Clinical management of coagulation status and placenta previa in a pregnant woman with Marfan ’s syndrome after mitral and aortic mechanical heart valve replacement
AbstractPregnancy with a mechanical heart valve (MHV) is high risk for valve thrombosis because pregnancy is a hyper-coagulation state. In addition, warfarin use during pregnancy is restricted due to its fetotoxicity, and postpartum bleeding may be increased with anticoagulation. In particular, placenta previa under anticoagulation may cause massive postpartum bleeding. The optimal anticoagulation for a pregnant woman with mitral and aortic double MHVs is not known. In addition, suitable techniques for control of bleeding in a case of placenta previa under anticoagulation are not known. Thus, a case of a pregnant woman wit...
Source: General Thoracic and Cardiovascular Surgery - September 27, 2020 Category: Cardiovascular & Thoracic Surgery Source Type: research

Standardization of Prothrombin Time/International Normalized Ratio (PT/INR).
Abstract The prothrombin time (PT) represents the most commonly used coagulation test in clinical laboratories. The PT is mathematically converted to the international normalized ratio (INR) for use in monitoring anticoagulant therapy with vitamin K antagonists such as warfarin in order to provide test results that are adjusted for thromboplastin and instrument used. The INR is created using two major PT 'correction factors', namely the mean normal PT (MNPT) and the international sensitivity index (ISI). Manufacturers of reagents and coagulometers have made some efforts to harmonizing INRs, for example, by tailori...
Source: International Journal of Laboratory Hematology - September 26, 2020 Category: Hematology Authors: Dorgalaleh A, Favaloro EJ, Bahraini M, Rad F Tags: Int J Lab Hematol Source Type: research

Emergent General Surgery Operations in Patients With Left Ventricular Assist Devices.
Abstract BACKGROUND: The left ventricle assist device (LVAD) patient population is rapidly expanding. Unique characteristics of these patients complicate the management of noncardiac surgical problems. Emergent general surgery (EGS) intervention is often warranted but remains poorly described. We reviewed EGS consultations in LVAD patients to better understand these patients. METHODS: During a 12-year period, 301 LVAD patients were reviewed. Demographics, comorbidities, reason for EGS consultation, operative intervention, transplantation, and mortality were analyzed. Wilcoxon, Fisher's exact, and chi-square t...
Source: The American Surgeon - September 24, 2020 Category: Surgery Authors: Bauman ZM, Cunningham R, Hodson A, Shostrom V, Evans CH, Schlitzkus LL Tags: Am Surg Source Type: research

Prevention of venous thromboembolic events occurring in myeloma patients treated with second-generation novel agents.
Authors: Santoro M, Romano A, Mancuso S, Siragusa S, Di Raimondo F, Martinelli G, Cerchione C Abstract Thrombosis and neoplasms are strictly linked and the diagnosis of a malignancy is a relevant risk factor for venous thromboembolism (VTE). In particular, between gammopathies, the VTE risk is known to be increased in both monoclonal gammopathy of uncertain significance and in multiple myeloma, with a 3- and 9-fold increase respectively, when compared to the general population. The risk appears to be further increased in patients treated with imunomodulating drugs, such as thalidomide, especially when in combinatio...
Source: Panminerva Medica - September 23, 2020 Category: General Medicine Tags: Panminerva Med Source Type: research

Therapeutic Protein Drug Interaction Potential in Subjects With Psoriasis: An Assessment Based on Population Pharmacokinetic Analyses of Sensitive Cytochrome P450 Probe Substrates.
Abstract Elevated cytokine levels in inflammatory diseases are associated with downregulation of certain cytochrome P450 (CYP) enzymes. Upon treatment with some cytokine-targeting therapeutic proteins, the CYP enzymes levels may be restored resulting in therapeutic protein-mediated drug interactions (TP-DI). These analyses characterized the worst-case scenario for CYP1A2, 2C9, and 3A-based TP-DI potential in patients with psoriasis by comparing the pharmacokinetics of probe substrates between healthy volunteers and subjects with moderate to severe psoriasis. Data for the CYP probe substrates midazolam (CYP3A), caf...
Source: The Journal of Clinical Pharmacology - September 22, 2020 Category: Drugs & Pharmacology Authors: Sathe AG, Othman AA, Mohamed MF Tags: J Clin Pharmacol Source Type: research

