A Critical N-Nitrosamine Impurity of Anticoagulant Drug, Rivaroxaban: Synthesis, Characterization, Development of LC–MS/MS Method for Nanogram Level Quantification

2022 ◽  
Author(s):  
Vijaya Kumar Baksam ◽  
Nimmakayala Saritha ◽  
Subba Rao Devineni ◽  
Mohit Jain ◽  
Prashanth Kumar ◽  
...  
Keyword(s):  
Anticoagulant Drug ◽  
Nanogram Level

Rationale for heparin treatment of colon cancer

2000 ◽  
Vol 20 (03) ◽  
pp. 136-142 ◽  
Author(s):  
D. L. Ornstein ◽  
L. R. Zacharski
Keyword(s):  
Clinical Trials ◽  
Substantial Improvement ◽  
Patients With Cancer ◽  
Coagulation Mechanism ◽  
Anticoagulant Drug ◽  
Cancer Outcome ◽  
Meta Analyses ◽  
Improvement In Survival ◽  
Spectrum Of Patients ◽  
To Receive

SummaryIt is widely known that the systemic blood coagulation mechanism is often activated in malignancy, leading to an increased incidence of vascular thromboses in patients with cancer. It is not widely appreciated, however, that products of the coagulation mechanism may also support tumor growth and dissemination. Interest in this approach to cancer therapy has surged recently because of mounting evidence that the familiar anticoagulant drug, heparin, may impede tumor progression. Heparin has the capacity to modify angiogenesis, growth factor and protease activity, immune function, cell proliferation and gene expression in ways that may block malignant dissemination. Clinical trials in which heparin has been administered to a broad spectrum of patients to prevent or treat thrombosis have unexpectedly shown improvement in survival in the subset of patients with malignancy entered to these studies. Meta-analyses of clinical trials comparing unfractionated (UF) versus low molecular weight (LMW) heparin treating venous thromboembolism suggest that there may be substantial improvement in cancer outcome in patients with malignancy randomized to receive LMW heparin. These findings provide a rationale for definitive clinical trials of LMW heparin in cancer, and the results of several such studies that are currently underway are awaited with interest.

Predicting Daily Maintenance Dose of Fluindione, an Oral Anticoagulant Drug

1996 ◽  
Vol 75 (05) ◽  
pp. 731-733 ◽  
Author(s):  
V Cazaux ◽  
B Gauthier ◽  
A Elias ◽  
D Lefebvre ◽  
J Tredez ◽  
...  
Keyword(s):  
Effective Dose ◽  
Maintenance Dose ◽  
Successive Approximations ◽  
Hemorrhagic Complication ◽  
Simple Method ◽  
Individual Variations ◽  
Anticoagulant Drug ◽  
The Mean ◽  
Mean Time ◽  
Daily Maintenance Dose

SummaryDue to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.

scholarly journals Spinal and cerebral hematoma in systemic lupus erythematosus and antiphospholipid syndrome: is drug interaction the culprit?

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Emine Duran ◽  
Emre Bilgin ◽  
Ertuğrul Çağrı Bölek ◽  
Oğuzhan Fırat ◽  
Elif Bulut ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Fresh Frozen Plasma ◽  
Systemic Lupus ◽  
Herbal Products ◽  
Spinal Subdural Hematoma ◽  
Anticoagulant Drug ◽  
Fresh Frozen ◽  
Cerebral Hematoma

Abstract Objectives Thrombotic events are common in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Warfarin is the most commonly used anticoagulant drug for thrombosis treatment, but it is can interact with many drugs, foods, or medicinal herbs. Herein, we presented a case with SLE and APS who was complicated by spinal and cerebral hematoma as a result of warfarin interaction. Case presentation Spinal subdural hematoma and frontal intraparenchymal hematoma were occurred in our patient, who was in remission for 2 years with rituximab, hydroxychloroquine and warfarin. We learned that she had been using some herbal products (shepherd’s purse and horsetail) and phenyramidol for a few days. Spinal and cerebral hematomas caused by the interaction of phenyramidol and warfarin were treated with fresh frozen plasma and vitamin K without the need for surgery. Conclusions The drug interactions with warfarin can cause fatal hemorrhagic or thrombotic events. Especially, the patients with SLE and/or APS using warfarin should be warned not to use different medications or herbal agents.

