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Ma F, Yuan L, Wen X, Wang Y, Li Q, Chen C. Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis. Clin Appl Thromb Hemost 2022; 28:10760296221131033. [PMID: 36198012 PMCID: PMC9537486 DOI: 10.1177/10760296221131033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/05/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Direct Oral Anticoagulants (DOACs) , which partially replace warfarin, have been developed as a safe and effective therapy for patients with stable coronary artery disease (SCAD) and atrial fibrillation (AF). However, the choice of DOACs and warfarin remains controversial. We conducted a network meta-analysis (NMA) using randomized controlled trials (RCTs) through a systematic literature review to evaluate the the efficacy and safety of DOACs in SCAD and AF patients. Five RCTs with 6524 patients were included. The results showed that patients taking DOACs had a lower risk of stroke/systemic embolism (OR, 0.64; 95% CI, 0.54-0.76, P < .00001, I2 = 89%), intracranial bleeding (OR, 0.41; 95% CI, 0.26-0.64, P = .0001, I2 = 0%), major bleeding (OR, 0.98; 95% CI, 0.81-1.148, P = .80, I2 = 88%), and all-cause mortality (OR, 1.04; 95% CI, 0.88-1.22, P = .66, I2 = 51%) than those taking warfarin. Compared to warfarin, rivaroxaban (20 mg, once/day) was more advantageous in preventing stroke/systemic embolism, as was apixaban (5 mg or 2.5 mg, twice/day) in reducing major bleeding (OR, 0.79; 95% CI, 0.48-1.3) and all-cause mortality (OR, 0.97; 95% CI, 0.69-1.4). Different doses of DOACs showed obvious advantages against intracranial hemorrhage, without significant differences. Thus, DOACs have more effective than warfarin in clinical efficacy and safety.
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Affiliation(s)
- Fang Ma
- Shaanxi University of Chinese Medicine, Xian Yang, Shaanxi, China
| | - Li Yuan
- First Affiliated Hospital of Xi'an Medical University The First Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an, Shaanxi, China
| | - Xinli Wen
- Shaanxi Academy of Traditional Chinese Medicine, Xi'an, Shaanxi, China
| | - Yangyang Wang
- Shaanxi University of Chinese Medicine, Xian Yang, Shaanxi, China
| | - Qiaofei Li
- Shaanxi University of Chinese Medicine, Xian Yang, Shaanxi, China
| | - Chu Chen
- Shaanxi Academy of Traditional Chinese Medicine, Xi'an, Shaanxi, China
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Zhao L, Zhang C, Abu‐Ershaid JM, Li M, Li Y, Naser Y, Dai X, Abbate MTA, Donnelly RF. Smart Responsive Microarray Patches for Transdermal Drug Delivery and Biological Monitoring. Adv Healthc Mater 2021; 10:e2100996. [PMID: 34449129 DOI: 10.1002/adhm.202100996] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/15/2021] [Indexed: 12/12/2022]
Abstract
Traditional drug delivery routes possess various disadvantages which make them unsuitable for certain population groups, or indeed unsuitable for drugs with certain physicochemical properties. As a result, a variety of alternative drug delivery routes have been explored in recent decades, including transdermal drug delivery. One of the most promising novel transdermal drug delivery technologies is a microarray patch (MAP), which can bypass the outermost skin barrier and deliver drugs directly into the viable epidermis and dermis. Unlike traditional MAPs which release loaded cargo simultaneously upon insertion into the skin, stimuli responsive MAPs based on biological stimuli are able to precisely release the drug in response to the need for additional doses. Thus, smart MAPs that are only responsive to certain external stimuli are highly desirable, as they provide safer and more efficient drug delivery. In addition to drug delivery, they can also be used for biological monitoring, which further expands their applications.
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Affiliation(s)
- Li Zhao
- School of Pharmacy Queen's University Belfast 97 Lisburn Road Belfast BT9 7BL UK
| | - Chunyang Zhang
- School of Pharmacy Queen's University Belfast 97 Lisburn Road Belfast BT9 7BL UK
| | | | - Mingshan Li
- School of Pharmacy Queen's University Belfast 97 Lisburn Road Belfast BT9 7BL UK
| | - Yaocun Li
- School of Pharmacy Queen's University Belfast 97 Lisburn Road Belfast BT9 7BL UK
| | - Yara Naser
- School of Pharmacy Queen's University Belfast 97 Lisburn Road Belfast BT9 7BL UK
| | - Xianbing Dai
- School of Pharmacy Queen's University Belfast 97 Lisburn Road Belfast BT9 7BL UK
| | - Marco T. A. Abbate
- School of Pharmacy Queen's University Belfast 97 Lisburn Road Belfast BT9 7BL UK
| | - Ryan F. Donnelly
- School of Pharmacy Queen's University Belfast 97 Lisburn Road Belfast BT9 7BL UK
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Gauer JS, Riva N, Page EM, Philippou H, Makris M, Gatt A, Ariëns RAS. Effect of anticoagulants on fibrin clot structure: A comparison between vitamin K antagonists and factor Xa inhibitors. Res Pract Thromb Haemost 2020; 4:1269-1281. [PMID: 33313466 PMCID: PMC7695561 DOI: 10.1002/rth2.12443] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/01/2020] [Accepted: 09/12/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Abnormal clot structure has been identified in patients with thrombotic disorders. Anticoagulant therapy offers clear benefits for thrombosis prevention and treatment by reducing blood clot formation and size; nevertheless, there are limited data on the effects of different anticoagulants, where clotting is initiated with different triggers, on clot structure. OBJECTIVES Our aim was to investigate the effects of vitamin K antagonists and factor Xa inhibitors on clot structure. METHODS Clots from pooled plasma spiked with rivaroxaban, apixaban, or enoxaparin, as well as plasma from patients on warfarin, were compared to plasma without anticoagulation. The kinetic profile of polymerizing clots was obtained by turbidity, fiber density was determined by confocal microscopy, clot pore size was investigated by permeation, and fiber size was analyzed using scanning electron microscopy. Clotting agonist was either tissue factor or thrombin. RESULTS Following clotting with tissue factor, all anticoagulated clots had a significantly increased lag time, with the exception of enoxaparin. Rivaroxaban additionally led to significantly less dense and more permeable clots, with thicker fibers. In contrast, turbidity analysis following initiation with thrombin showed few effects of anticoagulation, with only enoxaparin leading to a prolonged lag time. Enoxaparin clots made with thrombin were less dense and more permeable. CONCLUSION Our results show that anticoagulants modulate clot structure particularly when induced by tissue factor, most likely due to reduction of thrombin generation. We propose that the effects of different anticoagulants could be assessed with a global clot structure measurement such as permeation or turbidity, providing information on clot phenotype.
