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Anticoagulant reversal

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https://www.readbyqxmd.com/read/29665860/the-use-of-cangrelor-with-heparin-for-left-ventricular-assist-device-implantation-in-a-patient-with-acute-heparin-induced-thrombocytopenia
#1
Yan K Gernhofer, Michael Ross, Swapnil Khoche, Victor Pretorius
BACKGROUND: Optimal anticoagulation strategy for cardiopulmonary bypass (CPB) in end-stage heart failure patients with heparin-induced thrombocytopenia (HIT) requiring left ventricular assist device (LVAD) implantation remains uncertain. Presently, there are no large-scale randomized studies comparing outcomes of alternative anticoagulation strategies for CPB in this patient population. A novel antiplatelet agent - cangrelor, which is a potent P2Y12 inhibitor with robust antiplatelet efficacy, rapid reversibility, and measurable drug effect, has become available since 2015...
April 17, 2018: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29664892/the-role-of-4-factor-prothrombin-complex-concentrate-4-pcc-in-coagulopathy-of-trauma-a-propensity-matched-analysis
#2
Faisal Jehan, Hassan Aziz, Terence O'Keeffe, Muhammad Khan, El Rasheid Zakaria, Mohammad Hamidi, Muhammad Zeeshan, Narong Kulvatunyou, Bellal Joseph
INTRODUCTION: Coagulopathy is a common complication after severe trauma. The efficacy of 4-factor Prothrombin Complex Concentrate (4-PCC) as an adjunct to FFP in reversal of coagulopathy of trauma has not been studied. The aim of our study is to compare 4-PCC+FFP vs. FPP alone for the treatment of COT. METHODS: We reviewed all trauma patients >18y who received PCC+FFP or FFP alone at our Level I trauma center from 2015-16. We excluded patients on preinjury oral anticoagulants...
April 16, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29644298/use-of-idarucizumab-for-dabigatran-reversal-emergency-department-experience-in-two-cases-with-subdural-haematoma
#3
Gail Edwards, Cristina Roman, Rondhir Jithoo, Biswadev Mitra
Introduction: Idarucizumab is the first effective humanized monoclonal antibody fragment developed specifically as a reversal agent for dabigatran, a Direct Oral Anticoagulant. Despite recent trials demonstrating reversal of clinically relevant bleeding, there is a paucity of data on use outside the trial setting. This manuscript describes the use of Idarucizumab to reverse dabigatran in two patients presenting to the emergency department of a major tertiary hospital with acute traumatic subdural haematomas (SDH)...
February 2018: Trauma Case Reports
https://www.readbyqxmd.com/read/29625856/characteristics-and-outcomes-of-reversed-patients-admitted-to-an-emergency-department-for-vka-related-intramuscular-hematoma
#4
F Moustafa, L Poujol, N Vincent, J Saint-Denis, N Dublanchet, N Breuil, S Heuser, A Lebreton, F Dutheil, J Schmidt
BACKGROUND: According to the International Society on Thrombosis and Haemostasis (ISTH), intramuscular hematoma without other severity criteria is not considered a major bleeding. OBJECTIVES: In a large cohort of reversed vitamin K antagonist (VKA) patients admitted to the emergency unit for muscular hematoma, we assess frequency, severity, and anticoagulation management based on whether ISTH criteria were met or not. MATERIALS AND METHODS: We performed a retrospective single-center study involving patients admitted to an emergency unit for VKA-induced intramuscular hematoma whose bleeding was reversed with prothrombin complex concentrates...
March 27, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29619276/use-of-anticoagulants-remains-a-significant-threat-to-timely-hip-fracture-surgery
#5
Razvan Taranu, Chelsea Redclift, Patrick Williams, Marina Diament, Anne Tate, Jamie Maddox, Faye Wilson, Will Eardley
Introduction: Hip fracture remains the biggest single source of morbidity and mortality in the elderly trauma population, and any intervention focused on quality improvement and system efficiency is beneficial for both patients and clinicians. Two of the variables contributory to improving care and efficiency are time to theater and length of stay, with the overall goal being to improve care as reflected within the achievement of best practice tariff. One of the biggest barriers to optimizing these variables is preinjury anticoagulation...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/29608545/adherence-to-20-emergency-general-surgery-best-practices-results-of-a-national-survey
#6
Angela M Ingraham, M Didem Ayturk, Catarina I Kiefe, Heena P Santry
OBJECTIVE: To examine national adherence to emergency general surgery (EGS) best practices. BACKGROUND: There is a national crisis in access to high-quality care for general surgery emergencies. Acute care surgery (ACS), a specialty leveraging strengths of trauma systems, may ameliorate this crisis. A critical component of trauma care is adherence to clinical guidelines. We previously established best practices for EGS using RAND Appropriateness Methodology and pilot data...
