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1.
Int. j. cardiovasc. sci. (Impr.) ; 35(1): 88-94, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356309

ABSTRACT

Abstract Background Vitamin K antagonists (VKA) are indicated for the prevention of thromboembolic events and reduction of mortality in patients with atrial fibrillation and patients with valvular prostheses. However, their use is associated with bleeding complications and hospitalizations. Predictors of hospital admission for bleeding in these patients are poorly known. Objectives To define the predictors for hospitalization of VKA users who seek emergency care due to bleeding. Methods Single-center, cross-sectional study, with retrospective analysis of electronic medical records from 03/01/2012 to 02/27/2017. Clinical and laboratory variables were compared between patients who were hospitalized and those who were not. A logistic regression model as used, in which the variables were included using the Backward stepwise method, with a p value of 0.05 as the input criterion, a removal value of 0.20 and a confidence interval of 95%. The p-value was considered statistically significant when <0.05. Results A total of 510 patients with bleeding were included, of whom 158 were hospitalized. Predictors of hospitalization were: INR at supratherapeutic levels (OR 3.45; P <0.01; 95% CI 1.58 - 7.51), gastrointestinal bleeding (OR 2.36; P <0.01; CI 95% 1.24 - 4.50), drop in hemoglobin (OR 6.93; P <0.01; 95% CI 3.67 - 13.07), heart failure (OR 1.96; P 0.01; 95% CI 1.16 - 3.30) and need for blood transfusion (OR 8.03; P <0.01; 95% CI 2.98 - 21.64). Conclusion Drop in hemoglobin, heart failure, INR at supratherapeutic levels, gastrointestinal bleeding and need for blood transfusion were associated with hospitalization. Identification of these factors in the initial evaluation would help to define which patients will demand more intensive care.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Vitamin K/antagonists & inhibitors , Warfarin , Hemorrhage , Hospitalization , Platelet Aggregation , Cross-Sectional Studies , Retrospective Studies , Emergency Medical Services , Emergency Service, Hospital
2.
Evid. actual. práct. ambul ; 25(3): e002144, 2022. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1398442

ABSTRACT

Lograr un adecuado nivel de anticoagulación con antagonistas orales de la vitamina K suele ser un desafío frecuente en la práctica clínica, dado que su estrecho rango terapéutico suele verse afectado por diversas interacciones farmacológicas,alimentos y condiciones clínicas. A partir de un caso de un paciente anticoagulado que presenta una hemorragia gastro-intestinal posterior a realizar un tratamiento antibiótico, la autora de este artículo revisó la evidencia sobre el riesgo desangrado secundario a la interacción entre este tipo de anticoagulantes y antibióticos orales. Su conclusión tras realizar una búsqueda bibliográfica y seleccionar la mejor evidencia disponible, es que existe un aumento del riesgo relativo desangrado en pacientes anticoagulados que reciben antibióticos, por lo que deberían evitarse aquellos antibióticos con conocido potencial de interacción. Si ello no fuera posible, se recomienda monitorizar el estado de anticoagulación con dosaje de la razón internacional normatizada (RIN) posterior a la introducción del antibiótico. (AU)


Achieving an adequate level of anticoagulation with oral vitamin K antagonists is often a frequent challenge in clinical practice, given that their narrow therapeutic range is often affected by various drug interactions, food, and clinical conditions. Based on a case of an anticoagulated patient who presented gastrointestinal bleeding after antibiotic treatment, the authorof this article reviewed the evidence on the risk of secondary bleeding due to the interaction between this type of anticoagulants and oral antibiotics. Their conclusion, after performing a literature search and selecting the best available evidence, is that there is an increased relative risk of bleeding in anticoagulated patients receiving antibiotics, so antibiotics with known potential for interaction should be avoided. If it weren't possible, it is recommended to monitor the anticoagulation status with International Normalized Ratio (INR) dosing after the introduction of the antibiotic. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Vitamin K/antagonists & inhibitors , Warfarin/adverse effects , Hemorrhage/chemically induced , Acenocoumarol/adverse effects , Anti-Bacterial Agents/adverse effects , Anticoagulants/adverse effects , Warfarin/pharmacology , Warfarin/pharmacokinetics , Risk Factors , Risk Assessment , International Normalized Ratio , Drug Interactions , Acenocoumarol/pharmacology , Acenocoumarol/pharmacokinetics , Anti-Bacterial Agents/pharmacology , Anticoagulants/pharmacology , Anticoagulants/pharmacokinetics
3.
J. pediatr. (Rio J.) ; 97(5): 514-519, Sept.-Oct. 2021. tab, graf
Article in English | LILACS | ID: biblio-1340159

ABSTRACT

Abstract Objective: To study the presenting clinical and demographic features, risk factors, and outcome of infants with late vitamin K deficiency bleeding. Methods: Over a 5-year study period, the presenting clinical features and outcome of all 47 infants observed aged less than 6 months, who were diagnosed with late-onset primary and secondary VKDB by detailed history, physical examination, and laboratory findings were evaluated. Confirmed primary late VKDB was diagnosed when no cause other than breastfeeding could be found, while in the secondary subtype additional risk factors compromising the vitamin K effect were diagnosed. Results: Secondary late VKDB (83%, 39 patients) was more common than the primary subtype. The mean age of patients was 10.50 ± 5.75 and 9.74 ± 6.04 weeks in primary and secondary VKDB subtypes, respectively, and the age of infants did not have a significant difference (> 0.05). The male to female ratio was 2.13:1. The residency, place and mode of delivery, gestational age, and types of feeding of patients did not have a significant difference between VKDB subtypes. The skin and gastrointestinal tract (GIT) (40.4%) followed by intracranial hemorrhage (ICH) (32%), were common sites of bleeding. Neurological complications were seen in 21% of patients; however, lethality was 23%, and the outcome of patients did not have a significant difference (p > 0.05) between VKDB subtypes. Conclusion: Secondary late VKDB is more common than the primary subtypes, and late VKDB is still a serious disease in developing countries, including Iraq, when vitamin K prophylaxis isn't routinely used at birth.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Vitamin K Deficiency Bleeding/complications , Vitamin K Deficiency Bleeding/epidemiology , Vitamin K , Breast Feeding , Prospective Studies
4.
Biomédica (Bogotá) ; 41(3): 403-408, jul.-set. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1345391

