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Sample records for adjusted-dose oral warfarin

  1. Influence of sampling on the determination of warfarin and warfarin alcohols in oral fluid.

    Tommaso Lomonaco

    Full Text Available The determination of warfarin, RS/SR- and RR/SS-warfarin alcohols in oral fluid may offer additional information to the INR assay. This study aimed to establish an optimized sampling technique providing the best correlation between the oral fluid and the unbound plasma concentrations of these compounds.Samples of non-stimulated and stimulated oral fluid, and blood were collected from 14 patients undergoing warfarin therapy. After acidification, analytes were extracted with a dichloromethane/hexane mixture and determined by HPLC with fluorescence detection. Plasma samples were also ultrafiltered for the determination of the unbound fraction. The chromatographic separation was carried out in isocratic conditions with a phosphate buffer/methanol mobile phase on a C-18 reversed-phase column. The absence of interfering compounds was verified by HPLC-ESI-Q-TOF.Stimulation generally increased the oral fluid pH to values close to blood pH in about 6 minutes. The concentration of warfarin and RS/SR-warfarin alcohols in oral fluid followed the same trend, whereas the concentration of RR/SS-warfarin alcohols was not affected. Six minute stimulation with chewing gum followed by collection with a polyester swab was the best sampling procedure, with a good repeatability (RSD < 10% and relatively low inter-subject variability (RSD  = 30% of the oral fluid to plasma ratio. This procedure provided strong correlations between the measured oral fluid and unbound plasma concentration of warfarin (r  =  0.92, p < 0.001 and RS/SR-warfarin alcohols (r  =  0.84, p < 0.001, as well as between stimulated oral fluid and total plasma concentration of warfarin (r  =  0.78, p < 0.001 and RS/SR-warfarin alcohols (r  =  0.81, p < 0.001.The very good correlation between oral fluid and unbound plasma concentration of warfarin and RS/SR-warfarin alcohols suggests that oral fluid analysis could provide clinically useful information for the monitoring of

  2. Intestinal toxicity of oral warfarin intake in rats.

    Mirkov, Ivana; Popov Aleksandrov, Aleksandra; Demenesku, Jelena; Ninkov, Marina; Mileusnic, Dina; Zolotarevski, Lidija; Subota, Vesna; Kataranovski, Dragan; Kataranovski, Milena

    2016-08-01

    Though warfarin is extensively used in the prevention and treatment of thromboembolic processes in humans, adverse effects of warfarin therapy have been recognized. Intestinal hemorrhage is one of the hazards of anticoagulant therapy, but the mechanisms of warfarin toxicity are virtually unknown. In this work, the effects of 30 days oral warfarin (0.35 mg/l and 3.5 mg/l) intake on rat's gut were examined. Both doses resulted in prolongation of prothrombin time. Systemic effects of higher warfarin dose (increases in plasma AST, proteinuria, hematuria, changes in peripheral blood hematological parameters) were seen. Warfarin intake resulted in histologically evident tissue damage, leukocyte infiltration and intestinal inflammation [increases in myeloperoxidase activity, malondialdehyde content, superoxide dismutase and catalase activity, proinflammatory cytokine (IFN-γ, IL-17) concentrations in intestinal homogenates]. In contrast, suppression of gut-draining mesenteric lymph node (MLN) cell activity [proliferation responsiveness, production of IFN-γ and IL-17 to T lymphocyte mitogen Concanavalin A stimulation] was noted. Inhibition of regulatory cytokine IL-10 production by MLN cells, suggests commitment of MLN to the suppression of all inflammatory activities and creation of the microenvironment which is non-permissive for induction of potentially harmful immune response. These novel findings indicate the need of staying alert for (adverse) effects of warfarin therapy. PMID:27181730

  3. Warfarin

    ... certain types of irregular heartbeat, people with prosthetic (replacement or mechanical) heart valves, and people who have ... uncertain if a medication contains warfarin or warfarin sodium.tell your doctor and pharmacist what prescription and ...

  4. Interaktion mellem warfarin og oral miconazol-gel

    Ogard, C G; Vestergaard, Henrik

    2000-01-01

    We report a case of a 76 year-old woman who had been taking warfarin for seven years because of relapsing deep venous thrombosis. Her daily maintenance dose was 5 mg. Monthly measurements of international normalised ratio (INR) were stable between 2-3. She developed oral candidiasis and miconazol...

  5. Measurement of warfarin in the oral fluid of patients undergoing anticoagulant oral therapy.

    Silvia Ghimenti

    Full Text Available BACKGROUND: Patients on warfarin therapy undergo invasive and expensive checks for the coagulability of their blood. No information on coagulation levels is currently available between two controls. METHODOLOGY: A method was developed to determine warfarin in oral fluid by HPLC and fluorimetric detection. The chromatographic separation was performed at room temperature on a C-18 reversed-phase column, 65% PBS and 35% methanol mobile phase, flow rate 0.7 mL/min, injection volume 25 µL, excitation wavelength 310 nm, emission wavelength 400 nm. FINDINGS: The method was free from interference and matrix effect, linear in the range 0.2-100 ng/mL, with a detection limit of 0.2 ng/mL. Its coefficient of variation was <3% for intra-day measurements and <5% for inter-day measurements. The average concentration of warfarin in the oral fluid of 50 patients was 2.5±1.6 ng/mL (range 0.8-7.6 ng/mL. Dosage was not correlated to INR (r = -0.03, p = 0.85 but positively correlated to warfarin concentration in the oral fluid (r = 0.39, p = 0.006. The correlation between warfarin concentration and pH in the oral fluid (r = 0.37, p = 0.009 confirmed the importance of pH in regulating the drug transfer from blood. A correlation between warfarin concentration in the oral fluid and INR was only found in samples with pH values ≥7.2 (r = 0.84, p = 0.004. CONCLUSIONS: Warfarin diffuses from blood to oral fluid. The method allows to measure its concentration in this matrix and to analyze correlations with INR and other parameters.

  6. Intracerebral Hematoma Occurring During Warfarin Versus Non-Vitamin K Antagonist Oral Anticoagulant Therapy.

    Takahashi, Haruhiko; Jimbo, Yasushi; Takano, Hiroki; Abe, Hiroshi; Sato, Masahito; Fujii, Yukihiko; Aizawa, Yoshifusa

    2016-07-15

    The neuroradiological findings and its outcomes of intracerebral hemorrhage (ICH) were compared between the non-vitamin K antagonist oral anticoagulant (NOAC) therapy and warfarin therapy. In the latest 3 years, 13 cases of nonvalvular atrial fibrillation on NOAC therapy were admitted for ICH. For comparison, 65 age- and gender-comparable patients with ICH on warfarin therapy were recruited. Three NOACs had been prescribed: dabigatran (n = 4), rivaroxaban (n = 2), and apixaban (n = 7). The average ages were 76 ± 9 and 78 ± 8 years in the warfarin (n = 65) and NOAC groups (n = 13), respectively. There was no difference in the clinical features, including the CHADS2 score or HAS-BLED score: 2.62 ± 1.31 versus 2.62 ± 1.33, or 1.09 ± 0.43 versus 1.00 ± 0.41, for the warfarin and NOAC groups, respectively. The volume of ICH warfarin (p = 0.0106). The expansion of hematoma was limited to 7 patients (10.8%) of the warfarin group. A lower hospital mortality and better modified Rankin Scale were observed in the NOAC group than in the warfarin group: 1 (7.7%) versus 27 (41.5%; p = 0.0105) and 3.2 ± 1.4 versus 4.5 ± 1.6 (p = 0.0057), respectively. In conclusion, ICH on NOAC therapy had smaller volume of hematoma with reduced rate of expansion and decreased mortality compared with its occurrence on warfarin. PMID:27289294

  7. Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study

    Skjøth, Flemming; Nielsen, Peter Brønnum; Kjældgaard, Jette Nordstrøm; Lip, Gregory Y H

    2016-01-01

    Objective To study the effectiveness and safety of the non-vitamin K antagonist oral anticoagulants (novel oral anticoagulants, NOACs) dabigatran, rivaroxaban, and apixaban compared with warfarin in anticoagulant naïve patients with atrial fibrillation. Design Observational nationwide cohort study. Setting Three Danish nationwide databases, August 2011 to October 2015. Participants 61 678 patients with non-valvular atrial fibrillation who were naïve to oral anticoagulants and had no previous indication for valvular atrial fibrillation or venous thromboembolism. The study population was distributed according to treatment type: warfarin (n=35 436, 57%), dabigatran 150 mg (n=12 701, 21%), rivaroxaban 20 mg (n=7192, 12%), and apixaban 5 mg (n=6349, 10%). Main outcome measures Effectiveness outcomes defined a priori were ischaemic stroke; a composite of ischaemic stroke or systemic embolism; death; and a composite of ischaemic stroke, systemic embolism, or death. Safety outcomes were any bleeding, intracranial bleeding, and major bleeding. Results When the analysis was restricted to ischaemic stroke, NOACs were not significantly different from warfarin. During one year follow-up, rivaroxaban was associated with lower annual rates of ischaemic stroke or systemic embolism (3.0% v 3.3%, respectively) compared with warfarin: hazard ratio 0.83 (95% confidence interval 0.69 to 0.99). The hazard ratios for dabigatran and apixaban (2.8% and 4.9% annually, respectively) were non-significant compared with warfarin. The annual risk of death was significantly lower with apixaban (5.2%) and dabigatran (2.7%) (0.65, 0.56 to 0.75 and 0.63, 0.48 to 0.82, respectively) compared with warfarin (8.5%), but not with rivaroxaban (7.7%). For the combined endpoint of any bleeding, annual rates for apixaban (3.3%) and dabigatran (2.4%) were significantly lower than for warfarin (5.0%) (0.62, 0.51 to 0.74). Warfarin and rivaroxaban had comparable annual bleeding rates (5

  8. Safety and efficacy of direct oral anticoagulants compared to warfarin for extended treatment of venous thromboembolism -a systematic review and meta-analysis

    Sindet-Pedersen, Caroline; Pallisgaard, Jannik Langtved; Olesen, Jonas Bjerring; Gislason, Gunnar Hilmar; Arevalo, Lourdes Cantarero

    2015-01-01

    OBJECTIVE: To examine and compare the safety and efficacy of extended treatment with dabigatran, apixaban, rivaroxaban and warfarin in patients with unprovoked venous thromboembolism. METHODS: PubMed and Embase were searched for randomized clinical trials reporting on the use of direct oral......-analysis that dabigatran was non-inferior to VKA for the prevention of recurrent VTE (HR: 1.44, CI: 0.78-2.64, p=0.01 for noninferiority) and decreased the risk of NMCRB compared to VKA (RR: 0.58, CI: 0.43-0.77). CONCLUSION: Extended treatment with both warfarin and DOACs are effective in preventing recurrent...

  9. Computational investigation of potential dosing schedules for a switch of medication from warfarin to rivaroxaban – an oral, direct Factor Xa inhibitor

    Rolf eBurghaus

    2014-11-01

    Full Text Available The long-lasting anticoagulant effect of vitamin K antagonists can be problematic in cases of adverse drug reactions or when patients are switched to another anticoagulant therapy. The objective of this study was to examine in silico the anticoagulant effect of rivaroxaban, an oral, direct Factor Xa inhibitor, combined with the residual effect of discontinued warfarin. Our simulations were based on the recommended anticoagulant dosing regimen for stroke prevention in patients with atrial fibrillation. The effects of the combination of discontinued warfarin plus rivaroxaban were simulated using an extended version of a previously validated blood coagulation computer model. A strong synergistic effect of the two distinct mechanisms of action was observed in the first 2–3 days after warfarin discontinuation; thereafter, the effect was close to additive. Nomograms for the introduction of rivaroxaban therapy after warfarin discontinuation were derived for Caucasian and Japanese patients using safety and efficacy criteria described previously, together with the coagulation model. The findings of our study provide a mechanistic pharmacologic rationale for dosing schedules during the therapy switch from warfarin to rivaroxaban and support the switching strategies as outlined in the Summary of Product Characteristics and Prescribing Information for rivaroxaban.

  10. Long-Term Population-Based Cerebral Ischemic Event and Cognitive Outcomes of Direct Oral Anticoagulants Compared With Warfarin Among Long-term Anticoagulated Patients for Atrial Fibrillation.

    Jacobs, Victoria; May, Heidi T; Bair, Tami L; Crandall, Brian G; Cutler, Michael J; Day, John D; Mallender, Charles; Osborn, Jeffrey S; Stevens, Scott M; Weiss, J Peter; Woller, Scott C; Bunch, T Jared

    2016-07-15

    Direct oral anticoagulants (DOACs) have been used in clinical practice in the United States for the last 4 to 6 years. Although DOACs may be an attractive alternative to warfarin in many patients, long-term outcomes of use of these medications are unknown. We performed a propensity-matched analysis to report patient important outcomes of death, stroke/transient ischemic attack (TIA), bleeding, major bleeding, and dementia in patients taking a DOAC or warfarin. Patients receiving long-term anticoagulation from June 2010 to December 2014 for thromboembolism prevention with either warfarin or a DOAC were matched 1:1 by index date and propensity score. Multivariable Cox hazard regression was performed to determine the risk of death, stroke/TIA, major bleed, and dementia by the anticoagulant therapy received. A total of 5,254 patients were studied (2,627 per group). Average age was 72.4 ± 10.9 years, and 59.0% were men. Most patients were receiving long-term anticoagulation for AF management (warfarin: 96.5% vs DOAC: 92.7%, p <0.0001). Rivaroxaban (55.3%) was the most commonly used DOAC, followed by apixaban (22.5%) and dabigatran (22.2%). The use of DOACs compared with warfarin was associated with a reduced risk of long-term adverse outcomes: death (p = 0.09), stroke/TIA (p <0.0001), major bleed (p <0.0001), and bleed (p = 0.14). No significant outcome variance was noted in DOAC-type comparison. In the AF multivariable model patients taking DOAC were 43% less likely to develop stroke/TIA/dementia (hazard ratio 0.57 [CI 0.17, 1.97], p = 0.38) than those taking warfarin. Our community-based results suggest better long-term efficacy and safety of DOACs compared with warfarin. DOAC use was associated with a lower risk of cerebral ischemic events and new-onset dementia. PMID:27236255

  11. Cost-effectiveness of apixaban compared with warfarin for stroke prevention in atrial fibrillation.

    Soyon Lee

    Full Text Available BACKGROUND: Apixaban was shown to be superior to adjusted-dose warfarin in preventing stroke or systemic embolism in patients with atrial fibrillation (AF and at least one additional risk factor for stroke, and associated with reduced rates of hemorrhage. We sought to determine the cost-effectiveness of using apixaban for stroke prevention. METHODS: Based on the results from the Apixaban Versus Warfarin in Patients with Atrial Fibrillation (ARISTOTLE trial and other published studies, we constructed a Markov model to evaluate the cost-effectiveness of apixaban versus warfarin from the Medicare perspective. The base-case analysis assumed a cohort of 65-year-old patients with a CHADS(2 score of 2.1 and no contraindication to oral anticoagulation. We utilized a 2-week cycle length and a lifetime time horizon. Outcome measures included costs in 2012 US$, quality-adjusted life-years (QALYs, life years saved and incremental cost-effectiveness ratios. RESULTS: Under base case conditions, quality adjusted life expectancy was 10.69 and 11.16 years for warfarin and apixaban, respectively. Total costs were $94,941 for warfarin and $86,007 for apixaban, demonstrating apixaban to be a dominant economic strategy. Upon one-way sensitivity analysis, these results were sensitive to variability in the drug cost of apixaban and various intracranial hemorrhage related variables. In Monte Carlo simulation, apixaban was a dominant strategy in 57% of 10,000 simulations and cost-effective in 98% at a willingness-to-pay threshold of $50,000 per QALY. CONCLUSIONS: In patients with AF and at least one additional risk factor for stroke and a baseline risk of ICH risk of about 0.8%, treatment with apixaban may be a cost-effective alternative to warfarin.

  12. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    Hankey, Graeme J; Patel, Manesh R; Stevens, Susanna R;

    2012-01-01

    In ROCKET AF, rivaroxaban was non-inferior to adjusted-dose warfarin in preventing stroke or systemic embolism among patients with atrial fibrillation (AF). We aimed to investigate whether the efficacy and safety of rivaroxaban compared with warfarin is consistent among the subgroups of patients...

  13. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)

    Halperin, Jonathan L; Hankey, Graeme J; Wojdyla, Daniel M;

    2014-01-01

    BACKGROUND: Nonvalvular atrial fibrillation is common in elderly patients, who face an elevated risk of stroke but difficulty sustaining warfarin treatment. The oral factor Xa inhibitor rivaroxaban was noninferior to warfarin in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compar...

  14. Efficacy and safety of new oral anticoagulants compared with warfarin in cardioembolic prophylaxis of patients with non valvular atrial fibrillation. More lights than shadows

    Luca Masotti

    2012-10-01

    Full Text Available IntroductionThe prophylaxis of thromboembolic events represents a key point in the modern management of patients with non valvular atrial fibrillation (AF, both paroxysmal and persistent/permanent. Up to now, vitamin K antagonist (VKA drugs are the first choice in thromboembolic prophylaxis. Their treatment limitations have lead to development and clinical experimental use of new molecules aimed to overcome their limits. The new oral anticoagulants, such as dabigatran, a direct inhibitor of thrombin or rivaroxaban and apixaban, direct inhibitors of activated factor X, have been compared to warfarin in randomized clinical phase three trials (RCTs for thromboembolic prevention in patients with non valvular AF with the aim to demonstrate their non inferiority when compared to warfarin. The results of these trials have been recently published. In this article the authors review the results of efficacy and safety of these three more recently published large RCTs.Conclusions All RCTs, RE-LY for dabigatran, ROCKET-AF for rivaroxaban and ARISTOTLE for apixaban met the study end-points and demonstrated a good safety profile of each new oral anticoagulant, so promising a new era for thromboembolic prevention therapy in AF.

  15. Administración oral de preparado parenteral de vitamina K en anticoagulación excesiva por warfarina Oral administration of intravenous preparation of Vitamin K for excessive anticoagulation due to warfarin

    Yoleima Lozada

    2012-04-01

    Full Text Available La warfarina es frecuentemente usada en la terapia anticoagulante actual, su acción debe ser monitorizada usando el tiempo de protrombina expresado como International Normalized Ratio (INR; cuando se excede el rango de seguridad se puede administrar vitamina K (Vit-K, preferentemente por vía oral. Dicha presentación no está disponible en Venezuela. Se realizó un ensayo clínico, doble ciego, donde a 20 pacientes, edad 18-60 años, sin sangrado e INR inicial de 6 a 10 inclusive; les fue suspendida la warfarina e inmediatamente agrupados al azar a recibir dosis única de Vit-K (oral 1.25mg de Vit-K fraccionada de una presentación parenteral o placebo. El punto final primario, INR Anticoagulation therapy with warfarin, a common clinical practice, needs to be monitored using protombine time expressed as the International Normalized Ratio (INR; when safety range is exceeded, Vitamin K (Vit-K could be administered with preference orally. In Venezuela the specific oral preparation for Vit-K is not available. This is a double blinded, randomized, placebo controlled, clinical trial; 20 patients, age 18-60 year with initial INR ≥ 6, ≤10, were randomized to oral Vit-K 1.25mg (prepared from intravenous presentation or placebo plus withholding warfarin. INR < 3.5 at 24 hours of treatment (the primary end point was achieved by 70% among Vit-K, and 20% among placebo patients; given an absolute risk reduction (ARR, of 50% (CI95%: 14.4-85.6 ρ = 0.028, NNT 2 (CI95%: 1.3 - 6.9. No adverse events were recorded including INR < 2 at 24 hours of treatment administration. Our results are consistent with studies where specific oral presentation of Vit-K was used. The results indicate that oral administration of Vit-K, prepared from an intravenous Vit-K preparation, is safe and more effective to revert excessive anticoagulation than simply withholding warfarin, in places where specific preparation of oral Vit-K is not available or too expensive.

  16. Estimation of the impact of warfarin's time-in-therapeutic range on stroke and major bleeding rates and its influence on the medical cost avoidance associated with novel oral anticoagulant use-learnings from ARISTOTLE, ROCKET-AF, and RE-LY trials.

    Amin, Alpesh; Deitelzweig, Steve; Jing, Yonghua; Makenbaeva, Dinara; Wiederkehr, Daniel; Lin, Jay; Graham, John

    2014-01-01

    Warfarin's time-in-therapeutic range (TTR) is highly variable among patients with nonvalvular atrial fibrillation (NVAF). The objective of this study was to estimate the impact of variations in wafarin's TTR on rates of stroke/systemic embolism (SSE) and major bleedings among NVAF patients in the ARISTOTLE, ROCKET-AF, and RE-LY trials. Additionally, differences in medical costs for clinical endpoints when novel oral anticoagulants (NOACs) were used instead of warfarin at different TTR values were estimated. Quartile ranges of TTR values and corresponding event rates (%/patient - year = %/py) of SSE and major bleedings among NVAF patients treated with warfarin were estimated from published literature and FDA documents. The associations of SSE and major bleeding rates with TTR values were evaluated by regression analysis and then the calculated regression coefficients were used in analysis of medical cost differences associated with use of each NOAC versus warfarin (2010 costs; US payer perspective) at different TTRs. Each 10 % increase in warfarin's TTR correlated with a -0.32%/py decrease in SSE rate (R(2) = 0.61; p warfarin's TTR increased from 30 to 90% the estimated medical cost decreased from -$902 to -$83 for apixaban, from -$506 to +$314 for rivaroxaban, and from -$596 to +$223 for dabigatran. Among NVAF patients there is a significant negative correlation between warfarin's TTR and SSE rate, but not major bleedings. The variations in warfarin's TTR impacted the economic comparison of use of individual NOACs versus warfarin. PMID:24477787

  17. Moxifloxacin-warfarin interaction

    Ji, Yan; Hokayem, Youssef

    2012-01-01

    Two case reports presented here show elevated prothrombin time/international normalized ratios (PT/INR) following coadministration of warfarin and moxifloxacin. Although the underlying mechanism of this interaction still remains unclear, health care providers should be careful when prescribing moxifloxacin to patients on warfarin therapy, especially to patients with low albumin levels. More frequent monitoring of INR in these patients may be warranted.Keywords: warfarin; moxifloxacin; PT/INR;...

  18. Updates on the Clinical Evidenced Herb-Warfarin Interactions

    Beikang Ge

    2014-01-01

    Full Text Available Increasing and inadvertent use of herbs makes herb-drug interactions a focus of research. Concomitant use of warfarin, a highly efficacious oral anticoagulant, and herbs causes major safety concerns due to the narrow therapeutic window of warfarin. This paper presents an update overview of clinical findings regarding herb-warfarin interaction, highlighting clinical outcomes, severity of documented interactions, and quality of clinical evidence. Among thirty-eight herbs, Cannabis, Chamomile, Cranberry, Garlic, Ginkgo, Grapefruit, Lycium, Red clover, and St. John’s wort were evaluated to have major severity interaction with warfarin. Herbs were also classified on account of the likelihood of their supporting evidences for interaction. Four herbs were considered as highly probable to interact with warfarin (level I, three were estimated as probable (level II, and ten and twenty-one were possible (level III and doubtful (level IV, respectively. The general mechanism of herb-warfarin interaction almost remains unknown, yet several pharmacokinetic and pharmacodynamic factors were estimated to influence the effectiveness of warfarin. Based on limited literature and information reported, we identified corresponding mechanisms of interactions for a small amount of “interacting herbs.” In summary, herb-warfarin interaction, especially the clinical effects of herbs on warfarin therapy should be further investigated through multicenter studies with larger sample sizes.

  19. Impact of regular physical activity on weekly warfarin dose requirement.

    Rouleau-Mailloux, Étienne; Shahabi, Payman; Dumas, Stéphanie; Feroz Zada, Yassamin; Provost, Sylvie; Hu, Jason; Nguyen, Jacqueline; Bouchama, Nawal; Mongrain, Ian; Talajic, Mario; Tardif, Jean-Claude; Perreault, Sylvie; Dubé, Marie-Pierre

    2016-02-01

    Warfarin is an oral anticoagulant agent with a narrow therapeutic index. There is a marked inter- and intra-patient variability in warfarin dose requirement. All factors influencing warfarin response are not known and this study aims to evaluate if regular physical activity (RPA) is a determining factor. RPA level was collected with the Stanford Brief Activity Survey in 1064 incident warfarin users, as part of the Quebec Warfarin Cohort (QWC), and with the Global Physical Activity Questionnaire in 618 patients from the Montreal Heart Institute (MHI) Biobank. Linear regression was performed to model relationship of warfarin dose after 3 months of therapy in the QWC with RPA, while controlling for height, weight, age, CYP2C9 (*2 and *3 alleles) and VKORC1 (*2 allele) genotype. Warfarin dose of prevalent users was modeled in the MHI Biobank for replication. A higher level of physical activity was associated with higher doses of warfarin in both cohorts. In the QWC, physical activity could explain 5.4 % (P < 0.001) and 0.9 % (P = 3.23 × 10(-5)) of variance in dose, in univariate and multivariable models, respectively. Similarly, RPA was found to be associated with 1.7 % (P = 0.0012) and 0.5 % (P = 0.0391) of inter-individual variability in warfarin dose requirement before and after adjustment for other covariables, respectively. RPA is associated with higher warfarin dose requirement. The relevance of clinical recommendations on RPA to maintain a steady response to warfarin should be assessed in further studies. PMID:26238769

  20. [Pharmacogenetics of warfarin].

    Kessler, P

    2006-03-01

    There are significant differences among patients treated with warfarin in the dosage volumes necessary to reach an optimum therapeutic effect. Apart from the external influences (interactions with drugs and food), genetic predispositions play an important role. Polymorphysms of the P 450 2C9 cytochrome bear upon the speed ofbreaking down S-warfarin, polymorfysms VKORC1 bear on the volume and quality of epoxide reductase--an enzyme whose blockade is the crux of the mechanism how cumarin anticoagulants act. These two genes are responsible for at least 50% of the warfarin effect variability. Warfarin's effect is further determined by the genetic variants of gamma-carboxylase, prothrombin, factors VII and IX. In near future, further results of pharmacogenetic research and clinical studies can be expected. They study the impact of the findings in clinical practice. PMID:16637447

  1. Moxifloxacin-warfarin interaction

    Yan Ji

    2012-01-01

    Full Text Available Two case reports presented here show elevated prothrombin time/international normalized ratios (PT/INR following coadministration of warfarin and moxifloxacin. Although the underlying mechanism of this interaction still remains unclear, health care providers should be careful when prescribing moxifloxacin to patients on warfarin therapy, especially to patients with low albumin levels. More frequent monitoring of INR in these patients may be warranted.

  2. Safety of warfarin therapy during cataract surgery under topical anesthesia

    2015-01-01

    ABSTRACT Purpose: To analyze the safety of warfarin therapy during cataract surgery under topical anesthesia. Methods: This was a prospective nonrandomized comparative study of 60 eyes of 60 patients treated with or without concurrent oral warfarin anticoagulant therapy, referred for cataract surgery under topical anesthesia. The sample included a treatment (n=30) and a control (n=30) group. Results: There were no records of intraoperative or postoperative intracameral bleeding complications ...

  3. Warfarin-Induced Skin Necrosis

    Kakagia, Despoina D.; Papanas, Nikolaos; Karadimas, Efthimios; Polychronidis, Alexandros

    2014-01-01

    Warfarin-induced skin necrosis is an infrequent complication occurring in individuals under warfarin treatment who have a thrombophilic history or after administration of large loading doses of warfarin particularly without simultaneous initial use of heparin. A 62-year-old lady developed skin necrosis 4 days after initiating warfarin therapy of 5 mg daily without initial co-administration of heparin. The patient had a normal clotting profile. Skin necrosis progressed to eschar formation afte...

  4. CYP2C9*3 polymorphism presenting as lethal subdural hematoma with low-dose warfarin.

    Karnik, Niteen D; Sridharan, Kannan; Tiwari, D; Gupta, V

    2014-01-01

    Warfarin is the most common and cheap oral anticoagulant currently used in clinical practice. A high inter-individual variation is seen in the response to warfarin. Recently, pharmacogenetics has gained importance in managing patients on warfarin, both in predicting the optimum required dose as well as in decreasing the risk of bleeding. This case report is a description of a 49-year-old patient who had a lethal subdural hematoma with low-dose warfarin. He was subsequently found to have CYP2C9 gene polymorphism (*1/*3). This case report stresses the importance of pre-prescription assessment of genetic analysis for those initiated on warfarin. PMID:25298588

  5. Major Interaction between Warfarin and Na Valproate: A Case Report

    Bizhan Kouchaki

    2015-10-01

    Full Text Available  Abstract: Warfarin is the most commonly used oral anticoagulant drug in clinical practice with extreme inter and intra-individual variation in pharmacokinetic properties. Na Valproate, a broad spectrum anticonvulsant agent, is best known for its enzyme inhibition properties and also displacement of protein binding sites. Interaction between Warfarin and psychotropic drugs including Valproate are important and perhaps under recognized. In this report, we present a 48 year old female patient with chief complaints of abdominal pain, tea-color urine, blurred vision and headache. She had been suffering from "migraine headache" for 15 years that was relatively well controlled with Na Valproate 200mg twice daily. She was experienced a deep vein thrombosis (DVT following oral contraceptive. For management of DVT, she was received Warfarin 5mg/day which was increased to 7.5 mg /day after 2 weeks. Three days after this increment of dose, her Prothrombin Time (PT rose to 35.3 seconds (three times of normal value and evidences of bleeding including hematuria and hematemesis were observed. Based on  the history and laboratory findings, "Warfarin toxicity" was the first impression and she was treated with fresh frozen plasma and vitamin K with a well recovery. This experience emphasizes the clinical significant interaction between Warfarin and Na Valproate, which may take place even with the usual doses of each agent.  

  6. Edoxaban versus warfarin in patients with atrial fibrillation

    Giugliano, R.P.; Ruff, C.T.; Braunwald, E.; Murphy, S.A.; Wiviott, S.D.; Halperin, J.L.; Waldo, A.L.; Ezekowitz, M.D.; Weitz, J.I.; Spinar, J.; Ruzyllo, W.; Ruda, M.; Koretsune, Y.; Betcher, J.; Shi, M.; Grip, L.T.; Patel, S.P.; Patel, I.; Hanyok, J.J.; Mercuri, M.; Antman, E.M.; Verheugt, F.W.A.

    2013-01-01

    BACKGROUND: Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known. METHODS: We conducted a randomized, double-blind, double-dummy trial comparing two

  7. Pionerer bag vitamin K, dikumarol og warfarin

    Norn, Svend; Permin, Henrik; Kruse, Edith;

    2014-01-01

    The history of the discovery and development of vitamin K and its antagonists, the oral anticoagulants dicoumarol and warfarin, are fascinating, triumphant landmarks in the annals of medicine. Vitamin K was found by Carl Peter Henrik Dam and Fritz Schønheyder from the University of Copenhagen. The...... factor was determined by bioassay in different extracts of green vegetables and alfalfa by Dam and Schønheyder. Vitamin K was isolated in 1939 by Dam and Paul Karrer in Zurich and the structure was determined by Edward Adelbert Doisy. Dam and Doisy were awarded the Nobel Prize in 1943. A dramatic story...

  8. Safety of warfarin therapy during cataract surgery under topical anesthesia

    Newton Kara-Junior

    2015-06-01

    Full Text Available ABSTRACT Purpose: To analyze the safety of warfarin therapy during cataract surgery under topical anesthesia. Methods: This was a prospective nonrandomized comparative study of 60 eyes of 60 patients treated with or without concurrent oral warfarin anticoagulant therapy, referred for cataract surgery under topical anesthesia. The sample included a treatment (n=30 and a control (n=30 group. Results: There were no records of intraoperative or postoperative intracameral bleeding complications in both the groups. At 1-month postoperative follow-up, 90.0% of patients presented spectacle-corrected visual acuity of at least 20/40. Conclusion: Cataract surgery by phacoemulsification with topical anesthesia can be successfully conducted without discontinuing warfarin.

  9. Ischemic Stroke: Risk Stratification, Warfarin Teatment and Outcome Measure

    Srikanth Kaithoju

    2015-12-01

    Full Text Available Stroke is a focal neurological syndrome of vascular basis, which may be due to ischemic thrombo-embolism or intra-cerebral haemorrhage. This condition has to be treated on emergency basis as it may cause an irreversible neurological damage. Warfarin has been a widely used oral anti-coagulant in treating ischemic stroke patients. This review highlights the benefits and challenges of warfarin treatment in stroke patients and discusses about the importance of risk stratification scores & bleeding scores in estimating the bleeding risk associated with warfarin treatment. This review also highlights the use of stroke outcome measures in identifying the patients with post-stroke disabilities to provide patient specific treatment.

  10. CYP2C9*3 polymorphism presenting as lethal subdural hematoma with low-dose warfarin

    Karnik, Niteen D.; Sridharan, Kannan; Tiwari, D.; Gupta, V.

    2014-01-01

    Warfarin is the most common and cheap oral anticoagulant currently used in clinical practice. A high inter-individual variation is seen in the response to warfarin. Recently, pharmacogenetics has gained importance in managing patients on warfarin, both in predicting the optimum required dose as well as in decreasing the risk of bleeding. This case report is a description of a 49-year-old patient who had a lethal subdural hematoma with low-dose warfarin. He was subsequently found to have CYP2C...

  11. Efficacy and safety of new oral anticoagulants compared with warfarin in cardioembolic prophylaxis of patients with non valvular atrial fibrillation. More lights than shadows

    Luca Masotti; Mario Di Napoli; Walter Ageno; Davide Imberti; Daniel Godoy; Grazia Panigada; Niccolò Napoli; Giancarlo Landini; Roberto Cappelli; Ido Iori; Domenico Prisco; Giancarlo Agnelli

    2012-01-01

    IntroductionThe prophylaxis of thromboembolic events represents a key point in the modern management of patients with non valvular atrial fibrillation (AF), both paroxysmal and persistent/permanent. Up to now, vitamin K antagonist (VKA) drugs are the first choice in thromboembolic prophylaxis. Their treatment limitations have lead to development and clinical experimental use of new molecules aimed to overcome their limits. The new oral anticoagulants, such as dabigatran, a direct inhibitor of...

  12. Comparison of the phase III clinical trial designs of novel oral anticoagulants versus warfarin for the treatment of nonvalvular atrial fibrillation: implications for clinical practice.

    Gonzalez-Quesada, Carlos J; Giugliano, Robert P

    2014-04-01

    Although vitamin K antagonists (VKAs) have been the backbone of thromboprophylaxis in nonvalvular atrial fibrillation, their limitations have encouraged the development of a new generation of oral anticoagulants. This review compares the different designs and procedures used to conduct four phase III trials that tested dabigatran, rivaroxaban, apixaban, and edoxaban versus VKAs. Although pharmacologic characteristics and results of the main trials are briefly discussed, this review mainly focuses on study designs, enrollment criteria, populations studied, quality metrics, and transition strategies between oral anticoagulants. While each of the trials was of high quality, performed independently, and led by independent academic groups, substantial differences exist in terms of drug pharmacology and trial characteristics. Caution is advised when comparing results across trials as practicing clinicians strive to personalize anticoagulation treatments for their individual patients. We believe that the differences in the pharmacokinetic and pharmacodynamic profiles of the available novel oral anticoagulants (NOACs), coupled with substantial heterogeneity in the trial populations and designs and procedures used to conduct the trials, support an important role for each of the NOACs dependent upon the specific clinical scenario faced by the practicing clinician. PMID:24504768

  13. Genetics Home Reference: warfarin sensitivity

    ... SA, Patel M, Martis S, Lubitz SA, van der Zee S, Yoo C, Edelmann L, Halperin JL, Desnick RJ. ... or Free article on PubMed Central van der Zee SA, Halperin JL. Anticoagulant therapy: warfarin sensitivity genotyping ...

  14. An adverse interaction between warfarin and capecitabine: a case report and review of the literature.

    Copur, M S; Ledakis, P; Bolton, M; Morse, A K; Werner, T; Norvell, M; Muhvic, J; Chu, E

    2001-11-01

    Warfarin is one of the most commonly used oral anticoagulants in the clinic. It is well established that a wide range of antineoplastic drugs interact with warfarin, resulting in altered coagulation parameters and/or bleeding sequelae. While altered coagulation parameters have been observed in patients taking the oral 5-fluorouracil prodrug, capecitabine, in combination with warfarin, no report to date has described clinically overt evidence of bleeding. Herein, we report 2 cancer patients who presented with bleeding episodes that most likely resulted from an adverse interaction between capecitabine and warfarin after 6 weeks of concomitant therapy. In each case, there was a marked elevation in both the prothrombin time and international normalized ratio (> 10), with subsequent gastrointestinal bleeding. The exact mechanism of this interaction is yet unknown, but it is possible that capecitabine might, in some manner, reduce the hepatic metabolism of warfarin. Close monitoring of coagulation parameters is recommended for all patients receiving concomitant warfarin and capecitabine, with appropriate adjustment of warfarin dosage. The nature and extent of this interaction requires further investigation. PMID:12450435

  15. Effective feature selection of clinical and genetic to predict warfarin dose using artificial neural network

    Mohammad Karim Sohrabi; Alireza Tajik

    2016-01-01

    Background: Warfarin is one of the most common oral anticoagulant, which role is to prevent the clots. The dose of this medicine is very important because changes can be dangerous for patients. Diagnosis is difficult for physicians because increase and decrease in use of warfarin is so dangerous for patients. Identifying the clinical and genetic features involved in determining dose could be useful to predict using data mining techniques. The aim of this paper is to provide a convenient way t...

  16. Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis

    Snygg-Martin, U.; Rasmussen, R. V.; Hassager, C; Bruun, N. E.; Andersson, R.; Olaison, L.

    2010-01-01

    Abstract Anticoagulant therapy has been anticipated to increase the risk of cerebrovascular complications (CVC) in native valve endocarditis (NVE). This study investigates the relationship between ongoing oral anticoagulant therapy and the incidence of symptomatic CVC in left-sided NVE. In a prospective cohort study, the CVC incidence was compared between NVE patients with and without ongoing warfarin. Among 587 NVE episodes, 48 (8%) occurred in patients on warfarin. A symptomatic ...

  17. Reversal of Warfarin-Induced Hemorrhage in the Emergency Department

    Sean O Henderson

    2011-05-01

    Full Text Available Warfarin, an oral vitamin K antagonist, is used to prevent arterial and venous thromboembolism in patients suffering from a multitude of diseases. In 2004, 31 million warfarin prescriptions were dispensed in the United States. Warfarin inhibits the activation of the vitamin K–dependent clotting factors (Factors II, VII, IX, and X and regulatory proteins (proteins C, S, and Z. It is one of the leading drugs implicated in emergency room visits for adverse drug reactions. Annually the frequency of bleeding complications associated with overanticoagulation is 15% to 20%, with fatal bleeds measuring as high as 1% to 3%. The most effective method of warfarin reversal involves the use of Four Factor Prothrombin Complex Concentrate (PCC, which is widely used throughout Europe but is unavailable in the United States. The current therapies available to emergency room physicians in the United States are fresh frozen plasma, recombinant Factor VIIa (rFVIIa, Factor Eight Inhibitory Bypassing Activity, or Three Factor PCC concomitantly administered with vitamin K. We review the advantages and disadvantages of these therapies and recommend Three Factor PCC with small doses of rFVIIa and with vitamin K in life-threatening situations if Four Factor PCC is unavailable. [West J Emerg Med. 2011;12(4:386–392.

  18. Evaluation of the Effect of Lime Fruit Juice on the Anticoagulant Effect of Warfarin

    Adepoju, GKA; Adeyemi, T

    2010-01-01

    Aim: Citrus aurantifolia (Family Rutaceae) is commonly known as a familiar food and medicine, and s therapeutic effectiveness in a variety of diseases has been suggested in traditional medicine. Various complementary and alternative medicines (CAM) have been shown to interact with orthodox medicines. Hence, the aim of this study is to investigate such a phenomenon particularly the interaction of lime fruit juice with warfarin. Materials and Method: Wistar strain albino rats of both sexes weighing between 190 and 230g were administered with oral doses of the respective drugs used depending on the groups of animals. Effects on the anticoagulant activity of warfarin were determined by standard laboratory methods. Result: Lime fruit juice caused a reduction in the anticoagulant activity of warfarin. Conclusion: This finding has shown that CAM can interact with orthodox medicines hence, warfarin prescribers need to be aware of the usage of CAM and monitor the international normalized ratio (INR) of their patients more frequently. PMID:21042484

  19. Genetics Home Reference: warfarin resistance

    ... on PubMed or Free article on PubMed Central Oldenburg J, Müller CR, Rost S, Watzka M, Bevans CG. ... Scharrer I, Tuddenham EG, Müller CR, Strom TM, Oldenburg J. Mutations in VKORC1 cause warfarin resistance and ...

  20. CYP2C9FNx013 polymorphism presenting as lethal subdural hematoma with low-dose warfarin

    Niteen D Karnik

    2014-01-01

    Full Text Available Warfarin is the most common and cheap oral anticoagulant currently used in clinical practice. A high inter-individual variation is seen in the response to warfarin. Recently, pharmacogenetics has gained importance in managing patients on warfarin, both in predicting the optimum required dose as well as in decreasing the risk of bleeding. This case report is a description of a 49-year-old patient who had a lethal subdural hematoma with low-dose warfarin. He was subsequently found to have CYP2C9 gene polymorphism (FNx011/FNx013. This case report stresses the importance of pre-prescription assessment of genetic analysis for those initiated on warfarin.

  1. Prothrombin Gene G20210A Mutation in Acute Deep Venous Thrombosis Patients with Poor Response to Warfarin Therapy

    Attia, F.M; Mikhailidis, D. P.; Reffat, S.A

    2009-01-01

    Aim: The pathogenesis of deep venous thrombosis (DVT) involves an interaction between hereditary and acquired factors. Prothrombin gene mutation is one of the hereditary risk factors. We evaluated the frequency of the prothrombin gene mutation in patients with DVT and its relation to oral warfarin anticoagulant therapy response. Methods: Prothrombin gene mutation was looked for in 40 DVT patients with poor response to warfarin. The results were compared with 40 DVT patients with a normal resp...

  2. Survey of the use of warfarin and the newer anticoagulant dabigatran in patients with atrial fibrillation

    Choi JC

    2014-02-01

    Full Text Available Jiyoon C Choi,1 Marco d DiBonaventura,2 Lewis Kopenhafer,2 Winnie W Nelson31LifeScan, Inc, West Chester, PA, 2Health Sciences Practice, Kantar Health, New York, NY, 3Janssen Scientific Affairs LLC, Raritan, NJ, USABackground: Oral dabigatran was recently approved as an alternative to warfarin for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Unlike warfarin, dabigatran has a fixed dosage and few drug interactions, and does not require anticoagulation monitoring or dietary restrictions.Methods: This study aimed to describe and compare characteristics of patients with atrial fibrillation who used dabigatran or only warfarin. Patients with a self-reported diagnosis of atrial fibrillation aged ≥18 years who were receiving (or had received warfarin or dabigatran completed an online survey. Differences in characteristics of dabigatran and warfarin users were tested using chi-squared tests and analysis of variance for categorical and continuous variables, respectively.Results: Overall, 364 patients were surveyed (204 warfarin users, 160 dabigatran users. The mean age was 65.1 years, and 68.7% were male. Dabigatran users were more likely than warfarin users to be female (36.9% versus 27.0% and to have experienced adverse events, including gastrointestinal bleeding, in the 3 months before the survey (21.9% versus 6.9%; P<0.05. Both groups reported high medication adherence (dabigatran users 0.65 versus warfarin users 0.63 missed doses/month. Dabigatran users were more likely than warfarin users to discuss treatment options with their physician before beginning therapy (36.9% versus 24.5%; P<0.05 and less likely to switch anticoagulant medication (10.7% versus 31.9%; P<0.05. Although dabigatran users were more likely to experience adverse events, they reported greater satisfaction with anticoagulation treatment than warfarin users.Conclusion: The efficacy and convenience reported by dabigatran users

  3. Research progress in CYP2C9 and VKORC1 gene polymorphism and individualized warfarin therapeutic regimen

    Yue-ping LIU

    2015-04-01

    Full Text Available Warfarin is still the most clinically used oral anti-coagulant despite of its narrow therapeutic index and high risk of hemorrhage. The mean daily dose of warfarin varies widely from patient to patient, and to achieve the same therapeutic effect, the daily dose of warfarin could be varied over 20-fold. The variability in warfarin dosage depends on several factors, including gene polymorphisms, index of body mass, age and other drugs, and these factors compelled the clinicians to individualize warfarin dosage in order to optimize the therapeutic regimen. A number of genes are involved in metabolism of warfarin, such as cytochrome P450 2C9 (CYP2C9, vitamin K epoxide reductase complex subunit 1 (VKORC1, cytochrome P450 4F2 (CYP4F2, gamma-glutamylcarboxylase (GGCX, etc. Of them CYP2C9 and VKORC1 are the emphasis of current researches. The association between the polymorphism of CYP2C9 and VKORC1 and individualized warfarin therapeutic regimen are mainly discussed in this paper. DOI: 10.11855/j.issn.0577-7402.2015.02.16

  4. Vitamin K, osteoporose og warfarin

    2006-01-01

    The role and importance of vitamin K as a cofactor in the ã-carboxylation of coagulation-proteins factor II, VII, IX and X is well-known. But, during the last 30 years, a number of observations have indicated a role for the vitamin also in other areas, for example in bone physiology. The first clue to this connection, was the description of the Fetal Warfarin Syndrome, where children are born with nasal hypoplasia, stippled epiphyses and distal extremity hypoplasia, due to the administration ...

  5. Cardioversion and Risk of Adverse Events with Dabigatran versus Warfarin-A Nationwide Cohort Study.

    Jannik Langtved Pallisgaard

    Full Text Available Cardioversion can rapidly and effectively restore sinus rhythm in patients with persistent atrial fibrillation. Since 2011 dabigatran has been available as an alternative to warfarin to prevent thromboembolic events in patients with non-valvular atrial fibrillation undergoing cardioversion. We studied time to cardioversion, risk of adverse events, and risk of readmission with atrial fibrillation after cardioversion according to anticoagulation therapy.Through the nationwide Danish registries we included 1,230 oral anticoagulation naïve patients with first time non-valvular atrial fibrillation and first time cardioversion from 2011 to 2012; 37% in the dabigatran group (n = 456, and 63% in the warfarin group (n = 774. Median time to cardioversion was 4.0 (interquartile range [IQR] 2.9 to 6.5 and 6.9 (IQR 3.9 to 12.1 weeks in the dabigatran and warfarin groups respectively, and the adjusted odds ratio of cardioversion within the first 4 weeks was 2.3 (95% confidence interval [CI] 1.7 to 3.1 in favor of dabigatran. The cumulative incidence of composite endpoint of stroke, bleeding or death were 2.0% and 1.0% at 30 weeks in the warfarin and dabigatran groups respectively, with an adjusted hazard ratio of 1.33 (95% CI 0.33 to 5.42. Cumulative incidence of readmission with atrial fibrillation after 30 weeks were 9% and 11% in the warfarin and dabigatran groups, respectively, and an adjusted hazard ratio of 0.66 (95% CI 0.41 to 1.08.Anticoagulation treatment with dabigatran allows shorter time to cardioversion for atrial fibrillation than warfarin, and appears to be an effective and safe alternative treatment strategy to warfarin.

  6. Warfarin-Induced Penile Necrosis in a Patient with Heparin-Induced Thrombocytopenia

    Chang, In Ho; Ha, Moon Soo; Chi, Byung Hoon; Kown, Yong Wook; Lee, Sang-Jae

    2010-01-01

    A 56-yr-old man with lung adenocarcinoma presented with subsegmental pulmonary thrombosis. Platelet count on presentation was 531×109/L. The patient was anticoagulated with subcutaneous low molecular weight heparin (LMWH). Next day, oral anticoagulation was initiated with 5 mg of warfarin once daily with LMWH and LMWH was discontinued at third hospital day. On the third day of oral anticoagulation therapy, he complained of left leg swelling and prolonged painful penile erection of 24 hr-durat...

  7. Effect of regimen complexity on patient satisfaction and compliance with warfarin therapy.

    Hixson-Wallace, J A; Dotson, J B; Blakey, S A

    2001-01-01

    This study sought to determine patient satisfaction with anticoagulation care in a pharmacist-managed clinic and assess the effect of warfarin regimen complexity on patient satisfaction, compliance, and international normalized ratios (INRs). Retrospective chart reviews of 476 anticoagulation clinic patients were conducted. Patients were divided into groups by complexity of warfarin regimen (whole tablet, split tablet, alternating dose) for comparisons of compliance and INRs. An oral Likert scale satisfaction survey was administered to a convenience sample of 100 patients. Degree of satisfaction was compared based on warfarin regimen. Compliant patients were more likely to have therapeutic INRs (p pharmacist-managed clinic. There was a significantly (p < 0.025) higher score for patients on split tablet regimens, indicating a greater likelihood for agreement that alternating doses made taking their medication more difficult. A relationship exists between patient compliance and prescribed dosage regimen, as well as with therapeutic INR values. PMID:11190902

  8. Comparison of benefit between dabigatran and warfarin among patients with atrial fibrillation: A systematic review

    Amal K Sulieman

    2016-01-01

    Full Text Available Warfarin is recognized as the standard antithrombotic agent for stroke prevention. However, new oral anticoagulant such as dabigatran constitutes huge improvement to compensate for the limitation of warfarin. A literature review was performed to compare and contrast the overall benefit of dabigatran and warfarin among patients with atrial fibrillation. We utilized HighWire as the data source for randomized controlled trials based on inclusion and exclusion criteria (from January 2007 to September 2013. Descriptive and quantitative information related to stroke and major bleeding were extracted from each trial. After a comprehensive screening of 298 search results, 17 studies which enrolled a total of 127,594 patients were included. Warfarin was found to have higher mean event rates for incidence of stroke, major bleeding, and net clinical benefit compared to dabigatran 110 mg and dabigatran 150 mg. Dabigatran 110 mg has higher rate of stroke and net clinical benefit than dabigatran 150 mg with less major hemorrhage. Overall, dabigatran had higher efficacy and safety profile than warfarin. Further research is required to determine the clinical feasibility of dabigatran in real-life practice.

  9. 新型抗凝药治疗非瓣膜性房颤的有效性和安全性荟萃分析%Meta-Analysis of efficacy and safety of New Oral Anticoagulants (Apixaban & Rivaroxaban & Dabigatran) Versus Warfarin in Patients with atrial fibrillation

    李庆勇; 牛锁成; 牛好敏; 管文娟; 龙爱芳; 杨颖; 杨跃进

    2015-01-01

    目的:荟萃分析新型抗凝药(阿哌沙班、利伐沙班、达比加群)同华法林比较治疗房颤的有效性和安全性。方法:通过检索Medline、Cochrane数据库、中国知网(CNKI)及万方数据库,收集2001年1月至2014年12月期间有关阿哌沙班、利伐沙班、达比加群与华法林比较的随机对照临床试验。按纳入标准及排除标准选择文献,提取资料,采用RevMan5.1软件对患者全因死亡率、脑卒中及周围动脉栓塞发生率、全因出血及颅内出血率进行荟萃分析。结果:共纳入4项研究,包括64805例患者。荟萃分析显示:同华法林比较,新型抗凝药物(阿哌沙班、利伐沙班、达比加群)组明显降低房颤患者全因死亡率[RR=0.91(95%CI:0.86-0.97), P=0.002]、脑卒中发生率[RR=0.81(95%CI:0.73-0.89), P<0.001]、周围动脉栓塞率[RR=0.70(95%CI:0.50-0.97), P=0.03]及颅内出血发生率[RR=0.50(95%CI:0.37-0.69), P<0.001];两组全因出血率[RR=0.90(95%CI:0.73-1.10), P=0.29]无明显差异。结论:新型口服抗凝药物(阿哌沙班、利伐沙班、达比加群)可有效降低房颤患者脑卒中及死亡的风险,同时避免了颅内出血风险的增加,疗效优于传统药物华法林。%ObjectiveTo analysis of the efficacy and safety of New Oral Anticoagulants (Apixaban &Rivaroxaban& Dabigatran) Versus Warfarin in Patients with atrial fibrillation.Methods The Medline, Cochrane database, CNKI database and Chinese WanFang were searched to collect data from randomized controlled trials about the New Oral Anticoagulants(Apixaban &Rivaroxaban&Dabigatran) compared with Warfarin in Patients with atrial fibrillation from January, 2001 to December, 2014. Meta-analysis of date including death from any cause, stroke, periphery embolism, major bleeding and intracranial bleeding were carried out by using the RevMan5.1 package.ResultsA total of 64,805 patients with atrial fibrillation were

  10. Warfarin

    ... higher for people participating in an activity or sport that may result in serious injury. Tell your doctor and pharmacist if you are taking or plan to take any prescription or nonprescription medications, vitamins, nutritional supplements, and herbal or botanical products (See SPECIAL ...

  11. Bupropion-warfarin combination: A serious complication

    Bavle, Amar D.; Akshay S Phatak

    2013-01-01

    Depressive illness and thromboembolic disorders are both highly prevalent. Warfarin is frequently combined with an antidepressant drug, the choice of which depends mainly on the risk of a hemorrhagic complication. Patients requiring the warfarin are often in the older age group, where the newer antidepressants with a better safety profile are preferred over tricyclic antidepressants. We report herein, a patient who was on bupropion for depression, when he developed deep vein thrombosis high-r...

  12. [On the history of vitamin K, dicoumarol and warfarin].

    Norn, Svend; Permin, Henrik; Kruse, Edith; Kruse, Poul R

    2014-01-01

    The history of the discovery and development of vitamin K and its antagonists, the oral anticoagulants dicoumarol and warfarin, are fascinating, triumphant landmarks in the annals of medicine. Vitamin K was found by Carl Peter Henrik Dam and Fritz Schønheyder from the University of Copenhagen. The discovery was initiated by Dam, by a lucky choice of chicks in the dissertation of sterol metabolism, since the vitamin is not formed by intestinal bacteria in these animals. In these experiments the lack of an unknown factor in the synthetic diet caused internal bleeding similar to that found in scurvy, but the bleeding was not reversed by vitamin C and it could not be explained by the lack of classical vitamins. In 1935 the unknown antihaemorrhagic factor was named vitamin K and a few months later the phenomenon was also observed by H.J. Almquist and E.L.R. Stokstad in Berkeley. The activity of the factor was determined by bioassay in different extracts of green vegetables and alfalfa by Dam and Schønheyder. Vitamin K was isolated in 1939 by Dam and Paul Karrer in Zurich and the structure was determined by Edward Adelbert Doisy. Dam and Doisy were awarded the Nobel Prize in 1943. A dramatic story starts the discovery of dicoumarol. In the 1920s cattle in Canada began dying of internal bleeding with no obvious precipitating cause. Frank W. Schofield, a veterinary pathologist in Alberta, found that the mysterious disease was connected to the consumption of spoiled sweet clover hay and noted a prolonged clotting time. Ten years after a farmer traveled in a blizzard with his dead cow and a milk can of the unclotted blood to the University of Wisconsin. Only the door to the biochemical department of Karl Paul Link was open. This event started the isolation of the anticoagulant agent dicou- marol which was formed by microbial induced oxidation of coumarin in the mouldy sweet clover hay. More than hundred dicoumarol-like anticoagulants were synthesized by Link and his co

  13. The effects of ferulic acid on the pharmacokinetics of warfarin in rats after biliary drainage

    Li H

    2016-07-01

    Full Text Available Haigang Li,1,2 Yang Wang,1 Rong Fan,1 Huiying Lv,3 Hua Sun,4 Haitang Xie,4 Tao Tang,1 Jiekun Luo,1 Zian Xia1 1Department of Integrated Traditional Chinese and Western Medicine, Laboratory of Ethnopharmacology, Xiangya Hospital, Central South University, 2Department of Pharmacy, Changsha Medical University, 3Hunan Agricultural Product Processing Institute, Hunan Academy of Agricultural Sciences, Changsha, 4Anhui Provincial Centre for Drug Clinical Evaluation, Yijishan Hospital of Wannan Medical College, Wuhu, People’s Republic of China Abstract: According to previous research studies, warfarin can be detected in human bile after oral administration. Ferulic acid (FA is the main bioactive component of many Chinese herbs for the treatment of cardiovascular disease. To elucidate the effects of FA on the pharmacokinetics of warfarin in rats after biliary drainage is necessary. Twenty rats were randomly divided into four groups: Group 1 (WN: healthy rats after the administration of warfarin sodium, Group 2 (WO: a rat model of biliary drainage after the administration of warfarin sodium, Group 3 (WFN: healthy rats after the administration of warfarin sodium and FA, and Group 4 (WFO: a rat model of biliary drainage after the administration of warfarin sodium and FA. Blood samples were collected at different time points after administration. The concentrations of blood samples were determined by ultraperformance liquid chromatography–tandem mass spectrometry. Comparisons between groups were performed according to the main pharmacokinetic parameters calculated by the DAS 2.1.1 software. The pharmacokinetic parameters showed a significant difference between the WN and WO groups, the WO group showed a decrease of 51% and 41.6% in area under the curve from 0 to time (AUC0–t and peak plasma concentration (Cmax, respectively, whereas time to Cmax (Tmax was delayed 3.27 folds. There were significant differences between the WFO and WFN groups, the WFO

  14. Dental extraction in patients on warfarin treatment: a series of 35 patients

    Abdullah WA

    2014-08-01

    Full Text Available Walid Ahmed Abdullah,1,2 Hesham Khalil1 1Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2Department of Oral and Maxillofacial Surgery, College of Dentistry, Mansoura University, Mansoura, Egypt Background: Warfarin is one of the most common oral anticoagulants used to prevent thromboembolic episodes. The benefits of discontinuation of this drug before simple surgical procedures are not clear and this approach could be associated with complications. The aim of this study was to evaluate the risk of bleeding in a series of 35 patients (in cases where the international normalized ratio [INR] is less than 4 following simple tooth extraction without modification of the warfarin dose given to patients. Methods: Thirty-five patients taking warfarin who had been referred to the Oral and Maxillofacial Department, College of Dentistry, King Saud University, for dental extractions were included in the study. Exclusion criteria included patients with an INR of ≥4 or with a history of liver disease or coagulopathies. No alteration was made in warfarin dose, and the CoaguChek System was used to identify the INR on the same day of dental extraction. Bleeding from the extraction site was evaluated and recorded immediately after extraction until the second day. Results: A total of 35 patients (16 women and 19 men aged between 38 and 57 years (mean =48.7 were included in the present study. All patients underwent simple one-tooth extraction while undergoing warfarin treatment. Oozing, considered mild bleeding and which did not need intervention was seen in 88.6% of patients. Moderate bleeding occurred in 11.4% of all cases. The INR of the patients ranged from 2.00 to 3.50, with 77.2% of patients having INR between 2.0 and 2.5 on the day of extraction. No severe bleeding which needed hospital management was encountered after any of the extractions. The patients who suffered moderate

  15. Potential interactions between alternative therapies and warfarin.

    Heck, A M; DeWitt, B A; Lukes, A L

    2000-07-01

    Potential and documented interactions between alternative therapy agents and warfarin are discussed. An estimated one third of adults in the United States use alternative therapies, including herbs. A major safety concern is potential interactions of alternative medicine products with prescription medications. This issue is especially important with respect to drugs with narrow therapeutic indexes, such as warfarin. Herbal products that may potentially increase the risk of bleeding or potentiate the effects of warfarin therapy include angelica root, arnica flower, anise, asafoetida, bogbean, borage seed oil, bromelain, capsicum, celery, chamomile, clove, fenugreek, feverfew, garlic, ginger ginkgo, horse chestnut, licorice root, lovage root, meadowsweet, onion, parsley, passionflower herb, poplar, quassia, red clover, rue, sweet clover, turmeric, and willow bark. Products that have been associated with documented reports of potential interactions with warfarin include coenzyme Q10, danshen, devil's claw, dong quai, ginseng, green tea, papain, and vitamin E. Interpretation of the available information on herb-warfarin interactions is difficult because nearly all of it is based on in vitro data, animal studies, or individual case reports. More study is needed to confirm and assess the clinical significance of these potential interactions. There is evidence that a wide range of alternative therapy products have the potential to interact with warfarin. Pharmacists and other health care professionals should question all patients about use of alternative therapies and report documented interactions to FDA's MedWatch program. PMID:10902065

  16. Important Information to Know When You Are Taking: Warfarin (Coumadin) and Vitamin K

    ... when you are taking: Warfarin (Coumadin) and Vitamin K The food you eat can affect how your ... about the interaction between warfarin (Coumadin) and vitamin K. Why was warfarin (Coumadin) prescribed for you? Warfarin ( ...

