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Anticoagulant reversal

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https://www.readbyqxmd.com/read/29439477/a-practical-review-of-the-emerging-direct-anticoagulants-laboratory-monitoring-and-reversal-agents
#1
REVIEW
Stephanie A Joppa, Justin Salciccioli, Jill Adamski, Salma Patel, Waldemar Wysokinski, Robert McBane, Farah Al-Saffar, Heidi Esser, Fadi Shamoun
Millions of patients in the United States use anticoagulation for a variety of indications, such as the prevention of stroke in those with atrial fibrillation (AF) and the treatment and prevention of venous thrombosis. For over six decades warfarin was the only available oral anticoagulant, but now several DOACs are available and their use has become more prevalent in recent years. In spite of this increased use, many physicians remain reluctant to prescribe DOACs due to concerns about bleeding and reversibility...
February 11, 2018: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/29437808/reversible-bioprosthetic-valve-thrombosis-from-eosinophilia
#2
S S Kothari, Siddharthan Deepti, Nitish Rai
A 31-year-old man with a mitral bioprosthetic valve presented with recent worsening of exertional dyspnoea 7 years after the mitral valve replacement. Evaluation revealed an increased gradient across the thickened mitral bioprosthetic valve leaflets. Marked eosinophilia was present and was considered as a putative cause for bioprosthetic valve thrombosis. The treatment with systemic corticosteroids and oral anticoagulation led to complete resolution of symptoms with significant decrease in mitral bioprosthetic valve gradient and leaflet thinning...
February 8, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29437014/drug-induced-epistaxis-an-often-neglected-adverse-effect
#3
Sara Meirinho, Ricardo Relvas, Gilberto Alves
BACKGROUND: Epistaxis is an active nose bleeding with a population occurrence of approximately 60%. Although epistaxis is a common clinical complaint, the majority of the cases are benign and caused by local induced factors (e.g., trauma and local inflammation). Nevertheless, it is also recognised that epistaxis can be induced after some drugs intake. AIMS: Due to the increasing use of drugs or drug combinations that potentially may induce epistaxis, this review aims to alert healthcare professionals for this often neglected adverse drug effect and its possible complications...
February 12, 2018: Current Drug Safety
https://www.readbyqxmd.com/read/29433872/activated-prothrombin-complex-concentrate-for-warfarin-reversal-in-traumatic-intracranial-hemorrhage
#4
Chancey Carothers, Amanda Giancarelli, Joseph Ibrahim, Brandon Hobbs
BACKGROUND: Patients with traumatic intracranial hemorrhage (TIH) anticoagulated with warfarin are at an increased risk of mortality. Fresh frozen plasma (FFP) and vitamin K have been the standard treatment for warfarin reversal; however, guidelines now recommend the use of prothrombin complex concentrate (PCC) for warfarin reversal in patients with life-threatening bleeding. Our protocol uses one vial (∼1000 units) of activated PCC (aPCC) for warfarin reversal, regardless of the weight or presenting international normalized ratio (INR)...
March 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29430275/engineering-a-simple-lateral-flow-device-for-animal-blood-coagulation-monitoring
#5
Hua Li, Daewoo Han, Giovanni M Pauletti, Andrew J Steckl
Increasing numbers of animals are diagnosed with thromboembolism, requiring anticoagulation treatment to prevent thrombotic events. Frequent and periodic coagulation monitoring is critical to ensure treatment effectiveness and patient safety by limiting blood coagulation ability within the desired therapeutic range. Point-of-care diagnostics is an ideal candidate for frequent coagulation monitoring due to rapid test results and no need for laboratory setting. This article reports the first utilization of no-reaction lateral flow assay (nrLFA) device for simple and low-cost animal blood coagulation monitoring in resource-limited setting...
