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Unfractionated heparin

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https://www.readbyqxmd.com/read/28741848/pharmacologic-considerations-in-the-management-of-patients-receiving-left-ventricular-percutaneous-mechanical-circulatory-support
#1
J Erin Allender, Brent N Reed, Jenna L Foster, Jeremy D Moretz, Carrie S Oliphant, Douglas L Jennings, Robert J DiDomenico, James C Coons
Percutaneous mechanical circulatory support (MCS) devices, including the intra-aortic balloon pump, Impella, and TandemHeart, are often used for hemodynamic support in the setting of refractory cardiogenic shock. The thrombotic and bleeding complications associated with these devices is well recognized, and the Impella and TandemHeart devices have unique anticoagulation considerations that may influence patient outcomes. Both devices typically require use of a heparinized purge solution in combination with intravenous unfractionated heparin, thereby providing multiple sources of heparin exposure...
July 25, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28741113/approaches-to-prevent-bleeding-associated-with-anticoagulants-current-status-and-recent-developments
#2
REVIEW
Manu Thomas Kalathottukaren, Charles A Haynes, Jayachandran N Kizhakkedathu
Anticoagulants are widely used for the prophylaxis and treatment of cardiovascular disorders and to prevent blood clotting during surgeries. However, the major limitation associated with anticoagulant therapy is bleeding; all the current anticoagulants do have a bleeding risk. The propensity to bleed is much higher among the elderly population and patients with renal insufficiency. Therefore, there is an utmost and urgent clinical need for a highly efficient, nontoxic antidote with excellent anticoagulant reversal activity...
July 24, 2017: Drug Delivery and Translational Research
https://www.readbyqxmd.com/read/28737834/vitamin-k-antagonists-versus-low-molecular-weight-heparin-for-the-long-term-treatment-of-symptomatic-venous-thromboembolism
#3
REVIEW
Alina Andras, Adriano Sala Tenna, Marlene Stewart
BACKGROUND: People with venous thromboembolism (VTE) generally are treated for five days with intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin (LMWH), followed by three months of vitamin K antagonists (VKAs). Treatment with VKAs requires regular laboratory measurements and carries risk of bleeding; some patients have contraindications to such treatment. Treatment with LMWH has been proposed to minimise the risk of bleeding complications. This is the second update of a review first published in 2001...
July 24, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28737679/modernization-of-enoxaparin-molecular-weight-determination-using-homogeneous-standards
#4
Katelyn M Arnold, Stephen J Capuzzi, Yongmei Xu, Eugene N Muratov, Kevin Carrick, Anita Y Szajek, Alexander Tropsha, Jian Liu
Enoxaparin is a low-molecular weight heparin used to treat thrombotic disorders. Following the fatal contamination of the heparin supply chain in 2007-2008, the U.S. Pharmacopeia (USP) and U.S. Food and Drug Administration (FDA) have worked extensively to modernize the unfractionated heparin and enoxaparin monographs. As a result, the determination of molecular weight (MW) has been added to the monograph as a measure to strengthen the quality testing and to increase the protection of the global supply of this life-saving drug...
July 22, 2017: Pharmaceuticals
https://www.readbyqxmd.com/read/28735423/the-anticoagulant-effect-of-heparin-during-radiofrequency-ablation-rfa-in-patients-taking-apixaban-or-rivaroxaban
#5
L C Brendel, F Dobler, G Hessling, J Michel, S L Braun, A L Steinsiek, P Groha, R Eckl, I Deisenhofer, A Hyseni, M Roest, I Ott, B Steppich
PURPOSE: Measuring the anticoagulant effect of heparin during radiofrequency ablation (RFA) in patients taking apixaban and rivaroxaban is challenging, since the activated coagulation time (ACT) does not seem to reflect the true anticoagulant activity of these drugs. We therefore evaluated coagulation properties of apixaban and rivaroxaban during RFA by different coagulation assays to better monitor periprocedural hemostasis. METHODS: The study included 90 patients (61 ± 12 years) with atrial fibrillation who underwent RFA procedures...
