Thrombin generation estimates the anticoagulation effect of direct oral anticoagulants with significant interindividual variability observed

Direct oral anticoagulants (DOACs) are increasingly being used, primarily due to their drug stability and patient convenience. Although these drugs have been evaluated to be well tolerated in numerous clinical trials, their impact on in-vivo anticoagulation effect, variability and therapeutic drug level remains unknown. Hence, we aim to study the effect and variability of DOACs on thrombin generation via the calibrated automated thrombogram. Anonymized coagulation specimens from outpatients on warfarin were collected. Pooled normal plasma samples were spiked with increasing concentrations of dabigatran, rivaroxaban and apixaban. Similarly, plasma samples with normal coagulation profiles were spiked with two concentrations each of dabigatran, rivaroxaban and apixaban. Thrombin generation via calibrated automated thrombogram was run using the above samples and compared with a dataset of normal controls. Increasing international normalized ratio was associated with a reduction of endogenous thrombin potential (ETP) and thrombin peak and increasing lag time. Factor Xa inhibitors produced a flattened thrombin generation curve with a reduction of thrombin peak and relative preservation of ETP. Direct thrombin inhibitors produced a reduction of both ETP and thrombin peak and increasing lag time. Seventy-one citrated plasma samples (26 dabigatran, 21 rivaroxaban and 24 apixaban) were evaluated. The two concentrations produced a reduction of thrombin generation parameters with signifi...
Source: Blood Coagulation and Fibrinolysis - Category: Hematology Tags: Original Articles Source Type: research

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Authors: Brignardello-Petersen R PMID: 29907259 [PubMed - as supplied by publisher]
Source: Journal of the American Dental Association - Category: Dentistry Tags: J Am Dent Assoc Source Type: research
We report the first case of small bowel ulcers due to clopidogrel in a 74-year-old man. He presented with diarrhea and melena after having been taking low-dose aspirin (LDA) and clopidogrel. There was no evidence of bleeding in the stomach, duodenum, or colon. Capsule endoscopy showed multiple ulcers and erosions in the small intestine. Double-balloon endoscopy revealed multiple ulcers throughout the ileum. Examination of the biopsy specimen showed cytomegalovirus infection. His LDA was discontinued and he was prescribed ganciclovir. However, the small bowel ulcers were aggravated. Therefore, clopidogrel was discontinued. ...
Source: Case Reports in Gastroenterology - Category: Gastroenterology Source Type: research
We report the case of a patient with Turner syndrome with an episode of gastrointestinal bleeding, outlining our pathway for the investigation and treatment of this condition.Case Rep Gastroenterol 2018;12:292 –296
Source: Case Reports in Gastroenterology - Category: Gastroenterology Source Type: research
(Natural News) Tourniquets are finally getting some good press, an article in News Wise stated. A newly published study showed that a properly fitted tourniquet can increase the chances of survival for a civilian victim who has suffered traumatic injuries. The technique was originally developed to stop wounded soldiers from bleeding to death. It was...
Source: NaturalNews.com - Category: Consumer Health News Source Type: news
Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce excessive bleeding and transfusion requirements. Our aim was to examine if TXA was required in all osteoarthritis patients undergoing TKA ...
Source: Journal of Orthopaedic Surgery and Research - Category: Orthopaedics Authors: Tags: Research article Source Type: research
This study aims at the detection of subclinical knee-joint involvement by USG, in patients with moderate to severe Haemophilia. 27 patients suffering from moderate and severe Haemophilia and 27 age-matched controls were studied. USG of bilateral knee joints was done to analyse cartilage and synovial thickness, synovial vascularity and resistive index of vascular flow along with synovial collection. The relevant clinical parameters (age at diagnosis and study enrolment, severity of haemophilia A, annualized bleeding rates, total number of joint bleeds, spontaneous and provoked bleed, number of episodes treated with factor V...
Source: Indian Journal of Hematology and Blood Transfusion - Category: Hematology Source Type: research
Authors: Elías-Boneta AR, Toro MJ, Rivas-Tumanyan S, Rajendra-Santosh AB, Brache M, Collins C JR Abstract OBJECTIVE: To estimate the prevalence, severity, and associated risk factors of gingival inflammation in a group of adults from Kingston, Jamaica; Santo Domingo, Dominican Republic; and San Juan, Puerto Rico. METHODS: In this representative cross-sectional study, participants completed medical and oral health questionnaires and received an oral clinical examination by trained and calibrated examiners. Clinical assessments included: gingival health (modified Löe-Silness index), visible plaque and...
Source: Puerto Rico Health Sciences Journal - Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research
AbstractPlacental abruption is an important cause of feto-maternal hemorrhage, with significant impact on both fetal and maternal mortality. In most cases, it presents with abdominal pain and vaginal bleeding. However, vaginal bleeding may be absent with concealed intra-amniotic hemorrhage, as in cases with placenta previa, hence confounding this diagnosis. In such cases, imaging studies may be obtained to evaluate for abdominal pain in pregnancy; hence, radiologists should be aware of the ultrasound and magnetic resonance (MR) imaging appearance of intra-amniotic hemorrhage. This includes presence of markedly echogenic am...
Source: Emergency Radiology - Category: Emergency Medicine Source Type: research
Therapeutic options to manage bleeding in a dentist’s office Swiss Dent J. 2018 Jun 18;128(6):498-499 Authors: Rostetter C, Finkenstädt T, Rücker M, Lübbers HT Abstract This manuscript provides an overview of therapeutic options for the problem of bleeding in a dentist’s office. Bleeding after tooth extraction is a very common finding in dental medicine and persistent blood in the mouth is obviously uncomfortable and sometimes terrifying for the patient. Most bleedings can be stopped simply with compression, in some cases a homeostatic therapy is necessary. For local compress...
Source: Schweizer Monatsschrift fur Zahnmedizin - Category: Dentistry Tags: Swiss Dent J Source Type: research
Authors: Prieto RG, Mahler MA, Vidales G Abstract Lower gastrointestinal bleeding is a common pathology with diverse causes depending on the patients´ age. The most common causes in adults are polyps, neoplasias, diverticular disease and angiodysplasia. In neonates, necrotizing enterocolitis and volvulus, and anal fissures and bowel intussusception in infants. Polyps are reported as a cause of bleeding only in children of preschool age. PMID: 29900748 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
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