ABSTRACT

Se presenta el caso clínico de una paciente de 10 años diagnosticada con miocardiopatía dilatada, quien registró valores en el índice internacional normalizado (International Normalized Ratio, INR) superiores a 10 con la dosis estándar de acenocumarol, además de otros valores que indicaban el estado incoagulable, lo que obligó a suspender y reiniciar el tratamiento en varias ocasiones. Después de más de 30 días de tratamiento, sorprendentemente se lograron los niveles esperados y estables en el INR con la mitad de la dosis recomendada para una paciente de su edad y peso.Se decidió hacer un análisis farmacogenético retrospectivo del caso mediante RT-PCR con sondas TaqMan™ que incluyó cinco polimorfismos de un solo nucleótido y distinto grado de asociación con la dosis-respuesta a los fármacos antivitamínicos K (AVK): rs2108622 (gen CYP4F2), rs9923231, rs7294 (gen VKORC1), rs1799853 y rs1057910 (gen CYP2C9). La paciente resultó ser homocigota para el rs9923231 (VKORC1) y heterocigota para el rs2108622 (CYP4F2). Se ha evidenciado a nivel nacional e internacional que este perfil genético está fuertemente asociado con una necesidad de dosis menores de antivitamínicos K.En conclusión, el análisis farmacogenético confirmó que la condición genética de la paciente, la cual conlleva una baja expresión de la enzima VKORC1 (blanco terapéutico de los antivitamínicos K), hacía predecible la necesidad de una dosis menor a la establecida según los protocolos clínicos recomendados por la Food and Drug Administration (FDA) y PharmGKB™ para los fármacos cumarínicos. El análisis genotípico previo de la paciente hubiese permitido alcanzar el rango terapéutico más prontamente, evitando potenciales riesgos de hemorragia, lo que demuestra la importancia de los análisis farmacogenéticos en tratamientos de gran variabilidad y estrecho rango terapéutico.


Abstract We present the clinical case of a 10-year-old patient diagnosed with dilated cardiomyopathy who registered INR values above 10 upon receiving standard doses of acenocoumarol, as well as other values reported as uncoagulable, forcing the discontinuation and restart of treatment more than once. Expected and stable INR levels were achieved after more than 30 days of treatment, surprisingly with half the recommended dose for a patient of her age and weight. We decided to conduct a retrospective pharmacogenomic analysis including nucleotide genetic polymorphisms (SNPs) with different degrees of association with the dose/response to antivitamin K (AVK) drugs: rs2108622 (gene CYP4F2), rs9923231, rs7294 (gene VKORC1), rs1799853, and rs1057910 (CYP2C9 gene) using TaqMan® RT-PCR. The patient was homozygous for rs9923231 (VKORC1) and heterozygous for rs2108622 (CYP4F2), a genetic profile strongly associated with a requirement of lower AVK doses as shown by national and international evidence. In conclusion, the pharmacogenetic analysis confirmed that this patient's genetic conditions, involving low expression of the VKA therapeutic target, required a lower dose than that established in clinical protocols as recommended by the Food and Drug Administration (FDA) and the PharmGKB® for coumarin drugs. A previous genotypic analysis of the patient would have allowed reaching the therapeutic range sooner, thus avoiding potential bleeding risks. This shows the importance of pharmacogenetic analyses for highly variable treatments with a narrow therapeutic range.


Subject(s)
Pharmacogenetics , Acenocoumarol , Vitamin K , Anticoagulants
5.
Gac. méd. Méx ; 157(3): 296-304, may.-jun. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1346110

ABSTRACT

Resumen Introducción: Los antagonista de la vitamina K (AVK) son una alternativa terapéutica en los pacientes con enfermedad tromboembólica venosa; sin embargo, numerosos factores afectan su farmacología. Objetivo: Evaluar la calidad de la anticoagulación AVK durante tres diferentes periodos en México. Métodos: Estudio prospectivo, anidado en cohortes de pacientes en tres escenarios clínicos entre los años 2013-2019. Se incluyeron pacientes no hospitalizados con indicación para recibir AVK por al menos 12 meses, quienes fueron manejados de acuerdo con el criterio del médico tratante. Resultados: Las características generales de los pacientes fueron similares entre los grupos, excepto por la indicación para usar los AVK. Se analizaron los resultados de 4148 pacientes y 38 548 evaluaciones de INR. Los tiempos en rango terapéutico durante las tres fases del estudio y los datos acumulados fueron significativamente mayores en la clínica de anticoagulación. Solo el número de visitas de control de los pacientes se asoció significativamente con los resultados, a diferencia de la edad, el sexo y el tipo de AVK. Conclusiones: Los AVK se utilizan ampliamente, pero es difícil alcanzar la meta terapéutica, sobre todo en servicios clínicos no especializados. La creación de clínicas de anticoagulación es una necesidad urgente en el sistema mexicano de salud.


