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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Conclusions: This newly developed advanced ECMO simulation prototype was recently introduced into education and regularly training of healthcare providers of the "ECMO for Greater Poland" program. The simulation based training program is financially affordable and enables clinical teaching in a wider range of clinical scenarios. The ECMO simulation prototype consequently improves level of expertise of the healthcare providers and finally improves quality in patient care. PMID: 30233882 [PubMed]
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
A small startup is developing a device aimed at treating and preventing maternal bleeding. Menlo Park, CA-based Alydia has raised $10 million in a series B round to help it get the technology past clinical trials and onto the market in the U.S. The technology works with the normal contractions of the uterus to rapidly stop bleeding. The concept of the device was developed in 2010 at the Cal Poly Center for Innovation and Entrepreneurship. “What is used now are drugs, which work too slowly or might not work,” Anne Morrissey, CEO of Alydia Health, told MD+DI. “They also ...
Source: MDDI - Category: Medical Devices Authors: Tags: Business Source Type: news
Authors: Overtchouk P, Modine T Abstract INTRODUCTION: Alternative TAVI approaches offer the possibility of valve replacement in patients ineligible to the transfemoral route. Authors provide an updated review of the existing alternative approaches. Areas covered: A systematic review of alternative approaches for TAVI was undertaken. The feasibility, safety, efficacy and technical requirements of the transapical, transaortic, transcarotid, transsubclavian and transcaval approaches have been compared. A multi-slice computed tomography is often necessary for pre-operative planning. Although the first developed, the t...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
This report describes a case of ischemic colitis (IC) caused by PV and includes a review of the relevant literature. The patient was a 59-year-old male with a history of PV who presented with abdominal pain and hematochezia. Colonoscopy and histopathological examination results indicated suspected ischemic bowel disease. Following experimental anticoagulant therapy for 7 days, the patient no longer experienced abdominal pain and hematochezia had resolved. Colonoscopy review showed no obvious anomalies 1 month later. These data demonstrated that PV is an uncommon cause of IC. PMID: 30233723 [PubMed]
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
BACKGROUND: In the prehospital environment, nonmedical first responders are often the first to arrive on the scene of a traumatic event and must be prepared to provide initial care at the point of injury. In civilian communities, these nonmedical first res...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Economics of Injury and Safety, PTSD, Injury Outcomes Source Type: news
Condition:   Upper Gastrointestinal Bleeding Intervention:   Device: Upper Gastrointestinal Monitoring System Sponsor:   National Cheng-Kung University Hospital Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Publication date: Available online 19 September 2018Source: Revista Brasileira de Ortopedia (English Edition)Author(s): Mariana Diana Chaves de Almeida, Rodrigo Pires e Albuquerque, Guilherme Mathias Palhares, Juliana Patrícia Chaves de Almeida, João Mauricio Barretto, Naasson CavanellasAbstractObjectiveEvaluate the efficacy of tranexamic acid in reducing bleeding in patients undergoing total knee arthroplasty.Methods101 patients were randomized into two groups: the tranexamic acid group (n = 51) and the placebo group (n = 50). Patients were compared regarding the following parameters: red...
Source: Revista Brasileira de Ortopedia - Category: Orthopaedics Source Type: research
Publication date: Available online 20 September 2018Source: Revista Portuguesa de Cardiologia (English Edition)Author(s): Liliana Reis, Luís Paiva, Marco Costa, Joana Silva, Rogério Teixeira, Ana Botelho, Paulo Dinis, Marta Madeira, Joana Ribeiro, José Nascimento, Lino GonçalvesAbstractIntroductionPercutaneous closure of the left atrial appendage (LAA) is a promising therapy in patients with atrial fibrillation with high risk for stroke and contraindication for oral anticoagulation (OAC). Intracardiac echocardiography (ICE) may make this percutaneous procedure feasible in patients in whom transe...
Source: Revista Portuguesa de Cardiologia - Category: Cardiology Source Type: research
Conclusion: The accuracy of the prediction model allows an improvement of the quality of flow estimators and the detection of adverse events at an early stage. The evaluation of this approach with blood is suggested for further validation. Significance: Its clinical application could provide the clinicians with reliable and important hemodynamic information of the patient and, thus, enhance patient monitoring and supervision.
Source: IEEE Transactions on Biomedical Engineering - Category: Biomedical Engineering Source Type: research
This study evaluated outcomes in younger patients, specifically aged 50 years and younger, after mechanical aortic valve replacement (mAVR) and bioprosthetic AVR (bAVR).MethodsFrom 1994 to 2016, 643 patients underwent AVR (411 mAVR and 232 bAVR) at age 50 or younger. Concomitant coronary artery bypass grafting and mitral valve procedures were also included. Propensity score-matching methods resulted in 170 evenly matched patient pairs. Primary end points were operative mortality and long-term survival. Secondary end points were stroke, major bleeding, and redo AVR. Median observation time was 8.1 years (range, 0 to 23.6 ye...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
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