ka Lei Cheung, Pieter H Reitsma, Daan P Geerke, Mettine H A Bos
The absence of an adequate reversal strategy to prevent and stop potential life-threatening bleeding complications is a major drawback to the clinical use of the direct oral inhibitors of blood coagulation factor Xa. Here we show that specific modifications of the substrate-binding aromatic S4 subpocket within the factor Xa active site disrupt high-affinity engagement of the direct factor Xa inhibitors. These modifications either entail amino-acid substitution of S4 subsite residues Tyr99 and/or Phe174 (chymotrypsinogen numbering), or extension of the 99-loop that borders the S4 subsite...
September 13, 2017: Nature Communications
https://www.readbyqxmd.com/read/28901221/direct-oral-anticoagulant-reversal-how-when-and-issues-faced
#5
Mikhail S Dzeshka, Daniele Pastori, Gregory Y H Lip
The number of atrial fibrillation (AF) patients requiring thrombo-prophylaxis with oral anticoagulation is greatly increasing. The introduction of non-vitamin K oral anticoagulants (NOACs) in addition to standard therapy with dose-adjusted warfarin has increased the therapeutic options for AF patients. Despite a generally better safety profile of the NOACs, the risk of major bleedings still persists, and the management of serious bleeding is a clinical challenge. Areas covered: In the current review, risk of major bleeding in patients taking NOACs and general approaches to manage bleeding depending on severity, with a particular focus on specific reversal agents, are discussed...
September 13, 2017: Expert Review of Hematology
https://www.readbyqxmd.com/read/28887767/management-of-spontaneous-intracerebral-hemorrhage
#6
REVIEW
Roland Veltkamp, Jan Purrucker
PURPOSE OF REVIEW: We review the current evidence for medical and surgical treatments of spontaneous intracerebral hemorrhage (ICH). RECENT FINDINGS: Therapy with hemostatic agents (e.g. factor VIIa and tranexamic acid) if started early after bleeding onset may reduce hematoma expansion, but their clinical effectiveness has not been shown. Rapid anticoagulation reversal with prothrombin concentrates (PCC) plus vitamin K is the first choice in vitamin K antagonist-related ICH...
September 8, 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28880550/a-polymer-therapeutic-having-universal-heparin-reversal-activity-molecular-design-and-functional-mechanism
#7
Manu Thomas Kalathottukaren, Srinivas Abbina, Kai Yu, Rajesh A Shenoi, A Louise Creagh, Charles Haynes, Jayachandran N Kizhakkedathu
Heparins are widely used to prevent blood clotting during surgeries and for the treatment of thrombosis. However, bleeding associated with heparin therapy is a concern. Protamine, the only approved antidote for unfractionated heparin (UFH) could cause adverse cardiovascular events. Here, we describe a unique molecular design used in the development of a synthetic dendritic polycation named as Universal Heparin Reversal Agent (UHRA), an antidote for all clinically used heparin anticoagulants. We elucidate the mechanistic basis for the selectivity of UHRA to heparins and its non-toxic nature...
September 7, 2017: Biomacromolecules
https://www.readbyqxmd.com/read/28878572/dabigatran-reversal-with-idarucizumab-in-a-patient-undergoing-heart-transplantation-first-european-report
#8
António Tralhão, Carlos Aguiar, Jorge Ferreira, Maria José Rebocho, Emília Santos, Dinis Martins, José Pedro Neves
BACKGROUND: Dabigatran is a direct thrombin inhibitor with a favorable effectiveness and safety profile when compared to vitamin K antagonists, both in randomized trials and real world registries of atrial fibrillation patients. Yet, physicians' fear of high bleeding risk scenarios in daily clinical practice still precludes a more widespread use of oral anticoagulation. We hereby report a successful case of dabigatran reversal with the novel monoclonal antibody fragment idarucizumab in a patient undergoing heart transplantation...
2017: Thrombosis Journal
https://www.readbyqxmd.com/read/28876608/laparoscopic-left-lateral-sectionectomy-at-dr-george-mukhari-academic-hospital
#9
M Govender, O Y Matsevych
BACKGROUND: Laparoscopic left lateral sectionectomy has rapidly become a standard of care for patients requiring excision of segments 2 and 3. We present our technique of the resection. METHOD: Videos of patients having had left lateral sectionectomies were reviewed. Patients were placed in supine with reverse Trendelenburg position. Three ports were used: one 12 mm at the umbilicus for the camera, one 12 mm placed 5 cm above and to the right of the umbilicus and one 5 mm port to the left...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28867804/fviia-stf-and-thrombin-inhibitory-activities-of-compounds-isolated-from-microcystis-aeruginosa-k-139
#10
Andrea Roxanne J Anas, Akane Mori, Mineka Tone, Chiaki Naruse, Anna Nakajima, Hirohiko Asukabe, Yoshiaki Takaya, Susumu Y Imanishi, Tomoyasu Nishizawa, Makoto Shirai, Ken-Ichi Harada
The rise of bleeding and bleeding complications caused by oral anticoagulant use are serious problems nowadays. Strategies that block the initiation step in blood coagulation involving activated factor VII-tissue factor (fVIIa-TF) have been considered. This study explores toxic Microcystis aeruginosa K-139, from Lake Kasumigaura, Ibaraki, Japan, as a promising cyanobacterium for isolation of fVIIa-sTF inhibitors. M. aeruginosa K-139 underwent reversed-phase solid-phase extraction (ODS-SPE) from 20% MeOH to MeOH elution with 40%-MeOH increments, which afforded aeruginosin K-139 in the 60% MeOH fraction; micropeptin K-139 and microviridin B in the MeOH fraction...
