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[PMID]:29017215
[Au] Autor:Schuh T; Stöllberger C
[Ti] Título:[Pulmonary Embolism Despite Rivaroxaban in an Obese Patient].
[Ti] Título:Pulmonalembolie trotz Rivaroxaban bei einer adipösen Patientin..
[So] Source:Dtsch Med Wochenschr;142(20):1548-1551, 2017 Oct.
[Is] ISSN:1439-4413
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Rivaroxaban, an oral factor Xa inhibitor, is approved for therapy of venous thromboembolism. It is unclear whether the standard dose for patients with a body mass index (BMI) > 40 kg/m is sufficient. The 45-year-old patient was admitted because of increasing respiratory distress. She had a history of pulmonary embolism 30 months before the admission, a factor V Leiden mutation and several hospitalisations due to dermatomycoses. The patient briefly took phenprocoumon which was changed to 20 mg rivaroxaban due to a lack of adherence. Six months before admission, the patient paused the rivaroxaban therapy because of dental surgery and suffered a recurrent pulmonary embolism. The patient presented with increasing difficulty of breathing, morbid obesity with a BMI of 59.3 kg/m and intertrigo of the lower extremities. The ECG showed a right axis deviation, a pulmonary P-wave and an incomplete right bundle branch block. Computed tomography showed pulmonary embolisms of the left lower lobe. The pulmonary artery was dilated, and the right atrium was enlarged. Venous thrombosis of the lower limb could not be certainly ruled out. The D-dimer was elevated with 5.895 mg/L (normal value up to 169 mg/L) and NT-pro-BNP was elevated at 5.580 ng/L (normal value up to 0.5 ng/L). Sixteen hours after the onset of symptoms, 22 hours after the last dose, the serum rivaroxaban level was 137 ng/ml. According to manufacturers, the therapeutic range of rivaroxaban after 2 - 4 hours is 22 - 535 ng/ml, and after 24 hours 6 - 239 ng/ml. After initiation of a therapy with low-molecular weight heparin and subsequent oral anticoagulation with phenprocoumon, the symptoms decreased. It is highly probable that the pulmonary embolism occurred at a time when the rivaroxaban level was in the therapeutic range. Since there are only few data about safety and efficacy of rivaroxaban and other non-vitamin K-oral anticoagulants (NOACs) in severely obese patients, the recommendations of the "International Society for Thrombosis and Haemostasis" should be followed: Rivaroxaban and other NOACs should not be used in patients with a BMI > 40 kg/m or weight > 120 kg, since only few data on this patient group are available. If NOACs are necessary in these patients, serum concentrations of NOACs should be measured.
[Mh] Termos MeSH primário: Obesidade Mórbida/complicações
Embolia Pulmonar/etiologia
Rivaroxabana/efeitos adversos
Rivaroxabana/uso terapêutico
Síndrome de Abstinência a Substâncias/etiologia
Tromboembolia Venosa/complicações
Tromboembolia Venosa/tratamento farmacológico
[Mh] Termos MeSH secundário: Resistência à Proteína C Ativada/complicações
Resistência à Proteína C Ativada/tratamento farmacológico
Contraindicações
Relação Dose-Resposta a Droga
Substituição de Medicamentos
Feminino
Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo
Heparina de Baixo Peso Molecular/uso terapêutico
Seres Humanos
Meia-Idade
Femprocumona/uso terapêutico
Embolia Pulmonar/diagnóstico por imagem
Embolia Pulmonar/tratamento farmacológico
Recidiva
Cirurgia Bucal
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Fibrin Fibrinogen Degradation Products); 0 (Heparin, Low-Molecular-Weight); 0 (fibrin fragment D); 9NDF7JZ4M3 (Rivaroxaban); Q08SIO485D (Phenprocoumon)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE
[do] DOI:10.1055/s-0043-114547


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[PMID]:28530711
[Au] Autor:Licciardello MP; Ringler A; Markt P; Klepsch F; Lardeau CH; Sdelci S; Schirghuber E; Müller AC; Caldera M; Wagner A; Herzog R; Penz T; Schuster M; Boidol B; Dürnberger G; Folkvaljon Y; Stattin P; Ivanov V; Colinge J; Bock C; Kratochwill K; Menche J; Bennett KL; Kubicek S
[Ad] Endereço:CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.
