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[PMID]:29301740
[Au] Autor:Hunt BJ; Levi M
[Ad] Endereço:King's College, London, UK Beverley.hunt@gstt.nhs.uk.
[Ti] Título:Urgent reversal of vitamin K antagonists.
[So] Source:BMJ;360:j5424, 2018 01 04.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Fibrilação Atrial/complicações
Encéfalo/diagnóstico por imagem
Hemorragias Intracranianas/induzido quimicamente
Paresia/diagnóstico
Vitamina K/antagonistas & inibidores
Varfarina/efeitos adversos
[Mh] Termos MeSH secundário: Administração Intravenosa
Idoso
Anticoagulantes/uso terapêutico
Fibrilação Atrial/tratamento farmacológico
Encéfalo/patologia
Serviço Hospitalar de Emergência
Fator V/administração & dosagem
Fator V/economia
Fator V/uso terapêutico
Fator Xa/administração & dosagem
Fator Xa/economia
Fator Xa/uso terapêutico
Seres Humanos
Coeficiente Internacional Normatizado/normas
Hemorragias Intracranianas/diagnóstico por imagem
Hemorragias Intracranianas/mortalidade
Masculino
Paresia/etiologia
Plasma
Tomografia Computadorizada por Raios X/métodos
Vitamina K/administração & dosagem
Vitamina K/uso terapêutico
Varfarina/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (prothrombinase complex); 12001-79-5 (Vitamin K); 5Q7ZVV76EI (Warfarin); 9001-24-5 (Factor V); EC 3.4.21.6 (Factor Xa)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5424


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[PMID]:29269690
[Au] Autor:Kikuno M; Koga M; Kume Y; Ohtsuka T; Hayakawa M; Toyoda K
[Ad] Endereço:Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center.
[Ti] Título:[A case of cardiogenic embolism, which occurred under appropriate warfarin use, treated with thoracoscopic left atrial appendectomy].
[So] Source:Rinsho Shinkeigaku;58(1):9-14, 2018 Jan 26.
[Is] ISSN:1882-0654
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:A 74-year-old man with a past medical history of bradycardiac atrial fibrillation and an old cerebral infarction presented with dysarthria. He had been treated with warfarin and PT-INR on admission was 2.0. MRI of the head revealed an acute ischemic stroke involving the cerebellum and left occipital lobe. Because transesophageal cardiac echography showed a thrombus in the left atrial appendage, anticoagulant treatment with warfarin and heparin was initiated. The thrombus was enlarging; therefore, we changed the anticoagulant therapy to apixaban with heparin on day 11. On day 17, a hemorrhagic cerebral infarction occurred. After the hemorrhage diminished, we treated him with warfarin aiming for a PT-INR between 3 and 4. The thrombus gradually shrank and disappeared on day 110. Finally, a thoracoscopic left atrial appendectomy was performed as a secondary prevention, with no recurrence till date.
[Mh] Termos MeSH primário: Anticoagulantes/administração & dosagem
Procedimentos Cirúrgicos Cardíacos/métodos
Infarto Cerebral/etiologia
Átrios do Coração/cirurgia
Cardiopatias/etiologia
Toracoscopia/métodos
Trombose/etiologia
Varfarina/administração & dosagem
[Mh] Termos MeSH secundário: Idoso
Quimioterapia Combinada
Cardiopatias/terapia
Heparina/administração & dosagem
Seres Humanos
Coeficiente Internacional Normatizado
Masculino
Pirazóis/administração & dosagem
Piridonas/administração & dosagem
Recidiva
Síndrome do Nó Sinusal/complicações
Trombose/terapia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Pyrazoles); 0 (Pyridones); 3Z9Y7UWC1J (apixaban); 5Q7ZVV76EI (Warfarin); 9005-49-6 (Heparin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE
[do] DOI:10.5692/clinicalneurol.cn-001065


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[PMID]:29373602
[Au] Autor:Li X; Keshishian A; Hamilton M; Horblyuk R; Gupta K; Luo X; Mardekian J; Friend K; Nadkarni A; Pan X; Lip GYH; Deitelzweig S
[Ad] Endereço:Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America.
