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https://www.readbyqxmd.com/read/28808989/can-we-reliably-predict-the-level-of-anticoagulation-after-enoxaparin-injection-in-elderly-patients-with-renal-failure
#1
Luca Pellizzari, Roberto Facchinetti, Luigi Corrà, Anna Sepe, Francesco Fantin, Giorgia Fontana, Mauro Zamboni, Vincenzo Di Francesco
OBJECTIVES: The aim of this study was to evaluate the activity of anti-activated factor X (anti-Xa) in patients with different degrees of chronic renal failure (CRF), treated with therapeutic doses of low molecular weight heparin. DESIGN: This prospective study evaluated the effect of age, renal function, BMI, gender, in determining the efficacy and safety of treatment with enoxaparin, evaluated by assessing the anti-Xa. The therapeutic anticoagulant range was set between 0...
August 14, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28808492/assessment-of-anti-factor-xa-activity-of-enoxaparin-for-venous-thromboembolism-prophylaxis-in-morbidly-obese-surgical-patients
#2
Nouf Al Otaib, Zohour Bootah, Maha A Al Ammari, Tariq M Aldebasi, Abdulmalik M Alkatheri, Shmeylan A Al Harbi, Salah M AbuRuz, Abdulkareem M AlBekairy
BACKGROUND: Venous thromboembolism (VTE) can be encountered by 60% of hospitalized patients. Anticoagulants have been recommended to reduce the risk of VTE in patients with risk factors. However, no specific dosing recommendations for obese patients are provided in the current practice guidelines. The purpose of this study was to determine the efficacy and safety of weight-based dosing of enoxaparin for VTE prophylaxis among morbidly obese patients undergoing surgery. METHODS: Adult patients were enrolled if they have a body mass index (BMI) of ≥35 kg/m(2) and were scheduled for surgery...
July 2017: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/28804832/measuring-direct-oral-anticoagulants
#3
Robert C Gosselin, Jonathan Douxfils
Direct oral anticoagulants (DOACs) can be quantified using methods that can be performed in any clinical or research laboratory using manual or automated instrument platforms. Dabigatran etexilate, the oral direct thrombin inhibitor, can be quantified by drug-calibrated clot or chromogenic-based assays using either thrombin or ecarin as substrates. Oral direct anti-Xa inhibitors, such as rivaroxaban, apixaban, and edoxaban, can be quantified with drug-calibrated anti-Xa kits or reagents as typically used for measuring heparins (unfractionated, low molecular weight, or pentasaccharides)...
2017: Methods in Molecular Biology
https://www.readbyqxmd.com/read/28797813/sulfated-modification-and-anticoagulant-activity-of-pumpkin-cucurbita-pepo-lady-godiva-polysaccharide
#4
Li Liang, Le Ao, Tao Ma, Yuanying Ni, Xiaojun Liao, Xiaosong Hu, Yi Song
Sulfated modification of pumpkin polysaccharide using CAS with pyridines as catalysts under different conditions was conducted to obtain different degrees of sulfation on a laboratory scale. Anticoagulant activities of pumpkin polysaccharide and its sulfated derivatives were also investigated employing various established in vitro systems. Results showed that addition of high ratio of CAS/pyridine under constant conditions could increase the degree of substitution. Sulfate substitution was further confirmed by the FT-IR and 13C NMR analysis...
August 7, 2017: International Journal of Biological Macromolecules
https://www.readbyqxmd.com/read/28775134/emergency-coagulation-assessment-during-treatment-with-direct-oral-anticoagulants-limitations-and-solutions
#5
Matthias Ebner, Ingvild Birschmann, Andreas Peter, Florian Härtig, Charlotte Spencer, Joachim Kuhn, Gunnar Blumenstock, Christine S Zuern, Ulf Ziemann, Sven Poli
BACKGROUND AND PURPOSE: In patients receiving direct oral anticoagulants (DOACs), emergency treatment like thrombolysis for acute ischemic stroke is complicated by insufficient availability of DOAC-specific coagulation tests. Conflicting recommendations have been published concerning the use of global coagulation assays for ruling out relevant DOAC-induced anticoagulation. METHODS: Four hundred eighty-one samples from 96 DOAC-treated patients were tested using prothrombin time (PT), activated partial thromboplastin time (aPTT) and thrombin time (TT), DOAC-specific assays (anti-Xa activity, diluted TT), and liquid chromatography-tandem mass spectrometry...
August 3, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28767200/correlation-between-activated-partial-thromboplastin-time-and-anti-xa-activity-in-patients-who-received-low-molecular-weight-heparin-as-anticoagulation-for-haemodialysis
#6
Steve Siu-Man Wong, Wai-Yan Lau, Ping-Kwan Chan, Ching-Kit Wan, Yuk-Lun Cheng
Plasma anti-Xa activity, the recommended test to monitor low-molecular weight heparin (LMWH) therapy, is not readily available in many laboratories. In our clinical trials on the use of LMWH as anticoagulation for haemodialysis, a consistent prolongation of APTT in addition to the elevated anti-Xa activity was observed in the patients after LMWH administration. Hence, the paired anti-Xa activity and APTT data were re-analyzed. The APTT ratio, which was the proportional change in APTT from the baseline value after LMWH administration, was found to have a strong correlation with anti-Xa activity (coefficient of determination, R(2) = 0...
