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https://www.readbyqxmd.com/read/29792264/paradoxical-brain-embolism-shadowing-massive-pulmonary-embolism
#1
François Bagate, Alexandre Bedet, Armand Mekontso Dessap, Guillaume Carteaux
Patent foramen ovale is frequently observed in the general population. In case of massive pulmonary embolism, the sudden increase in the right heart cavity's pressure may cause a right-to-left shunting across this foramen, which could be associated with conflicting outcomes. Herein, we report a case of reversible cardiac arrest preceded by seizures, and followed by hemodynamic stability without any vasopressor. A brain CT-scan showed a limited ischemic stroke. Initial echocardiographic assessment revealed an acute cor pulmonale and a right-to-left intracardiac shunt across a large patent foramen ovale, suggesting the diagnosis of massive pulmonary embolism that was lately confirmed by a multidetector CT-angiography...
May 20, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29790081/transplant-renal-vein-thrombosis-in-a-recipient-with-aberrant-venous-anatomy
#2
Lyndsey Thiessen, Sarah MacDonell, Chris Wall, Preman Jacob, Ahmed Shoker, Michael A J Moser
Renal vein thrombosis in a transplanted kidney is an uncommon but critical complication that can result in graft loss if management is delayed. A 31-year-old male with known atresia of the inferior vena cava who received a deceased donor renal transplant 7 years previously presented to hospital with severe graft site pain and a week of nausea, vomiting, and chills. Serum creatinine was markedly elevated from baseline. Sonographic examination revealed external iliac vein thrombosis with extension of the thrombus into the transplant renal vein...
May 22, 2018: CEN Case Reports
https://www.readbyqxmd.com/read/29785470/four-factor-prothrombin-complex-concentrate-for-warfarin-reversal-in-patients-with-left-ventricular-assist-devices
#3
Jessica Rimsans, Amy Levesque, Erin Lyons, Katelyn Sylvester, Michael M Givertz, Mandeep R Mehra, Garrick C Stewart, Jean M Connors
Continuous flow left ventricular assist devices (CF-LVAD) require therapeutic anticoagulation which is often interrupted for procedures or bleeding. Prior to the availability of four factor prothrombin complex concentrate (4F-PCC) in the United States, warfarin was held and its effects reversed by vitamin K or fresh frozen plasma. We evaluated the use of 4F-PCC for temporary warfarin reversal in patients with CF-LVADs and assessed outcomes. This analysis is a retrospective study of CF-LVAD patients who received 4F-PCC for warfarin reversal in the setting of bleeding or need for urgent or elective procedures...
May 21, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29777547/tacrolimus-induced-asymptomatic-thrombotic-microangiopathy-diagnosed-by-laboratory-tests-in-pig-to-rhesus-corneal-xenotransplantation-a-case-report
#4
Jong-Min Kim, Jaeyoung Kim, Se-Hyun Choi, Jun-Seop Shin, Byoung-Hoon Min, Won Young Jeong, Ga-Eul Lee, Min-Sun Kim, Seeun Kwon, Mee Kum Kim, Chung-Gyu Park
Tacrolimus-associated thrombotic microangiopathy (TA-TMA) is a rare complication. TA-TMA is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ damage due to thrombus. We report asymptomatic TA-TMA diagnosed by laboratory tests in pig-to-rhesus corneal xenotransplantation. Corneal transplantation had been conducted from a wild-type SNU miniature pig to a rhesus macaque. The veterinary records were retrospectively reviewed in this case. The immunosuppressive regimen consisted of rituximab, basiliximab, and IVIg as inductive therapies, and steroids with tacrolimus (0...
May 18, 2018: Xenotransplantation
https://www.readbyqxmd.com/read/29769055/one-visceral-artery-may-be-enough-successful-pancreatectomy-in-a-patient-with-total-occlusion-of-the-celiac-and-superior-mesenteric-arteries
#5
Evangelos Tagkalos, Florian Jungmann, Hauke Lang, Stefan Heinrich
BACKGROUND: The anatomic variations of the visceral arteries are not uncommon. The liver arterial blood supply shows 50% variability between humans, with the most common anatomy being one hepatic artery arising from the celiac trunk and one pancreatico-duodenal arcade between the celiac trunk and the superior mesenteric artery. Occlusion of one artery are mostly asymptomatic but may become clinically relevant when surgery of the liver, bile duct or the pancreas is required. If these pathologies are not reversible, an oncologic pancreatic head resection cannot be performed...