scholarly journals CIRURGIAS ORAIS EM PACIENTES EM USO DE VARFARINA: REVISÃO DE LITERATURA

2016 ◽  
Vol 7 (2) ◽  
Author(s):  
Marlus Da Silva Pedrosa ◽  
Jézlia Chris Da Silva Galdino ◽  
Flávia Ennes Dourado Ferro ◽  
José Guilherme Férrer Pompeu ◽  
Marcia Socorro da Costa Borba
Keyword(s):  
Drug Therapy ◽  
Anticoagulant Therapy ◽  
Dental Treatment ◽  
Oral Surgery ◽  
Thromboembolic Events ◽  
Risk Of Bleeding ◽  
Dental Procedures ◽  
Therapy Interruption ◽  
Anticoagulant Drug ◽  
Dental Offices

Introduction: Dental treatment performed in patients on anticoagulant drug therapy is becoming increasingly common in dental offices. Thus, questions concerning thromboembolic and bleeding risks relative to invasive dental procedures, are frequently raised. Aim: To review the scientific evidences regarding anticoagulant therapy interruption in patients taking warfarin undergoing oral surgeries. Methods: It was carried out a literature review in the electronic SciELO, PubMed, Lilacs and Oviatt Library databases from January to March of 2016, using as descriptors: Anticoagulants, Warfarin, Oral Surgery, and Oral Hemorrhage. Results and Discussion: Anticoagulant therapy is extremely important in patients at high risk for development of thromboembolic events. Most studies show that the risk of bleeding oral surgery in patients taking warfarin is relatively insignificant and it can be controlled by simple measures such as hemostasis. Conclusion: It is highly recommended to not interrupt anticoagulant in minor oral surgeries.

scholarly journals Current therapeutic approaches to haemostasis correction in covid-19: a systematic review

2021 ◽  
Vol 28 (4) ◽  
pp. 72-84
Author(s):  
V. N. Antonov ◽  
M. V. Osikov ◽  
G. L. Ignatova ◽  
S. О. Zotov
Keyword(s):  
Oral Anticoagulants ◽  
Russian Language ◽  
Medical Community ◽  
Therapeutic Value ◽  
Anticoagulant Drug ◽  
Potential Benefits ◽  
Downstream Analysis ◽  
Randomised Controlled ◽  
Direct Acting ◽  
Drug Efficiency

Background. The coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has swept across countries worldwide. Despite an unprecedented volume of research, few drug therapies have been proved effective. The lack of evidence-based strategies entailed many practical treatments. Hypercoagulability observed in COVID-19 patients has sparked a debate in the medical community on therapeutic value of anticoagulants.Objectives. A review of up-to-date evidence supporting the therapeutic effect of unfractionated and low molecular-weight heparin as anticoagulant in treatment for COVID-19. Methods. Russian-language and foreign literature was mined in the RSCI, Scopus, PubMed, medRxiv and eLibrary databases for the years 2020–2021, with considering selected impactive publications within 1991–2019 as well. The query keywords were COVID-19, heparin [гепарин], hemostasis [гемостаз], thromboembolism [тромбоэмболия]. Peer-reviewed scientific journals received priority. Content and descriptive analytics were used as research tools.Results. The review surveyed 84 literature sources, with 51 articles selected for downstream analysis. We highlight usage of heparin and its fractions in treatment for COVID-19 and preclinical evidence verifying the antiviral and anti-inflammatory properties of heparin and synthetic heparin-like drugs in COVID-19. The known and plausible side effects demanding additional prospective randomised controlled trials on anticoagulant application in COVID-19 are reviewed, with an assessment of oral direct-acting anticoagulant drug efficiency.Conclusion. Drug-based therapies for haemostasis correction in COVID-19 are currently limited. The paucity of evidence warrants heparin usage as a safer therapy in acute COVID-19 compared to oral anticoagulants. However, the balance of its potential benefits vs. risks must be observed. The benefits and risk uncertainty in heparin treatment require randomised clinical trials and further studies to evaluate safety of direct-acting oral anticoagulants after the patient’s discharge in COVID-19.

