The algorithm of decision-making in administration of anticoagulant therapy due to COVID‑19. Review

2021 ◽  
Author(s):  
O. V. Petyunina
Keyword(s):  
Anticoagulant Therapy ◽  
Anticoagulation Therapy ◽  
Bed Rest ◽  
Blood Chemistry ◽  
Evidence Based ◽  
Elderly Age ◽  
Thrombotic Complications ◽  
Endothelial Functions ◽  
European Society Of Cardiology ◽  
Intravenous Catheters

There is a hypothesis that on its late complicated stages, coronavirus disease of 2019 (COVID‑19) represents an endothelial disease. According to Peter’s Libbi data (2020), the endothelial monolayer measures up to 7000 m2 in surface area. The endothelial functions include anticoagulant, antiplatelet, anti‑inflammatory, vasomotion, and structure. The aim of the review was to figure out COVID‑19 logistics from the standpoint of its pathogenesis, in particular its thrombotic complications, to summarize data on the choice of an anticoagulant, its dose and duration of use. COVID‑19 is a new disease with the lack of evidence‑based data, however, its per‑syndrome analysis results in conclusion that the most part of acute and post‑COVID complications refer to thromboembolic ones. According to the recommendations of the European Society of Cardiology on diagnostic and treatment of thromboembolism, the need for thromboembolism prevention is defined in case of respiratory failure, installed intravenous catheters, infection (specifically pneumonia), bed rest, elderly age, etc. The adherence to evidence‑based recommendations will allow one to administer rational anticoagulation therapy without harm to a patient. It concerns both patients, who are on anticoagulant therapy at hospital admission, and those who requires its new administration. The following questions are mostly frequent arising in doctors: How one should manage a patient with active bleeding, or platelet levels < 25 · 109/ L, or with congenital abnormality of coagulation? What types of blood chemistry should be considered when administering anticoagulant? What therapy should be administered at discharge? Compliance with clear anticoagulation algorithms will prevent thromboembolic complications, further damage to organs and systems, and significant bleeding.    

scholarly journals The Predictive Value of the aCL and Anti-β2GPI at the Time of Acute Deep Vein Thrombosis—A Two-Year Prospective Study

Biomedicines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 901
Author(s):  
Katja Perdan-Pirkmajer ◽  
Polona Žigon ◽  
Anja Boc ◽  
Eva Podovšovnik ◽  
Saša Čučnik ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Prospective Study ◽  
Anticoagulant Therapy ◽  
Predictive Value ◽  
Anticoagulation Therapy ◽  
Time Frame ◽  
Vein Thrombosis ◽  
Therapeutic Decisions ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

Antiphospholipid syndrome (APS) is an important cause of deep vein thrombosis (DVT). According to current APS classification criteria, APS cannot be confirmed until 24 weeks after DVT. This time frame results in frequent discontinuation of anticoagulant treatment before APS is diagnosed. Therefore, the aim of our study was to evaluate the potential predictive value of anticardiolipin (aCL) and anti-β2glycoprotein I (anti-β2GPI) before discontinuation of anticoagulation therapy. Patients with newly diagnosed DVT were included into a 24-month prospective study. All patients received anticoagulant therapy. aCL and anti-β2GPI were determined at inclusion and every four weeks for the first 24 weeks and then one and two years after inclusion. APS was confirmed in 24/221 (10.9%) patients. At the time of acute DVT 20/24 (83.3%), APS patients had positive aCL and/or anti-β2GPI. Two patients had low aCL levels and two were negative at the time of acute DVT but later met APS criteria due to lupus anticoagulant (LA). Our data indicate that negative aCL and/or anti-β2GPI at the time of acute DVT make further aPL testing unnecessary; however, LA should be determined after discontinuation of anticoagulant therapy. Positive aCL and/or anti-β2GPI at the time of acute DVT have a strong positive predictive value for APS and may support therapeutic decisions.

