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https://www.readbyqxmd.com/read/29395816/a-comparative-study-of-point-of-care-prothrombin-time-in-cardiopulmonary-bypass-surgery
#1
Shihoko Okabayashi, Satoru Ogawa, Kenichi A Tanaka, Takashi Nishiyama, Shusuke Takeshita, Yoshinobu Nakayama, Yasufumi Nakajima, Teiji Sawa, Toshiki Mizobe
OBJECTIVE: Point-of-care (POC) devices allow for prothrombin time/international normalized ratio (PT/INR) testing in whole blood (WB) and timely administration of plasma or prothrombin complex concentrate during cardiopulmonary bypass surgery. This study evaluated the sensitivities of a new POC PT test, a dry-hematology method with heparin neutralization technology (DRIHEMATO PT-S [DRI PT-S]; A&T Corporation, Kanagawa, Japan), and compared it with other POC tests currently available. DESIGN: Prospective, observational study...
December 29, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29368193/periprocedural-anticoagulation-management-for-atrial-fibrillation-ablation-current-knowledge-and-future-directions
#2
REVIEW
Alan Sugrue, Konstantinos C Siontis, Jonathan P Piccini, Peter A Noseworthy
Catheter ablation (CA) for atrial fibrillation (AF) is an established first-line approach to the management of drug-refractory AF. Although, advancements in procedural techniques and technology have improved the efficacy and safety of CA, thromboembolism (TE) remains one of the most feared periprocedural complications. Minimizing the risk of TE during and after CA requires a multifaceted approach, in which periprocedural anticoagulation plays a central role. The goal of anticoagulation before, during, and after CA is to minimize TE risk without excessively increasing the risk of adverse bleeding...
January 25, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29066923/setting-priorities-in-the-health-care-sector-the-case-of-oral-anticoagulants-in-nonvalvular-atrial-fibrillation-in-denmark
#3
Peter Bo Poulsen, Søren Paaske Johnsen, Morten Lock Hansen, Axel Brandes, Steen Husted, Louise Harboe, Lars Dybro
AIM: Resources devoted to health care are limited, therefore setting priorities is required. It differs between countries whether decision-making concerning health care technologies focus on broad economic perspectives or whether focus is narrow on single budgets ("silo mentality"). The cost perspective as one part of the full health economic analysis is important for decision-making. With the case of oral anticoagulants in patients with nonvalvular atrial fibrillation (NVAF), the aim is to discuss the implication of the use of different cost perspectives for decision-making and priority setting...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28994544/-effect-of-shuxuetong-injection-on-anticoagulant-effect-of-warfarin-in-rats
#4
Hai-Feng Zhao, Jia-Hui Sun, Shuang Liu, Yan Liu, Gao-Feng Liu
To explore the effect of Shuxuetong injection on the pharmacodynamics and pharmacokinetics of warfarin in rats, and to provide reference for rational drug use. In studies on the single dose of warfarin, Wistar rats were randomly divided into four groups: blank control group(group A), Shuxuetong injection group(group B), warfarin control group(group C), and warfarin+Shuxuetong injection group(group D). In studies on the steady state of warfarin, Wistar rats were randomly divided into warfarin control group(group E) and warfarin+Shuxuetong injection group(group F)...
March 2017: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
https://www.readbyqxmd.com/read/28912027/factor-analysis-in-optimization-of-formulation-of-high-content-uniformity-tablets-containing-low-dose-active-substance
#5
Ivana Lukášová, Jan Muselík, Aleš Franc, Roman Goněc, Filip Mika, David Vetchý
Warfarin is intensively discussed drug with narrow therapeutic range. There have been cases of bleeding attributed to varying content or altered quality of the active substance. Factor analysis is useful for finding suitable technological parameters leading to high content uniformity of tablets containing low amount of active substance. The composition of tabletting blend and technological procedure were set with respect to factor analysis of previously published results. The correctness of set parameters was checked by manufacturing and evaluation of tablets containing 1-10mg of warfarin sodium...