August 30, 2017: Marine Drugs
https://www.readbyqxmd.com/read/28863196/impact-of-inr-monitoring-reversal-agent-use-heparin-bridging-and-anticoagulant-interruption-on-rebleeding-and-thromboembolism-in-acute-gastrointestinal-bleeding
#11
Naoyoshi Nagata, Toshiyuki Sakurai, Shiori Moriyasu, Takuro Shimbo, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Mikio Yanase, Junichi Akiyama, Naomi Uemura
BACKGROUND: Anticoagulant management of acute gastrointestinal bleeding (GIB) during the pre-endoscopic period has not been fully addressed in American, European, or Asian guidelines. This study sought to evaluate the risks of rebleeding and thromboembolism in anticoagulated patients with acute GIB. METHODS: Baseline, endoscopy, and outcome data were reviewed for 314 patients with acute GIB: 157 anticoagulant users and 157 age-, sex-, and important risk-matched non-users...
2017: PloS One
https://www.readbyqxmd.com/read/28861269/defunctioning-stoma-a-prognosticator-for-leaks-in-low-rectal-restorative-cancer-resection-a-retrospective-analysis-of-stoma-database
#12
Haytham Abudeeb, Ahmed Hammad, Ajogwu Ugwu, Jamshid Darabnia, Lee Malcomson, Min Maung, Khurram Khan, Clare Mclaughlin, Arijit Mukherjee
AIMS: Low anterior resection (LAR) has higher risk of anastomotic leak with its attendant morbidity -mortality. De-functioning loop ileostomy (DLI), claimed to mitigate the consequences of anastomotic leak, has been questioned in recent years. This study aims to evaluate the impact of ileostomy on LAR. METHODS: A retrospective analysis of stoma database. 136 patients with stoma (March 2011-July 2015) were assessed. Data was analysed in respect to LAR anastomotic leak rate, impact on morbidity-mortality, short and long-term stoma complications, rate of ileostomy reversal and reasons for non-reversal...
September 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28857806/reversing-dabigatran-anticoagulation-with-prothrombin-complex-concentrate-versus-idarucizumab-as-part-of-multimodal-hemostatic-intervention-in-an-animal-model-of-polytrauma
#13
Markus Honickel, Till Braunschweig, Rolf Rossaint, Christian Stoppe, Hugo Ten Cate, Oliver Grottke
BACKGROUND: Although idarucizumab is the preferred treatment for urgent dabigatran reversal, it is not always available. Prothrombin complex concentrate (PCC) may be an alternative and, with bleeding in trauma, additional hemostatic therapy may be required. The authors investigated multimodal treatment in a preclinical polytrauma model. METHODS: Dabigatran etexilate (30 mg/kg twice daily) was given orally to 45 male pigs for 3 days. On day 4, animals received a dabigatran infusion before blunt liver injury and bilateral femur fractures...
August 30, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28857634/antiplatelets-and-profibrinolytic-activity-of-citrullus-colocynthis-in-control-and-high-fat-diet-induced-obese-rats-mechanisms-of-action
#14
Naif M Alhawiti
The current study aimed to investigate the effect of Citrullus colocynthis (C. colocynthis) hydro-alcoholic extract on blood haemostasis in control and high-fat diet (HFD) induced obese rats. In control rats, the extract significantly enhanced bleeding time and plasma levels of tPA and significantly decreased plasma levels PAI-1 and serum levels of thromboxane B2 leading to inhibition of platelets aggregation. In HFD induced obese rats, similar effects were seen and the extract was also able to reverse HFD induced increases in fibrinogen and VWF...
August 31, 2017: Archives of Physiology and Biochemistry
https://www.readbyqxmd.com/read/28843518/management-of-factor-xa-inhibitor-associated-life-threatening-major-hemorrhage-a-retrospective-multi-center-analysis
#15
Truman J Milling, Carol L Clark, Charles Feronti, Shlee S Song, Sam S Torbati, Gregory J Fermann, Jeffrey Weiss, Dony Patel
BACKGROUND: Factor Xa (FXa) inhibitors, used for stroke prevention in atrial fibrillation and venous thromboembolism treatment and prevention, are the dominant non-Vitamin K oral anticoagulants on the market. While major bleeding may be less common with these agents compared to warfarin, it is always a risk, and little has been published on the most serious bleeding scenarios. This study describes a cohort of patients with FXa inhibitor-associated life-threatening bleeding events, their clinical characteristics, interventions and outcomes...
