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https://www.readbyqxmd.com/read/28735353/non-vitamin-k-oral-anticoagulants-noacs-and-their-reversal
#1
REVIEW
Sujan T Reddy, T C Cossey, Sean I Savitz, James C Grotta
PURPOSE OF REVIEW: An 80-year-old man presents with an acute right hemiparesis and National Institutes of Health Stroke Scale (NIHSS) of 25, 14 h after taking dabigatran. Activated partial thromboplastin time (aPTT) is 42.8 s. Arteriogram demonstrates left internal carotid artery thrombosis. What is the appropriate management of this patient with acute ischemic stroke while on a NOAC? RECENT FINDINGS: Idarucizumab is a reversal agent approved for dabigatran, and two more reversal agents, andexanet alfa and aripazine, are currently in development for NOACs...
September 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28734839/recombinant-expression-of-ixolaris-a-kunitz-type-inhibitor-from-the-tick-salivary-gland-for-nmr-studies
#2
V S De Paula, F H S Silva, I M B Francischetti, R Q Monteiro, A P Valente
Ixolaris is an anticoagulant protein identified in the tick saliva of Ixodes scapularis. Ixolaris contains 2 Kunitz like domains and binds to Factor Xa or Factor X as a scaffold for inhibition of the Tissue Factor (TF)/Factor VIIa (FVIIa). In contrast to tissue factor pathway inhibitor (TFPI), however, Ixolaris does not bind to the active site cleft of FXa. Instead, complex formation is mediated by the FXa heparin-binding exosite. Due to its potent and long-lasting antithrombotic activity, Ixolaris is a promising agent for anticoagulant therapy...
July 19, 2017: Protein Expression and Purification
https://www.readbyqxmd.com/read/28728489/idarucizumab-for-the-treatment-of-hemorrhage-and-dabigatran-reversal-in-patients-requiring-urgent-surgery-or-procedures
#3
Ovidiu Vornicu, Anne-Sophie Larock, Anne-Sophie Dincq, Jonathan Douxfils, Jean-Michel Dogné, François Mullier, Sarah Lessire
Idarucizumab is a specific antagonist for dabigatran etexilate (DE). The recent market authorization of idarucizumab in Europe and the USA may reassure prescribers of DE, as it can increase the safety of the emergency management of patients taking this anticoagulant. However, idarucizumab use should be limited to specific indications to avoid unnecessary risks to patients and costs to healthcare systems. Areas covered: The authors provide an overview of idarucizumab development and its pharmacokinetic and pharmacodynamic properties...
July 20, 2017: Expert Opinion on Biological Therapy
https://www.readbyqxmd.com/read/28725332/thyrotoxic-valvulopathy-case-report-and-review-of-the-literature
#4
Keniel Pierre, Sushee Gadde, Bassam Omar, G Mustafa Awan, Christopher Malozzi
We report a 42-year-old female who was admitted for abdominal pain, and also endorsed dyspnea, fatigue and chronic palpitations. Past medical history included asthma, patent ductus arteriosus repaired in childhood and ill-defined thyroid disease. Physical examination revealed blood pressure of 136/88 mm Hg and heart rate of 149 beats per minute. Cardiovascular exam revealed an irregularly irregular rhythm, and pulmonary exam revealed mild expiratory wheezing. Abdomen was tender. Electrocardiogram revealed atrial fibrillation with rapid ventricular response which responded to intravenous diltiazem...
