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anticoagulation reversal

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https://www.readbyqxmd.com/read/29157712/reversal-of-non-vitamin-k-antagonist-oral-anticoagulants-noacs-in-the-presence-of-major%C3%A2-life-threatening-bleeding
#1
EDITORIAL
(no author information available yet)
No abstract text is available yet for this article.
December 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29156176/management-of-patients-with-left-ventricular-assist-devices-requiring-teeth-extraction-is-halting-anticoagulation-appropriate
#2
Visakha Suresh, Muath Bishawi, Michael W Manning, Chetan Patel, Joseph Rogers, Carmelo Milano, Jacob Schroder, Mani Daneshmand, David Powers
PURPOSE: An increasing number of patients with end-stage heart failure are supported with left ventricular assist device (LVAD) implantation and must be maintained on a consistent anticoagulation regimen. Pre-emptive extraction of carious teeth in these patients is necessary to prevent seeding of the implanted device and endocarditis. Thus, the objective of this study was to evaluate bleeding complications after minor oral surgery, specifically teeth extractions, in this unique patient population requiring long-term anticoagulation...
October 31, 2017: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29148292/cholestatic-liver-injury-as-a-side-effect-of-dabigatran-and-the-use-of-coagulation-tests-in-dabigatran-intoxication-and-after-reversal-by-idarucizumab-in-bleeding-and-sepsis
#3
Willemijn J Comuth, Anne-Mette Haase, Linda Ø Henriksen, Jerzy Malczynski, Daan van de Kerkhof, Anna-Marie B Münster
Idarucizumab, an antidote specific for dabigatran, became available recently. Dabigatran is not associated with increased risk of hepatotoxicity in comparison with warfarin, but it is seen as a rare side-effect. Cases of cholestatic liver injury due to dabigatran have not been reported previously. We present a case of severe gastro-intestinal bleeding with underlying dabigatran intoxication in a patient with renal failure and the effect of reversal of dabigatran using idaruzicumab on coagulation assays. International normalized ratio (INR) and activated partial thromboplastin time (APTT) results were elevated in a setting of sepsis, possibly due to liver failure...
November 17, 2017: Scandinavian Journal of Clinical and Laboratory Investigation
https://www.readbyqxmd.com/read/29135251/micellar-thrombin-binding-aptamers-reversible-nanoscale-anticoagulants
#4
Alexander Roloff, Andrea S Carlini, Cassandra E Callmann, Nathan C Gianneschi
Aptamers are nucleic acid-based ligands that exhibit promising features including specific and reversible target binding and inhibition. Aptamers can function as anticoagulants if they are directed against enzymes of the coagulation cascade. However, they typically suffer from nucleolytic digestion and fast clearance from the bloodstream. We present thrombin-binding aptamer amphiphiles that self-assemble into nanoscale polymeric micelles with a densely functionalized aptamer-displaying corona. We show that these micellar aptamers retain their native secondary structure in a crowded environment and are stabilized against degradation by nucleases in human serum...
November 14, 2017: Journal of the American Chemical Society
https://www.readbyqxmd.com/read/29132510/indications-and-methods-of-anticoagulation-reversal
#5
REVIEW
Jeremy L Holzmacher, Babak Sarani
The use of anticoagulation in the prevention of strokes due to atrial fibrillation or the treatment of venous thromboembolic disease has been on the rise. With the advent and proliferation of direct oral anticoagulation medications, the management of anticoagulation reversal has become increasingly complex, especially when urgent or emergent reversal is required. This review details the commonly used parenteral and oral anticoagulants, the treatment strategies necessary for their reversal, and therapies still in development...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29131074/tranexamic-acid-failed-to-reverse-the-anticoagulant-effect-and-bleeding-by-an-oral-direct-factor-xa-inhibitor-edoxaban
#6
Yuko Honda, Taketoshi Furugohri, Yoshiyuki Morishima
BACKGROUND/AIMS: Agents to reverse the anticoagulant effect of edoxaban, an oral direct factor Xa inhibitor, would be desirable in emergency situations. The aim of this study is to determine the effect of tranexamic acid, an antifibrinolytic agent, on the anticoagulant activity and bleeding by edoxaban in rats. METHODS: A supratherapeutic dose of edoxaban (3 mg/kg) was intravenously administered to rats. Three minutes after dosing, tranexamic acid (100 mg/kg) was given intravenously...