[Ti] Título:Apixaban 5 and 2.5 mg twice-daily versus warfarin for stroke prevention in nonvalvular atrial fibrillation patients: Comparative effectiveness and safety evaluated using a propensity-score-matched approach.
[So] Source:PLoS One;13(1):e0191722, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Prior real-world studies have shown that apixaban is associated with a reduced risk of stroke/systemic embolism (stroke/SE) and major bleeding versus warfarin. However, few studies evaluated the effectiveness and safety of apixaban according to its dosage, and most studies contained limited numbers of patients prescribed 2.5 mg twice-daily (BID) apixaban. Using pooled data from 4 American claims database sources, baseline characteristics and outcomes for patients prescribed 5 mg BID and 2.5 mg BID apixaban versus warfarin were compared. After 1:1 propensity-score matching, 31,827 5 mg BID apixaban-matched warfarin patients and 6600 2.5 mg BID apixaban-matched warfarin patients were identified. Patients prescribed 2.5 mg BID apixaban were older, had clinically more severe comorbidities, and were more likely to have a history of stroke and bleeding compared with 5 mg BID apixaban patients. Compared with warfarin, 5 mg BID apixaban was associated with a lower risk of stroke/SE (hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.60-0.81) and major bleeding (HR: 0.59, 95% CI: 0.53-0.66). Compared with warfarin, 2.5 mg BID apixaban was also associated with a lower risk of stroke/SE (HR: 0.63, 95% CI: 0.49-0.81) and major bleeding (HR: 0.59, 95% CI: 0.49-0.71). In this real-world study, both apixaban doses were assessed in 2 patient groups differing in age and clinical characteristics. Each apixaban dose was associated with a lower risk of stroke/SE and major bleeding compared with warfarin in the distinct population for which it is being prescribed in United States clinical practice. TRIAL REGISTRATION: Clinicaltrials.Gov Identifier: NCT03087487.
[Mh] Termos MeSH primário: Fibrilação Atrial/complicações
Pirazóis/administração & dosagem
Piridonas/administração & dosagem
Acidente Vascular Cerebral/prevenção & controle
Varfarina/administração & dosagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Esquema de Medicação
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Acidente Vascular Cerebral/etiologia
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Pyrazoles); 0 (Pyridones); 3Z9Y7UWC1J (apixaban); 5Q7ZVV76EI (Warfarin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180127
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191722


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[PMID]:29360845
[Au] Autor:Kim YG; Choi JI; Kim MN; Cho DH; Oh SK; Kook H; Park HS; Lee KN; Baek YS; Roh SY; Shim J; Park SM; Shim WJ; Kim YH
[Ad] Endereço:Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea.
[Ti] Título:Non-vitamin K antagonist oral anticoagulants versus warfarin for the prevention of spontaneous echo-contrast and thrombus in patients with atrial fibrillation or flutter undergoing cardioversion: A trans-esophageal echocardiography study.
