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Seminars in Neurology Nov 2010The incidence of anticoagulant-associated intracerebral hemorrhage (AAICH) quintupled during the 1990 s, probably due to increased warfarin use for the treatment of... (Review)
Review
The incidence of anticoagulant-associated intracerebral hemorrhage (AAICH) quintupled during the 1990 s, probably due to increased warfarin use for the treatment of atrial fibrillation. Anticoagulant-associated intracerebral hemorrhage now accounts for nearly 20% of all intracranial hemorrhage (ICH). Among patients using warfarin for atrial fibrillation, the annual risk of ICH in trials is 0.3 to 1.0%. Predictors of potential anticoagulant-associated hemorrhage are increasing age, prior ischemic stroke, hypertension, leukoaraiosis, the early period of warfarin use, higher intensity anticoagulation, and antiplatelet use in addition to anticoagulation. Compared with other intracranial hemorrhage patients, anticoagulated patients have a greater risk of hematoma expansion, subsequent clinical deterioration and death, necessitating vigorous reversal of their coagulopathy. Recommended methods of warfarin reversal are administration of intravenous vitamin K and either prothrombin complex concentrates or fresh frozen plasma. Reversal of unfractionated heparin is accomplished with intravenous protamine sulfate. Surgical treatment of intracranial hemorrhage may be life saving in select cases, but has not reduced morbidity or mortality in large randomized trials.
Topics: Anticoagulants; Blood Pressure; Cerebral Hemorrhage; Hemostatic Techniques; Humans; Neurosurgical Procedures; Risk Factors; Treatment Outcome
PubMed: 21207349
DOI: 10.1055/s-0030-1268866 -
Journal of Materials Chemistry. B Jun 2023Extracorporeal membrane oxygenation (ECMO) is an invasive and last-resort treatment for circulatory and respiratory failure. Prolonged ECMO support can disrupt the... (Review)
Review
Extracorporeal membrane oxygenation (ECMO) is an invasive and last-resort treatment for circulatory and respiratory failure. Prolonged ECMO support can disrupt the coagulation and anticoagulation systems in a patient, leading to adverse consequences, such as bleeding and thrombosis. To address this problem, anticoagulation coatings have been developed for use in ECMO circuits. This article reviews commonly used commercial and novel anticoagulant coatings developed in recent years and proposes a new classification of coatings based on the current state. While commercial coatings have been used clinically for decades, this review focuses on comparing the effectiveness and stability of coatings to support clinical selections. Furthermore, novel anticoagulation coatings often involve complex mechanisms and elaborate design strategies, and this review summarises representative studies on mainstream anticoagulation coatings to provide a point of reference for future studies.
Topics: Humans; Anticoagulants; Extracorporeal Membrane Oxygenation; Blood Coagulation; Thrombosis; Hemorrhage
PubMed: 37183615
DOI: 10.1039/d3tb00471f -
The Cochrane Database of Systematic... Jan 2016Acute pulmonary embolism (PE) is a common cause of death, accounting for 50,000 to 200,000 deaths annually. It is the third most common cause of mortality among the... (Review)
Review
BACKGROUND
Acute pulmonary embolism (PE) is a common cause of death, accounting for 50,000 to 200,000 deaths annually. It is the third most common cause of mortality among the cardiovascular diseases, after coronary artery disease and stroke.The advent of multi-detector computed tomographic pulmonary angiography (CTPA) has allowed better assessment of PE regarding visualisation of the peripheral pulmonary arteries, increasing its rate of diagnosis. More cases of peripheral PEs, such as isolated subsegmental PE (SSPE) and incidental PE, have thereby been identified. These two conditions are usually found in patients with few or none of the classic PE symptoms such as haemoptysis or pleuritic pain, acute dyspnoea or circulatory collapse. However, in patients with reduced cardio-pulmonary (C/P) reserve the classic PE symptoms can be found with isolated SSPEs. Incidental SSPE is found casually in asymptomatic patients, usually by diagnostic imaging performed for other reasons (for example routine CT for cancer staging in oncologic patients).Traditionally, all PEs are anticoagulated in a similar manner independent of the location, number and size of the thrombi. It has been suggested that many patients with SSPE may be treated without benefit, increasing adverse events by possible unnecessary use of anticoagulants.Patients with isolated SSPE or incidental PE may have a more benign clinical presentation compared with those with proximal PEs. However, the clinical significance in patients and their prognosis have to be studied to evaluate whether anticoagulation therapy is required.This review is an update of a Cochrane systematic review first published in 2014.