  17. The impact of peritransplant warfarin use on renal transplant outcome.

    Connaughton, Dervla M

    2011-03-31

    The unplanned nature of kidney transplantation necessitates that patients undergo surgery without prior cessation of warfarin. Our study analyses the impact of warfarin treatment in the peritransplant period on graft outcome and perioperative transfusion requirements.

  18. Warfarin-Associated Diaphragmatic Hernia: An Unusual Diagnosis

    Cristina Vilhena

    2015-01-01

    Full Text Available Fetal warfarin syndrome is a consequence of maternal intake of warfarin during pregnancy and comprises a wide range of manifestations, including some typical facial dysmorphologic features. The authors report a case of prenatal ultrasonographic diagnosis of warfarin embryopathy in an obese woman on unsupervised warfarin prophylaxis at the 16th week of gestation. The fetus presented with facial dysmorphism, pectus excavatum, diaphragmatic hernia, and pulmonary hypoplasia. To the best of our knowledge, this is the second reported case of warfarin-associated diaphragmatic hernia.

  19. Reinitiating Warfarin: Relationships Between Dose and Selected Patient, Clinical and Hospital Measures

    Leonhard, Lucas G.; Berg, Richard L.; Burmester, James K.; Mazza, Joseph J.; Schmelzer, John R.; Yale, Steven H.

    2015-01-01

    Background Warfarin is an oral anticoagulant used in the long-term treatment/prevention of venothromboembolic disease. Patients undergoing elective surgical and non-surgical procedures may require temporary warfarin discontinuation followed by reinitiation after their procedure. Because little information is available regarding best methods for warfarin reinitiation, we investigated current practices to inform management decisions. Methods Subjects were required to have a known and stable warfarin dose prior to discontinuation, which was operationalized by requiring, within 7-days prior to discontinuation, that they have at least one INR in therapeutic range (2.0–3.5), no INR(s) out of range, and no more than a 15% change in warfarin dose. Stable dose prior to discontinuation was defined as the average daily dose received in the 7 days immediately prior to discontinuation. Reinitiation dose was defined as the average daily dose received in the first 3 days after warfarin was restarted. Subjects were divided into three groups based on whether they received approximately the same, a higher, or a lower dose at reinitiation and were also grouped by calendar time into three distinct periods that reflected differing levels of availability of electronic and patient care data that may impact reinitiation dose decisions. These groupings facilitated analyses and descriptions of trends in reinitiation dosing and supported other analyses, including tests for association between dose group and selected subject demographic, clinical, medication and hospitalization measures. All study data were abstracted from Marshfield Clinic electronic patient care and administrative databases and electronic patient care databases from Ministry St. Joseph’s Hospital (Marshfield, WI). Results We identified 205 subjects with warfarin temporarily discontinued between 1994 and 2012: 99 subjects in same dose group, 32 subjects in the low group, and 74 subjects in the high group. Because

  20. Difficulties in anticoagulation management during coadministration of warfarin and rifampin.

    Lee, C R; Thrasher, K A

    2001-10-01

    The clinical significance of rifampin's induction of warfarin metabolism is well documented, but no published studies or case reports have quantified this interaction with respect to the international normalized ratio (INR). A patient receiving concomitant rifampin and warfarin to treat a mycobacterial infection and intraventricular thrombus, respectively, underwent routine INR testing at a pharmacist-managed anticoagulation clinic to assess his anticoagulation regimen. A 233% increase in warfarin dosage over 4 months proved insufficient to attain a therapeutic INR during long-term rifampin therapy More aggressive titration of the warfarin dosage was needed. In addition, a gradual 70% reduction in warfarin dosage over 4-5 weeks was necessary to maintain a therapeutic INR after rifampin discontinuation, demonstrating the clinically significant offset of this drug interaction. Extensive changes in warfarin dosage are required to attain and maintain a therapeutic INR during the initiation, maintenance, and discontinuation of rifampin. PMID:11601670

  1. Dabigatran, Rivaroxaban, or Apixaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Subgroups

    Antonio Gómez-Outes

    2013-01-01

    Full Text Available Background. New oral anticoagulants (NOAC; rivaroxaban, dabigatran, apixaban have become available as an alternative to warfarin anticoagulation in non-valvular atrial fibrillation (NVAF. Methods. MEDLINE and CENTRAL, regulatory agencies websites, clinical trials registers and conference proceedings were searched to identify randomised controlled trials of NOAC versus warfarin in NVAF. Two investigators reviewed all studies and extracted data on patient and study characteristics along with cardiovascular outcomes. Relative risks (RR and 95% confidence intervals (CI were estimated using a random effect meta-analysis. Results. Three clinical trials in 50,578 patients were included. The risk of non-hemorrhagic stroke and systemic embolic events (SEE was similar with the NOAC and warfarin (RR=0.93; 95% CI=0.83–1.04, while the risk of intracranial bleeding (ICB with the NOAC was lower than with warfarin (RR = 0.46; 95% CI = 0.33–0.65. We found differences in the effect size on all strokes and SEE depending on geographic region as well as on non-hemorrhagic stroke, SEE, bleeding and mortality depending on time in therapeutic range. Conclusion. The NOAC seem no more effective than warfarin for prevention of nonhemorrhagic stroke and SEE in the overall NVAF population, but are generally associated with a lower risk of ICB than warfarin.

  2. The use of warfarin in veterans with atrial fibrillation

    Rosenbeck Karen; Bravata Dawn M; Kancir Sue; Brass Lawrence M

    2004-01-01

    Abstract Background Warfarin therapy is effective for the prevention of stroke in patients with atrial fibrillation. However, warfarin therapy is underutilized even among ideal anticoagulation candidates. The purpose of this study was to examine the use of warfarin in both inpatients and outpatients with atrial fibrillation within a Veterans Affairs (VA) hospital system. Methods This retrospective medical record review included outpatients and inpatients with atrial fibrillation. The outpatie...

  3. Protocol for Birmingham Atrial Fibrillation Treatment of the Aged study (BAFTA: a randomised controlled trial of warfarin versus aspirin for stroke prevention in the management of atrial fibrillation in an elderly primary care population [ISRCTN89345269

    Fletcher Kate

    2003-08-01

    Full Text Available Abstract Background Atrial fibrillation (AF is an important independent risk factor for stroke. Randomised controlled trials have shown that this risk can be reduced substantially by treatment with warfarin or more modestly by treatment with aspirin. Existing trial data for the effectiveness of warfarin are drawn largely from studies in selected secondary care populations that under-represent the elderly. The Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA study will provide evidence of the risks and benefits of warfarin versus aspirin for the prevention of stroke for older people with AF in a primary care setting. Study design A randomised controlled trial where older patients with AF are randomised to receive adjusted dose warfarin or aspirin. Patients will be followed up at three months post-randomisation, then at six monthly intervals there after for an average of three years by their general practitioner. Patients will also receive an annual health questionnaire. 1240 patients will be recruited from over 200 practices in England. Patients must be aged 75 years or over and have AF. Patients will be excluded if they have a history of any of the following conditions: rheumatic heart disease; major non-traumatic haemorrhage; intra-cranial haemorrhage; oesophageal varices; active endoscopically proven peptic ulcer disease; allergic hypersensitivity to warfarin or aspirin; or terminal illness. Patients will also be excluded if the GP considers that there are clinical reasons to treat a patient with warfarin in preference to aspirin (or vice versa. The primary end-point is fatal or non-fatal disabling stroke (ischaemic or haemorrhagic or significant arterial embolism. Secondary outcomes include major extra-cranial haemorrhage, death (all cause, vascular, hospital admissions (all cause, vascular, cognition, quality of life, disability and compliance with study medication.

  4. Taking warfarin (Coumadin, Jantoven) - what to ask your doctor

    ... vein thrombosis Heart attack Pulmonary embolus Patient Instructions Atrial fibrillation - discharge Heart attack - discharge Heart failure - discharge Heart valve surgery - discharge Taking warfarin (Coumadin) ...

  5. An Education Program for Patient Self-Management of Warfarin

    Jenner, Kathleen M; Simmons, Brandon J; Delate, Thomas; Clark, Nathan P.; Kurz, Deanna; Witt, Daniel M.

    2015-01-01

    Developing and administering a warfarin Patient Self-Management (PSM) education program for those with atrial fibrillation was feasible. There was improvement in PSM competency (34.9% to 95.3%) and high levels of self-reported comfort (100% prepared to self-manage warfarin and 93% comfortable changing doses on their own).

  6. Warfarin use in hemodialysis patients: what is the risk?

    Phelan, P J

    2011-03-01

    Background: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. Methods: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. Results: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). Conclusions: This study confirms the higher bleeding risk associated with HD\\/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. Summary: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A

  7. Warfarin use in hemodialysis patients: what is the risk?

    Phelan, P J

    2012-02-01

    BACKGROUND: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. METHODS: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. RESULTS: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). CONCLUSIONS: This study confirms the higher bleeding risk associated with HD\\/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. SUMMARY: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A

  8. Lack of Pharmacokinetic Interaction between Aspirin and Warfarin.

    Fiske, William D.; Connell, Jill M.; Benedek, Irma H.

    1995-06-01

    An open-label, randomized, two-phase crossover study was conducted on 36 healthy male volunteers to identify the effects of coadministration of aspirin (acetylsalicylic acid; ASA) and crystalline warfarin sodium (Coumadin((R))) on the elimination and disposition kinetics of ASA, salicylic acid (SA) and R- and S-warfarin enantiomers. Twenty-four subjects were administered single doses of 325 mg of ASA alone and in combination with 10 mg of crystalline warfarin sodium with a 1-week washout between ASA doses. ASA and SA pharmacokinetic parameters were determined after each dose. Twelve subjects were administered single doses of 10 mg of crystalline warfarin sodium alone and in combination with 325 mg of ASA with a 4-week washout between warfarin doses. R- and S-warfarin enantiomer pharmacokinetic parameters were determined after each dose. Pharmacokinetic parameters were compared using analysis of variance and 90% confidence intervals. ASA and SA AUCs (the area under the plasma concentration versus time curve from time zero to time infinity) respectively were 3.28 plus minus 0.80 and 66.99 plus minus 11.73 &mgr;g h ml(minus sign1) (ASA alone), and 3.22 plus minus 0.61 and 69.48 plus minus 15.79 &mgr;g h ml(minus sign1) (ASA with warfarin). R-warfarin and S-warfarin AUCs respectively were 33.9 plus minus 9.3 and 23.9 plus minus 16.0 &mgr;g h ml(minus sign1) (warfarin alone) and 33.6 plus minus 10.2 and 22.6 plus minus 14.7 &mgr;g h ml(minus sign1) (warfarin with ASA). The only pharmacokinetic parameter which was statistically significantly different when the combination was administered was the S-warfarin elimination rate constant (p < 0.05), but the difference (9.2% increase in the presence of ASA) was small and no significant difference was found in S-warfarin clearance. It is concluded that there is no pharmacokinetic interaction when a single dose of ASA 325 mg is coadministered with a single dose of crystalline warfarin sodium 10 mg. PMID:11850685

  9. PHARMACOECONOMIC EVALUATION OF DABIGATRAN VS WARFARIN IN CARDIOVASCULAR EVENTS PREVENTION IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

    Yu. B. Belousov; V. Yu. Mareev; I. S. Yavelov; D. Yu. Belousov

    2015-01-01

    According to recent guidelines, oral dabigatran etexilate is indicated for stroke and systemic embolism prevention in patients with atrial fibrillation (AF). Aim. Based on the RE-LY study to evaluate the cost-effectiveness of dabigatran etexilate versus warfarin prescribed in “real-world” settings from a Russian payer perspective. Material and methods. Markov model simulated AF patients at moderate to high risk of stroke while tracking clinical events and resulting functional disability. Acut...

  10. Effect of Intravenous Versus Subcutaneous Phytonadione on Length of Stay for Patients in Need of Urgent Warfarin Reversal.

    Mottice, Brandon L; Soric, Mate M; Legros, Elizabeth

    2016-01-01

    This institutional review board-approved retrospective cohort study evaluated the impact of intravenous versus subcutaneous phytonadione on length of stay in hospitalized patients requiring urgent warfarin reversal. All patients were 18 years or older, on warfarin therapy with an international normalized ratio (INR) between 3.1 and 10.0, and had warfarin therapy restarted at discharge. Patients who received intramuscular or oral phytonadione, phytonadione by more than 1 route, fresh frozen plasma, or any other blood products containing clotting factors, patients with active or severe liver disease, and patients who received other forms of anticoagulation were excluded. A total of 4425 patients receiving phytonadione were evaluated and 79 patients were included. Baseline characteristics were similar between the intravenous and subcutaneous groups, including mean age, gender, warfarin indication, Charlson comorbidity index, and indication for phytonadione. Geometric mean length of stay in the intravenous group was 211.7 hours compared with 191.0 hours in the subcutaneous group (P = 0.47). Though intravenous phytonadione administration resulted in significantly lower INRs at all time points phytonadione. PMID:25461960

  11. Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis

    Snygg-Martin, U; Rasmussen, Rasmus Vedby; Hassager, C;

    2011-01-01

    Anticoagulant therapy has been anticipated to increase the risk of cerebrovascular complications (CVC) in native valve endocarditis (NVE). This study investigates the relationship between ongoing oral anticoagulant therapy and the incidence of symptomatic CVC in left-sided NVE. In a prospective...... factors for CVC, while warfarin on admission (aOR 0.26, 95% CI 0.07-0.94), history of congestive heart failure (adjusted OR 0.22, 95% CI 0.1-0.52) and previous endocarditis (aOR 0.1, 95% CI 0.01-0.79) correlated with lower CVC frequency....

  12. Individual Differences in Metabolic Clearance of S-Warfarin Efficiently Mediated by Polymorphic Marmoset Cytochrome P450 2C19 in Livers.

    Uehara, Shotaro; Uno, Yasuhiro; Inoue, Takashi; Kawano, Mirai; Shimizu, Makiko; Toda, Akiko; Utoh, Masahiro; Sasaki, Erika; Yamazaki, Hiroshi

    2016-07-01

    Marmoset cytochrome P450 2C19, highly homologous to human P450 2C9 and 2C19, has been identified in common marmosets (Callithrix jacchus), a nonhuman primate species used in drug metabolism studies. Although genetic variants in human and macaque P450 2C genes account for the interindividual variability in drug metabolism, genetic variants have not been investigated in the marmoset P450 2C19 In this study, sequencing of P450 2C19 in 24 marmosets identified three variants p.[(Phe7Leu; Ser254Leu; Ile469Thr)], which showed substantially reduced metabolic capacity of S-warfarin compared with the wild-type group in vivo and in vitro. Although mean plasma concentrations of R-warfarin in marmosets determined after chiral separation were similar between the homozygous mutant and wild-type groups up to 24 hours after the intravenous and oral administrations of racemic warfarin, S-warfarin depletion from plasma was significantly faster in the three wild-type marmosets compared with the three homozygous mutant marmosets. These variants, cosegregating in the marmosets analyzed, influenced metabolic activities in 18 marmoset liver microsomes because the homozygotes and heterozygotes showed significantly reduced catalytic activities in liver microsomes toward S-warfarin 7-hydroxylation compared with the wild-type group. Kinetic analysis for S-warfarin 7-hydroxylation indicated that the recombinant P450 2C19 Ser254Leu variant would change the metabolic capacity. These results indicated that the interindividual variability of P450 2C-dependent drug metabolism such as S-warfarin clearance is at least partly accounted for by P450 2C19 variants in marmosets, suggesting that polymorphic P450 2C-dependent catalytic functions are relatively similar between marmosets and humans. PMID:27098744

  13. Pharmacokinetics and 48 Week Efficacy of Adjusted Dose Indinavir/Ritonavir in Rifampicin-Treated HIV/Tuberculosis-Coinfected Patients: A Pilot Study

    Avihingsanon, A.; Lugt, J. van der; Singphore, U.; Gorowara, M.; Boyd, M.; Ananworanich, J.; Phanuphak, P.; Burger, D.M.; Ruxrungtham, K.

    2012-01-01

    Abstract HIV/tuberculosis (HIV/TB)-coinfected patients intolerant/resistant to nonnucleoside reverse transcriptase inhibitors (NNRTIs) have limited treatment options. We evaluated the pharmacokinetics (PK)/safety/efficacy of an adjusted dose of indinavir/ritonavir (IDV/r) 600/100 mg plus two NRTIs i

  14. Results of Adjusted-Dose Heparin for Thromboembolism Prophylaxis in Knee Replacement Compared to Those Found for its Use in Hip Fracture Surgery and Elective Hip Replacement

    Yen, David; Weiss, William

    2007-01-01

    The purpose of this study was to compare the results of adjusted-dose heparin (ADH) in the prevention of thromboembolism in knee replacement with those obtained for its use hip fracture surgery and elective hip replacement. Ultrasound was used to diagnose deep vein thrombosis (DVT) and ventilation/perfusion (V/Q) scan to diagnose pulmonary embolus (PE).

  15. Warfarin improves neuropathy in monoclonal gammopathy of undetermined significance.

    Henry Gomez, Teny; Holkova, Beata; Noreika, Danielle; Del Fabbro, Egidio

    2016-01-01

    We report a case of a 60-year-old man who was referred to a palliative care clinic with monoclonal gammopathy of undetermined significance (MGUS)-associated neuropathy, responding to a therapeutic trial of warfarin. Electromyography showed distal symmetric sensory axonal neuropathy. The patient reported having had improvement of his neuropathic symptoms while taking warfarin postoperatively for thromboprophylaxis 1 year prior, and recurrence of his symptoms after the warfarin was discontinued. The patient was rechallenged with a trial of warfarin, targeting an international normalised ratio of 1.5-2.0. His pain scores decreased from 5/10 to 3/10 at 1 month and symptom improvement was maintained through 24 months of follow-up. Warfarin had a remarkable impact on our patient's symptoms and quality of life. The mechanisms mediating the symptomatic benefit with warfarin are unclear; however, a placebo effect is unlikely. Further studies may help guide the use of warfarin for MGUS-associated neuropathy. PMID:27317760

  16. Meta-analysis of randomized controlled trials on risk of myocardial infarction from the use of oral direct thrombin inhibitors

    Artang, Ramin; Rome, Eric; Nielsen, Jørn Dalsgaard;

    2013-01-01

    Dabigatran has been associated with greater risk of myocardial infarction (MI) than warfarin. It is unknown whether the increased risk is unique to dabigatran, an adverse effect shared by other oral direct thrombin inhibitors (DTIs), or the result of a protective effect of warfarin against MI. To...... trials with alternative anticoagulants compared with warfarin with end point of MIs after randomization. A total of 11 trials (39,357 patients) that compared warfarin to DTIs (dabigatran, ximelagatran, and AZD0837) were identified. In these trials, patients treated with oral DTIs were more likely to...... inhibitors, DTIs, aspirin, and clopidogrel. There was no significant advantage in the rate of MIs with the use of warfarin versus comparators (odds ratio 1.06, 95% confidence interval 0.85 to 1.34, p = 0.59). In conclusion, our data suggest that oral DTIs were associated with increased risk of MI. This...

  17. Thoracic aorta pseudoaneurysm with hemopericardium: unusual presentation of warfarin overdose

    Liao Chiung-Ying

    2011-04-01

    Full Text Available Abstract There have been few case reports which discuss a relationship between warfarin overdose and aortic pseudoaneurysm leakage. We report the case of a female receiving warfarin who presented with dsypnea. Her international normalized ratio was > 10. Chest radiograph revealed cardiomegaly, and chest computed tomography (CT showed a bulging pouch-like lesion below the aortic arch greater than 6x6 cm in size and a fluid collection suggesting blood in the pericardium. Thoracic endovascular aneurysm repair (TEVAR was successfully performed by a cardiovascular surgeon. Aortic pseudoaneurysm formation and leakage may be considered as a rare complication in patients receiving warfarin therapy. Further study regarding warfarin use and the incidence of pseudoaneurysm leakage is needed.

  18. Warfarin dosage response related pharmacogenetics in Chinese population.

    Siyue Li

    Full Text Available OBJECTIVES: As the most frequently prescribed anticoagulant, warfarin has large inter-individual variability in dosage. Genetic polymorphisms could largely explain the differences in dosage requirement. rs9923231 (VKORC1, rs7294 (VKORC1, rs1057910 (CYP2C9, rs2108622 (CYP4F2, and rs699664 (GGCX involved in the warfarin action mechanism and the circulatory vitamin K were selected to investigate their polymorphism characteristics and their effects on the pharmacodynamics and pharmacokinetics of warfarin in Chinese population. METHODS: 220 patients with cardiac valve replacement were recruited. International normalized ratio and plasma warfarin concentrations were determined. The five genetic polymorphisms were genotyping by pyro-sequencing. The relationships of maintenance dose, plasma warfarin concentration and INR were assessed among groups categorized by genotypes. RESULTS: rs9923231 and rs7294 in VKORC1 had the analogous genotype frequencies (D': 0.969. 158 of 220 recruited individuals had the target INR (1.5-2.5. Patients with AA of rs9923231 and CC of rs7294 required a significantly lower maintenance dose and plasma concentration than those with AG and TC, respectively. The mean weekly maintenance dose was also significantly lower in CYP2C9 rs1057910 mutated heterozygote than in patients with the wild homozygote. Eliminating the influence from environment factors (age, body weight and gender, rs9923231 and rs1057910 could explain about 32.0% of the variability in warfarin maintenance dose; rs7294 could explain 26.7% of the variability in plasma concentration. For patients with allele G of rs9923231 and allele T of rs7294, higher plasma concentration was needed to achieve the similar goal INR. CONCLUSIONS: A better understanding of the genetic variants in individuals can be the foundation of warfarin dosing algorithm and facilitate the reasonable and effective use of warfarin in Chinese.

  19. Acute Myocardial Infarction after Switching from Warfarin to Dabigatran

    Wael Abuzeid; Hatim Al-Lawati; Neil Fam

    2015-01-01

    Dabigatran etexilate is a recently approved direct thrombin inhibitor (DTI), which is superior to warfarin in the prevention of stroke and systemic embolism in patients with atrial fibrillation (AF). However, dabigatran use is associated with an increased risk of myocardial infarction (MI) compared to warfarin. The mechanisms for this association effect remain speculative. We present a case of an acute MI and cardiac arrest in a patient with chronic AF who had been recently switched from warf...

  20. Thoracic aorta pseudoaneurysm with hemopericardium: unusual presentation of warfarin overdose

    Liao Chiung-Ying; Chen Ying-Cheng; Tien Ya-Chih; Chang Chia-Chu

    2011-01-01

    Abstract There have been few case reports which discuss a relationship between warfarin overdose and aortic pseudoaneurysm leakage. We report the case of a female receiving warfarin who presented with dsypnea. Her international normalized ratio was > 10. Chest radiograph revealed cardiomegaly, and chest computed tomography (CT) showed a bulging pouch-like lesion below the aortic arch greater than 6x6 cm in size and a fluid collection suggesting blood in the pericardium. Thoracic endovascular ...

  1. Effect of age and sex on warfarin dosing

    Khoury G

    2014-07-01

    Full Text Available Ghada Khoury,1 Marwan Sheikh-Taha2 1School of Pharmacy, 2Department of Pharmacy Practice, Lebanese American University, Byblos, Lebanon Objective: We examined the potential effect of sex and age on warfarin dosing in ambulatory adult patients. Methods: We conducted a retrospective chart review of patients attending an anticoagulation clinic. We included patients anticoagulated with warfarin for atrial fibrillation or venous thromboembolism who had a therapeutic international normalized ratio of 2–3 for 2 consecutive months. We excluded patients who had been on any drug that is known to have a major interaction with warfarin, smokers, and heavy alcohol consumers. Out of 340 screened medical records, 96 met the predetermined inclusion criteria. The primary outcome assessed was warfarin total weekly dose (TWD. Results: There was a statistically significant difference in the TWD among the ages (P<0.01; older patients required lower doses. However there was no statistically significant difference in the TWD between sexes (P=0.281. Conclusion: Age was found to have a significant effect on warfarin dosing. Even though women did require a lower TWD than men, this observation was not statistically significant. Keywords: warfarin, INR, anticoagulation, vitamin K antagonists, age

  2. Dabigatran Versus Warfarin in Atrial Fibrillation: Multicenter Experience in Turkey.

    Aslan, Onur; Yaylali, Y T; Yildirim, S; Yurtdas, M; Senol, H; Ugur-Yildiz, M; Ozdemir, M

    2016-03-01

    Safety issues have been raised about dabigatran. We aimed to investigate the occurrence of safety outcomes in patients who had atrial fibrillation and a risk of stroke. We analyzed 439 patients prescribed dabigatran (n = 220) or warfarin (n = 219). Ischemic stroke occurred in 15 (6.8%) patients in the warfarin group versus 5 (5.2%) patients in the 110-mg group versus 1 (0.8%) patient in the 150-mg dabigatran group (P = .015). Intracranial hemorrhage occurred in 6 (2.7%) patients in the warfarin group versus 3 (2.4%) patients in the 150-mg dabigatran group (P = .104). Death from any cause occurred in 10 (4.6%) patients in the warfarin group versus 1 (1.0%) patient in the 110-mg dabigatran group (P = .005). Dabigatran was associated with less ischemic stroke and death from any cause than warfarin. Dabigatran may be a better option for stroke prophylaxis, where recommended monitoring with warfarin is suboptimal. PMID:25115764

  3. The New Novel Oral Anticoagulants (NOACs in Patients with Atrial Fibrillation: Dogma, Dilemmas, and Decisions on Dosing

    Dr. James A. Reiffel, MD

    2014-02-01

    Full Text Available With the advent of the new novel oral anticoagulants (NOACs and specifically, their role in patients with atrial fibrillation (AF, the epitaph for warfarin is being written. Leaving aside AF patients with mechanical prosthetic valves or rheumatic mitral stenosis, for whom these agents are not indicated, there hardly seems a role for warfarin in this population any more. In the aftermath of RE-LY (dabigatran vs warfarin, ROCKET AF (rivaroxaban vs warfarin, ARISTOTLE (apixaban vs warfarin, and ENGAGE AF (edoxaban vs warfarin, the reports of these pivotal trials taken individually along with the data from multiple meta-analyses examining them together clearly show that better clinical outcomes are obtained with these new agents. All reduce stroke and systemic embolism at least as well as warfarin; all are superior in reducing hemorrhagic stroke and intracerebral bleeds than warfarin; some are superior to warfarin in reducing all strokes and systemic emboli; and dabigatran is superior at specifically reducing ischemic stroke. Simultaneously, the NOACs (several or all have reduced mortality versus warfarin and have reduced major and fatal bleeding versus warfarin. Gastrointestinal bleeding appears higher with the NOACs than warfarin (with the exception of apixaban in the ARISTOTLE trial but still with lower fatality. None of the NOACs require anticoagulant blood test monitoring (in contrast to warfarin and all have fewer drug interactions than warfarin. While rivaroxaban requires significant food intake at the time the dose is taken, none of the NOACs has the multiple food interactions that can plague warfarin users and warfarin dosing. Additionally, as regards dosing, the options with the NOACs are limited, and infrequently change over time, which contrasts dramatically with the picture seen with warfarin. Finally, while the medication cost itself of any of the NOACs is higher than that of generic warfarin, multiple cost-effectiveness analyses have

  4. Pharmacogenomics of warfarin and its personalized treatment%华法林药物基因组学和个体化用药

    彭娟; 谭胜蓝; 周宏灏; 李智

    2013-01-01

    华法林是临床使用最广泛的口服抗凝药,其治疗窗窄,剂量个体差异大,容易发生出血或栓塞的风险.CYP2C9和VKORC1基因多态性明显影响华法林剂量.其他参与维生素摄入和循环,华法林转运的基因变异,以及microRNA也可能影响华法林剂量.该文结合国内外各种华法林稳定剂量预测模型研究,总结影响华法林剂量相关基因的最新研究进展,旨在为华法林个体化治疗提供参考和指导依据.%Warfarin is the most widely used oral anticoagulant with narrow therapeutic window, wide inter-individual variability and high risks of bleeding or thromboembolism. Polymorphisms in CYP2C9 and VKORC1 are the major determinants of warfarin dosage requirement. Other genetic factors involving in vitamin K intake and recycle, and warfarin transportation may influence warfarin stable maintenance dosage as well. microRNA might al-so play a role. Based on numerous warfarin stable dosage prediction algorithms studies, this review updates the studies of warfarin pharmacogenomics and its personalized treatment, with the aim of providing evidence for clinical practice.

  5. Risk of gastrointestinal adverse effects of dabigatran compared with warfarin among patients with atrial fibrillation

    Staerk, Laila; Gislason, Gunnar H.; Lip, Gregory Y.H.;

    2015-01-01

    , gastritis, gastric, and duodenal ulcer) and gastrointestinal bleeding requiring hospitalization, gastroscopy, and discontinuation of dabigatran and warfarin was examined by cumulative incidence rates and multivariable adjusted Cox regression models. We identified five groups: OAC-naive warfarin (n = 4534...

  6. Old and new oral anticoagulants for secondary stroke prevention in atrial fibrillation

    Tommaso Sacquegna

    2015-12-01

    Full Text Available Vitamin K antagonists, such as warfarin, used in oral anticoagulation therapy currently represent the standard drugs for the primary and secondary prevention of stroke in non-valvular atrial fibrillation (AF, with a relative risk reduction close to 70%. Newer oral anticoagulants, such as direct thrombin inhibitors (i.e., dabigatran and direct factor Xa inhibitors (i.e., apixaban and rivaroxaban have been recently compared with warfarin in large randomized trials for stroke prevention in AF. The new oral anticoagulants showed, compared with warfarin, no statistically significant difference in the rate of stroke or systemic embolism in secondary prevention (patients with previous transient ischemic attack or stroke subgroups. With regard to safety, the risk of intracranial bleeding was reduced with new anticoagulants compared with warfarin. Indirect treatment comparisons of clinical trials on secondary prevention cohorts showed no significant difference in efficacy among apixaban, rivaroxaban, and dabigatran; but dabigatran 110 mg was associated with less intracranial bleedings than rivaroxaban.

  7. The effect of broad-spectrum antibiotics on warfarin excretion and metabolism in the rat

    The excretion and metabolism of 14C-warfarin in rats was examined in a crossover experiment, the first phase consisting of treatment with normal saline, the second phase using the same animals given neomycin, bacitracin, and tetracycline orally. Urine and feces were collected every 24 hours for 72 hours and examined for warfarin and its metabolites, both unconjugated and conjugated. Significantly more radioactivity was eliminated in th feces of antibiotic-treated rats. The feces of antibiotic-treated rats contained only trace amounts of beta-glucuronidase activity. Urine contained a similar ratio of unconjugated to conjugated radioactivity in both treatment groups, but the antibiotic-treated animals had significantly larger amount of conjugates in their feces. Examination of metabolic profiles of conjugated and unconjugated fractions revealed significantly fewer hydroxylated metabolites in antibiotic-treated rats, especially in the feces. The lower amount of hydroxylative metabolism in attributed to a reduction in gut flora-medicated interohepatic recycling caused by the antibiotics

  8. Advantages of a Warfarin Protocol for Long-term Care Pharmacists: a Retrospective Cohort Study

    Sargent, Randall; Brocklebank, Cynthia; Tam-Tham, Helen; Williamson, Tyler; Quail, Patrick; Turner, Diana; Drummond, Neil

    2016-01-01

    Background Warfarin is an anticoagulant prescribed to 12% of long-term care residents to reduce the risk of thrombo-embolism. This study used indicators to compare warfarin management by pharmacists to usual care. Methods This was a retrospective cohort study comparing a pharmacist-managed warfarin protocol with usual care of qualified warfarin recipients at long-term care facilities (two protocol, one control) in Calgary, Alberta. We compared the proportion of international normalized ratio ...

  9. Pharmacokinetic and pharmacodynamic interactions of aspirin with warfarin in beagle dogs.

    Shen, Chenlin; Huang, Xiaohui; Li, Jun; Zhang, Ping; Li, Lin; Zhang, Wei; Hu, Tingting; Pappoe, Faustina; Huang, Jihan; Tang, Haiqin

    2016-01-01

    1. Warfarin and aspirin are widely used in a wide spectrum of thromboembolic and atherothrombotic diseases. Despite the potential efficacy of warfarin-aspirin therapy, the safety and side effect of combined therapy remains unclear. 2. The aim of this study was to investigate the pharmacokinetic and pharmacodynamic interactions between warfarin and aspirin in beagles after single and multiple doses. 3. Coadministration of aspirin had no significant effects on the area under the plasma concentration time curve (AUC(0-t)) and maximum plasma concentration (Cmax) of R- and S-warfarin after a single dose of warfarin, but significantly increase the AUC(0-t) and Cmax and dramatically decrease the clearance (CL) of R- and S-warfarin after multiple dose of warfarin. Accordingly, there was a slight increase in the AUEC(0-t) and Emax of activated partial thromboplastin time (aPTT), prothrombin time (PT) and international normalized ratio (INR) after multiple dose of warfarin. 4. Coadministration of warfarin had no markedly effects on the AUC(0-t) and Cmax of aspirin and its metabolite salicylic acid after single or multiple dose of aspirin. Meanwhile, the AUEC(0-t) and Emax of inhibition of platelet aggregation (IPA) were not significantly affected by warfarin. 5. Our animal study indicated that coadministration of aspirin with warfarin can cause significant pharmacokinetic and pharmacodynamic drug-drug interactions in beagles. However, more studies are urgently needed to assess related information of warfarin-aspirin drug interactions in healthy volunteers or patients. PMID:26548565

  10. Is the HAS-BLED score useful in predicting post-extraction bleeding in patients taking warfarin? A retrospective cohort study

    Kataoka, Toshiyuki; HOSHI, KEIKA; Ando, Tomohiro

    2016-01-01

    Objective Unexpected post-extraction bleeding is often experienced in clinical practice. Therefore, determining the risk of post-extraction bleeding in patients receiving anticoagulant therapy prior to surgery is beneficial. This study aimed to verify whether the HAS-BLED score was useful in predicting post-extraction bleeding in patients taking warfarin. Design Retrospective cohort study. Setting Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University. Participants Par...

  11. Assessment and evaluation efficacy of a clinical pharmacist-led inpatient warfarin knowledge education program and follow-up at a Chinese tertiary referral teaching hospital

    Guy-Armel Bounda; Cosette Ngarambe; Wei Hong Ge; Feng Yu

    2013-01-01

    Background: Oral anticoagulation therapy with warfarin is used to prevent and to treat venous and arterial thrombosis and embolism. Its narrow therapeutic index should be monitored carefully in order to reach the desired outcomes. Objective: This study aims to evaluate the clinical pharmacist-led in-patient warfarin′s knowledge education program and to assess a follow-up efficacy in a Chinese tertiary referral teaching hospital. Design and Setting: A cross-sectional and observational ...

  12. Psychological effects of treatment with new oral anticoagulants in elderly patients with atrial fibrillation: a preliminary report

    Fumagalli, Stefano; Cardini, Francesca; Roberts, Anna T.; Boni, Serena; Gabbai, Debbie; Calvani, Silvia; Casalone Rinaldi, Marta; Manetti, Stefania; Tarantini, Francesca; Marchionni, Niccolò

    2015-01-01

    Background and aims: Atrial fibrillation (AF) is the most common arrhythmia in elderly people, yet oral anticoagulation is underused in the aged. We tried to determine whether new oral anticoagulants (NOA) have greater psychological tolerability than warfarin. Methods: Age-, gender-matched groups of AF patients receiving NOA (N = 15) or warfarin (N = 15) were assessed with the Anti-Clot Treatment Scale (ACTS) and the Perceived Stress Scale (PSS). Results: Patients were old (81 ...

  13. Adverse Interaction between Capecitabine and Warfarin Resulting in Altered Coagulation Parameters: A Review of the Literature Starting from a Case Report

    Giovanni Giunta

    2010-01-01

    Full Text Available Capecitabine is an orally active prodrug of fluorouracil and is extensively used as an antineoplastic agent. It is converted to 5-Fluorouracil in the liver and tumor tissues. Warfarin is an anticoagulant agent for preventing and treating venous and arterial thrombosis and embolism and is metabolized by cytochrome P450 isoenzymes in the liver. Preclinical in vitro studies using human liver microsomes report no inhibitory effects between capecitabine and substrates of cytochrome P. However, the concomitant administration of capecitabine and warfarin resulted in INR elevation in the cases previously reported in the literature. The exact mechanism of this interaction is unknown but may be related to downregulation of cytochrome P450 2C9 by capecitabine or its metabolites. We report on the possible adverse interaction between capecitabine and warfarin in a patient with metastatic breast cancer and critically review the existing literature on this topic. Physicians should be aware of adverse reactions arising from the combined use of capecitabine and warfarin. In the light of the current data, INR levels should be closely monitored in patients using these drugs together.

  14. Meta-analysis of randomized controlled trials on risk of myocardial infarction from the use of oral direct thrombin inhibitors.

    Artang, Ramin; Rome, Eric; Nielsen, Jørn Dalsgaard; Vidaillet, Humberto J

    2013-12-15

    Dabigatran has been associated with greater risk of myocardial infarction (MI) than warfarin. It is unknown whether the increased risk is unique to dabigatran, an adverse effect shared by other oral direct thrombin inhibitors (DTIs), or the result of a protective effect of warfarin against MI. To address these questions, we systematically searched MEDLINE and performed a meta-analysis on randomized trials that compared oral DTIs with warfarin for any indication with end point of MIs after randomization. We furthermore performed a secondary meta-analysis on atrial fibrillation stroke prevention trials with alternative anticoagulants compared with warfarin with end point of MIs after randomization. A total of 11 trials (39,357 patients) that compared warfarin to DTIs (dabigatran, ximelagatran, and AZD0837) were identified. In these trials, patients treated with oral DTIs were more likely to experience an MI than their counterparts treated with warfarin (285 of 23,333 vs 133 of 16,024, odds ratio 1.35, 95% confidence interval 1.10 to 1.66, p = 0.005). For secondary analysis, 8 studies (69,615 patients) were identified that compared warfarin with alternative anticoagulant including factor Xa inhibitors, DTIs, aspirin, and clopidogrel. There was no significant advantage in the rate of MIs with the use of warfarin versus comparators (odds ratio 1.06, 95% confidence interval 0.85 to 1.34, p = 0.59). In conclusion, our data suggest that oral DTIs were associated with increased risk of MI. This increased risk appears to be a class effect of these agents, not a specific phenomenon unique to dabigatran or protective effect of warfarin. These findings support the need for enhanced postmarket surveillance of oral DTIs and other novel agents. PMID:24075284

  15. Natural history of bleeding and characteristics of early bleeders among warfarin initiators – a cohort study in Finland

    Rikala M

    2016-02-01

    Full Text Available Maria Rikala,1 Helena Kastarinen,1,2 Pekka Tiittanen,1 Risto Huupponen,1,3 Maarit Jaana Korhonen1,4,5 1Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, 2Social Insurance Institution, Regional Office for Eastern and Northern Finland, Kuopio, 3Unit of Clinical Pharmacology, Turku University Hospital, 4Department of Public Health, University of Turku, Turku, Finland; 5Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC, USA Aims: The demand for oral anticoagulant therapy will continue to increase in the future along with the aging of the population. This study aimed to determine the rate of bleeding requiring hospitalization and to characterize early bleeders among persons initiating warfarin therapy. Characterization of those most susceptible to early bleeding is important in order to increase the safety of warfarin initiation. Patients and methods: Using data from nationwide health registers, we identified persons initiating warfarin therapy between January 1, 2009 and June 30, 2012, n=101,588, and followed them until hospitalization for bleeding, death, or administrative end of the study (December 31, 2012. We defined early bleeders as persons with a bleeding requiring hospitalization within 30 days since warfarin initiation. Results: The rate of hospitalization for bleeding during a median follow-up of 1.9 years was 2.6% per person-year (95% confidence interval [CI] 2.5%–2.7%, with a peak within the first 30 days of warfarin initiation (6.5% per person-year, 95% CI 6.0%–7.1%. In a multivariable Cox proportional hazards regression analysis, early bleeders were characterized by prior bleeding (<180 days before initiation, hazard ratio [HR] =13.7, 95% CI 10.9–17.1; during 180 days–7 years before initiation, HR =1.48, 95% CI 1.15–1.90, male sex (HR =1.32, 95% CI 1.10–1.57, older age (HR =1.13, 95% CI 1.04–1

  16. Edoxaban versus warfarin in patients with atrial fibrillation

    Giugliano, Robert P; Ruff, Christian T; Braunwald, Eugene;

    2013-01-01

    . The principal safety end point was major bleeding. RESULTS: The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P....001 for noninferiority) and 1.61% with low-dose edoxaban (hazard ratio, 1.07; 97.5% CI, 0.87 to 1.31; P=0.005 for noninferiority). In the intention-to-treat analysis, there was a trend favoring high-dose edoxaban versus warfarin (hazard ratio, 0.87; 97.5% CI, 0.73 to 1.04; P=0.08) and an unfavorable trend with low......-dose edoxaban versus warfarin (hazard ratio, 1.13; 97.5% CI, 0.96 to 1.34; P=0.10). The annualized rate of major bleeding was 3.43% with warfarin versus 2.75% with high-dose edoxaban (hazard ratio, 0.80; 95% CI, 0.71 to 0.91; Phazard ratio, 0.47; 95% CI, 0.41 to 0.55; P...

  17. Retrospective evaluation of a pharmacist-managed warfarin anticoagulation clinic.

    Garabedian-Ruffalo, S M; Gray, D R; Sax, M J; Ruffalo, R L

    1985-02-01

    The effectiveness of a pharmacist-managed warfarin anticoagulation clinic in maintaining therapeutic prothrombin times and preventing hospitalizations secondary to inadequate control of anticoagulation was evaluated. Patients who had received warfarin sodium for at least one year before being referred to the anticoagulation clinic were studied using retrospective chart reviews. Clinical pharmacists provided patient education, monitored patients for hemorrhagic and thromboembolic complications, and adjusted warfarin sodium dosage to maintain therapeutic prothrombin times. The patients' primary physicians retained responsibility for overall care and were consulted by pharmacists regarding complications of anticoagulation and patient unreliability. The percentage of patients requiring hospitalization (39% versus 4%) and the percentage of prothrombin times outside the therapeutic range (35.8% versus 14.4%) were significantly higher during the preclinic phase (before referral to the clinic) than during the clinic phase. Eight patients were hospitalized for hemorrhagic complications and four for thromboembolism during the preclinic phase; only one hospitalization for hemorrhage occurred during the clinic phase. The warfarin anticoagulation clinic staffed by specially trained pharmacists provided improved therapy compared with treatment received by patients before their referral to the clinic. PMID:3976675

  18. Use of novel oral anticoagulants for patients with atrial fibrillation: systematic review and clinical implications.

    Albert, Nancy M

    2014-01-01

    Atrial fibrillation (AF), a common arrhythmia, increases the risk of ischemic stroke. Stroke and bleeding scores for patients with AF can help to stratify risk and determine the need for antithrombotic therapy, for which warfarin has been the gold standard. Although highly effective, warfarin has several limitations that can lead to its underuse. Data from randomized, Phase III clinical trials of the novel oral anticoagulants, dabigatran, a direct thrombin inhibitor, and rivaroxaban and apixaban, both factor Xa inhibitors, indicate these drugs are at least noninferior to warfarin for the prevention of stroke and systemic embolism. They are easier to administer, and have an equivalent or lower risk of bleeding versus warfarin. A better understanding of the risks and benefits of the novel oral anticoagulants, and their use in clinical practice, will prepare clinicians to anticipate and address educational and clinical needs of AF patients and their families, and promote evidence-based prescription of appropriate and safe anticoagulation therapy. PMID:24373340

  19. Whether Warfarin Therapy is Associated with Damage on Renal Function in Chinese Patients with Nonvalvular Atrial Fibrillation

    Kong, Yu; Du, Xin; Tang, Ri-Bo; Zhang, Ting; Guo, Xue-Yuan; Wu, Jia-Hui; Xia, Shi-Jun; Ma, Chang-Sheng

    2016-01-01

    Background: Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation (AF). There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF (NVAF). The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy. Methods: From January 2011 to December 2013, a total of 951 NVAF patients from 18 hospitals were enrolled. The estimated glomerular filtration rate (eGFR) was calculated from baseline and follow-up serum creatinine levels. Kaplan–Meier survival curves compared the survival of a ≥25% decline in eGFR (hereafter, endpoint), while Cox models estimated hazard ratios (HRs) and 95% confidence intervals for this event after adjustment for age, gender, and selected potential risk factors for renal dysfunction. Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a ≥25% decline in eGFR. Results: After a 58-month follow-up, 951 NVAF patients were divided by observation into warfarin (n = 655) and no anticoagulation groups (n = 296) and 120 (12.6%) patients experienced renal endpoint. Kaplan–Meier survival curves showed that the survival period was not different in the two groups (χ2 = 0.178, log-rank P = 0.67), but patients with systolic blood pressure (SBP) Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint, with HRs of 1.00, and 1.02, respectively. Conclusion: In patients with NVAF, eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the ≥25% decline in eGFR. Trial Registration: Chinese Clinical Trial Registry (No. ChiCTR-OCH-13003729); http://www.chictr.org.cn/showproj.aspx?proj = 5831. PMID:27174319

  20. Nuevos anticoagulantes orales

    Alejandro Berkovits

    2011-10-01

    Full Text Available Thromboembolic disease (TED is the leading cause of morbidity and mortality worldwide. The hallmark of oral long-term anticoagulant therapy has been the use of vitamin K antagonists, whose anticoagulant effect is exerted inhibiting vitamin K epoxide reductase. Warfarin and acenocoumarol are the most commonly used. In the last five years several new drugs for long term anticoagulation have been developed, which can inhibit single clotting factors with the purpose of improving drug therapeutic range and, ideally, minimizing bleeding risks. This review addresses the state of the art on the clinical use of inhibitors of activated factor X and thrombin.

  1. COST-EFFECTIVENESS OF APIXABAN AS COMPARED WITH WARFARIN AND ACETYLSALICYLIC ACID IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION IN THE RUSSIAN FEDERATION

    A. V. Rudakova

    2015-09-01

    Full Text Available Background. For prevention of thromboembolic events in patients with non-valvular atrial fibrillation (NVAF the following types of antithrombotic therapy are used: anticoagulant therapy with vitamin K antagonists (such as warfarin, antiplatelet therapy (such as acetylsalicylic acid and novel oral anticoagulants such as apixaban, rivaroxaban and dabigatran. Administration of vitamin K antagonists (VKA is complicated by the need for individual dose adjustment and frequent monitoring of international normalized ratio (INR. Both warfarin and acetylsalicylic acid are widely used for thrombosis prevention in patients with NVAF in the Russian Federation.Aim. To evaluate the cost-effectiveness ratio of apixaban compared with warfarin and acetylsalicylic acid in patients with NVAF from the Russian Federation national health care system perspective.Material and methods. This analysis used a Markov model that allowed estimation of the incremental cost-effectiveness ratio (ICER for apixaban as compared with warfarin and acetylsalicylic acid over lifetime horizon in VKA suitable and VKA unsuitable patients with NVAF respectively. The model enclosed cardiovascular event rates based on the results of the randomized clinical trials comparing clinical effectiveness and safety of apixaban with warfarin (ARISTOTLE and acetylsalicylic acid (AVERROES. The following cardiovascular events were taken into consideration: ischemic and hemorrhagic stroke, systemic embolism, intracranial hemorrhage, other major bleeds, clinically relevant non-major bleeds and myocardial infarction. Direct medical costs were determined based on the rates of the compulsory national medical insurance system. The price of the antithrombotic drugs was taken as a weighted average tender price for the year 2013. In the model both costs and benefits (quality-adjusted life years and life-years were discounted at 3.5%. Cost-effectiveness threshold was set at 1.4 million rubles per quality

  2. Warfarin skin necrosis mimicking calciphylaxis in a patient with secondary hyperparathyroidism undergoing peritoneal dialysis.

    Park, Jee Eun; Byeon, Seonggyu; Kim, Hee Kyung; Moon, Seong Mi; Moon, Ji Hoon; Jang, Kee-Taek; Lee, Byung-Jae; Jang, Hye Ryoun; Huh, Wooseong; Kim, Dae Joong; Kim, Yoon-Goo; Oh, Ha Young; Lee, Jung Eun

    2016-03-01

    Warfarin skin necrosis (WSN) is an infrequent complication of warfarin treatment and is characterized by painful ulcerative skin lesions that appear a few days after the start of warfarin treatment. Calciphylaxis also appears as painful skin lesions caused by tissue injury resulting from localized ischemia caused by calcification of small- to medium-sized vessels in patients with end-stage renal disease. We report on a patient who presented with painful skin ulcers on the lower extremities after the administration of warfarin after a valve operation. Calciphylaxis was considered first because of the host factors; eventually, the skin lesions were diagnosed as WSN by biopsy. The skin lesions improved after warfarin discontinuation and short-term steroid therapy. Most patients with end-stage renal disease have some form of cardiovascular disease and some require temporary or continual warfarin treatment. It is important to differentiate between WSN and calciphylaxis in patients with painful skin lesions. PMID:27069859

  3. Natural selection mapping of the warfarin-resistance gene

    Kohn, Michael H.; Pelz, Hans-Joachim; Wayne, Robert K.

    2000-01-01

    In theory, genes under natural selection can be revealed by unique patterns of linkage disequilibrium (LD) and polymorphism at physically linked loci. However, given the effects of recombination and mutation, the physical extent and persistence of LD patterns in natural populations is uncertain. To assess the LD signature of selection, we survey variation in 26 microsatellite loci spanning an ≈32-cM region that includes the warfarin-resistance gene (Rw) in five wild rat populations having res...

  4. Warfarin-induced skin necrosis diagnosed on clinical grounds and treated with maggot debridement therapy

    Biscoe, Anna Louise; Bedlow, Alison

    2013-01-01

    A patient with a history of deep vein thrombosis presented with painful bruising and blistering on his left leg 7–10 days after warfarin treatment. A complicated 2-month treatment followed, where vasculitis was originally diagnosed from histological findings before the final diagnosis of warfarin-induced skin necrosis (WISN) was made on clinical grounds. Warfarin was stopped, reversed and low molecular weight heparin started but, the lesions had progressed to full thickness necrosis. This was...

  5. Lack of effect of influenza vaccine on warfarin anticoagulation in the elderly.

    Gomolin, I. H.

    1986-01-01

    Influenza vaccine may inhibit hepatic metabolism of drugs and has been reported to prolong the prothrombin time in patients receiving warfarin by affecting the coagulation pathway. In a group of seven elderly residents of a long-term care facility who were receiving warfarin, prolongation of the prothrombin and partial thromboplastin times could not be shown up to 5 weeks after vaccination against influenza. The results were similar in nine elderly subjects who were not receiving warfarin.

  6. Aspirin versus warfarin in atrial fibrillation: decision analysis may help patients' choice.

    Romero-Ortuno, Roman

    2012-03-01

    the primary prevention of ischaemic stroke in chronic non-valvular atrial fibrillation (AF) typically involves consideration of aspirin or warfarin. CHA(2)DS(2)-VASc estimates annual stroke rates for untreated AF patients, which are reduced by 60% with warfarin and by 20% with aspirin. HAS-BLED estimates annual rates of major bleeding on warfarin. The latter risk with aspirin is 0.5-1.2% per year.

  7. Cranberry juice and warfarin: when bad publicity trumps science.

    Zikria, Jennifer; Goldman, Raimonda; Ansell, Jack

    2010-05-01

    Based on anecdotal reports, the question of whether cranberry juice interacts with warfarin has been raised. This article discusses the potential mechanism, and systematically reviews case reports as well as clinical trials examining the possible interaction. We systematically searched MEDLINE via PubMed, and the Cochrane Library database. Fifteen case reports were summarized, including the initial unpublished brief reports to the Committee on Safety of Medicines and the subsequent 6 published case reports. Seven clinical trials were analyzed, including 3 studies using warfarin and 4 surrogate drugs. Only 2 cases had a validation scale suggesting a "probable" interaction, but even in these patients there were many reasons to question the validity of a relevant drug interaction. Randomized clinical trials and surrogate markers found no evidence to support the interaction between cranberry juice and warfarin. Because the moderate consumption of cranberry juice does not affect anticoagulation, we encourage the reexamination of initial warnings based on scientific evidence. We conclude that the initial precautionary warnings by administrating bodies are limited to anecdotal case reports and represent misleading conclusions. PMID:20399311

  8. Comparison of two methods for INR determination in a pharmacist-based oral anticoagulation clinic.

    Yamreudeewong, W; Johnson, J V; Cassidy, T G; Berg, J T

    1996-01-01

    Warfarin is a commonly used oral anticoagulant that is usually initiated after the definitive diagnosis of a certain thromboembolic disorder or disease. Warfarin therapy will usually be prescribed for 6-12 weeks or more, and some patients may continue therapy throughout life, depending on the type of thromboembolic disorder. Major problems associated with warfarin therapy include adverse effects such as bleeding complications and drug-drug or drug-food interactions. In addition, thromboembolic complications may occur due to subtherapeutic dosages of warfarin. The laboratory reference standards for monitoring warfarin therapy are the prothrombin time (PT) and the International Normalized Ratio (INR). While both the PT or INR will reflect the clinical response in the patient, results reported as INR values have been shown to be more accurate than those reported as PT values. Thirty-two patients were enrolled in this study. Our objectives were to compare INR values measured by both the Coumatrak and conventional laboratory method, and to demonstrate the effects of pharmacist intervention on managing patients receiving warfarin therapy. Results from our study reveal that INR monitoring by Coumatrak is similar to the conventional laboratory method. In addition, our study indicates that patients receiving warfarin therapy can be monitored and managed effectively by pharmacists. PMID:8947990

  9. The Impact of Warfarin on Patients with End Stage Renal Disease

    Anahita Dua

    2014-01-01

    Full Text Available Introduction. A deficiency in vitamin K through the utilization of warfarin may result in increased vascular calcification and complications. This study aimed to determine the impact of warfarin administration on patients with end stage renal disease (ESRD in a large, national sample. Methods. A retrospective analysis using the 2005–2010 National Inpatient Sample (NIS, a part of the Health Care Utilization Project (HCUP, was completed using ICD-9 diagnosis codes to capture patients with ESRD prescribed and not prescribed warfarin. Statistical analysis was through ANOVA and chi-squared testing. Results. From 2005–2010, 927,814 patients with ESRD were identified nationally. 3.5% (32,737 were prescribed warfarin. Patients prescribed warfarin had an average age of 64 years and 51% were male. For every comorbid condition (amputation, congestive heart failure, chronic obstructive pulmonary disorder, cerebrovascular accident, diabetes, hypertension, myocardial infarction, peripheral vascular diasese, and valvular disease patients prescribed Warfarin had significantly higher rates of disease as compared to their nonwarfarin ESRD counterparts. ESRD patients prescribed warfarin had significantly shorter length of stay but increased hospital charges. They were more likely to be discharged to home and had significantly decreased in-hospital mortality. Conclusion. Patients with ESRD taking warfarin are more likely to have comorbidities and/or complications but have a decreased LOS and in-hospital mortality compared to their ESRD counterparts not administered warfarin.

  10. APPLICATIONS OF PHARMACOGENETIC TESTING FOR PERSONALIZATION OF THERAPY WITH ORAL ANTICOAGULANTS IN RUSSIA

    D. A. Sychev

    2015-09-01

    Full Text Available The clinical significance of the patient genetic characteristics in the individual pharmacological response to oral anticoagulants is considered. Possible tactics of warfarin dosing and new oral anticoagulants choice on the basis of pharmacogenetic testing as well as indications for this approach in clinical practice are discussed. It should increase efficacy and safety of anticoagulant therapy.