Phenindione ‐ uncommon Vitamin K antagonist
AbstractWe would like to bring to your readership ’s attention to the drug phenindione. We came across this drug during a COVID‐19 pandemic phone triage at our dental hospital. A 48‐year‐old was referred for the management of a right sided facial swelling related to a carious unrestorable upper right molar. She had a complex medical histo ry, including rheumatic fever, total kidney failure with regular dialysis and was anticoagulated with phenindione following a tricuspid valve replacement as she was allergic to warfarin. When checked, her International Normalized Ratio (INR) was eight, likely due to ...
Source: Oral Surgery - September 21, 2020 Category: ENT & OMF Authors: Sylwia Maria Nowak, Bilal Ahmed, Michael Murphy Tags: LETTER TO THE EDITOR Source Type: research

The Use Of Molecular Docking And Spectroscopic Methods For Investigation Of The Interaction Between Regorafenib With Human Serum Albumin (HSA) And Calf Thymus DNA (Ct-DNA) In The Presence Of Different Site Markers.
CONCLUSION: In conclusion, REG can be delivered by HSA in a circulatory system and affect DNA as potential target. PMID: 32957871 [PubMed - as supplied by publisher] (Source: Protein and Peptide Letters)
Source: Protein and Peptide Letters - September 21, 2020 Category: Biochemistry Authors: Tanzadehpanah H, Mahaki H, Moradi M, Afshar S, Moghadam NH, Salehzadeh S, Najafi R, Amini R, Saidijam M Tags: Protein Pept Lett Source Type: research

Comparison of hospital length of stay of acute ischemic stroke patients with non-valvular atrial fibrillation started on rivaroxaban or warfarin treatment during hospitalization.
Conclusions: The rivaroxaban users had a 3-day shorter LOS-OAC after IPTW-adjustment. Using rivaroxaban was associated with a 4 to 5 days shorter LOS-OAC than using warfarin in patients with mild or moderate stroke, though treatment selection did not have a large impact in patients with severe stroke. PMID: 32936057 [PubMed - as supplied by publisher] (Source: Journal of Medical Economics)
Source: Journal of Medical Economics - September 18, 2020 Category: Health Management Tags: J Med Econ Source Type: research

Comparison of Antithrombotic Strategies in Chinese Patients in Sinus Rhythm after Bioprosthetic Mitral Valve Replacement: Early Outcomes from a Multicenter Registry in China
AbstractObjectivesTo compare antithrombotic strategies in Chinese patients undergoing bioprosthetic mitral valve implantation discharged in normal sinus rhythm.MethodsAt 28 hospitals in China, 1603 patients were followed for 2991.5 person-years. Adverse event and death rates during five postoperative time intervals ( ≤ 30, 31–90, 91–180, 181–365, and 366–730 days) were calculated in patients administered warfarin, aspirin, warfarin + aspirin, or neither treatment.ResultsThromboembolic and hemorrhagic events occurred in 22 (0.74/100 patient-years, 95%CI 0.43 –1.05) and 28 (0.94/100 pati...
Source: Cardiovascular Drugs and Therapy - September 17, 2020 Category: Cardiology Source Type: research

Challenges and Opportunities of Genomic Approaches in Therapeutics Development.
Abstract The magnitude of all therapeutic responses is significantly determined by genome structure, variation, and functional interactions. This determination occurs at many levels which are discussed in the current review. Well-established examples of structural variation between individuals are known to dictate an individual's response to numerous drugs, as clearly illustrated by warfarin. The exponential rate of genomic-based interrogation is coupled with an expanding repertoire of genomic technologies and applications. This is leading to an ever more sophisticated appreciation of how structural variation, reg...
Source: Mol Biol Cell - September 16, 2020 Category: Molecular Biology Authors: Gray JS, Campbell MJ Tags: Methods Mol Biol Source Type: research

The risks and characteristics of the delayed bleeding after endoscopic submucosal dissection for early gastric carcinoma in cases with anticoagulants.
Authors: Saito H, Igarashi K, Hirasawa D, Okuzono T, Suzuki K, Abe Y, Nawata Y, Tanaka Y, Tanaka I, Unno S, Nishikawa Y, Tsubokura M, Nakahori M, Chonan A, Matsuda T Abstract BACKGROUND: Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric carcinoma. Vitamin K antagonists and direct oral anticoagulants (DOAC) were reported to increase the risk of delayed bleeding after ESD. However, the evaluation of ESD cases taking anticoagulants is scarce. We analyzed the risk and characteristics of delayed bleeding after gastric ESD in patients on anticoagulants. METHODS: We performed a...
Source: Scandinavian Journal of Gastroenterology - September 16, 2020 Category: Gastroenterology Tags: Scand J Gastroenterol Source Type: research

