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JOURNAL ARTICLE
Seema P Anandalwar, Lindsay O'Meara, Roumen Vesselinov, Ashling Zhang, Jeffrey N Baum, Amanda Cooper, Cassandra Decker, Thomas Schroeppel, Jenny Cai, Daniel Cullinane, Richard D Catalano, Nikolay Bugaev, Madison LeClair, Christina Feather, Katherine McBride, Valerie Sams, Pak Shan Leung, Samantha Olafson, Devon S Callahan, Joseph Posluszny, Simon Moradian, Jordan Estroff, Beth Hochman, Natasha Coleman, Anna Goldenberg-Sandau, Jeffry Nahmias, Kathryn Rosenbaum, Jason Pasley, Lindsay Boll, Leah Hustad, Jessica Reynolds, Michael Truitt, Mira Ghneim
INTRODUCTION: To assess perioperative bleeding complications & in-hospital mortality in patients requiring emergency general surgery (EGS) presenting with a history of antiplatelet (AP) vs. direct oral anticoagulant (DOAC) vs warfarin use. METHODS: Prospective observational study across 21 centers between 2019-2022. Inclusion criteria were age ≥ 18 years, & DOAC, warfarin or AP use within 24 hours of an EGSP. Outcomes included perioperative bleeding and in-hospital mortality...
April 10, 2024: Journal of Trauma and Acute Care Surgery
#2
REVIEW
Qinan Yin, Lizhu Han, Yin Wang, Fengjiao Kang, Fengqun Cai, Liuyun Wu, Xingyue Zheng, Lian Li, Li E Dong, Limei Dong, Shuhong Liang, Min Chen, Yong Yang, Yuan Bian
Background: Thromboembolic disease is associated with a high rate of disability or death and gravely jeopardizes people's health and places considerable financial pressure on society. The primary treatment for thromboembolic illness is anticoagulant medication. Fondaparinux, a parenteral anticoagulant medicine, is still used but is confusing due to its disparate domestic and international indications and lack of knowledge about its usage. Its off-label drug usage in therapeutic settings and irrational drug use are also common...
2024: Frontiers in Pharmacology
#3
REVIEW
Michael H Chan, Feiyi Sun, Jonathan Malakan
Dental procedures can pose a risk of bleeding, and it is not uncommon for dentists to consult prescribing physicians regarding a mutual patient's antiplatelet and anticoagulant medication to prevent excessive bleeding during or after an upcoming procedure. However, there has been a growing controversy in the dental community surrounding the stoppage of these medications prior to dental procedures. Some believe that stopping these medications prior to dental procedures is necessary to reduce the risk of bleeding complications, while others argue that stopping them can increase the risk of stroke or other thromboembolic events...
January 2024: Dental Clinics of North America
#4
REVIEW
Medical Management of Pulmonary Arterial Hypertension: Current Approaches and Investigational Drugs.
Qi Jin, Dandan Chen, Xiaochun Zhang, Feng Zhang, Dongxiang Zhong, Dawei Lin, Lihua Guan, Wenzhi Pan, Daxin Zhou, Junbo Ge
Pulmonary arterial hypertension (PAH) is a malignant pulmonary vascular syndrome characterized by a progressive increase in pulmonary vascular resistance and pulmonary arterial pressure, which eventually leads to right heart failure and even death. Although the exact mechanism of PAH is not fully understood, pulmonary vasoconstriction, vascular remodeling, immune and inflammatory responses, and thrombosis are thought to be involved in the development and progression of PAH. In the era of non-targeted agents, PAH had a very dismal prognosis with a median survival time of only 2...
May 24, 2023: Pharmaceutics
#5
Ashish Kulhari, Farah Fourcand, Amrinder Singh, Haralabos Zacharatos, Siddhart Mehta, Jawad F Kirmani
Subdural hemorrhage (SDH) is a common neurological disease. In past, SDHs were managed either conservatively (non-surgically) or with surgical evacuation (burr hole versus craniotomy) depending on the severity. Surgical evacuation has major challenges including high recurrence rate, stoppage and reversal of antiplatelet or anticoagulation agents, risk of general anesthesia and surgery in elderly patients with multiple comorbidities. Given the above challenges, embolization of the distal branches of the middle meningeal artery (MMA) has recently emerged as an excellent alternate to surgical evacuation or conservative management...