  11. Pharmacokinetic and Pharmacodynamic Analyses of Drug-Drug Interactions between Iguratimod and Warfarin.

    Yamamoto, Tetsuya; Hasegawa, Kyoko; Onoda, Makoto; Tanaka, Keiichi

    2016-01-01

    Iguratimod (IGU), a disease-modifying antirheumatic drug launched in September 2012, has been reported to carry a risk of severe hemorrhages through a suspected interaction with warfarin (WF) in the all-case surveillance and early postmarketing-phase vigilance. To elucidate possible mechanisms of adverse interaction between IGU and WF, we analyzed the effects of IGU on the pharmacodynamics and pharmacokinetics of WF in rats. IGU was orally administered to male Wistar rats once daily for 5 d at 10 or 30 mg/kg in combination with WF at an oral dose of 0.25 mg/kg. Coadministration of IGU 30 mg/kg enhanced the anticoagulant activity of WF; prolonged blood coagulation time (prothrombin time and activated partial thromboplastin time) and decreased levels of vitamin K (VK)-dependent blood coagulation factors (II, VII, IX, and X) were observed. On the other hand, the pharmacokinetic parameters of WF including maximum plasma concentration (Cmax) and area under the plasma concentration-time curve from 0 to 24 h (AUC0-24 h) were not affected by the combination with IGU. IGU alone did not change blood coagulation time at doses up to 100 mg/kg, while VK-dependent blood coagulation factors decreased slightly at 30 and 100 mg/kg. These results suggest that the pharmacodynamic effect of IGU on VK-dependent blood coagulation factors is involved in the mechanism of drug-drug interaction of IGU with WF. PMID:27252068

  12. Personalised treatment with oral anticoagulant drugs : clinical and economic issues

    Verhoef, T.I.

    2013-01-01

    Coumarin derivatives such as acenocoumarol, phenprocoumon and warfarin are frequently used for the prevention of stroke and systemic embolism in patients with atrial fibrillation or for the treatment of venous thromboembolism. These oral anticoagulants have a narrow therapeutic range and a large var

  13. PHARMACOECONOMIC EVALUATION OF DABIGATRAN VS WARFARIN IN CARDIOVASCULAR EVENTS PREVENTION IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

    Yu. B. Belousov

    2015-12-01

    Full Text Available According to recent guidelines, oral dabigatran etexilate is indicated for stroke and systemic embolism prevention in patients with atrial fibrillation (AF. Aim. Based on the RE-LY study to evaluate the cost-effectiveness of dabigatran etexilate versus warfarin prescribed in “real-world” settings from a Russian payer perspective. Material and methods. Markov model simulated AF patients at moderate to high risk of stroke while tracking clinical events and resulting functional disability. Acute event costs and resulting long-term follow-up costs incurred by disabled stroke survivors were calculated using general tariff agreement of Russian obligatory health insurance system and official national statistics. Clinical events, summarized as events per 100 patient-years, expected life years, total costs, and incremental cost effectiveness ratios (ICER were calculated. Results. Over a lifetime, dabigatran etexilate treated patients experienced fewer intracranial haemorrhages and fewer ischaemic strokes. ICER of dabigatran etexilate was 461,602 roubles per one additional life year versus “real-world” warfarin. Conclusion. This study demonstrates that dabigatran etexilate is a cost-effective alternative to current care for the prevention of stroke and systemic embolism among Russian patients with AF .

  14. Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naive atrial fibrillation patients

    Olesen, Jonas Bjerring; Sørensen, Rikke; Hansen, Morten Lock;

    2015-01-01

    AIMS: Non-vitamin K antagonist oral anticoagulation (NOAC) agents have been approved for stroke prophylaxis in atrial fibrillation (AF). We investigated 'real-world' information on how these drugs are being adopted. METHODS AND RESULTS: Using Danish nationwide administrative registers, we...... the drug came on market. By October, 2013, 40% were being started on warfarin and dabigatran, respectively, and another 20% were started on either rivaroxaban or apixaban. Rivaroxaban and apixaban users generally had a higher predicted risk of stroke and bleeding compared with warfarin and dabigatran users....... Older age, female gender, and prior stroke were some of the factors associated with NOAC use vs. warfarin, whereas chronic kidney disease, myocardial infarction, and heart failure showed the opposite association. CONCLUSION: Among oral anticoagulation-naïve AF patients initiated on oral anticoagulation...

  15. The potential drug-drug interaction between proton pump inhibitors and warfarin

    Henriksen, Daniel Pilsgaard; Stage, Tore Bjerregaard; Hansen, Morten Rix;

    2015-01-01

    clinical setting. The aim was to assess whether initiation of PPI treatment among users of warfarin leads to increased INR values. METHODS: The study was an observational self-controlled study from 1998 to 2012 leveraging data on INR measurements on patients treated with warfarin from primary care and...

  16. Initiation and persistence with warfarin therapy in atrial fibrillation according to ethnicity

    Hansen, Carolina Malta; Olesen, Jonas Bjerring; Hansen, Morten Lock;

    2012-01-01

    The aim of this study was to investigate initiation of and persistence with warfarin treatment in patients with atrial fibrillation (AF) according to ethnicity. Patients hospitalized with first-time AF from 1997 to 2009, prescription claims of warfarin and country of birth were identified by indi...

  17. Fatal cerebral blødning på grund af mulig interaktionmellem paracetamol og warfarin

    Vinsand Naver, Signe; Papina, Maria; Jimenez Solem, Espen;

    2015-01-01

    This is a case report of an 83-year-old man in warfarin treatment with stable international normalised ratio (INR) after aortic valve replacement and atrial fibrillation. Due to back pain he took paracetamol (acetaminophen) 4 g/day, morphine 30 mg/day and diclofenac as rescue medication for two...... paracetamol and warfarin are discussed....

  18. Clinical and genetic determinants of warfarin pharmacokinetics and pharmacodynamics during treatment initiation.

    Inna Y Gong

    Full Text Available Variable warfarin response during treatment initiation poses a significant challenge to providing optimal anticoagulation therapy. We investigated the determinants of initial warfarin response in a cohort of 167 patients. During the first nine days of treatment with pharmacogenetics-guided dosing, S-warfarin plasma levels and international normalized ratio were obtained to serve as inputs to a pharmacokinetic-pharmacodynamic (PK-PD model. Individual PK (S-warfarin clearance and PD (I(max parameter values were estimated. Regression analysis demonstrated that CYP2C9 genotype, kidney function, and gender were independent determinants of S-warfarin clearance. The values for I(max were dependent on VKORC1 and CYP4F2 genotypes, vitamin K status (as measured by plasma concentrations of proteins induced by vitamin K absence, PIVKA-II and weight. Importantly, indication for warfarin was a major independent determinant of I(max during initiation, where PD sensitivity was greater in atrial fibrillation than venous thromboembolism. To demonstrate the utility of the global PK-PD model, we compared the predicted initial anticoagulation responses with previously established warfarin dosing algorithms. These insights and modeling approaches have application to personalized warfarin therapy.

  19. Relationship between diet and anticoagulant response to warfarin – A factor analysis

    Diet composition is one of the factors that may contribute to intraindividual variability in the anticoagulant response to warfarin. The aim of this study was to determine the associations between food pattern and anticoagulant response to warfarin in a group of Brazilian patients with vascular dis...

  20. Apixaban vs. warfarin with concomitant aspirin in patients with atrial fibrillation: insights from the ARISTOTLE trial

    Alexander, J.H.; Lopes, R.D.; Thomas, L.; Alings, M.; Atar, D.; Aylward, P.; Goto, S.; Hanna, M.; Huber, K.; Husted, S.; Lewis, B.S.; McMurray, J.J.; Pais, P.; Pouleur, H.; Steg, P.G.; Verheugt, F.W.A.; Wojdyla, D.M.; Granger, C.B.; Wallentin, L.

    2014-01-01

    AIMS: We assessed the effect of concomitant aspirin use on the efficacy and safety of apixaban compared with warfarin in patients with atrial fibrillation (AF). METHODS AND RESULTS: In ARISTOTLE, 18 201 patients were randomized to apixaban 5 mg twice daily or warfarin. Concomitant aspirin use was le

  1. Warfarin for the prevention of systemic embolism in patients with non-valvular atrial fibrillation

    Andersen, L V; Vestergaard, P; Deichgraeber, P;

    2008-01-01

    Warfarin for stroke prevention in patients with atrial fibrillation (AF) is well documented. However, it has not been examined in the prevention of systemic embolism.......Warfarin for stroke prevention in patients with atrial fibrillation (AF) is well documented. However, it has not been examined in the prevention of systemic embolism....

  2. The impact of genetics on the management of patients on warfarin awaiting surgery.

    Abohelaika, Salah; Wynne, Hilary; Cope, Lance; Kamali, Farhad

    2015-07-01

    Two older patients with atrial fibrillation, receiving warfarin for thromboembolic prophylaxis, with a target range of 2.0-3.0, were significantly over anticoagulated prior to elective intervention, in spite of having adhered to the standard protocol of 5 days of warfarin interruption. Neither patient had any abnormality of liver function nor was taking any interacting drug known to inhibit warfarin metabolism or affect sensitivity to warfarin. Both had variant cytochrome P2C9 (CYP2C9) alleles which reduce the metabolic capacity of the CYP2C9 enzyme responsible for the metabolism of the S-warfarin enantiomer. Need for preoperative administration of vitamin K or postponement of an operation because of an INR >1.5 could be explained by variant alleles for CYP2C9 and age. PMID:25758405

  3. Antidepressant-warfarin interaction and associated gastrointestinal bleeding risk in a case-control study.

    Hedi Schelleman

    Full Text Available BACKGROUND: Bleeding is the most common and worrisome adverse effect of warfarin therapy. One of the factors that might increase bleeding risk is initiation of interacting drugs that potentiate warfarin. We sought to evaluate whether initiation of an antidepressant increases the risk of hospitalization for gastrointestinal bleeding in warfarin users. METHODOLOGY/PRINCIPAL FINDINGS: Medicaid claims data (1999-2005 were used to perform an observational case-control study nested within person-time exposed to warfarin in those ≥18 years. In total, 430,455 warfarin users contributed 407,370 person-years of warfarin use. The incidence rate of hospitalization for GI bleeding among warfarin users was 4.48 per 100 person-years (95% CI, 4.42-4.55. Each gastrointestinal bleeding cases was matched to 50 controls based on index date and state. Warfarin users had an increased odds ratio of gastrointestinal bleeding upon initiation of citalopram (OR = 1.73 [95% CI, 1.25-2.38], fluoxetine (OR = 1.63 [95% CI, 1.11-2.38], paroxetine (OR = 1.64 [95% CI, 1.27-2.12], amitriptyline (OR = 1.47 [95% CI, 1.02-2.11]. Also mirtazapine, which is not believed to interact with warfarin, increased the risk of GI bleeding (OR = 1.75 [95% CI, 1.30-2.35]. CONCLUSIONS/SIGNIFICANCE: Warfarin users who initiated citalopram, fluoxetine, paroxetine, amitriptyline, or mirtazapine had an increased risk of hospitalization for gastrointestinal bleeding. However, the elevated risk with mirtazapine suggests that a drug-drug interaction may not have been responsible for all of the observed increased risk.

  4. AParadigm Shift: The New Novel Oral Anticoagulation Agents.

    Saeed, Wajeeha; Burke, James F; Mirrani, Ghazi; Sirinivasa, Minisha; Nabi, Usman; Hayat, Umar; Khan, Zubair; Sardar, Muhammad Rizwan

    2016-07-01

    Atrial fibrillation (AF) is the most common arrhythmia and represents one-third of the arrhythmia-related hospital admissions in the developed countries. Embolic strokes associated with AF are more severe and disabling. Thromboembolic stroke prevention is a major goal in treatment of AF and Warfarin has successfully served this purpose for many years. Drug-drug interaction and regular monitoring with Warfarin pose a significant challenge where health care system has limited resources; and lack of a well-structured health system, hinders regular International Normalized Ratio (INR) monitoring. Novel oral anticoagulants (NOACs) have opened up a new exciting chapter in the field of anticoagulation in non-valvular atrial fibrillation (NVAF). This review discussed the landmark trials that led to the development of NOACs and explored the potentials of these new agents with simultaneous comparison of Warfarin. PMID:27504556

  5. Evaluation of an In Silico PBPK Post-Bariatric Surgery Model through Simulating Oral Drug Bioavailability of Atorvastatin and Cyclosporine

    Darwich, A S; Pade, D; Rowland-Yeo, K; Jamei, M; A. Åsberg; Christensen, H; Ashcroft, D.M.; Rostami-Hodjegan, A

    2013-01-01

    An increasing prevalence of morbid obesity has led to dramatic increases in the number of bariatric surgeries performed. Altered gastrointestinal physiology following surgery can be associated with modified oral drug bioavailability (F oral). In the absence of clinical data, an indication of changes to F oral via systems pharmacology models would be of value in adjusting dose levels after surgery. A previously developed virtual “post-bariatric surgery” population was evaluated through mimicki...

  6. Inappropriate preinjury warfarin use in trauma patients: A call for a safety initiative

    HH, Hon; Elmously, A; Stehly, CD; Stoltzfus, JC; Granson, MA; Stawicki, SP; Hoey, BA

    2016-01-01

    Introduction: Warfarin continues to be widely prescribed for a variety of conditions. It has been shown that preinjury warfarin may worsen outcomes in trauma patients. We hypothesized that a substantial proportion of injured patients seen at our institution were receiving preinjury warfarin for inappropriate indications and that a significant number of such patients had subtherapeutic or supratherapeutic international normalized ratios as well as increased mortality. Materials and Methods: A retrospective review of registry data from a Level I trauma center was conducted for the period from January 2004 to July 2013. Included were patients aged ≥22 years (based on the youngest recorded patient on warfarin in this study). Abstracted variables included patient age, Injury Severity Score (ISS), Maximum Abbreviated Injury Score for Head (MAISH), mortality, hospital length of stay (HLOS), indication(s) for anticoagulant therapy, admission Glasgow Coma Scale (GCS), and admission international normalized ratio (INR). Suitability of warfarin indication(s) was determined using the most recent American College of Chest Physicians (ACCP) Guidelines. Inappropriate warfarin administration was defined as use inconsistent with these guidelines. For outcome comparisons, a case-control design with 1:1 ratio was used, matching patients taking preinjury warfarin to a random sample of trauma patients who were not taking warfarin. Severe traumatic brain injury (sTBI) was defined as MAISH ≥4. Results: A total of 700 out of 14,583 patients aged ≥22 years were receiving preinjury warfarin (4.8% incidence, WG). This group was age- and ISS-matched with 700 patients (4.8% total sample) who were not taking warfarin (NWG) in a total case-control sample of 1,400. The two groups were similar in age, gender, ISS, and initial GCS. According to the ACCP guidelines, 115/700 (16.4%) patients in the warfarin group were receiving anticoagulation for inappropriate indications. Nearly 65% of the

  7. A pharmacogenetics-based warfarin maintenance dosing algorithm from Northern Chinese patients.

    Jinxing Chen

    Full Text Available Inconsistent associations with warfarin dose were observed in genetic variants except VKORC1 haplotype and CYP2C9*3 in Chinese people, and few studies on warfarin dose algorithm was performed in a large Chinese Han population lived in Northern China. Of 787 consenting patients with heart-valve replacements who were receiving long-term warfarin maintenance therapy, 20 related Single nucleotide polymorphisms were genotyped. Only VKORC1 and CYP2C9 SNPs were observed to be significantly associated with warfarin dose. In the derivation cohort (n = 551, warfarin dose variability was influenced, in decreasing order, by VKORC1 rs7294 (27.3%, CYP2C9*3(7.0%, body surface area(4.2%, age(2.7%, target INR(1.4%, CYP4F2 rs2108622 (0.7%, amiodarone use(0.6%, diabetes mellitus(0.6%, and digoxin use(0.5%, which account for 45.1% of the warfarin dose variability. In the validation cohort (n = 236, the actual maintenance dose was significantly correlated with predicted dose (r = 0.609, P<0.001. Our algorithm could improve the personalized management of warfarin use in Northern Chinese patients.

  8. The Safety of Dabigatran Versus Warfarin in Patients Undergoing Atrial Fibrillation Ablation

    Luis I. Garcia, MD; Kartikya Ahuja, MD; Mark A. Mascarenhas, MD; Anthony Aizer, MD; Neil Bernstein, MD; Scott A. Bernstein, MD; Steve J. Fowler, MD; Douglas S. Holmes, MD; David S. Park, MD; Larry Chinitz, MD

    2014-02-01

    Full Text Available The safety and optimal strategy of the use of dabigatran versus uninterrupted warfarin in atrial fibrillation ablation is currently unclear. We performed a retrospective analysis between July 2011-October 2012 of all patients undergoing an AF ablation who received uninterrupted warfarin therapy (199 and the routine cessation of Dabigatran therapy (126 4 days pre-ablation. Major safety endpoints included: pericardial effusion (requiring pericardiocentesis, peripheral thromboembolism, CVA, and groin hematoma requiring blood transfusion. Minor endpoints included pericardial effusion and groin hematoma. Dabigatran was restarted the following day after ablation. The warfarin group was older, had a higher CHADS2, CHA2DS2VASc and HASBLED scores and greater prevalence of aortic plaque. The major complication rate was 2.0% in the warfarin group and 2.4% in the dabigatran group (P= 0.83. The minor complication rate was 2.5% in the warfarin group and <1% in the dabigatran group (P= 0.27. In the dabigatran group, there was one renal thromboembolic event 4 days post-ablation. All patients in the warfarin group who suffered a major complication required a blood transfusion. Cessation of dabigatran therapy 4 days pre AF ablation has a comparable safety profile to uninterrupted warfarin therapy.

  9. Warfarin-induced skin necrosis diagnosed on clinical grounds and treated with maggot debridement therapy.

    Biscoe, Anna Louise; Bedlow, Alison

    2013-01-01

    A patient with a history of deep vein thrombosis presented with painful bruising and blistering on his left leg 7-10 days after warfarin treatment. A complicated 2-month treatment followed, where vasculitis was originally diagnosed from histological findings before the final diagnosis of warfarin-induced skin necrosis (WISN) was made on clinical grounds. Warfarin was stopped, reversed and low molecular weight heparin started but, the lesions had progressed to full thickness necrosis. This was originally treated with conventional surgical debridement before introducing maggot debridement therapy (MDT) in an effort to try to salvage the limb. PMID:23362073

  10. Patterns of warfarin use and subsequent outcomes in atrial fibrillation in primary care practices

    Ewen E

    2012-10-01

    Full Text Available Edward Ewen,1 Zugui Zhang,1 Teresa A Simon,2 Paul Kolm,1 Xianchen Liu,3,4 William S Weintraub11Christiana Care Health System, Newark, DE, USA; 2Bristol-Myers Squibb, Princeton, NJ, USA; 3Indiana University School of Medicine, Indianapolis, IN, USA; 4Pfizer, Groton, CT, USABackground: Warfarin is recommended for stroke prevention in high-risk patients with atrial fibrillation. However, it is often underutilized and inadequately managed in actual clinical practice.Objectives: To examine the patterns of warfarin use and their relationship with stroke and bleeding in atrial fibrillation patients in community-based primary care practices.Design: Retrospective longitudinal cohort study.Participants: A total of 1141 atrial fibrillation patients were selected from 17 primary care practices with a shared electronic medical record and characterized by stroke risk, potential barriers to anticoagulation, and comorbid conditions.Main measures: Duration and number of warfarin exposures, interruptions in warfarin exposure > 45 days, stroke, and bleeding events.Results: Among 1141 patients with a mean age of 70 years (standard deviation 13.3 and mean follow-up of 3.4 years (standard deviation 3.0, 764 (67% were treated with warfarin. Warfarin was discontinued within 1 year in 194 (25.4%, and 349 (45.7% remained on warfarin at the end of follow-up. Interruptions in warfarin use were common, occurring in 32.6% (249 of 764 of patients. Those with two or more interruptions were younger and at lower baseline stroke risk when compared to those with no interruptions. There were 76 first strokes and 73 first-bleeding events in the follow-up period. When adjusted for baseline stroke risk, time to warfarin start, and total exposure time, two or more interruptions in warfarin use was associated with an increased risk of stroke (relative risk, 2.29; 95% confidence interval: 1.29–4.07. There was no significant association between warfarin interruptions and bleeding events

  11. A Summary of the Literature Evaluating Adherence and Persistence with Oral Anticoagulants in Atrial Fibrillation.

    Obamiro, Kehinde O; Chalmers, Leanne; Bereznicki, Luke R E

    2016-10-01

    Atrial fibrillation (AF) is a growing public health concern and remains an independent risk factor for ischemic stroke. Warfarin, a commonly used oral anticoagulant, is associated with a 60-70 % relative reduction in stroke risk and a reduction in mortality of 26 %. However, warfarin has several limitations, including a narrow therapeutic window, variable dose response, multiple interactions with other drugs and concurrent illnesses, and the need for frequent laboratory monitoring. In recent years, the direct acting oral anticoagulants (DOACs), including dabigatran, rivaroxaban, apixaban and edoxaban, have been developed to overcome the limitations of warfarin therapy. These treatment strategies are either comparable or superior to warfarin in stroke prevention in AF. Despite the documented effectiveness of oral anticoagulants in AF, patients may not derive optimal benefit if they fail to adhere or fail to continue with their medication. This may lead to treatment failure, increased hospitalization and mortality. This review summarizes the literature regarding adherence and persistence (or discontinuation) rates with oral anticoagulants in the management of AF; the impact of non-adherence and non-persistence on treatment outcomes; and the effectiveness of strategies to improve adherence and persistence with oral anticoagulant therapy. PMID:27262433

  12. Solitary pulmonary nodule by pulmonary hematoma under warfarin therapy

    Pulmonary hematoma is a rare cause of a pulmonary nodule. Mostly it results from penetrating or blunt chest injuries. The case of a patient is reported, whose chest X-ray showed a pulmonary nodule suspected of malignancy. This patient was maintained permanently on anticoagulants (warfarin derivates) after cardiac valve replacement with a prosthesis. A definite diagnosis could not be established by non-invasive methods. A needle biopsy of the lung was impracticable because of the location of the pulmonary lesion; an exploratory thoracotomy could not be carried out due to a general indication of nonoperability. Control examinations showed that the pulmonary nodule had vanished completely within four months. In consideration of the patient's clinical situation it can be concluded that the pulmonary lesion was caused by a hematoma of the lung. (orig.)

  13. Improving outpatient warfarin use for hospitalized patients with atrial fibrillation

    Touchette DR,

    2008-03-01

    Full Text Available Atrial fibrillation affects an estimated 5 million Americans and accounts for approximately 15% of all strokes. Few studies have successfully addressed patient screening, assessment, and introduction of appropriate antithrombotic therapy in patients with atrial fibrillation. Objective: To assess whether an intervention improved planned antithrombotic prescribing at the time of discharge in hospitalized patients. Methods: The study was a prospectively designed, retrospectively evaluated, non-blinded, historical control study of a pharmacist-initiated intervention. The intervention, consisting of pharmacist review and assessment of antithrombotic prescribing in patients with non-valvular atrial fibrillation, was conducted in an urban teaching hospital. Results: Although antithrombotic prescribing was not significantly higher at discharge in the 252 enrolled subjects (control 67.3% vs. intervention 70.8%; p = 0.58, a significantly greater number of patients had a written discharge plan for antithrombotic therapy (control 73.5% vs. intervention 88.3%; p < 0.01. The adjusted odds ratio that the study group was associated with an improvement in planned or actual warfarin use was 2.46 (95% CI 1.63-3.74. In addition, clinicians adhered to guidelines for antithrombotic therapy in patients with atrial fibrillation more frequently in the intervention group (control 70.4% vs. intervention 88.2%; p < 0.01. Conclusion: A program designed to identify hospitalized patients with non-valvular atrial fibrillation, assess their need for stroke prophylaxis, and initiate appropriate antithrombotic therapy led to an increase in planned antithrombotic, and most importantly, warfarin use upon discharge from the hospital. Confirmation that an increase in planned antithrombotic use upon discharge results in an actual increase in use after discharge is needed to determine the true effectiveness of this intervention.

  14. Endoscopic submucosal dissection for early gastric cancer without interruption of warfarin and aspirin

    Tounou, Shigetaka; Morita, Yasushi; Hosono, Tomohiro; Harada, Hideaki; Hayasaka, Kenji; Katsuyama, Yasushi; Suehiro, Satoshi; Nagano, Seishi; Shimizu, Takanori

    2015-01-01

    Many guidelines for the management of antithrombotic therapy in endoscopic procedures state that warfarin should be replaced by heparin in high risk endoscopic procedures. However, heparin bridging therapy is costly, requires a long hospital stay, and is indicated as a risk factor for bleeding after endoscopic submucosal dissection (ESD). It is not yet clear whether it is better to perform gastric ESD on continuous warfarin therapy or heparin bridging therapy. We report the case of a 65-year-...

  15. Assessment of patient perceptions concerning a community pharmacy-based warfarin monitoring service

    Stefanie Ferreri, PharmD, BCACP, CDE, FAPhA; Debbie Pruss Hiller, PharmD2; Macary Weck Marciniak, PharmD, BCACP, BCPS, FAPhA; Jennifer Waitzman, PharmD1

    2012-01-01

    Objective: To assess patient perceptions of a North Carolina community pharmacy-based warfarin monitoring service. Methods: Prospective study of patients 18 years of age and older, who filled a prescription for warfarin, in one of five Raleigh area community pharmacies, between May 1, 2010 and October 31, 2010. A 14 item survey, along with a self-addressed stamped envelope, was mailed to 330 identified patients. The survey inquired about details of current anticoagulation monitoring services,...

  16. Vitamin K2 for the reversal of warfarin-related coagulopathy.

    Hifumi, Toru; Takada, Hiroaki; Ogawa, Daisuke; Suzuki, Kenta; Hamaya, Hideyuki; Shinohara, Natsuyo; Abe, Yuko; Takano, Koshiro; Kawakita, Kenya; Hagiike, Masanobu; Koido, Yuichi; Kuroda, Yasuhiro

    2015-08-01

    The American Heart Association/American College of Cardiology Foundation recommends vitamin K1 for warfarin-related coagulopathy. In Japan, vitamin K2 is used more commonly for such purpose. The difference between vitamins K1 and K2 in reversing warfarin-related coagulopathy has not been discussed. Herein, we report a case that was reversed with vitamin K2; alterations in vitamins K1 and K2 levels and coagulation markers are also presented. PMID:25636520

  17. Safety and Efficacy Outcomes of Home and Hospital Warfarin Management Within a Pediatric Anticoagulation Clinic.

    Jones, Sophie; McLoughlin, Siobhan; Piovesan, Dana; Savoia, Helen; Monagle, Paul; Newall, Fiona

    2016-04-01

    The complexity of managing children with chronic disease has led to an increase in the use of long-term warfarin therapy. Time in therapeutic range (TTR) is the preferred method for determining efficacy and stability of warfarin management. This study aimed to determine the TTR achievement and incidence of adverse events among pediatric warfarin patients managed by an anticoagulation clinic over 12 months and to compare TTR achievement between patients self-testing (PST) at home and those monitored using routine methods. International normalized ratio (INR) results reported for 2012 for children currently having their warfarin therapy managed by a dedicated pediatric anticoagulation clinic were analyzed. Warfarin-related adverse events were recorded. A total of 164 patients were included. In total, 93 children performed PST and 71 children tested their INR at a hospital or pathology service. TTR achievement for the cohort was 67.1% (95% confidence interval, 64.4-69.7). A total of 69.2% of INR tests conducted at home were within the TTR compared with 64.3% of INR tests conducted at a hospital or pathology service (P=0.07). One major bleeding event occurred and there was 1 thrombotic episode. PST demonstrated noninferior warfarin stability compared with routine methods. Routine outcome evaluation of pediatric anticoagulation management within single institutions is necessary to confirm the success of such programs. PMID:26808370

  18. Molecular displacement of warfarin from human serum albumin by flavonoid aglycones

    Poór, Miklós [Institute of Laboratory Medicine, University of Pécs, Pécs H-7624 (Hungary); Li, Yin; Kunsági-Máté, Sándor [Department of General and Physical Chemistry, University of Pécs, Pécs H-7624 (Hungary); János Szentágothai Research Center, H-7624 Pécs (Hungary); Petrik, József [Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, HR-10000 Zagreb (Croatia); Vladimir-Knežević, Sanda [Department of Pharmacognosy, Faculty of Pharmacy and Biochemistry, University of Zagreb, HR-10000 Zagreb (Croatia); Kőszegi, Tamás, E-mail: koszegit@freemail.hu [Institute of Laboratory Medicine, University of Pécs, Pécs H-7624 (Hungary)

    2013-10-15

    The well-known 4-hydroxycoumarin derivative warfarin is a widespread anticoagulant drug. Besides its strong albumin binding property warfarin has a narrow therapeutic window. Therefore, a few percent of displacement from albumin can result in serious biological consequences. The flavonoid molecular group also shows very strong plasma albumin binding characteristics occupying the same binding site. It is plausible to hypothesize that flavonoid aglycones may be able to displace warfarin from human serum albumin (HSA). In our study the competing activities of different flavone (acacetin, apigenin, chrysin, luteolin), flavonol (galangin, quercetin) and flavanone (hesperetin, naringenin) aglycones were investigated using fluorescence spectroscopy. Our results represent that flavonoids are able to displace warfarin from the surface of HSA. On the other hand, when comparing flavone or flavonol groups to flavanones the latter group seems to be much weaker competitor. These observations were also supported by calculation of stability constants. Our investigations strongly suggest that we should reckon with the described molecular displacement. However, further in vivo studies are needed to support the findings of our model system. -- Highlights: • Various flavonoids are able to displace warfarin from human serum albumin. • Flavones and flavonols are much more effective competitors than flavanones. • Even 300 nM aglycone concentrations show the interaction with 3 μM warfarin. • Flavonoid pairs show quasi-additive desorbing property. • Flavones and flavonols are much stronger competitors than the examined drugs.

  19. Do Herbal Formulas Influence the International Normalized Ratio of Patients Taking Warfarin? A Retrospective Study

    Hsu-Yuan Lu

    2015-01-01

    Full Text Available Warfarin is a common anticoagulant agent for cardiovascular diseases, and it is known to interact with several foods and drugs. Several studies report an interaction between warfarin and herbal medicines; however, the influence of herbal medicines on the international normalized ratio (INR is still controversial. We investigated the influence of herbal formulas on INR of patients taking warfarin. We searched electronic medical records of inpatients for INR results. Then, we compared the changes in INR and any adverse events between the group taking herbal formulas and warfarin (herbal group and another group taking warfarin only (nonherbal group. Eighty-six patients were included; 45 patients were assigned to the herbal group and 41 patients to the nonherbal group. The herbal group had taken the same dose of warfarin for a longer period. The nonherbal group had a slightly higher mean INR value than the herbal group. The ratio of INR less than 2 and greater than 3, the ratio of INR that increased or decreased by one or more compared to the initial INR, and the ratio of adverse events were not significantly different between the two groups. It is suggested that use of herbal formulas may not influence INR value.

  20. Molecular displacement of warfarin from human serum albumin by flavonoid aglycones

    The well-known 4-hydroxycoumarin derivative warfarin is a widespread anticoagulant drug. Besides its strong albumin binding property warfarin has a narrow therapeutic window. Therefore, a few percent of displacement from albumin can result in serious biological consequences. The flavonoid molecular group also shows very strong plasma albumin binding characteristics occupying the same binding site. It is plausible to hypothesize that flavonoid aglycones may be able to displace warfarin from human serum albumin (HSA). In our study the competing activities of different flavone (acacetin, apigenin, chrysin, luteolin), flavonol (galangin, quercetin) and flavanone (hesperetin, naringenin) aglycones were investigated using fluorescence spectroscopy. Our results represent that flavonoids are able to displace warfarin from the surface of HSA. On the other hand, when comparing flavone or flavonol groups to flavanones the latter group seems to be much weaker competitor. These observations were also supported by calculation of stability constants. Our investigations strongly suggest that we should reckon with the described molecular displacement. However, further in vivo studies are needed to support the findings of our model system. -- Highlights: • Various flavonoids are able to displace warfarin from human serum albumin. • Flavones and flavonols are much more effective competitors than flavanones. • Even 300 nM aglycone concentrations show the interaction with 3 μM warfarin. • Flavonoid pairs show quasi-additive desorbing property. • Flavones and flavonols are much stronger competitors than the examined drugs

  1. Novel Oral Anticoagulants for Stroke Prophylaxis and Venous Thromboembolism Prevention and Treatment

    Laith G. Alsayegh

    2015-08-01

    Full Text Available Novel oral anticoagulants (NOACs are becoming popular management options for stroke prophylaxis in nonvalvular atrial fibrillation as well as deep vein thrombosis and pulmonary embolism treatment and prophylaxis. NOACs have similar efficacy to warfarin along with noninferior safety profiles. Patient comorbidities, size, renal and hepatic function, and concomitant drug regimen play a role in which NOAC a physician may choose.

  2. Novel Oral Anticoagulants for Stroke Prophylaxis and Venous Thromboembolism Prevention and Treatment

    Laith G. Alsayegh

    2015-01-01

    Novel oral anticoagulants (NOACs) are becoming popular management options for stroke prophylaxis in nonvalvular atrial fibrillation as well as deep vein thrombosis and pulmonary embolism treatment and prophylaxis. NOACs have similar efficacy to warfarin along with noninferior safety profiles. Patient comorbidities, size, renal and hepatic function, and concomitant drug regimen play a role in which NOAC a physician may choose.

  3. Hepatic uptake and storage of warfarin. The relation with the target enzyme vitamin K 2,3-epoxide reductase

    The mechanisms of the reported dose-dependent warfarin pharmacokinetics were investigated using [14C]warfarin. When administered in microdoses (9 micrograms i.v.) to rats (male Wistars, 270-300 g), a steep distribution phase (T1/2 = 0.25 hr) was followed by a relatively slow beta-phase (T1/2 = 40 hr). The observed volume of distribution was 390 ml. This pharmacokinetic behavior contrasted highly with the one seen for higher (greater than 0.2 mg/kg) doses (unlabeled) warfarin; volume of distribution = 45 ml, T1/2 = 12.5 hr. If a macrodose (0.2 mg/kg) preceded (16 hr) the microdose, normal pharmacokinetics were observed for the latter, suggesting a saturable deep compartment. The administration of 4-hydroxycoumarins (i.e., acenocoumarol, phenprocoumon and warfarin) after the microdose of [14C]warfarin was in its beta-phase caused a rapid rise of plasma [14C]warfarin indicating [14C]warfarin to be displaced from the deep compartment. The rate of appearance of [14C]warfarin was 0.3 hr-1 irrespective the 4-hydroxycoumarin used. The hepatic distribution of [14C]warfarin was investigated and the effect of a displacer thereupon. Fifty-three hours after the [14C]warfarin administration, the liver contained about 40% of the dose; 45% of it was bound to microsomes. The administration of acenocoumarol (0.2 mg/kg) at 48 hr, halved the liver content. [14C]warfarin was redistributed from microsomes (-65%) and from the 10,000 X g pellet (-65%) into the cytosol (+260%) and the plasma (+320%). Microsomal bound [14C]warfarin in vitro could not be washed out or be displaced unless dithiothreitol (50 mM) was included in the washing buffers

  4. Subcutaneous low molecular weight heparin in place of heparin infusion during warfarin dose optimisation in cerebral ischaemia.

    Venketasubramanian, N; Chua, H C

    1998-09-01

    We explored the feasibility of using subcutaneous low-molecular-weight-heparin (LMWH) injections in place unfractionated heparin (UFH) while anticoagulating patients with cerebral ischemia. In this open-labeled, prospective study, patients admitted to our hospital with transient ischemic attacks or stroke requiring anticoagulation who were otherwise medically fit for discharge home were enrolled. The LMWH nadroparin (Fraxiparine) 4100 antiXa BID was administered. In those on UFH, this was stopped after the first dose of LMWH. Patients were sent home and LMWH was administered on an outpatient basis with simultaneous oral warfarin titration till INR reached 2.0. Fifteen patients (13 inpatients, two outpatients) were enrolled; 12 had stroke, one each had crescendo transient ischaemia attacks (TIAs) while on aspirin, TIAs and intracranial arterial stenosis, TIA and atrial fibrillation. Inpatients were discharged home within a median of 1 day (range 1-3 days). Median duration of LMWH therapy was 9 days (range 4-47 days); nine required LMWH for 10 days or less. Two patients reported bruising at the injection site. There was no death, cerebral ischaemia recurrence or major hemorrhage. Using LMWH in place of UFH in patients with cerebral ischaemia is a feasible and safe way of achieving optimal oral anticoagulation and can be done on an outpatient basis. PMID:9822840

  5. Advantages of a Warfarin Protocol for Long-term Care Pharmacists: a Retrospective Cohort Study

    Sargent, Randall; Brocklebank, Cynthia; Tam-Tham, Helen; Williamson, Tyler; Quail, Patrick; Turner, Diana; Drummond, Neil

    2016-01-01

    Background Warfarin is an anticoagulant prescribed to 12% of long-term care residents to reduce the risk of thrombo-embolism. This study used indicators to compare warfarin management by pharmacists to usual care. Methods This was a retrospective cohort study comparing a pharmacist-managed warfarin protocol with usual care of qualified warfarin recipients at long-term care facilities (two protocol, one control) in Calgary, Alberta. We compared the proportion of international normalized ratio (INR) tests in the range 2.0 to 3.0, time in range, number of tests, and frequency of bleeding at protocol and control sites. Our primary outcome, time in INR therapeutic range, is an indicator for assuring care quality. A cross-sectional survey at these sites compared health professionals’ perceptions of workload and effectiveness of warfarin management. Results Of the 197 residents’ charts reviewed in the study period, those on protocol had 45.0 INR tests while those on usual care had 52.7 tests (p = .034, 95% CI for the difference: 0.6 to 14.6 INR tests). No significant difference was found for time in therapeutic range, number of tests in range, or major bleeding events. Of 178 health professionals surveyed, those from protocol facilities were more satisfied with warfarin management (p = .013). Workload and safety were perceived similarly at all sites. Interpretation Our results suggest that a pharmacist-managed warfarin protocol is as effective as usual care and has advantages pertaining to work satisfaction, knowledge of drug interactions, consistent documentation, and fewer INR tests. Further research on teamwork and coagulation management in long-term care facilities is recommended. PMID:27403212

  6. Underutilization of Warfarin Therapy in Elderly Patients with Atrial Fibrillation – Fear or False Sense of Security!

    Mazda Biria MD

    2008-09-01

    Full Text Available Background: Under utilization of warfarin in elderly patients with atrial fibrillation (AF has been recognized as a significant health care issue. This study examines the rate and reasons for warfarin underutilization in elderly patients with AF at the Kansas City Veterans Affairs Medical Center. Methods: Retrospective study reviewing electronic medical records of all patients aged 65 and older with the diagnosis of atrial fibrillation. Patients on warfarin were excluded. Reasons for not using warfarin were extracted by reviewing the electronic medical record. Anticoagulation indications for these patients were determined based on the ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation. Results: Warfarin was not used by 407 patients (25% with known AF. Average age was 79+6.2 years. 60% of patients had persistent or permanent AF. Prevalence of risk factors for thromboembolism included hypertension (74%, heart failure or ejection fraction of <40% (21%, diabetes (27% and coronary artery disease (48%. CHADS (2 scores were documented in the charts less than 1% of the times. Only 11 patients had CHADS (2 score of 0 and 70 had a score of 1. A class I or IIa indication for warfarin therapy was present in 298 (73% of patients. Return to sinus rhythm (37% was the most common reason for not using warfarin. In 30% of cases the reason not to use warfarin was not addressed. Other reasons not to use warfarin included fear of falls (7%, prior head or GI bleed (14%, patient refusal & noncompliance (12%. History of CVA or TIA was documented in 12% of patients. Conclusions: Underutilization of warfarin in elderly patients with atrial fibrillation remains a common problem despite their high risk for thromboembolic events. A false sense of security about the paroxysmal nature of AF, lack of proper insight about stroke risk (CHADS (2, and fear of bleeding are the most common reasons for non use of warfarin.

  7. Decreased warfarin effects in elder with recurrent Clostridium difficile infection during fidaxomicin therapy: a case report

    Antonio Riccardo Buonuomo

    2015-03-01

    Full Text Available Clostridium difficile infection is a disease with increasing incidence, particularly in high‑riskpatients such as the elderly, immunocompromised patients, etc.We report an unexpected decrease of International Normalized Ratio (INR response to warfarin during a first recurrence of Clostridium difficile infection (CDI treated with fidaxomicin. The patient, an old man who has prosthetic heart valves on anticoagulation therapy with warfarin, was treated with an association of vancomycin plus metronidazole for a first episode of CDI. Patient remained symptom‑free for few days and then he presented with recurrent diarrhea. A retreatment with vancomycin and metronidazole didn’t resolve symptoms of CDI, therefore he underwent fidaxomicin treatment for 10 days, with rapid resolution of diarrhea. In the meantime, warfarin effects diminished, and only with increases of dosage INR therapeutic range was achieved few days after discontinuing fidaxomicin. According to product information, fidaxomicin doesn’t interfere with warfarin. The authors highlight the different plausible mechanisms to explain the association between the unexpected decreased effect of warfarin and factors that could have influenced such event. The frequent update of product information through good pharmacovigilance practices could help clinicians in the management of unexpected events.http://dx.doi.org/10.7175/cmi.v9i1.953

  8. Lack of effect of multiple doses of vortioxetine on the pharmacokinetics and pharmacodynamics of aspirin and warfarin.

    Chen, Grace; Zhang, Wencan; Serenko, Michael

    2015-06-01

    Vortioxetine is an antidepressant with multimodal activity approved for the treatment of major depressive disorder. Two separate randomized, placebo-controlled trials evaluated the effects of multiple doses of vortioxetine (10 mg/day) on the pharmacokinetics and pharmacodynamics of aspirin and warfarin in healthy volunteers. In the aspirin study, subjects received vortioxetine 10 mg or placebo once daily for 14 days, followed by coadministration with aspirin 150 mg once daily for 6 days, in 2 periods with a crossover design. In the warfarin study, subjects were randomized after reaching target international normalized ratio (INR) values on warfarin to receive vortioxetine 10 mg or matching placebo once daily for 14 days, with all subjects receiving a maintenance dose of warfarin (1-10 mg). Vortioxetine had no effect on the steady-state pharmacokinetic parameters of aspirin or its metabolite salicylic acid, and no statistically significant effect on the inhibition of arachidonic acid-, adenosine-5'-diphosphate-, or collagen-induced platelet aggregation at any time points. Coadministration of vortioxetine did not alter the pharmacokinetics of (R)- and (S)-warfarin enantiomers, or the mean coagulation parameters of warfarin treatment alone. Coadministration of vortioxetine doses in healthy volunteers had no effect on aspirin or warfarin pharmacokinetics or pharmacodynamics. Vortioxetine was well tolerated when coadministered with aspirin or warfarin. PMID:25641606

  9. The impact of interacting drugs on dispensed doses of warfarin in the Swedish population: A novel use of population based drug registers.

    Andersson, M L; Lindh, J D; Mannheimer, B

    2013-12-01

    To investigate the impact of interacting drugs on the dispensed doses of warfarin in the Swedish population. This was a retrospective, cross-sectional population based register study of patients being dispensed warfarin. Warfarin doses were estimated in different age groups, in men and women, and in patients using interacting drugs. The influence of interacting drugs on the dispensed warfarin dose was analyzed using multiple regression. All 143,729 patients dispensed warfarin were analyzed. The dispensed dose of warfarin was highest in patients 30-39 years old and decreased with age. Co-medication with carbamazepine, simvastatin, paracetamol, amiodarone, fluconazole, lactulose, or bezafibrate was associated with significant changes in dispensed warfarin doses, by +40%, -3.4%, -7.3%, -8.2%, -8.8%, -9.0%, and -9.7%, respectively. After adjustment for age and gender, sulfamethoxazole was also found to significantly alter the dispensed warfarin dose (-6.1%). We provide new support for the previous scarce evidence of interactions between warfarin and carbamazepine, bezafibrate, and lactulose. Initiation or discontinuation of bezafibrate or lactulose in a patient on warfarin should warrant close clinical monitoring. The marked increased warfarin requirement associated with carbamazepine use supports moving from a more conservative reactive towards a proactive strategy including preventive warfarin dose adjustments to avoid potential adverse effects. PMID:24038065

  10. Comparison of a Frail-Friendly Nomogram with Physician-Adjusted Warfarin Dosage for Prophylaxis after Orthopaedic Surgery on a Geriatric Rehabilitation Unit

    Freter, Susan; Bowles, Susan K.

    2005-01-01

    Warfarin dosing for thromboprophylaxis in post-operative patients is time-consuming. Warfarin-dosing nomograms can be used in post-operative arthroplasty patients, but warfarin requirements are lower in frail older people. We modified an existing post-arthroplasty nomogram to a frail-friendly version and evaluated its performance in a frail…

  11. Comparison of initial loading doses of 5 mg and 10 mg for warfarin therapy

    Sidnei Lastória

    2014-03-01

    Full Text Available CONTEXT: The question of what is the best loading dosage of warfarin when starting anticoagulant treatment has been under discussion for ten years. We were unable to find any comparative studies of these characteristics conducted here in Brazil. OBJECTIVE: To compare the safety and efficacy of two initial warfarin dosage regimens for anticoagulant treatment. METHODS: One-hundred and ten consecutive patients of both sexes, with indications for anticoagulation because of venous or arterial thromboembolism, were analyzed prospectively. During the first 3 days of treatment, these patients were given adequate heparin to keep aPTT (activated partial thromboplastin time between 1.5 and 2.5, plus 5 mg of warfarin. From the fourth day onwards, their warfarin doses were adjusted using International Normalized Ratios (INR; target range: 2 to 3. This prospective cohort was compared with a historical series of 110 patients had been given 10 mg of warfarin on the first 2 days and 5 mg on the third day with adjustments based on INR thereafter. Outcomes analyzed were as follows: recurrence of thromboembolism, bleeding events and time taken to enter the therapeutic range. RESULTS: Efficacy, safety and length of hospital stay were similar in both samples. The sample that were given 10 mg entered the therapeutic range earlier (means: 4.5 days vs. 5.8 days, were on lower doses at discharge and had better therapeutic indicators at the first return appointment. CONCLUSIONS: The 10 mg dosage regimen took less time to attain the therapeutic range and was associated with lower warfarin doses at discharge and better INR at first out-patients follow-up visit.

  12. Bleeding events with dabigatran or warfarin in patients with venous thromboembolism.

    Majeed, Ammar; Goldhaber, Samuel Z; Kakkar, Ajay; Kearon, Clive; Eriksson, Henry; Kreuzer, Jörg; Feuring, Martin; Hantel, Stephan; Friedman, Jeffrey; Schellong, Sebastian; Schulman, Sam

    2016-01-01

    Dabigatran was as effective as warfarin for the acute treatment of venous thromboembolism in the RE-COVER and RE-COVER II trials. We compared the incidence of bleeding with dabigatran versus warfarin in pooled data from these studies. The localisation, bleeding severity, and the impact of key factors on the incidence of bleeding, were compared between the dabigatran and warfarin treatment group. Altogether, 2553 patients received dabigatran and 2554 warfarin, each for a mean of 164 days. The incidence of any bleeding event was significantly lower with dabigatran (hazard ratio [HR] 0.70; 95% confidence interval [CI], 0.61-0.79), as was the incidence of the composite of MBEs and clinically relevant non-major bleeding events (HR 0.62; 95% CI, 0.50-0.76). The incidence of major bleeding events (MBEs) was also significantly lower with dabigatran in the double-dummy phase (HR, 0.60; 95%CI, 0.36-0.99) but not statistically different between the two treatment arms when the entire treatment period is considered (HR 0.73 95% CI, 0.48-1.11). Increasing age, reduced renal function, Asian ethnicity, and concomitant antiplatelet therapy were associated with higher bleeding rates in both treatment groups. The reduction in bleeding with dabigatran compared to warfarin was consistent among the subgroups and with a similar pattern for intracranial, and urogenital major bleeding. In conclusion, treatment of venous thromboembolism with dabigatran is associated with a lower risk of bleeding compared to warfarin. This reduction did not differ with respect to the location of bleeding or among predefined subgroups. PMID:26403199

  13. Post-procedural Dabigatran Versus Interrupted Warfarin Therapy Following Catheter Ablation for Atrial Fibrillation

    Jeffrey Lin, MD; Sharon Shen, MD; Prashant Bhave, MD; Bradley Knight, MD; Martha Bohn, RN, BSN; Evaldas Giedrimas, MD; Taral K. Patel, MD; Alexandru Chicos, MD; Jeffrey Goldberger, MD; Leonard Ilkhanoff, MD, MS; Susan Kim, MD; Albert Lin, MD; Rod Passman, MD, MSCE.

    2014-02-01

    Full Text Available Purpose: Patients undergoing catheter ablation for atrial fibrillation (AF are at a higher risk of thromboembolic events post-procedure and therefore require therapeutic anticoagulation after ablation. Anticoagulation strategies include performing the procedure on or off therapeutic warfarin, though the latter approach requires post-procedure bridging therapy with low molecular-weight heparin (LMWH until a therapeutic INR is achieved. The purpose of this study is to compare the safety and efficacy of post-ablation dabigatran as compared to warfarin with LMWH bridging. Methods: We performed a single-center retrospective analysis of consecutive patients who underwent catheter ablation for AF between January 2010 and December 2012 and received either post-procedure warfarin with a LMWH bridge or dabigatran. Warfarin was started the night of ablation; LMWH was started the next morning and continued until the INR was ≥ 2.0. Dabigatran was started the morning post-ablation. Results: The analysis included 324 patients. Of these, mean age was 60 ± 9 years, 78% were male, 81% had CHADS2 scores of 0 or 1, and 181 (56% received dabigatran post-ablation. Patients who received dabigatran had lower CHADS2 scores and were more likely to be in NYHA Class I. At 30-days post-procedure, there were 0 thromboembolic or bleeding complications in the dabigatran group versus 4 (2.8% in the warfarin group (p=0.037. There were no deaths in either group at 30 days post-ablation. Conclusions: Post-ablation dabigatran appears safe and efficacious compared to an interrupted warfarin strategy with LMWH bridging.

  14. Predictors of warfarin non-adherence in younger adults after valve replacement surgery in the South Pacific

    Al-Sheyab, Nihaya

    2016-01-01

    Objectives Globally, mechanical valves are predominant as replacements for adolescents and younger adults with rheumatic heart disease (RHD). Mechanical valve implantation necessitates lifelong antithrombotic management (warfarin) and associated lifestyle modification, with event-free survival largely dependent on international normalised therapeutic ratios (INRs) remaining within the target therapeutic range. There is limited information on factors that may influence warfarin adherence among younger people or those in resource-limited settings. This study sought to identify predictors of warfarin adherence after valve replacement surgery for RHD in Fiji (n=127). Methods A cross-sectional study design was used. Results The sample had a mean age of 31.23 years (SD 13.34) and a mean time-since-surgery of 3.72 years (SD 3.95). Just over half were women (n=71, 56%) and almost two-thirds were indigenous (I-taukei, n=78, 61%). Most had an isolated valve procedure (n=94, 74%) and at the time of survey, they were in New York Heart Association Class I (n=97, 76%). A quarter (n=33, 26%) reported poor adherence with anticoagulation therapy and 13.38% (n=17) reported complete warfarin cessation. While younger age was significantly associated with non-adherence to warfarin therapy (p=0.008), the independent predictors of people who discontinue warfarin completely were those not understanding why warfarin was needed (OR=9.97, p=0.006); a history of forgetting to take warfarin (OR=8.64, p=0.0013) and travel time to heart clinic >1 hour (OR=5.80, p=0.039). Conclusions While medication adherence is complex and multifactorial, the consequences of warfarin non-adherence are potentially catastrophic. These results provide an important first step towards the development of country-specific and disease-specific strategies to improve warfarin adherence.

  15. Association between use of warfarin with common sulfonylureas and serious hypoglycemic events: retrospective cohort analysis

    Romley, John A; Gong, Cynthia; Jena, Anupam B; Goldman, Dana P; Williams, Bradley

    2015-01-01

    Study question Is warfarin use associated with an increased risk of serious hypoglycemic events among older people treated with the sulfonylureas glipizide and glimepiride? Methods This was a retrospective cohort analysis of pharmacy and medical claims from a 20% random sample of Medicare fee for service beneficiaries aged 65 years or older. It included 465 918 beneficiaries with diabetes who filled a prescription for glipizide or glimepiride between 2006 and 2011 (4 355 418 person quarters); 71 895 (15.4%) patients also filled a prescription for warfarin (416 479 person quarters with warfarin use). The main outcome measure was emergency department visit or hospital admission with a primary diagnosis of hypoglycemia in person quarters with concurrent fills of warfarin and glipizide/glimepiride compared with the rates in quarters with glipizide/glimepiride fills only, Multivariable logistic regression was used to adjust for individual characteristics. Secondary outcomes included fall related fracture and altered consciousness/mental status. Summary answer and limitations In quarters with glipizide/glimepiride use, hospital admissions or emergency department visits for hypoglycemia were more common in person quarters with concurrent warfarin use compared with quarters without warfarin use (294/416 479 v 1903/3 938 939; adjusted odds ratio 1.22, 95% confidence interval 1.05 to 1.42). The risk of hypoglycemia associated with concurrent use was higher among people using warfarin for the first time, as well as in those aged 65-74 years. Concurrent use of warfarin and glipizide/glimepiride was also associated with hospital admission or emergency department visit for fall related fractures (3919/416 479 v 20 759/3 938 939; adjusted odds ratio 1.47, 1.41 to 1.54) and altered consciousness/mental status (2490/416 479 v 14 414/3 938 939; adjusted odds ratio 1.22, 1.16 to 1.29). Unmeasured factors could be correlated with both warfarin use and

  16. Real Data on Effectiveness, Tolerability and Safety of New Oral Anticoagulant Agents: Focus on Dabigatran.

    Stabile, Eugenio; Izzo, Raffaele; Rozza, Francesco; Losi, Maria Angela; Coscioni, Enrico; Trimarco, Bruno

    2016-06-01

    Vitamin K-dependent antagonists (VKAs) are the most commonly used oral anticoagulants. Non-VKA oral anticoagulants (NOACs), directly target factor IIa (dabigatran) or Xa (rivaroxaban, apixaban, and edoxaban) have predictable pharmacological effects and relatively few drug and food interactions compared with VKA. Among NOACs, dabigatran has been extensively tested for stroke prevention in patients with non-valvular atrial fibrillation eligible for oral anticoagulation with VKA. Dabigatran is at least as effective as warfarin at preventing stroke with advantages of less serious bleeding except for gastrointestinal bleeding, which occurs more often than with warfarin. The findings of dabigatran use in randomized trials, post market registries and specific clinical settings are discussed in this article. PMID:27207360

  17. Direct oral anticoagulants for secondary prevention in patients with non-valvular atrial fibrillation

    Luca Masotti

    2013-12-01

    Full Text Available The patients with non-valvular atrial fibrillation (NVAF, both permanent and paroxysmal, and history of previous transient ischemic attack (TIA or stroke represent a category of patients at high risk of new embolic events, independently of the presence of other risk factors. In these patients, national and international guidelines recommend oral anticoagulants as first choice for antithrombotic prevention. Direct oral anticoagulants (DOACs have been demonstrated to be not inferior to warfarin for many end points in NVAF patients in terms of efficacy and safety. The post hoc analysis in selected subgroups of patients enrolled in the three mega trials of phase III comparing DOACs (RE-LY, ROCKET-AF and ARISTOTLE with warfarin help to evaluate whether superiority and non-inferiority persist in these subgroups. Here, patients with NVAF and history of previous TIA/stroke receiving DOACs as secondary prevention are compared with patients with the same characteristics receiving warfarin. An analysis of these patients has been recently published (separately for each of three DOACs. This analysis shows that DOACs maintain their non-inferiority when compared with warfarin in secondary prevention, representing a real alternative in this context of patients at high risk for ischemic and bleeding events.

  18. Direct-Acting Oral Anticoagulants: Practical Considerations for Emergency Medicine Physicians

    W. Frank Peacock

    2016-01-01

    Full Text Available Nonvalvular atrial fibrillation- (NVAF- related stroke and venous thromboembolism (VTE are cardiovascular diseases associated with significant morbidity and economic burden. The historical standard treatment of VTE has been the administration of parenteral heparinoid until oral warfarin therapy attains a therapeutic international normalized ratio. Warfarin has been the most common medication for stroke prevention in NVAF. Warfarin use is complicated by a narrow therapeutic window, unpredictable dose response, numerous food and drug interactions, and requirements for frequent monitoring. To overcome these disadvantages, direct-acting oral anticoagulants (DOACs—dabigatran, rivaroxaban, apixaban, and edoxaban—have been developed for the prevention of stroke or systemic embolic events (SEE in patients with NVAF and for the treatment of VTE. Advantages of DOACs include predictable pharmacokinetics, few drug-drug interactions, and low monitoring requirements. In clinical studies, DOACs are noninferior to warfarin for the prevention of NVAF-related stroke and the treatment and prevention of VTE as well as postoperative knee and hip surgery VTE prophylaxis, with decreased bleeding risks. This review addresses the practical considerations for the emergency physician in DOAC use, including dosing recommendations, laboratory monitoring, anticoagulation reversal, and cost-effectiveness. The challenges of DOACs, such as the lack of specific laboratory measurements and antidotes, are also discussed.

  19. A Novel Admixture-Based Pharmacogenetic Approach to Refine Warfarin Dosing in Caribbean Hispanics.

    Jorge Duconge

    Full Text Available This study is aimed at developing a novel admixture-adjusted pharmacogenomic approach to individually refine warfarin dosing in Caribbean Hispanic patients.A multiple linear regression analysis of effective warfarin doses versus relevant genotypes, admixture, clinical and demographic factors was performed in 255 patients and further validated externally in another cohort of 55 individuals.The admixture-adjusted, genotype-guided warfarin dosing refinement algorithm developed in Caribbean Hispanics showed better predictability (R2 = 0.70, MAE = 0.72mg/day than a clinical algorithm that excluded genotypes and admixture (R2 = 0.60, MAE = 0.99mg/day, and outperformed two prior pharmacogenetic algorithms in predicting effective dose in this population. For patients at the highest risk of adverse events, 45.5% of the dose predictions using the developed pharmacogenetic model resulted in ideal dose as compared with only 29% when using the clinical non-genetic algorithm (p<0.001. The admixture-driven pharmacogenetic algorithm predicted 58% of warfarin dose variance when externally validated in 55 individuals from an independent validation cohort (MAE = 0.89 mg/day, 24% mean bias.Results supported our rationale to incorporate individual's genotypes and unique admixture metrics into pharmacogenetic refinement models in order to increase predictability when expanding them to admixed populations like Caribbean Hispanics.ClinicalTrials.gov NCT01318057.

