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Heidenreich PA, Estes NAM, Fonarow GC, Jurgens CY, Kittleson MM, Marine JE, McManus DD, McNamara RL. 2020 Update to the 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2021; 77:326-341. [PMID: 33303319 DOI: 10.1016/j.jacc.2020.08.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Makohusová M, Mrázová V, Bednárová A, Milatová E, Sokol J, Pleško M, Bátorová A. Comparison of Two Different Techniques Of Warfarin Dosing Determination - A Chemometrics Study. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2019; 18:1010-1019. [PMID: 31531081 PMCID: PMC6706742 DOI: 10.22037/ijpr.2019.1100653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A high prevalence of genetic polymorphisms increases sensitivity to warfarin therapy. In this study, we investigated 47 patients with effective long-term therapy by warfarin well-controlled by monitoring of International Normalised Ratio (INR). All patients were tested for gene polymorphisms VKORC1, CYP2C9*C2, and CYP2C9*C3, which were used for a dose calculation employing a program www.WarfarinDosing.org. The main goal was to investigate whether the warfarin doses determined by INR are in accordance with the doses calculated according to the pharmacogenetic algorithm. For this purpose, several chemometric tools, namely principal component analysis, cluster analysis, correlation analysis, correspondence analysis, Passing-Bablock regression, Bland-Altman method, descriptive statistics, and ANOVA were used. We also analysed the relationship between the dose of warfarin determined by INR and several constitutional and genetic factors. Statistically significant association between clinically optimized warfarin dose and indication for the treatment, age, and warfarin sensitivity determined by VKORC1, CYP2C9 gene polymorphisms were confirmed. Finally, we confirmed a good concordance between the INR determined warfarin doses and pharmacogenetic approach.
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Affiliation(s)
- Miroslava Makohusová
- Department of Chemistry, Faculty of Natural Sciences, University of SS Cyril and Methodius, Trnava, Slovak Republic.,Department of Pediatric Hematology and Oncology, Comenius University - Faculty of Medicine and National Institute of Children's Diseases, Bratislava, Slovak Republic
| | - Viera Mrázová
- Department of Chemistry, Faculty of Natural Sciences, University of SS Cyril and Methodius, Trnava, Slovak Republic
| | - Adriána Bednárová
- Department of Chemistry, Faculty of Natural Sciences, University of SS Cyril and Methodius, Trnava, Slovak Republic
| | - Eva Milatová
- Department of Internal Medicine, Slovak Medical University, University Hospital, Bratislava, Slovak Republic
| | - Jozef Sokol
- Department of Chemistry, Faculty of Natural Sciences, University of SS Cyril and Methodius, Trnava, Slovak Republic
| | - Marek Pleško
- Department of Pediatric Hematology and Oncology, Comenius University - Faculty of Medicine and National Institute of Children's Diseases, Bratislava, Slovak Republic
| | - Angelika Bátorová
- National Hemophilia Center, Department of Hematology and Transfusion Medicine, Faculty of Medicine of the Comenius University and University Hospital, Bratislava, Slovak Republic
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January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Heart Rhythm 2019; 16:e66-e93. [DOI: 10.1016/j.hrthm.2019.01.024] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 02/08/2023]
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January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 2019; 140:e125-e151. [DOI: 10.1161/cir.0000000000000665] [Citation(s) in RCA: 1256] [Impact Index Per Article: 251.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Hugh Calkins
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Lin Y. Chen
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Joaquin E. Cigarroa
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Joseph C. Cleveland
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Patrick T. Ellinor
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Michael D. Ezekowitz
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Michael E. Field
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Karen L. Furie
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Paul A. Heidenreich
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Katherine T. Murray
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Julie B. Shea
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Cynthia M. Tracy
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
| | - Clyde W. Yancy
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †HRS Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §STS Representative. ‖ACC/AHA Representative. ¶ACC/AHA Task Force on Performance Measures Representative
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Michida M, Ishikawa H, Kaneda T, Tatekabe S, Nakamura Y. Development of an Efficient Manufacturing Process for a Key Intermediate in the Synthesis of Edoxaban. Org Process Res Dev 2019. [DOI: 10.1021/acs.oprd.8b00413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Makoto Michida
- Process Technology Research Laboratories (PTRL), Daiichi Sankyo Co., Ltd., 1-12-1 Shinomiya, Hiratsuka-shi, Kanagawa 254-0014, Japan
| | - Hideaki Ishikawa
- Process Technology Research Laboratories (PTRL), Daiichi Sankyo Co., Ltd., 1-12-1 Shinomiya, Hiratsuka-shi, Kanagawa 254-0014, Japan
| | - Takeshi Kaneda
- Process Technology Research Laboratories (PTRL), Daiichi Sankyo Co., Ltd., 1-12-1 Shinomiya, Hiratsuka-shi, Kanagawa 254-0014, Japan
| | - Shinya Tatekabe
- Plant Management Department, Daiichi Sankyo Chemical Pharma Co., Ltd., 477 Takada, Odawara-shi, Kanagawa 250-0216, Japan
| | - Yoshitaka Nakamura
- Global Supply Chain - Technology Function, Daiichi Sankyo, Inc., 211 Mt. Airy Road, Basking Ridge, New Jersey 07920, United States
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2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2019; 74:104-132. [PMID: 30703431 DOI: 10.1016/j.jacc.2019.01.011] [Citation(s) in RCA: 1314] [Impact Index Per Article: 262.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Michida M. Development of Efficient Manufacturing Method for Key Intermediate of Edoxaban. J SYN ORG CHEM JPN 2018. [DOI: 10.5059/yukigoseikyokaishi.76.1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Makoto Michida
- Process Technology Research Laboratories, Daiichi Sankyo Co., LTD
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ten Cate H. Monitoring new oral anticoagulants, managing thrombosis, or both? Thromb Haemost 2017; 107:803-5. [DOI: 10.1160/th12-03-0130] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 03/06/2012] [Indexed: 11/05/2022]
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Haghighi AG, Finder RG, Bennett JD. Systemic Disease and Bleeding Disorders for the Oral and Maxillofacial Surgeon. Oral Maxillofac Surg Clin North Am 2017; 28:461-471. [PMID: 27745617 DOI: 10.1016/j.coms.2016.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There are multiple systemic diseases that have an impact on coagulation, of which oral and maxillofacial surgeons must be cognizant. Recent evidence has supported the potential for both hypocoagulable and hypercoagulable states in patients with liver and kidney disease with an even less understood impact on prolonged bleeding in the oral cavity. These systemic diseases are not limited to diseases affecting the liver, kidney, and bone marrow; however, these diseases are common among the patient population and surgeons must be capable of making appropriate judgment and modifying care appropriately.
