scholarly journals Anticoagulant Effects of Dabigatran in Paediatric Patients Compared with Adults: Combined Data from Three Paediatric Clinical Trials

2018 ◽  
Vol 118 (09) ◽  
pp. 1625-1636 ◽  
Author(s):  
Hugo Maas ◽  
Savion Gropper ◽  
Fenglei Huang ◽  
Joachim Stangier ◽  
Igor Tartakovsky ◽  
...  

Background Physiological age-related changes in the haemostatic and coagulation systems result in differing anticoagulant assay responses to standard anticoagulants. Therefore, we investigated the response of anticoagulant assays to dabigatran etexilate (DE) in children compared with adults. Objective This article assesses the relationship between plasma dabigatran concentration and coagulation assay results across age groups in children and adults. Patients and Methods Data from three clinical trials in which children received DE following standard of care for venous thromboembolism were compared with data from adult clinical trials. The effects of dabigatran concentration on diluted thrombin time (dTT), ecarin clotting time (ECT) and activated partial thromboplastin time (aPTT) were analysed graphically and with modelling. Results The concentration–dTT relationships were consistent in children across all ages and adults in the graphical analysis. For ECT and aPTT, relationships based on ratios over baseline were similar across all ages; absolute clotting times showed that the same exposure resulted in longer clotting times in some of the children aged < 1 year versus adults. Modelling showed concentration–clotting time relationships for all three assays were largely comparable between adults and children, except in those aged < 2 months, in whom there was a slight upward shift in ECT and aPTT relative to adults. Conclusion Results suggest that developmental haemostatic changes will have little impact on response to DE. However, further paediatric clinical trials assessing the relationship between coagulation assay responses and clinical outcomes will be needed to confirm this finding.

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S257-S257
Author(s):  
Rehab A Sherlala ◽  
Candace M Kammerer ◽  
Allison L Kuipers ◽  
Mary K Wojczynski ◽  
Svetlana Ukraintseva ◽  
...  

Abstract Serum levels of insulin-like growth factor 1 (IGF-1) and measures of adiposity, such as body mass index (BMI), are associated with susceptibility to age-related diseases. Previous reports of the relationship between IGF-1 and BMI ranged from positive to negative to no relationship, perhaps because previous reports studied different age cohorts. Using data on 4270 participants (aged 24-110 years) from the Long Life Family Study, we investigated the relationship between IGF-1 and BMI overall and by age groups. IGF-1 and BMI were positively correlated in the total sample (β=0.161, r2= 0.0038, p=1.8-05). However, further analyses revealed that the relationship between IGF-1 and BMI varied by age quartile: in the 1st quartile (24-58yo) the relationship was negative (β=−0.204, r2= 0.011, p=0.0008); in the 2nd quartile (59-66yo) the relationship was negative but non-significant (β=−0.069, r2= 0.0012, p=0.28); in the 3rd quartile (67-86yo) the relationship was positive but non-significant (β=0.106, r2= 0.002, p=0.13); and in the 4th quartile (87-110yo) the relationship was positive (β=0.388, r2= 0.019, p=1.2−05). This pattern did not differ by sex. We also detected a similar age-related pattern between IGF-1 and BMI using an independent dataset (NHANES III), comprising 2550 men and women aged 20-90 years. Our results may clarify some of the inconsistency in previous literature about the relationship between IGF-1 and BMI. Additional studies of IGF-1 and adiposity measures are needed to better understand the underlying mechanisms involved.


Author(s):  
Rehab A Sherlala ◽  
Candace M Kammerer ◽  
Allison L Kuipers ◽  
Mary K Wojczynski ◽  
Svetlana V Ukraintseva ◽  
...  

Abstract Background Serum levels of insulin-like growth factor 1 (IGF-1) and body mass index (BMI) are both associated with susceptibility to age-related diseases. Reports on the correlation between them have been conflicting, with both positive to negative correlations reported. However, the age ranges of the participants varied widely among these studies. Methods Using data on 4241 participants (aged 24–110) from the Long Life Family Study, we investigated the relationship between IGF-1 and BMI by age groups using regression analysis. Results When stratified by age quartile, the relationship between IGF-1 and BMI varied: in the first quartile (Q1, 20–58 years) the relationship was negative (β = −0.2, p = .002); in Q2 (58–66 years) and Q3 (67–86 years) the relationship was negative (β = −0.07, β = −0.01, respectively) but nonsignificant; and in Q4 (87–110 years) the relationship was positive (β = 0.31, p = .0002). This pattern did not differ by sex. We observed a similar age-related pattern between IGF-1 and BMI among participants in the third National Health and Nutritional Examination Survey. Conclusions Our results that the relationship between IGF-1 and BMI differs by age may explain some of the inconsistency in reports about their relationship and encourage additional studies to understand the mechanisms underlying it.


