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An Adjusted Calculation Model Allows for Reduced Protamine Doses without Increasing Blood Loss in Cardiac Surgery.

https://arctichealth.org/en/permalink/ahliterature284260
Source
Thorac Cardiovasc Surg. 2016 Sep;64(6):487-93
Publication Type
Article
Date
Sep-2016
Author
Gunilla Kjellberg
Ulrik Sartipy
Jan van der Linden
Emelie Nissborg
Gabriella Lindvall
Source
Thorac Cardiovasc Surg. 2016 Sep;64(6):487-93
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - administration & dosage - adverse effects
Blood Coagulation - drug effects
Blood Coagulation Tests
Blood Loss, Surgical - prevention & control
Body Height
Body Weight
Cardiac Surgical Procedures - adverse effects
Cardiopulmonary Bypass - adverse effects
Computer simulation
Drug Dosage Calculations
Female
Heparin - administration & dosage - adverse effects
Heparin Antagonists - administration & dosage - adverse effects
Humans
Male
Middle Aged
Models, Biological
Postoperative Hemorrhage - etiology - prevention & control
Protamines - administration & dosage - adverse effects
Sweden
Time Factors
Treatment Outcome
Abstract
Background Heparin dosage for anticoagulation during cardiopulmonary bypass (CPB) is commonly calculated based on the patient's body weight. The protamine-heparin ratio used for heparin reversal varies widely among institutions (0.7-1.3?mg protamine/100 IU heparin). Excess protamine may impair coagulation. With an empirically developed algorithm, the HeProCalc program, heparin, and protamine doses are calculated during the procedure. The primary aim was to investigate whether HeProCalc-based dosage of heparin could reduce protamine use compared with traditional dosages. The secondary aim was to investigate whether HeProCalc-based dosage of protamine affected postoperative bleeding. Patients and Methods We consecutively randomized 40 patients into two groups. In the control group, traditional heparin and protamine doses, based on body weight alone, were given. In the treatment group, the HeProCalc program was used, which calculated the initial heparin bolus dose from weight, height, and baseline activated clotting time and the protamine dose at termination of CPB. Results We analyzed the results from 37 patients, after exclusion of three patients. Equal doses of heparin were given in both groups, whereas significantly lower mean doses of protamine were given in the treatment group versus control group (211?±?56 vs. 330?±?61?mg, p?
PubMed ID
26270199 View in PubMed
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Anticoagulant medication at time of needle biopsy for breast cancer in relation to risk of lymph node metastasis.

https://arctichealth.org/en/permalink/ahliterature103076
Source
Int J Cancer. 2014 Jul 1;135(1):238-41
Publication Type
Article
Date
Jul-1-2014
Author
Rickard Ljung
Roland Sennerstam
Fredrik Mattsson
Gert Auer
Jesper Lagergren
Author Affiliation
Upper Gastrointestinal Surgery Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Source
Int J Cancer. 2014 Jul 1;135(1):238-41
Date
Jul-1-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anticoagulants - administration & dosage - adverse effects
Aspirin - administration & dosage - adverse effects
Biopsy, Needle
Blood Coagulation - drug effects
Blood Platelets - drug effects - pathology
Breast Neoplasms - complications - diagnosis - pathology
Early Detection of Cancer
European Continental Ancestry Group
Female
Humans
Lymphatic Metastasis - pathology - prevention & control
Mammography
Middle Aged
Sweden
Abstract
Anticoagulant treatment might enhance the natural defense against tumor cell dissemination caused by diagnostic needle biopsy by counteracting thrombocyte coating of such cells. To clarify whether women using anticoagulant treatment at the time of biopsy have a lower occurrence of lymph node metastasis, we conducted a nationwide Swedish cohort study of 26,528 female incident breast cancer patients in 2006-2011. Point risk ratio (RR) of risk of lymph node metastasis among users of anticoagulant treatment adjusted for age, T-stage, socioeconomic factors, and concomitant medication was RR?=?0.94, (95% CI: 0.87-1.03), and lower in younger women (RR?=?0.80, 95% CI 0.50-1.29). Although nonsignificant, these associations may underestimate a true negative association since women using anticoagulant treatment are likely to have more concomitant diseases, lead an unhealthier lifestyle, and have lower participation in mammography screening. These findings provide some support for the hypothesis that anticoagulant medications might counteract breast cancer spread caused by needle biopsy.
PubMed ID
24346771 View in PubMed
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[Antithrombin III level in patients with acute viral myocarditis]