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Affiliation(s)
- Arman G Haghighi
- Department of Oral and Maxillofacial Surgery, Indiana University, Indianapolis, IN, USA.
| | - Rebecca G Finder
- Critical Care Pharmacy, Indiana University Health, 1701 N. Senate Blvd, Indianapolis, IN 46202, USA
| | - Jeffrey D Bennett
- Division of Oral and Maxillofacial Surgery, Roudebush VA Medical Center, Indianapolis, IN, USA
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Abstract
Objective: To evaluate the warfarin management patterns in an academic nursing home and evaluate what predetermined factors are associated with variability in the international normalized ratio (INR). Setting: A 566-bed academic nursing home. Methods: A retrospective chart review of all residents receiving warfarin therapy for >3 consecutive months in a calendar year was conducted. Data were collected regarding the number of times the INR fluctuated during the follow-up period and the degree of fluctuation between each blood sampling. An INR that changed by 0.5–0.99 between samplings was classified as a small fluctuation; a change >0.99 was defined as a large fluctuation. The sample was divided into 2 groups, easy management and difficult management, based on variability in the INR. The easy-management group consisted of residents who had small fluctuations in the INR and who had INRs outside of the therapeutic range ≤10% of the time. The difficult- management group had large fluctuations in the INR, with the ratio outside of the therapeutic range >10% of the time. Results: Thirty-seven patients were taking warfarin (mean ± SD age 71 ± 14 y; mean number of medical illnesses 7.6 ± 3). The mean length of time of warfarin therapy was 10.6 ± 3.2 months. The average dose and INR were 4.0 ± 1.9 mg and 2.0 ± 0.3, respectively. No statistically significant differences were found between age, dose, or INR. For patients who had INR values exceeding the therapeutic range, there was no significant difference between the management groups in length of treatment, age, number of medical illnesses, number of high-risk factors, dose, average monthly INR, number of medication adjustments per year, albumin and creatinine levels, total number of medications, or number of routine medications known to interact with warfarin. The difficult-management group received more medications known to interact with warfarin than the easy-management group. These medications may have caused the INR to increase above the normal range (p = 0.003), as well as producing a large (p = 0.001) or small fluctuation (p = 0.0007) in the INR. Of all the interacting medications, 55% were antibiotics and 28% were analgesics. No statistically significant differences in outcome were seen between groups. Conclusions: Results of this study indicate that large variations (>0.99) in the INR may be due to newly prescribed medications that enhance the anticoagulant effect of warfarin. These variations may be minimized by closely monitoring the INR when a drug known to interact with warfarin is prescribed.
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Affiliation(s)
- Shyam D Karki
- SHYAM D KARKI PHARMD MA (ECON) CGP FASCP FCCP, Director, Department of Pharmacy Services, Monroe Community Hospital, Rochester, NY; Associate Clinical Professor, School of Pharmacy, University of New York at Buffalo, Buffalo, NY
| | - Susan M Lander
- SUSAN M LANDER RN MS GNP, Assistant Professor, School of Nursing, University of Rochester, Rochester; Geriatric Nurse Practitioner, Monroe Community Hospital, Rochester
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2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter. J Am Coll Cardiol 2016; 68:525-568. [DOI: 10.1016/j.jacc.2016.03.521] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter. Circ Cardiovasc Qual Outcomes 2016; 9:443-88. [DOI: 10.1161/hcq.0000000000000018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Nevarre DR, Digiovanni A. Hypercoagulability and the Management of Anticoagulant Therapy in Surgical Patients: Review and Recommendations. J Endovasc Ther 2016. [DOI: 10.1177/152660289800500319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Alphonso Digiovanni
- Vascular and Noninvasive Surgical Laboratory, Mercy Hospital, Philadelphia, Pennsylvania, USA
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Real-world characteristics of hospitalized frail elderly patients with atrial fibrillation: can we improve the current prescription of anticoagulants? JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:226-32. [PMID: 27103917 PMCID: PMC4826892 DOI: 10.11909/j.issn.1671-5411.2016.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In elderly patients, especially those older than 80 years, atrial fibrillation (AF) is associated with an almost 25% increased risk of stroke. Stroke prophylaxis with anticoagulants is therefore highly recommended. The prevalence of factors that have been associated with a lower rate of prescription and adherence to anticoagulant therapy in these patients is little known. The objective of this study was to explore the clinical characteristics of elderly subjects, with and without AF, consecutively admitted to an acute geriatric unit, discussing factors that may decrease the persistence on stroke prophylaxis therapy. We also highlight possible strategies to overcome the barriers conditioning the current underuse of oral anticoagulants in this segment of the population. METHODS A retrospective observational study was performed on a cohort of elderly patients with and without AF admitted to the Acute Geriatric Unit of San Gerardo Hospital (Monza, Italy). RESULTS Compared to patients without AF (n = 1216), those with AF (n = 403) had a higher Charlson Comorbidity Index (3 vs. 2, P < 0.001), number of administered drugs (4 vs. 3, P < 0.001), rate of heart failure (36.5% vs. 12%, P < 0.001) and chronic kidney disease (20.6 vs. 13.2, P < 0.001). Many patients with AF were frail (54%) or pre-frail (29%). CONCLUSIONS Elderly patients with AF have higher rates of conditions that affect adherence to traditional anticoagulant therapy (vitamin K antagonists, VKA). New direct oral anticoagulants (DOAs) can help overcome this problem. In order to prescribe the most appropriate VKA or DOAs, with the best efficacy/safety profile and the highest compliance, a comprehensive geriatric assessment should always accompany the scores for thrombotic and hemorrhagic risk stratification.
