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Reversal anticoagulant

Luo-Dan Ouyang, Xiao-Song Hu, Ming Niu, Wen Gao, Yu Cheng, Jia-Bo Wang, Li Ma
The study aims to analyze the mechanisms of Hirudo in promoting blood circulation and removing blood stasis based on network pharmacology. A database of chemical components of Hirudo was established through literature retrieval. The targets were predicted by using the reverse pharmacophore matching method and screened according to the antithrombotic and anticoagulant drug targets approved by FDA in the DrugBank database. Then, the targets were analyzed by KEGG pathway analysis, the protein interactions were analyzed by using BioGrid database, and the active constituents-target-pathway network model of Hirudo was established to study the mechanisms of Hirudo in promoting blood circulation and removing blood stasis...
May 2018: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
Steven A Lubitz, Shaan Khurshid, Lu-Chen Weng, Gheorghe Doros, Joseph Walker Keach, Qi Gao, Anil K Gehi, Jonathan C Hsu, Matthew R Reynolds, Mintu P Turakhia, Thomas M Maddox
BACKGROUND: Many patients with atrial fibrillation (AF) and elevated stroke risk are not prescribed oral anticoagulation (OAC) despite evidence of benefit. Identification of factors associated with OAC non-prescription could lead to improvements in care. METHODS AND RESULTS: Using NCDR PINNACLE, a United States-based ambulatory cardiology registry, we examined factors associated with OAC non-prescription in patients with non-valvular AF at elevated stroke risk (CHA2 DS2 -VASc ≥2) between January 5, 2008 and December 31, 2014...
June 2018: American Heart Journal
Athina Chasapi, Adam Hobbs, Theodore Velissaris, Benoy N Shah
A 77 year old male underwent elective bioprosthetic aortic valve replacement (23mm Carpentier-Edwards Perimount MagnaEase) for severe aortic stenosis. His pre-discharge transthoracic echocardiogram (TTE) was normal. He presented 9 days after surgery with dyspnoea and fever. He was in sinus rhythm. Blood cultures were taken and he was commenced on empirical antibiotics for possible infective endocarditis (subsequently all negative). Repeat TTE showed a well-seated prosthesis without regurgitation but elevated gradients (peak / mean gradients 49 / 22 mmHg respectively)...
June 12, 2018: Echo Research and Practice
Weihua Jin, Shuai Li, Jiale Chen, Bing Liu, Jie Li, Xueliang Li, Fuming Zhang, Robert J Linhardt, Weihong Zhong
Heparan sulfate (HS), is a glycosaminoglycan (GAG) involved in various biological processes, including blood coagulation, wound healing and embryonic development. HS 3-O-sulfotransferases (3-OST), which transfer the sulfo group to the 3-hydroxyl group of certain glucosamine residues, is a key enzyme in the biosynthesis of a number of biologically important HS chains. The 3-OST-1 isoform is one of the 7 known 3-OST isoforms and is important for the biosynthesis of anticoagulant HS chains. In this study, we cloned 3-OST-1 from the rat brain by reverse transcription-polymerase chain reaction (RT-PCR)...
June 9, 2018: Protein Expression and Purification
Jose Coelho-Lima, Ashfaq Mohammed, Suzanne Cormack, Samuel Jones, Rajiv Das, Mohaned Egred, Pedram Panahi, Simi Ali, Ioakim Spyridopoulos
BACKGROUND:  Cardiac-enriched micro ribonucleic acids (miRNAs) are released into the circulation following ST-elevation myocardial infarction (STEMI). Lack of standardized approaches for reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) data normalization and presence of RT-qPCR inhibitors (e.g. heparin) in patient blood samples have prevented reproducible miRNA quantification in this cohort and subsequent translation of these biomarkers to clinical practice...
June 11, 2018: Thrombosis and Haemostasis
Predrag Sikiric, Rudolf Rucman, Branko Turkovic, Marko Sever, Robert Klicek, Bozo Radic, Domagoj Drmic, Mirjana Stupnisek, Marija Misic, Lovorka Batelja Vuletic, Katarina Horvat Pavlov, Ivan Barisic, Antonio Kokot, Marina Peklic, Sanja Strbe, Alenka Boban Blagaic, Ante Tvrdeic, Dinko Stancic Rokotov, Hrvoje Vrcic, Mario Staresinic, Sven Seiwerth
Years ago, we revealed a novel cytoprotective mediator, stable gastric pentadecapeptide BPC 157, particular anti-ulcer peptide that heals different organs lesions when given as a therapy, native in human gastric juice while maintaining GI- tract mucosal integrity, already tested in trials (ulcerative colitis and now multiple sclerosis). The stomach cytoprotection is the most fundamental concept, stomach cell protection and endothelium protection are largely elaborated, but so far cell, protection and endothelium protection outside of the stomach were not implemented in the therapy...
