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https://www.readbyqxmd.com/read/28599392/the-laboratory-control-of-anticoagulant-thromboprophylaxis-during-the-early-postpartum-period-after-cesarean-delivery
#1
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/28574652/accuracy-and-consistency-of-anti-xa-activity-measurement-for-determination-of-rivaroxaban-plasma-levels
#2
Jan-Dirk Studt, Lorenzo Alberio, Anne Angelillo-Scherrer, Lars M Asmis, Pierre Fontana, Wolfgang Korte, Adriana Mendez, Pirmin Schmid, Hans Stricker, Dimitrios A Tsakiris, Walter A Wuillemin, Michael Nagler
BACKGROUND: Determining the plasma level of direct oral anticoagulants reliably is important in the work-up of complex clinical situations. OBJECTIVES: To study the accuracy and consistency of anti-Xa assays for rivaroxaban plasma concentration in a prospective, multicentre evaluation study employing different reagents and analytical platforms. METHODS: Rivaroxaban 20 mg was administered once daily to 20 healthy volunteers and blood samples were taken at peak and trough level (clinicaltrials...
June 2, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28567119/direct-oral-anticoagulants-and-digestive-bleeding-therapeutic-management-and-preventive-measures
#3
REVIEW
David Deutsch, Christian Boustière, Emile Ferrari, Pierre Albaladejo, Pierre-Emmanuel Morange, Robert Benamouzig
The use of direct oral anticoagulants (DOACs) was an important step forward in the management of atrial fibrillation and venous thromboembolism (VTE). The DOACs, anti-IIa for dabigatran and anti-Xa for rivaroxaban, apixaban and edoxaban, all have a rapid onset of action and a short half life. There is no need for routine hemostasis testing for treatment monitoring of a DOAC. Compared with vitamin K antagonists (VKAs), DOACs may increase the risk of gastrointestinal bleeding (relative risk 1.25). Withholding the DOAC treatment, evaluating the time of the last intake and estimating the patient's renal function are the first steps in the management of gastrointestinal bleeding...
June 2017: Therapeutic Advances in Gastroenterology
https://www.readbyqxmd.com/read/28521068/association-of-outcomes-and-anti-xa-levels-in-the-treatment-of-pediatric-venous-thromboembolism
#4
Jennifer L Fan, Laura E Roberts, Michael E Scheurer, Donald L Yee, Mona D Shah, YoungNa J Lee-Kim
BACKGROUND: There are few data in the pediatric population evaluating the relationship between measured anti-Xa levels during enoxaparin therapy and thrombotic outcomes. OBJECTIVE: To determine whether there is a difference in outcomes in children who receive enoxaparin with mean anti-Xa levels between 0.45 and 0.79 unit/ml (low therapeutic range) versus between 0.80 and 1.05 unit/ml (high therapeutic range) throughout their course of their treatment. METHODS: We retrospectively identified subjects with uncomplicated venous thromboembolism treated with enoxaparin...
May 18, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28508323/the-impact-of-pharmacy-monitoring-and-intervention-in-patients-receiving-intravenous-heparin
#5
Michaela C Lysogorski, Amany K Hassan, Stacie J Lampkin, Richard Geisler
Background Intravenous unfractionated heparin (IV UFH) has a narrow therapeutic index and poses a high risk of bleeding. Objective To determine the impact of pharmacy monitoring and intervention on adherence to and appropriate implementation of IV UFH protocol. Setting A 438 bed hospital specializing in cardiac services. Methods This is a retrospective chart review study. Pre-pharmacy intervention data were collected from November 2013 to January 2014 and compared to post-pharmacy intervention data obtained between August 2014 and October 2014...
