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Anticoagulation in dialysis

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https://www.readbyqxmd.com/read/29789105/oral-anticoagulation-in-chronic-kidney-disease-and-atrial-fibrillation
#1
Gunnar H Heine, Vincent Brandenburg, Stephan H Schirmer
BACKGROUND: Cardiological societies recommend, in their guidelines, that patients with atrial fibrillation and an intermediate (or higher) risk of stroke and systemic embolization should be treated with oral anticoagulant drugs. For patients who do not have mitral valve stenosis or a mechanical valve prosthesis, non-vitamin-K dependent oral anticoagulants (NOAC) are preferred over vitamin K antagonists (VKA) for this purpose. It is unclear, however, whether patients with chronic kidney disease and atrial fibrillation benefit from oral anticoagulation to the same extent as those with normal kidney function...
April 27, 2018: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/29785661/atrial-fibrillation-in-dialysis-patients-is-there-a-place-for-non-vitamin-k-antagonist-oral-anticoagulants
#2
REVIEW
Elzbieta Mlodawska, Paulina Lopatowska, Jolanta Malyszko, Maciej Banach, Bożena Sobkowicz, Adrian Covic, Anna Tomaszuk-Kazberuk
Atrial fibrillation (AF) occurs approximately in 3% of general population, with greater prevalence in elderly. Non-vitamin K-dependent oral anticoagulant agents (NOACs) according to the current European guidelines are recommended for patients with AF at high risk for stroke as a first-choice treatment. NOACs are not inferior to warfarin or some of them are better than warfarin in reducing the rate of ischemic stroke. Moreover, they significantly reduce the rate of intracranial hemorrhages, major bleedings, and mortality compared with warfarin...
May 21, 2018: International Urology and Nephrology
https://www.readbyqxmd.com/read/29784566/preoperative-point-of-care-ultrasound-and-its-impact-on-arteriovenous-fistula-maturation-outcomes
#3
Sajjid Hossain, Amit Sharma, Luc Dubois, Guy DeRose, Audra Duncan, Adam H Power
OBJECTIVE: Duplex ultrasound as a preoperative assessment tool in the clinic may help identify anatomic factors predictive of fistula maturation. Preoperative point-of-care ultrasound (POCUS) offers surgeons an alternative to routine formal vein mapping as it can be performed by the operator during the initial clinic visit. We sought to determine the impact of POCUS as an adjunct to physical examination on arteriovenous fistula maturation. METHODS: All consecutive patients undergoing first-time dialysis access creation from December 2007 to December 2014 were retrospectively reviewed...
May 18, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29782261/-chronic-kidney-disease-as-basis-of-high-thrombotic-and-bleeding-risk-in-patients-with-atrial-fibrillation-place-of-oral-anticoagulants
#4
A G Obrezan, A Y Zemchenkov
Chronic kidney disease (CKD) aggravates course of practically all diseases by worsening outcomes and hindering adequate treatment. Specificities of renal excretion of various drugs, changes of parameters of their pharmacokinetics and pharmacodynamics, nephrotoxic effects of drugs, tactics of drug therapy in conditions of CKD, terminal stage of kidney failure and dialysis are in the focus of attention of internists. To a greatest degree difficulties of drug therapy in CKD and associated clinical states refer to the group of anticoagulants...
April 2018: Kardiologiia
https://www.readbyqxmd.com/read/29777813/polyphenolic-polysaccharide-conjugates-from-flowers-and-fruits-of-single-seeded-hawthorn-crataegus-monogyna-jacq-chemical-profiles-and-mechanisms-of-anticoagulant-activity
#5
Izabela Pawlaczyk-Graja
The polyphenolic-polysaccharide conjugates were isolated from flowers and fruits of medicinal plant Crataegus monogyna Jacq. (Lindm.) by the alkaline extraction, followed by neutralization, partitioning with organic solvents and dialysis against water. The isolates from flowers as well as from fruits were homogenous macromolecular compounds, with a molecular weight over 760 × 103  g/mol and 970 × 103  g/mol, respectively, what was assessed in HPGPC analysis. Both products were characterized spectrophotometrically, and by GLC-MS, FT-IR and NMR techniques...