2003 ◽  
Vol 88 (1) ◽  
pp. 185-191 ◽  
Author(s):  
Reinhold Vieth ◽  
Yasmin Ladak ◽  
Paul G. Walfish

Vitamin D requirements are thought to vary with age, but there is little comparative evidence for this. One goal in establishing a vitamin D requirement is to avoid secondary hyperparathyroidism. We studied 1741 euthyroid, thyroid clinic outpatients without evidence of calcium abnormalities, ranging in age from 19 to 97 yr, whose serum and urine had been analyzed for calcium, vitamin D, and parathyroid status. We found no effect of age on the 25-hydroxyvitamin D [25(OH)D] concentration associated with specific vitamin D intakes, and there was no relationship between 25(OH)D and 1,25hydroxyvitamin D [1,25(OH)2D]. In every age group, serum 1,25(OH)2D declined with increasing creatinine (P &lt; 0.001). What changed with age included creatinine, which correlated with 25(OH)D (r = 0.146, P &lt; 0.001) only in the youngest age group (19–50 yr) but not in the older age groups (P &gt; 0.1). Creatinine did not correlate with PTH in the youngest age group, but the relationship became significant as age increased (e.g. for the elderly, r = 0.365, P &lt; 0.001). Linear regression of log PTH vs. log 25(OH)D agreed with the natural shape of the relationship observed with scatterplot smoothing, and this showed no plateau in PTH as 25(OH)D increased. We compared PTH concentrations among age groups, based on 20 nmol/liter increments in 25(OH)D. Mean PTH in adults older than 70 yr was consistently higher than in adults younger than 50 yr (P &lt; 0.05 by ANOVA and Dunnett’s t test). PTH levels of the elderly who had 25(OH)D concentrations greater than 100 nmol/liter matched PTH of younger adults having 25(OH)D concentrations near 70 nmol/liter. This study shows that all age groups exhibit a high prevalence of 25(OH)D insufficiency and secondary hyperparathyroidism. Older adults are just as efficient in maintaining 25(OH)D, but they need more vitamin D to produce the higher 25(OH)D concentrations required to overcome the hyperparathyroidism associated with their diminishing renal function.


1992 ◽  
Vol 262 (5) ◽  
pp. R826-R833 ◽  
Author(s):  
G. Geelen ◽  
B. Corman

The relationship between arginine vasopressin (AVP) secretion and the age-related change in renal concentrating ability was studied in 10-, 20-, and 30-mo-old conscious rats. In control condition, urine osmolality (Uosmol) was 2,358 +/- 99, 1,919 +/- 87, and 1,135 +/- 173 mosmol/kgH2O (mean +/- SE) and the corresponding plasma AVP concentration 3.1 +/- 1.2, 2.8 +/- 0.7, and 3.3 +/- 0.7 pg/ml at 10, 20, and 30 mo. Urinary AVP excretion and AVP content in the hypothalamus were comparable in the 3 age groups, while the basal AVP pituitary content was significantly higher at 10 than at 20 or 30 mo. Three days of dehydration induced 1) a similar increase in plasma concentration and urinary excretion of AVP in the 3 groups, even though the maximal Uosmol reached by the oldest animals was significantly reduced (3,988 +/- 218, 3,652 +/- 273, and 2,826 +/- 197 mosmol/kgH2O at 10, 20, and 30 mo, respectively) and 2) a similar AVP depletion of the pituitary at 10, 20, and 30 mo and an increase of the AVP content in the hypothalamus at 10 mo but not at 20 and 30 mo. These results suggest that the decrease in renal concentrating ability reported in aging rats is not due to an inappropriate secretion of AVP along the hypothalamo-neurohypophysial axis but is rather related to an impaired responsiveness of the kidney to the antidiuretic hormone.


2012 ◽  
Vol 107 (05) ◽  
pp. 985-997 ◽  
Author(s):  
Séverine Robert ◽  
Christian Chatelain ◽  
Jonathan Douxfils ◽  
François Mullier ◽  
Bernard Chatelain ◽  
...  

