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Jones A, Al-Horani RA. Venous Thromboembolism Prophylaxis in Major Orthopedic Surgeries and Factor XIa Inhibitors. Med Sci (Basel) 2023; 11:49. [PMID: 37606428 PMCID: PMC10443384 DOI: 10.3390/medsci11030049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023] Open
Abstract
Venous thromboembolism (VTE), comprising pulmonary embolism (PE) and deep vein thrombosis (DVT), poses a significant risk during and after hospitalization, particularly for surgical patients. Among various patient groups, those undergoing major orthopedic surgeries are considered to have a higher susceptibility to PE and DVT. Major lower-extremity orthopedic procedures carry a higher risk of symptomatic VTE compared to most other surgeries, with an estimated incidence of ~4%. The greatest risk period occurs within the first 7-14 days following surgery. Major bleeding is also more prevalent in these surgeries compared to others, with rates estimated between 2% and 4%. For patients undergoing major lower-extremity orthopedic surgery who have a low bleeding risk, it is recommended to use pharmacological thromboprophylaxis with or without mechanical devices. The choice of the initial agent depends on the specific surgery and patient comorbidities. First-line options include low-molecular-weight heparins (LMWHs), direct oral anticoagulants, and aspirin. Second-line options consist of unfractionated heparin (UFH), fondaparinux, and warfarin. For most patients undergoing knee or hip arthroplasty, the initial agents recommended for the early perioperative period are LMWHs (enoxaparin or dalteparin) or direct oral anticoagulants (rivaroxaban or apixaban). In the case of hip fracture surgery, LMWH is recommended as the preferred agent for the entire duration of prophylaxis. However, emerging factor XI(a) inhibitors, as revealed by a recent meta-analysis, have shown a substantial decrease in the occurrence of VTE and bleeding events among patients undergoing major orthopedic surgery. This discovery poses a challenge to the existing paradigm of anticoagulant therapy in this specific patient population and indicates that factor XI(a) inhibitors hold great promise as a potential strategy to be taken into serious consideration.
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Affiliation(s)
| | - Rami A. Al-Horani
- Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA;
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Li X, Wang JW, Huang B, Peng ZX, Zhang YY, Zhao SY. Synthesis of 3,15-Disuccinate-12-Coumarin Substituted Andrographolide Derivatives and Their Antiplatelet Aggregation Activities In Vitro. Nat Prod Commun 2020. [DOI: 10.1177/1934578x20910863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In order to develop a series of novel compounds with antiplatelet aggregation activities, 3,15-disuccinate-12-coumarin substituted derivatives were designed and synthesized based on the natural product andrographolide. In vitro antiplatelet aggregation activities were evaluated by the turbidimetric method with thrombin, adenosine diphosphate (ADP), arachidonic acid (AA), and collagen as inducers. The biological evaluation revealed that compound 11k showed significant inhibition activity for thrombin, AA, and collagen-induced platelet aggregation at the same time and exhibited a dose-dependent behavior. Compound 11c showed the highest antiplatelet aggregation activity induced by ADP. Most of the derivatives had no significant cytotoxicity. Therefore, our work proved that 3,15-disuccinate-12-coumarin substituted andrographolide derivatives had the potential to become a novel candidate structure for antiplatelet aggregation and deserved further study.
