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Book Details
Abstract
Topics in this clinically focused publication devoted to Anticoagulants are: Antithrombin clinical applications and anti-inflammatory effects; Pharmacology and laboratory testing of oral direct thrombin inhibitor Dabigatran; Pharmacology and laboratory testing of the oral Xa inhibitors; Clinical use of the new oral anticoagulants; Pharmacology and safety of new oral anticoagulants-the challenge of bleeding; Emergency reversal of Warfarin anticoagulation - prothrombin complex concentrate compared with plasma; Prothrombin complex concentrate as reversal agent for new oral anticoagulants - lessons from prelinical models; Bleeding with new oral anticoagulants - clinical presentation and management; Treatment of ICH with new oral anticoagulants - a neurologist's view; Management of anticoagulation agents in trauma patients; and Anticoagulation and pediatric patients.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Anticoagulants\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Clinics In Laboratory Medicine\r | xii | ||
| Preface\r | xiii | ||
| Pharmacology and Safety of New Oral Anticoagulants | 443 | ||
| Key points | 443 | ||
| Introduction and background | 443 | ||
| Summary of pharmacology | 444 | ||
| Bleeding challenge | 445 | ||
| Anticoagulation Therapy and Elderly Patients | 446 | ||
| Evidence of Increased Bleeding Risk with NOACs Versus Standard Anticoagulants | 447 | ||
| Bleeding treatment strategies | 448 | ||
| Summary | 449 | ||
| References | 449 | ||
| Clinical Use of the Activated Partial Thromboplastin Time and Prothrombin Time for Screening | 453 | ||
| Key points | 453 | ||
| Introduction | 454 | ||
| aPTT | 454 | ||
| Clinical Uses of the aPTT | 455 | ||
| PT and INR | 455 | ||
| Clinical Uses of the PT/INR | 455 | ||
| Utility of aPTT and PT: evidence from the literature | 456 | ||
| Survey of Clinical Practice | 466 | ||
| Published Guidelines and Recommendations | 466 | ||
| Factors that may prolong the aPTT and/or PT | 466 | ||
| Drugs | 466 | ||
| Test Reagents | 467 | ||
| Temperature and Time | 467 | ||
| Diet | 467 | ||
| Genetically Determined and Acquired Coagulation Disorders | 467 | ||
| Coagulation tests as predictors of perioperative bleeding | 469 | ||
| Preoperative Bleeding History and Physical Examination | 469 | ||
| Hemostatic Testing for Patients | 469 | ||
| Use of Hemostatic Tests Before Dental Extractions | 470 | ||
| Use of PT, aPTT, and ACT for Clinical Decision-Making—Anticoagulation Monitoring | 470 | ||
| PT and aPTT | 470 | ||
| ACT | 471 | ||
| Use of PT and aPTT for Clinical Decision-Making—Variability of Testing | 471 | ||
| PT/INR | 471 | ||
| aPTT | 472 | ||
| Summary | 472 | ||
| References | 472 | ||
| Measurement of Dabigatran in Standardly Used Clinical Assays, Whole Blood Viscoelastic Coagulation, and Thrombin Generation ... | 479 | ||
| Key points | 480 | ||
| Introduction | 480 | ||
| Plasma-based clotting assays | 480 | ||
| Historical Perspectives | 480 | ||
| Laboratory Assays to Measure Dabigatran | 482 | ||
| Liquid chromatography with tandem mass spectrometry | 482 | ||
| Clinical coagulation tests and dabigatran measurement | 483 | ||
| Diluted thrombin time | 484 | ||
| Whole Blood Clotting Tests | 485 | ||