July 22, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28725329/ticagrelor-associated-conduction-disorder-a-case-report-and-review-of-the-literature
#6
Mustafa Yurtdas, Mahmut Ozdemir
A 47-year-old female presented to emergency clinic due to non-ST-elevation myocardial infarction (NSTEMI). After receiving acetylsalicylic acid, a loading dose of ticagrelor 180 mg and intravenous unfractionated heparin, she underwent successful placement of drug eluting stent on the distal part of non-dominant left circumflex artery. The patient had no pre-existing atrioventricular (AV) block and did not use AV blocking agent. Approximately 10 h after taking a loading dose of ticagrelor, baseline normal rhythm degenerated to the first and then complete AV block, with mild dizziness...
June 2017: Cardiology Research
https://www.readbyqxmd.com/read/28717966/association-between-aspirin-use-and-deep-venous-thrombosis-in-mechanically-ventilated-icu-patients
#7
Ena Gupta, Furqan S Siddiqi, Ryan Kunjal, Muhammad Faisal, Farah Al-Saffar, Abubakr A Bajwa, Lisa M Jones, Vandana Seeram, James D Cury, Adil Shujaat
Deep venous thrombosis (DVT) is common in intensive care unit (ICU) patients. It is often silent and may be complicated by pulmonary embolism and death. Thromboprophylaxis with heparin does not always prevent venous thromboembolism (VTE). Aspirin (ASA) reduces the risk of VTE in surgical and high-risk medical patients but it is unknown if ASA may prevent DVT in mechanically ventilated ICU patients. We performed a retrospective chart review of critically ill patients who received mechanical ventilation for >72 h and underwent venous ultrasonography for suspected DVT between Jan 2012 and Dec 2013...
July 17, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28705449/-venous-thromboembolic-disease-comparison-of-management-practices-in-france-italy-and-spain
#8
A Maurizot, A Bura-Rivière, K Gritli, L Bertoletti, L Hernández-Blasco, M Ciammaichella, M C Díaz-Pedroche, M Alfonso, M A Lorente, M Monreal
BACKGROUND: Many national and international guidelines have been established for venous thromboembolic disease (VTE). Homogeneous management practices could be expected in the different European countries. To verify this hypothesis, we compared practices in France, Italy and Spain. METHOD: We used data from the international RIETE registry to compare VTE management between France, Italy and Spain. RESULTS: From 2001 January to 2011 January, patients were consecutively included in France (n=1548), Italy (n=2083) and Spain (29,824)...
February 2017: J Med Vasc
https://www.readbyqxmd.com/read/28702113/cost-effectiveness-analysis-of-the-unfractionated-heparin-versus-low-molecular-weight-heparin-in-hospitalized-patients-with-stroke-due-to-atrial-fibrillation-in-shiraz-south-of-iran
#9
Nahid Hatam, Jamshid Bahmei, Khosro Keshavarz, Farnia Feiz, Reihaneh Sedghi, Afshin Borhani-Haghighi
BACKGROUND: Patients with atrial fibrillation (AF) make a unique group of strokes. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are among the medications used for preventing blood coagulation. This study was carried out aiming at analyzing the cost effectiveness of LMWH versus UFH in hospitalized patients with stroke due to AF with respect to the Iranian population. METHODS: This randomized study was an economic evaluation of cost effectiveness with the help of the cross-sectional data of 2013-2015...
June 2017: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/28695244/-diagnostic-and-treatment-standards-for-cerebral-sinus-venous-thrombosis-results-of-an-online-survey-of-german-stroke-units
#10
C Geisbüsch, P A Ringleb, O Busse, G F Hamann, S Nagel
BACKGROUND AND PURPOSE: The aim of this survey was to characterize the current diagnostic and therapeutic strategies for thrombosis of the cerebral sinus and veins (CVT) performed in German stroke units (SU). METHODS: Between September 2015 and January 2016 all clinical heads of certified SUs in Germany were invited to participate in a standardized online survey. The survey concentrated on the basic characteristics of SUs, diagnostic and therapeutic procedures and was made anonymous if so desired...