[Ti] Título:A combinatorial screen of the CLOUD uncovers a synergy targeting the androgen receptor.
[So] Source:Nat Chem Biol;13(7):771-778, 2017 Jul.
[Is] ISSN:1552-4469
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Approved drugs are invaluable tools to study biochemical pathways, and further characterization of these compounds may lead to repurposing of single drugs or combinations. Here we describe a collection of 308 small molecules representing the diversity of structures and molecular targets of all FDA-approved chemical entities. The CeMM Library of Unique Drugs (CLOUD) covers prodrugs and active forms at pharmacologically relevant concentrations and is ideally suited for combinatorial studies. We screened pairwise combinations of CLOUD drugs for impairment of cancer cell viability and discovered a synergistic interaction between flutamide and phenprocoumon (PPC). The combination of these drugs modulates the stability of the androgen receptor (AR) and resensitizes AR-mutant prostate cancer cells to flutamide. Mechanistically, we show that the AR is a substrate for γ-carboxylation, a post-translational modification inhibited by PPC. Collectively, our data suggest that PPC could be repurposed to tackle resistance to antiandrogens in prostate cancer patients.
[Mh] Termos MeSH primário: Avaliação Pré-Clínica de Medicamentos
Receptores Androgênicos/metabolismo
Bibliotecas de Moléculas Pequenas/análise
Bibliotecas de Moléculas Pequenas/farmacologia
[Mh] Termos MeSH secundário: Linhagem Celular Tumoral
Sobrevivência Celular/efeitos dos fármacos
Relação Dose-Resposta a Droga
Flutamida/farmacologia
Seres Humanos
Masculino
Estrutura Molecular
Femprocumona/farmacologia
Neoplasias da Próstata/tratamento farmacológico
Neoplasias da Próstata/metabolismo
Neoplasias da Próstata/patologia
Bibliotecas de Moléculas Pequenas/química
Relação Estrutura-Atividade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Receptors, Androgen); 0 (Small Molecule Libraries); 76W6J0943E (Flutamide); Q08SIO485D (Phenprocoumon)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170523
[St] Status:MEDLINE
[do] DOI:10.1038/nchembio.2382


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[PMID]:28500254
[Au] Autor:Andreas M; Moayedifar R; Wieselthaler G; Wolzt M; Riebandt J; Haberl T; Angleitner P; Schlöglhofer T; Wiedemann D; Schima H; Laufer G; Zimpfer D
[Ad] Endereço:From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Aust
[Ti] Título:Increased Thromboembolic Events With Dabigatran Compared With Vitamin K Antagonism in Left Ventricular Assist Device Patients: A Randomized Controlled Pilot Trial.
[So] Source:Circ Heart Fail;10(5), 2017 May.
[Is] ISSN:1941-3297
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Left ventricular assist device-supported patients are usually anticoagulated with a combination of aspirin and vitamin K antagonists. Long-term vitamin K antagonist therapy can be complicated by unstable international normalized ratio values and patient-related compliance problems. Therefore, direct thrombin inhibitors may represent an alternative to vitamin K antagonists. METHODS AND RESULTS: Thirty HeartWare ventricular assist device patients with stable renal function were planned for this prospective, randomized, open-label, single-center study. Patients were randomized to receive either phenprocoumon or dabigatran in addition to aspirin for long-term anticoagulation. Treatment duration was scheduled for 1 year and stopped after observation of a primary end point. Dabigatran dose was 110 and 75 mg BID in patients with normal or impaired renal function (glomerular filtration rate >80 mL/min or between 80 and 30 mL/min, respectively). The study was stopped prematurely for safety reasons after 16 patients (61±8 years, 1 female) were randomized. Thromboembolic events occurred in 4 subjects receiving dabigatran (50%) and in 1 receiving phenprocoumon (13%; =0.28). No major bleeding was recorded, and no patient died during the study. Median time to treatment termination was significantly shorter in dabigatran patients (8.5 versus 12.0 months; =0.015). CONCLUSIONS: Thromboembolic events on dabigatran led to early termination of a randomized controlled trial of dabigatran versus phenprocoumon in left ventricular assist device patients. CLINICAL TRIAL REGISTRATION: https://www.clinicaltrials.gov. Unique identifier: NCT02872649.