Abstract Introduction: Vitamin K antagonists (VKA) are a therapeutic alternative in patients with venous thromboembolic disease; however, numerous factors affect their pharmacology. Objective: To evaluate the quality of VKA anticoagulation at three different time periods in Mexico. Methods: Prospective study, nested in patient cohorts at three different clinical scenarios between 2013 and 2019. Outpatients with indication for treatment with VKAs for at least 12 months were included. Patients were managed according to the criteria of the treating physician. Results: Patient general characteristics were similar between groups, except for the VKA indication. The results of 4,148 patients and 38,548 INR assessments were analyzed. The times in therapeutic range during the three phases of the study and pooled data were significantly higher for the anticoagulation clinic. Only the number of patient visits was significantly associated with the results, unlike age, gender, and type of VKA. Conclusions: VKAs are widely used, but it is difficult for therapeutic goals to be achieved, especially in non-specialized clinical services. Creation of anticoagulation clinics is an urgent need for the Mexican health system.


Subject(s)
Humans , Vitamin K , Anticoagulants , Prospective Studies , Fibrinolytic Agents , Mexico
6.
Bol. méd. postgrado ; 37(1): 21-26, Ene-Jun 2021. graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1147874

ABSTRACT

El tratamiento anticoagulante oral con fármacos inhibidores de la vitamina K como la warfarina se viene utilizando desde hace décadas para la terapia y prevención de la enfermedad tromboembólica con efectos secundarios ampliamente conocidos, pero con una utilidad clínica bien contrastada. El objetivo de este estudio fue determinar la proporción de mortalidad y hospitalización de la consulta de anticoagulación y trombosis del Centro Cardiovascular Regional ASCARDIO en el año 2017 para lo cual se realizó un estudio descriptivo transversal que incluyó una muestra de 294 pacientes. La principal indicación de anticoagulación fue la fibrilación auricular (73%) seguida de la enfermedad tromboembólica venosa (13%) e isquemia miocárdica (9%). Se registró una mortalidad de 11,7% siendo la principal causa de muerte de origen cardíaco (58%). La edad promedio de los pacientes fallecidos fue de 65 años, siendo 53% del sexo femenino; para el momento de la muerte, el 65% de los pacientes estaba tomando warfarina. La hospitalización se observó en el 10% de la muestra siendo la principal causa de la misma la cardíaca (60%) seguida de causas hemorrágicas (18%); de los pacientes hospitalizados, la edad promedio fue de 66 años siendo 52% del sexo femenino; el 90% de los pacientes estaba tomando warfarina al momento de la hospitalización. El análisis de riesgo para mortalidad y hospitalización según causa y estatus de warfarina no mostró significancia estadística. No se evidenció relación de riesgo estadísticamente significativa entre muerte, hospitalización y estatus de la warfarina. Hubo mayor proporción de muertes (45%) y hospitalización (17%) en el grupo que ingresó con diagnóstico de isquemia miocárdica(AU)


Oral anticoagulant treatment with vitamin K inhibitor drugs such as warfarin has been used for decades for the therapy and prevention of thromboembolic disease with widely known side effects but with well-proven clinical utility. To determine the proportion of mortality and hospitalization of the anticoagulation and thrombosis clinic of the ASCARDIO Regional Cardiovascular Center in 2017 a descriptive cross-sectional study was carried out that included a sample of 294 patients. The results show that the main indication for anticoagulation was atrial fibrillation (73%) followed by venous thromboembolic disease (13%) and myocardial ischemia (9%). An 11.7% mortality rate was observed. The mean age of the deceased was 65 years with a slight prevalence of the female sex (53%). The main cause of death was cardiac (58%) and 65% of the deceased patients were taking warfarin at the moment of death. A 10% hospitalization rate was observed with an average age of hospitalized patients of 66 years; 52% were females. The main cause of hospitalization was cardiac (60%) followed by hemorrhage (18%) and 90% of the patients were taking warfarin at the time of hospitalization. The risk analysis for mortality and hospitalization according to cause and status of warfarin did not show statistical significance. There was a higher proportion of deaths (45%) and hospitalization (17%) in the group admitted with a diagnosis of myocardial ischemia(AU)


Subject(s)
Humans , Male , Female , Aged , Vitamin K/antagonists & inhibitors , Warfarin/therapeutic use , Venous Thrombosis/drug therapy , Anticoagulants , Atrial Fibrillation/drug therapy , Thromboembolism , Vascular Diseases , Myocardial Ischemia/drug therapy
7.
Chinese Journal of Biotechnology ; (12): 1748-1770, 2021.
Article in Chinese | WPRIM | ID: wpr-878665

ABSTRACT

Vitamins are organic substances that are essential for the maintenance of life activities. Generally, vitamins need to be obtained from the diet or from some synthetic source as the body cannot synthesize vitamins, or the amounts of the synthesized vitamins are insufficient. At present, vitamins are widely used in medicine, food additives, feed additives, cosmetics and other fields, and the global demand for vitamins is constantly growing. Vitamins can be produced from chemical or microbial synthesis. Chemical synthesis usually requires harsh reaction conditions, produces serious wastes, and creates great potential safety hazard. In contrast, microbial synthesis of vitamins is greener, safer, and requires much less energy input. This review summarizes the advances in metabolic engineering for vitamins production in the past 30 years, with a focus on production of water-soluble vitamins (vitamins B1, B2, B3, B5, B6, B7, B9, B12 and vitamin C precursors) and lipid-soluble vitamins (vitamin A, precursors of vitamin D, vitamin E and vitamin K). Moreover, the bottlenecks for fermentative production of vitamins are discussed, and future perspectives for developing next generation vitamins producing strains using synthetic biotechnology are prospected.