April 2023: Curēus
#6
REVIEW
William J Kane, Puja Shah Berry
The colorectal surgeon is often faced with medications that can be challenging to manage in the perioperative period. In the era of novel agents for anticoagulation and immunotherapies for inflammatory bowel disease and malignancy, understanding how to advise patients about these medications has become increasingly complex. Here, we aim to provide clarity regarding the use of these agents and their perioperative management, with a particular focus on when to stop and restart them perioperatively. This review will begin with the management of both nonbiologic and biologic therapies used in the treatment of inflammatory bowel disease and malignancy...
May 2023: Clinics in Colon and Rectal Surgery
#7
REVIEW
Jerrold H Levy, Kamrouz Ghadimi, Jayachandran N Kizhakkedathu, Toshiaki Iba
Protamine, a highly basic protein isolated from salmon sperm, is the only clinically available agent to reverse the anticoagulation of unfractionated heparin. Following intravenous administration, protamine binds to heparin in a nonspecific electrostatic interaction to reverse its anticoagulant effects. In clinical use, protamine is routinely administered to reverse high-dose heparin anticoagulation in cardiovascular procedures, including cardiac surgery with cardiopulmonary bypass. Despite the lack of supportive evidence regarding protamine's effectiveness to reverse low-molecular-weight heparin, it is recommended in guidelines with low-quality evidence...
July 2023: Journal of Thrombosis and Haemostasis: JTH
#8
JOURNAL ARTICLE
Asim Cengiz Akbulut, Ryanne A Arisz, Constance C F M J Baaten, Gaukhar Baidildinova, Aarazo Barakzie, Rupert Bauersachs, Jur Ten Berg, Wout W A van den Broek, H C de Boer, Amandine Bonifay, Vanessa Bröker, Richard J Buka, Hugo Ten Cate, Arina J Ten Cate-Hoek, S Cointe, Ciro De Luca, Ilaria De Simone, Rocio Vacik Diaz, Françoise Dignat-George, Kathleen Freson, Giulia Gazzaniga, Eric C M van Gorp, Anxhela Habibi, Yvonne M C Henskens, Aaron F J Iding, Abdullah Khan, Gijsje H Koenderink, Akhil Konkoth, Romaric Lacroix, Trisha Lahiri, Wilbur Lam, Rachel E Lamerton, Roberto Lorusso, Qi Luo, Coen Maas, Owen J T McCarty, Paola E J van der Meijden, Joost C M Meijers, Adarsh K Mohapatra, Neta Nevo, Alejandro Pallares Robles, Philippe Poncelet, Christoph Reinhardt, Wolfram Ruf, Ronald Saraswat, Claudia Schönichen, Roger Schutgens, Paolo Simioni, Stefano Spada, Henri M H Spronk, Karlygash Tazhibayeva, Jecko Thachil, Rocio Vacik Diaz, L Vallier, Alicia Veninga, Peter Verhamme, Chantal Visser, Steve P Watson, Philip Wenzel, Ruth A L Willems, Anne Willers, Pengyu Zhang, Konstantinos Zifkos, Anton Jan van Zonneveld
The Fourth Maastricht Consensus Conference on Thrombosis included the following themes. Theme 1: The "coagulome" as a critical driver of cardiovascular disease. Blood coagulation proteins also play divergent roles in biology and pathophysiology, related to specific organs, including brain, heart, bone marrow, and kidney. Four investigators shared their views on these organ-specific topics. Theme 2: Novel mechanisms of thrombosis. Mechanisms linking factor XII to fibrin, including their structural and physical properties, contribute to thrombosis, which is also affected by variation in microbiome status...
August 2023: Thrombosis and Haemostasis
#9
JOURNAL ARTICLE
Brian Brenner, Jessica Guerra, Campbell Williams, Keith Littlewood, John Kern, Kenichi Tanaka, John S McNeil, Venkat Mangunta
The management of patients on direct oral anticoagulants (DOACs) who require emergent cardiac surgery is slowly evolving. The introduction of andexanet alfa, a novel antidote for apixaban and rivaroxaban, added a specific reversal agent to our armamentarium, but its safety and efficacy are still being investigated. We report 2 patients on DOAC treatment who required emergency cardiac surgery. Both received perioperative andexanet alfa together with prothrombin complex concentrate (PCC) at some time during 6 hours before operative management...
