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anticoagulation therapy

Victoria Hampshire
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October 20, 2016: Lab Animal
Nicole A Lamparello, Vijay Jaswani, Keith DeSousa, Maksim Shapiro, Sandor Kovacs
We present a case of a 41-year-old man with symptomatic pulmonary cement embolism following percutaneous vertebral augmentation, which was successfully retrieved via a percutaneous endovascular approach, a novel technique with only two prior cases reported. Cement leakage, including venous embolization of cement into the cardiopulmonary circulation, is a known potential complication following percutaneous kyphoplasty and vertebroplasty. While many patients with pulmonary cement embolism are asymptomatic and likely go undiagnosed, others experience respiratory distress and hemodynamic compromise requiring surgical and medical intervention...
July 2016: Journal of Radiology Case Reports
Mark J Schuuring, Peter I Bonta, Michele van Vugt, Frank Smithuis, Otto M van Delden, Jouke T Annema, Kees Stijnis
A 44-year-old woman with a history of pulmonary embolism and abdominal echinococcosis complained of sudden thoracic pain and shortness of breath. A D-dimer of 77.5 mg/l (reference ≤0.5 mg/l) was found. Chest CT scan revealed obstruction of the right lower and middle lobe pulmonary artery (PA). Anticoagulation therapy was initiated for the presumed diagnosis of recurrent pulmonary embolism. However, due to persistent symptoms of dyspnea, follow-up CT angiography of the chest was performed 3 months later. A persistent PA obstruction was found and the presumed diagnosis of embolism was questioned...
October 20, 2016: Respiration; International Review of Thoracic Diseases
Christoffer C Jørgensen, Henrik Kehlet
Background - The benefit of preoperative bridging in surgical patients with continuous anticoagulant therapy is debatable, and drawing of meaningful conclusions may have been limited by mixed procedures with different thromboembolic and bleeding risks in most published studies. Patients and methods - This was an observational cohort treatment study in consecutive primary unilateral total hip and knee arthroplasty patients between January 2010 and November 2013 in 8 Danish fast-track departments. Data were collected prospectively on preoperative comorbidity and anticoagulants in patients with preoperative vitamin K antagonist (VKA) treatment...
October 19, 2016: Acta Orthopaedica
K Gayathri, P K Ramalingam, Rpsp Santhakumar, B V Manjunath, N Karuppuswamy, B Vetriveran, S Selvamani, P Vishnuram, Kumar Natarajan
We present the case of a 23 year old with acute onset left hemiparesis and meningeal irritation, associated with recent history of chickenpox 15 days prior. Varicella-IgG and IgM was positive in the CSF and blood along with reduced serum/CSF ratios of VZV immunoglobulins. MRV showed thrombosis (CVT) of superior sagittal, transverse, right sigmoid sinuses with haemorrhagic infarct in right frontoparietal region. Patient responded well to intravenous heparin, Acyclovir and oral anticoagulant therapy.
July 2016: Journal of the Association of Physicians of India
Jose F Condado, Vasilis Babaliaros, Travis S Henry, Brian Kaebnick, Dennis Kim, Gerald W Staton
BACKGROUND: The best treatment of patients with external pulmonary vascular compression due to advanced sarcoidosis is unknown. OBJECTIVES: To report a single-center experience of percutaneous treatment for pulmonary vascular stenosis caused by external compression due to advanced sarcoidosis. METHODS: We report a case series of 5 patients with biopsy confirmed advanced sarcoidosis, seen at our academic institution with worsening dyspnea despite increase of immunosuppressive therapy...
October 7, 2016: Sarcoidosis, Vasculitis, and Diffuse Lung Diseases: Official Journal of WASOG
Zixiao Li, Chunjuan Wang, Xingquan Zhao, Liping Liu, Chunxue Wang, Hao Li, Haipeng Shen, Li Liang, Janet Bettger, Qing Yang, David Wang, Anxin Wang, Yuesong Pan, Yong Jiang, Xiaomeng Yang, Changqing Zhang, Gregg C Fonarow, Lee H Schwamm, Bo Hu, Eric D Peterson, Ying Xian, Yilong Wang, Yongjun Wang
BACKGROUND AND PURPOSE: Stroke is a leading cause of death in China. Yet the adherence to guideline-recommended ischemic stroke performance metrics in the past decade has been previously shown to be suboptimal. Since then, several nationwide stroke quality management initiatives have been conducted in China. We sought to determine whether adherence had improved since then. METHODS: Data were obtained from the 2 phases of China National Stroke Registries, which included 131 hospitals (12 173 patients with acute ischemic stroke) in China National Stroke Registries phase 1 from 2007 to 2008 versus 219 hospitals (19 604 patients) in China National Stroke Registries phase 2 from 2012 to 2013...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
John H Griffin, Laurent O Mosnier, José A Fernández, Berislav V Zlokovic
APC (activated protein C), derived from the plasma protease zymogen, is antithrombotic and anti-inflammatory. In preclinical injury models, recombinant APC provides neuroprotection for multiple injuries, including ischemic stroke. APC acts directly on brain endothelial cells and neurons by initiating cell signaling that requires multiple receptors. Two or more major APC receptors mediate APC's neuroprotective cell signaling. When bound to endothelial cell protein C receptor, APC can cleave protease-activated receptor 1, causing biased cytoprotective signaling that reduces ischemia-induced injury...