Comparisons of Edoxaban versus Warfarin on Levels of Plasma Prothrombin Fragment in Patients with Non-Valvular Atrial Fibrillation
The effect of edoxaban on plasma prothrombin fragment 1+2 (PTF1+2), a sensitive maker of in vivo thrombin generation, has not been fully investigated in non-valvular atrial fibrillation (NVAF). We compared plasma PTF1+2 levels between 25 NVAF patients receiving warfarin and 100 NVAF patients receiving edoxaban and additionally analyzed the association between plasma PTF1+2 levels and the dose of edoxaban. Plasma PTF1+2 levels were significantly higher in patients receiving edoxaban than in those receiving warfarin (141.5 ± 50.0 pmol/l vs 93.1 ± 55.7 pmol/l, p (Source: The American Journal of Cardiology)
Source: The American Journal of Cardiology - September 15, 2020 Category: Cardiology Authors: Akira Tamura, Ena Yamamoto, Yoshiyuki Kawano Source Type: research

Letter to the editor: Discontinuation rates of warfarin versus direct acting oral anticoagulants in clinical practice.
Publication date: Available online 12 September 2020Source: American Heart JournalAuthor(s): Haris Khan, Moghees Hanif, Muhammad Asad Khan, Eushaa Mirza (Source: American Heart Journal)
Source: American Heart Journal - September 14, 2020 Category: Cardiology Source Type: research

Updating the Cost Effectiveness of Oral Anticoagulants for Patients with Atrial Fibrillation Based on Varying Stroke and Bleed Risk Profiles
ConclusionsFrom a US private payer ’s perspective, dabigatran appears cost effective compared with other anticoagulants. This study indicated risk stratification especially considering both stroke and bleed risk simultaneously is important not only in clinical practice but also in health technology assessment exercises among patien ts with atrial fibrillation. (Source: PharmacoEconomics)
Source: PharmacoEconomics - September 14, 2020 Category: Health Management Source Type: research

IJERPH, Vol. 17, Pages 6685: The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years
squo;Athis Alain Putot Jérémy Barben We compared very elderly people taking vitamin K antagonists (VKA) and those not taking VKA (noVKA). Individuals were included in the noVKA group if there was no VKA on their reimbursed prescriptions during the study period. We also compared three subgroups, constituted by VKA type (fluindione, warfarin, or acenocoumarol). We included individuals aged over 85 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for prescribed VKA in September 2017. The VKA and noVKA groups were compared in terms of demographic conditions, re...
Source: International Journal of Environmental Research and Public Health - September 14, 2020 Category: Environmental Health Authors: Patrick Manckoundia Cl émentine Rosay Didier Menu Valentine Nuss Anca-Maria Mihai J érémie Vovelle Gilles Nu émi Philippe d ’Athis Alain Putot J érémy Barben Tags: Article Source Type: research

Major bleeding risk with non ‐vitamin K antagonist oral anticoagulant vs. aspirin in heart failure: network meta‐analysis
ConclusionsIn network meta ‐analysis, apixaban might be associated with a comparable risk of major bleeding compared with aspirin in patients with HF, while other NOACs might be associated with a higher risk. However, such results were not strongly convincing because of lack of direct comparison in an original trial and sma ll sample size of trials and participants. A clinical trial directly comparing apixaban vs. aspirin in patients with HF and sinus rhythm may be worth undertaking. (Source: ESC Heart Failure)
Source: ESC Heart Failure - September 13, 2020 Category: Cardiology Authors: Wen ‐Yi Huang, Jeffrey L. Saver, Yi‐Ling Wu, Chun‐Jen Lin, Meng Lee, Bruce Ovbiagele Tags: Original Research Article Source Type: research

Edoxaban versus Warfarin in Patients with Atrial Fibrillation at the Extremes of Body Weight: An Analysis from the ENGAGE AF-TIMI 48 Trial.
Abstract BACKGROUND:  The effects of anticoagulants at extremes of body weight (BW) are not well described. The aim of this study was to analyze the pharmacokinetics/pharmacodynamics and clinical outcomes in patients randomized to warfarin, higher dose edoxaban (HDER), and lower dose edoxaban (LDER) regimens at extremes of BW in ENGAGE AF-TIMI 48. METHODS AND RESULTS:  We analyzed three BW groups: low BW (LBW: 95th percentile, ≥120 kg, N = 1,093). In the warfarin arm, LBW patients had higher rates of stroke/systemic embolism (SSE: 6.5 vs. 4.7 in MBW vs. 1.6% in HBW, P trend 
Source: Thrombosis and Haemostasis - September 13, 2020 Category: Hematology Authors: Boriani G, Ruff CT, Kuder JF, Shi M, Lanz HJ, Antman EM, Braunwald E, Giugliano RP Tags: Thromb Haemost Source Type: research

