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Sample records for anticoagulant citrate phosphate

  1. Citrate Anticoagulation for CRRT in Children: Comparison with Heparin

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    Sara Nicole Fernández

    2014-01-01

    Full Text Available Regional anticoagulation with citrate is an alternative to heparin in continuous renal replacement therapies, which may prolong circuit lifetime and decrease hemorrhagic complications. A retrospective comparative cohort study based on a prospective observational registry was conducted including critically ill children undergoing CRRT. Efficacy, measured as circuit survival, and secondary effects of heparin and citrate were compared. 12 patients on CRRT with citrate anticoagulation and 24 patients with heparin anticoagulation were analyzed. Median citrate dose was 2.6 mmol/L. Median calcium dose was 0.16 mEq/kg/h. Median heparin dose was 15 UI/kg/h. Median circuit survival was 48 hours with citrate and 31 hours with heparin (P=0.028. 66.6% of patients treated with citrate developed mild metabolic alkalosis, which was directly related to citrate dose. There were no cases of citrate intoxication: median total calcium/ionic calcium index (CaT/I of 2.16 and a maximum CaT/I of 2.33, without metabolic acidosis. In the citrate group, 45.5% of patients developed hypochloremia and 27.3% hypomagnesemia. In the heparin group, 27.8% developed hypophosphatemia. Three patients were moved from heparin to citrate to control postoperatory bleeding. In conclusion citrate is a safe and effective anticoagulation method for CRRT in children and it achieves longer circuit survival than heparin.

  2. Citrate anticoagulation in the ICU: the Leeds experience.

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    Trumper, Charlotte

    2016-09-01

    Continuous renal replacement therapy (CRRT) is widely used in the management of critically ill patients with acute kidney injury. It requires effective anticoagulation of the extracorporeal blood circuit. Although heparin is the most commonly prescribed anticoagulant, there are issues associated with heparin, and there has been increasing interest in regional citrate anticoagulation as an alternative. In 2013, The Leeds Teaching Hospitals NHS Trust switched from heparin to citrate anticoagulant for CRRT in intensive care units (ICUs) across the Trust. This article examines the reasons for the switch, the implementation of citrate and the impact of this quality-improvement project in terms of patient outcome data and feedback from the ICU nursing team. PMID:27615524

  3. Lifesaving citrate anticoagulation to bridge ineffective danaparoid [correction of to bridge to danaparoid] treatment.

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    Dworschak, Martin; Hiesmayr, Jörg Michael; Lassnigg, Andrea

    2002-05-01

    A case of successful regional anticoagulation with trisodium citrate in a patient who developed heparin-induced thrombocytopenia while on continuous hemofiltration is described. Immediate citrate anticoagulation allowed for maintenance of extracorporeal circulation until effective danaparoid therapy could be established. Recommended plasma antifactor Xa levels for hemodialysis may be inadequate in some cases. Values similar to those in use during cardiopulmonary bypass could be required. PMID:12022563

  4. Solute clearance effect of citrate anticoagulation hemodialysate for hemodialysis in patients with high risk of bleeding

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective To study the solute clearance effect of the new concentrated anticoagulation hemodialysate of citrate for hemodialysis in patients with high risk of bleeding. Methods Forty-two kidney failure patients with high risk of bleeding were divided into two groups (Group A and Group B) according to their hemodialysis manners. Patients in Group A were hemodialyzed with bicarbonate hemodialysate with low-molecular-weight heparin (dalteparin) anticoagulation and those in Group B with the new citrate anticoag...

  5. Hemodiafiltration using pre-dilutional on-line citrate dialysate: A new technique for regional citrate anticoagulation: A feasibility study

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    Radhouane Bousselmi

    2015-01-01

    Full Text Available A prospective, observational, feasibility study was carried out on four patients with end-stage renal failure undergoing bicarbonate hemodialysis to study the feasibility of an on-line hemodiafiltration technique using a citrate dialysate with pre-dilutional infusion of citrate as a technique for regional citrate anticoagulation. All patients had contraindication to systemic heparin anticoagulation. The dialysis technique consisted of an on-line hemodiafiltration with a citrate dialysate without calcium using a Fresenius 4008S dialysis machine and Fresenius Polysulfone F60 dialyzers. The infusion solution was procured directly from the dialysate and was infused into the arterial line. To avoid the risk of hypocalcemia, calcium gluconate was infused to the venous return line. The study was carried out in two stages. During the first stage, the citrate infusion rate was 80 mL/min and the calcium infusion rate was 9 mmol/h. At the second stage, the rates were 100 mL/min and 11 mmol/h, respectively. The primary endpoint of this study was the incidence of thrombosis in the extracorporeal blood circuit and/or the dialyzer. A total of 78 sessions were conducted. All the sessions were well tolerated clinically and there were no major incidents in any of the four patients. At the first stage of the study, there were five incidences of small clots in the venous blood chamber, an incidence of extracorporeal blood circuit thrombosis of 12.5%. At the second stage of the study, no cases of extracorporeal blood circuit or dialyzer thrombosis were noted. Hemodiafiltration with on-line citrate dialysate infusion to the arterial line is safe and allows an effective regional anticoagulation of the extracorporeal blood circuit without the need for systemic anticoagulation.

  6. Citrate versus unfractionated heparin for anticoagulation in continuous renal replacement therapy

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    LIAO Yu-jie; ZHANG Ling; ZENG Xiao-xi; FU Ping

    2013-01-01

    Background Unfractionated heparin is the most commonly used anticoagulant in continuous renal replacement therapy (CRRT),but it can increase the risk of bleeding.Citrate is a promising substitute.Our study was to assess the efficacy and safety of citrate versus unfractionated heparin in CRRT.Methods We searched the MEDLINE,the EMBASE,the Cochrane Central Register of Controlled Trials,and the China National Knowledge Infrastructure Database until up to November 2011 for randomized controlled trials comparing citrate with unfractionated heparin in adult patients with acute kidney injury prescribed CRRT.The primary outcome was mortality and the secondary outcomes included circuit survival,control of uremia,risk of bleeding,transfusion rates,acid-base statuses,and disturbance of sodium and calcium homeostasis.Results Four trials met the inclusion criteria.Meta-analysis found no significant difference between two anticoagulants on mortality.Less bleeding and more hypocalcemic episodes were with citrate.Citrate was superior or comparable to unfractionated heparin in circuit life.Conclusions Citrate anticoagulation in CRRT seems to be superior in reducing bleeding risk and with a longer or similar circuit life,although there is more metabolic derangement.Mortality superiority has not been approved.

  7. The safety and efficacy of regional citrate anticoagulation in sustained low efficiency dialysis

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    张凌

    2013-01-01

    Objective To evaluate the safety and efficacy of regional citrate anticoagulation in sustained low efficiency dialysis (SLED) .Methods A total of 45 patients with acute kidney injury (AKI) or end stage renal disease (ESRD) admitted in our hospital from August 2011 to

  8. EXPERIMENTAL STUDIES ON A NEW TYPE CONCENTRATED ANTICOAGULANT HEMODIALYSATE OF CITRATE IN DOGS

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    桂保松; 高卫华; 桂琳; 吕星; 王亮琪; 郭蕊军

    2002-01-01

    Objective To observe the hemodialysis effect of t he new type of concentrated anticoagulant hemodialysate of citrate. Methods Ten dogs were given intermittent hemodialysis and were divided into 3 groups according to hemodialysis manners. Group 1 was saline-flush hemodialysed with bicarbonate hemodialysate; Group 2 was hemodialysed with citrate hemodialysis without any anticoagulant; Group 3 wa s hemodialysed with bicarbonate hemodialysate and heparin .ACT, Ca2+, BUN, Cr,ALT, AST, TBIL, DBIL, Na+, Cl-, HCO3- and venous pressure were monitored in the animals of each group during hemodialysis. Results During the hemodialysis in Group 1,venous pressure increased lastingly, resulting in t he failure of hemodialysis for 2 hours. Hemodialysis for 2 hours in Group 2 were all finished successfully. ACT was extended and Ca2+ decreased obviously in the venous end during hemodialysis.And ALT、AST、Ca2+、K+、Na+、Cl -、HCO3- after the hemodialysis in Group 2 were not changed(P>0.05).Moreover, the clearance rat e of the dialyzers with citrate dialysate increased significantly compared with those of saline-flush and heparin anticoagulation.Conclusion The anticoagulant and dialytic effects of the new t ype citrate hemodialysis are satisfactory and better than that of saline-flush ..

  9. EXPERIMENTAL STUDIES ON A NEW TYPE CONCENTRATED ANTICOAGULANT HEMODIALYSATE OF CITRATE IN DOGS

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective:To observe the hemodialysis effcet of the new type of concentrated anticoagulant hemodialysate of citrate.Methods:Ten dogs were given intermittent hemodialysis and were divided into 3 groups according to hemodialysis manners.Group 1 was saline-flush hemodialysed with bicarbonate hemodialysate;Group 2 was hemodialysed with citrate hemodialysis without any anticoagulant;Group 3 was hemodialysed with bicarbonate hemodlalysate and heparin,ACT,Ca2+,BUN,Cr,ALT,AST,TBIL,BDIL,Na+,Cl-,HCO3- and venous pressure were monitored in the animals of each group during hemodialysis.Results:During the hemodialysis in Group 1,venous pressure increased lastingly,resulting in the failure of hemodialysis for 2 hours.Hemodialysis for 2 hours in Group 2 were all finished successfully.ACT was extended and Ca2+ decreased obviously in the venous end during hemodialysis,And ALT,AST,Ca2+,K+,Na+,Cl-,HCO3- after the hemodialysis in Group 2 were not changed(P>0.05).Moreover,the clearance rate of the dialyzers with citrate dialysate increased significantly compared with those of saline-flush and heparin anticoagulation.Conclusion:The anticoagulant and dialytic effects of the new type citrate hemodialysis are satisfactory and better than that of saline-flush.

  10. Online Hemoglobin and Oxygen Saturation Sensing During Continuous Renal Replacement Therapy with Regional Citrate Anticoagulation.

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    Yessayan, Lenar T; Yee, Jerry; Frinak, Stan; Szamosfalvi, Balazs

    2015-01-01

    Optical hemoglobin and oxygen saturation sensor (OHOS) monitor when used in combination with other hemodynamic tools may be useful for continuous hemodynamic monitoring during ultrafiltration. The stand-alone OHOS monitor can easily be deployed predialyzer into the extracorporeal circuit of continuous renal replacement therapy (CRRT) systems. To maximize the accuracy of the OHOS in 24 hr CRRT systems, clotting in the optical blood chamber and the presensor dilution incurred by replacement fluid should be minimized. Sustained low-efficiency dialysis (SLED) with regional citrate anticoagulation is a therapy that incorporates an OHOS and maintains the overall reliability of hemoglobin (Hb) and saturation sensing. The system operates at a blood flow rate of 60 ml/min and a fixed acid citrate infusion rate of 150 ml/hr. The presensor dilution incurred by concentrated citrate infusion would result in a minimal Hb dilution (<0.7 g/dl) while minimizing optical blood chamber clotting during 24 hr SLED.

  11. Regional citrate anticoagulation in critically ill patients during continuous blood purification

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    龚德华; 季大玺; 徐斌; 谢红浪; 刘云; 黎磊石

    2003-01-01

    Objectives To evaluate the safety and define the contraindication of regional citrate anticoagulation treatment on various critically ill patients being treated by continuous blood purification, who also had bleeding tendencies. Methods Forty critically ill patients being treated by continuous blood purification (CBP) were involved in this study. Due to their bleeding tendencies, regional citrate anticoagulation treatment was given to all of them. Those with hepatic function impairment (n=10) were classified as Group A, those with hypoxemia were classified as Group B (n=10), and the others as Group C (n=20). Blood samples were collected before treatment, and at 4, 12, 24, 36, and 48 hour intervals during CBP. These samples then were used arterial blood gas analysis, whole blood activated clotting time (WBACT) pre- and post-filter, and serum ionized calcium examination. Results WBACT pre-filter showed little fluctuant through the 48hr period of CBP, and WBACT post-filter showed obvious prolongation than that of the pre-filter (P<0.05) at all time points. Metabolic acidosis was found in Group A patients before CBP, and improved during CBP. Normal acid-base conditions of patients were disturbed and deteriorated in Group B during CBP, but not in Group C. Serum ionized calcium was maintained at a normal range during CBP in Group A and C patients, but declined significantly in Group B patients (vs. pre-treatment, P<0.05). Conclusions Regional citrate anticoagulation can be safely used in conjunction with CBP treatment for patients with hepatic function impairment , but may induce acidosis and a decline in serum ionized calcium when used with hypoxemic patients.

  12. L'anticoagulation de l'hémofiltration continue: Citrate versus Héparine

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    Damas, Pierre; Krzesinski, Jean-Marie

    2007-01-01

    L'insuffisance rénale aiguë aux Soins Intensifs affecte un patient sur cinq et souvent nécessite le recours à une épuration extra-rénale. L'hémofiltration continue est choisie pour certains patients (instabilité hémodynamique, neurologique, mais nécessite, comme d'ailleurs l'hémodialyse, une anticoagulation. Le citrate, utilisé dans le travail publié, est sorti vainqueur de sa comparaison avec l'héparine non fractionnée. Son utilisation nécessite cependant une surveillance attentive. P...

  13. Artificial citrate operon and Vitreoscilla hemoglobin gene enhanced mineral phosphate solubilizing ability of Enterobacter hormaechei DHRSS.

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    Yadav, Kavita; Kumar, Chanchal; Archana, G; Kumar, G Naresh

    2014-10-01

    Mineral phosphate solubilization by bacteria is mediated through secretion of organic acids, among which citrate is one of the most effective. To overproduce citrate in bacterial systems, an artificial citrate operon comprising of genes encoding NADH-insensitive citrate synthase of E. coli and Salmonella typhimurium sodium-dependent citrate transporter was constructed. In order to improve its mineral phosphate solubilizing (MPS) ability, the citrate operon was incorporated into E. hormaechei DHRSS. The artificial citrate operon transformant secreted 7.2 mM citric acid whereas in the native strain, it was undetectable. The transformant released 0.82 mM phosphate in flask studies in buffered medium containing rock phosphate as sole P source. In fermenter studies, similar phenotype was observed under aerobic conditions. However, under microaerobic conditions, no citrate was detected and P release was not observed. Therefore, an artificial citrate gene cluster containing Vitreoscilla hemoglobin (vgb) gene under its native promoter, along with artificial citrate operon under constitutive tac promoter, was constructed and transformed into E. hormaechei DHRSS. This transformant secreted 9 mM citric acid under microaerobic conditions and released 1.0 mM P. Thus, incorporation of citrate operon along with vgb gene improves MPS ability of E. hormaechei DHRSS under buffered, microaerobic conditions mimicking rhizospheric environment.

  14. Citrate impairs the micropore diffusion of phosphate into pure and C-coated goethite

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    Mikutta, Christian; Lang, Friederike; Kaupenjohann, Martin

    2006-02-01

    Anions of polycarboxylic low-molecular-weight organic acids (LMWOA) compete with phosphate for sorption sites of hydrous Fe and Al oxides. To test whether the sorption of LMWOA anions decreases the accessibility of micropores (citrate-induced changes in microporosity and the phosphate sorption kinetics of synthetic goethite in the presence and absence of citrate in batch systems for 3 weeks (500 μM of each ion, pH 5). We also used C-coated goethite obtained after sorption of dissolved organic matter in order to simulate organic coatings in the soil. We analyzed our samples with N 2 adsorption and electrophoretic mobility measurements. Citrate clogged the micropores of both adsorbents by up to 13% within 1 h of contact. The micropore volume decreased with increasing concentration and residence time of citrate. In the absence of citrate, phosphate diffused into micropores of the pure and C-coated goethite. The C coating (5.6 μmol C m -2) did not impair the intraparticle diffusion of phosphate. In the presence of citrate, the diffusion of phosphate into the micropores of both adsorbents was strongly impaired. We attribute this to the micropore clogging and the ligand-induced dissolution of goethite by citrate. While the diffusion limitation of phosphate by citrate was stronger when citrate was added before phosphate to pure goethite, the order of addition of both ions to C-coated goethite had only a minor effect on the intraparticle diffusion of phosphate. Micropore clogging and dissolution of microporous hydrous Fe and Al oxides may be regarded as potential strategies of plants to cope with phosphate deficiency in addition to ligand-exchange.

  15. Citrate adsorption can decrease soluble phosphate concentration in soil : experimental and modeling evidence

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    Duputel, M.; Van Hoye, F.; Toucet, Joële; F. Gerard

    2013-01-01

    The adsorption/desorption of phosphate (PO4) on soil minerals is a major process regulating soluble phosphate concentrations (i.e. phosphorus availability) and ultimately PO4 bio-availability. Release of citrate by roots is widely recognized as an effective biological mechanism for increasing available phosphorus (P) in soil. However, interactions between citrate and PO4 are poorly understood and little investigated in soils. Using surface complexation modeling we recently predicted that citr...

  16. Artificial citrate operon confers mineral phosphate solubilization ability to diverse fluorescent pseudomonads.

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    Hemanta Adhikary

    Full Text Available Citric acid is a strong acid with good cation chelating ability and can be very efficient in solubilizing mineral phosphates. Only a few phosphate solubilizing bacteria and fungi are known to secrete citric acids. In this work, we incorporated artificial citrate operon containing NADH insensitive citrate synthase (gltA1 and citrate transporter (citC genes into the genome of six-plant growth promoting P. fluorescens strains viz., PfO-1, Pf5, CHAO1, P109, ATCC13525 and Fp315 using MiniTn7 transposon gene delivery system. Comprehensive biochemical characterization of the genomic integrants and their comparison with plasmid transformants of the same operon in M9 minimal medium reveals the highest amount of ∼7.6±0.41 mM citric and 29.95±2.8 mM gluconic acid secretion along with ∼43.2±3.24 mM intracellular citrate without affecting the growth of these P. fluorescens strains. All genomic integrants showed enhanced citric and gluconic acid secretion on Tris-Cl rock phosphate (TRP buffered medium, which was sufficient to release 200-1000 µM Pi in TRP medium. This study demonstrates that MPS ability could be achieved in natural fluorescent pseudomonads by incorporation of artificial citrate operon not only as plasmid but also by genomic integration.

  17. Artificial citrate operon confers mineral phosphate solubilization ability to diverse fluorescent pseudomonads.

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    Adhikary, Hemanta; Sanghavi, Paulomi B; Macwan, Silviya R; Archana, Gattupalli; Naresh Kumar, G

    2014-01-01

    Citric acid is a strong acid with good cation chelating ability and can be very efficient in solubilizing mineral phosphates. Only a few phosphate solubilizing bacteria and fungi are known to secrete citric acids. In this work, we incorporated artificial citrate operon containing NADH insensitive citrate synthase (gltA1) and citrate transporter (citC) genes into the genome of six-plant growth promoting P. fluorescens strains viz., PfO-1, Pf5, CHAO1, P109, ATCC13525 and Fp315 using MiniTn7 transposon gene delivery system. Comprehensive biochemical characterization of the genomic integrants and their comparison with plasmid transformants of the same operon in M9 minimal medium reveals the highest amount of ∼7.6±0.41 mM citric and 29.95±2.8 mM gluconic acid secretion along with ∼43.2±3.24 mM intracellular citrate without affecting the growth of these P. fluorescens strains. All genomic integrants showed enhanced citric and gluconic acid secretion on Tris-Cl rock phosphate (TRP) buffered medium, which was sufficient to release 200-1000 µM Pi in TRP medium. This study demonstrates that MPS ability could be achieved in natural fluorescent pseudomonads by incorporation of artificial citrate operon not only as plasmid but also by genomic integration. PMID:25259527

  18. Competition between transferrin and the serum ligands citrate and phosphate for the binding of aluminum.

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    Harris, Wesley R; Wang, Zhepeng; Hamada, Yahia Z

    2003-05-19

    A key issue regarding the speciation of Al(3+) in serum is how well the ligands citric acid and phosphate can compete with the iron transport protein serum transferrin for the aluminum. Previous studies have attempted to measure binding constants for each ligand separately, but experimental problems make it very difficult to obtain stability constants with the accuracy required to make a meaningful comparison between these ligands. In this study, effective binding constants for Al-citrate and Al-phosphate at pH 7.4 have been determined using difference UV spectroscopy to monitor the direct competition between these ligands and transferrin. The analysis of this competition equilibrium also includes the binding of citrate and phosphate as anions to apotransferrin. The effective binding constants are 10(11.59) for the 1:1 Al-citrate complexes and 10(14.90) for the 1:2 Al-citrate complexes. The effective binding constant for the 1:2 Al-phosphate complex is 10(12.02). No 1:1 Al-phosphate complex was detected. Speciation calculations based on these effective binding constants indicate that, at serum concentrations of citrate and phosphate, citrate will be the primary low-molecular-mass ligand for aluminum. Formal stability constants for the Al-citrate system have also been determined by potentiometric methods. This equilibrium system is quite complex, and information from both electrospray mass spectrometry and difference UV experiments has been used to select the best model for fitting the potentiometric data. The mass spectra contain peaks that have been assigned to complexes having aluminum:citrate stoichiometries of 1:1, 1:2, 2:2, 2:3, and 3:3. The difference UV results were used to determine the stability constant for Al(H(-1)cta)-, which was then used in the least-squares fitting of the potentiometric data to determine stability constants for Al(Hcta)+, Al(cta), Al(cta)2(3-), Al(H(-1)cta)(cta)(4-), Al2(H(-1)cta)2(2-), and Al3(H(-1)cta)3(OH)(4-).

  19. The Effects of High Level Magnesium Dialysis/Substitution Fluid on Magnesium Homeostasis under Regional Citrate Anticoagulation in Critically Ill.

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    Mychajlo Zakharchenko

    Full Text Available The requirements for magnesium (Mg supplementation increase under regional citrate anticoagulation (RCA because citrate acts by chelation of bivalent cations within the blood circuit. The level of magnesium in commercially available fluids for continuous renal replacement therapy (CRRT may not be sufficient to prevent hypomagnesemia.Patients (n = 45 on CRRT (2,000 ml/h, blood flow (Qb 100 ml/min with RCA modality (4% trisodium citrate using calcium free fluid with 0.75 mmol/l of Mg with additional magnesium substitution were observed after switch to the calcium-free fluid with magnesium concentration of 1.50 mmol/l (n = 42 and no extra magnesium replenishment. All patients had renal indications for CRRT, were treated with the same devices, filters and the same postfilter ionized calcium endpoint (<0.4 mmol/l of prefilter citrate dosage. Under the high level Mg fluid the Qb, dosages of citrate and CRRT were consequently escalated in 9h steps to test various settings.Median balance of Mg was -0.91 (-1.18 to -0.53 mmol/h with Mg 0.75 mmol/l and 0.2 (0.06-0.35 mmol/h when fluid with Mg 1.50 mmol/l was used. It was close to zero (0.02 (-0.12-0.18 mmol/h with higher blood flow and dosage of citrate, increased again to 0.15 (-0.11-0.25 mmol/h with 3,000 ml/h of high magnesium containing fluid (p<0.001. The arterial levels of Mg were mildly increased after the change for high level magnesium containing fluid (p<0.01.Compared to ordinary dialysis fluid the mildly hypermagnesemic fluid provided even balances and adequate levels within ordinary configurations of CRRT with RCA and without a need for extra magnesium replenishment.ClinicalTrials.gov Identifier: NCT01361581.

  20. Magnesium citrate with a single dose of sodium phosphate for colonoscopy bowel preparation

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    Yong Sung Choi; Jung Pil Suh; Jong Kyu Kim; In Taek Lee; Eui Gon Youk; Doo Seok Lee; Do Sun Kim; Doo Han Lee

    2011-01-01

    AIM: To evaluate the efficacy and acceptability of magnesium citrate and a single dose of oral sodium phosphate (45 mL) solution for morning colonoscopy bowel preparation.METHODS: A total of 159 patients were randomly assigned to receive two split doses of 90 mg of sodium phosphate (Group Ⅰ, n = 79) or magnesium citrate (250 mL,the day before the procedure) followed by 45 mL of sodium phosphate (the day of procedure, Group Ⅱ, n =80). The quality of bowel cleansing and the acceptability of each regimen were compared, including the satisfaction,taste, willing to repeat and adverse effects of each regimen.RESULTS: The quality of bowel cleansing of Group Ⅱ was as good as that of Group Ⅰ (An Aronchick scale score of good or excellent: 70.9% vs 81.0%, respectively,P = 0.34; the Ottawa system score: 4.4 ± 2.6 vs 3.8± 3.0, respectively, P = 0.76). There was no statistically significant difference between both groups with regard to acceptability, including the satisfaction, taste and willingness to repeat the regimen. A significantly greater number of older patients (over 65 years old) in Group Ⅱ graded the overall satisfaction as satisfactory (48.1%vs 78.1%, respectively; Group Ⅰ vs Group Ⅱ, P = 0.01).There were no significant adverse reactions. CONCLUSION: Magnesium citrate and a single dose of sodium phosphate was as effective and tolerable as the conventional sodium phosphate regimen and is a satisfactory option.

  1. Adsorption of Acid Phosphatase on Minerals and Soil Colloids in Presence of Citrate and Phosphate

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    The aim of this work was to study the influence of phosphate and citrate, which are common inorganic andorganic anions in soils, on the adsorption of acid phosphatase by kaolin, goethite and the colloids separatedfrom yellow-brown soil (YBS) and latosol (LS) in central-south China. The YBS colloid has the major claymineral composition of 1.4 nm mineral, illite and kaolinite while the LS colloid mainly contains kaolinite andoxides. The adsorption isotherm of acid phosphatase on the examined soil colloids and minerals fitted tothe Langmuir model. The amount of enzyme adsorbed in the absence of ligands was in the order of YBScolloid >LS colloid>kaolin≈goethite. In the presence of phosphate or citrate, the amounts of the enzymeadsorbed followed the sequence YBS colloid>kaolin>LS colloid>goethite. The presence of ligands alsodecreased the binding energy between the enzyme and soil colloids or minerals. With the increase of ligandconcentration from 10 mmol L-1 to 400 m mol L-1, different behaviors for the adsorption of enzyme werefound in the colloid and mineral systems studied. A sharp decrease in enzyme adsorption was observed ongoethite while gradual decreases of enzyme adsorption were recorded in the two soil colloid systems. However,no any decrease was found for the amount of enzyme adsorbed on kaolin at higher ligand concentrations.When phosphate or citrate was introduced to the system before the addition of enzyme, the ligands usuallyenhanced the adsorption of enzyme. The results obtained in this study suggested the important role ofkaolinite mineral in the adsorption of enzyme molecules in acidic soils in the presence of various ligands.

  2. Sodium citrate regional anticoagulation in the hemoperfusion the application%枸橼酸钠局部抗凝在血液灌流中的应用

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    胡蓬勃; 姜海明; 杜绪强; 邱建清; 吕毅; 许玲

    2012-01-01

    目的 探讨枸橼酸钠局部抗凝在血液灌流中的临床应用效果.方法 对我科2009年11月至2011年11月行血液灌流患者的病例进行回顾性研究,按随机数字表法将其分为2组.对照组采用常规的肝素抗凝,枸橼酸钠组采用枸橼酸钠体外局部抗凝,观察两组患者灌流器管路血栓发生率、血小板降低程度、全血活化部分凝血活酶时间延长程度及出血发生率.结果 枸橼酸钠组患者灌流器管路血栓发生率、血小板降低程度、全血活化部分凝血活酶时间延长程度及出血发生率与对照组比较差异有统计学意义(P< 0.05).结论 枸橼酸钠局部抗凝能明显降低血液灌流过程中血栓发生率及出血发生率.%Objective To investigate the sodium citrate regional anticoagulation in the hemoperfusion the clinical application.Methods 2009 November to 2011 November hemoperfusion in patients with retrospective case study,will be divided into two groups,the control group using conventional anticoagulation with heparin,sodium citrate group using sodium citrate in vitro anticoagulation,two groups were observed in patients with perfusion line thrombosis,platelet decrease,APTT extension the degree and incidence of bleeding.Results sodium citrate group perfusion line thrombosis,platelet decrease,APTT extended degree andbleeding incidence rate decreased significantly,the difference was statistically significant ( P < 0.05).Conclusion sodium citrate anticoagulation can significantly reduce the blood perfusion of thrombosis and bleeding incidence.

  3. 局部枸椽酸钠抗凝法与肝素抗凝法在CRRT中的应用比较%Comparative study on regional citrate anticoagulation and the heparin law used in the application of CRRT

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    刘锦全; 郑志忠; 罗文晓; 蔡洧丹

    2013-01-01

    目的 比较局部枸椽酸钠抗凝法与肝素抗凝法在CRRT中的应用效果.方法 将我院2011年11月至2012年12月行CRRT治疗的126例患者随机分为两组,肝素抗凝组患者采用常规肝素抗凝方式治疗,局部枸椽酸钠抗凝组患者采用局部枸椽酸钠抗凝方式治疗.结果 治疗后局部枸椽酸钠抗凝组患者未出现高钠血症和代谢性碱中毒情况;治疗后肝素抗凝组患者的体内钙离子浓度明显下降,局部枸椽酸钠抗凝组明显上升,两组比较差异有统计学意义(P<0.05).结论 在CRRT治疗中,局部枸椽酸钠抗凝比常规肝素抗凝更有效、更安全.%Objective To compare the clinical effects of regional citrate anticoagulation with heparin sodium anticoagulation method in the application of continuous renal replacement therapy (CRRT).Methods In our hospital from November 2011 to December 2012,126 cases of C RRT were randomly divided into 2 groups,namely regional citrate anticoagulation group and heparin group.Heparin group was treated with conventional heparin anticoagulation therapy,regional citrate anticoagulation group was treated by regional citrate anticoagulation treatment.Results After treatment of regional citrate anticoagulation group patients did not appear hypernatremia and metabolic alkalosis; after treatment with heparin patients with total body calcium concentration decreased significantly,regional citrate anticoagulation group increased obviously.With comparison of the two groups,the difference was statistically significant (P<0.05).Conclusion In the treatment of CRRT,regional citrate anticoagulation is more effective and safer than heparin anticoagulation

  4. Delay in onset of metabolic alkalosis during regional citrate anti-coagulation in continous renal replacement therapy with calcium-free replacement solution

    Directory of Open Access Journals (Sweden)

    See Kay

    2009-01-01

    Full Text Available Regional citrate anti-coagulation for continuous renal replacement therapy chelates calcium to produce the anti- coagulation effect. We hypothesise that a calcium-free replacement solution will require less citrate and produce fewer metabolic side effects. Fifty patients, in a Medical Intensive Care Unit of a tertiary teaching hospital (25 in each group, received continuous venovenous hemofiltration using either calcium-containing or calcium-free replacement solutions. Both groups had no significant differences in filter life, metabolic alkalosis, hypernatremia, hypocalcemia, and hypercalcemia. However, patients using calcium-containing solution developed metabolic alkalosis earlier, compared to patients using calcium-free solution (mean 24.6 hours,CI 0.8-48.4 vs. 37.2 hours, CI 9.4-65, P = 0.020. When calcium-containing replacement solution was used, more citrate was required (mean 280ml/h, CI 227.2-332.8 vs. 265ml/h, CI 203.4-326.6, P = 0.069, but less calcium was infused (mean 21.2 ml/h, CI 1.2-21.2 vs 51.6ml/h, CI 26.8-76.4, P ≤ 0.0001.

