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https://www.readbyqxmd.com/read/29346209/the-society-of-thoracic-surgeons-the-society-of-cardiovascular-anesthesiologists-and-the-american-society-of-extracorporeal-technology-clinical-practice-guidelines-anticoagulation-during-cardiopulmonary-bypass
#1
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: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29345686/reversal-agents-for-non-vitamin-k-antagonist-oral-anticoagulants
#2
REVIEW
Jerrold H Levy, James Douketis, Jeffrey I Weitz
The non-vitamin K antagonist oral anticoagulants (NOACs) include dabigatran, which inhibits thrombin, and apixaban, betrixaban, edoxaban, and rivaroxaban, which inhibit coagulation factor Xa. Although clinical studies of NOACs were conducted without antidotes, patient outcomes with major bleeding when receiving NOACs were no worse than those in patients treated with a vitamin K antagonist. Nonetheless, in patients with life-threatening bleeding or requiring urgent surgery, the capacity for rapid NOAC reversal is likely to increase patient safety...
January 18, 2018: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/29344007/four-factor-prothrombin-complex-concentrate-improves-thrombin-generation-and-prothrombin-time-in-patients-with-bleeding-complications-related-to-rivaroxaban-a-single-center-pilot-trial
#3
Bettina Schenk, Stephanie Goerke, Ronny Beer, Raimund Helbok, Dietmar Fries, Mirjam Bachler
Background: Direct oral anticoagulants (DOACs) pose a great challenge for physicians in life-threatening bleeding events. The aim of this study was to test the efficacy of reversing the DOAC rivaroxaban using four-factor PCC (prothrombin complex concentrate), a non-specific reversing agent. Methods: Patients with life-threatening bleeding events during rivaroxaban treatment were included and administered 25 U kg-1 of PCC. Blood samples were collected immediately prior to as well as after PCC treatment at predefined time intervals...
2018: Thrombosis Journal
https://www.readbyqxmd.com/read/29343296/quantitative-method-for-analysis-of-six-anticoagulant-rodenticides-in-faeces-applied-in-a-case-with-repeated-samples-from-a-dog
#4
Kristin Opdal Seljetun, Elin Eliassen, Ritva Karinen, Lars Moe, Vigdis Vindenes
BACKGROUND: Accidental poisoning with anticoagulant rodenticides is not uncommon in dogs, but few reports of the elimination kinetics and half-lives in this species have been published. Our objectives were to develop and validate a new method for the quantification of anticoagulant rodenticides in canine blood and faeces using reversed phase ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) and apply the method on a case of anticoagulant rodenticide intoxication...
January 17, 2018: Acta Veterinaria Scandinavica
https://www.readbyqxmd.com/read/29338845/protocolized-warfarin-reversal-with-4-factor-prothrombin-complex-concentrate-versus-3-factor-prothrombin-complex-concentrate-with-recombinant-factor-viia
#5
Cassie A Barton, Marissa Hom, Nathan B Johnson, Jon Case, Ran Ran, Martin Schreiber
INTRODUCTION: Life-threatening bleeding can complicate warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin-K dependent clotting factors is essential for hemostasis. We compare two methods of rapid factor replacement for warfarin reversal. METHODS: A retrospective cohort study of warfarin-treated patients experiencing life-threatening bleeding who received a reversal protocol comprised of 4F PCC or 3F PCC and rFVIIa was performed. Demographic, clinical and anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded...
January 5, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29336885/structural-basis-for-activity-and-specificity-of-an-anticoagulant-anti-fxia-monoclonal-antibody-and-a-reversal-agent
#6
Lauren K Ely, Marco Lolicato, Tovo David, Kate Lowe, Yun Cheol Kim, Dharmaraj Samuel, Paul Bessette, Jorge L Garcia, Thomas Mikita, Daniel L Minor, Shaun R Coughlin
Coagulation factor XIa is a candidate target for anticoagulants that better separate antithrombotic efficacy from bleeding risk. We report a co-crystal structure of the FXIa protease domain with DEF, a human monoclonal antibody that blocks FXIa function and prevents thrombosis in animal models without detectable increased bleeding. The light chain of DEF occludes the FXIa S1 subsite and active site, while the heavy chain provides electrostatic interactions with the surface of FXIa. The structure accounts for the specificity of DEF for FXIa over its zymogen and related proteases, its active-site-dependent binding, and its ability to inhibit substrate cleavage...
