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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


  2 / 12101 MEDLINE  
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[PMID]:28457980
[Au] Autor:Innerhofer P; Fries D; Mittermayr M; Innerhofer N; von Langen D; Hell T; Gruber G; Schmid S; Friesenecker B; Lorenz IH; Ströhle M; Rastner V; Trübsbach S; Raab H; Treml B; Wally D; Treichl B; Mayr A; Kranewitter C; Oswald E
[Ad] Endereço:Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: Petra.Innerhofer@tirol-kliniken.at.
[Ti] Título:Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial.
[So] Source:Lancet Haematol;4(6):e258-e271, 2017 Jun.
[Is] ISSN:2352-3026
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Effective treatment of trauma-induced coagulopathy is important; however, the optimal therapy is still not known. We aimed to compare the efficacy of first-line therapy using fresh frozen plasma (FFP) or coagulation factor concentrates (CFC) for the reversal of trauma-induced coagulopathy, the arising transfusion requirements, and consequently the development of multiple organ failure. METHODS: This single-centre, parallel-group, open-label, randomised trial was done at the Level 1 Trauma Center in Innsbruck Medical University Hospital (Innsbruck, Austria). Patients with trauma aged 18-80 years, with an Injury Severity Score (ISS) greater than 15, bleeding signs, and plasmatic coagulopathy identified by abnormal fibrin polymerisation or prolonged coagulation time using rotational thromboelastometry (ROTEM) were eligible. Patients with injuries that were judged incompatible with survival, cardiopulmonary resuscitation on the scene, isolated brain injury, burn injury, avalanche injury, or prehospital coagulation therapy other than tranexamic acid were excluded. We used a computer-generated randomisation list, stratification for brain injury and ISS, and closed opaque envelopes to randomly allocate patients to treatment with FFP (15 mL/kg of bodyweight) or CFC (primarily fibrinogen concentrate [50 mg/kg of bodyweight]). Bleeding management began immediately after randomisation and continued until 24 h after admission to the intensive care unit. The primary clinical endpoint was multiple organ failure in the modified intention-to-treat population (excluding patients who discontinued treatment). Reversal of coagulopathy and need for massive transfusions were important secondary efficacy endpoints that were the reason for deciding the continuation or termination of the trial. This trial is registered with ClinicalTrials.gov, number NCT01545635. FINDINGS: Between March 3, 2012, and Feb 20, 2016, 100 out of 292 screened patients were included and randomly allocated to FFP (n=48) and CFC (n=52). Six patients (four in the FFP group and two in the CFC group) discontinued treatment because of overlooked exclusion criteria or a major protocol deviation with loss of follow-up. 44 patients in the FFP group and 50 patients in the CFC group were included in the final interim analysis. The study was terminated early for futility and safety reasons because of the high proportion of patients in the FFP group who required rescue therapy compared with those in the CFC group (23 [52%] in the FFP group vs two [4%] in the CFC group; odds ratio [OR] 25·34 [95% CI 5·47-240·03], p<0·0001) and increased needed for massive transfusion (13 [30%] in the FFP group vs six [12%] in the CFC group; OR 3·04 [0·95-10·87], p=0·042) in the FFP group. Multiple organ failure occurred in 29 (66%) patients in the FFP group and in 25 (50%) patients in the CFC group (OR 1·92 [95% CI 0·78-4·86], p=0·15). INTERPRETATION: Our results underline the importance of early and effective fibrinogen supplementation for severe clotting failure in multiple trauma. The available sample size in our study appears sufficient to make some conclusions that first-line CFC is superior to FFP. FUNDING: None.
[Mh] Termos MeSH primário: Fatores de Coagulação Sanguínea/uso terapêutico
Hemorragia/tratamento farmacológico
Hemorragia/etiologia
Plasma
Ferimentos e Lesões/complicações
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Blood Coagulation Factors)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE


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[PMID]:29227613
[Au] Autor:Danilova LD; Vynogradova RP; Grigorieva MV
[Ti] Título:[Inventive activity of the Department of Protein Structure and Function of the Palladin Institute of Biochemistry of NAS of Ukraine. Part I. Development of the diagnostic methods for detection of hemostasis disorders and characterization of certain blood coagulation factors].
