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https://www.readbyqxmd.com/read/28526159/anticoagulation-and-neuraxial-peripheral-anesthesia
#1
REVIEW
Mudit Kaushal, Ryan E Rubin, Alan D Kaye, Karina Gritsenko
Novel anticoagulants (NAGs) have emerged as the preferred alternatives to vitamin K antagonists. In patients being considered for regional anesthesia, these drugs present a layer of complexity in the preprocedure evaluation. There are no established tests to monitor anticoagulant activity and our experience is short with these drugs. These authors believe it is important to review the relevant hematology, orthopedics, and anesthesiology literature to provide a valuable reference for the clinician who is met with these challenges...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28526151/novel-anticoagulant-agents-in-the-perioperative-setting
#2
REVIEW
Allyson Lemay, Alan D Kaye, Richard D Urman
An increasing number of oral anticoagulants have become available over the past decade. Each of these agents has differing implications on both regional and neuraxial anesthetic techniques. This article describes the pharmacology, pharmacokinetics, and pharmacodynamics of the most commonly used novel oral anticoagulants (NOACs). It also outlines recent guidelines for the use of NOACs in the perioperative setting, especially with regard to neuraxial anesthesia.
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28522812/selection-and-characterization-of-a-dna-aptamer-inhibiting-coagulation-factor-xia
#3
David A Donkor, Varsha Bhakta, Louise J Eltringham-Smith, Alan R Stafford, Jeffrey I Weitz, William P Sheffield
Factor XIa (FXIa) is a serine protease that catalyzes the activation of Factor IX (FIX) in the blood coagulation cascade. FXIa and its precursor FXI are emergent therapeutic targets for the development of safer anticoagulant agents. Here, we sought a novel DNA-based agent to inhibit FXIa. Towards this goal, an 80 base, single-stranded DNA aptamer library (containing a 40 base randomized core) was screened for FXIa-binding candidates, using ten rounds of positive and negative selection. After selection, 6 of 89 different sequences inhibited FXIa-mediated chromogenic substrate S2366 cleavage...
May 18, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28521540/cost-effectiveness-analysis-of-rivaroxaban-for-treatment-and-secondary-prevention-of-venous-thromboembolism-in-the-netherlands
#4
Marieke Heisen, Maarten J Treur, Harald E Heemstra, Eric B W Giesen, Maarten J Postma
BACKGROUND: Until recently, standard treatment of venous thromboembolism (VTE) concerned a combination of short-term low-molecular-weight heparin (LMWH) and long-term vitamin-K antagonist (VKA). Risk of bleeding and the requirement for regular anticoagulation monitoring are, however, limiting their use. Rivaroxaban is a novel oral anticoagulant associated with a significantly lower risk of major bleeds (hazard ratio 0.54, 95% confidence interval 0.37-0.79) compared to LMWH/VKA therapy and does not require regular anticoagulation monitoring...
May 18, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28514646/heparin-removal-by-ecteola-cellulose-pre-treatment-enables-the-use-of-plasma-samples-for-accurate-measurement-of-anti-yellow-fever-virus-neutralizing-antibodies
#5
Ana Carolina Campi-Azevedo, Vanessa Peruhype-Magalhães, Jordana Grazziela Coelho-Dos-Reis, Christiane Costa-Pereira, Anna Yoshida Yamamura, Sheila Maria Barbosa de Lima, Marisol Simões, Fernanda Freire Campos Nunes, Aline de Castro Zacche Tonini, Elenice Moreira Lemos, Ricardo Cristiano Brum, Tatiana Guimarães de Noronha, Marcos da Silva Freire, Maria de Lourdes Sousa Maia, Luiz Antônio Bastos Camacho, Maria Rios, Caren Chancey, Alessandro Romano, Carla Magda Domingues, Andréa Teixeira-Carvalho, Olindo Assis Martins-Filho
Technological innovations in vaccinology have recently contributed to bring about novel insights for the vaccine-induced immune response. While the current protocols that use peripheral blood samples may provide abundant data, a range of distinct components of whole blood samples are required and the different anticoagulant systems employed may impair some properties of the biological sample and interfere with functional assays. Although the interference of heparin in functional assays for viral neutralizing antibodies such as the functional plaque-reduction neutralization test (PRNT), considered the gold-standard method to assess and monitor the protective immunity induced by the Yellow fever virus (YFV) vaccine, has been well characterized, the development of pre-analytical treatments is still required for the establishment of optimized protocols...