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Affiliation(s)
- Julia S. Gauer
- Discovery and Translational Science DepartmentInstitute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Nicoletta Riva
- Department of PathologyFaculty of Medicine & SurgeryUniversity of MaltaMsidaMalta
| | - Eden M. Page
- Discovery and Translational Science DepartmentInstitute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Helen Philippou
- Discovery and Translational Science DepartmentInstitute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Michael Makris
- Sheffield Haemophilia and Thrombosis CentreUniversity of SheffieldSheffieldUK
| | - Alex Gatt
- Department of PathologyFaculty of Medicine & SurgeryUniversity of MaltaMsidaMalta
| | - Robert A. S. Ariëns
- Discovery and Translational Science DepartmentInstitute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
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Warfarin pharmacogenetics in patients with heart valve replacement. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100769] [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]
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5
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Prospective validation of the International Warfarin Pharmacogenetics Consortium algorithm in high-risk elderly people (VIALE study). THE PHARMACOGENOMICS JOURNAL 2019; 20:451-461. [DOI: 10.1038/s41397-019-0129-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 11/13/2019] [Accepted: 11/20/2019] [Indexed: 01/10/2023]
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Therapeutic potential of coumarin bearing metal complexes: Where are we headed? Bioorg Med Chem Lett 2019; 30:126805. [PMID: 31753700 DOI: 10.1016/j.bmcl.2019.126805] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 11/21/2022]
Abstract
The successfully application of some metallodrugs such as salvarsan, silver sulfadiazine and cisplatin in modern medicine launched the biological investigation of organometallic and metal-organic complexes. The availability and tunability of various ligands including N-heterocycles, phosphines, N-heterocyclic carbenes present an extended research area to chemists. In recent years, the preparation of the metal complexes of bioactive organic compounds is a new strategy. Coumarin derivatives are one of the classes of compounds used for this purpose, and many complexes of coumarin derivatives were prepared for enhanced biological activity, especially anticancer and antimicrobial. In this paper, we discuss the current situation of this topic.
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Abstract
OBJECTIVES To identify and examine individual characteristics and socioeconomic factors that contribute to the knowledge of patients who receive warfarin anticoagulation. METHODS All patients treated using warfarin for anticoagulation were enrolled during a 6-month period at a university-affiliated cardiac clinic. All relevant demographic and clinical information were collected and the Anticoagulation Knowledge Assessment (AKA) questionnaire consisting of 29 questions was administered. After completion, the questionnaires were scored and the percent correct answers were analyzed for overall scores, as well as the following categories: drug/food interactions, pharmacological knowledge, recognition of complications, and patient compliance. Multiple linear regression analysis was used to identify the contributing factors to the knowledge level of the patients in each category. RESULTS One hundred fifty patients (79 men and 71 women) with a median age of 61.5 years completed the AKA questionnaire. The average overall score was 29.3%. Living alone (P = 0.008), higher levels of education (P = 0.001), and durations of ≥3 years of warfarin therapy (P = 0.018) positively impacted overall AKA scores. CONCLUSIONS Socioeconomic factors and level of general education remain the most important elements determining the patient awareness of therapeutic goals, possible drug/food interaction, recognition of adverse effects, and compliance of warfarin treatment.