November 3, 2017: Pharmacology
https://www.readbyqxmd.com/read/29122465/real-world-experience-with-idarucizumab-to-reverse-anticoagulant-effect-in-dabigatran-treated-patients-report-of-11-cases-from-taiwan
#7
Li-Kai Tsai, Huey-Juan Lin, Su-Kiat Chua, Pen-Chih Liao, Yuan-Po Yang, Ping-Chen Chou, Chun-Wei Lee, Mao-Jen Lin, Hsi-Ming Chen, Jung-Tze Yeh, Yi-Heng Li
BACKGROUND: This study aims to observe the effectiveness and safety of idarucizumab in dabigatran-treated patients with severe bleeding or requiring surgery in Taiwan. METHODS AND RESULTS: In Taiwan, 11 dabigatran-treated patients developed severe bleeding, fracture that needed surgery, and acute ischemic stroke requiring thrombolysis. These patients were treated with idarucizumab and obtained adequate hemostasis. Our experiences reconfirmed the efficacy and safety of idarucizumab in Asian patients...
November 6, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29121410/medication-management-of-patients-undergoing-transcatheter-aortic-valve-replacement
#8
Bethany A Kalich, J Erin Ledford, Ian B Hollis
Aortic stenosis (AS) is the most common form of valvular heart disease. A detailed diagnostic workup is necessary to promptly stage and classify disease severity to determine the optimal management. Medical therapy and valvuloplasty are options that fail to delay or reverse disease progression. Surgical aortic valve replacement (SAVR) is curative but has significant limitations for some patient populations. A newer option, transcatheter aortic valve replacement (TAVR), has become more widely available to patients with intermediate- or high-operative risk...
November 9, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29117993/an-update-on-the-bleeding-risks-associated-with-doacs
#9
(no author information available yet)
The direct oral anticoagulants (DOACs), also referred to as novel (or non-vitamin K antagonist) oral anticoagulants (NOACs), represent a major development in anticoagulation therapy due to their rapid onset of action, predictable dose-response with fixed doses and limited interactions with food and drugs.(1,2) However, these agents have been in widespread clinical use for less than a decade and, compared with extensive experience with warfarin, there is uncertainty relating to optimal laboratory monitoring of anticoagulation, perioperative management and treatment of bleeding...
November 2017: Drug and Therapeutics Bulletin
https://www.readbyqxmd.com/read/29117058/the-effect-of-time-to-international-normalized-ratio-reversal-on-intracranial-hemorrhage-evolution-in-patients-with-traumatic-brain-injury
#10
Hans Andrews, Katelyn Rittenhouse, Brian Gross, Frederick B Rogers
The incidence of geriatric traumatic brain injury (TBI) is increasing throughout the United States, with many of these patients taking anticoagulation (AC) medication. The purpose of this investigation was to determine the effect of time to international normalized ratio (INR) reversal on intracranial hemorrhage evolution in TBI patients taking prehospital AC medication. We hypothesized that rapid reversal of INR improves outcomes of head-injured patients taking AC medication. Admissions to a Level II trauma center between February 2011 and December 2013 were reviewed...