[So] Source:Ukr Biochem J;88(2):107-18, 2016 Mar-Apr.
[Is] ISSN:2409-4943
[Cp] País de publicação:Ukraine
[La] Idioma:rus; ukr
[Mh] Termos MeSH primário: Academias e Institutos/história
Bioquímica/história
Transtornos Herdados da Coagulação Sanguínea/diagnóstico
Invenções/história
[Mh] Termos MeSH secundário: Bioquímica/recursos humanos
Transtornos Herdados da Coagulação Sanguínea/história
Fatores de Coagulação Sanguínea/história
Fatores de Coagulação Sanguínea/metabolismo
Fatores de Coagulação Sanguínea/ultraestrutura
História do Século XX
História do Século XXI
Seres Humanos
Ucrânia
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE; PORTRAITS
[Nm] Nome de substância:
0 (Blood Coagulation Factors)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.15407/ubj88.02.107


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[PMID]:28466387
[Au] Autor:Zhao Z; Zhou Y; Tian Y; Li M; Dong JF; Zhang J
[Ad] Endereço:Department of Neurosurgery, Tianjin Institute of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
[Ti] Título:Cellular microparticles and pathophysiology of traumatic brain injury.
[So] Source:Protein Cell;8(11):801-810, 2017 Nov.
[Is] ISSN:1674-8018
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. The finding that cellular microparticles (MPs) generated by injured cells profoundly impact on pathological courses of TBI has paved the way for new diagnostic and therapeutic strategies. MPs are subcellular fragments or organelles that serve as carriers of lipids, adhesive receptors, cytokines, nucleic acids, and tissue-degrading enzymes that are unique to the parental cells. Their sub-micron sizes allow MPs to travel to areas that parental cells are unable to reach to exercise diverse biological functions. In this review, we summarize recent developments in identifying a casual role of MPs in the pathologies of TBI and suggest that MPs serve as a new class of therapeutic targets for the prevention and treatment of TBI and associated systemic complications.
[Mh] Termos MeSH primário: Astrócitos/metabolismo
Lesões Encefálicas Traumáticas/fisiopatologia
Micropartículas Derivadas de Células/metabolismo
Coagulação Intravascular Disseminada/fisiopatologia
Microglia/metabolismo
Neurônios/metabolismo
[Mh] Termos MeSH secundário: Animais
Astrócitos/patologia
Transporte Biológico
Fatores de Coagulação Sanguínea/genética
Fatores de Coagulação Sanguínea/metabolismo
Encéfalo/metabolismo
Encéfalo/patologia
Encéfalo/fisiopatologia
Lesões Encefálicas Traumáticas/genética
Lesões Encefálicas Traumáticas/metabolismo
Lesões Encefálicas Traumáticas/patologia
Micropartículas Derivadas de Células/química
Micropartículas Derivadas de Células/patologia
Citocinas/sangue
Citocinas/genética
Modelos Animais de Doenças
Coagulação Intravascular Disseminada/genética
Coagulação Intravascular Disseminada/metabolismo
Coagulação Intravascular Disseminada/patologia
Regulação da Expressão Gênica
Seres Humanos
Microglia/patologia
Neurônios/patologia
Transdução de Sinais
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Blood Coagulation Factors); 0 (Cytokines)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1007/s13238-017-0414-6


  5 / 12101 MEDLINE  
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[PMID]:28456301
[Au] Autor:Lefebvre S; Hascoët C; Damin-Pernik M; Rannou B; Benoit E; Lattard V
[Ad] Endereço:USC 1233 INRA-Vetagro Sup, Veterinary School of Lyon, 1 Avenue Bourgelat, 69280 Marcy l'Etoile, France.
[Ti] Título:Monitoring of antivitamin K-dependent anticoagulation in rodents - Towards an evolution of the methodology to detect resistance in rodents.
[So] Source:Pestic Biochem Physiol;138:29-36, 2017 May.