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Vasconcelos AA, Sucupira ID, Guedes AL, Queiroz IN, Frattani FS, Fonseca RJ, Pomin VH. Anticoagulant and Antithrombotic Properties of Three Structurally Correlated Sea Urchin Sulfated Glycans and Their Low-Molecular-Weight Derivatives. Mar Drugs 2018; 16:md16090304. [PMID: 30200211 PMCID: PMC6163371 DOI: 10.3390/md16090304] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 01/10/2023] Open
Abstract
The anticoagulant and antithrombotic properties of three structurally correlated sea urchin-derived 3-linked sulfated α-glycans and their low molecular-weight derivatives were screened comparatively through various in vitro and in vivo methods. These methods include activated partial thromboplastin time, the inhibitory activity of antithrombin over thrombin and factor Xa, venous antithrombosis, the inhibition of platelet aggregation, the activation of factor XII, and bleeding. While the 2-sulfated fucan from Strongylocentrotus franciscanus was observed to be poorly active in most assays, the 4-sulfated fucan from Lytechinus variegatus, the 2-sulfated galactan from Echinometra lucunter and their derivatives showed multiple effects. All marine compounds showed no capacity to activate factor XII and similar low bleeding tendencies regardless of the dose concentrations used to achieve the highest antithrombotic effect observed. The 2-sulfated galactan showed the best combination of results. Our work improves the background about the structure-function relationship of the marine sulfated glycans in anticoagulation and antithrombosis. Besides confirming the negative effect of the 2-sulfated fucose and the positive effect of the 2-sulfated galactose on anticoagulation in vitro, our results also demonstrate the importance of this set of structural requirements on antithrombosis in vivo, and further support the involvement of high-molecular weight and 4-sulfated fucose in both activities.
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Affiliation(s)
- Ariana A Vasconcelos
- Program of Glycobiology, Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, RJ, Brazil.
- University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, RJ, Brazil.
| | - Isabela D Sucupira
- Program of Glycobiology, Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, RJ, Brazil.
- University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, RJ, Brazil.
| | - Alessandra L Guedes
- Program of Glycobiology, Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, RJ, Brazil.
- Department of Clinical Analyses and Toxicology, School of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro 21941-599, RJ, Brazil.
| | - Ismael N Queiroz
- Program of Glycobiology, Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, RJ, Brazil.
- University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, RJ, Brazil.
| | - Flavia S Frattani
- Department of Clinical Analyses and Toxicology, School of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro 21941-599, RJ, Brazil.
| | - Roberto J Fonseca
- University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, RJ, Brazil.
- Undergraduate Program in Pharmacology, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil.
| | - Vitor H Pomin
- Program of Glycobiology, Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, RJ, Brazil.
- University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, RJ, Brazil.
- Department of BioMolecular Sciences, Division of Pharmacognosy, and Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677-1848, USA.
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9
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Weitz JI, Fredenburgh JC. 2017 Scientific Sessions Sol Sherry Distinguished Lecture in Thrombosis. Arterioscler Thromb Vasc Biol 2018; 38:304-310. [DOI: 10.1161/atvbaha.117.309664] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Jeffrey I. Weitz
- From the Department of Medicine (J.I.W., J.C.F.) and Department of Biochemistry and Biomedical Sciences (J.I.W.), McMaster University, Hamilton, Ontario, Canada; and Thrombosis and Atherosclerosis Research Institute (J.I.W., J.C.F.), Hamilton, Ontario, Canada
| | - James C. Fredenburgh
- From the Department of Medicine (J.I.W., J.C.F.) and Department of Biochemistry and Biomedical Sciences (J.I.W.), McMaster University, Hamilton, Ontario, Canada; and Thrombosis and Atherosclerosis Research Institute (J.I.W., J.C.F.), Hamilton, Ontario, Canada
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10
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Multi-objective feature selection for warfarin dose prediction. Comput Biol Chem 2017; 69:126-133. [DOI: 10.1016/j.compbiolchem.2017.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 06/06/2017] [Accepted: 06/22/2017] [Indexed: 02/05/2023]
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Franchini M, Mannucci PM. Direct oral anticoagulants and venous thromboembolism. Eur Respir Rev 2017; 25:295-302. [PMID: 27581829 DOI: 10.1183/16000617.0025-2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/12/2016] [Indexed: 11/05/2022] Open
Abstract
Venous thromboembolism (VTE), consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban) and thrombin inhibitors (e.g. dabigatran etexilate). This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE.
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Affiliation(s)
- Massimo Franchini
- Dept of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantua, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
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12
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Bahloul M, Regaieg K, Chtara K, Turki O, Baccouch N, Chaari A, Bouaziz M. [Posttraumatic thromboembolic complications: Incidence, risk factors, pathophysiology and prevention]. Ann Cardiol Angeiol (Paris) 2017; 66:92-101. [PMID: 28110934 DOI: 10.1016/j.ancard.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 12/08/2016] [Indexed: 06/06/2023]
Abstract
Venous thromboembolism (VTE) remains a major challenge in critically ill patients. Subjects admitted in intensive care unit (ICU), in particular trauma patients, are at high-risk for both deep vein thrombosis (DVT) and pulmonary embolism (PE). The rate of symptomatic PE in injured patients has been reported previously ranging from 1 to 6%. The high incidence of posttraumatic venous thromboembolic events is well known. In fact, major trauma is a hypercoagulable state. Several factors placing the individual patient at a higher risk for the development of DVT and PE have been suggested: high ISS score, meningeal hemorrhage and spinal cord injuries have frequently been reported as a significant risk factor for VTEs after trauma. Posttraumatic pulmonary embolism traditionally occurs after a period of at least 5 days from trauma. The prevention can reduce the incidence and mortality associated with the pulmonary embolism if it is effective. There is no consensus is now available about the prevention of venous thromboembolism in trauma patients.
