scholarly journals Anticoagulants in the Management of Pulmonary Embolism

2021 ◽  
Author(s):  
Ladan Panahi ◽  
George Udeani ◽  
Michael Horseman ◽  
Jaye Weston ◽  
Nephy Samuel ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Toxicity Profile ◽  
Oral Vitamin ◽  
Pharmacological Management ◽  
Reversal Agents ◽  
Outpatient Settings ◽  
Selection Of

Pulmonary embolism management has typically been accomplished with anticoagulant treatment that includes parenteral heparins and oral vitamin K antagonists. Even though heparins and oral vitamin K antagonists continue to play a role in pulmonary embolism management, other newer available options have somewhat reduced the role of heparins and vitamin K antagonists in pulmonary embolism management. This reduction in utilization involves their toxicity profile, clearance limitations, and many drug and nutrient interactions. New direct oral anticoagulation therapies have led to more available options in the management of pulmonary embolism in the inpatient and outpatient settings. More evidence and research are now available about reversal agents and monitoring parameters regarding these newer agents, leading to more interest in administering them for safe and effective pulmonary embolism management. Current research and literature have also helped direct the selection of appropriate use of pharmacological management of pulmonary embolism based on the specific population such as patients with liver failure, renal failure, malignancy, and COVID-19.

scholarly journals Review of Medical Therapies for the Management of Pulmonary Embolism

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 110
Author(s):  
Ladan Panahi ◽  
George Udeani ◽  
Michael Horseman ◽  
Jaye Weston ◽  
Nephy Samuel ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Toxicity Profile ◽  
Oral Vitamin ◽  
Pharmacological Management ◽  
Reversal Agents ◽  
Outpatient Settings ◽  
Oral Therapeutic ◽  
Selection Of

Traditionally, the management of patients with pulmonary embolism has been accomplished with anticoagulant treatment with parenteral heparins and oral vitamin K antagonists. Although the administration of heparins and oral vitamin K antagonists still plays a role in pulmonary embolism management, the use of these therapies are limited due to other options now available. This is due to their toxicity profile, clearance limitations, and many interactions with other medications and nutrients. The emergence of direct oral anticoagulation therapies has led to more options now being available to manage pulmonary embolism in inpatient and outpatient settings conveniently. These oral therapeutic options have opened up opportunities for safe and effective pulmonary embolism management, as more evidence and research is now available about reversal agents and monitoring parameters. The evolution of the pharmacological management of pulmonary embolism has provided us with better understanding regarding the selection of anticoagulants. There is also a better understanding and employment of anticoagulants in pulmonary embolism in special populations, such as patients with liver failure, renal failure, malignancy, and COVID-19.

Enoxaparin monotherapy without oral anticoagulation to treat acute symptomatic pulmonary embolism

2003 ◽  
Vol 89 (06) ◽  
pp. 953-958 ◽  
Author(s):  
Joshua Beckman ◽  
Kelly Dunn ◽  
Arthur Sasahara ◽  
Samuel Goldhaber
Keyword(s):  
Pulmonary Embolism ◽  
Unfractionated Heparin ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Standard Therapy ◽  
Vitamin K Antagonists ◽  
Hospital Length Of Stay ◽  
Hemorrhagic Complication ◽  
Oral Vitamin ◽  
Symptomatic Pulmonary Embolism

SummaryConventional anticoagulation for symptomatic pulmonary embolism consists of continuous intravenous unfractionated heparin as a “bridge” to oral anticoagulation. This strategy requires 5 days or more of intravenous heparin while oral vitamin K antagonists gradually achieve a therapeutic effect. Oral vitamin K antagonists require frequent blood testing to optimize dosing, and their interactions with other medications and foods make regulation difficult. Therefore we tested a different approach to therapy: long-term enoxaparin monotherapy.We randomized 60 symptomatic pulmonary embolism patients in a 2:1 ratio to 90 days of enoxaparin as monotherapy without warfarin (N=40) or to intravenous unfractionated heparin as a “bridge” to warfarin, target INR 2.0-3.0 (N=20). Enoxaparin patients received 1 mg/kg twice daily for 14 days during the acute phase followed by randomized assignment during the chronic phase to 1.0 mg/kg vs. 1.5 mg/kg once daily.In an intention-to-treat analysis, 3 of the 40 enoxaparin patients developed recurrent venous thromboembolism compared with 0 of 20 standard therapy patients (p = 0.54). One of the 40 enoxaparin patients had a major hemorrhagic complication compared with 2 of the 20 standard therapy patients (p = 0.26). Median hospital length of stay was shorter with enoxaparin compared to standard therapy (4 vs. 6 days) (p = 0.001). Following our study we can conclude that extended 3-month treatment with enoxaparin as monotherapy for symptomatic, acute pulmonary embolism is feasible and warrants further study in a large clinical trial.