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Dong MH, Chen HF, Ren YJ, Shao FM. Molecular modeling studies, synthesis and biological evaluation of dabigatran analogues as thrombin inhibitors. Bioorg Med Chem 2015; 24:73-84. [PMID: 26690913 DOI: 10.1016/j.bmc.2015.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 11/16/2022]
Abstract
In this work, 48 thrombin inhibitors based on the structural scaffold of dabigatran were analyzed using a combination of molecular modeling techniques. We generated three-dimensional quantitative structure-activity relationship (3D-QSAR) models based on three alignments for both comparative molecular field analysis (CoMFA) and comparative molecular similarity index analysis (CoMSIA) to highlight the structural requirements for thrombin protein inhibition. In addition to the 3D-QSAR study, Topomer CoMFA model also was established with a higher leave-one-out cross-validation q(2) and a non-cross-validation r(2), which suggest that the three models have good predictive ability. The results indicated that the steric, hydrophobic and electrostatic fields play key roles in QSAR model. Furthermore, we employed molecular docking and re-docking simulation explored the binding relationship of the ligand and the receptor protein in detail. Molecular docking simulations identified several key interactions that were also indicated through 3D-QSAR analysis. On the basis of the obtained results, two compounds were designed and predicted by three models, the biological evaluation in vitro (IC50) demonstrated that these molecular models were effective for the development of novel potent thrombin inhibitors.
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Affiliation(s)
- Ming-Hui Dong
- College of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai 201418, China
| | - Hai-Feng Chen
- College of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai 201418, China
| | - Yu-Jie Ren
- College of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai 201418, China.
| | - Fang-Ming Shao
- School of Science, East China University of Science and Technology, Shanghai 200237, China
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Alparslan MM, Danış Ö. In VitroInhibition of Human Placental GlutathioneS-Transferase by 3-Arylcoumarin Derivatives. Arch Pharm (Weinheim) 2015. [DOI: 10.1002/ardp.201500151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Özkan Danış
- Department of Chemistry; Faculty of Arts and Sciences; Marmara University; Istanbul Turkey
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He LW, Dai WC, Li NG. Development of Orally Active Thrombin Inhibitors for the Treatment of Thrombotic Disorder Diseases. Molecules 2015; 20:11046-62. [PMID: 26083038 PMCID: PMC6272601 DOI: 10.3390/molecules200611046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/10/2015] [Indexed: 12/16/2022] Open
Abstract
Thrombotic disorders represent the major share of the various cardiovascular diseases, and significant progress has been made in the development of synthetic thrombin inhibitors as new anticoagulants. In addition to the development of highly potent and selective inhibitors with improved safety and suitable half-life, several allosteric inhibitors have been designed and synthesized, that did not fully nullify the procoagulant signal and thus could result in reduced bleeding complications. Furthermore, natural products with thrombin inhibitory activity have been isolated, and some natural products have been modified in order to improve their inhibitory activity and metabolic stability. This review summarizes the development of orally active thrombin inhibitors for the treatment of thrombotic disorder diseases, which could serve as a reference for the interested researchers.
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Affiliation(s)
- Li-Wei He
- Department of Medicinal Chemistry, Nanjing University of Chinese Medicine, Nanjing 210023, China.
| | - Wei-Chen Dai
- Department of Medicinal Chemistry, Nanjing University of Chinese Medicine, Nanjing 210023, China.
| | - Nian-Guang Li
- Department of Medicinal Chemistry, Nanjing University of Chinese Medicine, Nanjing 210023, China.
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January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130:e199-267. [PMID: 24682347 PMCID: PMC4676081 DOI: 10.1161/cir.0000000000000041] [Citation(s) in RCA: 919] [Impact Index Per Article: 91.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.03.021] [Citation(s) in RCA: 508] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Shi ZH, Li NG, Tang YP, Duan JA. Prolinamide derivatives as thrombin inhibitors for the treatment of thrombin-mediated diseases: a patent evaluation of US2013296245. Expert Opin Ther Pat 2014; 24:1139-48. [PMID: 25231888 DOI: 10.1517/13543776.2014.959493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Thrombotic disorders can lead to deep vein thrombosis, myocardial infarction and stroke. Thrombin plays a vital role in cascade reaction of blood coagulation, inhibition of the activity of thrombin can block the formation of thrombus and direct thrombin inhibitor has a prospect to overcome the limitations in application of the traditional anticoagulant drugs. AREAS COVERED The current patent US2013296245 describes a series of prolinamide derivatives with formula (I) as thrombin inhibitors. These new compounds are defined to be pharmaceutically acceptable salts derived from pharmaceutically acceptable inorganic acid and organic acid, and pharmaceutically acceptable prodrug where N-alkoxycarbonyl is protected or carboxylic acid is protected by ester. EXPERT OPINION The patent used formamidine and its N-alkoxycarbonyl-protected derivatives as the P1 group; these groups were less basic compared with the traditional guanidine group, so their lipophilicity could be optimized to achieve oral absorption. Furthermore, these pharmaceutically acceptable prodrugs where N-alkoxycarbonyl is protected or carboxylic acid is protected by ester could achieve prolonged half-life for a convenient once- or twice-daily oral dosing. These efforts gave a new hope and confidence to treat thrombotic disorders with selective and orally active thrombin inhibitors.
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Affiliation(s)
- Zhi-Hao Shi
- Nanjing University of Chinese Medicine, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine , 138 Xianlin Road, Nanjing 210023, Jiangsu , PR China +86 25 85811916 ; +86 25 85811916 ; ,
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Abstract
Portal vein thrombosis (PVT) is a fairly common complication of liver cirrhosis. Importantly, occlusive PVT might influence the prognosis of patients with cirrhosis. Evidence from a randomized controlled trial has shown that anticoagulation can prevent the occurrence of PVT in patients with cirrhosis without prior PVT. Evidence from several case series has also demonstrated that anticoagulation can achieve portal vein recanalization in patients with cirrhosis and PVT. Early initiation of anticoagulation therapy and absence of previous portal hypertensive bleeding might be positively associated with a high rate of portal vein recanalization after anticoagulation. However, the possibility of spontaneous resolution of partial PVT questions the necessity of anticoagulation for the treatment of partial PVT. In addition, a relatively low recanalization rate of complete PVT after anticoagulation therapy suggests its limited usefulness in patients with complete PVT. Successful insertion of a transjugular intrahepatic portosystemic shunt (TIPS) not only recanalizes the thrombosed portal vein, but also relieves the symptomatic portal hypertension. However, the technical difficulty of TIPS potentially limits its widespread application, and the risk and benefits should be fully balanced. Notably, current recommendations regarding the management of PVT in liver cirrhosis are insufficient owing to low-quality evidence.