May 15, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28506952/retrospective-evaluation-of-pregnant-women-with-celiac-disease
#6
Kemal Beksaç, Gökçen Örgül, Murat Çağan, Ergun Karaağaoğlu, Serap Arslan, Mehmet Sinan Beksaç
OBJECTIVE: To show celiac disease (CD) and its poor pregnancy outcome relationship, and to demonstrate the importance of a gluten-free diet together with low-dose low-molecular-weight heparin (LMWH) and low-dose corticosteroid (LDC) in the management of pregnancies with CD. MATERIAL AND METHODS: This study consisted of 2 groups of patients. Six patients with CD (control group) on a gluten-free diet were monitored during their first pregnancies within the framework of antenatal care program and their pregnancy outcomes were compared with eight poorly-treated pregnant patients with CD (study group) who were referred from other medical institutions...
March 15, 2017: Journal of the Turkish German Gynecological Association
https://www.readbyqxmd.com/read/28492441/residual-enoxaparin-activity-anti-xa-levels-and-concerns-about-the-american-society-of-regional-anesthesia-and-pain-medicine-anticoagulation-guidelines
#7
Daryl S Henshaw, James D Turner, Daniel J Forest, Garrett R Thompson, Robert S Weller
Currently, the American Society of Regional Anesthesia and Pain Medicine (ASRA) anticoagulation guidelines recommend that before the performance of a neuraxial procedure a minimum of 24 hours should elapse following a treatment dose of enoxaparin (1 mg/kg twice daily or 1.5 mg/kg once daily). The guidelines have since their inception also consistently recommended against the routine use of anti-Xa level monitoring for patients receiving enoxaparin. However, we noted in our clinical practice that anti-Xa levels were frequently still elevated despite patients meeting the time-based recommendation for treatment dose enoxaparin...
July 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28479844/american-college-of-cardiology
#8
Walter Alexander
We report on selected research presented at the ACC 66th Annual Scientific Session and Expo, including sessions on proprotein convertase subtilisin/kexin type 9 inhibitors, anti-Xa anticoagulants, and a direct thrombin inhibitor.
May 2017: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/28460259/adjusted-value-of-thromboprophylaxis-in-hospitalized-obese-patients-a-comparative-study-of-two-regimens-of-enoxaparin-the-itohenox-study
#9
Sébastien Miranda, Véronique Le Cam-Duchez, Jacques Benichou, Nathalie Donnadieu, Virginie Barbay, Maelle Le Besnerais, François-Xavier Delmas, Antoine Cuvelier, Hervé Lévesque, Ygal Benhamou, Guillaume Armengol
Thromboprophylaxis is a mainstay of hospital care in patients at high risk of thrombosis. Fixed doses of low-molecular-weight heparin (LMWH) are recommended for thromboprophylaxis in patients admitted to hospital for an acute medical condition. However, the distribution of LMWH is weight-based, and the efficacy of standard doses in obese patients may be decreased. Data for obese patients are mainly available in bariatric surgery with extremely obese patients who are at greater risk of venous thromboembolism than those hospitalized for a medical condition...
April 12, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28439136/clinical-feasibility-of-monitoring-enoxaparin-anti-xa-concentrations-are-we-getting-it-right
#10
Wesley D Kufel, Robert W Seabury, William Darko, Luke A Probst, Christopher D Miller
Background: Anti-Xa monitoring is utilized to measure the extent of anticoagulation in certain patient populations receiving enoxaparin. It is essential to accurately obtain this pharmacodynamic marker for safe and effective anticoagulation management. Objectives: To determine the frequency of correctly drawn anti-Xa concentrations in accordance with predefined institutional criteria and to determine the number of dose adjustments implemented based on incorrectly drawn anti-Xa concentrations. Methods: This was a retrospective, single-center, cohort study among adult patients who received treatment doses of enoxaparin with measured anti-Xa concentrations...
March 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28434771/pharmacological-management-of-cerebral-venous-sinus-thrombosis-with-full-dose-iv-heparin-infusion-and-its-clinical-outcomes
#11
Andrea Fernandez, Vidya Nair, Anna Mckeone, Joseph Ho
OBJECTIVE: To report a case of successful use of unfractionated heparin (UFH) infusion to treat cerebral venous sinus thrombosis (CVST). CASE SUMMARY: A 54-year-old female with a history of ovarian cancer addressed through palliative care, presents to the Emergency Department complaining of nausea, vomiting and headache for the last 72h. The patient was on a home regimen of enoxaparin 1.5mg/kg subcutaneously daily for recent pulmonary embolism and deep vein thrombosis that developed while on warfarin therapy previously...