ETNA-VTE Europe: Benefits and risks of venous thromboembolism treatment using edoxaban in the first 3  months
The objective of this analysis of the ongoing ETNA-VTE Europe study was to assess the real-world benefits and risks of edoxaban during the first 3  months of treatment, the highest risk period for further VTE events. (Source: Thrombosis Research)
Source: Thrombosis Research - September 11, 2020 Category: Hematology Authors: Giancarlo Agnelli, Ulrich Hoffmann, Philippe Hainaut, Sean Gaine, Cihan Ay, Michiel Coppens, Marc Schindewolf, David Jimenez, Bernd Br üggenjürgen, Pierre Levy, Petra Laeis, Eva-Maria Fronk, Wolfgang Zierhut, Thomas Malzer, Marius Constantin Manu, Paul- Tags: Full Length Article Source Type: research

Comparison of novel oral anticoagulants versus warfarin for post-operative atrial fibrillation after coronary artery bypass grafting
Publication date: Available online 8 September 2020Source: Annals of Medicine and SurgeryAuthor(s): Lucy Manuel, Laura S. Fong, Zhen Hao Ang, Peter Grant (Source: Annals of Medicine and Surgery)
Source: Annals of Medicine and Surgery - September 10, 2020 Category: General Medicine Source Type: research

Anticoagulation Strategies in the Management of Lemierre Syndrome: A Systematic Review of the Literature.
CONCLUSIONS: Anticoagulation is both efficacious and safe in LS, including treatment using a DOAC. Although further studies are needed, clinicians should consider a duration of anticoagulation of 6 to 12 weeks. PMID: 32909436 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)
Source: The Annals of Pharmacotherapy - September 10, 2020 Category: Drugs & Pharmacology Authors: Adedeji A, Chukwura O, Obafemi T, McNulty SB, Reinert JP Tags: Ann Pharmacother Source Type: research

(S029) Managing therapeutic anticoagulation in bariatric surgery patients
ConclusionsBariatric surgery can be safely performed in patients on therapeutic anticoagulation, though this population is at greater risk for bleeding complications in the perioperative period. Meticulous hemostasis in the operating room is the most important aspect of preventing bleeding complications. (Source: Surgical Endoscopy)
Source: Surgical Endoscopy - September 9, 2020 Category: Surgery Source Type: research

Prothrombin Complex Concentrate in Liver Transplant Surgery: Correction of Therapeutic Anticoagulation and the Coagulopathy of End-Stage Liver Disease: Case Series
We report data from these cases including estimated blood loss, presence of complications, duration of ICU stay, and length of hospitalization. Perioperative orthotopic liver transplant hematologic management and a review of relevant literature is presented. (Source: Frontiers in Pharmacology)
Source: Frontiers in Pharmacology - September 8, 2020 Category: Drugs & Pharmacology Source Type: research

Closure Device-Related Thrombosis After Anticoagulation With Dabigatran in Patients Undergoing Percutaneous Left Atrial Appendage Closure: Case Reports and Literature Review
We presented four rare cases of thrombosis formation on the occluder device. After the LAAC operation was successfully performed on patients, they followed a course of anticoagulation with dabigatran (110 mg b.i.d.), and device-related thrombosis (DRT) occurred as indicated by a transesophageal echocardiogram (TEE) during the follow-up period. Regressions were achieved after replacing dabigatran with rivaroxaban or warfarin for more than 1 month. No thrombosis or bleeding-related complications occurred in subsequent follow-ups. (Source: Frontiers in Pharmacology)
Source: Frontiers in Pharmacology - September 8, 2020 Category: Drugs & Pharmacology Source Type: research

Network Meta-analysis Comparing Apixaban versus Rivaroxaban in Morbidly Obese Patients with Atrial Fibrillation
The efficacy and safety of DOACs in morbidly obese patients have been well investigated over the last few years.1-4 Our recent meta-analysis showed that the DOAC group did not increase stroke or systemic embolism (SE) event rate compared to the warfarin group and the DOAC use was significantly associated with a lower major bleeding event rate compared to the warfarin group.5 However, it is still unknown which DOAC is more appropriate than others. Apixaban and rivaroxaban are the two most common DOACs prescribed in the U.S but there is no guidance on which agent should be selected in morbidly obese patients with AF. (Source...
Source: The American Journal of Cardiology - September 8, 2020 Category: Cardiology Authors: Kazuhiko Kido, Mikiko Shimizu, Tsuyoshi Shiga, Masayuki Hashiguchi Source Type: research

