Cangrelor PK/PD analysis in post‐operative neonatal cardiac patients at risk for thrombosis

SummaryAntiphospholipid antibodies (aPL) characterize patients at risk for both arterial and venous thrombotic complications. Recently it has been recognized that the presence of plasma proteins such as β2-glycoprotein I (β2GPI) and prothrombin are essential for the binding of aPL to phospholipids and that these proteins are probably the real target of aPL. The discovery of these new antigens for aPL introduces the possibility of new assays to detect the presence of aPL. However, it is not known whether these assays improve the identification of patients at risk for thrombosis.In this retrospective study we compared the value of the classic assays LAC (lupus anticoagulant) and ACA (anticardiolipin antibodies) to detect aPL associated with thrombotic complications, with new assays which are based on the binding of aPL to the plasma proteins prothrombin and P2GPI. To do so, we have used these assays in a group of 175 SLE patients and correlated the positivity of the different assays with the presence of a history of venous and arterial thrombosis. Control groups were patients without SLE but with LAC and/or ACA and thrombosis (n = 23), patients with thrombosis without LAC and ACA (n = 40) and 42 healthy controls.In the univariate analysis, in which no distinction has been made between high and low antibody levels, we confirmed LAC and ACA to be related to both arterial and venous thrombosis. Anti-β2GPI- and anti-prothrombin-antibodies, both IgG and IgM correlate with venous thrombosis and anti-β2GPI-IgM with arterial thrombosis. Multivariate analysis showed that LAC is the strongest risk factor (OR 9.77; 95% CI 1.74-31.15) for arterial thrombosis. None of the other factors is a significant additional risk factor. For venous thrombosis LAC is the strongest risk factor (OR 6.55; 95% Cl 2.36-18.17), but ACA-IgM above 20 MPL units also appeared to be a significant (p = 0.0159) risk factor (OR 3.90; 95% Cl 1.29-11.80). Furthermore, the presence of anti-β2GPI- and/or anti-prothrombin-antibodies in LAC positive patients (n = 60) does not increase the risk for thrombosis.The results showed that (i) the LAC assay correlates best with a history of both arterial and venous thrombosis and (ii) neither the anti-P2GPI ELISA nor the anti-prothrombin ELISA gives additional information for a thrombotic risk in SLE patients.

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Intraoperative Identification of Cardiac Patients at Risk to Develop Postoperative Atrial Fibrillation

Annals of Surgery ◽

10.1097/00000658-199105000-00002 ◽

1991 ◽

Vol 213 (5) ◽

pp. 388-392 ◽

Cited By ~ 26

Author(s):

JAMES E. LOWE ◽

PAUL J. HENDRY ◽

STEVEN C. HENDRICKSON ◽

RANDALL WELLS

Keyword(s):

Atrial Fibrillation ◽

At Risk ◽

Postoperative Atrial Fibrillation ◽

Cardiac Patients ◽

Patients At Risk

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Cardiogastroenterology: Management of Elderly Cardiac Patients at Risk of GIB

Current Treatment Options in Gastroenterology ◽

10.1007/s11938-021-00361-y ◽

2021 ◽

Author(s):

Kimberly Huynh ◽

Neena S. Abraham

Keyword(s):

At Risk ◽

Cardiac Patients ◽

Patients At Risk

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Cluster analysis: a useful technique to identify elderly cardiac patients at risk for poor quality of life

Quality of Life Research ◽

10.1007/s11136-007-9272-7 ◽

2007 ◽

Vol 16 (10) ◽

pp. 1655-1663 ◽

Cited By ~ 25

Author(s):

Yoshimi Fukuoka ◽

Teri G. Lindgren ◽

Sally H. Rankin ◽

Bruce A. Cooper ◽

Diane L. Carroll

Keyword(s):

Quality Of Life ◽

At Risk ◽

Cluster Analysis ◽

Poor Quality ◽

Cardiac Patients ◽

Patients At Risk

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Preventing Medication Errors in Ambulatory Care: The Importance of Establishing Regimen Concordance

Journal of Medical Regulation ◽

10.30770/2572-1852-93.3.20 ◽

2007 ◽

Vol 93 (3) ◽

pp. 20-28

Author(s):

Dean Schillinger ◽

Eddie Machtinger ◽

Frances Wang ◽

Maytrella Rodriguez ◽

Andrew Bindman

Keyword(s):

At Risk ◽

Repeated Measures ◽

Odds Ratio ◽

Oral Anticoagulants ◽

Medication Management ◽

International Normalized Ratio ◽

Effective Care ◽

Hemorrhagic Events ◽

Patients At Risk ◽

Risk For Thrombosis

ABSTRACT Objective: Miscommunication between patients and providers can have serious consequences—especially where medications are concerned. Because oral anticoagulants are associated with preventable adverse events at disproportionately high rates, we used the model of anticoagulant care to examine the extent to which regimen discordance between patient and provider contributes to unsafe medication management. Methods: We performed a study among 220 long-term users of warfarin in an anticoagulation clinic to characterize the importance of two medication assessment components. We measured (1) adherence to warfarin by asking patients to report any missed doses during the prior 30 days, and (2) concordance between patients’ and providers’ reports of prescribed warfarin regimens. We categorized patients as having complete adherence if they missed no doses and regimen concordance if there was patient-provider agreement in the total weekly dosage. We examined the independent relationships between (a) adherence and anticoagulant outcomes, and (b) concordance and anticoagulant outcomes. We characterized anticoagulant outcomes as unsafe if international normalized ratio (INR) values either were < 2.0 (at risk for thrombosis) or > 4.0 (at risk for hemorrhage) over 90 days, using repeated measures analysis. Results: One hundred fifty-five patients (70.5 percent) reported no missed warfarin doses during the prior 30 days. In multivariate models, poor adherence was associated with under-anticoagulation (adjusted odds ratio [AOR] = 2.33; 95% confidence interval [CI] = 1.56–3.45; P < 0.001), but not with over-anticoagulation (AOR = 1.36; 95% CI = 0.69–2.66; P = 0.38). One hundred ten patients (50 percent) reported warfarin regimens that were discordant with respect to the clinicians’ report. Among adherent patients, discordance was associated with both under-anticoagulation (AOR = 1.67; 95% CI = 1.00–2.78; P = 0.05) and over-anticoagulation (AOR = 3.44; 95% CI = 1.32–9.09; P = 0.01). There was no relationship between patients’ reports of adherence and concordance (odds ratio [OR] = 1.14 95% CI = 0.64–2.04; P = 0.66). Conclusion: Discordance between clinicians and patients regarding warfarin regimens is unsettlingly common and places patients at risk for thromboembolic and hemorrhagic events. To promote safe and effective care, clinicians should sequentially determine adherence (missed doses) and regimen concordance during routine medication assessments. Systems need to be developed to ensure patient-provider concordance in medication regimens.

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