November 1, 2022: A&A Practice
#10
JOURNAL ARTICLE
Lauren E Schmidt, Matthew S Hinton, Niels D Martin
Background: Management of major life-threatening bleeding with factor Xa (FXa) inhibition poses complex challenges involving novel direct reversal agents competing with non-specific preexisting strategies. The recent availability of andexanet alfa (AA) led to a health-system guideline incorporating its use alongside the most commonly used historic agent, four-factor prothrombin complex concentrate (4F-PCC). Objectives: The objective was to characterize the use and efficacy of AA and 4F-PCC for reversal of FXa inhibition after implementation of the health-system guideline...
February 2024: Journal of Pharmacy Practice
#11
JOURNAL ARTICLE
Flavio De Maio, Mariagrazia Rullo, Modesto de Candia, Rosa Purgatorio, Gianfranco Lopopolo, Giulia Santarelli, Valentina Palmieri, Massimiliano Papi, Gabriella Elia, Erica De Candia, Maurizio Sanguinetti, Cosimo Damiano Altomare
Coagulation factor Xa (fXa) and thrombin (thr) are widely expressed in pulmonary tissues, where they may catalyze, together with the transmembrane serine protease 2 (TMPRSS2), the coronaviruses spike protein (SP) cleavage and activation, thus enhancing the SP binding to ACE2 and cell infection. In this study, we evaluate in vitro the ability of approved (i.e., dabigatran and rivaroxaban) and newly synthesized isonipecotamide-based reversible inhibitors of fXa/thr (cmpds 1 - 3 ) to hinder the SARS-CoV-2 infectivity of VERO cells...
August 5, 2022: Viruses
#12
Syed-Abdullah Uddin, Katerina Roma, Lindsey Ross, George Hanna, Doniel Drazin, Terrence T Kim
Background: Dabigatran is an anticoagulant (novel oral anticoagulant) that is a direct thrombin inhibitor and only recently has a reversal agent, idarucizumab, been made available (2015). Case Description: An 86-year-old male taking dabigatran for atrial fibrillation, acutely presented with the spontaneous onset of neck pain and quadriparesis. When the MRI demonstrated a C2-T2 spinal epidural hematoma, the patient was given the reversal agent idarucizumab. Due to his attendant major comorbidities, he was managed nonoperatively...
2022: Surgical Neurology International
#13
JOURNAL ARTICLE
Zhi-Li Zhang, Changming Chen, Si-Ying Qu, Qiulan Ding, Qin Xu
A novel coagulation factor X (FX) Tyr319Cys mutation (Y99C as chymotrypsin numbering) was identified in a patient with severe bleeding. Unlike the earlier reported Y99A mutant, this mutant can bind and cleave its specific chromogenetic substrate at a normal level, suggesting an intact binding pocket. Here, using molecular dynamics simulations and MM-PBSA calculations on a FX-rivaroxaban (RIV) complex, we confirmed a much stronger binding of RIV in Y99C than in Y99A on a molecular level, which is actually the average result of multiple binding poses in dynamics...
2022: Frontiers in Molecular Biosciences
#14
REVIEW
Shaughn Nalezinski
OBJECTIVE: Anticoagulant and antiplatelet therapy have become increasingly popular. The goal of therapy is to prevent venous thromboembolism and platelet aggregation, respectively. Traditional anticoagulant and antiplatelet drugs are quickly being replaced with novel medications with more predictable pharmacokinetics. Unfortunately, these drugs carry the risk of uncontrolled hemorrhage because of drug-induced coagulopathy. Uncontrolled hemorrhage continues to be a major cause of preventable death: hemorrhage accounts for approximately 30% of trauma-related deaths, second to brain injury...