Periprocedural and long-term safety and feasibility of direct oral anticoagulants in patients with biological valve undergoing radiofrequency catheter ablation for atrial fibrillation: a prospective multicenter study
ConclusionPeriprocedural and long-term administration of DOACs in patients with biological cardiac valves undergoing AF ablation appears as safe as warfarin therapy. (Source: Journal of Interventional Cardiac Electrophysiology)
Source: Journal of Interventional Cardiac Electrophysiology - September 7, 2020 Category: Cardiology Source Type: research

Evaluation of patients ’ knowledge about oral anticoagulant medicines and use of alert cards by community pharmacists
Conclusion Patients had reasonable knowledge of their anticoagulation therapy, but areas for improvement were identified. Community pharmacists are well placed to optimise the safe use of anticoagulants. (Source: International Journal of Clinical Pharmacy)
Source: International Journal of Clinical Pharmacy - September 7, 2020 Category: Drugs & Pharmacology Source Type: research

Effects of rare CYP2C9 alleles on stable warfarin doses in Chinese Han patients with atrial fibrillation
Pharmacogenomics, Ahead of Print. (Source: Future Medicine: Pharmacogenomics)
Source: Future Medicine: Pharmacogenomics - September 7, 2020 Category: Genetics & Stem Cells Authors: Dongxu Wang Da-Peng Dai Hualan Wu Jia Chong You L ü Ruoyun Yin Xinlong Zhao Anxu Zhao Jiefu Yang Hao Chen Source Type: research

Meningoencephalitis, coronary artery and keratitis as an onset of brucellosis: a case report.
CONCLUSION: Brucellosis can invade nervous system, coronary artery, and cornea. Brucellosis lacks specific signs for clinical diagnosis. The traditional agglutination test and the new mNGS are convenient and effective, which can provide the reference for clinical diagnosis. PMID: 32894070 [PubMed - as supplied by publisher] (Source: Emerging Infectious Diseases)
Source: Emerging Infectious Diseases - September 7, 2020 Category: Infectious Diseases Authors: Geng L, Feng Y, Li D, Nan N, Ma K, Tang X, Li X Tags: BMC Infect Dis Source Type: research

Should patients treated with oral anti-coagulants be operated on within 48  h of hip fracture?
AbstractTo investigate if patients treated with oral anticoagulants (OAC) have delayed surgical intervention (more than 48  h) compared to patients without OAC therapy, and if there is an impact to surgery timing on hospitalization length and mortality. A retrospective cohort study of all patients aged over 65 registered with a new diagnosis of hip fracture who underwent surgery in one of the general hospitals run by C lalit, Israel between 01/01/2014 and 31/12/2017. Data was retrieved for patient demographics, OAC treatment, and Charlson comorbidity index. 5828 patients were operated for hip fractures, mean age was 8...
Source: Journal of Thrombosis and Thrombolysis - September 5, 2020 Category: Hematology Source Type: research

Left atrial appendage thrombus formation in a patient with atrial fibrillation on dabigatran therapy associated with CES1 and ABCB1 genetic polymorphisms: A case report
Rationale: Dabigatran is a direct thrombin inhibitor that is widely used to prevent the formation of thrombus formation. Amiodarone can increase the plasma concentration of dabigatran. CES1 (carboxylesterase 1) and ABCB1 (ATP-binding cassette subfamily B member 1) genetic polymorphisms associate with the pharmacokinetics of dabigatran. Patient concerns: A 62-year-old woman was admitted to the hospital due to chest tightness, fatigue, and discomfort despite long-term anticoagulation with dabigatran 110 mg twice daily for 6 months, with concomitant use of amiodarone. Diagnoses: Left atrial appendage thrombus format...
Source: Medicine - September 4, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Efficacy and Safety of Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Liver Disease: a Meta-Analysis and Systematic Review
AbstractBackgroundLiver disease is associated with increased bleeding risk. The efficacy and safety of direct oral anticoagulants (DOACs) is a subject of contention in atrial fibrillation (AF) patients with liver disease.MethodsElectronic databases (PubMed, Embase, and Cochrane Library) were searched to retrieve studies on the efficacy and safety of DOACs versus warfarin in AF patients with liver disease from January 1980 to April 2020. A meta-analysis was conducted using a random-effects model.ResultsSix studies involving 41,859 patients were included. Compared with warfarin, DOACs demonstrated significant reduction in is...
Source: Cardiovascular Drugs and Therapy - September 3, 2020 Category: Cardiology Source Type: research