  20. Interaction between Gemcitabine and Warfarin Causing Gastrointestinal Bleeding in a Patient with Pancreatic Cancer

    Saif, M. Wasif

    2005-01-01

    Gemcitabine (Gemzar) is the only chemotherapeutic agent approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced pancreatic cancer. Thromboembolism requiring anticoagulation is a common paraneoplastic complication in these patients. We report a case of patient with pancreatic cancer, complicated by gastrointestinal bleeding following therapy with concomitant gemcitabine-warfarin (Coumadin).

  1. Clinical impact of temporary therapy interruptions on anticoagulation control in patients treated with warfarin.

    Boros, Melanie L; Rybarczyk, Amy M; Gallegos, Patrick J; Zimmerman, Jacob P

    2013-01-01

    This retrospective cohort study was completed to describe the impact of short-term therapy interruptions on anticoagulation control in patients receiving warfarin. Patients seen in a pharmacist-managed anticoagulation clinic were included if they were on a stable warfarin dose and then underwent a planned interruption in therapy. Patients were excluded if phytonadione was administered before the interruption or if medications known to interact with warfarin were altered during the interruption. Data were analyzed for 2 groups: (1) patients with a single interruption in therapy (group 1) and (2) patients with a single interruption in therapy plus patients with an extended interruption in therapy (group 2). The primary endpoint was the change in weekly maintenance warfarin dose from preinterruption to postinterruption. Evaluation of 199 patients resulted in 31 interruptions in group 1 and 34 interruptions in group 2. A change in dose was required in 58% of patients in group 1 and 56% of patients in group 2. The mean absolute change in dose was 2.03 ± 2.79 mg (P anticoagulation control and the direction of this dose change cannot be predicted. PMID:23011173

  2. Warfarin therapy in a dog with acute arterial thrombosis and pyometra.

    Arai, Shiori; Callan, Mary Beth

    2014-11-01

    This report describes the presentation of acute arterial thrombosis causing triparesis in a 6-year-old female Chihuahua with pyometra and its successful management in combination with warfarin therapy. This is the first case report of a dog with arterial thrombosis associated with pyometra. PMID:25392549

  3. Warfarin therapy in a dog with acute arterial thrombosis and pyometra

    Arai, Shiori; Callan, Mary Beth

    2014-01-01

    This report describes the presentation of acute arterial thrombosis causing triparesis in a 6-year-old female Chihuahua with pyometra and its successful management in combination with warfarin therapy. This is the first case report of a dog with arterial thrombosis associated with pyometra.

  4. Cardioversion and Risk of Adverse Events with Dabigatran versus Warfarin-A Nationwide Cohort Study

    Pallisgaard, Jannik Langtved; Lindhardt, Tommi Bo; Hansen, Morten Lock;

    2015-01-01

    AIM: Cardioversion can rapidly and effectively restore sinus rhythm in patients with persistent atrial fibrillation. Since 2011 dabigatran has been available as an alternative to warfarin to prevent thromboembolic events in patients with non-valvular atrial fibrillation undergoing cardioversion. We......-valvular atrial fibrillation and first time cardioversion from 2011 to 2012; 37% in the dabigatran group (n = 456), and 63% in the warfarin group (n = 774). Median time to cardioversion was 4.0 (interquartile range [IQR] 2.9 to 6.5) and 6.9 (IQR 3.9 to 12.1) weeks in the dabigatran and warfarin groups...... respectively, and the adjusted odds ratio of cardioversion within the first 4 weeks was 2.3 (95% confidence interval [CI] 1.7 to 3.1) in favor of dabigatran. The cumulative incidence of composite endpoint of stroke, bleeding or death were 2.0% and 1.0% at 30 weeks in the warfarin and dabigatran groups...

  5. Oral Cancer

    ... TMJ Disorders Oral Cancer Dry Mouth Burning Mouth Tooth Decay See All Oral Complications of Systemic Diseases Cancer ... Puts Someone at Risk? Possible Signs & Symptoms Early Detection About Oral Cancer Oral cancer includes cancers of ...

  6. Biopsy of the prostate guided by transrectal ultrasound: relation between warfarin use and incidence of bleeding complications

    Ihezue, C.U. [Department of Radiology, Southampton General Hospital (United Kingdom); Smart, J. [Department of Radiology, Southampton General Hospital (United Kingdom); Dewbury, K.C. [Department of Radiology, Southampton General Hospital (United Kingdom)]. E-mail: keith.dewbury@suht.swest.nhs.uk; Mehta, R. [Department of Radiology, Southampton General Hospital (United Kingdom); Burgess, L. [Department of Radiology, Southampton General Hospital (United Kingdom)

    2005-04-01

    AIM: To determine the relation between warfarin use and the frequency of bleeding complications after biopsy of the prostate guided by transrectal ultrasound (TRUS). METHODS: Overall, 1022 consecutive patients with suspected prostatic disease were followed after biopsy. Warfarin and aspirin use was determined on the day of the procedure. A TRUS-guided biopsy was performed and patients were offered a questionnaire to complete 10 days after the procedure, to determine any immediate or delayed bleeding complications. Follow-up telephone calls were made to those who had not replied within the stipulated period. RESULTS: Of the 1000 patients who replied, 49 were receiving warfarin, 220 were receiving aspirin and 731 were not receiving any anticoagulant drugs. Of the 49 subjects reporting current use of warfarin, 18 (36.7%) experienced haematuria, compared with 440 (60.2%) of the patients receiving no anti-coagulant drugs who reported haematuria. This was statistically significant (p=0.001). Of the group receiving warfarin, 4 (8.2%) experienced haematospermia whereas 153 (21%) of the group receiving no anticoagulant medication reported haematospermia. This difference also was statistically significant (p=0.030). Rectal bleeding was experienced by 7 (14.3%) of the group receiving warfarin compared with 95 (13%) in the group without anticoagulant medication, but this was not statistically significant (p=0.80). We also demonstrated that there was no statistically significant association between the severity of the bleeding complications and medication with warfarin. CONCLUSION: None of the group receiving warfarin experienced clinically important bleeding complications. Our results suggest that the frequency and severity of bleeding complications were no worse in the warfarin group than in the control group and that discontinuing anticoagulation medication before prostate biopsy may be unnecessary.

  7. Warfarin dose and INR related to genotypes of CYP2C9 and VKORC1 in patients with myocardial infarction

    Seljeflot Ingebjørg

    2008-06-01

    Full Text Available Abstract Background Warfarin treatment has a narrow therapeutic range, requiring meticulous monitoring and dosage titration. Individual dosage requirement has recently partly been explained by genetic variation of the warfarin metabolizing enzyme CYP2C9 and the Vitamin K-activating enzyme VKORC1. In the WARIS-II study, comparing three different antithrombotic regimens after myocardial infarction, warfarin treatment reduced thrombotic events, but was associated with more frequent bleeding than use of acetylsalisylic acid (ASA alone. Aims The primary aim of the present study was to investigate the relation between genotypes of CYP2C9 and VKORC1 and warfarin maintenance dose in myocardial infarction. The secondary aim was to relate the genotypes to international normalized ratio (INR. Methods Genotyping was performed in 212 myocardial infarction patients from the WARIS-II study by robotic isolation of DNA from EDTA whole blood (MagNa Pure LC before PCR amplification (LightCycler and melting point analysis. Results The 420 C>T substitution of CYP2C9*2, the 1075 A>C substitution of CYP2C9*3 and the 1173 C>T substitution of VKORC1 had minor allele frequencies of, 11.3%, 5.7% and 36.6% respectively. Warfarin weekly dose varied between 17 mg and 74 mg among the patients. INR did not vary between genotypes. Warfarin dosage requirement was significantly associated with CYP2C9 and VKORC1 genotypes, treatment group and age. The VKORC1 genotype contributed 24.5% to the interindividual variation in warfarin dosage, whereas the combined CYP2C9 genotypes were only responsible for 7.2% of the dose variation. Conclusion CYP2C9 and VKORC1 genotype frequencies in myocardial infarction patients appear similar to other patient groups and have similar impact on warfarin maintenance dose.

  8. Spontaneous intra-peritoneal bleeding secondary to warfarin, presenting as an acute appendicitis: a case report and review of literature

    Shah Dharmendra K; Kumar Vikas; Sagar Jayesh; Bhatnagar Ashok

    2006-01-01

    Abstract Background Warfarin is a coumarin anti-coagulant, used widely for the therapeutic and prophylactic anticoagulation. Although, it is considered as a life saving medicine, it is associated with the significant adverse effects including intra-abdominal bleeding, which have been very well documented in literature. However, the presentation of warfarin induced intra-peritoneal bleeding as an acute appendicitis has not been reported in English literature. We report this rare, spontaneous i...

  9. Comparative effect of the three rodenticides warfarin, difenacoum and brodifacoum on eight rodent species in short feeding periods.

    Lund, M

    1981-01-01

    Short laboratory feeding tests were carried out with the anticoagulants warfarin, difenacoum, and brodifacoum on a number of European rodent species: Clethrionomys glareolus, Microtus agrestis, M. arvalis, Apodemus flavicollis, A. sylvaticus, Mus musculus, Rattus rattus and R. norvegicus. It was found that the toxicity to all species was highest with brodifacoum and lowest with warfarin, and that only 0.005% brodifacoum would give a complete mortality in most species after one day's feeding. ...

  10. Validation and Application of a Simple UHPLC-MS-MS Method for the Enantiospecific Determination of Warfarin in Human Urine.

    Alshogran, Osama Y; Ocque, Andrew J; Leblond, François A; Pichette, Vincent; Nolin, Thomas D

    2016-04-01

    A simple and rapid liquid chromatographic-tandem mass spectrometric method has been developed and validated for the enantiospecific determination of R- and S-warfarin in human urine. Warfarin enantiomers were extracted from urine using methyl tert-butyl ether. Chromatographic separation of warfarin enantiomers and the internal standard d5-warfarin was achieved using a Astec Chirobiotic V column with gradient mobile phase at a flow rate of 400 µL/min over 10 min. Detection was performed on a TSQ Quantum Ultra triple quadrupole mass spectrometer equipped with a heated electrospray ionization source. Analytes were detected in negative ionization mode using selected reaction monitoring. Calibration curves were linear with a correlation coefficient of ≥0.996 for both enantiomers over a concentration range of 5-500 ng/mL. The intra- and interday accuracy and precision for both analytes were within ±9.0%. Excellent extraction efficiency and negligible matrix effects were observed. The applicability of the method was demonstrated by successful measurement of warfarin enantiomers in urine of patients with kidney disease. The method is simple, accurate and reproducible and is currently being used to support warfarin pharmacokinetic studies. PMID:26657732

  11. Efficacy and cost-effectiveness of dabigatran etexilate versus warfarin in atrial fibrillation in different age subgroups.

    Clemens, Andreas; Peng, Siyang; Brand, Sarah; Brueckmann, Martina; Kansal, Anuraag; Lim, Jonathan; Noack, Herbert; Sander, Stephen; Sorensen, Sonja

    2014-09-15

    This study aims to estimate the cost-effectiveness of dabigatran 150 mg twice daily versus warfarin for stroke and systemic embolism risk reduction in patients with nonvalvular atrial fibrillation initiating treatment before age 75 (dabigatran or warfarin for safety-on-treatment and intent-to-treat populations were estimated from Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY). An economic model was adapted using these data to evaluate the impact of starting age on clinical and economic outcomes. Costs were obtained from Medicare payment schedules and utilities from publications. Model outputs included event rates, costs, quality-adjusted life-years, and incremental cost-effectiveness ratios. The RE-LY analysis shows that the versus warfarin, dabigatran performed better in main efficacy and safety in all age cohorts with the exception of extracranial hemorrhage in the ≥ 75 cohort. The clinical event costs avoided per patient for dabigatran were $1,100, $135, and $713 for cohorts dabigatran resulted in lower rates of stroke and intracranial hemorrhage and higher rates for extracranial hemorrhage versus warfarin for all age cohorts. Lifetime quality-adjusted life-years and costs were higher for dabigatran than warfarin, resulting in incremental cost-effectiveness ratios of $52,773, $65,946, and $56,131 for cohorts dabigatran was cost-effective versus warfarin in US patients with atrial fibrillation regardless of age of treatment initiation. PMID:25103918

  12. Pharmacologic considerations for patients taking oral contraceptives.

    Hassan, T

    1987-03-01

    This is a brief review of the theoretical and known drug reactions with oral contraceptives. There are at least 6 possible types of drug reactions that may affect the action of oral contraceptives, not including malabsorption related to changes in intestinal motility or flora. Ampicillin is an example of an antibiotic that may cause diarrhea, thereby reducing absorption of pill steroids. The steroids in orals are subject to enterohepatic circulation, which is in turn affected by the gut flora. Antibiotics known to suppress gut flora include: penicillins, cephalosporins, tetracyclines, sulfas, neomycin and erythromycin. Although controlled clinical trials of antibiotic intake with oral contraception have not shown significant interactions, anecdotal reports of pill failures have been published. The other important drug interaction affecting contraception by orals is enhanced hepatic degradation, as seen with rifampicin. Other drugs such as cimetidine, MAO-inhibitor antidepressants, chloramphenicol, influenza or BCG vaccine, isoniazid, warfarin, metronidazole and disulfiram may delay steroid metabolism and possibly increase side effects. When prescribing drugs it is important to realize that certain drugs decrease oral contraceptive concentrations: antibiotics anticonvulsants, griseofulvin, purgatives and rifampicin. PMID:3155374

  13. Warfarin and acetaminophen interaction: a summary of the evidence and biologic plausibility.

    Lopes, Renato D; Horowitz, John D; Garcia, David A; Crowther, Mark A; Hylek, Elaine M

    2011-12-01

    Ms TS is a 66-year-old woman who receives warfarin for prevention of systemic embolization in the setting of hypertension, diabetes, and atrial fibrillation. She had a transient ischemic attack about 4 years ago when she was receiving aspirin. Her INR control was excellent; however, over the past few months it has become erratic, and her average dose required to maintain an INR of 2.0 to 3.0 appears to have decreased. She has had back pain over this same period and has been taking acetaminophen at doses at large as 650 mg four times daily, with her dose varying based on her symptoms. You recall a potential interaction and wonder if (1) her acetaminophen use is contributing to her loss of INR control, and (2) does this interaction place her at increased risk of warfarin-related complications? PMID:21911832

  14. Field trials of difenacoum against warfarin-resistant infestations of Rattus norvegicus.

    Rennison, B. D.; Hadler, M. R.

    1975-01-01

    The anticoagulant difenacoum was tested at two concentrations, 0-005 and 0-01%, in bait against warfarin-resistant rat infestations in farm buildings. Twelve out of the 14 treatments in which the lower concentration of the anticoagulant was used resulted in complete control. One of the remaining two treatments was probably also completely successful, but in the other a few rats, that were not eating the poisoned baits, were still active after 30 days of baiting. All six treatments done using the stronger concentration of poison were completely effective. Since it took as long to control infestations with 0.01% as with 0.005% difenacoum in treatments carried out under similar conditions, the lower concentration is recommended for use against warfarin-resistant rats. PMID:1056965

  15. In situ detection of warfarin using time-correlated single-photon counting

    Highlights: → Direct in situ measurement of specific isomeric forms of the anticoagulant warfarin. → TCSPC spectroscopy in conjunction with synthetic Sudlow I binding site receptors. → Development of sensor principle for use in clinical and environmental monitoring. -- Abstract: Here we report on a novel method for the direct in situ measurement of specific isomeric forms of the anticoagulant warfarin using time correlated single-photon counting (TCSPC) spectroscopy in conjunction with synthetic Sudlow I binding site receptors. The method is highly robust over the clinically significant concentration range, and demonstrates the potential of the binding site mimics in conjunction with the spectroscopic strategy employed here for the determination of this important pharmaceutical in clinical or even environmental samples.

  16. Oral cancer

    ... the immune system (immunosuppressants) Poor dental and oral hygiene Some oral cancers begin as a white plaque ( leukoplakia ) or ... use Visiting the dentist regularly and practicing good oral hygiene

  17. Clinical factors influencing normalization of prothrombin time after stopping warfarin: a retrospective cohort study

    Zondag Michelle

    2008-10-01

    Full Text Available Abstract Background Anticoagulation with warfarin should be stopped 4–6 days before invasive procedures to avoid bleeding complications. Despite this routine, some patients still have high International Normalized Ratio (INR values on the day of surgery and the procedure may be cancelled. We sought to identify easily available clinical characteristics that may influence the rate of normalization of prothrombin time when warfarin is stopped before surgery or invasive procedures. Methods Clinical data were collected retrospectively from consecutive cases from two cohorts, who stopped warfarin 6 days before surgery. An INR value of 1.6 or higher on the day of surgery or requirement for reversal with vitamin K the day before surgery were criteria for slow return (S to normal INR. Results Of 202 patients, 14 (7% were classified as S. Eight of the S-patients required reversal with vitamin K one day before surgery and in another case surgery was cancelled due to high INR. Baseline INR was the only variable significantly associated with classification as S in stepwise logistic regression analysis (p = 0.003. The odds ratio for being in the normal group was 0.27 (95% confidence interval 0.12–0.62 for each unit baseline INR increased. The positive predictive value of baseline INR with a cut off at > 3.0 was only 15% and for INR > 3.5 it was 33%. Conclusion Baseline INR, but not the size of the maintenance dose, is associated with the rate of normalization of prothrombin time after stopping warfarin, but it has limited utility as predictor in clinical practice. Whenever normal hemostasis is considered crucial for the safety, the INR should be checked again before the invasive procedure.

  18. Evaluation of the Effect of Lime Fruit Juice on the Anticoagulant Effect of Warfarin

    Adepoju, GKA; Adeyemi, T

    2010-01-01

    Aim: Citrus aurantifolia (Family Rutaceae) is commonly known as a familiar food and medicine, and s therapeutic effectiveness in a variety of diseases has been suggested in traditional medicine. Various complementary and alternative medicines (CAM) have been shown to interact with orthodox medicines. Hence, the aim of this study is to investigate such a phenomenon particularly the interaction of lime fruit juice with warfarin. Materials and Method: Wistar strain albino rats of both sexes weig...

  19. Patterns of warfarin use and subsequent outcomes in atrial fibrillation in primary care practices

    Ewen E; Zhang Z; Simon TA; Kolm P; Liu X; Weintraub WS

    2012-01-01

    Edward Ewen,1 Zugui Zhang,1 Teresa A Simon,2 Paul Kolm,1 Xianchen Liu,3,4 William S Weintraub11Christiana Care Health System, Newark, DE, USA; 2Bristol-Myers Squibb, Princeton, NJ, USA; 3Indiana University School of Medicine, Indianapolis, IN, USA; 4Pfizer, Groton, CT, USABackground: Warfarin is recommended for stroke prevention in high-risk patients with atrial fibrillation. However, it is often underutilized and inadequately managed in actual clinical practice.Objectives: To examine the pat...

  20. Association between use of warfarin with common sulfonylureas and serious hypoglycemic events: retrospective cohort analysis

    Romley, John A.; Gong, Cynthia; Jena, Anupam B.; Goldman, Dana P.; Williams, Bradley; Peters, Anne

    2015-01-01

    Study question Is warfarin use associated with an increased risk of serious hypoglycemic events among older people treated with the sulfonylureas glipizide and glimepiride? Methods: This was a retrospective cohort analysis of pharmacy and medical claims from a 20% random sample of Medicare fee for service beneficiaries aged 65 years or older. It included 465 918 beneficiaries with diabetes who filled a prescription for glipizide or glimepiride between 2006 and 2011 (4 355 418 person quarters)...

  1. Association between use of warfarin with common sulfonylureas and serious hypoglycemic events: retrospective cohort analysis

    Romley, John A.; Gong, Cynthia; Jena, Anupam B.; Goldman, Dana P.; Williams, Bradley; Peters, Anne

    2015-01-01

    Study question Is warfarin use associated with an increased risk of serious hypoglycemic events among older people treated with the sulfonylureas glipizide and glimepiride? Methods This was a retrospective cohort analysis of pharmacy and medical claims from a 20% random sample of Medicare fee for service beneficiaries aged 65 years or older. It included 465 918 beneficiaries with diabetes who filled a prescription for glipizide or glimepiride between 2006 and 2011 (4 355 418 person quarters);...

  2. Steric and allosteric effects of fatty acids on the binding of warfarin to human serum albumin revealed by molecular dynamics and free energy calculations.

    Fujiwara, Shin-Ichi; Amisaki, Takashi

    2011-01-01

    Human serum albumin (HSA) binds with drugs and fatty acids (FAs). This study was initiated to elucidate the relationship between the warfarin binding affinity of HSA and the positions of bound FA molecules. Molecular dynamics simulations of 11 HSA-warfarin-myristate complexes were performed. HSA-warfarin binding free energy was then calculated for each of the complexes by the molecular mechanics-Poisson-Boltzmann surface area (MM-PBSA) method. The results indicated that the magnitude of the binding free energy was smaller in HSA-warfarin complexes that had 4 or more myristate molecules than in complexes with no myristate molecules. The unfavorable effect on the HSA-warfarin binding affinity was caused sterically by the binding of a myristate molecule to the FA binding site closest to the warfarin binding site. On the other hand, the magnitude of HSA-warfarin binding free energy was largest when 3 myristate molecules were bound to the high-affinity sites. The strongest HSA-warfarin binding was attributable to favorable entropic contribution related to larger atomic fluctuations of the amino acid residues at the warfarin binding site. In the binding of 2 myristate molecules to the sites with the highest and second-highest affinities, allosteric modulation that enhanced electrostatic interactions between warfarin and some of the amino acid residues around the warfarin binding site was observed. This study clarified the structural and energetic properties of steric/allosteric effects of FAs on the HSA-warfarin binding affinity and illustrated the approach to analyze protein-ligand interactions in situations such that multiple ligands bind to the other sites of the protein. PMID:21720037

  3. A study of the relationship between the pharmacokinetics and the pharmacodynamics of the 4-hydroxycoumarin anticoagulants warfarin, difenacoum and brodifacoum in the rabbit.

    Breckenridge, A M; Cholerton, S; Hart, J. A.; Park, B. K.; Scott, A K

    1985-01-01

    The pharmacokinetics and pharmacodynamics of the 4-hydroxycoumarin anticoagulants, brodifacoum, difenacoum, and warfarin have been studied in the rabbit. Sensitive (50 ng ml-1) and specific high performance liquid chromatography assays have been developed for the determination of plasma concentrations of warfarin, brodifacoum and difenacoum. After administration of a single intravenous dose (20 mumol kg-1), plasma concentrations of warfarin underwent mono-exponential decay, with a terminal ha...

  4. The role of the transition between neutral and basic forms of human serum albumin in the kinetics of the binding to warfarin

    Kremer, J.M.H.; Bakker, G.; Wilting, J

    1982-01-01

    Between pH 6 and 9 in the kinetics of the binding of warfarin to human serum albumin a two-step mechanism operates: a diffusion-controlled step, followed by a much slower step during which the stable warfarin-albumin complex is formed. The association rate constant for the formation of the warfarin-albumin complex depends on the transition between neutral and basic forms of the albumin.

  5. THE PROBLEM OF THE USE OF NEW ORAL ANTICOAGULANTS IN CANCER PATIENTS RECEIVING CHEMOTHERAPY

    A. A. Rumyantsev; I. A. Pokataev; T.V. Kozlov; N.A. Rumyantsev

    2015-01-01

    Despite large number of known risk factors of venous thromboembolism (VTE) in cancer patients existing prediction models do not allow definite identification of cancer patients that have indications for anticoagulant prevention. Besides, heparin and warfarin use for VTE prevention in cancer is accompanied by some problems. New oral anticoagulants (NOAC) are promising drugs for use in oncology practice; however their use is complicated by the lack of data on efficacy and safety in these patien...

  6. Relationship between protein C antigen and anticoagulant activity during oral anticoagulation and in selected disease states.

    Vigano D'Angelo, S; Comp, P C; Esmon, C T; D'Angelo, A.

    1986-01-01

    Protein C is a natural vitamin K-dependent plasma anticoagulant, deficiencies of which have been found in patients with recurrent thrombosis and warfarin-induced skin necrosis. To appreciate more fully the role of protein C in disease states and during oral anticoagulation, a new functional assay for protein C involving adsorption of plasma protein C on a Ca+2-dependent monoclonal antibody, elution, quantitative activation, and assessment of plasma anticoagulant activity, has been developed. ...

  7. Nontraumatic Retroperitoneal Hematoma After Warfarin Administration: Fatal Case Report and Review of the Literature.

    Hosseini, Marzieh; Hosseinzadeh, Amin; Raufian, Kasra; Hedjazi, Arya

    2015-12-01

    Spontaneous retroperitoneal hematoma after warfarin therapy is an extremely rare event. Here, we report a 25-year-old man who was brought in to the emergency service with confusion. On arrival, the patient had hypotension, tachycardia, tachypnea, low-grade fever, and Glasgow Coma Scale score of 12. Abdominal examination revealed distention and mild tenderness in the right upper quadrant of the abdomen. The patient had a history of aortic valve replacement surgery and was on warfarin treatment at an international normalized ratio of 2.4. Our patient progressed to cardiorespiratory arrest. The resuscitation was initiated promptly. Despite all resuscitation measures, including transfusion and administration of high doses of catecholamine, the patient died of hypovolemic shock 3 hours after admission. At autopsy, the external surface of the abdominal great vessels (descending aorta and mesenteric vessels) showed scattered petechial hemorrhages without any visible site of perforation. After comprehensive exploration of the abdomen, no evidence of traumatic event was identified and the cause of internal blood loss was noted as warfarin adverse effect. PMID:26280884

  8. Interaction between Capecitabine and Gemcitabine with Warfarin in a Patient with Pancreatic Cancer

    Muhammad Wasif Saif

    2008-11-01

    Full Text Available Gemcitabine is the only chemotherapeutic agent approved by the U.S. Food and Drug Administration (FDA for the treatment of patients with pancreatic cancer [1]. It is also indicated for use in non-small-cell lung cancer, bladder cancer, and is commonly used in other gastrointestinal malignancies. Patients with cancer, specifically pancreatic carcinoma, are at increased risk for thrombosis requiring anticoagulation. In addition, due to aging and common risk factors, cardiac ailments such as atrial fibrillation are also common in this group. In such cases, warfarin is generally the agent of choice In 1999, a potential interaction between gemcitabine and warfarin was reported [2]. In 2002, the manufacturer of gemcitabine, Eli Lilly, reported four similar cases, indicating an incidence of 0.04% suspected drug interaction between gemcitabine and an anticoagulant [3]. They also reported that overall 5.4% of patients undergoing gemcitabine therapy received concomitant anticoagulants [3] Moreover, the U.S. Food and Drug Administration and Roche have added a "Black Box" warning and strengthened the "Precautions" section on the label of capecitabine, which is indicated for the treatment of colorectal and breast cancer [4, 5]. We present the seventh case of a patient with pancreatic cancer complicated by an elevated INR following treatment with concomitant gemcitabine-capecitabinewarfarin first and then gemcitabine-warfarin later.

  9. Drug interaction as cause of spontaneously resolving epidural spinal hematoma on warfarin therapy

    Amitabh Sagar

    2010-01-01

    Full Text Available We present a case of a 42-year-old male, an old case of deep vein thrombosis on warfarin and other drugs like quetiapine, aspirin, diclofenac sodium, fenofibrate, atorvastatin, propanolol and citalopram for concurrent illnesses, who presented with widespread mucocutaneous bleeding and epidural spinal hematoma. The epidural bleed presented clinically as a nontraumatic, rapidly improving myeloradiculopathy. Magnetic resonance imaging (MRI of the spine revealed an epidural hematoma at D12-L1 level. The case was managed conservatively due lack of neurosurgical facilities. The patient gained full neurological recovery on conservative management alone. This case highlights the problem of drug interaction on warfarin therapy and also an unusual spontaneous recovery of spinal hematoma. Our case was anticoagulated in the recommended therapeutic INR range of 2.2 to 2.4. Most of the similar cases reported in literature were also anticoagulated in the therapeutic range. Thus intraspinal hemorrhage is a rare but dangerous complication of anticoagulant therapy. It must be suspected in any patient on anticoagulant agents who complains of local or referred spinal pain associated with neurological deficits. Drug interactions with warfarin are common. High suspicion and immediate intervention are essential to prevent complications from intraspinal hemorrhage.

  10. Assessment of patient perceptions concerning a community pharmacy-based warfarin monitoring service

    Stefanie Ferreri, PharmD, CDE, BCACP, FAPhA1

    2012-01-01

    Full Text Available Objective: To assess patient perceptions of a North Carolina community pharmacy-based warfarin monitoring service. Methods: Prospective study of patients 18 years of age and older, who filled a prescription for warfarin, in one of five Raleigh area community pharmacies, between May 1, 2010 and October 31, 2010. A 14 item survey, along with a self-addressed stamped envelope, was mailed to 330 identified patients. The survey inquired about details of current anticoagulation monitoring services, interest in utilizing a local community pharmacy for this service, and confidence in a pharmacist-managed program. Results: 26% of surveys were returned. 48% of surveyed individuals responded that they would be interested in having their warfarin monitoring performed by a trained pharmacist in a community pharmacy setting. Conclusion: Many participants responded that the community pharmacy would be more convenient than or as convenient as their current location. This may be a new clinical service that could be offered in certain community pharmacies.

  11. Bleeding heart: a case of spontaneous hemopericardium and tamponade in a hyperthyroid patient on warfarin.

    Sajawal Ali, Muhammad; Mba, Benjamin I; Ciftci, Farah Diba; Ali, Ahya Sajawal

    2016-01-01

    We describe the case of an 81-year-old female, diagnosed with hyperthyroidism-related atrial fibrillation. Given her CHA2DS2VASc score of 3, she was started on warfarin for stroke prevention. One month later, she was admitted with cardiac tamponade. This tamponade was suspected to be secondary to hemopericardium, based on the elevated international normalized ratio (INR), drop in haemoglobin and the radiodensity (55 HU) of the pericardial effusion on CT. The patient was a Jehovah's witness who therefore initially refused measures for reversing coagulopathy. Given her coagulopathy and absence of imminent haemodynamic compromise, pericardiocentesis was deferred. Unfortunately, 1 day later, the patient deteriorated rapidly. By the time pericardiocentesis was performed and factor VIIa administered, the patient had already started developing multiple organ failure. She developed cardiac arrest and died 3 days after her admission. Only 10 cases of hemopericardium attributable to warfarin have previously been reported. In this report, we review the literature and also describe how hyperthyroidism most likely predisposed our patient to bleeding complications from warfarin. PMID:27413023

  12. Coagulation assessment with the new generation of oral anticoagulants.

    Pollack, Charles V

    2016-06-01

    Long-term oral anticoagulant (OAC) therapy is used for the treatment and prevention of thrombosis and thromboembolism. As OAC use is so widespread, emergency physicians are likely to encounter patients on anticoagulant therapy in the emergency department (ED) on a regular basis, either for the same reasons as the population in general or as a result of the increased bleeding risk that OAC use entails.The vitamin K antagonist warfarin has been the standard OAC for several decades, but recently, the newer agents dabigatran etexilate, rivaroxaban and apixaban (collectively, novel OACs, non-vitamin K OACs, or simply 'NOACs') have become available for long-term use. Protocols for assessing and managing warfarin-treated patients in the ED are well established and include international normalised ratio (INR) testing, which helps guide patient management. However, the INR does not give an accurate evaluation of coagulation status with NOACs, and alternative tests are therefore needed for use in emergency settings. This paper discusses what information the INR provides for a patient taking warfarin and which coagulation tests can guide the physician when treating patients on one of the NOACs, as well as other differences in emergency anticoagulation management. PMID:25987596

  13. Potentially avoidable inpatient nights among warfarin receiving patients; an audit of a single university teaching hospital.

    Forde, Dónall

    2009-01-01

    BACKGROUND: Warfarin is an oral anticoagulant (OAT) that needs active management to ensure therapeutic range. Initial management is often carried out as an inpatient, though not requiring inpatient facilities. This mismatch results in financial costs which could be directed more efficaciously. The extent of this has previously been unknown. Here we aim to calculate the potential number of bed nights which may be saved among those being dose optimized as inpatients and examine associated factors. METHODS: A 6 week prospective audit of inpatients receiving OAT, at Cork University Hospital, was carried out. The study period was from 11th June 2007 to 20th July 2007. Data was collected from patient\\'s medications prescription charts, medical record files, and computerised haematology laboratory records. The indications for OAT, the patient laboratory coagulation results and therapeutic intervals along with patient demographics were analysed. The level of potentially avoidable inpatient nights in those receiving OAT in hospital was calculated and the potential cost savings quantified. Potential avoidable bed nights were defined as patients remaining in hospital for the purpose of optimizing OAT dosage, while receiving subtherapeutic or therapeutic OAT (being titred up to therapeutic levels) and co-administered covering low molecular weight heparin, and requiring no other active care. The average cost of euro638 was taken as the per night hospital stay cost for a non-Intensive Care bed. Ethical approval was granted from the Ethical Committee of the Cork Teaching Hospitals, Cork, Ireland. RESULTS: A total of 158 patients were included in the audit. There was 94 men (59.4%) and 64 women (40.6%). The mean age was 67.8 years, with a median age of 70 years.Atrial Fibrillation (43%, n = 70), followed by aortic valve replacement (15%, n = 23) and pulmonary emboli (11%, n = 18) were the commonest reasons for prescribing OAT. 54% had previously been prescribed OAT prior to

  14. Potentially avoidable inpatient nights among warfarin receiving patients; an audit of a single university teaching hospital

    O'Connor Mortimer B

    2009-03-01

    Full Text Available Abstract Background Warfarin is an oral anticoagulant (OAT that needs active management to ensure therapeutic range. Initial management is often carried out as an inpatient, though not requiring inpatient facilities. This mismatch results in financial costs which could be directed more efficaciously. The extent of this has previously been unknown. Here we aim to calculate the potential number of bed nights which may be saved among those being dose optimized as inpatients and examine associated factors. Methods A 6 week prospective audit of inpatients receiving OAT, at Cork University Hospital, was carried out. The study period was from 11th June 2007 to 20th July 2007. Data was collected from patient's medications prescription charts, medical record files, and computerised haematology laboratory records. The indications for OAT, the patient laboratory coagulation results and therapeutic intervals along with patient demographics were analysed. The level of potentially avoidable inpatient nights in those receiving OAT in hospital was calculated and the potential cost savings quantified. Potential avoidable bed nights were defined as patients remaining in hospital for the purpose of optimizing OAT dosage, while receiving subtherapeutic or therapeutic OAT (being titred up to therapeutic levels and co-administered covering low molecular weight heparin, and requiring no other active care. The average cost of €638 was taken as the per night hospital stay cost for a non-Intensive Care bed. Ethical approval was granted from the Ethical Committee of the Cork Teaching Hospitals, Cork, Ireland. Results A total of 158 patients were included in the audit. There was 94 men (59.4% and 64 women (40.6%. The mean age was 67.8 years, with a median age of 70 years. Atrial Fibrillation (43%, n = 70, followed by aortic valve replacement (15%, n = 23 and pulmonary emboli (11%, n = 18 were the commonest reasons for prescribing OAT. 54% had previously been prescribed

  15. Quality of anticoagulation and use of warfarin-interacting medications in long-term care: A chart review

    Campbell Glenda

    2008-07-01

    Full Text Available Abstract Background Maintenance of therapeutic International Normalized Ratio (INR in the community is generally poor. The supervised environment in long-term care facilities may represent a more ideal setting for warfarin therapy since laboratory monitoring, compliance, dose adjustment, and interacting medications can all be monitored and controlled. The objectives of this study were to determine how effectively warfarin was administered to a cohort of residents in long-term care facilities, to identify the proportion of residents prescribed warfarin-interacting drugs and to ascertain factors associated with poor INR control. Methods A chart review of 105 residents receiving warfarin therapy in five long-term care facilities in Hamilton, Ontario was performed. Data were collected on INR levels, warfarin prescribing and monitoring practices, and use of interacting medications. Results Over a 12 month period (28,555 resident-days, 78.2 resident years 3065 INR values were available. Residents were within, below and above the therapeutic range 54%, 35% and 11% of the time, respectively. Seventy-nine percent of residents were prescribed at least one warfarin-interacting medication during the period in review. Residents receiving interacting medications spent less time in the therapeutic range (53.0% vs. 58.2%, OR = 0.93, 95% confidence interval 0.88 to 0.97, P = 0.002. Adequacy of anticoagulation varied significantly between physicians (time in therapeutic range 45.9 to 63.9%. Conclusion In this group of long-term care residents, warfarin control was suboptimal. Both prescriber and co-prescription of interacting medications were associated with poorer INR control. Future studies should seek strategies to improve prescriber skill and decrease use of interacting medications.

  16. LC/MS/MS warfarin assay − An emerging tool for the early detection of cytochrome P450-associated drug−drug interactions in drug discovery

    Zhang, Zhi-Yi

    2003-01-01

    The LC/MS/MS warfarin assay, combining stereo- and regioselective cytochrome P450 (CYP) form-specific warfarin hydroxylation with sensitive and specific LC/MS/MS detection technique, is emerging to be a promising tool for the study of CYP-associated drug−drug interactions for new chemical entities (NCEs) during drug discovery process.

  17. Self-Learning, DVD-Based Education Versus Traditional Education Approaches to Improve the Safety of Warfarin Use Among Patients with Atrial Fibrillation

    Hatch, Jessica Oliver

    2015-01-01

    Atrial fibrillation (AF) is a common cardiac arrhythmia that requires extensive medical and pharmaceutical management. The coagulation antagonist warfarin is commonly prescribed to reduce AF-associated stroke. Although warfarin effectively mediates thromboembolitic risk, its management is complex as many factors influence its therapeutic range including: genetics, diet, medication, and herbal and dietary supplement (HDS) interactions. Lack of patient knowledge regarding these factors contribu...

  18. Oral myiasis

    Thalaimalai Saravanan

    2015-01-01

    Full Text Available Myiasis is a pathologic condition in humans occurring because of parasitic infestation. Parasites causing myiasis belong to the order Diptera. Oral myiasis is seen secondary to oral wounds, suppurative lesions, and extraction wounds, especially in individuals with neurological deficit. In such cases, neglected oral hygiene and halitosis attracts the flies to lay eggs in oral wounds resulting in oral myiasis. We present a case of oral myiasis in 40-year-old male patient with mental disability and history of epilepsy.

  19. A role for pharmacists in community-based post-discharge warfarin management: protocol for the 'the role of community pharmacy in post hospital management of patients initiated on warfarin' study

    Bereznicki Luke RE

    2011-01-01

    Full Text Available Abstract Background Shorter periods of hospitalisation and increasing warfarin use have placed stress on community-based healthcare services to care for patients taking warfarin after hospital discharge, a high-risk period for these patients. A previous randomised controlled trial demonstrated that a post-discharge service of 4 home visits and point-of-care (POC International Normalised Ratio (INR testing by a trained pharmacist improved patients' outcomes. The current study aims to modify this previously trialled service model to implement and then evaluate a sustainable program to enable the smooth transition of patients taking warfarin from the hospital to community setting. Methods/Design The service will be trialled in 8 sites across 3 Australian states using a prospective, controlled cohort study design. Patients discharged from hospital taking warfarin will receive 2 or 3 home visits by a trained 'home medicines review (HMR-accredited' pharmacist in their 8 to 10 days after hospital discharge. Visits will involve a HMR, comprehensive warfarin education, and POC INR monitoring in collaboration with patients' general practitioners (GPs and community pharmacists. Patient outcomes will be compared to those in a control, or 'usual care', group. The primary outcome measure will be the proportion of patients experiencing a major bleeding event in the 90 days after discharge. Secondary outcome measures will include combined major bleeding and thromboembolic events, death, cessation of warfarin therapy, INR control at 8 days post-discharge and unplanned hospital readmissions from any cause. Stakeholder satisfaction will be assessed using structured postal questionnaire mailed to patients, GPs, community pharmacists and accredited pharmacists at the completion of their study involvement. Discussion This study design incorporates several aspects of prior interventions that have been demonstrated to improve warfarin management, including POC INR

  20. Factors affecting the quality of anticoagulation with warfarin: experience of one cardiac centre

    Ciurus, Tomasz; Cichocka-Radwan, Anna

    2015-01-01

    Introduction The risk of complications in anticoagulation therapy can be reduced by maximising the percentage of time spent by the patient in the optimal therapeutic range (TTR). However, little is known about the predictors of anticoagulation control. The aim of this paper was to assess the quality of anticoagulant therapy in patients on warfarin and to identify the factors affecting its deterioration. Material and methods We studied 149 patients who required anticoagulant therapy with warfarin due to non-valvular atrial fibrillation and/or venous thromboembolism. Each patient underwent proper training regarding the implemented treatment and remained under constant medical care. Results The mean age of the patients was 68.8 ± 12.6 years, and 59% were male. A total of 2460 international normalised ratio (INR) measurements were collected during the 18-month period. The mean TTR in the studied cohort was 76 ± 21%, and the median was 80%. The level at which high-quality anticoagulation was recorded for this study was based on TTR values above 80%. Seventy-five patients with TTR ≥ 80% were included in the stable anticoagulation group (TTR ≥ 80%); the remaining 74 patients constituted the unstable anticoagulation group (TTR < 80%). According to multivariate stepwise regression analysis, the independent variables increasing the risk of deterioration of anticoagulation quality were: arterial hypertension (OR 2.74 [CI 95%: 1.06-7.10]; p = 0.038), amiodarone therapy (OR 4.22 [CI 95%: 1.30-13.70]; p = 0.017), and obesity (OR 1.11 [CI 95%: 1.02-1.21]; p = 0.013). Conclusions The presence of obesity, hypertension, or amiodarone therapy decreases the quality of anticoagulation with warfarin. High quality of anticoagulation can be achieved through proper monitoring and education of patients. PMID:26855650

  1. A comparison of vitamin K antagonism by warfarin, difenacoum and brodifacoum in the rabbit.

    Park, B K; Leck, J B

    1982-11-15

    The pharmacological response to vitamin K1 (Konakion) in anticoagulated (prothrombin complex activity less than 30%) New Zealand white rabbits was determined by measuring prothrombin complex activity (P.C.A.) in peripheral plasma. In animals pretreated with either brodifacoum (1 mg/kg or 10 mg/kg) or difenacoum (0.85 mg/kg or 8.5 mg/kg) P.C.A. reached a maximum 4 hr after administration of vitamin K1 (0.5 mg/kg) and declined at a rate indicating complete inhibition of clotting factor synthesis. A different response to vitamin K1 (0.5 mg/kg) was observed in rabbits pretreated with warfarin (63 mg/kg); after an initial rise P.C.A. appeared to plateau for 11 hr and then fall at a rate which indicated incomplete inhibition of clotting factor synthesis. The response to several doses of vitamin K1(0.5, 1,2.5 and 5.0 mg/kg) was investigated in the same group of brodifacoum (1 mg/kg) anticoagulated animals. There was a linear relationship between the duration of clotting factor synthesis and the logarithm of the dose of the vitamin K; the pharmacological half-life of vitamin K1 was only 1.7 +/- 0.1 hr. The duration of action of brodifacoum and difenacoum was much longer than that of warfarin. Six weeks after administration of brodifacoum (1 mg/kg) animals were still anticoagulated (P.C.A. less than 30%). In conclusion, we have found that brodifacoum and difenacoum are both more potent and persistent antagonists of vitamin K1 than warfarin in vivo. In cases of poisoning with these compounds it will be necessary to give repeated and frequent doses of vitamin K to maintain clotting factor synthesis. PMID:7181945

  2. Interaction between Warfarin and the Herbal Product Shengmai-Yin: A Case Report of Intracerebral Hematoma

    Su, Qun; Li, Yuhong

    2010-01-01

    A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography reveale...

  3. Evaluation of an electronic warfarin nomogram for anticoagulation of hemodialysis patients

    MacKay Elizabeth

    2011-09-01

    Full Text Available Abstract Background Warfarin nomograms to guide dosing have been shown to improve control of the international normalized ratio (INR in the general outpatient setting. However, the effectiveness of these nomograms in hemodialysis patients is unknown. We evaluated the effectiveness of anticoagulation using an electronic warfarin nomogram administered by nurses in outpatient hemodialysis patients, compared to physician directed therapy. Methods Hemodialysis patients at any of the six outpatient clinics in Calgary, Alberta, treated with warfarin anticoagulation were included. Two five-month time periods were compared: prior to and post implementation of the nomogram. The primary endpoint was adequacy of anticoagulation (proportion of INR measurements within range ± 0.5 units. Results Overall, 67 patients were included in the pre- and 55 in the post-period (with 40 patients in both periods. Using generalized linear mixed models, the adequacy of INR control was similar in both periods for all range INR levels: in detail, range INR 1.5 to 2.5 (pre 93.6% (95% CI: 88.6% - 96.5%; post 95.6% (95% CI: 89.4% - 98.3%; p = 0.95; INR 2.0 to 3.0 (pre 82.2% (95% CI: 77.9% - 85.8%; post 77.4% (95% CI: 72.0% - 82.0%; p = 0.20; and, INR 2.5 to 3.5 (pre 84.3% (95% CI: 59.4% - 95.1%; post 66.8% (95% CI: 39.9% - 86.0%; p = 0.29. The mean number of INR measurements per patient decreased significantly between the pre- (30.5, 95% CI: 27.0 - 34.0 and post- (22.3, 95% CI: 18.4 - 26.1 (p = 0.003 period. There were 3 bleeding events in each of the periods. Conclusions An electronic warfarin anticoagulation nomogram administered by nurses achieved INR control similar to that of physician directed therapy among hemodialysis patients in an outpatient setting, with a significant reduction in frequency of testing. Future controlled trials are required to confirm the efficacy of this nomogram.

  4. Comparative effect of the three rodenticides warfarin, difenacoum and brodifacoum on eight rodent species in short feeding periods.

    Lund, M

    1981-08-01

    Short laboratory feeding tests were carried out with the anticoagulants warfarin, difenacoum, and brodifacoum on a number of European rodent species: Clethrionomys glareolus, Microtus agrestis, M. arvalis, Apodemus flavicollis, A. sylvaticus, Mus musculus, Rattus rattus and R. norvegicus. It was found that the toxicity to all species was highest with brodifacoum and lowest with warfarin, and that only 0.005% brodifacoum would give a complete mortality in most species after one day's feeding. The potential of this compound for the control of microtine field rodents is suggested. PMID:7019316

  5. Laboratory evaluation of bromadiolone as a rodenticide for use against warfarin-resistant and non-resistant rats and mice.

    Redfern, R; Gill, J E

    1980-04-01

    Laboratory feeding tests were carried out to determine the efficacy of the anticoagulant rodenticide bromadiolone against Rattus norvegicus, R. rattus and Mus musculus. Using 0.005% bromadiolone, complete kills of R. norvegicus and R. rattus not resistant to warfarin were obtained after exposure to the poison for 1 and 5 days respectively. Warfarin-resistant R. norvegicus were all killed in 4 days, and resistant M. musculus in 12 days. In general, the results resembled those obtained with difenacoum. Acceptance of bromadiolone was very good. PMID:7358966

  6. Warfarin Dosing in a Patient with CYP2C9*3*3 and VKORC1-1639 AA Genotypes

    Mark Johnson; Craig Richard; Renee Bogdan; Robert Kidd

    2014-01-01

    Genetic factors most correlated with warfarin dose requirements are variations in the genes encoding the enzymes cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKOR). Patients receiving warfarin who possess one or more genetic variations in CYP2C9 and VKORC1 are at increased risk of adverse drug events and require significant dose reductions to achieve a therapeutic international normalized ratio (INR). A 74-year-old white female with atrial fibrillation was initiated on a warf...

  7. Frequency of different disorders requiring warfarin therapy and its outcome in terms of dosage and inr value in pakistani population

    To determine the frequency of different disorders requiring warfarin therapy and to see the target INR and warfarin dose requirement in Pakistani population. Study Design:Descriptive study. Setting and Duration of Study: The study was carried out at Armed Forces Institut e of Cardiology (AFIC) Rawalpindi, Military Hospital Rawalpindi and National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan from October 2010 to March 2012. Patients and Methods: Stable patients taking warfarin therapy were recruited after detailed medical history, physical examination and laboratory tests. The demographic and clinical data of individuals were entered in a pre-structured proforma. Patients suffering from hepatic and renal disease, any co-morbid disease or taking any concurrent medication or diet which would have affected warfarin therapy, were excluded. Data was analyzed using PSS version 20.0. Results: A total of 607 stable patients fulfilling the eligibility criteria, participated in the study. There were 297 (48.9%) male and 310 (51.1%) female patients. The mean age was 37.93 +- 12.23 years (range 18-65 years). The most common indication for warfarin therapy was valvular heart diseases (93.4%) followed by atrial fibrillation (2.3%) whereas other indications for warfarin use are less commonly seen in our study population. Patients had mean international normalized ratio (INR) value of 2.3 +9- 0.8 (range 1.5-3.5). Mean daily dose of warfarin calculated in 607 patients was 5.62 and 1.98 mg with the range of 0.36-15 g whereas mean weekly dose was 39.36 +- 13.8 mg with the range of 2.5-105 mg. Conclusion: In Pakistani population the most common indications for warfarin use are valvular heart diseases followed by atrial fibrillation. The mean INR values were within recommended range of 2-3. The mean daily dose observed in long-term therapy is comparable to the empirical dose of 5 mg routinely started in clinical practice. (author)

  8. Oral Insulin

    Kalra Sanjay; Kalra Bharti; Agrawal Navneet

    2010-01-01

    Abstract Oral insulin is an exciting area of research and development in the field of diabetology. This brief review covers the various approaches used in the development of oral insulin, and highlights some of the recent data related to novel oral insulin preparation.

  9. Determination of acid dissociation constants of warfarin and hydroxywarfarins by capillary electrophoresis.

    Nowak, Paweł; Olechowska, Paulina; Mitoraj, Mariusz; Woźniakiewicz, Michał; Kościelniak, Paweł

    2015-08-10

    In this work the acid dissociation constants--pKa of warfarin and its all important oxidative metabolites have been determined by capillary electrophoresis-based methods. It has resulted in a complete description of two acid-base dissociation equilibria, yet not investigated experimentally for phase I metabolites of warfarin. The capillary electrophoresis (CE) method based on the relation between effective electrophoretic mobilities and pH has proven to be a suitable tool for pKa determination, while the spectrophotometric (CE-DAD) and the internal standard methods (IS-CE), have appeared to be promising alternative approaches. The CE-DAD approach based on the change in absorbance spectra between the acidic and basic forms is a combination between capillary electrophoresis and spectrophotometric titration, and yields very consistent values of pKa1 with CE. The IS-CE, in turn, enables an estimation of pKa1 and pKa2 from only two analytical runs, however, less accurate than CE and CE-DAD. The Debye-Hückel model has been confirmed experimentally as a good predictor of pKa values at various ionic strengths. Therefore, it has been used in determination of thermodynamic pKa1 and pKa2, referring to the zero ionic strength. The results are important from the analytical, pharmacological, and theoretical points of view. PMID:25968611

  10. Dentists' approach to patients on anti-platelet agents and warfarin: a survey of practice.

    Murphy, James

    2010-04-23

    In everyday practice, dentists are confronted with the dilemma of patients on anti-platelet agents and warfarin who require invasive dental procedures and, more pertinently, dental extractions. There may be a divergence of opinion among dentists regarding how they manage these patients. AIMS: To assess general dental practitioners\\' approach to the management of patients taking anti-platelet agents and\\/or warfarin who are undergoing invasive dental procedures. METHODS AND DATA: A semi-structured questionnaire was designed to survey general dental practitioners in a large Irish urban area. RESULTS: A response rate of 89% was achieved in a study population of 54 general dental practitioners. A total of 25% of respondents who carry out extractions on warfarinised patients do not check the INR prior to invasive dental procedures. Some 90% of respondents stop anti-platelet agents prior to extractions. CONCLUSIONS: A significant proportion of respondents fail to check warfarinised patients\\' INR prior to invasive dental procedures. Furthermore, a trend of stopping anti-platelet agents was noted, which is in contrast with current recommendations in the dental literature. Certain practices in this small study population proved alarming and highlight the need for improved awareness of current guidelines. A further large-scale study may be justified, as variation in practice may have clinical and medico-legal repercussions.

  11. Oral Melanoma

    A Forouzandeh

    2002-02-01

    Full Text Available Melanoma is a malignant tumor that originates from melanocyte cells. Its oral type is rare. The goal of this investigation was to determine the prevalence of oral malignant melanoma in Iran, as determined by age, sex and location. This research reviewed 623 cases of oral and non-oral malignant melanoma in Immam-Khomeini hospital, Mearaj cancer institute and department of oral pathology of dental faculty, Tehran University of Medical Sciences in a period of 19 years from 1981-1999. The results showed that 54 cases of biopsy lesions were melanoma of oral cavity that included 7.8% of these lesions. The mean age incidence of oral melanoma was 55.5(between 26-86 years. The most prevalent sites were palate (37.1% and alveolar mucosa (20.4% and less common sites included floor of mouth. buccal mucosa and tongue.

  12. Pharmacogenomics of warfarin and its rational use%华法林的药物基因组学及其合理应用

    娄莹; 李一石

    2011-01-01

    华法林为香豆素类抗凝血药,广泛用于防治血栓栓塞性疾病.华法林治疗窗窄,剂量个体差异大,临床应用中易出现出血合并症.近年研究表明,华法林个体剂量差异与影响华法林代谢和作用的多个基因多态性如CYP2C9、VKORC等有关.本文回顾华法林的药物基因组学研究进展,为临床合理应用华法林提供参考.%Warfarin is a coumarin anticoagulant widely used in the treatment and prevention of thrombo-embolic disorders.Warfarin has narrow therapeutic window and individual differences in dose, and hemorrhagic complications may occur in clinical use of warfarin.Recent studies indicate that the individual difference in warfarin dose is associated with gene polymorphisms influencing metabolism and action of warfarin such as CYP2C9,VKORC, and so on.The paper reviews the progress of the pharmacogenomics of Warfarin in order to provide a reference for rational use of warfarin in clinical practice.

  13. Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V

    White, Harvey D; Gruber, Michael; Feyzi, Jan;

    2007-01-01

    BACKGROUND: Warfarin sodium reduces stroke risk in patients with atrial fibrillation, but international normalized ratio (INR) monitoring is required. Target INRs are frequently not achieved, and the risk of death, bleeding, myocardial infarction (MI), and stroke or systemic embolism event (SEE) ...

  14. Development of novel delivery system for warfarin based on mesoporous silica: adsorption characteristics of silica materials for the anticoagulant.

    Dolinina, Ekaterina S; Vorobyeva, Evgeniya V; Parfenyuk, Elena V

    2016-08-01

    The adsorption of the anticoagulant warfarin onto unmodified (UMS) and modified (phenyl (PhMS), methyl (MMS), mercaptopropyl (MPMS)) mesoporous silica materials was studied at pH 1.6 and 7.4 and in the temperature range of 293-325 K. The silica materials were prepared by sol-gel method for further characterization by FTIR spectroscopy, N2 adsorption/desorption method, transmission electron microscopy and zeta potential measurements. The effects of medium pH, temperature and surface modification of mesoporous silica material on their adsorption characteristics (adsorption capacity, thermodynamic parameters of adsorption) relative to anticoagulant warfarin were investigated. It was found that medium acid-base properties strongly affect the adsorption of warfarin due to the pH-dependent structural diversity of the drug and ionization state of the silica surfaces. The adsorption capacity of the silica materials at pH 1.6 decreases in the order: MMS > MPMS > UMS > PhMS. The influence of various non-covalent interactions on the adsorption capacity of the silica materials and energy of the drug-silica interactions is discussed. These results may be useful for the development of a novel delivery system of warfarin. PMID:26465269

  15. Mechanism of coumarin action: sensitivity of vitamin K metabolizing enzymes of normal and warfarin-resistant rat liver.

    Hildebrandt, E F; Suttie, J W

    1982-05-11

    The in vitro effects of two coumarin anticoagulants, warfarin and difenacoum, on rat liver microsomal vitamin K dependent carboxylase, vitamin K epoxidase, vitamin K epoxide reductase, and cytosolic vitamin K reductase (DT-diaphorase) from the livers of normal and a warfarin-resistant strain of rats have been determined. Millimolar concentrations of both coumarins are required to inhibit the carboxylase and epoxidase activities in both strains of rats. Sensitivity of DT-diaphorase to coumarin inhibition differs when a soluble or liposomal-associated substrate is used, but the diaphorases isolated from both strains of rats have comparable sensitivity. The anticoagulant difenacoum is an effective rodenticide in the warfarin-resistant strain of rats, and the only enzyme studied from warfarin-resistant rat liver that demonstrated a significant differential inhibition by the two coumarins used was the vitamin K epoxide reductase. This enzyme also showed the greatest sensitivity to coumarin inhibition among the enzymes studied. These results support the hypothesis that the physiologically important site of action of coumarin anticoagulants is the vitamin K epoxide reductase. PMID:6807339

  16. A patient-centered approach to the development and pilot of a warfarin pharmacogenomics patient education tool for health professionals

    Barajas, Megan R.; McCormick, Jennifer B.; Abdalrhim, Ahmed D.; Han, Leona C.; McBane, Robert D.; Fiksdal, Alexander S.; Kullo, Iftikhar J.

    2015-01-01

    Objective To describe an exploratory project to develop and pilot a novel patient educational tool that explains the concept of pharmacogenomics and its impact on warfarin dosing that can be utilized by health professionals providing patient counseling. Methods A pharmacogenomics educational tool prototype was developed by an interdisciplinary team. During the pilot of the tool, focus group methodology was used to elicit input from patients based upon their perspectives and experiences with warfarin. Focus group sessions were audio-recorded and transcribed, and the data was analyzed through consensus coding in NVivo. Results The focus group participants were generally unfamiliar with the concept of pharmacogenomics but were receptive to the information. They thought the patient education tool was informative and would provide the most benefit to patients newly initiated on warfarin therapy. Conclusions Preliminary results from this exploratory project suggest that implementation and further feasibility testing of this pharmacogenomics patient education tool should be performed in a population of newly initiated patients taking warfarin. PMID:25729462

  17. Dabigatran versus warfarin major bleeding in practice: an observational comparison of patient characteristics, management and outcomes in atrial fibrillation patients.

