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warfarin understanding

Hua-Xin Zhang, Dan Zhou, Qing-Hua Xia
In this work, the interaction of an anti-HIV drug lamivudine and human serum albumin (HSA) was studied by multispectroscopic and molecular modeling methods. The fluorescence emission spectra showed that the fluorescence of HSA was quenched by lamivudine through static mechanism with HSA-lamivudine complex produced at ground state. According to the binding equilibriums observed at 4 different temperatures, the number of binding site, binding constant, enthalpy change, entropy change, and Gibbs free energy change of the interaction were calculated...
March 7, 2018: Journal of Molecular Recognition: JMR
Joanna Y Huang, Paul Monagle, M Patricia Massicotte, Christina J VanderPluym
INTRODUCTION: Ventricular Assist Devices (VADs) are increasingly utilised in children with end-stage heart failure, and experience high bleeding and clotting rates. In particular, pediatric VAD patients are more challenging than adults to anticoagulate due to developmental hemostasis, lack of suitable drug preparations, and difficult anticoagulation monitoring often due to poor vascular access; in addition to difficulties of VAD design in smaller children. This review aims to summarize the current evidence related to antithrombotic therapy in pediatric VAD patients...
February 28, 2018: Thrombosis Research
Hamid Tanzadehpanah, Hanie Mahaki, Neda Hosseinpour Moghadam, Sadegh Salehzadeh, Omid Rajabi, Rezvan Najafi, Razieh Amini, Massoud Saidijam
This study was carried out to evaluate the binding interaction of gefitinib (GEF) with human serum albumin (HSA) and calf thymus DNA (ct-DNA) using fluorescence, UV-visible, zeta potential measurements and molecular docking methods in order to understand its pharmacokinetic mechanism. By increasing the temperature, a steady decrease in Stern-Volmer quenching constants was observed for HSA binding properties; this indicates a static type of fluorescence quenching. Negative values were calculated for Gibbs free energy (ΔG), enthalpy (ΔH) and entropy (ΔS) changes, indicating that the reaction is spontaneous and enthalpy-driven...
February 15, 2018: Journal of Biomolecular Structure & Dynamics
Pavel Goriacko, Keith T Veltri
BACKGROUND: A complication of chronic liver disease (CLD) is the abnormality of coagulation. In clinical practice, this increased risk of bleeding has not been identified as a protective factor against stroke or systemic embolism associated with atrial fibrillation (AF). The objective of this study was to assess the safety of direct oral anticoagulant (DOAC) agents versus warfarin in CLD patients with AF. METHODS: This was a retrospective cohort study of patients with CLD and AF initiated on oral anticoagulants...
February 14, 2018: European Journal of Haematology
Jacob E Kurlander, Geoffrey D Barnes, Michelle A Anderson, Brian Haymart, Eva Kline-Rogers, Scott Kaatz, Sameer D Saini, Sarah L Krein, Caroline R Richardson, James B Froehlich
To understand how physicians from various specialties perceive coordination of care when managing peri-procedural anticoagulation. Cross-sectional survey of cardiologists, gastroenterologists, and primary care physicians (PCPs) in an integrated health system (N = 251). The survey began with a vignette of a patient with atrial fibrillation co-managed by his PCP, cardiologist, and an anticoagulation clinic who must hold warfarin for a colonoscopy. Respondents' experiences and opinions around responsibilities and institutional support for managing peri-procedural anticoagulation were elicited using multiple choice questions...
February 8, 2018: Journal of Thrombosis and Thrombolysis
Emma Gee
Anticoagulant drugs are widely used in hospital and community settings. Anticoagulation is the first-line treatment for venous thromboembolism, and anticoagulant drugs have an important role in the treatment and prevention of blood clots. However, maintaining the equilibrium between clotting and bleeding can be challenging and anticoagulants have been identified as a class of drug associated with preventable patient harm. Direct oral anticoagulants (DOACs) have become the first-line treatment for many patients requiring an anticoagulant, removing the burden of frequent tests and the many food and drug interactions associated with vitamin K antagonists such as warfarin sodium...
