Non-vitamin K Antagonists and Cardiac Implantable Electronic Devices

Direct Acting Oral Anticoagulants (DOAC) since last 9 years catch on medical treatment and number of patients who receive them forced guidelines on its usage in high bleeding risk circumstances including ablation and cardiac implantable electronic devices (CIED) procedures. In current paper the available publications and guidelines in this field were discussed. In VENTURE-AF, RE-CIRCUIT and AXAFA-AFNET 5 trials safety of uninterrupted DOAC therapy during ablation procedure were confirmed. All patient during procedure received additional unfractionated heparine (UFH) to obtain value of ACT > 300 s. Bleeding event rate was comparable in patients treated with DOAC and those on vitamin K antagonists (VKA), and even lower when patients were on dabigatran. In BRUISE CONTROL 2 trial, in which patients undergoing CIED implantation were enrolled, no statistically significant differences in effectiveness and safety between uninterrupted and interrupted periprocedural DOAC treatment were noticed.

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Idiopathic venous thrombosis

Hämostaseologie ◽

10.1055/s-0037-1616877 ◽

2006 ◽

Vol 26 (01) ◽

pp. 52-54 ◽

Cited By ~ 3

Author(s):

P. A. Kyrle

Keyword(s):

Chronic Disease ◽

Venous Thrombosis ◽

Vitamin K ◽

Clinical Benefit ◽

Plasma Levels ◽

Vitamin K Antagonists ◽

Antithrombin Deficiency ◽

Optimal Duration ◽

Risk Of Treatment

SummaryVenous thrombosis is a chronic disease with a recurrence rate of approximately 30% within 5-8 years. The optimal duration of secondary thromboprophylaxis in these patients entails balancing the risk of recurrence against the risk of treatment-associated bleeding. There is agreement that patients with a first idiopathic venous thrombosis should receive vitamin K antagonists for at least 3-6 months. Convincing trials showing a clinical benefit in terms of morbidity or mortality with respect to expansion of anticoagulation beyond 6 months are lacking. Nevertheless, some subgroups of patients with venous thrombosis may benefit from indefinite anticoagulation. Thus, patients with antithrombin deficiency, combined or homozygous defects, more than one unprovoked episode of thrombosis, the lupus anticoagulant or high factor VIII plasma levels are good candidates for long-term prevention.

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Spectrophotometric Assays of Prothrombin in Plasma of Patients Using Oral Anticoagulants

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657025 ◽

1979 ◽

Vol 42 (04) ◽

pp. 1296-1305 ◽

Cited By ~ 29

Author(s):

R M Bertina ◽

W van der Marel-van Nieuwkoop ◽

E A Loeliger

Keyword(s):

Prothrombin Time ◽

Vitamin K ◽

Oral Anticoagulation ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Factor Xa ◽

Factor V ◽

Anticoagulant Treatment ◽

Factor Ii ◽

K Deficiency

SummaryTwo spectrophotometric assays for prothrombin have been developed and compared with a one stage coagulant and an immunological assay. One of these assays (called the XAPC assay) uses a combination of factor Xa, phospholipid, Ca2+ and factor V as activator of prothrombin, and measures only normal prothrombin. The second (the ECAR assay) uses Echis carinatus venom as activator. This assay measures both normal prothrombin and PIVKA II (protein induced by vitamin K antagonists/absence). Combination of the results obtained by the XAPC and ECAR assays provides rapid and reliable information on the degree of “subcarboxylation” of prothrombin (oral anticoagulation, vitamin K deficiency).For patients on long term anticoagulant treatment the prothrombin time (Thrombotest) shows better correlation with the ratio prothrombin/prothrombin plus PIVKA II (XAPC/ ECAR) than with the factor II concentration. For patients starting the anticoagulant treatment there is no correlation between the Thrombotest time and the XAPC/ECAR ratio.It seems doubtful that (a) spectrophotometric factor II assay(s) will be as useful as the prothrombin time in the control of oral anticoagulation.

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Recent Advances in Pacing and Defibrillation

Asia Pacific Cardiology ◽

10.15420/apc.2011:3:1:74 ◽

2011 ◽

Vol 3 (1) ◽

pp. 74

Author(s):

Kathy L Lee ◽

Keyword(s):

Cardiac Death ◽

Electronic Devices ◽

Implantable Defibrillators ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Treatment And Prevention ◽

Recent Advances ◽

Pacing Lead ◽

Leadless Pacing ◽

Device Complications

Cardiac pacemakers have been the standard therapy for patients with bradyarrhythmias for several decades. The pacing lead is an integral part of the system, serving as a conduit for the delivery of energy pulses to stimulate the myocardium. However, it is also the Achilles’ heel of pacemakers, being the direct cause of most device complications both acutely during implant and chronically years afterwards. Leadless pacing with ultrasound-mediated energy has been demonstrated in animals and humans to be safe and feasible in acute studies. Implantable defibrillators revolutionised the treatment and prevention of sudden cardiac death. Subcutaneous implantable defibrillators have been under development for more than 10 years. A permanent implantable system has been shown to be feasible in treating induced and spontaneous ventricular tachyarrhythmias. These developments and recent advances in pacing and defibrillation will arouse further interest in the research and development of leadless cardiac implantable electronic devices.

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New Drugs for Thromboembolic Prevention in Atrial Fibrillation

European Cardiology Review ◽

10.15420/ecr.2010.6.4.64 ◽

2010 ◽

Vol 6 (4) ◽

pp. 64

Author(s):

Jose L Merino ◽

Jose López-Sendón ◽

◽

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Negative Impact ◽

Vitamin K Antagonists ◽

Coagulation Factor ◽

Developed Countries ◽

New Drugs ◽

Risk Scores ◽

Bleeding Events ◽

Risk Patients

Atrial fibrillation (AF) is the most frequent sustained arrhythmia and its prevalence is increasing in developed countries. This progressive increase and the negative impact of this arrhythmia on the patient’s prognosis make AF one of the main healthcare problems faced today. This has led to intense research into the main aspects of AF, one of them being thromboembolism prevention. AF patients have a four to five times higher risk of stroke than the general population. Several factors increase thromboembolic risk in patients with AF and the use of risk scores, such as the Congestive Heart Failure, Hypertension, Age Greater than 75, Diabetes, and Prior Stroke or Transient Ischemic Attack (CHADS2), have been used to identify the best candidates for anticoagulation. Antithrombotic drugs are the mainstay of therapy for embolic prevention. The clinical use of these drugs is based on the risk–benefit ratio, where benefit is the reduction of stroke and systemic embolic events and risk is mostly driven by the increase in bleeding events. Generally, antiplatelets are indicated for low-risk patients in light of the fact anticoagulants are the drug of choice for moderate- or high-risk patients. Vitamin K antagonists have been the only option for oral anticoagulation for the last 50 years. However, these drugs have many pharmacodynamic and pharmacokinetic problems. The problems of anticoagulation with vitamin K antagonists have led to the investigation of new drugs that can be administered orally and have a better dose–response relationship, a shorter half-life and, in particular, higher efficacy and safety without the need for frequent anticoagulation controls. The drugs that have been studied most thoroughly in patients with AF are inhibitors of the activated coagulation factor X and inhibitors of coagulation factor II (thrombin), including ximelagatran and dabigatran. In addition, non-pharmacological therapies have been developed to prevent recurrent embolism in certain patient populations.

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