May 14, 2017: Journal of Immunological Methods
https://www.readbyqxmd.com/read/28509703/pathway-for-the-management-of-atrial-fibrillation-and-atrial-flutter
#6
Eyal Herzog, Edgar Argulian, Steven B Levy, Emad F Aziz
Atrial fibrillation (AF) is the most common cardiac rhythm disturbance encountered in clinical practice, and its prevalence is increasing as the population ages. The American College of Cardiology, the American Heart Association, and the European Society of Cardiology established guidelines for the management of patients with AF. Atrial flutter (Afl) is less common and is often associated with or preceded by AF or occurs in an isolated pattern. A major limitation of the currently published guidelines for the management of patients with AF and Afl is their complexity, the fact that official guidelines are published separately for each of these arrhythmias, and that they were published several years ago...
June 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28509350/high-sodium-continuous-veno-venous-hemodialysis-with-regional-citrate-anticoagulation-and-online-dialysate-generation-in-patients-with-acute-liver-failure-and-cerebral-edema
#7
Tamim Hamdi, Lenar Yessayan, Jerry Yee, Balazs Szamosfalvi
INTRODUCTION: Acute liver failure is associated with a high mortality rate. Induction of plasma hypertonicity with mannitol or hypertonic saline remains the cornerstone in the management of resultant cerebral edema. Significant disadvantages of this approach include poor or unpredictable control of serum sodium concentration and volume expansion, among others. METHODS: We used high sodium continuous veno-venous hemodialysis with regional citrate anticoagulation and online dialysate generation to accurately control the serum sodium in eleven patients with acute liver failure, renal failure, and cerebral edema...
May 16, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28506647/acute-structural-failure-of-the-trifecta-aortic-valve-bioprosthesis
#8
Michael Z L Zhu, Mark A Newman, Pragnesh Joshi, Jurgen Passage
Advancements in bioprosthetic valve technology have greatly enhanced the haemodynamic performance and long-term durability of tissue valves. These features, along with the key advantage of avoiding lifelong anticoagulation, have made bioprosthetic valves increasingly attractive for clinicians and patients alike. The St Jude Trifecta valve is a novel, bovine pericardial bioprosthesis with promising early data for performance and safety. However, no prosthetic valve is perfect and prosthesis failure can occur with even the most reliable and well-designed devices...
April 20, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28503837/efficacy-of-protocol-based-pharmacotherapy-management-on-anticoagulation-with-warfarin-for-patients-with-cardiovascular-surgery
#9
Y Katada, S Nakagawa, K Minakata, M Odaka, H Taue, Y Sato, A Yonezawa, Y Kayano, I Yano, T Nakatsu, K Sakamoto, K Uehara, H Sakaguchi, K Yamazaki, K Minatoya, R Sakata, K Matsubara
WHAT IS KNOWN AND OBJECTIVE: Anticoagulation therapy with warfarin requires periodic monitoring of prothrombin time-international normalized ratio (PT-INR) and adequate dose adjustments based on the data to minimize the risk of bleeding and thromboembolic events. In our hospital, we have developed protocol-based pharmaceutical care, which we called protocol-based pharmacotherapy management (PBPM), for warfarin therapy. The protocol requires pharmacists to manage timing of blood sampling for measuring PT-INR and warfarin dosage determination based on an algorithm...
May 15, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28502675/genotype-guided-dosing-of-warfarin-through-modeling-and-simulation
#10
Jiexin Deng, Valvanera Vozmediano Esteban, Monica Rodriguez, Larisa H Cavallari, Stephan Schmidt
Current genotype-guided algorithms for warfarin dosing fail to deliver optimal performance in two aspects: 1) these algorithms are not able to achieve the same level of benefits in non-white populations, since they were developed based on multivariate regression analysis with mostly European/White data and did not include genetic variants found frequently in non-white populations; 2) these algorithms do not account for the dynamic dose/response relationship and were limited in their usefulness to guide dosing during the initiation phase, as the possession of variant VKORC1 and/or CYP2C9 polymorphisms has been associated with a more rapid attainment of target international normalized ratio (INR) and higher risk of over-anticoagulation even in genotype-guided patients...
