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1
Shelfer, Janet, David Zapala, and Larry Lundy. "Fall Risk, Vestibular Schwannoma, and Anticoagulation Therapy." Journal of the American Academy of Audiology 19, no. 03 (March 2008): 237–45. http://dx.doi.org/10.3766/jaaa.19.3.8.
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Elderly patients with balance problems are at high risk for falls. When these same patients are also on anticoagulants, the consequences of a fall can be serious. Anticoagulant therapy increases the risk of cerebral hemorrhage. Even mild head trauma can cause a fatal cerebral hemorrhage when anticoagulants are used. However, this risk needs to be weighed against the possibility of spontaneous stroke. The decision to choose anticoagulant therapy can become even more complicated if the patient has an increased risk of falling. A case is presented of an 87-year-old female with balance problems, in part from a small unilateral vestibular schwannoma. She was also receiving Coumadin anticoagulant therapy. When she began to fall, a decision had to be made about the relative risks and benefits of Coumadin therapy. The risk/benefit calculation could change, however, depending on whether her fall risk could be improved. This article presents the diagnostic test results and medical opinions surrounding this case. The importance of assessing patients' overall situation is stressed in planning rehabilitation. Los pacientes ancianos con problemas del equilibrio tienen un alto riesgo para caídas. Cuando esos mismos pacientes toman anticoagulantes, las consecuencias de una caída pueden ser serias. La terapia anticoagulante aumenta el riesgo de una hemorragia cerebral. Aún un trauma cefálico leve puede causar una hemorragia cerebral fatal cuando se usan anticoagulantes. Sin embargo, este riesgo debe ser ponderado contra la posibilidad de una apoplejía espontánea. La decisión de escoger una terapia anticoagulante puede volverse aún más complicada si el paciente tiene un riesgo aumentado de caídas. Se presenta un caso de una mujer de 87 años de edad con problemas de equilibrio, en parte por un pequeño schwanoma vestibular unilateral. Ella también estaba recibiendo terapia con el anticoagulante Coumadin. Cuando ella empezó a caerse, se tuvo que tomar una decisión sobre el riesgo relativo y los beneficios de la terapia con Coumadin. El cálculo del riesgo/beneficio podría cambiar, sin embargo, dependiendo de si su riesgo para caídas puede ser mejorado. Este artículo presenta los resultados de las pruebas diagnósticas y las opiniones médicas al respecto del caso. La importancia de evaluar la situación global del paciente se enfatiza a la hora de planear la rehabilitación.
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Jose Vicente Catalá Ripoll, Jose Ángel Monsalve Naharro, Esther Domingo Chiva, Pablo Cuesta Montero, and Jose María Jiménez Vizuete. "Terapia antitrombótica en pacientes con hemorragia intracraneal. ¿Revertimos?" Revista Electrónica AnestesiaR 10, no. 8 (August 31, 2018): 6. http://dx.doi.org/10.30445/rear.v10i8.599.
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Realizamos una revisión de la guía de práctica clínica de la reversión de la terapia antitrombótica en pacientes con hemorragia intracraneal que hayan recibido terapia antiagregante, anticoagulante o fibrinolítica. Se analizan recomendaciones para la reversión de antagonistas de vitamina K, anticoagulantes orales de acción directa, heparinas no fraccionadas y de bajo peso molecular, trombolíticos y antiagregantes plaquetarios, en el contexto de una hemorragia intracraneal. ABSTRACT Review the clinical practice guidelines for the reversal of antithrombotic therapy in patients with intracranial hemorrhage with antiplatelet, anticoagulant or fibrinolytic therapy. We analyzed the most important recommendations for the reversal of vitamin K antagonists, direct-acting oral anticoagulants, unfractionated and low-molecular-weight heparins, thrombolytics and platelet antiaggregants, in the context of an intracranial hemorrhage.
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Teruya, Jun, Aaron G. West, and Mary Nell Suell. "Lupus Anticoagulant Assays: Questions Answered and to Be Answered." Archives of Pathology & Laboratory Medicine 131, no. 6 (June 1, 2007): 885–89. http://dx.doi.org/10.5858/2007-131-885-laaqaa.
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Abstract Context.—Lupus anticoagulants are antibodies with heterogenous specificities to phospholipids. They have been associated with clinical syndromes consisting of thrombosis and recurrent fetal loss. Objective.—To address questions about the laboratory assay aspects of lupus anticoagulants. This review is intended for clinicians managing lupus anticoagulant testing in clinical laboratories. Data Sources.—Published literature on lupus anticoagulants, with emphasis on laboratory assay methods. Conclusions.—Although there are published criteria for confirming the presence of a lupus anticoagulant, there is no consensus on assay methods for lupus anticoagulant testing. The mixing study is a useful screening test for lupus anticoagulants, but it may have limited utility. Clinical context may necessitate the performance of factor assays in addition to lupus anticoagulant testing to rule out factor deficiency or factor-specific inhibitor. Additionally, the presence of different anticoagulants may affect the reliability of lupus anticoagulant assays. Lupus anticoagulants are an independent risk factor for thrombosis. It may be useful to use different assays when there is clinical suspicion for a lupus anticoagulant. When testing for lupus anticoagulants, clinicians must carefully consider the clinical context because factor assays may also be indicated.
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Moore, Gary W., Savita Rangarajan, and Geoffrey F. Savidge. "The Activated Seven Lupus Anticoagulant Assay Detects Clinically Significant Antibodies." Clinical and Applied Thrombosis/Hemostasis 14, no. 3 (June 19, 2008): 332–37. http://dx.doi.org/10.1177/1076029607305099.
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Lupus anticoagulants are a heterogeneous group of autoantibodies detected by their effects on phospholipid-dependent coagulation assays. Persistent lupus anticoagulants are associated with thrombotic disease, but not all are clinically significant. Antibody heterogeneity and reagent and test variability dictate that at least 2 tests, of different types, should be used to screen lupus anticoagulants. The objective of this study was to investigate whether the activated seven lupus anticoagulant assay detects clinically significant antibodies. Eighty-two patients with antiphospholipid syndrome (APS) and 32 with systemic lupus erythematosus + positive for activated seven lupus anticoagulant and who were without thrombosis, who were positive by activated seven lupus anticoagulant assay, were investigated for lupus anticoagulants by dilute Russell's viper venom time, dilute activated partial thromboplastin time, and Taipan snake venom time, and for anticardiolipin antibodies. Fifty-seven of the APS patients were positive for lupus anticoagulants in multiple assays, 25 in activated seven lupus anticoagulant alone. Fourteen of the latter group were previously positive in other antiphospholipid antibodies assays, and 11 had only been positive for lupus anticoagulants by activated seven lupus anticoagulant. Twenty-eight had elevated anticardiolipin antibodies, 6 of whom were from the group that was positive in activated seven lupus anticoagulant only. Eight of the systemic lupus erythematosus + lupus anticoagulants (without thrombosis) patients were positive for lupus anticoagulant by activated seven lupus anticoagulant alone and had only been positive in activated seven lupus anticoagulant previously, and none had elevated anticardiolipin antibodies. The remaining 24 patients were lupus-anticoagulant positive in multiple assays, and 9 had elevated anticardiolipin antibodies. Dilute Russell's viper venom time and Dilute activated partial thromboplastin time are widely used to detect lupus anticoagulants and are considered to detect clinically significant antibodies. Activated seven lupus anticoagulant detected antibodies in APS patients who were positive by these assays and also lupus anticoagulants undetectable by the dilute Russell's viper venom time/dilute activated partial thromboplastin time reagents used, demonstrating its utility as a first-line or second-line assay.
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KADYSEVA, E. R. "Pharmacoeconomic aspects of the use of anticoagulants in a multi-speciality hospital." Practical medicine 20, no. 6 (2022): 58–60. http://dx.doi.org/10.32000/2072-1757-2022-6-58-60.
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The article presents the dynamics of the consumption of oral anticoagulants and direct-acting anticoagulants for 2019–2021 in the Republic Clinical Hospital of the Republic of Tatarstan. Currently, anticoagulant therapy is very popular among clinicians. It is known that the economic component plays a rather important role in health care. The purpose — to analyze the costs of anticoagulant drugs in a multi-speciality hospital in 2019–2021. Material and methods. An analysis was made of the share of costs of direct-acting anticoagulants and oral anticoagulants in the total cost of medicines by years in a multi-speciality hospital using the Apteka 1C software. Results. There is a clear trend towards increased consumption of direct-acting anticoagulants and oral anticoagulants. The peak of consumption was observed in 2020 and 2021. Conclusions. The use of oral anticoagulants reduces direct costs compared to standard prophylaxis with direct anticoagulants.
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Cahill, Tom, Julie Broughton, Thomas Ferguson, and Stephen Jenkins. "The impact of the introduction of direct oral anticoagulants into a general practice and hospital anticoagulant services: two local service evaluations." British Journal of Healthcare Management 25, no. 6 (June 2, 2019): 1–12. http://dx.doi.org/10.12968/bjhc.2018.0060.
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Background/Aims Anticoagulants are indicated for stroke prevention in nonvalvular atrial fibrillation, and treatment and prevention of venous thromboembolism. The aim of this study was to describe the impact of introducing direct oral anticoagulants on anticoagulation services. Methods One primary and one secondary care anticoagulation service evaluation compared pre-direct oral anticoagulant (2012) and post-direct oral anticoagulant introduction (2015). Findings In the secondary care service, anticoagulant monitoring clinics decreased by 20% and service capacity increased by 38.5% post-direct oral anticoagulant introduction. Direct oral anticoagulants comprised 87.6% of newly-initiated anticoagulants post-direct oral anticoagulant introduction. In patients newly initiated on anticoagulation, a total of 62 anticoagulation-related inpatient admissions were recorded in 12.6% of patients in the pre-direct oral anticoagulant period, compared with a total of 21 anticoagulation-related admissions in 3.6% of patients in the post-direct oral anticoagulant period. In the primary care service, warfarin comprised 62.9% of all anticoagulants prescribed post-direct oral anticoagulant introduction. Overall, patients attended a mean of 14.2 anticoagulation service visits in 6 months pre-direct oral anticoagulant and 13.3 visits in 6 months post-direct oral anticoagulant introduction (non-direct oral anticoagulant-treated: 16.1/patient; direct oral anticoagulant treated: 0.8/patient). Few patients were offered a choice of anticoagulant; however, overall patient satisfaction was high in both services. Conclusions Direct oral anticoagulant introduction in secondary care was associated with increased service capacity and decreased patient visits. Patient choice was limited; however, satisfaction was high in both services.