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Affiliation(s)
- Xingshun Qi
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 17 West Changle Road, Xi'an, 710032 China
| | - Guohong Han
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 17 West Changle Road, Xi'an, 710032 China
| | - Daiming Fan
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 17 West Changle Road, Xi'an, 710032 China
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2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014; 64:e1-76. [PMID: 24685669 DOI: 10.1016/j.jacc.2014.03.022] [Citation(s) in RCA: 2877] [Impact Index Per Article: 287.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130:2071-104. [PMID: 24682348 DOI: 10.1161/cir.0000000000000040] [Citation(s) in RCA: 1547] [Impact Index Per Article: 154.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hematoma Formation During Breast Core Needle Biopsy in Women Taking Antithrombotic Therapy. AJR Am J Roentgenol 2013; 201:215-22. [DOI: 10.2214/ajr.12.9930] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Bivard A, Lin L, Parsonsb MW. Review of stroke thrombolytics. J Stroke 2013; 15:90-8. [PMID: 24324944 PMCID: PMC3779670 DOI: 10.5853/jos.2013.15.2.90] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/09/2013] [Accepted: 05/09/2013] [Indexed: 11/30/2022] Open
Abstract
The cornerstone of acute ischemic stroke treatment relies on rapid clearance of an offending thrombus in the cerebrovascular system. There are various drugs and different methods of assessment to select patients more likely to respond to treatment. Current clinical guidelines recommend the administration of intravenous alteplase (following a brain noncontract CT to exclude hemorrhage) within 4.5 hours of stroke onset. Because of the short therapeutic time window, the risk of hemorrhage, and relatively limited efficacy of alteplase for large clot burden, research is ongoing to find more effective and safer reperfusion therapy, as well as focussing on refinement of patient selection for acute reperfusion treatment. Studies using advanced imaging (incorporating perfusion CT or diffusion/perfusion MRI) may allow us to use thrombolytics, or possibly endovascular therapy, in an extended time window. Recent clinical trials have suggested that Tenecteplase, used in conjunction with advanced imaging selection, resulted in more effective reperfusion than alteplase, which translated into increased clinical benefit. Studies using Desmoteplase have suggested its potential benefit in a sub-group of patients with large artery occlusion and salveageable tissue, in an extended time window. Other ways to improve acute reperfusion approaches are being actively explored, including endovascular therapy, and the enhancement of thrombolysis by ultrasound insonation of the clot (sono-thrombolysis).
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Affiliation(s)
- Andrew Bivard
- Departments of Neurology and Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Erkens PMG, ten Cate H, Büller HR, Prins MH. Benchmark for time in therapeutic range in venous thromboembolism: a systematic review and meta-analysis. PLoS One 2012; 7:e42269. [PMID: 23049730 PMCID: PMC3458058 DOI: 10.1371/journal.pone.0042269] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/02/2012] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION The percentage of time within the target INR range 2.0 to 3.0 (TTR) in patients treated with vitamin K antagonists varies considerably among efficacy-studies of novel anticoagulants. In order to properly asses the quality of anticoagulant control in upcoming cost-effectiveness studies and real life registries this systematic review reports a benchmark of TTR for different treatment durations in patients with venous thromboembolism and discusses ways to calculate TTR. METHODS Medline and Embase were searched for studies published between January 1990 and May 2012. Randomized controlled trials and cohort studies reporting the TTR in patients with objectively confirmed venous thromboembolism treated with vitamin K antagonists (VKA) were eligible. Duplicate reports, studies only reporting INR during initial treatment or with VKA treatment less than 3 months were excluded. Three authors assessed trials for inclusion and extracted data independently. Discrepancies were resolved by discussion between the reviewers. A meta-analysis was performed by calculating a weighted mean, based on the number of participants in each included study, for each time-period in which the TTR was measured since the confirmation of the diagnosis of VTE. RESULTS Forty studies were included (26064 patients). The weighted means of TTR were 54.0% in the first month since the start of treatment, 55.6% in months 1 to 3, 60.0% in months 2 to 3, 60.0% in the months 1 to 6+ and 75.2% in months 4 to 12+. Five studies reported TTR in classes. The INR in these studies was ≥ 67% of time in therapeutic range in 72.0% of the patients. CONCLUSION Reported quality of VKA treatment is highly dependent on the time-period since the start of treatment, with TTR ranging from approximately 56% in studies including the 1(st) month to 75% in studies excluding the first 3 months.
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Affiliation(s)
- Petra M G Erkens
- Department of Family Medicine, School for Public Health and Primary Care and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Abstract
BACKGROUND Adherence to medications for chronic conditions is often very low, limiting the benefit to patients, even when the medications are effective and have favorable side effect profiles. PURPOSE This article reviews some of the prior work on treatment adherence, introduces novel concepts from behavioral economics that can be used to design interventions to improve adherence, and proposes new approaches for clinical trials. METHODS Relevant experience of the authors and insights from the literature were combined to identify key issues and propose methodological improvements. Specific examples regarding adherence to warfarin are provided. RESULTS Several new approaches to trial design can be effectively applied in the context of medication adherence. These include tailored intervention strategies and sequential multiple assignment randomized trial (SMART) designs. LIMITATIONS While we have proposed to use these new approaches for ongoing studies of adherence in behavioral health, practical experience with their application is still somewhat limited. CONCLUSIONS Behavioral economics offer a variety of concepts that, when used in the design of interventions to improve adherence, may be more successful than traditional approaches. New clinical trial designs can also be adopted to improve the efficiency of studies that assess these approaches.
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Affiliation(s)
- Stephen E Kimmel
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, 19104-6021, USA
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Ioannidis O, Paraskevas G, Kotronis A, Chatzopoulos S, Konstantara A, Papadimitriou N, Makrantonakis A, Kakoutis E. Surgical management of severe spontaneous hemorrhage of the abdominal wall complicating acenocoumarol treatment. ACTA MEDICA (HRADEC KRALOVE) 2012; 55:47-9. [PMID: 22696936 DOI: 10.14712/18059694.2015.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acenocoumarol is a vitamin K antagonist that is used for the treatment of acquired and congenital, both arterial and venous, thrombotic diseases. Its use is complicated by the narrow therapeutic range. Bleeding following oral anticoagulation, despite rare, remains the major complication. Most cases of hemorrhagic episodes usually require short hospitalization and transfusion, while surgical drainage of the hematoma is not recommended. However, in cases that conservative treatment isn't successful, surgical intervention remains an option. We present a case of severe spontaneous bleeding of the rectus abdominis muscle which was successfully managed surgically.