Anticoagulant drug utilization pattern and their cost analysis: a retrospective study from Saudi Arabia
ConclusionApixaban was the preferred oral anticoagulant among all the studied anticoagulants, although Warfarin is the cheapest. Therapeutic drug monitoring was recommended for Warfarin. The study highlights the importance of more studies to measure the advantages and disadvantages of all types of anticoagulants. (Source: Journal of Pharmaceutical Health Services Research)
Source: Journal of Pharmaceutical Health Services Research - September 2, 2020 Category: Drugs & Pharmacology Authors: Mohammad Daud Ali, Ayaz Ahmad, Nuzhat Banu, Munfis Patel, Sherihan Ahmad Ghosn, Zainab Eltrafi Tags: Short Communication Source Type: research

Spontaneous Compartment Syndrome of the Lower Extremity in a Patient on Warfarin
No abstract available (Source: American Journal of Therapeutics)
Source: American Journal of Therapeutics - September 1, 2020 Category: Drugs & Pharmacology Tags: Letters to the Editor Source Type: research

ABCA1 Polymorphism Is Associated With the Warfarin-Induced Aortic Stiffness After Coronary Artery Bypass Surgery in the Chinese Population
Abstract: Warfarin is the most widely prescribed oral anticoagulant and is recommended for patients recovering from coronary artery bypass graft (CABG) with atrial fibrillation. Increasing evidence suggested that warfarin increased arterial stiffness in those patients. We aimed to examine the effect of warfarin therapy on aortic stiffness in patients who underwent CABG with or without postoperative warfarin treatment and explored the potential relationships of warfarin therapy with ABCA1 polymorphisms. This was a retrospect observational study of 24 patients who were continuously treated with warfarin were selected as th...
Source: Journal of Cardiovascular Pharmacology - September 1, 2020 Category: Cardiology Tags: Original Article Source Type: research

Multiplexed measurement of variant abundance and activity reveals VKOR topology, active site and human variant impact
Vitamin K epoxide reductase (VKOR) drives the vitamin K cycle, activating vitamin K-dependent blood clotting factors. VKOR is also the target of the widely used anticoagulant drug, warfarin. Despite VKOR ’s pivotal role in coagulation, its structure and active site remain poorly understood. In addition, VKOR variants can cause vitamin K-dependent clotting factor deficiency or alter warfarin response. Here, we used multiplexed, sequencing-based assays to measure the effects of 2,695 VKOR missense v ariants on abundance and 697 variants on activity in cultured human cells. The large-scale functional data, along with an...
Source: eLife - September 1, 2020 Category: Biomedical Science Tags: Genetics and Genomics Source Type: research

Impact of hospitalization and medication switching on post ‐discharge adherence to oral anticoagulants in atrial fibrillation patients
AbstractBackgroundAdherence to chronic medications remains poor in practice. There is limited evidence on how hospitalization affects post ‐discharge adherence to oral anticoagulants (OACs) in individuals with atrial fibrillation (AF). The aim of this study is to examine the impact of hospitalization and medication switching on post‐discharge adherence to OACs in the AF population.MethodsA quasi ‐experimental pre‐post observational study was conducted using United States commercial insurance healthcare claims from the 2009‐2016 OptumTM. AF adults taking OACs who had a random hospitalization occurring after the fi...
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - September 1, 2020 Category: Drugs & Pharmacology Authors: Thanh Phuong Pham Nguyen, Yong Chen, Dylan Thibault, Charles E. Leonard, Sean Hennessy, Allison Willis Tags: ORIGINAL RESEARCH ARTICLE Source Type: research

Concomitant Use of NSAIDs or SSRIs with NOACs Requires Monitoring for Bleeding.
CONCLUSION: When NSAIDs or SSRIs are required for NOAC users with AF, physicians need to monitor bleeding events and consider the use of PPIs, especially for combined use of both drugs or when initiating NOACs treatment. PMID: 32882758 [PubMed - in process] (Source: Yonsei Medical Journal)
Source: Yonsei Medical Journal - September 1, 2020 Category: Universities & Medical Training Authors: Lee MT, Park KY, Kim MS, You SH, Kang YJ, Jung SY Tags: Yonsei Med J Source Type: research