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Affiliation(s)
- Xue Li
- Drug Research Center, Jiangxi Institute of Traditional Chinese Medicine, Nanchang, P. R. China
| | - Jiang-Wei Wang
- Drug Research Center, Jiangxi Institute of Traditional Chinese Medicine, Nanchang, P. R. China
| | - Bin Huang
- Drug Research Center, Jiangxi Institute of Traditional Chinese Medicine, Nanchang, P. R. China
| | - Zhi-Xiang Peng
- Drug Research Center, Jiangxi Institute of Traditional Chinese Medicine, Nanchang, P. R. China
| | - Yuan-Yuan Zhang
- Drug Research Center, Jiangxi Institute of Traditional Chinese Medicine, Nanchang, P. R. China
| | - Shi-Yun Zhao
- Drug Research Center, Jiangxi Institute of Traditional Chinese Medicine, Nanchang, P. R. China
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Ceviz T, Karakuş N, Basol N, Yigit S. Evaluation of Protein C Gene Polymorphism in Patients with Pulmonary Embolism. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2017. [DOI: 10.5799/jcei.328742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Prodger A, Saha P, Smith A, Evans CE. Cancer-Associated Thrombosis: Regulatory Mechanisms and Emerging Directions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 906:115-122. [PMID: 27638621 DOI: 10.1007/5584_2016_110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Venous thrombosis is a common complication in cancer patients, and some cancer chemotherapies are associated with an increased risk of venous thromboembolism. The regulatory mechanisms that control thrombus formation and subsequent resolution in patients with cancer, however, are incompletely understood, and novel treatments for cancer-associated thrombosis may arise from a better understanding of such mechanisms. In this chapter, pathways that regulate cancer-associated thrombus formation are outlined, and the effects of anti-angiogenic cancer chemotherapies on venous thrombus resolution are highlighted. Potentially pro-thrombotic effects of anti-angiogenic agents are important considerations when managing the complications of venous thrombosis in cancer patients.
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Affiliation(s)
- Alice Prodger
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Prakash Saha
- Academic Department of Vascular Surgery, King's College London, London, UK
| | - Alberto Smith
- Academic Department of Vascular Surgery, King's College London, London, UK
| | - Colin E Evans
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
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Azizi G, Abolhassani H, Asgardoon MH, Shaghaghi S, Negahdari B, Mohammadi J, Rezaei N, Aghamohammadi A. Managing patients with side effects and adverse events to immunoglobulin therapy. Expert Rev Clin Pharmacol 2015; 9:91-102. [PMID: 26496172 DOI: 10.1586/17512433.2016.1105131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Immunoglobulin therapy has not only served as a lifesaving approach for the prevention and treatment of infections in primary and secondary immunodeficiency diseases, but has also been used as an immunomodulatory agent for autoimmune and inflammatory disorders and to provide passive immunity for some infectious diseases. Most of the adverse effects associated with immunoglobulin therapy are mild, transient and self-limiting. However, serious side effects also occur. Therefore, to minimize the adverse events of immunoglobulin therapy, specialist review of patient clinical status and immunoglobulin products, in addition to selection of appropriate treatment strategy for the management of patients with associated side effects and adverse events, are crucial.
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Affiliation(s)
- Gholamreza Azizi
- a Imam Hassan Mojtaba Hospital , Alborz University of Medical Sciences , Karaj , Iran.,b Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Hassan Abolhassani
- b Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran.,c Division of Clinical Immunology, Department of Laboratory Medicine , Karolinska Institute at Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Mohammad Hossein Asgardoon
- b Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Shiva Shaghaghi
- b Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran.,d Faculty of Medicine , Guilan University of Medical Sciences , Rasht , Iran
| | - Babak Negahdari
- e School of Advanced Technologies in Medicine, Department of Medical Biotechnology, Tehran University of Medical Sciences , Tehran , Iran
| | - Javad Mohammadi
- f Department of Biomedical Engineering, Faculty of New Sciences and Technologies, University of Tehran , Tehran , Iran
| | - Nima Rezaei
- b Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Asghar Aghamohammadi
- b Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran
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Kontogiorgis C, Nicolotti O, Mangiatordi GF, Tognolini M, Karalaki F, Giorgio C, Patsilinakos A, Carotti A, Hadjipavlou-Litina D, Barocelli E. Studies on the antiplatelet and antithrombotic profile of anti-inflammatory coumarin derivatives. J Enzyme Inhib Med Chem 2015; 30:925-33. [PMID: 25807297 DOI: 10.3109/14756366.2014.995180] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The interest towards coumarin-based structures stems from their polypharmacological profile. Herein, we present a series of Mannich bases and 7-azomethine-linked coumarin derivatives exhibiting antiplatelet and antithrombotic activities, in addition to the already known anti-inflammatory and antioxidant activities. Among others, compounds 15 and 16 were found to be the most potent and selective inhibitors of platelet aggregation whereas compound 3 also proved to be the most potent in the clot retraction assay. Structure-activity relationship studies were conducted to elucidate the molecular determinants responsible for the herein observed activities. The chance of inhibiting cyclooxygenase-1 was also investigated for evaluating the platelet aggregation induced by arachidonic acid. Taken together, these results suggest that the investigation of other targets connected to the antiplatelet activity, such as phosphodiesterase-3 (PDE3), could be a viable strategy to shed light on the polypharmacological profile of coumarin-based compounds. Docking simulations towards PDE3 were also carried out.