    Smythe, Maureen A; Forman, Michael J; Bertran, Elizabeth A; Hoffman, Janet L; Priziola, Jennifer L; Koerber, John M

    2015-10-01

    Data comparing the patient characteristics, management and outcomes for dabigatran versus warfarin major bleeding in the practice setting are limited. We performed a retrospective single health system study of atrial fibrillation patients with dabigatran or warfarin major bleeding from October 2010 through September 2012. Patient identification occurred through both an internal adverse event reporting system and a structured stepwise data filtering approach using the International Classification of Diseases diagnosis codes. Thirty-five dabigatran major bleeding patients were identified and compared to 70 warfarin major bleeding patients. Intracranial bleed occurred in 4.3 % of warfarin patients and 8.6 % of dabigatran patients. Dabigatran patients tended to be older (79.9 vs. 76 years) and were more likely to have a creatinine clearance of 15-30 mL/min (40 vs. 18.6 %, p = 0.02). Over one-third of dabigatran patients had an excessive dose based on renal function. More dabigatran patients required a procedure for bleed management (37.1 vs. 17.1 %, p = 0.03) and received a hemostatic agent for reversal (11.4 vs. 1.4 %, p = 0.04). Dabigatran patients were twice as likely to spend time in an ICU (45.7 vs. 27.1 %, p = 0.06), be placed in hospice/comfort care (14.3 vs. 7.1 %, p = 0.24), expire during hospitalization (14.3 vs. 7.1 %, p = 0.24), and expire within 30-days (22.9 vs. 11.4 %, p = 0.28). In a single hospital center practice setting, as compared to warfarin, patients with dabigatran major bleeding were more likely to be older, have renal impairment, require a procedure for bleed management and receive a hemostatic agent. Patients with dabigatran major bleeding had an excessive dose for renal function in more than one-third of cases. PMID:25851800

  18. Oral Cancer Exam

    Full Text Available ... for providing oral care. NIDCR > OralHealth > Topics > Oral Cancer > Oral Cancer Exam Video Oral Cancer Exam Video This video shows what happens during an oral cancer examination. Quick and painless, the exam can detect ...

  19. Oral histoplasmosis

    Patil Karthikeya

    2009-01-01

    Full Text Available Histoplasmosis is a systemic fungal disease that takes various clinical forms, among which oral lesions are rare. The disseminated form of the disease that usually occurs in association with Human Immunodeficiency Virus (HIV is one of the AIDS-defining diseases. Isolated oral histoplasmosis, without systemic involvement, with underlying immunosuppression due to AIDS is very rare. We report one such case of isolated oral histoplasmosis in a HIV-infected patient.

  20. Varfarina ou Aspirina na prevenção de fenômenos embólicos na valvopatia mitral com fibrilação atrial Varfarina o aspirina en la prevención de fenómenos embólicos en la valvopatía mitral con fibrilación atrial Warfarin or Aspirin in embolism prevention in patients with mitral valvulopathy and atrial fibrillation

    Paulo de Lara Lavitola

    2010-12-01

    effectiveness of Aspirin vs Warfarin in TE prevention in patients with AF and RMVD. METHODS: A total of 229 patients (pts with AF and RMVD were followed in a prospective and randomized study. The first group consisted of 110 pts receiving Aspirin - 200 mg/day (Group Aspirin - GA and the second group consisted of 119 pts receiving Warfarin at individually-adjusted doses (Group Warfarin - GW. RESULTS: There were 15 embolic events in GA and 24 in GW (p = 0.187, of which 21 presented INR < 2.0. Thus, after excluding patients with inadequate INR, there was a higher number of embolic events in GA than in GW (15 vs 3 (p < 0.0061. The GW showed lower treatment adherence (p = 0.001. Neither group presented episodes of major bleeding. Small bleeding episodes were more frequent in the GW (p < 0.01. Increased serum levels of cholesterol and triglycerides constituted a risk factor for a higher number of thromboembolic events in the studied population, with no difference between the groups. CONCLUSION: In patients presenting RMVD with AF for less than a year and no previous embolism, Aspirin is little effective in preventing TE. Patients with lower-risk mitral valvulopathy (mitral regurgitation and mitral biological prosthesis, especially in cases presenting contraindication to or low adherence to Warfarin, Aspirin use can present some benefit in TE prevention.

  1. Perioperative venous thromboembolic disease and the emerging role of the novel oral anticoagulants: An analysis of the implications for perioperative management

    Martina Mookadam

    2015-01-01

    Full Text Available Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current accepted standard therapy with good efficacy. However, this therapeutic strategy has many limitations including the significant risk of bleeding and drug, food and disease interactions that require frequent monitoring. Dabigatran, rivaroxaban, apixaban, and edoxaban are the novel oral anticoagulants that are available for use in stroke prevention in atrial fibrillation and for the treatment and prevention of venous thromboembolism (HYPERLINK\\l "1. Recent prospective randomized trials comparing the NOACs with warfarin have shown similar efficacy between the treatment strategies but fewer bleeding episodes with the NOACs. This paper presents an evidence-based review describing the efficacy and safety of the new anticoagulants compared to warfarin.

  2. Spectral assignments and structural studies of a warfarin derivative stereoselectively formed by tandem cyclization

    Velayutham Pillai, M.; Rajeswari, K.; Vidhyasagar, T.

    2015-11-01

    The structural elucidation of a Mannich condensation product of rac-Warfarin with benzaldehyde and methyl amine was carried out using IR, Mass, 1H NMR, 13C NMR, 1H-1H COSY, 1H-13C COSY, DEPT-135, HMBC, NOESY spectra and single crystal X-ray diffraction. Formation of a new pyran ring via a tandem cyclization in the presence of methyl amine was observed. The optimized geometry and HOMO-LUMO energy gap along with other important physical parameters were found by Gaussian 09 program using HF 6-31G (d, p) and B3YLP/DFT 6-31G (d, p) level of theory. The preferred conformation of the piperidine ring in solution state was found to be chair from the NMR spectra. Single crystal X-ray diffraction and optimized geometry (by theoretical study) also confirms the chair conformation in the solid state.

  3. Extremely low warfarin dose in patients with genotypes of CYP2C9*3/*3 and VKORC1-1639A/A

    GAO Lei; WANG Hong-juan; ZHAO Yu-sheng; LU Cai-yi; ZHANG Wen-zi; YIN Tong; HE Lei; LUO Jin; XU Bin; YANG Jie; ZHANG Yu-xiao; YANG Ting; LI Ke; TIAN Jin-wen

    2011-01-01

    Background Patients with the genotypes of both CYP2C9*3/*3 and VKORC1-1639 A/A are expected to require the lowest dose of warfarin,and to have a greatly increased risk of bleeding.The experience for the dosing of warfarin in such extremely rare cases has been seldom reported.Methods Demographic and clinical data from two cases with stable low dose of warfarin in China were studied by resequencing the corresponding gene segments in their whole blood DNA.The potential clinical value of the pharmacogenetic algorithm for them was evaluated by calculating the stable dose of warfarin in pharmacogenetic algorithm developed by International Warfarin Pharmacogenetics Consortium.Results Both cases (68-year-old female and 50-year-old male) were diagnosed as chronic nonvalvular atrial fibrillation needing warfarin treatment,with target international normalized ratio (INR) 2 to 3.Case 1 had stable warfarin dose of 0.625 mg/d and case 2 1.25 mg/d.They needed more than 1 month to stabilize their anticoagulation.Exceeding INR values were recorded for them when the dose of warfarin was no more than 2 mg/d.Hemorrhagic complication appeared in case 1 when the dose was titrated from 2.5 to 1.25 mg/d.No concomitant medicine to increase or decrease the INR value was recorded for them.Genotyping CYP2C9 and VKORC1 showed both patients were the carriers of the homozygous alleles-CYP2C9*3/*3 and VKORC1-1639 A/A.Their stable doses of warfarin calculated by the pharmacogenetic dose algorithm (0.672 mg/d for case 1 and 1.16 mg/d for case 2) were comparable with their actual stable therapeutic doses.Conclusions Two Chinese with the rare genotypes of both CYP2C9*3/*3 and VKORC1-1639 A/A were found to require the extremely low dose of warfarin.The pharmacogenetic algorithm incorporating the variances of VKORC1 and CYP2C9 genotypes,as well as the non-genetic factors could predict their stable dose of warfarin with high accuracy.

  4. Use of oral anticoagulants in African-American and Caucasian patients with atrial fibrillation: is there a treatment disparity?

    Akinboboye O

    2015-05-01

    Full Text Available Olakunle AkinboboyeQueens Heart Institute, Rosedale, NY, USAAbstract: Atrial fibrillation (AF is a very common cardiac arrhythmia, and its prevalence is increasing along with aging in the developed world. This review discusses racial differences in the epidemiology and treatment of AF between African-American and Caucasian patients. Additionally, the effect of race on warfarin and novel oral anticoagulant use is discussed, as well as the role that physicians and patients play in achieving optimal treatment outcomes. Despite having a lower prevalence of AF compared with Caucasians, African-Americans suffer disproportionately from stroke and its sequelae. The possible reasons for this paradox include poorer access to health care, lower health literacy, and a higher prevalence of other stroke-risk factors among African-Americans. Consequently, it is important for providers to evaluate the effects of race, health literacy, access to health care, and cultural barriers on the use of anticoagulation in the management of AF. Warfarin-dose requirements vary across racial groups, with African-American patients requiring a higher dose than Caucasians to maintain a therapeutic international normalized ratio; the novel oral anticoagulants (dabigatran, rivaroxaban, and apixaban seem to differ in this regard, although data are currently limited. Minority racial groups are not proportionally represented in either real-world studies or clinical trials, but as more information becomes available and other social issues are addressed, the treatment disparities between African-American and Caucasian patients should decrease.Keywords: antithrombotic, atrial fibrillation, stroke, warfarin, race

  5. A study of the relationship between the pharmacokinetics and the pharmacodynamics of the 4-hydroxycoumarin anticoagulants warfarin, difenacoum and brodifacoum in the rabbit.

    Breckenridge, A M; Cholerton, S; Hart, J A; Park, B K; Scott, A K

    1985-01-01

    The pharmacokinetics and pharmacodynamics of the 4-hydroxycoumarin anticoagulants, brodifacoum, difenacoum, and warfarin have been studied in the rabbit. Sensitive (50 ng ml-1) and specific high performance liquid chromatography assays have been developed for the determination of plasma concentrations of warfarin, brodifacoum and difenacoum. After administration of a single intravenous dose (20 mumol kg-1), plasma concentrations of warfarin underwent mono-exponential decay, with a terminal half-life of 5.6 +/- 0.7 h (mean +/- s.e. mean), whereas plasma concentrations of brodifacoum and difenacoum underwent bi-exponential decay with terminal half-lives of 60.8 +/- 1.9 h and 83.1 +/- 10.3 h respectively. The plasma half-life of brodifacoum in a single patient poisoned with the compound was 487 h. The pharmacological response to the anticoagulants was measured as changes in prothrombin complex activity, from which the rate of clotting factor synthesis was determined. Clotting factor synthesis recovered in a monophasic fashion after a single intravenous dose of warfarin, compared with a more complex biphasic, pattern of recovery of clotting factor synthesis after administration of either brodifacoum or difenacoum. The slope (m) of the intensity of effect-log (amount of drug in the body) curve was derived for each anticoagulant. There was no significant difference in the value of m after single intravenous doses of racemic, R-, and S-warfarin, difenacoum and brodifacoum, which is consistent with the hypothesis that all the 4-hydroxycoumarin anticoagulants produce their anticoagulant effect by acting at the same receptor site, vitamin K epoxide reductase. Determination of the minimum plasma concentration of each anticoagulant that corresponded with the complete inhibition of clotting factor synthesis indicated that racemic warfarin, R-warfarin and brodifacoum have similar potencies in the rabbit and are less potent than S-warfarin and difenacoum. PMID:3978316

  6. Mechanism of the anticoagulant effect of warfarin as evaluated in rabbits by selective depression of individual procoagulant vitamin K-dependent clotting factors.

    Zivelin, A; Rao, L V; Rapaport, S I

    1993-01-01

    We have evaluated the contribution of depression of individual procoagulant vitamin K-dependent clotting factors to the ability of warfarin to protect rabbits against tissue factor-induced coagulation. Mean activities of individual procoagulant factors were determined, in assays with rabbit substrates, for a group of rabbits achieving a protective degree of anticoagulation with warfarin. Values were: factor VII, 12%; factor IX, 7%; factor X, 14%, and prothrombin, 13%. The effect upon tissue f...

  7. An electrochemical sensor for warfarin determination based on covalent immobilization of quantum dots onto carboxylated multiwalled carbon nanotubes and chitosan composite film modified electrode

    A method is described for the construction of a novel electrochemical warfarin sensor based on covalent immobilization of CdS-quantum dots (CdS-QDs) onto carboxylated multiwalled carbon nanotubes/chitosan (CS) composite film on the surface of a glassy carbon electrode. The CdS-QDs/CS/MWCNTs were characterized by field-emission scanning electron microscopy (FE-SEM), transmission electron microscopy (TEM), Fourier transform infra-red (FTIR) spectroscopy, XRD analysis and electrochemical impedance spectroscopy (EIS). The sensor showed optimum anodic stripping response within 90 s at an accumulation potential of 0.75 V. The modified electrode was used to detect the concentration of warfarin with a wide linear range of 0.05–80 μM and a detection limit (S/N = 3) of 8.5 nM. The proposed sensor has good storage stability, repeatability and reproducibility and was successfully applied for the determination of warfarin in real samples such as urine, serum and milk. - Highlights: • A new sensitive sensor for warfarin determination was developed. • The sensor was constructed based on covalent immobilization of CdS-QDs on the chitosan/MWCNTs/GCE. • The parameters affecting the stripping analysis of warfarin were optimized. • The proposed sensor is used for trace determination of warfarin in urine, serum and milk

  8. An electrochemical sensor for warfarin determination based on covalent immobilization of quantum dots onto carboxylated multiwalled carbon nanotubes and chitosan composite film modified electrode

    Gholivand, Mohammad Bagher, E-mail: mbgholivand2013@gmail.com; Mohammadi-Behzad, Leila

    2015-12-01

    A method is described for the construction of a novel electrochemical warfarin sensor based on covalent immobilization of CdS-quantum dots (CdS-QDs) onto carboxylated multiwalled carbon nanotubes/chitosan (CS) composite film on the surface of a glassy carbon electrode. The CdS-QDs/CS/MWCNTs were characterized by field-emission scanning electron microscopy (FE-SEM), transmission electron microscopy (TEM), Fourier transform infra-red (FTIR) spectroscopy, XRD analysis and electrochemical impedance spectroscopy (EIS). The sensor showed optimum anodic stripping response within 90 s at an accumulation potential of 0.75 V. The modified electrode was used to detect the concentration of warfarin with a wide linear range of 0.05–80 μM and a detection limit (S/N = 3) of 8.5 nM. The proposed sensor has good storage stability, repeatability and reproducibility and was successfully applied for the determination of warfarin in real samples such as urine, serum and milk. - Highlights: • A new sensitive sensor for warfarin determination was developed. • The sensor was constructed based on covalent immobilization of CdS-QDs on the chitosan/MWCNTs/GCE. • The parameters affecting the stripping analysis of warfarin were optimized. • The proposed sensor is used for trace determination of warfarin in urine, serum and milk.

  9. Oral Cancer Exam

    Full Text Available ... Dental Research See All Continuing Education Practical Oral Care for People With Developmental Disabilities – This booklet presents ... developmental disabilities and offers strategies for providing oral care. NIDCR > OralHealth > Topics > Oral Cancer > Oral Cancer Exam ...

  10. Oral Cancer Exam

    Full Text Available ... common in patients with developmental disabilities and offers strategies for providing oral care. NIDCR > OralHealth > Topics > Oral ... diagnosis, and treatment of oral cancer, along with definitions of selected medical terms and resource information. Oral ...

  11. Oral Cancer Exam

    ... Topics > Oral Cancer > The Oral Cancer Exam The Oral Cancer Exam Main Content See a step-by-step video explaining what happens during an oral cancer examination. An oral cancer exam is painless and quick — it takes ...

  12. Oral Cancer Exam

    Full Text Available ... Oral Cancer > Oral Cancer Exam Video Oral Cancer Exam Video This video shows what happens during an oral cancer examination. Quick and painless, the exam can detect oral cancer early—when it can ...

  13. Methylprednisolone Oral

    ... Nizoral), oral contraceptives, phenobarbital, phenytoin (Dilantin), rifampin (Rifadin), theophylline (Theo-Dur), and vitamins.if you have a ... stomach irritation vomiting headache dizziness insomnia restlessness depression anxiety acne increased hair growth easy bruising irregular or ...

  14. Dexamethasone Oral

    ... Nizoral), oral contraceptives, phenobarbital, phenytoin (Dilantin), rifampin (Rifadin), theophylline (Theo-Dur), and vitamins.if you have a ... stomach irritation vomiting headache dizziness insomnia restlessness depression anxiety acne increased hair growth easy bruising irregular or ...

  15. Hydrocortisone Oral

    ... Nizoral), oral contraceptives, phenobarbital, phenytoin (Dilantin), rifampin (Rifadin), theophylline (Theo-Dur), and vitamins.if you have a ... stomach irritation vomiting headache dizziness insomnia restlessness depression anxiety acne increased hair growth easy bruising irregular or ...

  16. Oral Cancer

    ... use. Some oral cancers are linked to human papilloma virus (HPV) infections of the mouth and throat. ... The number of oropharyngeal cancers linked to human papilloma virus (HPV) has risen dramatically over the past ...

  17. Sciatic Nerve Palsy following Total Hip Replacement via Direct Anterior Approach after Recommencement of Warfarin for Prophylaxis in Atrial Fibrillation

    Vipin Asopa; Shafic Al-Nammari; Tony Spriggins; Tony Menz; Adrian Bauze

    2014-01-01

    The occurrence of sciatic nerve palsy following posterior and anterolateral approaches to the hip has been well documented and is about 1-2%. To our knowledge, however, there are no reports of sciatic nerve palsy occurring secondary to the anterior approach to the hip for arthroplasty. We describe a case of sciatic nerve palsy secondary to haematoma formation following total hip replacement through the anterior approach. The recommencement of warfarin for prophylaxis against atrial fibrillati...

  18. The occurrence of warfarin-related nephropathy and effects on renal and patient outcomes in korean patients.

    Jung Nam An

    Full Text Available BACKGROUND: Warfarin-related nephropathy (WRN is a recently described disease entity, in which excessive warfarinization (international normalized ratio (INR >3.0 causes acute kidney injury. Previous reports regarding WRN included few Asian patients who might have differed from the western WRN patients in terms of genetic and environmental factors. METHODS: During the period of March 2003 to December 2011, the data about a total of 1297 patients who had serum creatinine (sCr level measured within 1 week after INR >3.0 and within 6 months before INR >3.0 was analyzed through the retrospective review of electronic medical records of a single tertiary hospital in Korea. RESULT: WRN developed in 19.3% of patients having excessive warfarinization. The incidence was higher in the chronic kidney disease (CKD group than the non-CKD group. The risk of WRN increased as the basal serum albumin level decreased and was strongly associated with highest quartile serum AST level at post INR elevation and the presence of congestive heart failure. But the presence of atrial fibrillation was protective against the development of WRN. Neither the presence of CKD nor basal estimated glomerular filtration rate (eGFR was an independent risk factor for WRN. Despite no difference in the basal sCr level, the sCr level was higher in patients with WRN than those without WRN after follow-up. The mortality rates were also higher in patients with WRN. CONCLUSIONS: WRN developed in 19.3% of patients having excessive warfarinization. A lower basal serum albumin, highest quartile serum AST level at post INR elevation, and congestive heart failure were associated with the occurrence of WRN. The development of WRN adversely affected renal and patient outcomes.

  19. Polypharmacy and effects of apixaban versus warfarin in patients with atrial fibrillation: post hoc analysis of the ARISTOTLE trial

    Jaspers Focks, Jeroen; Brouwer, Marc A; Wojdyla, Daniel M; Thomas, Laine; Lopes, Renato D.; Washam, Jeffrey B.; Lanas, Fernando; Xavier, Denis; Husted, Steen; Wallentin, Lars; Alexander, John H; Granger, Christopher B; Verheugt, Freek W A

    2016-01-01

    Objective To determine whether the treatment effect of apixaban versus warfarin differs with increasing numbers of concomitant drugs used by patients with atrial fibrillation. Design Post hoc analysis performed in 2015 of results from ARISTOTLE (apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation)—a multicentre, double blind, double dummy trial that started in 2006 and ended in 2011. Participants 18 201 ARISTOTLE trial participants. Interventions In the ARI...

  20. Oral myiasis

    Treville Pereira; Tamgadge, Avinash P.; Mayura S Chande; Sudhir Bhalerao; Sandhya Tamgadge

    2010-01-01

    Myiasis is a relatively rare condition arising from the invasion of body tissues or cavities of living animals or humans by maggots or larvae of certain species of flies. It is an uncommon clinical condition, being more frequent in underdeveloped countries and hot climate regions, and is associated with poor hygiene, suppurative oral lesions; alcoholism and senility. Its diagnosis is made basically by the presence of larvae. The present article reports a case of oral myiasis involving 20 larv...

  1. Supercritical fluid chromatography-tandem mass spectrometry for fast bioanalysis of R/S-warfarin in human plasma.

    Coe, Roger A; Rathe, Jonathan O; Lee, Jean W

    2006-11-16

    Chiral separation for the analysis of enantiomers in biological fluids by HPLC often takes relatively long chromatography time compared to achiral analysis. The advantage of fast mass transfer in packed-column supercritical fluid chromatography (pSFC) and the high-flow compatibility of APCI-MS/MS were applied to develop a fast bioanalytical method for R/S-warfarin in human plasma. Presented here are the main challenges encountered during method development of a semi-automated liquid extraction SFC-MS/MS method. The selection of internal standard, robustness of the SFC equipment, and carryover issues are discussed. The method has high-throughput: the chromatography time is at least two-fold faster than the our fastest previous method; and the liquid/liquid extraction time of 96 samples is less than 20 min using a Tecan Genesis RSP 100 pipetting station and a Tomtec Quadra-96 workstation. The standard curve range was 13.6-2500 ng/ml. Precision of QC concentrations from four validation runs was 7.0% for R-warfarin and 6.0% C.V. for S-warfarin; and the bias was 3.7 and 3.2% R.E., respectively. The method is sensitive, accurate, selective and robust, and was applied to a drug-interaction clinical study with rapid turnaround of sample analysis. PMID:16875793

  2. Early time courses of recurrent thromboembolism and bleeding during apixaban or enoxaparin/warfarin therapy. A sub-analysis of the AMPLIFY trial.

    Raskob, Gary E; Gallus, Alex S; Sanders, Paul; Thompson, John R; Agnelli, Giancarlo; Buller, Harry R; Cohen, Alexander T; Ramacciotti, Eduardo; Weitz, Jeffrey I

    2016-04-01

    Risks of recurrence and bleeding are highest during the first weeks of anticoagulant therapy for venous thromboembolism (VTE). We therefore examined the early time course of recurrence and major bleeding in a pre-specified sub-analysis of the AMPLIFY trial, a randomised, double-blind, six-month comparison of oral apixaban with conventional therapy (enoxaparin followed by warfarin) in 5,395 patients with symptomatic proximal deep-vein thrombosis or pulmonary embolism. Early events were of particular interest because apixaban was given without initial heparin treatment. The primary efficacy and safety outcomes were the incidences of the adjudicated composite of recurrent symptomatic VTE or death related to VTE, and of adjudicated major bleeding, respectively. This analysis reports on recurrence and bleeding after 7, 21, and 90 days of therapy, in addition to the previously reported end-of-study results. These were the times specified before statistical analysis. Recurrent VTE after 7, 21, and 90 days, and six months had occurred in 18 (0.7%), 29 (1.1%), 46 (1.8%), and 59 patients (2.3%), respectively, given apixaban, and in 23 (0.9%), 35 (1.3%), 58 (2.2%), and 71 patients (2.7%), respectively, given conventional therapy. Major bleeding had occurred during these time intervals in 3 (0.1%), 5 (0.2%), 11 (0.4%), and 15 patients (0.6%), respectively, who received apixaban, and in 16 (0.6%), 26 (1.0%), 38 (1.4%), and 49 patients (1.8%), respectively, given conventional therapy. Efficacy of apixaban was non-inferior at each time point, with no excess of early recurrences. The reduced bleeding risk associated with apixaban began early during the course of treatment. PMID:26661288

  3. Anticoagulation reversal in the era of the non-vitamin K oral anticoagulants

    Enriquez, Andres; Lip, Gregory Y H; Baranchuk, Adrian

    2016-01-01

    In recent years, non-vitamin K oral anticoagulants (NOACs) have emerged as an alternative to warfarin for the prevention and treatment of thrombo-embolic disease. Large randomized trials have demonstrated that these agents, which act by directly targeting thrombin (dabigatran) and factor Xa....... New specific antidotes (e.g. idarucizumab, andexanet alfa, and ciraparantag) show promising data, and may soon become available for clinical use. In this article, we review the pharmacology of these agents, the incidence and outcomes of haemorrhagic complications, the available strategies for...

  4. COMPARISON OF DIRECT COSTS OF DABIGATRAN AND WARFARIN THERAPY IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION DURING PREPARATION FOR ELECTIVE CARDIOVERSION IN THE REAL CLINICAL PRACTICE

    L. E. Kuvshinova

    2015-09-01

    Full Text Available Aim. To compare direct medical costs of dabigatran and warfarin therapy in patients with non-valvular atrial fibrillation (NVAF during preparation for elective cardioversion. Material and methods. An open non-randomized study was conducted to evaluate direct medical costs (cost of drug, cost of the international normalized ratio (INR adjust- ment in outpatient clinic, cost of visits to cardiologist. Patients (n=62 with persistent NVAF (AF paroxysm duration > 48 hours were enrolled. All of them requested medical as- sistance and were decided to perform an elective cardioversion. The patients received warfarin (n=32 or dabigatran (n=30. The patients of the both groups were similar in the main clinical characteristics and thromboembolic risk levels according to CHA2DS2-VASc scale.Results. Treatment duration before elective cardioversion was 21±2 and 30.5±4.5 days for dabigatran and warfarin groups, respectively (p<0.05. Average costs of visits to cardiologists were 3,720 and 744 RUB in warfarin and dabigatran groups, respectively (p<0.05, and drug costs were 53.63 and 1,172.01 RUB, respectively (p<0.05. The costs of laboratory INR monitoring were 3,058 RUB in warfarin group. Total costs per patient were 6,831.63 and 1,916.01 RUB in warfarin and dabigatran groups, respectively (p<0.05. Conclusion. In the real clinical practice in patients with NVAF dabigatran antithromboembolic therapy substantially reduces direct medical costs in comparison with warfarin ther- apy during preparation for elective cardioversion. Dabigatran therapy reduces time from the decision of elective cardioversion and antithromboembolic therapy start to car- dioversion performance.

  5. Increased PAC-1 expression among patients with multiple myeloma on concurrent thalidomide and warfarin.

    Abdullah, Wan Z; Roshan, Tariq M; Hussin, Azlan; Zain, Wan S W Md; Abdullah, Dzarr

    2013-12-01

    Treatment with thalidomide is associated with vascular thrombosis. The effect of thalidomide on platelet activation is unclear, although the use of aspirin is justified for thromboprophylaxis. A study on platelet activation markers was done among multiple myeloma patients receiving thalidomide therapy with warfarin as thromboprophylaxis. Strict criteria and procedure were set to avoid misinterpretation of platelet activation other than due to the thalidomide's effect. Blood specimen pre and post thalidomide therapy were used for flow cytometric analysis. Platelet surface P-selectin, CD62P expression and PAC-1 (antibody that recognizes conformational change of the GPIIb/IIIa complex) were examined by using three-colour flowcytometer. Increased expression marker for PAC-1 was observed after 4 weeks of thalidomide treatment (P thalidomide is probably multifactorial and one of them is likely through platelet activation. Further study on the affected pathway/s in the platelet activation process would confirm the exact mechanism of thalidomide-induced thrombosis and potential extended usage of this drug in future. PMID:24030118

  6. Understanding effect of formulation and manufacturing variables on the critical quality attributes of warfarin sodium product.

    Rahman, Ziyaur; Korang-Yeboah, Maxwell; Siddiqui, Akhtar; Mohammad, Adil; Khan, Mansoor A

    2015-11-10

    Warfarin sodium (WS) is a narrow therapeutic index drug and its product quality should be thoroughly understood and monitored in order to avoid clinical performance issues. This study was focused on understanding the effect of manufacturing and formulation variables on WS product critical quality attributes (CQAs). Eight formulations were developed with lactose monohydrate (LM) or lactose anhydrous (LA), and were either wet granulated or directly compressed. Formulations were granulated either with ethanol, isopropyl alcohol (IPA) and IPA-water mixture (50:50). Formulations were characterized for IPA, water content, hardness, disintegration time (DT), assay, dissolution and drug physical forms (scanning electron microscopy (SEM), near infrared chemical imaging (NIR-CI), X-ray powder diffraction (XRPD) and solid state nuclear magnetic resonance (ssNMR)), and performed accelerated stability studies at 40°C/75% RH for three days. The DT and dissolution of directly compressed formulations were faster than wet granulated formulations. This was due to phase transformation of crystalline drug into its amorphous form as indicated by SEM, NIR-CI, XRPD and ssNMR data which itself act as a binder. Similarly, LM showed faster disintegration and dissolution than LA containing formulations. Stability results indicated an increase in hardness and DT, and a decrease in dissolution rate and extent. This was due to phase transformation of the drug and consolidation with particles' bonding. In conclusion, the CQAs of WS product were significantly affected by manufacturing and formulation variables. PMID:26319638

  7. New anticoagulant drugs versus warfarin in atrial fibrillation: economic evaluation and cost-effectiveness analysis

    Mauro Silingardi

    2013-12-01

    Full Text Available Health care resources available for medical procedures, including pharmaceuticals, are limited worldwide. Health economic evidence is now accepted as an essential component of health technology appraisal, realizing the importance of value for money considerations for a more efficient (cost-effective prescribing. Regulatory agencies in more and more countries perform economic evaluation and cost-effectiveness analysis in order to decide about reimbursement of a new and almost always more expensive drug. Pharmacoeconomy is now acknowledged as a science. Cost-effective analysis is just one of its approaches, measuring cost in money and benefit in terms of Quality Adjusted Life Year, a new outcome measure which combines quantity/quality of additional life-years gained with the new drug/technology. A growing body of pharmacoeconomic evidence about new anticoagulant drugs (dabigatran, rivaroxaban, apixaban for stroke prevention in atrial fibrillation is now available. Most of this evidence comes from the National Institute of Health and Clinical Excellence (NICE in the United Kingdom, the most referenced regulatory agency in the world. Compared to current standard therapies (warfarin, dabigatran, rivaroxaban and apixaban are cost-effective treatments for the whole population of patients with atrial fibrillation, independently of poor/good international normalized ratio control (time in therapeutic range and risk stratification for stroke (CHADS2 score. Significant innovation and the lower rate of intracranial hemorrhage/hemorrhagic stroke coupled with the new drugs are the key drivers of these results.

  8. Oral myiasis

    Treville Pereira

    2010-01-01

    Full Text Available Myiasis is a relatively rare condition arising from the invasion of body tissues or cavities of living animals or humans by maggots or larvae of certain species of flies. It is an uncommon clinical condition, being more frequent in underdeveloped countries and hot climate regions, and is associated with poor hygiene, suppurative oral lesions; alcoholism and senility. Its diagnosis is made basically by the presence of larvae. The present article reports a case of oral myiasis involving 20 larvae in a patient with neurological deficiency.

  9. Oral candidiasis.

    Millsop, Jillian W; Fazel, Nasim

    2016-01-01

    Oral candidiasis (OC) is a common fungal disease encountered in dermatology, most commonly caused by an overgrowth of Candida albicans in the mouth. Although thrush is a well-recognized presentation of OC, it behooves clinicians to be aware of the many other presentations of this disease and how to accurately diagnose and manage these cases. The clinical presentations of OC can be broadly classified as white or erythematous candidiasis, with various subtypes in each category. The treatments include appropriate oral hygiene, topical agents, and systemic medications. This review focuses on the various clinical presentations of OC and treatment options. PMID:27343964

  10. A genome-wide association study confirms VKORC1, CYP2C9, and CYP4F2 as principal genetic determinants of warfarin dose.

    Fumihiko Takeuchi

    2009-03-01

    Full Text Available We report the first genome-wide association study (GWAS whose sample size (1,053 Swedish subjects is sufficiently powered to detect genome-wide significance (p<1.5 x 10(-7 for polymorphisms that modestly alter therapeutic warfarin dose. The anticoagulant drug warfarin is widely prescribed for reducing the risk of stroke, thrombosis, pulmonary embolism, and coronary malfunction. However, Caucasians vary widely (20-fold in the dose needed for therapeutic anticoagulation, and hence prescribed doses may be too low (risking serious illness or too high (risking severe bleeding. Prior work established that approximately 30% of the dose variance is explained by single nucleotide polymorphisms (SNPs in the warfarin drug target VKORC1 and another approximately 12% by two non-synonymous SNPs (*2, *3 in the cytochrome P450 warfarin-metabolizing gene CYP2C9. We initially tested each of 325,997 GWAS SNPs for association with warfarin dose by univariate regression and found the strongest statistical signals (p<10(-78 at SNPs clustering near VKORC1 and the second lowest p-values (p<10(-31 emanating from CYP2C9. No other SNPs approached genome-wide significance. To enhance detection of weaker effects, we conducted multiple regression adjusting for known influences on warfarin dose (VKORC1, CYP2C9, age, gender and identified a single SNP (rs2108622 with genome-wide significance (p = 8.3 x 10(-10 that alters protein coding of the CYP4F2 gene. We confirmed this result in 588 additional Swedish patients (p<0.0029 and, during our investigation, a second group provided independent confirmation from a scan of warfarin-metabolizing genes. We also thoroughly investigated copy number variations, haplotypes, and imputed SNPs, but found no additional highly significant warfarin associations. We present power analysis of our GWAS that is generalizable to other studies, and conclude we had 80% power to detect genome-wide significance for common causative variants or markers

  11. Oral calcitonin

    Hamdy RC

    2012-09-01

    Full Text Available Ronald C Hamdy,1,2 Dane N Daley11Osteoporosis Center, College of Medicine, East Tennessee State University, 2Veterans Affairs Medical Center, Johnson City, TN, USAAbstract: Calcitonin is a hormone secreted by the C-cells of the thyroid gland in response to elevations of the plasma calcium level. It reduces bone resorption by inhibiting mature active osteoclasts and increases renal calcium excretion. It is used in the management of postmenopausal osteoporosis, Paget's disease of bone, and malignancy-associated hypercalcemia. Synthetic and recombinant calcitonin preparations are available; both have similar pharmacokinetic and pharmacodynamic profiles. As calcitonin is a peptide, the traditional method of administration has been parenteral or intranasal. This hinders its clinical use: adherence with therapy is notoriously low, and withdrawal from clinical trials has been problematic. An oral formulation would be more attractive, practical, and convenient to patients. In addition to its effect on active osteoclasts and renal tubules, calcitonin has an analgesic action, possibly mediated through β-endorphins and the central modulation of pain perception. It also exerts a protective action on cartilage and may be useful in the management of osteoarthritis and possibly rheumatoid arthritis. Oral formulations of calcitonin have been developed using different techniques. The most studied involves drug-delivery carriers such as Eligen® 8-(N-2hydroxy-5-chloro-benzoyl-amino-caprylic acid (5-CNAC (Emisphere Technologies, Cedar Knolls, NJ. Several factors affect the bioavailability and efficacy of orally administered calcitonin, including amount of water used to take the tablet, time of day the tablet is taken, and proximity to intake of a meal. Preliminary results looked promising. Unfortunately, in two Phase III studies, oral calcitonin (0.8 mg with 200 mg 5-CNAC, once a day for postmenopausal osteoporosis and twice a day for osteoarthritis failed to

  12. Emergent Bleeding in Patients Receiving Direct Oral Anticoagulants.

    Summers, Richard L; Sterling, Sarah A

    2016-01-01

    Direct oral anticoagulants (DOACs) offer clinical advantages over warfarin, such as minimal medication and food interactions and fixed dosing without the need for routine monitoring of coagulation status. As with all anticoagulants, bleeding, either spontaneous or provoked, is the most common complication. The long-term use of these drugs is increasing, and there is a crucial need for emergency medicine service professionals to understand the optimal management of associated bleeding. This review aims to describe the indications and pharmacokinetics of available DOACs; to discuss the risk of bleeding; to provide a treatment algorithm to manage DOAC-associated emergency bleeding; and to discuss future directions in bleeding management, including the role of specific reversal agents, such as the recently approved idarucizumab for reversal of the direct thrombin inhibitor dabigatran. Because air medical personnel are increasingly likely to encounter patients receiving DOACs, it is important that they have an understanding of how to manage patients with emergent bleeding. PMID:27255877

  13. Oral Sex, Oral Health and Orogenital Infections

    Rajiv Saini; Santosh Saini; Sugandha Sharma

    2010-01-01

    Oral sex is commonly practiced by sexually active male-female and same-gender couples of various ages, including adolescents. The various type of oral sex practices are fellatio, cunnilingus and analingus. Oral sex is infrequently examined in research on adolescents; oral sex can transmit oral, respiratory, and genital pathogens. Oral health has a direct impact on the transmission of infection; a cut in your mouth, bleeding gums, lip sores or broken skin increases chances of infection. Althou...

  14. Oral care.

    Hitz Lindenmüller, Irène; Lambrecht, J Thomas

    2011-01-01

    Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing/recovering from chemo-/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases. The use of a toothbrush is the most important measure for oral hygiene. Toothbrushes with soft bristles operated carefully by hand or via an electric device help to remove plaque and to avoid mucosal trauma. A handlebar with a grip cover can be helpful for manually disabled patients or for those with reduced motor skills. In case of oral hygiene at the bedside or of patients during/after chemo-/radiotherapy a gauze pad can be helpful for gently cleaning the teeth, gums and tongue. The use of fluoride toothpaste is imperative for the daily oral hygiene. Detergents such as sodium lauryl sulphate improve the cleaning action but may also dehydrate and irritate the mucous membrane. The use of products containing detergents and flavouring agents (peppermint, menthol, cinnamon) should therefore be avoided by bedridden patients or those with dry mouth and sensitive mucosa. Aids for suitable interdental cleaning, such as dental floss, interdental brushes or dental sticks, are often complicated to operate. Their correct use should be instructed by healthcare professionals. To support dental care, additional fluoridation with a fluoride gel or rinse can be useful. Products further containing antiseptics such as chlorhexidine or triclosan reduce the quantity of bacteria in the mouth. For patients undergoing or having undergone radio-/chemotherapy, a mouthwash that concomitantly moisturizes the oral mucosa is advisable. PMID:21325845

  15. Oral Cancer Exam

    Full Text Available ... Topics > Oral Cancer > Oral Cancer Exam Video Oral Cancer Exam Video This video shows what happens during an oral cancer examination. Quick and painless, the exam can detect ...

  16. Oral Health and Aging

    ... please turn JavaScript on. Feature: Oral Health and Aging Oral Health and Aging Summer 2016 Table of Contents Jerrold H. Epstein, ... they may need. Read More "Oral Health and Aging" Articles Oral Health and Aging / 4 Myths About ...

  17. Vitamin K2 regression aortic calcification induced by warfarin via Gas6/Axl survival pathway in rats.

    Jiang, Xiaoyu; Tao, Huiren; Qiu, Cuiting; Ma, Xiaolei; Li, Shan; Guo, Xian; Lv, Anlin; Li, Huan

    2016-09-01

    The aim of this study was to investigate the effect of vitamin K2 on aortic calcification induced by warfarin via Gas6/Axl survival pathway in rats. A calcification model was established by administering 3mg/g warfarin to rats. Rats were divided into 9 groups: control group (0W, 4W, 6W and 12W groups), 4W calcification group, 6W calcification group, 12W calcification group, 6W calcification+6W normal group and 6W calcification+6W vitamin K2 group. Alizarin red S staining measured aortic calcium depositions; alkaline phosphatase activity in serum was measured by a kit; apoptosis was evaluated by TUNEL assay; protein expression levels of Gas6, Axl, phosphorylated Akt (p-Akt), and Bcl-2 were determined by western blotting. The calcium content, calcium depositions, ALP activity and apoptosis were significantly higher in the calcification groups than control group. Gas6, Axl, p-Akt and Bcl-2 expression was lower in the calcification group than control group. 100μg/g vitamin K2 treatment decreased calcium depositions, ALP activity and apoptosis significantly, but increased Gas6, Axl, p-Akt and Bcl-2 expression. 100μg/g vitamin K2 reversed 44% calcification. Pearson correlation analysis showed a positive correlation between formation calcification and apoptosis (R(2)=0.8853, Pvitamin K2 can inhibit warfarin-induced aortic calcification and apoptosis. The regression of aortic calcification by vitamin K2 involved the Gas6/Axl axis. This data may provide a theoretical basis for future clinical treatments for aortic calcification. PMID:27212383

  18. Genetic Variation of VKORC1 and CYP4F2 Genes Related to Warfarin Maintenance Dose in Patients with Myocardial Infarction

    Marianne K. Kringen

    2011-01-01

    Full Text Available The aim of this study was to investigate whether the VKORC1*3 (rs7294/9041 G > A, VKORC1*4 (rs17708472/6009 C > T, and CYP4F2 (rs2108622/1347 C > T polymorphisms were associated with elevated warfarin maintenance dose requirements in patients with myocardial infarction (n=105 from the Warfarin Aspirin Reinfarction Study (WARIS-II. We found significant associations between elevated warfarin dose requirements and VKORC1*3 and VKORC1*4 polymorphisms (P=.001 and P=.004, resp., whereas CYP4F2 (1347 C > T showed a weak association on higher warfarin dose requirements (P=.09. However, analysing these variant alleles in a regression analysis together with our previously reported data on VKORC1*2, CYP2C9*2 and CYP2C9*3 polymorphisms, gave no significant associations for neither VKORC1*3, VKORC1*4 nor CYP4F2 (1347 C > T. In conclusion, in patients with myocardial infarction, the individual contribution to warfarin dose requirements from VKORC1*3, VKORC1*4, and CYP4F2 (1347 C > T polymorphisms was negligible. Our results indicate that pharmacogenetic testing for VKORC1*2, CYP2C9*2 and CYP2C9*3 is more informative regarding warfarin dose requirements than testing for VKORC1*3, VKORC1*4, and CYP4F2 (1347 C > T polymorphisms.

  19. Chemostimuli for guanylyl cyclase-D-expressing olfactory sensory neurons promote the acquisition of preferences for foods adulterated with the rodenticide warfarin

    Kevin Robert Kelliher

    2015-07-01

    Full Text Available Many animals have the ability to acquire food preferences from conspecifics via social signals. For example, the coincident detection of a food odor by canonical olfactory sensory neurons (OSNs and agonists of the specialized OSNs expressing the receptor guanylyl cyclase GC-D (GC-D+ OSNs will promote a preference in recipient rodents for similarly odored foods. It has been hypothesized that these preferences are acquired and maintained regardless of the palatability or quality of the food. We assessed whether mice could acquire and maintain preferences for food that had been adulterated with the anticoagulant rodenticide warfarin. After olfactory investigation of a saline droplet containing either cocoa (2%, w/w or cinnamon (1%, w/w along with a GC-D+ OSN-specific chemostimulus (either of the guanylin-family peptides uroguanylin and guanylin; 1–50 nM, C57BL/6J mice exhibited robust preferences for unadulterated food containing the demonstrated odor. The peptide-dependent preference was observed even when the food contained warfarin (0.025% w/w. Repeated ingestion of warfarin-containing food over four days did not disrupt the preference, even though mice were not re-exposed to the peptide stimulus. Surprisingly, mice continued to prefer warfarin-adulterated food containing the demonstrated odor when presented with a choice of warfarin-free food containing a novel odor. Our results indicate that olfactory-mediated food preferences can be acquired and maintained for warfarin-containing foods and suggest that guanylin peptides may be effective stimuli for promoting the ingestion of foods or other edibles with low palatability or potential toxicity.

  20. Theoretical study of optical activity of 1:1 hydrogen bond complexes of water with S-warfarin.

    Dadsetani, Mehrdad; Abdolmaleki, Ahmad; Zabardasti, Abedin

    2016-11-01

    The molecular interaction between S-warfarin (SW) and a single water molecule was investigated using the B3LYP method at 6-311++G(d,p) basis set. The vibrational spectra of the optimized complexes have been investigated for stabilization checking. Quantum theories of atoms in molecules, natural bond orbitals, molecular electrostatic potentials and energy decomposition analysis methods have been applied to analyze the intermolecular interactions. The intermolecular charge transfer in the most stable complex is in the opposite direction from those in the other complexes. The optical spectra and the hyperpolarizabilities of SW-water hydrogen bond complexes have been computed. PMID:27294546

  1. Vitamina K: metabolismo, fontes e interação com o anticoagulante varfarina Vitamin K: metabolism, sources and interaction with the anticoagulant warfarin

    Karin Klack

    2006-12-01

    phylloquinone. Dark green leafy vegetables, usually mixed with oils, nuts and some fruits, including kiwi, avocado, grapes, plums, and figs are rich sources of vitamin K, whereas cereals, grains, breads, and dairy products present low amounts. The daily ingestion of approximately 1µg/kg body-weight is considered safe, even with concomitant oral anticoagulant use, since stable vitamin concentration contributes to anticoagulant efficacy. The most commonly used oral anticoagulant formation is warfarin, that is indicated to both prophylactic and therapeutic tromboembolic phenomena. It is currently monitored by assessing prothrombin time, after adjusting for the international normalized ratio (INR. Usually, the oral dose is adjusted to set the INR in the range of 2 - 3, in order to achieve the treatment objective. The anticoagulating efficacy is influenced by a variety of clinical factors, such as weight gain, diarrhoea, vomiting, age under 40, and excessive vitamin K daily consumption.

  2. Organobase catalyzed 1,4-conjugate addition of 4-hydroxycoumarin on chalcones: Synthesis, NMR and single-crystal X-ray diffraction studies of novel warfarin analogues

    Talhi, Oualid; Fernandes, José A.; Pinto, Diana C. G. A.; Almeida Paz, Filipe A.; Silva, Artur M. S.

    2015-08-01

    The synthesis of a new series of warfarin analogues by convenient organobase catalyzed 1,4-conjugate addition of 4-hydroxycoumarin to chalcone derivatives is described. 1H NMR spectroscopy evidenced the presence of a predominant acyclic open-form together with the cyclic hemiketal tautomers of the resulting Michael adducts. The acyclic open-form has been unequivocally proved by single-crystal X-ray diffraction analysis. The use of the B ring ortho-hydroxychalcone synthons in this reaction has led to a diastereoselective synthesis of warfarin bicyclo[3.3.1]nonane ketal derivatives.

  3. Pharmacokinetics of eight anticoagulant rodenticides in mice after single oral administration.

    Vandenbroucke, V; Bousquet-Melou, A; De Backer, P; Croubels, S

    2008-10-01

    The first aim of the study was to investigate the pharmacokinetics of eight anticoagulant rodenticides (brodifacoum, bromadiolone, chlorophacinone, coumatetralyl, difenacoum, difethialone, flocoumafen and warfarin) in plasma and liver of the mouse after single oral administration. Eight groups of mice dosed orally with a different anticoagulant rodenticide in a dose equal to one-half the lethal dose 50 (LD(50)), were killed at various times up to 21 days after administration. The eight anticoagulant rodenticides were assayed in plasma and liver by an LC-ESI-MS/MS method. Depending on the compound, the limit of quantification was set at 1 or 5 ng/mL in plasma. In liver, the limit of quantification was set at 250 ng/g for coumatetralyl and warfarin and at 100 ng/g for the other compounds. The elimination half-lives in plasma for first-generation rodenticides were shorter than those for second-generation rodenticides. Coumatetralyl, a first-generation product, had a plasma elimination half-life of 0.52 days. Brodifacoum, a second-generation product, showed a plasma elimination half-life of 91.7 days. The elimination half-lives in liver varied from 15.8 days for coumatetralyl to 307.4 days for brodifacoum. The second aim of the study was to illustrate the applicability of the developed method in a clinical case of a dog suspected of rodenticide poisoning. PMID:19000263

  4. Tutorial in oral antithrombotic therapy: Biology and dental implications

    Fakhri, Hamid R.; Janket, Sok J.; Baird, Alison E.; Dinnocenzo, Richard; Meurman, Jukka H.

    2013-01-01

    Objectives: Recent developments of new direct oral anticoagulants that target specific clotting factors necessitate understanding of coagulation biology. The objective of this tutorial is to offer dental professionals a review of coagulation mechanisms and the pharmacodynamics of the conventional and new oral anticoagulants. Also, we summarized the dental implications of the conventional and new anticoagulants. Method: We searched Medline using search terms “antithrombotic”, “antihemostasis” or “anticoagulation” and combined them with the search results of “dental”, “oral surgery” or “periodontal”. We restricted the results to “human” and “English”. Results: The early coagulation cascade, the new cell-based coagulation model, the pharmacokinetics and pharmacodynamics of conventional antithrombotics, and new oral anticoagulants were reviewed. The new direct factor Xa inhibitors and the direct thrombin inhibitor (s), called direct oral anticoagulants (DOAs) have rapid onset of action, fast elimination on cessation, and fewer drug-drug or drug-food interactions than warfarin. However, the lack of antidotes raises concerns that some dental procedures may trigger serious hemorrhagic events. Additionally, careful perioperative withdrawal and resumption protocols for the DOAs are reviewed, because DOAs’ blood levels are dependent on renal function. Also, various reversal strategies in the event of excessive bleedings are summarized. Perioperative management of dental patients taking new DOAs and conventional oral anticoagulants are also discussed. However, the perioperative strategies for DOAs are yet to be validated in randomized trials. Key words:Coagulation cascade, cell-based coagulation model, factor Xa inhibitors, direct thrombin inhibitors, prothrombin complex concentrates. PMID:23524440

  5. Good quality of oral anticoagulation treatment in general practice using international normalised ratio point of care testing

    Løkkegaard, Thomas; Pedersen, Tina Heidi; Lind, Bent;

    2015-01-01

    INTRODUCTION: Oral anticoagulation treatment (OACT)with warfarin is common in general practice. Increasingly,international normalised ratio (INR) point of care testing(POCT) is being used to manage patients. The aim of thisstudy was to describe and analyse the quality of OACT withwarfarin...... in the management of patients in warfarintreatment provided good quality of care. Sampling intervaland diagnostic coding were significantly correlated withtreatment quality. FUNDING: The study received financial support from theSarah Krabbe Foundation, the General Practitioners’ Educationand Development Foundation......, and Quality in PrimaryCare (KAP-H) – the Capital Region of Denmark. TRIAL REGISTRATION: not relevant....

  6. Novel oral anticoagulants in plastic surgery.

    Munson, C F; Reid, A J

    2016-05-01

    Novel oral anticoagulants (NOACs) have emerged as a good alternative to warfarin in the prevention of stroke for patients with atrial fibrillation. NOAC use is increasing rapidly; therefore, greater understanding of their use in the perioperative period is important for optimal care. Studies and reviews that reported on the use of NOACs were identified, with particular focus on the perioperative period. PubMed was searched for relevant articles published between January 2000 and August 2015. The inevitable rise in the use of NOACs such as rivaroxaban (Xarelto™), apixaban (Eliquis™), edoxaban (Lixiana™) and dabigatran (Pradaxa™) may present a simplified approach to perioperative anticoagulant management due to fewer drug interactions, rapidity of onset of action and relatively short half-lives. Coagulation status, however, cannot reliably be monitored and no antidotes are currently available. When planning for discontinuation of NOACs, special consideration of renal function is required. Advice regarding the management of bleeding complications is provided for consideration in emergency surgery. In extreme circumstances, haemodialysis may be considered for bleeding with the use of dabigatran. NOACs will increasingly affect operative planning in plastic surgery. In order to reduce the incidence of complications associated with anticoagulation, the management of NOACs in the perioperative period requires knowledge of the time of last dose, renal function and the bleeding risk of the planned procedure. Consideration of these factors will allow appropriate interpretation of the current guidelines. PMID:27013144

  7. Quantitative liquid chromatography/mass spectrometry/mass spectrometry warfarin assay for in vitro cytochrome P450 studies.

    Zhang, Z Y; King, B M; Wong, Y N

    2001-11-01

    A sensitive assay using high-performance liquid chromatography tandem mass spectrometry (MS/MS) has been established for the quantitative analysis of cytochrome P450 form-specific activities using warfarin as a probe substrate. Four metabolites, 6-, 7-, 8-, and 10-hydroxywarfarin, were chromatographically resolved within 10 min using gradient mobile phases. The mass spectrometry was operated under negative ionization mode. The MS/MS product ion spectra of warfarin and the metabolites were generated using collision-activated dissociation and interpreted. The abundant product ions of the metabolites were selected for quantification applying multiple reaction monitoring. Quantification was based on a quadratic or power curve of the peak area ratio of the metabolite over the internal standard against the respective concentration of the metabolite. This assay has been validated from 2 to 1000 nM for 10-hydroxywarfarin and from 2 to 5000 nM for 6-, 7-, and 8-hydroxywarfarin and successfully applied to evaluate cytochrome P450-mediated drug-drug interactions in vitro using human hepatocytes and liver microsomal preparations. PMID:11673893

  8. Trials of the anticoagulants rodenticide WBA 8119 against confined colonies of warfarin-resistant house mice (Mus musculus L.).

    Rowe, F P; Bradfield, A

    1976-12-01

    The efficacy of the newly developed anticoagulant rodenticide WBA 8119 was evaluated against the house mouse (Mus musculus L.) using individual and family groups of warfarin-resistant animals. WBA 8119 at 0-002%, 0-005% and 0-01% in pinhead oatmeal bait gave complete kills of mice in 'no-choice' feeding tests carried out in cages and small pens. In replicated 21-day treatments on families of mice confined in larger pens and conditioned to feeding on plain foods, the overall mortalities obtained using the three formulated poison baits were 71/72, 62/63 and 57/57 respectively. The results of the WBA 8119 toxicity tests are considered in relation to previous findings on other anticoagulant rodenticides, particularly difenacoum. In equivalent tests, WBA 8119 performed better than difenacoum. The data thus support the laboratory findings that WBA 8119 is the most active anticoagulant so far tested for the control of warfarin-resistant house mice. PMID:1069822

  9. Trials of the anticoagulant rodenticide WBA 8119 against confined colonies of warfarin-resistant house mice (Mus musculus L.).

    Roew, F. P.; Bradfield, A.

    1976-01-01

    The efficacy of the newly developed anticoagulant rodenticide WBA 8119 was evaluated against the house mouse (Mus musculus L.) using individual and family groups of warfarin-resistant animals. WBA 8119 at 0-002%, 0-005% and 0-01% in pinhead oatmeal bait gave complete kills of mice in 'no-choice' feeding tests carried out in cages and small pens. In replicated 21-day treatments on families of mice confined in larger pens conditioned to feeding on plain foods, the overall mortalities obtained using the three formulated poison baits were 71/72, 62/63 and 57/57 respectively. The results of the WBA 8119 toxicity tests are considered in relation to previous findings on other anticoagulant rodenticides, particularly difenacoum. In equivalents tests, WBA 8119 performed better than difenacoum. The data thus suport the laboratory findings that WBA 8119 is the most active anticoagulant so far tested for the control of warfarin-resistant house mice. PMID:1069821

  10. Oral / response

    Bartram, Angela; O'Neill, Mary

    2012-01-01

    The performance ‘Oral/Response’ joins an artist, Angela Bartram and a theorist, Mary O’Neill in research to analyse the dynamic, but often disjointed relationship between the live experience and its documentation by positioning both elements within the performance. Traditionally, the documentation of performance is a record left to stand for the work after the event that demonstrates an out of time viewpoint, which is a problem for ephemeral practice whose intention is to be ‘live’ and in the...

  11. Oral Haemangioma

    Jaspreet Singh Gill

    2012-01-01

    Full Text Available Vascular anomalies comprise a widely heterogeneous group of tumours and malformations. Haemangioma is the most common benign tumour of vascular origin of the head and neck region. The possible sites of occurrence in oral cavity are lips, tongue, buccal mucosa, and palate. Despite its benign origin and behaviour, it is always of clinical importance to the dental profession and requires appropriate management. This case study reports a rare case of capillary haemangioma on the palatal gingiva in a 14-year-old female.

  12. Towards understanding oral health

    E. Zaura; J.M. ten Cate

    2015-01-01

    During the last century, dental research has focused on unraveling the mechanisms behind various oral pathologies, while oral health was typically described as the mere absence of oral diseases. The term ‘oral microbial homeostasis' is used to describe the capacity of the oral ecosystem to maintain

  13. Stereoselective interactions of warfarin enantiomers with the pregnane X nuclear receptor in gene regulation of major drug-metabolizing cytochrome P450 enzymes

    Rulcová, A.; Prokopová, I.; Krausová, L.; Bitman, M.; Vrzal, R.; Dvořák, Z.; Blahoš, Jaroslav; Pávek, P.

    2010-01-01

    Roč. 8, č. 12 (2010), s. 2708-2717. ISSN 1538-7933 R&D Projects: GA MŠk(CZ) LC06063 Institutional research plan: CEZ:AV0Z50520514 Keywords : CYP3A4 * gene regulation * warfarin Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 5.439, year: 2010

  14. Warfarin and coumarin-like Murraya paniculata extract down-regulate EpCAM-mediated cell adhesion: individual components versus mixture for studying botanical metastatic chemopreventives.

    Shao, Jingwei; Zhou, Suxia; Jiang, Zhou; Chi, Ting; Ma, Ji; Kuo, Minliang; Lee, Alan Yueh-Luen; Jia, Lee

    2016-01-01

    We recently defined cancer metastatic chemoprevention as utilizing safe and effective molecules to comprehensively prevent the spark of activation-adhesion-extravasation-proliferation metastatic cascade caused by circulating tumor cells (CTCs). The strategy focuses on preventing the most important starting point of the cascade. We identified an extract from a well-known medical plant Murraya paniculata, which inhibited both embryonic implantation to human endometrium as traditionally-used for abortion and CTC adhesion to human endothelium. Here, we separated and characterized five coumarin-containing components (Z1-Z5) from the botanic extract. Flow cytometry revealed that within 1-100 μg/mL, Z3 and Z5 down-regulated EpCAM expression in human colon HCT116, whereas, Z1 and Z2 did oppositely. Warfarin and Z1-Z5 component mixture (CM) also down-regulated EpCAM expression. The down-regulation of EpCAM by Z3, Z5, CM and warfarin was confirmed by western blotting, and caused inhibition on adhesion of cancer cells to human endothelial cells. Rat coagulation study showed that warfarin prolonged prothrombin time, whereas, Z3 did not. The present studies revealed that, for the first time, warfarin and coumarin-like components Z3, Z5 and CM from Murraya paniculata could directly inhibit EpCAM-mediated cell-cell adhesion. PMID:27480614

  15. Cost-effectiveness of dabigatran versus genotype-guided management of warfarin therapy for stroke prevention in patients with atrial fibrillation.