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Affiliation(s)
- Orestis Ioannidis
- First Surgical Department, General Regional Hospital George Papanikolaou, Thessaloniki, Greece.
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Eichhorn W, Burkert J, Vorwig O, Blessmann M, Cachovan G, Zeuch J, Eichhorn M, Heiland M. Bleeding incidence after oral surgery with continued oral anticoagulation. Clin Oral Investig 2011; 16:1371-6. [PMID: 22160538 DOI: 10.1007/s00784-011-0649-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 11/21/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this retrospective study was to assess the incidence of postoperative hemorrhage in patients treated with coumarins without interruption of the anticoagulant treatment undergoing oral surgical procedures, mostly osteotomies for tooth removal, when compared with patients who had never been anticoagulated. MATERIAL AND METHODS Six hundred thirty-seven patients underwent 934 oral surgical procedures on an outpatient basis. The INR was measured preoperatively being 2.44 in the mean SD 0.61. Local hemostasis was carried out routinely (80%) with collagen fleece, local flap, and acrylic splint. RESULTS Of these 637 patients, 47 presented with a postoperative hemorrhage (7.4%), 15 of these 47 cases had to be treated in hospital (2.4%). All patients showed up finally with a good wound healing, no administration of blood was necessary, and local measures revealed to be sufficient in all cases except for two patients, where the preoperative anticoagulant treatment had to be changed for 6 days. The bleeding incidence in 285 patients with comparable oral surgical procedures, who had never been anticoagulated, was 0.7%. CONCLUSIONS The results suggest that oral surgical procedures can be performed safely without alteration of the oral anticoagulant treatment. CINICAL RELEVANCE: Local hemostasis with collagen fleece, local flap, and acrylic splint seems to be sufficient to prevent postoperative bleeding.
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Affiliation(s)
- Wolfgang Eichhorn
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
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Moualla H, Garcia D. Vitamin K antagonists--current concepts and challenges. Thromb Res 2011; 128:210-5. [PMID: 21570107 DOI: 10.1016/j.thromres.2011.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 04/05/2011] [Accepted: 04/15/2011] [Indexed: 11/19/2022]
Abstract
Vitamin K antagtonists (VKAs) have, for decades, been the corner-stone of anticoagulation in the outpatient setting. While the long half life makes once daily administration practical, close monitoring of VKA effect is necessary because these medicines have a narrow therapeutic index. Despite inter-individual variations in response to VKA doses, the increasing availability of specialized anticoagulation monitoring systems, along with a better understanding of potential drug and dietary interactions, has made the use of VKAs safer and less burdensome. In the future, newer classes of oral anticoagulants and genomic-based dosing strategies may further expand or improve the management options for many patients at risk for thromboembolism.
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Affiliation(s)
- Hayan Moualla
- Division of Hematology and Oncology, University of New Mexico, USA
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Khattab AA, Windecker S, Jüni P, Hildick-Smith D, Dudek D, Andersen HR, Ibrahim R, Schuler G, Walton AS, Wahl A, Mattle HP, Meier B. Randomized clinical trial comparing percutaneous closure of patent foramen ovale (PFO) using the Amplatzer PFO Occluder with medical treatment in patients with cryptogenic embolism (PC-Trial): rationale and design. Trials 2011; 12:56. [PMID: 21356042 PMCID: PMC3058012 DOI: 10.1186/1745-6215-12-56] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 02/28/2011] [Indexed: 12/20/2022] Open
Abstract
Background Several studies have shown an association of cryptogenic stroke and embolism with patent foramen ovale (PFO), but the question how to prevent further events in such patients is unresolved. Options include antithrombotic treatment with warfarin or antiplatelet agents or surgical or endovascular closure of the PFO. The PC-Trial was set up to compare endovascular closure and best medical treatment for prevention of recurrent events. Methods The PC-Trial is a randomized clinical trial comparing the efficacy of percutaneous closure of the PFO using the Amplatzer PFO occluder with best medical treatment in patients with cryptogenic embolism, i.e. mostly cryptogenic stroke. Warfarin for 6 months followed by antiplatelet agents is recommended as medical treatment. Randomization is stratified according to patients age (<45 versus ≥45 years), presence of atrial septal aneurysm (ASA yes or no) and number of embolic events before randomization (one versus more than one event). Primary endpoints are death, nonfatal stroke and peripheral embolism. Discussion patients were randomized in 29 centers of Europe, Canada, and Australia. Randomization started February 2000. Enrollment of 414 patients was completed in February 2009. All patients will be followed-up longitudinally. Follow-up is maintained until the last enrolled patient is beyond 2.5 years of follow-up (expected in 2011). Trial Registration Trial listed in ClinicalTrials.gov as NCT00166257 and sponsored by AGA Medical, Plymouth, MN, USA
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Affiliation(s)
- Ahmed A Khattab
- Cardiology Department, Bern University Hospital, Bern, Switzerland
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Kosyfaki P, Att W, Strub JR. The dental patient on oral anticoagulant medication: a literature review. J Oral Rehabil 2010; 38:615-33. [PMID: 21073495 DOI: 10.1111/j.1365-2842.2010.02184.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Specific diseases and medications may considerably influence the delivery of oral care and the course of dental therapy. The purpose of this literature review is to examine the relationship between oral anticoagulant medication and dental treatment. Electronic and manual searches were conducted for clinical studies in the English literature for the years 1988-2010. The review process provided a total of 110 pertinent literature references, out of which 38 studies dealt with oral anticoagulants and dental treatment. Different treatment strategies relative to dental periprocedural anticoagulation regimens have been identified, and their accompanying thromboembolic and bleeding risks are being presented and discussed. Regarding to what extent a safe and successful dental treatment in patients on anticoagulant medication is feasible, the level of evidence is lacking. Until high-level data are provided, an individualised treatment approach after consultation with the physician of the patient is highly recommended.