  5. Determinants of Calcium Infusion Rate During Continuous Veno-venous Hemofiltration with Regional Citrate Anticoagulation in Critically Ⅲ Patients with Acute Kidney Injury

    Institute of Scientific and Technical Information of China (English)

    De-Lin Liu; Li-Feng Huang; Wen-Liang Ma; Qi Ding; Yue Han; Yue Zheng; Wen-Xiong Li

    2016-01-01

    Background:It is unclear that how to decide the calcium infusion rate during continuous veno-venous hemofiltration (CVVH) with regional citrate anticoagulation (RCA).This study aimed to assess the determinants of calcium infusion rate during CVVH with RCA in critically ill patients with acute kidney injury (AKI).Methods:A total of 18 patients with AKI requiring CVVH were prospectively analyzed.Postdilution CVVH was performed with a fixed blood flow rate of 150 ml/min and a replacement fluid flow rate of 2000 ml/h for each new circuit.The infusion of 4% trisodium citrate was started at a rate of 29.9 mmol/h prefilter and adjusted according to postfilter ionized calcium.The infusion of 10% calcium gluconate was initiated at a rate of 5.5 mmol/h and adjusted according to systemic ionized calcium.The infusion rate oftrisodium citrate and calcium gluconate as well as ultrafiltrate flow rate were recorded at 1,2,4,6,12,and 24 h after starting CVVH,respectively.The calcium loss rate by CVVH was also calculated.Results:Fifty-seven sessions of CVVH were performed in 18 AKI patients.The citrate infusion rate,calcium loss rate by CVVH,and calcium infusion rate were 31.30 (interquartile range:2.70),4.60 ± 0.48,and 5.50 ± 0.35 mmol/h,respectively.The calcium infusion rate was significantly higher than that of calcium loss rate by CVVH (P < 0.01).The correlation coefficient between the calcium and citrate infusion rates,and calcium infusion and calcium loss rates by CVVH was-0.031 (P > 0.05) and 0.932 (P < 0.01),respectively.In addition,calcium infusion rate (mmol/h) =1.77 + 0.8 × (calcium loss rate by CVVH,mmol/h).Conclusions:The calcium infusion rate correlates significantly with the calcium loss rate by CVVH but not with the citrate infusion rate in a fixed blood flow rate during CVVH with RCA.

  6. A Retrospective Review of the Use of Regional Citrate Anticoagulation in Continuous Venovenous Hemofiltration for Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Anne Kit-Hung Leung

    2013-01-01

    Full Text Available Background. The emergence of a commercially prepared citrate solution has revolutionized the use of RCA in the intensive care unit (ICU. The aim of this study was to evaluate the safety profile of a commercially prepared citrate solution. Method. Predilution continuous venovenous hemofiltration (CVVH was performed using Prismocitrate 10/2 at 2500 mL/h and a blood flow rate of 150 mL/min. Calcium chloride solution was infused to maintain ionized calcium within 1.0–1.2 mmol/L. An 8.4% sodium bicarbonate solution was infused separately. Treatment was stopped when the predefined clinical target was reached or the filter clotted. Result. 58 sessions of citrate RCA were analyzed. The median circuit lifetime was 26.0 h (interquartile range IQR 21.2–44.3. The percentage of circuits lasting more than 12 h, 24 h, and 48 h was 94.6%, 58.9%, and 16.1%, respectively. There was no incidence of hypernatremia and median pH was 2.5, only four patients had evidence of citrate accumulation. Conclusion. The commercially prepared citrate solution could be used safely in critically ill patients who required CVVH with no major adverse events.

  7. Citrate adsorption can decrease soluble phosphate concentration in soils : results of theoretical modeling

    OpenAIRE

    Duputel, M.; Devau, N.; Brossard, Michel; Jaillard, B; Jones, D. L.; Hinsinger, P.; F. Gerard

    2013-01-01

    A major problem for 21st century agriculture is the prospect of P scarcity. Adsorption of PO4 on the soil's solid phase is the primary mechanism regulating P availability. Release of citrate by roots is generally thought to increase the availability of P, which in turn improves P acquisition by plants. However, the interaction between citrate and PO4 remains poorly understood in soils and conflicting results are found in the literature. Here modeling is used to investigate the effects of citr...

  8. Optimization and validation of a rapid method to determine citrate and inorganic phosphate in milk by capillary electrophoresis.

    Science.gov (United States)

    Izco, J M; Tormo, M; Harris, A; Tong, P S; Jimenez-Flores, R

    2003-01-01

    Quantification of phosphate and citrate compounds is very important because their distribution between soluble and colloidal phases of milk and their interactions with milk proteins influence the stability and some functional properties of dairy products. The aim of this work was to optimize and validate a capillary electrophoresis method for the rapid determination of these compounds in milk. Various parameters affecting analysis have been optimized, including type, composition, and pH of the electrolyte, and sample extraction. Ethanol, acetonitrile, sulfuric acid, water at 50 degrees C or at room temperature were tested as sample buffers (SB). Water at room temperature yielded the best overall results and was chosen for further validation. The extraction time was checked and could be shortened to less than 1 min. Also, sample preparation was simplified to pipet 12 microl of milk into 1 ml of water containing 20 ppm of tartaric acid as an internal standard. The linearity of the method was excellent (R2 > 0.999) with CV values of response factors yogurt, or Cheddar cheese were analyzed and accuracy was similar to milk in all products tested. The procedure is rapid and offers a very fast and simple sample preparation. Once the sample has arrived at the laboratory, less than 5 min (including handling, preparation, running, integration, and quantification) are necessary to determine the concentration of citric acid and inorganic phosphate. Because of the speed and accuracy of this method, it is promising as an analytical quantitative testing technique.

  9. Effect of the Food Additives Sodium Citrate and Disodium Phosphate on Shiga Toxin-Producing Escherichia coli and Production of stx-Phages and Shiga toxin.

    Science.gov (United States)

    Lenzi, Lucas J; Lucchesi, Paula M A; Medico, Lucía; Burgán, Julia; Krüger, Alejandra

    2016-01-01

    Induction and propagation of bacteriophages along the food production chain can represent a significant risk when bacteriophages carry genes for potent toxins. The aim of this study was to evaluate the effect of different compounds used in the food industry on the growth of Shiga toxin-producing Escherichia coli (STEC) and the production of stx-phage particles and Shiga toxin. We tested the in vitro effect of lactic acid, acetic acid, citric acid, disodium phosphate, and sodium citrate on STEC growth. A bacteriostatic effect was observed in most of treated cultures. The exceptions were those treated with sodium citrate and disodium phosphate in which similar growth curves to the untreated control were observed, but with reduced OD600 values. Evaluation of phage production by plaque-based assays showed that cultures treated with sodium citrate and disodium phosphate released phages in similar o lower levels than untreated cultures. However, semi-quantification of Stx revealed higher levels of extracellular Stx in STEC cultures treated with 2.5% sodium citrate than in untreated cultures. Our results reinforce the importance to evaluate if additives and other treatments used to decrease bacterial contamination in food induce stx-phage and Stx production. PMID:27446032

  10. Effect of the Food Additives Sodium Citrate and Disodium Phosphate on Shiga Toxin-Producing Escherichia coli and Production of stx-Phages and Shiga toxin.

    Science.gov (United States)

    Lenzi, Lucas J; Lucchesi, Paula M A; Medico, Lucía; Burgán, Julia; Krüger, Alejandra

    2016-01-01

    Induction and propagation of bacteriophages along the food production chain can represent a significant risk when bacteriophages carry genes for potent toxins. The aim of this study was to evaluate the effect of different compounds used in the food industry on the growth of Shiga toxin-producing Escherichia coli (STEC) and the production of stx-phage particles and Shiga toxin. We tested the in vitro effect of lactic acid, acetic acid, citric acid, disodium phosphate, and sodium citrate on STEC growth. A bacteriostatic effect was observed in most of treated cultures. The exceptions were those treated with sodium citrate and disodium phosphate in which similar growth curves to the untreated control were observed, but with reduced OD600 values. Evaluation of phage production by plaque-based assays showed that cultures treated with sodium citrate and disodium phosphate released phages in similar o lower levels than untreated cultures. However, semi-quantification of Stx revealed higher levels of extracellular Stx in STEC cultures treated with 2.5% sodium citrate than in untreated cultures. Our results reinforce the importance to evaluate if additives and other treatments used to decrease bacterial contamination in food induce stx-phage and Stx production.

  11. Effect of the Food Additives Sodium Citrate and Disodium Phosphate on Shiga Toxin-Producing Escherichia coli and Production of stx-Phages and Shiga toxin

    Science.gov (United States)

    Lenzi, Lucas J.; Lucchesi, Paula M. A.; Medico, Lucía; Burgán, Julia; Krüger, Alejandra

    2016-01-01

    Induction and propagation of bacteriophages along the food production chain can represent a significant risk when bacteriophages carry genes for potent toxins. The aim of this study was to evaluate the effect of different compounds used in the food industry on the growth of Shiga toxin-producing Escherichia coli (STEC) and the production of stx-phage particles and Shiga toxin. We tested the in vitro effect of lactic acid, acetic acid, citric acid, disodium phosphate, and sodium citrate on STEC growth. A bacteriostatic effect was observed in most of treated cultures. The exceptions were those treated with sodium citrate and disodium phosphate in which similar growth curves to the untreated control were observed, but with reduced OD600 values. Evaluation of phage production by plaque-based assays showed that cultures treated with sodium citrate and disodium phosphate released phages in similar o lower levels than untreated cultures. However, semi-quantification of Stx revealed higher levels of extracellular Stx in STEC cultures treated with 2.5% sodium citrate than in untreated cultures. Our results reinforce the importance to evaluate if additives and other treatments used to decrease bacterial contamination in food induce stx-phage and Stx production. PMID:27446032

  12. Effect of water and citrate solubility on agronomic effectiveness of acidulated phosphates in three consecutive corn crops

    Directory of Open Access Journals (Sweden)

    L. I. Prochnow

    2002-09-01

    Full Text Available In the process of phosphate rock acidulation, several impure P compounds may be formed along with the desirable Ca and NH4 phosphates. Such compounds normally reduce the content of water-soluble P and thus the agronomic effectiveness of commercial fertilizers. In order to study this problem, a greenhouse experiment consisting of three consecutive corn crops was conducted in samples of a Red-Yellow Latosol (Typical Hapludox in a completely randomized design (6 x 2 x 2, with four replicates. Six commercial fertilizers were added to 2 kg of soil at a rate of 70 mg kg-1 P, based on the content of soluble P in neutral ammonium citrate plus water (NAC + H2O of the fertilizers. Fertilizer application occurred either in the original form or leached to remove the water-soluble fraction, either by mixing the fertilizer with the whole soil in the pots or with only 1 % of its volume. The corn plants were harvested 40 days after emergence to determine the shoot dry matter and accumulated P. For the first crop and localized application, the elimination of water-soluble P from the original fertilizers resulted in less bioavailable P for the plants. For the second and third crops, the effects of P source, leaching and application methods were not as evident as for the first, suggesting that the tested P sources may have similar efficiencies when considering successive cropping. The conclusion was drawn that the water-insoluble but NAC-soluble fractions of commercial P fertilizers are not necessarily inert because they can provide P in the long run.

  13. Plasma membrane H+-ATPase-dependent citrate exudation from cluster roots of phosphate-deficient white lupin

    DEFF Research Database (Denmark)

    Tomasi, Nicola; Kretzschmar, Tobias; Espen, Luca;

    2009-01-01

    the rhizosphere.The relationship between acidification and carboxylate exudation is still largely unknown. In the present work,we studied the linkage between organic acids (malate and citrate) and proton exudations in cluster roots of P-deficient white lupin. After the illumination started, citrate exudation......,an activator of the plasmamembrane (PM)H+-ATPase, stimulated citrate exudation, whereas vanadate, an inhibitor of the H+-ATPase, reduced citrate exudation. The burst of citrate exudation was associated with an increase in expression of theLHA1PMH+-ATPase gene,an increased amount of H+-ATPase protein, a shift...... in pH optimum of the enzymeand post-translational modification of an H ++-ATPase protein involving binding of activating 14-3-3 protein.Taken together, our results indicate a close link in cluster roots of P-deficient white lupin between the burst of citrate exudation and PM H+-ATPase-catalysed proton...

  14. Effects of citrate and NaCl on size, morphology, crystallinity and microstructure of calcium phosphates obtained from aqueous solutions at acidic or near-neutral pH.

    Science.gov (United States)

    Mekmene, Omar; Rouillon, Thierry; Quillard, Sophie; Pilet, Paul; Bouler, Jean-Michel; Pezennec, Stéphane; Gaucheron, Frédéric

    2012-05-01

    Precipitation of calcium phosphates occurs in dairy products and depending on pH and ionic environment, several salts with different crystallinity can form. The present study aimed to investigate the effects of NaCl and citrate on the characteristics of precipitates obtained from model solutions of calcium phosphate at pH 6·70 maintained constant or left to drift. The ion speciation calculations showed that all the starting solutions were supersaturated with respect to dicalcium phosphate dihydrate (DCPD), octacalcium phosphate (OCP) and hydroxyapatite (HAP) in the order HAP>OCP>DCPD. X-ray diffraction (XRD) and Fourier transform infrared (FTIR) analyses of the precipitates showed that DCPD was formed at drifting pH (acidic final pH) whereas poor crystallised calcium deficient apatite was mainly formed at constant pH (6·70). Laser light scattering measurements and electron microscopy observations showed that citrate had a pronounced inhibitory effect on the crystallisation of calcium phosphates both at drifting and constant pH. This resulted in the decrease of the particle sizes and the modification of the morphology and the microstructure of the precipitates. The inhibitory effect of citrate mainly acted by the adsorption of the citrate molecules onto the surfaces of newly formed nuclei of calcium phosphate, thereby changing the morphology of the growing particles. These findings are relevant for the understanding of calcium phosphate precipitation from dairy byproducts that contain large amounts of NaCl and citrate. PMID:22559064

  15. Phosphoric ore treatment by roasting it with sodium carbonate and leaching it with ammonium citrate for the recovery of soluble phosphate and uranium

    International Nuclear Information System (INIS)

    By thermal treatment of phosphoric ore, with low phosphorus contents and iron, aluminum, and silicon impurities, basic fertilizers with P2O5 soluble in citric acid or ammonium citrate, can be produced. The phosphoric ore lightly grinded with alkaline salts like CO3Na2 y SiO2 is roasted between 800 to 1 000°C in rotary kilns. The roasted material contains from 25–30% of alkaline phosphates soluble in citrates. Phosphoric ore from the province of Napo-Ecuador with 24% of P2O5, 40% CaO in form of apatite, 20% of SiO2 and 7 g/ton U is tested by thermic differential analysis, roasting at 800°C for 2 hours with 50% w/w of sodium carbonate and 2% w/w of SiO2 by using a Nichols pilot furnace with 15 L of capacity which uses gas (propane-butane) as fuel, and agitated leaching with ammonium citrate (5% w/w). The initial ore and products are characterized by using atomic absorption spectrophotometry (Perkin Elmer AA400) and x-ray diffraction (Bruker D8 Advance). In the best conditions, 32% of phosphorus soluble in water is obtained as well as 40% of phosphorus and 56% uranium soluble in ammonium citrate. (author)

  16. 枸橼酸钠抗凝在出血性血液透析患者中的应用效果%Application effect of sodium citrate as anticoagulant in patients with hemorrhagic hemodialysis

    Institute of Scientific and Technical Information of China (English)

    吴晓芳

    2014-01-01

    目的:探讨枸橼酸钠抗凝在出血性血液透析患者中的应用效果及护理干预措施。方法选取本院2012年6月~2013年12月收治的22例出血性血液透析患者为研究对象,随机将其分为两组,各11例,对照组采取肝素抗凝,观察组采用枸橼酸钠抗凝,对两组凝血情况、电解质浓度及不良反应等进行比较。结果观察组透析过程中未出现出血情况,对照组透析过程中出现4次出血。两组患者的尿素清除指数、尿素氮减少率、超滤量比较差异无统计学意义(P>0.05)。观察组患者治疗后Na+、pH值明显高于对照组,差异有统计学意义(P0.05).In addition,the value of sodion and pH after treatment in observation group was higher than that in control group respectively,with statistical difference (P<0.05). Conclusion In the process of hemodialysis,application of sodium citrate can obtain a remarkable effect,which is safe and effective.At the same time,strengthen the nursing intervention sodium citrate anticoagulation can give full play to its anticoagulant role in hemorrhagic hemodialysis.

  17. 简化局部枸橼酸抗凝在连续性静-静脉血液滤过中的应用%The use of simplified regional citrate anticoagulation in continuous veno-venous hemofiltration

    Institute of Scientific and Technical Information of China (English)

    陈珊莹; 万建新; 吴彼得

    2010-01-01

    目的 探讨简化局部枸橼酸抗凝(RCA)在连续性静-静脉血液滤过(CVVH)中应用的安全性与有效性.方法 14例患者用简化RCA方法行CVVH治疗,将枸橼酸钠置换液以2 000 ml/h或3 000 ml/h的速度前稀释输入,10%葡萄糖酸钙和25%硫酸镁从外周静脉泵入或滤器静脉端输入;分别于治疗前及治疗后4、8、12 h测定患者血清电解质、血气分析、凝血功能,并观察患者病情变化,测定治疗后滤器容积.结果 14例患者共进行CVVH治疗34例次,治疗时间4~36 h,平均(16.0±7.5)h;30例次未更换滤器完成治疗,治疗后滤器容积(97.19±2.75)ml,均大于原有容积的80%;滤器使用寿命平均(14.79±5.98)h.治疗12 h时患者滤器动脉端采血检测凝血酶原时间(PT)较治疗前明显缩短[(12.2±1.2)s比(14.0±3.3)s],且滤器动脉端血浆总钙明显升高[(2.46±0.30)mmol/L比(2.07±0.36)mmol/L,均P2 000 ml/h的CVVH;并可避免RCA导致的高钠血症、碱中毒等并发症.%Objective To study the safety and effect of simplified regional citrate anticoagulation(RCA) in continuous veno-venous hemofiltration (CVVH).Methods Fourteen patients were treated with CVVH using simplified RAC.Simplified anticoagulation protocol included the addition of 4% sodium citrate into the replacement fluid.The citrate replacement fluid was infused in a speed of 2 000 ml/h or 3 000 ml/h,and at the same time 10% calcium glueonate and 25% magnesium sulfate were infused postfiher or with venous pump into peripheral veins.Serum electrolytes, arterial blood gas analysis, coagulation at the beginning and 4, 8, 12 hours after the treatment were monitored.Patient's general condition was observed carefully.After treatment, blood volume in the hollow fiber filter was measured.Results Fourteen patients underwent altogether 34 times of this procedure for a total of 544 hours.Each treatment lasted 4 - 36 hours,with a mean of (16.0±7.5) hours.The filter was not changed for 30 procedures

  18. Correlation of biological value of feed phosphates with their solubility in water, dilute hydrogen chloride, dilute citric acid, and neutral ammonium citrate.

    Science.gov (United States)

    Sullivan, T W; Douglas, J H; Gonzalez, N J; Bond, P L

    1992-12-01

    Relative biological values (BV) of 36 feed phosphates were determined with female turkeys in bioassays of 21-day duration using three response criteria: weight gain, tibia ash percentage, and gain:feed ratio. Calcium phosphate, dibasic dihydrate (United States Pharmacopeia) was the reference standard. Nine mono-dicalcium phosphates (M-DCP, 21.0% phosphorus), 13 di-monocalcium phosphates (D-MCP, 18.5% phosphorus), and 14 defluorinated phosphates (DFP, 18.0% phosphorus) were evaluated. The average relative BV for M-DCP, D-MCP, and DFP samples were 97.6, 94.6, and 90.8%, respectively. Solubility of phosphates was determined by four recognized methods. The solvents were water, .4% HCl, 2.0% citric acid (CA), and neutral ammonium citrate (NAC). Water solubility of M-DCP samples was greater (67.5%) than that of D-MCP (38.8%) and DFP (8.9%) samples. Correlation of water solubility of phosphates to their relative BV was quite low, and water solubility was a poor indicator of BV. When .4% HCl was the solvent, correlation coefficients (r) were .55, .33, and .72 for M-DCP, D-MCP, and DFP, respectively. Based on these results and prediction equations, .4% HCl solubility would be inappropriate for estimating BV of M-DCP and D-MCP samples. Solubility of feed phosphates (mainly D-MCP and DFP) in 2.0% CA or NAC was positively correlated with BV; the r values were .87 to .95. Both of these solubility tests provided a good index of BV. However, it would seem inappropriate and risky to replace bioassays totally with these tests. Feed phosphate users could perform either the 2.0% CA or NAC solubility test easily as a screen for BV along with other quality control procedures (i.e., phosphorus, calcium, sodium, and fluoride determinations).

  19. The safety and efficacy of regional citrate anticoagulation in sustained low efficiency dialysis%枸橼酸抗凝在持续缓慢低效血液透析中的疗效和安全性

    Institute of Scientific and Technical Information of China (English)

    张凌; 王婷立; 赵宇亮; 陈志文; 唐怡; 杨莹莹; 廖宇捷; 付平

    2013-01-01

    Objective To evaluate the safety and efficacy of regional citrate anticoagulation in sustained low efficiency dialysis (SLED).Methods A total of 45 patients with acute kidney injury (AKI) or end stage renal disease (ESRD) admitted in our hospital from August 2011 to September 2012 were prospectively enrolled in this study.All the patients received SLED treatment by Fresenius 4008sARrTplus dialyzer through either femoral or internal jugular venous catheter,with each session of SLED treatment lasting for 8 hours.All the patients were pumped in 4% tri-sodium citrate solution through the arterial line at 130 ml/hour and 10% calcium gluconate through the venous line at 40 ml/hour.The blood flow was 150 ml/minute while the calcium-free dialysate was delivered at 200 ml/minute.Systemic citrate concentration,peripheral and post dialyzer ionized calcium levels at 0,2 and 5 hour were recorded.Results All the 45 patients underwent 162 sessions of SLED with 2 were discontinued due to Ⅲ ° dialyzer coagulation,and other 160 SLED sessions (98.8%) were all successfully performed.The systemic citrate concentration at 0 hour was (0.14 ± 0.06) mmol/L,the systemic citrate concentrations at 2 and 5 hour were sightly increased while no statistical difference was found[(1.08 ± 0.12) mmol/L vs (1.l 1 ± 0.17) mmol/L,P > 0.05].The 0,2,5 hour peripheral blood ionized calcium levels were (1.04 ±0.13) mmol/L,(1.07 ±0.23) mmol/L and (1.04 ± 0.24) mmol/L,respectively,with no significant difference (P > 0.05).The post dialyzer ionized calcium levels were (0.31 ±0.04) mmol/L at 2 hour and (0.29 ±0.03) mmol/L at 5 hour.The transmembrane pressure at 2 hour was (104.5 ± 17.8) mm Hg(1 mm Hg =0.133 kPa),and (109.3 ± 20.1) mm Hg at 5 hour,however the increase was not of statistical significance (P > 0.05).At 5 hour,prothrombin time and activated partial thrombin time were identified to be similar to those before SLED.During the treatments,no bleeding complication

  20. Simulation of the effect of citrate exudation from roots on the plant availability of phosphate adsorbed on goethite

    NARCIS (Netherlands)

    Geelhoed, J.S.; Riemsdijk, van W.H.; Findenegg, G.R.

    1999-01-01

    Rhizosphere processes strongly influence the availability of phosphorus (P) to plants. Organic ligands that are exuded from the root surface mobilize phosphorus by dissolution of P minerals or by desorption of adsorbed phosphate. We developed a mechanistic model to study the mobilization of phosphat

  1. Role of citrate and phosphate anions in the mechanism of iron(III) sequestration by ferric binding protein: kinetic studies of the formation of the holoprotein of wild-type FbpA and its engineered mutants.

    Science.gov (United States)

    Weaver, Katherine D; Gabricević, Mario; Anderson, Damon S; Adhikari, Pratima; Mietzner, Timothy A; Crumbliss, Alvin L

    2010-07-27

    Ferric binding protein A (FbpA) plays a central role in the iron acquisition processes of pathogenic Neisseria gonorrheae, Neisseria meningitidis, and Haemophilus influenzae. FbpA functions as an iron shuttle within the periplasmic space of these Gram-negative human pathogens. Iron is picked up by FbpA at the periplasmic aspect of the outer membrane with concomitant acquisition of a synergistic anion. Here we report the kinetics and mechanisms involved with loading of iron(III) into iron-free FbpA using iron(III) citrate as an iron source in the presence of excess citrate or phosphate (physiologically available anions) at pH 6.5. In the presence of excess phosphate, iron(III) citrate loads into apo-FbpA in three kinetically distinguishable steps, while in the presence of excess citrate, only two steps are discernible. A stable intermediate containing iron(III) citrate-bound FbpA is observed in each case. The observation of an additional kinetic step and moderate increase in apparent rate constants suggests an active role for phosphate in the iron insertion process. To further elucidate a mechanism for iron loading, we report on the sequestration kinetics of iron(III) citrate in the presence of phosphate with binding site mutant apo-FbpAs, H9E, E57D, E57Q, Q58A, Y195F, and Y196H. Tyrosine mutations drastically alter the kinetics and hamper iron sequestration ability. H9E, E57D, and E57Q have near native iron sequestration behavior; however, iron binding rates are altered, enabling assignment of sequential side chain interactions. Additionally, this investigation elaborates on the function of FbpA as a carrier for iron chelates as well as "naked" or free iron as originally proposed.

  2. Correlation between the Female Apheresis Platelet Donors′ Sodium Citrate Toxic Reaction and the Anticoagulant Concentration%女性机采血小板献血者枸橼酸钠中毒与抗凝剂比例的关系

    Institute of Scientific and Technical Information of China (English)

    何晓露

    2012-01-01

    Objective To investigate the relationship of the female apheresis platelet donors' sodium citrate toxic reaction and the anticoagulant concentration. Methods 181 cases of female platelet donors at blood center were randomly divided into group A of 80 cases and group B. Of 101 cases, sodium citrate poisoning cases in anticoagulant/blood ratio of 1:10( group A)and 1: 11( group B )female platelet donors were observed and compared. Results When the ratio of anticoagulant and whole blood was 1=11,1.98% of the female donors of group B had sodium citrate toxicity reactions, which was significantly lower than group A with the ratio of anticoagulant and whole blood 1: 10. The difference of incidence of sodium toxic reactions was statistically significant( P <0. 05 ). Conclusion Women in Jiangsu Province generally have smaller body weight,the use of appropriate anticoagulant concentration( the ratio of anticoagulant and whole blood 1 : 11 )can significantly reduce the incidence of sodium citrate toxic reaction of the female apheresis platelet donors, which has important application value.%目的 探讨女性机采血小板献血者枸橼酸钠中毒与抗凝剂比例的关系.方法 对来血液中心进行机采血小板的181例女性献血者随机分为A组80例,B组101例.对比观察抗凝剂与全血比例为1:10(A组)和1:11时(B组)女性机采血小板献血者发生枸橼酸钠中毒的情况.结果 抗凝剂与全血比例为1:11的B组女性献血者枸橼酸钠中毒反应发生率为1.98%,明显低于抗凝剂与全血比例为1:10的A组女性献血者,比较差异有统计学意义(P<0.05).结论 江苏地区女性体质量普遍较轻,采用抗凝剂与全血比例为1:11可明显改善女性机采血小板献血者枸橼酸钠中毒反应的发生率,具有重要的应用价值.

  3. Mean platelet volume measurement, EDTA or citrate?

    Science.gov (United States)

    Dastjerdi, Mansour Siavash; Emami, Tajolmolouk; Najafian, Alireza; Amini, Masoud

    2006-10-01

    Most laboratories use EDTA for anticoagulation of whole blood prior to automated cell counting but due to platelet swelling, mean platelet volume (MPV) values may increase with its use. MPV changes may be less with acid citrate based anticoagulation. As MPV is a marker of platelet function and its precise measurement is important in a number of clinical situations, this study was performed to assess if EDTA and citrate based anticoagulated blood samples can be used interchangeably for MPV measurement. In this cross sectional descriptive study, EDTA and citrate based anticoagulated blood samples of the same patients were assessed by auto-analyzer within 1 h of sampling. In the 61 evaluated patients, there was a close correlation between MPV as measured by EDTA and citrate, but mean MPV measured from EDTA samples was 0.66 fL (9%) more than citrate. There was also a significant negative correlation between platelets count and MPV by both methods. The results of our study reveal that MPV can be measured accurately by both methods of anticoagulation; EDTA and citrate if analysis be performed within 1 h of sampling. PMID:17607580

  4. Gender and chronological age affect erythrocyte membrane oxidative indices in citrate phosphate dextrose adenine-formula 1 (CPDA-1) blood bank storage condition.

    Science.gov (United States)

    Erman, Hayriye; Aksu, Uğur; Belce, Ahmet; Atukeren, Pınar; Uzun, Duygu; Cebe, Tamer; Kansu, Ahmet D; Gelişgen, Remisa; Uslu, Ezel; Aydın, Seval; Çakatay, Ufuk

    2016-07-01

    It is well known that in vitro storage lesions lead to membrane dysfunction and decreased number of functional erythrocytes. As erythrocytes get older, in storage media as well as in peripheral circulation, they undergo a variety of biochemical changes. In our study, the erythrocytes with different age groups in citrate phosphate dextrose adenine-formula 1 (CPDA-1) storage solution were used in order to investigate the possible effect of gender factor on oxidative damage. Oxidative damage biomarkers in erythrocyte membranes such as ferric reducing antioxidant power, pro-oxidant-antioxidant balance, protein-bound advance glycation end products, and sialic acid were analyzed. Current study reveals that change in membrane redox status during blood-bank storage condition also depends on both gender depended homeostatic factors and the presence of CPDA-1. During the storage period in CPDA-1, erythrocytes from the male donors are mostly affected by free radical-mediated oxidative stress but erythrocytes obtained from females are severely affected by glyoxidative stress.

  5. Security of high concentration sodium citrate anticoagulation local part in maintenance hemodialysis%维持性血液透析患者局部运用高浓度枸橼酸钠抗凝治疗的疗效及安全性

    Institute of Scientific and Technical Information of China (English)

    王大云; 向闻明

    2012-01-01

    Objective To observe the efficacy and safety of high concentration sodium citrate anticoagulation local part in maintenance hemodialysis. Methods We analyzed 52 cases who had treat maintenance hemodialysis , the control group (30 cases) were given 30 sodium citrate for extracorporeal anticoagulatio , the experial group (22 cases) were given low molecular weight heparin for dialysis anticoagulation. Points of observation included the eficacy of dialysis. The change of Ca2 \\Na*N HCO3 ~ ^pH and adverse effect. Results 30 cases with 30% sodium citrate anticoagulation finished 4 ~5 hours hemodialysis and no blood. The blood were 5 cases(5/90)in the experial group. The level of Kt/V, URR,super strain quantity in the groups (P > 0.05). In citrate anticoagulation group,there was a striking difference between pie an d postdialysis in the concentration change of serum bicarbonate, calcium, potassium and natrium ( P < 0.01 or P < 0.05 ). The level of Na * NpH were higher in the control group (P < 0. 05 ). Conclusion It might be safe and feasible that the high concentration sodium citrate anticoagulation was used in mgular hemod ialysis,and a more optimal dialysis procedure for hemodialysis in patients of high risk hemorhagic tendency.%目的 探讨局部应用高浓度枸橼酸钠对维持血液透析患者的抗凝治疗的的疗效及安全性.方法 选择52例维持性血透患者,其中观察组30例用30%枸橼酸钠,对照组22例应用肝素抗凝,观察两组透析充分性、透析前后Ca2+、Na+、HCO3-、pH以及不良反应情况.结果 观察组30例患者行常规血透患者血液透析时间均达到4~5h,无出血,均透析完全.对照组治疗过程出现5次(5/90)出血.两组尿素清除指数(Kt/V),尿素氮减少率(URR),超滤量三项指标比较,差异无统计学意义,P>0.05.两组治疗后与治疗前比较,Ca2+、Na+、HCO3-、pH水平均显著变化,P<0.05,P<0.01.而观察组相对于对照组,Na+、pH均显著改善,P<0.05.

