Anticoagulation Management

Cook, Blaze W

doi:10.1055/s-0030-1267849

Cited by 25 publications

(22 citation statements)

References 8 publications

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“…Protamine was not available at the time of experimentation in this case. Due to the normally relatively short half-life of heparin (∼1.5 h) (41), and the non-linear heparin dose-response and elimination curves, protamine treatment is not always required (42), though may have been helpful in this case.…”

Section: Discussionmentioning

confidence: 99%

Fatal Ovarian Hemorrhage Associated With Anticoagulation Therapy in a Yucatan Mini-Pig Following Venous Stent Implantation

et al. 2020

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Swine models are commonly utilized in endovascular research for development of intravascular interventions and medical device development. As part of a pilot study for a venous vascular stent device, a 5-year-old female Yucatan mini-pig underwent bilateral external iliac vein stent placement under general anesthesia. To reduce thrombotic complications by reduction of thrombus formation on wires, sheaths, and catheters, the pig was heparinized with a total of 300 IU/kg of heparin, establishing an activated clotting time (ACT) of 436 s. The ACT had returned to below 200 s by the end of the procedure. To prevent postoperative thrombosis, the pig received an anticoagulation therapy protocol consisting of enoxaparin, clopidogrel, and aspirin. There were no complications during the immediate postoperative period. However, the pig died 4 days after surgery. Necropsy established the cause of death as abdominal exsanguination due to severe, acute, intra-ovarian hemorrhage, most likely related to ovulation. Life-threatening ovarian hemorrhage is occasionally seen in women with congenital or acquired bleeding disorders; to our knowledge this is the first report of fatal ovarian hemorrhage in an animal enrolled in a pre-clinical research trial.

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Section: Discussionmentioning

confidence: 99%

Fatal Ovarian Hemorrhage Associated With Anticoagulation Therapy in a Yucatan Mini-Pig Following Venous Stent Implantation

et al. 2020

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“…U RELY studiji koja je ispitivala efekte dabigatrana kod AF bolesnika pokazano je da dodavanje jednog ili dva antitrombocitna leka povećava rizik od krvarenja za 60 ili 130 %. Prednosti koje imaju NOAC u odnosu na VKA verovatno se održavaju i u dvojnoj i trojnoj terapiji, ali ova hipoteza do danas nije potvrđena u kliničkim studijama 14 . Tabela 1.…”

Section: Ponovno Uvođenje Antikoagulantne Terapije Posle Uspešne Pciunclassified

“…Važno je napomenuti da je potrebna potpuna individualizacija antitrombocitne i antikoagulantne terapije kod AF bolesnika koji su imali akutni koronarni sindrom (AKS) na osnovu aterotrombotskog, trombooembolijskog rizika i rizika od krvarenja. Oni se određuju na osnovu postojećih GRACE, CHA2DS2-VASc i HAS-BLED skorova 14 .…”

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Oralna antikoagulantna terapija u elektivnim perkutanim koronarnim intervencijama

Tomasević¹,

Aleksandrić²

2014

Srce i krvni sudovi

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Bolesnici koji imaju atrijalnu fibrilaciju (AF), a pripremaju se za elektivnu perkutanu koronarnu intervenciju (PCI), zahtevaju kombinovanu dvojnu antitrombocitnu i oralnu antikoagulantnu terapiju koja se danas naziva trojna antitrombotska terapija. Kod većine ovih bolesnika trojna terapija je neophodna u cilju prevencije arterijskih tromboza i tromboembolijskih komplikacija, naročito moždanog tromboembolizma. Oralni antikoagulantni lekovi ne mogu da zamene dvojnu antitrombocitnu terapiju (DAT) u prevenciji stent tromboze jer u ovom procesu vodeću ulogu imaju trombociti. Sa druge strane, studije ACTIVE-W 1 i BAFTA2 su pokazale da je oralna antikoagulantna terapija (OAKT) daleko superiornija u prevenciji moždanog tromboemboliza kod bolesnika sa AF u odnosu na DAT, jer u formiranju tromba u aurikuli leve pretkomore dominantnu ulogu ima fibrinogen, a ne aktivacija i agregacija trombocita. Danas su nam na raspolaganju brojni novi antitrombocitni i antikoagulantni lekovi, što odluku o načinu njihove istovremene primene čini težom. Od antitrombocitnih lekova, pored dobro poznatih aspirina i klopidogrela, sve su više u upotrebi novi blokatori trombocitnih P2Y12 receptora (prasugrel i tikagrelor). Od oralnih antikoagulantnih lekova, pored vitamin K-antagonista (VKA), sve se više primenjuju direktni inhibitori trombina (dabigatran) i direktni inhibitori faktora Xa (rivaroxaban i apixaban). Način primene ovih lekova i njihove kombinacije se razlikuju pre planirane interventne procedure, u toku same procedure i nakon završene procedure. Kod bolesnika sa AF petostruko raste rizik od moždanog tromboembolizma i isti je bez obzira na tip AF (paroksizmalna, perzistentna, permanentna) [3][4][5][6] . Moždani tromboembolizam je praćen velikom smrtnošću (oko 25 %), dok se kod dve trećine bolesnika javlja trajna nesposobnost [7][8] . Taj rizik nije homogeno raspoređen kod svih bolesnika sa AF, već zavisi od nekoliko faktora koji povećavaju ovaj rizik. Prema najnovijim preporukama Evropskog udruženja kardiologa za lečenje AF (IA preporuka), za procenu rizika od moždanog tromboembolizma koristi se klinički skoring sistem CHA2DS2-VASc skor [3][4] . Na osnovu vrednosti ovog skora donosi se odluka o primeni OAKT kod bolesnika sa AF. Primena OAKT neophodna je kod AF bolesnika kod kojih je CHA2DS2-VASc skor > 1, s tim da vrednosti INR-a (Internacionalni Normalizovan Odnos) treba da budu između 2 i 3, osim kod bolesnika sa veštačkim zaliscima kod kojih vrednosti INR-a treba da budu između 2,5 i 3,5. Kod AF bolesnika čiji je CHA2DS2-VASc skor 0, nije potrebna oralna antikoagulantna terapija [3][4] . Dakle, OAKT je indikovana kod svih bolesnika sa AF osim onih koji imaju mali rizik, mlađi su od 65 godina i nemaju dodatne tromboembolijske faktore rizika 3-4 . Istovremeno, pre uključivanja antikoagulantne terapije, potrebno je kod svih bolesnika sa AF proceniti i rizik od krvarenja, a za procenu ovog rizika koristi se HAS-BLED skor [3][4] . Vrednosti ovog skora > 3 ukazuju na visok rizik od nastanak krvarećih komplikacija. Kod onih bolesnika sa...