January 2018: Biomicrofluidics
https://www.readbyqxmd.com/read/29428263/evidence-based-diagnosis-and-management-of-chronic-subdural-hematoma-a-review-of-the-literature
#6
REVIEW
Vikram Mehta, Stephen C Harward, Eric W Sankey, Gautam Nayar, Patrick J Codd
Chronic subdural hematomas are encapsulated blood collections within the dural border cells with characteristic outer "neomembranes". Affected patients are more often male and typically above the age of 70. Imaging shows crescentic layering of fluid in the subdural space on a non-contrast computed tomography (CT) scan, best appreciated on sagittal or coronal reformats. Initial medical management involves reversing anticoagulant/antiplatelet therapies, and often initiation of anti-epileptic drugs (AEDs). Operative interventions, such as twist-drill craniostomy (TDC), burr-hole craniostomy (BHC), and craniotomy are indicated if imaging implies compression (maximum fluid collection thickness >1 cm) or the patient is symptomatic...
February 7, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29424964/development-of-zwitterionic-sulfobetaine-block-copolymer-conjugation-strategies-for-reduced-platelet-deposition-in-respiratory-assist-devices
#7
Alexander D Malkin, Sang-Ho Ye, Evan J Lee, Xiguang Yang, Yang Zhu, Lara J Gamble, William J Federspiel, William R Wagner
Respiratory assist devices, that utilize ∼2 m2 of hollow fiber membranes (HFMs) to achieve desired gas transfer rates, have been limited in their adoption due to such blood biocompatibility limitations. This study reports two techniques for the functionalization and subsequent conjugation of zwitterionic sulfobetaine (SB) block copolymers to polymethylpentene (PMP) HFM surfaces with the intention of reducing thrombus formation in respiratory assist devices. Amine or hydroxyl functionalization of PMP HFMs (PMP-A or PMP-H) was accomplished using plasma-enhanced chemical vapor deposition...
February 9, 2018: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
https://www.readbyqxmd.com/read/29408593/acute-compartment-syndrome-as-a-complication-of-the-use-of-intraoperative-neuromonitoring-needle-electrodes
#8
Ilyas M Eli, Nicholas T Gamboa, Jian Guan, Philipp Taussky
BACKGROUND: The use of intraoperative neurophysiologic monitoring (IOM) has become commonplace in many neurosurgical procedures as a tool to reduce the risk of complications through the early identification of reversible neurologic compromise. Although complications related to IOM itself are exceedingly rare, recognizing their clinical presentation in the postoperative neurosurgical patient is essential for the early identification and implementation of appropriate treatment. CASE DESCRIPTION: The authors present a case report of a patient who developed postoperative acute compartment syndrome in the right arm after placement of neuromonitoring needles for routine IOM during endovascular treatment of a left internal carotid artery aneurysm...
February 3, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29404875/acute-agranulocytosis-after-oral-administration-of-dabigatran-a-rare-case-report-and-a-short-review-of-literature
#9
Sergio Fasullo, Stefania Davì, Gioacchino Cosenza, Francesca Di Franco, Nicola La Manna, Alfonso Giubilato, Graziella Vetrano, Giorgio Maringhini
This case report describes agranulocytosis immediately after oral administration of dabigatran in a 68 years old man with atrial fibrillation (AF). Dabigatran is an oral, reversible and competitive thrombin inhibitor that has shown promising results. In patients with atrial fibrillation of RE-LY study (Randomized Evaluation of Long-Term Anticoagulant Therapy), dabigatran administered at a dose of 150 mg, as compared with warfarin, was associated with lower rates of stroke and systemic embolism but similar rates of major hemorrhage...
February 5, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29398917/ticagrelor-toward-more-efficient-platelet-inhibition-and-beyond
#10
REVIEW
Michał J Kubisa, Mateusz P Jezewski, Aleksandra Gasecka, Jolanta M Siller-Matula, Marek Postuła
Novel antiplatelet drugs, including ticagrelor, are being successively introduced into the therapy of atherothrombotic conditions due to their superiority over a standard combination of clopidogrel with acetylsalicylic acid in patients with acute coronary syndromes (ACS). A P2Y12 receptor antagonist, ticagrelor, is unique among antiplatelet drugs, because ticagrelor inhibits the platelet P2Y12 receptor in a reversible manner, and because it demonstrates a wide palette of advantageous pleiotropic effects associated with the increased concentration of adenosine...