  6. Safety test of a supplement, 5-aminolevulinic acid phosphate with sodium ferrous citrate, in diabetic patients treated with oral hypoglycemic agents

    Directory of Open Access Journals (Sweden)

    Naohide Yamashita

    2014-09-01

    Full Text Available Objective: This study aimed to examine the safety of 5-aminolevulinic acid phosphate (5-ALA with sodium ferrous citrate (SFC in diabetic patients treated with one or more oral hypoglycemic agents (OHAs. Background: Recent intervention studies performed in the USA and Japan have shown that a nutritional supplement of 5-ALA with SFC efficiently reduced blood glucose levels in pre-diabetic population without any adverse events. Thus, it was anticipated that 5-ALA with SFC may potentially be taken as a beneficial supplement by diabetic patients who were being treated with OHA therapy. Nevertheless, it is important to examine its safety and efficacy in diabetic population. Methods: This study was a prospective single-blinded, randomized, placebo-controlled and parallel-group comparison study. Medically treated diabetic patients between the ages of 30 and 75 were recruited from the Tokyo metropolitan area of Japan and 45 subjects were selected after screening. These subjects were randomly assigned to three groups: daily intake of 15mg 5-ALA, 50mg 5-ALA, and a placebo (n=15, respectively. The supplement or placebo was administered for 12 weeks followed by a four week washout period. The primary endpoint was safety and occurrence of hypoglycemic attack, while the secondary endpoint was changes of fasting blood glucose (FBG and hemoglobin A1c (HbA1c. Results: Adverse events related to 5-ALA with SFC were not observed in all the groups. Abnormalities in blood and urine tests were not observed either. Significant decrease in FBG was not detected in all the groups. However, there was a small but significant decrease in HbA1c at 4 and 8 week in the 15 mg 5-ALA group. Significant decrease in HbA1c was not observed in the 50 mg 5-ALA group, although a tendency to decrease after 4 weeks was apparent. Conclusion: 5-ALA with SFC is a safe and potentially beneficial supplement if taken by diabetic patients treated with OHAs.

  7. Anticoagulant rodenticides.

    Science.gov (United States)

    Watt, Barbara E; Proudfoot, Alex T; Bradberry, Sally M; Vale, J Allister

    2005-01-01

    Anticoagulant pesticides are used widely in agricultural and urban rodent control. The emergence of warfarin-resistant strains of rats led to the introduction of a new group of anticoagulant rodenticides variously referred to as 'superwarfarins', 'single dose' or 'long-acting'. This group includes the second generation 4-hydroxycoumarins brodifacoum, bromadiolone, difenacoum, flocoumafen and the indanedione derivatives chlorophacinone and diphacinone. Most cases of anticoagulant rodenticide exposure involve young children and, as a consequence, the amounts ingested are almost invariably small. In contrast, intentional ingestion of large quantities of long-acting anticoagulant rodenticides may cause anticoagulation for several weeks or months. Occupational exposure has also been reported. Anticoagulant rodenticides inhibit vitamin K(1)-2,3 epoxide reductase and thus the synthesis of vitamin K and subsequently clotting factors II, VII, IX and X. The greater potency and duration of action of long-acting anticoagulant rodenticides is attributed to their: (i) greater affinity for vitamin K(1)-2,3-epoxide reductase; (ii) ability to disrupt the vitamin K(1)-epoxide cycle at more than one point; (iii) hepatic accumulation; and (iv) unusually long biological half-lives due to high lipid solubility and enterohepatic circulation. Substantial ingestion produces epistaxis, gingival bleeding, widespread bruising, haematomas, haematuria with flank pain, menorrhagia, gastrointestinal bleeding, rectal bleeding and haemorrhage into any internal organ; anaemia may result. Spontaneous haemoperitoneum has been described. Severe blood loss may result in hypovolaemic shock, coma and death. The first clinical signs of bleeding may be delayed and patients may remain anticoagulated for several days (warfarin) or days, weeks or months (long-acting anticoagulants) after ingestion of large amounts. There are now sufficient data in young children exposed to anticoagulant rodenticides to

  8. 枸橼酸钠与阿加曲班在危重患者连续性静脉-静脉血液滤过治疗中的抗凝效果比较%Comparison of the Anticoagulant Effect between Sodium Citrate and Argatroban during Continuous Veno-ve-nous Hemofiltration Therapy for Critical Patients

    Institute of Scientific and Technical Information of China (English)

    杨嘉琳; 伍丽婵; 廖广园; 徐仲; 池凯仪; 高元妹

    2016-01-01

    Objective To contrast the anticoagulant effect and safety between Sodium Citrate and Argatroban during continuous veno-venous hemofiltration ( CVVH) therapy for critical patients so as to optimize anticoagulation meth-od for critical patients during continuous blood purification. Methods A total of 134 critical patients during June 2014 and May 2015 were divided into Sodium Citrate group (n=59) and Argatroban group (n=75) according to the principle of random sampling. The general condition, CVVH therapeutic time, blood clotting function, routine blood and biochemi-cal examinations were recorded and compared in the two groups. Results The Argatroban dosage showed negative corre-lation with acute physiology and chronic health evaluation II ( APACHE II) score. There were significant differences in prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , international normalized ratio ( INR) and fibrin-ogen ( Fb) before and after the treatment in Argatroban group ( P0. 05). There were significant differences in values of serum calcium in vivo and vitro after the filter between beginning and before the end of CVVH treatment in the Sodium Citrate group (P0.05)。枸橼酸钠组CVVH治疗开始时、结束前滤器后血钙与体内血钙比较差异均有统计学意义(P<0.01);阿加曲班组与枸橼酸钠组相同时点滤器后血钙比较差异亦有统计学意义(P<0.01)。结论枸橼酸钠和阿加曲班在危重症患者CVVH治疗中的应用均安全有效。枸橼酸钠更适合应用于有出血风险的危重症患者;阿加曲班在肾功能不全的患者中仍能安全使用,且代谢迅速、易于监测,亦为危重患者CVVH治疗中抗凝药物的较佳选择。

  9. New anticoagulants.

    Science.gov (United States)

    Weitz, J I; Bates, S M

    2005-08-01

    The limitations of heparin and warfarin have prompted the development of new anticoagulant drugs for prevention and treatment of venous and arterial thromboembolism. Novel parenteral agents include synthetic analogs of the pentasaccharide sequence of heparin that mediates its interaction with antithrombin. Fondaparinux, the first synthetic pentasaccharide, is licensed for prevention of venous thromboembolism (VTE) after major orthopedic surgery and for initial treatment of patients with VTE. Idraparinux, a long-acting pentasaccharide that is administered subcutaneously once-weekly, is being compared with warfarin for treatment of VTE and for prevention of cardioembolic events in patients with atrial fibrillation. New oral anticoagulants include direct inhibitors of thrombin, factor Xa and factor IXa. Designed to provide more streamlined anticoagulation than warfarin, these agents can be given without routine coagulation monitoring. Ximelagatran, the first oral direct thrombin inhibitor, is as effective and safe as warfarin for prevention of cardioembolic events in patients with atrial fibrillation. However, ximelagatran produces a three-fold elevation in alanine transaminase levels in 7.9% of patients treated for more than a month, the long-term significance of which is uncertain. Whether other direct thrombin inhibitors or inhibitors of factors Xa or IXa also have this problem is under investigation. After a brief review of coagulation pathways, this paper focuses on new anticoagulants in advanced stages of clinical testing. PMID:16102051

  10. Sequestration of Sr-90 Subsurface Contamination in the Hanford 100-N Area by Surface Infiltration of a Ca-Citrate-Phosphate Solution

    Energy Technology Data Exchange (ETDEWEB)

    Szecsody, James E.; Rockhold, Mark L.; Oostrom, Martinus; Moore, R. C.; Burns, Carolyn A.; Williams, Mark D.; Zhong, Lirong; Fruchter, Jonathan S.; McKinley, James P.; Vermeul, Vincent R.; Covert, Matthew A.; Wietsma, Thomas W.; Breshears, Andrew T.; Garcia, Ben J.

    2009-03-01

    The objective of this project is to develop a method to emplace apatite precipitate in the 100N vadose zone, which results in sorption and ultimately incorporation of Sr-90 into the apatite structure. The Ca-citrate-PO4 solution can be infiltrated into unsaturated sediments to result in apatite precipitate to provide effective treatment of Sr-90 contamination. Microbial redistribution during solution infiltration and a high rate of citrate biodegradation for river water microbes (water used for solution infiltration) results in a relatively even spatial distribution of the citrate biodegradation rate and ultimately apatite precipitate in the sediment. Manipulation of the Ca-citrate-PO4 solution infiltration strategy can be used to result in apatite precipitate in the lower half of the vadose zone (where most of the Sr-90 is located) and within low-K layers (which are hypothesized to have higher Sr-90 concentrations). The most effective infiltration strategy to precipitate apatite at depth (and with sufficient lateral spread) was to infiltrate a high concentration solution (6 mM Ca, 15 mM citrate, 60 mM PO4) at a rapid rate (near ponded conditions), followed by rapid, then slow water infiltration. Repeated infiltration events, with sufficient time between events to allow water drainage in the sediment profile can be used to buildup the mass of apatite precipitate at greater depth. Low-K heterogeneities were effectively treated, as the higher residual water content maintained in these zones resulted in higher apatite precipitate concentration. High-K zones did not receive sufficient treatment by infiltration, although an alternative strategy of air/surfactant (foam) was demonstrated effective for targeting high-K zones. The flow rate manipulation used in this study to treat specific depths and heterogeneities are not as easy to implement at field scale due to the lack of characterization of heterogeneities and difficulty tracking the wetting front over a large

  11. The Anticoagulant Effects of Local Sodium Citrate versus Unfractionated Heparin in Continuous Veno-venous Hemofiltration: A Systematic Analysis%局部枸橼酸钠与普通肝素在连续性静静脉血液滤过中抗凝效果的系统评价

    Institute of Scientific and Technical Information of China (English)

    杜兴; 马成; 杜娟

    2014-01-01

    Objective To assess the efficacy and safety of local citrate anticoagulation in the process of continuous veno-venous hemofiltration(CVVH) for acute kidney injury(AKI) patients in ICU.Methods We searched the Pubmed,EMBASE,CNKI,VIP,CBM,and Cochrane library for randomized controlled trials(RCTs) that comparing the anticoagulate effects of local citrate and unfractionated heparin in CVVH up to April 2014.The RCTs were selected and assessed based on the inclusion and exclusion criteria,then the data was extracted for meta-analysis.Results Finally 4 RCTs with 258 patients met the inclusion criteria.The meta-analysis showed that local sodium citrate obviously decreased the incidence of bleeding(RR =0.25,95 % CI =0.09 ~ 0.68,P =0.006) and prolonged the service life of filter (M D =14.36,95 % CI =1.11 ~ 27.61,P =0.03),but the incidence of metabolic alkalosis (RR =0.89,95 % CI =0.16 ~ 4.96,P =0.90) and hypocalcemia (RR =4.44,95 % CI =0.76 ~ 25.83,P =0.10) was no significant differences between two groups.Conclusion Based on the current clinical evidence,local citrate may be more suitable for the patients with higher risk of bleeding and the treatment of CVVH,because of its advantages of reducing the rate of hemorrhage and extending the service life of filter.%目的:系统评价局部枸橼酸盐抗凝在ICU急性肾损伤患者进行连续性静静脉血液滤过(CVVH)过程中的有效性和安全性.方法:计算机检索PubMed、EMBASE、CNKI、VIP、CBM和Cochrane图书馆,纳入比较枸橼酸盐与普通肝素在CVVH过程中抗凝效果的随机对照试验(RCT),检索日期截止至2014年4月.按照纳入排除标准选择试验并评价其质量,而后提取有效数据进行Meta分析.结果:共纳入4个RCTs,包括258例患者.Meta分析显示:局部枸橼酸钠抗凝能降低出血事件的发生率(RR=0.25,95%CI =0.09 ~0.68,P=0.006),且具有较长的滤器使用寿命(MD=14.36,95%CI=1.11 ~27.61,P=0.03),但代谢性碱中毒(RR =0

  12. Bench-to-bedside review: Citrate for continuous renal replacement therapy, from science to practice.

    Science.gov (United States)

    Oudemans-van Straaten, Heleen M; Ostermann, Marlies

    2012-12-07

    To prevent clotting in the extracorporeal circuit during continuous renal replacement therapy (CRRT) anticoagulation is required. Heparin is still the most commonly used anticoagulant. However, heparins increase the risk of bleeding, especially in critically ill patients. Evidence has accumulated that regional anticoagulation of the CRRT circuit with citrate is feasible and safe. Compared to heparin, citrate anticoagulation reduces the risk of bleeding and requirement for blood products, not only in patients with coagulopathy, but also in those without. Metabolic complications are largely prevented by the use of a strict protocol, comprehensive training and integrated citrate software. Recent studies indicate that citrate can even be used in patients with significant liver disease provided that monitoring is intensified and the dose is carefully adjusted. Since the citric acid cycle is oxygen dependent, patients at greatest risk of accumulation seem to be those with persistent lactic acidosis due to poor tissue perfusion. The use of citrate may also be associated with less inflammation due to hypocalcemia-induced suppression of intracellular signaling at the membrane and avoidance of heparin, which may have proinflammatory properties. Whether these beneficial effects increase patient survival needs to be confirmed. However, other benefits are the reason that citrate should become the first choice anticoagulant for CRRT provided that its safe use can be guaranteed.

  13. The Safety and Tolerability of 5-Aminolevulinic Acid Phosphate with Sodium Ferrous Citrate in Patients with Type 2 Diabetes Mellitus in Bahrain

    Science.gov (United States)

    Al-Saber, Feryal; Aldosari, Waleed; Alselaiti, Mariam; Khalfan, Hesham; Kaladari, Ahmed; Khan, Ghulam; Harb, George; Rehani, Riyadh; Kudo, Sizuka; Koda, Aya; Tanaka, Tohru

    2016-01-01

    Type 2 diabetes mellitus is prevalent especially in Gulf countries and poses serious long-term risks to patients. A multifaceted treatment approach can include nutritional supplements with antioxidant properties such as 5-aminolevulinic acid (5-ALA) with sodium ferrous citrate (SFC). This prospective, randomized, single-blind, placebo-controlled, dose escalating pilot clinical trial assessed the safety of 5-ALA with SFC at doses up to 200 mg 5-ALA/229.42 mg SFC per day in patients living in Bahrain with type 2 diabetes mellitus that was uncontrolled despite the use of one or more antidiabetic drugs. Fifty-three patients (n = 53) from 3 sites at one center were enrolled by Dr. Feryal (Site #01), Dr. Hesham (Site #02), and Dr. Waleed (Site #03) (n = 35, 5-ALA-SFC; n = 18, placebo). There was no significant difference in incidence of adverse events reported, and the most frequent events reported were gastrointestinal in nature, consistent with the known safety profile of 5-ALA in patients with diabetes. No significant changes in laboratory values and no difference in hypoglycemia between patients receiving 5-ALA and placebo were noted. Overall, the current results support that use of 5-ALA-SFC up to 200 mg per day taken as 2 divided doses is safe in patients taking concomitant oral antidiabetic medications and may offer benefits in the diabetic population. This trial is registered with ClinicalTrials.gov NCT02481141.

  14. 低分子肝素钠联合枸橼酸钠在血浆吸附灌流中的抗凝效果%Anticoagulant effects of low-molecular-weight heparin combined with citrate in plasma perfusion patients

    Institute of Scientific and Technical Information of China (English)

    李国强; 燕朋波; 刘阳; 魏路清; 孙亮

    2013-01-01

    Objective To observe the anticoagulant effects and safety of the low-molecular-weight heparin combined with citrate in plasma perfusion patients with high risk of bleeding.Methods A total of 24 patients of poisoning associated with upper gastrointestinal bleeding were treated with plasma perfusion treatment and the low molecular weight heparin combined with citrate was used to anticoagulate.The changes of arterial pH,serum ionized sodium,bicarbonate and gastric juice occult blood were observed before and after 2,4,6,8 hours of plasma perfusion.The filter pressure,venous pressure and heart rate were observed after 30 minutes and 1 hour,2,4,6,8 hours of plasma perfusion.Results Among the total of 24 patients,20 cases completed plasma perfusion successfully,3 cases generated plasma separator coagulation and 1 case occurred acute left ventricular failure.Compared with plasma perfusion after 30 rain,the filter pressure in the upper 2 hours of plasma perfusion continued to increase (P < 0.05),but after 2 hours the filter pressure began to decrease,after 6 hours the filter pressure was stable;the venous pressure and heart rate continued to decline after 2、4、6、8 hours of plasma perfusion (P < 0.05),after 4hours and 6 hours the venous pressure and heart rate were stable.At 2,4,6,8 hours after plasma perfusion,the serum sodium,bicarbonate and pH increased consistently,at 8 hours after plasma perfusion,the pH value,serum sodium and bicarbonate increased significantly compared with before plasma perfusion(P <0.05).Gastric juice occult blood had no significant changes at 2,4,6,8 hours of after plasma perfusion.Conclusion The low molecular weight heparin combined with citrate anticoagulant in plasma perfusion has a good anticoagulant effects,and doesn't aggravate the bleeding,but in earlier period,plasma separator coagulation will be generated easily,and with the extension of the treatment time,alkalosis and hypernatremia will happen.%目的 观察低分子肝素钠

  15. Pharmacologic Therapies in Anticoagulation.

    Science.gov (United States)

    Ferreira, Joana Lima; Wipf, Joyce E

    2016-07-01

    Anticoagulants are beneficial for prevention and treatment of venous thromboembolism and stroke prevention in atrial fibrillation. The development of target-specific oral anticoagulants is changing the landscape of anticoagulation therapy and created growing interest on this subject. Understanding the pharmacology of different anticoagulants is the first step to adequately treat patients with best available therapy while avoiding serious bleeding complications. This article reviews the pharmacology of the main anticoagulant classes (vitamin K antagonists, direct oral anticoagulants, and heparins) and their clinical indications based on evidence-based data currently available in the literature. PMID:27235611

  16. Venous Thromboembolism Anticoagulation Therapy

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2009-01-01

    @@ VTE of the main treatment for anticoagulant thera-py, anticoagulant therapy drug of choice for low molecu-lar weight heparin (LMWH) for the overwhelming major-ity of clinicians agree that long-term oral anticoagulant therapy is still Vit. K antagonist (mainly warfarin).

  17. Citrat og nyresten

    DEFF Research Database (Denmark)

    Osther, P J

    1993-01-01

    Citrate is an important naturally occurring inhibitor of calcium stone formation in urine. Urinary citrate excretion was examined in 43 consecutive patients with recurrent idiopathic calcium nephrolithiasis and in 50 normal controls by a specific enzymatic technique. Hypocitraturia (<1.6 mmol/24h...

  18. Anticoagulation for Prosthetic Valves

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Kaneko

    2013-01-01

    Full Text Available Implantation of prosthetic valve requires consideration for anticoagulation. The current guideline recommends warfarin on all mechanical valves. Dabigatran is the new generation anticoagulation medication which is taken orally and does not require frequent monitoring. This drug is approved for treatment for atrial fibrillation and venous thromboembolism, but the latest large trial showed that this drug increases adverse events when used for mechanical valve anticoagulation. On-X valve is the new generation mechanical valve which is considered to require less anticoagulation due to its flow dynamics. The latest study showed that lower anticoagulation level lowers the incidence of bleeding, while the risk of thromboembolism and thrombosis remained the same. Anticoagulation poses dilemma in cases such as pregnancy and major bleeding event. During pregnancy, warfarin can be continued throughout pregnancy and switched to heparin derivative during 6–12 weeks and >36 weeks of gestation. Warfarin can be safely started after 1-2 weeks of discontinuation following major bleeding episode.

  19. Rivaroxaban: A novel anticoagulant

    Directory of Open Access Journals (Sweden)

    Muzaffar Ali

    2010-01-01

    Full Text Available For more than 50 years, warfarin has single-handedly ruled the world of anti-coagulation without any competition, whatsoever! The anticoagulant was made available in 1940 and since then no other anti-coagulant has ever been able to match it in the clinical arena. But it looks like that the advances in the field of anti-coagulation, for the first time, have seriously started to erode its base. This review takes a look at rivaroxaban, a direct factor Xa inhibitor and one of the most foremost competitors of warfarin.

  20. Rivaroxaban: A novel anticoagulant

    OpenAIRE

    Muzaffar Ali; C.L. Nawal

    2010-01-01

    For more than 50 years, warfarin has single-handedly ruled the world of anti-coagulation without any competition, whatsoever! The anticoagulant was made available in 1940 and since then no other anti-coagulant has ever been able to match it in the clinical arena. But it looks like that the advances in the field of anti-coagulation, for the first time, have seriously started to erode its base. This review takes a look at rivaroxaban, a direct factor Xa inhibitor and one of the most foremost co...

  1. Trisilver(I citrate

    Directory of Open Access Journals (Sweden)

    Andreas Fischer

    2011-02-01

    Full Text Available Trisilver(I citrate, 3Ag+·C6H5O73−, was obtained by evaporation of a saturated aqueous solution of the raw material that had been obtained from sodium dihydrogen citrate and silver nitrate. It features one formula unit in the asymmetric unit. There is an intramolecular O—H...O hydrogen bond between the OH group and one of the terminal carboxylate groups. Different citrate groups are linked via the three Ag+ ions, yielding a three-dimensional network with rather irregular [AgO4] polyhedra.

  2. Influence of some anticoagulants on dynamics of sugar concentration in the goats’ blood

    Directory of Open Access Journals (Sweden)

    D. S. Zapryanova

    2007-06-01

    Full Text Available Dynamics of the content in the goats’ blood (at the instant the sample was taken, and then after 3, 6 and 24 hours under influence of 4 anticoagulants (sodium fluoride, sodium citrate, heparin and complexon III were studied. Long term storage of the blood samples resulted in the glucose level decrease. It was mostly pronounced under the sodium citrate treatment.

  3. Gastrointestinal citrate absorption in nephrolithiasis

    Science.gov (United States)

    Fegan, J.; Khan, R.; Poindexter, J.; Pak, C. Y.

    1992-01-01

    Gastrointestinal absorption of citrate was measured in stone patients with idiopathic hypocitraturia to determine if citrate malabsorption could account for low urinary citrate. Citrate absorption was measured directly from recovery of orally administered potassium citrate (40 mEq.) in the intestinal lavage fluid, using an intestinal washout technique. In 7 stone patients citrate absorption, serum citrate levels, peak citrate concentration in serum and area under the curve were not significantly different from those of 7 normal subjects. Citrate absorption was rapid and efficient in both groups, with 96 to 98% absorbed within 3 hours. The absorption of citrate was less efficient from a tablet preparation of potassium citrate than from a liquid preparation, probably due to a delayed release of citrate from wax matrix. However, citrate absorption from solid potassium citrate was still high at 91%, compared to 98% for a liquid preparation. Thus, hypocitraturia is unlikely to be due to an impaired gastrointestinal absorption of citrate in stone patients without overt bowel disease.

  4. Review: anticoagulation for haemodialysis.

    Science.gov (United States)

    Suranyi, Michael; Chow, Josephine S F

    2010-06-01

    The coagulation cascade is complex but well studied. Dialysis membranes and lines are inherently pro-coagulant and activate both the intrinsic and extrinsic pathways of coagulation, as well as platelets and other circulating cellular elements. To provide safe and effective dialysis, appropriate anticoagulant measures must be applied. Haemodialysis, including anticoagulation, is prescribed by dialysis doctors but delivered by dialysis nurses. The main agents used in clinical practice for anticoagulation during haemodialysis are unfractionated heparin (UF heparin) and low-molecular-weight heparin (LMWH). LMWH has a number of potential advantages, apart from cost. One of the most serious complications of the use of any form of heparin is heparin-induced thrombocytopaenia (HIT) Type II, which occurs more commonly with UF heparin than LMWH. HIT Type II risks severe morbidity and mortality and is challenging to treat successfully in both the acute and chronic phase. In HIT Type II anticoagulation must be delivered without heparin. A wide array of newer anticoagulants are becoming progressively available, each with unique advantages and disadvantages. In maintenance haemodialysis patients with an increased risk of bleeding, a 'no heparin' dialysis may be undertaken, or regional anticoagulation considered. Because this aspect of dialysis is so important to the safe and effective delivery of haemodialysis therapy, dialysis clinicians need to review and update their knowledge of dialysis anticoagulation on a regular basis. PMID:20609088

  5. [Heparin induced thrombocytopenia and anticoagulation in renal replacemant therapy].

    Science.gov (United States)

    Steinfeldt, Thorsten; Rolfes, Caroline

    2008-04-01

    The decision for an anticoagulant for renal replacement therapy (RRT) in patients with acute renal failure and heparin-induced thrombocytopenia (HIT) has to be made carefully. Based on results from the literature argatroban is favoured in patients without hepatic dysfunction, referring to its short halftime and easy feasable monitoring. In the case of coexsisting hepatic disorder, danaparoid provides a safe alternative therapy. However, long halftime and the difficult elimination of the substance are unfavourable. Lepirudin represents another possible anticoagulant therapy. Bleeding complications and monitoring of the ecarin clotting time imposes limitations. Experiences with bivalirudin, fondaparinux and prostaglandines are limited and future trials will have to determine the significance of their application in RRT in HIT patients. Furthermore it has to be proven whether the combination of alternative anticoagulants with citrate prolongates circuit halftime of CVVH.

  6. Anticoagulants used in plasma collection affect adipokine multiplexed measurements.

    Science.gov (United States)

    Allione, Alessandra; Di Gaetano, Cornelia; Dani, Nadia; Barberio, Davide; Sieri, Sabina; Krogh, Vittorio; Matullo, Giuseppe

    2016-04-01

    Obesity is an important health problem worldwide. Adipose tissue acts as an endocrine organ that secretes various bioactive substances, called adipokines, including pro-inflammatory biomarkers such as TNF-α, IL-6, leptin and C-reactive protein (CRP) and anti-inflammatory molecules such as adiponectin. The deregulated production of adipokines in obesity is linked to the pathogenesis of various disease processes and monitoring their variation is critical to understand metabolic diseases. The aim of this study was to determine the plasma concentration of adipokines in healthy subjects by multiplexed measurements and the effect of anticoagulants on their levels. Plasma samples from 10 healthy donors were collected in two different anticoagulants (sodium citrate or heparin). All markers, excluding TNF-α, showed significantly higher concentrations in heparinized compared to citrate plasma. However, levels of adipokines in different plasma samples were highly correlated for most of these markers. We reported that different anticoagulants used in the preparation of the plasma samples affected the measurements of some adipokines. The importance of the present results in epidemiology is relevant when comparing different studies in which blood samples were collected with different anticoagulants. PMID:26945995

  7. A comparison of two sodium citrate concentrations in two evacuated blood collection systems for prothrombin time and ISI determination.

    Science.gov (United States)

    van den Besselaar, A M; Chantarangkul, V; Tripodi, A

    2000-10-01

    The prothrombin time is usually measured in citrated plasma. The W.H.O. recommended concentration of sodium citrate for blood collection for laboratory control of oral anticoagulant therapy is 0.109 M. Some evacuated blood collection systems include 0.105 M sodium citrate. The purpose of the present study was to establish the difference in ISI calibration between 0.109 and 0.105 M citrate, using 7 types of thromboplastin and various types of instrumentation. The two citrate concentrations were provided in both evacuated siliconised glass tubes and in evacuated polyethylene terephtalate (PET) tubes. The ISI difference between the two citrate concentrations was 5.4% for one system but not greater than 3% for all other systems when blood samples were collected with either siliconized glass or PET tubes. Most of the ISI differences between the two citrate concentrations were not significant at the 5% level. It is concluded that the ISI differences between 0.105 M and 0.109 M citrate are not of practical importance. In contrast, ISI differences between siliconised glass and PET tubes, using either 0.105 or 0.109 M citrate, were significant (p <0.05) for most thromboplastin systems and amounted to 7%. ISI interchange between these glass and PET tubes could induce INR differences amounting to 14%, which could affect clinical dosage of oral anticoagulants. PMID:11057867

  8. Heterofucans from Dictyota menstrualis have anticoagulant activity

    Directory of Open Access Journals (Sweden)

    I.R.L. Albuquerque

    2004-02-01

    Full Text Available Fucan is a term used to denote a family of sulfated L-fucose-rich polysaccharides which are present in the extracellular matrix of brown seaweed and in the egg jelly coat of sea urchins. Plant fucans have several biological activities, including anticoagulant and antithrombotic, related to the structural and chemical composition of polysaccharides. We have extracted sulfated polysaccharides from the brown seaweed Dictyota menstrualis by proteolytic digestion, followed by separation into 5 fractions by sequential acetone precipitation. Gel electrophoresis using 0.05 M 1,3-diaminopropane-acetate buffer, pH 9.0, stained with 0.1% toluidine blue, showed the presence of sulfated polysaccharides in all fractions. The chemical analyses demonstrated that all fractions are composed mainly of fucose, xylose, galactose, uronic acid, and sulfate. The anticoagulant activity of these heterofucans was determined by activated partial thromboplastin time (APTT using citrate normal human plasma. Only the fucans F1.0v and F1.5v showed anticoagulant activity. To prolong the coagulation time to double the baseline value in the APTT, the required concentration of fucan F1.0v (20 µg/ml was only 4.88-fold higher than that of the low molecular weight heparin Clexane® (4.1 µg/ml, whereas 80 µg/ml fucan 1.5 was needed to obtain the same effect. For both fucans this effect was abolished by desulfation. These polymers are composed of fucose, xylose, uronic acid, galactose, and sulfate at molar ratios of 1.0:0.8:0.7:0.8:0.4 and 1.0:0.3:0.4:1.5:1.3, respectively. This is the fist report indicating the presence of a heterofucan with higher anticoagulant activity from brown seaweed.

  9. Lupus anticoagulants and antiphospholipid antibodies

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000547.htm Lupus anticoagulants and antiphospholipid antibodies To use the sharing features on this page, please enable JavaScript. Lupus anticoagulants are antibodies against substances in the lining ...

  10. In-vitro anticoagulant activity of fucoidan derivatives from brown seaweed Laminaria japonica

    Institute of Scientific and Technical Information of China (English)

    WANG Jing; ZHANG Quanbin; ZHANG Zhongshan; HOU Yun; ZHANG Hong

    2011-01-01

    Fucoidan, a group of sulfated heteropolysaccharides, was extracted from Laminariajaponica,an important economic alga species in China. The anticoagulant activity of fucoidan and its derivatives (including sulfated, phosphorylated, and aminated fucoidan) was examined using in-vitro anticoagulant systems. The correlation between chemical variations within the fucoidan group and anticoagulant activity was determined. The in-vitro anticoagulant properties of fucoidan and its derivatives were determined by measuring activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT).The results indicate anticoagulant activity in all samples using APTT and TT assays; however, only the fucoidan derivatives affected the PT assay. Thus, the fucoidan derivatives were able to inhibit both intrinsic and extrinsic blood coagulants. Fucoidan (FPS) and its derivatives presented better anticoagulant activity than low molecular weight fucoidan (DFPS) and its derivatives, suggesting that molecular weight and proper conformation are contributing factors for anticoagulant activity of polysaccharides. Amino groups have a positive charge and can thus change the charge density of fucoidan. Accordingly, among the tested samples, aminated fucoidan (NF) was the most active reflecting the importance of charge density for anticoagulant activity. Available data obtained using in-vitro models suggest that the sulfate content,sulfate/total-sugar ratio, molecular weight, and the substituted group of fucoidan are important factors for anticoagulant activity but that the influence of sulfate, phosphate and amino groups on anticoagulant activity was different.