January 2, 2018: Structure
https://www.readbyqxmd.com/read/29330279/rare-cause-of-isolated-severe-coagulation-failure-in-cirrhosis-traditional-healing-with-fenugreek
#7
Cyriac A Philips, Philip Augustine
Patients with cirrhosis develop decompensation events during the natural history of the disease that encompass ascites, variceal bleeding, hepatic encephalopathy and jaundice. Coagulation failure, defined using the international normalised ratio, even though not a decompensation event, is important in patients with stratifying cirrhosis into those who require liver transplantation for long-term survival. Isolated coagulation failure in cirrhosis is rare and usually occurs with use of anticoagulants in the setting of vascular diseases...
January 12, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29329075/anticoagulant-polyurethane-substrates-modified-with-poly-2-methacryloyloxyethyl-phosphorylcholine-via-si-ratrp
#8
Cheng Chi, Baohong Sun, Ninglin Zhou, Ming Zhang, Xiaohong Chu, Ping Yuan, Jian Shen
A novel catalyst system of Reverse Atom Transfer Radical Polymerization (RATRP) to prepare Polyurethane (PU) films modified by poly(2-methacryloyloxyethyl phosphorylcholine) (pMPC) was studied in this article. In this system, PU film was pretreated by LaCl3/CA ethanol solution to obtain a hydrated surface allowing more initiators to be immobilized on it. Moreover, complexes composed of silane coupling agent 3-chloropropyltrimethoxysilane (CPTM), chlorhexidine acetate (CA) and lanthanum(III) worked as ligands of copper ions as a whole during RATRP process...
January 8, 2018: Colloids and Surfaces. B, Biointerfaces
https://www.readbyqxmd.com/read/29327671/tissue-engineered-heart-valves-a-call-for-mechanistic-studies
#9
Kevin Blum, Joseph Drews, Christopher K Breuer
Heart valve disease carries a substantial risk of morbidity and mortality. Outcomes are significantly improved by valve replacement, but currently-available mechanical and biological replacement valves are associated with complications of their own. Mechanical valves have a high rate of thromboembolism and require lifelong anticoagulation. Biological prosthetic valves have a much shorter lifespan, and are prone to tearing and degradation. Both types of valves lack the capacity for growth, making them particularly problematic in pediatric patients...
January 12, 2018: Tissue Engineering. Part B, Reviews
https://www.readbyqxmd.com/read/29325746/first-report-of-the-characterization-of-a-snake-venom-apyrase-ruviapyrase-from-indian-russell-s-viper-daboia-russelii-venom
#10
Bhargab Kalita, Aparup Patra, Shagufta Jahan, Ashis K Mukherjee
A novel apyrase from Russell's viper venom (RVV) was purified and characterized, and it was named Ruviapyrase (Russell's viper apyrase). It is a high molecular weight (79.4 kDa) monomeric glycoprotein that contains 2.4% neutral sugars and 58.4% N-linked oligosaccharides and strongly binds to Concanavalin A. The LC-MS/MS analysis did not identify any protein in NCBI protein database, nevertheless some de novo sequences of Ruviapyrase showed putative conserved domain of apyrase superfamily. Ruviapyrase hydrolysed adenosine triphosphate (ATP) to a significantly greater extent (p < ...
January 8, 2018: International Journal of Biological Macromolecules
https://www.readbyqxmd.com/read/29321405/reversible-parkinsonism-and-multiple-cerebral-infarctions-after-pulmonary-endarterectomy-in-a-patient-with-antiphospholipid-syndrome
#11
Mitsumasa Okano, Kazuhiko Nakayama, Naoki Tamada, Yuto Shinkura, Ken-Ichi Yanaka, Hiroyuki Onishi, Hidekazu Tanaka, Toshiro Shinke, Hiroshi Tanaka, Yutaka Okita, Noriaki Emoto, Ken-Ichi Hirata
Antiphospholipid syndrome (APS) is a cause of chronic thromboembolic pulmonary hypertension (CTEPH) and it is associated with an increased risk of postoperative neurological complications. We experienced a case of reversible parkinsonism after pulmonary endarterectomy (PEA) and subsequent multiple cerebral infarctions under standard anticoagulation therapy in a patient with CTEPH associated with APS. Strict management using a combination of antiplatelet and anticoagulation therapy should be considered in patients with a high titer of triple antiphospholipid antibodies in the perioperative period...