Subject(s)
Biotechnology , Metabolic Engineering , Vitamin A , Vitamin K , Vitamins/analysis
8.
Medicina (B.Aires) ; 80(supl.4): 1-26, set. 2020. graf
Article in Spanish | LILACS | ID: biblio-1287231

ABSTRACT

Resumen El tratamiento de un paciente anticoagulado con antagonistas de la vitamina K (AVK) sigue siendo un desafío, especialmente en regiones donde, por el costo, los dicumarínicos son todavía la alternativa más buscada a la hora de elegir un anticoagulante oral. Las clínicas de anticoagulación han demostrado ser la forma más eficiente y segura de evitar complicaciones trombóticas y hemorrágicas y de mantener al paciente en rango óptimo de tratamiento. Sin embargo, requieren de una adecuada infraestructura y personal capacitado para que funcionen eficientemente. En este consenso argentino se propone una serie de parámetros para la gestión efectiva de una clínica de anticoagulación. El objetivo es lograr una elevada calidad desde el punto de vista clínico-asistencial a través de un laboratorio de hemostasia de excelencia. Los criterios desarrollados en el documento fueron consensuados por un amplio grupo de expertos especialistas en hematología y en bioquímica de todo el país. Estos criterios deben adaptarse a la irregular disponibilidad de recursos de cada centro, pero siempre se los debe tener en cuenta a la hora de indicar el tratamiento anticoagulante con estas drogas. Tener en consideración estas premisas nos permitirá optimizar la atención del enfermo anticoagulado con AVK y de esta forma minimizar las intercurrencias trombóticas y hemorrágicas a las que está expuesto, para así honrar nuestra promesa de no dañar al paciente.


Abstract Treating an anticoagulated patient with vitamin K antagonists (VKA) remains a challenge, especially in areas where dicoumarins are still the first drug of choice due to the cost of other oral anticoagulants. Anticoagulation clinics have proven to be the most efficient and safe way to avoid thrombotic and hemorrhagic complications and to keep patients in optimal treatment range. However, they require adequate infrastructure and trained personnel to work properly. In this Argentine consensus we propose a series of guidelines for the effective management of the anticoagulation clinics. The goal is to achieve the excellence in both the clinical healthcare and the hemostasis laboratory for the anticoagulated patient. The criteria developed in the document were agreed upon by a large group of expert specialists in hematology and biochemistry from all over the country. The criteria presented here must always be considered when indicating VKA although they had to be adapted to the unequal reality of each center. Taking these premises into consideration will allow us to optimize the management of the anticoagulated patient with VKA and thus minimize thrombotic and hemorrhagic intercurrences, in order to honor our promise not to harm the patient.


Subject(s)
Humans , Vitamin K/antagonists & inhibitors , Practice Guidelines as Topic , Fibrinolytic Agents/therapeutic use , Ambulatory Care Facilities/organization & administration , Anticoagulants/therapeutic use , Administration, Oral , International Normalized Ratio , Consensus , Ambulatory Care Facilities/standards
9.
Arch. endocrinol. metab. (Online) ; 64(4): 436-444, July-Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131103

ABSTRACT

ABSTRACT Objective Recent research has investigated the possible inverse relationship between vitamin K intake and body fat. In addition, an increasing number of studies are supporting a key role for this vitamin in improving lipid profile and insulin sensitivity and reducing the risk of type 2 diabetes mellitus, but little is known about what mechanisms would be involved. Thus, the objective of this study was to investigate the relationship between vitamin K intake (in the form of phylloquinone - PK), body fat, lipid profile and markers of glucose homeostasis in adults and the elderly. Subjects and methods A cross-sectional study with 298 participants (46% men) in the São Paulo Health Survey 2014-2015. Spearman correlations were performed to evaluate the associations between vitamin K intake and the biochemical and body composition measures. Results Among normal-weight male adults (n = 15), PK intake presented a positive correlation with the quantitative insulin sensitivity check index (QUICKI) (r = 0.525; p = 0.045). Among men with high fat mass index (FMI) (n = 101), PK intake had a negative correlation with homeostasis model assessment estimate for β-cell function (HOMA-β) (r = −0.227; p = 0.022). In women with high FMI (n = 122), PK intake had a negative correlation with HOMA-β (r = −0.199, p = 0.032) and insulin (r = −0.207, p = 0.026). No correlations were found between PK intake and lipid profile. Conclusions Our findings support a potential relationship among PK intake, body fat and markers of glucose homeostasis in adults and the elderly.


Subject(s)
Humans , Male , Female , Adult , Aged , Insulin Resistance , Diabetes Mellitus, Type 2 , Homeostasis , Vitamin K , Body Mass Index , Adipose Tissue , Cross-Sectional Studies , Glucose , Insulin , Lipids
10.
Rev. chil. nutr ; 47(3): 470-477, jun. 2020. tab, graf
Article in English | LILACS | ID: biblio-1126146

ABSTRACT

Vitamin K is found in higher concentrations in dark green plant and in vegetable oils. The adequate intake of vitamin K is 90 and 120ug/day for adult elderly men and women, respectively. The main function of vitamin K is to act as an enzymatic cofactor for hepatic prothrombin synthesis, blood coagulation factors, and anticoagulant proteins. Prominent among the many available anticoagulants is warfarin, an antagonist of vitamin K, which exerts its anticoagulant effects by inhibiting the synthesis of vitamin K1 and vitamin KH2. From the beginning of the therapy it is necessary that the patients carry out the monitoring through the prothrombin time and the international normalized ratio. However, it is known that very low intake and/or fluctuations in vitamin K intake are as harmful as high consumption. In addition, other foods can interact with warfarin, despite their content of vitamin K. The aim of this study was to gather information on the drug interaction of warfarin with vitamin K and with dietary supplements and other foods.