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Tatarsky, B. A., and N. V. Kazyonnova. "Safety and interaction of direct oral anticoagulants with antiarrhythmic drugs." Russian Journal of Cardiology 26, no. 7 (August 8, 2021): 4482. http://dx.doi.org/10.15829/1560-4071-2021-4482.
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The use of direct oral anticoagulants minimized the risks associated with vitamin K antagonist (warfarin) therapy. Currently, direct oral anticoagulants have priority over warfarin for the prevention of thromboembolic events in patients with atrial fibrillation and a number of other conditions requiring anticoagulant therapy. Direct oral anticoagulants along with antiarrhythmic therapy are the accepted strategy for atrial fibrillation treatment. At the same time, the effect of drug-drug interactions (DDI) between direct oral anticoagulants and antiarrhythmic drugs, which have common points of metabolic application, has not been fully elucidated. In order to provide effective and safe anticoagulant and antiarrhythmic therapy in patients with AF, it is important to understand the mechanisms and severity of DDI of direct oral anticoagulants and antiarrhythmic agents. This review discusses the issues of DDI of direct oral anticoagulants and antiarrhythmic drugs used to treat atrial fibrillation.
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Manfredini, Mattia, Pier Paolo Poli, Luca Creminelli, Alberto Porro, Carlo Maiorana, and Mario Beretta. "Comparative Risk of Bleeding of Anticoagulant Therapy with Vitamin K Antagonists (VKAs) and with Non-Vitamin K Antagonists in Patients Undergoing Dental Surgery." Journal of Clinical Medicine 10, no. 23 (November 25, 2021): 5526. http://dx.doi.org/10.3390/jcm10235526.
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Objectives: A wide variety of approaches have been proposed to manage anticoagulant drugs in patients undergoing dental surgery; vitamin K antagonists and novel direct oral anticoagulants have been used. The present study aims to explore the existing evidence concerning the management of patients in anticoagulant therapy undergoing oral surgery procedures and to give suggestions related to peri- and post-operative measures. Materials and methods: A comprehensive search of databases was conducted to identify studies that evaluated the relationship between direct oral anticoagulants and dental procedures. The present scoping review was realized in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The publications varied from randomized controlled trials (RCT) to cohort trials. Only articles written in English language and published between 2000 to 2020 were screened. The studies were included if discussing the management of a patient in anticoagulant therapy (warfarin or direct oral anticoagulants) scheduled for tooth extraction. Results: 33 studies were selected and included in the qualitative review. Nineteen considered anticoagulant therapy with warfarin, six considered anticoagulant therapy with new oral anticoagulants and eight compared patients taking warfarin with patients taking direct oral anticoagulants. Conclusions: No case of extractive surgery should alter the posology of the drug: thromboembolic risks derived from discontinuation are heavier than hemorrhagic risks. Clinical relevance: direct oral anticoagulants are safer in terms of bleeding and manageability and bleeding episodes are manageable with local hemostatic measures.
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Yang, Peiwen. "Analysis of the therapeutic effect and application of anticoagulant drugs." Theoretical and Natural Science 15, no. 1 (December 4, 2023): 188–92. http://dx.doi.org/10.54254/2753-8818/15/20240480.
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As the global population ages, the incidence of cardiovascular disease, stroke, and other diseases associated with thrombosis is also increasing, resulting in a great need for effective anticoagulant treatments. The purpose of this research is to summarize the development of anticoagulant drugs to date, including their drug types, version iterations, mechanisms of action, as well as current challenges and future development directions of anticoagulant drugs. The research will first review traditional anticoagulants, such as vitamin K antagonists and heparins, and discuss in detail their effects, advantages, and limitations. Next, it will give a detailed description of new anticoagulants, such as direct acting oral anticoagulants (DOACs), and analyse their advantages over traditional anticoagulants in terms of safety and efficacy. Finally, it will propose the strategy of individualized therapy for specific population and the combination therapy of anticoagulant therapy and other drugs, and look forward to the development of new anticoagulant drugs in the future. The application of anticoagulant drugs in medicine has a wide range of clinical significance. With the continuous deepening of research, new therapeutic strategies and drugs are constantly being developed and improved, aiming at providing more safe and effective anticoagulant therapy.
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Annisa, Lily, Nurfina Dian Kartikawati, and Vitarani Dwi Ananda Ningrum. "Use of anticoagulant drugs for hospitalised patients: A multicentre study." Pharmacy Education 24, no. 3 (May 12, 2024): 286–91. http://dx.doi.org/10.46542/pe.2024.243.286291.
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Background: Anticoagulants are indicated for several types of diseases with progression related to coagulation. Patients administered this drug need to be evaluated by the pharmacist regarding its effectiveness and possible side effects. Objective: This research aimed to analyse the profile use of anticoagulants among patients at Yogyakarta Hospital. Method: This research was a multicentre study conducted retrospectively using the medical records of inpatients who received anticoagulants. Result: Among a total of 486 respondents, the majority were male (63.58%), and the adult age category (18-59 years) was 55.76%. Most anticoagulants were used in cases of cardiovascular disease, diagnosed with NSTEMI as much as 20.21%. The most used anticoagulant drug was heparin (48.9%), followed by fondaparinux (34.3%) and enoxaparin (16.8%). The most duration of anticoagulant use was one to four days (73.02%) with the dose range being 200-1000 units/day. Conclusion: Heparin was the anticoagulant widely used in patients with NSTEMI. Although the elderly were the group most at risk of ADR due to anticoagulants, most of these drugs were precisely taken by adults, who also required serious attention. Further research is needed to provide a more comprehensive approach to anticoagulant therapy.
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Da Silva, Thaís Evellyn, Emanuele Castro de Araújo, Marcela Paschoal Rocha, and Leandro Moraes Coelho de Oliveira. "Manejo cirúrgico do paciente submetido à terapia anticoagulante oral." Revista Pró-UniverSUS 10, no. 1 (June 29, 2019): 145–49. http://dx.doi.org/10.21727/rpu.v10i1.1751.
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Resumo
Introdução: Bem se sabe que quando um paciente está submetido à terapia anticoagulante, seus níveis de coagulação ficam alterados, aumentando o risco de intercorrências transoperatórias. Dessa forma, tem-se levantado muitos questionamentos, tanto na área médica como na odontológica, quanto à melhor conduta a se seguir para a realização de um tratamento cirúrgico-odontológico seguro em pacientes anticoagulados. Com o objetivo de realizar uma revisão de literatura abordando as peculiaridades inerentes ao atendimento adequado e com segurança desses pacientes, elucidando o método de diagnóstico, os exames pré-operatórios a serem solicitados, bem como os riscos existentes na manutenção ou interrupção da terapia anticoagulante a qual os pacientes estão sendo submetidos. Materiais e Métodos: Foi realizada uma busca na base de dados Scientific Electronic Library Online (SCIELO), PubMed e Google acadêmico com os descritores: “surgery oral”, “anticoagulants” e “toothextraction”, no mês de Setembro de 2018, onde foram levantados 25 artigos e foram selecionados 18 artigos de acordo com os critérios de inclusão. Conclusão: Foi observado que a manutençãodaterapêutica anticoagulante oral vem sendo preconizada, considerando o valor da Razão normalizada internacional (RNI) dentro do adequado como de sumaimportância, assim como o uso de alguma medida hemostática local, bem como as devidas instruções para o período de pós-operatório.
Descritores: Cirurgia bucal. Anticoagulantes. Extração dentária.
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Eerenberg, E. S., P. W. Kampuisen, and M. Levi. "Anticoagulants." Hämostaseologie 31, no. 04 (2011): 229–35. http://dx.doi.org/10.5482/ha-1153.
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SummaryAnticoagulants are effective in the prevention and treatment of a variety of arterial and venous thrombotic disorders but are associated with an increased risk of serious bleeding complications. Based on well documented studies of patients using vitamin K antagonists the incidence of major bleeding is 0.5%/year and the incidence of intracranial bleeding is 0.2%/year, however, in real life practice this incidence may be even higher. Risk factors for bleeding are the intensity of anticoagulation, the management strategy to keep the anticoagulant effect in the desired range, and patient characteristics. Recently, a new generation of anticoagulants have been developed and is currently evaluated in clinical trials. Initial results show a similar or superior efficacy over conventional anticoagulant agents with a good safety profile. In case of serious bleeding complications in a patient who uses vitamin K antagonists, this anticoagulant treatment can be quickly reversed by administration of vitamin K or coagulation factor concentrates. For the newer anticoagulants, quick reversal strategies are more cumbersome, although some interventions, including prothrombin complex concentrates, show promising results in initial experimental studies.
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Pagès, Arnaud, Rémi Sabatier, and Brigitte Sallerin. "Factors Associated With the Choice of Oral Anticoagulant Class in the Older Patients: An Observational Study." Journal of Cardiovascular Pharmacology and Therapeutics 25, no. 4 (April 8, 2020): 332–37. http://dx.doi.org/10.1177/1074248420917811.