June 7, 2018: Current Pharmaceutical Design
Michael T Durheim, DaJuanicia N Holmes, Rosalia G Blanco, Larry A Allen, Paul S Chan, James V Freeman, Gregg C Fonarow, Alan S Go, Elaine M Hylek, Kenneth W Mahaffey, Sean D Pokorney, James A Reiffel, Daniel E Singer, Eric D Peterson, Jonathan P Piccini
OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is associated with the development of atrial fibrillation (AF), and may complicate treatment of AF. We examined the association between COPD and symptoms, quality of life (QoL), treatment and outcomes among patients with AF. METHODS: We compared patients with and without a diagnosis of COPD in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, a prospective registry that enrolled outpatients with AF not secondary to reversible causes, from both academic and community settings...
June 6, 2018: Heart: Official Journal of the British Cardiac Society
Máté Pásztor, Dániel Bereczki, Zoltán Szakács, Zsolt May
Introduction - Expanding indications have resulted in an increasing number of patients taking novel oral anticoagulants, posing a major treatment dilemma in acute ischemic stroke. Case presentation - We present a successful intravenous thrombolysis in a dabigatran-treated patient with acute ischemic stroke after the administration of idarucizumab. Discussion - According to current guidelines, systemic thrombolysis is contraindicated under treatment with novel oral anticoagulants (taken within 48 hours). In this scenario, idarucizumab offers a solution by reversing the anticoagulant effect of dabigatran...
July 30, 2017: Ideggyógyászati Szemle
Dániel Bereczki, Géza Szilágyi, Ilona Kakuk, Zoltán Szakács, Zsolt May
Introduction - Among antidotes in development for reversal of novel oral anticoagulants, dabigatran-specific idarucizumab was the first one to reach the market. Case presentation - We present the first Hungarian case of intracerebral hemorrhage under treatment with dabigatran, where idarucizumab was administered to suspend anticoagulation. Discussion - Our report is concordant with prior publications, confirming the efficacy of the antidote in reversing the effect of dabigatran, and thus, preventing intracerebral hematoma progression in the acute phase...
September 30, 2017: Ideggyógyászati Szemle
Joshua Payne, Trent Bickel, Sandeep Gautam
BACKGROUND: Ablation for atrial fibrillation (AF) requires multiple venous sheaths and anticoagulation with heparin, both risk factors for bleeding complications. Manual compression (MC) with heparin reversal is the standard method to achieve venous hemostasis post ablation, however temporary figure-of-eight sutures (F8S) are an alternative. While this technique has been shown to be safe and effective, little is known about its effect on post-procedural recovery time. METHODS: In this retrospective cohort study, consecutive patients who underwent AF radiofrequency ablation over a 23 month period were reviewed for type of hemostasis (manual compression or figure-of-eight suture), demographics, peri-procedural anticoagulation, groin complications, and procedural duration...
June 5, 2018: Pacing and Clinical Electrophysiology: PACE
Yvonne Brennan, Emmanuel J Favaloro, Leonardo Pasalic, Hayley Keenan, Jennifer Curnow
BACKGROUND: Idarucizumab is a specific antidote to the direct thrombin inhibitor oral anticoagulant, dabigatran etexilate. It has been used with increasing frequency in Australia since it was granted Therapeutic Goods Administration approval in October 2016. AIMS: To assess idarucizumab usage, effect on coagulation parameters and clinical outcomes in patients who received idarucizumab in Western Sydney Local Health District (WSLHD). METHODS: A retrospective audit was conducted of all patients who received idarucizumab in WSLHD between September 2015 and December 2017...
June 5, 2018: Internal Medicine Journal
Silvia Calabria, Emanuele Forcesi, Letizia Dondi, Antonella Pedrini, Aldo Pietro Maggioni, Nello Martini
PURPOSE: This observational study was aimed to identify patients who experienced non-deferrable surgery and/or uncontrolled severe bleeding following dabigatran administration and then are potentially eligible to the use of the specific antidote idarucizumab in a real-world setting. METHODS: From the big Italian real-world database ARCO, a cohort of adult patients treated with dabigatran and hospitalized due to diagnoses attributable to urgent interventions and/or major bleeding was selected in 2014...
June 4, 2018: Cardiovascular Drugs and Therapy
T Son Nguyen, Tsvee Lapidot, Wolfram Ruf
The hemostatic system plays pivotal roles in injury repair, innate immunity and adaptation to inflammatory challenges. We here review the evidence that these vascular protective mechanisms have non-traditional roles in hematopoietic stem cell (HSC) maintenance in their physiological bone marrow (BM) niches at steady state and under stress. Expression of coagulation factors and the extrinsic coagulation initiator tissue factor by osteoblasts, tissue resident macrophages and megakaryocytes suggests that endosteal as well as vascular HSC niches are functionally regulated by extravascular coagulation...
June 4, 2018: Blood
Ruwan Gunaratne, Shekhar Kumar, James W Frederiksen, Steven Stayrook, Jens L Lohrmann, Kay Perry, Kristin M Bompiani, Charlene V Chabata, Nabil K Thalji, Michelle D Ho, Gowthami Arepally, Rodney M Camire, Sriram Krishnaswamy, Bruce A Sullenger
Unfractionated heparin (UFH), the standard anticoagulant for cardiopulmonary bypass (CPB) surgery, carries a risk of post-operative bleeding and is potentially harmful in patients with heparin-induced thrombocytopenia-associated antibodies. To improve the activity of an alternative anticoagulant, the RNA aptamer 11F7t, we solved X-ray crystal structures of the aptamer bound to factor Xa (FXa). The finding that 11F7t did not bind the catalytic site suggested that it could complement small-molecule FXa inhibitors...
June 4, 2018: Nature Biotechnology
Muhammad Zeeshan, Faisal Jehan, Terence O'Keeffe, Muhammad Khan, El Rasheid Zakaria, Mohammad Hamidi, Lynn Gries, Narong Kulvatunyou, Bellal Joseph
INTRODUCTION: Novel-oral-anticoagulants(NOACs) use is increasing in trauma patients. The reversal of these agents after hemorrhage is still evolving. The aim of our study was to evaluate outcomes after traumatic brain injury in patients on NOACs. METHODS: 3-year (2014-2016) analysis of our prospectively maintained TBI database. We included all TBI patients with intracranial-hemorrhage (ICH) on anticoagulants. Patients were stratified into two groups; those on NOACs and on Warfarin, and were matched in a 1:2 ratio using propensity score matching for demographics, injury and vital parameters, type, and size of ICH...
May 30, 2018: Journal of Trauma and Acute Care Surgery
Jonathan Balakumar, Ruben Santiago, Mark Supino
Dabigatran etexilate mesylate is a direct thrombin inhibitor used for reducing the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Dabigatran belongs to a new generation of oral agents for anticoagulation - the direct oral anticoagulants (DOACs). The DOACs also include the factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. In the case of major or life-threatening bleeding and/or the need for emergent invasive procedures, a reversal agent is needed if a patient is taking one of these medications...
November 2017: Clinical practice and cases in emergency medicine
Hamza Zafar, Lisa Anderson, Andrew T Cox, Rachel Bastiaenen
A 59-year-old woman presented with a sudden onset of breathlessness and chest pain. An echocardiography and CT scan showed pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria. For haemodynamically stable patients, the optimal management strategy is poorly defined. Three main strategies were considered: surgical thrombectomy, thrombolysis and anticoagulation. Surgery with reversal of anticoagulation may lead to further coagulation and increased risk of bleeding complications...
May 30, 2018: BMJ Case Reports
Nobuhiro Akuzawa, Masahiko Kurabayashi
A 94 year-old Japanese woman with renal dysfunction was admitted to our hospital for congestive heart failure caused by atrial fibrillation with rapid ventricular response. Considering the risk of stroke, warfarin was commenced. However, she developed shock following brachial and retroperitoneal hemorrhage 4 days after starting warfarin despite not being over-anticoagulated. She recovered after receiving blood transfusion and intravenous vitamin K2. Bleeding during warfarin administration occurs more frequently in older individuals with lower glomerular filtration rates, especially within the first 30 days of warfarin treatment...
2018: SAGE Open Medical Case Reports
Varun Kumar, Joseph Allencherril, Arthur Bracey, Alice J Chen, Wilson W Lam
Direct oral anticoagulants, which include the factor Xa inhibitor rivaroxaban, have some advantages over vitamin K antagonists in regard to stroke prevention in patients with atrial fibrillation. However, no antidotes to reverse the effect of oral anticoagulants are commercially available, which can complicate treating patients in whom reversal is urgent. We faced this challenge in a kidney transplant candidate, a 65-year-old man with end-stage renal disease who had been taking rivaroxaban for paroxysmal atrial fibrillation...
April 2018: Texas Heart Institute Journal
Stefania Angela Di Fusco, Fabiana Lucà, Manuela Benvenuto, Annamaria Iorio, Damiana Fiscella, Fabrizio D'Ascenzo, Andrea Madeo, Furio Colivicchi, Andrea Di Lenarda, Michele Massimo Gulizia
Even though vitamin K antagonists (VKAs) have been employed for >50 years, there is still some uncertainty about the best strategy to reverse anticoagulation due to VKAs in cases of major bleeding. Furthermore, there is also scarce evidence about the most appropriate way to treat serious bleeding associated with non-vitamin K antagonist oral anticoagulants. This review analyses the main advantages and disadvantages of the various forthcoming therapeutic options to restore a normal coagulation status in anticoagulated patients with ongoing serious bleeding...
May 21, 2018: International Journal of Cardiology
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