July 10, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28694860/postpartum-aortic-bifurcation-thrombosis-on-the-background-of-thrombophilic-disorder
#11
Roxana Elena Bohîltea, Natalia Turcan, Horia Muresian, Silvia Condu, Elvira Bratila, Monica Mihaela Cîrstoiu
Two main causes of arterial thrombosis are known: fi rst - atherosclerosis, extensively studied, and the second - atrial fi brillation. The lack of any risk factors and the occurrence at young age of a thrombotic event requires us to investigate possible other conditions, including inherited thrombophilia that is represented by a series of genetic disorders that increase the risk of thromboembolic disease. The role of thrombophilia in the occurrence of arterial thrombosis is inconsequential; this disorder is characterized by the tendency of developing venous thrombosis...
September 2016: Mædica
https://www.readbyqxmd.com/read/28693359/coagulation-monitoring-correlation-with-heparin-dose-in-pediatric-extracorporeal-life-support
#12
Katie Moynihan, Kerry Johnson, Lahn Straney, Christian Stocker, Ben Anderson, Prem Venugopal, John Roy
OBJECTIVES: Extracorporeal Life Support (ECLS) risks thrombotic and hemorrhagic complications. Optimal anti-coagulation monitoring is controversial. We compared coagulation tests evaluating the heparin effect in pediatric ECLS. METHODS: A retrospective study of children (<18yrs) undergoing ECLS over 12 months in a tertiary pediatric intensive care unit (PICU). Variables included anti-Factor Xa activity (anti-Xa), activated partial thromboplastin time (aPTT), activated clotting time (ACT) and thromboelastogram (TEG(®)6s) parameters: ratio and delta reaction (R) times (the ratio and difference, respectively, between R times in kaolin assays with and without heparinase)...
July 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28680640/argatroban-for-an-alternative-anticoagulant-in-hit-during-ecmo
#13
Alain Rougé, Felix Pelen, Michel Durand, Carole Schwebel
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) have become more frequently used in daily ICU practice, heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication while on extracorporeal membrane oxygenation (ECMO). HIT confirmation directly impacts on anticoagulant strategy requiring no delay unfractionated heparin discontinuation to be replaced by alternative systemic anticoagulant treatment. CASE PRESENTATION: We report two clinical cases of HIT occurring during ECMO in various settings with subsequent recovery with argatroban and provide literature review to help physicians treat HIT during ECMO in clinical daily practice...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28677422/evaluation-of-a-standardized-perioperative-management-protocol-in-the-adult-hematology-anticoagulation-management-service
#14
Diane J Lum, Patricia A Ross, Martin A Bishop, Michelle L Caetano, Michael B Streiff
BACKGROUND: In North America, 250,000 patients on vitamin K antagonists require surgical procedures each year. Temporary interruption of oral anticoagulation and perioperative bridging therapy with unfractionated heparin or low-molecular-weight heparin are recommended by the American College of Chest Physicians 2012 for select patients. OBJECTIVES: The study objectives are to evaluate adherence and nonadherence to the Johns Hopkins clinic guidelines for perioperative management of anticoagulation and identify bleeding or thromboembolic events during perioperative management of anticoagulation...
July 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28675460/real-life-use-of-anticoagulants-in-venous-thromboembolism-with-focus-on-patients-with-exclusion-criteria-for-direct-oral-anticoagulants
#15
Farès Moustafa, Raffaele Pesavento, Pierpaolo Di Micco, José González-Martínez, Roberto Quintavalla, Maria-Luisa Peris, José Antonio Porras, Nicolas Falvo, Pilar Baños, Manuel Monreal
We assessed the real-life use of direct oral anticoagulants (DOACs) in patients with venous thromboembolism (VTE) and exclusion criteria for randomized trials. From 2013 to 2016, 3578 of 18853 patients (19%) had exclusion criteria. Irrespective of which anticoagulant was chosen, they had more VTE recurrences (hazard ratio [HR]: 3.10; 95%CI: 2.47-3.88), major bleeds (HR: 4.10; 95%CI: 3.38-4.96) and deaths (HR: 9.47; 95%CI: 8.46-10.6) than those without exclusion criteria. During initial therapy, no patient with exclusion criteria on DOACs (n=115) recurred, but those on rivaroxaban bled less often (adjusted HR: 0...
