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[PMID]: 29524860
[Au] Autor:Becattini C; Dentali F; Camporese G; Sembolini A; Rancan E; Tonello C; Manina G; Padayattil S; Agnelli G
[Ad] Address:Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Italy. Electronic address: cecilia.becattini@unipg.it.
[Ti] Title:Carotid atherosclerosis and risk for ischemic stroke in patients with atrial fibrillation on oral anticoagulant treatment.
[So] Source:Atherosclerosis;271:177-181, 2018 Mar 02.
[Is] ISSN:1879-1484
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:BACKGROUND AND AIMS: Whether carotid atherosclerosis is associated with an increased risk for ischemic stroke in patients with atrial fibrillation (AF) on anticoagulant treatment is undefined. To explore this association, patients with AF on treatment with vitamin K antagonists were included in a multicenter, prospective study. METHODS: At inclusion in the study, patients underwent Doppler-ultrasonography for the assessment of carotid atherosclerosis and then were prospectively followed. Ischemic stroke or transient ischemic attack (TIA) were the primary study outcomes; death and its causes were reported. RESULTS: Overall, 587 patients were included in the study. At ultrasonography, 380 patients had carotid atherosclerosis (64.7%) and 45 internal carotid (ICA) stenosis ≥50% (7.7%). During a mean follow-up of 41 ±â€¯15 months, 30 patients had an ischemic stroke or TIA (1.49% per patient-year, 95% CI 0.96-2.03) and 81 patients died (4.01% per patient-year, 95% CI 3.16-4.86). Carotid atherosclerosis was associated with a significant increase in the risk for the composite of ischemic stroke or TIA or death after adjusting for CHA DS VASc (6.0% vs. 3.1% patient-year; HR 1.60, 95% CI 0.99-2.59; p = 0.05). ICA ≥50% was associated with a not significant increase in the risk of ischemic stroke or TIA (2.05% vs. 1.45% patient-year; HR 1.39, 95% CI 0.42-4.58) or all-cause death (6.1% vs. 3.8% patient-year; HR 1.66, 95% CI 0.83-3.32). CONCLUSIONS: In patients with AF, carotid atherosclerosis is a predictor for the composite of cerebrovascular events or death while on anticoagulant therapy. In patients with AF and carotid atherosclerosis, the clinical benefit of a more intense antithrombotic treatment should be evaluated.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 70665 MEDLINE  
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[PMID]: 29523536
[Au] Autor:Popoola VO; Lau BD; Tan E; Shaffer DL; Kraus PS; Farrow NE; Hobson DB; Aboagye JK; Streiff MB; Haut ER
[Ad] Address:Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
[Ti] Title:Nonadministration of medication doses for venous thromboembolism prophylaxis in a cohort of hospitalized patients.
[So] Source:Am J Health Syst Pharm;75(6):392-397, 2018 Mar 15.
[Is] ISSN:1535-2900
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: Results of a study to characterize patterns of nonadministration of medication doses for venous thromboembolism (VTE) prevention among hospitalized patients are presented. METHODS: The electronic records of all patients admitted to 4 floors of a medical center during a 1-month period were examined to identify patients whose records indicated at least 1 nonadministered dose of medication for VTE prophylaxis. Proportions of nonadministered doses by medication type, intended route of administration, and VTE risk categorization were compared; reasons for nonadministration were evaluated. RESULTS: Overall, 12.7% of all medication doses prescribed to patients in the study cohort ( = 75) during the study period (857 of 6,758 doses in total) were not administered. Nonadministration of 1 or more doses of VTE prophylaxis medication was nearly twice as likely for subcutaneous anticoagulants than for all other medication types (231 of 1,112 doses [20.8%] versus 626 of 5,646 doses [11.2%], < 0.001). For all medications prescribed, the most common reason for nonadministration was patient refusal (559 of 857 doses [65.2%]); the refusal rate was higher for subcutaneous anticoagulants than for all other medication categories (82.7% versus 58.8%, < 0.001). Doses of antiretrovirals, immunosuppressives, antihypertensives, psychiatric medications, analgesics, and antiepileptics were less commonly missed than doses of electrolytes, vitamins, and gastrointestinal medications. CONCLUSION: Scheduled doses of subcutaneous anticoagulants for hospitalized patients were more likely to be missed than doses of all other medication types.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.2146/ajhp161057