June 2017: Cardiology Research
https://www.readbyqxmd.com/read/28707821/splenic-vein-thrombosis-following-pancreas-transplantation-identification-of-factors-that-support-conservative-management
#5
Jack W Harbell, Tara Morgan, Vickie A Feldstein, Garrett R Roll, Andrew Posselt, Sang-Mo Kang, Sandy Feng, Ryutaro Hirose, Chris E Freise, Peter Stock
Prophylaxis for graft portal/splenic venous thrombosis following pancreas transplant varies between institutions. Similarly, treatment of venous thrombosis ranges from early re-exploration to conservative management with anticoagulation. We wished to determine the prevalence of graft splenic vein (SV) thrombosis, as well as the clinical significance of non-occlusive thrombus observed on routine imaging. Records of 112 pancreas transplant recipients over a five-year period at a single center were reviewed. Venous thrombosis was defined as absence of flow or presence of thrombus identified in any part of the graft SV on ultrasound...
July 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28704111/incomplete-dabigatran-reversal-with-idarucizumab
#6
Aaron P Steele, Jin A Lee, William E Dager
CONTEXT: With increasing use of direct oral anticoagulants (DOACs), urgent reversal of these agents becomes a growing concern. Idarucizumab is a humanized monoclonal antibody fragment that specifically binds to dabigatran with higher affinity than thrombin, rapidly neutralizing its anticoagulant effect without increased risk of thrombosis. CASE DETAILS: We describe two cases in which the recommended dose of idarucizumab was unsuccessful in completely reversing the anticoagulant effects of dabigatran...
July 13, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28700408/three-versus-four-factor-prothrombin-complex-concentrates-for-factor-based-resuscitation-in-a-porcine-hemorrhagic-shock-model
#7
Donald Michael Moe, Michael Scott Lallemand, John Mason McClellan, Joshua Porter Smith, Shannon T Marko, Matthew J Eckert, Matthew J Martin
BACKGROUND: Bleeding is a leading cause of preventable death following severe injury. Prothrombin complex concentrates (PCC) treat inborn coagulation disorders and reverse oral anticoagulants, but are proposed for use in "factor-based" resuscitation strategies. Few studies exist for this indication in acidosis, or that compare 3-factor (3PCC) versus 4-factor (4PCC) products. We aimed to assess and compare their safety and efficacy in a porcine model of severe hemorrhagic shock and coagulopathy...
July 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28699743/development-and-validation-of-quantitative-uplc-ms-ms-assay-for-anticoagulant-rodenticides-in-liver
#8
Lori L Smith, Boying Liang, Marcia C Booth, Michael Filigenzi, Andriy Tkachenko, Cynthia L Gaskill
Anticoagulant rodenticides (ARs) are used to control rodent populations, however exposure to non-target animals occurs. A sensitive and rugged quantitative method was developed, optimized and validated for eight ARs in liver. Target analytes comprised two chemical classes: hydroxycoumarins (warfarin, coumachlor, dicoumarol, bromadiolone, brodifacoum and difethialone) and indanediones (diphacinone and chlorophacinone). In this method, liver extracts were cleaned up using dispersive solid phase extraction (d-SPE) to remove matrix interferences and analyzed by reverse phase ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS)...
July 12, 2017: Journal of Agricultural and Food Chemistry
https://www.readbyqxmd.com/read/28693366/idarucizumab-for-dabigatran-reversal-full-cohort-analysis
#9
Charles V Pollack, Paul A Reilly, Joanne van Ryn, John W Eikelboom, Stephan Glund, Richard A Bernstein, Robert Dubiel, Menno V Huisman, Elaine M Hylek, Chak-Wah Kam, Pieter W Kamphuisen, Jörg Kreuzer, Jerrold H Levy, Gordon Royle, Frank W Sellke, Joachim Stangier, Thorsten Steiner, Peter Verhamme, Bushi Wang, Laura Young, Jeffrey I Weitz
Background Idarucizumab, a monoclonal antibody fragment, was developed to reverse the anticoagulant effect of dabigatran. Methods We performed a multicenter, prospective, open-label study to determine whether 5 g of intravenous idarucizumab would be able to reverse the anticoagulant effect of dabigatran in patients who had uncontrolled bleeding (group A) or were about to undergo an urgent procedure (group B). The primary end point was the maximum percentage reversal of the anticoagulant effect of dabigatran within 4 hours after the administration of idarucizumab, on the basis of the diluted thrombin time or ecarin clotting time...