October 6, 2016: Arteriosclerosis, Thrombosis, and Vascular Biology
Silvia Riondino, Fiorella Guadagni, Vincenzo Formica, Patrizia Ferroni, Mario Roselli
Venous thromboembolism (VTE) is a commonly diagnosed multifactorial condition with significant morbidity and mortality, occurring in up to 20% of cancer patients. Indeed, patients with cancer are in a higher pro-thrombotic state due to alterations in their haemostatic-coagulative system, stasis and blood flow slowdown, endothelial dysfunction, vascular inflammation and platelet activation. Moreover, several cancer-dependent factors can sum up to trigger a first episode of VTE or to cause its recurrence in the course of anticoagulant treatment...
October 18, 2016: Current Medicinal Chemistry
Molly Howard, Andrew Lipshutz, Breanne Roess, Emily Hawes, Zachariah Deyo, Jena Ivey Burkhart, Stephan Moll, Betsy Bryant Shilliday
Direct Oral Anticoagulants (DOACs) require specific dosing and monitoring to ensure safe and appropriate use. The purpose of this evaluation was to identify patient- and process-related factors that correlate with increased risk of inappropriate prescribing of DOACs. A retrospective chart review was conducted in three outpatient clinics within an academic medical center to identify patients started on DOAC therapy and evaluate the appropriateness of DOAC initiation. Data collected included patient demographics, DOAC medication initiated, dose, indication, baseline laboratory values, concomitant medications, type and specialty of prescriber, and initiation setting...
October 18, 2016: Journal of Thrombosis and Thrombolysis
Lucia Barbieri, Monica Verdoia, Alon Schaffer, Harry Suryapranata, Giuseppe De Luca
BACKGROUND: Patients with coronary artery disease who undergo stent implantation and have concomitant indication for long-term oral anticoagulation represent a considerable proportion of the overall population. To date there is still no consensus about the optimal antithrombotic strategy to choose in this kind of patients, due to the difficult balance between an increased risk of bleeding and thromboembolic complications. Therefore, the aim of this study was to perform a meta-analysis to evaluate the risk and benefits of triple antithrombotic therapy versus dual antithrombotic therapy in patients undergoing coronary stent implantation, requiring long-term oral anticoagulation...
October 18, 2016: Cardiovascular Drugs and Therapy
Maria Luisa Fonte, Lauren Fietchner, Matteo Manuelli, Hellas Cena
BACKGROUND: The aim of this case report is to discuss the issue of nutritional therapy in patients taking warfarin. Patients are often prescribed vitamin K free diets without nutritional counseling, leading to possible health consequences. CASE PRESENTATION: A 52-year-old woman with obesity and hypertension was prescribed a low calorie diet by her family doctor in an effort to promote weight loss. After a pulmonary embolism, she was placed on anticoagulant therapy and on hospital discharge she was prescribed a vitamin K free diet to avoid interactions...
October 19, 2016: Nutrition Journal
Elvira Teles Sampaio, Luís Maia, Paulo Salgueiro, Ricardo Marcos-Pinto, Mário Dinis-Ribeiro, Isabel Pedroto
BACKGROUND: Nonvariceal upper gastrointestinal bleeding emerges as a major complication of using antiplatelet agents and/or anticoagulants and represents a clinical challenge in patients undergoing these therapies. AIM: To characterize patients with nonvariceal upper gastrointestinal bleeding related to antithrombotics and their management, and to determine clinical predictors of adverse outcomes. METHODS: Retrospective cohort of adults who underwent upper gastrointestinal endoscopy after nonvariceal upper gastrointestinal bleeding from 2010 to 2012...
