1
|
Inchingolo F, Inchingolo AM, Piras F, Ferrante L, Mancini A, Palermo A, Inchingolo AD, Dipalma G. Management of Patients Receiving Anticoagulation Therapy in Dental Practice: A Systematic Review. Healthcare (Basel) 2024; 12:1537. [PMID: 39120240 PMCID: PMC11311453 DOI: 10.3390/healthcare12151537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/22/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Anticoagulant drugs are a valuable tool for minimizing thrombotic risks in at-risk patients. The purpose of this study is to conduct a literature review highlighting the management of these drugs during daily clinical dental practice. MATERIALS AND METHODS We limited our search to English-language papers published between 1 January 1989, and 7 March 2024, in PubMed, Scopus and Web of Science that were relevant to our topic. In the search approach, the Boolean keywords "anticoagulant AND dentistry" were used. RESULTS Twenty-five clinical trials were included for final review from 623 articles obtained from the databases Web of Science (83), PubMed (382), and Scopus (158), eliminating duplicates and 79 off-topic items, resulting in 419 articles after removing 315 entries and confirming eligibility. Overall, these studies support the use of local hemostatic measures to manage the risk of bleeding in patients on anticoagulant therapy undergoing dental procedures and highlight the importance of greater education and collaboration among healthcare professionals. CONCLUSIONS Research and clinical investigation have improved understanding and management of dental procedures in patients undergoing anticoagulant or antiplatelet therapy. Hemostatic agents, clinical protocols, risk factors, and continuous education are essential for navigating the complexities of anticoagulant therapy, ensuring optimal outcomes and enhancing patient well-being.
Collapse
Affiliation(s)
- Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (L.F.); or (A.M.); or (A.D.I.); or (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (L.F.); or (A.M.); or (A.D.I.); or (G.D.)
| | - Fabio Piras
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (L.F.); or (A.M.); or (A.D.I.); or (G.D.)
| | - Laura Ferrante
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (L.F.); or (A.M.); or (A.D.I.); or (G.D.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (L.F.); or (A.M.); or (A.D.I.); or (G.D.)
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (L.F.); or (A.M.); or (A.D.I.); or (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (L.F.); or (A.M.); or (A.D.I.); or (G.D.)
| |
Collapse
|
2
|
Hsu CC, Chen CC, Chou CY, Chen KH, Wang SF, Chang SL, Chang YL. Effectiveness and safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation and advanced kidney disease. J Thromb Thrombolysis 2023; 56:518-528. [PMID: 37452906 PMCID: PMC10550875 DOI: 10.1007/s11239-023-02859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The effectiveness and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and advanced kidney disease (AKD) has not been fully established. OBJECTIVES To determine the effectiveness and safety related to pooled or specific DOACs to that with warfarin in patients with AF and AKD. METHODS Patients with AF and AKD (estimated glomerular filtration rate < 30 mL/min) who received DOAC or warfarin from July 2011 to December 2020 were retrospectively identified in a medical center in Taiwan. Primary outcomes were hospitalized for stroke/systemic embolism and major bleeding. Secondary outcomes included any ischemia and any bleeding. RESULTS A total of 1,011 patients were recruited, of whom 809 (80.0%) were in the DOACs group (15.3% dabigatran, 25.4% rivaroxaban, 25.2% apixaban, and 14.1% edoxaban), and 202 (20.0%) in the warfarin group. DOACs had considerably lower risks of stroke/systemic embolism (adjusted hazard ratio [aHR] 0.29; 95% CI, 0.09-0.97) and any ischemia (aHR, 0.42; 95% CI, 0.22-0.79), but had comparable risks of major bleeding (aHR, 0.99; 95% CI, 0.34-2.92) and any bleeding (aHR, 0.74; 95% CI, 0.50-1.09) than warfarin. Apixaban was linked to considerably lower risks of any ischemia (aHR, 0.13; 95% CI, 0.04-0.48) and any bleeding (aHR, 0.53; 95% CI, 0.28-0.99) than warfarin. CONCLUSION Among patients with AF and AKD, DOACs were linked to a lower risk of ischemic events, and apixaban was linked to a lower risk of any ischemia and any bleeding than warfarin.
