1,721,003 research outputs found
Direct oral anticoagulants (DOAC) – Management of emergency situations
No full textSummaryThe worldwide increase in the aging population and the associated increase in the prevalence of atrial fibrillation and venous thromboembolism as well as the widespread use of direct oral anticoagulants (DOAC) have resulted in an increase of the need for the management of bleeding complications and emergency operations in frail, elderly patients, in clinical practice. When severe bleeding occurs, general assessment should include evaluation of the bleeding site, onset and severity of bleeding, renal function, and concurrent medications with focus on anti-platelet drugs and nonsteroidal anti-inflammatory drugs (NSAID). The last intake of the DOAC and its residual concentration are also relevant. The site of bleeding should be immediately localized, anticoagulation should be interrupted, and local measures to stop bleeding should be taken. In life-threatening bleeding or emergency operations immediate reversal of the antithrombotic effect may be indicated. If relevant residual DOAC-concentrations are expected and surgery cannot be postponed, prothrombin complex concentrate (PCC) and/or a specific antidote should be given. While idarucizumab, the specific antidote for dabigatran, has been recently approved for clinical use, the recombinant factor X protein andexanet alfa, an antidote for the reversal of inhibitors of coagulation factor Xa, and ciraparantag, a universal antidote, are not available. Future cohort studies are necessary to assess the efficacy and safety of specific and unspecific reversal agents in “real-life” conditions. This was the rationale for introducing the RADOA-registry (RADOA: Reversal Agent use in patients treated with Direct Oral Anticoagulants or vitamin K antagonists), a prospective non-interventional registry, which will evaluate the effects of specific and unspecific reversal agents in patients with life-threatening bleeding or emergency operations either treated with DOACs or vitamin K antagonists.</jats:p
Main considerable factors for correct laboratory test interpretation under DOA treatment
No full textResponse to Mortensen et al. “Do the Behring Coagulation Timer (BCT®) and the Platelet Function Analyzer PFA-100® identify the same patients as being aspirin non-responder?”
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A Synovial Cyst Originating from the Hip Joint as a Rare Cause of Recurrent Femoral Vein Thrombosis: Case Report and Literature Review
No full textWenn das Blut in den Adern stockt : seltene Thrombosen können genetische Ursache haben
No full textJährlich erkranken etwa 80 000 Deutsche an einer Thrombose, die meisten trifft es im höheren Lebensalter, als Folge einer längeren Immobilisation oder der Einnahme von Hormonpräparaten. Bei einigen aber wird das Gerinnsel, das Venen oder Arterien verstopft, durch eine angeborene oder erworbene Thrombophilie verursacht. Manche dieser Gerinnungsneigungen sind häufig, andere sehen selbst die Ärzte im Schwerpunkt Angiologie/Hämostaseologie des Gefäßzentrums der Frankfurter Uniklinik höchstens ein-, zweimal im Monat. Weshalb belastbare Erkenntnisse auch zur Therapie dieser seltenen Thromboseformen fehlen. Dies zu ändern, ist das Ziel des Teams um Professor Edelgard Lindhoff-Last an der Frankfurter Uniklinik
Auswaschverhalten von Lepirudin als Antikoagulans bei der maschinellen Autotransfusion mit dem cell-saver 5
No full textRivaroxaban differentially influences ex vivo global coagulation assays based on the administration time
No full textSummaryIt was the objective of this study to quantify the effects of rivaroxaban administration on global coagulation parameters associated with routine clinical procedures, we collected plasma samples from patients undergoing major orthopaedic surgery receiving rivaroxaban at various time points after drug administration. Forty-seven patients received rivaroxaban (10 mg daily) for venous thromboembolism prophylaxis. Blood samples were collected at four different time points: A) before surgery; B) before drug administration at day 4–5 after surgery (steady state of rivaroxaban); C) 2 hours (h) after drug administration and D) 12 h after drug administration. The prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), antithrombin (AT) level, fibrinogen level by Clauss method (FibC), and derived fibrinogen (dFIB) level were assessed with various reagents. At 2 h after rivaroxaban administration, the PT and aPTT clotting times were significantly prolonged to different extents up to 1.4 fold, whereas 12 h after drug administration, no significant effect was observed. Rivaroxaban administration had no influence on the TT or the FibC concentration. The dFIB assay was differentially affected by rivaroxaban when different reagents were tested. The AT assay dependent on thrombin activity was not influenced by rivaroxaban, whereas the AT levels dependent on factor Xa activity were significantly increased by rivaroxaban. Clinicians should be aware of the time-dependent influence of rivaroxaban on factor Xa-dependent routine coagulation assays. Therefore, routine coagulation parameters should be assessed directly before drug administration to keep the interaction of rivaroxaban low.</jats:p
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