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Affiliation(s)
- M Bahloul
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie.
| | - K Regaieg
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - K Chtara
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - O Turki
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - N Baccouch
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - A Chaari
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - M Bouaziz
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
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Zhang Y, Yu J, Wang J, Hanne NJ, Cui Z, Qian C, Wang C, Xin H, Cole JH, Gallippi CM, Zhu Y, Gu Z. Thrombin-Responsive Transcutaneous Patch for Auto-Anticoagulant Regulation. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2017; 29:10.1002/adma.201604043. [PMID: 27885722 PMCID: PMC5250559 DOI: 10.1002/adma.201604043] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/24/2016] [Indexed: 05/19/2023]
Abstract
A thrombin-responsive closed-loop patch is developed for prolonged heparin delivery in a feedback-controlled manner. This microneedle-based patch can sense activated thrombin and subsequently releases heparin to prevent coagulation in the blood flow. This "smart" heparin patch can be transcutaneously inserted into skin without drug leakage and can sustainably regulate blood coagulation in response to thrombin.
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Affiliation(s)
- Yuqi Zhang
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics, UNC, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jicheng Yu
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics, UNC, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jinqiang Wang
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics, UNC, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Nicholas J. Hanne
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
| | - Zheng Cui
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Chenggen Qian
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
| | - Chao Wang
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics, UNC, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Hongliang Xin
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
- School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Jacqueline H. Cole
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
| | - Caterina M. Gallippi
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
| | - Yong Zhu
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Zhen Gu
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics, UNC, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Zhong C, Zhang L, Chen L, Deng L, Li R. Coagulation factor XI vaccination: an alternative strategy to prevent thrombosis. J Thromb Haemost 2017; 15:122-130. [PMID: 27813324 DOI: 10.1111/jth.13561] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 10/24/2016] [Indexed: 12/22/2022]
Abstract
Essentials Coagulation Factor (F) XI is a safe target for the development of antithrombotics. We designed an antigen comprising the human FXI catalytic domain and diphtheria toxin T domain. Antigen immunization reduced plasma FXI activity by 54% and prevented thrombosis in mice. FXI vaccination can serve as an effective strategy for thrombosis prevention. SUMMARY Background Coagulation factor XI serves as a signal amplifier in the intrinsic coagulation pathway. Blockade of FXI by mAbs or small-molecule inhibitors inhibits thrombosis without causing severe bleeding, which is an inherent risk of currently available antithrombotic agents. Objectives To design an FXI vaccine and assess its efficacy in inhibiting FXI activity and preventing thrombosis. Methods An FXI antigen was generated by fusing the catalytic domain of human FXI to the C-terminus of the transmembrane domain of diphtheria toxin. The anti-FXI antibody response, plasma FXI activity and antithrombotic efficacy in mice immunized with the FXI antigen were examined. Results The antigen elicited a significant antibody response against mouse FXI, and reduced the plasma FXI activity by 54.0% in mice. FXI vaccination markedly reduced the levels of coagulation and inflammation in a mouse model of inferior vena cava stenosis. Significant protective effects were also observed in mouse models of venous thrombosis and pulmonary embolism. Conclusions Our data demonstrate that FXI vaccination can serve as an effective strategy for thrombosis prevention.
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Affiliation(s)
- C Zhong
- State Key Laboratory of Microbial Metabolism and School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - L Zhang
- State Key Laboratory of Microbial Metabolism and School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - L Chen
- State Key Laboratory of Microbial Metabolism and School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - L Deng
- Shanghai HyCharm Inc., Shanghai, China
| | - R Li
- State Key Laboratory of Microbial Metabolism and School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, Shanghai, China
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15
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Ieko M, Naitoh S, Yoshida M, Takahashi N. Profiles of direct oral anticoagulants and clinical usage-dosage and dose regimen differences. J Intensive Care 2016; 4:19. [PMID: 26966542 PMCID: PMC4785699 DOI: 10.1186/s40560-016-0144-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/25/2016] [Indexed: 02/01/2023] Open
Abstract
The availability of direct oral anticoagulants (DOACs) has caused a paradigm shift in thrombosis management. DOAC profiles do not differ greatly, though they are quite different from that of warfarin, whereas their dosage and dose regimens are not consistent. The direct thrombin inhibitor dabigatran seems to obstruct tenase by inhibiting thrombin generated in the initial phase and feedback to the amplification phase of cell-based coagulation reactions. Factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) mainly inhibit factor Xa activity of the prothrombinase complex in the propagation phase. The dose regimens of these inhibitors can be classified into once (rivaroxaban, edoxaban) and twice (dabigatran, apixaban) daily. On the other hand, their plasma elimination half-life times are similar, which can be explained by differences in the type of aimed anticoagulation, such as persistent (e.g., warfarin) and intermittent (e.g., low-molecular-weight heparin). Because of the differences among DOACs, an indicator is necessary to compare them. We investigated relative potency to compare dosage and intensity by calculation of conversion using a profile comprised of molecular weight, bioavailability, protein-binding rate, inhibitory constant, and dosage. We found that the relative potencies were different, with that of apixaban higher than edoxaban (60 mg) and nearly twice that of rivaroxaban. However, dabigatran could not be evaluated with this profile, likely due to its different mode of action. These results suggest that rivaroxaban and apixaban differ in regard to anticoagulation type, as the former shows persistent and the latter intermittent anticoagulation.