Collapse
Affiliation(s)
- Chia-Chen Hsu
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taipei, Taiwan
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Chi Chen
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taipei, Taiwan
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chian-Ying Chou
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taipei, Taiwan
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuan-Hsuan Chen
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taipei, Taiwan
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Fan Wang
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taipei, Taiwan
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Research Center, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuh-Lih Chang
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taipei, Taiwan.
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
3
|
Ren C, Zhao Y, Liu D. Effects of direct oral anticoagulants vs. vitamin K antagonists on acute kidney injury in patients with atrial fibrillation: A systematic review. Front Cardiovasc Med 2023; 10:1068269. [PMID: 36776257 PMCID: PMC9909185 DOI: 10.3389/fcvm.2023.1068269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023] Open
Abstract
Background Patients with atrial fibrillation (AF) are routinely prescribed oral anticoagulants to prevent thromboembolism. Concerns regarding the efficacy and safety of oral anticoagulants, such as vitamin K antagonists (VKA) and direct oral anticoagulants (DOACs), arise for patients with non-valvular atrial fibrillation (NVAF) because of their widespread use in clinical practice. Even though there have been an abundance of studies on this topic, it is still not clear if DOAC users with NVAF have a lower risk of acute kidney injury (AKI) than warfarin users. Methods and results We conducted electronic searches in PubMed, Embase, and the Cochrane Library to identify relevant studies for this systematic review. We included randomized clinical trials and observational studies that reported on the incidence rate, hazard ratio (HR), and 95% confidence interval (95% CI) of AKI in patients using oral anticoagulants. This systemic review included six observational studies and four randomized clinical trials (RCT). The overall results showed that DOACs were associated with a lower AKI risk than warfarin. However, for NVAF patients with severe renal dysfunction, DOACs may not have a reduced risk of AKI compared to warfarin. Conclusion The overall results suggest that, except for edoxaban, patients using DOACs may experience a reduced risk of AKI. However, it is uncertain whether this is also the case for patients with severe renal dysfunction. Further research is needed to confirm the effect of DOACs on this population.
Collapse
Affiliation(s)
- Chengfa Ren
- Department of Nephrology, Ganzhou People's Hospital Affiliated to Nanchang University, Ganzhou, Jiangxi, China
| | - Yudan Zhao
- Medical Department, Queen Mary School, Nanchang University, Nanchang, China
| | - Dehui Liu
- Department of Nephrology, Ganzhou People's Hospital Affiliated to Nanchang University, Ganzhou, Jiangxi, China,*Correspondence: Dehui Liu ✉
| |
Collapse
|
4
|
Kandula V, Shah PV, Thirunavu VM, Yerneni K, Karras C, Abecassis ZA, Hopkins B, Bloch O, Potts MB, Jahromi BS, Tate MC. Low-molecular-weight Heparin (enoxaparin) versus unfractionated heparin for venous thromboembolism prophylaxis in patients undergoing craniotomy. Clin Neurol Neurosurg 2022; 223:107482. [DOI: 10.1016/j.clineuro.2022.107482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/03/2022]
|
5
|
Tanguay M, Séguin C. Recurrent thrombosis rescued by fondaparinux in high-risk patients: A case series. Res Pract Thromb Haemost 2022; 6:e12773. [PMID: 35919877 PMCID: PMC9336207 DOI: 10.1002/rth2.12773] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 05/23/2022] [Accepted: 06/19/2022] [Indexed: 12/11/2022] Open
Abstract
Background Recurrent thrombosis treatment options are limited when anticoagulation with dose escalation of low molecular weight heparin or unfractionated heparin fail. Fondaparinux is a pure, synthetic pentasaccharide that consists of heparin's essential five-sugar chain that binds antithrombin to inactivate factor Xa. There is scarce data regarding fondaparinux's use in recurrent thrombosis. Key Clinical Question We aim to explore fondaparinux's role in recurrent thrombosis when other standard anticoagulation treatments fail. Clinical Approach We report a case series of six high thrombotic risk patients successfully treated with fondaparinux after thrombosis progression while on supratherapeutic low molecular weight heparin or unfractionated heparin. Of our six patients, two were previously diagnosed with a high-risk thrombophilia: triple positive antiphospholipid syndrome, and homozygous factor V Leiden. The other four had an underlying malignancy. Conclusion With fondaparinux, no thrombosis progression was observed, and no bleeding complications occurred.