January 31, 2018: Nursing Standard
Haroon Khan, Aini Pervaiz, Mohammad A Kamal, Seema Patel
Blood platelets are crucial for maintaining hemostasis and several events in the wound-healing. However, platelet up-regulation leads to the development and the complications of several cardiovascular diseases. For the effective management of these complications, several synthetic drugs are in clinical practice such as aspirin and warfarin. since a long time. But some adverse reactions like aspirin resistance and bleed disorders cause patient in compliance and reduce their therapeutic potential. Thus, the search for potent and safer antiplatelet agents is of great interest...
December 27, 2017: Current Drug Metabolism
A Williams, A Biffen, N Pilkington, L Arrick, R J Williams, M E Smith, M Smith, J Birchall
BACKGROUND: The management of epistaxis requires an understanding of haematological factors that may complicate its treatment. This systematic review includes six distinct reviews examining the evidence supporting epistaxis-specific management strategies relating to warfarin, direct oral anticoagulants, heparin, antiplatelet agents, tranexamic acid and transfusion. METHOD: A systematic review of the literature was performed using a standardised methodology and search strategy...
December 2017: Journal of Laryngology and Otology
Yasuhiro Uno, Shotaro Uehara, Hiroshi Yamazaki
Cynomolgus monkeys (Macaca fascicularis, Old World Monkeys) and common marmosets (Callithrix jacchus, New World Monkeys) have been widely, and expectedly, used as non-human primate models in drug development studies. Major drug-metabolizing cytochrome P450 (P450) enzymes information is now available that supports these primate species as animal models, and it is established that multiple forms of cynomolgus monkey and common marmoset P450 enzymes have generally similar substrate recognition functionality to human P450 enzymes...
December 22, 2017: Biochemical Pharmacology
James A Reiffel
In recent clinical trials, the \"quality\" of warfarin management has been characterized by the time in therapeutic range (TTR) -- with the therapeutic range being an INR between 2.0 and 3.0. In many reviews of recent clinical trials, differences in the TTR have been used comparatively to critique and contrast the trials. However, TTR is a more complex measurement than is commonly appreciated, and many factors that underlie the TTR calculation, which can differ from trial to trial, have not been adequately addressed...
February 2017: Journal of Atrial Fibrillation
Allison S Dobry, Lauren N Ko, Jessica St John, J Mark Sloan, Sagar Nigwekar, Daniela Kroshinsky
Importance: Calciphylaxis is a rare skin disease with high morbidity and mortality that frequently affects patients with renal disease. Hypercoagulable conditions are frequently observed in both patients with calciphylaxis and those with chronic kidney disease (CKD), complicating our understanding of which hypercoagulable conditions are specific to calciphylaxis. Objective: To identify hypercoagulable conditions that are risk factors for developing calciphylaxis while controlling for CKD...
December 13, 2017: JAMA Dermatology
Natalie M Weir, Rosemary Newham, Emma D Corcoran, Ashwag Ali Atallah Al-Gethami, Ali Mohammed Abd Alridha, Paul Bowie, Anne Watson, Marion Bennie
OBJECTIVE: The Scottish Patient Safety Programme - Pharmacy in Primary Care collaborative is a quality improvement initiative adopting the Institute of Healthcare Improvement Breakthrough Series collaborative approach. The programme developed and piloted High Risk Medicine (HRM) Care Bundles (CB), focused on warfarin and non-steroidal anti-inflammatories (NSAIDs), within 27 community pharmacies over 4 NHS Regions. Each CB involves clinical assessment and patient education, although the CB content varies between regions...
November 21, 2017: Research in Social & Administrative Pharmacy: RSAP
Lea Wenskowsky, Herman Schreuder, Volker Derdau, Hans Matter, Julia Volkmar, Marc Nazaré, Till Opatz, Stefan Petry
A single high-affinity fatty acid binding site in the important human transport protein serum albumin (HSA) is identified and characterized using an NBD (7-nitrobenz-2-oxa-1,3-diazol-4-yl)-C12 fatty acid. This ligand exhibits a 1:1 binding stoichiometry in its HSA complex with high site-specificity. The complex dissociation constant is determined by titration experiments as well as radioactive equilibrium dialysis. Competition experiments with the known HSA-binding drugs warfarin and ibuprofen confirm the new binding site to be different from Sudlow-sites I and II...