November 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29106685/a-retrospective-propensity-score-matched-early-thromboembolic-event-analysis-of-prothrombin-complex-concentrate-vs-fresh-frozen-plasma-for-warfarin-reversal-prior-to-emergency-neurosurgical-procedures
#11
Prateek Agarwal, Kalil G Abdullah, Ashwin G Ramayya, Nikhil R Nayak, Timothy H Lucas
BACKGROUND: Reversal of therapeutic anticoagulation prior to emergency neurosurgical procedures is required in the setting of intracranial hemorrhage. Multifactor prothrombin complex concentrate (PCC) promises rapid efficacy but may increase the probability of thrombotic complications compared to fresh frozen plasma (FFP). OBJECTIVE: To compare the rate of thrombotic complications in patients treated with PCC or FFP to reverse therapeutic anticoagulation prior to emergency neurosurgical procedures in the setting of intracranial hemorrhage at a level I trauma center...
June 29, 2017: Neurosurgery
https://www.readbyqxmd.com/read/29088960/acute-subdural-hematoma-in-patients-on-oral-anticoagulant-therapy-management-and-outcome
#12
Sae-Yeon Won, Daniel Dubinski, Markus Bruder, Adriano Cattani, Volker Seifert, Juergen Konczalla
OBJECTIVE Isolated acute subdural hematoma (aSDH) is increasing in older populations and so is the use of oral anticoagulant therapy (OAT). The dramatic increase of OAT-with direct oral anticoagulants (DOACs) as well as with conventional anticoagulants-is leading to changes in the care of patients who present with aSDH while receiving OAT. The purpose of this study was to determine the management and outcome of patients being treated with OAT at the time of aSDH presentation. METHODS In this single-center, retrospective study, the authors analyzed 116 consecutive cases involving patients with aSDH treated from January 2007 to June 2016...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088950/neurosurgical-applications-of-viscoelastic-hemostatic-assays
#13
Svetlana Kvint, James Schuster, Monisha A Kumar
Patients taking antithrombotic agents are very common in neurosurgical practice. The perioperative management of these patients can be extremely challenging especially as newer agents, with poorly defined laboratory monitoring and reversal strategies, become more prevalent. This is especially true with emergent cases in which rapid reversal of anticoagulation is required and the patient's exact medical history is not available. With an aging patient population and the associated increase in diseases such as atrial fibrillation, it is expected that the use of these agents will continue to rise in coming years...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29082329/a-rare-case-report-of-hydronephrosis-and-acute-kidney-injury-secondary-to-gonadal-vein-thrombosis-in-a-young-male
#14
Jason M Sandberg, Raymond B Dyer, Majid Mirzazadeh
Background: Gonadal vein thrombosis (GVT) has been reported in association with malignancy and pelvic inflammatory conditions. Patients who develop GVT often require systemic anticoagulation to reduce the risk of pulmonary embolism and other local and distant thromboembolic effects. As the gonadal vein courses from the pelvis toward its outlet in the upper abdomen, its intimate relationship to the ureter in the setting of vascular pathology may pose a risk for urinary obstruction in the adult. We are reporting a rare case of GVT leading to ureteral obstruction and acute kidney injury (AKI) in a young otherwise healthy male and provide a review of similar literature...
2017: Journal of Endourology Case Reports
https://www.readbyqxmd.com/read/29081491/deep-vein-thrombosis-complicated-by-spontaneous-iliopsoas-hematoma-in-patient-with-septic-shock
#15
Muhammad Umer Butt, Lili A Buzsaki, Susan S Smyth, Samy-Claude Elayi
BACKGROUND Spontaneous retroperitoneal hemorrhage (SRH) is a rare and difficult-to-diagnose entity. It is not associated with trauma, pathology, or iatrogenic manipulations. Few cases have been reported, with the only precipitating factor recognized being bleeding diatheses such as anticoagulation states, inherited coagulopathies, and hemodialysis. However, none of these have been described in combination with septic shock, which itself is associated with platelet dysfunction, coagulation dysfunction, and vasculopathy...