[Is] ISSN:1095-9939
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Vitamin K antagonists are used as rodenticides for pest control management. In rodents, prothrombin time is used to monitor their effect despite its limits and the emergence of many coagulation methods. The aim of this study is to explore different coagulation monitoring methods in order to propose the best method and the best parameter to monitor vitamin K antagonists effect in rodents. The coagulation function was thus monitored with global coagulation assays and specialty assays after difethialone administration in rats. Despite many parameters obtained by thromboelastometry, only clotting time and clot formation time obtained by ExTEM were modified. Their evolution was fast with doubling time respectively of 4.0h and 3.7h but their increases were delayed with a lag time higher than 8h. Conversely, prothrombin time evolution presented a lag time of only 2h, but a higher doubling time of 7.2h. The measurements of factor VII and X activities were the most sensitive assays to monitor vitamin K antagonists effect with almost no lag time and the fastest evolution. Nevertheless, factor X was shown to be the only key factor driving prothrombin time. Monitoring factor X activity enables to follow most effectively the anticoagulation status in rats after rodenticides administration.
[Mh] Termos MeSH primário: 4-Hidroxicumarinas/farmacologia
Anticoagulantes/farmacologia
Vitamina K/metabolismo
[Mh] Termos MeSH secundário: Ração Animal
Animais
Coagulação Sanguínea/efeitos dos fármacos
Coagulação Sanguínea/genética
Fatores de Coagulação Sanguínea/metabolismo
Resistência a Medicamentos
Imunidade Inata
Fígado
Masculino
Ratos
Ratos Sprague-Dawley
Roedores
Rodenticidas
Vitamina K/antagonistas & inibidores
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (4-Hydroxycoumarins); 0 (Anticoagulants); 0 (Blood Coagulation Factors); 0 (Rodenticides); 12001-79-5 (Vitamin K); KOL4VXI5O0 (difethialone)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170501
[St] Status:MEDLINE


  6 / 12101 MEDLINE  
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[PMID]:28964439
[Au] Autor:Chen CX; Baker JR; Nichol MB
[Ad] Endereço:University of Southern California, Los Angeles, CA, USA.
[Ti] Título:Economic Burden of Illness among Persons with Hemophilia B from HUGS Vb: Examining the Association of Severity and Treatment Regimens with Costs and Annual Bleed Rates.
[So] Source:Value Health;20(8):1074-1082, 2017 Sep.
[Is] ISSN:1524-4733
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To determine US societal burden of illness, including direct and indirect costs and annual bleed rate (ABR), for persons with hemophilia B (HB), a rare and debilitating genetic disorder, and to examine associations of hemophilia severity and treatment regimens with costs and ABR. METHODS: From 2009 to 2014, the Hemophilia Utilization Group Studies Part Vb collected prospective data from 10 US hemophilia treatment centers. Participants with HB completed initial surveys on sociodemographic characteristics, clinical characteristics, and treatment patterns. During the 2-year follow-up, participants reported bleeding episodes, work absenteeism, and caregiver time quarterly. These data were used to calculate ABR and indirect costs. Direct costs were calculated using 1-year clinical chart records and 2-year dispensing records. RESULTS: Of the 148 participants, 112 with complete medical records and one or more follow-up survey were included. Total mean annual per-person costs were $85,852 (median $20,160) for mild/moderate HB, $198,733 (median $147,891) for severe HB, and $140,240 (median $63,617) for all participants without inhibitors (P < 0.0001). Mean ABR for participants with severe HB on prophylaxis (5.5 ± 7.9 bleeds/y) was almost half that of those treated episodically. Clotting factor and indirect costs accounted for 85% and 9% of total costs, respectively. Compared with episodic treatment, prophylaxis use was associated with 2.5-fold higher clotting factor costs (P < 0.01), low but significantly more missed parental workdays (P < 0.0001) and clinician (P < 0.001) or nursing visits (P < 0.0001), less part-time employment and unemployment, and lower hospitalizations costs (P = 0.17) and ABR (P < 0.0001). CONCLUSIONS: HB is associated with high economic burden, primarily because of clotting factor costs. Nevertheless, prophylaxis treatment leads to clinical benefits and may reduce other nonfactor costs.