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Affiliation(s)
- Masahiro Ieko
- Department of Internal Medicine, School of Dentistry, Health Sciences University of Hokkaido, 1757-Kanazawa, Ishikari-Tobetsu, Hokkaido 061-0293 Japan
| | - Sumiyoshi Naitoh
- Division of Clinical Laboratory, Health Sciences University of Hokkaido Hospital, 2-5, Ainosato, Kita-ku, Sapporo, Hokkaido 002-8072 Japan
| | - Mika Yoshida
- Division of Clinical Laboratory, Health Sciences University of Hokkaido Hospital, 2-5, Ainosato, Kita-ku, Sapporo, Hokkaido 002-8072 Japan
| | - Nobuhiko Takahashi
- Department of Internal Medicine, School of Dentistry, Health Sciences University of Hokkaido, 1757-Kanazawa, Ishikari-Tobetsu, Hokkaido 061-0293 Japan
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16
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The evolution of anticoagulant therapy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:175-84. [PMID: 26710352 DOI: 10.2450/2015.0096-15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/16/2015] [Indexed: 02/07/2023]
Abstract
Arterial and venous thromboembolism are leading causes of morbidity and mortality around the world. For almost 70 years, heparins (unfractionated heparin and low molecular weight heparins) and vitamin K antagonists have been the leading therapeutic medical options for the treatment and prevention of thromboembolic disorders. Nevertheless, the many limitations of these traditional anticoagulants have fuelled the search for novel agents over the past 15 years, and a new class of oral anticoagulants that specifically target activated factor X and thrombin has been developed and is now commercially available. In this narrative review, the evolution of anticoagulant therapy is summarised, with a focus on newer oral anticoagulants.
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17
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Wu B, Wei N, Thon V, Wei M, Yu Z, Xu Y, Chen X, Liu J, Wang PG, Li T. Facile chemoenzymatic synthesis of biotinylated heparosan hexasaccharide. Org Biomol Chem 2015; 13:5098-101. [PMID: 25858766 PMCID: PMC4472006 DOI: 10.1039/c5ob00462d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A biotinylated heparosan hexasaccharide was synthesized using a one-pot multi-enzyme strategy, in situ activation and transfer of N-trifluoroacetylglucosamine (GlcNTFA) to a heparin backbone significantly improved the synthetic efficiency. The biotinylated hexasaccharide could serve as a flexible core to diversify its conversion into heparan sulfate isoforms with potential biological applications and therapeutics.
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Affiliation(s)
- Baolin Wu
- Center for Diagnostics and Therapeutics, Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Na Wei
- Center for Diagnostics and Therapeutics, Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Vireak Thon
- Center for Diagnostics and Therapeutics, Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Mohui Wei
- Center for Diagnostics and Therapeutics, Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Zaikuan Yu
- Center for Diagnostics and Therapeutics, Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Yongmei Xu
- Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Xi Chen
- Department of Chemistry, University of California, One Shields Avenue, Davis, CA 95616, USA
| | - Jian Liu
- Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Peng George Wang
- Center for Diagnostics and Therapeutics, Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Tiehai Li
- Center for Diagnostics and Therapeutics, Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
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18
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Nasser S, Cecchele R, Touma S, Han P, Nair K, Vizgoft J, Murdoch V, Mullan J, Bajorek B. Documentation of Warfarin Education provided to Hospital Patients: A Clinical Audit. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2012.tb00150.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Judy Mullan
- Graduate School of Medicine; University of Wollongong
| | - Beata Bajorek
- Graduate School of Health, Departments of Pharmacy and Clinical Pharmacology, Royal North Shore Hospital; University of Technology Sydney; St Leonards New South Wales
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19
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Novel oral anticoagulants: what dermatologists need to know. J Am Acad Dermatol 2015; 72:535-40. [PMID: 25582538 DOI: 10.1016/j.jaad.2014.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/09/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
The development of novel oral anticoagulants provides clinicians and patients a welcome alternative to the challenges of warfarin therapy. Dermatologists must be aware of the potential impact of novel oral anticoagulants on their surgical and medical practice. This review provides a concise summary of the novel oral anticoagulants for dermatologists with particular emphasis on: (1) the pharmacokinetic properties of these drugs and how they differ from warfarin, (2) suggested management during cutaneous surgery, (3) adverse drug interactions with commonly prescribed medications in dermatology, and (4) potential use within dermatology for treatment of disorders of cutaneous thrombosis.
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20
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Lin KY, Lo JH, Consul N, Kwong GA, Bhatia SN. Self-titrating anticoagulant nanocomplexes that restore homeostatic regulation of the coagulation cascade. ACS NANO 2014; 8:8776-85. [PMID: 25119520 PMCID: PMC4174090 DOI: 10.1021/nn501129q] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Antithrombotic therapy is a critical portion of the treatment regime for a number of life-threatening conditions, including cardiovascular disease, stroke, and cancer; yet, proper clinical management of anticoagulation remains a challenge because existing agents increase the propensity for bleeding in patients. Here, we describe the development of a bioresponsive peptide-polysaccharide nanocomplex that utilizes a negative feedback mechanism to self-titrate the release of anticoagulant in response to varying levels of coagulation activity. This nanoscale self-titrating activatable therapeutic, or nanoSTAT, consists of a cationic thrombin-cleavable peptide and heparin, an anionic polysaccharide and widely used clinical anticoagulant. Under nonthrombotic conditions, nanoSTATs circulate inactively, neither releasing anticoagulant nor significantly prolonging bleeding time. However, in response to life-threatening pulmonary embolism, nanoSTATs locally release their drug payload and prevent thrombosis. This autonomous negative feedback regulator may improve antithrombotic therapy by increasing the therapeutic window and decreasing the bleeding risk of anticoagulants.
