Genetic Modulation of Oral Anticoagulation with Warfarin

2000 ◽  
Vol 84 (11) ◽  
pp. 775-778 ◽  
Author(s):  
Donatella Colaizzo ◽  
Giovanna D’Andrea ◽  
Vincenzo Brancaccio ◽  
Antonio Ciampa ◽  
Elvira Grandone ◽  
...  
Keyword(s):  
Bleeding Complication ◽  
Bleeding Complications ◽  
Gene Variants ◽  
Risk Of Bleeding ◽  
Cyp2c9 Gene ◽  
Small Doses ◽  
Local Bleeding ◽  
Estimated Risk ◽  
Adjusted Dose ◽  
Anticoagulation Intensity

SummaryCytochrome P450 CYP2C9 gene variants have been associated with hyperresponsiveness to small doses of warfarin and a higher bleeding complication rate. The aim of this study was to investigate whether CYP2C9 gene variants affect doses of drug prescribed to acquire the target anticoagulation intensity and the occurence of bleeding complications. In a cohort of 180 patients followed up at one specialized clinic from the start of the anticoagulation with warfarin, we have investigated whether CYP2C9 gene variants have affected doses of drug prescribed to acquire the target anticoagulation intensity and the incidence of bleeding complications.The adjusted dose required of warfarin was higher among patients with the CYP2C9*1 haplotype (5.6 mg) than those of patients carrying the CYP2C9*2 (4.7 mg; p = 0.007, Scheffé’s test) or the CYP2C9*3 haplotype (4.0 mg; p <0.001, Scheffé’s test). The occurrence of bleeding complications was more frequent among patients with the CYP2C9*2 and/or the CYP2C9*3 haplotype than in carriers of the CYP2C9*1 haplotype (OR: 2.57; 95% CI: 1.16–5.73). An interaction between the presence of local bleeding sources and the CYP2C9*2 and/or the CYP2C9*3 haplotype was observed (p <0.001). Patients with both local sites of potential bleeding and CYP2C9*2 and/or the CYP2C9*3 haplotype had the higher estimated risk of bleeding (OR: 12.81; 95% CI: 2.86–57.26).CYP2C9 gene variants modulate the anticoagulant effect of the dose of warfarin prescribed. The incidence of bleeding complications in CYP2C9*2 and CYP2C9*3 carriers was significantly higher than that in noncarriers and interacted with the presence of local bleeding sources.

scholarly journals Dental Extraction Can Be Performed Safely in Patients on Aspirin Therapy: A Timely Reminder

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Gaurav Verma
Keyword(s):  
Bleeding Complication ◽  
Tooth Extraction ◽  
Case Reports ◽  
Aspirin Therapy ◽  
Bleeding Complications ◽  
Thromboembolic Events ◽  
Excessive Bleeding ◽  
Risk Of Bleeding ◽  
Theoretical Risk ◽  
Timely Reminder

Cardiac patients on aspirin therapy may require extractions for their diseased teeth. It is a common practice among physicians and treating surgeons to stop aspirin prior to tooth extraction because of fear of bleeding complications. This practice often predisposes the patient to adverse thromboembolic events. This practice is based on theoretical risk of bleeding and on isolated case reports of excessive bleeding with aspirin therapy. The current consensus and recommendations are in favor of continuing aspirin therapy during simple tooth extraction as the bleeding complication incidence is very less and if it occurs can be controlled efficiently with local hemostasis measures.

Subcutaneous Heparin in the Prevention of Venous Thrombosis After Elective Aortic Bifurcation Graft Surgery

1979 ◽  
Author(s):  
J.J.F. Belch ◽  
G.D.O. Lowe ◽  
J.G. Pollock ◽  
C.D. Forbes ◽  
C.R.M. Prentice
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Controlled Trial ◽  
Bleeding Complications ◽  
Aortic Bifurcation ◽  
Double Blind ◽  
Risk Of Bleeding ◽  
Subcutaneous Heparin ◽  
Calcium Heparin ◽  
Intravenous Sodium

In a randomised double-blind controlled trial 24 patients undergoing elective aortic bifurcation graft surgery received subcutaneous calcium heparin (2, 500 u preoperatively then 5,000 u 12 hourly or 7 days) and 25 control patients received saline injections. All patients received the routine dose of intravenous sodium heparin intraoperatively. The trial was terminated because of excess bleeding complications in patients on subcutaneous heparin (8 vs. 1, p<0.05). Deep venous thrombosis was diagnosed by 125I-fibrinogen scanning in 8 control patients and 3 patients on heparin (p>0.05). In this group of patients the risk of bleeding due to subcutaneous heparin appeared to outweigh the benefit of thrombotic prophylaxis.

scholarly journals Current Concepts on Antiplatelet Therapy: Focus on the Novel Thienopyridine and Non-Thienopyridine Agents

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
L. Testa ◽  
G. G. L. Biondi Zoccai ◽  
M. Valgimigli ◽  
R. A. Latini ◽  
S. Pizzocri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Practice ◽  
Drug Targeting ◽  
Bleeding Risk ◽  
Daily Practice ◽  
Adenosine Diphosphate ◽  
Bleeding Complications ◽  
The Novel ◽  
Platelet Activity ◽  
Risk Of Bleeding

Thienopyridines are a class of drug targeting the platelet adenosine diphosphate (ADP) 2 receptor. They significantly reduce platelet activity and are therefore clinically beneficial in settings where platelet activation is a key pathophysiological feature, particularly myocardial infarction. Ticlopidine, the first of the class introduced to clinical practice, was soon challenged and almost completely replaced by clopidogrel for its better tolerability. More recently, prasugrel and ticagrelor have been shown to provide a more powerful antiplatelet action compared to clopidogrel but at a cost of higher risk of bleeding complications. Cangrelor, a molecule very similar to ticagrelor, is currently being evaluated against clopidogrel. Considering the key balance of ischemic protection and bleeding risk, this paper discusses the background to the development of prasugrel, ticagrelor, and cangrelor and aims to characterise their risk-benefit profile and possible implementation in daily practice.