Collapse
Affiliation(s)
- Mégane Tanguay
- Department of MedicineMcGill UniversityMontrealQuebecCanada
| | - Chantal Séguin
- Division of Hematology, Department of MedicineMcGill UniversityMontrealQuebecCanada
| |
Collapse
|
6
|
Alquraan S, Darwish El-Hajji F. Cost-effectiveness analysis for the parenteral anticoagulants in Jordan. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
Pharmacoeconomic dimensions linking clinical effectiveness of parenteral anticoagulants for management of acute venous thromboembolism (VTE) and cost of treatment are needed to support choices by healthcare providers. The objective of the study was to conduct a cost-effectiveness analysis for 5-day treatment with parenteral anticoagulants in Jordan.
Methods
Cost-effectiveness analysis was conducted based on decision analysis tree model. The perspective was the payer, considering direct medical costs. Probabilities of failure of treatment and major bleeding were derived from published clinical studies. Costs were estimated based on 2019 prices in Jordan.
Key findings
The average cost of VTE hospitalization and major bleeding management in Jordan were 2324.00 US$ and 3347.40 US$, respectively. Bemiparin was associated with the highest clinical efficacy and lowest probability of major bleeding. Nadroparin had the lowest clinical efficacy, while tinzaparin was found to have the highest risk of major bleeding. Bemiparin had the lowest average cost-effectiveness ratio (101.63 US$/success) and nadroparin had the highest cost-effectiveness ratio (295.56 US$/success). Throughout the sensitivity analysis calculations, bemiparin and nadroparin had the lowest and highest cost of treatment, respectively.
Conclusions
The cost of parenteral anticoagulant drugs, the same as many other drugs, does not always correlate with cost of VTE treatment. Other direct medical costs (e.g. treatment failure and management of bleeding) have a high contribution to the total cost calculation. Pharmacoeconomically, bemiparin is the dominant cost-effective parenteral anticoagulant in Jordan, while nadroparin is the dominated one.
Collapse
Affiliation(s)
- Shatha Alquraan
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Feras Darwish El-Hajji
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| |
Collapse
|
7
|
Burlacu A, Genovesi S, Ortiz A, Combe C, Basile C, Schneditz D, van der Sande F, Popa GT, Morosanu C, Covic A. Pros and cons of antithrombotic therapy in end-stage kidney disease: a 2019 update. Nephrol Dial Transplant 2020; 34:923-933. [PMID: 30879070 DOI: 10.1093/ndt/gfz040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 12/24/2022] Open
Abstract
Dialysis patients manifest both an increased thrombotic risk and a haemorrhagic tendency. A great number of patients with chronic kidney disease requiring dialysis have cardiovascular comorbidities (coronary artery disease, atrial fibrillation or venous thromboembolism) and different indications for treatment with antithrombotics (primary or secondary prevention). Unfortunately, few randomized controlled trials deal with antiplatelet and/or anticoagulant therapy in dialysis. Therefore cardiology and nephrology guidelines offer ambiguous recommendations and often exclude or ignore these patients. In our opinion, there is a need for an expert consensus that provides physicians with useful information to make correct decisions in different situations requiring antithrombotics. Herein the European Dialysis Working Group presents up-to-date evidence about the topic and encourages practitioners to choose among alternatives in order to limit bleeding and minimize atherothrombotic and cardioembolic risks. In the absence of clear evidence, these clinical settings and consequent therapeutic strategies will be discussed by highlighting data from observational studies for and against the use of antiplatelet and anticoagulant drugs alone or in combination. Until new studies shed light on unclear clinical situations, one should keep in mind that the objective of treatment is to minimize thrombotic risk while reducing bleeding events.
