Rapid Warfarin reversal in the setting of intracranial hemorrhage: a comparison of plasma, recombinant activated factor VII, and prothrombin complex concentrate.

OBJECTIVE: To compare the safety and effectiveness of three methods of reversing coagulopathic effects of warfarin in patients with potentially life-threatening intracranial hemorrhage. METHODS: A retrospective electronic medical record review of 63 patients with warfarin-related intracranial hemorrhage between 2007 and 2010 in an integrated health care delivery system was conducted. The three methods of rapid warfarin reversal were fresh-frozen plasma (FFP), activated factor VII (FVIIa; NovoSevenRT [Novo Nordisk, Bagsværd, Denmark]), and prothrombin complex concentrate (PCC; BebulinVH [Baxter, Westlake Village, California, USA], ProfilnineSD [Grifols, North Carolina, USA]), each used adjunctively with vitamin K (Vit K, phytonadione). We determined times from reversal agent order to laboratory evidence of warfarin reversal (international normalized ratio [INR]) in the first 48 hours and compared INR rebound rates and complications in the first 48 hours. RESULTS: Reversal with FFP took more than twice as long compared with FVIIa or PCC. To reach an INR of 1.3, mean (±SD) reversal times were 1933 ± 905 minutes for FFP, 784 ± 926 minutes for FVIIa, and 980 ± 1021 minutes for PCC (P < 0.001; P < 0.01 between FFP and FVIIa, P < 0.05 between FFP and PCC). INR rebound occurred in 0 of 31 patients for FFP, 4 of 8 for FVIIa, and 0 of 7 for PCC (P = 0.001). Complications were uncommon. FVIIa was 15 and 3.5 times as expensive as FFP and PCC, respectively. CONCLUSION: As an adjunct to Vit K for rapid warfarin reversal, FVIIa and PCC appear more effective than FFP. Either FVIIa or PCC are reasonable options for reversal, but FVIIa is considerably more expensive and may have greater risk of INR rebound.

Association of sleep duration with blood glucose level of Gujarati Indian adolescents.

Recently studies conducted in various parts of the world indicate short sleep duration as a novel risk factor for development of type 2 diabetes. However, ethnic differences exist in the etiopathogenesis of diseases, the current study was undertaken to study the effect of sleep duration on the blood glucose level of Gujarati Indian adolescents. A randomized, non-experimental, cross-sectional study was done on the voluntary participants n = 332 Gujarati adolescent boys and girls of age group 13-20 years studying at the schools and colleges in the Anand district. The participants were assessed for their sleep duration, body composition and blood glucose level. The sleep duration was reported by the subjects as the number of hours they slept on most of the nights in a week over the last one-year. The observations of the study were then analyzed after grouping them into: 1) Adequate sleep duration at night, ASDN (> or = 7 hrs) and 2) Inadequate sleep duration at night, ISDN (< 7 hrs) groups. One-way ANOVA and post hoc Tuky-Krammer test were used for finding significant differences (P < 0.05) between groups. No significant difference was found in all parameters of body composition and fasting blood glucose level between the ASDN group and ISDN group in both boys and girls. However, gender difference exists in the body composition and blood glucose level. The current study indicates that inadequate sleep duration at night (< 7 hrs) does not affect the blood glucose level of the Gujarati Indian adolescents of age group 13-20 years.

Association of physical activity and physical fitness with blood pressure profile in Gujarati Indian adolescents.

The current study was conducted to determine how physical activity level and physical fitness affects the blood pressure profile of Gujarati Indian adolescents so as to help in developing preventive strategies for the local population as ethnic differences exist in the aetiopathogenesis of hypertension. A cross-sectional study was conducted on 485 Gujarati Indian adolescent boys and girls of age group 16-19 years. Physical activity level was assessed using Johnson Space Center/NASA Physical Activity Rating Scale and VO2 max was used to assess the physical fitness. Body composition was assessed in terms of Body Mass Index, Fat Mass Index and Waist Circumference. Blood Pressure was measured by oscillometry. One-way ANOVA was used to study if any significant differences (P<0.05) existed in the blood pressure profile between the high, moderate and low physical activity groups. Pearson's correlation coefficient was determined to assess the relationship between VO2 max and blood pressure profile. In girls, physical activity level was not found to have a significant effect on the blood pressure profile. In boys, systolic blood pressure and mean arterial pressure were found to be significantly higher in Moderate Physical Activity Group as compared to Low Physical Activity Group. PVO2 max was found to have a significant negative correlationship with SBP, DBP and MAP in girls and a significant negative correlationship with SBP, PP and MAP in boys. It could thus be concluded that a better physical fitness rather than a higher physical activity level could keep the blood pressure in check in the Gujarati Indian adolescents.