    Joyce H S You

    Full Text Available BACKGROUND: Dabigatran is associated with lower rate of stroke comparing to warfarin when anticoagulation control is sub-optimal. Genotype-guided warfarin dosing and management may improve patient-time in target range (TTR and therefore affect the cost-effectiveness of dabigatran compared with warfain. We examined the cost-effectiveness of dabigatran versus warfarin therapy with genotype-guided management in patients with atrial fibrillation (AF. METHODOLOGY/PRINCIPAL FINDINGS: A Markov model was designed to compare life-long economic and treatment outcomes of dabigatran (110 mg and 150 mg twice daily, warfarin usual anticoagulation care (usual AC with mean TTR 64%, and genotype-guided anticoagulation care (genotype-guided AC in a hypothetical cohort of AF patients aged 65 years old with CHADS(2 score 2. Model inputs were derived from literature. The genotype-guided AC was assumed to achieve TTR = 78.9%, adopting the reported TTR achieved by warfarin service with good anticoagulation control in literature. Outcome measure was incremental cost per quality-adjusted life-year (QALY gained (ICER from perspective of healthcare payers. In base-case analysis, dabigatran 150 mg gained higher QALYs than genotype-guided AC (10.065QALYs versus 9.554QALYs at higher cost (USD92,684 versus USD85,627 with ICER = USD13,810. Dabigatran 110 mg and usual AC gained less QALYs but cost more than dabigatran 150 mg and genotype-guided AC, respectively. ICER of dabigatran 150 mg versus genotype-guided AC would be >USD50,000 (and genotype-guided AC would be most cost-effective when TTR in genotype-guided AC was >77% and utility value of warfarin was the same or higher than that of dabigatran. CONCLUSIONS/SIGNIFICANCE: The likelihood of genotype-guided anticoagulation service to be accepted as cost-effective would increase if the quality of life on warfarin and dabigatran therapy are compatible and genotype-guided service achieves high TTR (>77%.

  16. Oral sex, oral health and orogenital infections

    Rajiv Saini

    2010-01-01

    Full Text Available Oral sex is commonly practiced by sexually active male-female and same-gender couples of various ages, including adolescents. The various type of oral sex practices are fellatio, cunnilingus and analingus. Oral sex is infrequently examined in research on adolescents; oral sex can transmit oral, respiratory, and genital pathogens. Oral health has a direct impact on the transmission of infection; a cut in your mouth, bleeding gums, lip sores or broken skin increases chances of infection. Although oral sex is considered a low risk activity, it is important to use protection and safer sex precautions. There are various methods of preventing infection during oral sex such as physical barriers, health and medical issues, ethical issues and oral hygiene and dental issues. The lesions or unhealthy periodontal status of oral cavity accelerates the phenomenon of transmission of infections into the circulation. Thus consequences of unhealthy or painful oral cavity are significant and oral health should be given paramount importance for the practice of oral sex.

  17. Oral Cancer Exam

    Full Text Available ... the mouth for signs of oral cancer. For Patients and the Public Oral Cancer Pamphlet that describes ... step description of the oral cancer examination so patients know what to expect. What You Need to ...

  18. Oral Cancer Exam

    Full Text Available ... video shows what happens during an oral cancer examination. Quick and painless, the exam can detect oral ... Step-by-step description of the oral cancer examination so patients know what to expect. What You ...

  19. Oral Cancer Exam

    Full Text Available ... oral cancer. For Patients and the Public Oral Cancer Pamphlet that describes the risk factors, signs and symptoms of oral cancer, and the importance of detecting the disease in ...

  20. Oral Cancer Exam

    Full Text Available ... Text size: Website Contents NIDCR Home Oral Health Diseases and Conditions Gum Disease TMJ Disorders Oral Cancer ... Tooth Decay See All Oral Complications of Systemic Diseases Cancer Treatment Developmental Disabilities Diabetes Heart Disease HIV/ ...

  1. Oral Thrush (For Parents)

    ... About Oral Thrush Symptoms Prevention Treatment en español Candidiasis bucal About Oral Thrush Oral thrush is a ... digestive tract can overgrow and lead to an infection. Candida overgrowth also causes diaper rash and vaginal (yeast) ...

  2. Oral Cancer Prevention

    ... Quit General Information About Oral Cavity and Oropharyngeal Cancer Oral cavity cancer and oropharyngeal cancer are diseases in ... about how you might lower your risk of cancer. Oral cavity cancer and oropharyngeal cancer are two different ...

  3. Oral Cancer Exam

    Full Text Available ... Tips Careers & Training Fellowships and Internships for... High School and College Students Recent College Graduates Dental and ... Oral Cancer > Oral Cancer Exam Video Oral Cancer Exam Video This video shows what happens during an ...

  4. Determinants of the over-anticoagulation response during warfarin initiation therapy in Asian patients based on population pharmacokinetic-pharmacodynamic analyses.

    Minami Ohara

    Full Text Available To clarify pharmacokinetic-pharmacodynamic (PK-PD factors associated with the over-anticoagulation response in Asians during warfarin induction therapy, population PK-PD analyses were conducted in an attempt to predict the time-courses of the plasma S-warfarin concentration, Cp(S, and coagulation and anti-coagulation (INR responses. In 99 Chinese patients we analyzed the relationships between dose and Cp(S to estimate the clearance of S-warfarin, CL(S, and that between Cp(S and the normal prothrombin concentration (NPT as a coagulation marker for estimation of IC50. We also analyzed the non-linear relationship between NPT inhibition and the increase in INR to derive the non-linear index λ. Population analyses accurately predicted the time-courses of Cp(S, NPT and INR. Multivariate analysis showed that CYP2C9*3 mutation and body surface area were predictors of CL(S, that VKORC1 and CYP4F2 polymorphisms were predictors of IC50, and that baseline NPT was a predictor of λ. CL(S and λ were significantly lower in patients with INR≥4 than in those with INR<4 (190 mL/h vs 265 mL/h, P<0.01 and 3.2 vs 3.7, P<0.01, respectively. Finally, logistic regression analysis revealed that CL(S, ALT and hypertension contributed significantly to INR≥4. All these results indicate that factors associated with the reduced metabolic activity of warfarin represented by CL(S, might be critical determinants of the over-anticoagulation response during warfarin initiation in Asians.ClinicalTrials.gov NCT02065388.

  5. 心房颤动患者华法林剂量预测模型的构建与比较%Development and comparison of a warfarin-dosing algorithm in Chinese patients with atrial fibrillation

    陈浩; 吕游; 种甲; 田伟萌; 佟佳宾; 杜昕; 马长生; 杨杰孚

    2013-01-01

    rs9934438 by direct gene sequencing technique.Demographic variables were recorded during regular visit.All variables for multivariate regression analysis were those significant predictors derived from the univariate analysis,thereafter a stepwised multiple regression analysis was performed to deduce a new dosing algorithm.Results Four significant predictors (CYP2C9 A1075C,VKORC1 Cl173T,age and BAS) derived from univariate analysis were carried to step-wise multiple regression analysis and a new algorithm was deduced (R2 =0.436).Their weights for predicting of warfarin dosage were 20.8%,11.5%,4.5% and 6.8%,respectively.Conclusions For Chinese Han patients with AF who accepted oral anticoagulation drug therapy,age,BAS,CYP2C9 A1075C and VKORC1 Cl173T are the predictors which highly correlated to variation of warfarin dosage.In dosing prediction system,the weight of pharmacogenetic factors is more robust than that of clinical variables.The interpretation of our algorithm could account for nearly half of heterogeneity of individualized warfarin dosage.

  6. Oral Cancer Exam

    Full Text Available ... Main Content National Institute of Dental and Craniofacial Research (NIDCR) Improving the Nation's Oral ... Disorders Oral Cancer Dry Mouth Burning Mouth Tooth Decay See All ...

  7. Use of oral anticoagulants in African-American and Caucasian patients with atrial fibrillation: is there a treatment disparity?

    Akinboboye, Olakunle

    2015-01-01

    Atrial fibrillation (AF) is a very common cardiac arrhythmia, and its prevalence is increasing along with aging in the developed world. This review discusses racial differences in the epidemiology and treatment of AF between African-American and Caucasian patients. Additionally, the effect of race on warfarin and novel oral anticoagulant use is discussed, as well as the role that physicians and patients play in achieving optimal treatment outcomes. Despite having a lower prevalence of AF compared with Caucasians, African-Americans suffer disproportionately from stroke and its sequelae. The possible reasons for this paradox include poorer access to health care, lower health literacy, and a higher prevalence of other stroke-risk factors among African-Americans. Consequently, it is important for providers to evaluate the effects of race, health literacy, access to health care, and cultural barriers on the use of anticoagulation in the management of AF. Warfarin-dose requirements vary across racial groups, with African-American patients requiring a higher dose than Caucasians to maintain a therapeutic international normalized ratio; the novel oral anticoagulants (dabigatran, rivaroxaban, and apixaban) seem to differ in this regard, although data are currently limited. Minority racial groups are not proportionally represented in either real-world studies or clinical trials, but as more information becomes available and other social issues are addressed, the treatment disparities between African-American and Caucasian patients should decrease. PMID:26056467

  8. Oral Cancer Exam

    Full Text Available ... Search Text size: Website Contents NIDCR Home Oral Health Diseases and Conditions Gum Disease TMJ Disorders Oral Cancer Dry Mouth Burning Mouth Tooth Decay See All Oral Complications of Systemic Diseases Cancer Treatment Developmental ... Health Professionals Detecting Oral Cancer: A Guide for Health ...

  9. Prediction of rates of thromboembolic and major bleeding outcomes with dabigatran or warfarin among patients with atrial fibrillation: new initiator cohort study

    Franklin, Jessica M; Glynn, Robert J; Schneeweiss, Sebastian; Eddings, Wesley; Gagne, Joshua J

    2016-01-01

    Objectives To compare stratified event rates from randomized controlled trials with predicted event rates from models developed in observational data, and assess their ability to accurately capture observed rates of thromboembolism and major bleeding for patients treated with dabigatran or warfarin as part of routine care. Design New initiator cohort study. Setting Data from United Health (October 2009 to June 2013), a commercial healthcare claims database in the United States. Participants 21 934 adults with atrial fibrillation initiating dabigatran (150 mg dose only) or warfarin treatment as part of routine care. Main outcome measures Predicted annual rates of thromboembolism or major bleeding, based on estimates from randomized controlled trials, models developed in routine care patients, and baseline risk scores (CHADS2, CHA2DS2-VASc, and HAS-BLED). Thromboembolism was a composite outcome, including primary inpatient diagnosis codes for ischemic or ill defined stroke, transient ischemic attack, pulmonary embolism, deep vein thrombosis, and systemic embolism. Major bleeding was a composite outcome including codes occurring in an inpatient setting for hemorrhagic stroke; major upper, lower, or unspecified gastrointestinal bleed; and major urogenital or other bleed. Results 6516 (30%) and 15 418 (70%) of patients initiated dabigatran and warfarin, respectively. Annual event rates per 100 patients were 1.7 for thromboembolism and 4.6 for major bleeding. For thromboembolism, calibration of estimates from randomized controlled trials was similar to calibration for model based predictions; however, trial estimates for major bleeding consistently underestimated the rate of bleeding among patients in routine care. Underestimation of bleeding rates was particularly pronounced in warfarin initiators with high HAS-BLED scores, where event rates were underestimated by up to 4.0 per 100 patient years. Harrell’s c indices for discrimination for thromboembolism or

  10. Cost-Effectiveness of Apixaban versus Warfarin in Chinese Patients with Non-Valvular Atrial Fibrillation: A Real-Life and Modelling Analyses

    Li, Xue; Tse, Vicki C.; Lau, Wallis C. Y.; Cheung, Bernard M. Y.; Lip, Gregory Y. H.; Wong, Ian C. K.; Chan, Esther W.

    2016-01-01

    Objectives Many of the cost-effectiveness analyses of apixaban against warfarin focused on Western populations but Asian evidence remains less clear. The present study aims to evaluate the cost-effectiveness of apixaban against warfarin in Chinese patients with non-valvular atrial fibrillation (NVAF) from a public institutional perspective in Hong Kong. Methods We used a Markov model incorporating 12 health state transitions, and simulated the disease progression of NVAF in 1,000 hypothetical patients treated with apixaban/warfarin. Risks of clinical events were based on the ARISTOTLE trial and were adjusted with local International Normalized Ratio control, defined as the time in therapeutic range. Real-life input for the model, including patients’ demographics and clinical profiles, post-event treatment patterns, and healthcare costs, were determined by a retrospective cohort of 40,569 incident patients retrieved from a Hong Kong-wide electronic medical database. Main outcome measurements included numbers of thromboembolic and bleeding events, life years, quality-adjusted life years (QALYs) and direct healthcare cost. When comparing apixaban and warfarin, treatment with incremental cost-effectiveness ratio (ICER) less than one local GDP per capita (USD 33,534 in 2014) was defined to be cost-effective. Results In the lifetime simulation, fewer numbers of events were estimated for the apixaban group, resulting in reduced event-related direct medical costs. The estimated ICER of apixaban was USD 7,057 per QALY at base-case analysis and ranged from USD 1,061 to 14,867 per QALY under the 116 tested scenarios in deterministic sensitivity analysis. While in probabilistic sensitivity analysis, the probability of apixaban being the cost-effective alternative to warfarin was 96% and 98% at a willingness to pay threshold of USD 33,534 and 100,602 per QALY, respectively. Conclusions Apixaban is likely to be a cost-effective alternative to warfarin for stroke prophylaxis in

  11. Specific antidotes against direct oral anticoagulants: A comprehensive review of clinical trials data.

    Tummala, Ramyashree; Kavtaradze, Ana; Gupta, Anjan; Ghosh, Raktim Kumar

    2016-07-01

    The Vitamin K antagonist warfarin was the only oral anticoagulant available for decades for the treatment of thrombosis and prevention of thromboembolism until Direct Oral Anticoagulants (DOACs); a group of new oral anticoagulants got approved in the last few years. Direct thrombin inhibitor: dabigatran and factor Xa inhibitors: apixaban, rivaroxaban, and edoxaban directly inhibit the coagulation cascade. DOACs have many advantages over warfarin. However, the biggest drawback of DOACs has been the lack of specific antidotes to reverse the anticoagulant effect in emergency situations. Activated charcoal, hemodialysis, and activated Prothrombin Complex Concentrate (PCC) were amongst the nonspecific agents used in a DOAC associated bleeding but with limited success. Idarucizumab, the first novel antidote against direct thrombin inhibitor dabigatran was approved by US FDA in October 2015. It comprehensively reversed dabigatran-induced anticoagulation in a phase I study. A phase III trial on Idarucizumab also complete reversal of anticoagulant effect of dabigatran. Andexanet alfa (PRT064445), a specific reversal agent against factor Xa inhibitors, showed a complete reversal of anticoagulant activity of apixaban and rivaroxaban within minutes after administration without adverse effects in two recently completed parallel phase III trials ANNEXA-A and ANNEXA-R respectively. It is currently being studied in ANNEXA-4, a phase IV study. Aripazine (PER-977), the third reversal agent, has shown promising activity against dabigatran, apixaban, rivaroxaban, as well as subcutaneous fondaparinux and LMWH. This review article summarizes pharmacological characteristics of these novel antidotes, coagulation's tests affected, available clinical and preclinical data, and the need for phase III and IV studies. PMID:27082776

  12. Cost-effectiveness of new oral anticoagulants in the treatment and secondary prevention of venous thromboembolism

    A. V. Rudakova

    2015-11-01

    Full Text Available Aim. To assess the cost-effectiveness of apixaban in the treatment and secondary prevention of venous thromboembolism (VTE compared with low molecular weight heparin (LMWH/warfarin and other new oral anticoagulants (NOACs. Material and methods. Cost-effectiveness analysis was performed using a Markov model, developed on the basis of the results of AMPLIFY AMPLIFY-Ext trials, and network meta-analyzes on the use of antithrombotic drugs in acute VTE and long-term administration after VTE. Markov cycle duration was 3 months. The duration of therapy in the simulation was 6 and 12 months. The time horizon of the study was 5 years. Life expectancy and costs were discounted by 3.5% per year. The costs on drugs were estimated based on the registered marginal cost price. Besides, the analysis was performed to the weighted average auctions prices for NOACs. The costs of monitoring and treatment of complications were calculated on the basis of the collective agreement of compulsory health insurance system (St. Petersburg, 2015. Results. Apixaban provided significant cost savings compared with other modes of anticoagulant therapy for hospital treatment. Apixaban provided cost savings compared with other NOACs with a minimal increase in life expectancy with regard to quality in long-term analysis. Apixaban provided an increase in life expectancy compared with the appointment of LMWH/warfarin, but required some increase in costs. At therapy duration of 6 months, the costs per one additional year of life with regard to quality and to one additional calendar year of life were 309.8-403.7 and 481.6-627.4 thousand rubles, respectively; at therapy duration of 12 months – 1254.4-1476.9 and 649.0-764.1 thousand rubles, respectively. Conclusion. Apixaban provided a reduction in the incidence of bleeding compared with other NOACs and LMWH/warfarin with comparable efficacy in treatment and secondary prevention of VTE. Apixaban therapy costs were lower than these

  13. Oral cavity and leprosy

    Shambulingappa Pallagatti; Soheyl Sheikh; Anupreet Kaur; Amit Aggarwal; Ravinder Singh2

    2012-01-01

    Although leprosy involves the oral cavity in up to 60% of the patients, examination of the oral cavity in leprosy clinics or oral health science clinics is often neglected. Oral involvement in leprosy can broadly be divided into non-specific and specific lesions. In this review, we discuss various oral manifestations in leprosy patients so as to increase the awareness about this aspect among dermatologists and dental surgeons.

  14. Interpreting the quality of health care database studies on the comparative effectiveness of oral anticoagulants in routine care

    Schneeweiss S

    2013-09-01

    Full Text Available Sebastian Schneeweiss, Krista F Huybrechts, Joshua J Gagne Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA Background: Dabigatran, an oral direct thrombin inhibitor, has now been available for 2 years in the US for the prevention of stroke in patients with nonvalvular atrial fibrillation, and direct Xa inhibitors are also starting to enter the market. Studies examining the effects of new oral anticoagulants in health care databases are beginning to emerge. The purpose of this study was to describe the validity of early published observational studies on the comparative safety and effectiveness of new oral anticoagulants in patients with atrial fibrillation. Methods: We identified published nonrandomized post-marketing studies (articles or conference abstracts or posters and critically appraised their internal validity, with a particular focus on their ability to control confounding and other biases. Results: Two full-length journal articles, three conference posters, two conference presentation abstracts, and a US Food and Drug Administration analysis form the basis of the early comparative effectiveness and safety experience with new oral anticoagulants. Some published studies exhibit substantial biases and have insufficient precision for several important endpoints. Several studies suffer from biases arising from comparing ongoing users of the older drug, warfarin, who seem to tolerate it, to initiators of the new treatment who may have switched from warfarin or have had no prior experience with anticoagulants. Analyses tended to not adjust or not adjust adequately for confounding, and unsound propensity score application was also observed. Several studies introduced selection bias by excluding patients who died during follow-up and by restricting the study population to those with continuous database enrollment following cohort entry. We

  15. Perfil clínico de los pacientes adultos mayores anticoagulados con warfarina del Hospital Nacional de Geriatría y Gerontología Clinical Profile of Elderly Patients on Anticoagulation with Warfarin

    Luis Alberto Laínez-Sánchez

    2011-12-01

    adherencia al tratamiento, red social poco comprometida y efectos adversos relacionados con la sobre anticoagulación (sangrados menores. Hubo una incidencia similar de sangrados menores y mayores (4.3% y una mortalidad del 1.4%. Conclusión: El manejo del paciente adulto mayor que recibe terapia de anticoagulación oral es de alta complejidad hecho que se ve reflejado tanto en su perfil demográfico como clínico. Las complicaciones asociadas a la terapia no difirieron con las reportadas a nivel internacional.Aim: The National Hospital of Geriatrics and Gerontology (HNGG, handles tens of patients which receives an oral anti-coagulation therapy and which come from diverse provinces of the country; the study realised a clinical and socio-demographic characterization of the anticoagulated older adult population, which receives control and treatment in the external consultation of anti-coagulated persons during the period 2006-2007. Methods:141 older adult patients were studied, all of them anti-coagulated with warfarin during the period 2006-2007. It was performed a descriptive analysis of the demographic and clinical characteristics of all the patients, making emphasis in the causes of the anti-coagulation, comorbitities, amount of medicines used, cognitive, functional and social status, quality of the anti-coagulation, reasons for the suspension of the treatment and complications. Results: The average of age of the patients was of 78 years. The larger part of the population come from the cantons of San Jose province, and possess a low academic level which does not surpass the primary schooling. The Auricular Fibrillation was the main diagnostic, which justifies the anti -coagulation therapy. The most important comorbidity was the combination between the Cardiac Insufficiency and the Arterial Hypertension. The larger part of the population uses 5 or more medicines apart from the warfarin. The group of study mainly presents an adequate cognitive status, a total functional

  16. Trombocitopenia induzida por heparina e necrose cutânea por varfarina: relato de caso Heparin-induced thrombocytopenia and warfarin-induced skin necrosis: case report

    Flávia Larissa Kaiber

    2010-12-01

    Full Text Available É relatado um caso de trombocitopenia induzida por heparina complicada, com necrose cutânea induzida por varfarina em paciente de 74 anos, sexo feminino, internada com diagnóstico de fratura do colo do fêmur, trombose venosa profunda e tromboembolismo pulmonar. A necrose cutânea induzida por varfarina é uma complicação rara da terapia anticoagulante, com alta morbidade e mortalidade, que pode estar associada à trombocitopenia induzida por heparina.This paper describes a case of heparin-induced thrombocytopenia complicated by warfarin-induced skin necrosis in a 74-year old female patient hospitalized with diagnoses of a hip fracture, deep vein thrombosis and pulmonary thromboembolism. Warfarin-induced skin necrosis is a rare complication of anticoagulant therapy, with high morbidity and mortality that may be associated with heparin-induced thrombocytopenia.

  17. A systematic review on comparing 2 common models for management of warfarin therapy; pharmacist-led service versus usual medical care.

    Entezari-Maleki, Taher; Dousti, Samaneh; Hamishehkar, Hadi; Gholami, Kheirollah

    2016-01-01

    Despite a growing body of literature supporting the potential benefit of pharmacist-managed warfarin therapy (PMWT), comprehensive reviews regarding this topic are still lacking. A systematic search of literature was done in Pubmed/Medline, Scopus, Google Scholar, and Cochrane Library from database inception to January 2014. Studies comparing PMWT with usual medical care (UMC) regarding the control of anticoagulation, bleeding and thromboembolic events, mortality, hospitalization, emergency department visit, cost, patients' satisfaction, and quality of life were included. Of 758 potential articles identified, 24 studies (4 randomized controlled trials [RCT] and 20 non-RCT studies) with a population of 11,607 were included. Among non-RCT studies, the percentage of time in the therapeutic range (72.1% vs 56.7%; P = .013), major bleeding events (0.6% vs 1.7%, P managing warfarin therapy based on observational studies. As well, it is comparable to UMC based on RCT studies. PMID:26100092

  18. Edoxaban vs. warfarin in patients with atrial fibrillation on amiodarone: a subgroup analysis of the ENGAGE AF-TIMI 48 trial

    Steffel, J.; Giugliano, R. P.; Braunwald, E; Murphy, S. A.; Atar, D.; HEIDBUCHEL, Hein; Camm, A. J.; Antman, E. M.; Ruff, C. T.

    2015-01-01

    Background In the ENGAGE AF-TIMI 48 trial, the higher-dose edoxaban (HDE) regimen had a similar incidence of ischaemic stroke compared with warfarin, whereas a higher incidence was observed with the lower-dose regimen (LDE). Amiodarone increases edoxaban plasma levels via P-glycoprotein inhibition. The current pre-specified exploratory analysis was performed to determine the effect of amiodarone on the relative efficacy and safety profile of edoxaban. Methods and results At randomization, 249...

  19. Assessment and evaluation efficacy of a clinical pharmacist-led inpatient warfarin knowledge education program and follow-up at a Chinese tertiary referral teaching hospital

    Guy-Armel Bounda

    2013-01-01

    Conclusion: Chinese patients on warfarin therapy should benefit from periodic educational efforts reinforcing key medication safety information. Patient education is not a once-off procedure. A complete patient education program run by a clinical pharmacist in a Cardio-thoracic ward can considerably improve and enhance to reduce the hospital stays and significantly enlighten the role of the patient education in adherence to therapy.

  20. Warfarin for Prevention of Thrombosis Among Long-Term Care Residents with Atrial Fibrillation: Evidence of Continuing Low Use Despite Consideration of Stroke and Bleeding Risk

    Reardon, Gregory; Nelson, Winnie W.; Patel, Aarti A.; Philpot, Tommy; Neidecker, Marjorie

    2013-01-01

    Objectives The aims of the study were to evaluate usage rates of warfarin in stroke prophylaxis and the association with assessed stages of stroke and bleeding risk in long-term care (LTC) residents with atrial fibrillation (AFib). Methods A cross-sectional analysis of two LTC databases (the National Nursing Home Survey [NNHS] 2004 and an integrated LTC database: AnalytiCare) was conducted. The study involved LTC facilities across the USA (NNHS) and within 19 states (AnalytiCare). It included...

  1. Magnetic resonance venography to assess thrombus resolution with edoxaban monotherapy versus parenteral anticoagulation/warfarin for symptomatic deep vein thrombosis: A multicenter feasibility study.

    Piazza, Gregory; Mani, Venkatesh; Goldhaber, Samuel Z; Grosso, Michael A; Mercuri, Michele; Lanz, Hans J; Schussler, Steven; Hsu, Ching; Chinigo, Amy; Ritchie, Bruce; Nadar, Venkatesh; Cannon, Kevin; Pullman, John; Concha, Mauricio; Schul, Marlin; Fayad, Zahi A

    2016-08-01

    The feasibility of magnetic resonance venography (MRV) for measuring change in thrombus volume with a novel anticoagulation regimen versus standard anticoagulation in patients with symptomatic deep vein thrombosis (DVT) has not been assessed. Our aim was to study the feasibility of MRV to measure change in thrombus volume in patients with acute symptomatic objectively confirmed proximal DVT in an open-label multicenter trial (edoxaban Thrombus Reduction Imaging Study, eTRIS). We randomized patients in a 2:1 allocation ratio to edoxaban 90 mg/day for 10 days followed by 60 mg/day versus parenteral anticoagulation bridging to warfarin for 3 months. The primary efficacy outcome was a surrogate end point of the relative change in MRV-quantified thrombus volume from baseline to Day 14-21. A total of 85 eligible patients from 26 study sites were randomized to edoxaban monotherapy (n=56) versus parenteral anticoagulation as a 'bridge' to warfarin (n=29). The mean relative change in MRV-quantified thrombus volume from baseline to Day 14-21 was similar in patients treated with edoxaban and parenteral anticoagulation as a 'bridge' to warfarin (-50.1% vs -58.9%; 95% confidence interval of treatment difference, -12.7%, 30.2%). However, thrombus extension was observed in eight patients in the edoxaban monotherapy group and in none in the warfarin group. Rates of recurrent venous thromboembolism (3.6% vs 3.6%, p=0.45) and clinically relevant non-major bleeding (5.4% vs 7.1%, p=0.34) were also similar. No major bleeds occurred in either on-treatment group during the study period. In conclusion, MRV can assess change in thrombus volume in patients with acute DVT randomized to two different anticoagulant regimens.ClinicalTrials.gov IDENTIFIER NCT01662908: INVESTIGATIONAL NEW DRUG IND APPLICATION EDOXABAN IND # 63266. PMID:27165711

  2. The Effect of Medicinal Education on Adherence Taking Warfarin in Acute Coronary Syndrome (ACS and Atrial Fibrilation (AF Patients at PKU Muhammadiyah Yogyakarta Hospital

    Jastria Pusmarani

    2015-12-01

    Full Text Available In order to improve warfarin medication adherence in patient with Acute Coronary Syndrome (ACS and Atrial Fibrillation (AF, giving education with leaflet administration is one of the solutions. This study was aim to know the impact of pharmacist education with using prepared leaflet on the adherence to warfarin in ACS and AF patients. This study used pre test and post test with control group design. Data were collected prospectively during 8 weeks in June–July 2014 at the ambulatory ACS and AF patients at PKU Muhammadiyah Yogyakarta hospital, Indonesia. Data were collected by medical record and the questionnaire using Morisky Medication Adherence Scale (MMAS. Wilcoxon test was used for statistical analysis. The results shows pre test and post test value in the control group was p=0.194 and pre and post test value in the test group was p=0.058. There was no significant difference (p>0.05 after giving education with leaflet. The education with leaflet had no effect to adherence in warfarin in ACS and AF patients at PKU Muhammadiyah Yogyakarta hospital.

  3. Oral Cancer Exam

    Full Text Available ... Oral Complications of Systemic Diseases Cancer Treatment Developmental Disabilities Diabetes Heart Disease HIV/AIDS See All Order ... Education Practical Oral Care for People With Developmental Disabilities – This booklet presents an overview of physical, mental, ...

  4. Oral Cancer Exam

    Full Text Available ... Research Programs (Extramural Research) NIDCR Laboratories (Intramural Research) Science News in Brief Study Takes First Comprehensive Look ... diagnosis, and treatment of oral cancer, along with definitions of selected medical terms and resource information. Oral ...

  5. Oral Cancer Exam

    Full Text Available ... signs of oral cancer. For Patients and the Public Oral Cancer Pamphlet that describes the risk factors, ... not collect any actual information. External Web Site Policy This graphic notice ( ) means that you are leaving ...

  6. Oral Cancer Exam

    Full Text Available ... Professionals A step-by-step, illustrated guide for health professionals that provides instruction on examining the mouth for signs of oral cancer. For Patients and the Public Oral Cancer Pamphlet that describes the risk factors, ...

  7. Oral Cancer Exam

    Full Text Available ... See All Oral Complications of Systemic Diseases Cancer Treatment Developmental Disabilities Diabetes Heart Disease HIV/AIDS See ... this brochure includes information on symptoms, diagnosis, and treatment of oral cancer, along with definitions of selected ...

  8. Oral Cancer Exam

    Full Text Available ... Trials What Are Clinical Trials? About Clinical Trials Information for Clinical Researchers See All Browse Studies by ... been diagnosed with oral cancer, this brochure includes information on symptoms, diagnosis, and treatment of oral cancer, ...

  9. Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.

    Giuseppe Rengo

    Full Text Available BACKGROUND: Heart failure (HF patients show high morbidity and mortality rate with increased risk of malignant arrhythmia and thromboembolism. Anticoagulation reduces embolic event and death rates in HF patients with atrial fibrillation, but if antithrombotic therapy is beneficial in patients with HF in sinus rhythm is still debated. METHODOLOGY AND PRINCIPAL FINDINGS: We conducted a systematic review of prospective, randomized controlled trials (RCTs to assess the efficacy and safety of oral anticoagulant therapies (OATs compared to antiplatelet treatment in HF patients in sinus rhythm. MEDLINE, Web of Science, CENTRAL and Scopus databases were searched up to May 2012. Four RCTs were identified and a total of 3663 patients were included in the meta-analysis. Patients with both ischemic and non-ischemic HF were included. There was no significant difference in mortality (odds ratio (OR 1.01, 95% confidence interval (CI 0.86 to 1.19 between OATs group and antiplatelet drug group. OATs have reduced ischemic stroke risk (OR 0.49, 95% CI 0.32 to 0.74, but have increased major bleeding risk (OR 2.01, 95% CI 1.40 to 2.88 compared to antiplatelet treatment. CONCLUSION: In HF patients in sinus rhythm OATs do not show a better risk-benefit profile compared to antiplatelet treatment in cardioembolism prevention. Warfarin and aspirin seem to be similar in reducing mortality. Warfarin reduces the incidence of ischemic stroke, but increases major bleedings. Thus, it is possible to speculate that aspirin prescription be indicated in patients with high risk of bleeding, whereas warfarin could be preferred in patients with high thromboembolic risk.

  10. THE PROBLEM OF THE USE OF NEW ORAL ANTICOAGULANTS IN CANCER PATIENTS RECEIVING CHEMOTHERAPY

    A. A. Rumyantsev

    2015-09-01

    Full Text Available Despite large number of known risk factors of venous thromboembolism (VTE in cancer patients existing prediction models do not allow definite identification of cancer patients that have indications for anticoagulant prevention. Besides, heparin and warfarin use for VTE prevention in cancer is accompanied by some problems. New oral anticoagulants (NOAC are promising drugs for use in oncology practice; however their use is complicated by the lack of data on efficacy and safety in these patients, potential drug interactions and the possibility of unpredictable changes in effect during chemotherapy. Widespread use of NOAC for the prevention and treatment of tumor-associated VTE prior to phase III trials is not recommended. However, the criteria for selection of patients for whom the study of the efficacy and safety of NOAC is a priority can now be developed.

  11. Chrysomya Bezziana Oral Myiasis

    G S Vijay Kumar; G S Sowmya; Shivananda, S

    2011-01-01

    Myiasis is an opportunistic infestation of human and vertebrate animals with dipterous larvae. Oral myiasis is a rare condition associated with poor oral hygiene, mental disability, halitosis and other conditions. We present a case report of an adult mentally challenged woman with extensive necrotic oral lesion burrowing into the hard palate through which three live maggots (larvae) were seen emerging out. The larvae were removed using forceps and the patient was treated with oral ivermectin....

  12. Essentials of oral cancer

    Rivera, César

    2015-01-01

    Oral cancer is one of the 10 most common cancers in the world, with a delayed clinical detection, poor prognosis, without specific biomarkers for the disease and expensive therapeutic alternatives. This review aims to present the fundamental aspects of this cancer, focused on squamous cell carcinoma of the oral cavity (OSCC), moving from its definition and epidemiological aspects, addressing the oral carcinogenesis, oral potentially malignant disorders, epithelial precursor lesions and experi...

  13. Oral vaccination of fish

    Embregts, Carmen W.E.; Forlenza, Maria

    2016-01-01

    The limited number of oral vaccines currently approved for use in humans and veterinary species clearly illustrates that development of efficacious and safe oral vaccines has been a challenge not only for fish immunologists. The insufficient efficacy of oral vaccines is partly due to antigen breakdown in the harsh gastric environment, but also to the high tolerogenic gut environment and to inadequate vaccine design. In this review we discuss current approaches used to develop oral vaccines fo...

  14. Radiation induced oral mucositis

    P S Satheesh Kumar; Anita Balan; Arun Sankar; Tinky Bose

    2009-01-01

    Patients receiving radiotherapy or chemotherapy will receive some degree of oral mucositis The incidence of oral mucositis was especially high in patients: (i) With primary tumors in the oral cavity, oropharynx, or nasopharynx; (ii) who also received concomitant chemotherapy; (iii) who received a total dose over 5,000 cGy; and (iv) who were treated with altered fractionation radiation schedules. Radiation-induced oral mucositis affects the quality of life of the patients and the family concer...

  15. Oral health in pregnancy

    Blagojević Duška; Brkanić Tatjana; Stojić Siniša

    2002-01-01

    Introduction Good oral health care during pregnancy is essential but often overlooked factor of dental growth as well as of other structures of oral cavity. Pregnancy is the time when conscious approach to preventive oral care should increase. Preventive measures during pregnancy Preventive measures during pregnancy mean usage of fluorides, special dietary measures and increased oral hygiene habits. Preventive measures in pregnant women have one goal: providing conditions for development of f...

  16. Developing Oral Communication Skills.

    Washington Office of the State Superintendent of Public Instruction, Olympia.

    Intended for use by both elementary and secondary school teachers, the two papers in this report stress the importance of developing students' oral and written communication skills. The first paper, "Relationship of Oral Communication to Reading," by Phil Backlund and John Johnson, argues that ability in oral communication is a prerequisite to the…

  17. Thrush (Oral Candidiasis) in Adults

    ... rashes clinical tools newsletter | contact Share | Thrush (Oral Candidiasis) Information for adults A A A White, slightly ... the tongue and lips are typical of oral candidiasis. Overview Thrush (oral candidiasis), also known as oral ...

  18. Risk of bleeding and stroke with oral anticoagulation and antiplatelet therapy in patients with atrial fibrillation in Taiwan: a nationwide cohort study.

    Pei-Chun Chen

    Full Text Available Data on the use of oral anticoagulation (OAC and antiplatelet therapy and the risk of bleeding and stroke amongst Asian patients with atrial fibrillation (AF are limited. We investigated the risks of bleeding and stroke with use of oral anticoagulation (OAC and antiplatelet therapy as mono- or combination therapy, in patients with AF from a Chinese nationwide cohort study.We studied a cohort of 10384 patients (57.2% men, age 67.8 ± 13.2 yrs between 1999 and 2010 from the National Health Insurance Research Database in Taiwan. Records of prescriptions were obtained during follow-up. The main outcome was a recurrent stroke during the follow-up period. Time-dependent Cox proportional hazards models were used for this analysis.We documented 1009 events for bleeding, as well as 224 hemorrhagic stroke and 1642 ischemic stroke events during a median 3.2 (interquartile range, 1.05-6.54 years' follow-up. Compared with warfarin users, patients with antiplatelet therapy had a lower risk of bleeding (adjusted relative risk [RR], 0.59, 95% confidence interval [CI], 0.49-0.71, p<0.001 whilst combination therapy had a non-statistically significant higher bleeding risk (RR, 1.33, 95%, 0.91-1.94, p = 0.20. Patients on antiplatelet monotherapy had a similar risk for ischemic stroke compared with OAC (RR 1.05, 95% CI, 0.89-1.25, p = 0.50, whilst those on combination therapy had a significantly higher risk (RR 1.90, 95% CI, 1.34-2.70, p<0.001.In a national representative cohort, antiplatelet therapy had no significant difference in ischemic stroke risk to warfarin. For bleeding, aspirin had a lower risk compared to warfarin. This may reflect poor anticoagulation control, highlighting important missed opportunities for improved stroke prevention, especially in countries where anticoagulation management is suboptimal.

  19. Oral Health and Swallowing Problems

    Furuta, Michiko; Yamashita, Yoshihisa

    2013-01-01

    Oral health impacts systemic health. Therefore, oral care is an important consideration in maintaining quality of life (QOL). Previously, maintenance and improvement of oral hygiene was considered essential for achieving oral health. In addition to oral hygiene, oral care in terms of oral function is now considered to maintain QOL. Ingestion of exogenous nutrients via the oral cavity is fundamental to the function of all higher animals, not only human beings. Chewing and swallowing processes ...

  20. Application of NIR chemometric methods for quantification of the crystalline fraction of warfarin sodium in drug product.

    Korang-Yeboah, Maxwell; Akhtar, Sohail; Siddiqui, Akhtar; Rahman, Ziyaur; Khan, Mansoor A

    2016-01-01

    Monitoring of the physical state of warfarin sodium (WS) in products is essential for minimizing product quality variability in order to ensure consistent clinical performance. This study reports the development of chemometric models for quantifying the crystalline and amorphous fractions of WS in commercial drug products using NIR spectroscopy. Formulations based on commercially available products with different API to excipient ratio were used for the study. For each content, two formulations containing either lactose monohydrate or lactose anhydrous as the predominant formulation excipient were prepared. Two formulations containing either 100% amorphous WS (AWS) or crystalline WS (CWS) were prepared and mixed in various ratios to obtain sample matrices containing AWS/CWS 0-100%. The uniformity of the samples was confirmed by near infrared chemical imaging. Data were mathematically pretreated by multiplicative signal correction and Savitzky-Golay second derivative. Principal component regression and partial least square regression models were developed from mathematically treated data. All the models showed linear trend for amorphous and crystalline fractions of the WS as indicated by correlation and R(2) > 0.99 and >0.98, respectively. The models demonstrated good performance parameters with a low-root mean squared error, standard error and bias. The model predicted CWS and AWS contents were in very close agreement with the actual values. The study indicated the utility of NIR chemometric methods in quantification of the crystalline and/or amorphous fraction of WS in its products. PMID:26161939

  1. Oral contraceptives induced hepatotoxicity

    B. Akshaya Srikanth

    2013-02-01

    Full Text Available Oral Contraceptives are the pharmacological agents used to prevent pregnancy. These are divided as the combined and progestogen methods and are administered orally, transdermally, systemically and via vaginal route. All these methods contain both oestrogen and progestogen. Vigorous usage of oral contraceptives and anabolic steroids as associated with cholestasis, vascular lesions and hepatic neoplasm. Benign hepatic neoplasms are clearly associated with oral contraceptives. In this article we discuss the various hepatocellular complications like cholestasis, benign neoplasm and hepatocellular carcinoma occurred by oral contraceptives. [Int J Basic Clin Pharmacol 2013; 2(1.000: 91-93

  2. 口服华法林患者综合监测临床研究%Investigation on integrated monitoring of oral warfarin patients

    侯文权; 周凌云; 侯文锋; 徐胜

    2010-01-01

    目的 探讨冠状动脉造影及支架植入术后口服华法林患者血浆凝血酶原前体蛋白(PIVKA-Ⅱ)、凝血酶原时间(PT)、国际标准化比率(1NR)、蛋白质Z(PZ)、细胞色素P4502C9基因CYP2C9*3的改变、临床意义及心理干预的疗效.方法 158例冠状动脉造影及支架植入术后口服华法林患者为研究组,25名门诊体检人员为对照组,分别进行血浆PZ、PIVKA-Ⅱ、PT、INR、CYP2C9*3测定.比较上述指标与临床的关系及各指标问的相关性,并对上述人员采用90项症状自评量表(SCL-90)进行心理评定.结果 研究组首次服用华法林后4 h,血浆PIVKA-Ⅱ浓度显著增高(P<0.05);首次服用华法林后24 h,PT、INR显著增高(P<0.05);首次服用华法林后16 h PZ显著增高(P<0.05).研究组PIVKA-Ⅱ、PT、INR随时间增加而增高,而PZ随时间增加显著减低.CYP2C9*3的检出率为21.9%.另外95%的患者存在不同程度的心理问题(P<0.01),主要表现为焦虑、抑郁及其他症状.PIVKA-Ⅱ与INR正相关(P<0.05).结论 上述指标能较客观地反映冠状动脉造影及支架植入术后口服华法林患者的病理变化过程.动态观察对病情判断、指导治疗和预后有一定临床意义.同时还需要对患者进行心理健康指导.

  3. Oral biopsy: Oral pathologist′s perspective

    K L Kumaraswamy

    2012-01-01

    Full Text Available Many oral lesions may need to be diagnosed by removing a sample of tissue from the oral cavity. Biopsy is widely used in the medical field, but the practice is not quite widespread in dental practice. As oral pathologists, we have found many artifacts in the tissue specimen because of poor biopsy technique or handling, which has led to diagnostic pitfalls and misery to both the patient and the clinician. This article aims at alerting the clinicians about the clinical faults arising preoperatively, intraoperatively and postoperatively while dealing with oral biopsy that may affect the histological assessment of the tissue and, therefore, the diagnosis. It also reviews the different techniques, precautions and special considerations necessary for specific lesions.

  4. Reservations against new oral anticoagulants after stroke and cerebral bleeding.

    Stöllberger, Claudia; Finsterer, Josef

    2013-07-15

    Dabigatran, rivaroxaban, and apixaban are the new oral anticoagulants (NOAC) which have been investigated in patients with atrial fibrillation (AF) for primary and secondary prevention of stroke and thromboembolism. In these trials NOAC had a similar efficacy and safety profile compared to traditional vitamin-K-antagonists such as warfarin. We advise caution in the use of NOAC in patients with stroke or cerebral hemorrhage because of the following reasons: 1) Patients with cerebral bleeding were excluded from the trials. 2) Stroke within 14 days and severe stroke within 6 months before screening were exclusion criteria in the trials investigating dabigatran and rivaroxaban. 3) There is no antidote for reversal and no reliable laboratory monitoring of the anticoagulant effect for emergency situations. 4) NOAC are either substrates of the P-glycoprotein (P-gp) or are metabolized by the cytochrome P450 (CYP) system, or both. Drug-drug interactions between NOAC and P-gp and CYP-affecting drugs are largely unknown. 5) Long-term effects of thrombin generation inhibition on the occurrence of infections, malignancies, dementia, and other diseases are unknown. Based on these considerations it is our opinion that studies of NOAC in patients with stroke compared with other prevention strategies, as well as more post marketing surveillance data, are required. PMID:23628464

  5. Radiation induced oral mucositis

    P S Satheesh Kumar

    2009-01-01

    Full Text Available Patients receiving radiotherapy or chemotherapy will receive some degree of oral mucositis The incidence of oral mucositis was especially high in patients: (i With primary tumors in the oral cavity, oropharynx, or nasopharynx; (ii who also received concomitant chemotherapy; (iii who received a total dose over 5,000 cGy; and (iv who were treated with altered fractionation radiation schedules. Radiation-induced oral mucositis affects the quality of life of the patients and the family concerned. The present day management of oral mucositis is mostly palliative and or supportive care. The newer guidelines are suggesting Palifermin, which is the first active mucositis drug as well as Amifostine, for radiation protection and cryotherapy. The current management should focus more on palliative measures, such as pain management, nutritional support, and maintenance, of good oral hygiene

  6. Commentary: Oral rehydration solution

    Fontaine, O.

    1998-01-01

    Although it had been shown as early as 1968 that oral rehydration therapy was as effective as intravenous rehydration therapy in the treatment of dehydration due to diarrhoea, use of oral rehydration therapy was limited to rural health centres. In large urban hospitals oral rehydration therapy was held to be inferior to intravenous therapy and tended to be used only when the latter was not available. The results reported in the article by Samadi et al. in 1983 were extremely important in help...

  7. Oral microbiota and cancer

    Meurman, Jukka

    2010-01-01

    Inflammation caused by infections may be the most important preventable cause of cancer in general. However, in the oral cavity the role of microbiota in carcinogenesis is not known. Microbial populations on mouth mucosa differ between healthy and malignant sites and certain oral bacterial species have been linked with malignancies but the evidence is still weak in this respect. Nevertheless, oral microorganisms inevitably up-regulate cytokines and other inflammatory mediators that affect the...

  8. The Canine Oral Microbiome

    Dewhirst, Floyd E.; Klein, Erin A.; Thompson, Emily C.; Blanton, Jessica M.; Chen, Tsute; Milella, Lisa; Buckley, Catherine M. F.; Davis, Ian J.; Bennett, Marie-Lousie; Marshall-Jones, Zoe V.

    2012-01-01

    Determining the bacterial composition of the canine oral microbiome is of interest for two primary reasons. First, while the human oral microbiome has been well studied using molecular techniques, the oral microbiomes of other mammals have not been studied in equal depth using culture independent methods. This study allows a comparison of the number of bacterial taxa, based on 16S rRNA-gene sequence comparison, shared between humans and dogs, two divergent mammalian species. Second, canine or...

  9. Low-molecular-weight heparinoid compared with warfarin for prophylaxis of deep-vein thrombosis in patients who are operated on for fracture of the hip. A prospective, randomized trial

    In a randomized, prospective trial, a low-molecular-weight heparinoid (Org 10172 [Lomoparan]) was compared with warfarin for efficacy and safety in preventing deep-vein thrombosis in 263 patients who had an operatively treated fracture of the hip. One group of patients received Org 10172 in a dose of 750 units subcutaneously every twelve hours until the ninth postoperative day; on the seventh postoperative day, warfarin was added to the regimen. The other group received only warfarin. Both drugs were begun preoperatively, immediately after the admission evaluation. In the patients who received warfarin, the desired prothrombin time was one and one-half times the control level. Deep-vein thrombosis was detected by 125I-fibrinogen scanning and impedance plethysmography and was confirmed by phlebography and compression ultrasonography. Deep-vein thrombosis was found in nine (7 per cent) of the 132 patients who received Org 10172 and in twenty-eight (21 per cent) of the 131 patients who received warfarin (p less than 0.001). Adverse reactions were not significantly different in the two groups. Major bleeding complications occurred in eight patients in the Org-10172 group, only four of whom were receiving the drug at the time of bleeding, and in five patients who were receiving warfarin (not significant). There was no difference in intraoperative loss of blood or in requirements for transfusion. We concluded that the low-molecular-weight heparinoid Org 10172 is a safe, convenient, effective antithrombotic agent for the prevention of venous thrombosis after an operation for fracture of the hip

  10. CATCH: a randomised clinical trial comparing long-term tinzaparin versus warfarin for treatment of acute venous thromboembolism in cancer patients

    Low-molecular-weight heparin (LMWH) is recommended and commonly used for extended treatment of cancer-associated thrombosis (CAT), but its superiority over warfarin has been demonstrated in only one randomised study. We report here the rationale, design and a priori analysis plans of Comparison of Acute Treatments in Cancer Haemostasis (CATCH; NCT01130025), a multinational, Phase III, open-label, randomised controlled trial comparing tinzaparin with warfarin for extended treatment of CAT. The primary objective is to assess the efficacy of tinzaparin in preventing recurrent venous thromboembolism (VTE) in patients with active cancer and acute, symptomatic proximal deep vein thrombosis and/or pulmonary embolism. The secondary objectives are to determine: safety of tinzaparin given over 6 months; clinical and laboratory markers for recurrent VTE and/or major bleeding; 6-month overall mortality; incidence and severity of post-thrombotic syndrome; patient-reported quality of life; and healthcare resource utilisation. Nine hundred patients are randomised to receive tinzaparin 175 IU/kg once daily for 6 months or initial tinzaparin 175 IU/kg once daily for 5–10 days and dose-adjusted warfarin (target INR 2.0–3.0) for 6 months. The primary composite outcome is time to recurrent VTE, including incidental VTE and fatal pulmonary embolism. All patients are followed up to 6 months or death, whichever comes sooner. Blinded adjudication will be performed for all reported VTE, bleeding events and causes of death. Efficacy will be analysed using centrally adjudicated results of all patients according to intention-to-treat analysis. An independent Data Safety Monitoring Board is reviewing data at regular intervals and an interim analysis is planned after 450 patients have completed the study. The results will add significantly to the knowledge of the efficacy, safety and cost effectiveness of tinzaparin in the prevention of recurrent VTE in patients with cancer and thrombosis

  11. Chrysomya Bezziana oral myiasis

    G S Vijay Kumar

    2011-01-01

    Full Text Available Myiasis is an opportunistic infestation of human and vertebrate animals with dipterous larvae. Oral myiasis is a rare condition associated with poor oral hygiene, mental disability, halitosis and other conditions. We present a case report of an adult mentally challenged woman with extensive necrotic oral lesion burrowing into the hard palate through which three live maggots (larvae were seen emerging out. The larvae were removed using forceps and the patient was treated with oral ivermectin. The maggots were identified as larvae of the Chrysomya bezziana fly.

  12. Oral Cancer Exam

    Full Text Available ... Oral Health Diseases and Conditions Gum Disease TMJ ... – This booklet presents an overview of physical, mental, and behavioral challenges common in patients with developmental ...

  13. [Oral hygiene aids].

    Hovius, M; Leemans, G J

    1994-05-01

    Different dental hygiene aids are discussed, such as floss, tape, superfloss, gauze, flat shoelace, toothpick, interproximal brush, single-tufted brush, electric toothbrush, manual toothbrush and oral irrigation. Research shows that not one specific aid is superior to another if effectiveness is taken into consideration. Other factors which can influence oral hygiene efficacy are discussed as well. PMID:11830968

  14. Oral Microbiology and Immunology

    Dahlén, Gunnar; Fiehn, Nils-Erik; Olsen, Ingar

    , dental assistants and trainees may find it a useful source of reference. The contents are based on general microbiology and immunology. Oral microbiology is given particular attention, with examples relevant to oral infectious diseases. Each chapter opens with a relatively short pre-reading section...

  15. Oral administration of taxanes

    Malingré, M.M.

    2002-01-01

    Oral treatment with cytotoxic agents is to be preferred as this administration route is convenient to patients, reduces administration costs and facilitates the use of more chronic treatment regimens. For the taxanes paclitaxel and docetaxel, however, low oral bioavailability has limited development

  16. Oral Cancer Exam

    Full Text Available ... Oral Health Diseases and Conditions Gum Disease TMJ Disorders Oral Cancer Dry Mouth Burning Mouth Tooth Decay ... Need to Know ​​ Main Content Share This Page Facebook External link – please review our disclaimer Twitter External ...

  17. Shared Oral Care

    Hede, Børge; Elmelund Poulsen,, Johan; Christophersen, Rasmus;

    2014-01-01

    Shared Oral Care - Forebyggelse af orale sygdomme på plejecentre Introduktion og formål: Mangelfuld mundhygiejne hos plejekrævende ældre er et alment og veldokumenteret sundhedsproblem, der kan føre til massiv udvikling af tandsygdomme, og som yderligere kan være medvirkende årsag til alvorlige...

  18. Oral environment and cancer.

    Kudo, Yasusei; Tada, Hidesuke; Fujiwara, Natsumi; Tada, Yoshiko; Tsunematsu, Takaaki; Miyake, Yoichiro; Ishimaru, Naozumi

    2016-01-01

    Cancer is now the leading cause of death in Japan. A rapid increase in cancer mortality is expected as Japan is facing a super-aged society. Many causes of cancer are known to be closely linked to life style factors, such as smoking, drinking, and diet. The oral environment is known to be involved in the pathogenesis and development of various diseases such as bronchitis, pneumonia, diabetes, heart disease, and dementia. Because the oral cavity acts as the bodily entrance for air and food, it is constantly exposed to foreign substances, including bacteria and viruses. A large number of bacteria are endemic to the oral cavity, and indigenous oral flora act to prevent the settlement of foreign bacteria. The oral environment is influenced by local factors, including dental plaque, tartar, teeth alignment, occlusion, an incompatible prosthesis, and bad lifestyle habits, and systemic factors, including smoking, consumption of alcohol, irregular lifestyle and eating habits, obesity, stress, hormones, and heredity. It has recently been revealed that the oral environment is associated with cancer. In particular, commensal bacteria in the oral cavity are involved in the development of cancer. Moreover, Candida, human papilloma virus and Epstein-Barr virus as well as commensal bacteria have been reported to be associated with the pathogenesis of cancer. In this review, we introduce recent findings of the correlation between the oral environment and cancer. PMID:27482300

  19. American Academy of Oral Medicine

    ... Orlando, FL AAOM: Representing the Discipline of Oral Medicine Oral Medicine is the discipline of dentistry concerned with the ... offers credentialing, resources and professional community for oral medicine practitioners. Our membership provides care to thousands We ...

  20. Oral Contraceptive Pill and PCOS

    ... Medical Conditions Nutrition & Fitness Emotional Health PCOS: The Oral Contraceptive Pill Posted under Health Guides . Updated 1 June ... hormone levels in girls with PCOS. What are oral contraceptive pills? Oral contraceptive pills contain two types of ...

  1. Clinical Pharmacist Participating in the Treatment of Hemorrhage Induced by Warfarin Therapy in a Patient with Mechanical Heart Valve Prostheses%临床药师参与心脏机械瓣膜术后华法林致出血的治疗

    郭婷婷

    2015-01-01

    Objective To explore the modes and ideas of clinical pharmacists' participation in clinical drug treatment. Methods Clinical pharmacist participated in the whole treatment process of hemorrhage induced by oral warfarin pa tient with mechanical heart valve prostheses, and provided recommendations on rational drug use for doctors, gave phar-maceutical care and drug knowledge education on patient. Results Clinical pharmacist made treatment program more reasonable and reduced the incidence of adverse drug reactions. Conclusion Clinical pharmacist can further promote the safe, effective and reasonable drug use in clinic by providing clinical pharmacy services.%目的:探索临床药师参与临床药物治疗的工作模式及思路。方法临床药师参与心脏瓣膜术后口服华法林致患者出血的治疗全过程,为医生提供合理用药建议,并对患者进行药学监护及用药教育。结果临床药师的参与使治疗方案更为合理,减少了药品不良反应的发生。结论临床药师为临床提供药学服务,进一步促进临床用药安全、有效、合理。

  2. Delayed Bleeding and Pelvic Haematoma after Low-Energy Osteoporotic Pubic Rami Fracture in a Warfarin Patient: An Unusual Cause of Abdominal Pain

    Andrea Sandri

    2014-01-01

    Full Text Available Introduction. Acute abdominal pain may be the presenting symptom in a wide range of diseases in the elderly. Acute abdominal pain related to a delayed bleeding and pelvic haematoma after a low-energy pubic rami fracture is rare and can have important consequences; to the best of our knowledge, only one case has been previously described. Case Report. We present an unusual case of an 83-year-old woman taking warfarin for atrial fibrillation, admitted to the Emergency Department (ED with acute abdominal pain and progressive anemia related to a delayed bleeding and pelvic haematoma 72 hours after a low-energy osteoporotic pubic rami fracture. Warfarin was withheld, anticoagulation was reversed by using fresh frozen plasma and vitamin K, and concentrated red blood cells were given. Haemoglobin level gradually returned to normal with a progressive resorption of the haematoma. Conclusion. Delayed bleeding and pelvic haematoma after osteoporotic pubic rami fracture should be considered in the differential diagnosis of acute abdominal pain in the elderly. This case indicates the need for hospital admission, careful haemodynamic monitoring, and early identification of bleeding in patients with “benign” osteoporotic pubic rami fracture, especially those receiving anticoagulants, to provide an adequate management and prevent severe complications.

  3. Cyclodextrin-assisted enantioseparation of warfarin and 10-hydroxywarfarin by capillary electrophoresis studied from the analytical and thermodynamic points of view.