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Affiliation(s)
- P Kosyfaki
- Department of Prosthodontics, School of Dentistry, Albert-Ludwigs University, Freiburg, Germany.
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Joo J, Geller NL, French B, Kimmel SE, Rosenberg Y, Ellenberg JH. Prospective alpha allocation in the Clarification of Optimal Anticoagulation through Genetics (COAG) trial. Clin Trials 2010; 7:597-604. [PMID: 20693186 PMCID: PMC3111931 DOI: 10.1177/1740774510381285] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Clarification of Optimal Anticoagulation through Genetics (COAG) trial is a large, multicenter, double-blinded, randomized trial to determine whether use of a genotype-guided dosing algorithm (using clinical and genetic information) to initiate warfarin treatment will improve anticoagulation status when compared to a dosing algorithm using only clinical information. PURPOSE This article describes prospective alpha allocation and balanced alpha allocation for the design of the COAG trial. METHODS The trial involves two possibly heterogeneous populations, which can be distinguished by the difference in warfarin dose as predicted by the two algorithms. A statistical approach is detailed, which allows an overall comparison as well as a comparison of the primary endpoint in the subgroup for which sufficiently different doses are predicted by the two algorithms. Methods of allocating alpha for these analyses are given - a prospective alpha allocation and allocating alpha so that the two analyses have equal power, which we call a 'balanced alpha allocation.' RESULTS We show how to include an analysis of the primary endpoint in a subgroup as a co-primary analysis. Power can be improved by incorporating the correlation between the overall and subgroup analyses in a prospective alpha allocation approach. Balanced alpha allocation for the full cohort and subgroup tests to achieve the same desired power for both of the primary analyses is discussed in detail. LIMITATIONS In the COAG trial, it is impractical to stratify the randomization on subgroup membership because genetic information may not be available at the time of randomization. If imbalances in the treatment arms in the subgroup are found, they will need to be addressed. CONCLUSIONS The design of the COAG trial assures that the subgroup in which the largest treatment difference is expected is elevated to a co-primary analysis. Incorporating the correlation between the full cohort and the subgroup analyses provides an improvement in power for the subgroup comparison, and further improvement may be achieved via a balanced alpha allocation approach when the parameters involved in the sample size calculation are reasonably well estimated.
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Affiliation(s)
- Jungnam Joo
- Office of Biostatistics Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Fujimoto T, Imaeda Y, Konishi N, Hiroe K, Kawamura M, Textor GP, Aertgeerts K, Kubo K. Discovery of a tetrahydropyrimidin-2(1H)-one derivative (TAK-442) as a potent, selective, and orally active factor Xa inhibitor. J Med Chem 2010; 53:3517-31. [PMID: 20355714 DOI: 10.1021/jm901699j] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Coagulation enzyme factor Xa (FXa) is a particularly promising target for the development of new anticoagulant agents. We previously reported the imidazo[1,5-c]imidazol-3-one derivative 1 as a potent and orally active FXa inhibitor. However, it was found that 1 predominantly undergoes hydrolysis upon incubation with human liver microsomes, and the human specific metabolic pathway made it difficult to predict the human pharmacokinetics. To address this issue, our synthetic efforts were focused on modification of the imidazo[1,5-c]imidazol-3-one moiety of the active metabolite 3a, derived from 1, which resulted in the discovery of the tetrahydropyrimidin-2(1H)-one derivative 5k as a highly potent and selective FXa inhibitor. Compound 5k showed no detectable amide bond cleavage in human liver microsomes, exhibited a good pharmacokinetic profile in monkeys, and had a potent antithrombotic efficacy in a rabbit model without prolongation of bleeding time. Compound 5k is currently under clinical development with the code name TAK-442.
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Affiliation(s)
- Takuya Fujimoto
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Ltd., 2-17-85, Jusohomachi, Yodogawa-ku, Osaka 532-8686, Japan
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Pastore F, Losi MA, Carpinella G, Cavallaro M, Fundaliotis A, Chiacchio E, Betocchi S, Chiariello M. Thrombosis of mechanical valve prosthesis in patient with recent Caesarean delivery. Eur Heart J Cardiovasc Imaging 2009; 10:716-7. [PMID: 19454553 DOI: 10.1093/ejechocard/jep046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present a case of a mechanical mitral valve thrombosis in a 37-year-old woman occurred 2 days after a Caesarean delivery. The patient stopped warfarin and initiated low-molecular-weight heparin 1 week before the programmed delivery. Subsequently the diagnosis of thrombosis, heparin infusion was started however unsuccessfully and eventually patient was referred for cardiac surgery.
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Affiliation(s)
- Fabio Pastore
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University School of Medicine, Via S. Pansini, 5, 80131 Naples, Italy
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Nagata T, Yoshino T, Haginoya N, Yoshikawa K, Nagamochi M, Kobayashi S, Komoriya S, Yokomizo A, Muto R, Yamaguchi M, Osanai K, Suzuki M, Kanno H. Discovery of N-[(1R,2S,5S)-2-{[(5-chloroindol-2-yl)carbonyl]amino}-5-(dimethylcarbamoyl)cyclohexyl]-5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridine-2-carboxamide hydrochloride: A novel, potent and orally active direct inhibitor of factor Xa. Bioorg Med Chem 2009; 17:1193-206. [DOI: 10.1016/j.bmc.2008.12.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 12/10/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
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Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Nishimura RA, Carabello BA, Faxon DP, Freed MD, Lytle BW, O'Gara PT, O'Rourke RA, Shah PM. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52:e1-142. [PMID: 18848134 DOI: 10.1016/j.jacc.2008.05.007] [Citation(s) in RCA: 1058] [Impact Index Per Article: 66.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Nakai K, Tsuboi J, Okabayashi H, Fukuhiro Y, Oka T, Habano W, Fukushima N, Nakai K, Obara W, Fujioka T, Suwabe A, Gurwitz D. Ethnic differences in the VKORC1 gene polymorphism and an association with warfarin dosage requirements in cardiovascular surgery patients. Pharmacogenomics 2008; 8:713-9. [PMID: 18240904 DOI: 10.2217/14622416.8.7.713] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Vitamin K epoxide reductase (VKORC1) is the drug target for inhibition by coumarin-based anticoagulant drugs such as warfarin. Warfarin therapy has been reported as a leading cause of drug-related hospitalization and there is therefore an urgent need to develop tests for better warfarin prescription. We report here the distribution of the intron 1 -136 T>C (1173 T>C intron) polymorphism of VKORC1, previously reported to be associated with warfarin maintenance dose in Caucasians and Japanese, in several ethnic populations from Japan and Israel, and describe its significance for warfarin dosage in Japanese cardiovascular surgery patients. METHODS Subjects consisted of 132 Japanese individuals and 341 Israeli individuals from four Jewish ethnic groups (86 Ashkenazi Jews, 95 Yemenite Jews, 73 Moroccan Jews and 87 Libyan Jews). In addition, 31 Japanese patients receiving warfarin therapy after cardiovascular surgery, maintained with a target International Normalized Ratio, were studied. The genotyping for the 1173 T>C intron polymorphism of VKORC1 was determined using rapid real-time PCR. RESULTS The allele frequency of the combined VKORC1 1173 CT and CC genotypes varied among the four Israeli ethnic groups and was, on average, much higher in the Israeli (0.728) than in the Japanese population (0.152). For the Japanese cardiovascular surgery patients, the maintenance dose of warfarin was significantly larger in the combined VKORC1 1173 TC and CC genotype group than in the 1173 TT genotype group (3.6 +/- 0.5 mg vs 2.8 +/- 0.7 mg, respectively; p = 0.02). CONCLUSION The frequencies of the intron 1 VKORC1 1173 T>C SNP show significant differences between ethnic groups and are associated with warfarin dose requirements for achieving a recommended International Normalized Ratio range in Japanese cardiovascular surgery patients. This study supports the example of warfarin as an appropriate model for applying personalized medicine for anticoagulant drugs, and highlights the importance of ethnicity in pharmacogenetics.