| Activated clotting time | 485 | ||
| Thromboelastography/rotation thromboelastometry | 486 | ||
| Historical Perspective | 486 | ||
| Methodological Considerations | 486 | ||
| Clinical Studies with TEG or TEM | 488 | ||
| Anticoagulation with Dabigatran on TEG or TEM | 488 | ||
| Thrombin generation | 490 | ||
| Historical Perspective | 490 | ||
| Methodological Considerations | 490 | ||
| Correlation of Thrombin Generation with Thrombosis and Bleeding Outcomes | 492 | ||
| References | 496 | ||
| Pharmacology and Laboratory Testing of the Oral Xa Inhibitors | 503 | ||
| Key points | 503 | ||
| Introduction | 503 | ||
| Rivaroxaban | 504 | ||
| Pharmacologic characteristics | 504 | ||
| Clinical studies | 505 | ||
| Total hip and knee replacement in adults | 505 | ||
| Nonvalvular atrial fibrillation | 506 | ||
| Acute VTE | 506 | ||
| Patients at risk of VTE hospitalized with severe acute illness | 506 | ||
| Acute coronary syndrome | 507 | ||
| Apixaban | 508 | ||
| Pharmacologic characteristics | 508 | ||
| Populations and special situations | 508 | ||
| Clinical studies | 508 | ||
| Total hip and knee replacement in adults | 508 | ||
| Nonvalvular AF | 508 | ||
| AVERROES | 508 | ||
| ARISTOTLE | 509 | ||
| Acute VTE | 509 | ||
| Patients hospitalized for severe acute illness with a risk factor for VTE | 509 | ||
| ACS | 510 | ||
| Edoxaban | 510 | ||
| Pharmacologic characteristics | 510 | ||
| Clinical studies | 510 | ||
| Nonvalvular AF | 510 | ||
| Acute VTE | 510 | ||
| Betrixaban | 511 | ||
| Pharmacologic characteristics | 511 | ||
| Clinical studies | 511 | ||
| Major orthopedic surgery | 511 | ||
| Nonvalvular AF | 511 | ||
| Coagulation monitoring and new anticoagulants | 511 | ||
| In these cases, which test(s) can be used? | 512 | ||
| Guidelines for treatment initiation with new oral anticoagulants | 512 | ||
| Discussion | 513 | ||
| Summary | 514 | ||
| References | 514 | ||
| Treatment and Long-Term Management of Venous Thromboembolism | 519 | ||
| Key points | 519 | ||
| Introduction | 519 | ||
| Phases of anticoagulation | 520 | ||
| Acute Phase | 520 | ||
| Chronic Phase | 522 | ||
| Outpatient VTE treatment | 522 | ||
| Management | 526 | ||
| Acute-Phase Treatment | 527 | ||
| Thrombolytics and surgical embolectomy | 527 | ||
| Anticoagulation | 527 | ||
| Mechanical | 527 | ||
| Extended Therapy | 531 | ||
| Aspirin | 531 | ||
| Warfarin | 531 | ||
| LMWH | 531 | ||
| NOAC | 533 | ||
| Summary | 533 | ||
| References | 533 | ||
| Anticoagulation Strategies for the Management of Postoperative Atrial Fibrillation | 537 | ||
| Key points | 537 | ||
| Introduction | 538 | ||
| Incidence of Atrial Fibrillation | 538 | ||
| Risk Factors for the Development of POAF | 538 | ||
| Consequences of developing POAF | 539 | ||
| Preventing POAF | 540 | ||
| The Use of Magnesium, PUFAs, or ACE-Is/ARB | 540 | ||
| Management strategies in POAF: rate versus rhythm control | 541 | ||
| Pharmacologic Cardioversion and/or Synchronized DCC | 542 | ||
| Prevention of thromboembolism | 542 | ||
| Assessment/Risk Stratification of Stroke and Thromboembolism | 542 | ||
| Assessment of Bleeding Risk | 543 | ||
| Antithrombotic therapy for the management of AF and POAF | 544 | ||
| Evidence for Aspirin | 544 | ||
| Evidence for Vitamin K Antagonists/Warfarin | 546 | ||