May 16, 2018: BMC Surgery
https://www.readbyqxmd.com/read/29768672/catheter-ablation-for-atrial-fibrillation-on-uninterrupted-direct-oral-anticoagulants-a-safe-approach
#6
V Sawhney, M Shaukat, E Volkova, N Jones, R Providencia, S Honarbakhsh, G Dhillon, A Chow, M Lowe, P Lambiase, M Dhinoja, S Sporton, M J Earley, R J Schilling, R J Hunter
BACKGROUND: Current consensus guidelines suggest DOACs are interrupted peri-procedurally for catheter ablation (CA) of AF. However, this may predispose patients to thromboembolic complications. This study investigates the safety of CA for AF on uninterrupted DOACs compared to uninterrupted warfarin. METHODS: Single centre, retrospective study of consecutive patients undergoing CA for AF. All patients were heparinised prior to trans-septal puncture with a target activated clotting time (ACT) of 300-350 seconds...
May 16, 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29767640/burden-of-exposure-to-potential-interactions-between-antiretroviral-and-non-antiretroviral-medications-in-a-population-of-hiv-positive-patients-aged-50-years-or-older
#7
Alice Ranzani, Letizia Oreni, Massimiliano Agrò, Lorena van den Bogaart, Laura Milazzo, Andrea Giacomelli, Dario Cattaneo, Cristina Gervasoni, Anna Lisa Ridolfo
BACKGROUND: As HIV-infected patients aged 50 years or older are at increased risk of comorbidities and multidrug treatments, we examined their exposure to the potential drug-drug interactions (PDDIs) of antiretroviral (ARV) and other medications. METHODS: This cross-sectional study involved the patients aged 50 years or older receiving ARV and non-ARV medications at our clinic. PDDIs were identified using the University of Liverpool HIV Drug Interaction Checker...
June 1, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/29764497/activated-prothrombin-complex-concentrate-to-reverse-the-factor-xa-inhibitor-apixaban-effect-before-emergency-surgery-a-case-series
#8
Nina Haagenrud Schultz, Runar Lundblad, Pål Andre Holme
BACKGROUND: The lack of an antidote against factor Xa inhibitors in case of major bleeding or need for urgent surgery is a concern to clinicians. Guidelines on managing major bleeding in patients under anticoagulation with a factor Xa inhibitor suggest several hemostatic agents to reverse the effect, but there is no consensus regarding the choice of drug or appropriate dose. The ability of prothrombin complex concentrate, activated prothrombin complex concentrate, and recombinant factor VIIa to reverse the effect of factor Xa inhibitors has been evaluated in animal studies, in vitro studies, and healthy volunteers, but not yet in randomized clinical studies...
May 16, 2018: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29757137/reversal-of-apixaban-induced-alterations-in-haemostasis-by-different-coagulation-factor-concentrates-in-patients-after-hip-or-knee-replacement-surgery
#9
Katrin Schmidt, Kerstin Krüger, Elisabeth Langer, Martin Schmutzler, Elke Johnen, Klaus D Wernecke, Christian Von Heymann, Mareike K Körber
BACKGROUND: Apixaban is a direct oral anticoagulant (DOAC) with a specific inhibition of activated factor X (FXa). In case of bleeding or need of urgent surgery a direct antidote is not yet available. Off-label application of non-specific haemostatic agents, such as prothrombin complex concentrate (PCC) and recombinant FVIIa (rFVIIa), has been reported to reverse the effects of apixaban in in vitro and animal studies. The aim of this study is to measure the reversal potential of PCC and rFVIIa in patients with prophylactic apixaban concentrations...