[So] Source:PLoS One;13(1):e0191648, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Spontaneous echo-contrast (SEC) and thrombus observed in trans-esophageal echocardiography (TEE) is known as a strong surrogate marker for future risk of ischemic stroke in patients with atrial fibrillation (AF) or atrial flutter (AFL). The efficacy of non-vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin to prevent SEC or thrombus in patients with AF or AFL is currently unknown. AF or AFL patients who underwent direct current cardioversion (DCCV) and pre-DCCV TEE evaluation from January 2014 to October 2016 in a single center were analyzed. The prevalence of SEC and thrombus were compared between patients who received NOAC and those who took warfarin. NOAC included direct thrombin inhibitor and factor Xa inhibitors. Among 1,050 patients who were considered for DCCV, 424 patients anticoagulated with warfarin or NOAC underwent TEE prior to DCCV. Eighty patients who were anticoagulated for less than 21 days were excluded. Finally, 344 patients were included for the analysis (180 warfarin users vs. 164 NOAC users). No significant difference in the prevalence of SEC (44.4% vs. 43.9%; p = 0.919), dense SEC (13.9% vs. 15.2%; p = 0.722), or thrombus (2.2% vs. 4.3%; p = 0.281) was observed between the warfarin group and the NOAC group. In multivariate analysis, there was no association between NOAC and risk of SEC (odds ratio [OR]: 1.4, 95% CI: 0.796-2.297, p = 0.265) or thrombus (OR: 3.4, 95% CI: 0.726-16.039, p = 0.120). In conclusion, effectiveness of NOAC is comparable to warfarin in preventing SEC and thrombus in patients with AF or AFL undergoing DCCV. However, numerical increase in the prevalence of thrombus in NOAC group warrants further evaluation.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Fibrilação Atrial/complicações
Ecocardiografia Transesofagiana/métodos
Cardioversão Elétrica
Trombose/prevenção & controle
Varfarina/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Fibrilação Atrial/terapia
Feminino
Seres Humanos
Masculino
Meia-Idade
Trombose/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anticoagulants); 5Q7ZVV76EI (Warfarin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191648


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[PMID]:28741391
[Au] Autor:Moss AS; Dimitropoulous G; Lip GYH
[Ad] Endereço:a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , United Kingdom.
[Ti] Título:Clinical implications, benefits and pitfalls of using and reversing non-vitamin K antagonist oral anticoagulants.
[So] Source:Expert Rev Hematol;10(9):833-845, 2017 09.
[Is] ISSN:1747-4094
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The use of non-Vitamin K antagonist oral anticoagulant (NOAC) drugs is increasingly common in clinical practice. As compared to vitamin K antagonists they are more straightforward to initiate, require no hematological monitoring and offer potentially more stable therapeutic indices. Concern has been raised with regard to their safety profiles particularly in the context of acute reversal in major bleeding. Further issues pertain to patient concordance. Areas covered: This review article aims to provide an overview of the current evidence relating to NOAC safety as well as the management of NOAC-related major bleeding with particular emphasis on reversal agents in use and in development following a selective literature review. Second, the effects of medication concordance and dosing regimens on NOAC efficacy will be considered. Expert commentary: The short half-lives and low overall bleeding risk of NOACs is likely to mean that specific reversal agents in development are infrequently required and costly with associated practicality issues with their use in clinical emergencies. Concern regarding patient concordance can be practicably addressed with appropriate medication, dosing regimen and patient selection and continuous education with active, informed patient involvement in the decision-making process.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
[Mh] Termos MeSH secundário: Administração Oral
Anticorpos Monoclonais Humanizados/administração & dosagem
Anticorpos Monoclonais Humanizados/uso terapêutico
Anticoagulantes/administração & dosagem
Anticoagulantes/efeitos adversos
Anticoagulantes/farmacocinética
Antifibrinolíticos/administração & dosagem
Antifibrinolíticos/uso terapêutico
Gerenciamento Clínico
Monitoramento de Medicamentos
Hemorragia/sangue
Hemorragia/etiologia
Hemorragia/terapia
Seres Humanos
Adesão à Medicação
Tromboembolia/tratamento farmacológico
Vitamina K/antagonistas & inibidores
Varfarina/administração & dosagem
Varfarina/efeitos adversos
Varfarina/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Humanized); 0 (Anticoagulants); 0 (Antifibrinolytic Agents); 12001-79-5 (Vitamin K); 5Q7ZVV76EI (Warfarin); 97RWB5S1U6 (idarucizumab)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180225
[Lr] Data última revisão:
180225
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE
[do] DOI:10.1080/17474086.2017.1358085


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[PMID]:28468510
[Au] Autor:Sjögren V; Grzymala-Lubanski B; Renlund H; Svensson PJ; Själander A
[Ad] Endereço:1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
[Ti] Título:Safety and Efficacy of Bridging With Low-Molecular-Weight Heparin During Temporary Interruptions of Warfarin: A Register-Based Cohort Study.