March 30, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29606406/management-of-spontaneous-soft-tissue-hemorrhage-secondary-to-anticoagulant-therapy-a-cohort-study
#7
Vincenzo G Menditto, Francesca Fulgenzi, Sirio Lombardi, Anna Dimitriadou, Cinzia Mincarelli, Marzia Rosati, Roberto Candelari, Giovanni Pomponio, Aldo Salvi, Armando Gabrielli
STUDY OBJECTIVE: The optimal management of patients receiving heparin, warfarin or direct anti-coagulant therapy who experience spontaneous, severe, life-threatening soft-tissue hemorrhage (SSTH) is unclear. The purpose of this study is to investigate efficacy and safety of the interventional protocol implemented in our department. METHODS: In this retrospective cohort study, we analyzed data from 80 consecutive patients with SSTH secondary to anticoagulation therapy diagnosed by the appropriate computed tomography scan...
March 23, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29590221/andexanet-alfa-effectively-reverses-edoxaban-anticoagulation-effects-and-associated-bleeding-in-a-rabbit-acute-hemorrhage-model
#8
Genmin Lu, Polly Pine, Janet M Leeds, Francis DeGuzman, Pratikhya Pratikhya, Joyce Lin, John Malinowski, Stanley J Hollenbach, John T Curnutte, Pamela B Conley
INTRODUCTION: Increasing use of factor Xa (FXa) inhibitors necessitates effective reversal agents to manage bleeding. Andexanet alfa, a novel modified recombinant human FXa, rapidly reverses the anticoagulation effects of direct and indirect FXa inhibitors. OBJECTIVE: To evaluate the ability of andexanet to reverse anticoagulation in vitro and reduce bleeding in rabbits administered edoxaban. MATERIALS AND METHODS: In vitro studies characterized the interaction of andexanet with edoxaban and its ability to reverse edoxaban-mediated anti-FXa activity...
2018: PloS One
https://www.readbyqxmd.com/read/29589064/recent-major-advances-in-cardiovascular-pharmacotherapy
#9
REVIEW
James Milner, Andreia Cunha, Carlota Gamboa-Cruz, Julie Reis, Márcia Campos, Natália António
The field of cardiovascular pharmacotherapy remains extremely active. The aim of this review is to summarize the recent major advances in cardiovascular pharmacotherapy, with a focus on (1) the new approved drug for treatment of heart failure with reduced ejection fraction-sacubitril/valsartan; (2) proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors; (3) the novel reversal agents for non-vitamin K oral anticoagulants (NOACs); and finally, (4) new evidence on pharmacological treatment of coronary artery disease...
March 27, 2018: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29580268/the-impact-of-direct-oral-anticoagulants-in-traumatic-brain-injury-patients-greater-than-60-years-old
#10
Oliver Prexl, Martin Bruckbauer, Wolfgang Voelckel, Oliver Grottke, Martin Ponschab, Marc Maegele, Herbert Schöchl
BACKGROUND: Traumatic brain injury (TBI) is the leading cause of death among trauma patients. Patients under antithrombotic therapy (ATT) carry an increased risk for intracranial haematoma (ICH) formation. There is a paucity of data about the role of direct oral anticoagulants (DOACs) among TBI patients. METHODS: In this retrospective study, we investigated all TBI patients ≥60-years-old who were admitted to the intensive care unit (ICU) from January 2014 until May 2017...
March 27, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29576106/emergency-care-of-patients-receiving-non-vitamin-k-antagonist-oral-anticoagulants
#11
REVIEW
J W Eikelboom, S Kozek-Langenecker, A Exadaktylos, A Batorova, Z Boda, F Christory, I Gornik, G Kėkštas, A Kher, R Komadina, O Koval, G Mitic, T Novikova, E Pazvanska, S Ratobilska, J Sütt, A Winder, D Zateyshchikov
Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, edoxaban) have been introduced in several clinical indications. Although NOACs have a favourable benefit-risk profile and can be used without routine laboratory monitoring, they are associated-as any anticoagulant-with a risk of bleeding. In addition, treatment may need to be interrupted in patients who need surgery or other procedures. The objective of this article, developed by a multidisciplinary panel of experts in thrombosis and haemostasis, is to provide an update on the management of NOAC-treated patients who experience a bleeding episode or require an urgent procedure...
April 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29569500/mechanisms-of-action-and-clinical-use-of-specific-reversal-agents-for-non-vitamin-k-antagonist-oral-anticoagulants
#12
Kristoffer Andresen, Dan Atar, Erik Gjertsen, Waleed Ghanima, Svein Roseth, Odd Erik Johansen
OBJECTIVES: With a steadily growing number of patients with non-valvular atrial fibrillation, anticoagulation use increases. Anticoagulation therapy is associated with increased risk of serious bleeding and an increased complexity in management of patients in need for urgent surgery. We wanted to assess the magnitude of this challenge as well as review current and potential future clinical management strategies. DESIGN: A review of the literature on the magnitude of patients using antigoaculants in potential need for acute restoration of hemostasis was conducted, as well as current status of reversal agents for non-vitamin K antagonist oral anticoagulants (NOACs)...
