Understanding a therapeutic paradox for treating thrombo-vascular complications in kidney disease

(Boston University School of Medicine) Researchers at Boston University School of Medicine (BUSM) have discovered a potential treatment target to prevent chronic kidney disease patients from developing blood clots without causing bleeding complications - an unwanted and perplexing side effect. They say the strategy offers a much-needed therapeutic alternative to standard-of-care heparin, which throws off the finely-tuned balance between pro-clotting and anticoagulant factors in blood vessels that work to keep fluid flowing while protecting against excessive bleeding after injuries.
Source: EurekAlert! - Medicine and Health - Category: International Medicine & Public Health Source Type: news

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Conditions:   Chronic Kidney Diseases;   Cardiovascular Diseases;   Bleeding Intervention:   Drug: Aspirin Sponsors:   University of Southampton;   University of Nottingham;   University of Warwick;   Nottingham University Hospitals NHS Trust;   East Kent Hospitals University NHS Foundation Trust;   University of Durham;   Epsom and St Helier University Hospitals NHS Trust Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Ismaïl Elalamy Advanced age is one of the major determinants of frailty in patients with cancer-associated thrombosis. However, multiple other factors contribute to frailty in these patients. The identification of frailty in patients with cancer-associated thrombosis is critical as it influences the complexity of the anticoagulant treatment in this population at high risk of venous thromboembolism and bleeding. Factors that contribute to frailty in patients with cancer-associated thrombosis include age, type of cancer, comorbidities such as chronic kidney disease, poly-pharmacotherapy, treatment compliance, cognit...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Review Source Type: research
This article aims to present a contemporary literature review of the benefits versus harms of anticoagulation in atrial fibrillation for patients with CKD stages 3, 4, 5, and 5 on dialysis. Although unanswered questions and areas of clinical equipoise remain, this piece serves to assist physicians in interpreting the complex body of literature and applying it to their clinical care. PMID: 30593489 [PubMed - as supplied by publisher]
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
We report a case of severe bleeding with massive hematuria due to RAP, which was detected with duplex sonography. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: International Journal of Angiology - Category: Cardiology Authors: Tags: Case Report Source Type: research
ConclusionsIncidence rates of IS/TE, mortality and bleeding increased with worsening eGFR. Worsening eGFR was an independent predictor of IS/TE and bleeding, and a better predictor of IS/TE than renal impairment in AF. We were able to identify predictors of worsening renal function, which may help to tag patients needing regular FU for appropriate adaptation of antithrombotic therapy.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
This study aimed to evaluate the platelet reactivity in real-world patients with different chronic kidney disease (CKD) stages after percutaneous coronary intervention (PCI), and to examine whether high residual platelet reactivity (HRPR) is associated with higher incidence of adverse cardiovascular events in a 2-year follow up. A total of 10 724 consecutive patients receiving DAPT with aspirin and clopidogrel after PCI throughout 2013 were enrolled. We applied modified thromboelastography (mTEG) in 6745 patients. Kaplan-Meier analysis and Cox proportional regression analysis were applied to illustrate end points for patie...
Source: Platelets - Category: Hematology Tags: Platelets Source Type: research
Low-molecular-weight heparins (LMWHs) are used for the prevention of venous thromboembolism (VTE) [1]. Compared to unfractionated heparin (UFH), they offer a number of advantages, including a simplified dosing schedule, improved adherence and decreased risk for heparin-induced thrombocytopenia [2,3]. Severe chronic kidney disease (CKD) represents a high risk for VTE in hospitalized patients (1 –3). Clinicians typically prefer UFH over LMWH for thromboprophylaxis in severe CKD because of concerns with bioaccumulation and possible increased risk for bleeding [4,5].
Source: Thrombosis Research - Category: Hematology Authors: Tags: Letter to the Editors-in-Chief Source Type: research
Background:Von Willebrand disease (VWD) is a common congenital bleeding disorder, caused by defective or deficient von Willebrand factor (VWF), and characterized by mucosal bleeding. Among these, recurrent gastrointestinal (GI) bleeding may be serious and life-threatening,requiring hospitalization in 30%. Diagnosis and management remain challenging, and the prevalence and correlates of GI bleeding in VWD are not well understood.Methods. We conducted a cross-sectional study using discharge data from the National Inpatient Sample (NIS) between January 1, 2009 and December 31, 2014 to identify factors associated with GI bleed...
Source: Blood - Category: Hematology Authors: Tags: 322. Disorders of Coagulation or Fibrinolysis: Poster I Source Type: research
Conclusions: During long-term FU of more than 2.5 years, this very old population of NOAC recipients demonstrated low rates of cardiovascular or major bleeding complications during active NOAC therapy. Approximately one quarter of the study population died during follow-up, with cardiovascular events being the leading cause of death. Only 11 fatal bleeding events were observed; however, most of the 58 fatal thromboembolic events occurred after anticoagulation was discontinued. This indicates that continued anticoagulation with NOACs may result in a beneficial risk-benefit ratio also in very old patients.DisclosuresBeyer-We...
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy: Management of Challenging Patients and Scenarios Source Type: research
Background: Major bleeding is the most serious complication of oral anticoagulation. Consensus criteria to define major bleeding have been established by the International Society for Thrombosis and Haemostasis (ISTH), Bleeding Academic Research Consortium (BARC) and Thrombolysis in Myocardial Infarction (TIMI). Significant variability exists across these definitions, and their agreement for identifying oral anticoagulant (OAC) related major bleeding is unknown. Furthermore, the association between each definition and mortality in cases of OAC bleeding has not been evaluated. We therefore, sought to evaluate the agreement ...
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy: Management of Challenging Patients and Scenarios Source Type: research
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