[So] Source:Clin Appl Thromb Hemost;23(8):961-966, 2017 Nov.
[Is] ISSN:1938-2723
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Low-molecular-weight heparin (LMWH) is often recommended as a bridging therapy during temporary interruptions in warfarin treatment, despite lack of evidence. The aim of this study was to see whether we could find benefit from LMWH bridging. We studied all planned interruptions of warfarin within the Swedish anticoagulation register Auricula during 2006 to 2011. Low-molecular-weight heparin bridging was compared to nonbridging (control) after propensity score matching. Complications were identified in national clinical registers for 30 days following warfarin cessation, and defined as all-cause mortality, bleeding (intracranial, gastrointestinal, or other), or thrombosis (ischemic stroke or systemic embolism, venous thromboembolism, or myocardial infarction) that was fatal or required hospital care. Of the 14 556 identified warfarin interruptions, 12 659 with a known medical background had a mean age of 69 years, 61% were males, mean CHADS (1 point for each of congestive heart failure, hypertension, age ≥75 years, diabetes, and 2 points for stroke or transient ischemic attack) score was 1.7, and CHA DS -VASc score was 3.4. The total number of LMWH bridgings was 7021. Major indications for anticoagulation were mechanical heart valve prostheses 4331, atrial fibrillation 1097, and venous thromboembolism 1331. Bridging patients had a higher rate of thrombotic events overall. Total risk of any complication did not differ significantly between bridging (1.5%) and nonbridging (1.2%). Regardless of indication for warfarin treatment, we found no benefit from bridging. The type of procedure prompting bridging was not known, and the likely reason for the observed higher risk of thrombosis with LMWH bridging is that low-risk procedures more often meant no bridging. Results from randomized trials are needed, especially for patients with mechanical heart valves.
[Mh] Termos MeSH primário: Anticoagulantes/administração & dosagem
Heparina de Baixo Peso Molecular/administração & dosagem
Adesão à Medicação
Sistema de Registros
Varfarina/administração & dosagem
[Mh] Termos MeSH secundário: Administração Oral
Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/efeitos adversos
Estudos de Coortes
Feminino
Heparina de Baixo Peso Molecular/efeitos adversos
Seres Humanos
Masculino
Meia-Idade
Suécia/epidemiologia
Varfarina/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Heparin, Low-Molecular-Weight); 5Q7ZVV76EI (Warfarin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1177/1076029617706756


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[PMID]:29279560
[Au] Autor:Kubomura Y; Ise Y; Wako T; Katayama S; Noro R; Kubota K
[Ad] Endereço:Section of Pharmaceutical Services, Nippon Medical School Hospital.
[Ti] Título:A Drug Interaction between Crizotinib and Warfarin in Non-Small-Cell Lung Cancer: A Case Report.
[So] Source:J Nippon Med Sch;84(6):291-293, 2017.
[Is] ISSN:1347-3409
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:We report a case of increased prothrombin time-international normalized ratio (PT-INR) when crizotinib and warfarin were co-administered. A 74-year-old Japanese woman presented to the hospital with dyspnea, and was diagnosed with anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC). Three years after surgical resection of the tumor, the patient started crizotinib because of the recurrence of NSCLC. She received 2 mg/day warfarin due to a medical history of cerebral infarction and chronic atrial fibrillation. Before crizotinib initiation, the patient's PT-INR was 2.60. After 7 days of daily doses of crizotinib, the patient's PT-INR increased to 3.65. This case report provides the first evidence of a drug interaction between crizotinib and warfarin.
