Safety of venous thromboembolism prophylaxis with fondaparinux in ischemic stroke

Hackett, Chris; Ramanathan, Ramnath Santosh; Malhotra, Konark; Quigley, Matthew R.; Kelly, Kenneth G.; Tian, Melissa; Protetch, Jack; Wong, Cecillia Y; Wright, Brad; Tayal, Ashis H

doi:10.1016/j.thromres.2014.11.041

Cited by 13 publications

(5 citation statements)

References 25 publications

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“…porównali efekty stosowania heparyny niefrakcjonowanej (5000 IU/8h) i fondaparynuksu (2,5 mg/dobę) w profilaktyce żylnej choroby zatorowo-zakrzepowej u pacjentów z ostrym UNM. Wykazali, że podawanie fondaparynuksu nie wpływa na zwiększenie ryzyka wystąpienia poważnych krwawień, jak również na poprawę parametrów klinicznych w porównaniu ze standardową profilaktyką z użyciem heparyny [62].…”

Section: Pośrednie Inhibitory Aktywnego Czynnika Xaunclassified

Leczenie Antykoagulacyjne W Ostrych Zespołach Wieńcowych I Udarze Niedokrwiennym Mózgu

Cichoń¹,

Lach²,

Saluk‐Bijak³

et al. 2017

pps

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Choroby układu krążenia, w tym ostre zespoły wieńcowe oraz udary niedokrwienne mózgu, stanowią poważny problem współczesnej medycyny. Rocznie w Europie z tego powodu dochodzi do 4 milionów zgonów. Wspólną cechą wymienionych schorzeń jest podłoże niedokrwienne, tym samym postępowanie terapeutyczne obejmuje stosowanie leków o podobnym mechanizmie działania przeciwzakrzepowego. Wyróżnia się leczenie przeciwpłytkowe oraz antykoagulacyjne. Celem stosowania antykoagulantów jest prewencja incydentów zatorowo-zakrzepowych przez hamowanie aktywności enzymów kaskady krzepnięcia, do których zalicza się antagonistów witaminy K, inhibitory trombiny (pośrednie i bezpośrednie) oraz inhibitory czynnika Xa. W niniejszej pracy omówiono aktualny stan wiedzy na temat leczenia przeciwzakrzepowego u pacjentów po ostrym zespole wieńcowym oraz udarze niedokrwiennym mózgu, a także różnice i podobieństwa w algorytmie postępowania.

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Section: Pośrednie Inhibitory Aktywnego Czynnika Xaunclassified

Leczenie Antykoagulacyjne W Ostrych Zespołach Wieńcowych I Udarze Niedokrwiennym Mózgu

Cichoń¹,

Lach²,

Saluk‐Bijak³

et al. 2017

pps

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“…Fondaparinux is a selective factor Xa inhibitor that prevents the conversion of prothrombin to thrombin. [12] Direct oral anticoagulants (DOACs) include dabigatran and factor Xa inhibitors. Dabigatran etexilate is an oral prodrug that disrupts the coagulation cascade and inhibits the formation of clots by offering reversible and direct inhibition of direct thrombin.…”

Section: Introductionmentioning

confidence: 99%

Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice: a critical assessment and summary of the clinical practice guidelines

et al. 2020

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Purpose:The perioperative management of patients who are receiving antithrombotic (antiplatelet or anticoagulant) therapy and require urologic surgery is challenging due to the inherent risk for surgical bleeding and the need to minimize thromboembolic risk. The aim of this review is to assess the quality and consistency of clinical practice guidelines (CPGs) and clinical practice recommendations (CPRs) on this topic, and to summarize the evidence and associated strength of recommendations relating to perioperative antithrombotic management. Methods: A pragmatic search of electronic databases and guidelines websites was performed to identify relevant CPGs/CPRs. The AGREE II (Appraisal of Guidelines for REsearch and Evaluation) instrument was used to assess the methodological quality and integrity of the CPGs. Results: The CPGs provided by the European Association of Urology (EAU), the American College of Chest Physicians (ACCP) and the European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA), and the CPRs provided by the International Consultation on Urological Disease (ICUD)/American Urologic Association (AUA) were retrieved and reviewed. The 3 CPGs were critically assessed using the AGREE II instrument. Inconsistent recommendations were provided based on the indication for antithrombotic medication, the antiplatelet/anticoagulant agent and the type of urological procedure. Based on the AGREE II tool for CPG assessment, the EAU CPGs scored higher (83.3 points) compared to the ESC/ESA (75 points) and ACCP CPG (66.7 points). Conclusion:The perioperative management of antithrombotic therapy in urological patients is potentially challenging but inconsistent CPG of varying quality may create uncertainty as to best practices to minimize thromboembolic and bleeding risk.

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“…[3] Hemorrhage within an ischemic stroke can dictate the timing of antithrombotic treatment for the prevention of recurrent thromboembolic events. [45] Intraparenchymal blood can be accurately detected using gradient echo (GRE) sequence of magnetic resonance imaging (MRI), that is sensitive to static magnetic field inhomogeneity (T2-sensitive). [6]…”

Section: Introductionmentioning

confidence: 99%

Interaction of incidental microbleeds and prior use of antithrombotics with early hemorrhagic transformation: Causative or protective?

Malhotra

Khunger

Ouyang

et al. 2016

Ann Indian Acad Neurol

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Background:Gradient echo (GRE) sequence of magnetic resonance imaging (MRI) is a sensitive tool to detect hemorrhagic transformation (HT) and old cerebral microbleeds (CMBs). Presence of CMBs and prior use of antithrombotics pose a risk of HT in ischemic stroke. We evaluated the association of CMBs and antithrombotic use with resultant HT in acute ischemic stroke (AIS).Methods:This retrospective study included AIS patients admitted to our center between January 2009 and August 2010 who underwent GRE-weighted MRI within 48 h of admission. Demographic and clinical data including diabetes mellitus, hypertension, hyperlipidemia, prior intake of antiplatelets/anticoagulants/statins, and presence of CMBs at admission were collected and compared between patients who developed HT and those who did not. We did a multivariate analysis using logistic regression to assess the effect of CMBs and prior use of antithrombotic agents on the risk of development for early HT in ischemic stroke.Results:Of 529 AIS patients, 81 (15%) were found to have HT during the initial hospital course. CMBs were found in only 9 of 81 patients (11%) with HT and in 40 out of remaining 448 patients (9%) who did not develop HT. The presence of CMBs was not associated with increased risk of HT (P = 0.53). However, prior use of antiplatelets (33% vs. 47% in the patients without HT, P = 0.02) was associated with decreased risk of HT in ischemic stroke.Conclusion:Presence of incidental CMBs was not associated with increased risk for early HT of an ischemic stroke. Interestingly, the prior intake of antiplatelets was found to be protective against HT of ischemic stroke.

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Safety of venous thromboembolism prophylaxis with fondaparinux in ischemic stroke

Abstract: Fondaparinux is not associated with increased hemorrhagic complications compared with UFH in patients with ischemic stroke. There were low rates of symptomatic VTE in both groups.

Cited by 13 publications

References 25 publications

Leczenie Antykoagulacyjne W Ostrych Zespołach Wieńcowych I Udarze Niedokrwiennym Mózgu

Leczenie Antykoagulacyjne W Ostrych Zespołach Wieńcowych I Udarze Niedokrwiennym Mózgu

Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice: a critical assessment and summary of the clinical practice guidelines

Interaction of incidental microbleeds and prior use of antithrombotics with early hemorrhagic transformation: Causative or protective?

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