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Affiliation(s)
- Kenji Nakai
- Iwate Medical University, Department of Laboratory Medicine, Morioka 020-8505, Japan.
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Konagai N, Uchimura N, Nakamura K, Kudo T. Evaluation of coagulant activity after mechanical heart valve replacement. J Artif Organs 2006; 9:161-4. [PMID: 16998701 DOI: 10.1007/s10047-006-0339-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Accepted: 05/15/2006] [Indexed: 11/27/2022]
Abstract
Long-term oral anticoagulant therapy is required for recipients of mechanical heart valves. In our hospital, the international normalized ratio of prothrombin time (PT-INR) has been set in the range 1.5-2.5 since October 2001. To evaluate whether coagulant activity is fully suppressed by this target range, coagulant activity was evaluated by measuring thrombin-antithrombin III complex (TAT) levels and valve-related complications were investigated retrospectively. Two hundred twenty-three patients who underwent mechanical valve replacement were enrolled in this study. PT-INR and TAT were measured at our outpatient clinic in March 2005 and valve-related complications since October 2001, when we started to control PT-INR in the range 1.5-2.5, were investigated. Under adequate warfarin control, there was no significant correlation between PT-INR and TAT, however nine patients who exhibited a PT-INR of less than 2.0 had high levels of TAT. And in atrial fibrillation (AF) patients after mitral valve replacement (MVR), the level of TAT was significantly high compared with sinus rhythm patients after atrial valve replacement. Valve-related complications were bleeding events at 2.75% per patient year and thromboembolism at 0.32% per patient year. Attention to complications of thromboembolism is necessary when the PT-INR is less than 2.0, especially in AF patients after MVR and in those with a thrombotic past history or high levels of TAT. The monitoring of TAT is useful in detecting potential coagulation factors and to determine the therapeutic range of warfarin that can normalize coagulant activity.
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Affiliation(s)
- Naoki Konagai
- Department of Cardiovascular Surgery, Hachioji Medical Center of Tokyo Medical University, 1163 Tate-machi, Hachioji, Tokyo 193-0998, Japan.
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Sconce EA, Kamali F. Appraisal of current vitamin K dosing algorithms for the reversal of over-anticoagulation with warfarin: the need for a more tailored dosing regimen. Eur J Haematol 2006; 77:457-62. [PMID: 17042764 DOI: 10.1111/j.0902-4441.2006.t01-1-ejh2957.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Warfarin is the most commonly prescribed oral anticoagulant in the UK for the treatment and prevention of thromboembolic disorders. Vitamin K administration is an effective way of reversing excessive anticoagulation. Over-anticoagulated patients present with a wide range of international normalized ratio (INR) values and may respond differently to a fixed dose of vitamin K. Current dosing algorithms for vitamin K administration in the non-urgent treatment of over-anticoagulation do not take this variability in response into account. Consequently, over a third of over-anticoagulated patients still remain outside their target INR 24 h after treatment. Such patients are therefore prone to either haemorrhage (if the patient is still over-anticoagulated) or thromboembolism (if the INR reversal is over-corrected). A number of factors such as patient age, body weight, co-morbidity, frailty, warfarin daily dose and CYP2C9 and VKORC1 polymorphism could affect response to vitamin K and thus the rate and extent of INR reversal. There is a need for a more individualized approach to the reversal of over-anticoagulation in asymptomatic or mildly haemorrhagic patients in order to improve the safety of warfarin therapy.
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Affiliation(s)
- Elizabeth A Sconce
- Wolfson Unit of Clinical Pharmacology, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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Miura M, Seki N, Koike T, Ishihara T, Niimi T, Hirayama F, Shigenaga T, Sakai-Moritani Y, Kawasaki T, Sakamoto S, Okada M, Ohta M, Tsukamoto SI. Potent and selective TF/FVIIa inhibitors containing a neutral P1 ligand. Bioorg Med Chem 2006; 14:7688-705. [PMID: 16942884 DOI: 10.1016/j.bmc.2006.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 08/09/2006] [Accepted: 08/10/2006] [Indexed: 11/17/2022]
Abstract
Inhibition of tissue factor/factor VIIa complex (TF/FVIIa) is an attractive strategy for antithrombotic therapies. We began with an investigation of a non-amidine TF/FVIIa inhibitor based on a modification of amidine compound 1. Optimization of the substituents on the P1 phenyl portion of the compound 1 led to a neutral or less basic alternative for the 4-amidinophenyl moiety. By further optimization of the substituents on the central phenyl ring, a highly potent and selective TF/FVIIa inhibitor 17d was discovered.
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Affiliation(s)
- Masanori Miura
- Institute for Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan.