Impact of hospitalization and medication switching on post ‐discharge adherence to oral anticoagulants in atrial fibrillation patients
AbstractBackgroundAdherence to chronic medications remains poor in practice. There is limited evidence on how hospitalization affects post ‐discharge adherence to oral anticoagulants (OACs) in individuals with atrial fibrillation (AF). The aim of this study is to examine the impact of hospitalization and medication switching on post‐discharge adherence to OACs in the AF population.MethodsA quasi ‐experimental pre‐post observational study was conducted using United States commercial insurance healthcare claims from the 2009‐2016 OptumTM. AF adults taking OACs who had a random hospitalization occurring after the fi...
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - September 1, 2020 Category: Drugs & Pharmacology Authors: Thanh Phuong Pham Nguyen, Yong Chen, Dylan Thibault, Charles E. Leonard, Sean Hennessy, Allison Willis Tags: ORIGINAL RESEARCH ARTICLE Source Type: research

Hemostasia after dental extractions in leukemic and anticoagulated patient
Onco-hematological diseases have complex management, including dentistry. Patients taking anticoagulants need to be correctly evaluated. A 36-year-old female patient, with chronic myeloid leukemia, using 5 mg daily warfarin for risk of venous thrombosis, looked for an outpatient dentistry clinic, reporting pain in the region of the teeth 27 and 28. At first, expectant treatment was performed. The pain increased and the patient opted for exodontia instead of endodontic treatment. After discussion with the medical team, warfarin was replaced by heparin as anticoagulant. (Source: Oral Surgery, Oral Medicine, Oral Pathology, O...
Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics - September 1, 2020 Category: ENT & OMF Authors: SUELLEN VIEIRA DO NASCIMENTO, CYNTHIA LARISSA CORDEIRO DE SOUZA, CINTIA BAENA ELCHIN, YURI KALININ, LEVY ANDERSON CESAR ALVES, DENISE CALUTA ABRANCHES Tags: 20190957 Source Type: research

Seasonal Variations in the Incidence of Ischemic Stroke, Extracranial and Intracranial Hemorrhage in Atrial Fibrillation Patients.
CONCLUSIONS: Significant seasonal variations were observed for IS, ECH, and ICH events in AF patients, and were consistently the highest in winter. A small peak of ECH was observed in summer, which seemed, in part, to be related to increased DOAC use. PMID: 32863288 [PubMed - as supplied by publisher] (Source: Circulation Journal)
Source: Circulation Journal - August 28, 2020 Category: Cardiology Authors: Oida M, Suzuki S, Arita T, Yagi N, Otsuka T, Kishi M, Semba H, Kano H, Matsuno S, Kato Y, Uejima T, Oikawa Y, Hoshino S, Matsuhama M, Inoue T, Yajima J, Yamashita T Tags: Circ J Source Type: research

AntagomiR-29b inhibits vascular and valvular calcification and improves heart function in rats.
Abstract We aimed to investigate the role of the miR-29b and its effect on TGF-β3 pathway in vascular and valvular calcification in a rat model of calcific aortic valve diseases (CAVD). A rat model of CAVD was established by administration of warfarin plus vitamin K. The expression levels of miR-29b, osteogenic markers and other genes were determined by qRT-PCR, Western blot and/or immunofluorescence and immunohistochemistry. The calcium content and alkaline phosphatase (ALP) activity were measured. The calcium content, ALP activity and osteogenic markers levels in calcified aorta and aortic valve were augmen...
Source: J Cell Mol Med - August 26, 2020 Category: Molecular Biology Authors: Fang M, Liu K, Li X, Wang Y, Li W, Li B Tags: J Cell Mol Med Source Type: research

A Single-Center Retrospective Evaluation of the Use of Oral Factor Xa Inhibitors in Patients With Cerebral Venous Thrombosis.
CONCLUSIONS: Although the sample size is limited, these findings indicate that oral factor Xa inhibitors are a reasonable treatment option for patients with CVT. There was a trend toward more persistent symptoms in patients on warfarin, suggesting a potential improvement in recovery among patients that received an oral factor Xa inhibitor. PMID: 32844675 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)
Source: The Annals of Pharmacotherapy - August 26, 2020 Category: Drugs & Pharmacology Authors: Powell M, Tremolet de Villers K, Schwarz K, Case D, Trujillo T Tags: Ann Pharmacother Source Type: research

Vitamin K Deficiency: An Emerging Player in the Pathogenesis of Vascular Calcification and an Iatrogenic Consequence of Therapies in Advanced Renal Disease.
Abstract Vascular calcification is a known complication of chronic kidney disease (CKD). The prevalence of vascular calcification in patients with non-dialysis-dependent CKD stages 3-5 has been shown to be as high as 79%. [1] Vascular calcification has been associated with increased risk for mortality, hospital admissions, and cardiovascular disease. [1] [2] [3] [4] Alterations in mineral and bone metabolism play a pivotal role in the pathogenesis of vascular calcification in CKD. As CKD progresses, levels of fibroblast growth factor-23 (FGF-23), parathyroid hormone (PTH) and serum phosphorus increase and 1,25-(OH...
Source: Am J Physiol Renal P... - August 24, 2020 Category: Urology & Nephrology Authors: Levy D, Grewal R, Le TH Tags: Am J Physiol Renal Physiol Source Type: research