https://arctichealth.org/en/permalink/ahliterature53507
Source
Lik Sprava. 2003 Apr-Jun;(3-4):63-5
Publication Type
Article
Author
B H Doroshenko
Source
Lik Sprava. 2003 Apr-Jun;(3-4):63-5
Language
Ukrainian
Publication Type
Article
Keywords
Acute Disease
Adult
Anticoagulants - therapeutic use
Antithrombin III - metabolism
Blood Coagulation - drug effects
Diclofenac - therapeutic use
Drug Therapy, Combination
English Abstract
Heparin - therapeutic use
Humans
Myocarditis - blood - drug therapy - virology
Prednisolone - therapeutic use
Severity of Illness Index
Triazoles - therapeutic use
Virus Diseases - blood - drug therapy
Abstract
The article focuses on the status of a natural anticoagulant antithrombin III in patients with acute viral myocarditis (AVM) and on modes of treatment thereof. It has been proved that there is a statistically significant correlation between a drop in concentration of antithrombin III and degree of severity of AVM. Convincing, statistically significant data have been obtained that antithrombin III gets increased in AVM patients undergoing complex therapy: in those patients running a mild course of the illness, a mild one presenting with elevated indices for homeostasis, a medium gravity course (diclofenac, heparin, thiotriasoline, quick-frozen plasma), and grave course as well (prednizolon, heparin, thiotriasoline, quick-frozen plasma), which fact can be taken account of in choosing a therapeutic regimen.
PubMed ID
12889361 View in PubMed
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Assays of fibrin network properties altered by VKAs in atrial fibrillation - importance of using an appropriate coagulation trigger.

https://arctichealth.org/en/permalink/ahliterature271201
Source
Thromb Haemost. 2015 Apr;113(4):851-61
Publication Type
Article
Date
Apr-2015
Author
Michal Zabczyk
Margareta Blombäck
Jacek Majewski
Grzegorz Karkowski
Hakan N Wallen
Anetta Undas
Shu He
Source
Thromb Haemost. 2015 Apr;113(4):851-61
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Acenocoumarol - therapeutic use
Aged
Anticoagulants - therapeutic use
Atrial Fibrillation - blood - complications - diagnosis - drug therapy
Blood Coagulation - drug effects
Case-Control Studies
Fibrin - metabolism - ultrastructure
Fibrin Clot Lysis Time
Humans
International Normalized Ratio
Microscopy, Electron, Scanning
Poland
Porosity
Protein Conformation
Sweden
Thrombin - metabolism
Thrombosis - blood - etiology - prevention & control
Vitamin K - antagonists & inhibitors - blood
Warfarin - therapeutic use
Abstract
Atrial fibrillation (AF) is a prothrombotic condition, involving increased thrombin generation and fibrinogen concentrations. Vitamin K antagonists (VKAs) prevent arterial thromboembolism if optimal anticoagulation is achieved by individualised drug doses, assessed by determining the Prothrombin time-related International Normalized Ratio (Pt-INR). There is evidence that formation of tight-laced fibrin networks is pathogenic in prothrombotic diseases. This study was performed among AF patients, to test whether long-term treatment with VKAs affects the structure of fibrin networks, and whether the effect is altered by employing different coagulation triggers: exogenous thrombin (1 IU/ml), 10 pM tissue factor (TF) or a commercial Pt-INR reagent (containing 400-fold more TF). In the thrombin-based method, fibrin network porosity (scanning electron microscopy) and liquid permeability (flow measurements) correlated inversely to fibrinogen concentrations, while positive correlations to the degree of anticoagulation were shown with the Pt-INR reagent. In the method with 10 pM TF, the two above relationships were detected, though the influence of Pt-INR was more profound than that of fibrinogen concentrations. Moreover, greater shortening of clot lysis time (CLT) arose from more permeable clots. As a coagulation trigger, 10 pM TF vs exogenous thrombin or the Pt-INR reagent is more informative in reflecting the in vivo process from thrombin generation to fibrin formation. Since fibrin network permeability rose in parallel to elevations of INR and shortening of CLT in AF patients, antithrombotic effects on prevention of thrombotic complications may be achieved from impairment of thrombin generation, resulting in formation of permeable clots susceptible to fibrinolysis.
PubMed ID
25518887 View in PubMed
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Associations of long- and short-term air pollution exposure with markers of inflammation and coagulation in a population sample.