[Mh] Termos MeSH primário: Dabigatrana/administração & dosagem
Coração Auxiliar/efeitos adversos
Femprocumona/administração & dosagem
Tromboembolia/epidemiologia
Vitamina K/antagonistas & inibidores
[Mh] Termos MeSH secundário: Antitrombinas/administração & dosagem
Relação Dose-Resposta a Droga
Falha de Equipamento
Feminino
Seguimentos
Ventrículos do Coração/cirurgia
Seres Humanos
Masculino
Meia-Idade
Projetos Piloto
Estudos Prospectivos
Tromboembolia/etiologia
Tromboembolia/prevenção & controle
Fatores de Tempo
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antithrombins); 12001-79-5 (Vitamin K); I0VM4M70GC (Dabigatran); Q08SIO485D (Phenprocoumon)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170514
[St] Status:MEDLINE


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[PMID]:27976439
[Au] Autor:Koenen W; Kunte C; Hartmann D; Breuninger H; Moehrle M; Bechara FG; Schulze HJ; Lösler A; Löser CR; Wetzig T; Pappai D; Rapprich S; Weiß C; Faulhaber J
[Ad] Endereço:Department of Dermatology and Allergy, University Hospital Mannheim, Mannheim, Germany.
[Ti] Título:Prospective multicentre cohort study on 9154 surgical procedures to assess the risk of postoperative bleeding - a DESSI study.
[So] Source:J Eur Acad Dermatol Venereol;31(4):724-731, 2017 Apr.
[Is] ISSN:1468-3083
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To date, there is still a debate how to deal with patients receiving antithrombotic agents prior to surgical procedures on the skin. OBJECTIVE: To prospectively assess complications after dermatosurgical interventions, especially bleeding, depending on anticoagulation therapy. METHODS: Patients underwent surgery consecutively as scheduled, without randomization, whether or not they were currently taking anticoagulants. Nine institutions of the DESSI (DErmatoSurgical Study Initiative) working group documented patient data prospectively on a standardized study sheet prior to and after 9154 dermatosurgical interventions. RESULTS: Bleeding complications were observed in 7.14% of cases (654/9154 surgeries). A severe bleed requiring intervention by a physician occurred in 83 surgeries (0.91%). In multivariate analysis, INR, length of the defect, perioperative antibiotic treatment, current treatment with anticoagulation therapy, age and surgery on hidradenitis suppurativa/acne inversa (HS/AI) were significant parameters independently influencing the risk of bleeding. Discontinuation of phenprocoumon therapy and subsequent switching to low molecular weight heparin was associated with the highest risk of bleeding (9.26%). CONCLUSION: Bleeding complications in skin surgery are generally rare. Even if slightly increased complication rates are found in patients taking anticoagulants during skin surgery, platelet inhibitors should not be stopped prior to surgery. If a surgical procedure in patients on a combination therapy of 2 or more antiplatelet cannot be postponed, it should be conducted with the patient remaining on combination therapy. Discontinuation of DOACs is recommended 24 h prior to surgery. Bridging of phenprocoumon should be terminated. In patients with a bleeding history, the INR value should be within the therapeutic range.
[Mh] Termos MeSH primário: Anticoagulantes/efeitos adversos
Procedimentos Cirúrgicos Dermatológicos/efeitos adversos
Hemorragia Pós-Operatória/epidemiologia
Hemorragia Pós-Operatória/etiologia
Dermatopatias/cirurgia
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Antibacterianos/uso terapêutico
Feminino
Heparina/efeitos adversos
Hidradenite Supurativa/cirurgia
Seres Humanos
Coeficiente Internacional Normatizado
Masculino
Meia-Idade
Femprocumona/efeitos adversos
Hemorragia Pós-Operatória/terapia
Estudos Prospectivos
Medição de Risco
Fatores de Risco
Ferida Cirúrgica/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Anticoagulants); 9005-49-6 (Heparin); Q08SIO485D (Phenprocoumon)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161216
[St] Status:MEDLINE
[do] DOI:10.1111/jdv.14080


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[PMID]:27916486
[Au] Autor:Seeger J; Gonska B; Rodewald C; Rottbauer W; Wöhrle J
[Ad] Endereço:Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany.