SummaryDue to low bioavailability and high inter-individual variability, monitoring of dabigatran may be required in specific situations to prevent the risk of bleedings or thrombosis. The aim of the study was to determine which coagulation assay(s) could be used to assess the impact of dabig-atran on secondary haemostasis. Dabigatran was spiked at concentrations ranging from 4.7 ng/ml to 943.0 ng/ml in pooled citrated human platelet-poor plasma. The following clotting assays were performed: prothrombin time (PT); activated partial thromboplastin time (aPTT); thrombin time (TT); ecarin clotting time (ECT); ecarin chromo-genic assay (ECA); prothrombinase-induced clotting time (PiCT); activated clotting time (ACT); Hemoclot Thrombin Inhibitor (HTI) and thrombin generation assay (TGA). A concentration-dependent prolongation of PT, dPT, and aPTT was observed with aPTT being the more sensitive test. The results varied mostly due to the clotting reagent. HTI, ECT and TGA were the most sensitive tests but are not available 24 hours a day. In addition, HTI showed a linear correlation with a good reproduci-bility. Dabigatran induced a concentration-dependent delay and inhibition of tissue factor-induced TGA. Cut-offs related with higher risk of bleedings or thrombosis were defined for each reagent of aPTT and HTI. In conclusion, aPTT could be used for the monitoring of dabigatran and as screening test for the risk of overdose. However, because of its higher sensitivity, good reproducibility, excellent linear correlation at all doses, its simplicity of use, and possibilities of automation, HTI should be considered as the gold-standard.


Safety ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. 31 ◽  
Author(s):  
Danielle H. Taylor ◽  
Richard C. Franklin ◽  
Amy E. Peden

Aquatic competencies have been proposed as a prevention strategy for children aged 2–4 years who are over-represented in drowning statistics. For this recommendation to be made, exploration of the connection between aquatic competencies and drowning is required. This review critically analyzed studies exploring aquatic competencies and their effect on drowning and/or injury severity in children 2–4 years. English language peer-reviewed literature up to 31 July 2019 was searched and the PRISMA process utilized. Data were extracted from twelve studies that fulfilled the inclusion criteria. Findings from this study included that aquatic competencies were not found to increase risk of drowning and demonstrated children aged 2–4 years are capable of developing age-appropriate aquatic competencies. Age-appropriate aquatic competencies extracted were propulsion/locomotion, flotation/buoyancy, water familiarization, submersion and water exits. The acquisition of these competencies holds benefit for the prevention of drowning. No evidence was found relating to injury severity. There was limited exploration of the relationship between aquatic competencies attainment and age-related developmental readiness. The review highlights the need for consistent measures of exposure, clarity around skills acquisition, better age-specific data (2 years vs. 3 years vs. 4 years), studies with larger sample sizes, further exploration of the dose–response relationship and consistent skill level testing across age groups. Further investigation is required to establish the efficacy of aquatic competencies as a drowning prevention intervention, as well as exploring the relationship between aquatic competencies and age-related developmental readiness. In conclusion, early evidence suggests aquatic competencies can help to reduce drowning.


1970 ◽  
Vol 12 (3) ◽  
pp. 130-134
Author(s):  
Surabhi Sharma ◽  
Satyaswarup Tripathy ◽  
Syed Ali Raza Rizvi

Aim: To ascertain the association between different types and densities of age-related cataract with axial length and refractive state of the eye.Methods: This prospective observational institute-based study enrolled 462 eyes of 450 patients aged 40 years or older. Eyes were classified as myopic (axial length, >25 mm), emmetropic (axial length, 21-25 mm), and hypermetropic (axial length, <21 mm). Refractive error was defined as myopia (spherical equivalent, <-0.5 D) and hypermetropia (spherical equivalent, >+0.5 D). Cataract was categorised as nuclear, cortical, or posterior subcapsular. Nuclear density was measured based on the Emery and Little Classification after slit-lamp biomicroscopy. Student t test for unpaired samples and Fisher and Yates tables were used to analyse statistical significance.Results: Emmetropia was the most common condition (417 eyes). The most common cataract combination was nuclear with posterior subcapsular (n = 198; 44%). In the axial myopia group, nuclear cataract was thecommonest type, alone or in combination with other types (n = 33; 100%). Most eyes had refractive error of 0 to -5 D. The grade of nuclear cataract increased with increasing age (n = 48 for grade IV nuclear cataract in the 70 to 79 years age group). In all age groups, a higher grade of nuclear sclerosis was significantly associated with axial length (t = 2.2; p < 0.05). The relationship was also significant for posterior subcapsular cataract (t = 2.7; p < 0.05).Conclusions: Nuclear cataract leads to a myopic shift in refraction. In otherwise healthy eyes, there is a gradual hypermetropic shift. The prevalence and grade of nuclear cataract increases with age. Longer axial length is associated with a higher grade of nuclear and posterior subcapsular cataract.