Collapse
Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Simonetta Genovesi
- Department of Medicine and Surgery, San Gerardo Hospital, University of Milan Bicocca Nephrology Unit, Monza, Italy
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM, FRIAT and REDINREN, Madrid, Spain
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Unité INSERM 1026, Université de Bordeaux, Bordeaux, France
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Daniel Schneditz
- Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Frank van der Sande
- Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Grigore T Popa
- Department of General Surgery, Regional Institute of Oncology, University of Medicine, Iasi, Romania
| | - Cornel Morosanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. Parhon' University Hospital, 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | | |
Collapse
|
8
|
Abedi AS, Nasseri E, Esfarjani F, Mohammadi-Nasrabadi F, Hashemi Moosavi M, Hoseini H. A systematic review and meta-analysis of lead and cadmium concentrations in cow milk in Iran and human health risk assessment. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:10147-10159. [PMID: 32060829 DOI: 10.1007/s11356-020-07989-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 02/04/2020] [Indexed: 06/10/2023]
Abstract
The aim of the current research was to systematically review and summarize the studies that evaluated the concentration of lead (Pb) and cadmium (Cd) in cow milk in different regions of Iran and to perform a meta-analysis of the findings. Moreover, the non-carcinogenic and carcinogenic risks of Pb and Cd through milk consumption in adult and child consumers were assessed. As a result of a systematic search in the international and national databases between January 2008 and October 2018, 17 reports involving 1874 samples were incorporated in our study for meta-analysis. The pooled concentrations of Pb and Cd were estimated to be 13.95 μg mL-1 (95% CI 9.72-18.11 μg mL-1) and 3.55 μg mL-1 (95% CI - 2.38-9.48 μg mL-1), respectively, which were lower than the WHO/FAO and national standard limits. The estimated weekly intake (EWI) of Pb and Cd through consuming milk was 16.65 and 7 μg day-1 for adults of 70 kg and 45 and 34 μg day-1 for children of 26 kg, respectively, which was well below the risk values set by Joint FAO/WHO Expert Committee on Food Additives (JECFA). The maximum target hazard quotient values (THQs) of Pb and Cd were 5.55E-5 and 5.55E-5 for adults and 5.55E-5 and 5.55E-5 for children, respectively, which were lower than 1 value, suggesting that Iranian consumers are not exposed to non-carcinogenic risk through consuming milk. Moreover, the incremental lifetime cancer risk (ILCR) of Pb estimated to be 2.96E-04 in adults and 1.0E-03 in children, indicating that consumers in Iran are at threshold carcinogenic risk of Pb through consuming milk (ILCR > 10-4). Therefore, planning and policy making for the sustainable reduction of these toxic metals in milk, particularly in industrial regions of Iran, are crucial.
Collapse
Affiliation(s)
- Abdol-Samad Abedi
- Department of Research Deputy, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmat Nasseri
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Esfarjani
- Research Department of Food and Nutrition Policy and Planning, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, 46, West Arghavan St., Farahzadi Blvd., ShahrakQods, P.O. Box 19395-4741, Tehran, 1981619573, Iran
| | - Fatemeh Mohammadi-Nasrabadi
- Research Department of Food and Nutrition Policy and Planning, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, 46, West Arghavan St., Farahzadi Blvd., ShahrakQods, P.O. Box 19395-4741, Tehran, 1981619573, Iran.
| | - Motahareh Hashemi Moosavi
- Department of Food Science and Technology, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedayat Hoseini
- Department of Food Science and Technology, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
9
|
Dager WE, Ansell J, Barnes GD, Burnett A, Deitelzweig S, Minichiello T, Triller D, Kaatz S. "Reduce the Likelihood of Patient Harm Associated with the Use of Anticoagulant Therapy": Commentary from the Anticoagulation Forum on the Updated Joint Commission NPSG.03.05.01 Elements of Performance. Jt Comm J Qual Patient Saf 2020; 46:173-180. [PMID: 32005512 DOI: 10.1016/j.jcjq.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/26/2019] [Accepted: 12/04/2019] [Indexed: 12/18/2022]
|
10
|
Greger J, Bates V, Mechtler L, Gengo F. A Review of Cannabis and Interactions With Anticoagulant and Antiplatelet Agents. J Clin Pharmacol 2019; 60:432-438. [DOI: 10.1002/jcph.1557] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/24/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Jessica Greger
- Dent Neurologic Institute Amherst New York USA
- University at BuffaloThe State University of New York Buffalo New York USA
| | | | | | - Fran Gengo
- Dent Neurologic Institute Amherst New York USA
- University at BuffaloThe State University of New York Buffalo New York USA