[Ti] Título:Apixaban in Patients With Atrial Fibrillation After Transfemoral Aortic Valve Replacement.
[So] Source:JACC Cardiovasc Interv;10(1):66-74, 2017 Jan 09.
[Is] ISSN:1876-7605
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The aims of this study were to assess the impact of atrial fibrillation (AF) on outcome in transfemoral aortic valve replacement (TAVR) and to evaluate the safety and efficacy of apixaban compared with a vitamin K antagonist (VKA) in patients with AF after TAVR. BACKGROUND: Non-VKA oral anticoagulant agents have not been systematically used in patients with AF after TAVR. METHODS: Of the 617 patients enrolled, 55.9% (n = 345) were in sinus rhythm and 44.1% (n = 272) in AF. Clinical follow-up was performed after 30 days and 12 months. RESULTS: The early safety endpoint at 30 days was significantly more frequent in patients with AF compared with those in sinus rhythm (23.2% vs. 11.0%; p < 0.01). During 12-month follow-up, the secondary endpoint of all-cause mortality and stroke was significantly higher in patients with AF (20.6% vs. 9.7%; p = 0.02), driven by a significantly higher rate of all-cause mortality (19.1% vs. 7.8%; p = 0.01). Among patients with AF, 141 (51.8%) were treated with apixaban and 131 (48.2%) with a VKA. There was a significantly lower rate of the early safety endpoint in patients with AF treated with apixaban compared with patients treated with a VKA (13.5% vs. 30.5%; p < 0.01), with a numerically lower stroke rate (2.1% vs. 5.3%; p = 0.17) at 30 days and 12 months (1.2% vs. 2.0%; p = 0.73) of follow-up. CONCLUSIONS: In patients undergoing TAVR, AF was associated with a significantly higher rate of all-cause mortality throughout 12 months follow-up. The early safety endpoint in patients with AF on apixaban was significantly less frequent compared with patients receiving a VKA.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Fibrilação Atrial/tratamento farmacológico
Inibidores do Fator Xa/uso terapêutico
Artéria Femoral
Femprocumona/uso terapêutico
Pirazóis/uso terapêutico
Piridonas/uso terapêutico
Acidente Vascular Cerebral/prevenção & controle
Substituição da Valva Aórtica Transcateter/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/efeitos adversos
Fibrilação Atrial/diagnóstico
Fibrilação Atrial/etiologia
Fibrilação Atrial/mortalidade
Intervalo Livre de Doença
Inibidores do Fator Xa/efeitos adversos
Feminino
Artéria Femoral/diagnóstico por imagem
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Femprocumona/efeitos adversos
Modelos de Riscos Proporcionais
Estudos Prospectivos
Punções
Pirazóis/efeitos adversos
Piridonas/efeitos adversos
Sistema de Registros
Fatores de Risco
Acidente Vascular Cerebral/diagnóstico
Acidente Vascular Cerebral/etiologia
Acidente Vascular Cerebral/mortalidade
Fatores de Tempo
Substituição da Valva Aórtica Transcateter/métodos
Substituição da Valva Aórtica Transcateter/mortalidade
Resultado do Tratamento
Vitamina K/antagonistas & inibidores
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Factor Xa Inhibitors); 0 (Pyrazoles); 0 (Pyridones); 12001-79-5 (Vitamin K); 3Z9Y7UWC1J (apixaban); Q08SIO485D (Phenprocoumon)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161206
[St] Status:MEDLINE


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[PMID]:27853942
[Au] Autor:Ruile P; Jander N; Blanke P; Schoechlin S; Reinöhl J; Gick M; Rothe J; Langer M; Leipsic J; Buettner HJ; Neumann FJ; Pache G
[Ad] Endereço:Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany. philipp.ruile@universitaets-herzzentrum.de.
[Ti] Título:Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation.
[So] Source:Clin Res Cardiol;106(2):85-95, 2017 Feb.
