AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2...AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery(ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics(45 cases) who had delayed surgery(DS group) after 72 h during an earlier 3-year period. Postoperative outcomeswere followed for one year and compared. RESULTS: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality(P > 0.05 all). There were 2 patients(4%) in the DS group who died after surgery(P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome(P < 0.05 all).CONCLUSION: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.展开更多
Hepatic artery thrombosis(HAT) is the most serious vascular complication after liver transplantation. Multiple risk factors have been identified to impact its development. Changes in haemostasis associated with end st...Hepatic artery thrombosis(HAT) is the most serious vascular complication after liver transplantation. Multiple risk factors have been identified to impact its development. Changes in haemostasis associated with end stage liver disease and the disturbance of the coagulation and anticoagulation cascades play an important role in development of this lethal complication. Early recognition and therapeutic intervention is mandatory to avoid its consequences. Pharmacological prophylaxis, by the use of antiplatelet or anticoagulant agents, is an important tool to reduce its incidence and prevent graft loss. Only a few studies have shown a clear benefit of antiplatelet agents in reducing HAT occurrence, however, these studies are limited by being retrospective and by inhomogeneous populations. The use of anticoagulants such as heparin is associated with an improvement in the outcomes mainly when used for a high-risk patients like living related liver recipients. The major concern when using these agents is the tendency to increase bleeding complications in a setting of already unstable haemostasis. Hence, monitoring of their administration and careful selection of patients to be treated are of great importance. Well-designed clinical studies are still needed to further explore their effects and to formulate proper protocols that can be implemented safely.展开更多
Thromboembolic disease is a major leading cause of mortality and morbidity in industrialized countries. Currently, the management of these patients is challenging due to the availability of new drugs with proven effic...Thromboembolic disease is a major leading cause of mortality and morbidity in industrialized countries. Currently, the management of these patients is challenging due to the availability of new drugs with proven efficacy and security compared to traditional oral vitamin K antagonists. These compounds are characterized by a predictable pharmacokinetic profile for which blood monitoring is not routinely needed. Nevertheless, some data have suggested inter-patient variability in the anticoagulant effect of these drugs, raising concerns about their effectiveness and safety. Although mass-spectrometry is the gold standard to determine drug plasma concentrations, this method is not widely available in every-day practice and some coagulation assays are commonly used to determine the anticoagulant effect of these drugs. The present review aims to summarize the current knowledge regarding the clinical question of how and when to monitor patients with new anticoagulant oral agents.展开更多
The role of endoscopic procedures,in both diagnostic and therapeutic purposes is continually expanding and evolving rapidly.In this context,endoscopists will encounter patients prescribed on anticoagulant and antiplat...The role of endoscopic procedures,in both diagnostic and therapeutic purposes is continually expanding and evolving rapidly.In this context,endoscopists will encounter patients prescribed on anticoagulant and antiplatelet medications frequently.This poses an increased risk of intraprocedural and delayed gastrointestinal bleeding.Thus,there is now greater importance on optimal pre,peri and post-operative management of anticoagulant and/or antiplatelet therapy to minimise the risk of post-procedural bleeding,without increasing the risk of a thromboembolic event as a consequence of therapy interruption.Currently,there are position statements and guidelines from the major gastroenterology societies.These are available to assist endoscopists with an evidenced-based systematic approach to anticoagulant and/or antiplatelet management in endoscopic procedures,to ensure optimal patient safety.However,since the publication of these guidelines,there is emerging evidence not previously considered in the recommendations that may warrant changes to our current clinical practices.Most notably and divergent from current position statements,is a growing concern regarding the use of heparin bridging therapy during warfarin cessation and its associated risk of increased bleeding,suggestive that this practice should be avoided.In addition,there is emerging evidence that anticoagulant and/or antiplatelet therapy may be safe to be continued in cold snare polypectomy for small polyps(<10 mm).展开更多
Endoscopic procedures hold a basal risk of bleeding that depends on the type of procedure and patients’comorbidities.Moreover,they are often performed in patients taking antiplatelet and anticoagulants agents,increas...Endoscopic procedures hold a basal risk of bleeding that depends on the type of procedure and patients’comorbidities.Moreover,they are often performed in patients taking antiplatelet and anticoagulants agents,increasing the potential risk of intraprocedural and delayed bleeding.Even if the interruption of antithrombotic therapies is undoubtful effective in reducing the risk of bleeding,the thromboembolic risk that follows their suspension should not be underestimated.Therefore,it is fundamental for each endoscopist to be aware of the bleeding risk for every procedure,in order to measure the risk-benefit ratio for each patient.Moreover,knowledge of the proper management of antithrombotic agents before endoscopy,as well as the adequate timing for their resumption is essential.This review aims to analyze current evidence from literature assessing,for each procedure,the basal risk of bleeding and the risk of bleeding in patients taking antithrombotic therapy,as well as to review the recommendation of American society for gastrointestinal endoscopy,European society of gastrointestinal endoscopy,British society of gastroenterology,Asian pacific association of gastroenterology and Asian pacific society for digestive endoscopy guidelines for the management of antithrombotic agents in urgent and elective endoscopic procedures.展开更多
