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International Normalized Ratio

Asbjørn Støylen, Harald E Mølmen, Håvard Dalen
BACKGROUND: We aimed to study left ventricular (LV) geometry assessed by length (LVWL), external diameter (LVEDD) and relative wall thickness (RWT) in relation to age, body size and gender in healthy individuals. METHODS: 1266 individuals underwent echocardiography in the Nord-Trøndelag Health Study (HUNT3), Norway. Septum thickness (IVS), posterior wall thickness (LVPWd) and end-diastolic internal diameter (LVIDD) were measured in M-mode, and LVEDD was calculated as the sum...
2016: Open Heart
Xiaoshu Li, Fangyuan Gao, Huimin Liu, Henghui Zhang, Yao Liu, Xieqiong Ye, Mingfan Geng, Le Sun, Rui Wang, Yuxin Li, Yuyong Jiang, Xiaojing Wang, Guiqin Zhou, Zhiyun Yang, Ang Li, Hui Zeng, Xianbo Wang
AIM: Hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) has significant morbidity and mortality. There is no standard approach for the management of HBV-related ACLF with nucleos(t)ide analogs. Our objective was to compare the short-term mortality between entecavir (ETV) and lamivudine (LAM) in patients with HBV-related ACLF. METHODS: We recruited 311 inpatients with HBV-related ACLF from December 2002 to January 2015. The patients were treated with ETV (n=143) or LAM (n=168)...
October 4, 2016: European Journal of Gastroenterology & Hepatology
Julie A Fusco, Eric J Paulus, Alexandra R Shubat, Sharminara Miah
A 62-year-old African American man received unintentional duplicate anticoagulation therapy with warfarin 5 mg and rivaroxaban 20 mg daily for the treatment of recurrent pulmonary embolism. The patient presented to the anticoagulation clinic 6 days after hospital discharge with an International Normalized Ratio (INR) of 2.3 and he was instructed to continue warfarin 5 mg daily. Seven days later, he returned to the clinic with an INR >8.0 using a point-of-care device. He denied any signs or symptoms of bleeding...
December 2015: Drug Saf Case Rep
Eric Paulus, Kathy Komperda, Gabriel Park, Julie Fusco
Factor VII (FVII) deficiency is the most prevalent rare bleeding disorder in the USA and affects approximately 1 out of every 500,000 people. Warfarin inhibits the synthesis of FVII, in addition to other clotting factors. Warfarin is contraindicated in patients with bleeding tendencies or blood dyscrasias; therefore, the literature regarding the use of warfarin in FVII deficiency is very limited. We report a successful re-challenge of warfarin therapy in a patient with FVII deficiency. A 70-year-old woman with FVII deficiency experienced a significant decrease in FVII activity and subsequent vaginal bleeding roughly 5 weeks after starting warfarin for atrial fibrillation...
December 2016: Drug Saf Case Rep
Ivan Netuka, Pierre-Yves Litzler, Michael Berchtold-Herz, Erwan Flecher, Daniel Zimpfer, Laura Damme, Kartik S Sundareswaran, David J Farrar, Jan D Schmitto
BACKGROUND: Current recommendations of antithrombotic therapy for HeartMate II (HMII) patients include the use of both an anticoagulant and an antiplatelet agent. Because bleeding is still the most frequent adverse event, the TRACE (STudy of Reduced Anti-Coagulation/Anti-platelet Therapy in Patients with the HeartMatE II) study was initiated to evaluate the incidence of adverse events in HMII patients on reduced antithrombotic (RT) therapy. METHODS: HMII patients (n = 101) from nine centers were enrolled in the European arm of TRACE and were managed on a single anticoagulant (vitamin K antagonist) with no antiplatelet agents...
October 12, 2016: Annals of Thoracic Surgery
Isabel López, Estela Sangüesa, Yves Vancraenendonck, Estefanía Zuriaga, María Pilar Ribate, Cristina Belén García
Vitamin K antagonists are highly effective antithrombotic drugs. However, appropriate dosing is difficult to establish owing to its narrow therapeutic window as well as widespread inter- and intra-individual variability in dosage. Compared with dosing solely based on clinical information, pharmacogenetics can help improve the therapy with coumarins by decreasing the time to reach a stable dose and reducing the risk of bleeding. Most of the studies about genotyping of patients using vitamin K antagonists have focused on predicting the stable dose...