| Evidence for Vitamin K Antagonists/Warfarin Versus ASA | 546 | ||
| Evidence for Warfarin Versus Dual Antiplatelet Therapy | 550 | ||
| Evidence for Patients with AF and ACS with Stenting (Warfarin Plus Single Antiplatelet Versus Warfarin Plus DAPT) | 550 | ||
| Evidence for New Oral Anticoagulants Versus Warfarin | 550 | ||
| Evidence of Anticoagulation in POAF Patients | 553 | ||
| References | 554 | ||
| Management of Anticoagulation Agents in Trauma Patients | 563 | ||
| Key points | 563 | ||
| Introduction | 563 | ||
| Initial assessment of the anticoagulated trauma patient | 564 | ||
| Patient’s History and Physical Examination | 564 | ||
| Laboratory Analysis | 564 | ||
| Radiographic Studies | 565 | ||
| Management of the anticoagulated trauma patient | 565 | ||
| Vitamin K Antagonists | 565 | ||
| Direct Thrombin Inhibitors | 566 | ||
| Direct Factor Xa Inhibitors | 568 | ||
| Low Molecular Weight Heparin | 568 | ||
| Antiplatelet Agents | 569 | ||
| Summary | 570 | ||
| References | 570 | ||
| New Oral Anticoagulant–Induced Bleeding | 575 | ||
| Key points | 575 | ||
| Introduction | 576 | ||
| Prevalence and severity of bleeding events with traditional and new oral anticoagulants | 576 | ||
| Traditional Anticoagulants and Bleeding Risk | 576 | ||
| NOACs and Bleeding Risk | 577 | ||
| Currently available options for anticoagulation reversal and bleeding management | 578 | ||
| Warfarin Reversal | 578 | ||
| NOAC Reversal | 578 | ||
| Case studies of NOAC reversal | 579 | ||
| Dager and Colleagues | 579 | ||
| Diaz and Colleagues | 579 | ||
| Harinstein and Colleagues | 581 | ||
| Cano and Miyares | 581 | ||
| Warkentin and Colleagues | 581 | ||
| Discussion | 582 | ||
| References | 582 | ||
| Treatment of Intracerebral Hemorrhage Associated with New Oral Anticoagulant Use | 587 | ||
| Key points | 587 | ||
| Introduction | 587 | ||
| Epidemiology and prognosis of OAC-ICH | 588 | ||
| Predisposing factors for OAC-ICH | 588 | ||
| Emergency treatment of ICH associated with VKA therapy | 589 | ||
| Emergency treatment of ICH associated with NOAC therapy | 589 | ||
| Current Treatment Recommendations | 590 | ||
| References | 591 | ||
| Periprocedural Management of Patients on Anticoagulants | 595 | ||
| Key points | 595 | ||
| Introduction | 595 | ||
| Oral anticoagulants and laboratory tests | 596 | ||
| Laboratory Testing in Patient Management | 597 | ||
| Periprocedural management of warfarin-induced anticoagulation in patients with AF | 597 | ||
| Management for Urgent or Emergent Surgeries | 598 | ||
| Risk of TE | 598 | ||
| Bridging Therapy | 601 | ||
| Periprocedural management of warfarin-induced anticoagulation in patients with DVT and VTE | 601 | ||
| Periprocedural management of warfarin-induced anticoagulation in patients with mechanical heart valves | 602 | ||
| Periprocedural management of patients on antiplatelet medications | 602 | ||
| Periprocedural management of patients on aspirin | 602 | ||
| Periprocedural management of patients on other antiplatelet drugs | 605 | ||
| Approved uses of new oral anticoagulants | 605 | ||
| Periprocedural management of patients on new oral anticoagulants | 605 | ||
| Preprocedural period | 606 | ||
| Half-life of Dabigatran | 606 | ||
| Half-lives of Rivaroxaban and Apixaban | 606 | ||