  3 / 70665 MEDLINE  
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[PMID]: 29522647
[Au] Autor:Sennesael AL; Larock AS; Devalet B; Mathieux V; Verschuren F; Muschart X; Dalleur O; Dogné JM; Spinewine A
[Ad] Address:Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université catholique de Louvain, Brussels, Belgium.
[Ti] Title:Preventability of serious thromboembolic and bleeding events related to the use of oral anticoagulants: a prospective study.
[So] Source:Br J Clin Pharmacol;, 2018 Mar 09.
[Is] ISSN:1365-2125
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:AIMS: To determine the preventability of serious adverse drug reactions (ADR) related to the use of direct oral anticoagulants (DOAC), and to explore contributing factors to preventable ADRs. Results were compared with vitamin K antagonists (VKA). METHODS: We conducted a prospective observational study in the emergency departments of two teaching hospitals from July 2015 to January 2016. Patients admitted with a thrombotic or bleeding event while under DOAC or VKA were included. Four independent reviewers assessed causality, seriousness and preventability of ADRs, using pilot-tested scales. For cases of serious and potentially preventable ADRs, we performed semi-structured interviews with general practitioners to identify contributing factors to ADRs. The primary outcome was the proportion of serious ADRs that were potentially preventable. RESULTS: The analysis included 46 DOAC and 43 VKA patients (median age 79 years). Gastro-intestinal (n=44) and intracranial (n=16) bleedings were the most frequent ADRs. 53% of DOAC- and 61% of VKA-related serious ADRs were deemed potentially preventable. Prescribing issues and inadequate monitoring were frequent for DOAC and VKA respectively. We identified many causes of preventable ADRs that applied to all oral anticoagulants, such as pharmacodynamics drug interactions and lack of communication. CONCLUSIONS: More than half of serious ADRs were potentially preventable for both DOACs and VKAs. Interventions focusing on prescribing, patient education and continuity of care should help improve the use of DOACs in practice.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1111/bcp.13580

  4 / 70665 MEDLINE  
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[PMID]: 29475179
[Au] Autor:Comuth WJ; Henriksen LØ; van de Kerkhof D; Husted SE; Kristensen SD; de Maat MPM; Münster AB
[Ad] Address:Department of Clinical Biochemistry, Hospital Unit West, Herning, Holstebro, Denmark; Department of Cardiology, Hospital Unit West, Herning, Denmark; Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: wilcom@rm.dk.
[Ti] Title:Comprehensive characteristics of the anticoagulant activity of dabigatran in relation to its plasma concentration.
[So] Source:Thromb Res;164:32-39, 2018 Feb 17.
[Is] ISSN:1879-2472
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Issues with laboratory measurement of dabigatran include: 1. Do coagulation assays reflect dabigatran plasma concentrations? 2. Do samples from patients treated with dabigatran have the same coagulability as dabigatran-spiked samples from healthy volunteers? 3. What is the long-term stability of dabigatran after storage at -80 °C? This study aims to evaluate these questions. MATERIALS AND METHODS: Ecarin chromogenic assay (ECA), a laboratory-developed diluted thrombin time (LD-dTT), prothrombin time (PT) and activated partial thromboplastin time (APTT) and ROTEM® were used to measure dabigatran anticoagulant activity and liquid chromatography-tandem mass spectrometry (LC-MS/MS) to measure dabigatran plasma concentrations. ROTEM® (EXTEM, INTEM, FIBTEM) was performed in whole blood and the other assays in platelet poor plasma (PPP), both in samples spiked with dabigatran (0, 25, 50, 100, 250, 500 and 1000 ng/mL) from healthy donors and in ex vivo samples from patients treated with dabigatran etexilate. Citrated PPP samples were frozen and stored at -80 °C, 1, 3, 6 and 12 months until analysis. RESULTS: EXTEM and FIBTEM clotting time (CT), ECA and LD-dTT correlate well with dabigatran plasma concentrations. With the exception of few ROTEM® parameters, there were no differences between spiked and patient samples. Samples were stable for at least 12 months at -80 °C. CONCLUSIONS: EXTEM and FIBTEM CT, ECA and LD-dTT are suitable for measuring the effect of dabigatran in treated patients. In general, results from spiked plasma samples are similar to those of patient samples. Storage of dabigatran plasma samples for up to 12 months does not influence measured levels.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