[Is] ISSN:1861-0692
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: After transcatheter aortic valve implantation, early leaflet thickening, presumably reflecting thrombus, has recently been described on computed tomography angiography (CTA) in ~10% of the patients. We sought to investigate the impact of the antithrombotic regimen on the course of leaflet thickening. METHODS: The study comprised 51 patients with leaflet thickening. Based on the time period, patients without an established indication for anticoagulation were put on phenprocoumon plus clopidogrel for at least 3 months or on dual antiplatelet therapy with aspirin and clopidogrel. Follow-up CTAs were evaluated for leaflet restriction, assessed by four-point-grading score, and maximal thickness. FINDINGS: The anticoagulation and the dual antiplatelet therapy group comprised 29 and 22 patients, respectively. After a median of 86 days, we obtained follow-up CTAs in 22 patients on anticoagulation and in 16 patients on dual antiplatelet therapy. Leaflet thickening progressed in 11 on dual antiplatelet therapy, but always regressed onanticoagulation. The course of leaflet restriction and maximal thickness was significantly different between the two groups (P < 0.001): in the dual antiplatelet therapy group, maximal thickness increased by a mean of 1.37 ± 1.67 mm (P = 0.005) and leaflet restriction score by a median 1[quartiles 0;2] (P = 0.013), whereas in the anticoagulation group, maximal thickness regressed by 2.57 ± 1.52 mm (P < 0.001) and leaflet restriction score decreased by 1[-4;0] (P = 0.001). After a median of 91 days after discontinuation of anticoagulation, CTA performed in ten patients revealed a significant recurrent increase in leaflet restriction score and maximal thickness (P = 0.023, P = 0.007). In the entire cohort, changes in leaflet restriction correlated significantly with changes in transvalvular pressure gradients (r = 0.511, P < 0.001). INTERPRETATION: The course of leaflet restriction was fundamentally different depending on the presence or absence of anticoagulation, with consistent regression under phenprocoumon, but mostly progression under antiplatelet therapy alone. Changes in leaflet restriction were associated with changes in transvalvular pressure gradients.
[Mh] Termos MeSH primário: Anticoagulantes/administração & dosagem
Estenose da Valva Aórtica/terapia
Valva Aórtica/efeitos dos fármacos
Cateterismo Cardíaco/efeitos adversos
Implante de Prótese de Valva Cardíaca/efeitos adversos
Femprocumona/administração & dosagem
Trombose/prevenção & controle
[Mh] Termos MeSH secundário: Administração Oral
Idoso
Idoso de 80 Anos ou mais
Valva Aórtica/diagnóstico por imagem
Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/diagnóstico por imagem
Estenose da Valva Aórtica/fisiopatologia
Cateterismo Cardíaco/instrumentação
Cateterismo Cardíaco/métodos
Esquema de Medicação
Feminino
Próteses Valvulares Cardíacas
Implante de Prótese de Valva Cardíaca/instrumentação
Implante de Prótese de Valva Cardíaca/métodos
Hemodinâmica
Seres Humanos
Masculino
Inibidores da Agregação de Plaquetas/administração & dosagem
Estudos Prospectivos
Sistema de Registros
Fatores de Risco
Trombose/diagnóstico
Trombose/etiologia
Fatores de Tempo
Tomografia Computadorizada por Raios X
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Platelet Aggregation Inhibitors); Q08SIO485D (Phenprocoumon)
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170928
[Lr] Data última revisão:
170928
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161118
[St] Status:MEDLINE
[do] DOI:10.1007/s00392-016-1052-3


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[PMID]:27951617
[Au] Autor:Thiede A; Zimmermann HJ
[Ti] Título:Thromboserisiko, Thromboseprophylaxe und Folgen ­ Unterlassene medikamentöse Thromboseprophylaxe bei einem 14-jährigen Mädchen..
[So] Source:Zentralbl Chir;141(6):601-603, 2016 Dec.