Objective:To explore the anticoagulant,antiplatelet and antioxidant activities of protein extract of kenaf seed(PEKS).Methods:Sodium dodecyl sulphate polyacrylamide gel electrophoresis and reverse-phase high-performan...Objective:To explore the anticoagulant,antiplatelet and antioxidant activities of protein extract of kenaf seed(PEKS).Methods:Sodium dodecyl sulphate polyacrylamide gel electrophoresis and reverse-phase high-performance liquid chromatography techniques were employed for protein characterization.Antioxidant activity of PEKS was assessed using 1,1-diphenyl-2-picrylhydrazyl(DPPH)assay.The protective effect of PEKS on sodium nitrite(NaNO2)induced oxidative stress was evaluated using the in vitro red blood cell model,while the effect of PEKS on diclofenacinduced oxidative stress was examined in vivo in rats.Platelet-rich plasma and platelet-poor plasma were used for anticoagulant and antiplatelet activities of PEKS.Results:PEKS revealed similar protein bands on SDS-PAGE under reduced and non-reduced conditions.Several acidic proteins were present in native PAGE.PEKS showed antioxidant properties by scavenging DPPH with an IC50 of 24.58μg.PEKS exhibited a protective effect on NaNO2 induced oxidative stress in red blood cells by restoring the activity of stress markers.In addition,PEKS alleviated diclofenac-induced tissue damage of the liver,kidney,and small intestine.PEKS showed an anticoagulant effect in both in vivo and in vitro experiments by enhancing normal clotting time.PEKS did not affect prothrombin time but increase activated partial thromboplastin time.Furthermore,PEKS inhibited adenosine diphosphate and epinephrine-induced platelet aggregation.Conclusions:PEKS protects tissues from oxidative stress and exhibits antithrombotic activity.展开更多
Medicinal plants are under continuous analysis worldwide to explore new medication to treat atherosclerosis and cardiovascular diseases. Citrus fruits have displayed utmost antioxidant activity, particularly flavonoid...Medicinal plants are under continuous analysis worldwide to explore new medication to treat atherosclerosis and cardiovascular diseases. Citrus fruits have displayed utmost antioxidant activity, particularly flavonoids in Citrus paradisi have exhibited strong antioxidant and anti-inflammatory characteristics. This study was intended to examine effects of C. paradisi on blood coagulation and anticoagulation at doses of 0.1, 0.3 and 0.5 ml/kg. Highly significant increase in thrombin time (TT) and substantial decline in fibrinogen (Fb) level was noticed as related to control. There was substantial increase in TT, prothrombin time (PT) and activated partial thromboplastin time (aPTT) and noteworthy decrease in Fb level by warfarin. C. paradisi at 0.3 ml/kg considerably inhibited aggregation of platelet by collagen, adenosine phosphate, arachidonic acid and epinephrine, while there was also substantial rise in Protein C, TAT complex, RBC and hemoglobin concentration. In conclusion, these results suggest that the addition of C. paradisi to the diet of patients at risk of developing cardiovascular events could significantly decrease the morbidity or mortality in these patients due to high contents of phytochemicals like naringin, hesperidin, limonene and other flavonoids.展开更多
In this review article we analyze the historical evolution of anticoagulant and antiplatelet therapies in the treatment of atrial fibrillation plus complicated heart diseases. Its combined use, compared with anticoagu...In this review article we analyze the historical evolution of anticoagulant and antiplatelet therapies in the treatment of atrial fibrillation plus complicated heart diseases. Its combined use, compared with anticoagulation alone, has been widely used to significantly reduce thromboembolic risk. Major bleeding risk has been usually registered during combined antithrombotic therapy, which is mainly due to gastric bleeding, but enteric coating antiplatelet tablets can effectively protect against gastric mucosal damage, and the addition of proton-pump inhibitors (omeprazole) can avoid it.展开更多
Dual antiplatelet therapy(DAPT)with aspirin and clopidogrel has been widely used after percutaneous coronary intervention(PCI).The bleeding complications caused by it cannot be ignored and the incidence is as high as ...Dual antiplatelet therapy(DAPT)with aspirin and clopidogrel has been widely used after percutaneous coronary intervention(PCI).The bleeding complications caused by it cannot be ignored and the incidence is as high as 32.4%.[1]Among them,spinal cord hemorrhage is rare,acute and life-threatening.We herein report a case of spinal cord hemorrhage caused by DAPT with aspirin and clopidogrel used after PCI for non-ST elevation myocardial infarction(NSTEMI).展开更多
文摘AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery(ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics(45 cases) who had delayed surgery(DS group) after 72 h during an earlier 3-year period. Postoperative outcomeswere followed for one year and compared. RESULTS: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality(P > 0.05 all). There were 2 patients(4%) in the DS group who died after surgery(P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome(P < 0.05 all).CONCLUSION: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.