November 15, 2017: European Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/28648031/-impact-of-different-antithrombotic-therapy-strategy-on-prognosis-in-coronary-heart-disease-patients-combining-with-atrial-fibrillation-a-meta-analysis
#6
C Yuan, L Zhong, R C Huang
Objective: To evaluate the impact of various anticoagulation antiplatelet therapy strategies on the prognosis of patients with coronary heart disease combining with atrial fibrillation. Methods: Present meta analysis was performed according to search results on English EMBASE database by computer retrieval, Pubmed, the Cochrane Central Register of Controlled Trials, Medline, Chinese CBM database, CNKI database, Wan Fang database, China science and technology papers online electronic databases, manual retrieval for important international conference proceedings up to April 30 2016...
June 24, 2017: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/28528624/root-cause-analysis-of-adverse-events-in-an-outpatient-anticoagulation-management-consortium
#7
Christopher M Graves, Brian Haymart, Eva Kline-Rogers, Geoffrey D Barnes, Linda K Perry, Denise Pluhatsch, Nannette Gearhart, Helen Gikas, Noelle Ryan, Brian Kurtz
BACKGROUND: A number of factors can lead to adverse events (AEs) in patients taking warfarin. Performing a root cause analysis (RCA) of serious AEs is one systematic way of determining the causes of these events. METHODS: Multidisciplinary teams were formed at Michigan Anticoagulation Quality Improvement Initiative (MAQI(2)) sites with organized anticoagulation management services (AMS). Medical records from patients who suffered serious AEs (major bleed, embolic stroke, venous thromboembolism) were reviewed, and AMS staff were interviewed to determine the root cause using the "5 Whys" technique...
June 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28528365/the-value-of-evidence-in-the-decision-making-process-for-reimbursement-of-pharmacogenetic-dosing-of-warfarin
#8
Andrej Janzic, Igor Locatelli, Mitja Kos
BACKGROUND: After early clinical trials that evaluated pharmacogenetic (PG) algorithms, many healthcare payers were reluctant to cover this technology and, consequently, PG dosing of warfarin could not be translated into clinical practice. OBJECTIVE: The aim of this study was to estimate the value of upgrading evidence relating to PG dosing of warfarin from the healthcare payer perspective. METHODS: Randomized controlled trials (RCTs) that evaluated PG dosing of warfarin were identified through a systematic literature search, and their findings were combined by a cumulative meta-analysis...
May 20, 2017: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/28411903/left-atrial-appendage-closure-device-in-atrial-fibrillation
#9
REVIEW
Michael C Giudici, Prashant D Bhave
The relationship of stroke and atrial fibrillation seems to become more complex as we gain more knowledge of the issue. Recent studies have questioned the temporal relationship between the two, which also questions causation. Left atrial appendage closure is an attractive, but unproven technology when compared with the 50-year experience with warfarin. In a patient who is on warfarin and having no issues with bleeding, medication intolerance, or lack of efficacy, it is difficult to justify stopping the drug and placing a closure device as sole therapy to prevent a stroke...
May 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/28279251/oral-anticoagulants-for-primary-prevention-treatment-and-secondary-prevention-of-venous-thromboembolic-disease-and-for-prevention-of-stroke-in-atrial-fibrillation-systematic-review-network-meta-analysis-and-cost-effectiveness-analysis
#10
Jonathan Ac Sterne, Pritesh N Bodalia, Peter A Bryden, Philippa A Davies, Jose A López-López, George N Okoli, Howard Hz Thom, Deborah M Caldwell, Sofia Dias, Diane Eaton, Julian Pt Higgins, Will Hollingworth, Chris Salisbury, Jelena Savović, Reecha Sofat, Annya Stephens-Boal, Nicky J Welton, Aroon D Hingorani
BACKGROUND: Warfarin is effective for stroke prevention in atrial fibrillation (AF), but anticoagulation is underused in clinical care. The risk of venous thromboembolic disease during hospitalisation can be reduced by low-molecular-weight heparin (LMWH): warfarin is the most frequently prescribed anticoagulant for treatment and secondary prevention of venous thromboembolism (VTE). Warfarin-related bleeding is a major reason for hospitalisation for adverse drug effects. Warfarin is cheap but therapeutic monitoring increases treatment costs...