August 2, 2017: Nephrology
https://www.readbyqxmd.com/read/28759760/should-we-abandon-the-aptt-for-monitoring-unfractionated-heparin
#7
D R J Arachchillage, F Kamani, S Deplano, W Banya, M Laffan
INTRODUCTION: The activated partial thromboplastin time (APTT) is commonly used to monitor unfractionated heparin (UFH) but may not accurately measure the amount of heparin present. The anti-Xa assay is less susceptible to confounding factors and may be a better assay for this purpose. MATERIALS AND METHODS: The validity of the APTT for monitoring UFH was assessed by comparing with an anti-Xa assay on 3543 samples from 475 patients (infants [n=165], children 1-15years [n=60] and adults [n=250]) receiving treatment dose UFH...
July 6, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28735423/the-anticoagulant-effect-of-heparin-during-radiofrequency-ablation-rfa-in-patients-taking-apixaban-or-rivaroxaban
#8
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...
September 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28708713/platelet-aggregation-in-direct-oral-factor-xa-inhibitors-treated-patients-with-atrial-fibrillation-a-pilot-study
#9
Peter Bánovčin, Ingrid Škorňová, Matej Samoš, Martin Schnierer, Tomáš Bolek, František Kovář, Ján Staško, Peter Kubisz, Marián Mokáň
BACKGROUND: Activated factor X (factor Xa) plays an important role in regulation of platelets. The aim of this study was to test the effect of direct oral factor Xa inhibitors - rivaroxaban and apixaban - on platelet aggregation in patients with non-valvular atrial fibrillation (NV-AF). PATIENTS AND METHODS: This single-centre pilot study enrolled 21 factor Xa inhibitors-treated (9 rivaroxaban-treated and 12 apixaban-treated) patients with NV-AF. The trough and peak samples of these patients were tested for adenosinediphosphate-induced (ADP), epinephrine-induced, and collagen-induced platelet aggregation with light transmission aggregometry (LTA), and with factor Xa-calibrated anti-Xa chromogenic analysis...
July 13, 2017: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/28693359/coagulation-monitoring-correlation-with-heparin-dose-in-pediatric-extracorporeal-life-support
#10
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/28673500/-state-of-the-art-direct-oral-anticoagulants-and-transfusion
#11
A-C Martin, A Godier, D M Smadja, L Mauge, A-M Fischer
Direct oral anticoagulants (DOAC) are indicated for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism. As any anticoagulant, they are associated with a bleeding risk. Management of DOAC-induced bleeding is challenging. Idarucizumab, antidote for dabigatran, is currently available and is part of the therapeutic strategy, whereas antidotes for anti-Xa agents are under development. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain...
June 30, 2017: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
https://www.readbyqxmd.com/read/28667866/a-case-that-illustrates-the-challenges-of-managing-pregnant-patients-with-antithrombin-deficiency-more-questions-than-answers
#12
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/28662505/empirically-reduced-dosages-of-tinzaparin-in-patients-with-moderate-to-severe-renal-insufficiency-lead-to-inadequate-anti-xa-levels
#13
Renske H Olie, Nathalie E L Meertens, Yvonne M C Henskens, Hugo Ten Cate
BACKGROUND: Due to the higher molecular weight of tinzaparin, the low molecular weight heparin (LMWH) is less dependent on renal excretion than other LMWH preparations. However, several international guidelines recommend the same preemptive dosage reduction for all therapeutic dose LMWHs prescribed in renal insufficient patients, to ensure that there is no accumulation of anticoagulant activity and increased risk of bleeding. This study is aimed at assessing whether a preemptive dosage reduction of tinzaparin in all renal insufficient patients (comprising 25% reduction in patients with Modification of Diet in Renal Disease - estimated glomerular filtration rate (MDRD-eGFR) 30-60 mL/min/1...
June 30, 2017: Nephron
https://www.readbyqxmd.com/read/28645996/treatment-of-suspected-pulmonary-embolism-in-a-morbidly-obese-patient
#14
Viviene Heitlage, Mary Beth Borgstadt, Lisa Carlson
PURPOSE: A case highlighting challenges with enoxaparin dosage and monitoring in obese patients is presented. SUMMARY: A morbidly obese 22-year-old Caucasian female (height, 168 cm; weight, 322 kg; body mass index [BMI], 114 kg/m(2)) who presented to the emergency department with acute-onset dyspnea and hypoxia was empirically initiated on enoxaparin for suspected pulmonary embolism at the institution's standard maximum dosage (160 mg subcutaneously every 12 hours)...
July 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28599392/the-laboratory-control-of-anticoagulant-thromboprophylaxis-during-the-early-postpartum-period-after-cesarean-delivery
#15
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
#16
J-D Studt, L Alberio, A Angelillo-Scherrer, L M Asmis, P Fontana, W Korte, A Mendez, P Schmid, H Stricker, D A Tsakiris, W A Wuillemin, M Nagler
Essentials Accurate determination of anticoagulant plasma concentration is important in clinical practice. We studied the accuracy and consistency of anti-Xa assays for rivaroxaban in a multicentre study. In a range between 50 and 200 μg L(-1) , anti-Xa activity correlated well with plasma concentrations. The clinical value might be limited by overestimation and intra- and inter-individual variation. SUMMARY: Background Determining the plasma level of direct oral anticoagulants reliably is important in the work-up of complex clinical situations...
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
#17
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
#18
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
#19
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...
August 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28506952/retrospective-evaluation-of-pregnant-women-with-celiac-disease
#20
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
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