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Affiliation(s)
- Christos Kontogiorgis
- a Laboratory of Hygiene and Environmental Protection , Democritus University of Thrace , Alexandroupolis , Greece
| | - Orazio Nicolotti
- b Dipartimento di Farmacia - Scienze del Farmaco , Universita degli Studi Bari "Aldo Moro" , Bari , Italy
| | | | | | - Foteini Karalaki
- d Department of Pharmaceutical Chemistry , School of Pharmacy, Aristotle University of Thessaloniki , Thessaloniki , Greece , and
| | - Carmine Giorgio
- c Department of Pharmacy , University of Parma , Parma , Italy
| | - Alexandros Patsilinakos
- e Department of Chemistry and Drug Technologies , "Sapienza" University of Rome , Rome , Italy
| | - Angelo Carotti
- b Dipartimento di Farmacia - Scienze del Farmaco , Universita degli Studi Bari "Aldo Moro" , Bari , Italy
| | - Dimitra Hadjipavlou-Litina
- d Department of Pharmaceutical Chemistry , School of Pharmacy, Aristotle University of Thessaloniki , Thessaloniki , Greece , and
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Análisis coste-efectividad de rivaroxabán en la prevención de la enfermedad tromboembólica venosa en España. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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de Laforcade A. Diseases associated with thrombosis. Top Companion Anim Med 2012; 27:59-64. [PMID: 23031457 DOI: 10.1053/j.tcam.2012.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/13/2012] [Indexed: 01/10/2023]
Abstract
Coagulation abnormalities are commonly encountered in critical illness. Traditionally, clinically relevant coagulation disorders have consisted mostly of bleeding associated with advanced stages of disseminated intravascular coagulation or toxin ingestion. However, advances in critical care have highlighted hypercoagulability as a clinically relevant state that must be recognized and treated to optimize the chances of a positive outcome. Retrospective studies of dogs with confirmed thrombosis in varying locations have identified populations most likely to experience hypercoagulable states. Diseases most frequently complicated by thrombosis include immune-mediated disease, neoplasia, systemic inflammation and sepsis, cardiac disease, protein-losing states, and infectious diseases. In this report, the existing retrospective studies will be discussed along with a review of specific disease processes that predispose to a hypercoagulable state. Studies targeting those populations most at risk for thrombotic complications are necessary for better understanding the need for prophylactic anticoagulant therapy.
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Cynamon J, Stein EG, Dym RJ, Jagust MB, Binkert CA, Baum RA. A New Method for Aggressive Management of Deep Vein Thrombosis: Retrospective Study of the Power Pulse Technique. J Vasc Interv Radiol 2006; 17:1043-9. [PMID: 16778240 DOI: 10.1097/01.rvi.0000221085.25333.40] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Failure to treat deep vein thrombosis (DVT) is associated with significant morbidity and mortality. Anticoagulation, although effective at preventing clot progression, is not able to prevent postthrombotic syndrome. Catheter-directed thrombolysis is a more aggressive alternative, with some small studies suggesting a better long-term outcome, but the associated risks are significant, and the treatment can require 2-3 days in a monitored setting. This report describes the power pulse technique, in which mechanical thrombectomy is combined with thrombolytic agents to maximize the effectiveness of the treatment and reduce the need for prolonged infusion and its associated risks. A 24-patient retrospective study showed complete thrombus removal (>90%) in 12 patients, substantial thrombus removal (50%-90%) in seven patients, and partial thrombus removal (<50%) in five patients. All 24 patients had resolution of presenting symptoms. Only two patients required blood transfusion, and one patient experienced temporary nephropathy.
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Affiliation(s)
- Jacob Cynamon
- Department of Radiology, Division of Vascular Radiology, Montefiore Medical Center, University Hospital for the Albert Einstein College of Medicine, 111 East 210th Street, Bronx, New York 10467-2490, USA
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