La vitamina K se encuentra en concentraciones más altas en plantas de color verde oscuro y en aceites vegetales. La ingesta adecuada de vitamina K es de 90 y 120 ug/día para hombres y mujeres adultos mayores, respectivamente. La función principal de la vitamina K es actuar como un cofactor enzimático para la síntesis de protrombina hepática, factores de coagulación de la sangre y proteínas anticoagulantes. Entre los muchos anticoagulantes disponibles destaca la warfarina, un antagonista de la vitamina K, que ejerce sus efectos anticoagulantes al inhibir la síntesis de la vitamina K1 y la vitamina KH2. Desde el inicio de la terapia, es necesario que los pacientes realicen el monitoreo a través del tiempo de protrombina y la proporción normalizada internacional. Sin embargo, se sabe que una ingesta muy baja y/o fluctuaciones en la ingesta de vitamina K son tan dañinas como un consumo alto. Además, otros alimentos pueden interactuar con la warfarina, a pesar de su contenido de vitamina K. El objetivo de este estudio fue recopilar información sobre la interacción de los medicamentos de la warfarina con la vitamina K y con los suplementos dietéticos y otros alimentos.


Subject(s)
Humans , Vitamin K/antagonists & inhibitors , Warfarin/administration & dosage , Food-Drug Interactions , Anticoagulants/administration & dosage , Vitamin K/administration & dosage , Vitamin K/metabolism , Warfarin/metabolism , Dietary Supplements , International Normalized Ratio , Anticoagulants/metabolism
11.
Int. j. cardiovasc. sci. (Impr.) ; 33(1): 68-78, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090630

ABSTRACT

Abstract Background: Despite the efficacy of vitamin K antagonists against stroke in patients with atrial fibrillation (AF), the underuse of this therapy is well documented. Objectives: To evaluate trends and predictors of oral anticoagulants utilization in patients with AF. Methods: Observational, retrospective, serial cross-sectional study between 2011-2016. Comparisons between groups were performed using the Student t, Mann-Whitney and Chi-square tests. Logistic regression was used to identify independent predictors of anticoagulation. A p value < 0.05 was considered significant. Results: A total of 377 patients were analyzed. The mean age was 70 ± 15 years; 52% were male and 75% were anticoagulated (20% with VKA and 55% with DOAC). Over 5 years, the overall frequency of anticoagulation increased by 22.4%. The use of DOACs increased from 29% to 70%, whereas the use of VKA decreased from 36% to 17%. The use of antiplatelet agents alone also fell from 21% to 6%. The predictors of anticoagulation were previous episodes of AF (OR 3.1, p < 0.001), hypertension (OR 3.0, p < 0.001) and HASBLED score (OR 0.5, p < 0.001). The predictors of DOAC use were serum creatinine (OR 0.2, p = 0.002), left atrial size (OR 0.9, p = 0.003) and biological valve prosthesis (OR 0.1, p = 0.007). Of the 208 patients using DOACs, 63 (30%) received inadequate prescriptions: 5 with severe drug interactions and 58 with incorrect dosing. Conclusions: Between 2011 and 2016, DOACs were rapidly incorporated into clinical practice, replacing AVKs and antiplatelets, and contributing to greater use of anticoagulation in patients with AF.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Atrial Fibrillation/drug therapy , Vitamin K/antagonists & inhibitors , Thromboembolism/prevention & control , Serial Cross-Sectional Studies , Retrospective Studies , Anticoagulants/administration & dosage
13.
Chinese Journal of Cardiology ; (12): 689-696, 2020.
Article in Chinese | WPRIM | ID: wpr-941159

ABSTRACT

Object We aimed to compare the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonist (VKA) in the prevention and treatment of thrombotic diseases in patients with active cancer. Methods: To find randomized controlled trials (RCT) in which NOACs were compared VKAs in active cancer, we searched the electronic databases (PubMed, Web of Science and Clinical Trials) up to May 2019 and and languages restricted to Chinese and English. According to the screening strategy, two researchers independently screened and extracted literature, evaluated the quality of literature, the suitability of collected cross study data for analysis, and tested the heterogeneity. The relative risk (RR) and 95% confidence interval (95%CI) of major bleeding, clinically related non-major bleeding, VTE, stroke and all-cause mortality in active cancer patients with VTE, active cancer patients with non-valvular atrial fibrillation (NVAF) was calculated and the results were compared between NOAC with VKA. Results: A total of 9 RCTs were included, including 5 cancers with VTE (5/9) and 4 cancers with NVAF (4/9). A total of 5 867 patients were included. After excluding 1 818 (30.99%) patients with cancer history, 4 049 (68.86%) patients with active cancer were statistically analyzed. Among them, 2 278 (56.26%) received NOAC treatment, 1 771 patients (43.74%) received VKA treatment. The quality of the included documents was high (all scores were>5 points), and the data of each included document could be summarized and analyzed (P>0.05). The heterogeneity of main outcome events was very low (I2 = 0). In VTE patients with active cancer, NOACs were more effective in reducing recurrence of VTE (RR=0.55, 95%CI 0.36 -0.84; P = 0.005) and clinically related non-major bleeding (RR=0.77, 95%CI 0.60 -0.98; P = 0.03) than VKAs. In NVAF patients with active cancer, efficacy of NOACs and VKAs was similar in terms of reducing VTE, stroke, clinically related non-major bleeding, major bleeding and all-cause mortality events (P>0.05). Conclusions: For patients with active cancer accompanied by VTE, NOAC may has more advantages in efficacy and safety compared to VKA in the prevention and treatment of thrombotic diseases.


