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Ding Y, Han B, Yuan B, Nie M, Liu R, Zhao M, Wang H. Occurrence rates and risk factors of in-hospital venous thromboembolism, major bleeding, and death in patients receiving fondaparinux after orthopedic surgery or trauma surgery. Ir J Med Sci 2023; 192:2973-2979. [PMID: 36787027 PMCID: PMC10692026 DOI: 10.1007/s11845-023-03289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023]
Abstract
AIM Fondaparinux is a synthetic anticoagulant that inhibits thrombosis by suppressing factor Xa. The efficacy of fondaparinux for orthopedic surgeries has been revealed by several foreign studies; however, relevant evidence in Chinese patients is lacking. This study intended to investigate the occurrence rate and risk factors of in-hospital venous thromboembolism (VTE), major bleeding, and death in patients receiving fondaparinux after orthopedic surgery or trauma surgery. METHODS Totally, 1258 patients who received fondaparinux after orthopedic surgery or trauma surgery were retrospectively enrolled. Meanwhile, in-hospital VTE, major bleeding, and death were obtained for assessment. Besides, adverse events were recorded. RESULTS The occurrence rates of in-hospital VTE, major bleeding, and death were 2.5%, 21.8%, and 0.0%, respectively. The multivariate logistic regression analysis revealed that only age (> 60 years vs. ≤ 60 years) (odd ratios (OR) = 3.380, P = 0.013) was independently correlated with increased risk of in-hospital VTE. Additionally, osteoarthritis diagnosis (OR = 3.826, P < 0.001), femoral head necrosis diagnosis (OR = 1.809, P = 0.034), hip replacement (vs. internal fracture fixation) (OR = 2.199, P = 0.007), knee replacement (vs. internal fracture fixation) (OR = 2.781, P = 0.002), and serum creatinine (abnormal vs. normal) (OR = 1.677, P = 0.012) were independently linked to a higher risk of in-hospital major bleeding. Moreover, the common adverse events included pain (56.6%), wound bleeding (23.0%), increased drainage (5.2%), etc. CONCLUSION: Fondaparinux realizes low occurrence rates of in-hospital VTE and major bleeding with tolerable adverse events in patients receiving orthopedic surgery or trauma surgery.
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Affiliation(s)
- Ya Ding
- Department of Orthopedics, Anhui Spinal Deformities Clinical Medical Research Center, Fuyang People's Hospital, No. 501 Sanqing Road, Fuyang, Anhui, 236000, China
| | - Bowen Han
- Department of Orthopedics, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453000, China
| | - Bin Yuan
- Department of Orthopedics, Xinyi People's Hospital, Xuzhou, 221400, China
| | - Mingjun Nie
- Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Renyang Liu
- Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Ming Zhao
- Department of Traumatology, The Affiliated Taian City Central Hospital of Qingdao University, Taian, 271000, China
| | - Hongliang Wang
- Department of Orthopedics, Anhui Spinal Deformities Clinical Medical Research Center, Fuyang People's Hospital, No. 501 Sanqing Road, Fuyang, Anhui, 236000, China.
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Rabe E, Hoffmann U, Schimke A, Heinken A, Langer F, Noppeney T, Pittrow D, Klotsche J, Gerlach HE, Bauersachs R. Determinants of Late Venous Thromboembolic Events After Acute Isolated Superficial Vein Thrombosis in Daily Practice: 12 Month Results of the INSIGHTS-SVT Study. Eur J Vasc Endovasc Surg 2023; 66:697-704. [PMID: 37573936 DOI: 10.1016/j.ejvs.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/11/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Long term incidence of symptomatic venous thromboembolism (VTE) and bleeding events in patients with superficial vein thrombosis (SVT) was investigated. METHODS In this prospective, observational study, patients with acute SVT were treated at the discretion of the responsible physician. The primary efficacy outcome was symptomatic VTE including deep vein thrombosis (DVT), pulmonary embolism (PE), and recurrent or extending SVT. The primary safety outcome was clinically relevant bleeding, recorded at periodic clinic visits over a 12 month period. RESULTS The mean age of 872 patients with 12 month follow up was 60.6 ± 14.5 years, 64.5% were female, 80.1% had chronic venous disease (defined as chronic venous insufficiency and or varicose veins), and 41.9% had a history of VTE. They were receiving fondaparinux in 62.1% (mean duration 34.9 ± 15.7 days), low molecular weight heparin (LMWH) in 25.0% (mean duration 26.2 ± 23.2 days), any other anticoagulants in 6.2%, and no anticoagulant in 6.7%. At 12 months, 108 patients (14.3%) achieved the primary efficacy outcome. The most common VTE event was recurrent or extending SVT in 11.0%, followed by symptomatic DVT in 2.7%, symptomatic PE in 2.4%, hospitalisation due to VTE in 1.8%, and death in 1.1%. Clinically relevant bleeding events occurred in 2.1% of patients, and major bleedings in 0.3%. By drug, the rate of the primary efficacy outcome was highest in the LMWH group (22.4%) and lowest in the fondaparinux group (10.4%). In a multivariable model, patients with events between three months and 12 months were significantly more likely to have higher BMI (hazard ratio [HR] 1.06; p = .002), history of VTE (HR 2.89; p = .002), and severe systemic infections (HR 7.59; p = .006). CONCLUSION The risk of symptomatic VTE remained elevated over 12 months of follow up. Therefore, anticoagulation beyond 45 days may be considered in patients with risk factors. [ClinicalTrials.gov identifier: NCT02699151.].
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Affiliation(s)
- Eberhard Rabe
- Praxis für Dermatologie & Phlebologie PD Dr. Pannier, Bonn, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Ludwig-Maximilian University, Munich, Germany
| | | | | | - Florian Langer
- II. Medical Clinic and Policlinic, Centre for Oncology, University Medical Centre Eppendorf, Hamburg, Germany
| | - Thomas Noppeney
- Department of Vascular and Endovascular Surgery, University Hospital, Regensburg, Germany
| | - David Pittrow
- Institute for Clinical Pharmacology, Medical Faculty, Technical University, Dresden, Germany; Innovation Centre Real World Evidence, GWT-TUD GmbH, Dresden, Germany
| | - Jens Klotsche
- Deutsches Rheuma-Forschungszentrum Berlin, ein Institut der Leibniz-Gemeinschaft, Epidemiology and Health Services Research, Berlin, Germany
| | | | - Rupert Bauersachs
- Center for Thrombosis and Haemostasis, University Medical Centre Mainz, Mainz, Germany; Cardioangiologisches Centrum Bethanien CCB, Standort AGAPLESION Bethanien Krankenhaus, Frankfurt am Main, Germany.
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Cosmi B, Legnani C, Cini M, Borgese L, Sartori M, Palareti G. Incidence and clinical outcomes of heparin-induced thrombocytopenia: 11 year experience in a tertiary care university hospital. Intern Emerg Med 2023; 18:1971-1980. [PMID: 37568069 DOI: 10.1007/s11739-023-03379-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/12/2023] [Indexed: 08/13/2023]
Abstract
Heparin-induced thrombocytopenia (HIT) is a rare immuno-mediated adverse reaction with high thrombotic and mortality risk. To evaluate incidence and outcomes of HIT cases diagnosed at a tertiary care hospital from 2007 to 2018. A retrospective study was conducted. Patients with suspected HIT underwent 4Ts score assessment and anti-heparin PF4 IgG antibodies ELISA screening test. If the latter was positive, platelet aggregation test (PAT) was performed. If the latter was positive, any form of heparin was stopped, alternative anticoagulants were started and then overlapped with warfarin. HIT incidence was calculated by dividing HIT cases by the mean yearly number of admitted patients over 11 years. Follow-up was 90 days. Among 2125 screening tests, 96 (4.5%) were positive with confirmatory PAT in 82/90 (3.8% for missing data in 6). Median age was 75; 39 patients were surgical and 51 medical. The median 4Ts score was 5. Unfractionated heparin was employed in 34 (37%). HIT incidence was 0.16/1000/patient/years (95% CI: 0.12-0.23) in surgical and 0.15/1000/patient/years (95%: 0.12-0.20) in medical patients. HIT with thrombosis (HIT-T) was observed in 31 patients (0.05/1000/patient/years 95% CI: 0.04-0.1), with venous thromboses in 25 (80%). HIT without thrombosis was observed in 59 patients (0.1/1000 patient/years; 95% CI: 0.08-0.13, twofold vs HIT-T). All cause mortality was 25.5% (95% CI: 17.6-35.4), major bleeding 7.7% (95% CI:3.2-15.3), and thromboembolic complications 3.3% (95% CI:1.1-9.3). HIT is a rare event with high mortality, despite the use of non heparin anticoagulants.
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Affiliation(s)
- Benilde Cosmi
- Angiology and Blood Coagulation Unit , IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Angiology and Blood Coagulation Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | | | | | - Laura Borgese
- Angiology and Blood Coagulation Unit , IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Angiology and Blood Coagulation Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Michelangelo Sartori
- Angiology and Blood Coagulation Unit , IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Christian JM, Zoepfl M, Johnson WE, Ginsburg E, Peterson EJ, Hampton JD, Farrell NP. Glycosaminoglycan-directed cobalt complexes. J Inorg Biochem 2023; 245:112254. [PMID: 37182504 DOI: 10.1016/j.jinorgbio.2023.112254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
The biological activity of the 6+ Co containing Werner's Complex has been described and mechanistic considerations suggest that the highly anionic glycosaminoglycans (heparan sulfate, HS, GAGs) are implicated in this activity [Paiva et al. 2021]. To examine in detail the molecular basis of Werner's Complex biological properties we have examined a selection of simple mononuclear Co3+ compounds for their interactions with HS and Fondaparinux (FPX). FPX is a highly sulfated synthetic pentasaccharide used as a model HS substrate [Mangrum et al. 2014, Peterson et al. 2017]. The Co complexes were chosen to be formally substitution-inert and/or have the potential for covalent binding to the biomolecule. Using both indirect competitive inhibition assays and direct mass spectrometric assays, formally substitution-inert complexes bound to FPX with protection from multiple sulfate loss in the gas phase through metalloshielding. Covalent binding of Co-Cl complexes as in [CoCl(NH3)5]2+ and cis-[CoCl2(en)2]+ was confirmed by mass spectrometry. Interestingly, the former complex was shown to be an effective inhibitor of bacterial heparinase enzyme activity and to inhibit heparanase-dependent cellular invasion through the extracellular matrix (ECM). Pursuing the theme of metalloglycomics, we have observed the hitherto unappreciated biological activity of the simple [CoCl(NH3)5]2+ compound, a staple of most inorganic chemistry lab curricula.
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Affiliation(s)
- Jessica M Christian
- Department of Chemistry, Virginia Commonwealth University, 1001 W Main St, Richmond, VA 23284, United States of America
| | - Mary Zoepfl
- Department of Chemistry, Virginia Commonwealth University, 1001 W Main St, Richmond, VA 23284, United States of America
| | - Wyatt E Johnson
- Massey Cancer Center, Virginia Commonwealth University, 1300 E Marshall Street, Richmond, VA 23298-0037, United States of America
| | - Eric Ginsburg
- Department of Chemistry, Virginia Commonwealth University, 1001 W Main St, Richmond, VA 23284, United States of America
| | - Erica J Peterson
- Massey Cancer Center, Virginia Commonwealth University, 1300 E Marshall Street, Richmond, VA 23298-0037, United States of America
| | - J David Hampton
- Massey Cancer Center, Virginia Commonwealth University, 1300 E Marshall Street, Richmond, VA 23298-0037, United States of America
| | - Nicholas P Farrell
- Department of Chemistry, Virginia Commonwealth University, 1001 W Main St, Richmond, VA 23284, United States of America; Massey Cancer Center, Virginia Commonwealth University, 1300 E Marshall Street, Richmond, VA 23298-0037, United States of America.