July 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28682477/preclinical-safety-and-efficacy-of-andexanet-alfa-in-animal-models
#10
G Lu, S J Hollenbach, D C Baker, S Tan, A Hutchaleelaha, J T Curnutte, P B Conley
BACKGROUND: Andexanet is a recombinant modified form of factor Xa (FXa), designed to bind to and reverse the anticoagulant activity of FXa inhibitors. OBJECTIVES: To evaluate the ability of andexanet to reverse the anticoagulant activity of rivaroxaban, and assess its pharmacokinetics (PK) and toxicity in animal models. METHODS: The effects of andexanet on blood loss, anti-FXa activity, rivaroxaban unbound plasma concentrations, and other coagulation parameters were assessed in a rabbit liver laceration 'treatment' model...
July 6, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28680466/atrial-fibrillation-with-a-structurally-normal-heart-in-pregnancy-an-international-survey-on-current-practice
#11
Annabelle Cumyn, Nadine Sauvé, Évelyne Rey
BACKGROUND: Little evidence exists for the optimal management of atrial fibrillation with a structurally normal heart in pregnancy. METHODS: A survey was sent to members of two associations to obtain input on optimal management of atrial fibrillation in pregnancy. The survey presented four cases with respect to (1) baseline investigations; (2) rate versus rhythm control; (3) chemical versus electrical cardioversion; and (4) anticoagulation. RESULTS: Sixty-one responders from 11 countries participated...
June 2017: Obstetric Medicine
https://www.readbyqxmd.com/read/28673500/-state-of-the-art-direct-oral-anticoagulants-and-transfusion
#12
A-C Martin, A Godier, D M Smadja, L Mauge, A-M Fischer
Direct oral anticoagulants (DOAC) are indicated for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism. As any anticoagulant, they are associated with a bleeding risk. Management of DOAC-induced bleeding is challenging. Idarucizumab, antidote for dabigatran, is currently available and is part of the therapeutic strategy, whereas antidotes for anti-Xa agents are under development. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain...
June 30, 2017: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
https://www.readbyqxmd.com/read/28671421/idarucizumab-praxbind-for-dabigatran-pradaxa-anticoagulant-reversal
#13
Jennie B Jarrett, Renee Petzel Gimbar
No abstract text is available yet for this article.
June 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/28663010/intravenous-fibrinolysis-in-ischemic-stroke-of-large-vessel-after-reversing-effect-of-dabigatran-with-idarucizumab
#14
Gary Alvarez Bravo, Emilio Orts Castro, Guilherme Carvalho Monteiro, Ignacio López Zuazo
Currently the use of idarucizumab to reverse the effect of dabigatran emerges as a possibility of treatment for those patients who present with an ischemic stroke despite taking this anticoagulant. We present our experience regarding the use of intravenous tissue plasminogen activator in a patient with ischemic stroke due to complete occlusion of the left middle cerebral artery after blocking the effect of dabigatran with idarucizumab and whose result was an almost total improvement of the neurologic deficit...
June 26, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28662919/risk-factor-management-and-atrial-fibrillation-clinics-saving-the-best-for-last
#15
REVIEW
Rajiv Mahajan, Rajeev K Pathak, Anand Thiyagarajah, Dennis H Lau, Francis E Marchlinski, Sanjay Dixit, John D Day, Jeroen M L Hendriks, Melinda Carrington, Jonathan M Kalman, Prashanthan Sanders
Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and mortality worldwide. Management of AF is a complex process involving: 1) the prevention of thromboembolic complications with anticoagulation; 2) rhythm control; and 3) the detection and treatment of underlying heart disease. However, cardiometabolic risk factors, such as obesity, hypertension, diabetes mellitus, and obstructive sleep apnoea, have been proposed as contributors to the expanding epidemic of atrial fibrillation (AF). Thus, a fourth pillar of AF care would include aggressive targeting of interdependent, modifiable cardiovascular risk factors as part of an integrated care model...