May 16, 2018: International Journal of Biological Macromolecules
https://www.readbyqxmd.com/read/29775967/bilateral-breast-calciphylaxis-in-a-patient-who-survived-earlier-extensive-tissue-necrosis-5-years-previously-a-case-report
#6
E M J Verstappen, A J G Maaskant-Braat, M R Scheltinga
INTRODUCTION: Calciphylaxis is a rare condition including patchy dermal necrosis that mostly affects chronic hemodialysis patients. The syndrome usually heralds impending death although patients may survive following a set of measures including an adapted dialysis regimen. The present case is a unique patient who recovered from an earlier episode of upper leg calciphylaxis 5 years previously but developed fatal bilateral breast necrosis. PRESENTATION OF CASE: A 69 year old Caucasian woman with a history of atrial fibrillation, hypertension, CVA, hyperparathyroidectomy for secondary hyperparathyroidism and end stage renal disease with hemodialysis recovered in 2012 from extensive symptomatic left upper leg necrosis due to calciphylaxis...
May 7, 2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29744595/synthesis-and-biocompatibility-of-an-argatroban-modified-polysulfone-membrane-that-directly-inhibits-thrombosis
#7
Xiao Fu, Jian-Ping Ning
Anticoagulation therapy plays a vital role in the prevention of blood clot formation during hemodialysis and hemofiltration, especially for critical care patients. Here, we synthesized a novel argatroban (Arg)-modified polysulfone (PSf) membrane for anticoagulation. Arg was grafted onto the PSF membrane via chemical modification to increase membrane hydrophilicity. Protein adsorption, coagulation, as well as activation of platelets and complement systems were greatly reduced on the Arg-modified PSf membrane...
May 9, 2018: Journal of Materials Science. Materials in Medicine
https://www.readbyqxmd.com/read/29737362/-regional-citrate-anticoagulation-in-renal-replacement-therapy-in-the-intensive-care-station-recommendations-from-the-renal-section-of-the-dgiin-%C3%A3-giain-and-divi
#8
REVIEW
M Schmitz, M Joannidis, D Czock, S John, A Jörres, S J Klein, M Oppert, V Schwenger, J Kielstein, A Zarbock, D Kindgen-Milles, C Willam
BACKGROUND: Regional citrate anticoagulation (RCA) in continuous renal replacement therapy can effectively anticoagulate dialysis circuits without having adverse effects on systemic heparin application. In particular, in continuous renal replacement therapy RCA is well established and represents a safe procedure with longer filter lifetimes and fewer bleeding complications. OBJECTIVES: To provide guidance on the indications, advantages and disadvantages, and use of RCA, current recommendations from the renal section of the DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin) are stated...
May 8, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29694310/superior-vena-cava-syndrome-due-to-central-port-catheter-thrombosis-a-real-life-threatening-condition
#9
G D Lianos, N Hasemaki, E Tzima, G Vangelis, A Tselios, I Mpailis, E Lekkas
Superior vena cava syndrome (SVCS) represents undoubtedly a rare life-threatening condition. Herein, we present a rare case of a 69-year-old woman, with a history of hepatic flexure tumor and an indwelling central venous port, presenting with acute signs and symptoms of SVCS due to thrombosis of the catheter. The patient was treated with intravenous anticoagulation and fibrinolytic therapy and showed regression of symptoms. It is reported that central venous catheters are routinely used in clinical practice mainly in oncological cases for chemotherapy, parenteral nutrition or dialysis...
March 2018: Il Giornale di Chirurgia
https://www.readbyqxmd.com/read/29685512/causes-and-outcomes-of-finger-ischemia-in-hospitalized-patients-in-the-intensive-care-unit
#10
Gregory J Landry, Courtney J Mostul, Daniel S Ahn, Bryant J McLafferty, Timothy K Liem, Erica L Mitchell, Enjae Jung, Cherrie Z Abraham, Amir F Azarbal, Robert B McLafferty, Gregory L Moneta
OBJECTIVE: Vascular surgeons may be consulted to evaluate hospitalized patients with finger ischemia. We sought to characterize causes and outcomes of finger ischemia in intensive care unit (ICU) patients. METHODS: All ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed. All were evaluated with finger photoplethysmography. The patients' demographics, comorbidities, ICU care (ventilator status, arterial lines, use of vasoactive medications), finger amputations, and survival were also recorded...