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5
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Arora A, Kumar A, Anand AC, Kumar A, Yadav A, Bhagwat A, Mullasari AS, Satwik A, Saraya A, Mehta A, Roy D, Reddy DN, Makharia G, Murthy JMK, Roy J, Sawhney JPS, Prasad K, Goenka M, Philip M, Umaiorubahan M, Sinha N, Mohanan PP, Sylaja PN, Ramakrishna P, Kerkar P, Rai P, Kochhar R, Yadav R, Nijhawan S, Sinha SK, Hastak SM, Viswanathan S, Ghoshal UC, Madathipat U, Thakore V, Dhir V, Saraswat VA, Nabi Z. Position statement from the Indian Society of Gastroenterology, Cardiological Society of India, Indian Academy of Neurology and Vascular Society of India on gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy. Indian J Gastroenterol 2023; 42:332-346. [PMID: 37273146 PMCID: PMC10240467 DOI: 10.1007/s12664-022-01324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/12/2022] [Indexed: 06/06/2023]
Abstract
Antiplatelet and/or anticoagulant agents (collectively known as antithrombotic agents) are used to reduce the risk of thromboembolic events in patients with conditions such as atrial fibrillation, acute coronary syndrome, recurrent stroke prevention, deep vein thrombosis, hypercoagulable states and endoprostheses. Antithrombotic-associated gastrointestinal (GI) bleeding is an increasing burden due to the growing population of advanced age with multiple comorbidities and the expanding indications for the use of antiplatelet agents and anticoagulants. GI bleeding in antithrombotic users is associated with an increase in short-term and long-term mortality. In addition, in recent decades, there has been an exponential increase in the use of diagnostic and therapeutic GI endoscopic procedures. Since endoscopic procedures hold an inherent risk of bleeding that depends on the type of endoscopy and patients' comorbidities, in patients already on antithrombotic therapies, the risk of procedure-related bleeding is further increased. Interrupting or modifying doses of these agents prior to any invasive procedures put these patients at increased risk of thromboembolic events. Although many international GI societies have published guidelines for the management of antithrombotic agents during an event of GI bleeding and during urgent and elective endoscopic procedures, no Indian guidelines exist that cater to Indian gastroenterologists and their patients. In this regard, the Indian Society of Gastroenterology (ISG), in association with the Cardiological Society of India (CSI), Indian Academy of Neurology (IAN) and Vascular Society of India (VSI), have developed a "Guidance Document" for the management of antithrombotic agents during an event of GI bleeding and during urgent and elective endoscopic procedures.
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Affiliation(s)
- Anil Arora
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India.
| | - Ashish Kumar
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Anil C Anand
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Kushabhadra Campus, 5, KIIT Road, Bhubaneswar, 751 024, India
| | - Ajay Kumar
- Department of Gastroenterology and Hepatology, BLK Max Multispeciality Hospital, Pusa Road, Radha Soami Satsang, Rajendra Place, New Delhi, 110 005, India
| | - Ajay Yadav
- Department of Vascular and Endovascular Surgery, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Ajit Bhagwat
- Department of Cardiology, Kamalnayan Bajaj Hospital, Gut No 43 Bajaj Marg, Beed Bypass Road, Satara Deolai Parisar, Aurangabad, 431 010, India
| | - Ajit S Mullasari
- Department of Adult Cardiology, Madras Medical Mission, 4-A, Dr. J. Jayalalitha Nagar, Chennai, 600 037, India
| | - Ambarish Satwik
- Department of Vascular and Endovascular Surgery, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, 110 029, India
| | - Ashwani Mehta
- Department of Cardiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Debabrata Roy
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, 124, Eastern Metropolitan Bypass, Mukundapur, Kolkata, 700 099, India
| | - Duvvur Nageshwar Reddy
- Department of Medical Gastroenterology, AIG Hospitals, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, 110 029, India
| | - Jagarapudi M K Murthy
- Department of Neurology, CARE Hospitals, Road No.1, Banjara Hills, Hyderabad, 500 034, India
| | - Jayanta Roy
- Department of Neurology, Institute of Neurosciences, 185/1, Acharya Jagadish Chandra Bose Road, Kolkata, 700 017, India
| | - Jitendra P S Sawhney
- Department of Cardiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Kameshwar Prasad
- Rajendra Institute of Medical Sciences, Bariatu, Ranchi, 834 009, India
| | - Mahesh Goenka
- Institute of Gastrosciences, Apollo Multispeciality Hospitals, 58, Canal Circular Road, Kadapara, Phool Bagan, Kankurgachi, Kolkata, 700 054, India
| | - Mathew Philip
- Department of Medical Gastroenterology, Lisie Hospital, Lisie Hospital Road, North Kaloor, Kaloor, Ernakulam, 682 018, India
| | - Meenakshisundaram Umaiorubahan
- Department of Neuro Science, SIMS Hospital, No.1, Jawaharlal Nehru Salai (100 Feet Road), Vadapalani, Chennai, 600 026, India
| | - Nakul Sinha
- Department of Cardiac Sciences, Medanta Super Speciality Hospital, Sector - A, Pocket - 1, Amar Shaheed Path, Golf City, Lucknow, 226 030, India
| | - Padinhare P Mohanan
- Department of Cardiology and Cardiothoracic Surgery, Westfort High-Tech Hospital, Guruayoor Road, Punkunnam, Thrissur, 680 002, India
| | - Padmavathy N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Jai Nagar W Road, Chalakkuzhi, Thiruvananthapuram, 695 011, India
| | - Pinjala Ramakrishna
- Department of Vascular Surgery, Apollo Hospital Jubilee Hills, Road No 72, Opp. Bharatiya Vidya Bhavan School Film Nagar, Jubilee Hills, Hyderabad, 500 033, India
| | - Prafulla Kerkar
- Department of Cardiology, KEM Hospital and Seth G. S. Medical College, Acharya Donde Marg, Parel East, Parel, Mumbai, 400 012, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Fortis Hospital, Sector 62, Phase - VIII, Mohali, 160 062, India
| | - Rakesh Yadav
- Department of Cardiology, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, 110 029, India
| | - Sandeep Nijhawan
- Department of Medical Gastroenterology, SMS Medical College and Hospitals, J.L.N. Marg, Jaipur, 302 004, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh, 160 012, India
| | - Shirish M Hastak
- Department of Neurology, Global Hospitals, 35, Dr. E Borges Road, Hospital Avenue, Opposite Shirodkar High School, Parel, Mumbai, 400 012, India
| | - Sidharth Viswanathan
- Department of Vascular and Endovascular Surgery, Amrita Institute of Medical Sciences, Ponekkara, AIMS (P.O.), Kochi, 682 041, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Unnikrishnan Madathipat
- Department of Vascular and Endovascular Surgery, SUT Pattom Multi Super Specialty Hospitals, Pattom, Thiruvananthapuram, 695 004, India
| | - Vijay Thakore
- Department of Vascular and Endovascular Surgery, Aadicura Superspeciality Hospital, Winward Business Park, Jetalpur Road, Vadodara, 390 020, India
| | - Vinay Dhir
- Institute of Digestive and Liver Care, SL Raheja Hospital, Raheja Rugnalaya Marg, Mahim West, Mahim, Mumbai, 400 016, India
| | - Vivek A Saraswat
- Department of Gastroenterology and Hepatology, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Tonk Road, Jaipur, 302 022, India
| | - Zaheer Nabi
- Department of Medical Gastroenterology, AIG Hospitals, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
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Mu F, Wang M, Huang J, Wang F. Pregnancy outcomes and adverse events in patients with recurrent miscarriage receiving fondaparinux versus low molecular-weight heparin: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 287:29-35. [PMID: 37276726 DOI: 10.1016/j.ejogrb.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/14/2023] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Current opinion on the superiority of fondaparinux versus low molecular-weight heparin (LMWH) in treating recurrent miscarriage is controversial. This meta-analysis aimed to comprehensively compare the pregnancy outcomes and adverse events in patients with recurrent miscarriage receiving fondaparinux versus LMWH. METHODS EMBASE, PubMed, Cochrane, China National Knowledge Internet (CNKI), Wanfang Database, and China Science and Technology Journal Database (CQVIP) databases were searched for articles reporting fondaparinux versus LMWH in treating recurrent miscarriage till June 10, 2022. Inclusion criteria for study screening were: (i) randomized, controlled trials (RCT), non-randomized controlled studies, or observational studies; (ii) patients aged over 18 years; (iii) patients with recurrent miscarriage during gestation period; (iv) patients in the experimental/observational group who received FD, and patients in the control group who received LMWH; (v) studies involving at least one outcome of interest for the current analysis. Exclusion criteria were: (i) systematic reviews, meta-analyses, case reports, or animal studies; (ii) duplicated studies; (iii) incomplete or inconsistent data. Quality assessment was conducted with Newcastle-Ottawa Scale criteria or Cochrane Collaboration. Data of live birth, abortion, birth weight, fetal growth restriction (FGR), and adverse events were extracted and synthesized. RESULTS Six eligible studies (4 observational studies and 2 RCTs) with 321 patients receiving fondaparinux and 546 patients receiving LMWH were enrolled. Live birth (relative risks (RR) = 1.05, 95% confidence interval (CI) = 0.97 ∼ 1.14, P = 0.217), abortion (RR = 0.73, 95% CI = 0.50 ∼ 1.08, P = 0.113), birth weight (weighted mean difference = 167.20, 95% CI = -236.89 ∼ 571.30, P = 0.417), and FGR (RR = 0.95, 95% CI = 0.25 ∼ 3.59, P = 0.942) were of no difference between patients receiving fondaparinux and LMWH. Regarding adverse events, the incidence of ecchymosis (RR = 0.11, 95% CI = 0.03 ∼ 0.46, P = 0.002) and skin reaction at injection site (RR = 0.15 95% CI = 0.05 ∼ 0.44, P = 0.001) were lower in patients receiving fondaparinux compared with those receiving LMWH, while that of thrombocytopenia (RR = 0.45, 95% CI = 0.09 ∼ 2.14, P = 0.315), vagina bleeding (RR = 1.03, 95% CI = 0.62 ∼ 1.71, P = 0.646), and oral mucosa hemorrhage (RR = 1.08, 95% CI = 0.33 ∼ 3.51, P = 0.899) did not vary between these patients receiving these two treatments. However, most studies were conducted in China, which could induce regional and ethnic bias. CONCLUSION Fondaparinux is attributable to fewer adverse events and similar pregnancy outcomes compared with LMWH in patients with recurrent miscarriage.
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Affiliation(s)
- Fangxiang Mu
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou 730000, China
| | - Mei Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou 730000, China
| | - Jinge Huang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou 730000, China
| | - Fang Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou 730000, China.
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Ray S, Shivdasani B, Mohan JC, Shah VT, Hiremath J, Karnik R, Desai B, Madan H, Garg R, Christopher J. Clinical Decision Pathway for the Use of Fondaparinux in the Management of Acute Coronary Syndrome (ACS) in Hospitals with and Without Catheter Laboratories: An Expert Opinion from India. Cardiol Ther 2023; 12:261-274. [PMID: 37043080 DOI: 10.1007/s40119-023-00312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/22/2023] [Indexed: 04/13/2023] Open
Abstract
The current recommendations by Indian experts who are focused on the challenges in the management of patients with acute coronary syndrome (ACS) in rural areas, due to limited catheterization (CATH) lab facilities and interventional cardiologist coverage across the country, are described. 120 cardiologist experts drafted recommendations during ten advisory board meetings conducted from April to May 2022. Experts framed statements based on experience, collective clinical judgment from practical experience, and available scientific evidence regarding ACS. The consensus positioned fondaparinux as highly useful in non-CATH-lab-based hospitals for patients diagnosed with non-ST elevation acute coronary syndrome (NSTE-ACS) and ST elevation acute coronary syndrome (STE-ACS) patients who cannot be shifted to percutaneous coronary intervention (PCI)-capable centres, or for patients who are thrombolysed at peripheral centres.
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Affiliation(s)
| | | | | | - V T Shah
- Dr. V T Shah Diagnostic Centre & Clinic, Mumbai, 8595513162, India
| | | | | | | | - Hemant Madan
- Dharamshila Narayana Superspeciality Hospital, Delhi, India
| | - Rajeev Garg
- Aware Gleneagles Global Hospitals, Hyderabad, India
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Ghaziri D, Dehaini H, Msheik M, Bahmad M, Zorkot M, Saad GA. Novel fondaparinux protocol for anticoagulation therapy in adults with renal failure and suspected heparin-induced thrombocytopenia: a retrospective review of institutional protocol. BMC Pharmacol Toxicol 2023; 24:2. [PMID: 36639796 PMCID: PMC9837750 DOI: 10.1186/s40360-023-00643-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The literature recommends against the use of fondaparinux in patients with kidney failure and dialysis as it may, with repeated dosing, accumulate and put patients at risk of bleeding. The management of patients with thrombosis in the presence of heparin-induced thrombocytopenia HIT requires the introduction of an alternative anticoagulant like bivalirudin or argatroban. When these drugs are not available, fondaparinux, remains the only alternative. In similar scenarios, there are few studies addressing how to administer it. METHODS: We developed a protocol for fondaparinux in patients with renal failure where pharmacokinetic parameters are altered, and levels changed only after hemodialysis or in cases of residual renal activity. Patients received a full first dose except for high risk of bleeding. We targeted a peak anti-factor Xa activity level of 0.6-1.3 units/ml and changed the subsequent dose accordingly. Furthermore, we monitored the patients for signs of bleeding, a drop in hemoglobin level, or clinical signs of thrombosis. DISCUSSION: We described 10 patients with kidney failure and suspected HIT taking fondaparinux. All the patients achieved therapeutic anti-factor Xa activity levels. However, one developed new-onset venous thromboembolism (VTE) despite therapeutic anti-factor Xa levels. Another patient experienced a bleeding episode. We believe that these two patients developed complications due to their medical conditions rather than the use of fondaparinux. CONCLUSION Fondaparinux can be safely used in kidney failure using our protocol. However, despite its safety profile and relative success, this case series was small. More robust studies need to be conducted prior to drawing conclusions.