[Mh] Termos MeSH primário: Fatores de Coagulação Sanguínea/administração & dosagem
Efeitos Psicossociais da Doença
Custos de Cuidados de Saúde/estatística & dados numéricos
Hemofilia B/terapia
Hemorragia/terapia
[Mh] Termos MeSH secundário: Absenteísmo
Adolescente
Adulto
Fatores de Coagulação Sanguínea/economia
Cuidadores/estatística & dados numéricos
Criança
Pré-Escolar
Emprego/estatística & dados numéricos
Feminino
Seguimentos
Hemofilia B/economia
Hemofilia B/fisiopatologia
Hemorragia/economia
Hemorragia/etiologia
Hospitalização/economia
Hospitalização/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Índice de Gravidade de Doença
Inquéritos e Questionários
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Blood Coagulation Factors)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171002
[St] Status:MEDLINE


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[PMID]:28918742
[Au] Autor:Gorbacheva LR; Kiseleva EV; Savinkova IG; Strukova SM
[Ad] Endereço:Lomonosov Moscow State University, Faculty of Biology, Moscow, 119991, Russia. sstrukova@yahoo.com.
[Ti] Título:A New Concept of Action of Hemostatic Proteases on Inflammation, Neurotoxicity, and Tissue Regeneration.
[So] Source:Biochemistry (Mosc);82(7):778-790, 2017 Jul.
[Is] ISSN:1608-3040
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Key hemostatic serine proteases such as thrombin and activated protein C (APC) are signaling molecules controlling blood coagulation and inflammation, tissue regeneration, neurodegeneration, and some other processes. By interacting with protease-activated receptors (PARs), these enzymes cleave a receptor exodomain and liberate new amino acid sequence known as a tethered ligand, which then activates the initial receptor and induces multiple signaling pathways and cell responses. Among four PAR family members, APC and thrombin mainly act via PAR1, and they trigger divergent effects. APC is an anticoagulant with antiinflammatory and cytoprotective activity, whereas thrombin is a protease with procoagulant and proinflammatory effects. Hallmark features of APC-induced effects result from acting via different pathways: limited proteolysis of PAR1 localized in membrane caveolae with coreceptor (endothelial protein C receptor) as well as its targeted proteolytic action at a receptor exodomain site differing from the canonical thrombin cleavage site. Hence, a new noncanonical tethered PAR1 agonist peptide (PAR1-AP) is formed, whose effects are poorly investigated in inflammation, tissue regeneration, and neurotoxicity. In this review, a concept about a role of biased agonism in effects exerted by APC and PAR1-AP via PAR1 on cells involved in inflammation and related processes is developed. New evidence showing a role for a biased agonism in activating PAR1 both by APC and PAR1-AP as well as induction of antiinflammatory and cytoprotective cellular responses in experimental inflammation, wound healing, and excitotoxicity is presented. It seems that synthetic PAR1 peptide-agonists may compete with APC in controlling some inflammatory and neurodegenerative diseases.
[Mh] Termos MeSH primário: Inflamação
Proteína C/metabolismo
Regeneração/fisiologia
Trombina/metabolismo
[Mh] Termos MeSH secundário: Apoptose/efeitos dos fármacos
Fatores de Coagulação Sanguínea/agonistas
Fatores de Coagulação Sanguínea/metabolismo
Ácido Glutâmico/toxicidade
Seres Humanos
Mastócitos/citologia
Mastócitos/efeitos dos fármacos
Mastócitos/metabolismo
Fármacos Neuroprotetores/farmacologia
Receptor PAR-1/agonistas
Receptor PAR-1/metabolismo
Receptores de Superfície Celular/agonistas
Receptores de Superfície Celular/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Blood Coagulation Factors); 0 (Neuroprotective Agents); 0 (Protein C); 0 (Receptor, PAR-1); 0 (Receptors, Cell Surface); 0 (activated protein C receptor); 3KX376GY7L (Glutamic Acid); EC 3.4.21.5 (Thrombin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170919
[St] Status:MEDLINE
[do] DOI:10.1134/S0006297917070033


  8 / 12101 MEDLINE  
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[PMID]:28857856
[Au] Autor:Schöchl H; Grottke O; Sutor K; Dony K; Schreiber M; Ranucci M; Collins PW
[Ad] Endereço:From the *Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria; †Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria; ‡Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany; §Meridian HealthComms Ltd, Plumley, Cheshire, United Kingdom; ‖Parker Design Consultants Ltd, Lostock Gralam, Cheshire, United Kingdom; ¶Trauma, Critical Care and Acute Care Surgery Division, Oregon Health and Science University, Portland, Oregon; #Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy; and **School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, United Kingdom.