Subject(s)
Administration, Oral , Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Humans , Neoplasms/drug therapy , Randomized Controlled Trials as Topic , Venous Thromboembolism/prevention & control , Vitamin K/therapeutic use
15.
Rev. Hosp. El Cruce ; (27): 26-30, 2020.
Article in Spanish | LILACS | ID: biblio-1282786

ABSTRACT

La hipertensión pulmonar tromboembólica crónica se trata con angioplastia pulmonar con balón (APB) cuando la enfermedad es distal o la clase funcional cardíaca no permite la tromboendarectomía. La anticoagulación con antagonistas de vitamina k es uno de los pilares del tratamiento. Se describe la experiencia de 25 procedimientos de ABP bajo tratamiento anticoagulante con AVK y sus complicaciones de sangrado (8% de las ABP). Realizar APB, con RIN mayor igual a 2 no presenta un riesgo significativo de sangrado en nuestra serie.


Subject(s)
Vitamin K , Angioplasty, Balloon , Hypertension, Pulmonary
16.
Arch. cardiol. Méx ; 89(4): 382-392, Oct.-Dec. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1149097

ABSTRACT

Resumen Introducción: La llegada de los anticoagulantes directos (ACD) ha supuesto un cambio en el tratamiento de la fibrilación auricular no valvular (FANV) en los últimos años. Los objetivos de este estudio son determinar el grado de control de la anticoagulación con antivitamina K (AVK) y su posible implicación en efectos cardiovasculares adversos mayores (ECAM) y evaluar las diferencias entre el grupo en tratamiento con AVK respecto del grupo con ACD. Pacientes y métodos: Estudio de cohorte prospectivo que incluyó a pacientes consecutivos diagnosticados con FANV valorados en el Servicio de Cardiología con un seguimiento de 18 meses. Se analizaron diferencias demográficas, clínicas y analíticas entre grupos, incluido el grado de control de la anticoagulación del grupo AVK y su posible relación con ECAM. Resultados: Se incluyó a 273 pacientes: 46.5% tratados con AVK, 42.5% con ACD y 11% sin tratamiento anticoagulante. El control de la anticoagulación con AVK fue del 62.1%, sin diferencias en ECAM en función de control. El grupo ACD presentó menos ECAM que el grupo de AVK (13.4 vs. 4.3%; HR, 0.90; 0.83-0.98; p = 0.01), con una menor mortalidad cardiovascular (0.0 vs. 5.5%; HR, 0.94; 0.90-0.98; p = 0.01) y total (0.9 vs. 12.6%; HR, 0.88; 0.82-0.94; p menor que 0,01), aunque sin diferencias significativas en eventos hemorrágicos (0.9 vs. 4.7%; p = 0.07) ni isquémicos (2.6 vs. 0.8%; p = 0.27). Discusión: Los pacientes con AVK poseen un perfil clínico diferente en comparación con los que reciben ACD. El control de anticoagulación del grupo de AVK fue inadecuado en casi la mitad de los casos. El grupo de AVK presentó más ECAM que el grupo de ACD.


Abstract Introduction: The arrival of direct-acting oral anticoagulants (DOACs) has led to a change in the management of non-valvular atrial fibrillation (NVAF) in recent years. The objectives of this study are to determine the level of therapeutic control of anticoagulation with vitamin K antagonists (VKA) and its possible involvement in major adverse cardiovascular events (MACE) and to evaluate differences between the group on VKA with respect to the group on DOACs. Patients and methods: Prospective cohort study that included consecutive patients diagnosed with NVAF in Cardiology Consultations with a clinical follow-up of 18 months. Demographic, clinical and analytical differences between groups were analyzed, including the level of therapeutic control of anticoagulation on the VKA group and its association with MACE. Results: Overall, 273 patients were included: 46.5% on VKA, 42.5% on DOACs, 11% without antithrombotic treatment. Patients on VKA spent 62.1% of their time within therapeutic range (TTR by the Rosendaal formule). There were no differences in MACE depending on anticoagulation control. The DOACs group presented lesser MACE rate than the VKA group (13.4 vs. 4.3%; 0.90; HR 0.90; 0.83-0.98 p = 0.01) with lower cardiovascular mortality (0.0 vs. 5.5%; HR, 0.94; 0.90-0.98; p = 0.01) and total mortality (0.9 vs. 12.6%; HR, 0.88; 0.82-0.94; p less 0.01) although without significant differences in hemorrhagic (0.9 vs. 4.7 %; p = 0.07), or ischemic events (2.6 vs. 0.8%, p = 0.27). Conclusions: Patients on VKA have a different clinical profile than those who receive DOACs. Patients on VKA have an inadequate control of the anticoagulation in quite the half of the cases. The VKA group presented more MACE than the DOACs group.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Atrial Fibrillation/drug therapy , Vitamin K/antagonists & inhibitors , Factor Xa Inhibitors/administration & dosage , Anticoagulants/administration & dosage , Atrial Fibrillation/complications , Cardiovascular Diseases/epidemiology , Administration, Oral , Prospective Studies , Cohort Studies , Follow-Up Studies , Factor Xa Inhibitors/adverse effects , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Anticoagulants/adverse effects
17.
Acta toxicol. argent ; 27(2): 60-64, Sept. 2019.
Article in Spanish | LILACS | ID: biblio-1088538