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Affiliation(s)
- Kevin Y. Lin
- Department of Chemical Engineering and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Justin H. Lo
- Department of Chemical Engineering and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Medical Scientist Training Program, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Nikita Consul
- Department of Chemical Engineering and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Gabriel A. Kwong
- Department of Chemical Engineering and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Sangeeta N. Bhatia
- Department of Chemical Engineering and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
- Electrical Engineering and Computer Science, David H. Koch Institute for Integrative Cancer Research, MIT, Cambridge, Massachusetts 02139, United States
- Howard Hughes Medical Institute, Chevy Chase, Maryland 20815, United States
- Address correspondence to
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21
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Franchini M, Mengoli C, Cruciani M, Bonfanti C, Mannucci PM. Effects on bleeding complications of pharmacogenetic testing for initial dosing of vitamin K antagonists: a systematic review and meta-analysis. J Thromb Haemost 2014; 12:1480-7. [PMID: 25040440 DOI: 10.1111/jth.12647] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/18/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although warfarin and other vitamin K antagonists (VKAs) are the most widely used oral anticoagulants for the prevention and treatment of thromboembolic events, a number of factors hamper their manageability, the most important being the inter-individual variability of the therapeutic dose requirement. Following the discovery of the influence of CYP2C9 and VKORC1 polymorphisms on VKA dose requirements, there has been interest in genotype-guided VKA dosing in order to reduce the risk of over-anticoagulation at the time of therapy initiation and hence the risk of bleeding, particularly prominent during the early days of treatment. To assess the impact on clinical outcomes of pharmacogenetic testing for initial VKA dosing, we have performed a systematic review and meta-analysis of the literature. METHODS MEDLINE, EMBASE and Cochrane databases were searched up to March 2014. Only randomized controlled trials comparing genotype-guided vs. clinically-guided warfarin dosing were included. RESULTS Nine trials including 2812 patients met the inclusion criteria and were pooled for meta-analytical evaluation. Risk of bias, assessed according to the Cochrane methodology, showed a low risk for the majority of domains analyzed in the included trials. A statistically significant reduction in the risk ratio (RR) for developing major bleeding events was observed in the pharmacogenetic-guided group compared with the control group (RR = 0.47; 95% CI, 0.23-0.96; P = 0.040). CONCLUSIONS The results of this meta-analysis show that genotype-guided initial VKA dosing is able to reduce serious bleeding events by approximately 50% compared with clinically-guided dosing approaches.
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Affiliation(s)
- M Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
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22
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Abstract
Thromboembolic episodes are disorders encountered in both children and adults, but relatively more common in adults. However, the occurrence of venous thromboembolism and use of anticoagulants in pediatrics are increasing. Unfractionated Heparin (UH) is used as a treatment and prevention of thrombosis in adults and critically ill children. Heparin utilization in pediatric is limited by many factors and the most important ones are Heparin Induced Thrombocytopenia (HIT) and anaphylaxis. However, Low Molecular Weight Heparin (LMWH) appears to be an effective and safe alternative treatment. Hence, it is preferred over than UH due to favorable pharmacokinetic and side effect profile. Direct Thrombin Inhibitors (DTI) is a promising class over the other anticoagulants since it offers potential advantages. The aim of this review is to discuss the differences between adult and pediatric thromboembolism and to review the current anticoagulants in terms of pharmacological action, doses, drug reactions, pharmacokinetics, interactions, and parameters. This review also highlights the differences between old and new anticoagulant therapy in pediatrics.
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Affiliation(s)
- Mariam K Dabbous
- Department of Pharmacy Practice, School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Fouad R Sakr
- Department of Biomedical Sciences, School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Diana N Malaeb
- Department of PharmD, School of Pharmacy, Lebanese International University, Beirut, Lebanon
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23
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Suárez Ortega S. [Dabigatran: transforming the management of oral anticoagulation]. Rev Clin Esp 2013; 212 Suppl 2:15-22. [PMID: 23117717 DOI: 10.1016/s0014-2565(12)70014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The utility of oral anticoagulation with warfarin in thromboembolic disease has been demonstrated for several decades, although these drugs have significant problems in terms of adequate control, interactions and risk of bleeding. In the last decade, new anticoagulants have emerged. The first was dabigatran with a demonstrated anticoagulant effect approaching the ideal anticoagulant profile. The view that dabigatran transforms oral anticoagulation therapy has arisen from the RE-VOLUTION program, with more than 34000 patients analyzed. This program has confirmed the value of oral anticoagulation with dabigatran compared with other anticoagulants; this drug eliminates all the drawbacks of warfarin, benefitting both patients and the healthcare system. The growth of the aging population has increased the number of risk situations in which anticoagulation is used. There is now a drug that meets the criteria for the ideal anticoagulant, transforming the management of oral anticoagulation. The findings demonstrated with dabigatran in prior studies are progressively being transferred to clinical practice. Following the usual development of new drugs, and according to the latest Laurence Desmond stages, results in agreement with those of previous studies are expected, namely, indisputable improvements in oral anticoagulation for patients and the health system.
