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https://www.readbyqxmd.com/read/28639882/management-of-oral-anticoagulation-therapy-after-gastrointestinal-bleeding-whether-to-when-to-and-how-to-restart-an-anticoagulation-therapy
#1
Kazuhiko Kido, Michael J Scalese
OBJECTIVE: To evaluate current clinical evidence for management of oral anticoagulation therapy after gastrointestinal bleeding (GIB) with an emphasis on whether to, when to, and how to resume an anticoagulation therapy. DATA SOURCES: Relevant articles from MEDLINE, Cochrane Library, and EMBASE databases were identified from 1946 through May 20, 2017, using the keywords: gastrointestinal hemorrhage or gastrointestinal bleeding and antithrombotic therapy or anticoagulation therapy or warfarin or dabigatran or rivaroxaban or apixaban or edoxaban...
June 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28635130/prothrombin-complex-concentrate-for-emergent-reversal-of-warfarin-an-international-survey-of-hospital-protocols
#2
J Gorlin, S Kinney, M K Fung, A Tinmouth
For emergent warfarin reversal, four-factor prothrombin complex concentrates (4FPCCs) are recommended by many international guidelines. We surveyed international clinical sites including members of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Most sites have emergent warfarin reversal protocols (53% use PCC, 25% use PCC+ plasma and 2% use plasma alone); however, variation between adjusted dosing and fixed dosing was observed.
June 21, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/28612131/three-factor-versus-four-factor-prothrombin-complex-concentrate-for-the-emergent-management-of-warfarin-associated-intracranial-hemorrhage
#3
Daniel Fischer, Jeffrey Sorensen, Gabriel V Fontaine
BACKGROUND: Four-factor prothrombin complex concentrates (PCC) produce a more rapid and complete INR correction compared with 3-factor PCC in patients receiving warfarin. It is unknown if this improves clinical outcomes in the setting of intracranial hemorrhage (ICH). METHODS: This multicenter, retrospective cohort study included patients presenting with warfarin-associated ICH reversed with either 4- or 3-factor PCC. The primary outcome was in-hospital mortality...
June 13, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28604569/use-of-four-factor-prothrombin-complex-concentrate-in-the-reversal-of-warfarin-induced-and-nonvitamin-k-antagonist-related-coagulopathy
#4
Hannah Young, Jeremy L Holzmacher, Richard Amdur, Stephen Gondek, Babak Sarani, Mary E Schroeder
: To evaluate the efficacy of international normalized ratio (INR) reversal using four-factor prothrombin complex concentrate (4F-PCC) in nonmedication-induced coagulopathy. We performed a single-site, retrospective cohort study of patients receiving off-label use of 4F-PCC. Cohorts included liver dysfunction if they had acute liver decompensation or cirrhosis without other causative factors of liver failure such as sepsis, coagulopathy of acute sepsis (CAS) if they had documentation of sepsis and no underlying liver disorder, known factor deficiencies, or medication-induced coagulopathy, or warfarin if they were taking warfarin...
June 9, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28594426/new-developments-in-anticoagulants-past-present-and-future
#5
Jeffrey I Weitz, Job Harenberg
Thrombosis is a leading cause of death and disability worldwide, and anticoagulants are the mainstay of its prevention and treatment. Starting with unfractionated heparin (UFH) and vitamin K antagonists (VKAs) such as warfarin, the choices of anticoagulants have exploded in the past 20 years. With over 90 % subcutaneous bioavailability, no need for coagulation monitoring and dose adjustment, and a lower risk of heparin-induced thrombocytopenia, low-molecular-weight heparin and fondaparinux have replaced UFH for prevention and initial treatment of venous thromboembolism and for secondary prevention in cancer patients...
June 8, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28581331/exploring-indications-for-the-use-of-direct-oral-anticoagulants-and-the-associated-risks-of-major-bleeding
#6
Truman J Milling, Jennifer Frontera
Thrombosis is a leading cause of morbidity and mortality in the United States. Arterial and venous thromboses are implicated in the pathogenesis of major disorders, including myocardial infarction, ischemic stroke, and venous thromboembolism. Over the past decade, direct oral anticoagulants (DOACs) (eg, direct thrombin inhibitor and factor Xa [FXa] inhibitors) have been adopted as alternatives to warfarin due to their clinical advantages and efficacy for the treatment of thrombosis. As with all anticoagulants, treatment with DOACs is associated with a risk of major bleeding, including life-threatening gastrointestinal bleeds and intracranial hemorrhages (ICHs)...
April 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28575123/induction-of-axial-chirality-in-divanillin-by-interaction-with-bovine-serum-albumin
#7
Diego Venturini, Aguinaldo Robinson de Souza, Ignez Caracelli, Nelson Henrique Morgon, Luiz Carlos da Silva-Filho, Valdecir Farias Ximenes
Vanillin is a plant secondary metabolite and has numerous beneficial health applications. Divanillin is the homodimer of vanillin and used as a taste enhancer compound and also a promissory anticancer drug. Here, divanillin was synthesized and studied in the context of its interaction with bovine serum albumin (BSA). We found that divanillin acquires axial chirality when complexed with BSA. This chiroptical property was demonstrated by a strong induced circular dichroism (ICD) signal. In agreement with this finding, the association constant between BSA and divanillin (3...