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Aim: Oral anticoagulants are the first-line drugs for treating thrombotic disorders related to nonvalvular atrial fibrillation and for treating deep vein thrombosis, diseases that increase in prevalence with age. Older patients have a greater risk of thrombotic and hemorrhagic events and are more prone to drug interactions. Given this backdrop, we wanted to determine the factors associated with the prescription of direct oral anticoagulants and vitamin K antagonists in older patients. Methods: We performed a cross-sectional observational study using a hospital prescription database. The study population consists of 405 older patients who were given oral anticoagulants. The 2 variables of interest were the prescription of 1 of the 2 classes of oral anticoagulants (direct oral anticoagulants vs vitamin K antagonists) and appropriateness of oral anticoagulant prescribing according to Summary of Product Characteristics (potentially inappropriate vs appropriate). Results: The factors associated with direct oral anticoagulant prescribing were the female gender (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.88) and initiation during hospital stay (OR: 2.56, 95% CI: [1.52-4.32]). Stage 4 and 5 chronic kidney diseases (OR: 0.39, 95% CI: [0.19-0.79] and OR: 0.07, 95% CI: [0.01-0.53]) were factors favoring vitamin K antagonist prescription. Being 90 years of age or more (OR: 2.05, 95% CI: [1.06-3.98]) was a factor for potentially inappropriate anticoagulant prescribing. The gastroenterology department (OR: 2.91, 95% CI: [1.05-8.11]) was associated with potentially inappropriate anticoagulant prescribing. Conclusions: Direct oral anticoagulants are the drugs of choice for anticoagulant treatment, including in older adults. The female gender and the initiation during hospital stay increased the chances of being prescribed a direct oral anticoagulant in older adults. Stage 4 and 5 chronic kidney disease increased the likelihood of having a vitamin K antagonist prescribed. Our study also revealed a persistence of potentially inappropriate oral anticoagulant prescriptions in older patients.
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Spence, J. David. "Anticoagulation in patients with Embolic Stroke of Unknown Source." International Journal of Stroke 14, no. 4 (January 15, 2019): 334–36. http://dx.doi.org/10.1177/1747493019826363.
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When warfarin was the mainstay of anticoagulation for the prevention of cardioembolic stroke, the paradigm was essentially “we mustn’t anticoagulate anyone unless we prove that the stroke was cardioembolic.” Now that direct-acting oral anticoagulants are available, the paradigm should change. The risk of stroke is highest soon after the initial event, particularly in patients with more than one infarction. Direct-acting oral anticoagulants are not significantly more likely than aspirin to cause severe hemorrhage, and it is now clear that patients with paradoxical embolism are better treated with anticoagulant than aspirin. Percutaneous closure of a patent foramen ovale is better than aspirin, but not better than anticoagulant, and some patients with paradoxical embolism may be better treated with anticoagulant than with percutaneous closure, which cannot prevent pulmonary embolism. Patients in whom cardioembolic stroke is strongly suspected should probably be anticoagulated pending the results of investigations such as echocardiography and prolonged cardiac monitoring for atrial fibrillation, and some of them, in whom the suspicion of a cardioembolic source is very strong, should probably be anticoagulated long term, even if such investigations do not confirm a cardiac source.
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Fujii, Takashi, Hidenori Oishi, Kohsuke Teranishi, Kenji Yatomi, Kazumoto Suzuki, and Hajime Arai. "Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy." Interventional Neuroradiology 26, no. 5 (July 29, 2020): 532–38. http://dx.doi.org/10.1177/1591019920947878.
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Purpose Antiplatelet therapy initiated before flow diverter placement is effective for the prevention of ischemic complications. However, the effectiveness of oral anticoagulant treatment is unclear. This retrospective study evaluated the complications and obliteration rates after flow diverter placement in patients taking anticoagulants. Methods A total of 155 cases were treated by Pipeline Flex placement for unruptured large and giant cerebral aneurysms in our hospital between October 2015 and June 2019. The groups of 8 patients taking anticoagulants before operation and 147 patients not taking anticoagulants were compared. Results Clopidogrel oral dose ( P = 0.002) was significantly lower in the anticoagulant group. Delayed aneurysm rupture ( P = 0.002) and additional treatment ( P = 0.009) rates were significantly higher and complete obliteration rate ( P = 0.011) was lower in the anticoagulant group. Conclusions Additional oral anticoagulant administration before flow diverter placement does not reduce ischemic complications compared to dual antiplatelet therapy, but does increase hemorrhagic complications, especially delayed aneurysm rupture. Complete obliteration of the cerebral aneurysm is difficult to achieve in patients taking anticoagulants.
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Mamatov, S. M., B. Kanat kyzy, A. O. Musakeev, N. K. Kinderbaeva, and T. J. Tagaev. "Analysis of Anticoagulant Therapy in the Elderly Patients, in Clinical Practice of Family Medicine Centers in the Kyrgyz Republic." Rational Pharmacotherapy in Cardiology 17, no. 2 (May 7, 2021): 228–32. http://dx.doi.org/10.20996/1819-6446-2021-03-06.
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Aim. To study the current state of the anticoagulant's prescription in elderly and senile patients with atrial fibrillation in the clinical practice of family medicine center, in the southern regions of the Kyrgyz Republic.Material and methods. Of the 1974 ambulatory medical observation cards, 470 patients with atrial fibrillation were selected who had indications for prescribing antithrombotic therapy (87 [18.5%] men and 383 [81.5%] women; 212 [45.1%] urban residents and 258 [54.9%] rural residents). The average age was 66.9±10.2 years. The analysis included data from 387 patients who received anticoagulant therapy. The frequency of prescribing antithrombotic therapy has been studied.Results. There were indications for anticoagulant therapy in 387 patients. Anticoagulants were taken by 167 (43.2%) patients, antiplatelet agents - 196 (50.6%), no therapy - 24 (6.2%). Anticoagulant therapy in 153 patients included warfarin, while only 11.8% had adequate INR control after one year of follow-up. Rivaroxaban was prescribed in 14 (8.4%) patients. 50% of patients had antiplatelet agents instead of anticoagulants, which were mainly prescribed by therapists of rural family medicine centers.Conclusion. In the southern regions of the republic, an unfavorable situation is observed with the prescription and management of elderly and senile patients on anticoagulant therapy. It is necessary to continue the research across the country in order to obtain a complete and real picture of the problem, and to develop a unified and relevant recommendation.
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Frain, Bridget, Ronald Castelino, and Luke R. Bereznicki. "The Utilization of Antithrombotic Therapy in Older Patients in Aged Care Facilities With Atrial Fibrillation." Clinical and Applied Thrombosis/Hemostasis 24, no. 3 (January 10, 2017): 519–24. http://dx.doi.org/10.1177/1076029616686421.
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Oral anticoagulants are essential drugs for the prevention of thromboembolic events in patients with atrial fibrillation (AF). Anticoagulants are, however, commonly withheld in older people due to the risk and fear of hemorrhage. Although the underutilization of anticoagulants in patients with AF has been demonstrated internationally, few studies have been conducted among aged care residents. The aim of this study was to determine the utilization of anticoagulants among people with AF residing in aged care facilities. We performed a non-experimental, retrospective analysis designed to evaluate antithrombotic usage in patients with AF in Australia residing in aged care facilities, using data collected by pharmacists while performing Residential Medication Management Reviews (RMMRs). The utilization of antithrombotic therapy and the appropriateness of therapy were determined based on the CHADS2, CHA2DS2-VASc, and HAS-BLED risk stratification schemes in consideration of documented contraindications to treatment. Predictors of anticoagulant use were determined using multivariate logistic regression. A total of 1952 RMMR patients with AF were identified. Only 35.6% of eligible patients (CHADS2 score ≥2 and no contraindications to anticoagulants) received an anticoagulant. As age increased, the likelihood of receiving an anticoagulant decreased and the likelihood of receiving an antiplatelet or no therapy increased. In patients at high risk of stroke (CHADS score ≥2), utilization of anticoagulants dropped by 19.7% when the HAS-BLED score increased from 2 to 3, suggesting that physicians placed a heavier weighting on bleeding risk rather than stroke risk. Prescribing of anticoagulants was influenced to a greater extent by bleeding risk than it was by the risk of stroke. Further research investigating whether the growing availability of direct oral anticoagulants influences practice in this patient population is needed.
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Astuti, Engrid Juni, Slamet Ibrahim, Muhammad Ali Zulfikar, and Sophi Damayanti. "A Deep Overview of Anticoagulant Drugs: Recent Synthesis and Their Activity Assay." Indonesian Journal of Chemistry 24, no. 2 (April 1, 2024): 606. http://dx.doi.org/10.22146/ijc.87252.
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During the unprecedented COVID-19 pandemic, anticoagulant drugs have emerged as a crucial component of treatment alongside antivirus medications. Patients with severe COVID-19 frequently have critical conditions marked by blood clot development, necessitating the administration of anticoagulants. This review aims to provide a comprehensive overview of various anticoagulant drugs, their synthesis methods, and assays employed to predict their anticoagulant activity. Notable anticoagulant categories frequently utilized include oral anticoagulants heparin, non-vitamin K antagonists, and vitamin K antagonists. In recent years, the development of new anticoagulants has seen a shift towards a multifaceted approach that combines in silico prediction with in vitro and in vivo assays. In silico prediction techniques play a pivotal role in the initial screening process. This integrated approach has yielded promising results, paving the way for the synthesis of novel anticoagulant candidates, as substantiated by a battery of in vitro, in vivo, and ex-vivo tests.
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Sayeed, S. K. Jakaria Been, Md Moniruzzaman, and Md Mujibur Rahman. "Anticoagulant in Acute Ischemic Stroke with Atrial Fibrillation: A Narrative Review." Journal of Medicine 25, no. 2 (July 16, 2024): 155–58. http://dx.doi.org/10.3329/jom.v25i2.74657.
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Embolic stroke due to atrial fibrillation is often underdiagnosed and has high morbidity and mortality among ischemic stroke. So it is of paramount importance to start anticoagulants as early as possible to prevent further ischemic stroke. However, early initiation of anticoagulants has created much debate, major & minor bleeding related to it are a major concern, and resumption of anticoagulants after intracranial hemorrhage is still a gray zone. Here, we described a narrative review to shed some light on the major concerns such as the optimal time to start an anticoagulant, the best agent to administer, the resumption of anticoagulant after a hemorrhagic stroke, and anticoagulant therapy in chronic rheumatic heart disease (CRHD) based on the recently published article. J MEDICINE 2024; 25: 155-158
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Sankhi, Sabina, Nirmal Raj Marasine, Parbati Thapa, and Nim Bahadur Dangi. "Anticoagulant Utilization and Cost Analysis among Cardiology Inpatients in a Tertiary Care Teaching Hospital of Western Nepal." Advances in Pharmacological and Pharmaceutical Sciences 2020 (November 23, 2020): 1–6. http://dx.doi.org/10.1155/2020/8890921.