  5 / 70665 MEDLINE  
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[PMID]: 29472185
[Au] Autor:Amin O; Howlett DC
[Ad] Address:Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, UK omedamin@doctors.org.uk.
[Ti] Title:Atypical chest pain in an older woman.
[So] Source:BMJ;360:k345, 2018 02 22.
[Is] ISSN:1756-1833
[Cp] Country of publication:England
[La] Language:eng
[Mh] MeSH terms primary: Chest Pain/diagnostic imaging
Pulmonary Embolism/diagnostic imaging
[Mh] MeSH terms secundary: Aged
Anticoagulants/therapeutic use
Chest Pain/drug therapy
Computed Tomography Angiography
Coronary Angiography
Diagnosis, Differential
Female
Humans
Pulmonary Embolism/drug therapy
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:0 (Anticoagulants)
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180224
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k345

  6 / 70665 MEDLINE  
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[PMID]: 29472180
[Au] Autor:Stubbs MJ; Mouyis M; Thomas M
[Ad] Address:University College London Hospital, London, UK m.stubbs@doctors.org.uk.
[Ti] Title:Deep vein thrombosis.
[So] Source:BMJ;360:k351, 2018 02 22.
[Is] ISSN:1756-1833
[Cp] Country of publication:England
[La] Language:eng
[Mh] MeSH terms primary: Leg/blood supply
Venous Thrombosis/diagnosis
[Mh] MeSH terms secundary: Anticoagulants/therapeutic use
Biomarkers/analysis
Fibrin Fibrinogen Degradation Products/analysis
Humans
Risk Factors
Ultrasonography
Venous Thrombosis/blood
Venous Thrombosis/drug therapy
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Nm] Name of substance:0 (Anticoagulants); 0 (Biomarkers); 0 (Fibrin Fibrinogen Degradation Products); 0 (fibrin fragment D)
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180224
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k351

  7 / 70665 MEDLINE  
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[PMID]: 29452497
[Au] Autor:Carnovale C; Raschi E; Leonardi L; Moretti U; De Ponti F; Gentili M; Pozzi M; Clementi E; Poluzzi E; Radice S
[Ad] Address:a Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco , 'Luigi Sacco' University Hospital, Università di Milano , Milan , Italy.
[Ti] Title:No signal of interactions between influenza vaccines and drugs used for chronic diseases: a case-by-case analysis of the vaccine adverse event reporting system and vigibase.
[So] Source:Expert Rev Vaccines;:1-19, 2018 Mar 09.
[Is] ISSN:1744-8395
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: An increasing number of reports indicates that vaccines against influenza may interact with specific drugs via drug metabolism. To date, actual impact of vaccine-drug interactions observed in the real world clinical practice has not been investigated. METHODS: From VAERS and VigiBase, we collected Adverse Event Following Immunization (AEFI) reports for individuals receiving vaccines against influenza recorded as suspect and selected cases where predictable toxicity was recorded with oral anticoagulants, antiepileptics and statins (i.e. hemorrhages, overdosage and rhabdomyolysis, respectively). We applied AEFI and Drug Interaction Probability Scale (DIPS) Algorithms to assess causality of drug-vaccine interactions. RESULTS: 116 AEFI reports submitted to VAERS and 83 from Vigibase were included in our analysis; antiepileptics and statins were related to the highest number of indeterminate/consistent (93.7%; 65.3%) and possible/probable (50%; 57.7%) cases according to the AEFI and DIPS, respectively. The majority of cases occurred within the first week after vaccine administration (5-7 days). CONCLUSION: The relative paucity of detected interactions does not impact on the benefit of the vaccination against influenza, which remains strongly recommended; this does not exclude that closer monitoring for selected patients exposed to concomitant chronic pharmacological therapies and affected by predisposing factors may be useful.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1080/14760584.2018.1442718