October 30, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/29079069/spontaneous-spinal-epidural-hematoma-in-a-patient-on-rivaroxaban-case-report-and-literature-review
#16
Raed Ismail, Elie Zaghrini, Eveline Hitti
BACKGROUND: Spinal hematomas (SHs) are rare yet potentially debilitating causes of acute back pain. Although spontaneous SHs have been described in the setting of anticoagulation with warfarin or enoxaparin, few cases of spontaneous SH on direct oral anticoagulants (DOACs) have been reported. CASE REPORT: We report a case of spontaneous spinal epidural hematoma in a patient on rivaroxaban. A 72-year-old man on rivaroxaban and aspirin presented with a 4-day history of nontraumatic back pain...
October 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29078928/antithrombotic-reversal-agents
#17
REVIEW
Matthew D Wilson, Jonathan E Davis
The actively bleeding anticoagulated patient presenting to the emergency department requires rapid evaluation and treatment, which is made increasingly complicated by the ever-evolving antithrombotic treatment options used in medicine. Even with excellent supportive care, the timeliness with which reversal decisions need to be made continues to demand of the emergency practitioner a familiarity with the properties and general characteristics of a variety of antithrombotic agents. Reversal options vary and may include vitamin K, FFP, PCC, rFVIIa, platelets, and desmopressin, among others...
December 2017: Hematology/oncology Clinics of North America
https://www.readbyqxmd.com/read/29077228/air-ambulance-delivery-and-administration-of-4-factor-prothrombin-complex-concentrate-is-feasible-and-decreases-time-to-anticoagulation-reversal
#18
Claire Vines, Stephanie J Tesseneer, Robert D Cox, Damon A Darsey, Kristin Carbrey, Michael A Puskarich
OBJECTIVES: To evaluate the feasibility, safety, and preliminary efficacy of four-factor prothrombin complex concentrate (4-factor PCC) administration by an air ambulance service prior to or during transfer of patients with warfarin-associated major hemorrhage to a tertiary care center for definitive management (interventional arm) compared to patients receiving 4-factor PCC following transfer by air ambulance or ground without 4-factor PCC treatment (conventional arm). METHODS: Retrospective chart review of patients presenting to a large academic medical center...
October 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29072602/isolation-and-functional-characterization-of-an-acidic-myotoxic-phospholipase-a%C3%A2-from-colombian-bothrops-asper-venom
#19
Silvia Posada Arias, Paola Rey-Suárez, Andrés Pereáñez J, Cristian Acosta, Mauricio Rojas, Lucilene Delazari Dos Santos, Rui Seabra Ferreira, Vitelbina Núñez
Myotoxic phospholipases A₂ (PLA₂) are responsible for many clinical manifestations in envenomation by Bothrops snakes. A new myotoxic acidic Asp49 PLA₂ (BaCol PLA₂) was isolated from Colombian Bothrops asper venom using reverse-phase high performance liquid chromatography (RP-HPLC). BaCol PLA₂ had a molecular mass of 14,180.69 Da (by mass spectrometry) and an isoelectric point of 4.4. The complete amino acid sequence was obtained by cDNA cloning (GenBank accession No. MF319968) and revealed a mature product of 124 amino acids with Asp at position 49...
October 26, 2017: Toxins
https://www.readbyqxmd.com/read/29071124/management-of-anticoagulation-in-hip-fractures-a-pragmatic-approach
#20
Rafik Yassa, Mahdi Yacine Khalfaoui, Ihab Hujazi, Hannah Sevenoaks, Paul Dunkow
Hip fractures are common and increasing with an ageing population. In the United Kingdom, the national guidelines recommend operative intervention within 36 hours of diagnosis. However, long-term anticoagulant treatment is frequently encountered in these patients which can delay surgical intervention. Despite this, there are no set national standards for management of drug-induced coagulopathy pre-operatively in the context of hip fractures.The aim of this study was to evaluate the management protocols available in the current literature for the commonly encountered coagulopathy-inducing agents...
September 2017: EFORT open reviews
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