March 18, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28427508/review-of-current-evidence-available-for-guiding-optimal-enoxaparin-prophylactic-dosing-strategies-in-obese-patients-actual-weight-based-vs-fixed
#12
REVIEW
Zikai He, Hana Morrissey, Patrick Ball
BACKGROUND: The current debate over the optimal Enoxaparin prophylactic dosing strategies in obese patients centre around whether it should be based on the actual weight of the patient (i.e. weight-based), or at an artificially fixed amount, as it is the case in Australia (40mg daily). The vast majority of the evidence available today is laboratory-based, measuring serum Antifactor-Xa activities as a marker for physiological response. AIM: The aim of the parent study is to compare the clinical outcomes for obese patients who received fixed doses of enoxaparin compared to those who received weight-based doses within the licensed dosage recommendations...
May 2017: Critical Reviews in Oncology/hematology
https://www.readbyqxmd.com/read/28423431/-treatment-and-secondary-prevention-of-venous-thromboembolism-change-in-oral-anticoagulation
#13
Thomas-Maria Helms, Dietrich Gulba, Ingo Ahrens, Andreas Schäfer, Johannes Hankowitz, Peter Kuhlencordt, Hans-Peter Lipp, Sigrid Nikol, Hanno Riess, Tom Stargardt, Peter Bramlage
With the recent approval of the fourth direct non vitamin K dependent oral anticoagulant (NOAC) edoxaban the range of available NOACs for the treatment of venous thromboembolism (VTE) has expanded. Shortly thereafter, two updated guidelines for the prevention and treatment of VTE have been published. In these NOACs are listed as equal anticoagulants to low-molecular weight heparin (LMWH), or fondaparinux (FDX), and VKA for the initial or maintenance treatment of VTE. All NOACs are approved for the maintenance therapy after VTE and two NOACs (rivaroxaban and apixaban) for the initial treatment in addition in an increased dose...
April 19, 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28375032/pharmacodynamic-properties-and-bioequivalence-of-dalteparin-sodium-subcutaneous-injection-in-healthy-chinese-male-subjects
#14
Lijin Yu, Xin Guo, Sujie Jia, Yuanyuan Xiang, Zhigang Ding, Ren Guo
1. Dalteparin sodium (DS) is a low molecular weight heparin that is widely used in the treatment of thromboembolism. The purpose of this study was to compare the pharmacodynamic properties and bioequivalence of the two formulations of DS with subcutaneous injection in healthy Chinese male subjects. 2. In this randomized, open-label, two-period crossover study, a total of 24 male subjects were recruited to receive single subcutaneous doses of test and reference DS injection in two different sequences (12 subjects each) with a seven-day washout period...
April 21, 2017: Xenobiotica; the Fate of Foreign Compounds in Biological Systems
https://www.readbyqxmd.com/read/28322799/novel-method-for-measurement-of-heparin-anticoagulant-activity-using-spr
#15
Jing Zhao, Xinyue Liu, Anju Malhotra, Quanhong Li, Fuming Zhang, Robert J Linhardt
A novel method has been developed for the easy measurement of heparin's anticoagulant activity using surface plasmon resonance. The anticoagulant activity of target heparin was evaluated by measuring the competitive antithrombin III binding of analyte heparin in the solution phase and USP heparin immobilized on chip surface. Heparins, obtained from different animal sources, and low molecular weight heparins were analyzed. The results were reproducible and correlated well with the results of chromogenic assays (correlation coefficient r = 0...