https://arctichealth.org/en/permalink/ahliterature149080
Source
Occup Environ Med. 2009 Nov;66(11):747-53
Publication Type
Article
Date
Nov-2009
Author
S. Panasevich
K. Leander
M. Rosenlund
P. Ljungman
T. Bellander
U. de Faire
G. Pershagen
F. Nyberg
Author Affiliation
Unit of Environmental Epidemiology, Institute of Environmental Medicine, Nobels väg 13, Box 210 Karolinska Institutet, SE-171 77 Stockholm, Sweden. Sviatlana.Panasevich@ki.se
Source
Occup Environ Med. 2009 Nov;66(11):747-53
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Aged
Air Pollutants - adverse effects - analysis
Air Pollution - adverse effects - analysis
Biological Markers - blood
Blood Coagulation - drug effects
Case-Control Studies
Environmental Exposure - adverse effects - analysis
Environmental Monitoring - methods
Female
Fibrinogen - metabolism
Humans
Inflammation - blood - chemically induced - complications
Inflammation Mediators - blood
Male
Middle Aged
Myocardial Infarction - blood - etiology
Plasminogen Activator Inhibitor 1 - blood
Sweden
Urban Health - statistics & numerical data
Abstract
Exposure to elevated levels of ambient air pollutants can lead to adverse cardiovascular effects. Potential mechanisms include systemic inflammation and perturbation of the coagulation balance.
To investigate long- and short-term effects of air pollution exposure on serum levels of inflammatory (IL-6, TNF-alpha and CRP) and coagulation (fibrinogen and PAI-1) markers relevant for cardiovascular pathology.
The study group consisted of a population sample of 1028 men and 508 women aged 45-70 years from Stockholm. Long-term air pollution exposure was assessed using spatial modelling of traffic-related NO(2) and heating-related SO(2) emissions at each subject's residential addresses over retrospective periods of 1, 5 and 30 years. Short-term exposure was assessed as averages of rooftop measurements over 12-120 h before blood sampling.
Long-term exposures to both traffic-NO(2) and heating-SO(2) emissions showed consistent associations with IL-6 levels. 30-year average traffic-NO(2) exposure was associated with a 64.5% (95% CI 6.7% to 153.8%) increase in serum IL-6 per 28.8 microg/m(3) (corresponding to the difference between the 5th and 95th percentile exposure value), and 30-year exposure to heating-SO(2) with a 67.6% (95% CI 7.1% to 162.2%) increase per 39.4 microg/m(3) (5th-95th percentile value difference). The association appeared stronger in non-smokers, physically active people and hypertensive subjects. We observed positive non-significant associations of inflammatory markers with NO(2) and PM(10) during 24 h before blood sampling. Short-term exposure to O(3) was associated with increased, and SO(2) with decreased, fibrinogen levels.
Our results suggest that exposure to moderate levels of air pollution may influence serum levels of inflammatory markers.
PubMed ID
19687019 View in PubMed
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[Balance of hemostasis and anticoagulation therapy techniques for hip arthroplasty].

https://arctichealth.org/en/permalink/ahliterature275704
Source
Khirurgiia (Mosk). 2016;(6):77-82
Publication Type
Article
Date
2016
Author
O A Kaplunov
I V Mikhin
S N Biryukov
Source
Khirurgiia (Mosk). 2016;(6):77-82
Date
2016
Language
Russian
Publication Type
Article
Keywords
Aged
Anticoagulants - therapeutic use
Arthroplasty - adverse effects - methods
Blood Coagulation - drug effects
Blood Loss, Surgical - prevention & control
Blood Transfusion - methods - statistics & numerical data
Female
Hemostasis, Surgical - methods - statistics & numerical data
Hemostatics - therapeutic use
Humans
Male
Monitoring, Intraoperative
Osteoarthritis, Hip - surgery
Outcome Assessment (Health Care)
Postoperative Hemorrhage - therapy
Russia
Abstract
Studied a rational balance of prevention and control of blood loss and antithrombotic therapy in hip arthroplasty.
In view of literature data about significant blood loss during and after the intervention, as well as the formation of the group of patients who refuse blood transfusions for social (including religious) reasons, taken innovative methods for reducing blood loss and needs for blood transfusions.
Complex of techniques, including conducting spinal anesthesia, controlled hypotension with nitroglycerin and pentamine, intraoperative use of systemic hemostatic and preventive use of erythropoietic stimulating agents, was formed in our proprietary technology to reduce blood loss. Its use has allowed to reach a statistically significant reduction of blood loss and transfusion rate in hip arthroplasty patients.
PubMed ID
27296127 View in PubMed
Less detail

