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Anticoagulant Reversal Drugs Stop Patient's Internal Hemorrhage

Pharmacology to the tune of anticoagulant reversal Your EMS flight crew is dispatched by rotor to a remote hospital in the Great Basin Desert for a patient with gastrointestinal (GI) bleeding. The patient was brought in by her grandson. She was vomiting blood as well as suffering from bloody diarrhea. On arrival, you find an 80-year-old female sitting up in a hospital bed, although she's extremely weak. She has a Glasgow coma scale (GCS) of 15 and states she's been throwing up blood all day. She appears pale but is in no obvious distress. Her vital signs are a heart rate of 100 with regular pulse; blood pressure 60/35 mmHg; respiratory rate of 20; and SpO2 of 94% with poor waveform on 2 L/min via nasal cannula. The patient's history is limited to atrial fibrillation and hypertension. Her nurse informs you that she's received 80mg Protonix (pantoprazole) and a liter of normal saline (NS). Given the patient's active GI bleed, her current blood pressure, and the 1.5 hour-plus flight to the receiving facility, you decide it's appropriate to request the hospital's only two units of packed red blood cells (PRBCs). You load the patient into the helo without difficulty. As you begin transport, you find yourselves facing a strong headwind. Your pilot says that because of this you'll have to stop for fuel on the way to complete transport. You and the crew put your heads together and decide the best course of action is to set down at your home hospital pad. This will take you off course...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Patient Care Columns Source Type: news

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The number of patients with nonvalvular atrial fibrillation (NV-AF) who require long-term anticoagulation and also have a higher risk of bleeding is increasing. Recently, there is no information regarding real on-treatment anti-Xa activity in patients with NV-AF and a higher risk of bleeding who receive oral factor Xa inhibitors. The aim of this study was to determine trough and peak anti-Xa activity in these patients. This single-centre pilot study enrolled 41 patients with NV-AF and a higher risk of bleeding defined as Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, El...
Source: Blood Coagulation and Fibrinolysis - Category: Hematology Tags: Original Articles Source Type: research
Purpose of review Patients with chronic kidney disease (CKD) are at increased risk of atrial fibrillation, stroke, and bleeding posing unique clinical challenges. Novel oral anticoagulants (NOACs) including dabigatran, rivaroxaban, and apixaban have become recognized as alternative therapy to Vitamin K Antagonists (VKA) regarding the prevention of venous thromboembolism (VTE) and reduce the risk of stroke in atrial fibrillation. However, the understanding of NOACs in CKD is still underdeveloped. This review summarizes recent literature on the efficacy and safety of NOACs in patients with CKD. Recent findings Studies f...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research
CONCLUSION: Antithrombotic therapy after percutaneous LAAO is needed to prevent thrombotic complications, yet these impose bleeding complications in this high-risk population. Further efforts are needed to define the optimal duration of DAPT, aimed at reducing bleeding complications while maintaining a low thrombosis rate. PMID: 29607737 [PubMed - as supplied by publisher]
Source: Acta Cardiologica - Category: Cardiology Tags: Acta Cardiol Source Type: research
ConclusionsThis meta‐analysis concludes that LAAO occlusion is a safe and effective stroke prevention strategy in patients with NVAF.
Source: Journal of Interventional Cardiology - Category: Cardiology Authors: Tags: ORIGINAL INVESTIGATION Source Type: research
CONCLUSION: The RAFFINE registry at baseline described the current status of anticoagulation therapy in Japan and long-term follow-up data will identify how outcomes vary between stratified groups in patients with AF in the DOAC era (UMIN Clinical Trials Registry UMIN000009617). PMID: 29502944 [PubMed - as supplied by publisher]
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research
ConclusionsThe efficacy and safety of non‐vitamin K oral anticoagulants compared with warfarin generally extend to participants with diabetes mellitus, although dedicated randomized trials or real‐world data are lacking.This article is protected by copyright. All rights reserved.
Source: Diabetic Medicine - Category: Endocrinology Authors: Tags: Review Source Type: research
Atrial fibrillation (AF) is one of the leading heart rhythm disorder, with relevant morbidity and mortality [1]. Similarly, hypertension is known to be the most prevalent and incident cardiovascular risk factor [1]. Both conditions share a similar epidemiology, being progressively more prevalent in elderly and male subjects and associated with increased risk for major clinical adverse events [1]. AF and hypertension have a deep and profound relationship [Fig. 1], with hypertension being one of the most relevant risk factor for developing AF and, subsequently, carrying a relevant increase in thromboembolic and bleeding risk in AF patients [2].
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Editorial Source Type: research
This article summarizes the main basic mechanisms through which hypertension is believed to promote AF. It also explores epidemiological data supporting an evolutionary pathway from hypertension to AF, including the emerging evidence favoring an intensive BP control or the use of drugs, which inhibit the renin-angiotensin-aldosterone system to reduce the risk of AF. Finally, it examines the impact of non-vitamin K antagonist oral anticoagulants compared with warfarin in relation to hypertension. PMID: 29348255 [PubMed - in process]
Source: Circulation Research - Category: Cardiology Authors: Tags: Circ Res Source Type: research
CONCLUSION: A patient who had recently undergone PCI and DES placement and was receiving aspirin, clopidogrel, and dabigatran for atrial fibrillation was successfully treated for acute GI bleeding with idarucizumab without the use of a hemostatic agent. PMID: 29343478 [PubMed - as supplied by publisher]
Source: American Journal of Health-System Pharmacy : AJHP - Category: Drugs & Pharmacology Authors: Tags: Am J Health Syst Pharm Source Type: research
Background: Although chronic kidney disease (CKD) is an independent risk factor for stroke, official recommendations for the primary prevention of stroke in CKD are generally lacking.Summary: We searched PubMed and ISI Web of Science for randomised controlled trials, observational studies, reviews, meta-analyses and guidelines referring to measures of stroke prevention or to the treatment of stroke-associated risk factors (cardiovascular disease in general and atrial fibrillation (AF), arterial hypertension or carotid artery disease in particular) among the CKD population. The use of oral anticoagulation in AF appears safe...
Source: Cerebrovascular Diseases - Category: Neurology Source Type: research
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