文摘Hepatic artery thrombosis(HAT) is the most serious vascular complication after liver transplantation. Multiple risk factors have been identified to impact its development. Changes in haemostasis associated with end stage liver disease and the disturbance of the coagulation and anticoagulation cascades play an important role in development of this lethal complication. Early recognition and therapeutic intervention is mandatory to avoid its consequences. Pharmacological prophylaxis, by the use of antiplatelet or anticoagulant agents, is an important tool to reduce its incidence and prevent graft loss. Only a few studies have shown a clear benefit of antiplatelet agents in reducing HAT occurrence, however, these studies are limited by being retrospective and by inhomogeneous populations. The use of anticoagulants such as heparin is associated with an improvement in the outcomes mainly when used for a high-risk patients like living related liver recipients. The major concern when using these agents is the tendency to increase bleeding complications in a setting of already unstable haemostasis. Hence, monitoring of their administration and careful selection of patients to be treated are of great importance. Well-designed clinical studies are still needed to further explore their effects and to formulate proper protocols that can be implemented safely.
文摘Thromboembolic disease is a major leading cause of mortality and morbidity in industrialized countries. Currently, the management of these patients is challenging due to the availability of new drugs with proven efficacy and security compared to traditional oral vitamin K antagonists. These compounds are characterized by a predictable pharmacokinetic profile for which blood monitoring is not routinely needed. Nevertheless, some data have suggested inter-patient variability in the anticoagulant effect of these drugs, raising concerns about their effectiveness and safety. Although mass-spectrometry is the gold standard to determine drug plasma concentrations, this method is not widely available in every-day practice and some coagulation assays are commonly used to determine the anticoagulant effect of these drugs. The present review aims to summarize the current knowledge regarding the clinical question of how and when to monitor patients with new anticoagulant oral agents.
文摘The role of endoscopic procedures,in both diagnostic and therapeutic purposes is continually expanding and evolving rapidly.In this context,endoscopists will encounter patients prescribed on anticoagulant and antiplatelet medications frequently.This poses an increased risk of intraprocedural and delayed gastrointestinal bleeding.Thus,there is now greater importance on optimal pre,peri and post-operative management of anticoagulant and/or antiplatelet therapy to minimise the risk of post-procedural bleeding,without increasing the risk of a thromboembolic event as a consequence of therapy interruption.Currently,there are position statements and guidelines from the major gastroenterology societies.These are available to assist endoscopists with an evidenced-based systematic approach to anticoagulant and/or antiplatelet management in endoscopic procedures,to ensure optimal patient safety.However,since the publication of these guidelines,there is emerging evidence not previously considered in the recommendations that may warrant changes to our current clinical practices.Most notably and divergent from current position statements,is a growing concern regarding the use of heparin bridging therapy during warfarin cessation and its associated risk of increased bleeding,suggestive that this practice should be avoided.In addition,there is emerging evidence that anticoagulant and/or antiplatelet therapy may be safe to be continued in cold snare polypectomy for small polyps(<10 mm).