July 4, 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28671597/precipitation-and-neutralization-of-heparin-from-different-sources-by-protamine-sulfate
#16
John Hogwood, Barbara Mulloy, Elaine Gray
Current therapeutic unfractionated heparin available in Europe and US is of porcine mucosal origin. There is now interest, specifically in the US, to use bovine mucosa as an additional source for the production of heparin. The anticoagulant action of heparin can be neutralized by protamine sulfate, and in this study the ability of protamine to bind and neutralize the anticoagulant activities of heparin from porcine mucosa, bovine mucosa and bovine lung were assessed. Protamine sulfate was able to bind and precipitate similar amounts of heparins from different sources on a mass basis...
July 2, 2017: Pharmaceuticals
https://www.readbyqxmd.com/read/28667310/surface-modification-of-pig-endothelial-cells-with-a-branched-heparin-conjugate-improves-their-compatibility-with-human-blood
#17
Anjan K Bongoni, Evelyn Salvaris, Sofia Nordling, Nikolai Klymiuk, Eckhard Wolf, David L Ayares, Robert Rieben, Peetra U Magnusson, Peter J Cowan
Corline Heparin Conjugate (CHC), a compound of multiple unfractionated heparin chains, coats cells with a glycocalyx-like layer and may inhibit (xeno)transplant-associated activation of the plasma cascade systems. Here, we investigated the use of CHC to protect WT and genetically modified (GTKO.hCD46.hTBM) pig aortic endothelial cells (PAEC) in two pig-to-human in vitro xenotransplantation settings. Model 1: incubation of untreated or hTNFα-treated PAEC with 10% human plasma induced complement C3b/c and C5b-9 deposition, cellular activation and coagulation activation in WT and GTKO...
June 30, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28664670/population-pharmacokinetics-of-human-antithrombin-concentrate-in-pediatric-patients
#18
Brady S Moffett, Rosa Diaz, Marianne Galati, Donald Mahoney, Jun Teruya, Donald L Yee
AIMS: Antithrombin is increasingly used in pediatric patients, yet there are few age-specific pharmacokinetic data to guide dosing. We aim to describe the pharmacokinetic profile of human (plasma-derived) antithrombin concentrate in pediatric patients. METHODS: A retrospective review of 5 years of patients < 19 years of age admitted to our institution who received antithrombin concentrate, were not on mechanical circulatory support and had baseline (pre-dose) and post-dose plasma antithrombin activity levels available for analysis, was performed...
June 29, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28652016/overall-effectiveness-of-rivaroxaban-in-patients-with-pulmonary-embolism
#19
Li Wang, Onur Baser, Phil Wells, W Frank Peacock, Craig I Coleman, Gregory J Fermann, Jeff Schein, Concetta Crivera
PURPOSE: Due to limited evidence on the impact of rivaroxaban in clinical practice, we compared the effectiveness of rivaroxaban versus standard of care (SOC) among patients in the Veterans Health Administration. METHODS: Adult patients with continuous enrollment in a health plan with medical and pharmacy benefits for ≥12 months before and ≥3 months after an inpatient diagnosis of pulmonary embolism (PE) between October 1, 2011, and June 30, 2015, and a prescription claim for an anticoagulant during the index hospitalization, were included...
June 23, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28650361/pharmacological-thromboembolic-prophylaxis-in-traumatic-brain-injuries-low-molecular-weight-heparin-is-superior-to-unfractionated-heparin
#20
Elizabeth Benjamin, Gustavo Recinos, Alberto Aiolfi, Kenji Inaba, Demetrios Demetriades
OBJECTIVE: We hypothesized that low molecular weight heparin (LMWH) is superior to unfractionated heparin (UH) for venous thromboembolism (VTE) prophylaxis in patients with severe traumatic brain injuries (TBI). SUMMARY BACKGROUND DATA: Pharmacological VTE prophylaxis with LMWH or UH is the current standard of care in TBI. Clinical work suggests that LMWH may be more effective than UH for VTE prophylaxis in trauma patients. Experimental work shows that heparinoids may have neuroprotective properties...
June 22, 2017: Annals of Surgery
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