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“…Interestingly, it has been demonstrated that selective desulfation of heparin can significantly reduce its anticoagulant activity . Heparin also clears from the bloodstream rapidly, necessitating an increased frequency of administration . Therefore, a heparin formulation that features non‐/low‐anticoagulation and long‐acting properties is desirable and provides for a promising anti‐metastasis agent.…”

Section: Introductionmentioning

confidence: 99%

Non‐Anticoagulant Heparin Prodrug Loaded Biodegradable and Injectable Thermoresponsive Hydrogels for Enhanced Anti‐Metastasis Therapy

Andrgie

Mekuria

Addisu

et al. 2019

Macromolecular Bioscience

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required for successful cancer metastasis are: detachment of cancer cells from the primary mass, invasion of the local host tissue stroma, penetration of local lymphatic and blood vessels, survival during circulation, arrest in the capillaries of other organs, formation of microemboli, extravasation, and proliferation within the organ parenchyma. [8][9][10][11] The main challenges for metastasis treatment are systemic complexity, therapeutic resistance, and difficulty in early diagnosis. [10] Currently, there are no medicines available to specifically prevent cancer cell metastasis, but the development of inhibitory agents that selectively suppress or block metastasis-associated mechanisms provide an alternative for metastatic treatments. [12,13] Anti-metastasis therapy mainly focuses on interrupting the metastatic cascade of tumor cells. Even if the types of therapy depend on the timing of diagnosis, the typical anti-metastasis strategies are designed to block the initiation of metastasis, intercept and eradicate circulating tumor cells, and limit the formation of tumor cell colonies at distant organs. [14] For instance, MMP inhibitors, the Axl kinase inhibitor R428, miR-10b antagonists, and the fascin inhibitor Migrastatin are used as anti-metastatic agents for impairing the initial dissemination events. However effective anti-metastatic therapeutic agents must be capable of destroying the proliferation and survival of already disseminated tumor cells, rather than only seeking to block the exit of these cells from the primary tumor. [8] Treatments that involve a targeted sustained release of chemotherapeutic agents are the most prevalent approach to cancer treatment and inhibition of tumor metastasis. [15] Studies on cancer research have investigated hydrogels, nanoparticles, micelles, and liposomes for enhancing the efficacy of tumor treatment. Current studies on polymer-based tumor therapeutic systems focus on achieving the following goals: 1) providing anti-metastatic effects, 2) specific drug release in the tumor tissue, 3) enhanced antitumor efficacy, and 4) good biocompatibility and biodegradable properties of the nanoparticles. [16] Nevertheless, intravenous administration of therapeutic agents often leads to adverse systemic effects and rapid clearance from the circulating blood. Furthermore, frequent administration of anti-metastatic agents Injectable HydrogelsMetastasis is a pathogenic spread of cancer cells from the primary site to surrounding tissues and distant organs, making it one of the primary challenges for effective cancer treatment and the major cause of cancer mortality. Heparin-based biomaterials exhibit significant inhibition of cancer cell metastasis. In this study, a non-anticoagulate heparin prodrug is developed for metastasis treatment with a localized treatment system using temperature sensitive, injectable, and biodegradable (poly-(ε-caprolactone-co-lactide)-bpoly(ethylene glycol)-b-poly(ε-caprolactone-co-lactide) polymeric hydrogel. The drug molecule (heparin) is conjugated with th...

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Anticoagulation Management

Cited by 25 publications

References 8 publications

Fatal Ovarian Hemorrhage Associated With Anticoagulation Therapy in a Yucatan Mini-Pig Following Venous Stent Implantation

Fatal Ovarian Hemorrhage Associated With Anticoagulation Therapy in a Yucatan Mini-Pig Following Venous Stent Implantation

Oralna antikoagulantna terapija u elektivnim perkutanim koronarnim intervencijama

Non‐Anticoagulant Heparin Prodrug Loaded Biodegradable and Injectable Thermoresponsive Hydrogels for Enhanced Anti‐Metastasis Therapy

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