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Introduction. Anticoagulants have a wide spectrum of use and risks associated with their therapy due to their narrow therapeutic range. This study aimed to evaluate the anticoagulant utilization and cost analysis in patients admitted to the cardiology ward of a tertiary care hospital in western Nepal. Methods. A prospective cohort study was conducted in patients admitted to the cardiology ward of Manipal Teaching Hospital (MTH), Pokhara, Kaski, Nepal, from August to November 2019. All patients (n = 132) aged ≥18 years of either gender receiving anticoagulants for any indication in the cardiology ward were included in the study. Anticoagulant utilization, the average prescribed daily dose (PDD/DDD) and the cost of anticoagulant per patient were calculated. Descriptive statistics were performed using IBM-SPSS 20.0. Results. Acute coronary syndrome (66.67%) was a common indication, unfractionated heparin + enoxaparin (45.45%) and enoxaparin (27.3%) were the most frequently prescribed anticoagulants. The performance of monitoring parameters such as international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (aPTT), and renal function test were consistent with the American College of Chest Physician (ACCP) guidelines. The average prescribed daily dose of anticoagulants was 1.3 (unfractionated heparin), 2.25 (enoxaparin), 0.5 (warfarin), and 1.0 (dabigatran). Heparin was associated with the majority of cases of drug interactions (52 cases). Enoxaparin was the most expensive of all the anticoagulant drug classes. The median (IQR) cost of anticoagulants used per patient was US$79.92 ($46.32). Conclusion. Our study suggests that the utilization of unfractionated heparin and enoxaparin and the cost of anticoagulants per patient were higher in the patients admitted to the cardiology ward of the hospital.
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Tatarsky, B. A., and N. V. Kazennova. "Thrombocytopenia Induced by Direct Oral Anticoagulants: a Clinical Case and Literature Review." Rational Pharmacotherapy in Cardiology 18, no. 5 (November 6, 2022): 600–605. http://dx.doi.org/10.20996/1819-6446-2022-10-06.
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The last decade has dramatically changed the strategy of anticoagulant therapy in patients with atrial fibrillation. Direct oral anticoagulants have replaced vitamin K antagonists: either direct thrombin blockers (dabigatran) or factor IIa blockers (apixaban, rivaroxaban, edoxaban). According to the regulatory domestic and foreign documents, the use of direct oral anticoagulants in patients with atrial fibrillation has priority in comparison with vitamin K antagonists, since they have a predictable anticoagulant effect, the possibility of taking fixed doses without the need for routine anticoagulant monitoring, rapid onset and termination of action, relatively low potential for food and drug interactions. Direct oral anticoagulants are used for the prevention of thromboembolic complications in patients with atrial fibrillation, for the prevention of deep vein thrombosis in patients who have undergone surgery on the knee or hip joints, for emergency treatment and secondary prevention of deep vein thrombosis and pulmonary embolism. Alertness to side effects tends to focus on the likelihood of bleeding, with the possibility of other side effects of direct oral anticoagulants receiving less attention or going unnoticed. These mainly include liver damage, kidney damage and a number of other rare adverse reactions. The finding of isolated thrombocytopenia in patients taking direct oral anticoagulants may be associated with a high risk of life-threatening bleeding. The article analyzes published data on the occurrence of thrombocytopenia associated with the intake of direct oral anticoagulants, and presents a clinical case of thrombocytopenia while taking apixaban.
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Maulidiyanti, Ellies Tunjung Sari, Fitrotin Azizah, Tri Ade Saputro, and Firdausi Nuzula. "Penggunaan Berbagai Jenis Antikoagulan Terhadap Mutu Hasil Pemeriksaan Activated Partial Thromboplastine Time (APTT)." JOURNAL OF MUHAMMADIYAH MEDICAL LABORATORY TECHNOLOGIST 5, no. 1 (May 30, 2022): 91. http://dx.doi.org/10.30651/jmlt.v5i1.14604.
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Activated Partial Thromboplastine Time (APTT) is a type of hemostasis examination with citrate anticoagulant 3.2% ratio 1:9. Ethylene Diamine Tetraacetic Acid (EDTA) is one of the examination materials for hematology which is often used as an anticoagulant. Apart from EDTA, other types of anticoagulants are sodium citrate and potassium oxalate. The three anticoagulants work to bind calcium ions. The purpose of this examination is to determine the use of various anticoagulants on the quality of the results of the Activated Partial Thromboplastine Time (APCT) examination. The method used in this study is an experimental study with 3 sample groups, each consisting of 9 samples in one group. The SPSS results showed a probability value of 0.000 with the Anova test, the average results of the APTT examination were administration of sodium citrate anticoagulant 25.9 seconds, potassium oxalate 70.92 seconds, and EDTA 37.5 seconds. Based on the results of these studies, there are significant differences related to the use of various anticoagulants on the quality of the results of the Activated Partial Thromboplastine Time (APTT) examination.Keywords : Activated Partial Thromboplastine Time, Antikoagulans,
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Foletti, Mauro, Thomas Schmutz, Yvan Fleury, Jean-Luc Magnin, Christophe Le Terrier, and Youcef Guechi. "Bleeding on oral anticoagulants: overview of reversal strategies." Swiss Medical Weekly 153, no. 2 (February 20, 2023): 40036. http://dx.doi.org/10.57187/smw.2023.40036.
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Oral anticoagulants (antivitamin K, direct oral anticoagulants) are routinely prescribed for the prevention or treatment of thromboembolic events, and many patients are now on long-term anticoagulant therapy. However, this complicates the management of urgent surgical conditions or major bleeding. Various strategies have been developed to reverse the anticoagulant effect and this narrative review provides an overview of the wide range of therapies currently available.
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Piran, Siavash, Jennifer Delaney, Sam Schulman, Mary Salib, Mohamed Panju, and Menaka Pai. "Direct Oral Anticoagulants in the Real World." Canadian Journal of Nursing Research 49, no. 3 (July 5, 2017): 105–7. http://dx.doi.org/10.1177/0844562117716852.
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Background Direct oral anticoagulants are convenient because of their fixed dosing and without laboratory monitoring. There are instructions on avoidance of moisture, no crushing of capsules, and administration with food for some direct oral anticoagulants. Whether patients adhere to this and are prescribed appropriate doses are unknown. Aims To assess direct oral anticoagulant dosing and medication use. Methods Patients ≥18 years old, receiving a direct oral anticoagulant for any diagnosis, were prospectively included. Nurses at our perioperative anticoagulation clinic helped patients complete a 12-item questionnaire. Results Ninety-three consecutive patients were recruited. Forty-nine were on dabigatran, 18 on apixaban, and 26 were on rivaroxaban. Sixty-two patients (67%) received appropriate direct oral anticoagulant dosing and administered the medication correctly. Eighteen patients (19%) administered the direct oral anticoagulant properly but at an inappropriate dose. Thirteen patients (14%) received an appropriate dose but administered the direct oral anticoagulant inappropriately: 10 (11%) removed dabigatran from its packaging before administration (exposing it to moisture); 2 (2%) did not take rivaroxaban with food; and 1 (1%) crushed the dabigatran capsule. Conclusion Our study demonstrates a large variability in how direct oral anticoagulants are dosed, and how patients take them. Improved medication literacy around direct oral anticoagulants is needed. Our study highlights opportunities that nurses have to improve patients’ medication literacy.
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Seiffge, David J., Duncan Wilson, Gareth Ambler, Gargi Banerjee, Isabel Charlotte Hostettler, Henry Houlden, Clare Shakeshaft, et al. "Small vessel disease burden and intracerebral haemorrhage in patients taking oral anticoagulants." Journal of Neurology, Neurosurgery & Psychiatry 92, no. 8 (March 19, 2021): 805–14. http://dx.doi.org/10.1136/jnnp-2020-325299.
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ObjectiveWe investigated the contribution of small vessel disease (SVD) to anticoagulant-associated intracerebral haemorrhage (ICH).MethodsClinical Relevance of Microbleeds in Stroke-2 comprised two independent multicentre observation studies: first, a cross-sectional study of patients with ICH; and second, a prospective study of patients taking anticoagulants for atrial fibrillation (AF) after cerebral ischaemia. In patients with ICH, we compared SVD markers on CT and MRI according to prior anticoagulant therapy. In patients with AF and cerebral ischaemia treated with anticoagulants, we compared the rates of ICH and ischaemic stroke according to SVD burden score during 2 years follow-up.ResultsWe included 1030 patients with ICH (421 on anticoagulants), and 1447 patients with AF and cerebral ischaemia. Medium-to-high severity SVD was more prevalent in patients with anticoagulant-associated ICH (CT 56.1%, MRI 78.7%) than in those without prior anticoagulant therapy (CT 43.5%, p<0.001; MRI 64.5%, p=0.072). Leukoaraiosis and atrophy were more frequent and severe in ICH associated with prior anticoagulation. In the cerebral ischaemia cohort (779 with SVD), during 3366 patient-years of follow-up the rate of ICH was 0.56%/year (IQR 0.27–1.03) in patients with SVD, and 0.06%/year (IQR 0.00–0.35) in those without (p=0.001); ICH was independently associated with severity of SVD (HR 5.0, 95% CI 1.9 to 12.2,p=0.001), and was predicted by models including SVD (c-index 0.75, 95% CI 0.63 to 0.85).ConclusionsMedium-to-high severity SVD is associated with ICH occurring on anticoagulants, and independently predicts ICH in patients with AF taking anticoagulants; its absence identifies patients at low risk of ICH. Findings from these two complementary studies suggest that SVD is a contributory factor in ICH in patients taking anticoagulants and suggest that anticoagulation alone should no longer be regarded as a sufficient ‘cause’ of ICH.Trial registrationNCT02513316
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Hirsh, Jack, Martin O'Donnell, and Jeffrey I. Weitz. "New anticoagulants." Blood 105, no. 2 (January 15, 2005): 453–63. http://dx.doi.org/10.1182/blood-2003-12-4195.