May 11, 2018: Blood Transfusion, Trasfusione del Sangue
https://www.readbyqxmd.com/read/29756268/does-rotational-thromboelastometry-accurately-predict-coagulation-status-in-patients-with-lupus-anticoagulant
#10
L Hensch, V Kostousov, K Bruzdoski, M Losos, M Pereira, M de Guzman, S Hui, J Teruya
INTRODUCTION: Rotational thromboelastometry (ROTEM) is increasingly used as a tool for monitoring coagulation status. However, ROTEM is susceptible to misinterpretation due to particular coagulation abnormalities. Here, we report the effects of lupus anticoagulant (LA) on ROTEM. METHODS: A prospective observational analysis was performed on 16 children with prior studies indicating the presence of LA or antiphospholipid antibodies. ROTEM analysis was performed, and samples were further analyzed by adding phospholipids (PL) to repeat ROTEM analysis if clotting time (CT) abnormalities were discovered with comparison to ROTEM using an equal volume of isotonic saline...
May 13, 2018: International Journal of Laboratory Hematology
https://www.readbyqxmd.com/read/29753603/direct-oral-anticoagulant-agents-pharmacologic-profile-indications-coagulation-monitoring-and-reversal-agents
#11
REVIEW
Deborah K Rose, Barak Bar
Vitamin K antagonists (VKAs), such as warfarin, have been used for thromboprophylaxis and for the treatment of thromboembolic events in patients with nonvalvular atrial fibrillation for over 60 years. The increasing use of direct oral anticoagulants (DOACs) in recent years has shown greater advantages and safer use over VKA, including reduced bleeding, fewer drug interactions, no food interactions, a quick onset and offset of activity, and predictable dose-response properties. Despite their advantages, there are a couple of major limitations that raise concerns among clinicians, including the need for more coagulation assays to monitor their effects and more specific reversal antidotes in life-threatening circumstances of bleeding...
May 9, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29744595/synthesis-and-biocompatibility-of-an-argatroban-modified-polysulfone-membrane-that-directly-inhibits-thrombosis
#12
Xiao Fu, Jian-Ping Ning
Anticoagulation therapy plays a vital role in the prevention of blood clot formation during hemodialysis and hemofiltration, especially for critical care patients. Here, we synthesized a novel argatroban (Arg)-modified polysulfone (PSf) membrane for anticoagulation. Arg was grafted onto the PSF membrane via chemical modification to increase membrane hydrophilicity. Protein adsorption, coagulation, as well as activation of platelets and complement systems were greatly reduced on the Arg-modified PSf membrane...
May 9, 2018: Journal of Materials Science. Materials in Medicine
https://www.readbyqxmd.com/read/29743410/safety-of-reversing-anticoagulation-by-protamine-following-elective-transfemoral-percutaneous-coronary-intervention-in-the-drug-eluting-stent-era
#13
Shingo Yamamoto, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
Bleeding complications following percutaneous coronary interventions (PCI) have been closely associated with morbidity and mortality. Although radial arteries have been widely used in current PCI, including primary PCI, transfemoral PCI remains necessary for complex PCI. The purpose of this study was to compare the incidence of complications following elective transfemoral PCI between manual compression with and without protamine. We identified 249 consecutive patients who underwent elective transfemoral PCI from hospital records, and divided them into two groups: patients who used protamine for manual compression (the protamine group; n = 205) and patients who did not (the non-protamine group, n = 44)...
May 9, 2018: International Heart Journal
https://www.readbyqxmd.com/read/29743176/warfarin-and-vitamin-k-epoxide-reductase-a-molecular-accounting-for-observed-inhibition
#14
Sangwook Wu, Xuejie Chen, Da-Yun Jin, Darrel W Stafford, Lee G Pedersen, Jian-Ke Tie
Vitamin K epoxide reductase (VKOR), an endoplasmic reticulum membrane protein, is the key enzyme for vitamin K-dependent carboxylation, a post-translational modification that is essential for the biological functions of coagulation factors. VKOR is the target of the most widely prescribed oral anticoagulant warfarin. However, the topological structure of VKOR and the mechanism of warfarin's inhibition of VKOR remain elusive. Additionally, it is not clear why warfarin-resistant VKOR mutations identified in patients significantly decrease warfarin's binding affinity, but have only a minor effect on vitamin K binding...