Anticoagulation Regimens and Interventional Pain Procedures

2018 ◽  
Author(s):  
Christine Oryhan ◽  
Kevin Vorenkamp ◽  
Daniel Warren
Keyword(s):  
Chronic Pain ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Patient Characteristics ◽  
The United States ◽  
Bleeding Complications ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Spinal Epidural ◽  
The Ideal

With the aging population and new anticoagulant medications, such as direct oral anticoagulants, being marketed in the United States, it is very important for pain physicians to be aware of the anticoagulants available and how they affect the safety of interventional pain procedures. In addition to anticoagulant and antiplatelet medications, other medications commonly used in the chronic pain population may put patients at increased risk of bleeding complications. Certain patient characteristics, particularly in the chronic pain population, may also increase a patient’s risk of bleeding. The chapter reviews common and emerging anticoagulant and antiplatelet medications and the ideal holding time before or after interventional pain procedures, particularly in the spine. The chapter also discusses the diagnosis, treatment, and outcomes of spinal epidural hematomas.

Effect Of Intracoronary And Systemic Thrombolysis With Streptokinase In Patients With Acute Myocardial Infarction And Unstable Angina Pectoris. On Coagulation Tests And Plasminogen

1981 ◽  
Author(s):  
H Kösteriag ◽  
K L Neuhaus ◽  
U Kasten ◽  
J Schrader ◽  
U Artmann ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Blood Coagulation ◽  
Coronary Arteries ◽  
Bleeding Complication ◽  
Coagulation System ◽  
Bleeding Complications ◽  
Small Decrease ◽  
Mean Values ◽  
Systemic Thrombolysis

Streptokinase, aplicated by intracoronary infusion in pat. with acute myocardial infarction has proven to be successfull in recanalisation of occluded coronary arteries. The good clinical, angiographic, chemical and EKG results suggests that jeopardized myocardium was salvaged by acute recanalisation. Till now, we infused Streptokinase (about 2000 U/min) in 78 pat. into the ischemia related occluded coronary artery. In this presentation we intend to demonstrate the results of these pat. and of a study, done before starting intracoronary Streptokinase infusion to be safe for bleeding complication. Neither after the infusion of 50 000 U.(n = 24) of 100 000 U. (n = 15) nor in 20 pat. who received SK equal to their ASTK-titres plus 50 000 U. SK whe found severe alterations of the blood-coagulation system. Only in the last group there was a small decrease of Fibrinogen of about 100 mg% and of Plasminogen 4 mg%. In none of the 78 pat., treated by intracoronary SK aplication, we resulted bleeding complication and the mean values of blood coagulation test remained within the normal range. On the other hand, we infused SK by veins and controlled the thrombolytic effect by coronarangiography. In 5 of 6 pat. we succeded in recanalisation of occluded coronary arteries within 45 Used very high dosages of SK, (about 2 Mill U) there was only a small decrease of 210 mg of Fibrinogen and no bleeding complications.

Identification of Adverse Drug Reactions by Evaluation of a Prescription Database, Demonstrated for “Risk of Bleeding”

2005 ◽  
Vol 44 (05) ◽  
pp. 697-703 ◽  
Author(s):  
J. Westendorf ◽  
R. Diebow ◽  
M. Kieser ◽  
W. Gaus
Keyword(s):  
Adverse Drug Reactions ◽  
Cholinesterase Inhibitors ◽  
Risk Profile ◽  
Bleeding Complications ◽  
Prescription Database ◽  
Drug Reactions ◽  
Risk Of Bleeding ◽  
Antidementia Drugs ◽  
Glutamate Modulators ◽  
Prescription Databases

Summary Objective: Information about adverse drug reactions plays an important role when assessing the benefit/risk profile of a drug. Identifying rare adverse drug reactions, however, is a difficult task. This paper illustrates the advantages of using a prescription database for this purpose. Methods: The mediplus® database used in our analysis covered data from 320,644 outpatients observed between July 1999 and June 2002. The example of bleeding complications during intake of antidementia drugs is used to illustrate this approach. The comparison of cohorts and subgroups is nearly always a problem in surveys. For our analyses we considered a set of patients who had taken a selected medication for a certain period of time and compared the frequency of adverse events with those occurring when the same patients did not take this medication. Hence, the comparison with versus without a certain medication is based on the same set of patients as in a cross-over study. Results: Our evaluations indicate that the rate of bleeding complications is low when taking any of the widely used antidementia drugs, glutamate modulators, cholinesterase inhibitors, calcium antagonists or the phytomedicine Ginkgo biloba. Conclusion: Basing the comparison of the rates of complications during periods with and without intake of a certain drug on the same set of patients may be a useful tool for assessing adverse drug reactions from data reported in prescription databases.

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