August 19, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28838728/perioperative-use-of-coagulation-factor-concentrates-in-patients-undergoing-cardiac-surgery
#16
REVIEW
Mark M Smith, Elena Ashikhmina, Nathan J Brinkman, David W Barbara
Coagulopathy and bleeding are common in patients undergoing cardiac surgery, with a perioperative transfusion rate in excess of 50%. The mechanism of coagulopathy associated with cardiac surgery using cardiopulmonary bypass is multifactorial. Historically, coagulation factor-mediated bleeding in such instances has been treated with allogeneic plasma transfusion. Coagulation factor concentrate use for treatment of hemophilia, congenital factor deficiencies and, more recently, emergency warfarin reversal is common...
May 10, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28835439/management-of-rivaroxaban-or-apixaban-associated-major-bleeding-with-prothrombin-complex-concentrates-a-cohort-study
#17
Ammar Majeed, Anna Ågren, Margareta Holmström, Maria Bruzelius, Roza Chaireti, Jacob Odeberg, Eva-Lotta Hempel, Maria Magnusson, Tony Frisk, Sam Schulman
There is uncertainty regarding the effectiveness and occurrence of thromboembolic events in patients treated with prothrombin complex concentrates (PCC) for management of major bleeding events (MBE) on rivaroxaban or apixaban. We investigated the effectiveness of PCC given for management of MBE on rivaroxaban or apixaban. Between 1/1/2014 and 1/10/2016, we prospectively included patients treated with PCC for management of MBE on rivaroxaban or apixaban. The effectiveness of PCC was assessed using the International Society of Thrombosis and Hemostasis' Scientific and Standardization Subcommittee criteria for the assessment of effectiveness of major bleeding management...
August 23, 2017: Blood
https://www.readbyqxmd.com/read/28833357/prothrombin-complex-concentrate-reduces-blood-product-utilization-in-heart-transplantation
#18
Daniel H Enter, Anthony L Zaki, Megan Marsh, Nikki Cool, Jane Kruse, Zhi Li, Adin-Cristian Andrei, Adam Iddriss, Patrick M McCarthy, S Chris Malaisrie, Allen Anderson, Jonathan D Rich, Duc Thinh Pham
BACKGROUND: Current practices for the reversal of warfarin prior to cardiac surgery include the use of vitamin K and fresh frozen plasma (FFP) to reduce the risk of bleeding. Although the 2010 International Society of Heart and Lung Transplantation guidelines acknowledge the use of PCC (Prothrombin Complex Concentrate), there is no clear consensus on its efficacy. The objective of this study was to assess the efficacy of 4-factor Prothrombin Complex Concentrate (4-F PCC) administration in patients requiring warfarin reversal prior to heart transplantation by determining blood product utilization perioperatively...
August 22, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28831047/flow-induced-elongation-of-von-willebrand-factor-precedes-tension-dependent-activation
#19
Hongxia Fu, Yan Jiang, Darren Yang, Friedrich Scheiflinger, Wesley P Wong, Timothy A Springer
Von Willebrand factor, an ultralarge concatemeric blood protein, must bind to platelet GPIbα during bleeding to mediate hemostasis, but not in the normal circulation to avoid thrombosis. Von Willebrand factor is proposed to be mechanically activated by flow, but the mechanism remains unclear. Using microfluidics with single-molecule imaging, we simultaneously monitored reversible Von Willebrand factor extension and binding to GPIbα under flow. We show that Von Willebrand factor is activated through a two-step conformational transition: first, elongation from compact to linear form, and subsequently, a tension-dependent local transition to a state with high affinity for GPIbα...
August 23, 2017: Nature Communications
https://www.readbyqxmd.com/read/28821556/dasatinib-reversibly-disrupts-endothelial-vascular-integrity-by-increasing-non-muscle-myosin-ii-contractility-in-a-rock-dependent-manner
#20
Anna Kreutzman, Beatriz Colom-Fernández, Ana Marcos Jiménez, Mette Ilander, Carlos Cuesta-Mateos, Yaiza Perez-García, Cristina Delgado Arévalo, Oscar Brück, Henna Hakanen, Jani Saarela, Alvaro Ortega-Carrión, Ana de Rosendo, Alba Juanes-García, Juan Luis Steegmann, Satu Mustjoki, Miguel Vicente-Manzanares, Cecilia Muñoz-Calleja
Purpose: Dasatinib is a short-acting dual ABL/SRC family tyrosine kinase inhibitor (TKI), which is frequently used to treat chronic myeloid leukemia. Although very effective, dasatinib often displays severe adverse effects, including pleural effusions and increased risk of bleeding primarily in the gastrointestinal tract. The actual causes of these side effects are currently undetermined. We hypothesize that endothelial cells (ECs) that line the inner walls of blood vessels and control the traffic to the underlying tissues, might be involved...
August 18, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
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