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AbstractAnticoagulants are pivotal agents for prevention and treatment of thromboembolic disorders. Limitations of existing anticoagulants, vitamin K antagonist and heparins, have led to the development of newer anticoagulant therapies. These anticoagulants have been designed to target specific coagulation enzymes or steps in the coagulation pathway. New anticoagulants that are under evaluation in clinical trials include: (1) inhibitors of the factor VIIa/tissue factor pathway; (2) factor Xa inhibitors, both indirect and direct; (3) activated protein C and soluble thrombomodulin; and (4) direct thrombin inhibitors. Although most of these are parenteral agents, several of the direct inhibitors of factor Xa and thrombin are orally active. Clinical development of these therapies often starts with studies in the prevention of venous thrombosis before evaluation for other indications, such as prevention of cardioembolism in patients with atrial fibrillation or prosthetic heart valves. At present, the greatest clinical need is for an oral anticoagulant to replace warfarin for long-term prevention and treatment of patients with venous and arterial thrombosis. Ximelagatran, an oral direct thrombin inhibitor, is the first of a series of promising new agents that might fulfill this need. Large phase 3 trials evaluating ximelagatran for the secondary prevention of venous thromboembolism and prevention of cardioembolic events in patients with atrial fibrillation have been completed.
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Schellong, S., and S. Haas. "New anticoagulants." Hämostaseologie 27, no. 01 (2007): 41–47. http://dx.doi.org/10.1055/s-0037-1616898.
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SummaryHeparins and vitamin K antagonists have been the cornerstones of anticoagulation therapy for several decades. Although they are very effective at inhibiting the coagulation process, they have several practical limitations. This was a challenge for the development of therapies that will overcome these drawbacks while matching the efficacy of the two classes of anticoagulants. Advances were achieved in the development of safer, convenient, more specific treatments, which should provide predictable anticoagulant responses and substantially improve the prevention and management of thromboembolic disorders. In the search for new agents matching the ideal anticoagulant profile, different steps in the coagulation cascade have been targeted, including direct thrombin inhibition, and inhibition of factor Xa, factor IXa, the factor Vlla-tissue factor complex and the factor Va-factor Vllla complex. The most advanced clinical development has been achieved with direct factor Xa- and factor IIa-inhibitors which may replace conventional anticoagulants for long-term prevention and treatment of venous and arterial thromboembolic complications.
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Efimova, O. I., and T. V. Pavlova. "CHOICE OF DIRECT ORAL ANTICOAGULANTS BASED ON THE INDIVIDUAL APPROACH." Translational Medicine 5, no. 6 (February 21, 2019): 10–22. http://dx.doi.org/10.18705/2311-4495-2018-5-6-10-22.
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This review article deals with the comparison of different modes of anticoagulant therapy, taking into account the risk profile and the individual characteristics of patients with atrial fibrillation. This paper analyzes the efficacy and safety of direct oral anticoagulants in different clinical situations. Modifiable and unmodifiable bleeding risk factors are evaluated based on the hemorrhagic complication risk assessment scales for patients taking anticoagulants. The evidence base for anticoagulant therapy in the presence of a single episode of atrial fibrillation is represented. Regimens and terms of initiation of anticoagulant therapy after a cardioembolic stroke or transient ischemic attack are considered. In addition, great attention is paid to the problem of early prescription of anticoagulants after intracranial hemorrhage. For patients at high risk of gastrointestinal bleeding or impaired renal function, an optimal strategy for reducing thromboembolic complications is evaluated. Anticoagulant therapy is also evaluated in patients with stable coronary heart disease, including after coronary stenting.
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Kryukov, N. N., E. V. Sayutina, A. M. Osadchuk, and M. A. Osadchuk. "Stroke prevention for non-valvular atrial fibrillation: how to make the right choice of directly acting oral anticoagulants?" Russian Journal of Cardiology, no. 1 (February 9, 2019): 94–102. http://dx.doi.org/10.15829/1560-4071-2019-1-94-102.
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Patients with atrial fibrillation have a high risk of developing stroke and death, which requires constant anticoagulant support. In this regard, the physician faces the difficult task of selecting the appropriate oral anticoagulant for patient with individual risk factors and comorbidities. Currently, three non-vitamin K antagonist oral anticoagulants or directly acting oral anticoagulants have been registered in the Russia, which in large randomized clinical trials (RCTs) were compared with warfarin in the prevention of stroke and systemic embolism. The present article analyzes the data of RCTs, postmarketing studies of oral anticoagulants, and presents groups of patients for whom these drugs are preferred. The choice of oral anticoagulants for the prevention of stroke in the following subgroups of patients with atrial fibrillation is discussed: patients with one stroke risk factor (CHA2DS2VASc1 in men or 2 in women), patients of different age groups, patients with concomitant coronary artery disease/acute coronary syndrome, a history of stroke, patients with chronic kidney disease, patients with a high risk of gastrointestinal bleeding, and a group of patients with concomitant arterial hypertension and chronic heart failure. We compared the efficacy and safety of oral non-vitamin K antagonist oral anticoagulants or directly acting oral anticoagulants with vitamin K antagonists in patients with non-valvular atrial fibrillation.
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Zhang, Jian-Ying, Yun-Bing Wang, Jian-Ping Gong, Fan Zhang, and Yong Zhao. "Postoperative Anticoagulants in Preventing Portal Vein Thrombosis in Patients Undergoing Splenectomy Because of Liver Cirrhosis: A Meta-Analysis." American Surgeon 82, no. 12 (December 2016): 1169–77. http://dx.doi.org/10.1177/000313481608201222.
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Portal vein thrombosis (PVT) frequently occurs in patients undergoing splenectomy because of liver cirrhosis. Whether the use of postoperative anticoagulants can decrease the incidence of PVT in these subjects is inconclusive. Moreover, the safety of the use of postoperative anticoagulants in the aforementioned patients is a concern. This meta-analysis aims to explore the effectiveness and safety of the preventive anticoagulants to prevent PVT in patients undergoing splenectomy because of liver cirrhosis. Four English language databases (i.e., PubMed, Embase, Cochrane Library, and Web of Science) and four Chinese language databases (i.e., Wanfang, CNKI, Cqvip, and CBM) were searched for randomized controlled trials, cohort studies, and case-control studies on the use of preventive anticoagulants to prevent PVT in patients undergoing splenectomy because of liver cirrhosis from their inception to September 15, 2015. The primary outcome was postoperative PVT incidence. The secondary outcomes included postoperative complications and adverse reaction. Study-specific odds ratios were combined to calculate pooled value through a fixed effects model. A total of 17 original studies were included, involving 1,497 patients. This meta-analysis showed that the preventive anticoagulant group had a lower incidence of PVT than the no anticoagulant group (odds ratio, 0.31; 95% confidence interval, 0.23–0.40; P < 0.05). According to the description of limited studies, the upper gastrointestinal hemorrhage mainly occurred in the no anticoagulant group. Meanwhile, the adverse reaction was trivial in the group using anticoagulants, which could easily be released with no special management. Postoperative anticoagulants can effectively decrease PVT incidence in subjects undergoing splenectomy because of liver cirrhosis. These published studies are more prone to show that no serious negative influence of anticoagulants exists in the aspect of safety. However, further studies are still needed.
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Kino, Tabito, Minako Kagimoto, Takayuki Yamada, Satoshi Ishii, Masanari Asai, Shunichi Asano, Hideto Yano, Toshiyuki Ishikawa, and Tomoaki Ishigami. "Optimal Anticoagulant Strategy for Periprocedural Management of Atrial Fibrillation Ablation: A Systematic Review and Network Meta-Analysis." Journal of Clinical Medicine 11, no. 7 (March 28, 2022): 1872. http://dx.doi.org/10.3390/jcm11071872.
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This network meta-analysis was performed to rank the safety and efficacy of periprocedural anticoagulant strategies in patients undergoing atrial fibrillation ablation. MEDLINE, EMBASE, CENTRAL, and Web of Science were searched to identify randomized controlled trials comparing anticoagulant regimens in patients undergoing atrial fibrillation ablation up to July 1, 2021. The primary efficacy and safety outcomes were thromboembolic and major bleeding events, respectively, and the net clinical benefit was investigated as the primary-outcome composite. Seventeen studies were included (n = 6950). The mean age ranged from 59 to 70 years; 74% of patients were men and 55% had paroxysmal atrial fibrillation. Compared with the uninterrupted vitamin-K antagonist strategy, the odds ratios for the composite of primary safety and efficacy outcomes were 0.61 (95%CI: 0.31–1.17) with uninterrupted direct oral anticoagulants, 0.63 (95%CI: 0.26–1.54) with interrupted direct oral anticoagulants, and 8.02 (95%CI: 2.35–27.45) with interrupted vitamin-K antagonists. Uninterrupted dabigatran significantly reduced the risk of the composite of primary safety and efficacy outcomes (odds ratio, 0.21; 95%CI, 0.08–0.55). Uninterrupted direct oral anticoagulants are preferred alternatives to uninterrupted vitamin-K antagonists. Interrupted direct oral anticoagulants may be feasible as alternatives. Our results support the use of uninterrupted direct oral anticoagulants as the optimal periprocedural anticoagulant strategy for patients undergoing atrial fibrillation ablation.
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Ardashev, A. V., and I. V. Zotova. "PREVENTION OF STROKE IN ATRIAL FIBRILLATION: THE APPROACHES TO THE CHOICE OF ANTICOAGULANT, DEPENDING ON AGE." Eurasian heart journal, no. 4 (December 30, 2016): 68–75. http://dx.doi.org/10.38109/2225-1685-2016-4-68-75.
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SUMMERY The main objective of the management of patients with atrial fibrillation (AF) is an effective prevention of ischemic stroke. For this purpose indirect and direct oral anticoagulants may be used. The choice of anticoagulant should be based on a comprehensive assessment of a number of factors - the presence of significant valvular disease, kidney function, potential drug interactions, risk of complications of anticoagulant therapy. Individual assessment of the profile of thromboembolic and hemorrhagic risks are largely determined by the age, can help choose an efficient anticoagulant with minimal risk of complications. In patients younger than 75 years, in the absence of contraindications to the use of direct oral anticoagulants, the drug of choice can be dabigatran, administered at a dose of 150 mg 2 b.i.d. Keywords: prevention of stroke, atrial fibrillation, cardiovascular disease, new oral anticoagulants.