ABSTRACT

Introducción. Los superwarfarinicos (SWF) son una de las herramientas utilizadas por el ser humano para el control de roedores y a la vez son tóxicos para el hombre y pueden conducir a la muerte sin los debidos cuidados en su uso.Casos clinicos. Tres pacientes masculinos, que consultaron por sangrados (gingivorragia, epistaxis, hematuria, hemartrosis y hematomas cutaneos) asociados a alteraciones del coagulograma (Tiempo de protrombina (TP) y tiempo de tromboplastina parcial (KPTT) prolongados). Todos tuvieron exposición a superwarfarinicos. Nuestro servicio no dispone del análisis de SWF en suero. Se administró vitamina K1 en los tres pacientes y plasma fresco congelado (PFC) en uno solo (sangrado mayor: hematuria). El seguimiento se realizó mediante controles seriados de coagulograma y su evolución fue favorable. Discusión. En todos los casos, el diagnóstico de intoxicación por SWF fue clínico, basado en caracteristicas clínicas de pacientes y alteraciones en sus parámetros de coagulación, y debido a imposibilidad de derivación de análisis a otro laboratorio. Se realizo tratamiento especifico (vitamina K1 y PFC) segun recomendación de expertos, ya que no hay hasta la fecha, estudios clinicos que evaluen las diferentes opciones terapéuticas. Conclusión. La intoxicación por SWF aunque no es frecuente, debe sospecharse en casos de paciente con coagulopatia sin otras causas que puedan justificarlo. El manejo del cuadro tóxico es la reposición de vitamina k y de plasma fresco congelado, en casos donde se necesite una rápida corrección de la alteración hemostática, como los sangrados mayores. Es imprescindible la oportuna consulta con médicos hematólogos y/o la consulta con un centro regional de control de intoxicaciones para todas las exposiciones sospechosas por SWF.


Introduction. Superwarfarinics (SWF) are one of the tools used by humans for rodent control. They are toxic to humans and can lead to death without due care in its use. Clinical cases. Three male patients, who consulted due to bleeding (gingivorragia, epistaxis, hematuria, hamartrosis and skin hematomas) associated with coagulogram alterations (prolonged protombine time (PT) and partial thromboplastin time (KPTT)). All them exposure to superwarfarinics. SWF serum analysis was not available in our hospital. Vitamin K1 was administered in all three patients and fresh frozen plasma (PFC) in only one (major bleeding: hematuria). The followup was performed by serial coagulogram controls and the evolution was. Discussion. In all cases, the diagnosis of SWF intoxication was clinical, based on clinical characteristics of patients and alterations in their coagulation parameters, due to the impossibility of deriving the analysis of SWF in serum to another laboratory. Specific treatment was carried out (vitamin k and PFC) according to experts' recommendation, since there are no clinical studies to evaluate the different therapeutic options to date. Conclusion. SWF poisoning, although not frequent, should be suspected in patients with coagulopathy without other causes that may justify it. The management of toxic symptoms is the administration of vitamin K1 and fresh frozen plasma, in cases where a rapid correction of the haemostatic alteration is required, such as major bleedings. It is essential to consult with hematologists and / or consult a regional poison control center for all suspicious exposures by superwarfarins.


Subject(s)
Humans , Male , Adult , Rodenticides/poisoning , Rodenticides/toxicity , Vitamin K/therapeutic use , Argentina , Vitamin K Deficiency Bleeding
18.
Int. j. cardiovasc. sci. (Impr.) ; 32(2): 110-117, mar.-abr. 2019. tab, graf
Article in English | LILACS | ID: biblio-987748

ABSTRACT

Background: Warfarin is an oral anticoagulant involved in important interactions with foods and other drugs. Objectives: To evaluate the occurrence of adverse events reported by warfarin users and their relationship with drug interactions. Methods: This was an open cohort, prospective study conducted in an 18-month period with warfarin users attending public health clinics of the city of Ijuí, Brazil. Data were collected by means of interviews administered at patients' home every month. Patients' responses were confirmed by review of medical records when patients sought medical care. Data were analyzed by descriptive statistics. Potential drug interactions were evaluated in a database and vitamin K consumption was quantified using a validated method. Results: A total of 68 patients were followed-up; 63 completed the study and 5 died in the study period. Mean number of medications taken by the patients was 9.6 ± 4.5, and mean number of interactions involving warfarin was 2.91 ± 1.52. Most potential interactions increased the risk of bleeding, 61 of them severe interactions and 116 moderate interactions. Eighty-seven episodes of bleeding and 4 episodes of thrombosis were reported by a total of 37 and 4 patients, respectively. At the occurrence of these events, 56.5% of warfarin users were also taking omeprazole, 35.9% were taking simvastatin and 25.0% paracetamol. Most patients had a low vitamin K intake. Conclusions: A high frequency of potential interactions between warfarin and other drugs was detected, but a low intake of foods that could possibly affect the effects of warfarin was observed. Based on our results, it seems prudent to follow patients on warfarin therapy for drug-drug interactions, aiming to control adverse effects and to promote a safe and effective therapy


Subject(s)
Humans , Male , Female , Middle Aged , Warfarin/adverse effects , Community Health Services/statistics & numerical data , Drug Interactions , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Vitamin K , Omeprazole/therapeutic use , Data Interpretation, Statistical , Prospective Studies , Statistics as Topic , Treatment Outcome , Drug Monitoring , Simvastatin/therapeutic use , Drug Incompatibility , Pharmacovigilance , Acetaminophen
19.
Rev. inf. cient ; 98(4): 458-468, 2019. tabs
Article in Spanish | LILACS, CUMED | ID: biblio-1023817

