Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Apr 2016
Review Meta Analysis Comparative StudyComparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism: a systematic review and meta-analysis.
The Wells score and the revised Geneva score are two most commonly used clinical rules for excluding pulmonary embolism (PE). In this study, we aimed to assess the diagnostic accuracy of these two rules; we also compared the diagnostic accuracy between them. We searched PubMed and Web of science up to April 2015. ⋯ Meta-regression showed diagnostic accuracy of these two rules was not related with PE prevalence. Sensitivity analysis by only included prospective studies showed the results were robust. Our results showed the Wells score was more effective than the revised Geneva score in discriminate PE in suspected patients.
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J. Thromb. Thrombolysis · Apr 2016
Impact of microparticles derived from erythrocytes on fibrinolysis.
It has long been known that negatively charged membranes of erythrocyte-derived microparticles display procoagulant activity. However, relatively little is known about the possible fibrinolytic activity of such microparticles. This issue becomes particularly important during red blood cell storage, which significantly increases the number of microparticles. ⋯ Microparticles present fibrinolytic activity mainly due to the presence of plasminogen on them. Microparticles derived from erythrocytes significantly enhance cleavage of the chromogenic substrate by the streptokinase-plasminogen complex, but to a lesser extent accelerate euglobulin clot lysis time. Erythrocyte-derived microparticles display prominent fibrinolytic activity, which significantly decreases during storage of red blood cells.
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J. Thromb. Thrombolysis · Feb 2016
ReviewWho, when, and how to reverse non-vitamin K oral anticoagulants.
Non-vitamin K oral anticoagulants (NOACs) have been a major addition to our therapeutic armamentarium. They are at least as effective as warfarin in the thromboprophylaxis of non-valvular atrial fibrillation and management of thromboembolic disease, with a more favorable safety profile. Their predictable pharmacokinetics and pharmacodynamics allow for a fixed oral dosing without the need for anticoagulation monitoring. ⋯ Preclinical studies show promising results and these agents are already in different stages of clinical development. Phase I and II clinical trials demonstrate efficacy in reversing NOACs without major side effects. Until these agents become commercially available, management of patients receiving NOACs who present with major bleeding or require emergent surgery should focus on (a) immediate discontinuation of NOACs, (b) supportive measures or postponing surgery for 12-24 h after the last NOAC dose, and/or
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J. Thromb. Thrombolysis · Feb 2016
ReviewUniversal, class-specific and drug-specific reversal agents for the new oral anticoagulants.
Although there is controversy about the absolute need for a reversal agent for the new direct oral anticoagulants (DOACs), the absence of such an agent is a barrier to more widespread use of these agents. For the management of major life-threatening bleeding with the DOACs, most authorities recommend the use of four factor prothrombin complex concentrates, although the evidence to support their use in terms of improving outcomes is meager. ⋯ Andexanet alfa is a class-specific antidote targeted to reverse the oral direct factor Xa inhibitors as well as the indirect inhibitor, enoxaparin. Ciraparantag is a universal antidote targeted to reverse the direct thrombin and factor Xa inhibitors as well as the indirect inhibitor, enoxaparin.
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J. Thromb. Thrombolysis · Feb 2016
ReviewDecision-making about the use of non-vitamin K oral anticoagulant therapies for patients with atrial fibrillation.
Until recently, vitamin K antagonists, warfarin being the most commonly used agent in the United States, have been the only oral anticoagulant therapies available to prevent stroke in patients with atrial fibrillation (AF). In the last 5 years four new, non-vitamin K oral anticoagulants, the so-called NOACs or novel oral anticoagulants, have come to market and been approved by the Federal Drug Administration. Despite comparable if not superior efficacy in preventing AF-related stroke, and generally lower risks of major hemorrhage, particularly intracranial bleeding, the uptake of these agents has been slow. ⋯ Three reversal agents, idarucizumab, andexanet alfa, and aripazine, have already progressed to human studies and show great promise as either antidotes for specific drugs or as universal reversal agents. The availability of these reversal agents will likely increase the clinical use of the non-vitamin K oral anticoagulants. In light of the many complex and nuanced issues surrounding the choice of an optimal anticoagulant for any AF patient, a patient-centered/shared decision-making approach will be useful.