[Is] ISSN:1438-9592
[Cp] País de publicação:Germany
[La] Idioma:ger
[Mh] Termos MeSH primário: Apendicectomia
Apendicite/cirurgia
Prova Pericial/legislação & jurisprudência
Imperícia/legislação & jurisprudência
Complicações Pós-Operatórias/etiologia
Complicações Pós-Operatórias/prevenção & controle
Trombose Venosa/etiologia
Trombose Venosa/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Anticoncepcionais Orais Hormonais/administração & dosagem
Anticoncepcionais Orais Hormonais/efeitos adversos
Avaliação da Deficiência
Feminino
Alemanha
Heparina/uso terapêutico
Seres Humanos
Femprocumona/uso terapêutico
Complicações Pós-Operatórias/terapia
Fatores de Risco
Meias de Compressão
Trombose Venosa/terapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contraceptives, Oral, Hormonal); 9005-49-6 (Heparin); Q08SIO485D (Phenprocoumon)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161213
[St] Status:MEDLINE


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[PMID]:27935941
[Au] Autor:van Rein N; Lijfering WM; Bos MH; Herruer MH; Vermaas HW; van der Meer FJ; Reitsma PH
[Ad] Endereço:Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
[Ti] Título:Objectives and Design of BLEEDS: A Cohort Study to Identify New Risk Factors and Predictors for Major Bleeding during Treatment with Vitamin K Antagonists.
[So] Source:PLoS One;11(12):e0164485, 2016.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Risk scores for patients who are at high risk for major bleeding complications during treatment with vitamin K antagonists (VKAs) do not perform that well. BLEEDS was initiated to search for new biomarkers that predict bleeding in these patients. OBJECTIVES: To describe the outline and objectives of BLEEDS and to examine whether the study population is generalizable to other VKA treated populations. METHODS: A cohort was created consisting of all patients starting VKA treatment at three Dutch anticoagulation clinics between January-2012 and July-2014. We stored leftover plasma and DNA following analysis of the INR. RESULTS: Of 16,706 eligible patients, 16,570 (99%) were included in BLEEDS and plasma was stored from 13,779 patients (83%). Patients had a mean age of 70 years (SD 14), 8713 were male (53%). The most common VKA indications were atrial fibrillation (10,876 patients, 66%) and venous thrombosis (3920 patients, 24%). 326 Major bleeds occurred during 17,613 years of follow-up (incidence rate 1.85/100 person years, 95%CI 1.66-2.06). The risk for major bleeding was highest in the initial three months of VKA treatment and increased when the international normalized ratio increased. These results and characteristics are in concordance with results from other VKA treated populations. CONCLUSION: BLEEDS is generalizable to other VKA treated populations and will permit innovative and unbiased research of biomarkers that may predict major bleeding during VKA treatment.
[Mh] Termos MeSH primário: Acenocumarol/efeitos adversos
Anticoagulantes/efeitos adversos
Fibrinolíticos/efeitos adversos
Hemorragia/diagnóstico
Femprocumona/efeitos adversos
[Mh] Termos MeSH secundário: Acenocumarol/administração & dosagem
Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/administração & dosagem
Fibrilação Atrial/tratamento farmacológico
Fibrilação Atrial/fisiopatologia
Feminino
Fibrinolíticos/administração & dosagem
Seguimentos
Hemorragia/sangue
Hemorragia/induzido quimicamente
Seres Humanos
Coeficiente Internacional Normatizado
Estudos Longitudinais
Masculino
Meia-Idade
Femprocumona/administração & dosagem
Prognóstico
Fatores de Risco
Trombose Venosa/tratamento farmacológico
Trombose Venosa/fisiopatologia
Vitamina K/antagonistas & inibidores
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Fibrinolytic Agents); 12001-79-5 (Vitamin K); I6WP63U32H (Acenocoumarol); Q08SIO485D (Phenprocoumon)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161210
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0164485


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[PMID]:27858919
[Au] Autor:Pfeiffer H; Herbst L; Schwarze B; Eckstein R; Weisbach V
[Ad] Endereço:aTransfusion Medicine and Hemostaseology DepartmentbDepartment of Internal Medicine 4cDepartment of Forensic Medicine, University Hospital Erlangen, Erlangen, Germany.
[Ti] Título:Massive intoxication with rivaroxaban, phenprocoumon, and diclofenac: A case report.