[Biological effects of vitamin K and concentration of vitamin K in Norwegian food]

https://arctichealth.org/en/permalink/ahliterature30249
Source
Tidsskr Nor Laegeforen. 2004 Jun 17;124(12):1650-4
Publication Type
Article
Date
Jun-17-2004
Author
Christian A Drevon
Hege Berg Henriksen
Marianne Sanderud
Thomas E Gundersen
Rune Blomhoff
Author Affiliation
Avdeling for ernaeringsvitenskap, Institutt for medisinske basalfag, Universitetet i Oslo, Postboks 1046 Blindern, 0316 Oslo. c.a.drevon@basalmed.uio.no
Source
Tidsskr Nor Laegeforen. 2004 Jun 17;124(12):1650-4
Date
Jun-17-2004
Language
Norwegian
Publication Type
Article
Keywords
Adult
Blood Coagulation - drug effects - physiology
Bone Density - drug effects - physiology
Calcinosis - prevention & control
Child
English Abstract
Female
Food analysis
Humans
Male
Nerve Degeneration
Norway
Nutritional Requirements
Osteoporosis - etiology - prevention & control
Vitamin K - administration & dosage - analysis - metabolism - physiology
Abstract
BACKGROUND: Vitamin K has several biological effects and dietary intake seems to be more important than previously believed because of low bioavailability of the vitamins from the colon. MATERIALS AND METHODS: Data from the literature were identified on PubMed, and data from NORKOST II (a dietary study from 1997 based on a nation-wide sample of respondents) were used to calculate dietary intake of vitamin K. RESULTS: The dietary intake of vitamin K in Norway seems to be
Notes
Comment In: Tidsskr Nor Laegeforen. 2004 Dec 16;124(24):3261; author reply 3261-215608790
PubMed ID
15229714 View in PubMed
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Comparison and evaluation of a Point-of-care device (CoaguChek XS) to Owren-type prothrombin time assay for monitoring of oral anticoagulant therapy with warfarin.

https://arctichealth.org/en/permalink/ahliterature151122
Source
Thromb Res. 2009 Jul;124(3):344-8
Publication Type
Article
Date
Jul-2009
Author
Mattias Wieloch
Andreas Hillarp
Karin Strandberg
Camilla Nilsson
Peter J Svensson
Author Affiliation
Department of Cardiology, Malmo University Hospital, Malmo, Sweden. mattias.wieloch@med.lu.se
Source
Thromb Res. 2009 Jul;124(3):344-8
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Anticoagulants - administration & dosage
Blood Coagulation - drug effects
Female
Humans
International Normalized Ratio - instrumentation
Male
Point-of-Care Systems
Prothrombin Time - instrumentation - methods
Reproducibility of Results
Sensitivity and specificity
Sweden
Treatment Outcome
Warfarin - administration & dosage
Abstract
The standardized test used for evaluating the effect of warfarin is the prothrombin time (PT) which is measured and expressed in international normalized ratio (INR). Regular control of treatment intensity is required since inappropriate dosage increases the risk for complications. Portable point-of-care analytical instruments for measurement of capillary whole blood PT have been available for the last decades. The purpose of this study was to compare and evaluate INR values obtained by the point-of-care device CoaguChek XS, to Owren PT in a hospital setting.
In 397 warfarin-treated patients, capillary whole blood was analyzed with the CoaguChek XS and the results were compared to analysis of venous plasma samples with the Owren PT assay. To study reproducibility and rule out preanalytical errors, a subgroup of 152 patients had two capillary blood samples analyzed with the CoaguChek XS.
In 397 patients, with a median age(+/-2SD) of 69.0(50-88) years, there was a positive correlation between results from the CoaguChek XS and the Owren-type PT assay (r=0.94;p
PubMed ID
19423152 View in PubMed
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Comparison of the efficacy of different doses of Ukrain in the combined treatment of breast cancer.