文摘Endoscopic procedures hold a basal risk of bleeding that depends on the type of procedure and patients’comorbidities.Moreover,they are often performed in patients taking antiplatelet and anticoagulants agents,increasing the potential risk of intraprocedural and delayed bleeding.Even if the interruption of antithrombotic therapies is undoubtful effective in reducing the risk of bleeding,the thromboembolic risk that follows their suspension should not be underestimated.Therefore,it is fundamental for each endoscopist to be aware of the bleeding risk for every procedure,in order to measure the risk-benefit ratio for each patient.Moreover,knowledge of the proper management of antithrombotic agents before endoscopy,as well as the adequate timing for their resumption is essential.This review aims to analyze current evidence from literature assessing,for each procedure,the basal risk of bleeding and the risk of bleeding in patients taking antithrombotic therapy,as well as to review the recommendation of American society for gastrointestinal endoscopy,European society of gastrointestinal endoscopy,British society of gastroenterology,Asian pacific association of gastroenterology and Asian pacific society for digestive endoscopy guidelines for the management of antithrombotic agents in urgent and elective endoscopic procedures.
基金supported by Vision Group of Science and Technology,Government of Karnataka,India(VGST/CISEE/2012-13/282,dated March 16th 2013)。
文摘Objective:To explore the anticoagulant,antiplatelet and antioxidant activities of protein extract of kenaf seed(PEKS).Methods:Sodium dodecyl sulphate polyacrylamide gel electrophoresis and reverse-phase high-performance liquid chromatography techniques were employed for protein characterization.Antioxidant activity of PEKS was assessed using 1,1-diphenyl-2-picrylhydrazyl(DPPH)assay.The protective effect of PEKS on sodium nitrite(NaNO2)induced oxidative stress was evaluated using the in vitro red blood cell model,while the effect of PEKS on diclofenacinduced oxidative stress was examined in vivo in rats.Platelet-rich plasma and platelet-poor plasma were used for anticoagulant and antiplatelet activities of PEKS.Results:PEKS revealed similar protein bands on SDS-PAGE under reduced and non-reduced conditions.Several acidic proteins were present in native PAGE.PEKS showed antioxidant properties by scavenging DPPH with an IC50 of 24.58μg.PEKS exhibited a protective effect on NaNO2 induced oxidative stress in red blood cells by restoring the activity of stress markers.In addition,PEKS alleviated diclofenac-induced tissue damage of the liver,kidney,and small intestine.PEKS showed an anticoagulant effect in both in vivo and in vitro experiments by enhancing normal clotting time.PEKS did not affect prothrombin time but increase activated partial thromboplastin time.Furthermore,PEKS inhibited adenosine diphosphate and epinephrine-induced platelet aggregation.Conclusions:PEKS protects tissues from oxidative stress and exhibits antithrombotic activity.
文摘Medicinal plants are under continuous analysis worldwide to explore new medication to treat atherosclerosis and cardiovascular diseases. Citrus fruits have displayed utmost antioxidant activity, particularly flavonoids in Citrus paradisi have exhibited strong antioxidant and anti-inflammatory characteristics. This study was intended to examine effects of C. paradisi on blood coagulation and anticoagulation at doses of 0.1, 0.3 and 0.5 ml/kg. Highly significant increase in thrombin time (TT) and substantial decline in fibrinogen (Fb) level was noticed as related to control. There was substantial increase in TT, prothrombin time (PT) and activated partial thromboplastin time (aPTT) and noteworthy decrease in Fb level by warfarin. C. paradisi at 0.3 ml/kg considerably inhibited aggregation of platelet by collagen, adenosine phosphate, arachidonic acid and epinephrine, while there was also substantial rise in Protein C, TAT complex, RBC and hemoglobin concentration. In conclusion, these results suggest that the addition of C. paradisi to the diet of patients at risk of developing cardiovascular events could significantly decrease the morbidity or mortality in these patients due to high contents of phytochemicals like naringin, hesperidin, limonene and other flavonoids.
文摘In this review article we analyze the historical evolution of anticoagulant and antiplatelet therapies in the treatment of atrial fibrillation plus complicated heart diseases. Its combined use, compared with anticoagulation alone, has been widely used to significantly reduce thromboembolic risk. Major bleeding risk has been usually registered during combined antithrombotic therapy, which is mainly due to gastric bleeding, but enteric coating antiplatelet tablets can effectively protect against gastric mucosal damage, and the addition of proton-pump inhibitors (omeprazole) can avoid it.
文摘Dual antiplatelet therapy(DAPT)with aspirin and clopidogrel has been widely used after percutaneous coronary intervention(PCI).The bleeding complications caused by it cannot be ignored and the incidence is as high as 32.4%.[1]Among them,spinal cord hemorrhage is rare,acute and life-threatening.We herein report a case of spinal cord hemorrhage caused by DAPT with aspirin and clopidogrel used after PCI for non-ST elevation myocardial infarction(NSTEMI).