March 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28243904/the-use-of-human-liver-cell-model-and-cytochrome-p450-substrate-inhibitor-panel-for-studies-of-dasatinib-and-warfarin-interactions
#11
A A Zakharyants, O A Burmistrova, A A Poloznikov
The possibility of interactions between warfarin and dasatinib and their interactions with other drugs metabolized by cytochrome P450 isoform CYP3A4 was demonstrated using a previously created cytochrome P450 substrate-inhibitor panel for preclinical in vitro studies of drug biotransformation on a 3D histotypical microfluidic cell model of human liver (liver-on-a-chip technology). Dasatinib and warfarin are inhibitors of CYP2C19 isoform and hence, can interfere the drugs metabolized by this isoform. Our findings are in line with the data obtained on primary culture of human hepatocytes and suggest that the model can be used in preclinical in vitro studies of drugs...
February 2017: Bulletin of Experimental Biology and Medicine
https://www.readbyqxmd.com/read/27745964/characterization-of-cerebrovascular-events-after-left-atrial-appendage-occlusion
#12
Xavier Freixa, Laura Llull, Sameer Gafoor, Ignacio Cruz-Gonzalez, Samera Shakir, Heyder Omran, Sergio Berti, Gennaro Santoro, Joelle Kefer, Ulf Landmesser, Jens Erik Nielsen-Kudsk, Prapa Kanagaratnam, Fabian Nietlispach, Steffen Gloekler, Adel Aminian, Paolo Danna, Marco Rezzaghi, Friederike Stock, Miroslava Stolcova, Luis Paiva, Marco Costa, Xavier Millán, Reda Ibrahim, Tobias Tichelbäcker, Wolfgang Schillinger, Jai-Wun Park, Horst Sievert, Bernhard Meier, Apostolos Tzikas
Cardioembolic strokes are generally more lethal and disabling than other source of strokes. Data from PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) suggest that strokes after left atrial appendage occlusion (LAAO) with the Watchman device are less disabling than those in the warfarin group. No data assessing the severity of strokes after LAAO with the AMPLATZER Cardiac Plug (ACP) are available. The objective of the study was to evaluate the severity of cerebrovascular events after LAAO with the ACP in a population mostly characterized by an absolute or relative contraindication to oral anticoagulation...
December 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27714756/cardiovascular-pharmacogenetics-a-promise-for-genomically-guided-therapy-and-personalized-medicine
#13
REVIEW
M Zaiou, H El Amri
Cardiovascular disease (CVD) is the leading cause of death worldwide. The basic causes of CVD are not fully understood yet. Substantial evidence suggests that genetic predisposition plays a vital role in the physiopathology of this complex disease. Hence, identification of genetic contributors to CVD will likely add diagnostic accuracy and better prediction of an individual's risk. With high-throughput genetics and genomics technology and newer genome-wide study approaches, a number of genetic variations across the human genome were uncovered...
March 2017: Clinical Genetics
https://www.readbyqxmd.com/read/27570120/management-of-new-onset-postoperative-atrial-fibrillation-utilizing-insertable-cardiac-monitor-technology-to-observe-recurrence-of-af-monitor-af
#14
Mikhael F El-Chami, Faisal M Merchant, Paige Smith, Mathew Levy, Angela Gill Nelms, John Merlino, John Puskas, Angel R Leon
BACKGROUND: New-onset postoperative atrial fibrillation (POAF) occurs in up to 30% of patients undergoing coronary artery bypass grafting (CABG). POAF is associated with short- and long-term mortality. METHODS: To identify the true incidence and time course of recurrent atrial fibrillation (AF) in patients with POAF, we prospectively assigned 23 patients with POAF to receive an implantable loop recorder (ILR; Medtronic Inc., Minneapolis, MN, USA) for the detection of recurrent AF...
October 2016: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/27569231/percutaneous-ventricular-restoration-therapy-using-the-parachute-device-in-chinese-patients-with-ischemic-heart-failure-three-month-primary-end-point-results-of-parachute-china-study
#15
Yue-Jin Yang, Yong Huo, Ya-Wei Xu, Jian-An Wang, Ya-Ling Han, Jun-Bo Ge, Rui-Yan Zhang, Xiao-Yan Yan, Run-Lin Gao
BACKGROUND: The primary cause of ischemic heart failure (HF) is myocardial infarction (MI) resulting in left ventricle (LV) wall motion abnormality secondary to ventricular remodeling. A prospective, nonrandomized study conducted in China was designed to assess safety and efficacy of the percutaneous ventricular restoration therapy using Parachute device (CardioKinetix, Inc., CA, USA) in ischemic HF patients as a result of LV remodeling after anterior wall MI. METHODS: Thirty-one patients with New York Heart Association (NYHA) Class II, III ischemic HF, ejection fraction between 15% and 40%, and dilated akinetic or dyskinetic anterior-apical wall without the need to be revascularized were enrolled from seven sites in China from October to December 2014...