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Saw JT, Bahari MB, Ang HH, Lim YH. Potential drug–herb interaction with antiplatelet/anticoagulant drugs. Complement Ther Clin Pract 2006; 12:236-41. [PMID: 17030294 DOI: 10.1016/j.ctcp.2006.06.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Revised: 06/06/2006] [Accepted: 06/07/2006] [Indexed: 11/19/2022]
Abstract
This is a cross-sectional survey evaluating the use of herbal medicines in medical wards patients that may interfere with the effect of antiplatelet or anticoagulant therapy. Among the 250 patients participated, 42.4% (n=106) were taking herbs with 76 patients (71.7%) using herbs for the past 12 months. Overall, almost 31% (n=23, N=76) of patients were taking one or more of the specified herbal medicines [ginseng (Panax ginseng), garlic (Allium sativum), ginkgo (Gingko biloba) thought to interact with antiplatelet or anticoagulant therapy. The study showed that 21% (n=16, N=76) of patients co-ingested specified herbs with antiplatelet or anticoagulant therapy, of which half of them were at risk of potential drug-herb interactions. A large proportion of respondents involved in potential drug-herb interaction were elderly people (62.5%, n=5). However, more than 90% of herbal users did not disclose the use of herbal medicine to their health professionals. It is thus prudent for all care givers to be aware of the possibility of drug-herb interaction and inquire about herbal use from patients.
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Affiliation(s)
- Jun Tze Saw
- School of Pharmaceutical Sciences, University Science Malaysia, Minden, 11800 Penang, Malaysia.
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Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48:e1-148. [PMID: 16875962 DOI: 10.1016/j.jacc.2006.05.021] [Citation(s) in RCA: 1094] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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44
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ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.05.030] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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46
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Stroud LF, Mamdami MM, Kopp A, Bell CM. The safety of levofloxacin in elderly patients on warfarin. Am J Med 2005; 118:1417. [PMID: 16378802 DOI: 10.1016/j.amjmed.2005.06.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Accepted: 06/30/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Lynfa F Stroud
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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47
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Komoriya S, Haginoya N, Kobayashi S, Nagata T, Mochizuki A, Suzuki M, Yoshino T, Horino H, Nagahara T, Suzuki M, Isobe Y, Furugoori T. Design, synthesis, and biological activity of non-basic compounds as factor Xa inhibitors: SAR study of S1 and aryl binding sites. Bioorg Med Chem 2005; 13:3927-54. [PMID: 15911309 DOI: 10.1016/j.bmc.2005.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Revised: 03/26/2005] [Accepted: 04/06/2005] [Indexed: 10/25/2022]
Abstract
Compound 7 was identified as the active metabolite of 6 by HPLC and mass spectral analysis. Modification of lead compound 7 by transformation of its N-oxide 6-6 biaryl ring system and fused aromatics produced a series of non-basic fXa inhibitors with excellent potency in anti-fXa and anticoagulant assays. The optimized compounds 73b and 75b showed sub to one digit micromolar anticoagulant activity (PTCT2). Particularly, anti-fXa activity was detected in plasma of rats orally administered with 1mg/kg of compound 75b.
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Affiliation(s)
- Satoshi Komoriya
- Tokyo R&D Center, Daiichi Pharmaceutical Co. Ltd, 16-13 Kita-Kasai 1-Chome, Edogawa-ku, Tokyo 134-8630, Japan.
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48
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Srivastava S, Goswami LN, Dikshit DK. Progress in the design of low molecular weight thrombin inhibitors. Med Res Rev 2005; 25:66-92. [PMID: 15389730 DOI: 10.1002/med.20016] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Intravascular thrombosis and its complication, embolism, is a leading cause of morbidity and mortality throughout the world. Past few decades have seen a great deal of progress in the development of antithrombotic agents, though the current treatment options are limited to heparin, LMW heparins, and warfarin. Detailed understanding of the biochemical and biophysical mechanisms of activation and regulation of blood coagulation have helped in developing specific inhibitors of enzymes, especially thrombin, within the coagulation cascade. Thrombin plays a central role in the coagulation cascade and so has become the primary target for the development of antithrombotic drugs. The review covers the main pharmacological aspects of haemostasis and thrombosis and provides an update on low molecular weight thrombin inhibitors along with the limitations of the prevalent antithrombotic agents. Recent developments in small molecule inhibitors of Protease Activated Receptor-1 (PAR-1) which can be helpful for the treatment of thrombotic and vascular proliferative disorders, have also been discussed.
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Affiliation(s)
- Stuti Srivastava
- Medicinal Chemistry Division, Central Drug Research Institute, Lucknow, India
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50
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Schurgers LJ, Shearer MJ, Hamulyák K, Stöcklin E, Vermeer C. Effect of vitamin K intake on the stability of oral anticoagulant treatment: dose-response relationships in healthy subjects. Blood 2004; 104:2682-9. [PMID: 15231565 DOI: 10.1182/blood-2004-04-1525] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Abstract
Oral anticoagulants exert their effect by blocking the utilization of vitamin K, yet little is known about competitive aspects of their interaction with dietary vitamin K. We carried out systematic dose-response studies in healthy volunteers who had been stably anticoagulated and maintained on their individualized doses for 13 weeks. First, we studied the response to weekly incremental doses (50 μg-500 μg) of vitamin K1 supplements (K1) taken daily for 7 days. The threshold K1 dose causing a statistically significant lowering of the INR was 150 μg/day. In 25% of the participants the INR change was regarded as clinically relevant at a vitamin K intake of 150 μg/day. Circulating undercarboxylated osteocalcin did not decrease until 300 μg K1/day compared with 100 μg K1/day for undercarboxylated FII, suggesting differential antidotal effects on bone and hepatic γ-carboxylation. Next, we tested the response to vitamin K-rich food items. The short-lived response after meals of spinach and broccoli suggested an inefficient bioavailability from these 2 sources. We conclude that short-term variability in intake of K1 is less important to fluctuations in the international normalized ratio (INR) than has been commonly assumed and that food supplements providing 100 μg/day of vitamin K1 do not significantly interfere with oral anticoagulant therapy. (Blood. 2004;104:2682-2689)
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Affiliation(s)
- Leon J Schurgers
- Cardiovascular Research Institute Maastricht and VitaK BV, Maastricht, The Netherlands.
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