January 11, 2018: Internal Medicine
https://www.readbyqxmd.com/read/29321061/enoxaparin-attenuates-doxorubicin-induced-cardiotoxicity-in-rats-via-interfering-with-oxidative-stress-inflammation-and-apoptosis
#12
Reem Ali Shaker, Samer Hassan Abboud, Hayder Chasib Assad, Najah Hadi
BACKGROUND: Doxorubicin (DOX) is commonly used in the treatment of many types of cancers but its cardiotoxicity is limiting its clinical use. Beyond its anticoagulant action, enoxaparin (ENX), a low molecular weight heparin, has been shown to exert multiple pharmacological actions including antioxidant, anti-inflammatory and antiapoptotic effects. Therefore, the current study aimed to assess if ENX could ameliorate cardiotoxicity induced by DOX. METHODS: Twenty-one adult male Wistar albino rats were randomly allocated into three groups (n = 7 each) of control, receiving 0...
January 10, 2018: BMC Pharmacology & Toxicology
https://www.readbyqxmd.com/read/29317397/factors-associated-with-availability-of-anticoagulation-reversal-agents-in-rural-and-community-emergency-departments
#13
Brett A Faine, Julie Amendola, Jordan Homan, Azeemuddin Ahmed, Nicholas Mohr
PURPOSE: Results of a study of anticoagulation reversal agent availability in rural and community hospital emergency departments (EDs) are reported. METHODS: A cross-sectional telephone survey was conducted to test the hypothesis that anticoagulation reversal agents are not commonly stocked in low-volume EDs. In phase 1 of the study, a physician, pharmacist, or nurse manager at a sample of EDs in 1 state was surveyed to characterize anticoagulation reversal agent availability and the presence or absence of reversal protocols; in phase 2, follow-up qualitative interviews were conducted with hospital pharmacists selected by purposive sampling to identify barriers to availability...
January 15, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29314216/association-of-prothrombin-complex-concentrates-administration-and-hematoma-enlargement-in-noac-related-intracerebral-hemorrhage
#14
Stefan T Gerner, Joji B Kuramatsu, Jochen A Sembill, Maximilian I Sprügel, Matthias Endres, Karl Georg Haeusler, Peter Vajkoczy, Peter A Ringleb, Jan Purrucker, Timolaos Rizos, Frank Erbguth, Peter D Schellinger, Gereon R Fink, Henning Stetefeld, Hauke Schneider, Hermann Neugebauer, Joachim Röther, Joseph Claßen, Dominik Michalski, Arnd Dörfler, Stefan Schwab, Hagen B Huttner
OBJECTIVE: To investigate parameters associated with hematoma enlargement in non-vitamin-K-antagonist-anticoagulant(NOAC)-related intracerebral hemorrhage(ICH). METHODS: Retrospective cohort study including individual patient data of 190 patients with NOAC-associated ICH over a 5-year-period(2011-2015) at 19 Departments of Neurology across Germany. Primary outcome was the association of PCC-administration with hematoma enlargement. Subanalyses were calculated for blood-pressure management and its association with the primary outcome...
January 3, 2018: Annals of Neurology
https://www.readbyqxmd.com/read/29307210/bleeding-in-cancer-patients-and-its-treatment-a-review
#15
Candice Johnstone, Shayna E Rich
Bleeding is a common problem in cancer patients, related to local tumor invasion, tumor angiogenesis, systemic effects of the cancer, or anti-cancer treatments. Existing bleeds can also be exacerbated by medications such as bevacizumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticoagulants. Patients may develop acute catastrophic bleeding, episodic major bleeding, or low-volume oozing. Bleeding may present as bruising, petechiae, epistaxis, hemoptysis, hematemesis, hematochezia, melena, hematuria, or vaginal bleeding...