  11. In-vitro anticoagulant activity of fucoidan derivatives from brown seaweed Laminaria japonica

    Science.gov (United States)

    Wang, Jing; Zhang, Quanbin; Zhang, Zhongshan; Hou, Yun; Zhang, Hong

    2011-05-01

    Fucoidan, a group of sulfated heteropolysaccharides, was extracted from Laminaria japonica, an important economic alga species in China. The anticoagulant activity of fucoidan and its derivatives (including sulfated, phosphorylated, and aminated fucoidan) was examined using in-vitro anticoagulant systems. The correlation between chemical variations within the fucoidan group and anticoagulant activity was determined. The in-vitro anticoagulant properties of fucoidan and its derivatives were determined by measuring activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT). The results indicate anticoagulant activity in all samples using APTT and TT assays; however, only the fucoidan derivatives affected the PT assay. Thus, the fucoidan derivatives were able to inhibit both intrinsic and extrinsic blood coagulants. Fucoidan (FPS) and its derivatives presented better anticoagulant activity than low molecular weight fucoidan (DFPS) and its derivatives, suggesting that molecular weight and proper conformation are contributing factors for anticoagulant activity of polysaccharides. Amino groups have a positive charge and can thus change the charge density of fucoidan. Accordingly, among the tested samples, aminated fucoidan (NF) was the most active reflecting the importance of charge density for anticoagulant activity. Available data obtained using in-vitro models suggest that the sulfate content, sulfate/total-sugar ratio, molecular weight, and the substituted group of fucoidan are important factors for anticoagulant activity but that the influence of sulfate, phosphate and amino groups on anticoagulant activity was different.

  12. Cataract surgery and anticoagulants

    NARCIS (Netherlands)

    Koopmans, SA; VanRij, G

    1996-01-01

    A questionnaire was sent to 240 members of the Netherlands Intraocular implant Club (NIOIC) to register their policy followed in 1993 with regard to anticoagulant therapy (ACT) and the use of aspirin in patients having cataract surgery. Ninety-one (32%) forms were suitable for analysis. Most eye sur

  13. Anticoagulation in atrial fibrillation.

    Science.gov (United States)

    Steinberg, Benjamin A; Piccini, Jonathan P

    2014-01-01

    Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide. The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes. However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential. Vitamin K antagonism has been the mainstay of treatment; however, newer drugs with novel mechanisms are also available. These novel oral anticoagulants (direct thrombin inhibitors and factor Xa inhibitors) obviate many of warfarin's shortcomings, and they have demonstrated safety and efficacy in large randomized trials of patients with non-valvular atrial fibrillation. However, the management of patients taking warfarin or novel agents remains a clinical challenge. There are several important considerations when selecting anticoagulant therapy for patients with atrial fibrillation. This review will discuss the rationale for anticoagulation in patients with atrial fibrillation; risk stratification for treatment; available agents; the appropriate implementation of these agents; and additional, specific clinical considerations for treatment. PMID:24733535

  14. Alverine citrate induced acute hepatitis

    Institute of Scientific and Technical Information of China (English)

    Mehmet Arhan; Seyfettin K(o)klü; Aydln S K(o)ksal; (O)mer F Yolcu; Senem Koruk; Irfan Koruk; Ertugrul Kayacetin

    2004-01-01

    Alverine citrate is a commonly used smooth muscle relaxant agent. A MEDLINE search on January 2004 revealed only 1 report implicating the hepatotoxicity of this agent. A 34-year-old woman was investigated because of the finding of elevated liver function tests on biochemical screening. Other etiologies of hepatitis were appropriately ruled out and elevated enzymes were ascribed to alverine citrate treatment.Although alverine citrate hepatotoxicity was related to an immune mechanism in the first case, several features such as absence of predictable dose-dependent toxicity of alverine citrate in a previous study and absence of hypersensitivity manifestations in our patient are suggestive of a metabolic type of idiosyncratic toxicity.

  15. Anticoagulation in Atrial Fibrillation

    OpenAIRE

    Ahmad, Yousif; YH Lip, Gregory

    2012-01-01

    Patients with atrial fibrillation (AF) are at increased thromboembolic risk, and they suffer more severe strokes with worse outcomes. Most thromboembolic complications of AF are eminently preventable with oral anticoagulation, and the increasing numbers of AF patients mean antithrombotic therapy is the most crucial management aspect of this common arrhythmia. Despite the proven efficacy of warfarin, a string of limitations have meant that it is underused by physicians and patients alike. This...

  16. Anticoagulation in atrial fibrillation

    OpenAIRE

    Steinberg, Benjamin A; Piccini, Jonathan P.

    2014-01-01

    Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide. The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes. However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential. Vitamin K antagonism has been the mainstay of treatment; however, newer drugs with novel mechanisms are also availabl...

  17. Strongly bound citrate stabilizes the apatite nanocrystals in bone

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Y.-Y.; Rawal, A.; Schmidt-Rohr, K.

    2010-10-12

    Nanocrystals of apatitic calcium phosphate impart the organic-inorganic nanocomposite in bone with favorable mechanical properties. So far, the factors preventing crystal growth beyond the favorable thickness of ca. 3 nm have not been identified. Here we show that the apatite surfaces are studded with strongly bound citrate molecules, whose signals have been identified unambiguously by multinuclear magnetic resonance (NMR) analysis. NMR reveals that bound citrate accounts for 5.5 wt% of the organic matter in bone and covers apatite at a density of about 1 molecule per (2 nm){sup 2}, with its three carboxylate groups at distances of 0.3 to 0.45 nm from the apatite surface. Bound citrate is highly conserved, being found in fish, avian, and mammalian bone, which indicates its critical role in interfering with crystal thickening and stabilizing the apatite nanocrystals in bone

  18. Sodium picosulfate/magnesium citrate: a review of its use as a colorectal cleanser.

    Science.gov (United States)

    Hoy, Sheridan M; Scott, Lesley J; Wagstaff, Antona J

    2009-01-01

    Oral sodium picosulfate/magnesium citrate (CitraFleet; Picolax), consisting of sodium picosulfate (a stimulant laxative) and magnesium citrate (an osmotic laxative), is approved for use in adults (CitraFleet; Picolax) and/or adolescents and children (Picolax) as a colorectal cleansing agent prior to any diagnostic procedure (e.g. colonoscopy or x-ray examination) requiring a clean bowel and/or surgery. It is dispensed in powder form (sodium picosulfate 0.01 g, magnesium oxide 3.5 g, citric acid 12.0 g per sachet), with the magnesium oxide and citric acid components forming magnesium citrate when the powder is dissolved in water. In adult patients, two sachets of sodium picosulfate/magnesium citrate was at least as effective and well tolerated as oral magnesium citrate 17.7 or 35.4 g, or oral polyethylene glycol 236 g in adult patients undergoing a double-contrast barium enema procedure in three large, randomized, comparative clinical studies. In contrast, sodium picosulfate/magnesium citrate was less effective than a sodium phosphate enema preparation in two studies in patients undergoing flexible sigmoidoscopy. A similar number of patients receiving two sachets of sodium picosulfate/magnesium citrate or two 45 mL doses of oral sodium phosphate the day before a double-contrast barium enema procedure achieved satisfactory barium coating and none/minimal faecal residue in one study. However, the data from three of these studies should be interpreted with caution because the administrative regimens used differed from that recommended. Sodium picosulfate/magnesium citrate is also an effective and generally well tolerated colorectal cleansing agent in children and adolescents; the preparation was more effective than oral bisacodyl 0.01 or 0.02 g plus a sodium phosphate enema preparation in this population. Further research is thus required to accurately position sodium picosulfate/magnesium citrate and fully establish its efficacy and tolerability prior to various

  19. 21 CFR 184.1301 - Ferric phosphate.

    Science.gov (United States)

    2010-04-01

    ... reaction of sodium phosphate with ferric chloride or ferric citrate. (b) The ingredient meets the... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Ferric phosphate. 184.1301 Section 184.1301 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD...

  20. Anticoagulation Strategies in Venovenous Hemodialysis in Critically Ill Patients: A Five-Year Evaluation in a Surgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Christoph Sponholz

    2014-01-01

    Full Text Available Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC. Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (P=0.001. Femoral vascular access was associated with reduced filter life span (P=0.012, especially under heparin anticoagulation (P=0.015. Patients on RAC had higher rates of metabolic alkalosis (P=0.001, required more transfusions (P=0.045, and showed higher illness severity measured by SOFA scores (P=0.001. RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances.

  1. [Novel oral anticoagulants (NOAC)].

    Science.gov (United States)

    Ieko, Masahiro

    2015-10-01

    Novel oral anticoagulants (NOACs), a direct thrombin inhibitor (TDI), and direct factor Xa inhibitors (Xa-INHs) have mainly been used for prevention of stroke associated with atrial fibrillation in place of warfarin. DTI obstructs tenase by inhibiting thrombin generated in the initial phase and feedback to the amplification phase of cell-based coagulation reactions. Xa-INHs inhibit factor Xa activity in the prothrombinase complex of the propagation phase. Since the half-life of NOACs is in the approximate range of 8-14 hours, there are peak and trough periods in the blood concentrations of these agents. During the trough period, a small amount of thrombin is generated and plays a physiological role. The antithrombotic effect of NOACs is exerted during the peak period in combination with the effects of physiological coagulation inhibitors (PCIs) such as antithrombin in the trough period. Endothelial cells are the site for action of PCIs, such that it is important that they remain in a good state for effective anticoagulation by NOACs within the lesions. In a meta-analysis of NOACs vs. warfarin treatment, the former significantly reduced stroke or systemic embolic events by 19% as compared with warfarin, due mainly to a reduction in hemorrhagic stroke, while NOAC administration also significantly reduced intracranial hemorrhage by 52%. PMID:26458452

  2. Alverine citrate induced acute hepatitis.

    Science.gov (United States)

    Arhan, Mehmet; Koklu, Seyfettin; Koksal, Aydln-S; Yolcu, Omer-F; Koruk, Senem; Koruk, Irfan; Kayacetin, Ertugrul

    2004-08-01

    Alverine citrate is a commonly used smooth muscle relaxant agent. A MEDLINE search on January 2004 revealed only 1 report implicating the hepatotoxicity of this agent. A 34-year-old woman was investigated because of the finding of elevated liver function tests on biochemical screening. Other etiologies of hepatitis were appropriately ruled out and elevated enzymes were ascribed to alverine citrate treatment. Although alverine citrate hepatotoxicity was related to an immune mechanism in the first case, several features such as absence of predictable dose-dependent toxicity of alverine citrate in a previous study and absence of hypersensitivity manifestations in our patient are suggestive of a metabolic type of idiosyncratic toxicity. PMID:15259090

  3. Citrate-Stabilized Gold Nanorods

    OpenAIRE

    Mehtala, Jonathan G; Zemlyanov, Dmitry Y.; Max, Joann P.; Kadasala, Naveen; Zhao, Shou; Wei, Alexander

    2014-01-01

    Stable aqueous dispersions of citrate-stabilized gold nanorods (cit-GNRs) have been prepared in scalable fashion by surfactant exchange from cetyltrimethylammonium bromide (CTAB)-stabilized GNRs, using polystyrenesulfonate (PSS) as a detergent. The surfactant exchange process was monitored by infrared spectroscopy, surface-enhanced Raman scattering (SERS), and X-ray photoelectron spectroscopy (XPS). The latter established the quantitative displacement of CTAB (by PSS) and of PSS (by citrate)....

  4. Characterization of citrate utilization in Corynebacterium glutamicum by transcriptome and proteome analysis.

    Science.gov (United States)

    Polen, Tino; Schluesener, Daniela; Poetsch, Ansgar; Bott, Michael; Wendisch, Volker F

    2007-08-01

    Corynebacterium glutamicum grows aerobically on a variety of carbohydrates and organic acids as single or combined sources of carbon and energy. To characterize the citrate utilization in C. glutamicum on a genomewide scale, a comparative analysis was carried out by combining transcriptome and proteome analysis. In cells grown on citrate, transcriptome analysis revealed highest expression changes for two different citrate-uptake systems encoded by citM and tctCBA, whereas genes encoding uptake systems for the glucose- (ptsG), sucrose- (ptsS) and fructose- (ptsF) specific PTS components and permeases for gluconate (gntP) and glutamate (gluC) displayed decreased mRNA levels in citrate-grown cells. This pattern was also observed when cells grown in Luria-Bertani (LB) medium plus citrate were compared with cells grown in LB medium, indicating some kind of catabolite repression. Genes encoding enzymes of the tricarboxylic acid cycle (aconitase, succinyl-CoA synthetase, succinate dehydrogenase and fumarase), malic enzyme, PEP carboxykinase, gluconeogenic glyceraldehyde-3-phosphate dehydrogenase and ATP synthase displayed increased expression in cells grown on citrate. Accordingly, proteome analysis revealed elevated protein levels of these enzymes and showed a good correlation with the mRNA levels. In conclusion, this study revealed the citrate stimulon in C. glutamicum and the regulated central metabolic genes when grown on citrate. PMID:17559405

  5. Comparing new anticoagulants.

    Science.gov (United States)

    Wooten, James M

    2012-12-01

    For years, the pharmaceutical industry has been trying to find a safe and effective drug to replace warfarin. Although warfarin is an effective anticoagulant, its pharmacology, adverse effects, and risk profiles dictate that patients taking this medication must be monitored judiciously. The US Food and Drug Administration has approved two drugs for commercial use, dabigatran and rivaroxaban, that will compete directly with warfarin for use in specific indications. Because of direct marketing to patients, physicians are being asked to comment on these new medications. This brief review illustrates the data available for the two new drugs when compared to warfarin for the specified indications. For some patients, these drugs may be highly beneficial and offer an excellent alternative to warfarin. For others, warfarin may still be the preferred drug. PMID:23211502

  6. Best practices for use of the HEMOX analyzer in the clinical laboratory: quality control determination and choice of anticoagulant.

    Science.gov (United States)

    Vanhille, Derek L; Nussenzveig, Roberto H; Glezos, Christopher; Perkins, Sherrie; Agarwal, Archana M

    2012-09-01

    The HEMOX Analyzer (TCS Scientific) has been used to measure the full oxygen-dissociation curve (ODC) and to calculate P(50) and the Hill coefficient. The effects of different anticoagulants on sample stability and P(50) values have not been evaluated extensively for this instrument. We characterized an artificial hemoglobin (Equil QC463) for quality control (QC) and compared P(50) values for blood samples drawn into 3 different anticoagulants (acid citrate dextrose [ACD], heparin, and EDTA). P(50) values were not stable in ACD but were stable in heparin and EDTA anticoagulants for up to 4 days. Tests with Equil QC463 showed that P(50) values were quite sensitive to small variations in buffer pH. Use of the correct anticoagulant and strict control of buffer pH are 2 parameters that need to be accounted for in best-practices use of this hemoximeter and before determining P(50).

  7. Safety Assessment of Citric Acid, Inorganic Citrate Salts, and Alkyl Citrate Esters as Used in Cosmetics.

    Science.gov (United States)

    Fiume, Monice M; Heldreth, Bart A; Bergfeld, Wilma F; Belsito, Donald V; Hill, Ronald A; Klaassen, Curtis D; Liebler, Daniel C; Marks, James G; Shank, Ronald C; Slaga, Thomas J; Snyder, Paul W; Andersen, F Alan

    2014-05-26

    The CIR Expert Panel (Panel) assessed the safety of citric acid, 12 inorganic citrate salts, and 20 alkyl citrate esters as used in cosmetics, concluding that these ingredients are safe in the present practices of use and concentration. Citric acid is reported to function as a pH adjuster, chelating agent, or fragrance ingredient. Some of the salts are also reported to function as chelating agents, and a number of the citrates are reported to function as skin-conditioning agents but other functions are also reported. The Panel reviewed available animal and clinical data, but because citric acid, calcium citrate, ferric citrate, manganese citrate, potassium citrate, sodium citrate, diammonium citrate, isopropyl citrate, stearyl citrate, and triethyl citrate are generally recognized as safe direct food additives, dermal exposure was the focus for these ingredients in this cosmetic ingredient safety assessment.

  8. Enhancement of Aminoacylase Activity by Sodium Citrate

    Institute of Scientific and Technical Information of China (English)

    于范利; 曹志方; 李森; 周海梦

    2001-01-01

    Kidney and other tissues of animals and humans have a high concentration of citrate which is an important intermediate substance in the citrate cycle. Citrate may play an important physiological role in metabolism. In this paper, we studied the interaction of the sodium salt of citrate with aminoacylase which is an important enzyme in metabolism and found sodium citrate can enhance the activity of aminoacylase. The maximum enzyme activity induced by sodium citrate increased approximately 3 folds over the enzyme activity without sodium citrate. The initial reaction rates (Ⅴ) for different concentrations of sodium citrate were obtained, showing that sodium citrate is a non-competitive activator. The result of the ANS binding fluorescence measurements for aminoacylase indicated that increasing sodium citrate concentrations markedly increased the ANS binding fluorescence with a blue shift of the emission spectra peak. This suggests the formation of more hydrophobic regions. Aggregates formed quickly when aminoacylase was incubated with sodium citrate (0.3 mol/L) and guanidinium chloride (0- 3. 5 mol/L). Aminoacylase lost enzyme activity in the guanidinium chloride more quickly in the presence of sodium citrate than in the absence of sodium citrate. The intrinsic fluorescence emission intensity decreased more quickly and the red shift of the emission spectra peak was larger than that without sodium citrate.

  9. Influence of the sample anticoagulant on the measurements of impedance aggregometry in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Cristina Solomon

    2008-10-01

    Full Text Available Cristina Solomon1, Michael Winterhalter1, Isabel Gilde1, Ludwig Hoy2, Andreas Calatzis3, Niels Rahe-Meyer11Department of Anesthesiology, Hannover Medical School, Hannover, Germany; 2Institute for Biometry, Hannover Medical School, Hannover, Germany; 3Department Hemostasis Transfusion Medicine, University Hospital Munich, Munich, GermanyBackground: The standard method of assessment of platelet function is represented by light transmission aggregometry (LTA, performed in citrated platelet-rich plasma (PRP. With LTA, decrease and subsequent post-cardiopulmonary bypass (CPB recovery of platelet function have been reported during cardiac surgery. Multiple electrode aggregometry (MEA may be used as point-of-care method to monitor perioperative changes in platelet function. Since MEA assesses macroaggregation which is influenced by the plasmatic levels of unbound calcium, citrate may be inadequate as anticoagulant for MEA. We used citrate and heparin for MEA samples, to see with which anticoagulant the intraoperative decrease and postoperative recovery in platelet function previously described with other aggregometric methods in cardiac surgery may be observed with MEA.Methods: Blood was obtained from 60 patients undergoing routine cardiac surgery and the samples were collected in standard tubes containing unfractionated heparin (50 U/mL or trisodium citrate (3.2%. The samples were obtained before CPB, at 30 minutes on CPB, end of CPB and on the first postoperative day. MEA was performed using the Multiplate® analyzer. Collagen (COLtest, 100 μg/mL and TRAP-6 (thrombin receptor activating peptide, TRAPtest, 1mM/mL were used as aggregation agonists.Results: Platelet aggregometric response decreased significantly during CPB. Platelet aggregation assessed using TRAP-6 as agonist on heparinized blood significantly correlated with the duration of CPB (r = −0.41, p = 0.001, 2-tailed Pearson test. The aggregometric analysis performed on the first

  10. Can citrate efflux from roots improve phosphorus uptake by plants? Testing the hypothesis with near-isogenic lines of wheat.

    Science.gov (United States)

    Ryan, Peter R; James, Richard A; Weligama, Chandrakumara; Delhaize, Emmanuel; Rattey, Allan; Lewis, David C; Bovill, William D; McDonald, Glenn; Rathjen, Tina M; Wang, Enli; Fettell, Neil A; Richardson, Alan E

    2014-07-01

    Phosphorus (P) deficiency in some plant species triggers the release of organic anions such as citrate and malate from roots. These anions are widely suggested to enhance the availability of phosphate for plant uptake by mobilizing sparingly-soluble forms in the soil. Carazinho is an old wheat (Triticum aestivum) cultivar from Brazil, which secretes citrate constitutively from its root apices, and here we show that it also produces relatively more biomass on soils with low P availability than two recent Australian cultivars that lack citrate efflux. To test whether citrate efflux explains this phenotype, we generated two sets of near-isogenic lines that differ in citrate efflux and compared their biomass production in different soil types and with different P treatments in glasshouse experiments and field trials. Citrate efflux improved relative biomass production in two of six glasshouse trials but only at the lowest P treatments where growth was most severely limited by P availability. Furthermore, citrate efflux provided no consistent advantage for biomass production or yield in multiple field trials. Theoretical modeling indicates that the effectiveness of citrate efflux in mobilizing soil P is greater as the volume of soil into which it diffuses increases. As efflux from these wheat plants is restricted to the root apices, the potential for citrate to mobilize sufficient P to increase shoot biomass may be limited. We conclude that Carazinho has other attributes that contribute to its comparatively good performance in low-P soils.

  11. 21 CFR 184.1751 - Sodium citrate.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Sodium citrate. 184.1751 Section 184.1751 Food and... Substances Affirmed as GRAS § 184.1751 Sodium citrate. (a) Sodium citrate (C6H5Na3O7·2H2O, CAS Reg. No. 68... may be prepared in an anhydrous state or may contain two moles of water per mole of sodium citrate....

  12. 21 CFR 184.1449 - Manganese citrate.

    Science.gov (United States)

    2010-04-01

    ... sodium citrate to complete the reaction. (b) The ingredient must be of a purity suitable for its intended... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Manganese citrate. 184.1449 Section 184.1449 Food... Specific Substances Affirmed as GRAS § 184.1449 Manganese citrate. (a) Manganese citrate (Mn3(C6H5O7)2,...

  13. Does plasmin have anticoagulant activity?

    Directory of Open Access Journals (Sweden)

    Jane Hoover-Plow

    2010-03-01

    Full Text Available Jane Hoover-PlowJoseph J Jacobs Center for Thrombosis and Vascular Biology, Departments of Cardiovascular Medicine and Molecular Cardiology, Lerner Research Institute Cleveland Clinic, Ohio, USAAbstract: The coagulation and fibrinolytic pathways regulate hemostasis and thrombosis, and an imbalance in these pathways may result in pathologic hemophilia or thrombosis. The plasminogen system is the primary proteolytic pathway for fibrinolysis, but also has important proteolytic functions in cell migration, extracellular matrix degradation, metalloproteinase activation, and hormone processing. Several studies have demonstrated plasmin cleavage and inactivation of several coagulation factors, suggesting plasmin may be not only be the primary fibrinolytic enzyme, but may have anticoagulant properties as well. The objective of this review is to examine both in vitro and in vivo evidence for plasmin inactivation of coagulation, and to consider whether plasmin may act as a physiological regulator of coagulation. While several studies have demonstrated strong evidence for plasmin cleavage and inactivation of coagulation factors FV, FVIII, FIX, and FX in vitro, in vivo evidence is lacking for a physiologic role for plasmin as an anticoagulant. However, inactivation of coagulation factors by plasmin may be useful as a localized anticoagulant therapy or as a combined thrombolytic and anticoagulant therapy.Keywords: thrombosis, anticoagulant, cardiovascular disease, plasminogen’s protease, blood

  14. 21 CFR 184.1298 - Ferric citrate.

    Science.gov (United States)

    2010-04-01

    ... Substances Affirmed as GRAS § 184.1298 Ferric citrate. (a) Ferric citrate (iron (III) citrate, C6H5FeO7, CAS Reg. No. 2338-05-8) is prepared from reaction of citric acid with ferric hydroxide. It is a compound of indefinite ratio of citric acid and iron. (b) The ingredient must be of a purity suitable for...

  15. 21 CFR 582.6751 - Sodium citrate.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Sodium citrate. 582.6751 Section 582.6751 Food and..., FEEDS, AND RELATED PRODUCTS SUBSTANCES GENERALLY RECOGNIZED AS SAFE Sequestrants 2 § 582.6751 Sodium citrate. (a) Product. Sodium citrate. (b) Conditions of use. This substance is generally recognized...

  16. 21 CFR 582.1751 - Sodium citrate.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Sodium citrate. 582.1751 Section 582.1751 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS....1751 Sodium citrate. (a) Product. Sodium citrate. (b) Conditions of use. This substance is...

  17. 21 CFR 582.6625 - Potassium citrate.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Potassium citrate. 582.6625 Section 582.6625 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL... Potassium citrate. (a) Product. Potassium citrate. (b) Conditions of use. This substance is...

  18. 21 CFR 582.1625 - Potassium citrate.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Potassium citrate. 582.1625 Section 582.1625 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL... Additives § 582.1625 Potassium citrate. (a) Product. Potassium citrate. (b) Conditions of use....

  19. Colonoscopic polypectomy in anticoagulated patients

    Institute of Scientific and Technical Information of China (English)

    Shai Friedland; Daniel Sedehi; Roy Soetikno

    2009-01-01

    AIM: To review our experience performing polypectomy in anticoagulated patients without interruption of anticoagulation.METHODS: Retrospective chart review at the Veterans Affairs Palo Alto Health Care System. Two hundred and twenty five polypectomies were performed in 123 patients. Patients followed a standardized protocol that included stopping warfarin for 36 h to avoid supratherapeutic anticoagulation from the bowel preparation. Patients with lesions larger than 1 cm were generally rescheduled for polypectomy off warfarin. Endoscopic clips were routinely applied prophylactically.RESULTS: One patient (0.8%, 95% CI: 0.1%-4.5%)developed major post-polypectomy bleeding that required transfusion. Two others (1.6%, 95% CI:0.5%-5.7%) had self-limited hematochezia at home and did not seek medical attention. The average polyp size was 5.1 ± 2.2 mm.

  20. [Direct oral anticoagulants in cardiology].

    Science.gov (United States)

    Kiss, Róbert Gábor

    2016-09-01

    Antithrombotic drug therapy is a main cornerstone - sometimes a fairly uneven cornerstone - of today's clinical practice. Patients treated with antithrombotic drugs appear sometimes unawaited at those of our colleagues, who are not necessarily experts of this narrow field. Furthermore, new and newer molecules of antiplatelet and anticoagulant medicines have come into practice, frequently in combination. This dramatic development has been important to patients; pharmacological - and recently nonpharmacological - antithrombotic treatment has paved the way to improve current modalities in cardiology. Combining elements of the "old four" (heparin, coumadin, aspirin, clopidogrel) have been the basis of any improvement for a long time. Nowadays, there has been an involvement of new drugs, direct oral anticoagulants into practice. It is time now to catch up in using new anticoagulants, regardless of our current speciality in medicine. Orv. Hetil., 2016, 157(38), 1507-1510. PMID:27640616

  1. Coagulant and anticoagulant activities of Bothrops lanceolatus (Fer de lance) venom.

    Science.gov (United States)

    Lôbo de Araújo, A; Kamiguti, A; Bon, C

    2001-01-01

    Bothrops lanceolatus venom contains caseinolytic, phospholipase, esterase and haemorrhagic activities. We have investigated the coagulant and anticoagulant actions of B. lanceolatus venom on human citrated plasma and on purified plasma components. Although B. lanceolatus venom up to 50 microg/ml was unable to clot citrated plasma, at concentrations > or = 5 microg/ml the venom dose-dependently clotted purified human fibrinogen, indicating the presence of a thrombin-like enzyme. Human plasma (final concentration > or = 12.5%) dose-dependently inhibited the venom-induced fibrinogen clotting. This finding suggested that endogenous plasma protease inhibitors can affect the venom's action on fibrinogen. To investigate this possibility, B. lanceolatus venom was incubated with different plasma protease inhibitors and the activity on fibrinogen tested. alpha(2)-Macroglobulin and alpha(1)-antitrypsin did not interfere with the coagulant activity of the venom whereas the antithrombin-III/heparin complex partially inhibited this activity. A non-toxic, acidic phospholipase A(2) purified from B. lanceolatus venom prolonged the activated partial thromboplastin time in human plasma from 39.7+/-0.5 s (control with saline) to 60.2+/-0.9 s with 50 microg of PLA(2) (p<0.001), suggesting an anticoagulant activity associated with this enzyme. This anticoagulant activity may account for some of the effects of the venom on blood coagulation. PMID:10978756

  2. Field evaluation of water or citrate soluble phosphorus in modified phosphate rocks for soybean Avaliação agronômica do fósforo solúvel em água ou citrato de fosfatos de rocha acidulados para a soja

    Directory of Open Access Journals (Sweden)

    Luís Ignácio Prochnow

    2001-03-01

    Full Text Available Ten P fertilizers were collected (commercial fertilizers or synthesized (experimental sources in order to obtain single superphosphates varying in water and citrate solubility. A standard source of P was also produced by crystallization of the water-soluble fraction of a triple superphosphate. Eleven P sources were band applied to a medium textured Xanthic Hapludox, in Bahia, Brazil (low content of resin-extractable P at a rate of 80 kg ha-1 of NAC + H2O (neutral ammonium citrate plus water soluble P2O5, with soybean as the crop which was grown to maturity. A check plot (control was included in the study. Three of the P sources [single superphosphate produced from Araxa phosphate rock (PR, low-grade single superphosphate produced from Lagamar PR and the standard source of P] were also applied at rates to provide 40 and 120 kg ha-1 of NAC + H2O soluble P2O5. Yield of soybean was evaluated by analysis of variance with mean comparison performed utilizing LSD lines, considering the P sources applied at a rate of 80 kg ha-1 of P2O5 + control. Regression procedures were used to study the relation between yield of soybean and rates of P2O5. The fertilizers tested performed equally well as a source of P for soybean. The level of water-soluble P did not influence fertilizer performance.Dez fontes de P foram coletadas em unidades revendedoras de fertilizantes comerciais ou produzidas em laboratório de tal forma a obter superfosfatos simples com variabilidade em água e citrato neutro de amônio + água (CNA + H2O. Utilizou-se como fonte padrão de fósforo a fração solubilizada, filtrada e cristalizada de um superfosfato triplo. As onze fontes de P foram aplicadas nas linhas de semeadura de soja de um Xanthic Hapludox textura média, localizado no Município de Barreiras, Bahia (baixo teor de fósforo resina na dose de 80 kg ha-1 de P2O5 solúvel em CNA + H2O. Três das fontes (superfosfatos simples produzido a partir da rocha fosfática de Araxá e

  3. [Phosphate metabolism and iron deficiency].

    Science.gov (United States)

    Yokoyama, Keitaro

    2016-02-01

    Autosomal dominant hypophosphatemic rickets(ADHR)is caused by gain-of-function mutations in FGF23 that prevent its proteolytic cleavage. Fibroblast growth factor 23(FGF23)is a hormone that inhibits renal phosphate reabsorption and 1,25-dihydroxyvitamin D biosynthesis. Low iron status plays a role in the pathophysiology of ADHR. Iron deficiency is an environmental trigger that stimulates FGF23 expression and hypophosphatemia in ADHR. It was reported that FGF23 elevation in patients with CKD, who are often iron deficient. In patients with nondialysis-dependent CKD, treatment with ferric citrate hydrate resulted in significant reductions in serum phosphate and FGF23.

  4. [Influence of PO4(3-) and citrate on REE accumulation and fractionation in wheat].

    Science.gov (United States)

    Yan, Jun-Cai; Liang, Tao; Zhang, Zi-Li; Ding, Shi-Ming

    2005-09-01

    This paper has studied the influence of phosphate (Pi, one of inorganic ligands) and citrate (Cit, one of organic ligands) on accumulation and fractionation of REEs in wheat based on aqueous culture, added with extraneous mixed REEs (MRE) and ICP-MS analysis technology. The results show that initial phosphate (Pi) solution of different levels followed by exposure to fixed-MRE solution has no significant effects on accumulation of the total concentrations of REEs (sigma REE) in the wheat roots, but it decrease the REE dramatically in the wheat leaves. Simultaneous culture of wheat with mixture of MRE and citrate solution caused obvious decreases of the sigma REE both in wheat roots and leaves. Compared to the control (no Pi or citrate was added), the distribution and fractionation characters of MRE had M-type tetrad effect and MREE enrichment in wheat roots, and W-type tetrad effect and HREE enrichment in wheat leaves. Different levels of Pi had no significant effects on the tetrad effect of MRE, but it notable increased the enrichment of HREE in wheat leaves. Added with citrate of different levels led the fractionation of REE decreasing gradually in wheat roots and leaves, as the concentration of citrate > or = 150 micromol x L(-1), light REE (LREE) enrichment both existed in the roots and leaves.