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Affiliation(s)
- Dania Ghaziri
- grid.411654.30000 0004 0581 3406Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hassan Dehaini
- grid.239578.20000 0001 0675 4725Departments of Vascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - Mayyas Msheik
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan Bahmad
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Zorkot
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - George Abi Saad
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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9
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Hammond E, Ferro V. An Enzymatic Activity Assay for Heparanase That Is Useful for Evaluating Clinically Relevant Inhibitors and Studying Kinetics. Methods Mol Biol 2023; 2619:227-238. [PMID: 36662473 DOI: 10.1007/978-1-0716-2946-8_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The enzyme heparanase cleaves heparan sulfate and is involved in a range of human diseases including cancer, inflammation, diabetes, and viral infection. There is a need for a simple and reliable enzymatic assay to allow for the screening of compounds to find inhibitors of heparanase. We have developed an assay that uses the heparinoid fondaparinux as enzyme substrate and detects one of the products of catalysis, which contains a newly formed reducing terminus, with the tetrazolium salt WST-1. Due to the homogenous substrate and single point of cleavage therein, this assay allows for more systematic kinetic analysis of heparanase inhibitors. Here, we provide a detailed method for conducting this assay and also provide information to assist researchers in evaluating whether the assay is performing properly in their laboratories.
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Affiliation(s)
| | - Vito Ferro
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
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10
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Ertan-Bolelli T, Bolelli K, Elçi SD, Belen-Apak FB. Promising Drug Fondaparinux for the Treatment of COVID-19: an In Silico Analysis of Low Molecular Weight Heparin, Direct Oral Anticoagulant, and Antiplatelet Drug Interactions with Host Protease Furin. Cardiovasc Drugs Ther 2022:10.1007/s10557-022-07406-z. [PMID: 36401727 PMCID: PMC9676724 DOI: 10.1007/s10557-022-07406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE As of July 2022, the COVID-19 pandemic has affected over 555 million worldwide confirmed cases and caused more than 6.3 million deaths. The studies showed that the D-dimer levels were increased in non-survivors compared to survivors and heparin treatment has begun to be administered to the patients in severe clinics. As we knew that the entrance of SARS-CoV-2 to the host cell needs to be facilitated by host proteases; we published our hypothesis that heparin as a serine protease inhibitor may block the interaction between spike protein receptor-binding domain and host proteases. In our study, we aimed to investigate the interactions between not only heparins but also other antiplatelet and anticoagulant drugs including fondaparinux. METHODS In this study, docking studies were carried out to evaluate the interactions between low molecular weight heparins (LMWHs) (enoxaparin, dalteparin, tinzaparin), direct oral anticoagulant, and antiplatelet drugs with host proteases. Molecular docking studies were performed by using Schrödinger molecular modeling software. 3D structures of the ligands were obtained from the 2D structures by assigning the OPLS-2005 force field using the Maestro 12.7. The 3D crystal structure of the furin complexed with an inhibitor, 2,5-dideoksistreptamin derivative, was extracted from the Protein Data Bank (PDB ID: 5MIM). Docking studies were carried out using the Grid-based Ligand Docking with Energetics module of the Schrödinger Software. RESULTS The docking studies revealed that fondaparinux was the most relevant molecule to interact with furin with a docking score of - 12.74. It showed better interaction than the natural ligand of furin with an increased score compared to the docking score of - 8.155 of the natural ligand. AnaGA*IsA structure representing LMWH structure has shown a docking score of - 11.562 which was also better than the score of the natural ligand of furin. CONCLUSION Our findings have shown that LMWHs and fondaparinux can be used for their possible antiviral effects in COVID-19 patients. Our results have shown that in accordance with heparin and LMWH, fondaparinux can also be a candidate for "drug repurposing" in COVID-19 therapy, not only because of their anticoagulant but also possible antiviral effects.
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Affiliation(s)
- Tugba Ertan-Bolelli
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Ankara University, 06560 Ankara, Turkey
- Bolelli Lab LLC, Stone Mountain, GA 30083 USA
| | - Kayhan Bolelli
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Ankara University, 06560 Ankara, Turkey
- Bolelli Lab LLC, Stone Mountain, GA 30083 USA
- LumiLabs, Ulus, Ankara, 06610 Turkey
| | | | - F. Burcu Belen-Apak
- Department of Pediatric Hematology and Oncology, Medical Faculty, Baskent University, Sehit Temel Kuguluoglu Street No 24, 06490 Bahcelievler/Ankara, Turkey
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11
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Trautmann A, Grän F, Stoevesandt J. Delayed-Type Heparin Allergy: Intravenous Tolerance Despite Inflammatory Skin Reaction After Subcutaneous Injection. J Allergy Clin Immunol Pract 2022; 10:2977-2983.e1. [PMID: 35788063 DOI: 10.1016/j.jaip.2022.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/09/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Heparin allergy most frequently manifests as delayed-type hypersensitivity (DTH) causing an itchy inflammatory skin reaction at the site of subcutaneous injection. An important differential diagnosis is circumscribed skin necrosis due to heparin-induced thrombocytopenia. OBJECTIVES An inflammatory skin reaction to subcutaneously injected heparin generally entails the quest for alternative anticoagulation; concerns may particularly arise in an emergency situation requiring intravenous heparin administration. METHODS All heparin DTH cases seen in our department over the last 17 years underwent standardized allergy diagnostics including challenge testing, that is, subcutaneous injection of fondaparinux and intravenous administration of unfractionated heparin (UFH). RESULTS Of a total of 50 patients with confirmed heparin allergy, DTH was found in 48 (96.0%), and immediate-type, presumably IgE-mediated hypersensitivity was diagnosed in only 2 (4.0%). In the 48 DTH cases, intradermal testing revealed broad cross-reactivity between UFH and low-molecular-weight heparins (LMWH) including nadroparin, dalteparin, and enoxaparin. Cross-reactivity with (or concomitant sensitization to) fondaparinux was seen in only 3 (6.3%) cases. Intravenous administration of UFH was tolerated by all 45 patients challenged, despite DTH to UFH and LMWH as demonstrated by intradermal testing. CONCLUSIONS If an inflammatory skin reaction at the site of subcutaneously injected heparin is observed or reported without any evidence of skin necrosis or thrombocytopenia, intravenous administration of UFH seems to be sufficiently safe and may be considered without allergy testing if urgently indicated in an emergency situation. Fondaparinux is the most suitable alternative for subcutaneous application.
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Affiliation(s)
- Axel Trautmann
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
| | - Franziska Grän
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
| | - Johanna Stoevesandt
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
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12
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Bouget J, Balusson F, Kerbrat S, Roy PM, Viglino D, Lacut K, Pavageau L, Oger E. Clinical use of low-dose parenteral anticoagulation, incidence of major bleeding and mortality: a multi-centre cohort study using the French national health data system. Eur J Clin Pharmacol 2022. [PMID: 35385975 DOI: 10.1007/s00228-022-03318-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Low-dose parenteral anticoagulation has demonstrated its efficacy for venous thromboembolism prophylaxis in randomized trials. However, current practice is not widely documented. In ambulatory settings, we aimed to provide an overview of the clinical use of low-dose parenteral anticoagulation in France and to assess the incidence of major bleeding and death rates. METHODS A population-based prospective cohort study using the French national health data system (SNIIRAM) identified 142,815 adults living in five well-defined geographical areas who had a course of low-dose parenteral anticoagulants (a total of 150,389 courses) in the period 2013-2015. The main outcome measures were the types of low-dose parenteral anticoagulant, the duration and the clinical context. Adjusted incidence rate ratios (IRR) were derived from Poisson models. RESULTS Enoxaparin was the most frequently prescribed anticoagulant (58.9%) followed by tinzaparin (27.3%) and fondaparinux (10.9%). Patients receiving unfractionated heparin (N = 766, 0.53%) were older, more frequently had renal disease (48.75%) and had a higher modified HAS-B(L)ED score (≥ 3 in 61.6%) than patients receiving low-molecular weight heparin (LMWH). Surgical thrombo-prophylaxis was the most frequent indication (47.6%), followed by medical prophylaxis (29.9%). Course durations were in line with regulatory agency specifications. Only 43 (0.028%) major bleeding events and 478 (0.32%) deaths were observed. Adjusted IRRs for major bleeding or death were not significantly different for dalteparin/nadroparin, tinzaparin or fondaparinux compared to enoxaparin. CONCLUSION Very low incidence rates of major bleeding and all-cause mortality were observed. Our study confirms the safety of LMWHs and fondaparinux in thrombo-prophylaxis in ambulatory settings. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02886533.
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13
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Rauch-Kröhnert U, Riess H. [Anticoagulation in coronavirus disease 2019 (COVID-19): confirmed and controversial aspects]. Internist (Berl) 2022; 63:453-460. [PMID: 35290499 PMCID: PMC8922984 DOI: 10.1007/s00108-022-01296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 01/08/2023]
Abstract
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a high risk of microvascular immunothrombosis as well as symptomatic and incidental thromboembolisms, predominantly in the venous system but also in the arterial system. This explains among other things the high cardiovascular morbidity and mortality of the patients. The present state of knowledge on the pathophysiology of immunothrombosis and the strategies of anticoagulation in patients with coronavirus disease 2019 (COVID-19) are summarized and illuminated in this article. According to the current guidelines moderately to severely ill patients who are being treated in hospital should receive thrombosis prophylaxis with low molecular weight or unfractionated heparin or alternatively with fondaparinux, as long as there is no clearly increased risk of bleeding. Apart from the established indications for treatment, an intensified or therapeutic dose prophylaxis should be considered very cautiously in these critically ill patients, also due to the increased bleeding complications. The routine continuation of prophylactic anticoagulation after discharge from hospital is currently not recommended.
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Affiliation(s)
- Ursula Rauch-Kröhnert
- Klinik für Kardiologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
| | - Hanno Riess
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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14
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Dalal J, Mohan JC, Sathe S, Kumar AS, Hiremath J, Khan MY, Gaurav K, Mane A, Pandit S, Meel B, Subramaniyan A. Evaluation of Effectiveness and Tolerability of Fondaparinux in the Management of Symptomatic Acute Coronary Syndrome: A Real-World Evidence-Based Study on an Indian Population. Cardiol Ther 2022; 11:129-141. [PMID: 35138595 PMCID: PMC8933594 DOI: 10.1007/s40119-022-00253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Fondaparinux is a low molecular weight heparin anticoagulant used to manage the full spectrum of acute coronary syndrome (ACS) patients and has proved its efficacy and safety in multiple clinical trials. However, there are limited data available showing whether the same results could be reproduced in real-world practice on an Indian population. Our objective was to determine the effectiveness and tolerability of fondaparinux in the management of symptomatic ACS in real-world clinical practice. METHODS The EMR data of hospitalized ACS patients (n = 611), from January 2015 to January 2020, representing UA or NSTEMI or STEMI and were prescribed fondaparinux (2.5 mg once daily) to manage ACS were analyzed. The effectiveness was analyzed as recurrence of ACS and tolerability as total incidence of major bleeding during hospitalization, at 30 days and 180 days. Appropriate statistical analysis was used with a statistically significance of p value < 0.05. RESULTS The incidence of recurrent ACS was not seen during hospitalization and in the first 30 days, while in only 0.65% (n = 4) patients, ACS reoccurred within 180 days. In a mean duration of 172.75 ± 3.20 days, UA was reported in 0.49% (n = 3) patients, NSTEMI in 0.16% (n = 1) of patients, and STEMI was not documented. None of the major bleeding events occurred during the entire study period, whereas minor bleeding events were reported during hospitalization 0.98% (n = 6) and at 30 days 0.16% (n = 1). The bleeding events were statistically insignificant (p value > 0.05). No incidences of stent thrombosis were reported during the entire study period. CONCLUSIONS In the real world, fondaparinux was found to be effective and tolerable when used to manage symptomatic ACS patients regardless of revascularization procedure with no incidence of stent thrombosis, and minimal recurrent ACS and insignificant increase in bleeding events.
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Affiliation(s)
| | - J. C. Mohan
- Fortis Hospital, Shalimar Bagh, Delhi, India
| | - Sunil Sathe
- Cardiac Care and Counselling Centre, Pune, India
| | | | | | | | | | - Amey Mane
- Dr. Reddy’s Laboratories Ltd, Hyderabad, India
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15
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Khan MY, Ponde CK, Kumar V, Gaurav K. Fondaparinux: A cornerstone drug in acute coronary syndromes. World J Cardiol 2022; 14:40-53. [PMID: 35126871 PMCID: PMC8788176 DOI: 10.4330/wjc.v14.i1.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/22/2021] [Accepted: 01/12/2022] [Indexed: 02/06/2023] Open
Abstract
In acute coronary syndrome (ACS), the use of anticoagulants in conjunction with antiplatelet agents in the acute phase has resulted in reduced ischemic events and is more effective than either class of drug used alone. Though parenteral anticoagulation is essential at the time of diagnosis, a balance must be made between ischemic benefit and the increased risk of bleeding when prescribing anticoagulants. Adverse events associated with anticoagulants, such as heparin-induced thrombocytopenia, bleeding problems, and the need for close monitoring of anticoagulant activity, have contributed to finding agents that reduce these limitations. Studies like the Organization to Assess Strategies in Ischemic Syndromes 5 and 6 and their meta-analysis have proven the efficacy of Fondaparinux over the entire ACS spectrum. The convenience of administration (once daily), lack of monitoring, reduction in mortality, and better safety profile make Fondaparinux a simple and effective anti-coagulant for the management of ACS.