[Ti] Título:Theoretical Modeling of Coagulation Management With Therapeutic Plasma or Prothrombin Complex Concentrate.
[So] Source:Anesth Analg;125(5):1471-1474, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Prothrombin complex concentrates (PCCs) have been associated with a possible risk of thromboembolic complications, potentially attributable to an increased ratio of the plasma concentration of factor II (FII) to antithrombin (AT). We developed a mathematical model to examine the relationship between amounts of PCC or therapeutic plasma administered, and plasma levels of FII and AT. The model showed that PCC produces substantial increases in plasma levels of FII but only small changes in AT, increasing the FII:AT ratio. Therapeutic plasma was shown to have only modest effects on levels of FII or AT, unless high doses are used.
[Mh] Termos MeSH primário: Fatores de Coagulação Sanguínea/uso terapêutico
Coagulação Sanguínea/efeitos dos fármacos
Hemorragia/prevenção & controle
Hemostáticos/uso terapêutico
Modelos Biológicos
[Mh] Termos MeSH secundário: Antitrombinas/metabolismo
Fatores de Coagulação Sanguínea/efeitos adversos
Hemorragia/sangue
Hemostáticos/efeitos adversos
Seres Humanos
Soluções Isotônicas/uso terapêutico
Substitutos do Plasma/uso terapêutico
Volume Plasmático
Protrombina/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antithrombins); 0 (Blood Coagulation Factors); 0 (Hemostatics); 0 (Isotonic Solutions); 0 (Plasma Substitutes); 0 (crystalloid solutions); 37224-63-8 (prothrombin complex concentrates); 9001-26-7 (Prothrombin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002410


  9 / 12101 MEDLINE  
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[PMID]:28857806
[Au] Autor:Honickel M; Braunschweig T; Rossaint R; Stoppe C; Ten Cate H; Grottke O
[Ad] Endereço:From the Department of Anesthesiology (M.H., R.R., C.S., O.G.) and Department of Pathology (T.B.), RWTH Aachen University Hospital, Aachen, Germany; and the Division of Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands (H.t.C.).
[Ti] Título:Reversing Dabigatran Anticoagulation with Prothrombin Complex Concentrate versus Idarucizumab as Part of Multimodal Hemostatic Intervention in an Animal Model of Polytrauma.
[So] Source:Anesthesiology;127(5):852-861, 2017 Nov.
[Is] ISSN:1528-1175
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although idarucizumab is the preferred treatment for urgent dabigatran reversal, it is not always available. Prothrombin complex concentrate (PCC) may be an alternative and, with bleeding in trauma, additional hemostatic therapy may be required. The authors investigated multimodal treatment in a preclinical polytrauma model. METHODS: Dabigatran etexilate (30 mg/kg twice daily) was given orally to 45 male pigs for 3 days. On day 4, animals received a dabigatran infusion before blunt liver injury and bilateral femur fractures. After injury, animals were randomized 1:1:1:1:1 to receive placebo (control), tranexamic acid (TXA; 20 mg/kg) plus human fibrinogen concentrate (FCH; 80 mg/kg) (TXA-FCH group), PCC (25 U/kg or 50 U/kg) plus TXA plus FCH (PCC25 and PCC50 groups), or 60 mg/kg idarucizumab (IDA) plus TXA plus FCH (IDA group). Animals were monitored for 240 min after trauma, or until death. RESULTS: The degree of injury was similar in all animals before intervention. Control and TXA-FCH animals had the highest total postinjury blood loss (3,652 ± 601 and 3,497 ± 418 ml) and 100% mortality (mean survival time 96 and 109 min). Blood loss was significantly lower in the PCC50 (1,367 ± 273 ml) and IDA (986 ± 144 ml) groups, with 100% survival. Thrombin-antithrombin levels and thrombin generation were significantly elevated in the PCC50 group. CONCLUSIONS: Idarucizumab may be considered the optimal treatment for emergency reversal of dabigatran anticoagulation. However, this study suggests that PCC may be similarly effective as idarucizumab and could therefore be valuable when idarucizumab is unavailable. (Anesthesiology 2017; 127:852-61).