The Role of Oral Vitamin K Antagonists in the Outcome of Infrainguinal Bypass Procedures

Angiology ◽  
2013 ◽  
Vol 65 (7) ◽  
pp. 568-573 ◽  
Author(s):  
Athanasios D. Giannoukas ◽  
Kosmas I. Paraskevas ◽  
Stylianos Koutsias ◽  
Christos Argyriou ◽  
Vasilios Saleptsis ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Vitamin ◽  
Infrainguinal Bypass

The role of dietary vitamin K in the management of oral vitamin K antagonists

Blood Reviews ◽  
2012 ◽  
Vol 26 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Michael V. Holmes ◽  
Beverley J. Hunt ◽  
Martin J. Shearer
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Dietary Vitamin ◽  
Oral Vitamin

scholarly journals Direct Oral Anticoagulants after Ischemic Stroke: Which Patient? Which Drug? And How Early?

2021 ◽  
Vol 41 (01) ◽  
pp. 031-034
Author(s):  
Gian Marco De Marchis
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Vitamin K ◽  
Randomized Clinical Trials ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Reversal Agents

AbstractDirect oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and ischemic stroke. The main advantage of DOAC over VKA is the lower rate of bleeding and mortality. This review covers challenges clinicians can encounter when treating patients with AF and ischemic stroke, including timing of DOAC start and ongoing randomized clinical trials, appropriate dosing, and available comparative evidence across DOACs. For patients without AF but with an ischemic stroke, the review outlines the role of DOACs. Finally, the risk of thrombotic events associated with specific DOAC reversal agents and DOAC pausing is reviewed.

scholarly journals Role of P-glycoprotein in the Uptake/Efflux Transport of Oral Vitamin K Antagonists and Rivaroxaban through the Caco-2 Cell Model

2013 ◽  
Vol 113 (4) ◽  
pp. 259-265 ◽  
Author(s):  
Liliane Gschwind ◽  
Victoria Rollason ◽  
Youssef Daali ◽  
Pascal Bonnabry ◽  
Pierre Dayer ◽  
...  
Keyword(s):  
Vitamin K ◽  
Cell Model ◽  
Vitamin K Antagonists ◽  
Oral Vitamin ◽  
Efflux Transport ◽  
P Glycoprotein

Perioperative Management of Patients Receiving New Anticoagulants

2019 ◽  
Vol 25 (19) ◽  
pp. 2149-2157 ◽  
Author(s):  
Massimo Lamperti ◽  
Andrey Khozenko ◽  
Arun Kumar
Keyword(s):  
Vitamin K ◽  
Elective Surgery ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Oral Intake ◽  
Bleeding Risk ◽  
Dietary Vitamin ◽  
Reversal Agent ◽  
Onset Of Action ◽  
Reversal Agents

There is an increased use of oral anticoagulants for the prevention of venous and arterial thrombosis. Vitamin-K antagonists have been used for decades as the main oral anticoagulants but they have the draback a complex therapeutic management, slow onset of action and by a different oral intake caused by dietary vitamin K intake. New non-vitamin K antagonist oral anticoagulants (NOACs) have been developed to overcome the limitations of warfarin. Their management is easier as it requires a fixed daily dose without coagulation monitoring. Although their therapeutic profile is safe, proper attention should be paid in case of unexpected need for the reversal of their coagulation effect and in case a patient needs to have a scheduled surgery. For non-acute cardiac surgery, discontinuation of NOACs should start at least 48 hours prior surgery. Intracranial bleedings associated with NOACs are less dangerous comparing to those warfarin-induced. NOACs need to be stopped ≥24 hours in case of elective surgery for low bleeding-risk procedures and ≥48 hours for high bleeding-risk surgery in patients with normal renal function and 72 hours in case of reduced CrCl < 80. The therapy with NOACs should be resumed from 48 to 72 hours after the procedure depending on the perceived bleeding, type of surgery and thrombotic risks. There are some available NOAC reversal agents acting within 5 to 20 minutes. In case of lack of reversal agent, adequate diuresis, renal replacement therapy and activated charcoal in case of recent ingestion should be considered.