  8 / 70665 MEDLINE  
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[PMID]: 29257737
[Au] Autor:Bartholomew JR
[Ad] Address:Section Head, Department of Vascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA. barthoj@ccf.org.
[Ti] Title:Update on the management of venous thromboembolism.
[So] Source:Cleve Clin J Med;84(12 Suppl 3):39-46, 2017 Dec.
[Is] ISSN:1939-2869
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism, is a common cardiovascular disease associated with significant morbidity ranging from painful leg swelling, chest pain, shortness of breath, and even death. Long-term complications include recurrent VTE, postpulmonary embolism syndrome, chronic thromboembolic pulmonary hypertension, and postthrombotic syndrome (PTS). Management of VTE requires immediate anticoagulation therapy based on a risk assessment for bleeding. Direct oral anticoagulants (DOACs) have become an important option for patients as reflected in the most recent American College of Chest Physician treatment guidelines.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1712
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process
[do] DOI:10.3949/ccjm.84.s3.04

  9 / 70665 MEDLINE  
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[PMID]: 29239808
[Au] Autor:Wang KL; Chiu CC; Giugliano RP; Tan DS; Lin CY; Lai EY; Goto S; Chiang CE
[Ad] Address:General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: klwang2@vghtpe.gov.tw.
[Ti] Title:Drug Class, Renal Elimination, and Outcomes of Direct Oral Anticoagulants in Asian Patients: A Meta-Analysis.
[So] Source:J Stroke Cerebrovasc Dis;27(4):857-864, 2018 Apr.
[Is] ISSN:1532-8511
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Direct oral anticoagulants (DOACs) have a better risk benefit profile in Asian patients with atrial fibrillation (AF). Whether treatment effects could be modified by drug class and dependency on renal elimination of studied agents has not yet been explored. METHODS: We searched PubMed, CENTRAL, and CINAHL databases through November 2016 for phase III randomized controlled trials comparing DOACs with warfarin in patients with AF. Efficacy and safety outcomes were pooled according to drug class and dependency on renal elimination of DOACs and were compared with the Mantel-Haenszel fixed-effects model. Effect differences were assessed with Bucher's indirect comparisons using common estimates, once heterogeneity was low, and with the Bayesian method. RESULTS: Among 6496 Asian patients from 6 trials, both direct thrombin inhibitors and factor Xa inhibitors, compared with warfarin, were associated with lower risks of stroke or systemic embolism and major bleeding (risk ratio [95% confidence interval], 0.51 [0.33-0.78], 0.74 ([0.58-0.96], 0.60 [0.41-0.86], and 0.59 [0.47-0.76], respectively). There was no between-group difference in direct thrombin inhibitors and factor Xa inhibitors or in DOACs with renal elimination less than 50% and 50% or greater (all I < 25% and interaction P > .05). Indirect comparisons within strata of drug class and dependency on renal elimination showed no preferential effect of any given regimen over another. There was no difference in effects on ischemic and hemorrhagic stroke, intracranial hemorrhage, myocardial infarction, and all-cause mortality between DOACs stratified by pharmacologic characteristics. CONCLUSIONS: DOACs, as a therapeutic class, outperform warfarin in efficacy and safety in Asian patients with AF.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Process

