To stop or not to stop novel oral anticoagulants prior to performing joint interventional maneuvers? Evidence from a prospective study that the therapy can be maintained.

Anticoagulation is common in patients undergoing routine musculoskeletal interventional maneuvers. Previous retrospective studies have established the safety of continuing anticoagulation with novel oral anticoagulants (NOACs) when performing this kind of interventions. Indeed, ultrasound (US)-guided interventional maneuvers have shown a superior safety profile compared to blind anatomical maneuvers. To evaluate prospectively the periprocedural bleeding events in NOAC-anticoagulated patients undergoing interventional articular or periarticular procedures. Consecutive patients diagnosed with inflammatory or degenerative rheumatologic pathology requiring interventional maneuvers were prospectively recruited. Group 1 was treated with NOACs, group 2 was treated with vitamin K antagonists, and group 3 was not anticoagulated. Prior to the international maneuver, NOAC therapy was continuously administered, in regimens dictated by the underlying anticoagulation indication. Demographics, comorbidities, laboratory parameters, locally administered medication (corticosteroids or viscosupplementation), interventional maneuver location, needle size, and local bleeding events were recorded. Post-procedural control was performed at 30 min, 48 h, and 7 days. No articular/periarticular bleeding event occurred in patients treated with NOACs, regardless of their type and dosage, locally administered medication, needle size, location, and number of interventions per individual. Several patients in all groups developed small superficial ecchymoses at the injection site. Our results suggest that NOACs are safe to be used in a continuous regimen prior to US-guided injections, even as dual antithrombotic therapy (in combination with aspirin). The use of lower gauge needles, chosen for viscosupplementation therapy, was not burdened with adverse effects on the procedural outcome. Key Points • Currently, no prospective studies have been performed to establish the safety of continuous NOAC anticoagulation when performing routine intra- or periarticular interventional maneuvers. • The study offers an extensive view on a wide spectrum of intra- and periarticular interventional maneuvers including anatomic targets and needle sizes that were not previously assessed. • The study offers a perspective into performing repetitive maneuvers in the same patient, both over a short time and at longer intervals. • The zero periprocedural bleeding risk observed in our study may reassure practitioners and suggest that US-guided interventional therapeutic interventions are safe in patients treated with a continuous regimen of different NOACs.

Paternal exposure to antirheumatic drugs-What physicians should know: Review of the literature.

Reproduction capacity and long-term preserved hormonal function are important aspects with big impacts on patients' quality of life. Updated information on the interaction between drug therapy and reproductive function is essential when discussing family planning with patients. Currently, limited data is published regarding paternal exposure to different medications. Thus, it may be a challenge for the practitioner to choose the right therapy for a young male patient. Therefore we reviewed the literature, for effects of antirheumatic drugs on male gonadal function with a focus on spermatogenesis and offspring.

Serum myoglobin in the diagnosis of acute myocardial infarction.

Serum myoglobin (Mgl) level was studied by the method of passive hemagglutination inhibition in 128 patients of whom 65 with acute myocardial infarction, 27 with unstable angina and 36 with various diseases as well as in 197 apparently normal subjects. The immunologic determination of serum myoglobin by the passive hemagglutination inhibition reaction was proved useful in the diagnosis of acute myocardial infarction (AMI) since in 95.3% of the cases myoglobin was found present in the serum in concentrations of 100-4.800 ng/ml depending on the moment of blood collection and the severity of infarction. The passive hemagglutination inhibition reaction for the determination of serum Mgl is superior to the biochemical tests (transaminases) both by the proportion of positive results obtained (95.3% by the Mgl test as compared with 73.8% by the transaminase test) and by its precocity, Mgl appearing in the serum within the first 1-2 hrs after onset of infarction. In the cases of AMI with negative or uninterpretable biochemical tests and/or ECG, serum Mgl determination can be decisive for the diagnosis. The presence of serum Mgl in 37.5% of the cases with intermediary syndrome (unstable angina) suggests the existence of some microfoci of myocardial necrosis undetectable by the usual biochemical or electric methods. Serum Mgl determination by the passive hemagglutination inhibition reaction is a relatively simple method, rapid (the results are obtained 1-2 hrs after blood collection) and practical since it can be performed in any laboratory with the usual equipment.

Electrophoretic investigation of L-asparaginase influence on blood and spleen blood globulins. Experimental study.

In view of detecting the influence of L-asparaginase on blood and spleen blood globulins, 42 rabbits were daily injected for three weeks with different doses of this drug. Electrophoretic analysis of blood and spleen blood samples from these animals showed no relationship between the doses used and the changes of circulating blood globulins indicating the well known immunodepressing effects of the drug. However, in the spleen blood from the inoculated rabbits (as compared with a control group) a small excess of gamma globulins which appeared especially after 1-2 weeks of daily injections with 2,000 or 10,000 I.U.L-asparaginase/kg b.w. was interpreted as due to the antigenic action of the enzymatic product administered.