HEMATURIA AND OTHER KINDS OF BLEEDINGS ON NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION: AN UPDATED OVERVIEW ON OCCURRENCE, PATHOMECHANISMS AND MANAGEMENT

2020 ◽  
Vol 73 (11) ◽  
pp. 2528-2534
Author(s):  
Dagmara Wojtowicz ◽  
Anna Tomaszuk-Kazberuk ◽  
Jolanta Małyszko ◽  
Marek Koziński
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Anticoagulant Activity ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Bleeding Complications ◽  
Reversal Agents ◽  
Limited Availability ◽  
Increased Risk

Non-vitamin K antagonist oral anticoagulants (NOACs) are currently recommended for oral anticoagulation in patients with non-valvular atrial fibrillation. In the setting, NOACs effectively prevent from stroke and systemic embolic events. In spite of the favorable safety profile of NOACs when compared with vitamin K antagonists, the use of any kind of anticoagulation is associated with an increased risk of bleeding. However, there is still a lack of direct comparisons of effectiveness and safety among NOACs. The results of indirect comparisons and meta-analyses suggest that the risk of various types of hemorrhagic complications differ among the particular NOACs. Management of bleeding in patients under NOAC therapy can be challenging because of limited availability of antidotes and the lack of routine laboratory test monitoring the NOAC anticoagulant effect. In case of life-threatening or critical site bleeding, reversal of NOAC anticoagulant activity is essential together with immediate implementation of causative treatment. Moreover, some patients on chronic NOAC therapy may require urgent surgery or invasive procedures. Specific reversal agents for NOACs have been developed, i.e. more widely available idarucizumab for the factor IIa inhibitor (dabigatran) and andexanet alfa for the factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) with limited availability. This review summarizes the occurrence and management of NOAC-related bleeding complications with a particular emphasis on hematuria.

Management of pulmonary embolism in patients with cancer

ESC CardioMed ◽  
2018 ◽  
pp. 2790-2794
Author(s):  
Cihan Ay ◽  
Florian Posch
Keyword(s):  
Pulmonary Embolism ◽  
Vitamin K ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Standard Of Care ◽  
Current Standard ◽  
Patients With Cancer ◽  
High Index Of Suspicion ◽  
Excessive Anticoagulation

Pulmonary embolism (PE) is a frequent complication in patients with cancer. Clinicians have to maintain a high index of suspicion to reduce the large proportion of PEs that remain undiagnosed in the cancer population. Thrombolysis is not a standard treatment for haemodynamically unstable patients with cancer-associated PE because the risk of haemorrhage can be excessive. Anticoagulation with a low-molecular-weight heparin (LMWH) for at least 6 months is the current standard of care for the treatment of cancer-associated PE, while vitamin K antagonists are a reasonable second choice for patients with contraindications against LMWH or a strong preference towards an oral agent. Although an indirect network meta-analysis suggests that non-vitamin K-dependent oral anticoagulants may be comparably efficacious and safe as LMWH for treating PE in cancer patients, these agents cannot be recommended as a standard first-line treatment at this time because a head-to-head comparison to the standard of care has not yet been reported. Anticoagulation beyond 6 months is an emerging concept; however, the patient population that may benefit from this intervention still needs to be defined. Guidance statements facilitate the management of challenging patients with brain metastases, unsuspected PE, thrombocytopenia, and recurrent PE.

The Relation between Staphylocoagulase Reacting Factor and Proteins Induced by Vitamin K Absence

1975 ◽  
Author(s):  
B. M. Bas ◽  
A. D. Muller ◽  
H. G. Hemker
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
The Other ◽  
Two Stage ◽  
One Stage ◽  
Echis Carinatus ◽  
The Difference ◽  
The One ◽  
Factor Assay

Five different ways of estimating prothrombin are applied to the plasma of persons receiving vitamin K antagonists, to know: the one-stage assay, the two-stage assay, the Echis Carinatus Venom assay, the coagulase-reacting factor assay and the immunological assay. The Protein Induced by Vitamin K Absence analogous to prothrombin (PIVKA-II) can be shown to be co-estimated in all but the one-stage assay. There are minor differences, however, between the other four tests. The most practical way to assess both prothrombin and PIVKA-II seems to be the coagulase-reacting factor assay. The difference between the one-stage assay and the others can be explained on basis of the new data on the role of vitamin K in prothrombin biosynthesis. The differences between the other tests are smaller and remain to be explained.

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