| |
Collapse
|
11
|
Fakhri Y, Bjørklund G, Bandpei AM, Chirumbolo S, Keramati H, Hosseini Pouya R, Asadi A, Amanidaz N, Sarafraz M, Sheikhmohammad A, Alipour M, Baninameh Z, Mohseni SM, Sarkhosh M, Ghasemi SM. Concentrations of arsenic and lead in rice (Oryza sativa L.) in Iran: A systematic review and carcinogenic risk assessment. Food Chem Toxicol 2018; 113:267-277. [PMID: 29341878 DOI: 10.1016/j.fct.2018.01.018] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/02/2018] [Accepted: 01/11/2018] [Indexed: 12/11/2022]
Abstract
Exposure to heavy metals such as arsenic (As), lead (Pb), and cadmium (Cd) in either the short or the long term can cause cancers in humans. Dietary intake and consumption of rice (Oryza sativa L.) is increasing in Iran, and several studies on the concentration of heavy metals in rice have been carried out in this country in recent years. In this perspective, the main objective of the present study was to investigate, even via a meta-analysis of the existing literature, the presence of As and Pb in rice from many geographical areas in Iran, as well as to estimate the carcinogenic risk of these heavy metals in rice consumers. The results of the present ten years-spanning systematic review indicate that 21 reports, collecting a total of 2088 samples, were performed between 2008 and October 2017. The minimum and maximum concentration of As was observed in the Golestan area (0.01 ± 0.01 mg/kg d.w) and the Gillan region (3 mg/kg d.w); and Pb in the Shahrekord (0.07 ± 0.02 mg/kg d.w) and Mazandaran (35 mg/kg d.w). The meta-analysis of data showed that pooled concentration of As in the rice was 0.04 (95%CI: 0.02-0.06 mg/kg d.w), which resulted lower than the National Standard (NS) limits. However, the pooled concentration of Pb in the rice was 0.38 (95%CI: 0.25-0.5 mg/kg d.w), i.e., higher than NS limits. The heterogeneity was significant between As (I2 = 63%, P value = .003) and Pb (I2 = 96%, P value < .001) studies. The carcinogenic risk assessment showed that minimum and maximum incremental lifetime cancer risk (ILCR) of As was in the 45-54 (4.53 × 10-2) and 15-24 (5.50 × 10-2) year age groups consumers; and Pb, 45-54 (2.442 × 10-3) and 15-24 (2.96 × 10-3), respectively. The overall carcinogenesis risk of As (4.864 × 10-2) was 18.5 times higher than Pb (2.623 × 10-3). All age groups consumers of rice content of As and Pb are at considerable carcinogenesis risk (ILCR > 10-3). Therefore a decreased level of heavy metals in rice cultivation should be encouraged and performed in next planning.
Collapse
Affiliation(s)
- Yadolah Fakhri
- Department of Environmental Health Engineering, Student Research Committee, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway.
| | - Anoushiravan Mohseni Bandpei
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hassan Keramati
- Department of Environmental Health Engineering, School of Public Health, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Anvar Asadi
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nazak Amanidaz
- Environmental Health Research Center, Golestan University of Medical Sciences, Golestan, Iran
| | - Mansour Sarafraz
- Department of Environmental Health Engineering, Student Research Committee, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sheikhmohammad
- Department of Environmental Health Engineering, School of Health, Khoy University of Medical Sciences, Khoy, Iran
| | - Mohamadreza Alipour
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Baninameh
- Sina Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mohsen Mohseni
- Department of Environmental Health Engineering, School of Public Health, Qom University of Medical Sciences, Qom, Iran
| | - Maryam Sarkhosh
- Department of Environmental Health Engineering, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | | |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW The purpose of this review was to offer practical management strategies for when patients receiving direct oral anticoagulants require elective surgery or present with bleeding complications. RECENT FINDINGS Clinical practice guidelines are now available on the timing of periprocedural interruption of treatment with the newer direct oral anticoagulants based on their pharmacodynamics and pharmacokinetics and based on findings from cohort studies and clinical trials. An antibody that reverses the effects of dabigatran is now available, and a factor Xa decoy is being developed as an antidote to apixaban, betrixaban, edoxaban, and rivaroxaban. The timing of interruption of direct oral anticoagulants for elective surgery is based on multiple factors, including pharmacologic properties and interactions, the patient's renal function, and the type of planned surgery. There is little role for low-molecular-weight heparin bridging. Idarucizumab is the treatment of choice for dabigatran-related life-threatening bleeding, while andexanet alfa is being developed to reverse factor Xa inhibitors.