[Mh] Termos MeSH primário: Anticorpos Monoclonais Humanizados/uso terapêutico
Fatores de Coagulação Sanguínea/uso terapêutico
Coagulação Sanguínea/efeitos dos fármacos
Dabigatrana/toxicidade
Modelos Animais de Doenças
Traumatismo Múltiplo/tratamento farmacológico
[Mh] Termos MeSH secundário: Animais
Anticorpos Monoclonais Humanizados/farmacologia
Anticoagulantes/toxicidade
Coagulação Sanguínea/fisiologia
Fatores de Coagulação Sanguínea/farmacologia
Hemorragia/induzido quimicamente
Hemorragia/tratamento farmacológico
Hemostasia/efeitos dos fármacos
Hemostasia/fisiologia
Seres Humanos
Masculino
Traumatismo Múltiplo/patologia
Distribuição Aleatória
Suínos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Humanized); 0 (Anticoagulants); 0 (Blood Coagulation Factors); 37224-63-8 (prothrombin complex concentrates); 97RWB5S1U6 (idarucizumab); I0VM4M70GC (Dabigatran)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1097/ALN.0000000000001856


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[PMID]:28835439
[Au] Autor:Majeed A; Ågren A; Holmström M; Bruzelius M; Chaireti R; Odeberg J; Hempel EL; Magnusson M; Frisk T; Schulman S
[Ad] Endereço:Department of Medicine and.
[Ti] Título:Management of rivaroxaban- or apixaban-associated major bleeding with prothrombin complex concentrates: a cohort study.
[So] Source:Blood;130(15):1706-1712, 2017 Oct 12.
[Is] ISSN:1528-0020
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:There is uncertainty regarding the effectiveness and occurrence of thromboembolic events in patients treated with prothrombin complex concentrates (PCCs) for the management of major bleeding events (MBEs) on rivaroxaban or apixaban. We investigated the effectiveness of PCCs given for the management of MBEs in patients on rivaroxaban or apixaban. Between 1 January 2014 and 1 October 2016, we prospectively included patients on rivaroxaban or apixaban treated with PCCs for the management of MBEs. The effectiveness of PCCs was assessed by using the International Society of Thrombosis and Hemostasis Scientific and Standardization Subcommittee criteria for the assessment of the effectiveness of major bleeding management. The safety outcomes were thromboembolic events and all-cause mortality within 30 days after treatment with PCCs. A total of 84 patients received PCCs for the reversal of rivaroxaban or apixaban due to a MBE. PCCs were given at a median (interquartile range) dose of 2000 IU (1500-2000 IU). Intracranial hemorrhage (ICH) was the most common site of bleeding requiring reversal (n = 59; 70.2%), followed by gastrointestinal bleeding in 13 (15.5%) patients. Management with PCCs was assessed as effective in 58 (69.1%) patients and ineffective in 26 (30.9%) patients. Most patients with ineffective hemostasis with PCCs had ICH (n = 16; 61.5%). Two patients developed an ischemic stroke, occurring 5 and 10 days after treatment with PCC. Twenty-seven (32%) patients died within 30 days after a MBE. The administration of PCCs for the management of MBEs associated with rivaroxaban or apixaban is effective in most cases and is associated with a low risk of thromboembolism. Our findings are limited by the absence of a control group in the study.
[Mh] Termos MeSH primário: Fatores de Coagulação Sanguínea/uso terapêutico
Hemorragia/tratamento farmacológico
Pirazóis/uso terapêutico
Piridonas/uso terapêutico
Rivaroxabana/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Fatores de Coagulação Sanguínea/efeitos adversos
Estudos de Coortes
Demografia
Feminino
Hemorragia/mortalidade
Seres Humanos
Masculino
Pirazóis/efeitos adversos
Piridonas/efeitos adversos
Rivaroxabana/efeitos adversos
Tromboembolia/induzido quimicamente
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Blood Coagulation Factors); 0 (Pyrazoles); 0 (Pyridones); 37224-63-8 (prothrombin complex concentrates); 3Z9Y7UWC1J (apixaban); 9NDF7JZ4M3 (Rivaroxaban)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170825
[St] Status:MEDLINE
[do] DOI:10.1182/blood-2017-05-782060



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