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Affiliation(s)
| | - Chandrashekhar K Ponde
- Department of Cardiology, P.D. Hinduja Hospital & Medical Research Centre, Mumbai 400016, India
| | - Viveka Kumar
- Department of Cardiology, Max Super Speciality Hospital, New Delhi 110017, India
| | - Kumar Gaurav
- Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad 500018, India
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16
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Lovatt CA, Crowther MA. Challenging anticoagulation cases: A case of heparin-induced-thrombocytopenia in the first trimester of pregnancy. Thromb Res 2021; 207:58-61. [PMID: 34547613 DOI: 10.1016/j.thromres.2021.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/19/2022]
Abstract
Heparin-induced thrombocytopenia in pregnancy is an uncommon phenomenon which rarely occurs in the first trimester. Therapeutic options and duration of therapeutic anticoagulation are varied amongst reported published cases. We report a 41-year-old female with confirmed HIT following anticoagulation with dalteparin for deep vein thrombosis (DVT). She was treated with therapeutic fondaparinux for 3 months followed by prophylaxis dosage until delivery and for 6 weeks thereafter. A review of reported cases of the development of HIT in the first trimester and subsequent clinical management is discussed.
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Affiliation(s)
- Catherine Anne Lovatt
- Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Mark A Crowther
- Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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17
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Senzolo M, Piano S, Shalaby S, Tonon M, Tonello S, Zanetto A, Sacerdoti D, Simioni P, Bombonato G, Burra P, Angeli P. Comparison of Fondaparinux and Low-Molecular-Weight Heparin in the Treatment of Portal Vein Thrombosis in Cirrhosis. Am J Med 2021; 134:1278-1285.e2. [PMID: 34197784 DOI: 10.1016/j.amjmed.2021.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 03/02/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Portal vein thrombosis is the most common thrombotic complication in cirrhosis. About 60% of anticoagulated patients can achieve recanalization. Despite fondaparinux (FPX) theoretical advantages, data are lacking about safety and efficacy for treatment of portal vein thrombosis in cirrhosis. METHODS Cirrhotic patients with portal vein thrombosis treated with FPX or low-molecular-weight heparin (LMWH) were retrospectively included. The extension of thrombosis at baseline and its evolution during anticoagulant treatment were evaluated. Patients were treated with LMWH or FPX at therapeutic dosage and reduction was considered in selected cases. RESULTS There were 124 patients included. Main portal vein branch, splenic, and superior mesenteric veins were involved in 84%, 13%, and 36% of cases, respectively. Forty-one patients (33%) were treated with FPX and 83 (67%) with LMWH. The probability of resolution of thrombosis at 36 months was significantly higher in patients treated with FPX than in those treated with LMWH (77% vs 51%; P = .001), particularly when prescribed at reduced dose. With multivariate analysis, the treatment with FPX (hazard ratio 2.38; P = .002) and use of a full dose (hazard ratio 1.78; P = .035) were independent predictors of portal vein full recanalization. Bleeding rate was higher in patients treated with FPX than in those treated with LMWH (27% vs 13%; P = .06). CONCLUSIONS FPX appears to be more effective than LMWH in the treatment of portal vein thrombosis when used at reduced dose, also in complete thrombosis. FPX should be considered among possible treatments for portal vein thrombosis in cirrhosis.
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Affiliation(s)
- Marco Senzolo
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology.
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine-DIMED
| | - Sarah Shalaby
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology
| | - Marta Tonon
- Unit of Internal Medicine and Hepatology, Department of Medicine-DIMED
| | - Silvia Tonello
- Unit of Internal Medicine and Hepatology, Department of Medicine-DIMED
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology
| | - David Sacerdoti
- Unit of Internal Medicine and Hepatology, Department of Medicine-DIMED
| | - Paolo Simioni
- Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
| | | | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine-DIMED
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18
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Michaličková D, Hartinger JM, Hladinová Z, Bednářová V, Szonowská B, Polakovič V, Matthios A, Tesař V, Slanař O, Krekels EHJ. Population pharmacokinetics-pharmacodynamics of fondaparinux in dialysis-dependent chronic kidney disease patients undergoing chronic renal replacement therapy. Eur J Clin Pharmacol 2021; 78:89-98. [PMID: 34414464 DOI: 10.1007/s00228-021-03201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Data on the anti-Xa efficacy of fondaparinux in dialysis-dependent chronic kidney disease (DD-CKD) patients are scarce. This study characterizes the pharmacokinetics (PK) and pharmacodynamics (PD) of fondaparinux in DD-CKD patients undergoing renal replacement therapy (RRT), to assess dosing strategies. METHODS A retrospective, observational study was conducted using data on anti-Xa activity (112 samples) from 12 (3 male and 9 female) DD-CKD patients (median (IQR) age 71 years (63-88), weight 73 kg (59-98.5)). Eleven patients underwent high-flux or low-flux hemodialysis (HD) and one patient underwent peritoneal dialysis. Three patients were also treated with therapeutic plasma exchange (TPE). A non-linear mixed effects analysis was performed using NONMEM 7.3.0. RESULTS The lab-specific slope of the relationship between fondaparinux concentration and anti-Xa levels was 1.18 IU/µg. In a one-compartment model, clearance (CL) and volume of distribution (Vd) were 0.05289 L/h and 5.55 L, respectively. High-flux HD was found to increase the CL of fondaparinux 2.26 times. TPE also considerably increased CL, but the fold-change could not be accurately estimated. Low-flux HD and peritoneal dialysis did not impact PK parameters. CONCLUSIONS Model-based simulations showed that standard dosing (2.5 mg three times weekly before HD) results in a median anti-Xa activity of 0.55 IU/mL and 0.98 IU/mL, pre- and post-low-flux HD, respectively. In patients undergoing high-flux HD, these values are approximately 27% lower. Additional caution is warranted with TPE, as this treatment can reduce anti-Xa activity even further.
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Affiliation(s)
- Danica Michaličková
- Institute of Pharmacology, First Faculty of Medicine & General University Hospital, Charles University, Prague, Czech Republic.
| | - Jan Miroslav Hartinger
- Institute of Pharmacology, First Faculty of Medicine & General University Hospital, Charles University, Prague, Czech Republic
| | - Zuzana Hladinová
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Vladimíra Bednářová
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Barbora Szonowská
- Internal Department of Strahov, General University Hospital, Prague, Czech Republic
| | - Vladimír Polakovič
- Internal Department of Strahov, General University Hospital, Prague, Czech Republic
| | - Andreas Matthios
- Institute of Pharmacology, First Faculty of Medicine & General University Hospital, Charles University, Prague, Czech Republic.,Department of Biophysics and Physical Chemistry, Faculty of Pharmacy, Charles University, Hradec Králové, Czech Republic
| | - Vladimír Tesař
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ondřej Slanař
- Institute of Pharmacology, First Faculty of Medicine & General University Hospital, Charles University, Prague, Czech Republic
| | - Elke H J Krekels
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
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19
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Rianda RV, Subkhan M, Pradana AD, Fatimah FN, Rianda RA, Airlangga MP, Miftahussurur M. The Challenging Anticoagulant Therapy in COVID19 Patient with Associated Coagulopathy. Acta Med Indones 2021; 53:308-314. [PMID: 34611070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
COVID-19 became a widespread infectious disease in late 2019. Indonesia currently has the highest COVID-19 mortality rate in Asia, between 4-5 percent. Interestingly, COVID-19-associated coagulopathy characterized by an increase of several procoagulant factor levels, including fibrinogen and D-dimer, that has been associated with higher mortality and unfavorable outcomes. We report a case of a 30-year-old male admitted to the hospital with a profuse vomiting and worsening fever, cough and shortness of breath, and was diagnosed with COVID-19-associated coagulopathy. Seven days after admission, he became deteriorated with significant reduction of oxygen saturation and his coagulation parameter levels were increased with highly suspicion of pulmonary embolism. He was treated with azithromycin, isoprinosine, lopinavir, and fondaparinux with thromboprophylaxis dosage since admission. The role of increased fondaparinux dosage at the time of clinical deterioration was then followed by clinical improvement and reduced D-dimer level. Anticoagulant therapy, mainly with fondaparinux, showed a better prognosis in patients with markedly elevated D-Dimer. Fondaparinux needs to be monitored appropriately to prevent bleeding and adverse. The patient was discharged from the hospital in an improved condition and normal D-Dimer levels. There was no bleeding event nor other major side effects had been found in this case. The decision for increasing dose of anticoagulant may be determined on individual basis, considering risks, benefits, and also the most important is clinical findings.
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Affiliation(s)
- Raissa Virgy Rianda
- Department of Emergency Service, Siti Khodijah Hospital, Sidoarjo, East Java, Indonesia.
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Jourdi G, Abdoul J, Siguret V, Decleves X, Frezza E, Pailleret C, Gouin-Thibault I, Gandrille S, Neveux N, Samama CM, Pasquali S, Gaussem P. Induced forms of α 2-macroglobulin neutralize heparin and direct oral anticoagulant effects. Int J Biol Macromol 2021; 184:209-217. [PMID: 34126147 DOI: 10.1016/j.ijbiomac.2021.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
Alpha2-macroglobulin (α2M) is a physiological macromolecule that facilitates the clearance of many proteinases, cytokines and growth factors in human. Here, we explored the effect of induced forms of α2M on anticoagulant drugs. Gla-domainless factor Xa (GDFXa) and methylamine (MA)-induced α2M were prepared and characterized by electrophoresis, immunonephelometry, chromogenic, clot waveform and rotational thromboelastometry assays. Samples from healthy volunteers and anticoagulated patients were included. In vivo neutralization of anticoagulants was evaluated in C57Bl/6JRj mouse bleeding-model. Anticoagulant binding sites on induced α2M were depicted by computer-aided energy minimization modeling. GDFXa-induced α2M neutralized dabigatran and heparins in plasma and whole blood. In mice, a single IV dose of GDFXa-induced α2M following anticoagulant administration significantly reduced blood loss and bleeding time. Being far easier to prepare, we investigated the efficacy of MA-induced α2M. It neutralized rivaroxaban, apixaban, dabigatran and heparins in spiked samples in a concentration-dependent manner and in samples from treated patients. Molecular docking analysis evidenced the ability of MA-induced α2M to bind non-covalently these compounds via some deeply buried binding sites. Induced forms of α2M have the potential to neutralize direct oral anticoagulants and heparins, and might be developed as a universal antidote in case of major bleeding or urgent surgery.
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Affiliation(s)
- Georges Jourdi
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, F-75006, Paris, France; AP-HP. Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France; Research Centre, Montreal Heart Institute, University of Montreal, Faculty of Pharmacy, Montreal, Canada.
| | - Johan Abdoul
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, F-75006, Paris, France
| | - Virginie Siguret
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, F-75006, Paris, France; AP-HP. Nord-Université de Paris, Hôpital Lariboisière, F-75010 Paris, France
| | - Xavier Decleves
- AP-HP. Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France; Université de Paris, Variabilité de réponse aux psychotropes, INSERM UMR_S1144, F-75006 Paris, France
| | - Elisa Frezza
- Laboratoire CiTCoM, Université de Paris, CNRS, F-75006 Paris, France
| | - Claire Pailleret
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, F-75006, Paris, France; Clinique du Mont Louis, F-75011 Paris, France
| | - Isabelle Gouin-Thibault
- Laboratoire d'hématologie, CHU Pontchaillou, Université de Rennes 1, CIC-Inserm1414, F-35000 Rennes, France
| | - Sophie Gandrille
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, F-75006, Paris, France; AP-HP. Centre-Université de Paris, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Nathalie Neveux
- AP-HP. Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Charles Marc Samama
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, F-75006, Paris, France; AP-HP. Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Samuela Pasquali
- Laboratoire CiTCoM, Université de Paris, CNRS, F-75006 Paris, France
| | - Pascale Gaussem
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, F-75006, Paris, France; AP-HP. Centre-Université de Paris, Hôpital Européen Georges Pompidou, F-75015 Paris, France.