2018: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29395765/emergency-medicine-considerations-in-atrial-fibrillation
#11
REVIEW
Brit Long, Jennifer Robertson, Alex Koyfman, Kurian Maliel, Justin R Warix
BACKGROUND: Atrial fibrillation (AF) is an abnormal heart rhythm which may lead to stroke, heart failure, and death. Emergency physicians play a role in diagnosing AF, managing symptoms, and lessening complications from this dysrhythmia. OBJECTIVE: This review evaluates recent literature and addresses ED considerations in the management of AF. DISCUSSION: Emergency physicians should first assess patient clinical stability and evaluate and treat reversible causes...
January 30, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29395759/evaluation-of-activated-charcoal-and-lipid-emulsion-treatment-in-model-of-acute-rivaroxaban-toxicity
#12
Sinan Cem Uzunget, Togay Evrin, Sezen Baglan Uzunget, Zamir Kemal Ertürk, Egemen Akıncıoğlu, Saffet Özdemir, Atila Korkmaz
AIM: Reducing or reversing the toxicity effects of new oral anticoagulants is an important question.The purpose of the present study is to evaluate the effect of lipid emulsion (LE) and Activated Charcoal (AC) therapy on the intoxication of rivaroxaban, on mice. METHODS: Adult male Balb/c mice weighing approximately 30g were used in the study. Seven groups were assigned, with six mice in each group. Groups were defined; given only rivaroxaban, given only LE, given only AC, after the administration of rivaroxaban LE applied group in the 1st hour, after the administration of rivaroxaban LE applied group in the 3rd hour, after the administration of rivaroxaban AC applied group in the1st hour, after the administration of rivaroxaban AC applied group in the 1st hour and LE applied group in the 3rd hour...
December 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29394504/rivaroxaban-plasma-levels-in-acute-ischemic-stroke-and-intracerebral-hemorrhage
#13
David J Seiffge, Georg Kägi, Patrik Michel, Urs Fischer, Yannick Béjot, Susanne Wegener, Marialuisa Zedde, Guillaume Turc, Charlotte Cordonnier, Peter S Sandor, Gilles Rodier, Andrea Zini, Manuel Cappellari, Sabine Schädelin, Alexandros A Polymeris, David Werring, Sebastian Thilemann, Ilaria Maestrini, Eivind Berge, Christopher Traenka, Jochen Vehoff, Gian Marco De Marchis, Monika Kapauer, Nils Peters, Gaia Sirimarco, Leo H Bonati, Marcel Arnold, Philippe A Lyrer, Emmanuel De Maistre, Andreas Luft, Dimtrios A Tsakiris, Stefan T Engelter
OBJECTIVE: Information about Rivaroxaban plasma levels (RivLev) may guide treatment decisions in patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) taking rivaroxaban. METHODS: In a multicenter registry-based study (Novel-Oral-Anticoagulants-In-Stroke-Patients collaboration;NOACISP;ClinicalTrials.gov:NCT02353585) of patients with stroke while taking rivaroxaban, we compared RivLev in patients with AIS and ICH. We determined how many AIS-patients had RivLev≤100ng/ml, indicating possible eligibility for thrombolysis and how many ICH-patients had RivLev≥75ng/ml, possibly eligible for the use of specific reversal agents...
February 2, 2018: Annals of Neurology
https://www.readbyqxmd.com/read/29376487/surfing-the-blood-coagulation-cascade-insight-into-the-vital-factor-xa
#14
Nicolas E Nunez-Navarro, Fabian M Santana, Loreto P Parra, Flavia C Zacconi
Factor Xa (FXa) plays a key role in haemostasis, it is a central part of the blood coagulation cascade which catalyzes the production of thrombin and leads to clot formation and wound closure. Therefore, FXa is an attractive target for the development of new anticoagulant agents. In this review, we will first describe the molecular features of this fundamental protein in order to understand its mechanism of action, an essential background for the design of novel inhibitors by means of synthetic organic chemistry or using peptides obtained from recombinant methodologies...
January 25, 2018: Current Medicinal Chemistry
https://www.readbyqxmd.com/read/29372400/andexanet-alfa-to-reverse-the-anticoagulant-activity-of-factor-xa-inhibitors-a-review-of-design-development-and-potential-place-in-therapy
#15
REVIEW
Michelangelo Sartori, Benilde Cosmi
Direct oral anticoagulants are associated with rates of major bleeding which are not negligible, albeit lower than those associated with vitamin K antagonists. No specific reversal agent for factor Xa (FXa) direct inhibitors is currently available for clinical use. A modified activated human FXa decoy protein, andexanet alfa, is being developed that binds FXa direct inhibitors in their active site, thus reversing their anticoagulant effect. The purpose of this article is to review the design, development and clinical trials of andexanet alfa...