March 23, 2018: Scandinavian Cardiovascular Journal: SCJ
https://www.readbyqxmd.com/read/29564837/prothrombin-complex-concentrate-for-major-bleeding-on-factor-xa-inhibitors-a-prospective-cohort-study
#13
Sam Schulman, Peter L Gross, Bruce Ritchie, Susan Nahirniak, Yulia Lin, Lani Lieberman, Marc Carrier, Mark A Crowther, Indy Ghosh, Alejandro Lazo-Langner, Michelle Zondag
Oral factor Xa inhibitors are increasingly used for anticoagulation, but there is no approved reversal agent. Prothrombin complex concentrate (PCC) for the management of Xa-inhibitor-associated bleeding has been described in small case series and one cohort study. Patients on apixaban or rivaroxaban, suffering a major bleed, were treated at nine Canadian hospitals as per existing hospital protocol with a fixed dose of PCC 2,000 units and subsequently recruited for a 30-day follow-up. The treating physician evaluated the haemostatic effectiveness as observed during the first day as good, moderate or poor/none, using an assessment guide...
March 21, 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29564687/prothrombin-complex-concentrate-for-reversal-of-direct-factor-xa-inhibitors-prior-to-emergency-surgery-or-invasive-procedure-a-retrospective-study
#14
Siavash Piran, Caroline Gabriel, Sam Schulman
Direct oral factor Xa (FXa) inhibitors are widely used for anticoagulation but a targeted antidote is not available. Four-factor prothrombin complex concentrate (4FPCC) has been shown in observational studies to support hemostasis in most patients with major bleeding related to FXa inhibitors with an acceptable rate of thromboembolic events. However, the effectiveness of 4FPCC for reversal of FXa inhibitors prior to emergency surgery or invasive procedures is unclear. A retrospective chart review was performed in patients that received 4FPCC at Hamilton General Hospital from 2015 to 2017...
March 21, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29561270/low-dose-prothrombin-complex-concentrate-in-patients-with-left-ventricular-assist-devices
#15
Caitlin S Brown, Wesley R Zemrak, Kaitlin J Dyer, Stephen Rolfe
Left ventricular assist devices (LVADs) have become an important advancement for patients with end-stage heart failure. Left ventricular assist devices come with the risk of stroke and pump thrombosis, and to mitigate these risks, anticoagulation is given to these patients. With anticoagulation comes increased bleeding risk, and urgent reversal may be necessary. Reports have shown that the risk of thrombosis with prothrombin complex concentrate (PCC) does exist, especially in patients with baseline risk factors for thrombosis...
March 20, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29559753/clinical-evaluation-of-measuring-the-act-during-elective-cardiac-surgery-with-two-different-devices
#16
Florian Falter, Nabeel Razzaq, Martin John, Jens Fassl, Markus Maurer, Sean Ewing, Ross Hofmeyr
Unfractionated heparin is the mainstay of anticoagulation during cardiac surgery on cardiopulmonary bypass (CPB) due to its low cost, quick onset, and ease of reversal. Since over 30 years, the activated clotting time (ACT) has been used to assess the level of heparin activity both before and after CPB. We compared two different methods of measuring the ACT: i-STAT, which uses amperometric detection of thrombin cleavage, and Hemochron Jr, which is based on detecting viscoelastic changes in blood. We included 402 patients from three institutions (Papworth Hospital, Cambridge, UK; Groote Schuur, Cape Town, South Africa; University Hospital Basel, Basel, Switzerland) undergoing elective cardiac surgery on CPB in our study...
March 2018: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29559750/sts-sca-amsect-clinical-practice-guidelines-anticoagulation-during-cardiopulmonary-bypass
#17
Linda Shore-Lesserson, Robert A Baker, Victor Ferraris, Philip E Greilich, David Fitzgerald, Philip Roman, John Hammon
Despite more than a half century of "safe" cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, the Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), and the American Society of Extracorporeal Technology (AmSECT) developed an Evidence Based Workgroup...
March 2018: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29555505/haemostatic-agent-etamsylate-in-vitro-and-in-vivo-antagonizes-anti-coagulant-activity-of-heparin
#18
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
https://www.readbyqxmd.com/read/29555403/spinal-cord-hemorrhage
#19
REVIEW
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
https://www.readbyqxmd.com/read/29538795/how-i-manage-patients-with-anticoagulation-associated-bleeding-or-urgent-surgery
#20
Thomas C Sauter, Balthasar Eberle, Walter A Wuillemin, Thomas Thiele, Anne Angelillo-Scherrer, Aristomenis K Exadaktylos, Gabor Erdös, Adam Cuker, Michael Nagler
Antithrombotic treatment puts patients at risk of major bleeding. Fast and adequate response to anticoagulant-associated bleeding may not only stop the bleeding but prevent severe complications. However, practical treatment algorithms to guide physicians in emergency situations are lacking. Important principles that arise from management of bleeding in general are (a) implementation of an in-house algorithm, (b) rapid identification and treatment of the bleeding source, (c) adequate fluid resuscitation, (d) consideration of the application of tranexamic acid and (e) appropriate coagulation testing...
March 14, 2018: Swiss Medical Weekly
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