May 11, 2017: European Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/28498476/effects-of-unfractionated-heparin-and-rivaroxaban-on-the-expression-of-heparanase-and-fibroblast-growth-factor-2-in-human-osteoblasts
#11
Jingjun Xia, Wei Sheng, Liubao Pei, Ning Li, Zhipeng Zhang, Jialiang Wang, Jianing Zu, Nanxiang Wang, Duanyang Wang
Long-term treatment with anticoagulants may contribute to osteoporosis. Although unfractionated heparin and rivaroxaban have adverse effects on bone microstructure and function in adult rats, the underlying mechanism remains to be elucidated. Heparanase (HPSE) and fibroblast growth factor (FGF)2 are important signals in bone formation and fracture healing. Therefore, the present study was designed to investigate the effects of unfractionated heparin and rivaroxaban on the expression of HPSE and FGF2 in human osteoblasts...
May 10, 2017: Molecular Medicine Reports
https://www.readbyqxmd.com/read/28498066/atrial-fibrillation-in-pregnancy-a-growing-challenge
#12
Vasiliki Katsi, Georgios Georgiopoulos, Maria Marketou, Dimitrios Oikonomou, Fragiskos Parthenakis, Thomas Makris, Petros Nihoyannopoulos, P Vardas, Dimitris Tousoulis
Atrial fibrillation (AF) constitutes a relatively infrequent pregnancy complication, which may be a therapeutic Gordian knot. Indeed, sparse data exist regarding the prevalence, prognosis and management of AF during pregnancy. In general, AF occurs as a benign, self-limited arrhythmia but occasionally may have severe hemodynamic consequences in pregnant patients suffering from heart failure, congenital heart disease, or other comorbidities. Extra-cardiac causes of AF should always be meticulously excluded. Treatment decisions are difficult, since medications may cross placental barrier and potentially affect fetal growth and organogenesis or even result in fetal bradyarrhythmias...
May 12, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28497899/replacing-warfarin-with-a-novel-oral-anticoagulant-risk-of-recurrent-bleeding-and-stroke-in-patients-with-warfarin-ineligible-or-failure-in-patients-with-atrial-fibrillation-the-roar-study
#13
Mohit K Turagam, Valay Parikh, Muhammad R Afzal, Rakesh Gopinnathanair, Madhav Lavu, Arun Kanmanthareddy, Jayasree Pillarisetti, Madhu Reddy, Donita Atkins, Sudharani Bommana, Melissa Jaeger, Courtney Jeffery, Sanghamitra Mohanty, Pasquale Santangeli, Jie Cheng, Luigi Dibiase, Calambur Narasimhan, Andrea Natale, Dhanunjaya Lakkireddy
BACKGROUND: A significant proportion of patients treated with warfarin for atrial fibrillation (AF) become warfarin ineligible (WI) due to major bleeding events (MBE) or systemic thromboembolism (STE). We report a large multicenter real-world experience of the use of DOACs in these WI patients. METHODS: We report the outcomes of 263 WI patients treated with DOACs. The primary objective was to evaluate clinical outcomes of STE and MBE with DOACs. Secondary objective was to assess clinical predictors of repeat MBE and STE on DOACs...
May 12, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28496931/safety-of-the-direct-oral-anticoagulant-edoxaban-for-atrial-fibrillation-after-cardiac-surgery-pilot-study
#14
Akira Sezai, Shunji Osaka, Hiroko Yaoita, Munehito Arimoto, Hiroaki Hata, Motomi Shiono
Direct oral anticoagulants have recently been recommended for non-valvular atrial fibrillation, but have rarely been studied in the field of cardiac surgery. We prospectively investigated the safety of edoxaban, a novel oral anticoagulant, for use in cardiac surgery patients with postoperative atrial fibrillation (POAF), which is the most common complication of cardiac surgery and can lead to stroke. The subjects were adult cardiac surgery patients with POAF who received oral edoxaban for 2 months in an open-label pilot study...
October 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/28496929/management-of-patients-with-atrial-fibrillation-focus-on-treatment-options
#15
REVIEW
Pawel Matusik, Jacek Lelakowski, Barbara Malecka, Jacek Bednarek, Remigiusz Noworolski
Atrial fibrillation (AF) is leading cardiac arrhythmia with important clinical implications. Its diagnosis is usually made on the basis on 12-lead ECG or 24-hour Holter monitoring. More and more clinical evidence supports diagnostic use of cardiac event recorders and cardiovascular implantable electronic devices (CIED). Treatment options in patients with atrial fibrillation are extensive and are based on chosen rhythm and/or rate control strategy. The use and selected contraindications to AF related pharmacotherapy, including anticoagulants are shown...