October 19, 2016: Revista Española de Enfermedades Digestivas
Ömer Erküner, Roy Claessen, Ron Pisters, Germaine Schulmer, Roos Ramaekers, Laura Sonneveld, Elton Dudink, Theo Lankveld, Ione Limantoro, Bob Weijs, Laurent Pison, Yuri Blaauw, Cees B de Vos, Harry Jgm Crijns
BACKGROUND: Patients undergoing elective electrical cardioversion (ECV) for atrial fibrillation have a temporarily increased risk of thromboembolism. Current guidelines recommend adequate anticoagulation for ≥3 consecutive weeks precardioversion, i.e. consecutive INR values 2.0-3.0 in patients with vitamin K antagonists (VKA). We aimed to evaluate the occurrence and impact of subtherapeutic INRs precardioversion and to study factors associated with these unwanted fluctuations. METHODS: We recruited 346 consecutive patients undergoing elective ECV in the Maastricht University Medical Centre between 2008 and 2013...
October 11, 2016: International Journal of Cardiology
Doris Barcellona, Lara Fenu, Francesco Marongiu
Oral anticoagulant therapies with the anti-vitamin K drugs (AVK), warfarin, acenocoumarol and phenprocoumon, are employed in primary and secondary anti-thrombotic prophylaxis in patients with venous thromboembolism, atrial fibrillation and cardiac mechanical valves. However, a monitoring test such as the International Normalized Ratio (INR) is required. The periodic monitoring of this therapy entails discomfort for the patients. Telemedicine and telecare can provide significant aid in the management of this therapy allowing patients to perform the test at home or anywhere else with a portable device, i...
October 18, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Sun-Wook Kim, Sol-Ji Yoon, Jung-Yeon Choi, Min-Gu Kang, Kwang-Il Kim, Cheol-Ho Kim
OBJECTIVE: Atrial fibrillation is the common arrhythmia in the elderly, and the average age of atrial fibrillation patients is rising. Elderly patients with atrial fibrillation have high incidence of thromboembolic complication and increasing age is associated with stroke severity. Assessing CHADS-VASc score is pivotal to evaluate substantial morbidity and mortality, especially regarding the increased risk of stroke. In addition, considering bleeding risk with HAS-BLED score is important to balance the benefit against the risk of bleeding...
September 2016: Journal of Hypertension
Adam J Singer, Henry C Thode, W Frank Peacock
OBJECTIVE: Introduction of target specific anticoagulants and recent guidelines encourage outpatient management of low risk patients with venous thromboembolism. We describe hospital admission rates over time for patients presenting to US emergency departments (EDs) with deep vein thrombosis (DVT) and pulmonary embolism (PE) and estimate the proportion of low-risk PE patients who could potentially be managed as outpatients. METHODS: We performed a structured analysis of the National Hospital Ambulatory Medical Care Survey (a nationally representative weighted sampling of US ED visits) database for the years 2006-2010 including all adult patients with a primary diagnosis of DVT or PE...
September 2016: Clin Exp Emerg Med
Daniel Corrigan, Christiana Prucnal, Christopher Kabrhel
The diagnosis or exclusion of pulmonary embolism (PE) remains challenging for emergency physicians. Symptoms can be vague or non-existent, and the clinical presentation shares features with many other common diagnoses. Diagnostic testing is complicated, as biomarkers, like the D-dimer, are frequently false positive, and imaging, like computed tomography pulmonary angiography, carries risks of radiation and contrast dye exposure. It is therefore incumbent on emergency physicians to be both vigilant and thoughtful about this diagnosis...
September 2016: Clin Exp Emerg Med
Clemens Feistritzer, Stefan Schmidt
During the 57(th) annual meeting of the American Society of Hematology 2015 in Orlando, Florida, various aspects in the field of hemostaseology were presented. The Choosing Wisely® campaign pointed out the importance of the critical use of diagnostic tools to rule out pulmonary embolism and questioned the relevance of thrombophilia testing in women undergoing routine infertility evaluation. Furthermore, the approval of idarucizumab, a specific antidote for the reversal of the anticoagulant effects of the direct thrombin inhibitor dabigatran, was highlighted...
2016: Memo
Noha A Osman, Nevine El-Abd, Mohamed Nasrallah
Vitamin K is necessary for the carboxylation of clotting factors and matrix Gla protein (MGP). Vitamin K epoxide reductase (VKOR) is the enzyme responsible for recirculation of Vitamin K increasing its tissue availability. Polymorphisms of VKOR may alter the function of MGP, thereby influencing vascular calcification. We conducted this study to investigate the relationship of VKORC1 gene single nucleotide polymorphisms (SNP's) to vascular calcification and clinically overt cardiovascular disease in chronic kidney disease (CKD) patients on hemodialysis (HD)...
September 2016: Saudi Journal of Kidney Diseases and Transplantation
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