Evaluation of inter-patient variability in the pharmacodynamic indices of warfarin.
Authors: Sridharan K, Al Banny R, Qader AM, Ahmed A Abstract OBJECTIVES: Warfarin exhibits huge inter-individual variability in therapeutic response. We assessed the extent and the factors affecting inter-individual variability in the anticoagulation control using pre-validated pharmacodynamic indices. METHODS: Patients receiving warfarin for at least 6 months were recruited. CHA₂DS₂-VASc, HASBLED, SAMe-TT2R2 scores, warfarin sensitive index (WSI), log-INR variability and warfarin composite measure (WCM) were assessed. National Institute for Health and Care Excellence (NICE) guideline was adhered for assess...
Source: Expert Review of Cardiovascular Therapy - August 23, 2020 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

We are heartened by the interest of Drs Zhu and Xu1 in our work.2 Regarding bridging, the medical decision making behind bridging off warfarin comes from active comanagement by our region-wide anticoagulation service. Their current guidelines are aligned with the 2017 American College of Cardiology (ACC) Expert Consensus Decision Pathway, which recommends the consideration of bridging for patients with a moderate to high thrombotic risk (CHA2DS2-VASc of 5 to 6, or 7+).3 In our methods, we stated that we excluded patients who were receiving single-agent therapy with heparin, clopidogrel, and low-molecular-weight heparin. (S...
Source: Gastrointestinal Endoscopy - August 21, 2020 Category: Gastroenterology Authors: Andy Tien, Karl Kwok Tags: Letter to the Editor Source Type: research

Warfarin should be switched to heparin bridging for patients with high thromboembolic risk
We read with great interest the article by Tien et  al.1 The authors presented some new findings indicating that direct oral anticoagulants (DOAC) did not increase the risk of postendoscopic GI bleeding and thromboembolic (TE) events when compared with warfarin, as per the data of a large integrated healthcare system. Endoscopists need to continual ly strike a balance between bleeding and thromboembolism in patients taking anticoagulants. Notably, this research provided evidence for endoscopists regarding anticoagulant management in the preoperative stage, especially for DOAC. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - August 21, 2020 Category: Gastroenterology Authors: He Zhu, Hong Xu Tags: Letter to the Editor Source Type: research

Thromboelastometry-guided anticoagulation reversal in a patient with ventricular assist device with intracranial hemorrhage
We present a case of a 42-year-old male with a VAD and on warfarin who presented to the emergency department with ICH necessitating anticoagulant reversal. An attenuated dose of 15  units/kg of 4-factor prothrombin complex-concentrates (4F-PCC) was given and the patient’s coagulation profile was subsequently assessed using rotational thromboelastometry (ROTEM®) to determine appropriateness of reversal. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Authors: Veronica A. Bonderski, Josue Portillo, Lydia Sharp, Megan A. Rech Source Type: research

Appropriate Dosing Regimens of Non-Vitamin K Antagonist Oral Anticoagulants for Treatment of Patients With Non-Valvular Atrial Fibrillation: An Evidence-Based Consideration
This article summarizes the discrepancy in NOACs management with emphasis on the dosing regimens and influencing factors, such as stroke risk, age, body weight, renal function, gastrointestinal bleeding (GIB) risk, and combination of antiplatelet therapy, in order to identify individual groups with particular clinical characteristics who may obtain more benefit from a certain dosing regimen of NOACs. Determination of a particular subset of patient populations for the appropriate dose regimen of NOACs will help to achieve desired clinical outcomes. Furthermore, to compensate clinical evidence, we should place more emphasis ...
Source: Frontiers in Pharmacology - August 20, 2020 Category: Drugs & Pharmacology Source Type: research

Anticoagulation with warfarin compared to novel oral anticoagulants for atrial fibrillation in adults with transthyretin cardiac amyloidosis: comparison of thromboembolic events and major bleeding
. (Source: Amyloid: The Journal of Protein Folding Disorders)
Source: Amyloid: The Journal of Protein Folding Disorders - August 20, 2020 Category: Biochemistry Authors: Lindsey R. Mitrani Jeffeny De Los Santos Elissa Driggin Rebecca Kogan Stephen Helmke Jeff Goldsmith Angelo B. Biviano Mathew S. Maurer Source Type: research