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Specialty: Emergency Medicine
Condition: Bleeding
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Total 109 results found since Jan 2013.
Preclinical and clinical data for factor Xa and “Universal” reversal agents
Oral Factor Xa (FXa) inhibitors, a growing class of direct-acting anticoagulants, are frequently used to prevent stroke and systemic embolism in patients with atrial fibrillation and to prevent and treat venous thromboembolism. These drugs reduce the risk of clotting at the expense of increasing the risk of bleeding, and currently they have no specific reversal agent. However, andexanet alfa, a recombinant modified FXa decoy molecule, is in a late-phase clinical trial in bleeding patients, and ciraparantag, a small molecule that appears to reverse many anticoagulants including the FXa inhibitors, is in development.
Source: The American Journal of Emergency Medicine - September 27, 2016 Category: Emergency Medicine Authors: Truman J. Milling, Scott Kaatz Tags: Review Source Type: research
Safety of Direct Oral Anticoagulants: Insights from Postmarketing Studies
Direct oral anticoagulants (DOACs) have been marketed in the United States since 2010. While numerous large-scale prospective phase 3 outcomes studies have documented the effectiveness of DOACs for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, the primary safety concern with all of these drugs —as it is with the more established oral anticoagulant warfarin—is the risk of major bleeding. Postmarketing surveillance studies (PMSS) provide the opportunity to evaluate the safety of these recently approved drugs across a spectrum of patients that may be broader than those in...
Source: The American Journal of Emergency Medicine - September 27, 2016 Category: Emergency Medicine Authors: Todd C. Villines, W. Frank Peacock Tags: Review Source Type: research
Moderate Hypothermia Improves Cardiac and Vascular Function in a Pig Model of Ischemic Cardiogenic Shock Treated With Veno-Arterial ECMO
In conclusion, moderate and rapid hypothermia improves hemodynamics and cardiac and vascular function in a pig model of ischemic CS treated with ECMO.
Source: Shock - January 14, 2017 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
Pre-hospital ct diagnosis of subarachnoid hemorrhage
Subarachnoid hemorrhage (SAH) is associated with higher mortality in the acute phase than other stroke types. There is a particular risk of early and devastating re-bleeding. Patients therefore need urgent ass...
Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine - February 28, 2017 Category: Emergency Medicine Authors: Maren Ranhoff Hov, Annette Ryen, Katrine Finsnes, Janne Storflor, Thomas Lindner, Jostein Gleditsch and Christian Georg Lund Source Type: research
Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients
AbstractDabigatran etexilate (DE) is a direct thrombin inhibitor, which has been approved for the treatment of non-valvular atrial fibrillation (AF), and for the prevention and treatment of venous thromboembolism (VTE). Despite large randomized clinical trials and independent observational studies providing robust data concerning DE safety and efficacy, some physicians still perceive mild-to-moderate renal impairment and old age as a relative contraindication to its use. In this article, we review the available scientific evidence supporting the use of DE in these clinical situations. Patients with AF and chronic kidney di...
Source: Internal and Emergency Medicine - April 24, 2017 Category: Emergency Medicine Source Type: research
Is it reasonable to use a lower DOAC dose in some patients with VTE? NO
AbstractThe international guidelines recommend the use of direct oral anticoagulants (DOACs) over vitamin K antagonists for anticoagulation long-term therapy in patients diagnosed with venous thromboembolism (VTE), and for stroke prevention in patients with non-valvular atrial fibrillation (AF). Efficacy and safety of DOACS have been extensively evaluated in large phase III trials. According to the product label, dose reductions of DOACs are recommended for patients with AF and renal impairment, low body weight and concomitant use of interfering medications. Except for Edoxaban, dose reductions of DOACs are not recommended...
Source: Internal and Emergency Medicine - June 27, 2017 Category: Emergency Medicine Source Type: research
Management of Factor Xa inhibitor-associated life-threatening major hemorrhage: A retrospective multi-center analysis
This study describes a cohort of patients with FXa inhibitor-associated life-threatening bleeding events, their clinical characteristics, interventions and outcomes.
Source: The American Journal of Emergency Medicine - August 19, 2017 Category: Emergency Medicine Authors: Truman J. Milling, Carol L. Clark, Charles Feronti, Shlee S. Song, Sam S. Torbati, Gregory J. Fermann, Jeffrey Weiss, Dony Patel Source Type: research
Anticoagulation therapy among patients presenting to the emergency department with symptomatic atrial fibrillation – the FinFib2 study
Conclusion: These data showed that OAC was prescribed frequently to patients with symptomatic AF and risk factors for stroke. However, in patients using warfarin, international normalized ratio was not at the therapeutic level in a large proportion of the patients with previously diagnosed AF.
Source: European Journal of Emergency Medicine - August 30, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research
Direct Oral Anticoagulant or Warfarin Related Major Bleeding
Recent years have marked the development of antithrombotic agents besides warfarin in the prevention of stroke in patients with atrial fibrillation. Initial studies have demonstrated equal or lower mortality following major bleeding related to Direct Oral Anticoagulants (DOACs) when compared with warfarin despite the lack of reversal agents early on. A major limitation of these studies was a low rate of warfarin reversal (
Source: The Journal of Emergency Medicine - November 1, 2017 Category: Emergency Medicine Authors: Tara Garland Tags: Abstract Source Type: research
Is it an Emergency? Insurer Asks Patients to Question ED Visits
INDIANAPOLIS (AP) — Alison Wrenne was making waffles for her two young children one morning when abdominal pain forced her to the floor. A neighbor who is a physician assistant urged her to go to the emergency room.
Wrong decision, according to her health insurer. Wrenne was diagnosed with a ruptured ovarian cyst, but Anthem said that wasn't an emergency and stuck her with a $4,110 bill.
"How are you supposed to know that?" said the 34-year-old from Lexington, Kentucky. "I'm not a doctor ... that's what the emergency room is for."
In an effort to curb unnecessary and costly ER visits, the Blue Cross-B...
Source: JEMS Patient Care - November 10, 2017 Category: Emergency Medicine Authors: Tom Murphy, Associated Press Tags: Patient Care News Administration and Leadership Source Type: news
The Role of Thromboelastography Testing in the Emergency Medicine, Trauma Center, and Critical Care Environments
AbstractPurpose of ReviewThromboelastography (TEG) has been gaining attention for its potential use in a variety of disease of states to guide therapies and determine prognosis. This review will explore recent research specifically regarding the use of thromboelastography in the emergency, trauma, and critical care clinical environments.Recent FindingsThromboelastography has its drawbacks. TEG has wide operator and machine variability. Known coagulopathic states may exhibit normal viscoelastic results, indicating inconsistent results. Thromboelastography has shown to decrease transfusion of blood products in traumatic hemo...
Source: Current Emergency and Hospital Medicine Reports - February 15, 2018 Category: Emergency Medicine Source Type: research
In Loudon County, Tenn., Priority Ambulance Trains More Than 110 Residents to Stop the Bleed
Last week, Priority Ambulance and Fort Loudoun Medical Center observed the national Stop the Bleed initiative with training events and donations that targeted Loudon County schools and the general public.
In total, more than 110 Loudon County community members were trained in lifesaving bleeding control techniques, including 40 teachers who serve as a medical first response team at each high school. Priority Ambulance and Fort Loudoun also donated bleeding control kits, which include gauze, gloves, tourniquet and trauma shears, to each public and private elementary, middle and high school in Loudon County. The kits will be...
Source: JEMS Administration and Leadership - April 3, 2018 Category: Emergency Medicine Authors: Priority Ambulance Tags: News Administration and Leadership Source Type: news