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Barthélémy O, Jobs A, Meliga E, Mueller C, Rutten FH, Siontis GCM, Thiele H, Collet JP. Questions and answers on workup diagnosis and risk stratification: a companion document of the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1379-1386. [PMID: 32860030 PMCID: PMC8026278 DOI: 10.1093/eurheartj/ehaa602] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Olivier Barthélémy
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique- Hôpitaux de Paris) (AP-HP), Paris, France
| | - Alexander Jobs
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Emanuele Meliga
- Interventional Cardiology, AO Mauriziano Umberto I, Turin, Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Frans H Rutten
- General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - George C M Siontis
- Department of Cardiology, University Hospital of Bern, Inselspital, Bern, Switzerland
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22
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Barbato E, Mehilli J, Sibbing D, Siontis GCM, Collet JP, Thiele H. Questions and answers on antithrombotic therapy and revascularization strategies in non-ST-elevation acute coronary syndrome (NSTE-ACS): a companion document of the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1368-1378. [PMID: 32860046 DOI: 10.1093/eurheartj/ehaa601] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emanuele Barbato
- Advanced Biomedical Sciences, University Federico II, Napoli, Italy
| | - Julinda Mehilli
- Advanced Biomedical Sciences, University Federico II, Napoli, Italy
| | - Dirk Sibbing
- Advanced Biomedical Sciences, University Federico II, Napoli, Italy
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De Luca L, Uguccioni M, Putini RL, Natale E, Terranova A, Pugliese M, Biffani E, De Lio L, Piazza V, Musumeci F. Fondaparinux During Intra-Aortic Balloon Pump Counterpulsation in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2021; 30:1545-1551. [PMID: 33994282 DOI: 10.1016/j.hlc.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/28/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although anticoagulation with unfractionated heparin (UFH) is commonly used during intra-aortic balloon pump (IABP) counterpulsation to prevent thromboembolic events, no data or guidelines exist to support this strategy, especially in the setting of acute myocardial infarction (AMI). This study sought to compare the short-term outcome of UFH vs fondaparinux in AMI patients who underwent successful percutaneous coronary intervention (PCI) and IABP insertion. METHODS The anticoagulation therapy of revascularised AMI patients who received IABP counterpulsation and admitted to a tertiary hospital in the last decade was retrospectively evaluated. The primary outcome was the occurrence of all-cause mortality, stroke or transient ischaemic attack, reinfarction, unplanned revascularisation, major or minor limb ischaemia, and any bleeding at 1 month. Propensity score matching was performed to compare the primary outcome between UFH and fondaparinux. RESULTS Of 1,355 AMI survivors at 2 days after hospital admission and who underwent successful PCI, an IABP was inserted in 197 (14.5%): 72 (36.5%) were treated with UFH and 125 (63.5%) with fondaparinux (2.5 mg o.d.). At clinical follow-up, completed in 98.5% of cases, the incidence of the primary outcome was 22.5% in UFH and 5.7% in fondaparinux groups (p=0.0009). More than two-thirds of the events included in the primary outcome were related to early bleeding complications. In the matched cohort of 62 patients, the primary outcome occurred in 14 (45.2%) patients in the UFH and two (6.5%) in the fondaparinux group (p=0.01). CONCLUSIONS This study suggested that fondaparinux is safer, by reducing early bleeding complications at one month, than UFH in the management of IABP.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy.
| | - Massimo Uguccioni
- Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy
| | - Rita Lucia Putini
- Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy
| | - Enrico Natale
- Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy
| | - Antonio Terranova
- Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy
| | - Marco Pugliese
- Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy
| | | | - Lucia De Lio
- Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy
| | - Vito Piazza
- Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy
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De Luca L, Uguccioni M, Natale E, Pugliese M, Terranova A, Biffani E, De Lio L, Piazza V, Putini RL, Musumeci F. Effectiveness of fondaparinux vs unfractionated heparin following percutaneous coronary intervention in survivors of out-of-hospital cardiac arrest due to acute myocardial infarction. Eur J Clin Pharmacol 2021. [PMID: 33963425 DOI: 10.1007/s00228-021-03152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
AIM There is no specific evidence on the antithrombotic management of survivors of out-of-hospital cardiac arrest (OHCA) due to acute myocardial infarction (AMI). We sought to compare the short-term outcome of unfractioned heparin (UFH) vs fondaparinux in OHCA survivors due to AMI admitted in our Institution in the last decade. METHODS We performed a retrospective cohort study on survivors of OHCA due to AMI managed with UFH or fondaparinux during the hospitalization. The primary outcome was the occurrence of any bleeding, all-cause mortality, cerebrovascular accidents, re-MI, and unplanned revascularization at 1 month. A propensity-score matching was performed to compare the outcome between UFH and fondaparinux. RESULTS Out of 2083 AMI patients undergoing successful PCI, OHCA was present in 94 (4.5%): 41 (43.6%) treated with UFH and 53 (56.4%) with fondaparinux. At clinical follow-up, the incidence of the primary outcome was 65.9% in UFH and 35.8% in fondaparinux group (p = 0.007). More than half of the events included in the primary outcome were related to bleeding complications. In the matched cohort of 56 patients, the primary outcome occurred in 46.4% and 25.0% (p = 0.16), while bleeding was present in 32.1% and 7.1% (p = 0.04), in the UFH and fondaparinux group, respectively. CONCLUSIONS The present analysis suggests that fondaparinux is safer than UFH in the management of OHCA due to AMI by reducing early bleeding complications at one month.
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25
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Silverio A, Galasso G, De Luca G. Consolidating the value of fondaparinux for current treatment of non-ST-elevation acute coronary syndromes. Int J Cardiol 2021; 335:21-23. [PMID: 33839173 DOI: 10.1016/j.ijcard.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
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26
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Almendro-Delia M, Izquierdo-Bajo Á, Madrona-Jiménez L, Blanco-Ponce E, Seoane-García T, García-Del Río M, Carmona-Carmona J, Arboleda Sánchez JA, Rodríguez Yáñez JC, Soto Blanco JM, Fernández García I, Castillo Caballero JA, Hidalgo-Urbano RJ, García-Rubira JC. Fondaparinux versus enoxaparin in the contemporary management of non-ST-elevation acute coronary syndromes. Insights from a multicenter registry. Int J Cardiol 2021; 332:29-34. [PMID: 33667576 DOI: 10.1016/j.ijcard.2021.02.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Fondaparinux is thought to have the most favorable risk-benefit profile among all anticoagulants in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, conflicting findings exist whether this holds true in current clinical practice. We aimed to assess the net clinical benefit of fondaparinux versus enoxaparin in the contemporary management of NSTE-ACS. METHODS Analysis of prospective multicenter registry data of NSTE-ACS patients who received fondaparinux or enoxaparin from February 2015, through December 2017. Survival models within a competing risks framework including site-specific random effects, were used to assess the composite of clinically relevant bleedings and major adverse cardiovascular events at 30 days. RESULTS Of 2094 patients, 1724 (82%) received enoxaparin and 370 (18%) fondaparinux. Both groups were comparable except for a lower prevalence of diabetes and renal impairment, and greater use of transradial approach in the fondaparinux group. Multivariate analysis revealed a net clinical benefit in favour of fondaparinux versus enoxaparin (Subhazard Ratio [SHR] 0.59; 95%CI 0.37-0.92), mainly driven by a reduction in bleeding (SHR 0.57; 95%CI 0.37-0.89). Exploratory analysis suggested greater reductions in bleeding with fondaparinux among patients undergoing transradial approach, revealing a significant interaction between treatment and vascular access on the multiplicative scale (Pinteraction = 0.0056), but not on an additive scale (P = 0.457). Propensity-score-matching analysis yielded similar results. CONCLUSIONS In contemporary management of NSTE-ACS, fondaparinux seems to provide a favorable net clinical benefit compared with enoxaparin, primarily driven by a bleeding reduction. Effect modification on the safety profile of fondaparinux by the vascular access approach warrants further investigation.
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Dailiana ZH, Stefanou N, Varitimids S, Rigopoulos N, Dimitroulias A, Karachalios T, Malizos KN, Kyriakou D, Kollia P. Factors predisposing to thrombosis after major joint arthroplasty. World J Orthop 2020; 11:400-410. [PMID: 32999860 PMCID: PMC7507077 DOI: 10.5312/wjo.v11.i9.400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/16/2020] [Accepted: 08/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Total joint arthroplasty is one of the most common options for end stage osteoarthritis of major joints. However, we must take into account that thrombosis after hip/knee arthroplasty may be related to mutations in genes encoding for blood coagulation factors and immune reactions to anticoagulants [heparin-induced thrombocytopenia (HIT)/thrombosis]. Identifying and characterizing genetic risk should help to develop diagnostic strategies or modify anticoagulant options in the search for etiological mechanisms that cause thrombophilia following major orthopedic surgery.
AIM To evaluate the impact of patients’ coagulation profiles and to study specific pharmacologic factors in the development of post-arthroplasty thrombosis.
METHODS In 212 (51 male and 161 female) patients that underwent primary total hip arthroplasty (100) or total knee arthroplasty (112) due to osteoarthritis during a period of 1 year, platelet counts and anti-platelet factor 4 (PF4)/heparin antibodies were evaluated pre/postoperatively, and antithrombin III, methylenetetrahydrofolate reductase, factor V and prothrombin gene mutations were evaluated preoperatively. In a minimum follow-up of 3 years, 196 patients receiving either low-molecular-weight heparins (173) or fondaparinux (23) were monitored for the development of thrombocytopenia, anti-PF4/heparin antibodies, HIT, and thrombosis.
RESULTS Of 196 patients, 32 developed thrombocytopenia (nonsignificant correlation between anticoagulant type and thrombocytopenia, P = 0134.) and 18 developed anti-PF4/heparin antibodies (12/173 for low-molecular-weight heparins and 6/23 for fondaparinux; significant correlation between anticoagulant type and appearance of antibodies, P = 0.005). Odds of antibody emergence: 8.2% greater in patients receiving fondaparinux than low-molecular-weight heparins. Gene mutations in factor II or V (two heterozygotes for both factor V and II) were identified in 15 of 196 patients. Abnormal low protein C and/or S levels were found in 3 of 196 (1.5%) patients, while all patients had normal levels of von Willebrand factor, lupus anticoagulant, and antithrombin III. Four patients developed HIT (insignificant correlation between thrombocytopenia and antibodies) and five developed thrombosis (two had positive antibodies and two were heterozygotes for both factor II & V mutations). Thrombosis was not significantly correlated to platelet counts or HIT. The correlation of thrombosis to antibodies, factor II, factor V was P = 0.076, P = 0.043, P = 0.013, respectively.
CONCLUSION Screening of coagulation profile, instead of platelet monitoring, is probably the safest way to minimize the risk of post-arthroplasty thrombosis. In addition, fondaparinux can lead to the formation of anti-PF4/heparin antibodies or HIT.
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Affiliation(s)
- Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Nikolaos Stefanou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Sokratis Varitimids
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Nikolaos Rigopoulos
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Apostolos Dimitroulias
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Theofilos Karachalios
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Despoina Kyriakou
- Laboratory of Haematology - Transfusion Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Panagoula Kollia
- Department of Human Genetics, Faculty of Biology, National and Kapodistrian University of Athens, Athens 11635, Greece
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Prandoni P, Cattelan AM, Carrozzi L, Leone L, Filippi L, De Gaudenzi E, Villalta S, Pesavento R. The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin. Thromb Res 2020; 196:395-397. [PMID: 33007739 PMCID: PMC7497738 DOI: 10.1016/j.thromres.2020.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/28/2020] [Accepted: 09/16/2020] [Indexed: 11/03/2022]
Affiliation(s)
| | - Anna Maria Cattelan
- Department of Medicine, Infectious Diseases Unit, University Hospital of Padua, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical, Molecular and Intensive Care Medicine, University Hospital of Pisa, Italy
| | - Lucia Leone
- Division of General Medicine, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Lucia Filippi
- Division of General Medicine, Alto Vicentino Hospital, Santorso, Italy
| | - Egidio De Gaudenzi
- Division of Internal Medicine, Angiology and Thrombosis Unit, Domodossola, Italy
| | - Sabina Villalta
- Division of General Medicine, San Giacomo Hospital, Castelfranco Veneto, Italy
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Li JF, Wu LJ, Wen GY, Zhou RR, Liu F, Wang W, Yang SQ, Gong JN, Miao R, Gu S, Liu Y, Yang YH. Platelet count trends and response to fondaparinux in a cohort of heparin-induced thrombocytopenia suspected patients after pulmonary endarterectomy. J Thromb Thrombolysis 2020; 51:703-710. [PMID: 32894400 DOI: 10.1007/s11239-020-02260-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A definitive diagnosis of heparin-induced thrombocytopenia (HIT) is difficult to make, especially in patients undergoing cardiac surgery. In this retrospective cohort study, we assessed the platelet count trends and the response to fondaparinux in a population of patients of suspected HIT after pulmonary endarterectomy (PEA). Patients enrolled in this study were over the age of 18 years, and survived longer than 7 days after PEA between January 1, 2011 and December 31, 2015. HIT likelihood was assessed by the 4 T's score and interpreted by our institutional algorithm. 54 patients were operated, and 49 patients met the inclusion criteria. Six patients met the criteria for suspected HIT and were treated with fondaparinux until the platelet recovered. No significant difference was observed of clinical characteristics between intermediate to high HIT likelihood patients (HIT SUSPECTED) and low HIT likelihood patients (NO HIT SUSPECTED). HIT SUSPECTED patients reached platelet count lowest later (about 5.5 days after PEA), while NO HIT SUSPECTED patients is about 4.0 days after PEA. Percentage of platelet counts decrease (> 50%) was larger than NO HIT SUSPECTED patients (< 50%). There was no difference in mortality or residual pulmonary hypertension between HIT SUSPECTED and NO HIT SUSPECTED patients. Two HIT SUSPECTED patients who used heparin after PEA died, the other four survived by replacing heparin or low molecular weight heparin with fondaparinux. Suspected HIT patients should be surveilled carefully. Platelet counts trends may have some hints in the prevention of HIT. Fondaparinux may be effective for patients with suspected HIT.