October 14, 2016: Drug Metabolism and Personalized Therapy
Rebecca N Howie, Timothy L Foutz, Curtis C Cathcart, Jeff S Burmeister, Steve C Budsberg
OBJECTIVE: To investigate the relationship between tibiofemoral kinematics before and after total knee replacement (TKR) in vitro. ANIMALS: Eight canine hemipelves. METHODS: A modified Oxford Knee Rig was used to place cadaveric limbs through a range of passive motion allowing the kinematics of the stifle to be evaluated. Four measurements were performed: a control stage, followed by a cranial cruciate transection stage, then following TKR with the musculature intact stage, and finally TKR with removal of limb musculature stage...
October 14, 2016: Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T
Mário Augusto Cray da Costa, Lucas Kraeski Krum, Juliana da Silva Geraldino, Marcelo Derbli Schafranski, Ricardo Zanetti Gomes, Elise Souza Dos Santos Reis
Introduction: In patients with mechanical prosthetic heart valves or atrial fibrillation requiring anticoagulation to prevent thromboembolic events, several factors influence adherence and anticoagulation complications. Objective: To evaluate the factors that interfere with the quality and complications of anticoagulation with vitamin K antagonists. Methods: A retrospective cohort study of 100 patients, in the period from 2011 to 2014, was performed...
May 2016: Brazilian Journal of Cardiovascular Surgery
F Y Wang, W Meng, Y Li, T Li, C Y Qin
Transarterial chemoembolization (TACE) has mostly been used in hypervascular tumours such as hepatocellular carcinoma, and may be an effective palliative treatment in patients with metastatic liver cancer. Our goal is to determine whether TACE increases overall survival (OS) of in patients with liver metastases. The retrospective cohort study included 171 patients with liver metastases diagnosed between 2001 and 2015. OS was compared between the TACE and non-TACE groups after propensity score matching to reduce the effects of selection bias and potential confounders...
October 13, 2016: Scientific Reports
Kuk Hui Son, Chang-Hyu Choi, Jae-Ik Lee, Kun Woo Kim, Ji Sung Kim, So Young Lee, Kook Yang Park, Chul Hyun Park
BACKGROUND: Guidelines for esophagogastroduodenoscopy (EGD) in the West allow the continued use of warfarin under therapeutic international normalized ratio (INR) level. In Korea, no guidelines have been issued regarding warfarin treatment before EGD. The authors surveyed Korean cardiac surgeons about how Korean cardiac surgeons handle warfarin therapy before EGD using a questionnaire. Participants were requested to make decisions regarding the continuation of warfarin therapy in two hypothetical cases...
October 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Md Asiful Islam, Kah Keng Wong, Teguh Haryo Sasongko, Siew Hua Gan, Jin Shyan Wong
Here we present a case report of three familial primary antiphospholipid syndrome (PAPS) patients from Malaysia. The three familial patients comprised two females and one male with a mean age of 26.3 years. The first diagnosis was made between 2005 and 2009, and all patients demonstrated deep vein thrombosis, high levels of IgM and IgG anticardiolipin antibodies, and received warfarin treatment international normalized ratio (INR) 2.0-3.0. The patients ceased to show clinical symptoms after treatment. Recently (August 2014), we investigated whether the levels of antiphospholipid antibodies remained elevated, and we found that seronegativity occurred in the patients...
September 2016: Eur J Rheumatol
Monique Mounce, Candace Essel, Tiffany Kim, Che Matthew Harris
BACKGROUND: Supratherapeutic international normalized ratio (INR) in patients on warfarin is a common side effect. Updated guidelines recommend against using vitamin K to correct INRs 4.5 to 10 in the absence of bleeding. The impact of compliance with updated guidelines during hospitalization has not been fully explored. METHODS: A retrospective, observational study was performed utilizing electronic medical records. The goal was to evaluate management of supratherapeutic INR values for medicine inpatients and identify differences in clinical outcomes among inpatients treated and not treated with vitamin K...
November 2015: Hospital Pharmacy
Fuat H Saner, Carmen Kirchner
BACKGROUND: Patients with end-stage liver disease (ESLD) are assumed to be at high risk of bleeding when undergoing any kind of invasive intervention (any kind of operation, including transplantation or minimally invasive interventions). Both bleeding and thrombosis are associated with a poor outcome. METHODS: A selective literature research was conducted with the following key words: 'cirrhosis', 'coagulation', 'bleeding', 'INR' (international normalized ratio), 'aPTT' (activated partial thromboplastin time), and 'thrombocytopenia'...
August 2016: Visc Med
Marjaana Viljanto, James Scarth, Pamela Hincks, Lynn Hillyer, Adam Cawley, Craig Suann, Glenys Noble, Christopher J Walker, Andrew T Kicman, Mark C Parkin
Detection of testosterone and/or its pro-drugs in the gelding is currently regulated by the application of an international threshold for urinary testosterone of 20 ng/mL. The use of steroid ratios may provide a useful supplementary approach to aid in differentiating between the administration of these steroids and unusual physiological conditions that may result in atypically high testosterone concentrations. In the current study, an ultra high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method was developed to quantify testosterone (T) and epitestosterone (E)...