2017: PloS One
https://www.readbyqxmd.com/read/28573379/timing-of-inr-reversal-using-fresh-frozen-plasma-in-warfarin-associated-intracerebral-hemorrhage
#8
Murtaza Akhter, Andrea Morotti, Abigail Sara Cohen, Yuchiao Chang, Alison M Ayres, Kristin Schwab, Anand Viswanathan, Mahmut Edip Gurol, Christopher David Anderson, Steven Mark Greenberg, Jonathan Rosand, Joshua Norkin Goldstein
Rapid reversal of coagulopathy is recommended in warfarin-associated intracerebral hemorrhage (WAICH). However, rapid correction of the INR has not yet been proven to improve clinical outcomes, and the rate of correction with fresh-frozen plasma (FFP) can be variable. We sought to determine whether faster INR reversal with FFP is associated with decreased hematoma expansion and improved outcome. We performed a retrospective analysis of a prospectively collected cohort of consecutive patients with WAICH presenting to an urban tertiary care hospital from 2000 to 2013...
June 1, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28552276/adjuncts-to-blood-component-therapies-for-the-treatment-of-bleeding-in-the-intensive-care-unit
#9
REVIEW
Jerrold H Levy, Kamrouz Ghadimi, Quintin J Quinones, Raquel R Bartz, Ian Welsby
Patients who are critically ill following surgical or traumatic injury often present with coagulopathy as a component of the complex multisystem dysfunction that clinicians must rapidly diagnose and treat in the intensive care environment. Failure to recognize coagulopathy while volume resuscitation with crystalloid or colloid takes place, or an unbalanced transfusion strategy focused on packed red blood cell transfusion can all significantly worsen coagulopathy, leading to increased transfusion requirements and poor outcomes...
April 25, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28549534/dabigatran-reversal-in-a-patient-with-end-stage-liver-disease%C3%A2-and-acute-kidney-injury
#10
James E Novak, Khalid Alamiri, Jerry Yee
Dabigatran, a direct thrombin inhibitor and one of the new class of direct oral anticoagulants, is increasingly used in preference to warfarin because of its efficacy and ease of administration. However, because the drug is cleared by the kidneys, it can accumulate in plasma and increase the risk for bleeding in patients with decreased kidney function. We report a patient with end-stage liver disease who developed life-threatening hemorrhage and acute kidney injury while taking dabigatran, 150mg, twice daily...
May 24, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28543073/rapid-response-to-intravenous-vitamin%C3%A2-k-may-obviate-the-need-to-transfuse-prothrombin-complex-concentrates
#11
Tanmay Sahai, Maria F Tavares, Joseph D Sweeney
BACKGROUND: Patients on warfarin who present with bleeding or who require an urgent procedure are commonly treated with intravenous (IV) vitamin K, which is supplemented with repletion of the vitamin K factors using either plasma or a prothrombin complex concentrate (PCC). In some such cases, use of vitamin K alone could be adequate to achieve acceptable hemostasis. STUDY DESIGN AND METHODS: An algorithm emphasizing the use of vitamin K alone in patients presenting with non-life-threatening bleeding was encouraged, with repeat testing of the international normalized ratio (INR) within 5 hours...
May 19, 2017: Transfusion
https://www.readbyqxmd.com/read/28537975/reduced-requirement-for-prothrombin-complex-concentrate-for-the-restoration-of-thrombin-generation-in-plasma-from-liver-transplant-recipients
#12
Ezeldeen Abuelkasem, Shaheer Hasan, Michael A Mazzeffi, Raymond M Planinsic, Tetsuro Sakai, Kenichi A Tanaka
BACKGROUND: Plasma transfusion remains the mainstay hemostatic therapy during liver transplantation (LT) in most countries. However, a large volume is required for plasma to achieve clinically relevant factor increases. Prothrombin complex concentrate (PCC) is a low-volume alternative to plasma in warfarin reversal, but its efficacy has not been well studied in LT. METHODS: Blood samples were collected from 28 LT patients at baseline (T0) and 30 minutes after graft reperfusion (T1)...
May 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28536415/late-obstructive-transcatheter-heart-valve-thrombosis-resolved-by-rivaroxaban
#13
Ole Norling Mathiassen, Erik Lerkevang Grove, Nicolaj Christoffer Hansson, Bjarne Linde Norgaard
BACKGROUND Although transcatheter aortic valve replacement (TAVR) has become a worldwide and generally accepted treatment of patients with aortic stenosis at high surgical risk, there is a rising concern and debate about the occurrence of transcatheter heart valve (THV) thrombosis and its impact on TAVR outcome. It seems that the incidence of THV thrombosis is higher than first anticipated, but uncertainty remains regarding how to prevent and how to treat it. Hence, there is an urgent need for understanding THV thrombosis and to communicate experiences within the field...