    Nowak, Paweł Mateusz; Woźniakiewicz, Michał; Kościelniak, Paweł

    2016-07-15

    In this work cyclodextrin-assisted enantioseparation of warfarin and 10-hydroxywarfarin by CE has been studied from the analytical and thermodynamic points of view. The role of cyclodextrin concentration and temperature has been analyzed in reference to three different analytical parameters, corresponding to selectivity, resolution and resolution/analysis time ratio. The optimal conditions for enantioseparation have been found, they have been selected on the basis of critical difference in electrophoretic mobility and possibly short analysis time. The values of complexation percentage have also been calculated, to provide a link between the state of complexation equilibrium and the effectiveness of enantioseparation. In the optimal conditions the difference in complexation degree between enantiomers reaches 2.5% and 7.3% for warfarin and 10-hydroxywarfarin, respectively. At each temperature the highest enantioresolution is observed when the average complexation degree is close to 50%. In each case complexation is exothermic and driven by some enthalpically favorable process. 10-hydroxywarfarin exerts the stronger affinity to cyclodextrin and the stronger stereoselective effect. The presented results may be helpful in optimization and understanding of chiral separations by CE. PMID:27160739

  4. The influence of VKORC1 and CYP2C9 gene sequence variants on the stability of maintenance phase warfarin treatment

    Skov, Jane; Bladbjerg, Else-Marie; Leppin, Anja; Jespersen, Jørgen

    2013-01-01

    INTRODUCTION: A substantial part of the inter-individual variation in vitamin K-antagonist dose can be explained by certain sequence variants in the genes CYP2C9 (NG_008385.1:g.8633C>T or *1/*2, NG_008385.1:g.47639A>C or *1/*3) and VKORC1 (NG_011564.1:g.6399C>T). Patients possessing these variant...... alleles require lower doses and have increased risk of overanticoagulation. METHODS: We investigated the influence of the above sequence variants on stability of maintenance phase warfarin therapy in a prospective study of 300 consecutive patients followed for one year at an anticoagulant clinic. RESULTS...... effects of common gene sequence variants in CYP2C9 and VKORC1 on stability of maintenance phase warfarin therapy. Patients attending an anticoagulant clinic using computer-assisted dosage were safely monitored regardless of these sequence variants, but for the small subgroup of patients with the CYP2C9...

  5. Novel mutations in the VKORC1 gene of wild rats and mice – a response to 50 years of selection pressure by warfarin?

    Jäkel Thomas

    2009-02-01

    Full Text Available Abstract Background Coumarin derivatives have been in world-wide use for rodent pest control for more than 50 years. Due to their retarded action as inhibitors of blood coagulation by repression of the vitamin K reductase (VKOR activity, they are the rodenticides of choice against several species. Resistance to these compounds has been reported for rodent populations from many countries around the world and poses a considerable problem for efficacy of pest control. Results In the present study, we have sequenced the VKORC1 genes of more than 250 rats and mice trapped in anticoagulant-exposed areas from four continents, and identified 18 novel and five published missense mutations, as well as eight neutral sequence variants, in a total of 178 animals. Mutagenesis in VKORC1 cDNA constructs and their recombinant expression revealed that these mutations reduced VKOR activities as compared to the wild-type protein. However, the in vitro enzyme assay used was not suited to convincingly demonstrate the warfarin resistance of all mutant proteins Conclusion Our results corroborate the VKORC1 gene as the main target for spontaneous mutations conferring warfarin resistance. The mechanism(s of how mutations in the VKORC1 gene mediate insensitivity to coumarins in vivo has still to be elucidated.

  6. Literatura Oral Hispanica (Hispanic Oral Literature).

    McAlpine, Dave

    As part of a class in Hispanic Oral Literature, students collected pieces of folklore from various Hispanic residents in the region known as "Siouxland" in Iowa. Consisting of some of the folklore recorded from the residents, this paper includes 18 "cuentos y leyendas" (tales and legends), 48 "refranes" (proverbs), 17 "chistes" (jokes), 1…

  7. Rivaroxaban as an oral anticoagulant for stroke prevention in atrial fibrillation

    Turpie AGG

    2014-03-01

    Full Text Available Alexander GG Turpie Department of Medicine, McMaster University, Hamilton, ONT, Canada Abstract: Atrial fibrillation (AF is the most common cardiac arrhythmia in the developed world and is associated with a fivefold increase in the risk of stroke, accounting for up to 15% of strokes in the general population. The European Society of Cardiology now recommends direct oral anticoagulants, such as rivaroxaban, apixaban, and dabigatran, in preference to vitamin K antagonist therapy for the prevention of stroke in patients with AF. This review focuses on the direct Factor Xa inhibitor rivaroxaban, summarizing the properties that make rivaroxaban appropriate for anticoagulant therapy in this indication (including its predictable pharmacokinetic and pharmacodynamic profile and once-daily dosing regimen and describing data from the Phase III ROCKET AF trial, which showed once-daily rivaroxaban to be noninferior to warfarin for the prevention of stroke in patients with nonvalvular AF. In this trial, similar rates of major and nonmajor clinically relevant bleeding were observed; however, when compared with warfarin, rivaroxaban was associated with clinically significant reductions in intracranial and fatal bleeding. On the basis of these results, rivaroxaban was approved in both the United States and the European Union for the prevention of stroke and systemic embolism in patients with nonvalvular AF. Subanalyses of ROCKET AF data showed rivaroxaban to have consistent efficacy and safety across a wide range of patients, and studies to confirm these results in real-world settings are underway. This review also describes practical considerations for treatment with rivaroxaban in clinical practice (including dose reductions in specific high-risk patients, eg, those with renal impairment, recommendations for the transition from vitamin K antagonists to rivaroxaban, the management of bleeding events, and the measurement of rivaroxaban exposure. Keywords: atrial

  8. Oral health in pregnancy

    Blagojević Duška

    2002-01-01

    Full Text Available Introduction Good oral health care during pregnancy is essential but often overlooked factor of dental growth as well as of other structures of oral cavity. Pregnancy is the time when conscious approach to preventive oral care should increase. Preventive measures during pregnancy Preventive measures during pregnancy mean usage of fluorides, special dietary measures and increased oral hygiene habits. Preventive measures in pregnant women have one goal: providing conditions for development of fetal teeth as well as preventing tooth decay in pregnant women. The optimal period for introducing preventive measures is the first trimester of pregnancy. Alterations of oral health during pregnancy Because of hormonal alterations there is an increased incidence of dental diseases: gingivitis and low salivary pH (inflammation and bleeding gums. Impact of nutrition during pregnancy on oral health Eating habits of pregnant women may lead to frequent snacking on candy or other decay-promoting foods, thereby increasing the risk of caries. However, very poor oral health, possible dental complications and their consequences to the health as well as emotional status represent very strong reasons for activation of dental health care in this period.

  9. Oral Lesions in Neonates

    Rao, Roopa S; Majumdar, Barnali; Jafer, Mohammed; Maralingannavar, Mahesh; Sukumaran, Anil

    2016-01-01

    ABSTRACT Oral lesions in neonates represent a wide range of diseases often creating apprehension and anxiety among parents. Early examination and prompt diagnosis can aid in prudent management and serve as baseline against the future course of the disease. The present review aims to enlist and describe the diagnostic features of commonly encountered oral lesions in neonates. How to cite this article: Patil S, Rao RS, Majumdar B, Jafer M, Maralingannavar M, Sukumaran A. Oral Lesions in Neonates. Int J Clin Pediatr Dent 2016;9(2):131-138. PMID:27365934

  10. Oral sex and oral health: An enigma in itself

    Tarun Kumar

    2015-01-01

    Full Text Available Oral sex is commonly practiced by sexually active couples of various age groups, including male-female and same-gender adolescents. The various type of oral sex practices are fellatio, cunnilingus, and analingus. Oral sex can transmit oral, respiratory, and genital infections from one site in body to the other. Oral health has a direct correlation on the transmission of infection; a cut in the mouth, bleeding gums, lip sores or broken skin increases chances of life-threatening infections. Although oral sex is considered a low risk activity, it is important to use protection such as physical barriers, health and medical issues, ethical issues, and oral hygiene and dental issues. The ulcerations or unhealthy periodontium in mouth accelerates the phenomenon of transmission of infections into the circulation. Thus, consequences of unhealthy or painful oral cavity are significant and oral health should be given paramount importance for the practice of oral sex.

  11. Oral sex and oral health: An enigma in itself.

    Kumar, Tarun; Puri, Gagan; Aravinda, Konidena; Arora, Neha; Patil, Deepa; Gupta, Rajesh

    2015-01-01

    Oral sex is commonly practiced by sexually active couples of various age groups, including male-female and same-gender adolescents. The various type of oral sex practices are fellatio, cunnilingus, and analingus. Oral sex can transmit oral, respiratory, and genital infections from one site in body to the other. Oral health has a direct correlation on the transmission of infection; a cut in the mouth, bleeding gums, lip sores or broken skin increases chances of life-threatening infections. Although oral sex is considered a low risk activity, it is important to use protection such as physical barriers, health and medical issues, ethical issues, and oral hygiene and dental issues. The ulcerations or unhealthy periodontium in mouth accelerates the phenomenon of transmission of infections into the circulation. Thus, consequences of unhealthy or painful oral cavity are significant and oral health should be given paramount importance for the practice of oral sex. PMID:26692602

  12. Oral Cancer Exam

    Full Text Available ... Health Professionals Detecting Oral Cancer: A Guide for Health Care Professionals A step-by-step, illustrated guide for health professionals that provides instruction on examining the mouth ...

  13. Oral Cancer Exam

    Full Text Available ... College Students Recent College Graduates Dental and Medical Students See All Careers & Training Opportunities Job Openings Loan Repayment Programs Careers in Dental Research See All Continuing Education Practical Oral Care for People With Developmental Disabilities – ...

  14. Oral Cancer Exam

    Full Text Available ... and Medical Students See All Careers & Training Opportunities Job Openings Loan Repayment Programs Careers in Dental Research See All Continuing Education Practical Oral Care for People With Developmental Disabilities – ...

  15. Oral Cancer Exam

    Full Text Available ... Z Index Search Text size: Website Contents NIDCR Home Oral Health Diseases and Conditions Gum Disease TMJ ... site’s privacy policy when you follow the link. Home Contact Us Viewers and Players Site Map FOIA ...

  16. Oral Cancer Exam

    Full Text Available ... it can be treated more successfully. Publications​ For Health Professionals Detecting Oral Cancer: A Guide for Health Care Professionals A step-by-step, illustrated guide ...

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    Full Text Available ... Disabilities – This booklet presents an overview of physical, mental, and behavioral challenges common in ... and the importance of detecting the disease in its early stages. The Oral Cancer Exam ...

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    Full Text Available ... Disabilities – This booklet presents an overview of physical, mental, and behavioral challenges common in patients with developmental disabilities and offers ... Health Professionals Detecting Oral Cancer: A Guide for Health ...

  19. Oral Cancer Exam

    Full Text Available Skip to Main Content National Institute of Dental and Craniofacial Research (NIDCR) Improving the Nation's Oral Health National Institutes of Health Español Staff Directory A–Z Index Search Text size: Website ...

  20. Oral Cancer Exam

    Full Text Available ... Graduates Dental and Medical Students See All Careers & Training Opportunities Job Openings Loan Repayment Programs Careers in Dental Research See All Continuing Education Practical Oral Care for People With Developmental Disabilities – ...

  1. Oral Cancer Exam

    Full Text Available ... Programs Careers in Dental Research See All Continuing Education Practical Oral Care for People With Developmental Disabilities – This booklet presents an overview of physical, mental, and behavioral challenges common in patients with developmental ...

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    Full Text Available ... Diabetes Heart Disease HIV/AIDS See All Order Publications English and Spanish brochures available free of charge. ... early—when it can be treated more successfully. Publications​ For Health Professionals Detecting Oral Cancer: A Guide ...

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    Full Text Available ... Submission of Applications Grants 101 (How to Write a Grant) Questions and Answers Grant Writing Tips Careers & ... successfully. Publications​ For Health Professionals Detecting Oral Cancer: A Guide for Health Care Professionals A step-by- ...

  5. Oral Carcinogenesis and Oral Cancer Chemoprevention: A Review

    Takahiro Tanaka; Mayu Tanaka; Takuji Tanaka

    2011-01-01

    Oral cancer is one of the major global threats to public health. The development of oral cancer is a tobacco-related multistep and multifocal process involving field cancerization and carcinogenesis. The rationale for molecular-targeted prevention of oral cancer is promising. Biomarkers of genomic instability, including aneuploidy and allelic imbalance, are possible to measure the cancer risk of oral premalignancies. Understanding of the biology of oral carcinogenesis will yield important adv...

  6. Oral microbiome and oral and gastrointestinal cancer risk

    Ahn, Jiyoung; Chen, Calvin Y.; Hayes, Richard B.

    2012-01-01

    A growing body of evidence implicates human oral bacteria in the etiology of oral and gastrointestinal cancers. Epidemiological studies consistently report increased risks of these cancers in men and women with periodontal disease or tooth loss, conditions caused by oral bacteria. More than 700 bacterial species inhabit the oral cavity, including at least 11 bacterial phyla and 70 genera. Oral bacteria may activate alcohol and smoking-related carcinogens locally or act systemically, through c...

  7. Determinants of Oral Health: Does Oral Health Literacy Matter?

    Mohammad Mehdi Naghibi Sistani; Reza Yazdani; Jorma Virtanen; Afsaneh Pakdaman; Heikki Murtomaa

    2013-01-01

    Objective. To evaluate oral health literacy, independent of other oral health determinants, as a risk indicator for self-reported oral health. Methods. A cross-sectional population-based survey conducted in Tehran, Iran. Multiple logistic regression analysis served to estimate the predictive effect of oral health literacy on self-reported oral health status (good versus poor) controlling for socioeconomic and demographic factors and tooth-brushing behavior. Results. In all, among 1031 partici...

  8. Oral sex and oral health: An enigma in itself

    Tarun Kumar; Gagan Puri; Konidena Aravinda; Neha Arora; Deepa Patil; Rajesh Gupta

    2015-01-01

    Oral sex is commonly practiced by sexually active couples of various age groups, including male-female and same-gender adolescents. The various type of oral sex practices are fellatio, cunnilingus, and analingus. Oral sex can transmit oral, respiratory, and genital infections from one site in body to the other. Oral health has a direct correlation on the transmission of infection; a cut in the mouth, bleeding gums, lip sores or broken skin increases chances of life-threatening infections. Alt...

  9. Clinical Effect of Warfarin Anticoagulant Therapy for Treatment of Chronic Severe Heart Failure with Persistent Atrial Fibrillation%华法林抗凝治疗慢性重度心力衰竭合并持续性心房颤动的临床疗效

    周铁军

    2016-01-01

    Objective To investigate the clinical efficacy of warfarin anticoagulation for treatment of severe chronic heart failure with persistent atrial fibrillation.Methods From January 2012 to July 2014, 109 cases with severe chronic heart failure with persistent atrial fibrillation in the second people's hospital of Yuhong District were selected as the research object, they were randomly divided into experimental group and control group; the control group received aspirin therapy, and the experimental group used oral warfarin therapy; the clinical efficacy and incidence rate of complications were compared between two groups.Results In the experimental group, the left ventricular ejection fraction(left ventricular ejection fractions, LVEF)is respectively(25.9 ±9.7)mm and(30.6±10.3)mm before and after treatment; atrial fibrillation cardioversion rate was 76.36%(42 cases); the occurrence rate of complications was 14.55%, including 2 cases of thromboembolism, bleeding in 6 cases. In the control group, LVEF is respectively(25.2±10.4)mm and(26.5±10.7)mm before and after treatment; atrial fibrillation cardioversion rate was 53.70%(29 cases); the occurrence rate of complications was 27.78%, including 9 cases of thromboembolism and hemorrhage in 6 cases. The comparison between two groups,P<0.05, there was statistical difference.Conclusion Clinical efficacy of warfarin for treatment of chronic severe heart failure with persistent atrial fibrillation is remarkable. It is recommended that internal physicians using the therapeutic regimen.%目的 探讨华法林抗凝治疗慢性重度心力衰竭合并持续性心房颤动的临床疗效.方法 收集2012年1月至2014年7月于我院治疗慢性重度心力衰竭合并持续性心房颤动的109例患者为研究对象,将其随机分为实验组和对照组,对照组使用阿司匹林口服治疗,实验组使用华法林口服治疗,对两组患者临床疗效及并发症的发生率进行对比分析.结果 实验组:

  10. Melatonin and Oral Cavity

    Murat İnanç Cengiz; Seda Cengiz; Hom-Lay Wang

    2012-01-01

    While initially the oral cavity was considered to be mainly a source of various bacteria, their toxins and antigens, recent studies showed that it may also be a location of oxidative stress and periodontal inflammation. Accordingly, this paper focuses on the involvement of melatonin in oxidative stress diseases of oral cavity as well as on potential therapeutic implications of melatonin in dental disorders. Melatonin has immunomodulatory and antioxidant activities, stimulates the proliferatio...

  11. Damaging Oral Habits

    Kamdar, Rajesh J; Al-Shahrani, Ibrahim

    2015-01-01

    Oral habits, if persist beyond certain developmental age, can pose great harm to the developing teeth, occlusion, and surrounding oral tissues. In the formative years, almost all children engage in some non-nutritive sucking habits. Clinicians, by proper differential diagnosis and thorough understanding of natural growth and developmental processes, should take a decision for intervening. This article describes case series reports of thumb sucking, finger sucking, and tongue thrusting habits,...

  12. Oral pregnancy tumor

    Gondivkar, Shailesh M.; Amol Gadbail; Revant Chole

    2010-01-01

    Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury, or hormonal factors. It predominantly occurs in the second decade of life in young females, possibly because of the vascular effects of female hormones. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manife...

  13. Oral Precancer and Cancer

    Ramachandran Sudarshan; G. Sree Vijayabala

    2013-01-01

    Oral cancer is a well known disorder causing mortality. Even though many etiological factors have been proposed, but it is mainly due to tobacco (smoking and smokeless form). This tobacco has several carcinogenic substances which results in the formation of cancer. We represent a male patient 60 years of age with Oral cancer in the left vestibule induced due to smokeless tobacco. It was associated with leukoplakia in the left buccal mucosa. [Cukurova Med J 2013; 38(2.000): 342-344

  14. Oral Precancer and Cancer

    Sudarshan, Ramachandran; Vijayabala, G. Sree

    2013-01-01

    Oral cancer is a well known disorder causing mortality. Even though many etiological factors have been proposed, but it is mainly due to tobacco (smoking and smokeless form). This tobacco has several carcinogenic substances which results in the formation of cancer. We represent a male patient 60 years of age with Oral cancer in the left vestibule induced due to smokeless tobacco. It was associated with leukoplakia in the left buccal mucosa.

  15. Oral vs. salivary diagnostics

    Marques, Joana; Corby, Patricia M.; Barber, Cheryl A.; Abrams, William R.; Malamud, Daniel

    2015-05-01

    The field of "salivary diagnostics" includes studies utilizing samples obtained from a variety of sources within the oral cavity. These samples include; whole unstimulated saliva, stimulated whole saliva, duct saliva collected directly from the parotid, submandibular/sublingual glands or minor salivary glands, swabs of the buccal mucosa, tongue or tonsils, and gingival crevicular fluid. Many publications state "we collected saliva from subjects" without fully describing the process or source of the oral fluid. Factors that need to be documented in any study include the time of day of the collection, the method used to stimulate and collect the fluid, and how much fluid is being collected and for how long. The handling of the oral fluid during and post-collection is also critical and may include addition of protease or nuclease inhibitors, centrifugation, and cold or frozen storage prior to assay. In an effort to create a standard protocol for determining a biomarker's origin we carried out a pilot study collecting oral fluid from 5 different sites in the mouth and monitoring the concentrations of pro- and anti-inflammatory cytokines detected using MesoScaleDiscovery (MSD) electrochemiluminesence assays. Our data suggested that 3 of the cytokines are primarily derived from the submandibular gland, while 7 of the cytokines come from a source other than the major salivary glands such as the minor salivary glands or cells in the oral mucosae. Here we review the literature on monitoring biomarkers in oral samples and stress the need for determining the blood/saliva ratio when a quantitative determination is needed and suggest that the term oral diagnostic be used if the source of an analyte in the oral cavity is unknown.

  16. Immunologically mediated oral diseases

    Sudha Jimson; Balachader, N.; N Anita; Babu, R

    2015-01-01

    Immune mediated diseases of oral cavity are uncommon. The lesions may be self-limiting and undergo remission spontaneously. Among the immune mediated oral lesions the most important are lichen planus, pemphigus, erythema multiformi, epidermolysis bullosa, systemic lupus erythematosis. Cellular and humoral mediated immunity play a major role directed against epithelial and connective tissue in chronic and recurrent patterns. Confirmatory diagnosis can be made by biopsy, direct and indirect imm...

  17. ON ORAL CANCER

    P. V. Svetitsky

    2015-04-01

    Full Text Available The paper analyzes a rise in the incidence of oral cancer in the Rostov Region since the 1990s. The study has indicated that this rise is associated with regional population growth due to the forced migrants after the collapse of the USSR. Financial problems, unbalanced nutrition, poor oral hygiene, and depression in this group of patients have contributed to the higher incidence of precancers and cancers.

  18. Oral and systemic photoprotection.

    Chen, Andrew C; Damian, Diona L; Halliday, Gary M

    2014-01-01

    Photoprotection can be provided not only by ultraviolet (UV) blockers but also by oral substances. Epidemiologically identified associations between foods and skin cancer and interventional experiments have discovered mechanisms of UV skin damage. These approaches have identified oral substances that are photoprotective in humans. UV inhibits adenosine triphosphate (ATP) production causing an energy crisis, which prevents optimal skin immunity and DNA repair. Enhancing ATP production with oral nicotinamide protects from UV immunosuppression, enhances DNA repair and reduces skin cancer in humans. Reactive oxygen species also contribute to photodamage. Nontoxic substances consumed in the diet, or available as oral supplements, can protect the skin by multiple potential mechanisms. These substances include polyphenols in fruit, vegetables, wine, tea and caffeine-containing foods. UV-induced prostaglandin E2 (PGE2 ) contributes to photodamage. Nonsteroidal anti-inflammatory drugs and food substances reduce production of this lipid mediator. Fish oils are photoprotective, at least partially by reducing PGE2 . Orally consumed substances, either in the diet or as supplements, can influence cutaneous responses to UV. A current research goal is to develop an oral supplement that could be used in conjunction with other sun protective strategies in order to provide improved protection from sunlight. PMID:24313740

  19. Comparison of Characteristics and Outcomes of Dabigatran Versus Warfarin in Hypertensive Patients With Atrial Fibrillation (from the RE-LY Trial).

    Nagarakanti, Rangadham; Wallentin, Lars; Noack, Herbert; Brueckmann, Martina; Reilly, Paul; Clemens, Andreas; Connolly, Stuart J; Yusuf, Salim; Ezekowitz, Michael D

    2015-10-15

    Hypertension is frequent in patients with atrial fibrillation (AF) and is an independent risk factor for stroke. The Randomized Evaluation of Long Term Anticoagulant TherapY (RE-LY) trial found dabigatran 110 mg (D110) and 150 mg twice daily (D150) noninferior or superior to warfarin for stroke reduction in patients with AF, with either a reduction (D110) or similar rates (D150) of major bleeding. Baseline characteristics and outcomes were compared in patients with and without hypertension. The quality of blood pressure control was also assessed. In RE-LY, 14,283 patients (78.9%) had hypertension. The mean blood pressure at baseline was 132.6 ± 17.6/77.7 ± 10.6 and 124.8 ± 16.7/74.6 ± 10.0 mm Hg for patients with and without hypertension, respectively. More patients with hypertension were diabetic (25.6% vs 14.8%, p warfarin were similar (p = nonsignificant) in hypertensive (stroke/systemic embolism rate of 1.47%, 1.20%, and 1.81% and major bleed rate of 2.89%, 3.70%, and 3.69% in the D110, D150, and W, respectively) and normotensive patients (stroke/systemic embolism rate of 1.79%, 0.78%, and 1.36% and major bleed rate of 2.84%, 2.37%, and 3.03% per year in the D110, D150, and W, respectively). Hypertensive patients had more major bleeds (3.39% vs 2.76%; p = 0.007). Intracranial bleeds were similar (0.47% vs 0.31%; p = 0.12). In conclusion, patients with hypertension in RE-LY were more likely female, diabetic, with a greater CHADS2 and CHA2DS2-VASc scores. Blood pressure control in RE-LY was excellent. The benefits of dabigatran over warfarin, including a substantial reduction of intracranial hemorrhage, were similar in both hypertensive and non-hypertensive patients. PMID:26282726

  20. Non-vitamin K antagonist oral anticoagulants for the prevention of recurrent venous thromboembolism.

    Bauersachs, Rupert

    2016-08-01

    Venous thromboembolism (VTE) is associated with a risk of recurrence that depends on factors specific to index event and patient. A first unprovoked VTE increases the risk of a recurrent event, particularly during the first year after anticoagulation cessation. Determining a strategy for the long-term prevention of recurrent VTE poses challenges that stem from a lack of agreement on recommended therapy duration and varying treatment burden for the patient. Oral anticoagulants, including vitamin K antagonists and non-vitamin K antagonist oral anticoagulants (NOACs), are the main treatment options for the long-term prevention of recurrent VTE. However, the risk of VTE recurrence must be balanced against the risk of bleeding in each patient. Phase III clinical trials have evaluated rivaroxaban, apixaban and dabigatran for extended treatment and prevention of VTE versus placebo, and versus warfarin in the case of dabigatran. Compared with placebo treatment, each NOAC showed superior efficacy together with an acceptable safety profile during extended treatment periods of 6-18months. Patients receiving long-term NOAC therapy will still require regular risk factor assessment, but these agents may permit longer treatment duration with an improved benefit-risk profile. PMID:27263046

  1. Taking warfarin (Coumadin)

    ... open Pulmonary embolus Transient ischemic attack Patient Instructions Atrial fibrillation - discharge Carotid artery surgery - discharge Heart attack - discharge Heart failure - discharge Heart valve surgery - discharge Hip replacement - discharge ...

  2. Graphite oral tattoo: case report

    Moraes, Renata Mendonça; Gouvêa Lima, Gabriela de Morais; Guilhermino, Marinaldo; Vieira, Mayana Soares; Carvalho, Yasmin Rodarte; Anbinder, Ana Lia

    2015-01-01

    Pigmented oral lesions compose a large number of pathological entities, including exogenous pigmentat oral tattoos, such as amalgam and graphite tattoos. We report a rare case of a graphite tattoo on the palate of a 62-year-old patient with a history of pencil injury, compare it with amalgam tattoos, and determine the prevalence of oral tattoos in our Oral Pathology Service. We also compare the clinical and histological findings of grafite and amalgam tattoos. Oral tattoos affect women more f...

  3. ORAL MYIASIS CONVERTING TO ORAL SQUAMOUS CELL CARCINOMA

    Akshay

    2015-10-01

    Full Text Available INTRODUCTION: Oral Myiasis, a condition of infestation of the body by fly larvae (maggots is a rare pathology in humans. It is associated with poor oral hygiene, alcoholism, senility, suppurating lesions, severe halitosis. It is seen frequently in tropical countries and hot climatic regions. The reported cases in literature of oral Myiasis associated with oral cancer are few. The treatment is a mechanical removal of the maggots but a systemic treatment with Ivermectin, a semi - synthetic macrolide antibiotic, has been used successfully for treatment for oral m yiasis. We present a case of 55 yr old male alcoholic patient with oral myiasis with extensive proliferative growth of oral cavity. Our patient was managed with manual debridement and administration of systemic ivermect in along with antibiotic coverage. Incisional biopsy of the proliferative lesion showed well differentiated squamous cell carcinoma. Thus our patient showed presence of oral myiasis in association with oral squamous cell carcinoma.

  4. Randomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system.

    Ryan, F

    2009-08-01

    Increased frequency of prothrombin time testing, facilitated by patient self-testing (PST) of the International Normalized Ratio (INR) can improve the clinical outcomes of oral anticoagulation therapy (OAT). However, oversight of this type of management is often difficult and time-consuming for healthcare professionals. This study reports the first randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on OAT.

  5. Oral pregnancy tumor

    Shailesh M Gondivkar

    2010-01-01

    Full Text Available Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury, or hormonal factors. It predominantly occurs in the second decade of life in young females, possibly because of the vascular effects of female hormones. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous growth on a pedunculated or sometimes sessile base, which is usually hemorrhagic. Although excisional surgery is the treatment of choice , some other treatment protocols such as the use of Nd:YAG laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection of ethanol or corticosteroids, and sodium tetradecyl sulfate sclerotherapy have been proposed. We present the case of a 25-year-old pregnant woman with large oral pyogenic granuloma.

  6. [Oral problems in divers].

    Scheper, W A; Lobbezoo, F; Eijkman, M A J

    2005-05-01

    Divers can have several oral problems. Firstly, problems caused by pressure changes. These are barodontalgia and odontocrexis. Barodontalgia is toothache by barotrauma. Odontocrexis is restorations coming lose or breaking or tooth fractures by expansion of air beneath restorations. Other problems can occur by cements used to fix casted restorations, by inflammations in the orofacial region, and by not yet fully healed oral wounds. Secondly, there are problems related to the diver's mouthpiece. To keep the mouthpiece in place, the mandible has to be forced in a forward position. Holding this position often and for long periods of time, may develop or aggravate temporomandibular dysfunction. Insufficient fit of the mouthpiece may induce oral mucosal lesions. Therefore, it is recommended to produce individual diver mouthpieces. It is also recommended to produce individual diver mouthpieces for complete dentures wearing divers and for divers with fixed orthodontic appliances. PMID:15932043

  7. Oral myiasis in children

    M H Raghunath Reddy

    2012-01-01

    Full Text Available Oral myiasis is a rare condition in humans and is associated with poor oral hygiene, severe halitosis, mouth breathing during sleep, mental handicap, cerebral palsy, epilepsy, anterior open bite, incompetent lips, and other conditions. In this report, a 14 year-old boy who had an orofacial trauma in the maxillary dentoalveolar region,which was neglected, has been described. There was a deep lacerated wound on the upper vestibule which was infected and maggots were found on the same wound. The clinical features, management, treatment are discussed and relevant literature is reviewed.

  8. Oral Myiasis: Case report

    S Jimson

    2013-01-01

    Full Text Available Oral myiasis is a rare disease caused by larvae of dipteran flies. Houseflies are strongly suspected of transmitting at least 65 diseases to humans, including typhoid fever, dysentery and cholera. Flies regurgitate and excrete wherever they come to rest and thereby mechanically are the root cause for disease organisms. A case of oral myiasis caused by Chrysomya bezziana in the maxillary anterior region in a 40-year-old patient is presented. Manual removal of maggots, and surgical debridement of wound was done followed by broad-spectrum anti-parasitic medications. A note on the identification of the larva and histopathology of the tissue is also highlighted here.

  9. Oral allergy syndrome

    Sergeev, A. V.; M. A. Mokronosova

    2003-01-01

    Abstract. Oral allergy syndrome (OAS) is defined as a set of clinical manifestations caused by IgE-mediated allergic  reactions  that  occur  at  oral  and  pharyngeal  mucosae  in  the  patients  with  pollen  sensitization  after ingestion of certain fruits, vegetables, nuts and spices. OAS arises from cross-reactivity between specific pollen and food allergens, due to similarity of a configuration and amino acid sequence of allergenic molecules. OAS is considered as class II food allergy, ...

  10. Oral lichen planus

    Lichen planus is a mucocutaneous dermatological disorder, with intraoral manifestation. Skin lesions prevail with oral mucosal lesions. Prevalence of lichen planus, as an oral pre-malignant lesion, is 1-2 % population. Lateral border, dorsal tongue, gingiva, hard palate and vermilion border are common sites and lesions appear as reticular, plaque-like and papular intraoral types. Skin presents with pururitic, polygonal papules. Atrophic and erosive are the known intraoral pre-malignant types. A case report is presented, which responded well to steroid therapy. (author)

  11. Metabolomic Studies of Oral Biofilm, Oral Cancer, and Beyond

    Jumpei Washio; Nobuhiro Takahashi

    2016-01-01

    Oral diseases are known to be closely associated with oral biofilm metabolism, while cancer tissue is reported to possess specific metabolism such as the ‘Warburg effect’. Metabolomics might be a useful method for clarifying the whole metabolic systems that operate in oral biofilm and oral cancer, however, technical limitations have hampered such research. Fortunately, metabolomics techniques have developed rapidly in the past decade, which has helped to solve these difficulties. In vivo meta...

  12. Oral health as a predictive factor for oral mucositis

    Fabio Luiz Coracin; Paulo Sergio da Silva Santos; Gallottini, Marina H. C.; Rosaura Saboya; Priscila Tavares Musqueira; Alessandra Barban; Dalton de Alencar Fischer Chamone; Frederico Luiz Dulley; Fabio Daumas Nunes

    2013-01-01

    OBJECTIVES: Oral mucositis is a complication frequently associated with hematopoietic stem cell transplantation, decreasing a patient's quality of life and increasing the occurrence of opportunistic infections. The purpose of this study was to determine the incidence and severity of oral mucositis and to assess the correlation of this disease with the oral health of an individual at the time of hematopoietic stem cell transplantation. METHODS: Before transplantation, patients' oral health a...

  13. ORAL MYIASIS CONVERTING TO ORAL SQUAMOUS CELL CARCINOMA

    Akshay; Aparna; Kriti Bagri

    2015-01-01

    INTRODUCTION: Oral Myiasis, a condition of infestation of the body by fly larvae (maggots) is a rare pathology in humans. It is associated with poor oral hygiene, alcoholism, senility, suppurating lesions, severe halitosis. It is seen frequently in tropical countries and hot climatic regions. The reported cases in literature of oral Myiasis associated with oral cancer are few. The treatment is a mechanical removal of the m...

  14. Paracoccidioidomicosis en cavidad oral Oral cavity paracoccidioidomycosis

    D. Antunes Freitas

    2012-02-01

    Full Text Available La paracoccidioidomicosis (PCM o blastomicosis suramericana es la micosis sistémica más importante de América latina que es relativamente común en Brasil, Venezuela, Colombia, Ecuador y Argentina. Los casos esporádicos también pueden verse en algunos otros países, la cual es progresiva y con un infrecuente desenlace fatal si no es tratada a tiempo. Se considera como una enfermedad multifocal, con lesiones orales como la característica prominente. Es causada por un hongo dimórfico, Paracoccidioides brasiliensis, que afecta principalmente la piel, los ganglios linfáticos, los pulmones y membranas mucosas oral, nasal y gastrointestinal. Dependiendo de la inmunidad específica del huésped, la infección puede asumir muchas formas y afecta a uno o varios órganos, llegando a ser una enfermedad grave y potencialmente fatal. Es muy importante para los profesionales de la salud de todo el mundo tener conocimiento acerca de la Paracoccidioidomicosis porque a veces la enfermedad sólo se manifiesta muchos años después de que haya abandonado la zona endémica. Para proporcionar información útil sobre el diagnóstico y tratamiento de la enfermedad se presenta caso clínico de un paciente masculino de 48 años de edad procedente de una zona rural de Juramento Brasil, por presentar múltiples úlceras dolorosas en encía y paladar de 3 meses de evolución; refiere antecedentes de fumador crónico, al examen clínico extraoral se descartan lesiones en otros órganos y al examen intraoral se observan múltiples úlceras con fondo necrótico y granulomatoso localizadas en encía y paladar. Se realizó una biopsia incisional de la lesión y el material fue enviado para estudio anatomopatológico. El informe histopatológico confirmó la impresión clínica de Paracoccidioidomicosis. El paciente fue tratado con el uso de sulfametoxazol + trimetoprima - 800/60 mg/día, vía oral, cada 12 horas durante 30 días. Las lesiones bucales desaparecieron

  15. Oral Cancer Exam

    Full Text Available ... Nation's Oral Health National Institutes of Health Español Staff Directory A–Z Index Search Text size: Website ... an endorsement by NIH or any of its employees of the sponsors or the information and products ...

  16. History of oral contraception.

    Dhont, Marc

    2010-12-01

    On the 50th birthday of the pill, it is appropriate to recall the milestones which have led to its development and evolution during the last five decades. The main contraceptive effect of the pill being inhibition of ovulation, it may be called a small miracle that this drug was developed long before the complex regulation of ovulation and the menstrual cycle was elucidated. Another stumbling block on its way was the hostile climate with regard to contraception that prevailed at the time. Animal experiments on the effect of sex steroids on ovulation, and the synthesis of sex steroids and orally active analogues were the necessary preliminaries. We owe the development of oral contraceptives to a handful of persons: two determined feminists, Margaret Sanger and Katherine McCormick; a biologist, Gregory Pincus; and a gynaecologist, John Rock. Soon after the introduction of the first pills, some nasty and life-threatening side effects emerged, which were due to the high doses of sex steroids. This led to the development of new preparations with reduced oestrogen content, progestins with more specific action, and alternative administration routes. Almost every decade we have witnessed a breakthrough in oral contraception. Social and moral objections to birth control have gradually disappeared and, notwithstanding some pill scares, oral contraceptives are now one of the most used methods of contraception. Finally, all's well that ends well: recent reports have substantiated the multiple noncontraceptive health benefits paving the way for a bright future for this 50-year-old product. PMID:21091163

  17. Oral Supplementation of Myoinositol

    Gregersen, G.; Bertelsen, B.; Harbo, H.;

    1983-01-01

    28 young diabetics with short disease duration participated in a double-blind study by taking 6 g of myoinositol or placebo daily for 2 months. The aim was to demonstrate a possible beneficial effect of this compound on subclinical diabetic neuropathy. Measurement of vibratory perception threshol...... of myoinositol in their muscle tissue remained uninfluenced by oral supplementation of myoinositol....

  18. Oral Cancer Exam

    Full Text Available ... Internships for... High School and College Students Recent College Graduates Dental and Medical Students See All Careers & Training Opportunities Job Openings Loan Repayment Programs Careers in Dental Research See All Continuing Education Practical Oral Care for People With Developmental Disabilities – ...

  19. AAS Oral History Project

    Buxner, Sanlyn; Holbrook, Jarita; AAS Oral History Team

    2016-06-01

    Now in its fourth year, the AAS Oral History Project has interviewed over 80 astronomers from all over the world. Led by the AAS Historical Astronomy Division (HAD) and partially funded by the American Institute of Physics Niels Bohr Library and ongoing support from the AAS, volunteers have collected oral histories from astronomers at professional meetings starting in 2015, including AAS, DPS, and the IAU general assembly. Each interview lasts one and a half to two hours and focuses on interviewees’ personal and professional lives. Questions include those about one’s family, childhood, strong influences on one’s scientific career, career path, successes and challenges, perspectives on how astronomy is changing as a field, and advice to the next generation. Each interview is audio recorded and transcribed, the content of which is checked with each interviewee. Once complete, interview transcripts are posted online as part of a larger oral history library at https://www.aip.org/history-programs/niels-bohr-library/oral-histories. Future analysis will reveal a rich story of astronomers and will help the community address issues of diversity, controversies, and the changing landscape of science. We are still recruiting individuals to be interviewed from all stages of career from undergraduate students to retired and emeritus astronomers. Contact Jarita Holbrook to schedule an interview or to find out more information about the project (astroholbrook@gmail.com). Also, contact Jarita Holbrook if you would like to become an interviewer for the project.

  20. Oral Health and Women

    2009-05-12

    This women's health podcast focuses on the importance of maintaining good oral health during pregnancy.  Created: 5/12/2009 by Office of Women’s Health (OWH) and National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/12/2009.

  1. Oral Cancer Exam

    Full Text Available ... Programs Careers in Dental Research See All Continuing Education Practical Oral Care for People With Developmental Disabilities – This booklet presents an overview of physical, mental, and behavioral challenges common in patients with developmental disabilities and offers strategies for providing ...

  2. Progestin-Only Oral Contraceptives

    Progestin-only oral contraceptives are used to prevent pregnancy. Progestin is a female hormone. It works by preventing the ... mucus and the lining of the uterus. Progestin-only oral contraceptives are a very effective method of ...

  3. Head, Neck, and Oral Cancer

    ... and Soft Tissue Surgery Dental and Soft Tissue Surgery Oral and facial surgeons surgically treat the soft tissues ... and Soft Tissue Surgery Dental and Soft Tissue Surgery Oral and facial surgeons surgically treat the soft tissues ...

  4. Estrogen and Progestin (Oral Contraceptives)

    Oral contraceptives (birth-control pills) are used to prevent pregnancy. Estrogen and progestin are two female sex hormones. ... to prevent sperm (male reproductive cells) from entering. Oral contraceptives are a very effective method of birth control, ...

  5. Age-related oral changes.

    Mckenna, Gerald

    2010-10-01

    Age-related oral changes are seen in the oral hard and soft tissues as well as in bone, the temporomandibular joints and the oral mucosa. As older patients retain their natural teeth for longer, the clinical picture consists of normal physiological age changes in combination with pathological and iatrogenic effects. Clinical Relevance: With an ageing population retaining more of its natural teeth for longer, dental professionals should expect to observe oral age changes more frequently.

  6. Oral health and institutionalised elderly

    Samson, Heidi

    2009-01-01

    Aim: The main aim of this thesis was to generate initiatives promoting good oral health for institutionalised elderly. It was therefore essential to investigate how their oral health status has changed over time, whether care professionals have adequate oral care knowledge and if the oral hygiene of the institutionalised elderly can be improved in the long-term by a new quality assurance system. Methods: Several different methods were used, with both descriptive and analytical ...

  7. Changeability of Oral Cavity Environment

    Surdacka, Anna; Strzyka³a, Krystyna; Rydzewska, Anna

    2007-01-01

    Objectives In dentistry, the results of in vivo studies on drugs, dental fillings or prostheses are routinely evaluated based on selected oral cavity environment parameters at specific time points. Such evaluation may be confounded by ongoing changes in the oral cavity environment induced by diet, drug use, stress and other factors. The study aimed to confirm oral cavity environment changeability. Methods 24 healthy individuals aged 20–30 had their oral cavity environment prepared by having p...

  8. Oral manifestations of vitiligo

    Anitha Nagarajan

    2015-01-01

    Full Text Available Background: Vitiligo is one of the disorder that has social impact . Both skin and mucous membrane show depigmentation in vitiligo. Depigmentation in oral cavity can be more easily observed and the patient can be given awareness regarding the condition if they are unaware of vitiligo elsewhere in their body and can be guided for treatment. Aim and objectives: The aim of this study is to determine the frequency of occurrence of oral mucosal vitiligo in vitiligo patients and to determine the most commonly involved oral mucosal site. Materials and methods: The study sample included 100 vitiligo patients. The patients of all age groups and both genders were included. Vitiligo patients associated with systemic conditions such as thyroid disorders, juvenile diabetes mellitus, pernicious anemia, Addison′s disease were excluded in this study. Results: Out of 100 vitiligo patients 44 % male and 56% were female. The oral presentation of vitiligo in this study showed depigmentation of buccal mucosa in 5% of patients, labial mucosa in 5% of patients, palate in 8% of patients, gingiva in 2% of patients and alveolar mucosa 1% . Depigmentation of lip was seen in 42% of patients. Lip involvement refers to depigmentation of both the lips or either lip. Also vermilion border involvement was noted in majority of cases. In some cases, the depigmentation of lip extended to the facial skin also. Conclusion: In this study 55 patients out of 100 patients showed depigmentation in the oral cavity. Lip involvement was most common in this study showing about 42% of patients. Intraoral mucosal involvement was found in 21% of patients. Among intraoral mucosal site palate was common followed by buccal and labial mucosa, gingiva. Two patients had lip pigmentation as the only manifestation without any depigmentation in the skin.

  9. Social disparity and oral health

    Maria Fidela de Lima Navarro

    2012-01-01

    Full Text Available There is a clear reported association between social disparity and oral health, for example, between dental caries and malnutrition in children. This fact is detected in several studies, and also found amongst the Brazilian population. However, several efforts have been made to improve the quality of life of the population and to achieve the 2015 Millennium Development Goals. Oral health is a branch to be improved among these goals. The Brazilian experience has been drawing the attention of authorities, insofar as there have been direct improvements in oral health through state oral health programs, and also indirect results by improving the quality of life of the population. Included within the Brazilian oral health programs are the Family Health Program and Smiling Brazil Program. The former is a global healthcare program which involves primary oral healthcare, while the latter is a specialized oral care program. Among the social programs that would indirectly improve oral health are Family Stipend and the Edmond and Lily Safra International Institute of Neuroscience of Natal (ELS-IINN. In conclusion, although oral health problems are related to socioeconomic factors, the implementation of primary oral health programs and programs to improve the population's quality of life may directly or indirectly improve the oral health scenario. This fact is being observed in Brazil, where the oral health policies have changed, and social programs have been implemented.

  10. Oral health: equity and social determinants

    Kwan, Stella; Petersen, Poul Erik

    This book chapter discusses the social determinants of oral health, and identifies interventions that have been, or can be, used in addressing oral health inequities (e.g. oral health promotion, education programmes, improving access to oral health care)....

  11. Efficacy and safety of new oral anticoagulants in prophylaxis and treatment of venous thromboembolism

    Luca Masotti

    2011-04-01

    Full Text Available One of the main innovation emerged in recent years in the field of venous thromboembolism (VTE has been represented by the clinical development and marketing of new oral anticoagulant agents used for prophylaxis and acute treatment. These drugs are represented by direct thrombin inhibitors (anti-factor IIa and the direct inhibitors of activated factor X (anti-Xa. The main achievement of these new agents is represented by their ease of use without laboratory monitoring or dose adjustment. Dabigatran (anti-factor IIa, rivaroxaban, and apixaban (anti-Xa are in advanced phase of clinical development with concluded phase III trials. Up to now the results of efficacy and safety of phase III clinical trials are available, while phase IV studies are currently ongoing. Overall, the phase III clinical trials showed the non inferiority of new oral anticoagulants in VTE prophylaxis of patients undergone to major orthopedic surgery, such as hip and knee arthroplasty, compared to conventional prophylaxis represented by subcutaneous low molecular weight heparin with similar safety. Moreover dabigatran has shown to be not inferior when compared to warfarin for the prevention of six months VTE recurrences, with a significative lower incidence of bleedings. Awaiting the results of many other ongoing phase III trials, since now it is possible to think that, in the next future, new oral anticoagulants will be widely diffused in clinical practice for their ease of use and feasibility. In this review the Authors analyse the available results of phase III clinical trials for dabigatran, rivaroxaban and apixaban, focusing on the antithrombotic endpoints for prevention and treatment of VTE and the bleeding risk. Moreover synthesis of ongoing trials will be displayed.

  12. Scandinavian Fellowship for Oral Pathology and Oral Medicine

    Kragelund, Camilla; Reibel, Jesper; Hietanen, J;

    2012-01-01

    In Scandinavia, as in many European countries, most patients consult their general dentist once a year or more. This gives the dentist a unique opportunity and an obligation to make an early diagnosis of oral diseases, which is beneficial for both the patient and the society. Thus, the dentist must...... new approaches, treatments and diagnostic possibilities develop. Likewise, the role of the dentist in the community changes and may vary in different countries. As members of the Scandinavian Fellowship for Oral Pathology and Oral Medicine and subject representatives of oral pathology and oral...... medicine, we feel obliged to contribute to the discussion of how the guidelines of the dental curriculum support the highest possible standards of dental education. This article is meant to delineate a reasonable standard of oral pathology and oral medicine in the European dental curriculum and to guide...

  13. THE ASSESSMENT OF COMPLIANCE TO THE USE OF NEW ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION ACCORDING TO THE PROFILE REGISTER

    S. Y. Martsevich

    2015-09-01

    Full Text Available Aim. To study in the PROFILE register the rate of new oral anticoagulants (NOAC taking in patients with atrial fibrillation (AF and to identify the factors influencing it.Material and methods. Patients with AF who applied to the Cardiology Center in 2013-2014 (n=111 were included into the study. The oral anticoagulants (OAC were recommended to patients at the reference visit (n=97. Inquiry in questionnaire format was performed to assess the compliance to recommended therapy at the follow-up visit. Patients were divided into two groups according to taking/not-taking NOAC. Analysis of the facts that influence the compliance to NOAC therapy was performed.Results. At the reference visit 70 patients desired to receive NOAC. At the follow-up visit 29 (41.4% patients refused to take NOAC. Leading causes of NOAC refusal were satisfactory with warfarin (32.6%, the high price of these drugs (23.9%, the description of adverse reactions in the patient information leaflet for medicines (15.2%, and withdrawal by physician in outpatient clinic/hospital (8.7%. Preferential provision of medicines and warfarin therapy at the time of reference visit had a negative impact on the taking of NOAC. Patients taking NOAC were more aware of the possible outcomes of their illness, the possible side effects of OAC and were more familiar with patient information leaflet for medicines.Conclusion. The study assessed NOAC taking rate and the factors influencing patients' compliance to NOAC therapy.

  14. Quantitative Immunoexpression of EGFR in Oral Potentially Malignant Disorders: Oral Leukoplakia and Oral Submucous Fibrosis

    Jyothi Meka, Naga; Ugrappa, Sridevi; Velpula, Nagalaxmi; Kumar, Sravan; Naik Maloth, Kotya; Kodangal, Srikanth; Ch, Lalitha; Goyal, Stuti

    2015-01-01

    Background and aims. Many oral squamous cell carcinomas develop from potentially malignant disorders (PMDs)which include a variety of lesions and conditions characterized by an increased risk for malignant transformation. Thisstudy evaluated the quantitative expression of EGFR in normal oral mucosa, oral leukoplakia and oral submucous fibrosis to predict the malignant risk in compliance with the intensity of staining with EGFR. Materials and methods. Thirty subjects were included in the study...

  15. Immunologically mediated oral diseases

    Sudha Jimson

    2015-01-01

    Full Text Available Immune mediated diseases of oral cavity are uncommon. The lesions may be self-limiting and undergo remission spontaneously. Among the immune mediated oral lesions the most important are lichen planus, pemphigus, erythema multiformi, epidermolysis bullosa, systemic lupus erythematosis. Cellular and humoral mediated immunity play a major role directed against epithelial and connective tissue in chronic and recurrent patterns. Confirmatory diagnosis can be made by biopsy, direct and indirect immunoflouresence, immune precipitation and immunoblotting. Therapeutic agents should be selected after thorough evaluation of immune status through a variety of tests and after determining any aggravating or provoking factors. Early and appropriate diagnosis is important for proper treatment planning contributing to better prognosis and better quality of life of patient.

  16. Immunologically mediated oral diseases.

    Jimson, Sudha; Balachader, N; Anita, N; Babu, R

    2015-04-01

    Immune mediated diseases of oral cavity are uncommon. The lesions may be self-limiting and undergo remission spontaneously. Among the immune mediated oral lesions the most important are lichen planus, pemphigus, erythema multiformi, epidermolysis bullosa, systemic lupus erythematosis. Cellular and humoral mediated immunity play a major role directed against epithelial and connective tissue in chronic and recurrent patterns. Confirmatory diagnosis can be made by biopsy, direct and indirect immunoflouresence, immune precipitation and immunoblotting. Therapeutic agents should be selected after thorough evaluation of immune status through a variety of tests and after determining any aggravating or provoking factors. Early and appropriate diagnosis is important for proper treatment planning contributing to better prognosis and better quality of life of patient. PMID:26015713

  17. Oral and Facial Pain

    Mock, David

    1988-01-01

    Diagnosis of oral and facial pain is often difficult because several anatomical structures within this small area are capable of producing similar symptoms, and pain referred from cranial or distant sites and emotional or psychiatric disturbances complicate matters further. This article summarizes some of the more common causes of orofacial pain, with the exception of disorders of the temporomandibular joint and associated musculature, which are covered in a separate article.

  18. Feline oral pathology

    Costa, S.; Pais, B.; Almeida, D.; Simões, J.; Mega, A. C.; Vala, Helena

    2013-01-01

    The main pathologies of the oral cavity are of utmost importance, not only by the number of exposed individuals, but also by the consequences which stems. With the development of this work, we intend to conduct a brief approach to the same, since, specifically affecting domestic felines. Feline Lymphoplasmatic Gingivostomatitis (GELF), the Feline Odontoclastic Reabsorption Lesions (LROF) Complex and gingivitis-stomatitis-pharyngitis, have been studied, some of which are considered an enigma i...

  19. Training in oral medicine.

    Zakrzewska, J M

    2001-01-01

    88 members of the UK specialty society of oral medicine were asked about career satisfaction and their views on training programmes. 70% responded (79% of consultants and all accredited trainees). Men work longer hours than women, report less control over their work and experience more stress. Although high work satisfaction is reported, nearly one-third regret their choice of specialty. Men more than women do locum work while training. Most respondents would welcome flexible training, job sh...

  20. Oral Myiasis : Case Report

    Ramli, Roszalina; Abd Rahman, Roslan

    2002-01-01

    Myiasis occurs when living tissues of mammals are invaded by eggs or larvae of flies, mainly from the order of Diptera. Most of the previousty reported cases are in the tropics and they were usually associated with inadequate personal hygiene, sometimes with poor manual dexterity. This report describes two cases of oral myiasis in cerebral palsy patients in Seremban General Hospital, Malaysia. This article also discusses the therapeutic property of maggots and highlights the importance of ora...

  1. Oral lymphangioma: case report

    Marcelo Gadelha Vasconcelos; Bruna Câmara Santos; Luciana Cristina Peixoto Lemos; Betania Fachetti Ribeiro; Déborah Pitta Paraíso Iglesias; Rodrigo Gadelha Vasconcelos; Ana Myriam Costa de Medeiros

    2011-01-01

    Introduction: Lymphangioma is a change of lymphatic vessels that frequently affects the head and neck region. Its occurrence at oral cavity is rare and it is most commonly identified at the anterior two-thirds of the tongue. At this location, it is clinically characterized as transparent and generally grouped vesicles, which can be red or purple. The deep lesions appear as nodular masses of variable color and superficial texture. It can be classified according to the size of vessels into thre...

  2. Fluoride and Oral Health.

    O'Mullane, D M; Baez, R J; Jones, S; Lennon, M A; Petersen, P E; Rugg-Gunn, A J; Whelton, H; Whitford, G M

    2016-06-01

    The discovery during the first half of the 20th century of the link between natural fluoride, adjusted fluoride levels in drinking water and reduced dental caries prevalence proved to be a stimulus for worldwide on-going research into the role of fluoride in improving oral health. Epidemiological studies of fluoridation programmes have confirmed their safety and their effectiveness in controlling dental caries. Major advances in our knowledge of how fluoride impacts the caries process have led to the development, assessment of effectiveness and promotion of other fluoride vehicles including salt, milk, tablets, toothpaste, gels and varnishes. In 1993, the World Health Organization convened an Expert Committee to provide authoritative information on the role of fluorides in the promotion of oral health throughout the world (WHO TRS 846, 1994). This present publication is a revision of the original 1994 document, again using the expertise of researchers from the extensive fields of knowledge required to successfully implement complex interventions such as the use of fluorides to improve dental and oral health. Financial support for research into the development of these new fluoride strategies has come from many sources including government health departments as well as international and national grant agencies. In addition, the unique role which industry has played in the development, formulation, assessment of effectiveness and promotion of the various fluoride vehicles and strategies is noteworthy. This updated version of 'Fluoride and Oral Health' has adopted an evidence-based approach to its commentary on the different fluoride vehicles and strategies and also to its recommendations. In this regard, full account is taken of the many recent systematic reviews published in peer reviewed literature. PMID:27352462

  3. Milk and oral health.

    Johansson, Ingegerd; Lif Holgerson, Pernilla

    2011-01-01

    Oral health includes freedom from disease in the gums, the mucosa and the teeth. There has been a striking reduction in dental caries and periodontitis in industrialized countries, although the proportion with severe disease has remained at 10-15%, and the prevalence increases in less developed countries. If left untreated, these diseases may lead to pain, and impaired quality of life and nutritional status. Prevention and treatment need, besides traditional implementation of proper oral hygiene, sugar restriction and use of fluoride, newer cost-effective strategies. Non-sweetened dairy products, which are proven non-cariogenic, or specific bioactive components from alike sources might prove to be part of such strategies. Thus, milk proteins, such as bovine and human caseins and lactoferrin, inhibit initial attachment of cariogenic mutans streptococci to hydroxyapatite coated with saliva or purified saliva host ligands. In contrast, both bovine and human milk coated on hydroxyapatite promotes attachment of commensal Actinomyces naeslundii and other streptococci in vitro, and phosphorylated milk-derived peptides promote maintenance of tooth minerals, as shown for the β-casein-derived caseino-phosphate peptide. Observational studies are promising, but randomized clinical trials are needed to reveal if dairy products could be a complementary treatment for oral health. PMID:21335990

  4. Antibiotics and oral contraceptives.

    Rubin, D F

    1981-04-01

    Dermatologists often prescribe oral tetracycline for the control of acne, primarily, and to a much lesser extent, for the treatment of cutaneous infections. A number of the patients taking tetracycline are also taking birth control pills. A recent article in the British Medical Journal (1980;1:293) indicates that this combination can lead to a failure of the (OC) oral contraceptive. Such failure had been associated with ampicillin as well. It is believed that the mechanism for this was the disturbance in normal gut flora, with consequent effects on bacterial hydrolysis of steroid conjugates. This would interrupt the enterohepatic circulation of contraceptive steroids, resulting in a less than normal concentration of circulating steroids. It was recommended that women taking low-dose OCs take extra precautions against pregnancy during any cycle in which antibiotics are given. In regard to our care of and responsibilities to our patients, and in an era when malpractice suits for all types of reasons are more common, it certainly behooves dermatologists to recognize and be concerned about this potential consequence of prescribing oral antibiotics. PMID:7212735

  5. Oral lymphangioma: case report

    Marcelo Gadelha Vasconcelos

    2011-07-01

    Full Text Available Introduction: Lymphangioma is a change of lymphatic vessels that frequently affects the head and neck region. Its occurrence at oral cavity is rare and it is most commonly identified at the anterior two-thirds of the tongue. At this location, it is clinically characterized as transparent and generally grouped vesicles, which can be red or purple. The deep lesions appear as nodular masses of variable color and superficial texture. It can be classified according to the size of vessels into three types: capillary, cavernous, and cystic lymphangioma. Several types of treatment have been suggested; and the most commonly used treatments are: surgical excision, application of carbon dioxide laser, cryotherapy using liquid nitrogen, and sclerosing agents. Objective and case report: To describe a case of oral lymphangioma diagnosed in a 17-year-old female patient. The lesion was presented as multiple vesicles of soft consistency with thin epithelial lining and color ranging from translucent to yellow-reddish, involving the soft palate and the left retromolar region. Incisional biopsy confirmed the hypothesis of cavernous lymphangioma. Patient was followed-up for one year without signs of lesion relapse. Conclusion: Through this clinical case report and literature review, this study emphasizes the relevance of the clinical and histopathological features that should be considered to confirm the clinical hypothesis and indicate the proper therapeutic for oral lymphangiomas.

