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Hui Yin Lim, Harshal Nandurkar, Prahlad Ho
The advent of direct oral anticoagulants (DOACs) has revolutionized anticoagulation management in both stroke prevention and venous thromboembolism (VTE) treatment/prevention. Clinical trials and secondary real-world data have shown that DOACs have similar efficacy and, in some cases, improved bleeding safety profiles compared with vitamin K antagonists. Together with benefits of patient convenience, this has shifted the risk-benefit ratio toward long-term anticoagulation. However, current VTE risk assessment models are based on vitamin K antagonists and do not take into account the new paradigm of DOACs...
March 20, 2018: Seminars in Thrombosis and Hemostasis
Chi Zhang, Peizhe Zhang, Hongxia Li, Lianhua Han, Lei Zhang, Lei Zhang, Xiangjun Yang
OBJECTIVES: Dabigatran etexilate is widely used for stroke prevention in the patients with atrial fibrillation. The anticoagulation activity of dabigatran is not necessary monitored in routine clinical practice. We aimed to study the effect of dabigatran on thrombin generation (TG) and coagulation assays in rabbit and human plasma. METHODS: Rabbits received different concentrations of dabigatran etexilate (5 mg/kg, 10 mg/kg). Patients with atrial fibrillation took 110 mg dabigatran etexilate twice daily...
March 15, 2018: Thrombosis Research
Sven Haller, Meike W Vernooij, Joost P A Kuijer, Elna-Marie Larsson, Hans Rolf Jäger, Frederik Barkhof
Cerebral microbleeds (CMBs), also referred to as microhemorrhages, appear on magnetic resonance (MR) images as hypointense foci notably at T2*-weighted or susceptibility-weighted (SW) imaging. CMBs are detected with increasing frequency because of the more widespread use of high magnetic field strength and of newer dedicated MR imaging techniques such as three-dimensional gradient-echo T2*-weighted and SW imaging. The imaging appearance of CMBs is mainly because of changes in local magnetic susceptibility and reflects the pathologic iron accumulation, most often in perivascular macrophages, because of vasculopathy...
April 2018: Radiology
Toshihiro Okamoto, Keika Hoshi, Kenji Fukada, Toshiyuki Kataoka, Akira Kumasaka, Nobuyuki Kaibuchi, Satoshi Fukuzawa, Tomohiro Ando
OBJECTIVE: To evaluate the background factors related to the occurrence of complications in the early stages after dental implant placement. MATERIALS AND METHODS: A total of 289 outpatients who received dental implants were retrospectively evaluated for the presence or absence of complications. Background factors, including age, sex, implant width, implant length, implant site, number of implants placed, Periotest values at the time of implant placement, presence/absence of systemic disease (particularly diabetes), and the use of anticoagulation therapy, were compared between patients with and without complications...
March 19, 2018: Implant Dentistry
Patrick Mouret, Reinhold Kreutz, Katrin Deilmann, Ariane Dihlmann, Gerlind Holberg, Sylvia Haas
BACKGROUND: In global admission studies (RECORD I-IV) Rivaroxaban and enoxaparin as a standard prophylaxis were comparable in safety of treatment, but rivaroxaban appeared more effective in prevention of venous thromboembolism (VTE) when used in elective hip and knee replacement. The worldwide non-interventional cohort study XAMOS confirmed these results in the clinical routine compared to proven anticoagulants. METHOD: Efficacy and safety of rivaroxaban was to be compared with the standard prophylaxis in the prevention of VTE after elective hip and knee replacement surgery in clinical practice in Germany...
October 2017: MMW Fortschritte der Medizin
Megan Z Roberts, G Eric Gaskill, Julie Kanter-Washko, T Rogers Kyle, Brittany C Jones, Nicole M Bohm
Patients with sickle cell disease (SCD) experience initial and recurrent venous thromboembolism (VTE) more commonly and at a younger age than the general population, and it confers a higher mortality for patients with SCD. However, limited evidence is available to guide anticoagulant use for VTE treatment in this population. The primary objective of this study is to characterize the effectiveness and safety of direct oral anticoagulants (DOAC) and warfarin for VTE treatment among patients with SCD. This single-center retrospective study includes adult patients with SCD who were diagnosed with VTE...
March 19, 2018: Journal of Thrombosis and Thrombolysis
Nicolas Palaskas, Kara Thompson, Gregory Gladish, Ali M Agha, Saamir Hassan, Cezar Iliescu, Peter Kim, Jean B Durand, Juan C Lopez-Mattei
PURPOSE OF REVIEW: Our purpose is to discuss the importance of multimodality imaging in the assessment of cardiac tumors and management. We have compiled a recent review of the scientific literature and embedded our clinical pathways and recommendations based on data and clinical experience. RECENT FINDINGS: The use of contrast echocardiography in the assessment of cardiac masses has been shown to be helpful in distinguishing tumor from thrombus. Deformation imaging of cardiac tumors has been shown to differentiate better rhabdomyomas from fibromas in pediatric patients...