October 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/28493007/gastrointestinal-endoscopy-in-patients-receiving-novel-direct-oral-anticoagulants-results-from-the-prospective-dresden-noac-registry
#16
Vera Heublein, Sven Pannach, Katharina Daschkow, Luise Tittl, Jan Beyer-Westendorf
BACKGROUND: Patients receiving direct-acting, non-vitamin K oral anticoagulants (NOAC) frequently undergo gastrointestinal endoscopies (GIE) but little is known on the management and outcome of these interventions. METHODS: With use of data from an ongoing, prospective, noninterventional registry of NOAC patients, the management and outcome of GIE were evaluated with use of standard event definitions. Patients undergoing GIE were categorized into two subgroups: (1) scheduled GIE (scheduled appointment, no acute bleeding) and (2) unscheduled GIE (unscheduled including management of acute gastrointestinal bleeding)...
May 10, 2017: Journal of Gastroenterology
https://www.readbyqxmd.com/read/28492485/sulfated-alginates-as-heparin-analogues-a-review-of-chemical-and-functional-properties
#17
REVIEW
Øystein Arlov, Gudmund Skjåk-Bræk
Heparin is widely recognized for its potent anticoagulating effects, but has an additional wide range of biological properties due to its high negative charge and heterogeneous molecular structure. This heterogeneity has been one of the factors in motivating the exploration of functional analogues with a more predictable modification pattern and monosaccharide sequence, that can aid in elucidating structure-function relationships and further be structurally customized to fine-tune physical and biological properties toward novel therapeutic applications and biomaterials...
May 11, 2017: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
https://www.readbyqxmd.com/read/28488882/development-of-bioanalytical-assays-for-variegin-a-peptide-based-bivalent-direct-thrombin-inhibitor
#18
Norrapat Shih, Leonardo Pinto de Carvalho, Yie Hou Lee, Mauricio Macario Rocha, Adriano Henrique Pereira Barbosa, José Marconi A de Sousa, Antonio Carlos de C Carvalho, R Manjunatha Kini, Mark Y Chan
AIM: Variegin is an anticoagulant peptide that will be tested in porcine models of percutaneous coronary intervention. We developed three bioanalytical assays for variegin quantitation and utilized these methods to evaluate pharmacokinetics of variegin in pigs. Results & methodology: The LC-MS/MS, thrombin amidolytic and modified thrombin time assays had a quantitation range of 21.6-5541.7, 10.8-5541.7 and 5.4-5541.7 nM in human plasma, respectively. The elimination half-lives obtained using the LC-MS/MS, modified thrombin time and thrombin amidolytic assays were 52...
May 10, 2017: Bioanalysis
https://www.readbyqxmd.com/read/28480082/life-threatening-hemopericardium-associated-with-rivaroxaban
#19
Sijan Basnet, Niranjan Tachamo, Biswaraj Tharu, Rashmi Dhital, Sushil Ghimire, Dilli Ram Poudel
Rivaroxaban is a novel oral anticoagulant used in the treatment of venous thromboembolism. The use of this medication has expanded over the recent years with resultant expansion of side effect profile. We present a case of a 56-year-old female who presented with shortness of breath and chest pain 12 weeks after starting rivaroxaban for left upper extremity deep vein thrombosis. She was later diagnosed with spontaneous hemopericardium requiring pericardial fluid drainage. Rarer side effects like this will be encountered more often with the increasing use of novel oral anticoagulants...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28477098/predictors-of-thrombus-formation-after-percutaneous-left-atrial-appendage-closure-using-the-watchman-device
#20
Hidehiro Kaneko, Michael Neuss, Jens Weissenborn, Christian Butter
Percutaneous left atrial appendage (LAA) closure using the WATCHMAN device is a novel option for prevention of stroke associated with atrial fibrillation. However, device-related thrombus (DRT) formation is a concern after WATCHMAN implantation and the predictors of DRT still remain unclear. We aimed to clarify the predictors of DRT after WATCHMAN implantation by analyzing 78 patients (50 males, 72 ± 8 years, average CHA2DS2-VASc score of 4.3 + 1.8) who had undergone WATCHMAN implantation. WATCHMAN was successfully implanted in all patients and four (5%) developed DRT...
May 5, 2017: Heart and Vessels
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