Collapse
|
13
|
Abtahi M, Fakhri Y, Oliveri Conti G, Keramati H, Zandsalimi Y, Bahmani Z, Hosseini Pouya R, Sarkhosh M, Moradi B, Amanidaz N, Ghasemi SM. Heavy metals (As, Cr, Pb, Cd and Ni) concentrations in rice (Oryza sativa) from Iran and associated risk assessment: a systematic review. TOXIN REV 2017. [DOI: 10.1080/15569543.2017.1354307] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mehrnoosh Abtahi
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadolah Fakhri
- Student Research Committee, Department of Environmental Health Engineering, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gea Oliveri Conti
- Department of Medical Sciences, Surgical and Advanced Technologies “G.F. Ingrassia” – Hygiene and Public Health, Laboratory of Environmental and Food Hygiene (LIAA), University of Catania, Catania, Italy
| | - Hassan Keramati
- Department of Environmental Health Engineering, School of Public Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Yahya Zandsalimi
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Zohreh Bahmani
- Environmental Health Engineering, Developmental Center for Student Research and Technology Talent, Faculty of School of Public Health Branch, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Sarkhosh
- Department of Environmental Health Engineering, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bigard Moradi
- Department of Health Public, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nazak Amanidaz
- Environmental Health Research Center, Golestan University of Medical Sciences, Golestan, Iran
| | | |
Collapse
|
14
|
Rao P, Burkart T. Advances in oral anticoagulation therapy – What's in the pipeline? Blood Rev 2017; 31:205-211. [DOI: 10.1016/j.blre.2017.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/02/2017] [Indexed: 01/14/2023]
|
15
|
Zhang Y, Ying D, Liu H, Yu Z, Han L, Xie J, Xie Y. Serum pharmacokinetics and coagulation aberration induced by sodium dehydroacetate in male and female Wistar rats. Sci Rep 2017; 7:46210. [PMID: 28387309 PMCID: PMC5384240 DOI: 10.1038/srep46210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/10/2017] [Indexed: 11/09/2022] Open
Abstract
Sodium dehydroacetate (Na-DHA) is used as a preservative in food, animal feeds and cosmetics. Severe haemorrhage in organs and prolongation of coagulation factors in Sprague-Dawley rats has been reported upon oral administration of Na-DHA. We investigated alterations in coagulation parameters and serum pharmacokinetics upon Na-DHA administration. Wistar rats were administered Na-DHA (50-200 mg/kg, p.o.). Weight gain, food consumption, prothrombin time (PT), activated partial thromboplastin time (APTT), serum levels of Vitamin k (Vk)1, and serum levels of Na-DHA were measured, and histopathology undertaken. Significant reductions in body weight, food consumption and serum levels of Vk1, as well as prolonged PT and APTT, were observed. Females were significantly different from males in terms of serum Na-DHA concentration. Congestion in hepatic sinusoids, renal tubules and spleen, as well as haemorrhage in lung alveoli, gastric mucosa, intestinal mucosa and cardiac muscle cells, were observed by histopathological analyses. Correlation of serum Na-DHA via PT and APTT, as well as serum Vk1 via PT and APTT, in females was better than that in males. Female rats are more sensitive than males to Na-DHA. Hence, Na-DHA can induce coagulation aberration in Wistar rats, with higher sensitivity seen in females than males.
Collapse
Affiliation(s)
- Yumei Zhang
- College of Veterinary Medicine, Yangzhou Universitys, Yangzhou, Jiangsu 225009, PR China
- Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, Jiangsu 225009, PR China
| | - Donglai Ying
- College of Veterinary Medicine, Yangzhou Universitys, Yangzhou, Jiangsu 225009, PR China
| | - Hao Liu
- College of Veterinary Medicine, Yangzhou Universitys, Yangzhou, Jiangsu 225009, PR China
| | - Zengrong Yu
- College of Veterinary Medicine, Yangzhou Universitys, Yangzhou, Jiangsu 225009, PR China
| | - Lingling Han
- College of Veterinary Medicine, Yangzhou Universitys, Yangzhou, Jiangsu 225009, PR China
| | - Jiayu Xie
- College of Veterinary Medicine, Yangzhou Universitys, Yangzhou, Jiangsu 225009, PR China
| | - Yang Xie
- College of Veterinary Medicine, Yangzhou Universitys, Yangzhou, Jiangsu 225009, PR China
| |
Collapse
|