April 20, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29614970/a-novel-citrate-based-protocol-versus-heparin-anticoagulation-for-sustained-low-efficiency-dialysis-in-the-icu-safety-efficacy-and-cost
#11
Ming Wen, Claudius Küchle, Dominik Steubl, Robin Satanovskji, Uwe Heemann, Yana Suttmann, Susanne Angermann, Stephan Kemmner, Lisa Rehbehn, Monika Huber, Christine Hauser, Christoph Schmaderer, Anna-Lena Reichelt, Bernhard Haller, Lutz Renders
BACKGROUND: The high cost, complexity of the available protocols, and metabolic complications are the major barriers that impede the clinical utilization of regional citrate anticoagulation (RCA) for sustained low efficiency dialysis (SLED) in critically ill patients. By comparing a novel protocol for SLED using 30% citrate solution with common protocol using unfractionated heparin, this study aimed to provide new insights for clinical applications of RCA. METHODS: In this retrospective study, a total of 282 critically ill patients who underwent SLED with citrate and/or heparin anticoagulation in six adult ICUs were enrolled...
April 3, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29597222/clinical-complications-of-continuous-renal-replacement-therapy
#12
Florent Sigwalt, Axelle Bouteleux, François Dambricourt, Théo Asselborn, Florent Moriceau, Thomas Rimmelé
The various complications of continuous renal replacement therapy (CRRT) are mostly preventable. Hemodynamic disturbances are dominated by hypotension due to the modification of volume status, myocardial dysfunction, cardiac arrhythmia, or modification of systemic vascular resistances, which are correlated with body temperature changes. Metabolic complications remain at the forefront and have profoundly changed with the use of regional citrate anticoagulation (RCA). RCA may lead to two distinct situations: citrate overload and citrate accumulation, respectively, responsible for metabolic alkalosis and metabolic acidosis...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29578207/use-of-oral-anticoagulants-in-patients-with-atrial-fibrillation-and-renal-dysfunction
#13
REVIEW
Tatjana S Potpara, Charles J Ferro, Gregory Y H Lip
Atrial fibrillation (AF) and chronic kidney disease (CKD) are increasingly prevalent in the general population and share common risk factors such as older age, hypertension and diabetes mellitus. The presence of CKD increases the risk of incident AF, and, likewise, AF increases the risk of CKD development and/or progression. Both conditions are associated with substantial thromboembolic risk, but patients with advanced CKD also exhibit a paradoxical increase in bleeding risk. In the landmark randomized clinical trials that compared non-vitamin K antagonist oral anticoagulants (NOACs) with warfarin for thromboprophylaxis in patients with AF, the efficacy and safety of NOACs in patients with mild-to-moderate CKD were similar to those in patients without CKD...
March 26, 2018: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/29577340/safety-and-efficacy-of-apixaban-versus-warfarin-in-patients-with-end-stage-renal-disease-meta-analysis
#14
Ronpichai Chokesuwattanaskul, Charat Thongprayoon, Tanyanan Tanawuttiwat, Wisit Kaewput, Pavida Pachariyanon, Wisit Cheungpasitporn
BACKGROUND: At the present, apixaban is the only nonvitamin K oral anticoagulant approved by the Food and Drug Administration for use with patients with creatinine clearance <15 mL/min or end-stage renal disease (ESRD). However, the recommendations are based on pharmacokinetic and pharmacodynamic data and there was lack of clinical trial evidence. We aimed to assess safety and efficacy of apixaban in patients with advanced chronic kidney disease (CKD) or ESRD. METHODS: Databases were searched through November 2017...
March 25, 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29572101/impact-of-connecting-continuous-renal-replacement-therapy-to-the-extracorporeal-membrane-oxygenation-circuit
#15
Christian de Tymowski, Mathieu Desmard, Brice Lortat-Jacob, Quentin Pellenc, Soleiman Alkhoder, Arezki Alouache, Benedicte Fritz, Philippe Montravers, Augustin Pascal
Purpose Continuous veno-venous haemofiltration (CVVH) directly connected to extracorporeal membrane oxygenation (ECMO) may ensure better blood flow and allow prolonged circuit life. The objective of this study was to assess circuit life of CVVH connected to ECMO and to a dialysis catheter. Materials and Methods In this prospective observational study, patients receiving CVVH via ECMO were compared to time-matched patients receiving CVVH via a conventional dialysis catheter. CVVH circuit life and the safety and efficacy of the two CVVH procedures were analysed...