1987 ◽  
Vol 65 (10) ◽  
pp. 2417-2420 ◽  
Author(s):  
Ray T. Alisauskas ◽  
C. Davison Ankney

We analyzed the relationship between age and nutrient reserves of 186 American Coots, Fulica americana, collected in southern Manitoba during the breeding season in 1981. The first principal component from the correlation matrix of 13 morphological variables was used as the measure of body size. Protein reserves, as indexed by lean dry weight, and fat reserves were related to body size, but the relationship for fat reserves was weak. The oldest coots of each sex were the largest, and this partly explained their larger protein reserves compared with the youngest coots. However, by scaling different sex–age groups to the same body size, we found that older coots had relatively larger protein reserves before breeding than did younger coots. Males and females did not differ in relative protein reserves, but females had relatively more fat reserves than did males. The results also indicated that body size is an important consideration in studies of nutrient reserve dynamics.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3332-3332
Author(s):  
Severine Robert ◽  
François Mullier ◽  
Hassan Mekouar ◽  
Florence Polet ◽  
Jonathan Douxfils ◽  
...  

Abstract Abstract 3332 Introduction: Recently, 2 oral anticoagulants have been marketed: dabigatran, a direct thrombin inhibitor, and rivaroxaban, a direct FXa inhibitor. Thanks to their safety and efficacy profiles, routine coagulation monitoring is generally not required. However, the most commonly reported adverse reactions with these drugs are bleedings. A sensitive laboratory assay might be valuable to measure the pharmacodynamics of these 2 drugs in different situations including risks of drug interaction (i.e. strong P-gp inhibitors), overdose or to measure patient compliance. Due to their different mechanism of action, the measurement of their anticoagulant level in plasma may require different types of clotting assays. Aims: The aim of the present study was to determine which coagulation assay(s) could be used to measure the impact of rivaroxaban and dabigatran among a range of routine or more specific tests. Methods: Both drugs were spiked at increasing concentrations in pooled citrated normal human platelet-poor plasma (PPP). The final concentrations were ranging from 10 nM to 2 μM for dabigatran and from 25 nM to 5 μM for rivaroxaban. Such concentrations covered the plasma range in patients during orthopedic surgery. The following routine clotting assays were performed with the spiked plasma according to the manufacturer's protocols: Prothrombin Time (PT) with Neoplastin CI+ and Neoplastin R on STA-R (Roche Diagnostics), with Innovin on BCS (Siemens) and with Recombiplastin on ACL-TOP (Instrumentation Laboratories); activated Partial Thromboplastin Time (aPTT) with CK-Prest, PTT-A and Cephascreen on STA-R, with Actin FS on BCS and with Synthasil on ACL TOP and Thrombin Time (TT) on STA-R. More specific tests included Prothrombinase-induced Clotting Time (PiCT, Pefakit®, Pentapharm) and Ecarin Clotting Time (ECT) on STA-R; dilute PT (dPT) and activated Clotting time (ACT) on KC10. Thrombin Generation Tests (TGT) were also performed with Calibrated Automated Thrombogram (CAT) using PPP or PPP LOW reagents (Thrombinoscope). Sensitivity of a coagulation assay was defined as the concentration required to double clotting time (2XCT). Results: Dabigatran. A concentration-dependent prolongation of PT, dPT and aPTT was observed. However, at high concentrations, sensitivity of aPTT decreased whereas sensitivity of PT increased. The results varied depending on the clotting reagent used. TT was too sensitive leading to high variability for concentrations higher than 250nM. PiCT showed a linear concentration coagulation time (CT) relationship until a plateau at 750nM. ECT showed a high sensitivity (2X CT &ap; 93 nM), a linear relationship in the whole concentration range and a very low variability (CV≤ 1,8%). ACT gave a similar profile to PT (Innovin) with a slightly higher sensitivity (2X CT &ap; 716 nM vs 842nM). Dabigatran induced a concentration-dependent delay and inhibition of the tissue factor-induced thrombin generation with 5 pM TF or 1 pM TF with 4 μM PL and 16.7 mM CaCl2. The drug strongly increased the lag time and Tmax whereas it slightly decreased the Cmax and ETP. The lag time was the most sensitive CAT parameter with a high sensitivity (2x lag time &ap; 145 nM) and a low variability (CV≤6%). Rivaroxaban. A concentration-dependent prolongation of PT, dPT and aPTT was observed. However, at high concentrations, sensitivity of aPTT increased. Sensitivity of dPT (2X CT &ap; 109 to 550 nM) and PT (2X CT &ap; 138 to 764 nM) were similar and superior to aPTT (2X CT &ap; 897 to 2050 nM). The results varied depending on the clotting reagent used. TT was insensitive to rivaroxaban until 2500nM. Both PiCT and ECT showed a low sensitivity (2X CT &ap; 2536 nM and 5750 nM, respectively). A concentration-dependent prolongation of ACT was observed until 2500nM (2X CT &ap; 2275 nM). Rivaroxaban induced a concentration-dependent reduction and delay of the TF-induced thrombin generation. The Cmax was more strongly decreased than the ETP whereas the Tmax was more prolonged than the lag time, showing a major influence on the amplification phase. The Cmax was the most sensitive CAT parameter with a high sensitivity (Cmax EC50 &ap; 50 nM) and a low variability (CV<1%). Conclusions: ECT and PT are the most appropriate tests to study the pharmacodynamic effects of dabigatran and rivaroxaban respectively, thanks to high sensitivity, linear relationship in the whole concentration range and low variability. Disclosures: No relevant conflicts of interest to declare.