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Affiliation(s)
- S Suárez Ortega
- Servicio de Medicina Interna, Hospital General de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España.
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24
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Novaković A, Divac T, Stojanović I, Milojević P, Nenezić D. NEW ORAL ANTICOAGULANT DRUGS IN ATRIAL FIBRILLATION AND ACUTE CORONARY SYNDROME. ACTA MEDICA MEDIANAE 2013. [DOI: 10.5633/amm.2013.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Moia M, Mantovani LG, Carpenedo M, Scalone L, Monzini MS, Cesana G, Mannucci PM. Patient preferences and willingness to pay for different options of anticoagulant therapy. Intern Emerg Med 2013; 8:237-43. [PMID: 22926743 DOI: 10.1007/s11739-012-0844-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 08/08/2012] [Indexed: 10/27/2022]
Abstract
New anticoagulant drugs alternative to vitamin K antagonists are currently under clinical evaluation. Patient's preferences should be considered in the development of new therapeutic strategies. Our study aim was to elicit patient preferences, and estimate their willingness to pay for the different treatment options. A Discrete Choice Experiment was administered to patients consecutively attending an anticoagulation clinic, either on stable oral anticoagulant therapy, or during their first visit at the time of starting therapy. Six treatment characteristics were analysed: route and number of medication administrations, frequency of monitoring, risk of some minor bleeding, the amount of attention required for drug/food interactions, requirement for dose adjustment, and out-of-pocket treatment cost. Relationships between patient's preferences and their characteristics were analysed. 255 patients participated (55 % men, with a mean age 64 years; 35.7 % on stable therapy). A statistically significant importance was attributed to all but two characteristics (the amount of attention required for interaction with other drugs/food and for dose adjustment.) Monthly patient willingness to pay was <euro> 79 for tablets versus injections; <euro> 41 for once-daily versus twice-daily tablets, <euro> 25 for drugs without risk of minor bleeding events and <euro> 20 for once-monthly versus twice-monthly monitoring. Patients on stable therapy considered more important the amount of attention required for drug/food interactions than did the starters. Younger or working patients considered the reduction of monitoring frequency more important than did the older or not working patients (retired, housewives). This study elicited preferences from patients on oral anticoagulant therapy with a simple and well established method, which allows to obtain information warranted for planning optimal healthcare.
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Affiliation(s)
- Marco Moia
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Via Pace 9, 20122, Milan, Italy
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26
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Harris LF, Rainey P, Castro-López V, O'Donnell JS, Killard AJ. A microfluidic anti-Factor Xa assay device for point of care monitoring of anticoagulation therapy. Analyst 2013; 138:4769-76. [DOI: 10.1039/c3an00401e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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27
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Franchini M, Mannucci PM. New anticoagulants for treatment of venous thromboembolism. Eur J Intern Med 2012; 23:692-5. [PMID: 23095463 DOI: 10.1016/j.ejim.2012.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/03/2012] [Indexed: 11/19/2022]
Abstract
Venous thromboembolism (VTE) is a major cause of morbidity and mortality and anticoagulation is the cornerstone of treatment. Although effective, traditional anticoagulants (i.e., heparins and vitamin K antagonists) have significant limitations and there are several unmet needs. Therefore, new drugs have been developed, including direct factor Xa inhibitors (e.g., rivaroxaban, apixaban and edoxaban) and thrombin inhibitors (e.g., dabigatran etexilate). The characteristics of these agents and the main results of published clinical studies dealing with VTE treatment are critically summarized in this article.
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Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
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28
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Nucleic acid scavengers inhibit thrombosis without increasing bleeding. Proc Natl Acad Sci U S A 2012; 109:12938-43. [PMID: 22837404 DOI: 10.1073/pnas.1204928109] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Development of effective, yet safe, antithrombotic agents has been challenging because such agents increase the propensity of patients to bleed. Recently, naturally occurring polyphosphates such as extracellular DNA, RNA, and inorganic polyphosphates have been shown to activate blood coagulation. In this report, we evaluate the anticoagulant and antithrombotic activity of nucleic acid-binding polymers in vitro and in vivo. Such polymers bind to DNA, RNA, and inorganic polyphosphate molecules with high affinity and inhibit RNA- and polyphosphate-induced clotting and the activation of the intrinsic pathway of coagulation in vitro. Moreover, [NH(2)(CH(2))(2)NH(2)](G = 3);dendri PAMAM(NH(2))(32) (PAMAM G-3) prevents thrombosis following carotid artery injury and pulmonary thromboembolism in mice without significantly increasing blood loss from surgically challenged animals. These studies indicate that nucleic acid-binding polymers are able to scavenge effectively prothrombotic nucleic acids and other polyphosphates in vivo and represent a new and potentially safer class of antithrombotic agents.