Duration of Anticoagulation Therapy for Venous Thromboembolism

Hematology ◽  
2008 ◽  
Vol 2008 (1) ◽  
pp. 252-258 ◽  
Author(s):  
Henri Bounameaux ◽  
Arnaud Perrier
Keyword(s):  
Venous Thromboembolism ◽  
Anticoagulant Therapy ◽  
Odds Ratio ◽  
Vitamin K Antagonists ◽  
Initial Period ◽  
Anticoagulation Therapy ◽  
Case Fatality ◽  
Clinical Decision ◽  
Venous Thromboembolic Event ◽  
Anticoagulant Treatment

Abstract Treatment of acute deep vein thrombosis and pulmonary embolism-often denominated together as venous thromboembolism (VTE)- consists of parenteral administration of heparin (usually low-molecular-weight heparin or alternatively unfractionated heparin or fondaparinux) overlapped and followed by oral vitamin K antagonists that are administered for a certain period (usually 3 to 12 months). Recommended or suggested durations differ according to guidelines. Practically, the clinical decision in an individual patient depends upon the estimated risks of VTE recurrence and treatment-induced bleeding. The risk of VTE recurrence is higher in idiopathic events (about 10% per year during the first two years and 3% per year thereafter) (odds ratio of 2.4, compared to secondary events); in male subjects (at least before the age of 60, with an odds ratio of 2–4); in patients with persistently elevated D-dimer level (odds ratio of 2.3, compared with normal level); and during the first two years after discontinuation of treatment. The annual risk of major bleeding on anticoagulant treatment vary largely in observational studies with figures of 2% to 29%, depending on the patient characteristics. The case-fatality rate is 8% (DVT), 12% (PE) for recurrent VTE, and about 10% for major bleed. These figures do not support long-term anticoagulant therapy, except in those patients exhibiting a very high risk of recurrence and/or a very low risk of bleeding. New therapeutic aspects might impact on the duration of anticoagulant therapy after a venous thromboembolic event. They include the possibility of pursuing anticoagulant treatment at a reduced INR after an initial period with an INR 2-3, and the advent of new, more specific and orally active anticoagulants. These features might modify the risk-benefit balance of extending anticoagulant therapy beyond the usual, limited duration.

International normalized ratio in anticoagulant therapy: understanding the issues

1997 ◽  
Vol 6 (2) ◽  
pp. 88-92 ◽  
Author(s):  
AL Severson ◽  
LR Baldwin ◽  
TG DeLoughery
Keyword(s):  
Anticoagulant Therapy ◽  
Warfarin Therapy ◽  
Healthcare Providers ◽  
Anticoagulation Therapy ◽  
International Normalized Ratio ◽  
Laboratory Methods ◽  
Current Monitoring

Recently, a change in anticoagulation therapy occurred that is still partially ignored by the healthcare community. Understanding the controversy over the use of the internal normalized ratio in monitoring patients receiving warfarin therapy is important for nurses who provide care to these patients. Five questions related to current monitoring of patients treated with anticoagulants are addressed. Nurses must recognize the importance to their practice of changes in laboratory methods and move toward using the most useful measures available to influence patients' outcomes. The international normalized ratio is the most appropriate way to evaluate the effects of warfarin therapy. All healthcare providers should use this ratio as the standard in evaluating the effects of anticoagulation therapy.

scholarly journals Clinical practice guideline on the prevention and management of neonatal extravasation injury: a before-and-after study design

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kam Ming Chan ◽  
Janita Pak Chun Chau ◽  
Kai Chow Choi ◽  
Genevieve Po Gee Fung ◽  
Wai Wa Lui ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Central Line ◽  
Evidence Based ◽  
Post Intervention ◽  
Before And After ◽  
Level Of Knowledge ◽  
Intravenous Catheters ◽  
Before And After Study