[Mh] Termos MeSH primário: Anticoagulantes/administração & dosagem
Anticoagulantes/efeitos adversos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico
Coeficiente Internacional Normatizado
Neoplasias Pulmonares/tratamento farmacológico
Recidiva Local de Neoplasia/tratamento farmacológico
Inibidores de Proteínas Quinases/administração & dosagem
Inibidores de Proteínas Quinases/efeitos adversos
Tempo de Protrombina
Pirazóis/administração & dosagem
Pirazóis/efeitos adversos
Piridinas/administração & dosagem
Piridinas/efeitos adversos
Varfarina/administração & dosagem
Varfarina/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Carcinoma Pulmonar de Células não Pequenas/sangue
Interações Medicamentosas
Quimioterapia Combinada/efeitos adversos
Feminino
Seres Humanos
Neoplasias Pulmonares/sangue
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Protein Kinase Inhibitors); 0 (Pyrazoles); 0 (Pyridines); 53AH36668S (crizotinib); 5Q7ZVV76EI (Warfarin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1272/jnms.84.291


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[PMID]:27774726
[Au] Autor:Jonsson PI; Letertre L; Juliusson SJ; Gudmundsdottir BR; Francis CW; Onundarson PT
[Ad] Endereço:Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
[Ti] Título:During warfarin induction, the Fiix-prothrombin time reflects the anticoagulation level better than the standard prothrombin time.
[So] Source:J Thromb Haemost;15(1):131-139, 2017 01.
[Is] ISSN:1538-7836
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Essentials Fiix-prothrombin time (PT) monitoring of warfarin measuring factor (F) II and X, is effective. Plasma obtained during warfarin induction and stable phase in Fiix-trial was assayed. Fiix-PT stabilized anticoagulation earlier than monitoring with traditional PT-INR. FVII had little effect on thrombin generation that was mainly determined by FII and FX. SUMMARY: Background The prothrombin time (PT) is equally prolonged by reduction of each of the vitamin K-dependent (VKD) factors (F) II, VII and X. The Fiix-PT is only affected by FII and FX, the main contributors to thrombin generation (TG). Objective To test the hypothesis that variability in warfarin anticoagulation is reduced early during monitoring with the normalized PT-ratio calculated from Fiix-PT (Fiix-International Normalized Ratio [INR]) compared with traditional PT-INR monitoring. Also, that because of its insensitivity to FVII, Fiix-PT more accurately reflects TG when Fiix-INR and PT-INR are discrepant. Methods Samples from Fiix-trial participants monitored with either Fiix-PT or PT were used. VKD coagulation factors and TG were measured in samples from 40 patients during stable anticoagulation and in serial samples obtained from 26 patients during warfarin induction. TG was assessed in relation to selective reduction in single VKD factors. Results During Fiix-warfarin induction full anticoagulation measured as FII or FX activity was achieved at a similar rate to that with PT-warfarin but subsequently stabilized better. Fiix-INR but not PT-INR mirrored total TG during initiation. During induction, FII (R = 0.66) and FX (R = 0.52) correlated better with TG and with a steeper slope than did FIX (R = 0.37) and in particular FVII (R = 0.21). In vitro, FII and FX were the main determinants of TG at concentrations observed during VKA anticoagulation, whereas FVII and FIX had little influence. Conclusions Fiix-PT monitoring reduces anticoagulation variability, suggesting that monitoring FVII has a limited role during VKA management. TG is better reflected by Fiix-PT.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Fator X/química
Protrombina/química
Varfarina/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Coagulação Sanguínea/efeitos dos fármacos
Fatores de Coagulação Sanguínea/uso terapêutico
Testes de Coagulação Sanguínea/métodos
Método Duplo-Cego
Monitoramento de Medicamentos
Feminino
Hemostáticos/uso terapêutico
Seres Humanos
Coeficiente Internacional Normatizado
Masculino
Meia-Idade
Tempo de Protrombina
Trombina/química
Vitamina K/química
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Blood Coagulation Factors); 0 (Hemostatics); 12001-79-5 (Vitamin K); 5Q7ZVV76EI (Warfarin); 9001-26-7 (Prothrombin); 9001-29-0 (Factor X); EC 3.4.21.5 (Thrombin)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1111/jth.13549


  9 / 17075 MEDLINE  
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[PMID]:29390530
[Au] Autor:Raasck K; Khoury J; Aoude A; Abduljabbar F; Jarzem P
[Ti] Título:Nonsurgical management of an extensive spontaneous spinal epidural hematoma causing quadriplegia and respiratory distress in a choledocholithiasis patient: A case report.
