1,721,000 research outputs found
Investigational anticoagulants for hematological conditions: a new generation of therapies
No full textThe introduction of novel anticoagulants has had contrasting effects on the agents in the pipeline, fueling the development of some and sinking the others. The complexity of the coagulation cascade offers interesting inhibition choices that might become valid treatment options.
AREAS COVERED:
This review will highlight some of the anticoagulants in the pipeline. Following the success of the direct thrombin and FXa inhibitors already in the market, new agents are being tested. These include AZD0837, betrixaban, letaxaban, darexaban, and LY517717. Targeting other components of the hemostatic pathway might lead to better safety profiles without influencing efficacy. Inhibitors to FVIIa-tissue factor (FVIIa/TF) complex, FIX, FXI, and FXII are being assessed. New inspiring inhibitors are antisense oligonucleotides (ASOs) and aptamers. These are highly specific agents with readily reversible effect and might be engineered to inhibit any coagulation factor. Currently tested ASOs and aptamers are inhibitors of FXI, FXII, thrombin, FIXa, and platelet GPIV.
EXPERT OPINION:
Some of the agents in the pipeline offer valid treatment option for long-term therapy, overcoming some of the drawbacks of the novel anticoagulants. Research is being driven by an expanding market in the anticoagulation field that has been unexploited for a long time
Diagnostics and treatment of thrombotic antiphospholipid syndrome (APS): A personal perspective
No full textOptimizing quality care for the oral vitamin K antagonists (VKAs)
No full textVitamin K antagonists (VKAs) have been the only oral anticoagulants for decades. The management of anticoagulant therapy with VKA is challenging because of the intricate pharmacological properties of these agents. The success of VKA therapy depends on the quality of treatment that is ensured through continuing comprehensive communication and education. The educational program should address important issues of the VKA therapy such as beginning of treatment, pharmacological, dietary, and drug-drug interactions, as well as treatment temporary suspension during surgical interventions or invasive maneuvers. In addition, the initial and continuing patient education is of imperative importance. A major role in the educational process may be addressed by patient associations. The quality of treatment is better reached if patients are followed in anticoagulation clinics. Moreover, a federation of anticoagulation clinics may improve patient care through regular meetings to update knowledge on VKA treatment. Learning objectives of this paper is to allow readers to correctly approach patients starting VKA treatment, recognize possible pitfalls of treatment, and provide adequate solutions
Cancer as a risk factor for stroke in atrial fibrillation patients receiving long-term oral anticoagulant therapy
No full textThe benefit of betrixaban for the extended thromboprophylaxis in acutely ill medical patients
No full textAntiphospholipid syndrome and the heart: A case series and literature review
No full textAntiphospholipid syndrome is a rare autoimmune disease characterised by a high tendency of developing thrombotic events. It is diagnosed in the presence of specific laboratory criteria (positivity for lupus anticoagulant, and the presence of anticardiolipin and aβ2GPI antibodies) and clinical criteria such as thrombosis in any district (arterial or venous) and pregnancy morbidity. Being a multisystem disease, heart is commonly affected by direct (autoimmune mediated action) or indirect (thrombosis) pathological mechanisms. Heart valve lesions are the most frequent manifestations; however, the haemodynamic significance is quite uncommon but when it occurs it may require surgery that further complicates the picture due to the high risk of thrombosis. Coronary arteries and myocardium are also affected leading to ischaemic heart disease and left ventricular dysfunction. Other findings include chronic thromboembolic pulmonary hypertension and accelerated atherosclerosis. The consequences of heart involvement may be significant in overt disease. The treatment of cardiac complications is challenging and requires an in depth knowledge of the disease
Antiphospholipid antibodies in chronic thromboembolic pulmonary hypertension
Full text linkAcquired thrombophilia and in particular the presence of antiphospholipid antibodies (aPL) may play an important role in the development of chronic thromboembolic pulmonary hypertension (CTEPH). Young patients suffering from an episode of unprovoked pulmonary embolism (PE), or PE provoked by mild risk factors, should be tested for aPL. In case of a positive result, they should be closely followed up and lifelong anticoagulant treatment should be considered. Indeed, aPL-induced thrombophilia may favor PE recurrence with the consequence of possible CTEPH development. The aPL profiles play an important role in this pathway. Patients with PE and triple positivity (lupus anticoagulant, LAC, anti-cardiolipin, aCL, and anti-β2-glycoprotein I, aβ2GPI) are at the highest risk of recurrence and deserve maximum protection by anticoagulant treatment with warfarin
Minimizing the risk of hemorrhagic stroke during anticoagulant therapy for atrial fibrillation
No full textIntroduction: Oral anticoagulation (OAC) is given for ischemic stroke
prevention in patients with nonvalvular atrial fibrillation. OAC’s most serious
complications are major bleeding and, in particular, hemorrhagic stroke.
Together with vitamin K antagonists (VKAs), direct oral anticoagulants
(DOAC) are now available which have a more rapid onset/offset of action
and more predictable anticoagulant effect. The advent of DOAC has given
to the clinician an opportunity to tailor OAC therapy in order to maximize
advantages and minimize complications.
Areas covered: This review covers data published in literature regarding the
risk of hemorrhagic stroke in patients taking OAC. Bleeding risk assessment
is discussed and different bleeding risk factors are presented. The paper will
also review clinical studies comparing DOAC against standard anticoagulation,
in regard to the risk of hemorrhagic stroke.
Expert opinion: Bleeding assessment is mandatory in order to select patients
at high hemorrhagic risk who will benefit the most from close monitoring.
Blood pressure, alcohol intake, concomitant medication and comorbidities
should be constantly evaluated and treated accordingly. During VKA therapy,
adherence and intensity of anticoagulation must be strictly monitored. DOAC
are associated with lower risk of hemorrhagic stroke than VKA. However,
periodic hepatic and renal checks as well as careful evaluation of time adherence are necessary to reduce the risk of bleeding
Efficacy and safety of rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome: Rationale and design of the Trial on Rivaroxaban in AntiPhospholipid Syndrome (TRAPS) trial
No full textCorrect laboratory approach to APS diagnosis and monitoring
No full textTriple positivity (positive Lupus Anticoagulant, anticardiolipin and anti β2-glycoptrotein I antibodies) identifies the pathogenic autoantibody (anti Domain I of β2-glycoptroteinI) that is present in patients with definite Antiphospholipid Syndrome (APS). This is supported by the fact that aβ2GPI antibodies obtained by affinity purification in these patients possess LA activity. Moreover, patients and carriers of this profile carry a much higher risk of thrombosis and pregnancy loss than APS patients with positivity for only one of the tests. Thus, very different risk categories exist among patients with APS as well as among carriers of aPL. Clinical studies and interventional trials should first take these high risk subjects into consideration.
Copyright © 2012 Elsevier B.V. All rights reserved
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