September 5, 2016: Chinese Medical Journal
https://www.readbyqxmd.com/read/27256135/contrasting-medical-and-legal-standards-of-evidence-a-precision-medicine-case-study
#16
Gary E Marchant, Kathryn Scheckel, Doug Campos-Outcalt
As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin...
March 2016: Journal of Law, Medicine & Ethics: a Journal of the American Society of Law, Medicine & Ethics
https://www.readbyqxmd.com/read/27105651/how-to-invest-in-getting-cost-effective-technologies-into-practice-a-framework-for-value-of-implementation-analysis-applied-to-novel-oral-anticoagulants
#17
Rita Faria, Simon Walker, Sophie Whyte, Simon Dixon, Stephen Palmer, Mark Sculpher
Cost-effective interventions are often implemented slowly and suboptimally in clinical practice. In such situations, a range of implementation activities may be considered to increase uptake. A framework is proposed to use cost-effectiveness analysis to inform decisions on how best to invest in implementation activities. This framework addresses 2 key issues: 1) how to account for changes in utilization in the future in the absence of implementation activities; and 2) how to prioritize implementation efforts between subgroups...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27087888/left-atrial-appendage-ligation-and-exclusion-technology-in-the-incubator
#18
Faisal F Syed, Amit Noheria, Christopher V DeSimone, Samuel J Asirvatham
Stroke is the most feared complication of atrial fibrillation (AF). Targeting the left atrial appendage (LAA) mechanically is attractive as a means to simultaneously reduce stroke risk, the need for anticoagulation, and hemorrhagic complications in patients with non-valvular AF. The results of the PROTECT-AF and PREVAIL randomized clinical trials support this approach as a viable therapeutic alternative to warfarin in selected patients and add to accumulating evidence regarding the importance of the LAA in thromboembolism in AF...
August 1, 2015: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/26655108/comparison-of-enzyme-kinetics-of-warfarin-analyzed-by-lc-ms-ms-qtrap-and-differential-mobility-spectrometry
#19
COMPARATIVE STUDY
Abdul Naveed Shaik, Richard Grater, Mukesh Lulla, David A Williams, Lawrence L Gan, Tonika Bohnert, Barbara W LeDuc
Warfarin is an anticoagulant used in the treatment of thrombosis and thromboembolism. It is given as a racemic mixture of R and S enantiomers. These two enantiomers show differences in metabolism by CYPs: S-warfarin undergoes 7 hydroxylation by CYP2C9 and R-warfarin by CYP3A4 to form 10 hydroxy warfarin. In addition, warfarin is acted upon by different CYPs to form the minor metabolites 3'-hydroxy, 4'-hydroxy, 6-hydroxy, and 8-hydroxy warfarin. For analysis, separation of these metabolites is necessary since all have the same m/z ratio and similar fragmentation pattern...
January 1, 2016: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
https://www.readbyqxmd.com/read/26560704/whose-preferences-should-be-elicited-for-use-in-health-care-decision-making-a-case-study-using-anticoagulant-therapy
#20
David John Mott, Mehdi Najafzadeh
The question of whose preferences to elicit in health-state valuation has been widely discussed in the literature. The importance of this debate lies in the fact that health-state utility values are used in health technology assessment (HTA); therefore, an individual's preferences can influence decision-making. If preferences differ across groups, making decisions based on one group's preferences may be suboptimal for the other. Preferences for benefits, risks, experiences and health states associated with anticoagulant therapies have been elicited by researchers due to the underutilization of warfarin and the introduction of non-vitamin K antagonist oral anticoagulants...
2016: Expert Review of Pharmacoeconomics & Outcomes Research
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