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Affiliation(s)
- Ji-Feng Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China
- Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China
- Department of Respiratory Disease, Capital Medical University, 100069, Beijing, P.R. China
| | - Li-Juan Wu
- School of Public Health, Capital Medical University, 100020, Beijing, P.R. China
- Beijing Key Laboratory of Epidemilology, Capital Medical University, 100020, Beijing, P.R. China
| | - Ge-Yi Wen
- Department of Respiratory Disease, Capital Medical University, 100069, Beijing, P.R. China
| | - Rong-Rong Zhou
- Department of Respiratory Disease, Capital Medical University, 100069, Beijing, P.R. China
| | - Fang Liu
- Department of Respiratory Medicine, The Branch of Tangshan Gongren Hospital, 063000, Tangshan, P.R. China
| | - Wei Wang
- Department of Respiratory Disease, Capital Medical University, 100069, Beijing, P.R. China
| | - Su-Qiao Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China
- Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China
- Department of Respiratory Disease, Capital Medical University, 100069, Beijing, P.R. China
| | - Juan-Ni Gong
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China
- Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China
- Department of Respiratory Disease, Capital Medical University, 100069, Beijing, P.R. China
| | - Ran Miao
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China
- Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China
- Department of Respiratory Disease, Capital Medical University, 100069, Beijing, P.R. China
| | - Song Gu
- Department of Cardiac Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China
| | - Yan Liu
- Department of Cardiac Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China.
| | - Yuan-Hua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China.
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China.
- Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China.
- Department of Respiratory Disease, Capital Medical University, 100069, Beijing, P.R. China.
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Patterson S, Al Nabhani I, Linkins LA. Adverse outcomes associated with managing suspected heparin induced thrombocytopenia in the critically ill. Thromb Res 2020; 193:218-20. [PMID: 32798962 DOI: 10.1016/j.thromres.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/23/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022]
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Lettow M, Grabarics M, Mucha E, Thomas DA, Polewski Ł, Freyse J, Rademann J, Meijer G, von Helden G, Pagel K. IR action spectroscopy of glycosaminoglycan oligosaccharides. Anal Bioanal Chem 2019; 412:533-537. [PMID: 31853603 PMCID: PMC6992547 DOI: 10.1007/s00216-019-02327-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 02/06/2023]
Abstract
Glycosaminoglycans (GAGs) are a physio- and pharmacologically highly relevant class of complex saccharides, possessing a linear sequence and strongly acidic character. Their repetitive linear core makes them seem structurally simple at first glance, yet differences in sulfation and epimerization lead to an enormous structural diversity with only a few GAGs having been successfully characterized to date. Recent infrared action spectroscopic experiments on sulfated mono- and disaccharide ions show great promise. Here, we assess the potential of two types of gas-phase action spectroscopy approaches in the range from 1000 to 1800 cm−1 for the structural analysis of complex GAG oligosaccharides. Synthetic tetra- and pentasaccharides were chosen as model compounds for this benchmark study. Utilizing infrared multiple photon dissociation action spectroscopy at room temperature, diagnostic bands are largely unresolved. In contrast, cryogenic infrared action spectroscopy of ions trapped in helium nanodroplets yields resolved infrared spectra with diagnostic features for monosaccharide composition and sulfation pattern. The analysis of GAGs could therefore significantly benefit from expanding the conventional MS-based toolkit with gas-phase cryogenic IR spectroscopy. Graphical abstract ![]()
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Affiliation(s)
- Maike Lettow
- Department of Molecular Physics, Fritz Haber Institute of the Max Planck Society, Faradayweg 4-6, 14195, Berlin, Germany
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustraße 3, 14195, Berlin, Germany
| | - Márkó Grabarics
- Department of Molecular Physics, Fritz Haber Institute of the Max Planck Society, Faradayweg 4-6, 14195, Berlin, Germany
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustraße 3, 14195, Berlin, Germany
| | - Eike Mucha
- Department of Molecular Physics, Fritz Haber Institute of the Max Planck Society, Faradayweg 4-6, 14195, Berlin, Germany
| | - Daniel A Thomas
- Department of Molecular Physics, Fritz Haber Institute of the Max Planck Society, Faradayweg 4-6, 14195, Berlin, Germany
| | - Łukasz Polewski
- Department of Molecular Physics, Fritz Haber Institute of the Max Planck Society, Faradayweg 4-6, 14195, Berlin, Germany
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustraße 3, 14195, Berlin, Germany
| | - Joanna Freyse
- Institute of Pharmacy, Medicinal Chemistry, Freie Universität Berlin, Königin-Luise-Str. 2+4, 14195, Berlin, Germany
| | - Jörg Rademann
- Institute of Pharmacy, Medicinal Chemistry, Freie Universität Berlin, Königin-Luise-Str. 2+4, 14195, Berlin, Germany
| | - Gerard Meijer
- Department of Molecular Physics, Fritz Haber Institute of the Max Planck Society, Faradayweg 4-6, 14195, Berlin, Germany
| | - Gert von Helden
- Department of Molecular Physics, Fritz Haber Institute of the Max Planck Society, Faradayweg 4-6, 14195, Berlin, Germany
| | - Kevin Pagel
- Department of Molecular Physics, Fritz Haber Institute of the Max Planck Society, Faradayweg 4-6, 14195, Berlin, Germany.
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustraße 3, 14195, Berlin, Germany.
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Ohta H, Miyake T, Shimizu T, Sonoda H, Ueki T, Kaida S, Yamaguchi T, Iida H, Tani M. The impact of pharmacological thromboprophylaxis and disease-stage on postoperative bleeding following colorectal cancer surgery. World J Surg Oncol 2019; 17:110. [PMID: 31248419 PMCID: PMC6598357 DOI: 10.1186/s12957-019-1653-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background Pharmacological thromboprophylaxis after colorectal cancer (CRC) surgery is internationally recommended for venous thromboembolism (VTE) prevention. The aim of this retrospective study was to evaluate the risk factors of postoperative bleeding after elective surgery for patients with primary CRC receiving pharmacological thromboprophylaxis of fondaparinux or enoxaparin. Methods We experienced consecutive 266 patients who underwent elective surgery for CRC during the study period. Finally, the medical records of 218 patients with CRC administrated fondaparinux or enoxaparin following surgery were retrospectively reviewed to evaluate symptomatic VTE until 28 days and postoperative bleeding comparing perioperative D-dimer levels. Results The significant differences in TNM classification staging and type of thromboprophylaxis were observed between postoperative bleeding-negative and bleeding-positive group. There was no statistical significance among other backgrounds of patients between the two groups. One case (0.46%) of symptomatic VTE and total 11 cases (5%) of postoperative bleeding were observed. In the univariate analysis, fondaparinux thromboprophylaxis and early disease-stage CRC (stages 0 and I) were associated with risk for postoperative bleeding. Multivariate analysis revealed that fondaparinux thromboprophylaxis was identified as an independent risk factor of postoperative bleeding. Moreover, preoperative levels of D-dimer in patients with stage IV CRC were significantly higher than those with the other stages. The significant elevation in preoperative D-dimer was also observed in patients with stage II CRC compared to those with stage I CRC. Perioperative levels of D-dimer in patients with advanced disease-stage CRC (stages II, III, and IV) were significantly higher than those in patients with early disease-stage CRC. Conclusions Fondaparinux administration and early disease-stage CRC appeared to be risk factors for postoperative bleeding in patients with pharmacological thromboprophylaxis undergoing surgical treatment for CRC. Patients’ hypercoagulative condition depending on disease progression of CRC might be related to the occurrence of postoperative bleeding following CRC surgery.
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Affiliation(s)
- Hiroyuki Ohta
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan.
| | - Hiromichi Sonoda
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Tomoyuki Ueki
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Tsuyoshi Yamaguchi
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
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Nojiri S, Hayakawa K, Date H, Yamada H. Efficacy and risks of fondaparinux 7.5 mg for deep vein thrombosis after total knee arthroplasty. Fujita Med J 2019; 5:9-13. [PMID: 35111494 PMCID: PMC8766234 DOI: 10.20407/fmj.2017-020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 06/01/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES High-dose fondaparinux therapy at 7.5 mg/day (FPX 7.5 mg) for deep vein thrombosis (DVT) may increase the risk of hemorrhage. We investigated the efficacy and safety of FPX 7.5 mg to treat DVT after total knee arthroplasty. METHODS This study included 101 patients (91 with osteoarthritis, 10 with rheumatoid arthritis; mean age at total knee arthroplasty: 72.9 years) with asymptomatic postoperative DVT. Medical prophylaxis for DVT was started on postoperative day 1. Vascular ultrasound was conducted within 2 days postoperatively; patients were switched to FPX 7.5 mg after DVT diagnosis. Ultrasound was repeated to monitor DVT resolution. Adverse reactions were assessed. RESULTS DVT resolved in 72 patients (71.3%) receiving FPX 7.5 mg. There were no significant differences between patients with versus without DVT resolution in the timing of FPX 7.5 mg therapy, treatment period, age, body mass index, or D-dimer or hemoglobin levels. There was no significant difference in DVT outcome between patients starting FPX 7.5 mg within 4 days postoperatively versus on day 5 or later, or between patients treated for ≤7 versus ≥8 days. Hemoglobin decreased to ≤7 g/dL in three patients (2.9%). CONCLUSIONS FPX 7.5 mg can be expected to resolve DVT in 71.3% of patients; however, the risk of associated hemorrhagic complications may be higher than the risk of pulmonary embolism. To treat DVT with FPX 7.5 mg without compromising safety, patients should be selected carefully and the timing of treatment should be adjusted appropriately.
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Affiliation(s)
- Sho Nojiri
- Department of Orthopedic Surgery, Fujita Health University School of
Medicine, Toyoake, Aichi, Japan
| | - Kazue Hayakawa
- Department of Orthopedic Surgery, Fujita Health University School of
Medicine, Toyoake, Aichi, Japan
| | - Hideki Date
- Department of Orthopedic Surgery, Fujita Health University School of
Medicine, Toyoake, Aichi, Japan
| | - Harumoto Yamada
- Department of Orthopedic Surgery, Fujita Health University School of
Medicine, Toyoake, Aichi, Japan
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Al-Eidan FAS, Alrawkan S, Alshammary H, Crowther MA. Comparison of argatroban and fondaparinux for the management of patients with isolated heparin-induced thrombocytopenia. Ann Hematol 2018; 97:2055-2059. [PMID: 30003318 DOI: 10.1007/s00277-018-3422-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
Abstract
Heparin-induced thrombocytopenia (HIT) is a serious complication of the administration of heparin and its derivatives. Non-heparin anticoagulants such as argatroban and fondaparinux are widely used in the management of HIT to compare the effectiveness of argatroban and fondaparinux in the resolution of thrombocytopenia and to compare clinical outcomes in patients with isolated HIT. A retrospective cohort analysis was performed at King Abdulaziz Medical City (KAMC) on patients diagnosed with isolated HIT between 31 Jan, 2014 and 30 June, 2017. Demographics data, non-heparin anticoagulants, related laboratory results, and clinical outcomes were retrieved and analysed. The cohort comprised a total of 95 adult patients who received either argatroban (56 patients) or fondaparinux (39 patients) for isolated HIT. The median age and sex distribution were similar in both argatroban and fondaparinux groups. The mean (+ SD) time (in days) for the resolution of thrombocytopenia was 3.5 (± 1.8) for patients who received argatroban and 3.7 (± 1.7) for patients administered fondaparinux (p = 0.843). Thromboembolic events occurred in five patients (8.9%) administered argatroban and in three patients (7.7%) administered fondaparinux (p = 0.382). There was no significant difference in the rates of bleeding or death (p = 0.829); however, the small number of cases limits our ability to draw conclusions about these outcomes. In this retrospective study, fondaparinux and argatroban were similarly effective in resolving thrombocytopenia, preventing further thromboembolic events, and maintaining safety in patients with confirmed HIT. To confirm this observation, larger prospective studies are needed.