[So] Source:Medicine (Baltimore);95(44):e5343, 2016 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Oral anticoagulants and painkillers, some with an additional effect on the coagulation system, are widely used and are therefore prone to abuse and (intentional) overdose. We report the case of a patient with a massive mixed anticoagulant intoxication. PATIENT CONCERNS: The patient had ingested 1960 mg rivaroxaban, 31.5 mg phenprocoumon, 1425 mg diclofenac, and 21,000 mg metamizole in suicidal intention. DIAGNOSES: Massive mixed anticoagulant overdose. INTERVENTIONS: The patient was closely monitored. The phenprocoumon overdose was treated by the administration of vitamin K and PCC. OUTCOMES: Despite the massive inhibition of the coagulation system, the patient did not experience bleeding apart from a slight gross hematuria. LESSONS: Despite the ingestion of a massive amount of rivaroxaban, the plasma levels were not as high as feared, due to the ceiling effect of rivaroxaban absorption. Elimination occurred according to the half-life of rivaroxaban and was not unduly prolonged by the ingested quantity.
[Mh] Termos MeSH primário: Anticoagulantes/envenenamento
Inibidores de Ciclo-Oxigenase/envenenamento
Diclofenaco/envenenamento
Inibidores do Fator Xa/envenenamento
Femprocumona/envenenamento
Rivaroxabana/envenenamento
[Mh] Termos MeSH secundário: Seres Humanos
Masculino
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Cyclooxygenase Inhibitors); 0 (Factor Xa Inhibitors); 144O8QL0L1 (Diclofenac); 9NDF7JZ4M3 (Rivaroxaban); Q08SIO485D (Phenprocoumon)
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170917
[Lr] Data última revisão:
170917
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161119
[St] Status:MEDLINE


  10 / 842 MEDLINE  
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[PMID]:27709253
[Au] Autor:van Rein N; Biedermann JS; Bonafacio SM; Kruip MJ; van der Meer FJ; Lijfering WM
[Ad] Endereço:Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands. n.van_rein@lumc.nl.
[Ti] Título:Statin use decreases coagulation in users of vitamin K antagonists.
[So] Source:Eur J Clin Pharmacol;72(12):1441-1447, 2016 Dec.
[Is] ISSN:1432-1041
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The purpose of the study is to determine the immediate and long-term effect of statins on coagulation in patients treated with vitamin K antagonists (VKAs). METHODS: We selected patients on VKAs of two Dutch anticoagulation clinics who initiated treatment with a statin between 2009 and 2013. Patients who initiated or stopped concomitant drugs that interact with VKAs or were hospitalised during follow-up were excluded. The VKA dosage (mg/day) after statin initiation was compared with the last VKA dosage before the statin was started. Immediate and long-term differences in VKA dosage (at 6 and 12 weeks) were calculated with a paired student t test. RESULTS: Four hundred thirty-five phenprocoumon users (mean age 70 years, 60 % men) and 303 acenocoumarol users (mean age 69 years, 58 % men) were included. After start of statin use, the immediate phenprocoumon dosage was 0.02 mg/day (95 % CI, 0.00 to 0.03) lower. At 6 and 12 weeks, these phenprocoumon dosages were 0.03 (95 % CI, 0.01 to 0.05) and 0.07 mg/day (95 % CI, 0.04 to 0.09) lower as compared with the dosage before first statin use. In acenocoumarol users, VKA dosage was 0.04 mg/day (95%CI, 0.01 to 0.07) (immediate effect), 0.10 (95 % CI, 0.03 to 0.16) (at 6 weeks), and 0.11 mg/day (95 % CI, 0.04 to 0.18) (after 12 weeks) lower. CONCLUSIONS: Initiation of statin treatment was associated with an immediate and long-term minor although statistically significant decrease in VKA dosage in both phenprocoumon and acenocoumarol users, which suggests that statins may have anticoagulant properties.
[Mh] Termos MeSH primário: Acenocumarol/farmacologia
Anticoagulantes/farmacologia
Coagulação Sanguínea/efeitos dos fármacos
Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia
Femprocumona/farmacologia
Vitamina K/antagonistas & inibidores
[Mh] Termos MeSH secundário: Acenocumarol/uso terapêutico
Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/uso terapêutico
Feminino
Seres Humanos
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico
Coeficiente Internacional Normatizado
Masculino
Meia-Idade
Femprocumona/uso terapêutico
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors); 12001-79-5 (Vitamin K); I6WP63U32H (Acenocoumarol); Q08SIO485D (Phenprocoumon)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161007
[St] Status:MEDLINE



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