October 7, 2016: Drug Testing and Analysis
Sara R Britnell, Amy E Willets, Adam J Vanderman, Catherine L Woodard, Rachel B Britt
STUDY OBJECTIVE: To describe international normalized ratio (INR) trends and warfarin dosage adjustments required for four veterans who were receiving warfarin therapy and started treatment for hepatitis C virus (HCV) with ledipasvir/sofosbuvir with or without ribavirin. DESIGN: Case series. SETTING: Pharmacist-led anticoagulation clinic at a Veterans Affairs medical center. PATIENTS: Four patients aged 59-66 years who were receiving warfarin and had stable, therapeutic INRs and started ledipasvir/sofosbuvir therapy with or without ribavirin for HCV infection...
October 7, 2016: Pharmacotherapy
Mario Schiavoni, Antonella Coluccia
BACKGROUND: Evidence from clinical trials shows rivaroxaban to be effective for the treatment of deep vein thrombosis. Switching to rivaroxaban following failure of indirect anticoagulants in deep vein thrombosis has not been demonstrated in a real-life setting. CASE PRESENTATION: A 43-year-old white woman was switched from warfarin to rivaroxaban for the treatment of thrombosis of her right common femoral vein after saphenectomy. The reason for the switch was due to the instability of anti-coagulation therapy with vitamin K antagonists over a period of 3 months during which she did not reach the "therapeutic range" of prothrombin time-international normalized ratio...
October 5, 2016: Journal of Medical Case Reports
Malgorzata Kolpa, Agnieszka Jankowicz-Szymanska, Beata Jurkiewicz
BACKGROUND: Childhood overweight and obesity are common causes of metabolic disorders that persist until adulthood. OBJECTIVES: The purpose of this study was to determine the prevalence of high-normal arterial blood pressure (ABP) in children with excess body weight. MATERIAL AND METHODS: A total of 1,093 schoolchildren aged 10 - 12 years (51% girls and 49% boys) participated in the study. The children's weight, height, body fat percentage (BFP), waist and hip circumference, and ABP were measured...
August 2016: Iranian Journal of Pediatrics
Jan Biegus, Robert Zymliński, Mateusz Sokolski, Paweł Siwołowski, Piotr Gajewski, Sylwia Nawrocka-Millward, Elżbieta Poniewierka, Ewa A Jankowska, Waldemar Banasiak, Piotr Ponikowski
AIM: Multi-organ dysfunction often complicates the natural course of acute heart failure (AHF) and identifies patients with poor prognosis. The MELD score (Model of End-Stage Liver Dysfunction) combines data reflecting liver and kidney function, which makes it a potentially useful tool for the assessment of patients with AHF. To assess the prognostic utility of the MELD score in patients with AHF. METHODS AND RESULTS: The MELD score was calculated on admission and during hospital stay (days 2-3) using a formula that does not take into account the international normalized ratio (MELD XI)...
October 6, 2016: European Journal of Heart Failure
Mingyu He, Lillian Ro, Jing Liu, Chih-Chang Chu
Gambogic acid (GA) exhibits a broad spectrum of anticancer activity and low chemotoxicity to normal tissues. However, poor aqueous solubility and sensitivity to hydrolysis make its pharmaceutical applications a challenge. Linear and branched Arg-based poly(ester urea urethane)s (Arg-PEUUs), folate (FA) conjugated Arg PEUUs (FA-Arg-PEUUs) and their self-assembled nanoparticles (NPs) were designed, synthesized, and studied as the potential GA carriers for cancer treatment. The average diameters of linear or branched Arg-PEUU/FA-Arg-PEUU NPs were 98 to 267 nm...
October 5, 2016: Journal of Biomedical Materials Research. Part A
J K Böhlke, Stanley J Mroczkowski, Neil C Sturchio, Linnea J Heraty, Kent W Richman, Donald B Sullivan, Kris N Griffith, Baohua Gu, Paul B Hatzinger
RATIONALE: Perchlorate (ClO4(-) ) is a common trace constituent of water, soils, and plants; it has both natural and synthetic sources and is subject to biodegradation. The stable isotope ratios of Cl and O provide three independent quantities for ClO4(-) source attribution and natural attenuation studies: δ(37) Cl, δ(18) O, and δ(17) O (or Δ(17) O or (17) Δ) values. Documented reference materials, calibration schemes, methods, and interferences will improve the reliability of such studies...
October 3, 2016: Rapid Communications in Mass Spectrometry: RCM
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