  6. Self-rated oral health status, oral health service utilization, and oral hygiene practices among adult Nigerians

    Olusile, Adeyemi Oluniyi; Adeniyi, Abiola Adetokunbo; Orebanjo, Olufemi

    2014-01-01

    Background There is scarce information available on oral health service utilization patterns and common oral hygiene practices among adult Nigerians. We conducted the 2010–2011 national oral health survey before the introduction of the national oral health policy to determine the prevalence of oral health service utilization, patterns of oral hygiene practices, and self reported oral health status, among adults in various social classes, educational strata, ethnic groups and geopolitical zone...

  7. Oral IIa and Xa inhibitors for prevention of stroke in atrial fibrillation: clinical studies and regulatory considerations.

    Deftereos, Spyridon; Tsounis, Dimitrios; Giannopoulos, Georgios; Kossyvakis, Charalampos; Panagopoulou, Vasiliki; Raisakis, Konstantinos; Stefanadis, Christodoulos

    2012-08-01

    Atrial fibrillation (AF), the most common, clinically significant, cardiac arrhythmia affects 1% of the general population and has important hemodynamic and thromboembolic complications that contribute to elevated morbidity and mortality. AF increases the overall risk of stroke five-fold, accounting for approximately 15% of all strokes and is associated with particularly severe stroke. For the last 50 years, long-term anticoagulation with vitamin K antagonists has been the most effective therapy for preventing stroke and systemic embolism in patients with AF and other risk factors, but their use has a lot of limitations and drawbacks (frequent monitoring and dose adjustment, food and drug interactions, delayed onset of action etc). Nowadays, new oral anticoagulants have emerged that seem to overcome those limitations. Direct thrombin inhibitor dabigatran and factor Xa inhibitors rivaroxaban and apixaban have proven, in large, multicenter, randomized, phase III, clinical studies, to be at least as efficient as warfarin in stroke prevention in patients with AF. RELY and ROCKET AF trials have contributed to market approval of dabigatran and rivaroxaban, respectively and made them available to clinical practice. Another factor Xa inhibitor, edoxaban, is under evaluation in an ongoing phase III clinical trial and others such as AZD0837, betrixaban and darexaban are still in safety and tolerability phase II studies. The oral anticoagulation landscape is changing rapidly and these new agents seem to be very promising. However future post-marketing studies and registries will help clarify their efficacy and safety. PMID:22564122

  8. The recent clinical trials on use of the novel direct oral anticoagulants in patients with venous thromboembolism: a review

    Gualtiero Palareti

    2014-10-01

    Full Text Available Venous thromboembolism (VTE, encompassing deep vein thrombosis and pulmonary embolism, requires an immediate anticoagulation, that has been carried out so far by administering a parenteral anticoagulant drug (heparin or derivatives overlapped with an oral vitamin K antagonist (VKA, more often warfarin. Several new direct oral anticoagulants (DOACs, with a mechanism of action completely different than VKA, have been developed in recent years. Recent clinical trials have investigated their use in VTE patients showing results at least equal for efficacy and safety, and sometime even better, as the standard anticoagulant treatment. There are differences in the design of the trials. In two cases the involved DOAC was administered immediately after VTE diagnosis as a single drug treatment (rivaroxaban and apixaban, whereas in the other trials (involving dabigatran and edoxaban the DOAC was administered after an initial course of approximately 7 days with heparin or derivatives. Some clinical trials have also investigated the use of DOACs for extended anticoagulant treatment after the acute phase. Aim of this article is to review the results of the currently available clinical trials that have compared the use of DOACs versus the standard of care in patients with VTE.

  9. Irradiation mucositis and oral flora

    This study, which is motivated by the substantial morbidity of local signs of mucositis and generalized symptoms that result from mucositis induced by therapeutic irradiation, has the following objectives: To investigate if it is possible to prevent irradiation mucositis via oral flora elimination, and, if it is true that flora plays a role in irradiation mucositis, what fraction of the oral flora may be involved; to evaluate oral Gram-negative bacillary carriage; to investigate the possibility to eradicate Gram-negative bacilli from the oral cavity; to evaluate oral yeast carriage; to investigate the possibility to eradicate yeasts stomatitis and the 'selectivity' of elimination of flora. Two methods are described for monitoring alterations of mucositis of the oral cavity and changes in oral flora. Chlorhexidine has been tested as the commonly used prophylaxis. The effect of chlorhexidine 0.1% rinses on oral flora and mucositis has been studied in a prospective placebo controlled double blind randomized programme. The results of the influence of saliva on the antimicrobial activity of chlorhexidine and the results of selective elimination of oral flora in irradiated patients who have head and neck cancer are reported. Salivary inactivation of the topical antimicrobials used for selective elimination of oral flora has been studied and the results are reported. Finally, the objectives that have been achieved (or not) are delineated. The significance of the results of the study are discussed in terms of published information and further lines of research are suggested. (author). 559 refs.; 29 figs.; 20 tabs

  10. Update of oral surgery management in orally anticoagulated patients

    Dimova, Cena; Evrosimovska, Biljana; Pandilova, Maja; Kovacevska, Ivona; Zabokova-Bilbilova, Efka

    2013-01-01

    Aim of this study is to review the evidence of different therapy approach, to highlight the areas of major concern and to suggest specific oral surgery treatment for patients on oral anticoagulants. The aim of operative treatment is to minimize the risk of hemorrhage while continuing to protect the patient against thromboembolism formation. The ordinary treatment includes the interruption of anticoagulant therapy for oral surgery interventions to prevent hemorrhage. However, this practice may...

  11. Management of oral surgery procedures in orally anticoagulated patients

    Dimova, Cena

    2010-01-01

    The oral and maxillofacial surgeons are frequently asked to manage patients who are receiving oral anticoagulants. The goal of treatment is to minimize the risk of hemorrhage while continuing to protect the patient against thromboembolism formation. The ordinary treatment includes the interruption of anticoagulant therapy for oral surgery interventions to prevent hemorrhage. However, this practice may logically increase the risk of a potentially life-threatening thromboembolism. Thus, this is...

  12. Management of oral surgery procedures in oral anticoagulated patients

    Dimova, Cena

    2010-01-01

    The oral and maxillofacial surgeons are frequently asked to manage patients who are receiving oral anticoagulants. The goal of treatment is to minimize the risk of hemorrhage while continuing to protect the patient against thromboembolism formation. The ordinary treatment includes the interruption of anticoagulant therapy for oral surgery interventions to prevent hemorrhage. However, this practice may logically increase the risk of a potentially life-threatening thromboembolism. Thus, this is...

  13. Oral hygiene, dentition, sexual habits and risk of oral cancer

    Talamini, R; Vaccarella, S; Barbone, F; Tavani, A; Vecchia, C La; Herrero, R.; Muñoz, N.; de Franceschi, S.

    2000-01-01

    In an Italian case-control study of oral cancer, number of missing teeth and other aspects of dental care were similar, but the general condition of the mouth, as indicated by gum bleeding, tartar deposits and mucosal irritation, was worse among oral cancer cases than controls. No differences were detected in sexual practices (including oral sex) and (previous) sexually transmitted infections. © 2000 Cancer Research Campaign

  14. [ST-segment elevation myocardial infarction in a patient with thrombophilia taking new oral anticoagulants].

    Li Calzi, Mauro; Placci, Angelo; Lina, Daniela; Grassi, Francesca; Paoli, Giorgia; Bianconcini, Michele; Cattabiani, Maria Alberta; Menozzi, Alberto

    2016-06-01

    We report the case of a 65--year-old woman admitted for inferior ST-segment elevation myocardial infarction complicated by complete atrioventricular block. The patient was under treatment with a novel oral anticoagulant (NOAC, rivaroxaban) because of a history of recurrent idiopathic pulmonary embolism. Emergency angiography showed complete acute thrombotic occlusion of the right coronary artery. After manual thrombectomy, there was no angiographic evidence of underlying atherosclerosis, therefore no further percutaneous coronary intervention was performed. Subsequent clinical course was uneventful. Laboratory tests demonstrated the presence of a heterozygous mutation of the factor II gene (G20210A), confirming the clinical evidence of a thrombophilic state. As rivaroxaban seemed to be ineffective in preventing spontaneous coronary thrombosis in this patient, antithrombotic therapy was shifted to warfarin plus low-dose aspirin. No further ischemic events occurred during the 1-year follow-up. It can be hypothesized that factor Xa inhibition by NOACs, such as rivaroxaban, could be insufficient in case of a thrombophilic state due to thrombin mutation. A brief review of the current literature on use of NOACs in acute coronary syndromes is also reported. PMID:27384603

  15. Nonvitamin K antagonist oral anticoagulants (NOACs: the tide continues to come in

    Blann A

    2015-08-01

    Full Text Available Andrew Blann University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UKThrombosis is the major common endpoint in most human diseases. In the coronary circulation, occlusive thrombi and/or the rupture of atherosclerotic plaque causes myocardial infarction, and in the cerebral circulation thrombosis, causes ischemic stroke. In the venous circulation, venous thromboembolism (VTE, manifesting clinically as pulmonary embolus and deep vein thrombosis (DVT, is a frequent complication among inpatients, and contributes to longer hospital stays with increased morbidity and mortality. Until perhaps 5 years ago, heparinoids (unfractionated heparin, low molecular weight heparin [LMWH], and fondaparinux and vitamin K antagonists (VKAs: warfarin, acenocoumarol, phenocoumarol were the only options for the prevention of thrombotic stroke in atrial fibrillation, and of VTE in general. Although effective, these traditional drugs have several practical, management, and clinical disadvantages, a fact that our colleagues in industry have not been slow to recognize and address by developing improved drugs, now collectively known as nonvitamin K antagonist oral anti coagulants (NOACs. These agents are steadily replacing the heparinoids and VKAs in both inpatient and outpatient prevention and treatment of thrombosis.

  16. [Non-VKA oral anticoagulants: an update for the clinical biologists].

    Mullier, François; Douxfils, Jonathan; Tamigniau, Anne; Dogné, Jean-Michel; Horellou, Marie-Hélène; Flaujac, Claire; Chatelain, Bernard; Goffinet, Catherine; Samama, Meyer-Michel; Gouin-Thibault, Isabelle

    2015-01-01

    Non-VKA oral anticoagulants (NOACs), thanks to their ease of use and their similar or superior safety/efficacy profiles versus warfarin, have now widely reached the lucrative market of anticoagulation. However, while the marketing authorization holders always claim, in a quite unclear way that no monitoring is required, accumulative evidence and cases of major bleeding have been described in the literature and reported by spontaneous reporting systems at the regulator's level. These compounds are usually given at fixed doses without routine coagulation monitoring. However, new data suggests that an assessment of the response at the individual level could improve the benefit-risk ratio of, at least dabigatran. Therefore, in certain patient populations, i.e. acute or chronic renal impairment or multiple drug interactions, measurement of drug exposure may be useful to ensure an optimal treatment response. More specific circumstances such as patients experiencing a haemorrhagic or thromboembolic event during the treatment duration, patients who require urgent surgery or an invasive procedure, or patient with a suspected overdose could benefit from such a measurement. This article aims at providing guidance on how to best estimate the intensity of anticoagulation using laboratory assays in daily practice. PMID:25857818

  17. Cognitive function in ambulatory patients with systolic heart failure: insights from the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF trial.

    Susan Graham

    Full Text Available We sought to determine whether cognitive function in stable outpatients with heart failure (HF is affected by HF severity. A retrospective, cross-sectional analysis was performed using data from 2, 043 outpatients with systolic HF and without prior stroke enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF Trial. Multivariable regression analysis was used to assess the relationship between cognitive function measured using the Mini-Mental Status Exam (MMSE and markers of HF severity (left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, and 6-minute walk distance. The mean (SD for the MMSE was 28.6 (2.0, with 64 (3.1% of the 2,043 patients meeting the cut-off of MMSE <24 that indicates need for further evaluation of cognitive impairment. After adjustment for demographic and clinical covariates, 6-minute walk distance (β-coefficient 0.002, p<0.0001, but not LVEF or NYHA functional class, was independently associated with the MMSE as a continuous measure. Age, education, smoking status, body mass index, and hemoglobin level were also independently associated with the MMSE. In conclusion, six-minute walk distance, but not LVEF or NYHA functional class, was an important predictor of cognitive function in ambulatory patients with systolic heart failure.

  18. Exploiting Co-solubilization of Warfarin, Curcumin, and Rhodamine B for Modulation of Energy Transfer: A Micelle FRET On/Off Switch.

    Bhat, Parvaiz Ahmad; Chat, Oyais Ahmad; Dar, Aijaz Ahmad

    2016-08-01

    Two new FRET pairs, warfarin (WF)-curcumin (CUR) and curcumin-rhodamine B (RhB), are explored by using surfactant-based self-assembled soft systems as scaffolds. The study is extended to design a two-step concurrent FRET system based on these three fluorophores, which is an important mechanism to devise artificial light-harvesting/antenna systems. Surfactant systems of varying nature (cationic, anionic, nonionic, and zwitterionic) are exploited to modulate the energy transfer in different FRET systems. Interestingly, micelle/water interfacial-charge-responsive FRET is observed owing to selective solubilization of the fluorophores during co-solubilization. The step-one FRET (WF→CUR) is switched on in cationic and zwitterionic media but switched off in anionic/nonionic media, whereas the step-two FRET from CUR to RhB is switched on in anionic/nonionic and zwitterionic media. However, both the FRET steps (WF→CUR→RhB) are observed to be active only in zwitterionic medium. Co-solubilized, appropriately mixed fluorophores having multistep FRET possibilities can be switched on/off selectively as and when required and energy efficiency can be tuned to an optimal level by varying the nature and geometry of the micellar scaffold. Thus, the two FRET pairs selectively acknowledge all types of media for their anticipated applications in biological systems, as structural tools, and for the development of artificial light-harvesting/antenna systems and lasers. PMID:27123553

  19. 3-Factor Versus 4-Factor Prothrombin Complex Concentrate for Warfarin Reversal in Severe Bleeding: A Multicenter, Retrospective, Propensity-Matched Pilot Study.

    Jones, G Morgan; Erdman, Michael J; Smetana, Keaton S; Mohrien, Kerry M; Vandigo, Joseph E; Elijovich, Lucas

    2016-07-01

    Current guidelines recommend 4-factor prothrombin complex concentrate (4PCC) for emergent reversal of bleeding secondary to warfarin. While current research has demonstrated superiority of 4PCC over plasma, direct comparisons with 3-factor PCC (3PCC) are lacking. The purpose of this study is to compare the efficacy and safety of 3PCC and 4PCC. We conducted a retrospective analysis of patients who received PCC at one of four medical centers. All patients in the 3PCC group were treated at one center that utilizes a fixed, weight-based dosing protocol. After evaluation of all patients meeting inclusion criteria, propensity-score matching was used to adjust for differences in treatment characteristics. There was no difference in the primary outcome of INR ≤ 1.4 between 3PCC and 4PCC in both the unmatched (85.7 vs. 90.6 %; p = 0.37) and matched (84.2 vs. 92.1 %; p = 0.48) analyses. There was a significant difference in goal INR achieved favoring 4PCC (56.3 vs 90.0 %; p  4.0. A total of three thrombotic events were documented, all in the 4PCC group. We found no difference in the rate of INR reversal in those treated with 3PCC and 4PCC. However, those with a baseline INR > 4.0 may experience more successful INR reversal with 4PCC. PMID:26721625

  20. Canine and feline oral pathology

    Costa, S.; Pais, B.; Almeida, D.; Simões, J.; Mega, A. C.; Vala, Helena

    2013-01-01

    The aim of this work was to present a brief review of the main conditions affecting the oral cavity of dogs and cats. In recent years there has been increased attention with regard to veterinary dentistry, being several and frequent the pathologies located in the oral cavity of our pets. These diseases mainly affect the teeth and the mucous membranes of the oral cavity, and may, in chronic cases, also affect vital organs. This condition could have different causes, including hereditary, conge...

  1. Oral and Perioral Piercing Complications

    N Escudero-Castaño; M.A. Perea-García; Campo-Trapero, J; Cano-Sánchez,; A Bascones-Martínez

    2008-01-01

    Background. The oral an perioral piercing has a long history as part of religious, tribal,cultural or sexual symbolism and nowdays there is a high incidence of oral and perioral piercing in the adolescent population. This practice has a long history as part of religious, tribal, cultural or sexual symbolism. This article reviews current knowledge on injuries or diseases that might be produced by piercing in the oral cavity. We propose a classification to diagnosed the pathologies related to o...

  2. Oral complications in cancer patients

    Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications

  3. Strengthening of oral health systems

    Petersen, Poul Erik

    2014-01-01

    diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the...... newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. © 2014 P.E. Petersen, Geneva....

  4. Oral Health in Psychiatric Patients

    Ozlem Gurbuz; Kursat Altinbas; Erhan Kurt

    2011-01-01

    Although oral health is a major determinant of general health and quality of life, it has a low priority in the context of mental illness. Chronic mental illness and its treatment carry inherent risks for significant oral diseases. Both the disease itself and its various pharmacologic management modalities lead to a range of oral complications and side effects, with caries, periodontal disease and xerostomia being encountered most frequently. Older age, female gender, length of hospitalizatio...

  5. Oral submucous fibrosis: an update

    Wollina U; Verma SB; Ali FM; Patil K

    2015-01-01

    Uwe Wollina,1 Shyam B Verma,2 Fareedi Mukram Ali,3 Kishor Patil4 1Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany; 2Nirvana Skin Clinic, Vadodara, Gujarat, India; 3Departments of Oral and Maxillofacial Surgery, SMBT Dental College, Sangamner, Maharashtra, India; 4Departments of Oral Pathology and Microbiology, SMBT Dental College, Sangamner, Maharashtra, India Abstract: Oral submucous fibrosis (OSF) is a premalignant condition ca...

  6. Oral epithelial dysplasia classification systems

    Warnakulasuriya, S; Reibel, J; Bouquot, J;

    2008-01-01

    report, we review the oral epithelial dysplasia classification systems. The three classification schemes [oral epithelial dysplasia scoring system, squamous intraepithelial neoplasia and Ljubljana classification] were presented and the Working Group recommended epithelial dysplasia grading for routine....... Several studies have shown great interexaminer and intraexaminer variability in the assessment of the presence or absence and the grade of oral epithelial dysplasia. The Working Group considered the two class classification (no/questionable/ mild - low risk; moderate or severe - implying high risk) and...

  7. Drug Reactions in Oral Mucosa

    Emine Derviş

    2012-12-01

    Full Text Available Both immunologic and nonimmunologic drug reactions can be seen in oral mucosa. Since considerable number of these reactions heals spontaneously without being noticed by the patients, exact frequency of the lesions is unknown. Most common lesions are xerostomia, taste disorders, mucosal ulcerations and edema. In this article, oral lesions resulting from drug intake similar to those from oral lesions of local and systemic diseases, and diagnostic problems caused by these similarities, have been reviewed.

  8. Oral Manifestations of Secondary Syphilis

    Luiz Fernando Barbosa de Paulo

    2015-06-01

    Full Text Available Known as “the great imitator,” secondary syphilis may clinically manifest itself in myriad ways, involving different organs including the oral mucosa, and mimicking, both clinically and histologically, several diseases, thereby making diagnosis a challenge for clinicians. We highlight the clinical aspects of oral manifestation in 7 patients with secondary syphilis. Clinicians should consider secondary syphilis in the differential diagnosis of ulcerative and/or white oral lesions.

  9. Drug Testing in Oral Fluid

    Drummer, Olaf H

    2006-01-01

    Over the last decade there have been considerable developments in the use of oral fluid (saliva) for drug testing. Oral fluid can provide a quick and non-invasive specimen for drug testing. However, its collection may be thwarted by lack of available fluid due to a range of physiological factors, including drug use itself. Food and techniques designed to stimulate production of oral fluid can also affect the concentration of drugs. Current applications are mainly focused on drugs of abuse tes...

  10. Practical pearls for oral procedures.

    Davari, Parastoo; Fazel, Nasim

    2016-01-01

    We provide an overview of clinically relevant principles of oral surgical procedures required in the workup and management of oral mucosal diseases. An understanding of the fundamental concepts of how to perform safely and effectively minor oral procedures is important to the practicing dermatologist and can minimize the need for patient referrals. This chapter reviews the principles of minor oral procedures, including incisional, excisional, and punch biopsies, as well as minor salivary gland excision. Pre- and postoperative patient care is also discussed. PMID:27343958

  11. Oral myiasis: A rare entity

    Basavaraj T Bhagawati

    2013-01-01

    Full Text Available Oral myiasis is a relatively rare pathology in humans caused by invasion of body tissue or cavities of living animals or humans by larvae of certain dipteran flies. It is an uncommon clinical condition, being more frequent in underdeveloped countries, and in countries with tropical climate. Common pre-disposing factors are poor oral hygiene, halitosis, trauma, senility, suppurative oral lesions, and in patients with neuro-psychiatric deficits. The present article reports a case of oral myiasis involving the anterior palate in a physically and mentally disabled 24-year-old female patient.

  12. Oral Health in Psychiatric Patients

    Ozlem Gurbuz

    2011-12-01

    Full Text Available Although oral health is a major determinant of general health and quality of life, it has a low priority in the context of mental illness. Chronic mental illness and its treatment carry inherent risks for significant oral diseases. Both the disease itself and its various pharmacologic management modalities lead to a range of oral complications and side effects, with caries, periodontal disease and xerostomia being encountered most frequently. Older age, female gender, length of hospitalization, duration of mental illness, psychiatric diagnosis are the most discussed predictors for adverse dental outcomes in the reviewed studies. Poor oral hygiene, higher intake of carbonates, smoking, poor perception of oral health self-needs, length of psychiatric disorder, length of psychotropic treatment, and less access to dental care pose at high risk for poor oral health among this population. This article emphasizes the importance of preventive dentistry programs to improve dental healthcare psychiatric chronic inpatients and the signifance of bridging dental health education to psychiatric rehabilitation programs. In this review, general information concerning the oral manifestations of mental illness, effect of medication of mental illness on oral health, the factors affecting oral health among this special population have been provided.

  13. Oral periopathogens and systemic effects.

    Costerton, John; Keller, Duane

    2007-01-01

    Management of oral biofilms allows dentists to help control the pathogens responsible for periodontal disease and decay. Increasing evidence indicates that the oral system is a portal for pathogenic microorganisms. This is a cumulative situation with systemic effects that can overcome an individual's resistance threshold, culminating in systemic sequela. New evidence indicates that controlling these oral pathogens has systemic benefits, as oral pathology is related to cardiovascular and respiratory disease, diabetes, and systemic inflammatory responses, as well as low birth weight and pre-term deliveries. Some insurance companies now cover periodontal scaling for gingivitis and periodontal disease for pregnant women and patients at risk for pregnancy. PMID:17511362

  14. Implementing hospital guidelines improves warfarin use in non-valvular atrial fibrillation: a before-after study

    Piobbici Marina

    2007-08-01

    Full Text Available Abstract Background The use of oral anticoagulant therapy (OAT to prevent non-valvular atrial fibrillation (NVAF related-strokes is often sub-optimal. We aimed to evaluate whether implementing guidelines on antithrombotic therapy (AT by a multifaceted strategy may improve appropriateness of its prescription in NVAF-patients discharged from a large tertiary-care hospital. Methods A survey was conducted on all consecutive NVAF patients discharged before (1st January–30th June 2000, n = 313 and after (1st January–30th June 2004, n = 388 guideline development and implementation. Results When strongly recommended, OAT use increased from 56.6% (60/106 in 2000 to 81.9% (86/105 in 2004, with an absolute difference of +25.3% (95%CI: 15% 35%. In patients for whom the choice OAT/acetylsalicylic acid should be individualised, those discharged without any AT were 33.7% (34/101 in 2000 and 16.9% (21/124 in 2004 (-16.7%;95%CI: -26.2% -7.2%. In a logistic regression model, OAT prescription in 2004 was increased by 2.11 times (95%CI: 1.47 3.04, after accounting for stroke risk, presence of contraindications (OR = 0.18; 0.13 0.27, older age (OR = 0.30; 0.21 0.45, prophylaxis at admission (OR = 3.03; 2.08 4.43. OAT was positively associated with the stroke risk in the 2004 sample only. Conclusion The guideline implementation has substantially improved the appropriateness of OAT at discharge, through a better evaluation at patient's individual level of the benefit-to-risk ratio.

  15. [Oral jewelry: a review].

    Jeger, Franziska; Lussi, Adrian; Zimmerli, Brigitte

    2009-01-01

    Oral jewelry is popular. One of the most widely spread types are so-called tooth diamonds made of composite materials which are applied to the teeth with an adhesive. Note that parents are required to sign a release form for under-aged patients in Switzerland. Tooth cap grills and gold teeth are considered status symbols within the Hip-Hop fashion scene. However, tooth ornaments favour the accumulation of plaque and can diminish the ability to articulate. With respect to jewelry in oral soft tissue especially tongue and lip piercings are of significance to dentists. Besides the systemic complications, which are mostly caused by a lack of hygiene or the failure of noting medical contraindications by the piercer, local complications occur frequently. After surgery, pain, swelling, infections as well as hemorrhages or hematomas can be observed. Long-term effects can be problematic: gingival recession can be discernes mainly in the case of lip piercings the loss of hard tooth substance in the case of tongue piercings. Because of that, conservation therapies can become indespensable. Patients wearing dental jewelry have to be aware of risks of tooth damage, and they regularly have to undergo dental check-ups. Information campaigns--for dentists as well as patients--are necessary. PMID:20112640

  16. Oral Conversations Online: Redefining Oral Competence in Synchronous Environments

    Lamy, Marie-Noelle

    2004-01-01

    In this article the focus is on methodology for analysing learner-learner oral conversations mediated by computers. With the increasing availability of synchronous voice-based groupware and the additional facilities offered by audio-graphic tools, language learners have opportunities for collaborating on oral tasks, supported by visual and textual…

  17. Scandinavian Fellowship for Oral Pathology and Oral Medicine

    Kragelund, Camilla; Reibel, J; Hadler-Olsen, E S;

    2010-01-01

    source in revisions of dental curricula throughout Europe converging towards a European Dental Curriculum. In order to render the best conditions for future curriculum revisions providing the best quality dentist we feel obliged to analyse and comment the outlines of oral pathology and oral medicine in...

  18. Different models for oral anticoagulation management may be applied provided that minimal assistance criteria are fulfilled: an Italian experience.

    Prisco, Domenico; Antonucci, Emilia; Grifoni, Elisa; Mazzaglia, Giampiero; Bellandi, Tommaso; Tartaglia, Riccardo; Poli, Daniela

    2009-09-01

    The efficacy of adjusted-dose oral anticoagulant therapy (OAT) in the prevention of thrombotic complications in various clinical conditions is well documented. Management of OAT requires a trained physician, an organized system of follow-up, reliable international normalized ratio monitoring, and good patient communication and education. Drug interactions with coumarins are a major cause of excessive anticoagulation and hence could be an important determinant of bleeding in patients on OAT. An analysis conducted in Toscana in 2005 found 31,221 patients persistently on OAT. During the same period, potential drug-drug interactions were detected in 11,778 of these patients (37.7%). Thus, the regional government enacted a specific law for the organization of OAT management to give all patients a minimal standard of quality of OAT. A specific educational campaign was promoted with the slogan "Written is better." Three possible models to follow individual patients were identified in relation to available resources and geographic characteristics of the living area: Anticoagulation Clinic (AC), General Practitioner (GP), or combined AC and GP management. This experience, although obtained in a limited geographic area, could help improve the efficacy and safety of OAT management. PMID:19787561

  19. Evaluation of an In Silico PBPK Post-Bariatric Surgery Model through Simulating Oral Drug Bioavailability of Atorvastatin and Cyclosporine.

    Darwich, A S; Pade, D; Rowland-Yeo, K; Jamei, M; Asberg, A; Christensen, H; Ashcroft, D M; Rostami-Hodjegan, A

    2013-01-01

    An increasing prevalence of morbid obesity has led to dramatic increases in the number of bariatric surgeries performed. Altered gastrointestinal physiology following surgery can be associated with modified oral drug bioavailability (Foral). In the absence of clinical data, an indication of changes to Foral via systems pharmacology models would be of value in adjusting dose levels after surgery. A previously developed virtual "post-bariatric surgery" population was evaluated through mimicking clinical investigations on cyclosporine and atorvastatin after bariatric surgery. Cyclosporine simulations displayed a reduced fraction absorbed through gut wall (fa) and Foral after surgery, consistent with reported observations. Simulated atorvastatin Foral postsurgery was broadly reflective of observed data with indications of counteracting interplay between reduced fa and an increased fraction escaping gut wall metabolism (FG). Inability to fully recover observed atorvastatin exposure after biliopancreatic diversion with duodenal switch highlights the current gap regarding the knowledge of associated biological changes.CPT: Pharmacometrics & Systems Pharmacology (2013) 2, e47; doi:10.1038/psp.2013.23; advance online publication 12 June 2013. PMID:23903405

  20. Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation

    Tawfik A

    2016-08-01

    Full Text Available Amy Tawfik,1,2 Joanna M Bielecki,2 Murray Krahn,1,2 Paul Dorian,3,4 Jeffrey S Hoch,1,3,5 Heather Boon,1 Don Husereau,6 Petros Pechlivanoglou2 1Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, 2Toronto Health Economics and Technology Assessment (THETA Collaborative, University of Toronto, 3Centre for Excellence in Economic Analysis Research (CLEAR, Li Ka Shing Knowledge Institute, St Michael’s Hospital, 4Department of Medicine and Cardiology, University of Toronto, 5Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, 6Institute of Health Economics, Edmonton, AB, Canada Background: In the last 4 years, four novel oral anticoagulants have been developed as alternatives to warfarin and antiplatelet agents for stroke prevention in atrial fibrillation (AF patients. The objective of this review was to estimate the comparative effectiveness of all antithrombotic treatments for AF patients.Materials and methods: Data sources were Medline Ovid (1946 to October 2015, Embase Ovid (1980 to October 2015, and the Cochrane Central Register of Controlled Trials (­CENTRAL, Issue 9, 2015. Randomized controlled trials of AF patients were selected if they compared at least two of the following: placebo, aspirin, aspirin and clopidogrel combination therapy, adjusted-dose warfarin (target international normalized ratio 2.0–3.0, dabigatran, rivaroxaban, apixaban, and edoxaban. Bayesian network meta-analyses were conducted for outcomes of interest (all stroke, ischemic stroke, myocardial infarction, overall mortality, major bleeding, and intracranial hemorrhage.Results: Based on 16 randomized controlled trials of 96,826 patients, all oral anticoagulants were more effective than antiplatelet agents at reducing the risk of ischemic stroke and all strokes. Compared to warfarin, dabigatran 150 mg (rate ratio 0.65, 95% credible interval 0.52–0.82 and apixaban (rate ratio 0.82, 95% credible interval 0.69–0.97 reduced the risk of

  1. Preliminary Observation on the Impact of Pregnant Women Taking Warfarin after Mechanical Valve Replacement on Children's Physical and Mental Development%机械瓣置换术后妊娠妇女妊娠期间全程服用华法林对儿童体格及智力发育的影响初探

    蒋露; 杨凡; 李永波; 朱喜亮; 肖锡俊

    2012-01-01

    , and then the difference of each index between the two groups was analyzed. Results In the aspects of both physical development indexes and mental development indexes, there were no significant differences in the children aged 0 to 3 yrs, 4 to 6 yrs, and 6 to 12 yrs in the two groups (P>0.05). Conclusion After mechanical valve replacement, women taking oral anticoagulant warfarin in daily dose not exceeding 5mg are safe, and there are no negative effects on children's physical and mental development.

  2. Expression of Galectins 1, 3 and 9 in normal oral epithelium, oral squamous papilloma, and oral squamous cell carcinoma

    Thais Ayako Hossaka; Ribeiro, Daniel A.; Gustavo Focchi; Sabine André; Mariana Fernandes; Fernando Cintra Lopes Carapeto; Marcelo de Souza Silva; Celina T F Oshima

    2014-01-01

    Background: The aim of this study was to characterize the immunohistochemical expression of galectin 1, 3, and 9 in normal oral epithelium, oral squamous papilloma, and oral squamous cell carcinoma. Materials and Methods: Immunohistochemical staining for galectins 1, 3, and 9 was evaluated in 8 samples of normal oral squamous epithelium, 15 samples of oral squamous papilloma, and 41 samples of oral squamous cell carcinoma. Immunohistochemical data were assessed by Kruskal-Wallis non-para...

  3. Comparison of Immunohistochemical Expression of Antiapoptotic Protein Survivin in Normal Oral Mucosa, Oral Leukoplakia, and Oral Squamous Cell Carcinoma

    Amita Negi; Abhiney Puri; Rakhi Gupta; Rajat Nangia; Alisha Sachdeva; Megha Mittal

    2015-01-01

    Background. Oral squamous cell carcinoma is the sixth most frequent malignant tumor worldwide and the third most common cancers in developing countries. Oral leukoplakia is the best-known precursor lesion of oral squamous cell carcinoma. The aim of the present study was to compare immunohistochemical expression of antiapoptotic protein survivin in normal oral mucosa, oral leukoplakia, and oral squamous cell carcinoma. Method. Total 45 specimens of formalin fixed paraffin embedded tissue block...

  4. Pediatric soft tissue oral lesions.

    Pinto, Andres; Haberland, Christel M; Baker, Suher

    2014-04-01

    This article provides an overview of common color changes and soft tissue oral nodular abnormalities in children and adolescents. The clinical presentation and treatment options to address these conditions are presented in a concise approach, highlighting key features relevant to the oral health care professional. PMID:24655531

  5. Oral Contraceptives and Cancer Risk

    ... benefits associated with oral contraception. American Journal of Obstetrics and Gynecology 2004; 190(4 Suppl):S5–22. [ ... oral contraceptive use and risk of ovarian cancer. Obstetrics and Gynecology 1992; 80(4):708–714. [PubMed ...

  6. Progestin-Only Oral Contraceptives

    Progestin-only oral contraceptives are used to prevent pregnancy. Progestin is a female hormone. It works by preventing the release of eggs ... and the lining of the uterus. Progestin-only oral contraceptives are a very effective method of birth control, ...

  7. Tobacco Use and Oral Health.

    Seffrin, John R.; Randall, B. Grove

    1982-01-01

    Oral disease risks regarding the use of tobacco arise not only from smoking but also from the oral use of tobacco in the form of snuff. Such diseases range from simple tooth decay to various forms of cancer. A fact list is suggested for presenting the risks to school-age youth. (JN)

  8. Nutrition and oral mucosal diseases.

    Thomas, Danielle Marie; Mirowski, Ginat W

    2010-01-01

    Oral manifestations of nutritional deficiencies can affect the mucous membranes, teeth, periodontal tissue, salivary glands, and perioral skin. This contribution reviews how the water-soluble vitamins (B(2), B(3), B(6), B(12), C, and folic acid), fat-soluble vitamins (A, D, and E), and minerals (calcium, fluoride, iron, and zinc) can affect the oral mucosa. PMID:20620760

  9. Tips for Good Oral Health during Pregnancy

    ... are pregnant. Getting oral health care, practicing good oral hygiene, eating healthy foods, and practicing other healthy behaviors ... provide the best care for you. Practice Good Oral Hygiene  Brush your teeth with fluoridated toothpaste twice a ...

  10. What Are Oral Cavity and Oropharyngeal Cancers?

    ... Research Get Involved Find Local ACS Learn About Cancer » Oral Cavity and Oropharyngeal Cancer » Detailed Guide » What are ... how cancers start and spread, see What Is Cancer? Oral cavity cancer, or just oral cancer, is cancer ...

  11. 药师干预对华法林抗凝患者治疗认知度的影响研究%Influence of pharmacist intervention on patients′knowledge of anticoagulation therapy with warfarin

    蒋捷; 谢秋芬; 向倩; 王梓凝; 霍东波; 曹利佳; 周双; 周颖; 崔一民

    2015-01-01

    ;Objective To investigate the influence of pharmacist inter-vention on patients′knowledge of anticoagulation therapy with warfarin . Methods Two hundred sixteen patients who were admitted to cardiovas-cular wards and were prescribed anticoagulation therapy with warfarin from October 2013 to August 2014 were included in the study .According to the ward they stayed , patients were divided into control group ( Cardiology ward No1.) and intervention group ( Cardiology ward No 2.) . In the control group , physicians and nurses introduced anticoagulation knowledge for the patients as usual , while intervention group received medication education and guidance on warfarin use by pharmacists .All patients of two groups filled out an assessment questionnaire about warfa-rin anticoagulation at discharge ( outpoint =13 ) .If any answer to the questions was wrong , pharmacists would educate them again .The score of the questionnaire were compared between the two groups . Results The intervention group enrolled 112 patients while the control group enrolled 104 patients. Scores of assessment questionnaire at discharge of the intervention group and the control group were (10.50 ±2.24) vs (8.08 ±2.61) respectively,with statistical difference ( P <0.05 ) .Conclusion Knowledge of warfarin therapy was much better in patients who received pharmacist intervention than patients who received usual care . Integrated management model with pharmacist interventions can improve patients′cognition in anticoagulation therapy with warfarin .%目的:探讨药师干预对华法林抗凝患者治疗认知度的影响。方法选取2013年10月至2014年8月在我院心血管内科病房住院的口服华法林抗凝患者216例为研究对象,按照病区分为对照组(心内科一病房)和干预组(心内科二病房),对照组由医师及护士介绍华法林抗凝知识,干预组接受药师关于华法林抗凝的用药教育和指导。在出院时,2组患者均填

  12. Biomechanics of oral mucosa

    Chen, Junning; Ahmad, Rohana; Li, Wei; Swain, Michael; Li, Qing

    2015-01-01

    The prevalence of prosthodontic treatment has been well recognized, and the need is continuously increasing with the ageing population. While the oral mucosa plays a critical role in the treatment outcome, the associated biomechanics is not yet fully understood. Using the literature available, this paper provides a critical review on four aspects of mucosal biomechanics, including static, dynamic, volumetric and interactive responses, which are interpreted by its elasticity, viscosity/permeability, apparent Poisson's ratio and friction coefficient, respectively. Both empirical studies and numerical models are analysed and compared to gain anatomical and physiological insights. Furthermore, the clinical applications of such biomechanical knowledge on the mucosa are explored to address some critical concerns, including stimuli for tissue remodelling (interstitial hydrostatic pressure), pressure–pain thresholds, tissue displaceability and residual bone resorption. Through this review, the state of the art in mucosal biomechanics and their clinical implications are discussed for future research interests, including clinical applications, computational modelling, design optimization and prosthetic fabrication. PMID:26224566

  13. Laboratory evaluation of WBA 8119 as a rodenticide for use against warfarin-resistant and non-resistant rats and mice.

    Redfern, R.; Gill, J. E.; Hadler, M. R.

    1976-01-01

    Feeding tests were carried out in the laboratory to evaluate WBA 8119 as a potential new rodenticide against wild common rats (Rattus norvegicus), ship rats (R. rattus) and house mice (Mus musculus). The results obtained are compared with data previously obtained for difenacoum, another member of the same series of 4-hydroxycoumarin anticoagulants. With warfarin-resistnat and non-resistant common rats, complete kills were obtained using a concentration of 0-0005% for 2 days, or 0-001% for 1 day: a 1-day test at 0-0005% killed 6 out of 10 and 17 out of 20 of the two types respectively. At 0-0005% complete kills of resistant ship rats were obtained after 2 days exposure and of resistant house mice after 1 day, but at 0-002% for 2 days there was some survival. Non-resistant ship rats and house mice were all killed after 2 days feeding on 0-002% bait. In 2-day palatability tests, R. norvegicus showed no significant aversion to the poison at 0-002% and 100% mortality was obtained. The poison was significantly unpalatable to R. rattus at 0-005% and to M. musculus at 0-005% and 0-002%, although with the last species these concentrations gave complete kills. It is concluded that WBA 8119 has greater activity than other known anticoagulants against the three commensal species examined. The laboratory results suggest that concentrations between 0-0005% and 0-002% would be suitable for field use against common rats, and between 0-002% and 0-005% for ship rats and house mice. PMID:1069820

  14. Precipitants of oral cancer in India

    Ranjith Raveendran; Nath, Sameera G

    2012-01-01

    Oral cancers are malignant neoplasms that affect the mouth. Oral cancer remains a major personal tragedy and public health problem. There is a very high incidence of oral cancer in Southern Asia. In India, the oral cavity is the most common site for cancer. The majority of oral squamous cell carcinomas are related to tobacco, areca nut / betel quid chewing, alcoholism. Control of oral potentially malignant diseases will only be achieved by effective and comprehensive primary and secondary pre...

  15. Salivary Markers for Oral Cancer Detection

    Markopoulos, Anastasios K; Michailidou, Evangelia Z.; Tzimagiorgis, Georgios

    2010-01-01

    Oral cancer refers to all malignancies that arise in the oral cavity, lips and pharynx, with 90% of all oral cancers being oral squamous cell carcinoma. Despite the recent treatment advances, oral cancer is reported as having one of the highest mortality ratios amongst other malignancies and this can much be attributed to the late diagnosis of the disease. Saliva has long been tested as a valuable tool for drug monitoring and the diagnosis systemic diseases among which oral cancer. The new em...

  16. Case Analysis and Intervention of Warfarin Drug Interactions by Clinical Pharmacist%临床药师对华法林药物相互作用的病例分析和干预

    杨周生; 郑萍

    2014-01-01

    Objective: To explore the role of clinical pharmacists in the treatment based on one case analysis and intervention of warfarin drug interactions . Methods: In view of the patient medication and the drug interaction , the mechanism affecting warfarin anticoagulation by combined drug use was explored . Results: Amiodarone was one of the main factors enhancing the effect of warfarin anticoagulation . With the assistance of clinical pharmacist a safe and effective treatment plan for the patient was made . Conclusion: Clinical pharmacist ’ s participating in making therapeutic regimen can provide a safe and effective medication plan for both doctors and patients .%目的:通过临床药师对1例华法林药物相互作用的病例分析和干预,探讨药师在临床治疗中发挥的作用。方法:针对病例的用药情况,从药物相互作用角度,探讨分析合并用药对华法林抗凝作用影响的机制。结果:胺碘酮是增强华法林抗凝作用的主要因素,临床药师协助医师为患者制定了安全、有效的治疗方案。结论:临床药师参与药物治疗方案的制定,可为医师、患者双方提供安全、有效的用药方案。

  17. Oral melanoacanthoma: A rare case of diffuse oral pigmentation

    Anish Ashok Gupta

    2012-01-01

    Full Text Available The clinical presentation of diffuse pigmentation can be alarming to the patient as well as the clinician. A histopathologic examination of a pigmented lesion is necessary in most of the cases in the oral cavity. Oral melanoacanthoma is a very rare diffuse pigmentation with no specific treatment required. It shows increased number of dendritic melanocytes in an acanthotic epithelium. We present a rare case of diffuse pigmentation in the oral cavity whose diagnosis was done on the basis of clinical presentation and histopathology. Also immunohistochemistry was done.

  18. Oral lichen planus to oral lichenoid lesions: Evolution or revolution

    Bhavin B Dudhia

    2015-01-01

    Full Text Available The diagnosis between different diseases may be impaired by clinical and histopathologic similarities, as observed in the oral lichen planus (OLP and oral lichenoid lesion (OLL. Inspite of similar clinicopathological features; etiology, diagnosis and prognosis differ which mandates separation of OLL from OLP. Hence, it is essential for the oral physician and oral pathologist to be familiarized with the individual variations among clinicopathological features of OLP and OLL as well as to obtain a thorough history and perform a complete mucocutaneous examination in addition to specific diagnostic testing. The difficulties faced to establish the diagnosis between these two pathologies are widely investigated in the literature with a lack of definite conclusion. This review is an attempt to throw some light on these clinicopathologic entities with the aim to resolve the diagnostic dilemma.

  19. Diabetes mellitus and oral health.

    Kudiyirickal, Marina George; Pappachan, Joseph M

    2015-05-01

    The oral health is influenced by systemic health, and one of the most common chronic diseases encountered in dental practice is diabetes mellitus. Diabetes can worsen oral infections and vice versa. In the literature, periodontitis and diabetes in the young to middle-aged adults have been the most widely researched area. Understanding the patho-physiology, clinical manifestations and management of different types of orofacial diseases in diabetic patients are important to the diabetologist and the dentist for the optimal care of patients with these diseases. This review explores the inter-link between diabetes and oral health. PMID:25487035

  20. Oral health promotion efficiency in the control of oral biofilm

    Nélio Jorge Veiga; Patricia Carvalho; Octávio Ribeiro; Inês Coelho

    2014-01-01

    Objective: To assess the efficacy of oral health instructions, particularly in the control of dental plaque, as well as assess the effectiveness of the reinforcement of the same instructions. Methods: A quasi-experimental study was conducted at the University Clinic of the Portuguese Catholic University (UCP) in Viseu-Portugal from January to June 2012. Three different assessments were performed with 30 participants using the O’Leary Plaque Index and a questionnaire on oral health behavior, w...

  1. Evaluating awareness regarding oral hygiene practices and exploring gender differences among patients attending for oral prophylaxis

    Oberoi, Sukhvinder Singh; Mohanty, Vikrant; Mahajan, Ananya; Oberoi, Avneet

    2014-01-01

    Background: Oral hygiene is intimated in health of all parts of the body including oral cavity. The understanding of actual practices in keeping the oral heath at standard based on patient's perceptions of oral health care is vital. Understanding the effect of gender on oral health would facilitate the development of successful attitude and behavior modification approach towards sustainable oral health. Purpose of Study: To evaluate awareness regarding oral hygiene practices and exploring gen...

  2. Oral contraceptives and exercise.

    Mostardi, R A; Woebkenberg, N R; Jarrett, M T

    1980-01-01

    A laboratory study was undertaken with volunteer females (aged 20-25) to determine the effect of OCs (oral contraceptives) on hematologic and metabolic variables during exercise. 5 of the women studied were naturally cycling and 7 were taking OCs. The women worked at 2 workloads on a bicycle ergometer at 50% and 90% of their maximal aerobic capacity during 3 different phases of their menstrual cycle. There was no better time of the month for doing the 50% or the 90% workload in either group. Heartrate for the OC group was significantly higher at the 50% maximal capacity. Results of the test indicate tha women on OCs have somewhat reduced cardiac efficiency and are ventilating more to carry out a given amount of work when compared to women who are naturally cycling. Possible explanations for the higher heart rate are put forward. The main limitation of the study is that the subject numbers involved are small and the number of cycles studied is also small. PMID:12278397

  3. As-yet-uncultivated oral bacteria: breadth and association with oral and extra-oral diseases

    José F. Siqueira

    2013-05-01

    Full Text Available It has been shown that 40–60% of the bacteria found in different healthy and diseased oral sites still remain to be grown in vitro, phenotypically characterized, and formally named as species. The possibility exists that these as-yet-uncultivated bacteria play important ecological roles in oral bacterial communities and may participate in the pathogenesis of several oral infectious diseases. There is also a potential for these as-yet-uncultivated oral bacteria to take part in extra-oral infections. For a comprehensive characterization of physiological and pathogenic properties as well as antimicrobial susceptibility of individual bacterial species, strains need to be grown in pure culture. Advances in culturing techniques have allowed the cultivation of several oral bacterial taxa only previously known by a 16S rRNA gene sequence signature, and novel species have been proposed. There is a growing need for developing improved methods to cultivate and characterize the as-yet-uncultivated portion of the oral microbiome so as to unravel its role in health and disease.

  4. Expression of E-cadherin in normal oral mucosa, in oral precancerous lesions and in oral carcinomas

    Sridevi, Ugrappa; Jain, Ajay; Nagalaxmi, Velpula; Kumar, Ugrappa Vijay; Goyal, Stuti

    2015-01-01

    Objective: The aim of the present study was to assess the expression of E-cad in oral precancerous lesions and conditions and oral carcinomas in comparison with normal mucosa. Materials and Methods: Total of 50 samples were selected for the study and were categorized into five groups and 10 samples in each group as Group I-oral leukoplakia (OL), Group II-oral lichen planus (OLP), Group III-oral submucous fibrosis (OSMF), Group IV-oral squamous cell carcinoma (OSCC) and Group V-normal oral muc...

  5. Personalized versus non-personalized computerized decision support system to increase therapeutic quality control of oral anticoagulant therapy: an alternating time series analysis

    Chatellier Gilles

    2004-09-01

    Full Text Available Abstract Background The quality control of oral anticoagulant therapy (OAT during the initiation and maintenance treatment is generally poor. Physicians' ordering of OAT (especially fluindione and warfarin can be improved by dose adjustment algorithms, taking into account the results of International Normalized Ratio (INR. Reminders at the point of care, computerized or not, have been demonstrated to be effective in changing physicians prescription behavior. However, few studies have addressed the benefit of personalized reminders versus non personalized reminders, whereas the personalized reminders require more development to access patient record data and integrate with the computerized physician order entry system. The Hospital Information System of George Pompidou European Hospital integrates an electronic medical record, lab test and drugs order entry system. This system allows to evaluate such reminders and to consider their implementation for routine use as well as the continuous evaluation of their impact on medical practice quality indicators. The objective of this study is to evaluate the impact of two types of reminders on overtreatment by oral anticoagulant: a simple reminder of text formatted dose adjustment table and a personalized recommendation for oral anticoagulant dose and next date of INR control, adapted to patient data. Both types of reminders appear to the physician at the moment of drug ordering. Methods The study is an alternating time series experiment with three 6 months periods, each one including every 2 months according to a Latin square scheme: a control period without any reminder, a period with the simple non personalized reminder, a period with personalized reminder. All patients hospitalized in departments using the computerized physician order entry system and ordered fluindione or warfarin, will be included in the study between November 2004 and May 2006. Main outcome will be the proportion of overcoagulation

  6. Oral delivery of anticancer drugs

    Thanki, Kaushik; Gangwal, Rahul P; Sangamwar, Abhay T;

    2013-01-01

    The present report focuses on the various aspects of oral delivery of anticancer drugs. The significance of oral delivery in cancer therapeutics has been highlighted which principally includes improvement in quality of life of patients and reduced health care costs. Subsequently, the challenges...... incurred in the oral delivery of anticancer agents have been especially emphasized. Sincere efforts have been made to compile the various physicochemical properties of anticancer drugs from either literature or predicted in silico via GastroPlus™. The later section of the paper reviews various emerging...... trends to tackle the challenges associated with oral delivery of anticancer drugs. These invariably include efflux transporter based-, functional excipient- and nanocarrier based-approaches. The role of drug nanocrystals and various others such as polymer based- and lipid based-nanocarriers in the...

  7. Oral candidosis in lichen planus

    Kragelund, Camilla; Kieffer-Kristensen, L; Reibel, J;

    2012-01-01

    OBJECTIVES: Candida albicans is the most common fungal pathogen in humans, but other Candida species cause candidosis. Candida species display significant differences in their susceptibility to antimycotic drugs. Patients with symptomatic or erythematous oral lichen planus (OLP) commonly have...

  8. ORAL MELANOMA: A FATAL ENTITY

    Amit

    2014-08-01

    Full Text Available : Oral melanomas are uncommon and similar to their cutaneous counterparts, are neoplasm that developed from melanocytic cells lying in the basal layer of the mucosa, its incidence is about 1.2 cases per 10 million inhabitants per year with a variation between 0.2% to 8% of all the melanomas and 0.5% of all the malignant neoplasias of the oral cavity.1 Oral conditions with increased melanin pigmentation are common; however, melanocytic hyperplasias are rare. The relative incidence amongst mucosal neoplasms of the head and neck had been reviewed by Hormia and Vuori2, about 7253 cases of malignancies of upper respiratory and gastrointestinal tracts between 1953-1964, five cases of oral melanoma were found with an incidence of 0.07%

  9. Oral agents in multiple sclerosis.

    Lorefice, L; Fenu, G; Frau, J; Coghe, G C; Marrosu, M G; Cocco, E

    2015-01-01

    Multiple sclerosis (MS) is a complex autoimmune disease of the central nervous system. Disease-modifying drugs licensed for MS treatment have been developed to reduce relapse rates and halt disease progression. The majority of current MS drugs involve regular, parenteral administration, affecting long-term adherence and thus reducing treatment efficacy. Over the last two decades great progress has been made towards developing new MS therapies with different modes of action and biologic effects. In particular, oral drugs have generated much interest because of their convenience and positive impact on medication adherence. Fingolimod was the first launched oral treatment for relapsing-remitting MS; recently, Teriflunomide and Dimethyl fumarate have also been approved as oral disease-modifying agents. In this review, we summarize and discuss the history, pharmacodynamics, efficacy, and safety of oral agents that have been approved or are under development for the selective treatment of MS. PMID:25924620

  10. Oral Health in Rural Communities

    ... Rural Oral Health Toolkit identifies the resources and best practices to help implement a rural Mobile Dental Services ... Health Information Hub is supported by the Health Resources and ... Human Services (HHS) under Grant Number U56RH05539 (Rural Assistance ...

  11. Tuberculosis involving the oral cavity

    Ferguson, Kathleen A.; McCormack, David G

    1993-01-01

    The oral cavity is a rare site for extrapulmonary tuberculosis. A case is reported of a young woman with dysphagia and oral ulceration. The original mucosal biopsy was negative on smear for acid-fast bacilli, and the patient subsequently developed pulmonary symptoms. A diagnosis of Mycobacterium tuberculosis was ultimately made on open lung biopsy. Complete resolution of both mouth lesion and chest involvement occurred with standard antituberculous therapy.

  12. Oral cysticercosis: a clinical dilemma

    Wanjari, Sangeeta Panjab; Patidar, Kalpana A; Parwani, Rajkumar N; Satyajitraje A Tekade

    2013-01-01

    Cysticercosis is a potentially fatal parasitic disease caused by cysticercus cellulosae, the larval stage of Taenia solium. Oral cysticercosis is a rare entity and represents difficulty in clinical diagnosis. This article reports two cases of oral cysticercosis involving buccal and labial mucosa. Both the cases presented with solitary, nodular swelling that had been clinically diagnosed as a mucocele. Histopathology of excisional biopsy revealed it to be cysticercosis. Single, cystic nodular ...

  13. Oral phenoxymethylpenicillin treatment during pregnancy

    Czeizel, A.E.; Rockenbauer, M.; Olsen, Jørn; Sørensen, Henrik Toft

    2000-01-01

    The objective of the study was to examine the human teratogenic potential of oral penicillin V: phenoxymethylpenicillin treatment during pregnancy in the large population-based dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980–1996. The dataset included 22......, i.e. in the critical period for most major congenital abnormalities in case-matched control pairs. Thus, treatment with oral phenoxymethylpenicillin during pregnancy presents very little if any teratogenic risk to the fetus....

  14. Oral Complications of HIV Disease

    Leao, Jair C.; Camila M. B. Ribeiro; Carvalho, Alessandra A. T.; Cristina Frezzini; Stephen Porter

    2009-01-01

    Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well...

  15. ORAL CANDIDIASIS AND HIV INFECTION

    Prabhu, Rachana Vishnudas

    2013-01-01

    The acquired immunodeficiency syndrome (AIDS) pandemic, caused by infection with human immunodeficiency virus (HIV) dramatically illustrates the awesome transmission capabilities of disease. Oral manifestations of HIV have been important in identification of patients harboring the HIV virus and in predicting the decline in their immune system Oral candidiasis is one of the earliest premonitory signs of HIV infection and its diagnosis may have grave prognostic implications for the eventual dev...

  16. Peran 'Oral Splint' pada Bruxisme

    Antonia Tanzil

    2013-01-01

    Oral splints have been frequently used in the treatment of bruxism to protect teeth and periodontium from damage, but the mechanism of action and efficacy of oral splints remain controversial. It has been suggested that they can be used to treat bruxism, based on the assumption that the device can eliminate or remove occlusal interference. Currently there are no reliable data to support the assumption of occlusion as an etiologic factor for bruxism, because several other factors have a role i...

  17. Oral manifestations in transplant patients

    Nappalli, Deepika; Lingappa, Ashok

    2015-01-01

    Organ transplantation is a widely undertaken procedure and has become an important alternative for the treatment of different end-stage organ diseases that previously had a poor prognosis. The field of organ transplant and hematopoietic stem cell transplant is developing rapidly. The increase in the number of transplant recipients also has an impact on oral and dental services. Most of the oral problems develop as a direct consequence of drug-induced immunosuppression or the procedure itself....

  18. Superoxide dismutase and glutathione peroxidase in oral submucous fibrosis, oral leukoplakia, and oral cancer: A comparative study

    Shubha Gurudath; Raghavendra Mahadev Naik; Ganapathy, K.S.; Yadavalli Guruprasad; Sujatha, D; Anuradha Pai

    2012-01-01

    Objectives: Present study was undertaken to estimate and compare erythrocyte superoxide dismutase (E-SOD) and glutathione peroxidase (GPx) levels in oral submucous fibrosis, oral leukoplakia, oral cancer patients, and healthy subjects. Materials and Methods: E-SOD and GPx levels were estimated in OSF, oral leukoplakia, and oral cancer patients with 25 subjects in each group. The results obtained were compared with the corresponding age-/sex- matched control groups. Results: Statistically sign...

  19. Inpatient Oral Anticoagulation Management by Clinical Pharmacists: Safety and Cost effectiveness

    Hosmane, Sharath R.; Tucker, Johanna; Osman, Dave; Williams, Steve; Waterworth, Paul

    2010-01-01

    Background Warfarin prescription for anticoagulation after cardiac surgery has always been a challenge for junior medical staff. Methods A prospective study was carried out to assess the quality of anticoagulation control by junior doctors compared with clinical pharmacists at South Manchester University hospitals NHS Trust. The junior medical staff prescribed warfarin for 50 consecutive patients from April to September 2006 (group A, n = 50) and experienced clinical pharmacists dosed 46 cons...

  20. Inflammatory Hyperplasia of the Oral Cavity

    Sudarshan, Ramachandran; Vijayabala, G. Sree; Kumar, KS Prem

    2012-01-01

    Oral inflammatory hyperplasias' are the most common oral abnormalities. It manifests as diverse signs and symptoms. It may occur in any part of the oral cavity. They occur mainly due to reactive stimulus hence these lesions are called reactive hyperplasia. Distinguishing these entities and removal of etiological factors are essential. This review illustrates the various hyperplasia of the oral mucosa. Anahtar Kelimeler: