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https://www.readbyqxmd.com/read/28429198/managing-the-perioperative-patient-on-direct-oral-anticoagulants
#1
Jordan Leitch, Janet van Vlymen
PURPOSE: Patients are increasingly treated with direct oral anticoagulants (DOACs) for the prevention of stroke due to non-valvular atrial fibrillation and for the treatment of venous thromboembolism. When these patients present for urgent or emergent surgical procedures, they present a challenge to the anesthesiologist who must manage perioperative risk due to anticoagulation. The purpose of this module is to review the literature surrounding the perioperative management of DOACs. Timing, laboratory monitoring, and availability of reversal agents are important considerations to optimize patients being treated with DOACs who require emergent surgery...
April 20, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28427335/cholesterol-esterification-in-plasma-as-a-biomarker-for-liver-function-and-prediction-of-mortality
#2
Thorsten Kaiser, Benedict Kinny-Köster, Michael Bartels, Thomas Berg, Markus Scholz, Cornelius Engelmann, Daniel Seehofer, Susen Becker, Uta Ceglarek, Joachim Thiery
BACKGROUND: Advanced stages of liver cirrhosis lead to a dramatically increased mortality. For valid identification of these patients suitable biomarkers are essential. The most important biomarkers for liver function are bilirubin and prothrombin time expressed as International Normalized Ratio (INR). However, the influence of several anticoagulants on the prothrombin time limits its diagnostic value. Aim of this study was the evaluation of cholesterol esterification (CE) fraction (esterified cholesterol vs...
April 20, 2017: BMC Gastroenterology
https://www.readbyqxmd.com/read/28421343/antiplatelets-and-anticoagulants-in-vitreoretinal-surgery-with-a-special-emphasis-on-novel-anticoagulants-a-national-survey-and-review
#3
REVIEW
Rupa Patel, Stephen Charles, Assad Jalil
PURPOSE: To survey current practice and opinion regarding the cessation of antiplatelet and anticoagulant agents prior to vitreoretinal surgery, with special emphasis on novel anticoagulants, and to provide an overview of current literature. METHODS: An online survey was sent to 167 members of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS). A literature search and analysis was conducted on studies that reviewed the bleeding risk of antiplatelet and anticoagulant agents...
April 18, 2017: Graefe's Archive for Clinical and Experimental Ophthalmology
https://www.readbyqxmd.com/read/28420729/factor-v-anticoagulant-cofactor-activity-that-targets-the-early-phase-of-coagulation
#4
Salvatore Santamaria, Natalia Reglińska-Matveyev, Magdalena Gierula, Rodney M Camire, James T B Crawley, David A Lane, Josefin Ahnström
Tissue factor pathway inhibitor (TFPI), the main inhibitor of initiation of coagulation, exerts an important anticoagulant role through the factor Xa (FXa)-dependent inhibition of tissue factor/factor VIIa (FVIIa). Protein S is a TFPI cofactor, enhancing the efficiency of FXa inhibition. TFPI can also inhibit prothrombinase assembly by directly interacting with coagulation factor V (FV) which has been activated by FXa. Since full-length TFPI associates with FV in plasma, we hypothesized that FV may influence TFPI inhibitory function...
April 18, 2017: Journal of Biological Chemistry
https://www.readbyqxmd.com/read/28415603/synthesis-and-evaluation-of-anthranilamide-based-derivatives-as-fxa-inhibitors
#5
Changjiang Huang, Wenzhi Wang, Yao Li, Shijun Zhang, Fancui Meng, Weiren Xu, Jing Yuan, Ligong Chen
Factor Xa (FXa) plays a significant role in the blood coagulation cascade and is a promising target for anticoagulation drugs. Three oral FXa inhibitors have been approved by FDA for treating thrombotic diseases. In this study, 43 novel compounds were synthesized anthranilamide-based FXa inhibitors aiming to ameliorate the toxicity of traditional FXa inhibitors in clinic. The data indicated that the compounds 6a, 6a-b, 6a-e, 6k, 6k-a and 6k-b showed remarkable FXa inhibitory activity and excellent selectivity over thrombin in vitro...
March 21, 2017: Oncotarget
https://www.readbyqxmd.com/read/28412907/review-of-the-pharmacology-of-the-emerging-possibilities-of-the-direct-oral-anticoagulants-reversal
#6
Matej Samos, Lucia Stanciakova, Ingrid Skornova, Tomas Bolek, Frantisek Kovar, Jan Stasko, Peter Galajda, Marian Mokan, Peter Kubisz
BACKGROUND: Direct oral anticoagulants (DOACs) offer consistent and predictable anticoagulation, oral administration with good patient compliance and a good safety profile. Dabigatran - a direct thrombin inhibitor, apixaban and rivaroxaban - direct factor Xa inhibitors are now largely used for anticoagulation in patients with non-valvular atrial fibrillation and in patients with venous thromboembolism. These agents have emerged as an expediential clinical choice in long-term anticoagulation for an increasing number of patients...
April 13, 2017: Current Drug Metabolism
https://www.readbyqxmd.com/read/28412317/medical-treatment-for-spontaneous-anticoagulation-related-intracerebral-hemorrhage-in-the-netherlands
#7
Laura J de Schipper, M Irem Baharoglu, Yvo B W E M Roos, Frank de Beer
BACKGROUND: Spontaneous anticoagulation-related intracerebral hemorrhage accounts for up to a quarter of spontaneous intracerebral hemorrhage cases and is associated with higher hematoma volume and a worse outcome. Guidelines recommend rapid anticoagulant reversal but mode and timing are not specified and optimal strategy is uncertain. Variability in everyday practice is unknown. METHODS: An invitation to a web-based survey was sent to 85 Dutch stroke neurologists in different hospitals, with questions about importance, timing, and medical management of spontaneous anticoagulation-related intracerebral hemorrhage...
April 12, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28403994/risk-of-gastrointestinal-bleeding-with-direct-oral-anticoagulants-a-systematic-review-and-network-meta-analysis
#8
Nick Burr, Katie Lummis, Ruchit Sood, John Samuel Kane, Aaron Corp, Venkataraman Subramanian
BACKGROUND: Direct oral anticoagulants are increasingly used for a wide range of indications. However, data are conflicting about the risk of major gastrointestinal bleeding with these drugs. We compared the risk of gastrointestinal bleeding with direct oral anticoagulants, warfarin, and low-molecular-weight heparin. METHODS: For this systematic review and meta-analysis, we searched MEDLINE and Embase from database inception to April 1, 2016, for prospective and retrospective studies that reported the risk of gastrointestinal bleeding with use of a direct oral anticoagulant compared with warfarin or low-molecular-weight heparin for all indications...
February 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28400185/purification-and-characterization-of-cc-lec-c-type-lactose-binding-lectin-a-platelet-aggregation-and-blood-clotting-inhibitor-from-cerastes-cerastes-venom
#9
Saoud Samah, Chérifi Fatah, Berjeaud Jean-Marc, Kellou-Taîri Safia, Laraba-Djebari Fatima
In this study, we reported for the first time the biochemical and structural characterization of Cc-Lec, a C-type lectin purified from Cerastes cerastes venom by affinity chromatography. This lectin was homogeneous by SDS-PAGE, and was shown to be a 34 271.59Da polypeptide by Electrospray mass spectrometry MS-ES-TOF. Its identified sequence of 160 amino acids corresponding to one subunit, revealed a high identity with other related proteins. Cc-Lec modeled 3D structure appeared as homodimer cross-linked by one disulfide bridge...
April 8, 2017: International Journal of Biological Macromolecules
https://www.readbyqxmd.com/read/28398382/-use-of-rivaroxaban-in-real-life-treatment-of-venous-thromboembolism-results-of-the-tev-survey-an-italian-epidemiological-study
#10
Raffaele Pesavento, Ido Iori
BACKGROUND: Rivaroxaban is a direct and selective inhibitor of factor Xa. The randomized clinical trials EINSTEIN evaluated the efficacy and safety of rivaroxaban for the treatment of venous thromboembolism (VTE) proving that the drug was non-inferior to standard treatment. The aim of this survey was to describe how rivaroxaban was used in a group of "real-life" patients with VTE. METHODS: Between June and October 2014, physicians collected aggregate data, through an online questionnaire, on consecutive patients affected by VTE and treated with rivaroxaban in the previous 6 months...
March 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28396988/the-non-vitamin-k-antagonist-oral-anticoagulants-noacs-and-extremes-of-body-weight-a-systematic-literature-review
#11
REVIEW
Raffaele De Caterina, Gregory Y H Lip
The non-vitamin K antagonist oral anticoagulants (NOACs) exert their anticoagulant effect closely related to their plasma concentrations. Since their distribution volume is related to body weight (and its correlates, i.e., surface area and body mass index, BMI), extremes in body weight may affect their efficacy or safety. Four NOACs are currently available for long-term use, with few exceptions, in atrial fibrillation and venous thromboembolism: the direct thrombin inhibitor dabigatran etexilate, and the factor (F) Xa inhibitors rivaroxaban, apixaban, and edoxaban...
April 10, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28392512/direct-oral-anticoagulants-for-the-treatment-of-venous-thromboembolism-in-japan
#12
Mashio Nakamura, Norikazu Yamada, Masaaki Ito
Direct oral anticoagulants (DOACs) were developed to compensate for the demerits of warfarin. In Japan, three factor Xa inhibitors are used for the treatment of venous thromboembolism (VTE): edoxaban, rivaroxaban, and apixaban. Despite problems, such as the inability to monitor their effect and the lack of an antidote, these inhibitors have the same efficacy as conventional treatment with warfarin, and they are associated with a significantly high degree of safety in relation to hemorrhagic complications. East Asians, including Japanese, suffer from hemorrhage more frequently; therefore, DOACs are considered to be highly effective...
April 7, 2017: Journal of Atherosclerosis and Thrombosis
https://www.readbyqxmd.com/read/28390791/edoxaban-defining-place-in-therapy-for-the-newest-direct-acting-oral-anticoagulant
#13
REVIEW
Caitlin M Gibson, Shannon W Finks
Edoxaban is the most recently approved factor Xa inhibitor within the class of direct oral anticoagulants (DOACs). Like other DOACs, edoxaban was approved by the FDA for treatment of venous thromboembolism and prevention of stroke in patients with non-valvular atrial fibrillation. Similar to other DOACs, edoxaban has fewer drug-drug interactions than warfarin and does not require routine laboratory monitoring. Unlike other DOACs, edoxaban has yet to be approved for secondary or postoperative venous thromboembolism thromboprophylaxis...
April 5, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28387109/-edoxaban-lixiana%C3%A2-new-oral-anticoagulant-forthetreatment-and-secondary-prevention-of-thromboembolic-disease
#14
REVIEW
A J Scheen, P Lancellotti
Edoxaban (Lixiana®) is a new oral anticoagulant that selectively inhibits Xa coagulation factor. It was carefully evaluated in the treatment and secondary prevention of deep venous thrombosis and pulmonary embolism in the Hokusai-VTE trial and in the prevention of systemic and cerebral embolisms in patients with non valvular atrial fibrillation in the ENGAGE AF-TIMI 48 trial. In both studies, edoxaban has proven its non-inferiority regarding its efficacy compared with warfarin as reference treatment while demonstrating a superiority regarding safety...
November 2016: Revue Médicale de Liège
https://www.readbyqxmd.com/read/28386620/direct-oral-anticoagulants-doac-management-of-emergency-situations-rationale-and-design-of-the-radoa-registry
#15
Edelgard Lindhoff-Last
The worldwide increase in the aging population and the associated increase in the prevalence of atrial fibrillation and venous thromboembolism as well as the widespread use of direct oral anticoagulants (DOAC) have resulted in an increase of the need for the management of bleeding complications and emergency operations in frail, elderly patients, in clinical practice. When severe bleeding occurs, general assessment should include evaluation of the bleeding site, onset and severity of bleeding, renal function, and concurrent medications with focus on antiplatelet drugs and nonsteroidal anti-inflammatory drugs (NSAID)...
April 6, 2017: Hämostaseologie
https://www.readbyqxmd.com/read/28378693/hematoma-expansion-following-intracerebral-hemorrhage-mechanisms-targeting-the-coagulation-cascade-and-platelet-activation
#16
Sherrefa R Burchell, Jiping Tang, John H Zhang
Hematoma expansion (HE), defined as a greater than 33% increase in intracerebral hemorrhage (ICH) volume within the first 24 hours, results in significant neurological deficits, and enhancement of ICH-induced primary and secondary brain injury. An escalation in the use of oral anticoagulants has led to a surge in the incidences of oral anticoagulation-associated ICH (OAT-ICH), which has been associated with a greater risk for HE and worse functional outcomes following ICH. The oral anticoagulants in use include vitamin K antagonists, and direct thrombin and factor Xa inhibitors...
March 29, 2017: Current Drug Targets
https://www.readbyqxmd.com/read/28378374/the-surprising-importance-of-peptide-bond-contacts-in-drug-protein-interactions
#17
Robert M Parrish, Doree F Sitkovv, Daniel L Cheney, C David Sherrill
The study of noncovalent interactions, notably including drug-protein binding, relies heavily on the language of localized functional group contacts: hydrogen bonding, π-π interactions, CH-π contacts, halogen bonding, etc. Applying the state-of-the-art functional group symmetry-adapted perturbation theory (F-SAPT) to an important question of chloro vs. methyl aryl substitution in factor Xa inhibitor drugs, we find that a localized contact model provides an incorrect picture for the origin of the enhancement of chloro-containing ligands...
April 4, 2017: Chemistry: a European Journal
https://www.readbyqxmd.com/read/28373761/gastrointestinal-bleeding-in-patients-on-novel-oral-anticoagulants-risk-prevention-and-management
#18
REVIEW
Ka-Shing Cheung, Wai K Leung
Novel oral anticoagulants (NOACs), which include direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitors (rivaroxaban, apixaban and edoxaban), are gaining popularity in the prevention of embolic stroke in non-valvular atrial fibrillation as well as in the prevention and treatment of venous thromboembolism. However, similar to traditional anticoagulants, NOACs have the side effects of bleeding, including gastrointestinal bleeding (GIB). Results from both randomized clinical trials and observations studies suggest that high-dose dabigatran (150 mg b...
March 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28366787/manduca-sexta-hemolymph-protease-1-activated-by%C3%A2-an%C3%A2-unconventional-non-proteolytic-mechanism-mediates%C3%A2-immune%C3%A2-responses
#19
Yan He, Yang Wang, Fan Yang, Haobo Jiang
Tissue damage or pathogen invasion triggers the auto-proteolysis of an initiating serine protease (SP), rapidly leading to sequential cleavage activation of other cascade members to set off innate immune responses in insects. Recently, we presented evidence that Manduca sexta hemolymph protease-1 zymogen (proHP1) is a member of the SP system in this species, and may activate proHP6. HP6 stimulates melanization and induces antimicrobial peptide synthesis. Here we report that proHP1 adopts an active conformation (*) to carry out its function, without a requirement for proteolytic activation...
March 31, 2017: Insect Biochemistry and Molecular Biology
https://www.readbyqxmd.com/read/28364736/bleeding-complications-and-management-on-anticoagulant-therapy
#20
Sam Schulman
Patients treated with anticoagulants have an unavoidable risk of bleeding complications. There are, for all oral anticoagulants, several potential options for management of major bleeding. The first action is to assess the causative role of the anticoagulant in the current bleeding. Supportive measures have been assessed in several post hoc analyses of the phase III pivotal trials with the non-vitamin K antagonist oral anticoagulants (NOACs). Those results will be reviewed here together with emerging data on the efficacy and safety of the specific antidotes idarucizumab (for dabigatran) and andexanet-α (for factor Xa inhibitors)...
April 1, 2017: Seminars in Thrombosis and Hemostasis
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