OBJECTIVES
To assess the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE.
SEARCH METHODS
The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (last searched December 2015) and CENTRAL (2015, Issue 11). MEDLINE, EMBASE, LILACS and clinical trials databases were also searched.
SELECTION CRITERIA
Randomised controlled trials of anticoagulation therapy versus no intervention in patients with SSPE or incidental SSPE.
DATA COLLECTION AND ANALYSIS
Two review authors inspected all citations to ensure reliable selection. We planned for two review authors to independently extract data and to assess the methodological quality of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions.
MAIN RESULTS
No studies were identified that met the inclusion criteria.
AUTHORS' CONCLUSIONS
There is no randomised controlled trial evidence for the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE, and therefore we can not draw any conclusions. Well-conducted research is required before informed practice decisions can be made.
Topics: Anticoagulants; Humans; Pulmonary Embolism; Watchful Waiting
PubMed: 26756331
DOI: 10.1002/14651858.CD010222.pub3 -
Hematology. American Society of... Dec 2022Estrogen exposure, in the setting of pregnancy, the postpartum state, combined hormonal contraceptives (CHCs), or hormone therapy use, has been clearly associated with...
Estrogen exposure, in the setting of pregnancy, the postpartum state, combined hormonal contraceptives (CHCs), or hormone therapy use, has been clearly associated with increased rates of venous thromboembolism (VTE). Although recurrence rates are low in these settings, up to 70% of anticoagulated menstruating individuals experience abnormal or heavy menstrual bleeding (HMB), which commonly results in iron deficiency with or without anemia. Patients taking rivaroxaban appear to experience higher rates of HMB compared with those on apixaban, dabigatran, or warfarin. HMB can often be diagnosed in a single visit with a good menstrual history assessing for factors with a known association with increased or heavy bleeding, such as changing pads or tampons more often than every 2 hours, clots larger than a quarter, and iron deficiency (ferritin <50 ng/mL). HMB can be managed with hormonal therapies, including those associated with VTE risk, such as CHCs and depot-medroxyprogesterone acetate (DMPA). In many cases, continuing CHCs or DMPA while a patient is therapeutically anticoagulated is reasonable, so long as the therapy is discontinued before anticoagulation is stopped. Modification of the anticoagulation regimen, such as decreasing to a prophylactic dose in the acute treatment period, is not currently recommended. For patients who are currently pregnant, low-molecular-weight heparin (LMWH) is still standard of care during pregnancy; routine monitoring of anti-factor Xa levels is not currently recommended. Warfarin or LMWH may be considered in the postpartum setting, but direct-acting oral anticoagulants are currently not recommended for lactating patients.
Topics: Pregnancy; Humans; Female; Heparin, Low-Molecular-Weight; Lactation; Anticoagulants; Venous Thromboembolism; Warfarin; Menorrhagia; Iron Deficiencies
PubMed: 36485151
DOI: 10.1182/hematology.2022000401 -
Current Clinical Pharmacology 2017The prevalence of anticoagulant use has increased in the United States. Medical providers have the responsibility to explain to patients the management of anticoagulant... (Review)
Review
BACKGROUND
The prevalence of anticoagulant use has increased in the United States. Medical providers have the responsibility to explain to patients the management of anticoagulant regimens before an invasive procedure. The pharmacologic characteristics of these medications, specifically their half-lives, are important in timing an interruption of anticoagulant therapy.
OBJECTIVE
The authors review the current guidelines and recommendations for therapeutic interruption of anticoagulants and the involved pharmacologic factors.
METHODS
Guidelines and other literature are summarized with discussion on the pharmacology of each medication. Recommendations on how and when to provide bridging for anticoagulants are discussed. Newer oral anticoagulants also are discussed, along with interruption recommendations.