May 9, 2018: Blood
https://www.readbyqxmd.com/read/29738632/reversal-of-hypercoagulability-in-patients-with-hcv-related-cirrhosis-after-treatment-with-direct-acting-antivirals
#15
Francesco Paolo Russo, Alberto Zanetto, Elena Campello, Cristiana Bulato, Sarah Shalaby, Luca Spiezia, Sabrina Gavasso, Enrica Franceschet, Claudia Radu, Marco Senzolo, Patrizia Burra, Ton Lisman, Paolo Simioni
BACKGROUND AND AIMS: The long-term impact of sustained virological response (SVR) after direct-acting antivirals (DAAs) on the hypercoagulability associated with HCV cirrhosis is unknown. We longitudinally evaluated the effect of DAAs treatment on cirrhotic coagulopathy. METHODS: Pro- and anticoagulant factors levels and thrombin generation were assessed in patients with HCV-related cirrhosis at baseline, end of therapy (EOT), at 12, 24 and 48 weeks (W) after EOT...
May 8, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29733637/anticoagulant-properties-of-poly-sodium-2-acrylamido-2-methylpropanesulfonate-based-di-and-triblock-polymers
#16
Bartlomiej Kalaska, Kamil Kamiński, Joanna Miklosz, Keita Nakai, Shin-Ichi Yusa, Dariusz Pawlak, Maria Nowakowska, Andrzej Mogielnicki, Krzysztof Szczubiałka
Di- and triblock copolymers with low dispersity of molecular weight were synthesized using radical addition-fragmentation chain transfer polymerization. The copolymers contained anionic poly(sodium 2-acrylamido-2-methylpropanesulfonate) (PAMPS) block as an anticoagulant component. The block added to lower the toxicity was either poly(ethylene glycol) (PEG) or poly(2-(methacryloyloxy)ethyl phosphorylcholine) (PMPC). The polymers prolonged clotting times both in vitro and in vivo. The influence of the polymer architecture and composition on the efficacy of anticoagulation and safety parameters was evaluated...
May 7, 2018: Biomacromolecules
https://www.readbyqxmd.com/read/29727737/morbidity-and-mortality-after-fragility-hip-fracture-surgery-in-patients-receiving-vitamin-k-antagonists-and-direct-oral-anticoagulants
#17
Tal Frenkel Rutenberg, Steven Velkes, Maria Vitenberg, Avi Leader, Yael Halavy, Pia Raanani, Mustafa Yassin, Galia Spectre
INTRODUCTION: Early surgical treatment is recommended to reduce morbidity and mortality in patients with fragility hip fractures. Anticoagulation treatment poses a surgical challenge. While the action of vitamin K antagonists (VKAs) can be reversed, for direct oral anticoagulants (DOACs) antidote is only available for dabigatran. We aimed to assess the outcomes of patients treated with VKAs or DOACs undergoing surgical treatment for fragility hip fractures. MATERIALS AND METHODS: A retrospective study of patients presenting with proximal femoral fractures between January 2012 and June 2016...
June 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29727244/reversal-of-direct-oral-anticoagulants
#18
Oliver Cohen, Lucy-Anne Frank, Susan Bradley
No abstract text is available yet for this article.
May 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29714993/issues-in-geriatric-care-falls
#19
Dipesh Patel, Richard J Ackermann
One in three older adults falls each year. There are approximately 2.5 million falls among older adults treated in emergency departments. Falls account for 87% of all fractures in this age group. The biggest risk factor for falling is a history of falls. Other risk factors include frailty, sedative and anticholinergic drugs, polypharmacy, and a variety of medical conditions. Current recommendations are that all patients age 65 years and older should be asked about falls each year. Patients also can be screened for fall risk with a variety of approaches including questionnaires and the Timed Up & Go test...
May 2018: FP Essentials
https://www.readbyqxmd.com/read/29710221/what-surgeons-should-know-about-non-vitamin-k-oral-anticoagulants-a-review
#20
Atul Verma, Andrew C T Ha, James T Rutka, Subodh Verma
Importance: Non-vitamin K oral anticoagulants (NOACs) are increasingly prescribed for patients to treat or prevent arterial or venous thromboembolism. The following 4 NOAC agents are approved by the US Food and Drug Administration for clinical use: dabigatran etexilate, apixaban, edoxaban tosylate, and rivaroxaban. A good understanding of these agents' pharmacologic properties is important for surgeons given their marked differences compared with warfarin sodium. This review highlights key practical issues surrounding the use of NOACs in the perioperative setting...
April 18, 2018: JAMA Surgery
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