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Al-Obaidy, E. N. J., M. M. Ismail, and M. Z. Muhi. "The Effect of Some Different Blood Anticoagulants on Rabbits Plasma Biochemical Parameters under Different Temperatures." CARDIOMETRY, no. 29 (November 1, 2023): 111–15. http://dx.doi.org/10.18137/cardiometry.2023.29.111115.
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The aim of present study was to compare the effect of Ca chelating anticoagulants (EDTA, citrate and oxalate) and antithrombin anticoagulant (heparin) on some rabbits plasma biochemical parameters at room temperature 25℃ and extreme temperatures -18℃and 50℃ for 1hr. Five male rabbits weighting between 800-1000gm, kept in the animal house /College of Veterinary Medicine/University of Diyala, under 12:12 dark light cycle with ad libtum food and water in individual cages (60cm,40cm) during November and December /2022. Four ml of blood samples were collected by cardiac puncture (23G needle) into four tubes contain anticoagulants: (EDTA, citrate, oxalate and heparin)one ml of blood for each tube; then the blood samples were kept at :room temperature 25℃, waterbath50℃ and refrigerator -18 ℃, for 1hr then put in centrifuge at 3000rpm for 15min. From total examined blood samples =24 for each Ca chelating anticoagulants (EDTA, citrate and oxalate) and antithrombin anticoagulant (heparin) after 1hr under in 25c℃ , -18℃ and 50℃. The both groups of anticoagulants (Ca chelating and antithrombin) showed no significant differences P>0.05 between them in level of biochemical parameters (glucose, total protein, cholesterol and urea) after 1 hr at 25C; on the other hand significant increase in plasma glucose, total protein and cholesterol beside significant decrease in plasma urea of Ca chelating anticoagulants after 1hr at -18C and 50C as compare with antithrombin anticoagulant. In conclusion; heparin was more effective than Ca chelating anticoagulant in preserve plasma biochemical parameters within normal values under extreme cool and hot condition.
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Dewi, Lilis Septiana, Tantri Analisawati Sudarsono, and Retno Sulistiyowati. "Perbandingan Hasil Pemeriksaan Hitung Jumlah Eritrosit Menggunakan EDTA Konvensional dan Vacutainer." Jurnal Surya Medika 7, no. 2 (February 1, 2022): 181–84. http://dx.doi.org/10.33084/jsm.v7i2.2842.
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Hematology examination in practice often uses anticoagulants to prevent clotting in blood samples, including in the examination of the erythrocyte count. The anticoagulant that is often used for examination is EDTA (Ethylene Diamine Tetra Acetic Acid). With the changing times, the addition of anticoagulants to the examination is no longer done conventionally but is already contained in the vacutainer tube. However, the vacutainer anticoagulant cannot be adjusted to the blood volume obtained during phlebotomy, while the conventional anticoagulant can be added according to the blood volume obtained. This research is a pre-experimental research design with a One-Shot Case Study design, in which each blood sample is added with conventional anticoagulants and vacutainers. The method used is manual using a hemocytometer and a microscope. Analysis of the data using the Independent T-test. The purpose of this study was to find out the comparison of the results of the erythrocyte count using conventional EDTA and a vacutainer. After examination with both anticoagulants, p-value = 0.822 (p>0.05) so there is no comparison. Based on these results, it can be concluded that there is no comparison of erythrocyte count examination using conventional EDTA and vacutainer.
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Bakulina, Natalya V., Sergey V. Tikhonov, Anna G. Apresyan, and Inna G. Ilyashevich. "Features of the use of oral anticoagulants in clinical practice: focus on gastrointestinal complications." Cardiac Arrhythmias 3, no. 2 (September 13, 2023): 29–40. http://dx.doi.org/10.17816/cardar321821.
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The review article presents dates about the physiology and pathophysiology of the hemostasis system, discusses the features of the use of oral anticoagulants in clinical practice. Oral anticoagulants are drugs characterized by predictable pharmacokinetics and pharmacodynamics, a favorable efficacy and safety profile. The article considers the main clinical and pharmacological characteristics of apixaban, rivaroxaban and dabigatran (bioavailability, metabolism, excretion); factors that increase the risk of gastrointestinal bleeding associated with anticoagulant therapy; drug interactions; the possibility of gastroprotection in patients taking oral anticoagulants. In real clinical practice, the reason for not prescribing or unreasonably reducing the dose of oral anticoagulants is the fear of bleeding. In this case, the risks of bleeding, as a rule, are overestimated. Knowledge of bleeding risk factors, prognostic scales and management of risk factors is an approach that can improve the safety of anticoagulant therapy. In clinical practice, the choice of the ideal oral anticoagulants, in addition to taking into account the risk of bleeding, should be based on a comprehensive assessment, including an assessment of the patient's age, risk of stroke and coronary events, renal function, and predicted compliance.
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Cherebillo, V. Yu, A. D. Kanarskiy, A. S. Sosnovski, M. Yu Kurnukhina, and V. K. Chernichenko. "Use of anticoagulants in patients with traumatic brain injury and intracranial hematomas with the novel coronavirus infection as a concomitant pathology." Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery), no. 7 (July 20, 2023): 558–65. http://dx.doi.org/10.33920/med-01-2307-09.
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Anticoagulant therapy is an integral part in the treatment and prevention of diseases and symptoms associated with pathological thrombosis in the human body. Anticoagulant therapy is traditionally not used in traumatic brain injury and hemorrhagic strokes with the formation of intracranial hematomas, intracerebral hematomas, and contusion hemorrhagic foci. However, in such diseases as the novel coronavirus infection, anticoagulant therapy is life-saving, since there is a high risk of developing various thromboses. The article considers the indications for the prescription of anticoagulants in the combination of these pathologies. The article discusses the possibility of using anticoagulants in patients with the novel coronavirus infection and intracranial hematomas, when there are two life-threatening diseases, in which anticoagulants are vital in one case and contraindicated in the other one. It is necessary to understand the complex mechanisms of hemostasis and weigh the risks and benefits in each case.
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Bitsadze, V. O., E. V. Slukhanchuk, J. Kh Khizroeva, M. V. Tretyakova, V. I. Tsibizova, N. R. Gashimova, I. A. Nakaidze, I. Elalamy, J. C. Gris, and A. D. Makatsariya. "Anticoagulants: dose control methods and inhibitors." Obstetrics, Gynecology and Reproduction 16, no. 2 (May 19, 2022): 158–75. http://dx.doi.org/10.17749/2313-7347/ob.gyn.rep.2022.293.
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These days, anticoagulants are in great demand. They are used as a prophylaxis for thromboembolic complications in various diseases and conditions in general therapeutic practice, cardiology, neurology, as well as obstetrics to manage high-risk pregnancies. The relevance of anticoagulants competent use has come to the fore in connection with the emergence of a new disease – COVID-19 and its serious complications such as developing thrombotic storm, in which the timely applied anticoagulant therapy is the key to the success of therapy. The risk of bleeding should be considered when using any anticoagulant. Age, impaired renal function and concomitant use of antiplatelet agents are common risk factors for bleeding. Moreover, only vitamin K antagonists and heparin have specific antidotes – vitamin K and protamine, respectively. Inhibitors of other anticoagulants are universal presented as inactivated or activated prothrombin complex concentrate and recombinant factor VIIa. Hemodialysis effectively reduces dabigatran concentration, activated charcoal is effective in the case of recent oral administration of lipophilic drugs. Research on new antidotes of currently available anticoagulants is under way, similar to testing of new types of anticoagulants that are sufficiently effective in preventing and treating thromboembolic complications with minimal risk of hemorrhagic. The main contraindication to anticoagulants use is the doctor's ignorance of the mechanisms of drug action and opportunities for suppressing its effect.
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Nazari Sabet, Milad, Elham Ahmadipour, and Shadi Zamansaraei. "Lupus anticoagulant in patients with COVID-19: A review." Journal of Preventive Epidemiology 6, no. 1 (July 30, 2021): e07-e07. http://dx.doi.org/10.34172/jpe.2021.07.
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Introduction: Coronavirus disease 2019 (COVID-19) is characterized by a pro-coagulant state that can lead to fatal thromboembolic events. A high prevalence of lupus anticoagulant has been shown in several studies that may at least partially explain the pro-coagulant profile of COVID-19. However, the relation between COVID-19 and lupus anticoagulant is arguable, and no study has clearly evaluated the concussion of lupus anticoagulant on mortality. Methods: We searched the articles that related to lupus anticoagulant and patients with COVID-19. Two authors independently reviewed the search results to select English language articles discussing lupus anticoagulant in patients with COVID-19. Results: Recent studies found conflicting results about the association between lupus anticoagulant and thromboembolic complications of COVID-19. Studies documented a high prevalence of lupus anticoagulants as well as several other studies. Patients with lupus anticoagulants were older, and their C-reactive protein, high-sensitivity troponin, and activated partial thromboplastin time (aPTT) were significantly higher than patients without lupus anticoagulants. Conclusion: Those started on therapeutic anticoagulation showed more severe and complicated involvements and a higher risk of death. According to our results, lupus anticoagulant is highly prevalent among hospitalized COVID-19 patients. Whether these antibodies promote a hypercoagulable state or they are merely a coincidence, epiphenomenon needs further evaluation.
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Yamakawa, Kazuma, Yutaka Umemura, Shuhei Murao, Mineji Hayakawa, and Satoshi Fujimi. "Optimal Timing and Early Intervention With Anticoagulant Therapy for Sepsis-Induced Disseminated Intravascular Coagulation." Clinical and Applied Thrombosis/Hemostasis 25 (January 1, 2019): 107602961983505. http://dx.doi.org/10.1177/1076029619835055.