ABSTRACT

Introducción: la prescripción de fármacos inhibidores de la vitamina K exige el control del efecto anticoagulante. Objetivo: caracterizar a los pacientes con antecedentes de tratamiento con warfarina sódica al momento del ingreso en la unidad de terapia intensiva del Hospital General Docente Dr Agostinho Neto durante el periodo 2016- 2018. Método: se realizó estudio analítico, retrospectivo y longitudinal. Se estudiaron 54 pacientes con las características señaladas, que se agruparon en un grupo control (n=16) con anticoagulación adecuada y un grupo estudio (n=38) también con anticoagulación adecuada. Se estudiaron variables sociodemográficas, clínicas y de laboratorio. Resultados: Un total de 16 pacientes presentó nivel adecuado de anticoagulación y en, 38, nivel de anticoagulación fue inadecuado. La warfarina sódica se indicó más en pacientes con prótesis valvular cardiaca mecánica (20,0 por ciento), y en estos fue más común la anticoagulación inadecuada. Los factores más relacionados con la anticoagulación adecuada fueron la supervisión médica frecuente (p=0,0000), que no usaron fármacos que interfieran con la acción del fármaco (p=0,0000) y el cumplimiento del tratamiento (p=0,0000). En 22 pacientes se presentaron complicaciones hemorrágicas y la más común fue la hemorragia cerebral y, 16, presentaron complicaciones tromboembólicas y la más frecuente fue el embolismo cerebral. Fallecieron 3 pacientes por complicaciones hemorrágicas y 9 por complicaciones tromboembólicas. En 21 pacientes la indicación del fármaco fue inapropiada. Conclusiones: se revela la necesidad del control de la adecuada adherencia terapéutica del paciente pues el inadecuado efecto anticoagulante genera complicaciones que pueden determinar la muerte del paciente(AU)


Introduction: the prescription of vitamin K inhibitor drugs requires control of the anticoagulant effect. Objective: to characterize patients with a history of treatment with warfarin sodium at the time of admission to the intensive care unit of the General Teaching Hospital Dr Agostinho Neto during the 2016-2018 period. Method: an analytical, retrospective and longitudinal study was carried out. 54 patients with the characteristics indicated were studied, which were grouped in a control group (n=16) with adequate anticoagulation and a study group (n=38) also with adequate anticoagulation. Sociodemographic, clinical and laboratory variables were studied. Results: A total of 16 patients presented adequate level of anticoagulation and, in 38, level of anticoagulation was inadequate. Sodium warfarin was indicated more in patients with mechanical cardiac valve prostheses (20.0per cent), and inadequate anticoagulation was more common in these. The factors most related to adequate anticoagulation were frequent medical supervision (p=0.0000), who did not use drugs that interfere with the action of the drug (p=0.0000) and treatment compliance (p=0.0000). In 22 patients there were hemorrhagic complications and the most common was cerebral hemorrhage and, 16, they presented thromboembolic complications and the most frequent was cerebral embolism. Three patients died from bleeding complications and 9 from thromboembolic complications. In 21 patients the indication of the drug was inappropriate. Conclusions: the need to control the adequate therapeutic adherence of the patient is revealed because the inadequate anticoagulant effect generates complications that can determine the death of the patient(AU)


Introdução: a prescrição de medicamentos inibidores da vitamina K requer controle do efeito anticoagulante. Objetivo: caracterizar pacientes com histórico de tratamento com varfarina sódica no momento da admissão na unidade de terapia intensiva do Hospital Geral de Ensino Dr Agostinho Neto no período 2016-2018.Método: estudo analítico, retrospectivo e longitudinal. Foram estudados 54 pacientes com as características indicadas, os quais foram agrupados em um grupo controle (n=16) com anticoagulação adequada e um grupo estudo (n=38) também com anticoagulação adequada. Foram estudadas variáveis sociodemográficas, clínicas e laboratoriais. Resultados: Um total de 16pacientes apresentou nível adequado de anticoagulação e, em 38, o nível de anticoagulação foi inadequado. A varfarina sódica foi mais indicada em pacientes com próteses valvares cardíacas mecânicas (20,0 por cento), sendo a anticoagulação inadequada mais comum. Os fatores mais relacionados à anticoagulação adequada foram a supervisão médica frequente (p=0,0000), que não utilizou medicamentos que interferem na ação do medicamento (p=0,0000) e adesão ao tratamento (p=0,0000) Em 22 pacientes houve complicações hemorrágicas e a mais comum foi hemorragia cerebral; 16 apresentaram complicações tromboembólicas e a mais frequente foi embolia cerebral. Três pacientes morreram por complicações hemorrágicas e 9 por complicações tromboembólicas. Em 21 pacientes, a indicação do medicamento foi inadequada. Conclusões: a necessidade de controlar a aderência terapêutica adequada do paciente é revelada, pois o efeito anticoagulante inadequado gera complicações que podem determinar a morte do paciente(AU)


Subject(s)
Humans , Vitamin K/antagonists & inhibitors , Warfarin/administration & dosage , Anticoagulants/adverse effects , Thromboembolism/mortality , Cerebral Hemorrhage/mortality , Retrospective Studies , Longitudinal Studies
20.
Article in English | WPRIM | ID: wpr-765148

ABSTRACT

Cancer-associated venous thromboembolism (CAT) is a common complication associated with high morbidity and mortality. In accordance with major clinical trials comparing low-molecular-weight heparin (LMWH) with a vitamin K antagonist (VKA), LMWH is currently the standard treatment for CAT, owing to its efficacy for thrombosis recurrence and improved safety profile compared to VKA. Over the past few years, direct oral anticoagulants (DOACs) have emerged as potential alternative therapies to LMWH due to their convenient route of administration and predictable pharmacokinetics, but evidence for their use in CAT is inconclusive, as only a small fraction of the study populations in these trials had CAT. Recently, two large head-to-head trials comparing DOACs to LMWH in CAT patients reported comparable efficacies of DOACs with increased bleeding risk. Occasionally, CAT treatment can be challenging due to the heterogeneity of underlying malignancies and comorbidities. Renal insufficiency and gastrointestinal defects are the main obstacles in anticoagulant selection. Careful choice of treatment candidates and proper anticoagulant strategies are critical for the treatment of CAT; hence, more studies are required to address these challenges.


Subject(s)
Animals , Anticoagulants , Cats , Comorbidity , Complementary Therapies , Hemorrhage , Heparin, Low-Molecular-Weight , Humans , Mortality , Pharmacokinetics , Population Characteristics , Recurrence , Renal Insufficiency , Thrombosis , Venous Thromboembolism , Vitamin K
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