  5. Comparison of sodium citrate with defibrination for the processing of blood for tsetse mass-rearing

    International Nuclear Information System (INIS)

    Full text: Various experimental bioassays comparing the use of sodium citrated bovine blood to defibrinated bovine blood were performed in order to reach an alternative anticoagulant procedure. Defibrination is the standard process to obtain blood, which is the only source of nutrients for tsetse flies. This process is time consuming, requires special equipment, trained personnel and could be an extra source of blood contamination. For the blood collection, special care was taken to rule out biological bias by using the same donor animal for both citrated and defibrinated collections. Contamination was avoided by sterile collection from the jugular vein. As the university owns these animals, their medical history is known and could be inspected prior to collection in order to rule out any recent antibiotic treatments, which could influence the results of the experiment. Both blood treatments were transported under refrigeration, irradiated in a Gammacell 220 Co60 irradiator with 1 kGy, stored at -20 deg. C and bacteriologically tested (nutrient agar plate test). All flies were kept under standard condition of temperature (24.5 ± 0.5 deg. C) and relative humidity (75 ± 5%). For the bioassays, flies from the Glossina pallidipes colony, Entomology Unit, Seibersdorf, were used. The flies were divided into 2 groups of males and females in a 1:4 ratio and each group was composed of 4 cages. The first experiment lasted for 37 days and the second 93 days. One group received defibrinated bovine blood and the other group received citrated bovine blood (0.02M final concentration). Survival, mortality and fecundity rates of the flies and pupal size category and weight were recorded for both groups and were analysed and compared. The results showed that there was no significant difference between the two treatments for survival, mortality and fecundity and that the pupal size category and weight for the citrated group had slightly better results than the defibrinated group

  6. Anticoagulation in Older Adults with Multimorbidity.

    Science.gov (United States)

    Parks, Anna L; Fang, Margaret C

    2016-05-01

    The number of patients with atrial fibrillation (AF) who are of advanced age or have multiple comorbidities is expected to increase substantially. Older patients with AF generally gain a net benefit from anticoagulation. Guidelines typically recommend anticoagulation. There are multiple challenges in the safe use of anticoagulation in frail patients, including bleeding risk, monitoring and adherence, and polypharmacy. Although there are options for chronic oral anticoagulation, clinicians must understand the unique advantages and disadvantages of these medications when developing a management plan. This article reviews issues surrounding the appropriate use and selection of anticoagulants in complex older patients with AF. PMID:27113150

  7. Lupus-anticoagulant testing at NOAC trough levels.

    Science.gov (United States)

    Ratzinger, Franz; Lang, Mona; Belik, Sabine; Jilma-Stohlawetz, Petra; Schmetterer, Klaus G; Haslacher, Helmuth; Perkmann, Thomas; Quehenberger, Peter

    2016-08-01

    Non-vitamin K antagonist oral anticoagulants (NOAC), including rivaroxaban, apixaban or dabigatran, regularly show relevant effects on coagulation tests, making the interpretation of results difficult. The aim of this study was to evaluate possible interferences of NOACs in trough level concentrations in lupus anticoagulant (LA) testing. Citrate plasma specimens of 30 healthy volunteers were spiked with rivaroxaban, apixaban or dabigatran in four plasma concentration levels at or below trough NOAC levels. The NOAC concentration was measured using dedicated surrogate concentration tests and a stepwise diagnostic procedure for LA-testing was applied using screening, mixing and confirmatory testing. Results were compared to NOAC-free specimens. Starting with a plasma concentration of 12.5 ng/ml, dabigatran-spiked specimens showed significant prolongations in the lupus anticoagulant-sensitive activated partial thromboplastin time (aPTT-LA) as well as in the Dilute Russell viper venom time (dRVVT), leading to 43.3 % false positives in confirmatory testing in the dRVVT. In contrast, rivaroxaban, beginning with 7.5 ng/ml, exclusively affected dRVVT-based tests. In confirmatory tests, 30.0 % of rivaroxaban-spiked specimens showed false positive results. Starting with 18.75 ng/ml apixaban, a significant prolongation of the dRVVT and up to 20.7 % false positives in confirmatory tests were found. In contrast to other NOACs tested, apixaban did not present with a dose-dependent increase of the dRVVT ratio. In conclusion, the rate of false positive results in LA-testing is unacceptably high at expected trough levels of NOACs. Even at plasma concentrations below the LLOQ of commercially available surrogate tests, LA testing is best avoided in patients with NOAC therapy.

  8. Phosphate salts

    Science.gov (United States)

    ... reduces the body's ability to absorb phosphate and iron. To avoid this interaction, phosphate should be taken at least 2 hours before or after taking iron.MagnesiumPhosphate can combine with magnesium. This reduces ... phosphate and magnesium. To avoid this interaction, phosphate should ...

  9. Aluminum resistance in common bean (Phaseolus vulgaris) involves induction and maintenance of citrate exudation from root apices.

    Science.gov (United States)

    Rangel, Andrés Felipe; Rao, Idupulapati Madhusudana; Braun, Hans-Peter; Horst, Walter Johannes

    2010-02-01

    Two common bean (Phaseolus vulgaris L.) genotypes differing in aluminum (Al) resistance, Quimbaya (Al-resistant) and VAX-1 (Al-sensitive) were grown in hydroponics for up to 25 h with or without Al, and several parameters related to the exudation of organic acids anions from the root apex were investigated. Al treatment enhanced the exudation of citrate from the root tips of both genotypes. However, its dynamic offers the most consistent relationship between Al-induced inhibition of root elongation and Al accumulation in and exclusion from the root apices. Initially, in both genotypes the short-term (4 h) Al-injury period was characterized by the absence of citrate efflux independent of the citrate content of the root apices, and reduction of cytosolic turnover of citrate conferred by a reduced Nicotinamide adenine dinucleotide phosphate-isocitrate dehydrogenase (EC 1.1.1.42) activity. Transient recovery from initial Al stress (4-12 h) was found to be dependent mainly on the capacity to utilize internal citrate pools (Al-resistant genotype Quimbaya) or enhanced citrate synthesis [increased activities of NAD-malate dehydrogenase (EC 1.1.1.37) and ATP-phosphofructokinase (EC 2.7.1.11) in Al-sensitive VAX-1]. Sustained recovery from Al stress through citrate exudation in genotype Quimbaya after 24 h Al treatment relied on restoring the internal citrate pool and the constitutive high activity of citrate synthase (CS) (EC 4.1.3.7) fuelled by high phosphoenolpyruvate carboxylase (EC 4.1.1.31) activity. In the Al-sensitive genotype VAX-1 the citrate exudation and thus Al exclusion and root elongation could not be maintained coinciding with an exhaustion of the internal citrate pool and decreased CS activity. PMID:20053183

  10. On-chip recalcification of citrated whole blood using a microfluidic herringbone mixer.

    Science.gov (United States)

    Lehmann, Marcus; Wallbank, Alison M; Dennis, Kimberly A; Wufsus, Adam R; Davis, Kara M; Rana, Kuldeepsinh; Neeves, Keith B

    2015-11-01

    In vitro assays of platelet function and coagulation are typically performed in the presence of an anticoagulant. The divalent cation chelator sodium citrate is among the most common because its effect on coagulation is reversible upon reintroduction of divalent cations. Adding divalent cations into citrated blood by batch mixing leads to platelet activation and initiation of coagulation after several minutes, thus limiting the time blood can be used before spontaneously clotting. In this work, we describe a herringbone microfluidic mixer to continuously introduce divalent cations into citrated blood. The mixing ratio, defined as the ratio of the volumetric flow rates of citrated blood and recalcification buffer, can be adjusted by changing the relative inlet pressures of these two solutions. This feature is useful in whole blood assays in order to account for differences in hematocrit, and thus viscosity. The recalcification process in the herringbone mixer does not activate platelets. The advantage of this continuous mixing approach is demonstrated in microfluidic vascular injury model in which platelets and fibrin accumulate on a collagen-tissue factor surface under flow. Continuous recalcification with the herringbone mixer allowed for flow assay times of up to 30 min, more than three times longer than the time achieved by batch recalcification. This continuous mixer allows for measurements of thrombus formation, remodeling, and fibrinolysis in vitro over time scales that are relevant to these physiological processes. PMID:26634014

  11. Evaluation of anticoagulant control in a pharmacist operated anticoagulant clinic.

    OpenAIRE

    Radley, A S; Hall, J; Farrow, M.; Carey, P J

    1995-01-01

    AIMS--To compare the quality of outpatient anticoagulant control before and after the transfer of dosing responsibility to designated trained pharmacists from rotating junior medical staff. METHODS--All International Normalised Ratio (INR) values for an eight month period either side of the staff changeover were assessed for precision of therapeutic control according to described standards. Allowing for patient associated effects, observed and expected frequencies of "successful" control for ...

  12. Anticoagulant surface of 316 L stainless steel modified by surface-initiated atom transfer radical polymerization.

    Science.gov (United States)

    Guo, Weihua; Zhu, Jian; Cheng, Zhenping; Zhang, Zhengbiao; Zhu, Xiulin

    2011-05-01

    Polished 316 L stainless steel (SS) was first treated with air plasma to enhance surface hydrophilicity and was subsequently allowed to react with 2-(4-chlorosulfonylphenyl)ethyltrimethoxysilane to introduce an atom transfer radical polymerization (ATRP) initiator. Accordingly, the surface-initiated atom transfer radical polymerization of polyethylene glycol methacrylate (PEGMA) was carried out on the surface of the modified SS. The grafting progress was monitored by water contact angle measurements, X-ray photoelectron spectroscopy and atomic force microscopy. The polymer thickness as a function different polymerization times was characterized using a step profiler. The anticoagulative properties of the PEGMA modified SS surface were investigated. The results showed enhanced anticoagulative to acid-citrate-dextrose (ACD) blood after grafting PEGMA on the SS surface. PMID:21528878

  13. 21 CFR 184.1625 - Potassium citrate.

    Science.gov (United States)

    2010-04-01

    ... is incorporated by reference in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies are... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Potassium citrate. 184.1625 Section 184.1625 Food... Specific Substances Affirmed as GRAS § 184.1625 Potassium citrate. (a) Potassium citrate (C6H5K3O7·H2O,...

  14. Transitions of care in anticoagulated patients

    Directory of Open Access Journals (Sweden)

    Michota F

    2013-06-01

    Full Text Available Franklin Michota Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA Abstract: Anticoagulation is an effective therapeutic means of reducing thrombotic risk in patients with various conditions, including atrial fibrillation, mechanical heart valves, and major surgery. By its nature, anticoagulation increases the risk of bleeding; this risk is particularly high during transitions of care. Established anticoagulants are not ideal, due to requirements for parenteral administration, narrow therapeutic indices, and/or a need for frequent therapeutic monitoring. The development of effective oral anticoagulants that are administered as a fixed dose, have low potential for drug-drug and drug-food interactions, do not require regular anticoagulation monitoring, and are suitable for both inpatient and outpatient use is to be welcomed. Three new oral anticoagulants, the direct thrombin inhibitor, dabigatran etexilate, and the factor Xa inhibitors, rivaroxaban and apixaban, have been approved in the US for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; rivaroxaban is also approved for prophylaxis and treatment of deep vein thrombosis, which may lead to pulmonary embolism in patients undergoing knee or hip replacement surgery. This review examines current options for anticoagulant therapy, with a focus on maintaining efficacy and safety during transitions of care. The characteristics of dabigatran etexilate, rivaroxaban, and apixaban are discussed in the context of traditional anticoagulant therapy. Keywords: hemorrhagic events, oral anticoagulation, parenteral anticoagulation, stroke, transitions of care

  15. Protein source and choice of anticoagulant decisively affect nanoparticle protein corona and cellular uptake

    Science.gov (United States)

    Schöttler, S.; Klein, Katja; Landfester, K.; Mailänder, V.

    2016-03-01

    Protein adsorption on nanoparticles has been a focus of the field of nanocarrier research in the past few years and more and more papers are dealing with increasingly detailed lists of proteins adsorbed to a plethora of nanocarriers. While there is an urgent need to understand the influence of this protein corona on nanocarriers' interactions with cells the strong impact of the protein source on corona formation and the consequence for interaction with different cell types are factors that are regularly neglected, but should be taken into account for a meaningful analysis. In this study, the importance of the choice of protein source used for in vitro protein corona analysis is concisely investigated. Major and decisive differences in cellular uptake of a polystyrene nanoparticle incubated in fetal bovine serum, human serum, human citrate and heparin plasma are reported. Furthermore, the protein compositions are determined for coronas formed in the respective incubation media. A strong influence of heparin, which is used as an anticoagulant for plasma generation, on cell interaction is demonstrated. While heparin enhances the uptake into macrophages, it prevents internalization into HeLa cells. Taken together we can give the recommendation that human plasma anticoagulated with citrate seems to give the most relevant results for in vitro studies of nanoparticle uptake.Protein adsorption on nanoparticles has been a focus of the field of nanocarrier research in the past few years and more and more papers are dealing with increasingly detailed lists of proteins adsorbed to a plethora of nanocarriers. While there is an urgent need to understand the influence of this protein corona on nanocarriers' interactions with cells the strong impact of the protein source on corona formation and the consequence for interaction with different cell types are factors that are regularly neglected, but should be taken into account for a meaningful analysis. In this study, the importance

  16. The challenges of lupus anticoagulants.

    Science.gov (United States)

    Chighizola, Cecilia Beatrice; Raschi, Elena; Banzato, Alessandra; Borghi, Maria Orietta; Pengo, Vittorio; Meroni, Pier Luigi

    2016-01-01

    The term "lupus anticoagulant" (LA) refers to a heterogeneous group of immunoglobulins behaving as acquired in vitro inhibitors of coagulation. These antibodies, namely anti-β2GPI and anti-prothrombin antibodies, induce the in vitro elongation of clotting time interfering with phospholipid-dependent coagulation cofactors. Positive LA is associated with thrombosis and pregnancy complications, providing one of the three laboratory criteria for the classification of the anti-phospholipid syndrome. LA is the strongest predictor of clinical events, especially when associated with other anti-phospholipid antibodies. Much more controversial is the risk conveyed by isolated and weak LA. LA detection is technically laborious, envisaging screening, mixing and confirming tests. Hopefully critical issues in LA detection, such as the interference of anticoagulants, will be overcome, in the next future. PMID:26789237

  17. New Type of Oral Anticoagulants

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2012-01-01

    Since 1960,so far,has half a century,long-term oral vitamin K antagonists (VKA) for anticoagulation main plan,but the shortcomings of the VKA but not allow to ignore:( 1 ) the VKA effect to be slow,VKA after diagnosis should be immediate treatment,this plan have to start with unfractionated heparin (UFH),low molecular weight heparin (LMWH) and fondaparinux injection,use 5 ~ 10 d transition again after oral VKA,this plan for outpatient greatly inconvenience;(2) in the use of heparin drugs there is also monitoring problem during or the occurrence of heparin induction thrombocytopenic thrombosis disease (HITT) risk;(3) VKA treatment vulnerable to food,drugs,to VKA considerations of the interference of the individual differences are of great reaction;(4)VKA treatment window,need to narrow in close monitoring of adjusting dosage benefits under,but the present survey indicates that at least a third of patients with clinically failed to control the INR within the scope of the treatment.So send development new anticoagulants,especially oral anticoagulants listed was imminent

  18. Ranitidine bismuth citrate: A review

    Directory of Open Access Journals (Sweden)

    N Chiba

    2001-01-01

    Full Text Available Recognition of the relationship between Helicobacter pylori infection and the development of gastroduodenal disease has increased greatly in recent years. To avoid complications of H pylori infection, such as the development of recurrent duodenal and gastric ulcers, effective therapies are required for eradication of the infection. This article reviews ranitidine bismuth citrate (RBC, a novel complex of ranitidine, bismuth and citrate, which was developed specifically for the purpose of eradicating H pylori. Dual therapy with RBC in combination with clarithromycin for 14 days yields eradication rates of 76%. Triple therapy bid for one week with a proton pump inhibitor, clarithromycin and either amoxicillin or a nitroimidazole (tinidazole or metronidazole is advocated as the treatment of choice for H pylori eradication. Analogous regimens with RBC in place of proton pump inhibitors show effective eradication rates in comparative studies and with pooled data. RBC, used alone or in combination with other antibiotics, appears to be a safe and effective drug for the treatment of H pylori infection. Bismuth levels do not appear to rise to toxic levels.

  19. Phosphate sensing

    OpenAIRE

    Bergwitz, Clemens; Jüppner, Harald

    2011-01-01

    Human phosphate homeostasis is regulated at the level of intestinal absorption of phosphate from the diet, release of phosphate through bone resorption, and renal phosphate excretion and involves the actions of parathyroid hormone (PTH), 1,25-dihydroxy-vitamin D (1,25-(OH)2-D), and fibroblast growth factor 23 (FGF23) to maintain circulating phosphate levels within a narrow normal range, which is essential for numerous cellular functions, for the growth of tissues and for bone mineralization. ...

  20. Direct oral anticoagulants and venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Massimo Franchini

    2016-09-01

    Full Text Available Venous thromboembolism (VTE, consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban and thrombin inhibitors (e.g. dabigatran etexilate. This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE.

  1. Effects of EDTA and Sodium Citrate on hormone measurements by fluorometric (FIA and immunofluorometric (IFMA methods

    Directory of Open Access Journals (Sweden)

    Lando Valeria

    2002-05-01

    Full Text Available Abstract Background Measurements of hormonal concentrations by immunoassays using fluorescent tracer substance (Eu3+ are susceptible to the action of chemical agents that may cause alterations in its original structure. Our goal was to verify the effect of two types of anticoagulants in the hormone assays performed by fluorometric (FIA or immunofluorometric (IFMA methods. Methods Blood samples were obtained from 30 outpatients and were drawn in EDTA, sodium citrate, and serum separation Vacutainer®Blood Collection Tubes. Samples were analyzed in automatized equipment AutoDelfia™ (Perkin Elmer Brazil, Wallac, Finland for the following hormones: Luteinizing hormone (LH, Follicle stimulating homone (FSH, prolactin (PRL, growth hormone (GH, Sex hormone binding globulin (SHBG, thyroid stimulating hormone (TSH, insulin, C peptide, total T3, total T4, free T4, estradiol, progesterone, testosterone, and cortisol. Statistical analysis was carried out by Kruskal-Wallis method and Dunn's test. Results No significant differences were seen between samples for LH, FSH, PRL and free T4. Results from GH, TSH, insulin, C peptide, SHBG, total T3, total T4, estradiol, testosterone, cortisol, and progesterone were significant different between serum and EDTA-treated samples groups. Differences were also identified between serum and sodium citrate-treated samples in the analysis for TSH, insulin, total T3, estradiol, testosterone and progesterone. Conclusions We conclude that the hormonal analysis carried through by FIA or IFMA are susceptible to the effects of anticoagulants in the biological material collected that vary depending on the type of assay.

  2. Bio-inspired citrate functionalized apatite coating on rapid prototyped titanium scaffold

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Peng [National engineering research center for tissue restoration and reconstruction, South China University of Technology, Guangzhou 510641 (China); Lu, Fang [School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou 510006 (China); Zhu, Wenjun [Department of Prosthodontics, Guanghua School of Stomatology, Guang Dong Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510055 (China); Wang, Di [National engineering research center for tissue restoration and reconstruction, South China University of Technology, Guangzhou 510641 (China); Zhu, Xiaojing [Department of Prosthodontics, Guanghua School of Stomatology, Guang Dong Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510055 (China); Tan, Guoxin, E-mail: tanguoxin@126.com [Institute of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510006 (China); Wang, Xiaolan [National engineering research center for tissue restoration and reconstruction, South China University of Technology, Guangzhou 510641 (China); Zhang, Yu; Li, Lihua [General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010 (China); Ning, Chengyun, E-mail: imcyning@scut.edu.cn [National engineering research center for tissue restoration and reconstruction, South China University of Technology, Guangzhou 510641 (China)

    2014-09-15

    Highlights: • Designed and reproducible porous titanium scaffolds were produced. • Hydrophilic nanoporous film was built on scaffold. • Apatite coating was deposited on scaffold under the modulation of citrate ions. • Citrate ions could affect CO{sub 3}{sup 2−} incorporation in apatite coatings. - Abstract: Scaffold functionalized with appropriate osteogenic coatings can significantly improve implant-bone response. In this study, with designed model and optimized manufacture parameters, reproducible and precise titanium scaffolds were produced. Reconstructed three-dimensional image and sectional structure of the scaffold were examined by micro-computed tomography and relative software. Alkali treatment was carried out on these manufactured porous scaffolds to produce nanoporous hydrophilic film. After 6 days deposition in simulated body fluid (SBF) containing sodium citrate (SC-SBF), plate-like amorphous calcium phosphate (ACP) coating was deposited on scaffold surface. Ultrasonication tests qualitatively indicated an enhanced adhesion force of apatite coatings deposited in SC-SBF compared to that deposited in SBF. And the effect of citrate ions on the CO{sub 3}{sup 2−} incorporation rate in apatite coating was quantitatively examined by bending vibration of CO{sub 3}{sup 2−} at ∼874 cm{sup −1}. Results indicated the highest carbonate content was obtained at the citrate ion concentration of 6 × 10{sup −5} mol/L in SC-SBF. These three-dimensional porous titanium-apatite hybrid scaffolds are expected to find application in bone tissue regeneration.

  3. Anticoagulant Medicine: Potential for Drug-Food Interactions

    Science.gov (United States)

    ... AerobiKa® Cardiology Medications Anticoagulant Medicine Anticoagulants and Drug-Food Interactions COPD Medications Bronchodilators Anti-Inflammatories Antibiotics Managing Your Medications Devices ...

  4. Allosteric inhibition of factor XIa. Sulfated non-saccharide glycosaminoglycan mimetics as promising anticoagulants.

    Science.gov (United States)

    Al-Horani, Rami A; Gailani, David; Desai, Umesh R

    2015-08-01

    Recent development of sulfated non-saccharide glycosaminoglycan mimetics, especially sulfated pentagalloyl glucopyranoside (SPGG), as potent inhibitors of factor XIa (FXIa) (J. Med. Chem. 2013; 56:867-878 and J. Med. Chem. 2014; 57:4805-4818) has led to a strong possibility of developing a new line of factor XIa-based anticoagulants. In fact, SPGG represents the first synthetic, small molecule inhibitor that appears to bind in site remote from the active site. Considering that allosteric inhibition of FXIa is a new mechanism for developing a distinct line of anticoagulants, we have studied SPGG's interaction with FXIa with a goal of evaluating its pre-clinical relevance. Comparative inhibition studies with several glycosaminoglycans revealed the importance of SPGG's non-saccharide backbone. SPGG did not affect the activity of plasma kallikrein, activated protein C and factor XIIIa suggesting that SPGG-based anticoagulation is unlikely to affect other pathways connected with coagulation factors. SPGG's effect on APTT of citrated human plasma was also not dependent on antithrombin or heparin cofactor II. Interestingly, SPGG's anticoagulant potential was diminished by serum albumin as well as factor XI, while it could be reversed by protamine or polybrene, which implies possible avenues for developing antidote strategy. Studies with FXIa mutants indicated that SPGG engages Lys529, Arg530 and Arg532, but not Arg250, Lys252, Lys253 and Lys255. Finally, SPGG competes with unfractionated heparin, but not with polyphosphates and/or glycoprotein Ibα, for binding to FXIa. These studies enhance understanding on the first allosteric inhibitor of FXIa and highlight its value as a promising anticoagulant. PMID:25935648

  5. Protein source and choice of anticoagulant decisively affect nanoparticle protein corona and cellular uptake.

    Science.gov (United States)

    Schöttler, S; Klein, Katja; Landfester, K; Mailänder, V

    2016-03-14

    Protein adsorption on nanoparticles has been a focus of the field of nanocarrier research in the past few years and more and more papers are dealing with increasingly detailed lists of proteins adsorbed to a plethora of nanocarriers. While there is an urgent need to understand the influence of this protein corona on nanocarriers' interactions with cells the strong impact of the protein source on corona formation and the consequence for interaction with different cell types are factors that are regularly neglected, but should be taken into account for a meaningful analysis. In this study, the importance of the choice of protein source used for in vitro protein corona analysis is concisely investigated. Major and decisive differences in cellular uptake of a polystyrene nanoparticle incubated in fetal bovine serum, human serum, human citrate and heparin plasma are reported. Furthermore, the protein compositions are determined for coronas formed in the respective incubation media. A strong influence of heparin, which is used as an anticoagulant for plasma generation, on cell interaction is demonstrated. While heparin enhances the uptake into macrophages, it prevents internalization into HeLa cells. Taken together we can give the recommendation that human plasma anticoagulated with citrate seems to give the most relevant results for in vitro studies of nanoparticle uptake. PMID:26804616

  6. Sodium Phosphate

    Science.gov (United States)

    Sodium phosphate is used in adults 18 years of age or older to empty the colon (large intestine, bowel) ... view of the walls of the colon. Sodium phosphate is in a class of medications called saline ...

  7. Anticoagulants

    Science.gov (United States)

    ... even if it is not listed below. Aspirin Acetaminophen (e.g., Tylenol, Excedrin) Ibuprofen (e.g., Motrin, ... skin or eyes (jaundice) Rare side effects: Headache Dizziness Shortness of breath Mouth sores or bleeding gums ...

  8. 21 CFR 184.1307c - Ferrous citrate.

    Science.gov (United States)

    2010-04-01

    ... the reaction of sodium citrate with ferrous sulfate or by direct action of citric acid on iron filings... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Ferrous citrate. 184.1307c Section 184.1307c Food... Specific Substances Affirmed as GRAS § 184.1307c Ferrous citrate. (a) Ferrous citrate (iron (II)...

  9. 21 CFR 184.1195 - Calcium citrate.

    Science.gov (United States)

    2010-04-01

    ... with 5 U.S.C. 552(a) and 1 CFR part 51. Copies are available from the National Academy Press, 2101... four moles of water per mole of calcium citrate. (b) The ingredient meets the specifications of...

  10. Characterization of Al-responsive citrate excretion and citrate-transporting MATEs in Eucalyptus camaldulensis.

    Science.gov (United States)

    Sawaki, Yoshiharu; Kihara-Doi, Tomonori; Kobayashi, Yuriko; Nishikubo, Nobuyuki; Kawazu, Tetsu; Kobayashi, Yasufumi; Koyama, Hiroyuki; Sato, Shigeru

    2013-04-01

    Many plant species excrete organic acids into the rhizosphere in response to aluminum stress to protect sensitive cells from aluminum rhizotoxicity. When the roots of Eucalyptus camaldulensis, a major source of pulp production, were incubated in aluminum-toxic medium, citrate released into the solution increased as a function of time. Citrate excretion was inducible by aluminum, but not by copper or sodium chloride stresses. This indicated that citrate is the major responsive organic acid released from the roots of this plant species to protect the root tips from aluminum damage. Four genes highly homologs to known citrate-transporting multidrugs and toxic compounds exclusion proteins, named EcMATE1-4, were isolated using polymerase chain reaction-based cloning techniques. Their predicted proteins included 12 membrane spanning domains, a common structural feature of citrate-transporting MATE proteins, and consisted of 502-579 amino acids with >60 % homology to orthologous genes in other plant species. One of the homologs, designated EcMATE1, was expressed in the roots more abundantly than in the shoots and in response to both Al and low pH stresses. Ectopic expression of EcMATE1 and 3 in tobacco hairy roots enhanced Al-responsive citrate excretion. Pharmacological characterization indicated that Al-responsive citrate excretion involved a protein phosphorylation/dephosphorylation process. These results indicate that citrate excretion through citrate-transporting multidrugs and toxic compounds exclusion proteins is one of the important aluminum-tolerance mechanisms in Eucalyptus camaldulensis.

  11. Optical profiling of anticoagulation status (Conference Presentation)

    Science.gov (United States)

    Tshikudi, Diane M.; Tripathi, Markandey M.; Hajjarian, Zeinab; Nadkarni, Seemantini K.

    2016-02-01

    Defective blood coagulation resulting from excessive procoagulant activity often leads to thrombotic disorders such as stroke and myocardial infarction. A variety of oral and injectable anticoagulant drugs are prescribed to prevent or treat life-threatening thrombosis. However, due to bleeding complications often associated with anticoagulant treatment, routine monitoring and accurate dosing of anticoagulant therapy is imperative. We have developed Optical thromboelastography (OTEG), a non-contact approach that utilizes a drop of whole blood to measure blood coagulation status in patients. Here, we demonstrate the capability of OTEG for rapidly monitoring anticoagulation in whole blood samples. OTEG monitors coagulation status by assessing changes in blood viscosity from temporal intensity fluctuations of laser speckle patterns during clotting. In OTEG a blood drop is illuminated with coherent light and the blood viscosity is measured from the speckle intensity autocorrelation curve, g2 (t). The metrics, clotting time (R+k), clot progression (angle) and maximum clot stiffness (MA) are then extracted. The aim of the current study was to evaluate the accuracy of OTEG in assessing anticoagulation status of common anticoagulants including heparin, argatroban and rivaroxaban status. A dose-dependent prolongation of R+k was observed in anticoagulated blood, which closely corresponded with standard-reference Thromboelastography (TEG) (r 0.87-0.99, P>0.01 for all cases). OTEG angle was unaltered by anticoagulation whereas TEG angle presented a dose-dependent diminution probably linked to clot rupture. In both OTEG and TEG, MA was unaffected by heparin, argatroban or rivaroxaban. We conclude that OTEG can accurately monitor anticoagulation status following treatment, potentially providing a powerful tool for routine monitoring of patients in the doctor's office or in the home setting.

  12. [Direct oral anticoagulant associated bleeding].

    Science.gov (United States)

    Godier, A; Martin, A-C; Rosencher, N; Susen, S

    2016-07-01

    Direct oral anticoagulants (DOAC) are recommended for stroke prevention in atrial fibrillation and for the treatment of venous thromboembolism. However, they are associated with hemorrhagic complications. Management of DOAC-induced bleeding remains challenging. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. Therapeutic options also include antidotes: idarucizumab, antidote for dabigatran, has been approved for use whereas andexanet alpha, antidote for anti-Xa agents, and aripazine, antidote for all DOAC, are under development. Other options include hemodialysis for the treatment of dabigatran-associated bleeding and administration of oral charcoal if recent DOAC ingestion. DOAC plasma concentration measurement is necessary to guide DOAC reversal. We propose an update on DOAC-associated bleeding, integrating the availability of dabigatran antidote and the critical place of DOAC concentration measurements. PMID:27297642

  13. Platelet-Rich Plasma Obtained with Different Anticoagulants and Their Effect on Platelet Numbers and Mesenchymal Stromal Cells Behavior In Vitro.