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Optimizing diagnostic criteria to detect specific patients likely to benefit from anticoagulants is warranted. A cutoff of 5 points for the International Society on Thrombosis and Haemostasis overt disseminated intravascular coagulation (DIC) scoring system was determined in the original article, but its validity was not evaluated. This study aimed to explore the optimal cutoff points of DIC scoring systems and evaluate the effectiveness of early intervention with anticoagulants. We used a nationwide retrospective registry of consecutive adult patients with sepsis in Japan to develop simulated survival data, assuming anticoagulants were conducted strictly according to each cutoff point. Estimated treatment effects of anticoagulants for in-hospital mortality and risk of bleeding were calculated by logistic regression analysis with inverse probability of treatment weighting using propensity scoring. Of 2663 patients with sepsis, 1247 patients received anticoagulants and 1416 none. The simulation model showed no increase in estimated mortality between 0 and 3 cutoff points, whereas at ≥4 cutoff points, mortality increased linearly. The estimated bleeding tended to decrease in accordance with the increase in cutoff points. The optimal cutoff for determining anticoagulant therapy may be 3 points to minimize nonsurvival with acceptable bleeding complications. The findings of the present study suggested a beneficial association of early intervention with anticoagulant therapy and mortality in the patients with sepsis-induced DIC. Present cutoff points of DIC scoring systems may be suboptimal for determining the start of anticoagulant therapy and delay its initiation.
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Bajalan, M., T. C. Biggs, S. Jayaram, J. Mainwaring, and R. Salib. "A guide to new anticoagulant medications for ENT surgeons." Journal of Laryngology & Otology 129, no. 12 (December 2015): 1167–73. http://dx.doi.org/10.1017/s0022215115002765.
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AbstractObjectives:This study aimed to ascertain otolaryngologists’ current knowledge of new (e.g. apixaban, rivaroxaban) and old (e.g. warfarin) anticoagulant medications, and to provide an educational overview of new anticoagulants for use by surgeons.Methods:A questionnaire survey was distributed across the Wessex region, UK, to ascertain the levels of knowledge of and confidence in managing patients taking various anticoagulants. In total, 50 questionnaires were completed (41 by trainees and 9 by consultants). A literature review of new anticoagulant medications was then conducted.Results:In general, there was poor clinical and pharmacokinetic knowledge of newly licensed anticoagulant medications. Respondents were more confident in the use of older vs newer forms of anticoagulants. This was true across all grades of doctors, but particularly at the senior level. All respondents stated that they would like to see an educational resource on anticoagulants.Conclusion:Knowledge of newly licensed anticoagulation medications is poor. This study has produced an educational resource for the management of anticoagulant agents. A thorough knowledge of these drugs is essential for the acute management of bleeding patients and in peri-operative surgical planning.
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Martins Almeida, Renata, and Gilson Soares Feitosa. "Uso em Longo Prazo de Anticoagulantes Orais na Cardiologia." Revista Científica Hospital Santa Izabel 4, no. 1 (May 11, 2020): 14–27. http://dx.doi.org/10.35753/rchsi.v4i1.68.
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Os anticoagulantes orais são medicações amplamente utilizadas na cardiologia. Durante muito tempo, a varfarina foi a única opção disponível no mercado para esta terapia, tendo ainda hoje papel singular em determinadas situações. Porém, com o surgimento dos anticoagulantes orais de ação direta (DOACs), no século XXI, o tratamento anticoagulante vem apresentando grande avanço, dispondo de novas opções terapêuticas que ofertam mais segurança e efetividade à terapia. Diversos cenários da cardiologia requerem o seu uso e, recentemente, muitos estudos têm sido realizados a fim de esclarecer os riscos e benefícios de sua empregabilidade, a segurança e eficácia dos fármacos disponíveis em variadas situações clínicas, bem como a interação dessas drogas com outras medicações amplamente utilizadas na cardiologia. Dessa forma, os DOACs vêm cada vez mais ganhando espaço nos diversos cenários, apresentando maior segurança, menor perfil de interações medicamentosas e alimentares, maior comodidade posológica, acarretando maior adesão dos pacientes à terapia, além de melhor eficácia, se comparados à varfarina. É importante ressaltar que o uso dessa nova classe de droga está reservado a situações específicas, tendo em vista que não mostrou benefício em determinadas situações e, em outras situações, essas drogas precisam ser estudadas para terem seu uso validado na prática clínica. O objetivo dessa revisão é promover uma atualização, à luz dos principais e mais robustos ensaios clínicos publicados até o momento, sobre o uso dos anticoagulantes orais nos diversos cenários da cardiologia, abordando as suas principais indicações, contraindicações, assim como o tempo de uso dessa terapia e orientações posológicas em cada situação, com base nas melhores e mais atuais evidências sobre o tema.
Oral anticoagulants are medications widely used in cardiology. For a long time, warfarin was the only option available on the market for this therapy, and today it still has a unique role in some cases. However, with the emergence of direct oral anticoagulants (DOACs) in the 21st century, anticoagulant treatment has had a big breakthrough, constituting a new therapeutic option that offers more safety and effectiveness for anticoagulant therapy. Several cardiology scenarios require its uses. Recently, many studies have been carried out in order to clarify the risks and benefits of their use, the safety and efficiency of the drugs available in many clinical situations, and the interaction of these drugs with other medications commonly used in cardiology. Thus, DOACs are increasingly finding spaces in several settings, presenting safety, a lower profile of drug and food interactions, a better dosage convenience, adhesion of patients to the therapy, and efficiency when compared to warfarin. The use of this new class of drugs is reserved for specific situations, considering that it didn’t show any benefits in some conditions, and in many situations, these drugs need to be studied to have their use validated in clinical practice. The purpose of this review is to promote an update of the use of oral anticoagulants in many cardiology scenarios, considering the most robust clinical trials published to date to discuss the main indications, contraindications, as well as, time of use and dosage guidelines in each situation.
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Baranova, E. I., V. A. Ionin, A. A. Katsap, O. S. Kolesnik, and E. V. Lebedeva. "Safety of direct oral anticoagulants in patients with atrial fibrillation and high risk of stroke (review of literature)." Scientific Notes of the Pavlov University 26, no. 3 (February 4, 2020): 43–56. http://dx.doi.org/10.24884/1607-4181-2019-26-3-43-56.
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Review discusses the problem of non-vitamin K antagonist oral anticoagulants safety in patients with non-valvular atrial fibrillation. Bleeding risk assessment while applying anticoagulant therapy, preventive methods for major bleeding (intracranial, gastro-intestinal) during this therapy as well as the strategy of treating patients with bleedings occurring on direct oral anticoagulants intake are discussed in this review. Special attention is paid to the choice of direct oral anticoagulant, the importance of specific antagonist of dabigatran – idarucizumab and indications for its clinical application.
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Roman, Rareş C., Andreea Miron, Horaţiu Rotaru, Mădălina-Ana Văleanu, Cristian-Niky Cumpătă, and Dragoş Ţermure. "Tooth extraction in patients on chronic anticoagulant treatment – preliminary results of a clinical prospective study." Romanian Journal of Stomatology 61, no. 4 (December 31, 2015): 285–91. http://dx.doi.org/10.37897/rjs.2015.4.5.
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Patients under anticoagulant treatment which needs dental extractions have a significant high risk of postoperative bleeding, in consequence they need either hospitalization or ambulatory postextractional monitoring. The objective of this study was while using Surgicel® as a socket local hemostat for extractions at patients under anticoagulants to prove his efficacy during a clinical prospective experimental study. We followed three groups of patients under anticoagulant treatment with single or multiple dental extractions: one group under oral anticoagulants (warfarin) and socket meshing with Surgicel®, one group under i.v. anticoagulants (heparin) and one control group under antithrombotics. Many parameters were observed and studied with special focus on postextractional hemorrhage. Results were statistically analyzed and they were compared with the latest findings on international literature. The study conclusions suggest using Surgicel® as viable intraalveolar hemostat which can reduce many postoperative bleeding accidents and avoid thrombotic risks associated with suppression of oral anticoagulant or heparin treatment.
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Ware, Kyle M., Douglas L. Feinstein, Israel Rubinstein, Prudhvi Battula, Jose Otero, Lee Hebert, Tzu-Fei Wang, et al. "The Severity of Intracranial Hemorrhages Measured by Free Hemoglobin in the Brain Depends on the Anticoagulant Class: Experimental Data." Stroke Research and Treatment 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/6516401.
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Background and Purpose. Anticoagulant therapy is broadly used to prevent thromboembolic events. Intracranial hemorrhages are serious complications of anticoagulation, especially with warfarin. Direct oral anticoagulants reduce but do not eliminate the risk of intracranial hemorrhages. The aim of this study is to determine the degree of intracranial hemorrhage after application of anticoagulants without additional triggers. Methods. Rats were treated with different anticoagulant classes (vitamin K antagonists, heparin, direct thrombin inhibitor, and factor Xa inhibitor). Brain hemorrhages were assessed by the free hemoglobin concentration in the brain parenchyma. Results. Vitamin K antagonists (warfarin and brodifacoum) significantly increased free hemoglobin in the brain. Among direct oral anticoagulants, thrombin inhibitor dabigatran also significantly increased free hemoglobin in the brain, whereas treatment with factor Xa inhibitor rivaroxaban did not have significant effect on the free hemoglobin concentration. Conclusions. Our data indicates that the severity of brain hemorrhages depends on the anticoagulant class and it is more pronounced with vitamin K antagonists.
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Piran, Siavash, and Sam Schulman. "Treatment of bleeding complications in patients on anticoagulant therapy." Blood 133, no. 5 (January 31, 2019): 425–35. http://dx.doi.org/10.1182/blood-2018-06-820746.
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Abstract Anticoagulant therapy is often refrained from out of fear of hemorrhagic complications. The most frequent type of major bleeding is gastrointestinal, but intracranial hemorrhage has the worst prognosis. Management of these complications in patients on anticoagulants should follow the same routines as for nonanticoagulated patients, as described here with the previously mentioned bleeds as examples. In addition, for life-threatening or massive hemorrhages, reversal of the anticoagulant effect is also crucial. Adequate reversal requires information on which anticoagulant the patient has taken and when the last dose was ingested. Laboratory data can be of some help, but not for all anticoagulants in the emergency setting. This is reviewed here for the different types of anticoagulants: vitamin K antagonists, heparins, fondaparinux, thrombin inhibitors and factor Xa inhibitors. Specific antidotes for the latter are becoming available, but supportive care and nonspecific support for hemostasis with antifibrinolytic agents or prothrombin complex concentrates, which are widely available, should be kept in mind.