June 9, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28662704/thrombocytopenia-induced-by-dabigatran-two-case-reports
#16
Hyun Goo Kang, Seung Jae Lee, Ji Yeon Chung, Jin Sung Cheong
BACKGROUND: Vitamin K inhibitors (e.g. warfarin) and indirect thrombin inhibitors (e.g. heparin) are widely used to prevent thromboembolic disorders (e.g. myocardial infarction, venous thromboembolism, and stroke). These agents have been mainstays of anticoagulation for people older than 60 years. However, their administration is associated with a risk of bleeding and requires careful monitoring of patients. Novel oral anticoagulants (NOACs), such as dabigatran, are significantly safer in preventing thromboembolism than warfarin and heparin (sporadically causes thrombocytopenia) and are more specific for their target protein, thrombin...
June 29, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28654426/use-of-three-procoagulants-in-improving-bleeding-outcomes-in-the-warfarin-patient-with-intracranial-hemorrhage
#17
Emma P DeLoughery, Thomas G DeLoughery
: When patients on anticoagulation present with intracranial bleeding, stopping the bleeding is paramount. Despite the availability of multiple options to reverse anticoagulation, no study has directly compared the effectiveness of the procoagulants recombinant activated factor VII (rFVIIa), the rFVIIa and 3-factor prothrombin complex concentrate (PCC) combination, and 4-factor PCC on improving patient outcomes compared with a control. This study examined the medical records of 197 warfarin patients with intracranial hemorrhage, an initial international normalized ratio (INR) greater than 1...
June 24, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28650000/andexanet-alfa-a-recombinant-mimetic-of-human-factor-xa-for-the-reversal-of-anticoagulant-therapies
#18
G Escolar, M Diaz-Ricart, E Arellano-Rodrigo
Activated coagulation factor X (FXa) is a common target for classic and newer anticoagulants. Parenteral anticoagulants with an indirect inhibitory action on FXa (low-molecular-weight heparins) have a well-established clinical efficacy in the prophylaxis and therapy of thromboembolic conditions. More recently developed direct oral anticoagulants (DOACs) have emerged as a new class of antithrombotic drugs. Rivaroxaban, apixaban and edoxaban are direct inhibitors of FXa approved for the management of venous thromboembolism and stroke prevention in atrial fibrillation...
May 2017: Drugs of Today
https://www.readbyqxmd.com/read/28641892/fighting-fake-medicines-first-quality-evaluation-of-cardiac-drugs-in-africa
#19
Marie Antignac, Bara Ibrahima Diop, Diane Macquart de Terline, Melisande Bernard, Bernard Do, Stéphane Méo Ikama, Roland N'Guetta, Dadhi M Balde, Yessoufou Tchabi, Abdallahi Sidi Aly, Ibrahim Ali Toure, Patrick Zabsonre, Jean Marie F Damorou, Jean Laurent Takombe, Christine Fernandez, Muriel Tafflet, Jean Philippe Empana, Pierre François Plouin, Kumar Narayanan, Eloi Marijon, Xavier Jouven
BACKGROUND: The growing menace of poor quality and falsified drugs constitutes a major hazard, compromising healthcare and patient outcomes. Efforts to assess drug standards worldwide have almost exclusively focused on anti-microbial drugs; with no study to date on cardiovascular drugs. Our study aims to assess quality of seven routinely used cardiovascular medications (anticoagulants, antihypertensives and statins) in ten Sub-Saharan African countries. METHODS: Drugs were prospectively collected using standardized methods between 2012 and 2014 from licensed (random pharmacies) and unlicensed (street-markets) places of sale in Africa...
June 19, 2017: International Journal of Cardiology
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
#20
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
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