    Science.gov (United States)

    do Amaral, Ronaldo José Farias Corrêa; da Silva, Nemias Pereira; Haddad, Natália Ferreira; Lopes, Luana Siqueira; Ferreira, Fábio Dias; Filho, Ricardo Bastos; Cappelletti, Paola Alejandra; de Mello, Wallace; Cordeiro-Spinetti, Eric; Balduino, Alex

    2016-01-01

    There are promising results in the use of platelet-rich plasma (PRP) for musculoskeletal tissue repair. However, the variability in the methodology for its obtaining may cause different and opposing findings in the literature. Particularly, the choice of the anticoagulant is the first definition to be made. In this work, blood was collected with sodium citrate (SC), ethylenediaminetetraacetic acid (EDTA), or anticoagulant citrate dextrose (ACD) solution A, as anticoagulants, prior to PRP obtaining. Hematological analysis and growth factors release quantification were performed, and the effects on mesenchymal stromal cell (MSC) culture, such as cytotoxicity and cell proliferation (evaluated by MTT method) and gene expression, were evaluated. The use of EDTA resulted in higher platelet yield in whole blood; however, it induced an increase in the mean platelet volume (MPV) following the blood centrifugation steps for PRP obtaining. The use of SC and ACD resulted in higher induction of MSC proliferation. On the other hand, PRP obtained in SC presented the higher platelet recovery after the blood first centrifugation step and a minimal change in MSC gene expression. Therefore, we suggest the use of SC as the anticoagulant for PRP obtaining. PMID:27340410

  14. Peripheral blood microvesicles secretion is influenced by storage time, temperature, and anticoagulants.

    Science.gov (United States)

    Wisgrill, Lukas; Lamm, Christian; Hartmann, Julia; Preißing, Falk; Dragosits, Klaus; Bee, Annica; Hell, Lena; Thaler, Johannes; Ay, Cihan; Pabinger, Ingrid; Berger, Angelika; Spittler, Andreas

    2016-07-01

    Microvesicles (MVs) are small membrane bound vesicles released from various cell types after activation or apoptosis. In the last decades, MVs received an increased interest as biomarkers in inflammation, coagulation and cancer. However, standardized pre-analytical steps are crucial for the minimization of artifacts in the MV analysis. Thus, this study evaluated the MV release in whole blood samples under the influence of different anticoagulants, storage time and various temperature conditions. Samples were collected from healthy probands and processed immediately, after 4, 8, 24 and 48 hours at room temperature (RT) or 4°C. To identify MV subpopulations, platelet free plasma (PFP) was stained with Annexin V, calcein AM, CD15, CD41 and CD235a. Analysis was performend on a CytoFLEX flow cytometer. Procoagulatory function of MVs was measured using a phospholipid dependent activity and a tissue factor MVactivity assay. Without prior storage, sodium citrate showed the lowest MV count compared to heparin and EDTA. Interestingly, EDTA showed a significant release of myeloid-derived MVs (MMVs) compared to sodium citrate. Sodium citrate showed a stable MV count at RT in the first 8 hours after blood collection. Total MV counts increased after 24 hours in sodium citrated or heparinzed blood which was related to all subpopulations. Interestingly, EDTA showed stable platelet-derived MV (PMV) and erythrocyte-derived MV (EryMV) count at RT over a 48 h period. In addition, the procoagulatory potential increased significantly after 8-hour storage. Based on both, this work and literature data, the used anticoagulant, storage time and storage temperature differently influence the analysis of MVs within 8 hours. To date, sodium citrated tubes are recommended for MV enumeration and functional analysis. EDTA tubes might be an option for the clinical routine due to stable PMV and EryMV counts. These new approaches need to be validated in a clinical laboratory setting before being

  15. Insulin-stimulated phosphorylation of ATP-citrate lyase in isolated hepatocytes. Stoichiometry and relation to the phosphoenzyme intermediate.

    Science.gov (United States)

    Alexander, M C; Palmer, J L; Pointer, R H; Kowaloff, E M; Koumjian, L L; Avruch, J

    1982-02-25

    We have estimated the insulin-stimulated phosphorylation of ATP-citrate lyase by two methods. Isolated hepatocytes incorporate extracellular 32P into [gamma-35P] ATP and immunoprecipitated ATP-citrate lyase to steady state levels by 1 h. The content of acid-stable 32P in hepatocyte ATP-citrate lyase at steady state is 0.33 +/- 0.038 mol of P/mol (tetrameric) holoenzyme. Insulin (1 milliunit/ml) increases the 32P content of immunoprecipitated lyase 2- to 3-fold in 10 min. Over 90% of acid-stable 32P on lyase is 32P-serine in enzyme isolated from both control and insulin-treated cells. ATP-citrate lyase isolated from hepatocytes contains 0.95 +/- 0.1 mol of alkali-labile phosphate/mol of holoenzyme. Insulin treatment of hepatocytes (1 milliunit/ml for 10 min) increases the alkali-labile P content by 45%. Evidence is presented which indicates that the insulin-stimulated phosphorylation does not arise by intramolecular migration from the catalytic phosphoenzyme intermediate. These observations support the conclusion that insulin-stimulated phosphorylation of ATP-citrate lyase is mediated either by an insulin-induced increase in the activity of lyase kinase and/or decrease in a lyase phosphatase. The functional role of the substoichiometric phosphorylation of ATP-citrate lyase remains unknown.

  16. Monitoring Oral Anticoagulant Therapy: Measuring Coagulant Activity

    DEFF Research Database (Denmark)

    Attermann, Jorn

    Life-long oral anticoagulant therapy (OAT) with vitamin K antagonists is offered to patients with increased risk of thrombosis, e.g. patients with artificial heart valves or with atrial fibrillation. It is estimated that in 1992 in the Nordic countries 0.3 – 0.5% of the population was undergoing...... daily anticoagulant therapy. The therapy necessitates close monitoring of coagulant activity, since excess doses of anticoagulant medicine may lead to life-threatening bleedings. Traditionally, patients on OAT are required to pay regular visits to a physician, who decides on drug dosage adjustments...

  17. Anticoagulant modulation of inflammation in severe sepsis.

    Science.gov (United States)

    Allen, Karen S; Sawheny, Eva; Kinasewitz, Gary T

    2015-05-01

    Inflammation and coagulation are so tightly linked that the cytokine storm which accompanies the development of sepsis initiates thrombin activation and the development of an intravascular coagulopathy. This review examines the interaction between the inflammatory and coagulation cascades, as well as the role of endogenous anticoagulants in regulating this interaction and dampening the activity of both pathways. Clinical trials attempting to improve outcomes in patients with severe sepsis by inhibiting thrombin generation with heparin and or endogenous anticoagulants are reviewed. In general, these trials have failed to demonstrate that anticoagulant therapy is associated with improvement in mortality or morbidity. While it is possible that selective patients who are severely ill with a high expected mortality may be shown to benefit from such therapy, at the present time none of these anticoagulants are neither approved nor can they be recommended for the treatment of sepsis. PMID:25938026

  18. Rerouting Citrate Metabolism in Lactococcus lactis to Citrate-Driven Transamination

    NARCIS (Netherlands)

    Pudlik, Agata M.; Lolkema, Juke S.

    2012-01-01

    Oxaloacetate is an intermediate of the citrate fermentation pathway that accumulates in the cytoplasm of Lactococcus lactis ILCitM(pFL3) at a high concentration due to the inactivation of oxaloacetate decarboxylase. An excess of toxic oxaloacetate is excreted into the medium in exchange for citrate

  19. Anticoagulation for pediatric mechanical circulatory support.

    Science.gov (United States)

    Annich, Gail; Adachi, Iki

    2013-06-01

    Extracorporeal life support applications have evolved considerably in recent years. However, the blood-biomaterial interface remains incompletely understood, and management of the acute inflammatory response and coagulation pathways continues to be challenging. At present, the gold standard for anticoagulation is unfractionated heparin. Since the inception of extracorporeal life support, the mainstay for anticoagulation monitoring has been activated clotting time. However, alongside the technological evolution in extracorporeal life support, the methods for monitoring heparin have also become more sophisticated, adding additional layers of complexity to creating an ideal safe protocol for anticoagulation during extracorporeal life support. To address this, the Extracorporeal Life Support Organization has formed an Anticoagulation Task Force to help direct both a consensus statement and potential guidelines within which the multiple monitoring methods can be customized for extracorporeal life support. One key question that remains in the use of these monitoring methods is whether the objective during extracorporeal life support is to anticoagulate the circuit to prevent thrombus formation within the extracorporeal device or whether it is to systemically anticoagulate the patient. This review details all current monitoring methods and highlights how they can be used during pediatric mechanical circulatory support. PMID:23735984

  20. In Vitro Assessment of the Antimicrobial Efficacy of Optimized Nitroglycerin-Citrate-Ethanol as a Nonantibiotic, Antimicrobial Catheter Lock Solution for Prevention of Central Line-Associated Bloodstream Infections.

    Science.gov (United States)

    Reitzel, Ruth A; Rosenblatt, Joel; Hirsh-Ginsberg, Cheryl; Murray, Kimberly; Chaftari, Anne-Marie; Hachem, Ray; Raad, Issam

    2016-09-01

    The rapid, broad-spectrum, biofilm-eradicating activity of the combination of 0.01% nitroglycerin, 7% citrate, and 20% ethanol and its potential as a nonantibiotic, antimicrobial catheter lock solution (ACLS) were previously reported. Here, a nitroglycerin-citrate-ethanol (NiCE) ACLS optimized for clinical assessment was developed by reducing the nitroglycerin and citrate concentrations and increasing the ethanol concentration. Biofilm-eradicating activity was sustained when the ethanol concentration was increased from 20 to 22% which fully compensated for reducing the citrate concentration from 7% to 4% as well as the nitroglycerin concentration from 0.01% to 0.0015% or 0.003%. The optimized formulations demonstrated complete and rapid (2 h) eradication of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate Staphylococcus aureus (VISA), methicillin-resistant Staphylococcus epidermidis (MRSE), vancomycin-resistant enterococci (VRE), multidrug-resistant (MDR) Pseudomonas aeruginosa, MDR Klebsiella pneumoniae, MDR Enterobacter cloacae, MDR Acinetobacter baumannii, MDR Escherichia coli, MDR Stenotrophomonas maltophilia, Candida albicans, and Candida glabrata biofilms. The optimized NiCE lock solutions demonstrated anticoagulant activities comparable to those of heparin lock solutions. NiCE lock solution was significantly more effective than taurolidine-citrate-heparin lock solution in eradicating biofilms of Staphylococcus aureus and Candida glabrata The optimized, nonantibiotic, heparin-free NiCE lock solution demonstrates rapid broad-spectrum biofilm eradication as well as effective anticoagulant activity, making NiCE a high-quality ACLS candidate for clinical assessment.

  1. Sodium bicarbonate and sodium citrate: ergogenic aids?

    Science.gov (United States)

    Requena, Bernardo; Zabala, Mikel; Padial, Paulino; Feriche, Belén

    2005-02-01

    Numerous studies have used exogenous administration of sodium bicarbonate (NaHCO(3)) and sodium citrate (Na-citrate) in an attempt to enhance human performance. After ingestion of NaHCO(3) and Na-citrate, two observations have been made: (a) There was great individual variability in the ergogenic benefit reached, which can be attributed to the level of physical conditioning of the subjects and to their tolerance of the buffer substance; and (b) the subjects who had ingested NaHCO(3) and Na-citrate show higher levels of pH, bicarbonate, and lactate ions concentrations in their exercising blood than do the subjects who had ingested the placebo. A majority of the studies have suggested that the ingestion of both substances provides an ergogenic effect due to the establishment and maintenance of an elevated pH level during exercise. However, the exact mechanism by which the ergogenic effects occur has not been demonstrated conclusively. Sodium bicarbonate and Na-citrate seem to be effective in activities with a sufficient duration to generate a difference in the hydrogen ion gradient, characterized by a very high intensity and involving large muscular groups. However, in activities of equally high intensity, but with longer duration, the results obtained have been conflicting and inconclusive. PMID:15705037

  2. Patient values and preferences when choosing anticoagulants

    Directory of Open Access Journals (Sweden)

    Palacio AM

    2015-01-01

    Full Text Available Ana M Palacio,1–3 Irene Kirolos,2,3 Leonardo Tamariz1–3 1The Department of Medicine, Miller School of Medicine, University of Miami, 2The Veterans Affairs Medical Center, Miami, FL, USA; 3Division of Public Health Sciences, University of Miami, Miami, Florida, USA Background: New oral anticoagulants have similar efficacy and lower bleeding rates compared with warfarin. However, in case of bleeding there is no specific antidote to reverse their effects. We evaluated the preferences and values of anticoagulants of patients at risk of atrial fibrillation and those who have already made a decision regarding anticoagulation.Methods: We conducted a cross-sectional study of Veterans in the primary care clinics and the international normalized ratio (INR laboratory. We developed an instrument with patient and physician input to measure patient values and preferences. The survey contained a hypothetical scenario of the risk of atrial fibrillation and the attributes of each anticoagulant. After the scenario, we asked participants to choose the option that best fits their preferences. The options were: 1 has better efficacy at reducing risk of stroke; 2 has been in the market for a long period of time; 3 has an antidote to reverse the rare case of bleeding; 4 has better quality of life profile with no required frequent laboratory tests; or 5 I want to follow physician recommendations. We stratified our results by those patients who are currently exposed to anticoagulants and those who are not exposed but are at risk of atrial fibrillation.Results: We approached 173 Veterans and completed 137 surveys (79% response rate. Ninety subjects were not exposed to anticoagulants, 46 reported being on warfarin, and one reported being on dabigatran at the time of the survey. Ninety-eight percent of subjects stated they would like to participate in the decision-making process of selecting an anticoagulant. Thirty-six percent of those exposed and 37% of those

  3. Parenteral anticoagulation in patients with cancer who have no therapeutic or prophylactic indication for anticoagulation

    NARCIS (Netherlands)

    E.A. Akl; S. Gunukula; M. Barba; V.E.D. Yosuico; F.F. van Doormaal; S. Kuipers; S. Middeldorp; H.O. Dickinson; A. Bryant; H. Schuenemann

    2011-01-01

    Background Anticoagulation may improve survival in patients with cancer through an antitumor effect in addition to the perceived antithrombotic effect. Objectives To evaluate the efficacy and safety of parenteral anticoagulants in patients with cancer with no therapeutic or prophylactic indication f

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    . 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...

  5. Anticoagulation control in atrial fibrillation patients present to outpatient clinic of cardiology versus anticoagulant clinics

    Institute of Scientific and Technical Information of China (English)

    DU Xin; MA Chang-sheng; LIU Xiao-hui; DONG Jian-zeng; WANG Jun-nan; CHENG Xiao-jing

    2005-01-01

    @@ Nonvalvular atrial fibrillation (NVAF) is the most common sustained cardiac arrhythmia in clinical practice, which if untreated results in a doubling of cardiovascular morbidity and mortality. AF is an independent predictor of stroke, with an annual risk 5 to 6 times higher than patients in sinus rhythm.1 During recent years, several randomised clinical trials conducted by investigators around the world involving 13 843 participants with NVAF have demonstrated convincingly the value of warfarin therapies for stroke prevention in high risk patients.2-8 However, the dose response of warfarin is complex and its activity is easily altered by concurrent medications, food interactions, alcohol and illnesses. Adherence to medical advice and routine monitoring of the international normalized ratio (INR) is important, because low anticoagulant intensity predisposes the patients to thromboembolic complications and high intensity to haemorrhage. Studies suggested that anticoagulant clinics could improve the quality of anticoagulation control,9 and anticoagulant clinics are common in western countries. However, in China, most AF patients taking warfarin usually attend the outpatient clinic of cardiology, while the quality of anticoagulation control is never investigated. We therefore assessed anticoagulation control in the outpatient clinic of cardiology, and the quality of anticoagulation control since the establishment of anticoagulant clinics.

  6. Phosphate inhibits in vitro Fe3+ loading into transferrin by forming a soluble Fe(III)-phosphate complex: a potential non-transferrin bound iron species.

    Science.gov (United States)

    Hilton, Robert J; Seare, Matthew C; Andros, N David; Kenealey, Zachary; Orozco, Catalina Matias; Webb, Michael; Watt, Richard K

    2012-05-01

    In chronic kidney diseases, NTBI can occur even when total iron levels in serum are low and transferrin is not saturated. We postulated that elevated serum phosphate concentrations, present in CKD patients, might disrupt Fe(3+) loading into apo-transferrin by forming Fe(III)-phosphate species. We report that phosphate competes with apo-transferrin for Fe(3+) by forming a soluble Fe(III)-phosphate complex. Once formed, the Fe(III)-phosphate complex is not a substrate for donating Fe(3+) to apo-transferrin. Phosphate (1-10mM) does not chelate Fe(III) from diferric transferrin under the conditions examined. Complexed forms of Fe(3+), such as iron nitrilotriacetic acid (Fe(3+)-NTA), and Fe(III)-citrate are not susceptible to this phosphate complexation reaction and efficiently deliver Fe(3+) to apo-transferrin in the presence of phosphate. This reaction suggests that citrate might play an important role in protecting against Fe(III), phosphate interactions in vivo. In contrast to the reactions of Fe(3+) and phosphate, the addition of Fe(2+) to a solution of apo-transferrin and phosphate lead to rapid oxidation and deposition of Fe(3+) into apo-transferrin. These in vitro data suggest that, in principle, elevated phosphate concentrations can influence the ability of apo-transferrin to bind iron, depending on the oxidation state of the iron.

  7. A new plastic collection tube made of polyethylene terephtalate is suitable for monitoring traditional anticoagulant therapy (oral anticoagulant, unfractionated heparin, and low molecular weight heparin).

    Science.gov (United States)

    Toulon, Pierre; Ajzenberg, Nadine; Smahi, Motalib; Guillin, Marie-Claude

    2007-01-01

    To improve the safety of blood collection, plastic tubes have been developed but various interactions with the coagulation system and/or antithrombotic drugs were reported with the first generation of such tubes. The aim of this multicentre study was to compare hemostasis test results measured in evacuated plastic tubes made of polyethylene terephtalate (VenoSafe, Terumo Europe) and in siliconized glass tubes containing the same citrate concentration (0.129 M). In addition, the impact of aging of the plastic tube was investigated by collecting blood samples in tubes at 8 months and at 1 month before expiry. Blood was drawn in 3 centres from untreated patients (n=269), patients on oral anticoagulant treatment (OAT, n=221), and patients treated with either unfractionated heparin (UFH, n=73) or a low molecular weight derivative (LMWH, n=48). Prothrombin time (PT) or INR, activated partial thromboplastin time (APTT) and anti-FXa activity were locally performed, when applicable. In untreated patients and in patients on OAT, PT and APTT values were found statistically shorter (p<0.05) when evaluated in plastic tubes than in glass tubes, except when PT was evaluated using a human thromboplastin. Surprisingly, significantly longer APTT and higher anti-FXa activities were obtained when blood from patients on UFH was drawn in plastic than in glass tubes. However, none of the differences had any clinical relevance (Bland-Altman analysis). In patients on anticoagulant treatment, there was no effect of aging of the plastic tubes. These results suggest that the plastic tube VenoSafe is suitable for coagulation testing both in untreated subjects and more interestingly in patients on traditional anticoagulant therapy during the whole shelf life indicated by the manufacturer. PMID:16426667

  8. Vibrational study of tamoxifen citrate polymorphism

    Science.gov (United States)

    Gamberini, M. C.; Baraldi, C.; Tinti, A.; Palazzoli, F.; Ferioli, V.

    2007-09-01

    The trans isomer of ( Z)-2-[ p-(1,2-diphenyl-butenyl)phenoxy]- N, N-dimethyletylamine (tamoxifen) is well known for its endocrine activity as an antiestrogenic agent. Its citrate salt, a widely used pharmaceutical agent, appears in three main polymorphic forms, two of which are well known (I and II) and another form not yet well evidenced. A vibrational study has been conducted for identifying the two known polymorphic forms of tamoxifen citrate (I and II) and for characterising the other form (form III) examined in this study. Other techniques for the characterization of the different polymorphs, such as XRDP, have been used.

  9. Newer Oral Anticoagulants: Stroke Prevention and Pitfalls.

    Science.gov (United States)

    Patel, Anand; Goddeau, Richard P; Henninger, Nils

    2016-01-01

    Warfarin is very effective in preventing stroke in patients with atrial fibrillation. However, its use is limited due to fear of hemorrhagic complications, unpredictable anticoagulant effects related to multiple drug interactions and dietary restrictions, a narrow therapeutic window, frequent difficulty maintaining the anticoagulant effect within a narrow therapeutic window, and the need for inconvenient monitoring. Several newer oral anticoagulants have been approved for primary and secondary prevention of stroke in patients with non-valvular atrial fibrillation. These agents have several advantages relative to warfarin therapy. As a group, these direct oral anticoagulants (DOAC), which include the direct thrombin inhibitor, dabigatran, and the factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban), are more effective than dose adjusted warfarin for prevention of all-cause stroke (including both ischemic and hemorrhagic stroke), and have an overall more favorable safety profile. Nevertheless, an increased risk of gastrointestinal bleeding (with the exception of apixaban), increased risk for thrombotic complication with sudden discontinuation, and inability to accurately assess and reverse anticoagulant effect require consideration prior to therapy initiation, and pose a challenge for decision making in acute stroke therapy. PMID:27347226

  10. Physicochemical action of potassium-magnesium citrate in nephrolithiasis

    Science.gov (United States)

    Pak, C. Y.; Koenig, K.; Khan, R.; Haynes, S.; Padalino, P.

    1992-01-01

    Effect of potassium-magnesium citrate on urinary biochemistry and crystallization of stone-forming salts was compared with that of potassium citrate at same dose of potassium in five normal subjects and five patients with calcium nephrolithiasis. Compared to the placebo phase, urinary pH rose significantly from 6.06 +/- 0.27 to 6.48 +/- 0.36 (mean +/- SD, p less than 0.0167) during treatment with potassium citrate (50 mEq/day for 7 days) and to 6.68 +/- 0.31 during therapy with potassium-magnesium citrate (containing 49 mEq K, 24.5 mEq Mg, and 73.5 mEq citrate per day). Urinary pH was significantly higher during potassium-magnesium citrate than during potassium citrate therapy. Thus, the amount of undissociated uric acid declined from 118 +/- 61 mg/day during the placebo phase to 68 +/- 54 mg/day during potassium citrate treatment and, more prominently, to 41 +/- 46 mg/day during potassium-magnesium citrate therapy. Urinary magnesium rose significantly from 102 +/- 25 to 146 +/- 37 mg/day during potassium-magnesium citrate therapy but not during potassium citrate therapy. Urinary citrate rose more prominently during potassium-magnesium citrate therapy (to 1027 +/- 478 mg/day from 638 +/- 252 mg/day) than during potassium citrate treatment (to 932 +/- 297 mg/day). Consequently, urinary saturation (activity product) of calcium oxalate declined significantly (from 1.49 x 10(-8) to 1.03 x 10(-8) M2) during potassium-magnesium citrate therapy and marginally (to 1.14 x 10(-8) M2) during potassium citrate therapy.(ABSTRACT TRUNCATED AT 250 WORDS).

  11. 21 CFR 172.370 - Iron-choline citrate complex.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Iron-choline citrate complex. 172.370 Section 172... CONSUMPTION Special Dietary and Nutritional Additives § 172.370 Iron-choline citrate complex. Iron-choline citrate complex made by reacting approximately equimolecular quantities of ferric hydroxide, choline,...

  12. 21 CFR 573.580 - Iron-choline citrate complex.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Iron-choline citrate complex. 573.580 Section 573.580 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Food Additive Listing § 573.580 Iron-choline citrate complex. Iron-choline citrate complex made...

  13. Ventricular tachycardia after administration of sildenafil citrate: a case report

    Directory of Open Access Journals (Sweden)

    Rasmussen Jeppe G

    2007-08-01

    Full Text Available Abstract Background It has not previously been reported that sildenafil citrate causes malignant arrhythmias in humans. Case presentation A 41-year-old man developed sustained ventricular tachycardia following sildenafil citrate administration. Conclusion It cannot be dismissed that this patient experienced ventricular tachycardia as an adverse effect of sildenafil citrate administration.

  14. 21 CFR 184.1296 - Ferric ammonium citrate.

    Science.gov (United States)

    2010-04-01

    ... citrate (iron (III) ammonium citrate) is prepared by the reaction of ferric hydroxide with citric acid, followed by treatment with ammonium hydroxide, evaporating, and drying. The resulting product occurs in two forms depending on the stoichiometry of the initial reactants. (1) Ferric ammonium citrate (iron...

  15. 21 CFR 522.800 - Droperidol and fentanyl citrate injection.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Droperidol and fentanyl citrate injection. 522.800... § 522.800 Droperidol and fentanyl citrate injection. (a) Specifications. Droperidol and fentanyl citrate injection is a sterile solution containing 20 milligrams of droperidol and 0.4 milligram of fentanyl...

  16. The pharmacology of novel oral anticoagulants.

    Science.gov (United States)

    DeWald, Tracy A; Becker, Richard C

    2014-01-01

    Anticoagulation for the prevention of stroke is an important aspect of the management of atrial fibrillation. Novel anticoagulants including oral factor Xa inhibitors rivaroxaban and apixaban and the direct thrombin inhibitor dabigatran have emerged as important therapeutic treatment options for prevention of stroke in non-valvular atrial fibrillation. These agents offer practical advantages over traditional vitamin K antagonists, however an understanding of their individual pharmacokinetic and other agent-specific differences is essential for identifying appropriate candidates for therapy, and for selecting the appropriate agent that will be effective and safe. Here, we review the pharmacokinetic process of oral medication use, summarize the newer anticoagulants, their pharmacology, individual pharmacokinetic features, and explore possible explanations for the differences in bleeding outcomes observed in the clinical trials. PMID:23860880

  17. [New oral anticoagulants for atrial fibrillation: a neurologist's view

    NARCIS (Netherlands)

    Dijk, E.J. van; Koudstaal, P.J.; Roos, Y.B.; Brouwers, P.J.; Kappelle, L.J.

    2012-01-01

    - Recent randomized controlled trials have shown that new oral anticoagulants (dabigatran, rivaroxaban en apixaban) in patients with atrial fibrillation are equally or more effective in preventing cerebral infarction than vitamin K antagonists (VKA).- New oral anticoagulants cause significant less i

  18. Excessive anticoagulation with warfarin or phenprocoumon may have multiple causes

    DEFF Research Database (Denmark)

    Meegaard, Peter Martin; Holck, Line H V; Pottegård, Anton;

    2012-01-01

    Excessive anticoagulation with vitamin K antagonists is a serious condition with a substantial risk of an adverse outcome. We thus found it of interest to review a large case series to characterize the underlying causes of excessive anticoagulation....

  19. Pharmacology of anticoagulants used in the treatment of venous thromboembolism

    OpenAIRE

    Nutescu, Edith A.; Burnett, Allison; Fanikos, John; Spinler, Sarah; Wittkowsky, Ann

    2016-01-01

    Anticoagulant drugs are the foundation of therapy for patients with VTE. While effective therapeutic agents, anticoagulants can also result in hemorrhage and other side effects. Thus, anticoagulant therapy selection should be guided by the risks, benefits and pharmacologic characteristics of each agent for each patient. Safe use of anticoagulants requires not only an in-depth knowledge of their pharmacologic properties but also a comprehensive approach to patient management and education. Thi...

  20. Fatal pulmonary hemorrhage after taking anticoagulation medication

    Directory of Open Access Journals (Sweden)

    Samuel P. Hammar

    2015-01-01

    Full Text Available We describe a 64-year-old man with extensive diffuse acute lung hemorrhage, presumably as a result of anticoagulation therapy. We evaluated reports in the literature concerning acute exacerbation (acute lung injury of unknown cause in UIP and other forms of fibrotic interstitial pneumonias. We also evaluated autopsy tissue in this case in order to determine the cause of death in this 64-year-old man, who was initially thought to have an asbestos-related disease. Based on the autopsy findings, this man died as a result of anticoagulation therapy; specifically, the use of Xarelto® (rivaroxaban.

  1. Anticoagulated patient management in primary care service

    Directory of Open Access Journals (Sweden)

    Marco Antonio Zapata Sampedro

    2008-05-01

    Full Text Available Out-patients undergoing anticoagulant treatment are attended by nursing staff, working with doctors.To be able to provide adequate medical care, nurses must have the minimum knowledge and skills needed to work with the programme described in this article. These include basic and specific knowledge of anticoagulation. The correct functioning of the service will help provide an optimum control of the INR (International Normalized Ratio and reduce the complications of bleeding, both of which are the main objectives of the nursing care of these patients.

  2. [Anticoagulation in patients with chronic renal failure].

    Science.gov (United States)

    Niksic, L; Saudan, P; Boehlen, F

    2006-03-01

    Anticoagulation may be difficult to implement in patients suffering from chronic renal failure on account of platelet disorders and impaired clearance of some anticoagulant drugs. Although no adjustment of heparin and coumarin dosage is necessary, more frequent testing of coagulation pathways may be required when these drugs are used in patients with renal failure. Long-term use of LMWH should be implemented cautiously with regular testing of anti-factor Xa activity and a half-dose may be advocated in patients with a creatinine clearance heparin-induced thrombocytopenia with regular monitoring of coagulation tests. PMID:16562602

  3. The influence of different anticoagulants and sample preparation methods on measurement of mCD14 on bovine monocytes and polymorphonuclear neutrophil leukocytes

    Directory of Open Access Journals (Sweden)

    Ibeagha-Awemu Eveline M

    2012-02-01

    Full Text Available Abstract Background Membrane-CD14 (mCD14 is expressed on the surface of monocytes, macrophages and polymorphonuclear neutrophil leukocytes (PMN. mCD14 acts as a co-receptor along with Toll like receptor 4 (TLR 4 and MD-2 for the detection of lipopolysaccharide (LPS. However, studies using different sample preparation methods and anticoagulants have reported different levels of mCD14 on the surface of monocytes and neutrophils. In this study, the influence of various anticoagulants and processing methods on measurement of mCD14 on monocytes and neutrophils was examined. Results Whole blood samples were collected in vacutainer tubes containing either sodium heparin (HEPARIN, ethylenediaminetetraacetic acid (EDTA or sodium citrate (CITRATE. mCD14 on neutrophils and monocytes in whole blood samples or isolated cells was measured by the method of flow cytometry using fluorescein isothiocyanate (FITC-labeled monoclonal antibody. There was a significant difference (p p Conclusion From these results, it is suggested that sodium heparin should be the preferred anticoagulant for use in the reliable quantification of the surface expression of mCD14. Furthermore, measurement of mCD14 is best carried out in whole blood samples, both for neutrophils and monocytes.

  4. Anticoagulation in patients with impaired renal function and with haemodialysis. Anticoagulant effects, efficacy, safety, therapeutic options.

    Science.gov (United States)

    Harenberg, J; Hentschel, V A-T; Du, S; Zolfaghari, S; Krämer, R; Weiss, C; Krämer, B K; Wehling, M

    2015-01-01

    Patients with impaired renal function are exposed to an increased risk for bleeding complications depending on the amount of the anticoagulant eliminated by the kidneys. The elimination of unfractionated heparins, vitamin K antagonists and argatroban is only minimally influenced by a reduced renal function. Low-molecular weight heparins, fondaparinux, danaparoid, hirudins and non-vitamin K antagonist oral anticoagulants (NOAC) cause a variably increased bleeding risk in renal impairment. Dose reductions are recommended for all of these anticoagulants in renal impairment, some are even contraindicated at certain levels of renal impairment. Their benefit over the conventional anticoagulants is preserved if renal dosing is employed. For end-stage renal disease patients specific treatment regimens are required. PMID:25405246

  5. Expanding horizons of anticoagulant therapy: Dabigatran etexilate a novel oral anticoagulant

    Directory of Open Access Journals (Sweden)

    Pradeep Jadhav

    2013-10-01

    Full Text Available Thrombo-embolic disease is a major challenging clinical problem associated with significant mortality and morbidity. Anticoagulation with the existing heparin products and vitamin K antagonist (VKA anticoagulants are still the mainstay of management. However, due to the risk of bleeding and well-documented drawbacks, the quest for a novel oral anticoagulant has led to the clinical development of dabigatran etexilate. Dabigatran etexilate is a direct thrombin (IIa inhibitor which has recently been approved in India for prevention of venous thromboembolic events (VTE in patients who have undergone major orthopaedic (total knee or hip replacement surgery and for prevention of stroke, systemic embolism and reduction of vascular mortality in adult patients with atrial fibrillation. Thus dabigatran etexilate is a promising alternative to the current heparin products and VKAs in patients who require long-term oral anticoagulation. [Int J Basic Clin Pharmacol 2013; 2(5.000: 663-667

  6. Anticoagulant management in the cardiovascular setting.

    NARCIS (Netherlands)

    Verheugt, F.W.A.