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Jarrar, R., T. Chadwick, J. Lally, R. Thomson, C. Wilkinson, and C. Price. "Temporal changes in anticoagulant prescribing and atrial fibrillation: results of interrupted time-series analysis of openly available routine data in England." International Journal of Pharmacy Practice 30, Supplement_1 (April 1, 2022): i35—i36. http://dx.doi.org/10.1093/ijpp/riac019.049.
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Abstract Introduction The use of anticoagulants for stroke prevention in patients with atrial fibrillation (AF) has been increasing in England in the recent years (1, 2). The changes in practice coincided with several developments in the area of anticoagulants and AF, including: the emergence of evidence supporting anticoagulant use for stroke prevention in AF, changes in guideline recommendations, and the licensing of direct oral anticoagulants (DOACs) as an alternative to warfarin, which was the mainstay of stroke prevention in AF. Currently, there are four DOACs available for use: dabigatran, rivaroxaban, apixaban, and edoxaban. Recent analyses of time trends of anticoagulant prescribing in England showed an increase in DOACs prescribing and a decrease in warfarin prescribing (1, 2). However, more recent exploration of recent anticoagulant prescribing trends is needed. Aim To explore the changes in anticoagulant prescribing for AF in England. Methods Interrupted time-series analysis (ITSA) of openly available data on anticoagulant prescribing and AF. Separate analyses were conducted for data from Sentinel Stroke National Audit Programme (SSNAP) and Quality and Outcomes Framework (QOF). The timeframe of the analysis and the length of time intervals depended on the characteristics of each dataset. Results Analysis of data from SSNAP showed that the proportion of stroke patients who have a diagnosis of AF who were taking an anticoagulant alone prior to admission increased from 32.51% in the third quarter of 2013 to 62.63% in the third quarter of 2020; this coincided with a decreased proportion of stroke patients who have a diagnosis of AF taking antiplatelets alone from 37.10% to 8.31% during the same period. Analysed QOF data on anticoagulants and AF included information about AF prevalence in QOF datasets, the eligibility of patients with AF for anticoagulant based on stroke risk assessment, and the use of anticoagulants among eligible patients. Prevalence of AF in England in QOF datasets increased from 1.52% in 2012/2013 to 2.05% in 2019/2020 (ITSA gradient=0.08, p-value<.001, 95% confidence interval: 0.07- 0.09). The proportion of patients with AF who are considered eligible for anticoagulation per all patients with AF in QOF datasets increased from 44.95% in 2012/2013 to 80.87% in 2019/2020; there was an increase by 25.24% between 2014/2015 and 2015/2016 which corresponds to modifying risk assessment scores to include additional criteria. The proportion of eligible patients with AF being prescribed anticoagulants also increased in the period between 2012/2013 and 2019/2020 (ITSA gradient = 1.98, p-value<.001, 95% confidence interval: 1.52- 2.44). Conclusion The analysis of data from different sources identified an increase in anticoagulant prescribing for patients with AF in England, which is likely to translate into health gains. However, the use of aggregate data in the analysis did not allow for detailed inspection of patient characteristics, and individual anticoagulants were not specified in the datasets. Therefore, quantitative analyses of primary care data of individual anticoagulant prescribing for different patient groups with AF are needed to further understand whether additional improvements are possible in the prevention of complications from atrial fibrillation. References (1) Adderley NJ, Ryan R, Nirantharakumar K, Marshall T. Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016. Heart. 2019;105(1):27-33. (2) Loo SY, Dell’Aniello S, Huiart L, Renoux C. Trends in the prescription of novel oral anticoagulants in UK primary care. British Journal of Clinical Pharmacology. 2017;83(9):2096-106.
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Omčikus, Maja, and Ivan Milivojević. "Oral anticoagulation therapy in the treatment of pulmonary thromboembolism." Galenika Medical Journal 2, no. 5 (2023): 62–66. http://dx.doi.org/10.5937/galmed2305062o.
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Venous thromboembolic disease, which includes pulmonary thromboembolism and deep vein thrombosis, is one of the most common causes of morbidity and mortality. Management of patients with acute pulmonary thromboembolism is challenging, due to the wide spectrum of clinical presentation and possible outcomes. Certainly, anticoagulant therapy is the basis of treatment for these patients. Until recently, parenteral anticoagulants and oral vitamin K antagonists were used to achieve an anticoagulant effect. These drugs still have their place in the treatment of venous thromboembolic disease, but new, i.e. direct oral anticoagulants have replaced oral vitamin K antagonists due to their more favorable pharmacological characteristics. In this paper, based on available literature, clinical trials and good clinical practice guidelines, we highlight critical errors and discuss potential advantages and disadvantages of oral anticoagulants.
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Exner, Thomas, Monica Ahuja, and Lisa Ellwood. "Effect of an activated charcoal product (DOAC Stop™) intended for extracting DOACs on various other APTT-prolonging anticoagulants." Clinical Chemistry and Laboratory Medicine (CCLM) 57, no. 5 (April 24, 2019): 690–96. http://dx.doi.org/10.1515/cclm-2018-0967.
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Abstract Background The aim of the study was to investigate the specificity of an activated charcoal-based product (DOAC Stop™) initially intended for the specific extraction of direct oral anticoagulants (DOACs) from test plasmas on a range of other anticoagulants. Methods Test plasmas were prepared by adding various anticoagulants to pooled normal plasma at concentrations prolonging an activated partial thromboplastin time (APTT) test by a factor of 1.5–3. These plasmas were treated with DOAC Stop™ for 5 and 20 min. Then APTTs were repeated and residual anticoagulant concentrations estimated from dose-response curves. Results The activated charcoal (AC)-based product was found to extract DOACs efficiently. It also bound the intravenous anticoagulants argatroban and lepirudin, but it had no effect on heparin, enoxaparin or danaparoid in plasma. Among other APTT-inhibiting agents that might be present in test plasmas from patients, it extracted protamine, aprotinin and polymyxin. It had no effect on annexin V, thrombomodulin, a typical lupus anticoagulant, a factor VIII antibody, activated protein C or its activator, but it did bind some cationic inhibitors of the APTT with molecular weight below approximately 30 kDa. Conclusions The AC-based product extracted DOACs efficiently with no effect on heparin-type anticoagulants. It did bind argatroban and hirudin-type anticoagulants, which might occur in plasmas from some inpatients, and APTT results obtained after its use should be interpreted after due consideration of patient medications.
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Clarissa, Sheila Clarissa, Jusak Nugraha Nugraha, and Triagung Ruddy. "Perbedaan Jumlah Trombosit Platelet Rich Plasma Yang Menggunakan Tabung Natrium Sitrat Dan Tabung ACD-A." Jurnal Widya Medika 5, no. 1 (April 2019): 24–34. http://dx.doi.org/10.33508/jwm.v5i1.1996.
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Background: PRP is a relatively new field and there is still minor researches that are usage. However, PRP can be applied to a lot of various fields. This study willmake a comparison between tubes that have sodium citrate anticoagulant and tubes that have ACD-A anticoagulants, to be able to find out which of the two are able to produce a higher number of PRPs. Objective: To obtain the anticoagulants that produce more platelet countsand to know the difference in the platelet counts in PRPs found in tubes that have sodium citrate anticoagulants and tubes that have ACD-A anticoagulants. Method: This study was an experimental laboratorium research with an equivalent control group design. Data is normally distributed, so that the parametic statistical analysis test uses Paired T-Test. Results: From 32 respondents, there was an increase in both anticoagulant tubes, where the average increase in platelet counts in PRP using sodium citrate tubes was 337593.75 / μl and the standard deviation was 158795.437 whereas, the average increase in platelet counts in PRP using ACD-A tubes was 909062.50 / μL and the standard deviation is. 284336.005. The difference in platelet counts in PRP using sodium citrate tubes and ACD-A tubes was stated to be significant because the result of the Paired T-Test analysis showed Sig (2-Tailed) = 0,000 (p <0.05). Conclusion: There was a significant difference platelet counts in PRP using sodium citrate tubes and ACD-A tubes. Tubes that have ACD-A anticoagulants had higher results than the ones that have sodium citrate anticoagulant.
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Ware, Kenric, Marty Faile, and Carrie Lynch. "An Analysis of Perceived and Actual Anticoagulant Knowledge among Independent Pharmacy Patients." INNOVATIONS in pharmacy 11, no. 4 (November 17, 2020): 13. http://dx.doi.org/10.24926/iip.v11i4.3421.
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Background: Deficits in knowledge of parameters surrounding anticoagulant therapy administration carry substantial risks for patient harm. Patients prescribed anticoagulants may overestimate their knowledge of anticoagulant use principles. The purpose of this study was to analyze independent pharmacy patients’ perceived versus actual knowledge of their anticoagulation therapies. Methods: A 15-item survey across a dual-site pharmacy location evaluated patients’ confidence in their understanding of anticoagulant prescribing parameters and their awareness of measures to take to safeguard anticoagulant therapy routines. A pharmacist reviewed patient responses to survey items referencing actual understanding of anticoagulant therapies at the conclusion of the survey. Data analyses occurred by gender, age, ethnicity, location, living situation, self-management of anticoagulants, patient perception of anticoagulant safety, and reported receipt of anticoagulant education. Linear regressions were used for statistical analyses, with significance set at p<.05. Results: During the span of three months, 45 patients, 20 females and 25 males, completed the survey. Perceived anticoagulant knowledge did not differ significantly by demographics. Actual anticoagulant knowledge declined by over 20% between age groups 60-69 and 80-89 years old. African Americans displayed 10% lower actual anticoagulant knowledge than Caucasian Americans. Conclusions: This study revealed gaps in knowledge of anticoagulants among patients at an independent pharmacy. An appeal remains for more strategies to assist with knowledge of anticoagulant regimens. Healthcare institutions should continue to incorporate programs geared towards ongoing anticoagulant education, such as question and answer sessions, along with peer support mediums that foster optimal outcomes. Article Type: Original Research