[So] Source:Medicine (Baltimore);96(51):e9368, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord, and leading to acute neurological deficits. The disease's cloudy etiology and rarity contribute to dangerously suboptimal therapeutic principles. These neural deficits can be permanent, even fatal, if the SSEH is not treated in a timely and appropriate manner. Standard therapy is decompressive laminectomy, though nonsurgical management is a viable course of action for patients who meet a criterion that is continuously being refined. PATIENT CONCERNS: A 76-year-old woman on warfarin for a past pulmonary embolism presented to the emergency room with jaundice, myalgia, hematuria, neck pain, and an International Normalized Ratio (INR) of 14. Upon admission, she rapidly developed quadriplegia and respiratory distress that necessitated intubation. DIAGNOSES: T2-weighted magnetic resonance imaging (MRI) revealed an epidural space-occupying hyperintensity from C2 to S5 consistent with a spinal epidural hematoma. An incidental finding of dilated intrahepatic and common bile ducts prompted an endoscopic retrograde cholangiopancreatography, which demonstrated choledocholithiasis. INTERVENTIONS: The patient's INR was normalized with Vitamin K and Beriplex. Upon transfer to the surgical spine team for assessment of a possible intervention, the patient began to demonstrate recovery of neural functions. The ensuing sustained motor improvement motivated the team's preference for close neurologic monitoring and continued medical therapy over surgery. Thirteen hours after the onset of her symptoms, the patient was extubated. A sphincterotomy was later performed, removing 81 common bile duct stones. OUTCOMES: MRI demonstrated complete resorption of the SSEH and the patient maintained full neurological function at final follow-up. LESSONS: Nonsurgical management of SSEH should be considered in the context of early and sustained recovery. Severe initial neural deficit does not necessitate surgical decompression. Choledocholithiasis and subsequent Vitamin K deficiency, particularly when coupled with anticoagulant use, can increase INR and is a novel proposed risk factor for SSEH. Furthermore, coagulopathies should be medically corrected before surgical intervention within a given timeframe, as spontaneous recovery may manifest. This should be favored over surgery in patients demonstrating early and sustained recovery, as nonsurgical management is 25% more effective in achieving full recovery.
[Mh] Termos MeSH primário: Coledocolitíase/cirurgia
Hematoma Epidural Espinal/diagnóstico por imagem
Quadriplegia/reabilitação
Insuficiência Respiratória/terapia
Varfarina/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Colangiopancreatografia Retrógrada Endoscópica/métodos
Coledocolitíase/complicações
Coledocolitíase/diagnóstico por imagem
Tratamento Conservador
Serviço Hospitalar de Emergência
Feminino
Seguimentos
Hematoma Epidural Espinal/complicações
Hematoma Epidural Espinal/etiologia
Seres Humanos
Coeficiente Internacional Normatizado
Intubação Intratraqueal
Embolia Pulmonar/diagnóstico
Embolia Pulmonar/tratamento farmacológico
Quadriplegia/diagnóstico
Quadriplegia/etiologia
Recuperação de Função Fisiológica
Insuficiência Respiratória/diagnóstico
Medição de Risco
Índice de Gravidade de Doença
Varfarina/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
5Q7ZVV76EI (Warfarin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009368


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[PMID]:29372247
[Au] Autor:Inohara T; Xian Y; Liang L; Matsouaka RA; Saver JL; Smith EE; Schwamm LH; Reeves MJ; Hernandez AF; Bhatt DL; Peterson ED; Fonarow GC
[Ad] Endereço:Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
[Ti] Título:Association of Intracerebral Hemorrhage Among Patients Taking Non-Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality.