    2012-01-01

    Vitamin K antagonists have been used as oral anticoagulants (OACs) for over five decades, yet their use in real-world practice is problematic primarily because of their narrow therapeutic window, exacerbated by extensive food and drug interactions, necessitating regular coagulation monitoring and do

  7. Safety of anticoagulant treatment in cancer patients

    NARCIS (Netherlands)

    Wilts, Ineke Theodora; Bleker, Suzanne Mariella; Van Es, Nick; Buller, Harry Roger; Di Nisio, Marcello; Kamphuisen, Pieter Willem

    2015-01-01

    Introduction: Patients with cancer are at increased risk of (recurrent) venous thronnboembolism. They are also at increased risk of bleeding. This makes treatment of venous thromboembolisms (VTE) in cancer patients challenging. Areas covered: In this review, we will focus on the safety of anticoagul

  8. DABIGATRAN ETEXILATE: NEW DIRECT THROMBIN INHIBITORS ANTICOAGULANTS

    Directory of Open Access Journals (Sweden)

    Patel Kinjal B

    2011-04-01

    Full Text Available Thrombin plays a key role in thrombotic events, and therefore thrombin inhibition represents a therapeutic target for numerous thromboembolic diseases. Thrombin is responsible for the conversion of soluble fibrinogen to fibrin; clot stabilization through activation of factor XIII and the formation of cross-linkage among fibrin molecules; and the generation of additional thrombin through activation of factors V, VIII, and XI. Direct thrombin inhibitors are an innovative class of anticoagulants that bind directly to thrombin to inhibit its actions and impede the clotting process. Dabigatran is the first direct thrombin inhibitor, orally available first approval by US Food and Drugs Administration in 2010. Specifically and reversibly inhibits thrombin, so the duration of action is predictable. The anticoagulant effect correlates well with plasma drug concentrations, which implies an effective anticoagulation with low bleeding risk without major problems of interactions with other drugs. The predictable pharmacokinetics and pharmacodynamics characteristics of dabigatran may facilitate dental management of patients who until now have been in treatment with traditional anticoagulants, given that it doesn’t require routine laboratory monitoring in the vast majority of patients treated. They also present a profile of drug interactions very favorable.

  9. Pharmacology of anticoagulants used in the treatment of venous thromboembolism.

    Science.gov (United States)

    Nutescu, Edith A; Burnett, Allison; Fanikos, John; Spinler, Sarah; Wittkowsky, Ann

    2016-01-01

    Anticoagulant drugs are the foundation of therapy for patients with VTE. While effective therapeutic agents, anticoagulants can also result in hemorrhage and other side effects. Thus, anticoagulant therapy selection should be guided by the risks, benefits and pharmacologic characteristics of each agent for each patient. Safe use of anticoagulants requires not only an in-depth knowledge of their pharmacologic properties but also a comprehensive approach to patient management and education. This paper will summarize the key pharmacologic properties of the anticoagulant agents used in the treatment of patients with VTE. PMID:26780737

  10. Pyrolytic citrate synthesis and ozone annealing

    International Nuclear Information System (INIS)

    A pyrolytic procedure is described that via a citrate synthesis allowed us to obtain very fine grained YBCO powders that, after a first furnace thermal treatment in ozone, results already to contain a large amount of superconducting microcrystals. A second identical thermal treatment gives a final product strongly textured, as shown by magnetic torque measurements. Complementary structural and diamagnetic measurement show the high quality of these sintered pellets. The role covered by both the pyrolytic preparation and the ozone annealing are discussed

  11. Pyrolitic citrate synthesis and ozone annealing

    International Nuclear Information System (INIS)

    A pyrolytic procedure that via a citrate synthesis allowed to obtain very fine grained YBCO powders that, after a first furnace thermal treatment in ozone, result already to contain a large amount of superconducting microcystals is described. A second identical thermal treatment gives a final product strongly textured, as shown by magnetic torque measurements. Complementary structural and diamagnetic measurements show the high quality of these sintered pellets. The role covered by both the pyrolytic preparation and the ozone annealing are discussed

  12. Assembly of citrate gold nanoparticles on hydrophilic monolayers

    Science.gov (United States)

    Vikholm-Lundin, Inger; Rosqvist, Emil; Ihalainen, Petri; Munter, Tony; Honkimaa, Anni; Marjomäki, Varpu; Albers, Willem M.; Peltonen, Jouko

    2016-08-01

    Self-assembled monolayers (SAMs) as model surfaces were linked onto planar gold films thorough lipoic acid or disulfide groups. The molecules used were polyethylene glycol (EG-S-S), N-[tris-(hydroxymethyl)methyl]acrylamide polymers with and without lipoic acid (Lipa-pTHMMAA and pTHMMAA) and a lipoic acid triazine derivative (Lipa-MF). All the layers, but Lipa-MF with a primary amino group were hydroxyl terminated. The layers were characterized by contact angle measurements and atomic force microscopy, AFM. Citrate stabilized nanoparticles, AuNPs in water and phosphate buffer were allowed to assemble on the layers for 10 min and the binding was followed in real-time with surface plasmon resonance, SPR. The SPR resonance curves were observed to shift to higher angles and become increasingly damped, while also the peaks strongly broaden when large nanoparticles assembled on the surface. Both the angular shift and the damping of the curve was largest for nanoparticles assembling on the EG-S-S monolayer. High amounts of particles were also assembled on the pTHMMAA layer without the lipoic acid group, but the damping of the curve was considerably lower with a more even distribution of the particles. Topographical images confirmed that the highest number of particles were assembled on the polyethylene glycol monolayer. By increasing the interaction time more particles could be assembled on the surface.

  13. Nickel electrodeposition from novel citrate bath

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    A new type of electroplating bath suitable for nickel electrodeposition was developed. Trisodium citrate was used as a complexing agent and a buffer in the bath. The buffering capacity between trisodium citrate and boric acid were compared. The effects were investigated under different conditions of bath composition, current density, pH and temperature on the potentiodynamic cathodic polarization curves, cathodic current efficiency and throwing index, as well as the electrical conductivity of these baths. The optimum conditions for producing sound and satisfactory nickel deposits were: NiSO4·6H2O 350 g/L, NiC12·6H2O 45 g/L and Na3C6H5O7 30 g/L at pH=4 and 55 ℃. The surface morphology of the as-plated Ni deposit was examined by SEM. The results reveal that the nickel deposition obtained from the optimum conditions are composed of compact, non-porous fine grains covering the entire surface. X-ray analysis shows that nickel deposits obtained from the citrate bath have a fine crystal structure compared with deposits from the Watts bath.

  14. Nanoscale observations of the effect of citrate on calcium oxalate precipitation on calcite surfaces.

    Science.gov (United States)

    Burgos-Cara, Alejandro; Ruiz-Agudo, Encarnacion; Putnis, Christine V.

    2016-04-01

    Calcium oxalate (CaC2O4ṡxH2O) minerals are naturally occurring minerals found in fossils, plants, kidney stones and is a by-product in some processes such as paper, food and beverage production [1,2]. In particular, calcium oxalate monohydrate phase (COM) also known as whewellite (CaC2O4ṡH2O), is the most frequently reported mineral phase found in urinary and kidney stones together with phosphates. Organic additives are well known to play a key role in the formation of minerals in both biotic and abiotic systems, either facilitating their precipitation or hindering it. In this regard, recent studies have provided direct evidence demonstrating that citrate species could enhance dissolution of COM and inhibit their precipitation. [3,4] The present work aims at evauate the influence of pH, citrate and oxalic acid concentrations in calcium oxalate precipitation on calcite surfaces (Island Spar, Chihuahua, Mexico) through in-situ nanoscale observation using in situ atomic force microscopy (AFM, Multimode, Bruker) in flow-through experiments. Changes in calcium oxalate morphologies and precipitated phases were observed, as well as the inhibitory effect of citrate on calcium oxalate precipitation, which also lead to stabilization an the amorphous calcium oxalate phase. [1] K.D. Demadis, M. Öner, Inhibitory effects of "green"additives on the crystal growth of sparingly soluble salts, in: J.T. Pearlman (Ed.), Green Chemistry Research Trends, Nova Science Publishers Inc., New York, 2009, pp. 265-287. [2] M. Masár, M. Zuborová, D. Kaniansky, B. Stanislawski, Determination of oxalate in beer by zone electrophoresis on a chip with conductivity detection, J. Sep. Sci. 26 (2003) 647-652. [3] Chutipongtanate S, Chaiyarit S, Thongboonkerd V. Citrate, not phosphate, can dissolve calcium oxalate monohydrate crystals and detach these crystals from renal tubular cells. Eur J Pharmacol 2012;689:219-25. [4] Weaver ML, Qiu SR, Hoyer JR, Casey WH, Nancollas GH, De Yoreo JJ

  15. Dietary citrate treatment of polycystic kidney disease in rats.

    Science.gov (United States)

    Tanner, George A; Tanner, Judith A

    2003-01-01

    Progression of autosomal-dominant polycystic kidney disease (ADPKD) in the heterozygous male Han:SPRD rat is dramatically slowed by ingestion of potassium or sodium citrate. This study examined the efficacy of delayed therapy with sodium citrate, the effect of sodium citrate therapy on kidney cortex levels of transforming growth factor-beta (TGF-beta), and the response to calcium citrate ingestion. Rats were provided with citrate salts in their food, and renal clearance, blood pressure, blood chemistry, and survival determinations were made. Sodium citrate therapy was most effective when started at age 1 month, and delay of therapy until age 3 months produced no benefit. Kidney cortex TGF-beta levels were elevated in 3- and 8-month-old rats with ADPKD, but not in 6-week-old rats. Sodium citrate treatment, started at age 1 month, lowered TGF-beta levels to normal in 3-month-old rats, but this is probably not the primary mechanism of citrate's beneficial effect. Calcium citrate had only a modest effect in preserving glomerular filtration rate. Effective treatment of ADPKD in this rat model requires early administration of a readily absorbed alkalinizing citrate salt. Existing data on ADPKD patients on vegetarian diets or with kidney stones should be studied in light of these findings.

  16. Application of Amikacin as Anticoagulant in Clinical Laboratory Medicine%丁胺卡那霉素的抗凝功能在临床检验中的应用

    Institute of Scientific and Technical Information of China (English)

    费鲜明; 袁武峰; 蒋雷; 张蕾; 严长水; 周永列

    2013-01-01

    analyze its application value in clinical laboratory medicine. Methods The clotting time (CT) of fresh blood mixed with different 、 concentration of amikacin was determined by salicified tube method. The experimental anticoagulating concentration was derived from the lowest concentration of amikacin with a mean CT value over 168 hours. Fresh blood with amikacin and other relative anticoagulants from volunteers were detected for clotting time (CT) , complete blood count and leukocyte differentiation, maximal ratio of platelet aggregation, tests of blood coagulation function ( PT, APPT, TT and Fib) , whole blood and plasma viscosity, electrolytes ( K + , Na + , CI- , Ca2 + , Mg2 + and total phosphate) of plasma and serum, and expression levels of p - selectin( CD62p) and Fibrinogen receptor( Fib - R). Results Experimental anticoagulating concentration of amikacin was 18g/L. In 18g/L amikacin group, percentage of lymphocyte was significantly lower but that of neutrophils was higher than those in EDTA - K2 group(P 0. 05 ) . In amikacin group, APTT and TT were significantly higher than those in sodium citrate group (P0. 05). In amikacin group, maximal ratio of platelet aggregation was significantly lower than that in sodium citrate group (P 0. 05). For whole blood and plasma viscosity as well as electrolytes concentration, there was also less difference between amikacin group and lithium heparin(P >0. 05). Conclusion Amikacin can be used as an in vitro anticoagulant. Blood samples anticoagula-ted with amikacin is suitable for the detection of leukocyte count, erythrocyte parameters, hemorheology and plasma electrolytes, but not suitable for the differentiation of leukocyte, tests of coagulation function, and the markers of platelet function and activation.

  17. Exploring plant factors for increasing phosphorus utilization from rock phosphates and native soil phosphates in acidic soils

    International Nuclear Information System (INIS)

    Six plant species with contrasting capacity in utilizing rock phosphates were compared with regard to their responses to phosphorus starvation in hydroponic cultures. Radish, buckwheat and oil rapeseed are known to have strong ability to use rock phosphates while ryegrass, wheat and sesbania are less efficient. Whereas other plants acidified their culture solution under P starvation (-P), radish plants make alkaline the solution. When neutralizing the pH of the solutions cultured with plants under either -P or + P conditions, solutions with P starved buckwheat, rapeseed, and radish had a higher ability to solubilize Al and Fe phosphates than did those cultured with sesbania, ryegrass and wheat. Characterization of organic ligands in the solutions identified that citrate and malate were the major organic anions exuded by rapeseed and radish. Besides citrate and malate, buckwheat exuded a large amount of tartrate under P starvation. In contrast, ryegrass, wheat and sesbania secreted only a limited amount of oxalic acid, regardless of P status. Changes in activities of phosphoenolpyruvate carboxylase, acid phosphatase, and nitrate reductase in these plants were also compared under P- sufficient or -deficient conditions. The results indicated that plant ability to use rock phosphates or soil phosphates is closely related to their responses toward P starvation. The diversity of P starvation responses was discussed in the context of co-evolution between plants and their environment. Approaches to use plant factors to enhance the effectiveness of rock phosphates were also discussed. (author)

  18. Lupus anticoagulants: pathogenesis and laboratory diagnosis.

    Science.gov (United States)

    Court, E L

    1997-12-01

    The pathogenesis of the lupus anticoagulant (LA) has been the focus of much research over the past decade, and a plethora of laboratory tests have been developed to detect it. This essay reviews the nature of LA and its pathogenesis, and a number of approaches employed in its diagnosis. These range from well established tests such as the kaolin clotting time (KCT), activated partial thromboplastin time (APTT) and tissue thromboplastin inhibition test (TTI), to the 'newer' tests such as the dilute Russell's viper venom time (DRVVT) and more recent snake venom tests such as the textarin/ecarin ratio and Taipan snake venom time (TSVT). The criteria for diagnosis are discussed, including pre-analytical variables such as sample preparation, and the effects of therapeutic anticoagulants used to treat thrombotic manifestations of the syndrome or an underlying disease process. PMID:9624740

  19. Anticoagulant modulation of inflammation in severe sepsis

    OpenAIRE

    Allen, Karen S; Sawheny, Eva; Kinasewitz, Gary T

    2015-01-01

    Inflammation and coagulation are so tightly linked that the cytokine storm which accompanies the development of sepsis initiates thrombin activation and the development of an intravascular coagulopathy. This review examines the interaction between the inflammatory and coagulation cascades, as well as the role of endogenous anticoagulants in regulating this interaction and dampening the activity of both pathways. Clinical trials attempting to improve outcomes in patients with severe sepsis by ...

  20. [New orally anticoagulants and brain stroke].

    Science.gov (United States)

    Kaczorowska, Beata; Pawełczyk, Małgorzata; Przybyła, Monika

    2016-05-26

    Brain stroke is a grave society problem. About 20% ischemic strokes are cardiac related problems. Atrial fibrillation (AF) is the most common cause of ischemic strokes. Decision to deploy anticoagulant treatment with AF patient depends on bleeding and thrombo-embolic risk which summerise scale CHA2DS2VASc and HAS-BLED. Past recent years in AF treatment anticoagulants from the group of vitamin K antagonist were used. At present in brain stroke prevention and systemic emboilment, new oral anticoagulants (NOA) which weren't worst than vitamin K antagonists, and they are recomendet in most cases of AF unrelated with heart valve defets. Useing NOA causes lower risk of bleeding, including intracranial heamorrhage. It is believed that this is related to the selective inhibition of specific coagulation factors, and respect other hemostatic mechanisms. Results from clinical studies NOA are encouraging, but still lacks clear answers regarding, among other things: long-term safety of treatment and economically viable in everyday clinical practice. In addition, to date there is no specific antidote for this group of drugs. PMID:27234866

  1. [New oral anticoagulants in atrial fibrillation].

    Science.gov (United States)

    Veltkamp, R; Hacke, W

    2011-02-01

    Atrial fibrillation (AF) causes at least 20% of all ischemic strokes. In large randomized trials of primary and secondary stroke prevention, anticoagulation with vitamin K antagonists (VKA) protected much more efficiently than antiplatelet agents against stroke. Because of the problematic pharmacological properties of VKA only part of the AF patients are currently being treated with oral anticoagulants (OAK). The targeted development of specific oral inhibitors of the central coagulation factors thrombin and factor Xa allows reliable anticoagulation without regular coagulation monitoring. In the present review, pharmacological properties of the different agents are compared. Of the four large randomized phase 3 studies in AF (RELY, ROCKET-AF, ARISTOTLE, ENGAGE-AF) with the primary efficacy endpoint stroke and systemic embolism, the published data from the RELY trial indicate a superior efficacy of dabigatran etexilate (2 × 150 mg/day) and a lower risk of intracranial hemorrhage compared to warfarin. Favorable preliminary results have been demonstrated for the factor Xa inhibitor rivaroxaban. Apixaban was more efficacious than ASA and had a similar risk of hemorrhage in the AVERROES study. Thus, the available data suggest a favorable benefit-risk ratio for the new substances in addition to improved patient comfort. Currently unresolved issues relate to the verification of patient adherence by suitable coagulation tests and to the emergency coagulation diagnostics and therapy in acute ischemic or hemorrhagic strokes under the new OAC.

  2. 77 FR 24461 - Citric Acid and Certain Citrate Salts From Canada: Final Results of Antidumping Duty...

    Science.gov (United States)

    2012-04-24

    ... all grades and granulation sizes of citric acid, sodium citrate, and potassium citrate in their... blends of citric acid, sodium citrate, and potassium citrate; as well as blends with other ingredients, such as sugar, where the unblended form(s) of citric acid, sodium citrate, and potassium...

  3. 76 FR 5782 - Citric Acid and Certain Citrate Salts From Canada: Preliminary Results of Antidumping Duty...

    Science.gov (United States)

    2011-02-02

    ... includes all grades and granulation sizes of citric acid, sodium citrate, and potassium citrate in their... blends of citric acid, sodium citrate, and potassium citrate; as well as blends with other ingredients, such as sugar, where the unblended form(s) of citric acid, sodium citrate, and potassium...

  4. 77 FR 6061 - Citric Acid and Certain Citrate Salts From Canada: Preliminary Results of Antidumping Duty...

    Science.gov (United States)

    2012-02-07

    ... includes all grades and granulation sizes of citric acid, sodium citrate, and potassium citrate in their... blends of citric acid, sodium citrate, and potassium citrate; as well as blends with other ingredients, such as sugar, where the unblended form(s) of citric acid, sodium citrate, and potassium...

  5. [A case report of alverine-citrate-induced acute hepatitis].

    Science.gov (United States)

    Han, Jee Young; Lee, Jin Woo; Kim, Joon Mee; Joo, Kowoon; Chon, Ung; Lee, Jung Il; Jeong, Seok; Lee, Don Haeng; Kim, Young Soo; Min, Kyung Sun

    2010-03-01

    Alverine citrate is one of the most commonly used antispasmodic drugs for patients with irritable bowel syndrome. Alverine-citrate-induced hepatotoxicity is extremely rare, with only a few cases having been reported worldwide. We present a case of a 75-year-old female patient who experienced complicated jaundice and abdominal discomfort after taking alverine citrate. Other causes of hepatitis were ruled out and the results of the liver function test returned to normal after ceasing the drug. This is the first case report in Korea of alverine-citrate-induced hepatotoxicity. PMID:20375645

  6. Urinary Citrate: A view in Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    SANTHOSH KUMAR.N

    2013-12-01

    Full Text Available Aim & Objective: To evaluate the 24 hour urinary citrate levels in chronic renal failure and healthy controls and to define the role of urinary citrates in the chronic renal failures. Materials and Methods: The 24 hours urinary citrates, Blood urea, Serum creatinine, Na+, K+were evaluated in 25 chronic renal failure patients and25 healthy subjects taken as controls. In both groups participants were on their usual diet. In addition, none of the participant was taking any drugs that could interfere with the citrate excretion. Results: The mean 24 hour urinary citrate excretion in patients and healthy controls was 296.3 ± 8.543mg and 323.9 ± 4.304mg respectively. Using previously defined values of normal urinary citrates as more than 320 mg.The difference in 24 hour urinary citrateexcretion in all patients and healthy control was statistically significant (

    citrate excretion in recurrent renal failures and healthy controls. Uniformly low citrate excretion in patients indicates that low citrate levels may be a feature seen in predisposing factor for renal failure

  7. Effects of Sodium Citrate Solution on Hemodialysis Patients%枸橼酸钠溶液抗凝法对血液透析患者的影响

    Institute of Scientific and Technical Information of China (English)

    朱蕊; 陈静; 戎殳; 张斌; 王建新

    2011-01-01

    目的 探讨枸橼酸钠溶液抗凝法对血液透析患者的影响.方法 选择2004年1月至2010年8月在第二军医大学长征医院肾内科住院的围术期维持性血液透析患者90例,按随机数字表法分成两组:枸橼酸钠组(45例,169例次)和无抗凝剂组(45例,157例次).枸橼酸钠组患者采用30%的枸橼酸钠溶液进行血透抗凝,无抗凝剂组患者采用无抗凝剂透析.观察两组患者透析器及管路凝血情况、检测透析前后部分凝血活酶时间(activated partial thromboplastin time,APTT)、患者出血情况、尿素氮(blood urea nitrogen,BUN)及血肌酐(serum ereatinine,SCr)浓度、血电解质浓度,测定尿素清除率(KT/V),并观察不良反应的发生情况.结果 无抗凝剂组体外循环管路凝血率明显高于枸橼酸钠组(P<0.05).血透过程中枸橼酸钠组患者透析过程中体外APTT的差异有统计学意义(P<0.05).透析后两组患者血BUN及Scr值均较透析前明显下降(P<0.05),透析后枸橼酸钠组较无抗凝剂组BUN及SCr值明显降低(P<0.05),血HCO-3明显升高(P<0.05),血离子钙水平较透析前降低(P<0.05).两组患者KT/V值的差异有统计学意义(P<0.05).枸橼酸纳组9例次(5.3%)出现唇周及四肢麻木症状,经调整枸橼酸钠速度及静脉补充钙剂后症状消失.结论 作为围术期血液透析患者抗凝方式,局部枸橼酸钠溶液抗凝法较之无抗凝剂法抗凝效果显著,安全性好,护理方便.%Objective To observe the effect of sodium citrate solution anticoagulation on patients with hemodialysis. Methods From January 2004 to August 2010, 90 perioperative maintenance hemodialysis patients in the hospital were randomly divided into two groups: sodium citrate group (45 patients, 169 cases) using 30% sodium citrate anticoagulant hemodialysis,and non - anticoagulation group (45 patients, 157 cases) using anticoagulant-free dialysis method. The clotting of dialyzers and lines of patients was

  8. Inositol hexa-phosphate: a potential chelating agent for uranium

    Energy Technology Data Exchange (ETDEWEB)

    Cebrian, D.; Tapia, A.; Real, A.; Morcillo, M.A. [Radiobiology Laboratory, Radiation Dosimetry Unit, Department of Environment, CIEMAT, Avda Complutense 22, 28040 Madrid (Spain)

    2007-07-01

    Chelation therapy is an optimal method to reduce the radionuclide-related risks. In the case of uranium incorporation, the treatment of choice is so far i.v infusion of a 1.4% sodium bicarbonate solution, but the efficacy has been proved to be not very high. In this study, we examine the efficacy of some substances: bicarbonate, citrate, diethylenetriamine pentaacetic acid (DTPA), ethidronate (EHBP) and inositol hexa-phosphate (phytic acid) to chelate uranium using a test developed by Braun et al. Different concentrations of phytic acid, an abundant component of plant seeds that is widely distributed in animal cells and tissues in substantial levels, were tested and compared to the same concentrations of sodium citrate, bicarbonate, EHBP and DTPA. The results showed a strong affinity of inositol hexa-phosphate for uranium, suggesting that it could be an effective chelating agent for uranium in vivo. (authors)

  9. Inositol hexa-phosphate: a potential chelating agent for uranium

    International Nuclear Information System (INIS)

    Chelation therapy is an optimal method to reduce the radionuclide-related risks. In the case of uranium incorporation, the treatment of choice is so far i.v infusion of a 1.4% sodium bicarbonate solution, but the efficacy has been proved to be not very high. In this study, we examine the efficacy of some substances: bicarbonate, citrate, diethylenetriamine pentaacetic acid (DTPA), ethidronate (EHBP) and inositol hexa-phosphate (phytic acid) to chelate uranium using a test developed by Braun et al. Different concentrations of phytic acid, an abundant component of plant seeds that is widely distributed in animal cells and tissues in substantial levels, were tested and compared to the same concentrations of sodium citrate, bicarbonate, EHBP and DTPA. The results showed a strong affinity of inositol hexa-phosphate for uranium, suggesting that it could be an effective chelating agent for uranium in vivo. (authors)

  10. Review of Urgent Reversal Therapies for Oral Anticoagulation

    Directory of Open Access Journals (Sweden)

    John J. Mondin II

    2016-09-01

    Full Text Available Anticoagulation has proven to be one of the most essential breakthroughs in cardiology in the last 100 years. The first major oral anticoagulant, warfarin, is a 4-hydroxycourmarin first synthesized in the 1940s for use as a rodenticide. It was not until 1954 that warfarin was finally approved by the FDA for use in patients requiring systemic anticoagulation. For over 55 years, warfarin was the only oral anticoagulant available in the United States until the approval of dabigatran in 2010, ushering in the era of the direct oral anticoagulants. This article will review modalities of anticoagulation reversal including activated charcoal, hemodialysis, blood-derived products, and medications currently available as well as in development.

  11. Anticoagulation for the Acute Management of Ischemic Stroke

    OpenAIRE

    Robinson, Austin A.; Ikuta, Kevin; Soverow, Jonathan

    2014-01-01

    Few prospective studies support the use of anticoagulation during the acute phase of ischemic stroke, though observational data suggest a role in certain populations. Depending on the mechanism of stroke, systemic anticoagulation may prevent recurrent cerebral infarction, but concomitantly carries a risk of hemorrhagic transformation. In this article, we describe a case where anticoagulation shows promise for ischemic stroke and review the evidence that has discredited its use in some circums...

  12. New anticoagulants for the prevention of venous thromboembolism

    OpenAIRE

    Becattini, Cecilia

    2010-01-01

    Cecilia Becattini, Alessandra Lignani, Giancarlo AgnelliInternal and Cardiovascular Medicine and Stroke Unit, University of Perugia, ItalyAbstract: Anticoagulant drugs have an essential role in the prevention and treatment of thromboembolic diseases. Currently available anticoagulants substantially reduce the incidence of thromboembolic events in a number of clinical conditions. However, these agents have limitations that strengthen the case for the development of new anticoagulants. An ideal...

  13. Secretion of a proteolytic anticoagulant by Ancylostoma hookworms

    OpenAIRE

    1983-01-01

    Hookworms of the genus Ancylostoma secrete an anticoagulant that both inhibits the clotting of human plasma and promotes fibrin clot dissolution. This anticoagulant activity is attributable to a 36,000 dalton proteolytic enzyme. The protease can degrade fibrinogen into five smaller polypeptides that intrinsically have anticoagulating properties, covert plasminogen to a mini-plasminogen-like molecule, and hydrolyze a synthetic peptide substrate with specificity for elastolytic enzymes. It is h...

  14. Contemporary anticoagulation therapy in patients undergoing percutaneous intervention.

    Science.gov (United States)

    Bhatty, Shaun; Ali, Asghar; Shetty, Ranjith; Sumption, Kevin F; Topaz, On; Jovin, Ion S

    2014-04-01

    The proper use of anticoagulants is crucial for ensuring optimal patient outcomes post percutaneous interventions in the cardiac catheterization laboratory. Anticoagulant agents such as unfractionated heparin, a thrombin inhibitor; low-molecular weight heparins, predominantly Factor Xa inhibitors; fondaparinux, a Factor Xa inhibitor and bivalirudin, a direct thrombin inhibitor have been developed to target various steps in the coagulation cascade to prevent formation of thrombin. Optimal anticoagulation achieves the correct balance between thrombosis and bleeding and is related to optimal outcomes with minimal complications. This review will discuss the mechanisms and appropriate use of current and emerging anticoagulant therapies used during percutaneous interventions. PMID:24506409

  15. Physical and sensory properties of low-salt phosphate-free frankfurters composed with various ingredients

    OpenAIRE

    Ruusunen, Marita; VainionpÀÀ, Jukka; Puolanne, Eero; Lyly, Marika; LÀhteenmÀki, Liisa; Niemistö, Markku; Ahvenainen, Raija

    2003-01-01

    http://www.elsevier.com/locate/meatsci The physical properties and sensory attributes of phosphate-free frankfurters were examined using response surface methodology by varying the amounts of five compositional variables: salt, modified tapioca starch-, sodium citrate (NaC)- and wheat bran and fat in the batter. Altogether, 20 different types of frankfurters were prepared. When the frankfurters were made without phosphate, additional non-meat ingredients were needed at salt contents of ...

  16. MONITORING OF ANTICOAGULATION IN APROTININ-TREATED PATIENTS DURING HEART OPERATION

    NARCIS (Netherlands)

    TABUCHI, N; NJO, TL; TIGCHELAAR, [No Value; HUYZEN, RJ; BOONSTRA, PW; VANOEVEREN, W

    1994-01-01

    Since aprotinin has become extensively used during cardiopulmonary bypass the maintenance of safe anticoagulation is a concern. Aprotinin affects anticoagulation measurement by the activated clotting time. Therefore, a reliable new measurement is needed to monitor anticoagulation during cardiopulmon

  17. Reagentless phosphate ion sensor system for environmental monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, M.; Kurata, H.; Inoue, Y.; Shin, H. [Kyushu Institute of Technology, Fukuoka (Japan). Faculty of computer Science and Systems; Kubo, I. [Soka University, Tokyo (Japan). Faculty of Engineering; Nakamura, H.; Ikebukuro, K.; Karube, I. [The University of Tokyo, Tokyo (Japan). Research Center for Advanced Science and Technology

    1998-06-05

    Phosphate ion sensor system using an electrochemical detector was developed by the use of recombinant pyruvate oxidase (PyOD) from Lactobacillus plantarum, which needs no addition of thiamine pyrophosphate and flavin adenine dinucleotide for reaction. This system could detect 2 nM hydrogen peroxide. Response time for phosphate ion was 80 s and total measurement time for one sample was 3 min. Citrate buffer solution (pH 6.3) was most suitable for the measurement and optimum flow rate was 0.6 ml/min. Under these optimum conditions minimum detection limit of phosphate ion was 15 nM, which was enough for the determination of phosphate ion in dam-lake. 6 refs., 5 figs., 1 tab.

  18. 21 CFR 520.622b - Diethylcarbamazine citrate syrup.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Diethylcarbamazine citrate syrup. 520.622b Section... Diethylcarbamazine citrate syrup. (a)(1) Specifications. Each milliliter of syrup contains 60 milligrams of... veterinarian. (b)(1) Specifications. Each milliliter of syrup contains 60 milligrams of...

  19. Citrate increases glass transition temperature of vitrified sucrose preparations

    NARCIS (Netherlands)

    Kets, E.P.W.; Lipelaar, P.J.; Hoekstra, F.A.; Vromans, H.