Abstract Background Extravasation injury resulting from intravenous therapies delivered via peripheral intravenous catheters or umbilical and peripherally inserted central venous catheters is a common iatrogenic complication occurring in neonatal intensive care units. This study aimed to evaluate the effectiveness of an evidence-based clinical practice guideline in the prevention and management of neonatal extravasation injury by nurses. Methods A controlled before-and-after study was conducted in a neonatal unit. The clinical practice guideline was developed, and a multifaceted educational program was delivered to nurses. Neonatal outcomes, including the rates of peripheral intravenous extravasation and extravasation from a central line, were collected at the pre- and post-intervention periods. Post-intervention data for nurses, including the nurses’ level of knowledge and adherence, were collected at six months after the program. Results 104 and 109 neonates were recruited in the pre-intervention period (control) and the post-intervention period (intervention), respectively. The extravasation rate before and after the intervention was 14.04 and 2.90 per 1,000 peripheral intravenous catheters days, respectively. The adjusted odds ratio of peripheral intravenous extravasation post-intervention compared with that of pre-intervention was 0.20 (95% confidence interval: 0.05–0.74; p = 0.02) after adjusting for peripheral intravenous catheter days. The extravasation from a central line rate of the control and intervention groups post-intervention was 4.94 and zero per 1,000 central venous catheter days, respectively. Fifty-nine registered nurses were recruited. At six months post-program, there were significant improvements in the nurses’ level of knowledge and adherence. Conclusions These findings suggest that the implementation of an evidence-based clinical practice guideline significantly reduced the rate of peripheral intravenous extravasation and extravasation from a central line in neonates. However, to maintain nurses’ knowledge and adherence to the evidence-based practice, the educational program will have to be conducted periodically and incorporated into the nurses’ induction program. Trial registration ClinicalTrials.gov, Identifiers: NCT04321447. Registered 20 March 2020 - Retrospectively registered.

scholarly journals How to define the relative contraindications to oral anticoagulant therapy

2017 ◽  
Vol 87 (2) ◽  
Author(s):  
Roberto F.E. Pedretti
Keyword(s):  
Risk Factors ◽  
Anticoagulant Therapy ◽  
Clinical Judgment ◽  
Oral Anticoagulant Therapy ◽  
Hierarchical Classification ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Clinical Settings ◽  
High Bleeding Risk ◽  
European Society Of Cardiology

<p>There is currently a lack of consensus on which anticoagulant therapy contraindications should be considered “absolute” and which should be considered “relative”. Guidelines do not clearly identify absolute and relative contraindications to anticoagulant therapy. Recent guidelines on AF of the European Society of Cardiology underline the relevance of several factors and their use in scores, leaving anyway space to the clinical judgment of the physician. A high bleeding risk score should generally not result per se in a contraindication to anticoagulant therapy. Rather, bleeding risk factors should be identified and treatable factors corrected. A combined use of a more hierarchical classification of the different bleeding risk factors and the risk scores probably represents the best approach to maximize the benefit of anticoagulant therapy in various clinical settings.</p>

Rebound Phenomenon After Discontinuation Of Oral Anticoagulant Therapy?

1981 ◽  
Author(s):  
J Harenberg ◽  
R Haas ◽  
R Zimmermann
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
In Vitro Release ◽  
Oral Anticoagulant Treatment ◽  
Thrombin Activity ◽  
Rebound Phenomenon

Duration and discontinuation of oral anticoagulant therapy in the prophylaxis of recurrent thrombembolic diseases is often discussed. After stopping of the therapy an elevated incidence of rethromboses are observed. Therefore we determined fibrinopeptide A (FPA) as the most sensitive parameter of thrombin activity in vivo in patients treated with phenprocoumon in order to get information on the effectivity of the oral anticoagulant therapy and on the rebound phenomenon after discontinuation of the treatment.In 136 outpatients a significant relation between FPA and the effectivity of the anticoagulant therapy was observed: 2.7 ng/ml plasma (mean, thrombotest values < 5%), 3.5 ng/ml (5%-15%) and 4.1 ng/ml (>15%, p < 0.01). Normal FPA were 1.4ng/ml. In 11 patients with low FPA the oral anticoagulants were discontinued. FPA was determined in weekly intervalls. Within four weeks a continous increase of FPA from 1.6 ng/ml (median) to 3.8 ng/ml was observed. After eight weeks FPA was 8.2 ng/ ml (p < 0.05). The in vitro release of FPA after 10 min incubation of blood increased from 3.4ng/ml to 72 ng/ml after eight weeks (p < 0.05, normal release up to 5 ng/ml).The data indicate the clinical relevance and the different therapeutic implications of the determination of FPA in patients treated with phenprocoumon. They further give the first criterion, which outlines the effectivity of an oral anticoagulation therapy by reducing the thrombin activity in vivo. They give some evidence for a rebound like phenomenon after discontinuation of the oral anticoagulant treatment.