RESULTS
Literature reveals a conservative approach for using bridging when anticoagulation is interrupted because of higher risks of bleeding. Caution is advised when resuming anticoagulant therapy when neuraxial anesthesia is used.
CONCLUSION
Perioperative healthcare providers need to balance risks and benefits of anticoagulant therapy with its interruption preoperatively.
Topics: Administration, Oral; Anesthesia, Local; Anticoagulants; Drug Administration Schedule; Half-Life; Hemorrhage; Humans; Perioperative Care; Time Factors
PubMed: 28828987
DOI: 10.2174/1574884712666170822092709 -
The Cochrane Database of Systematic... Apr 2014Acute pulmonary embolism (PE) is a common cause of death, accounting for 50,000 to 200,000 deaths annually. It is the third most common cause of mortality among the... (Review)
Review
BACKGROUND
Acute pulmonary embolism (PE) is a common cause of death, accounting for 50,000 to 200,000 deaths annually. It is the third most common cause of mortality among the cardiovascular diseases, after coronary artery disease and stroke.The advent of multi-detector computed tomographic pulmonary angiography (CTPA) has allowed better assessment of PE regarding visualisation of the peripheral pulmonary arteries, increasing its rate of diagnosis. More cases of peripheral PEs, such as isolated subsegmental PE (SSPE) and incidental PE, have thereby been identified. These two conditions are usually found in patients with few or none of the classic PE symptoms such as haemoptysis or pleuritic pain, acute dyspnoea or circulatory collapse. However, in patients with reduced cardio-pulmonary (C/P) reserve the classic PE symptoms can be found with isolated SSPEs. Incidental SSPE is found casually in asymptomatic patients, usually by diagnostic imaging performed for other reasons (for example routine CT for cancer staging in oncologic patients).Traditionally, all PEs are anticoagulated in a similar manner independent of the location, number and size of the thrombi. It has been suggested that many patients with SSPE may be treated without benefit, increasing adverse events by possible unnecessary use of anticoagulants.Patients with isolated SSPE or incidental PE may have a more benign clinical presentation compared with those with proximal PEs. However, the clinical significance in patients and their prognosis have to be studied to evaluate whether anticoagulation therapy is required.
OBJECTIVES
To assess the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE.
SEARCH METHODS
The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2013) and CENTRAL (2013, Issue 9). MEDLINE, EMBASE, LILACS and clinical trials databases were also searched (October 2013).
SELECTION CRITERIA
Randomised controlled trials of anticoagulation therapy versus no intervention in patients with SSPE or incidental SSPE.
DATA COLLECTION AND ANALYSIS
Two review authors inspected all citations to ensure reliable selection. We planned for two review authors to independently extract data and to assess the methodological quality of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions.
MAIN RESULTS
No studies were identified that met the inclusion criteria.
AUTHORS' CONCLUSIONS
There is no randomised controlled trial evidence for the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE, and therefore we can not draw any conclusions. Well-conducted research is required before informed practice decisions can be made.
Topics: Anticoagulants; Humans; Pulmonary Embolism; Watchful Waiting
PubMed: 24771493
DOI: 10.1002/14651858.CD010222.pub2 -
Hematology. American Society of... Nov 2018The direct oral anticoagulants (DOACs) have a wide therapeutic index, few drug interaction, no dietary interactions and do not require dose adjustment according to the... (Review)
Review
The direct oral anticoagulants (DOACs) have a wide therapeutic index, few drug interaction, no dietary interactions and do not require dose adjustment according to the results of routine coagulation testing. Despite these advantages over warfarin, the DOACs remain high risk medications. There is evidence that non-adherence, off-label dosing and inadequate care transitions during DOAC therapy increase the risk of bleeding and thromboembolic complications. Although DOACs are approved for a growing number of indications, there remain patient populations who are not good candidates. Existing expertise within an Anticoagulation Management Service (AMS) should be leveraged to optimize all anticoagulant therapies including the DOACs. The AMS can facilitate initial drug therapy selection and dose management, reinforce patient education and adherence as well as managing drug interactions and invasive procedures. In the event that a transition to warfarin is warranted, the AMS is already engaged which limits the risk of fragmented patient care and ensures that therapeutic anticoagulation is re-established in a timely manner. The AMS of the future will provide comprehensive management for all patients receiving anticoagulant medications and continue to provide anticoagulation expertise to the healthcare team.