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Affiliation(s)
- Fahad A S Al-Eidan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia. .,King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | - Saud Alrawkan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Mark A Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Kobayashi M, Akatsu M, Fujita Y, Nishikawa K. Successful perioperative management of a patient with erythropoietin-producing uterine myoma. JA Clin Rep 2018; 4:50. [PMID: 32025892 PMCID: PMC6967353 DOI: 10.1186/s40981-018-0185-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/05/2018] [Indexed: 01/14/2023] Open
Abstract
Background Erythropoietin-producing uterine myoma can cause various complications such as arterial or venous thrombosis and bleeding. Therefore, caution is required in the anesthetic management of affected patients. Case presentation A 57-year-old female was suspected to have an erythropoietin-producing uterine myoma and was scheduled to undergo an abdominal total hysterectomy and bilateral salpingo-oophorectomy. Preoperative levels of hemoglobin and erythropoietin were 21.9 g/dl (normal 11.5–15 g/dl) and 23.2 IU/ml (normal 4.2–23.7 IU/ml), respectively. Preoperative phlebotomy and isovolemic hemodilution were performed to prevent arterial and venous thrombosis, following previous evidence that a hemoglobin level < 16 g/dl reduces the occurrence of polycythemia vera-related complications. Fondaparinux 2.5 mg was subcutaneously injected once daily after the operation, resulting in a good perioperative course without major complications. Conclusion Herein, we have described a successful perioperative management of a patient with erythropoietin-producing uterine myoma. Our findings in this case suggest that this combination of antithrombotic therapies can facilitate anesthetic management of patients with this disease.
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Affiliation(s)
- Masato Kobayashi
- Department of Anesthesiology, Iwaki Kyoritsu General Hospital, 16 Kusehara, Mimaya-machi, Uchigo, Iwaki, Fukushima Prefecture, 9738555, Japan.
| | - Masahiko Akatsu
- Department of Anesthesiology, Iwaki Kyoritsu General Hospital, 16 Kusehara, Mimaya-machi, Uchigo, Iwaki, Fukushima Prefecture, 9738555, Japan.,Department of Disaster and Comprehensive Medicine, Fukushima Medical University, Fukushima, Fukushima Prefecture, 9601295, Japan
| | - Yoshihisa Fujita
- Department of Anesthesiology, Iwaki Kyoritsu General Hospital, 16 Kusehara, Mimaya-machi, Uchigo, Iwaki, Fukushima Prefecture, 9738555, Japan
| | - Koichi Nishikawa
- Department of Disaster and Comprehensive Medicine, Fukushima Medical University, Fukushima, Fukushima Prefecture, 9601295, Japan
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Lum ZC, Monzon RA, Bosque J, Coleman S, Pereira GC, Di Cesare PE. Effects of fondaparinux on wound drainage after total hip and knee arthroplasty. J Orthop 2018; 15:388-390. [PMID: 29881160 DOI: 10.1016/j.jor.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 03/16/2018] [Indexed: 01/22/2023] Open
Abstract
Background The purpose of this investigation was to determine the effects of fondaparinux on postoperative wound drainage, length of hospital stay (LOS) and rate of surgical site infection in total joint patients. Methods 117 patients undergoing total joint arthroplasty treated with fondaparinux for venous thromboembolism (VTE) prophylaxis were prospectively studied. Results The average time to a dry wound was 3.4 days, with an average LOS of 3.77 days. Perioperative complications included 2 cases each of superficial cellulitis, deep vein thrombosis, and pulmonary embolism; there were no cases of deep infection. Multi-variate analysis showed increased patient BMI increased LOS (p = 0.0169). Conclusion Fondaparinux is an effective drug for VTE prophylaxis in total joint arthroplasty with wound drainage and LOS comparable to historical controls of enoxaparin, warfarin, and rivaroxaban.
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Affiliation(s)
- Zachary C Lum
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Rene A Monzon
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Jose Bosque
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Sheldon Coleman
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Gavin C Pereira
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Paul E Di Cesare
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
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Song J, Xuan L, Wu W, Shen Y, Tan L, Zhong M. Fondaparinux versus nadroparin for thromboprophylaxis following minimally invasive esophagectomy: A randomized controlled trial. Thromb Res 2018; 166:22-27. [PMID: 29653390 DOI: 10.1016/j.thromres.2018.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/10/2018] [Accepted: 04/01/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The methodology of thromboprophylaxis post minimally invasive esophagectomy (MIE) is unclear. Thus, we compared the efficacy and safety of fondaparinux and nadroparin on the prophylaxis of venous thromboembolism (VTE) after MIE. MATERIALS AND METHODS We conducted a randomized, double-blind, treatment-controlled study. Consecutive patients undergoing MIE randomly received a single dose of either nadroparin 2850 AxaIU (Group H) or fondaparinux 2.5 mg (Group F) daily. We used ultrasonography to identify deep vein thrombosis (DVT) on postoperative day 7. The coagulation status was examined using thromboelastography (TEG) prior to and at 0, 24, 48, and 72 h after the operation. Bleeding events were recorded during anticoagulation therapy and analysis was performed on an intention-to-treat basis. RESULTS We randomly assigned the patients to Group H (n = 57) or Group F (n = 59). Symptomatic or asymptomatic DVT was identified in seven patients in Group H and one patient in Group F (12.28% vs. 1.69%, p = 0.031). Pulmonary embolism developed in one patient in Group H, and the VTE incidence was significantly lower in Group F than Group H (1.69% vs. 14.04%, RR: 0.121, 95% CI: 0.016-0.935, p = 0.016). TEG analysis showed a more inhibited coagulation profile of Group F compared with Group H reflected by the significantly prolonged R time at 48 h and 72 h after operation (6.8 ± 2.2 min vs. 8.4 ± 2.7 min, p = 0.005; 7.1 ± 1.6 min vs. 9.2 ± 3.7 min, p = 0.002). Bleeding events were not recorded in either group. CONCLUSIONS Fondaparinux could provide similar efficacy and safety in postoperative thromboprophylaxis following MIE compared with nadroparin.
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Affiliation(s)
- Jieqiong Song
- Department of Critical Care Medicine, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, China
| | - Lizhen Xuan
- Department of Critical Care Medicine, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, China
| | - Wei Wu
- Department of Critical Care Medicine, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, China.
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Abstract
Fondaparinux, a pentasaccharide administered for heparin-induced thrombocytopenia (HIT), can lead to the occurrence of thrombocytopenia. This patient underwent aortic stent graft placement for Salmonella paratyphi A-infected abdominal aortic aneurysm. Fondaparinux was administered for anticoagulation that led to a dramatic decline in his platelet counts. Investigations revealed HIT profile, PF4/heparin by particle gel immunoassay to be positive. Fondaparinux, a prescribed anticoagulant for HIT can paradoxically predispose to thrombocytopenia.
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Affiliation(s)
- Sonali Vadi
- Department of Critical Care Medicine, Global Hospitals, Mumbai, Maharashtra, India
| | - Vishal Peshattiwar
- Department of Spine Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
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Abstract
Venous thromboembolism is occurring with increasing frequency in children resulting in the more widespread use of anticoagulation in pediatrics. Antithrombotic drugs in children can be divided into the standard and alternative agents. This review discusses standard and alternative anticoagulants. Because standard anticoagulants have significant limitations, including variable pharmacokinetics, issues with therapeutic drug monitoring, frequency of administration, efficacy, and adverse effects, it is expected that the use of alternative anticoagulants will increase over time. With their improved properties and recent prospective clinical trial data, the current and future use of these agents will likely slowly replace of the standard anticoagulants.
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Affiliation(s)
- Guy Young
- Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Southern California Keck School of Medicine, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
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Kawaguchi R, Haruta S, Kobayashi H. Efficacy and safety of venous thromboembolism prophylaxis with fondaparinux in women at risk after cesarean section. Obstet Gynecol Sci 2017; 60:535-41. [PMID: 29184861 DOI: 10.5468/ogs.2017.60.6.535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/23/2017] [Accepted: 06/08/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives Cesarean section is associated with an increased risk for venous thromboembolism (VTE). The safety and efficacy of primary prophylaxis of fondaparinux, a synthetic sulfated pentasaccharide heparin analog, in women at risk after cesarean section is uncertain. Methods This was a retrospective study of 295 cases of pregnant women presenting to a tertiary referral center of Nara, Japan, to evaluate the usefulness of thromboprophylaxis with fondaparinux after cesarean delivery between 2011 and 2012. Patients were initially received unfractionated heparin (once 5,000 IU subcutaneously, twice a day), starting 6 hours after cesarean section for 24 hours, and then treated with fondaparinux (once 2.5 mg daily, subcutaneously) for 5 days. The primary efficacy end-point was an improvement in the incidence of symptomatic VTE or fatal post-cesarean pulmonary thromboembolism. The primary safety end-point was major bleeding during treatment. Results There were neither any episodes of symptomatic VTE cases nor maternal deaths. A total of 10 patients had a bleeding event. Major bleeding complication was observed in 2 (0.68%) of 295 patients receiving fondaparinux. Non-major bleeding into critical sites was observed in 8 patients, often at surgical sites, and recovery was not delayed. Conclusion This study demonstrates the safety and efficacy of fondaparinux in women at high risk of VTE after cesarean section. Large phase trials comparing clinical outcomes with fondaparinux across a wide spectrum of patients are needed to confirm these observations.
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Abstract
Alopecia has been observed with many anticoagulants although the mechanism is unclear. A 20 year old female with recurrent DVTs developed alopecia with multiple anticoagulants, including heparin derivatives and the new oral anticoagulants. This resolved with discontinuation of the agents. The patient was ultimately able to be anticoagulated with fondaparinux long term without any alopecia. This case addresses the Key Clinical Question of management and recognition of anticoagulant induced alopecia. This side effect can result from almost any of the available agents and is quickly reversible, underlining the importance of tailoring treatment to the individual and their experiences.
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Affiliation(s)
- Angela C Weyand
- University of Michigan Medical School, Department of Pediatrics and Communicable Diseases, Division of Pediatric Hematology and Oncology, 8200 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, (ph) 734-615-8232
| | - Jordan A Shavit
- University of Michigan Medical School, Department of Pediatrics and Communicable Diseases, Division of Pediatric Hematology and Oncology, 8200 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, (ph) 734-615-8232, @clot1
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Bundhun PK, Shaik M, Yuan J. Choosing between Enoxaparin and Fondaparinux for the management of patients with acute coronary syndrome: A systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17:116. [PMID: 28482804 PMCID: PMC5422952 DOI: 10.1186/s12872-017-0552-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enoxaparin and Fondaparinux are potential anticoagulants which are used peri-operatively in the management of patients with Acute Coronary Syndrome (ACS). We aimed to compare the adverse clinical outcomes which are associated with the use of these anticoagulants in patients who were treated for ACS. METHODS Online databases (PubMed/Medline, EMBASE, Cochrane library) were searched for studies which compared differences in clinical outcomes observed with the use of enoxaparin and fondaparinux in patients who were treated peri-operatively for ACS. Statistical analysis was carried out by Revman 5.3 software with odds ratio (OR) and 95% confidence intervals (CI) as the analytical parameters. RESULTS Seven studies with a total number of 9618 patients (mainly composed of non-ST elevated myocardial infarction/NSTEMI) were included. This analysis showed mortality to be similarly observed between enoxaparin and fondaparinux with OR: 1.05, 95% CI: 0.67-1.63; P = 0.84. Myocardial infarction (MI) and stroke were also not significantly different throughout different follow up periods. However, minor, major and total bleeding were significantly lower with fondaparinux (OR: 0.40, 95% CI: 0.27-0.58; P = 0.00001), (OR: 0.46, 95% CI: 0.32-0.66; P = 0.0001) and (OR: 0.47, 95% CI: 0.37-0.60; P = 0.00001) respectively during the 10-day follow up period. Even during a follow up period of 30 days or a midterm follow up, major and minor bleeding still significantly favored fondaparinux in comparison to enoxaparin. CONCLUSION In patients who were treated for ACS, fondaparinux might be a better choice when compared to enoxaparin in terms of short to midterm bleeding events. This result was mainly applicable to patients with NSTEMI. However, due to a limited number of patients analyzed, further larger randomized trials should be able to confirm this hypothesis.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China
| | - Musaben Shaik
- Department of Paediatrics, Pragati Children's Hospital, Ch Pet, Andhra Pradesh, India
| | - Jun Yuan
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, China.