June 1, 2017: Analytical Biochemistry
https://www.readbyqxmd.com/read/28279428/nadroparin-or-fondaparinux-versus-no-thromboprophylaxis-in-patients-immobilised-in-a-below-knee-plaster-cast-protect-a-randomised-controlled-trial
#16
Marlieke M Bruntink, Yannick M E Groutars, Inger B Schipper, Roelf S Breederveld, Wim E Tuinebreijer, Robert J Derksen
BACKGROUND: The immobilisation of the lower leg is associated with deep vein thrombosis (DVT). However, thromboprophylaxis in patients with a below-knee plaster cast remains controversial. We examined the efficacy and safety of nadroparin and fondaparinux to ascertain the need for thromboprophylaxis in these patients. METHODS: PROTECT was a randomised, controlled, single-blind, multicentre study that enrolled adults with an ankle or foot fracture who required immobilisation for a minimum of four weeks...
April 2017: Injury
https://www.readbyqxmd.com/read/28247290/determination-of-non-vitamin-k-oral-anticoagulant-noac-effects-using-a-new-generation-thrombelastography-teg-6s-system
#17
Kevin P Bliden, Rahul Chaudhary, Nafees Mohammed, Adina A Muresan, Carlos G Lopez-Espina, Eli Cohen, Gabriel Raviv, Marc Doubleday, Fowzia Zaman, Blessy Mathew, Udaya S Tantry, Paul A Gurbel
Non vitamin K oral anticoagulants (NOACs) do not require regular monitoring but information about their pharmacodynamic effect may be importantin situations like trauma, stroke oremergent surgery. Currently, no standardized point-of-care test is available to evaluate the anticoagulant effects of NOACs. We evaluated the anticoagulant effect of NOACs with the next generation point-of-care TEG assay (TEG® 6S) based on a fully-automated thrombelastography system. We used two TEG® 6S assays, the DTI assay and Anti-Factor Xa (AFXa) assay, to detect anticoagulant effects and classify NOACs...
May 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28244023/-perioperative-anticoagulation-with-noac-using-the-example-of-rivaroxaban
#18
Jürgen Koscielny, Christian von Heymann, Rupert Bauersachs, Patrick Mouret, Matthias Antz
BACKGROUND: Recent findings require an update of earlier recommendations on the perioperative management of non Vitamin K antagonist oral anticoagulants (NOAC). METHOD: The present position paper summarises the outcomes of an expert panel discussion. RESULTS AND CONCLUSIONS: Based on the pharmacokinetic profile of rivaroxaban, a preoperative interruption of 24-72 hours is recommended depending on the patient's renal function, as well as individual and surgery-related bleeding risks...
March 2017: MMW Fortschritte der Medizin
https://www.readbyqxmd.com/read/28215696/recurrent-venous-thrombosis-under-rivaroxaban-and-carbamazepine-for-symptomatic-epilepsy
#19
Claudia Stöllberger, Josef Finsterer
BACKGROUND: The direct oral anticoagulant (DOAC) rivaroxaban, an oral Factor Xa inhibitor, is increasingly used as an alternative to vitamin-K-antagonists (VKAs). Absorption and elimination of DOACs are dependent on the permeability glycoprotein (P-gp) efflux transporter protein system, and DOACs are substrates of the hepatic cytochrome P 450 3A4 (CYP3A4) enzymes. Therefore, drug-interactions may occur when DOACs are administered with drugs affecting the activity of P-gp or CYP3A4 systems...
March 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/28196509/point-of-care-testing-for-emergency-assessment-of-coagulation-in-patients-treated-with-direct-oral-anticoagulants
#20
Matthias Ebner, Ingvild Birschmann, Andreas Peter, Charlotte Spencer, Florian Härtig, Joachim Kuhn, Gunnar Blumenstock, Christine S Zuern, Ulf Ziemann, Sven Poli
BACKGROUND: Point-of-care testing (POCT) of coagulation has been proven to be of great value in accelerating emergency treatment. Specific POCT for direct oral anticoagulants (DOAC) is not available, but the effects of DOAC on established POCT have been described. We aimed to determine the diagnostic accuracy of Hemochron® Signature coagulation POCT to qualitatively rule out relevant concentrations of apixaban, rivaroxaban, and dabigatran in real-life patients. METHODS: We enrolled 68 patients receiving apixaban, rivaroxaban, or dabigatran and obtained blood samples at six pre-specified time points...
February 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
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