2018 ◽  
Vol 63 (1) ◽  
pp. 5-27 ◽  
Author(s):  
А. Котеров ◽  
A. Koterov ◽  
Л. Ушенкова ◽  
L. Ushenkova ◽  
Э. Зубенкова ◽  
...  

Purpose: Survey-synthetic study of published scientific data on the relationship between the ages of the most used laboratory animals (mice, rats, hamsters and dogs) and humans to obtain the corresponding formula dependencies and calibration curves. Basis: The work is a preamble for a more extensive analysis of data on the age-related radiosensitivity of animals as applied to the extrapolation of the revealed patterns to humans. The presented introductory review of the history of research in this field showed that the main works were carried out in the 1950s – 1960s, and, much less, in the 1970s, and the results, apparently, produced almost nothing for practical radiation medicine and radiation safety. Investigations of the relationship between the age and the radiosensitivity for the human which were exposed to total irradiation in significant doses were practically not found although such data are important because of the permanent threat of nuclear incidents and terrorism. In this regard, the quantitative transfer of the corresponding dependencies, identified for various species of animals, on the situation with acute human radiation syndrome continues to be relevant. In its entirety, according to our analysis of sources it has not been carried out until now, including the documents of UNSCEAR, ICRP, WHO, and others. Material and methods: Data on physiological age periods and their boundaries for animals and humans, published in reliable scientific sources, were used for calculations and general analysis. Based on the extracted values (from tables and one chart of originals), using the IBM SPSS and Statistica programs, a formula was derived for the ‘standard’ dependencies on ‘age of the animal – age of the human’ and a corresponding calibration schedule was constructed. Both direct and indirect data were used. In the first case (mice, rats, dogs) we used the data for direct comparison of the age periods of animals and humans and in the second (mice, rats, hamsters) we used the quantitative information about a particular age period for an animal. It allowed us to conduct own comparison of such data with a similar period of human life. Results: ‘Standard’ formulas were derived and ‘standard’ calibration curves were obtained, which made it possible to compare the age of mice, rats, hamsters and dogs with human age. In parallel, it turned out that many of the so-called ‘calculators’ in the English and Russian-language Internet, which can translate the age of almost any animal into human age (according to the statements of their developers), give the mistakes at comparative estimates with the observed dependencies on the basis of scientific data (difference up to 20–60 %). Conclusions: The obtained data fill the existing scientific gaps, creating the prerequisites for both comparison of the parameters of the age-related radiosensitivity of laboratory animals and humans (important for radiation safety) and for use in other experimental areas of biomedical disciplines. On the basis of detailed approaches to the problem considered in the paper, it is possible to derive similar relationships for the age of any other animal and human.


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