January 25, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29368938/severe-obscure-gastrointestinal-bleeding-successfully-treated-with-idarucizumab
#16
Enrique Rodríguez de Santiago, María Sierra Morales, Javier Martínez González
Idarucizumab is a monoclonal antibody that rapidly reverses the anticoagulant effect of dabigatran. The experience with this drug in the setting of gastrointestinal bleeding is scarce. We present the case of an 84-year-old male with known history of non-valvular atrial fibrillation anticoagulated with dabigatran who presented to the emergency room with melena. During his stay in the emergency department he suddenly worsened with hemodynamic derangement and massive melena so idarucizumab was administered. Gastroscopy and colonoscopy were performed without identifying a bleeding source...
January 25, 2018: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/29366484/discussion-of-protocolized-warfarin-reversal-with-4-factor-prothrombin-complex-concentrate-versus-3-factor-prothrombin-complex-concentrate-with-recombinant-factor-viia
#17
Rachel Van Dusen
INTRODUCTION: Life-threatening bleeding is the most feared complication of warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin K dependent clotting factors is essential for hemostasis. METHODS: A retrospective cohort study of warfarin-treated patients experiencing a life-threatening bleed treated with a warfarin reversal protocol comprised of 4F PCC (post-implementation group) and those who received the prior reversal protocol of 3F PCC and rFVIIa (pre-implementation group) was performed...
January 5, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29363751/inactivated-antithombin-as-anticoagulant-reversal-in-a-rat-model-of-cardiopulmonary-bypass-a-potent-and-potentially-safer-alternative-to-protamine
#18
Elsa P Bianchini, Alexandre Sebestyen, Toufik Abache, Yasmine Bourti, Alexandre Fontayne, Vincent Richard, Fabienne Tamion, Jean-Luc Plantier, Fabien Doguet, Delphine Borgel
Heparin anticoagulation followed by protamine reversal is commonly used in cardiopulmonary bypass (CPB). As an alternative to protamine, a recombinant inactive antithrombin (riAT) was designed as an antidote to heparin and was previously shown to be as potent as protamine in-vitro. In the present study, riAT was assessed for its ability to neutralize heparin after CPB in a rat model. After 60 min of CPB under heparin, rats received 5 mg/kg protamine, 37.5 mg/kg riAT or phosphate buffered saline (PBS) as placebo...
January 24, 2018: British Journal of Haematology
https://www.readbyqxmd.com/read/29362176/the-society-of-thoracic-surgeons-the-society-of-cardiovascular-anesthesiologists-and-the-american-society-of-extracorporeal-technology-clinical-practice-guidelines-anticoagulation-during-cardiopulmonary-bypass
#19
Linda Shore-Lesserson, Robert A Baker, Victor A Ferraris, Philip E Greilich, David Fitzgerald, Philip Roman, John W Hammon
Despite more than a half century of "safe" cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation therapy 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, the Society of Cardiovascular Anesthesiologists, and the American Society of Extracorporeal Technology developed an Evidence Based Workgroup...
February 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29348918/safety-and-timing-of-resuming-dabigatran-after-major-gastrointestinal-bleeding-reversed-by-idarucizumab
#20
Gian Galeazzo Riario Sforza, Francesco Gentile, Fabio Stock, Francesco Caggiano, Enrica Chiocca, Cristoforo Incorvaia
The recent introduction of direct oral anticoagulants, including rivaroxaban, dabigatran, apixaban, and edoxaban, for the acute treatment and secondary prevention of venous thromboembolism and in atrial fibrillation has been shown to provide greater clinical benefit than oral vitamin K antagonists. However, direct oral anticoagulants are associated with adverse events, the most common being major bleeding; such events require the reversal of the anticoagulant effects by specific agents. In this case report, we describe an 87-year-old female with atrial fibrillation treated with dabigatran who had massive rectal bleeding...
2018: SAGE Open Medical Case Reports
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