Drugs Used to Prevent Complications

2018 ◽  
Author(s):  
Eelco F. M. Wijdicks ◽  
Sarah L. Clark
Keyword(s):  
Urinary Tract ◽  
Nursing Care ◽  
Preventive Measures ◽  
Bed Rest ◽  
Ventilator Associated Pneumonia ◽  
Stress Ulcers ◽  
Drug Levels ◽  
Prophylactic Drugs ◽  
Tract Infections ◽  
Intravenous Catheters

Comprehensive neurosciences nursing care goes far in providing optimal support, but the acute immobilization and anticipated prolonged bed rest requires the use of prophylactic drugs. Many options relate to failure to move limbs, failure to breathe adequately and placement of intravenous catheters This chapter covers the more critical preventive measures.Prevention of deep venous thrombosis, hyperglycemia, stress ulcers, ventilator-associated pneumonia, urinary tract infections, vascular access infections, ventriculitis, and post-craniotomy infections are discussed in this chapter. Pharmacists assist in effective stewardship and surveillance of critically ill patients by helping select the appropriate antibiotics, determining the need for drug levels, and initiating or stopping preventative medications.

Conclusion

2018 ◽  
Author(s):  
Marc Humbert
Keyword(s):  
Pulmonary Hypertension ◽  
European Society ◽  
Hypertension Management ◽  
Evidence Based ◽  
European Respiratory Society ◽  
Fast Growing ◽  
Recent Advances ◽  
European Society Of Cardiology ◽  
Future Work

Pulmonary hypertension is a fast-growing field in cardiopulmonary medicine. Thanks to recent advances summarized in the 2015 European Society of Cardiology/European Respiratory Society guidelines, evidence-based pulmonary hypertension management can now be provided to all pulmonary hypertension patients. There are, however, important gaps of evidence which should be clarified in future work.

scholarly journals Effects of 21 days of bed rest, with or without artificial gravity, on nutritional status of humans

2009 ◽  
Vol 107 (1) ◽  
pp. 54-62 ◽  
Author(s):  
S. R. Zwart ◽  
G. E. Crawford ◽  
P. L. Gillman ◽  
G. Kala ◽  
A. S. Rodgers ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Rest Period ◽  
Nutrient Status ◽  
Bed Rest ◽  
Blood Chemistry ◽  
Artificial Gravity ◽  
Blood Levels ◽  
Negative Effects ◽  
Vitamin Status ◽  
Β Carotene

Spaceflight and bed rest models of microgravity have profound effects on physiological systems, including the cardiovascular, musculoskeletal, and immune systems. These effects can be exacerbated by suboptimal nutrient status, and therefore it is critical to monitor nutritional status when evaluating countermeasures to mitigate negative effects of spaceflight. As part of a larger study to investigate the usefulness of artificial gravity as a countermeasure for musculoskeletal and cardiovascular deficits during bed rest, we tested the hypothesis that artificial gravity would have an effect on some aspects of nutritional status. Dietary intake was recorded daily before, during, and after 21 days of bed rest with artificial gravity ( n = 8) or bed rest alone ( n = 7). We examined body composition, hematology, general blood chemistry, markers of oxidative damage, and blood levels of selected vitamins and minerals before, during, and after the bed rest period. Several indicators of vitamin status changed in response to diet changes: serum α- and γ-tocopherol and urinary 4-pyridoxic acid decreased ( P < 0.001) and plasma β-carotene increased ( P < 0.001) in both groups during bed rest compared with before bed rest. A decrease in hematocrit ( P < 0.001) after bed rest was accompanied by a decrease in transferrin (P < 0.001), but transferrin receptors were not changed. These data provide evidence that artificial gravity itself does not negatively affect nutritional status during bed rest. Likewise, artificial gravity has no protective effect on nutritional status during bed rest.

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