Thermal lens studies of the reaction of iron(II) with 1,10-phenanthroline at the nanogram level

2001 ◽  
Vol 369 (6) ◽  
pp. 535-542 ◽  
Author(s):  
Valerii V. Chernysh ◽  
Mikhail Yu. Kononets ◽  
M. A. Proskurnin ◽  
Svetlana V. Pakhomova ◽  
Vsevolod V. Komissarov ◽  
...  
Keyword(s):  
Thermal Lens ◽  
Nanogram Level

Underdosed Direct Oral Anticoagulants in Atrial Fibrillation Patients Reduce Stroke Severity and Improve Outcome

2021 ◽  
pp. 1-8
Author(s):  
Masaki Naganuma ◽  
Yuichiro Inatomi ◽  
Toshiro Yonehara ◽  
Makoto Nakajima ◽  
Mitsuharu Ueda
Keyword(s):  
Atrial Fibrillation ◽  
Functional Outcomes ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Anticoagulant Drugs ◽  
Scale Scores ◽  
Anticoagulant Drug ◽  
Ischemic Attack

<b><i>Background and Purpose:</i></b> Anticoagulant drugs, including vitamin K antagonist (VKA) and direct oral anticoagulants (DOACs), can reduce stroke severity and are associated with good functional outcomes. Some patients are prescribed lower-than-recommended doses of DOACs; whether these have similar effects has not been clarified. <b><i>Methods:</i></b> We retrospectively evaluated 1,139 consecutive ischemic stroke and transient ischemic attack patients with atrial fibrillation. Patients were divided into 5 groups according to their preceding anticoagulant drug therapies: no anticoagulant therapy (AC<sub>n</sub>), undercontrolling VKA doses (VKA<sub>uc</sub>), recommended, controlling VKA doses (VKA<sub>rec</sub>), prescribed underdoses of DOAC (DOAC<sub>ud</sub>), and recommended doses of DOAC (DOAC<sub>rec</sub>). We investigated the associations between these anticoagulant drug therapies and patients’ initial stroke severity and 3-month outcomes. <b><i>Results:</i></b> Median National Institutes of Health Stroke Scale scores at admission were as follows: AC<sub>n</sub>: 16, VKA<sub>uc</sub>: 15, VKA<sub>rec</sub>: 9, DOAC<sub>ud</sub>: 5, and DOAC<sub>rec</sub>: 7. When the AC<sub>n</sub> group was used as a reference, regression analysis showed that VKA<sub>rec</sub> (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.01–2.21), DOAC<sub>ud</sub> (OR 2.84, 95% CI: 1.47–5.66), and DOAC<sub>rec</sub> (OR 1.83, 95% CI: 1.23–2.74) were associated with milder stroke severity, while VKA<sub>uc</sub> was not. Median 3-month modified Rankin Scale scores were 2 in the DOAC<sub>ud</sub> and DOAC<sub>rec</sub> groups and 4 in all other groups. After adjusting for confounding factors, DOAC<sub>ud</sub> (OR 3.14, 95% CI: 1.50–6.57) and DOAC<sub>rec</sub> (OR 1.67, 95% CI: 1.05–2.64) were associated with good 3-month outcomes while VKA<sub>uc</sub> and VKA<sub>rec</sub> were not. <b><i>Conclusions:</i></b> In patients with atrial fibrillation, recommended doses and underdoses of DOACs reduced stroke severity on admission and were associated with good 3-month outcomes.

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