May 24, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28526897/the-impact-of-pre-injury-direct-oral-anticoagulants-compared-to-warfarin-in-geriatric-g-60-trauma-patients
#14
J F Barletta, S Hall, J F Sucher, J K Dzandu, M Haley, A J Mangram
PURPOSE: Pre-injury oral anticoagulants are associated with worse outcomes in geriatric (G-60) trauma patients, but there are limited data comparing warfarin with direct oral anticoagulants (DOAC). We sought to compare outcomes in G-60 trauma patients taking pre-injury DOACs vs. warfarin. METHODS: All trauma patients, age ≥60 who were admitted to the hospital and taking an oral anticoagulant pre-injury were retrospectively identified. Patients were excluded if their reason for admission was a suicide attempt or penetrating extremity injury...
May 19, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28526142/anticoagulant-reversal-and-anesthetic-considerations
#15
REVIEW
Joseph Meltzer, Joseph R Guenzer
Bleeding complications are a common concern with the use of anticoagulant agents. In many situations, reversing of neutralizing their effects may be warranted. Prothrombin complex concentrate replaces coagulation factors lowered by warfarin, as does fresh frozen plasma, but in a more concentrated form. Protamine negates the effect of heparin and combines chemically with heparin molecules to form an inactive salt. It also partially reverses the effects of low-molecular-weight heparin. Recombinant activated factor VII is a nonspecific procoagulant that activates the extrinsic clotting pathway, resulting in thrombin generation, but does not directly neutralize the activity of any of the new oral anticoagulants...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28509761/dabigatran-in-nonvalvular-atrial-fibrillation-from-clinical-trials-to-real-life-experience
#16
Nicola Mumoli, Daniela Mastroiacovo, Eleonora Tamborini-Permunian, Josè Vitale, Matteo Giorgi-Pierfranceschi, Marco Cei, Francesco Dentali
: Atrial fibrillation is the most common arrhythmia in over-midlife patients. In addition to systolic heart failure, cerebral thromboembolism represents the most dramatic complication of this rhythm disorder, contributing to morbidity and mortality. Traditionally, anticoagulation has been considered the main strategy in preventing stroke and systemic embolism in atrial fibrillation patients and vitamin K-dependent antagonists have been widely used in clinical practice. Recently, the development of direct oral anticoagulants has certainly improved the management of this disease, providing, for the first time, the opportunity to go beyond vitamin K-dependent antagonists limits...
July 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28507892/a-case-of-massive-hemoptysis-following-transesophageal-echocardiogram
#17
Sean J Callahan, Robert M Jones, Dana Albon, Andrew D Mihalek
INTRODUCTION: Tracheal intubation leading to injury of the airway is a rare complication of transesophageal echocardiography (TEE). Tracheal trauma is not a described complication of TEE, and safety literature for this procedure remains silent on the matter. We describe the case of a patient on systemic anticoagulation and antiplatelet therapy who underwent TEE and suffered massive hemoptysis requiring bronchial artery embolization (BAE). CASE PRESENTATION: An elderly patient was admitted to the hospital with recently diagnosed atrial fibrillation and shortness of breath...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/28474439/estimating-medication-stopping-fraction-and-real-time-prevalence-of-drug-use-in-pharmaco-epidemiologic-databases-an-application-of-the-reverse-waiting-time-distribution
#18
Henrik Støvring, Anton Pottegård, Jesper Hallas
PURPOSE: To introduce the reverse waiting time distribution (WTD) and show how it can be used to estimate stopping fractions and real-time prevalence of treatment in pharmacoepidemiological studies. METHODS: The reverse WTD is the distribution of time from the last dispensed prescription of each patient within a time window to the end of it. It is a mirrored version of the ordinary WTD, which considers the first dispensed prescription of patients within a time window...
May 4, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/28466973/refining-estimates-of-prescription-durations-by-using-observed-covariates-in-pharmacoepidemiological-databases-an-application-of-the-reverse-waiting-time-distribution
#19
Henrik Støvring, Anton Pottegård, Jesper Hallas
PURPOSE: The study aimed to develop an automated method to estimate prescription durations in pharmacoepidemiological studies that may depend on patient and redemption characteristics. METHODS: We developed an estimation algorithm based on maximum likelihood estimation for the reverse waiting time distribution (WTD), which is the distribution of time from the last prescription of each patient within a time window to the end of the time window. The reverse WTD consists of two distinctly different components: one component for prevalent users and one for patients stopping treatment...
May 3, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/28465988/thrombotic-risk-after-a-major-bleeding-during-anticoagulation-a-clinical-case
#20
Serenella Conti, Marco Ciuffetti, Maria Cristina Vedovati
We report on a 81-year-old female admitted to the emergency department for the occurrence of abdominal pain after a minor trauma. She was on treatment with warfarin for atrial fibrillation. The abdominal computed tomography (CT) angiography revealed a retroperitoneal hematoma (RH) of the left iliopsoas muscle with no evidence of active bleeding. The international normalized ratio exceeded the upper recommended anticoagulation limit. Prothrombin complex concentrates (PCCs) were used for anticoagulation reversal...
January 2017: Journal of Cardiovascular Echography
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