March 20, 2018: Current Treatment Options in Cardiovascular Medicine
Anas Boulemden, Gemma L Malin, Suzanne V F Wallace, Amr Mahmoud, William H T Smith, Adam A Szafranek
We report the case of a 44-year-old pregnant woman who was diagnosed with symptomatic severe mitral stenosis that did not respond to optimal medical therapy and balloon valvuloplasty. After a multidisciplinary team discussion on the timing and risks of interventions and postoperative optimization of peripartum anticoagulation, the patient underwent mechanical mitral valve replacement during the 2nd trimester of pregnancy. The outcome was excellent for the mother and the infant. This case emphasizes the importance of a multidisciplinary approach in managing unusual cases...
February 2018: Texas Heart Institute Journal
Teresa C Assumpção, Daniella M Mizurini, Dongying Ma, Robson Q Monteiro, Sydney Ahlstedt, Morayma Reyes, Michail Kotsyfakis, Thomas N Mather, John F Andersen, Jan Lukszo, José M C Ribeiro, Ivo M B Francischetti
Tick saliva is a rich source of modulators of vascular biology. We have characterized Ixonnexin, a member of the "Basic-tail" family of salivary proteins from the tick Ixodes scapularis. Ixonnexin is a 104 residues (11.8 KDa), non-enzymatic basic protein which contains 3 disulfide bonds and a C-terminal rich in lysine. It is homologous to SALP14, a tick salivary FXa anticoagulant. Ixonnexin was produced by ligation of synthesized fragments (51-104) and (1-50) followed by folding. Ixonnexin, like SALP14, interacts with FXa...
March 19, 2018: Scientific Reports
Sarah E Sartain, Nancy A Turner, Joel L Moake
Atypical hemolytic uremic syndrome (aHUS) and bone marrow transplantation-associated thrombotic microangiopathy (TA-TMA) are associated with excessive activation of the alternative complement pathway (AP) and with severe renal - and rarely, cerebral - microvascular damage. Here, we compared AP activation and regulation in human glomerular and brain microvascular endothelial cells (GMVECs and BMVECs, respectively) unstimulated or stimulated by the proinflammatory cytokine, tumor necrosis factor (TNF). Compared with GMVECs and under both experimental conditions, BMVECs had increased gene expression of the AP-related genes C3 , CFB , and C5 , and decreased expression of CFD This was associated with increased expression in BMVECs (relative to GMVECs) of the genes for surface and soluble regulatory molecules ( CD46 , THBD , CD55 , CFI , and CFH ) suppressing formation of the AP C3 and C5 convertases...
March 19, 2018: Journal of Biological Chemistry
M Yolanda Cobo-Nuñez, Mariam El Assar, Pedro Cuevas, Alberto Sánchez-Ferrer, Jennifer Martínez-González, Leocadio Rodríguez-Mañas, Javier Angulo
Etamsylate is indicated for several anti-hemorrhagic indications in human and veterinary medicine. However, etamsylate has been shown to be effective only in specific haemorrhagic situations. Furthermore, mechanism of action of etamsylate is not known but recent research has shown its ability to inhibit heparin binding to several growth factors. We have evaluated the ability of etamsylate to interfere with the activities of heparin. Effects of etamsylate on vasodilatory activity of heparin were evaluated in rat aortic segments...
March 16, 2018: European Journal of Pharmacology
Amir Shaban, Toshio Moritani, Sami Al Kasab, Ali Sheharyar, Kaustubh S Limaye, Harold P Adams
BACKGROUND AND PURPOSE: Spinal cord hemorrhages are rare conditions that can be classified based on the primary location of bleeding into intramedullary (hematomyelia), subarachnoid hemorrhage (SAH), subdural hemorrhage, and epidural hemorrhage. We conducted a literature review to better understand the presenting symptoms, etiology, diagnosis, and treatment of spinal cord hemorrhages. METHODS: We performed a literature search using PubMed with the key words spinal hemorrhage, hematomyelia, spinal subarachnoid hemorrhage, spinal subdural hematoma, and spinal epidural hematoma RESULTS: Most commonly, spinal hematomas present with acute onset of pain and myelopathy but a more insidious course also may occur...
March 16, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Ali Yousif, Rajesh Samannan, Mazen Abu-Fadel
Acute renal artery embolism (RAE) is a rare condition associated with significant morbidity and mortality. The treatment strategy for RAE includes anticoagulation with or without thrombolysis or surgical or endovascular embolectomy. We describe here a case presentation of acute RAE secondary to atrial fibrillation treated successfully with Penumbra Indigo Aspiration System, a novel device in peripheral endovascular interventions. Our patient had ongoing symptoms and acute renal failure on presentation with contraindication to thrombolysis given hypertensive emergency...