January 22, 2018: Angewandte Chemie
Sireen Abdul Rahim Shilbayeh, Wejdan Ali Almutairi, Sarah Ahmed Alyahya, Nouf Hayef Alshammari, Eiad Shaheen, Alya Adam
Background Although it can result in serious complications due to its narrow therapeutic index, warfarin is widely used in the treatment and prevention of thromboembolic disorders. However, patients' adherence and knowledge are determinants of therapeutic success. Objective We sought to validate instruments to provide a reliable means of identifying gaps in patient understanding and nonadherence to inform targeted pharmacists' interventions to improve these measures. Methods A cross-sectional survey was conducted...
November 30, 2017: International Journal of Clinical Pharmacy
Siavash Piran, Sam Schulman, Mohamed Panju, Menaka Pai
Direct oral anticoagulant (DOAC) use is increasing worldwide. However, if not taken or prescribed correctly, DOACs have serious side effects. It is crucial that healthcare providers (HCPs) offer patients accurate information and counselling around DOACs, to optimize safe and effective use. To assess knowledge around oral anticoagulant indication, dosing, storage, and administration, an electronic survey was distributed to HCPs across Canada from June to August 2017, with 18 questions on the practical use of oral anticoagulants...
January 2018: Journal of Thrombosis and Thrombolysis
Iki Adachi, Vadim Kostousov, Lisa Hensch, Martin A Chacon-Portillo, Jun Teruya
Ventricular-assist devices (VADs) have seen increased utilization in the pediatric population. Formerly, this therapeutic modality was limited to only the pulsatile VAD, EXCOR (Berlin Heart GmbH). However, the continuous flow VAD devices, HeartMate II (Abbott Inc.) and HeartWare (Medtronic Inc.), are now increasingly used in this population. Postoperatively, VAD patients are acutely anticoagulated using unfractionated heparin, often beginning 24 to 48 hours after VAD placement. Once the patient is stabilized and ready to transition to a lower acuity or outpatient setting, low-molecular-weight heparin or warfarin therapy may be instituted...
February 2018: Seminars in Thrombosis and Hemostasis
Syed F Imam, Omair Ul Haq Lodhi, Zainab Fatima, Saneeya Nasim, Waseem T Malik, Muhammad Sabih Saleem
Primary varicella zoster virus (VZV) infection, predominantly in the pediatric population, presents with pyrexia and a classic pruritic vesicular rash. In adults, although less common, it is more severe and linked to more complications. Neurological complications, which account for less than 1% of all VZV complications, include meningitis, encephalitis, arterial vasculopathy, and venous thrombosis. We present a case of a 39-year-old male who developed extensive cerebral venous sinus thrombosis following primary VZV infection...
September 16, 2017: Curēus
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
Kazem Karami, Zohreh Mehri Lighvan, Hossein Farrokhpour, Maryam Dehdashti Jahromi, Amir Abbas Momtazi-Borojeni
[Pd{(C,N)-C6H4CH2NH(Et) (Qu)] (2) and [Pd{(C,N)-C6H4CH2NH(Et) (Nar)] (3) (Qu=Quercetin, Nar=Naringin) mononuclear palladium (II) complexes have been synthesized and characterized using elemental analysis, IR and electronic spectroscopy. The interaction of the prepared complexes with calf thymus DNA (CT DNA) and bovine serum albumin (BSA), monitored by UV-visible and fluorescence titrations, respectively, have been carried out to better understand the mode of their action under biological conditions. Intercalative binding mode between the complexes and DNA is suggested by the binding constant (Kb) values of 2...
October 11, 2017: Journal of Biomolecular Structure & Dynamics
Ganesan Arunkumar, Durairajpandian Vishnuprabu, Bitt Nupur, Thiruvengadam Vidyasagaran, Avaniyapuram Kannan Murugan, Arasambattu Kannan Munirajan
Deep vein thrombosis (DVT) is a life-threatening disease. Warfarin and acenocoumarol are anticoagulants used to treat DVT and vary among individuals in terms of treatment response/toxicity. Single nucleotide polymorphisms (SNPs) in CYP2C9 and VKORC1 play a role in the pharmacokinetics and dynamics of warfarin and acenocoumarol and they determine the efficacy of treatment by controlling drug clearance in treated individuals. The aim of the current study was to genotype the critical SNPs of CYP2C9 and VKORC1 genes in a south Indian population in order to understand the metabolizer phenotype of patients with DVT...
2017: Drug Discoveries & Therapeutics
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