| Postprocedural management of patients on new oral anticoagulants | 606 | ||
| Management of anticoagulation with neuraxial anesthesia or analgesia | 607 | ||
| Summary | 607 | ||
| References | 608 | ||
| Four-Factor Prothrombin Complex Concentrate Versus Plasma for Urgent Vitamin K Antagonist Reversal | 613 | ||
| Key points | 613 | ||
| Introduction and background | 613 | ||
| Recent data | 615 | ||
| Sarode and Colleagues | 615 | ||
| Hickey and Colleagues | 617 | ||
| Discussion of the Randomized Controlled Trial Data | 617 | ||
| 4F- versus 3F-PCCS | 618 | ||
| Future research questions | 618 | ||
| Summary | 619 | ||
| Acknowledgements | 619 | ||
| References | 619 | ||
| Prothrombin Complex Concentrates as Reversal Agents for New Oral Anticoagulants | 623 | ||
| Key points | 623 | ||
| Introduction | 623 | ||
| Preclinical studies of NOAC reversal with Beriplex | 625 | ||
| FIIa Inhibitors: Dabigatran | 625 | ||
| In vivo rabbit model combined with in vitro/ex vivo studies | 625 | ||
| In vitro reversal studies | 625 | ||
| Ex vivo reversal studies | 626 | ||
| In vivo reversal studies | 627 | ||
| FXa Inhibitors: Rivaroxaban | 627 | ||
| In vitro reversal studies | 627 | ||
| Ex vivo reversal studies | 627 | ||
| Perioperative Management of Patients Receiving New Oral Anticoagulants | 637 | ||
| Key points | 637 | ||
| Introduction | 638 | ||
| Methods | 638 | ||
| Statistical Analysis | 638 | ||
| Results | 638 | ||
| Questionnaire Responses | 638 | ||
| Responder Profile | 639 | ||
| Guideline Use | 639 | ||
| NOAC Reversal Strategies | 639 | ||
| Discussion | 641 | ||
| References | 645 | ||
| Appendix 1 The survey questionnaire | 647 | ||
| Management of Anticoagulation and Hemostasis for Pediatric Extracorporeal Membrane Oxygenation | 655 | ||
| Key points | 655 | ||
| Introduction | 655 | ||
| ECMO-induced coagulopathy | 656 | ||
| The ECMO Circuit | 656 | ||
| Inflammation | 657 | ||
| Thrombin Generation | 657 | ||
| Endothelial Dysfunction | 658 | ||
| Platelet Dysfunction | 658 | ||
| Summary | 658 | ||
| Anticoagulation monitoring | 659 | ||
| ACT Values and its Limitations | 659 | ||
| Anti-Xa Concentration Assays | 660 | ||
| Anti-Xa Range | 660 | ||
| Activated Partial Thromboplastin Time | 661 | ||
| TEG or ROTEM-Guided Algorithms | 661 | ||
| Summary | 663 | ||
| Anticoagulation agents | 663 | ||
| Direct Thrombin Inhibitors | 664 | ||
| ATIII Activity | 664 | ||
| Antiplatelet agents | 666 | ||
| Hemostatic adjuncts | 666 | ||
| Antifibrinolytic Agents | 666 | ||
| Recombinant Activated Factor VII | 668 | ||
| Blood products transfusion | 668 | ||
| Summary | 669 | ||
| References | 669 | ||
| The Influence of Various Patient Characteristics on D-dimer Concentration in Critically Ill Patients and Its Role as a Prog ... | 675 | ||
| Key points | 675 | ||
| Introduction | 675 | ||
| Materials and methods | 677 | ||
| Subjects | 677 | ||
| Data Analysis | 677 | ||
| Results | 678 | ||
| D-dimer Concentration and Renal Function | 679 | ||
| Discussion | 681 | ||
| Results with Patients Undergoing Dialysis | 682 | ||
| Effect of Gender and Race on D-dimer Concentration | 683 | ||
| No Connection with In-Hospital Mortality | 683 | ||
| Summary | 684 | ||
| Acknowledgments | 684 | ||
| References | 684 | ||
| Index | 687 |