https://arctichealth.org/en/permalink/ahliterature19820
Source
Drugs Exp Clin Res. 2000;26(5-6):201-21
Publication Type
Article
Date
2000
Author
K N Uglyanitsa
L I Nefyodov
Y M Doroshenko
W J Brzosko
Author Affiliation
Grodno Medical University, Grodno, Belarus.
Source
Drugs Exp Clin Res. 2000;26(5-6):201-21
Date
2000
Language
English
Publication Type
Article
Keywords
Aged
Alkaloids - administration & dosage - adverse effects - therapeutic use
Antineoplastic Agents, Phytogenic - administration & dosage - adverse effects - therapeutic use
Blood Coagulation - drug effects
Breast Neoplasms - drug therapy - surgery - therapy
Combined Modality Therapy
Comparative Study
Female
Humans
Immunity, Cellular - drug effects
Lymphocyte Count
Mastectomy
Middle Aged
Treatment Outcome
Abstract
The aim of this study was to compare the efficacy of different Ukrain doses in the combined treatment of 75 patients with breast cancer. The patients were divided into three groups: groups I and II (25 patients each) were treated with 50 mg and 100 mg of Ukrain, respectively, before surgery; group III (25 patients) served as control (without Ukrain treatment). Clinical observations, biochemical, hormonal and immunologic indices indicated that both doses of Ukrain had a similar beneficial effect on patient outcome and may be indicated in the presurgical treatment of patients with breast cancer.
PubMed ID
11345028 View in PubMed
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Concurrent use of tramadol and oral vitamin K antagonists and the risk of excessive anticoagulation: a register-based nested case-control study.

https://arctichealth.org/en/permalink/ahliterature122117
Source
Eur J Clin Pharmacol. 2013 Mar;69(3):641-6
Publication Type
Article
Date
Mar-2013
Author
Anton Pottegård
Peter M Meegaard
Line H V Holck
Rene dePont Christensen
Hanne Madsen
Jesper Hallas
Author Affiliation
Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, Odense, Denmark. apottegaard@health.sdu.dk
Source
Eur J Clin Pharmacol. 2013 Mar;69(3):641-6
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Aged, 80 and over
Analgesics, Opioid - adverse effects
Anticoagulants - administration & dosage - adverse effects
Blood Coagulation - drug effects
Case-Control Studies
Confounding Factors (Epidemiology)
Denmark
Drug Interactions
Drug Prescriptions
Female
Hemorrhage - blood - chemically induced
Humans
Logistic Models
Male
Odds Ratio
Patient Selection
Registries
Risk assessment
Risk factors
Tramadol - adverse effects
Vitamin K - antagonists & inhibitors
Abstract
The objective was to assess whether the concurrent use of tramadol and vitamin K antagonists (VKAs) leads to an increased risk of excessive anticoagulation.
The study was designed as a case-control study, nested within users of VKA and with tramadol use as our main exposure. We used conditional logistic regression to control for potential confounders.
Prescription data from primary care were obtained from Odense Pharmacoepidemiological Database (OPED). Information about hospital admissions was obtained from the patient administrative system of Funen County (FPAS).
Both cases and controls were selected from users of VKA. Cases were defined by being hospitalised with a main diagnosis indicating excessive anticoagulation. For each case, we selected 15 controls among VKA users, matched by age and sex.
Odds ratio for experiencing excessive anticoagulation attributable to the use of tramadol.
A total of 178 patients were included, 30 of which were exposed to tramadol, along with 2643 controls, 114 of which were exposed to tramadol. The adjusted odds-ratio for experiencing excessive anticoagulation during use of tramadol was 3.1 (1.9-5.2). This corresponds to, on average, one excess case per 250 treatment years (CI 125-584). The result is potentially confounded by concomitant paracetamol use and the presence of acute illness.
Caution is advised when using tramadol in patients using VKA, and if possible, an alternative pain-medication should be used.
PubMed ID
22847619 View in PubMed
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