  10 / 70665 MEDLINE  
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[PMID]: 29238189
[Au] Autor:Zhang CY; Sun XY; Ouyang JM; Gui BS
[Ad] Address:Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou.
[Ti] Title:Diethyl citrate and sodium citrate reduce the cytotoxic effects of nanosized hydroxyapatite crystals on mouse vascular smooth muscle cells.
[So] Source:Int J Nanomedicine;12:8511-8525, 2017.
[Is] ISSN:1178-2013
[Cp] Country of publication:New Zealand
[La] Language:eng
[Ab] Abstract:Objective: This study aimed to investigate the damage mechanism of nanosized hydroxyapatite (nano-HAp) on mouse aortic smooth muscle cells (MOVASs) and the injury-inhibiting effects of diethyl citrate (Et Cit) and sodium citrate (Na Cit) to develop new drugs that can simultaneously induce anticoagulation and inhibit vascular calcification. Methods: The change in cell viability was evaluated using a cell proliferation assay kit, and the amount of lactate dehydrogenase (LDH) released was measured using an LDH kit. Intracellular reactive oxygen species (ROS) and mitochondrial damage were detected by DCFH-DA staining and JC-1 staining. Cell apoptosis and necrosis were detected by Annexin V staining. Intracellular calcium concentration and lysosomal integrity were measured using Fluo-4/AM and acridine orange, respectively. Results: Nano-HAp decreased cell viability and damaged the cell membrane, resulting in the release of a large amount of LDH. Nano-HAp entered the cells and damaged the mitochondria, and then induced cell apoptosis by producing a large amount of ROS. In addition, nano-HAp increased the intracellular Ca concentration, leading to lysosomal rupture and cell necrosis. On addition of the anticoagulant Et Cit or Na Cit, cell viability and mitochondrial membrane potential increased, whereas the amount of LDH released, ROS, and apoptosis rate decreased. Et Cit and Na Cit could also chelate with Ca to inhibit the intracellular Ca elevations induced by nano-HAp, prevent lysosomal rupture, and reduce cell necrosis. High concentrations of Et Cit and Na Cit exhibited strong inhibitory effects. The inhibitory capacity of Na Cit was stronger than that of Et Cit at similar concentrations. Conclusion: Both Et Cit and Na Cit significantly reduced the cytotoxicity of nano-HAp on MOVASs and inhibited the apoptosis and necrosis induced by nano-HAp crystals. The chelating function of citrate resulted in both anticoagulation and binding to HAp. Et Cit and Na Cit may play a role as anticoagulants in reducing injury to the vascular wall caused by nano-HAp.
[Mh] MeSH terms primary: Citrates/pharmacology
Durapatite/adverse effects
Muscle, Smooth, Vascular/cytology
Nanoparticles/adverse effects
[Mh] MeSH terms secundary: Animals
Anticoagulants/pharmacology
Apoptosis/drug effects
Calcinosis/prevention & control
Calcium/metabolism
Cell Survival/drug effects
Cells, Cultured
Durapatite/chemistry
Membrane Potential, Mitochondrial/drug effects
Mice
Mitochondria/drug effects
Mitochondria/metabolism
Muscle, Smooth, Vascular/drug effects
Muscle, Smooth, Vascular/metabolism
Nanoparticles/chemistry
Reactive Oxygen Species/metabolism
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Anticoagulants); 0 (Citrates); 0 (Reactive Oxygen Species); 0 (diethyl citrate); 1Q73Q2JULR (sodium citrate); 91D9GV0Z28 (Durapatite); SY7Q814VUP (Calcium)
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:IM
[Da] Date of entry for processing:171215
[St] Status:MEDLINE
[do] DOI:10.2147/IJN.S145386


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