Topics: Administration, Oral; Anticoagulants; Drug Monitoring; Humans; Warfarin
PubMed: 30504331
DOI: 10.1182/asheducation-2018.1.348 -
Romanian Journal of Morphology and... 2019Patients with anticoagulant therapy have a high thromboembolic risk. Due to the rich oro-maxillofacial vasculature and the fact that some dental procedures may cause a... (Review)
Review
Patients with anticoagulant therapy have a high thromboembolic risk. Due to the rich oro-maxillofacial vasculature and the fact that some dental procedures may cause a bleeding, the physician should be able to correlate this risk with the hemorrhagic risk. Dental procedures are a trigger for psychic stress. One of the most important changes in acute stress is in cardiovascular system. In healthy patients, these changes are reversible and have no significant consequences, but in patients with cardiovascular diseases, the response to the catecholamine stress can cause organic lesions resulting in an acute myocardial infarction or stroke. This review explores in a concise manner the biochemical changes concerning anticoagulation and thrombolytic treatment in dental procedures.
Topics: Anticoagulants; Dental Care; Humans; Thrombolytic Therapy
PubMed: 31658312
DOI: No ID Found -
Journal of Veterinary Pharmacology and... Jan 2022Our study objective was to identify a subcutaneous enoxaparin dosage that provided a consistent anticoagulant intensity in dogs. Our hypotheses were that a dose of...
Our study objective was to identify a subcutaneous enoxaparin dosage that provided a consistent anticoagulant intensity in dogs. Our hypotheses were that a dose of 0.8 mg/kg would provide inconsistent anticoagulation, a higher dose would provide consistent anticoagulation over a greater duration of time, and viscoelastometry would effectively monitor the anticoagulant status. Six healthy dogs received two subcutaneous enoxaparin doses (0.8 and 2 mg/kg) for anti-Xa activity determinations and pharmacokinetic modeling. Based on calculations derived from these results, 1.3 mg/kg, SC, q8 h was administered for seven doses. Target ranges for anticoagulant intensity were defined as anti-Xa activity of 0.5-1 U/ml, and change from baseline of two viscoelastometric parameters: activated clotting time (ΔACT; ≥40 s), and clot rate (CRpost; ≤20 U/min). Following an initial injection at 1.3 mg/kg, anti-Xa activity of 5/6 dogs reached or exceeded the target range. Following the final dose, anti-Xa activity reached or exceeded the target range in all dogs, and ΔACT and CRpost values exceeded target for 2-6 and 4-12 h, respectively. At an enoxaparin dosage of 1.3 mg/kg, SC, q8 h, anti-Xa activity was consistently above the minimum threshold of the target range; however, the safety of this dosage remains to be determined.
Topics: Animals; Anticoagulants; Blood Coagulation; Dogs; Enoxaparin; Injections, Subcutaneous
PubMed: 34622463
DOI: 10.1111/jvp.13015 -
Hematology. American Society of... Nov 2018Traditionally, the athlete who requires long-term anticoagulation has been told to forgo participation in contact and collision sports. However, a strategy of short-term... (Review)
Review
Traditionally, the athlete who requires long-term anticoagulation has been told to forgo participation in contact and collision sports. However, a strategy of short-term interruption of anticoagulant therapy may be designed for some athletes, allowing them return to full athletic activity. A personalized pharmacokinetic/pharmacodynamic study of a direct oral anticoagulant (DOAC) may allow athletic participation when plasma drug concentration is minimal and resumption of treatment after the risk of bleeding sufficiently normalizes. Scientific data and uncertainties regarding this approach, as well as practical challenges in the implementation, will be discussed.
Topics: Administration, Oral; Anticoagulants; Athletes; Drug Monitoring; Female; Hemorrhage; Humans; Male; Risk Factors; Sports Medicine
PubMed: 30504340
DOI: 10.1182/asheducation-2018.1.412