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29
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Kerlin BA. Current and future management of pediatric venous thromboembolism. Am J Hematol 2012; 87 Suppl 1:S68-74. [PMID: 22367975 DOI: 10.1002/ajh.23131] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 01/17/2023]
Abstract
Venous thromboembolism (VTE) is an increasingly common complication encountered in tertiary care pediatric settings. The purpose of this review is to summarize the epidemiology, current and emerging pharmacotherapeutic options, and management of this disease. Over 70% of VTE occur in children with chronic diseases. Although they are seen in children of all ages, adolescents are at greatest risk. Pediatric VTE is associated with an increased risk of in-hospital mortality; recurrent VTE and post-thrombotic syndrome are commonly seen in survivors. In recent years, anticoagulation with low molecular weight heparin has emerged as the mainstay of therapy, but compliance is limited by its onerous subcutaneous administration route. New anticoagulants either already approved for use in adults or in the pipeline offer the possibility of improved dose stability and oral routes of administration. Current recommended anticoagulation course durations are derived from very limited case series and cohort data, or extrapolations from adult literature. However, the pathophysiologic underpinnings of pediatric VTE are dissimilar from those seen in adults and are often variable within groups of pediatric patients. Clinical studies and trials in pediatric VTE are underway which will hopefully improve the quality of evidence from which therapeutic guidelines are derived.
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Affiliation(s)
- Bryce A Kerlin
- Division of Hem/Onc/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA.
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30
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Little JW. New oral anticoagulants: will they replace warfarin? Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:575-80. [PMID: 22668618 DOI: 10.1016/j.oooo.2011.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/07/2011] [Accepted: 10/17/2011] [Indexed: 11/19/2022]
Abstract
Vitamin K antagonists, such as warfarin, are considered to be the treatment of choice to prevent thromboembolic events, but problems, such as the need for frequent dose adjustment and monitoring of coagulation status, as well as multiple drug and food interactions, make their use difficult for both physician and patient. Two new anticoagulants are now being considered as possible replacements of vitamin K antagonists. Dabigatran, an oral direct thrombin inhibitor has already been approved in the USA for prevention of stroke in patients with atrial fibrillation. Rivaroxaban, a factor Xa inhibitor, and dabigatran are licensed in Europe and Canada for short-term thromboprophylaxis after elective hip or knee replacement surgery. The advantages of these drugs are that they are safe and effective, require no monitoring, have a direct mode of action against only one clotting factor (thrombin or factor Xa), have limited drug interactions, and have rapid peak blood levels. Based on the fact that dabigatran has already been approved for use in the USA, it would appear that it has an advantage over rivaroxaban in becoming the replacement drug for vitamin K antagonists.
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31
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32
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Siles R, Kawasaki Y, Ross P, Freire E. Synthesis and biochemical evaluation of triazole/tetrazole-containing sulfonamides against thrombin and related serine proteases. Bioorg Med Chem Lett 2011; 21:5305-9. [PMID: 21807511 PMCID: PMC3159800 DOI: 10.1016/j.bmcl.2011.07.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 06/30/2011] [Accepted: 07/06/2011] [Indexed: 11/25/2022]
Abstract
A small library of 25 triazole/tetrazole-based sulfonamides have been synthesized and further evaluated for their inhibitory activity against thrombin, trypsin, tryptase and chymase. In general, the triazole-based sulfonamides inhibited thrombin more efficiently than the tetrazole counterparts. Particularly, compound 26 showed strong thrombin inhibition (K(i)=880 nM) and significant selectivity against other human related serine proteases like trypsin (K(i)=729 μM). Thrombin binding affinity of the same compound was determined by ITC and demonstrated that the binding of this new triazole-based scaffold is enthalpically driven, making it a good candidate for further development.
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Affiliation(s)
- Rogelio Siles
- Department of Biology, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Yuko Kawasaki
- Department of Biology, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Patrick Ross
- Department of Biology, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Ernesto Freire
- Department of Biology, The Johns Hopkins University, Baltimore, MD, 21218, USA
- Department of Biophysics and Biophysical Chemistry, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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33
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Nasser S, Mullan J, Bajorek B. Challenges of Older Patients’ Knowledge About Warfarin Therapy. J Prim Care Community Health 2011; 3:65-74. [DOI: 10.1177/2150131911416365] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To review the challenges of warfarin education for older patients (aged 65 years or older) in terms of knowledge, access to warfarin education, and education resources. Methods: A quasi-systematic review of the literature was performed via electronic database searches (eg, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Meditext, and Google Scholar) from 1990 to May 2011. Results: The 62 articles reviewed found that improved patient knowledge results in better anticoagulation control. The review also found that between 50% and 80% of older patients have inadequate knowledge about the basic aspects of warfarin therapy (eg, action, benefits and risks, interactions with other drugs or foods, international normalized ratio management). Demographic factors, such as advancing age, lower family income, and limited health literacy, were found to inversely affect patients’ warfarin knowledge, and access to warfarin education and information resources were often suboptimal in different practice settings. Finally, a number of educational strategies and resources that could be readily incorporated to improve the effectiveness of current warfarin education programs were extracted from the review. Conclusion: This comprehensive review highlights that education about warfarin in older patients is currently suboptimal and may in part contribute to poor therapeutic outcomes. This review article also acknowledges the need to identify, target, and develop educational strategies and resources to further improve older patients’ knowledge about their warfarin therapy.
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