March 20, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29536479/repeated-administration-of-idarucizumab-to-a-patient-with-dabigatran-overdose
#16
Zdeňka Hajšmanová, Pavla Šigutová, Alena Lavičková
Idarucizumab is designed to reverse the anticoagulant effect of dabigatran. This case report describes the administration of three independent doses of idarucizumab to a 76-year-old man suffering from atrial flutter being treated with dabigatran to prevent ischaemic stroke. The last dose of dabigatran was administered in the morning of the same day the patient was transferred to hospital because of the need for urgent pericardium puncture. Baseline dTT (dilute thrombin time) reached 700 ng/mL as glomerular filtration (GF) dropped to 0...
February 2018: Hämostaseologie
https://www.readbyqxmd.com/read/29526376/clinical-effectiveness-of-open-thrombectomy-for-thrombosed-autogenous-arteriovenous-fistulas-and-grafts
#17
Amir A Ghaffarian, Ragheed Al-Dulaimi, Larry W Kraiss, Mark Sarfati, Claire L Griffin, Brigitte K Smith, Graham Donald, Benjamin S Brooke
OBJECTIVE: Arteriovenous (AV) fistulas are the preferred hemodialysis access for patients with end-stage renal disease, although multiple interventions are typically needed to maintain patency. When AV fistulas thrombose, however, there is debate as to whether open thrombectomy should be attempted, particularly for salvage of upper arm fistulas. This study was designed to evaluate outcomes after open thrombectomy of upper arm and forearm AV fistulas compared with AV grafts. METHODS: We identified all patients who underwent an open thrombectomy procedure for a thrombosed AV fistula or graft at a single academic medical center between January 2006 and March 2017...
March 8, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29509922/a-systematic-review-of-direct-oral-anticoagulant-use-in-chronic-kidney-disease-and-dialysis-patients-with-atrial-fibrillation
#18
Jordanne Feldberg, Param Patel, Ashley Farrell, Sylvia Sivarajahkumar, Karen Cameron, Jennifer Ma, Marisa Battistella
Background: There is a lack of clear benefit and a potential risk of bleeding with direct oral anticoagulant (DOAC) use in chronic kidney disease (CKD) and dialysis patients with atrial fibrillation. The objective of this study was to evaluate how treatment with DOACs affects stroke and bleeding outcomes compared with warfarin or aspirin. Methods: We conducted a systematic review of randomized controlled trials, cohort studies and case series, and searched electronic databases from 1946 to 2017...
March 2, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29468649/is-anticoagulating-haemodialysis-patients-with-non-valvular-atrial-fibrillation-too-risky
#19
REVIEW
Kathrine Parker, Sandip Mitra, Jecko Thachil
There is an increasing understanding of the risks from atrial fibrillation (AF) in the current era. In patients with end-stage renal disease (ESRD) on dialysis, the prevalence of AF is significantly higher compared to the general population and those with earlier stages of CKD. Although anticoagulation of these patients may seem appropriate, there is a lack of conclusive evidence that it provides the same protection from thromboembolic complications as it does in patients not on dialysis. In addition, the increased risk of bleeding in patients requiring dialysis makes the use of anticoagulants less favourable...
February 22, 2018: British Journal of Haematology
https://www.readbyqxmd.com/read/29444881/ischaemic-stroke-haemorrhage-and-mortality-in-older-patients-with-chronic-kidney-disease-newly-started-on-anticoagulation-for-atrial-fibrillation-a-population-based-study-from-uk-primary-care
#20
MULTICENTER STUDY
Shankar Kumar, Simon de Lusignan, Andrew McGovern, Ana Correa, Mariya Hriskova, Piers Gatenby, Simon Jones, David Goldsmith, A John Camm
OBJECTIVE: To assess the association between anticoagulation, ischaemic stroke, gastrointestinal and cerebral haemorrhage, and all cause mortality in older people with atrial fibrillation and chronic kidney disease. DESIGN: Propensity matched, population based, retrospective cohort analysis from January 2006 through December 2016. SETTING: The Royal College of General Practitioners Research and Surveillance Centre database population of almost 2...
February 14, 2018: BMJ: British Medical Journal
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