January 1, 2018: Vascular and Endovascular Surgery
Ying Su, Jingli Chen, Zengxiang Dong, Yan Zhang, Ruishuang Ma, Junjie Kou, Feng Wang, Jialan Shi
BACKGROUND/AIMS: The mechanisms for thrombosis in diabetic retinopathy (DR) are complex and need to be further elucidated. The purpose of this study was to test phosphatidylserine (PS) exposure on microparticles (MPs) and MP-origin cells from the circulation and to analyze cell-/MP-associated procoagulant activity (PCA) in DR patients. METHODS: PS-positive MPs and cells from healthy controls (n = 20) and diabetic patients (n = 60) were analyzed by flow cytometry and confocal microscopy...
March 15, 2018: Cellular Physiology and Biochemistry
Angelica G Mancone, Alyssa R Dickey, Brian M Fitzgerald, Gregory P Kraus, Sandeep T Dhanjal
Introduction: Wrong site peripheral nerve blocks are included in the National Quality Forum and Joint Commission's category of "never event." Multiple attempts have been made by various groups in an effort to eliminate these events. Prior attempts to eliminate these never events include the Regional Block Preprocedural Checklist provided by the American Society of Regional Anesthesia (ASRA) taskforce. Following a series of errors involving anticoagulation prior to regional anesthesia, our department saw a need for a more comprehensive checklist...
March 15, 2018: Military Medicine
Daniele Pastori, José Miguel Rivera-Caravaca, María Asunción Esteve-Pastor, Vanessa Roldán, Francisco Marín, Pasquale Pignatelli, Francesco Violi, Gregory Y H Lip
BACKGROUND: Two risk scores have been developed to predict composite outcomes in atrial fibrillation (AF): the 2MACE and TIMI-AF scores. The aim of this study was to compare the predictive ability of these scores in 2 separate warfarin-treated cohorts (one 'real world', one clinical trial) of AF patients.Methods and Results:The 2MACE and TIMI-AF scores were calculated in the 'real-world' ATHERO-AF cohort (n=907), and in the randomized controlled AMADEUS trial (n=2,265). Endpoints were major adverse cardiovascular events (MACEs), net clinical outcomes (NCO) and a combination of them, namely "clinically relevant events" (CREs)...
March 16, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Frans Moll, Iris Baumgartner, Michael Jaff, Chuke Nwachuku, Marco Tangelder, Gary Ansel, George Adams, Thomas Zeller, John Rundback, Michael Grosso, Min Lin, Michele F Mercur, Erich Minar
PURPOSE: To report a randomized study that investigated the safety (risk of major bleeds) and potential efficacy of edoxaban, an oral anticoagulant that targets the major components of arterial thrombi, to prevent loss of patency following endovascular treatment (EVT). METHODS: Between February 2012 and June 2014, 203 patients who underwent femoropopliteal EVT were randomized to receive aspirin plus edoxaban or aspirin plus clopidogrel for 3 months in the Edoxaban in Peripheral Arterial Disease (ePAD) study ( ClinicalTrials...
April 2018: Journal of Endovascular Therapy
Andrea Szegedi, Zoltán Csanádi
The significantly increased incidence of stroke and systemic embolisation caused by atrial fibrillation can be prevented by adequately adjusted anticoagulant therapy. Vitamin K antagonists effectively decrease the risk of thromboembolic events but this effect is influenced by many factors. The development of the new direct oral anticoagulant drugs (DOAC) in the last few years provided new opportunities for us to choose the suitable anticoagulant therapy. According to the results of the ENGAGE AF-TIMI 48 and ENSURE-AF multicenter, randomized trials, edoxaban, the recently introduced DOAC is equally effective as the traditional coumarin therapy, nevertheless, it ensures more tolerable anticoagulation for patients suffering from non-valvular atrial fibrillation...
March 2018: Orvosi Hetilap
Tianming Zhao, Jixiang Ni, Xuehua Hu, Yingnan Wang, Xinge Du
Thrombolysis and anticoagulation were the main treatment methods for acute pulmonary embolism. However, the use of thrombolysis drugs may lead to bleeding complications. We compared intermittent low-dose urokinase (UK) and alteplase (recombinant tissue plasminogen activator [rt-PA]) in normotensive patients with intermediate-high-risk pulmonary embolism. The UK group was treated with intravenous UK 10 000 U/kg once a day for 7 days. The rt-PA group was given alteplase 50 mg by intravenous injection within 2 hours of admission...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Hee Kyung Yang, Ki Won Moon, Min Jung Ji, Sang Beom Han, Jeong-Min Hwang
Purpose: To report a case of primary antiphospholipid syndrome presenting with isolated homonymous superior quadrantanopsia. Observations: A 50-year-old Korean man presented with subjective visual disturbance for 1 month. Visual field testing showed a right homonymous superior quadrantanopsia. Brain magnetic resonance imaging (MRI) revealed an old infarct in his left occipital lobe and multiple lesions in other areas of the brain. Laboratory tests showed a marked increase in serum anti-β2 glycoprotein I antibody, which remained elevated after 12 weeks...
June 2018: American Journal of Ophthalmology Case Reports
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