December 18, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/29297661/the-role-of-direct-oral-anticoagulants-in-the-management-of-venous-thromboembolism
#16
Taylor Steuber
Appropriate treatment of venous thromboembolism (VTE) is critical to minimizing long-term morbidity and mortality. The emergence of direct oral anticoagulants (DOACs) has provided clinicians with expanded therapeutic options for patients with VTE, and as a result, updated practice guidelines released by the American College of Chest Physicians favor DOACs over traditional anticoagulants, such as warfarin. The newest DOAC, betrixaban, received FDA approval in 2017, with an indication for VTE prophylaxis in hospitalized adults...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29296829/safety-pharmacokinetics-and-reversal-of-apixaban-anticoagulation-with-andexanet-alfa
#17
Deborah Siegal, Genmin Lu, Janet M Leeds, Mark Karbarz, Janice Castillo, Vandana Mathur, Athiwat Hutchaleelaha, Uma Sinha, Michael Kitt, Matt McClure, Stanley J Hollenbach, John T Curnutte, Pamela B Conley, Mark Crowther
Direct factor Xa (FXa) inhibitors lack a specific reversal agent for emergencies such as major bleeding or urgent surgery. Andexanet alfa, a modified, catalytically inactive, recombinant human FXa derivative, reverses anticoagulant effect by binding and sequestering FXa inhibitors. This original report of safety and dose-finding, phase 1 and 2 randomized, double-blind, placebo-controlled studies, investigated various doses of andexanet in healthy volunteers. Phase 1 evaluated the safety and pharmacokinetics of andexanet (n = 24) or placebo (n = 8)...
September 26, 2017: Blood Advances
https://www.readbyqxmd.com/read/29277547/recurrent-bioprosthetic-valve-thrombosis-should-long-term-anticoagulation-be-considered
#18
Matthew S Yong, Robert Grant, Pankaj Saxena, Sumit Yadav
Bioprosthetic valve thrombosis (BPVT) is an important and potentially reversible cause of valvular dysfunction. This complication can occur many years after surgery and understanding of the precise mechanisms and risk factors are limited. Anticoagulation therapy has been demonstrated to be effective in improving BPVT. However, the optimal duration of therapy and the risk of recurrence are unknown. Herein, we describe two cases-one of late BPVT and one of recurrence of BPVT after cessation of anticoagulation therapy...
December 11, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29276558/before-after-study-of-an-electronic-order-set-for-reversal-of-vitamin-k-antagonist-associated-intracerebral-hemorrhage
#19
Jeffrey R Vitt, Lynn V Do, Nirav H Shah, Gary Fong, Nicole Y Nguyen, Anthony S Kim
Background: Vitamin K antagonist (VKA)-associated intracerebral hemorrhages (ICHs) are more likely to expand and are associated with higher mortality than primary ICH. Prompt reversal of anticoagulant effect with prothrombin complex concentrate (PCC) may promote hemostasis and decrease hematoma expansion. The aim of this study was to evaluate the impact of an electronic order set designed to standardize and facilitate more timely reversal of coagulopathy in VKA-associated ICH. Methods: We identified all adults who received PCC for VKA-associated ICH from June 2012 to June 2015 at University of California San Francisco Medical Center, which included a period before and after an electronic order set became available in 2014...
January 2018: Neurohospitalist
https://www.readbyqxmd.com/read/29276283/bivalirudin-medication-use-evaluation-and-cost-savings-initiative
#20
Adam C Sieg, Jennifer A Gass
Bivalirudin is a parenteral anticoagulant that elicits its effect through inhibition of both free and clot bound-thrombin. Inhibition of thrombin serves as a unique mechanism for anticoagulation when compared to heparin as thrombin serves as the final common pathway for the intrinsic and extrinsic coagulation cascades. Due to unclear benefit over heparin, concerns regarding reversibility, and most importantly cost its use as a parenteral anticoagulant varies by institution. A recent drug expenditure review within our institution noted a significant increase in the contribution bivalirudin had on the overall drug budget...
September 2017: Hospital Pharmacy
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