July 4, 2022: Laboratory Medicine
#15
JOURNAL ARTICLE
Yajie Zhang, Rong Yang, Liwei Wang, Ye Li, Jing Han, Yaya Yang, Hanxue Zheng, Mengyao Lu, Yuping Shen, Huan Yang
ETHNOPHARMACOLOGICAL RELEVANCE: The prevalence of cardiovascular disease (CVD) is increasing worldwide. Despite significant improvements in novel targeted treatment agents, natural products purified from medicinal animals with minimal side effects have attracted much attention. Several native proteins explored from suck-blood leeches, such as non-thermostable hirudin and its variants, revealed potent anticoagulant activity. Traditional Chinese medicine clinics have proved that non-suck-blood leech Whitmania pigra Whitman (W...
April 24, 2022: Journal of Ethnopharmacology
#16
REVIEW
Stefan Hofer, Christoph J Schlimp, Sebastian Casu, Elisavet Grouzi
Early recognition of coagulopathy is necessary for its prompt correction and successful management. Novel approaches, such as point-of-care testing (POC) and administration of coagulation factor concentrates (CFCs), aim to tailor the haemostatic therapy to each patient and thus reduce the risks of over- or under-transfusion. CFCs are an effective alternative to ratio-based transfusion therapies for the correction of different types of coagulopathies. In case of major bleeding or urgent surgery in patients treated with vitamin K antagonist anticoagulants, prothrombin complex concentrate (PCC) can effectively reverse the effects of the anticoagulant drug...
December 21, 2021: Journal of Clinical Medicine
#17
REVIEW
Rafal Kopanczyk, Nicolas Kumar, Thomas Papadimos
Post-acute coronavirus disease 2019 (COVID-19) syndrome is a novel, poorly understood clinical entity with life-impacting ramifications. Patients with this syndrome, also known as "COVID-19 long-haulers," often present with nonspecific ailments involving more than one body system. The most common complaints include dyspnea, fatigue, brain fog, and chest pain. There currently is no single agreed-upon definition for post-acute COVID-19 syndrome, but most agree that criterion for this syndrome is the persistence of mental and physical health consequences after initial infection...
August 2022: Journal of Cardiothoracic and Vascular Anesthesia
#18
JOURNAL ARTICLE
Anne E Zepeski, Brett A Faine, Anna E Merrill, Grerk Sutamtewagul, Sharathkumar Bhagavathi
PURPOSE: Oral factor Xa inhibitors (FXaIs) are increasingly utilized for outpatient anticoagulation therapy; however, laboratory monitoring is not routinely used to assess the safety and efficacy of these agents. We aimed to evaluate the role of chromogenic anti-factor Xa (anti-Xa) assays in the emergency department (ED) in the setting of patients with an acute bleed or requiring emergent procedures. METHODS: A retrospective review of anti-Xa levels obtained in the ED between June 1, 2019, and April 30, 2020, was completed...
January 1, 2022: American Journal of Health-system Pharmacy: AJHP
#19
REVIEW
Rana A Alaaeddine, Ibrahim AlZaim, Safaa H Hammoud, Aya Arakji, Ali H Eid, Khaled S Abd-Elrahman, Ahmed F El-Yazbi
Antithrombotic drugs are widely used for primary and secondary prevention, as well as treatment of many cardiovascular disorders. Over the past few decades, major advances in the pharmacology of these agents have been made with the introduction of new drug classes as novel therapeutic options. Accumulating evidence indicates that the beneficial outcomes of some of these antithrombotic agents are not solely related to their ability to reduce thrombosis. Here, we review the evidence supporting established and potential pleiotropic effects of four novel classes of antithrombotic drugs, adenosine diphosphate (ADP) P2Y12-receptor antagonists, Glycoprotein IIb/IIIa receptor Inhibitors, and Direct Oral Anticoagulants (DOACs), which include Direct Factor Xa (FXa) and Direct Thrombin Inhibitors...
April 30, 2021: Clinical Science (1979-)
#20
EDITORIAL
Shehani Alwis, Shahzad G Raja
Excessive bleeding is an important cause of morbidity and mortality after cardiac surgery. Bleeding after cardiac surgery is multifactorial. Adherence to the proverbial 6 Ps remains the cornerstone of any strategy for management of postoperative bleeding after cardiac surgery. Recent years have seen a surge in the number of patients who have been prescribed novel oral anticoagulants (NOACs) for the prevention and treatment of thromboembolic events. This phenomenon has significant repercussions particularly for patients presenting for emergency cardiac surgery...
March 2021: International Journal of Surgery
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