[So] Source:JAMA;319(5):463-473, 2018 02 06.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Although non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used to prevent thromboembolic disease, there are limited data on NOAC-related intracerebral hemorrhage (ICH). Objective: To assess the association between preceding oral anticoagulant use (warfarin, NOACs, and no oral anticoagulants [OACs]) and in-hospital mortality among patients with ICH. Design, Setting, and Participants: Retrospective cohort study of 141 311 patients with ICH admitted from October 2013 to December 2016 to 1662 Get With The Guidelines-Stroke hospitals. Exposures: Anticoagulation therapy before ICH, defined as any use of OACs within 7 days prior to hospital arrival. Main Outcomes and Measures: In-hospital mortality. Results: Among 141 311 patients with ICH (mean [SD] age, 68.3 [15.3] years; 48.1% women), 15 036 (10.6%) were taking warfarin and 4918 (3.5%) were taking NOACs preceding ICH, and 39 585 (28.0%) and 5783 (4.1%) were taking concomitant single and dual antiplatelet agents, respectively. Patients with prior use of warfarin or NOACs were older and had higher prevalence of atrial fibrillation and prior stroke. Acute ICH stroke severity (measured by the National Institutes of Health Stroke Scale) was not significantly different across the 3 groups (median, 9 [interquartile range, 2-21] for warfarin, 8 [2-20] for NOACs, and 8 [2-19] for no OACs). The unadjusted in-hospital mortality rates were 32.6% for warfarin, 26.5% for NOACs, and 22.5% for no OACs. Compared with patients without prior use of OACs, the risk of in-hospital mortality was higher among patients with prior use of warfarin (adjusted risk difference [ARD], 9.0% [97.5% CI, 7.9% to 10.1%]; adjusted odds ratio [AOR], 1.62 [97.5% CI, 1.53 to 1.71]) and higher among patients with prior use of NOACs (ARD, 3.3% [97.5% CI, 1.7% to 4.8%]; AOR, 1.21 [97.5% CI, 1.11-1.32]). Compared with patients with prior use of warfarin, patients with prior use of NOACs had a lower risk of in-hospital mortality (ARD, -5.7% [97.5% CI, -7.3% to -4.2%]; AOR, 0.75 [97.5% CI, 0.69 to 0.81]). The difference in mortality between NOAC-treated patients and warfarin-treated patients was numerically greater among patients with prior use of dual antiplatelet agents (32.7% vs 47.1%; ARD, -15.0% [95.5% CI, -26.3% to -3.8%]; AOR, 0.50 [97.5% CI, 0.29 to 0.86]) than among those taking these agents without prior antiplatelet therapy (26.4% vs 31.7%; ARD, -5.0% [97.5% CI, -6.8% to -3.2%]; AOR, 0.77 [97.5% CI, 0.70 to 0.85]), although the interaction P value (.07) was not statistically significant. Conclusions and Relevance: Among patients with ICH, prior use of NOACs or warfarin was associated with higher in-hospital mortality compared with no OACs. Prior use of NOACs, compared with prior use of warfarin, was associated with lower risk of in-hospital mortality.
[Mh] Termos MeSH primário: Anticoagulantes/efeitos adversos
Hemorragia Cerebral/induzido quimicamente
Mortalidade Hospitalar
Inibidores da Agregação de Plaquetas/efeitos adversos
Vitamina K/antagonistas & inibidores
Varfarina/efeitos adversos
[Mh] Termos MeSH secundário: Administração Oral
Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/uso terapêutico
Hemorragia Cerebral/mortalidade
Fatores de Confusão (Epidemiologia)
Feminino
Seres Humanos
Masculino
Inibidores da Agregação de Plaquetas/uso terapêutico
Sistema de Registros
Estudos Retrospectivos
Risco
Varfarina/uso terapêutico
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Platelet Aggregation Inhibitors); 12001-79-5 (Vitamin K); 5Q7ZVV76EI (Warfarin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180127
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.21917



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