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Young G, Male C, van Ommen CH. Anticoagulation in children: Making the most of little patients and little evidence. Blood Cells Mol Dis 2017; 67:48-53. [PMID: 28552476 DOI: 10.1016/j.bcmd.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 04/25/2017] [Accepted: 05/03/2017] [Indexed: 01/19/2023]
Abstract
Thrombotic complications are increasing at a steady and significant rate in children resulting in the more widespread use of anticoagulation in this population. Anticoagulant drugs in children can be divided into the standard agents (heparin, low molecular weight heparin, and vitamin K antagonists) and alternative agents (argatroban, bivalirudin, and fondaparinux). This review will compare and contrast the standard and alternative anticoagulants and suggest situations in which it may be appropriate to use argatroban, bivalirudin, and fondaparinux. Clearly, the standard anticoagulants all have significant shortcomings including variable pharmacokinetics, issues with therapeutic drug monitoring, frequency of administration, efficacy, and adverse effects. The alternative anticoagulants have properties which overcome these shortcomings and prospective clinical trial data are presented supporting the current and future use of these agents in place of the standard anticoagulants.
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Affiliation(s)
- Guy Young
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine.
| | - Christoph Male
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - C Heleen van Ommen
- Department of Pediatric Hematology/Oncology, Erasmus MC Sophia's Children's Hospital, Rotterdam, Netherlands
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Tokuhara K, Matsushima H, Ueyama Y, Nakatani K, Yoshioka K, Kon M. Efficacy and safety of thromboembolism prophylaxis with fondaparinux in Japanese colorectal cancer patients undergoing laparoscopic surgery: A phase II study. Int J Surg 2017; 42:203-8. [PMID: 28392450 DOI: 10.1016/j.ijsu.2017.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 10/25/2022]
Abstract
PURPOSE We aimed to assess the safety and efficacy of fondaparinux (FPNX) for patients undergoing laparoscopic colorectal surgery (LAC). METHODS Patients scheduled for LAC received once-daily subcutaneous injections of FPNX 1.5-2.5 mg for 4-8 days. The primary endpoint was the incidence of bleeding events. The secondary endpoint was the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). RESULTS Among 128 patients evaluable for efficacy, 119 patients were administered FPNX. Nine patients were excluded owing to intraoperative events, including conversion to open surgery among others. Thirteen patients discontinued treatment owing to anastomotic bleeding (n = 5), anastomotic leakage (n = 3), bleeding at drain insertion site (n = 2), subcutaneous bleeding (n = 1), drug-induced rash (n = 1), and sepsis (n = 1). Among the FPNX discontinuations, there were eight cases of bleeding (6.7%), and two cases of major bleeding (1.7%). In multivariate analysis, operative time >300 min was identified as a risk factor for bleeding events (p = 0.001) secondary to FPNX. The incidence rate of DVT was 2.5% (3/119 cases); these patients were asymptomatic. CONCLUSION There were no cases of PE. It is necessary to establish strict criteria for VTE prophylaxis with FPNX after LAC for Japanese patients considering the incidence of bleeding events.
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Herodotou Y, Papaioannou AI, Karakatsani A, Reppas L, Manali ED, Apollonatou V, Tomos I, Brountzos E, Papiris S. Massive hemoptysis in a patient with pulmonary embolism, a real therapeutic conundrum. Respir Med Case Rep 2017; 20:179-183. [PMID: 28289598 PMCID: PMC5339407 DOI: 10.1016/j.rmcr.2017.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/19/2017] [Accepted: 02/27/2017] [Indexed: 12/28/2022] Open
Abstract
Massive Hemoptysis and pulmonary embolism are two very severe and potentially fatal pulmonary emergencies requiring completely different treatments. We present the case of a 45-year old male transmitted to our Hospital for massive hemoptysis who at the same time was found to suffer from pulmonary embolism. Hemoptysis was treated with bronchial artery embolization which resulted in cessation of haemorrhage and allowed the administration of anticoagulant therapy a few days later. This case report gives an answer on how to manage a real therapeutic conundrum which is the coexistence of a massive hemoptysis and a concomitant pulmonary embolism.
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Affiliation(s)
- Yiolanda Herodotou
- 2nd Respiratory Medicine Department, “Attikon” University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Andriana I. Papaioannou
- 2nd Respiratory Medicine Department, “Attikon” University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
- Corresponding author. 2nd Respiratory Medicine Department, Attikon University Hospital, University of Athens, Athens, Greece.2nd Respiratory Medicine DepartmentAttikon University HospitalUniversity of AthensAthensGreece
| | - Anna Karakatsani
- 2nd Respiratory Medicine Department, “Attikon” University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, “Attikon” University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Effrosyni D. Manali
- 2nd Respiratory Medicine Department, “Attikon” University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Vasiliki Apollonatou
- 2nd Respiratory Medicine Department, “Attikon” University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioannis Tomos
- 2nd Respiratory Medicine Department, “Attikon” University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, “Attikon” University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Spyros Papiris
- 2nd Respiratory Medicine Department, “Attikon” University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
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Hisatake S, Kabuki T, Kiuchi S, Oka T, Dobashi S, Fujii T, Iwasaki Y, Ikeda T. Short-Term Subcutaneous Fondaparinux and Oral Edoxaban for Acute Venous Thromboembolism. Circ J 2017; 81:855-861. [PMID: 28239036 DOI: 10.1253/circj.cj-16-1012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND No studies have compared treatment efficacy between subcutaneous (SC) fondaparinux and oral edoxaban, which are categorized as factor Xa inhibitors, for venous thromboembolism (VTE) in the acute phase, and only a limited number of imaging-based quantitative studies have evaluated treatment.Methods and Results:In this open-label, randomized study, 50 patients with acute non-massive pulmonary embolism (PE) and/or deep-vein thrombosis (DVT) were assigned to fondaparinux or edoxaban groups. Lower-limb venous ultrasonography (US), and chest computed tomography (CT) were compared before and 7 days after treatment. Thrombus volume in DVT was calculated using quantitative ultrasound thrombosis (QUT) score on US. For evaluation of PE thrombus volume, lung perfused blood volume (PBV) on CT was calculated. The measurements before and after treatment, respectively, were as follows: QUT score: fondaparinux, 8.1±7.3 to 4.1±4.5; edoxaban, 7.7±6.3 to 4.4±4.3, both significant decreases (P=0.001, P<0.001, respectively); lung PBV: fondaparinux, 32.0±7.8 to 32.1±8.2 HU; edoxaban, 34.2±8.6 to 38.5±11.8 HU (P=0.732, P=0.426, respectively). On subjective CT-based evaluation, all pulmonary artery-related filling defects decreased/disappeared after treatment in both groups (P=NS). CONCLUSIONS Both SC fondaparinux and oral edoxaban are effective in acute VTE. Effects on thrombus regression on imaging-based quantitative measurement did not differ between the 2 drugs.
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Affiliation(s)
- Shinji Hisatake
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Takayuki Kabuki
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Shunsuke Kiuchi
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Takashi Oka
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Shintaro Dobashi
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Takahiro Fujii
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yoshihiro Iwasaki
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
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Cafolla A, Gentile G. Anticoagulant therapy with fondaparinux in a liver transplant patient with thrombosis and liver fibrosis: a case report. Clin Case Rep 2017; 5:342-345. [PMID: 28265403 PMCID: PMC5331225 DOI: 10.1002/ccr3.820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 07/25/2016] [Accepted: 12/05/2016] [Indexed: 11/12/2022] Open
Abstract
The treatment with fondaparinux is the effective and safe anticoagulant therapy in liver transplant patient on immunosuppressive therapy with arterial thrombosis, and it seems able to reduce liver fibrosis. Although this treatment is not generalizable, further prospective large studies need to confirm this case report.
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Affiliation(s)
- Arturo Cafolla
- Department of Cellular Biotechnologies and Hematology Thrombosis Centre Sapienza University of Rome Rome Italy
| | - Giuseppe Gentile
- Department of Cellular Biotechnologies and Hematology Infectious Diseases Unit Sapienza University of Rome Rome Italy
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Paubel P, Cousin M, Amar C, Gourmelen J, Fabron C, Detournay B. [Economic consequences of biological monitoring and medical complications of injectable anticoagulants in France]. ACTA ACUST UNITED AC 2016; 41:371-7. [PMID: 27817998 DOI: 10.1016/j.jmv.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/26/2016] [Indexed: 11/21/2022]
Abstract
AIM To assess the frequency of platelet monitoring and bleeding risks associated with the use of injectable anticoagulants in a real life setting and to estimate the associated costs. METHOD An analysis of the 2013 data from a random sample of ≈600,000 patients registered in the French National Health Insurances reimbursement database was conducted to identify platelet counts performed during injectable anticoagulants exposure period and treatment interruptions due to heparin-induced thrombocytopenia or transfusion. Events were then valued to establish associated costs. RESULTS Overall 15,985 adult patients representing a cumulated injectable anticoagulants exposure time of 12,264 months were selected. Treatment sequences involved unfractionated heparin (2.8%), low molecular weight heparin (86.9%), and fondaparinux (13.1%). Patients treated with unfractionated heparin were older (77 vs. 57 and 59 years) with longer treatment duration (32.6 vs. 25.1 and 21 days). After statistical adjustment, the average monthly number of platelet counts was 1.36-fold lower in patients treated with fondaparinux compared to low molecular weight heparin (P<0.0001). No difference was found between low molecular weight heparin and fondaparinux regarding the incidence of bleeding with transfusion (P=0.76) or hospitalized thrombocytopenia (P=0.82). Extrapolated for the whole country, the estimated costs for biological monitoring were € 21.6 million for low molecular weight heparin and € 0.9 million for fondaparinux. CONCLUSION Significantly fewer platelet counts were performed among patients treated with fondaparinux than among patients receiving low molecular weight heparin without additional bleeding risk. This finding should be taken into account when assessing the costs of such treatments.
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Hari Krishna Reddy M, Sangeetha B, Aruna M, Sarat Chandra V, Venkata Kumar AC, Ram R, Sivakumar V. Phlegmasia cerulean dolens: complication of femoral vein catheterization. CEN Case Rep 2016; 5:184-187. [PMID: 28508973 PMCID: PMC5413756 DOI: 10.1007/s13730-016-0221-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 05/11/2016] [Indexed: 11/27/2022] Open
Abstract
There are three less frequent manifestations of acute massive venous thrombosis and obstruction of the venous drainage of an extremity. They are phlegmasia alba dolens, phlegmasia cerulean dolens (PCD), and venous gangrene. The term PCD differentiates ischemia-associated massive venous thrombosis from phlegmasia alba dolens, which describes fulminant venous thrombosis without ischemia. We present a 55-year-old hypertensive, who presented with paedal oedema and breathlessness at rest. About a month prior to this admission, she suffered dislocation of left patella. She was treated with a plaster cast and immobilization for 3 weeks. Her serum creatinine was 8.8 mg/dL. She was initiated on haemodialysis via two single-lumen catheters placed in left femoral vein. The femoral vein catheters were removed after third session of haemodialysis. On fourth day, the patient complained pain and blue discolouration of left toes. On examination, the left lower limb was swollen, discoloured, and cold with blebs up to upper one-third of left leg. The left dorsalis pedis and posterior tibial arteries were not palpable. A Doppler of veins of lower limb revealed, thrombosis of deep, and superficial venous system of left lower limb. As there was no response to anticoagulation below, knee amputation was performed.
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Affiliation(s)
| | - B Sangeetha
- Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - M Aruna
- Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - V Sarat Chandra
- Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | | | - R Ram
- Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
| | - V Sivakumar
- Sri Venkateswara Institute of Medical Sciences, Tirupati, India
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50
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Abstract
Background Venous thromboembolism (VTE) is a major cause of perioperative morbidity and mortality. Historically, otolaryngology surgery has been seen as very low risk of VTE, given the relatively short procedures and healthy patient population. However, head and neck surgery patients have multiple additional risk factors for VTE compared to general otolaryngology patients, and only recently has research been directed at examining this population of patients regarding VTE risk. Review VTE has long been recognized as a major issue in other surgical specialties, with VTE rates of 15–60 % in some specialties in the absence of prophylaxis with either mechanical compression or anticoagulation. Multiple large-scale retrospective studies have shown that the incidence of VTE in otolaryngology patients is quite low, ranging between 0.1 and 1.6 %. However, these studies indicated that head and neck cancer patients may have an increased risk of VTE. Further retrospective studies focusing on head and neck cancer patients found a VTE rate of approximately 2 %, but one study also found a suspected VTE rate of 5.6 % based on clinical symptoms, indicating that retrospective studies may underreport the true incidence. A single prospective study found a 13 % risk of VTE after major head and neck surgery. Furthermore, risk stratification using the Caprini risk assessment model demonstrates that the highest risk patients may have a VTE risk of 18.3 %, although this may be lowered (but not eliminated) through the use of appropriate prophylactic anticoagulation. Conclusion VTE is likely a more significant concern in head and neck surgery patients than previously realized. Appropriate prophylaxis with mechanical compression and anticoagulation is essential; risk stratification may serve as a useful tool to identify head and neck cancer patients at highest risk for VTE.
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Affiliation(s)
- Faisal I Ahmad
- Department of Otolaryngology- Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, PV01, Portland, OR 97239 USA
| | - Daniel R Clayburgh
- Department of Otolaryngology- Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, PV01, Portland, OR 97239 USA
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