    2004-01-01

    The aim of this study was to investigate the effect of sodium citrate on the properties of dried amorphous sucrose glasses. Addition of sodium citrate to a sucrose solution followed by freeze-drying or convective drying resulted in a glass transition temperature (T-g) that was higher than the well-s

  20. Structural basis for norovirus inhibition and fucose mimicry by citrate.

    Science.gov (United States)

    Hansman, Grant S; Shahzad-Ul-Hussan, Syed; McLellan, Jason S; Chuang, Gwo-Yu; Georgiev, Ivelin; Shimoike, Takashi; Katayama, Kazuhiko; Bewley, Carole A; Kwong, Peter D

    2012-01-01

    Human noroviruses bind with their capsid-protruding domains to histo-blood-group antigens (HBGAs), an interaction thought to direct their entry into cells. Although human noroviruses are the major cause of gastroenteritis outbreaks, development of antivirals has been lacking, mainly because human noroviruses cannot be cultivated. Here we use X-ray crystallography and saturation transfer difference nuclear magnetic resonance (STD NMR) to analyze the interaction of citrate with genogroup II (GII) noroviruses. Crystals of citrate in complex with the protruding domain from norovirus GII.10 Vietnam026 diffracted to 1.4 Å and showed a single citrate bound at the site of HBGA interaction. The citrate interaction was coordinated with a set of capsid interactions almost identical to that involved in recognizing the terminal HBGA fucose, the saccharide which forms the primary conserved interaction between HBGAs and GII noroviruses. Citrate and a water molecule formed a ring-like structure that mimicked the pyranoside ring of fucose. STD NMR showed the protruding domain to have weak affinity for citrate (460 μM). This affinity, however, was similar to the affinities of the protruding domain for fucose (460 μM) and H type 2 trisaccharide (390 μM), an HBGA shown previously to be specifically recognized by human noroviruses. Importantly, competition STD NMR showed that citrate could compete with HBGA for norovirus binding. Together, the results suggest that citrate and other glycomimetics have the potential to block human noroviruses from binding to HBGAs.

  1. Structural Basis for Norovirus Inhibition and Fucose Mimicry by Citrate

    Energy Technology Data Exchange (ETDEWEB)

    Hansman, Grant S.; Shahzad-ul-Hussan, Syed; McLellan, Jason S.; Chuang, Gwo-Yu; Georgiev, Ivelin; Shimoike, Takashi; Katayama, Kazuhiko; Bewley, Carole A.; Kwong, Peter D. (NIAID)

    2012-01-20

    Human noroviruses bind with their capsid-protruding domains to histo-blood-group antigens (HBGAs), an interaction thought to direct their entry into cells. Although human noroviruses are the major cause of gastroenteritis outbreaks, development of antivirals has been lacking, mainly because human noroviruses cannot be cultivated. Here we use X-ray crystallography and saturation transfer difference nuclear magnetic resonance (STD NMR) to analyze the interaction of citrate with genogroup II (GII) noroviruses. Crystals of citrate in complex with the protruding domain from norovirus GII.10 Vietnam026 diffracted to 1.4 {angstrom} and showed a single citrate bound at the site of HBGA interaction. The citrate interaction was coordinated with a set of capsid interactions almost identical to that involved in recognizing the terminal HBGA fucose, the saccharide which forms the primary conserved interaction between HBGAs and GII noroviruses. Citrate and a water molecule formed a ring-like structure that mimicked the pyranoside ring of fucose. STD NMR showed the protruding domain to have weak affinity for citrate (460 {mu}M). This affinity, however, was similar to the affinities of the protruding domain for fucose (460 {mu}M) and H type 2 trisaccharide (390 {mu}M), an HBGA shown previously to be specifically recognized by human noroviruses. Importantly, competition STD NMR showed that citrate could compete with HBGA for norovirus binding. Together, the results suggest that citrate and other glycomimetics have the potential to block human noroviruses from binding to HBGAs.

  2. Anticoagulation therapy in intra-aortic balloon counterpulsation:Does IABP really need anti-coagulation?

    Institute of Scientific and Technical Information of China (English)

    JIANG Chen-yang(蒋晨阳); ZHAO Li-li(赵莉莉); WANG Jian-an(王建安); SAN Jiang(单江); MOHAMMOD Balgaith

    2003-01-01

    Objective: To investigate if intra-aortic balloon pump(IABP) is contraindicated without anticoagulation therapy. Methods: Some 153 IABP patients in the King Abdulaziz Cardiac Center(KSA) were randomly assigned into two groups. Anticoagulation group(Group A) consisted of 71 patients who were given heparin intravenously with target aPTT 50-70 seconds. Non-anticoagulation group(Group B) consisted of 82 patients without intravenous heparin during balloon pumping. Hematological parameters including platelet count, D-dimer, Plasminogen activator inhibitor-1(PAI-1) and fibrinogen degradation products(FDP) were checked respectively at the point of baseline, 24 hours, 48 hours and 24 hours post IABP counterpulsation. Clot deposits on balloon surface, vascular complications from IABP including bleeding and limb ischemia were recorded. Results: Platelet count and PAI-1 level decreased at 24 hours and 48 hours in both groups (P0.05). Three patients in Group A and 2 patients in Group B developed minor limb ischemia(P>0.05). No major limb ischemia in either group. Two patients in Group A suffered major bleeding and required blood transfusion or surgical intervention, whereas no patient had major bleeding in Group B. Eight patients had minor bleeding in Group A, but only 2 patients in Group B(P<0.05). No clot deposit developed on IABP surface in either group. Conclusion: IABP is safe without routine anticoagulation therapy. Selecting appropriate artery approach and early detection intervention are key methods for preventing complications.

  3. The Role of Anticoagulation Clinics in the Era of New Oral Anticoagulants

    Directory of Open Access Journals (Sweden)

    Sophie Testa

    2012-01-01

    Full Text Available Anticoagulation Clinics (ACs are services specialized in management of patients on anticoagulant treatment. At present, ACs manage patients chiefly on antivitamin K antagonists (AVKs, but patient population has already changed in the last few years, because of an increase of treatments with other anticoagulant drugs, which require different management systems. The strong increase in the number of patients at AC, mainly on long-term treatment, has determined the development of web management, through telemedicine systems, improving the quality of life and maintaining the same clinical quality levels. New oral anticoagulants (NOAs have shown to be as effective as AVK antagonists in stroke prevention in atrial fibrillation and for treatment of venous thromboembolism in addition to VTE prophylaxis in orthopaedic surgery, when administered at a fixed dose, but patient adherence and compliance are crucial for good quality treatment. At present, lacking data from the real world, an oversimplification of treatment with NOAs could cause unjustified risks for patients and also a possible future underuse of good drugs. For these reasons the vigilance must be high and ACs can have a crucial role in defining which is the best management for NOA patients and how to do it, as it happened for AVKs.

  4. The role of anticoagulation clinics in the era of new oral anticoagulants.

    Science.gov (United States)

    Testa, Sophie; Paoletti, Oriana; Zimmermann, Anke; Bassi, Laura; Zambelli, Silvia; Cancellieri, Emilia

    2012-01-01

    Anticoagulation Clinics (ACs) are services specialized in management of patients on anticoagulant treatment. At present, ACs manage patients chiefly on antivitamin K antagonists (AVKs), but patient population has already changed in the last few years, because of an increase of treatments with other anticoagulant drugs, which require different management systems. The strong increase in the number of patients at AC, mainly on long-term treatment, has determined the development of web management, through telemedicine systems, improving the quality of life and maintaining the same clinical quality levels. New oral anticoagulants (NOAs) have shown to be as effective as AVK antagonists in stroke prevention in atrial fibrillation and for treatment of venous thromboembolism in addition to VTE prophylaxis in orthopaedic surgery, when administered at a fixed dose, but patient adherence and compliance are crucial for good quality treatment. At present, lacking data from the real world, an oversimplification of treatment with NOAs could cause unjustified risks for patients and also a possible future underuse of good drugs. For these reasons the vigilance must be high and ACs can have a crucial role in defining which is the best management for NOA patients and how to do it, as it happened for AVKs.

  5. Anticoagulation therapy in intra-aortic balloon counterpulsation: Does IABP really need anti-coagulation

    Institute of Scientific and Technical Information of China (English)

    蒋晨阳; 赵莉莉; 王建安; 单江; MOHAMMODBalgaith

    2003-01-01

    Objective: To investigate if intra-aortic balloon pump(IABP) is contraindicated without anticoag-ulation therapy. Methods: Some 153 IABP patients in the King Abdulaziz Cardiac Center(KSA) were random-ly assigned into two groups. Anticoagulation group( Group A) consisted of 71 patients who were given heparin intravenously with target aPTT 50 - 70 seconds. Non-anticoagulation group( Group B) consisted of 82 patients without intravenous heparin during balloon pumping. Hematological parameters including platelet count, D-dimer, Plasminogen activator inhibitor-1 (PAI-1) and fibrinogen degradation products(FDP) were checked respectively at the point of baseline, 24 hours, 48 hours and 24 hours post IABP counterpulsation. Clot deposits on balloon surface, vascular complications from IABP including bleeding and limb ischemia were recorded.Results: Platelet count and PAI-1 level decreased at 24 hours and 48 hours in both groups ( P 0.05) . Three patients in Group A and 2 patients in Group B developed minor limb ischemia( P > 0.05). No major limb ischemia in either group. Two patients in Group A suffered major bleeding and required blood transfusion or surgical intervention, whereas no patient had major bleeding in Group B. Eight patients had minor bleeding in Group A, but only 2 patients in Group B ( P <0.05). No clot deposit developed on IABP surface in either group. Conclusion: IABP is safe without routine anticoagulation therapy. Selecting appropriate artery approach and early detection intervention are key methods for preventing complications.

  6. Antibodies for detecting and quantifying anticoagulant agents

    OpenAIRE

    Salvador, Juan Pablo; Marco, María Pilar

    2012-01-01

    [EN] The present invention relates to the design of haptens that are structurally related to coumarin oral anticoagulant compounds (COAC), to be used for the production of specific antibodies against said type of substances and the subsequent use thereof for the development of diagnosis tools for use in laboratories or in point-of-care (PoC) devices. In particular, the produced antibodies have been used to develop a diagnosis tool that enables the plasma levels of COAC to be quantified in pat...

  7. Shortfalls using second-generation anticoagulant rodenticides.

    Science.gov (United States)

    Borst, G H A; Counotte, G H M

    2002-03-01

    Second-generation anticoagulant rodenticides can give rise to unexpected casualties in nontarget species in zoos. The first two offspring of a pair of turkey vultures (Cathartes aura) died of brodifacoum toxicosis. The adult birds fed rodenticide-killed mice to their offspring. There are previous case reports of small carnivorous birds (Dacelo novae-guinae and Tockus deckeni) killed eating poisoned (difenacoum and brodifacoum) mice. Even a granivorous species (Rollulus roulroul) died, probably by contamination of its food by cockroaches that transported the rodenticide. PMID:12216801

  8. Vitamin K requirement in Danish anticoagulant-resistant Norway rats (Rattus norvegicus)

    DEFF Research Database (Denmark)

    Markussen, Mette D.; Heiberg, Ann-Charlotte; Nielsen, Robert;

    2003-01-01

    Norway rats, Rattus norvegicus, Denmark, anticoagulant rodenticide resistance, vitamin K requirement......Norway rats, Rattus norvegicus, Denmark, anticoagulant rodenticide resistance, vitamin K requirement...

  9. New anticoagulants for the prevention of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Cecilia Becattini

    2010-04-01

    Full Text Available Cecilia Becattini, Alessandra Lignani, Giancarlo AgnelliInternal and Cardiovascular Medicine and Stroke Unit, University of Perugia, ItalyAbstract: Anticoagulant drugs have an essential role in the prevention and treatment of thromboembolic diseases. Currently available anticoagulants substantially reduce the incidence of thromboembolic events in a number of clinical conditions. However, these agents have limitations that strengthen the case for the development of new anticoagulants. An ideal anticoagulant should be at least as effective as those currently in use, as well as safe, simple to use, and widely applicable. The majority of new anticoagulants currently under investigation are small molecules with a selective and direct anti-Xa or antithrombin action, allowing oral administration in fixed doses. These new agents are in different phases of clinical development. The anti-Xa agent rivaroxaban and the antithrombin agent dabigatran are already available for the prophylaxis of venous thromboembolism in some countries. Apixaban is in an advanced phase of clinical development and several anti-Xa agents are currently approaching phase III clinical trials. Promising results in terms of efficacy and safety profiles have been obtained with these agents in different clinical conditions. Differences in pharmacokinetics and pharmacodynamics could offer the potential for individualized anticoagulant therapies in the near future.Keywords: anticoagulant therapy, antithrombotic therapy, anticoagulants, direct thrombin inhibitors, factor Xa inhibitors

  10. Genetic and environmental factors affecting the coumarin anticoagulant level

    NARCIS (Netherlands)

    L.E. Visser (Loes)

    2004-01-01

    textabstractThis introductory chapter has illustrated that various factors, such as genetic factors, drugs, diet and intercurrent diseases may affect anticoagulation levels. Most of the clinical and pharmacological data related to coumarin anticoagulants have so far been obtained from studying warfa

  11. Clinical considerations of anticoagulation therapy for patients with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Shu ZHANG

    2012-01-01

    Atrial fibrillation (AF) increases the risk of stroke.New anticoagulation agents have recently provided alternative and promising approaches.This paper reviews the current state of anticoagulation therapy in AF patients,focusing on various clinical scenarios and on comparisons,where possible,between western and eastern populations.

  12. Update of the guidelines for lupus anticoagulant detection

    NARCIS (Netherlands)

    Pengo, V.; Tripodi, A.; Reber, G.; Rand, J. H.; Ortel, T. L.; Galli, M.; de Groot, P. G.

    2009-01-01

    One of the conclusions of the subcommittee meeting on Lupus Anticoagulant/Phospholipid dependent antibodies, held in Geneva on 2007, was the need to update the guidelines on Lupus Anticoagulant (LA) detection. Particular emphasis was given to several aspects discussed in this official communication.

  13. 76 FR 77206 - Citric Acid and Certain Citrate Salts From the People's Republic of China: Final Results of...

    Science.gov (United States)

    2011-12-12

    ... grades and granulation sizes of citric acid, sodium citrate, and potassium citrate in their unblended... citric acid, sodium citrate, and potassium citrate; as well as blends with other ingredients, such as sugar, where the unblended ] form(s) of citric acid, sodium citrate, and potassium citrate constitute...

  14. 76 FR 77772 - Citric Acid and Certain Citrate Salts from the People's Republic of China: Final Results of the...

    Science.gov (United States)

    2011-12-14

    ... granulation sizes of citric acid, sodium citrate, and potassium citrate in their unblended forms, whether dry..., sodium citrate, and potassium citrate; as well as blends with other ingredients, such as sugar, where the unblended form(s) of citric acid, sodium citrate, and potassium citrate constitute 40 percent or more,...

  15. 77 FR 74171 - Citric Acid and Certain Citrate Salts From the People's Republic of China: Final Results of...

    Science.gov (United States)

    2012-12-13

    ... sodium citrate, otherwise known as citric acid sodium salt, and the monohydrate and monopotassium forms of potassium citrate.\\5\\ Sodium citrate also includes both trisodium citrate and monosodium citrate... acid and sodium citrate are classifiable under 2918.14.0000 and 2918.15.1000 of the Harmonized...

  16. Novel oral anticoagulants in the management of coronary artery disease.

    Science.gov (United States)

    McMahon, Sean R; Brummel-Ziedins, Kathleen; Schneider, David J

    2016-08-01

    Despite advances in interventional and pharmacologic therapy, survivors of myocardial infarction remain at an increased risk of subsequent cardiovascular events. Initial pharmacological management includes both platelet inhibition and parenteral anticoagulation, whereas long-term pharmacological therapy relies on antiplatelet therapy for prevention of thrombotic complications. Biomarkers showing ongoing thrombin generation after acute coronary syndromes suggest that anticoagulants may provide additional benefit in reducing cardiovascular events. We review the pharmacokinetics of novel anticoagulants, clinical trial results, the role of monitoring, and future directions for the use of novel oral anticoagulants in the treatment of coronary artery disease. Clinical trials have shown that long-term use of oral anticoagulants decreases the risk of cardiovascular events, but they do so at a cost of an increased risk of bleeding. Future studies will need to identify optimal treatment combinations for selected patients and conditions that address both the appropriate combination of therapy and the appropriate dosage of each agent when used in combination. PMID:27228186

  17. Anticoagulation management during cross-clamping and bypass.

    Science.gov (United States)

    Lander, H; Zammert, M; FitzGerald, D

    2016-09-01

    Anticoagulation is required for successful implementation of cardiopulmonary bypass (CPB), as well as for surgeries requiring temporary aortic occlusion. It is well established that both coagulation and fibrinolysis are activated during CPB (Teufelsbauer et al., 1992) [1]. Appropriate dosing, monitoring, and maintenance of anticoagulation are essential to prevent devastating thrombosis of the CPB circuit or the occluded aorta and to minimize the activation of the hemostatic system. Although numerous novel anticoagulants have been developed over the past decade, unfractionated heparin remains the primary anticoagulant utilized during these types of procedures, with monitoring systems primarily based upon the activated clotting time and/or heparin concentration. This article will review the current state of anticoagulation management during cross-clamp and CPB. PMID:27650345

  18. Intracranial hemorrhage in cancer patients treated with anticoagulation.

    Science.gov (United States)

    Weinstock, Matthew J; Uhlmann, Erik J; Zwicker, Jeffrey I

    2016-04-01

    Both venous thromboembolism and intracranial metastases are common complications in the setting of primary brain tumors and metastatic malignancies. Anticoagulation is indicated in the presence of cancer-associated thrombosis in order to limit the risk of pulmonary embolism; however, there is reluctance to initiate anticoagulation in the setting of intracranial metastatic disease due to potential for intracranial hemorrhage. Recent evidence suggests that therapeutic anticoagulation can be safely administered in the setting of metastatic brain tumors. This review examines the current understanding of the pathophysiology of intracranial hemorrhage in malignancy, describes the incidence of intracranial hemorrhage in the setting of brain tumors with therapeutic anticoagulation, and outlines management strategies relevant to the treatment of intracranial hemorrhage in the setting of anticoagulation. PMID:27067980

  19. Effects of computer-assisted oral anticoagulant therapy

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Corell, Pernille; Madsen, Poul;

    2012-01-01

    the therapeutic target range compared to traditional oral anticoagulant therapy by physicians. METHODS: 54 patients were randomized equally into 3 groups. Patients in two groups used CoaguChek® systems to measure international normalized ratio (INR) values and had dosages of anticoagulation treatment calculated......UNLABELLED: BACKGROUND: Computer-assistance and self-monitoring lower the cost and may improve the quality of anticoagulation therapy. The main purpose of this clinical investigation was to use computer-assisted oral anticoagulant therapy to improve the time to reach and the time spent within...... in a computer system by an algorithm specific to each group. The third group received traditional anticoagulation treatment by physicians. The obtained INR values were compared regarding the time to reach, and the time spent within, the therapeutic target range, corresponding to INR values from 2 to 3. RESULTS...

  20. Novel oral anticoagulants for thromboprophylaxis after orthopaedic surgery.

    Science.gov (United States)

    Quinlan, Daniel J; Eriksson, Bengt I

    2013-06-01

    The direct thrombin inhibitor, dabigatran, and the selective factor Xa inhibitors, rivaroxaban and apixaban, are new oral anticoagulants that are approved in many countries for prevention of venous thromboembolism in patients undergoing elective hip or knee arthroplasty. All have a rapid onset of action, a low potential for food and drug interactions and a predictable anticoagulant effect that obviates the need for routine coagulation monitoring. These agents offer a convenient alternative to conventional anticoagulant drug regimens, including parenteral low-molecular-weight heparins and fondaparinux, and oral adjusted-dose vitamin K antagonists, for the prevention of venous thromboembolism in this surgical setting. This review summarizes the pharmacology, clinical trial results, bleeding risk and practical use of these new oral anticoagulants in clinical orthopaedic practice. Potential issues to be considered when using these oral anticoagulants include renal impairment, potential drug interactions, neuraxial anaesthesia and management of bleeding. PMID:23953905

  1. [New anticoagulants in the treatment of venous thromboembolism].

    Science.gov (United States)

    Bura-Rivière, Alessandra

    2013-09-01

    Anticoagulant therapy is the cornerstone of treatment of venous thromboembolism (VTE). The treatment needs rapid initial anticoagulaton to minimize the risk of thrombus extension and fata pulmonary embolism, followed by an extended anticoagulation, aimed at preventing recurrent VTE. Till very recently, immediate anticoagulation can only be achieved with parenteral agents, such as heparin, low-molecular-weight heparin, or fondaparinux. Extended treatment usually involves the administration of vitamin K antagonists, such as warfarin. Emerging direct oral anticoagulants have the potential to streamline VTE treatment. These agents include oral anticoagulants that target thrombin or factor Xa. This article reviews the characteristics of these agents, describes the results of clinical trials in venous thromboembolic disease and outlines their strengths and weakness. PMID:24167902

  2. New anticoagulants for the treatment of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Caio Julio Cesar dos Santos Fernandes

    2016-04-01

    Full Text Available Worldwide, venous thromboembolism (VTE is among the leading causes of death from cardiovascular disease, surpassed only by acute myocardial infarction and stroke. The spectrum of VTE presentations ranges, by degree of severity, from deep vein thrombosis to acute pulmonary thromboembolism. Treatment is based on full anticoagulation of the patients. For many decades, it has been known that anticoagulation directly affects the mortality associated with VTE. Until the beginning of this century, anticoagulant therapy was based on the use of unfractionated or low-molecular-weight heparin and vitamin K antagonists, warfarin in particular. Over the past decades, new classes of anticoagulants have been developed, such as factor Xa inhibitors and direct thrombin inhibitors, which significantly changed the therapeutic arsenal against VTE, due to their efficacy and safety when compared with the conventional treatment. The focus of this review was on evaluating the role of these new anticoagulants in this clinical context.

  3. Cardioversion in Acute Atrial Fibrillation without Anticoagulation

    Directory of Open Access Journals (Sweden)

    KE Juhani Airaksinen, MD, PhD; Wail Nammas, MD, PhD; Ilpo Nuotio, MD, PhD

    2013-12-01

    Full Text Available The main alternative therapeutic strategies for acute atrial fibrillation are rate versus rhythm control. A major concern in cardioversion of newly detected atrial fibrillation is the risk of thromboembolic events. The vast majority of these events occur in the first week following cardioversion. Transesophageal echocardiography has demonstrated that thrombus and dense spontaneous echo contrast may occur in the left atrium and left atrial appendage also in patients with acute atrial fibrillation (<48 hours scheduled for cardioversion. Moreover, atrial function may become impaired immediately following successful cardioversion. Thus, the current North American and European guidelines recommend that patients with acute atrial fibrillation should undergo cardioversion under cover of unfractionated or low-molecular weight heparin followed by oral anticoagulation for at least 4 weeks in patients in patients at moderate-to-high risk for stroke. In line with the guidelines, new evidence from a large patient population suggests that after successful cardioversion of acute atrial fibrillation, patients have a low overall risk of thromboembolic events without any anticoagulation when they have no risk factors for thromboembolism. In contrast, the risk is in the range of 10% in patients with multiple classic risk factors for thromboembolism.

  4. Anticoagulation in adults with congenital heart disease

    DEFF Research Database (Denmark)

    Jensen, A S; Idorn, L; Nørager, B;

    2015-01-01

    Adults with congenital heart disease are a growing population. One of the major challenges in the care of these patients is to prevent thromboembolic episodes. Despite relative young age and no typical cardiovascular risk factors, this cohort has a high prevalence of thrombotic events. It is diff......Adults with congenital heart disease are a growing population. One of the major challenges in the care of these patients is to prevent thromboembolic episodes. Despite relative young age and no typical cardiovascular risk factors, this cohort has a high prevalence of thrombotic events....... It is difficult to use treatment algorithms from the general adult population with acquired heart disease in this heterogeneous population due to special conditions such as myocardial scarring after previous surgery, atypical atrial flutter, prothrombotic conditions and the presence of interatrial shunts....... Furthermore, there is a lack of scientific evidence regarding how to prevent thromboembolic events with anticoagulation in adults with congenital heart disease. The aim of this paper is to review the current literature pertaining to anticoagulation in adults with congenital heart disease and hence enable...

  5. 抗凝剂对富含血小板血浆质量的影响%The study of anticoagulants selection in platelet-rich plasma preparation

    Institute of Scientific and Technical Information of China (English)

    雷华; 归来; 刘珍君; 马桂娥

    2015-01-01

    目的 探讨抗凝剂对富含血小板血浆中血小板活性的影响,以明确抗凝剂的选择是否影响富含血小板血浆的质量.方法 分别用肝素钠、枸橼酸钠、抗凝枸橼酸葡萄糖、枸橼酸-茶碱-腺苷-潘生丁作为抗凝剂,抽取志愿者全血,分离血小板、制备富含血小板血浆.电镜观察血小板的微观结构;检测血浆中可溶性P-选择素浓度,以观察血小板的自发激活情况;测定富含血小板血浆激活后转移生长因子释放量.结果 枸橼酸-茶碱-腺苷-潘生丁抗凝剂和抗凝枸橼酸葡萄糖与肝素钠和枸橼酸钠相比,能长时间保持血小板结构完整,减少血小板在富含血小板血浆制备过程中的自发激活.抗凝枸橼酸葡萄糖对血小板的保护作用较枸橼酸-茶碱-腺苷-潘生丁弱,但二者与肝素钠和枸橼酸钠相比,均能使富含血小板血浆释放较多的生长因子.结论 不同抗凝剂对富含血小板血浆的质量和生物活性有显著影响.复合试剂抗凝枸橼酸葡萄糖、枸橼酸-茶碱-腺苷-潘生丁能更长时间地保持富含血小板血浆的生物活性,提高其质量.%Objective To investigate the effect of the anticoagulants on PRP quality,so as to clarify the appropriate anticoagulant used in PRP production.Methods The microstructure change of platelets collected via heparin,citrate,acid citrate dextrose (ACD) and citrate-theophylline-adenosinedipyridamole (CTAD) was observed by TEM following time course.The extent of spontaneous activation of platelets in four groups was detected by measuring sP-selectin in plasma.The TGF-β1 release amount of activated PRP of four groups was measured.Results CTAD is superior to other anticoagulants in maintaining the integrity of platelet structures for a long time and preventing platelet spontaneous activation.ACD slightly surpassed heparin and citrate in above two aspects.ACD-PRP and CTAD-PRP released significantly more TGF-β1 compared with heparin

  6. Role of Ga-67 citrate imaging in pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Aburano, T.; Yokoyama, K.; Hisada, K.; Kakuma, K.; Ichiyanagi, K.

    1988-11-01

    Two patients with pancreatitis in whom an area of predominant uptake of Ga-67 citrate was demonstrated involving the entire pancreas are presented. Ultrasound and x-ray CT did not reveal any morphologic abnormalities in the pancreas, whereas Ga-67 citrate imaging indicated the presence of active inflammatory change. Ga-67 citrate imaging may be useful in confirming the diagnosis of acute pancreatitis or acute exacerbation of chronic pancreatitis based on clinical and laboratory data, especially when ultrasound and/or x-ray CT cannot reveal any morphologic abnormalities in the pancreas.

  7. Management of antiplatelet and anticoagulant therapy for endoscopic procedures: introduction to novel oral anticoagulants

    Directory of Open Access Journals (Sweden)

    Martha L. González-Bárcenas

    2016-02-01

    Full Text Available The development of novel antithrombotic therapy in the past few years and its prescription in patients with cardiovascular and circulatory disease has widened the spectrum of drugs that need to be considered when performing an endoscopic procedure. The balance between the thrombotic risk patients carry due to their medical history and the bleeding risk involved in endoscopic procedures should be thoroughly analyzed by Gastroenterologists. New oral anticoagulants (NOACs impose an additional task. These agents, that specifically target factor IIa or Xa, do not dispose of an anticoagulation monitoring method nor have an antidote to revert their effect, just as with antiplatelet agents. Understanding the fundamental aspects of these drugs provides the necessary knowledge to determine the ideal period the antithrombotic therapy should be interrupted in order to perform the endoscopic procedure, offering maximum safety for patients and optimal results.

  8. 76 FR 34044 - Citric Acid and Certain Citrate Salts From Canada: Final Results of Antidumping Duty...

    Science.gov (United States)

    2011-06-10

    ... Citrate Salts From Canada: Preliminary Results of Antidumping Duty Administrative Review, 76 FR 5782... The scope of this order includes all grades and granulation sizes of citric acid, sodium citrate, and.... The scope also includes blends of citric acid, sodium citrate, and potassium citrate; as well...

  9. Oral and parenteral anticoagulants: New kids on the block

    Directory of Open Access Journals (Sweden)

    S Aditya

    2012-01-01

    Full Text Available Well-documented drawbacks of traditional anticoagulants have lead to the quest for an ideal anticoagulant resulting in a surge of novel anticoagulant molecules. These newer agents directly target specific steps in coagulation cascade and include newer low molecular weight heparins (adomiparin, ultra low molecular weight heparins (semuloparin, RO-14, inhibitors of activated factor II (dabigatran, AZD0837, X (rivaroxaban, apixaban, edoxaban, betrixaban, IX (REG1,2, XI (antisense oligonucleotides, BMS 262084, clavatadine A, VII/tissue factor (tifacogin, PCI 274836, and BMS 593214, V (recomodulin, solulin, VIII (TB402, dual thrombin/factor X inhibitors (EP21709, tanogitran, and newer vitamin K antagonists (tecarfarin. Direct thrombin inhibitors and Factor X inhibitors are the most clinically advanced. This article discusses the recent advances in the development of novel targets of anticoagulants. Medline, EMBASE, cochrane database, medscape, SCOPUS, and clinicaltrials.gov were searched using terms "anticoagulants", "blood coagulation inhibitors", "anticoagulants and venous thromboembolism", "anticoagulants and atrial fibrillation", and "′antithrombins." Journal articles published from 2007 to 2012 discussing pharmacology and/or clinical trials were screened.

  10. Momordica charantia seed extract exhibits strong anticoagulant effect by specifically interfering in intrinsic pathway of blood coagulation and dissolves fibrin clot.

    Science.gov (United States)

    Manjappa, Bhagyalakshmi; Gangaraju, Sowmyashree; Girish, Kesturu S; Kemparaju, Kempaiah; Gonchigar, Sathish J; Shankar, Rohit L; Shinde, Manohar; Sannaningaiah, Devaraja

    2015-03-01

    The current study explores the anticoagulant and fibrin clot-hydrolyzing properties of Momordica charantia seed extract (MCSE). MCSE hydrolyzed casein with the specific activity of 0.780 units/mg per min. Interestingly, it enhanced the clot formation process of citrated human plasma from control 146 to 432 s. In addition, the intravenous injection of MCSE significantly prolonged the bleeding time in a dose-dependent manner from control 150 to more than 800 s, and strengthened its anticoagulant activity. Interestingly, MCSE specifically prolonged the clotting time of only activated partial thromboplastin time, but not prothrombin time, and revealed the participation of MCSE in the intrinsic pathway of the blood coagulation cascade. Furthermore, MCSE completely hydrolyzed both Aα and Bβ chains of the human fibrinogen and partially hydrolyzed the γ chain. However, it hydrolyzed all the chains (α polymer, α chain, β chain and γ-γ dimmers) of partially cross-linked human fibrin clot. The proteolytic activity followed by the anticoagulant effect of the MCSE was completely abolished by the 1,10-phenanthroline and phenyl methyl sulphonyl fluoride, but iodoacetic acid, EDTA, and ethylene glycol-N,N,N',N'-tetra acetic acid did not. Curiously, MCSE did not hydrolyze any other plasma proteins except the plasma fibrinogen. Moreover, MCSE was devoid of RBC lysis, edema and hemorrhagic properties, suggesting its nontoxic nature. Taken together, MCSE may be a valuable candidate in the treatment of blood clot/thrombotic disorders. PMID:25192240

  11. Role of phosphate in the regulation of the Pasteur effect in Saccharomyces cerevisiae.

    Science.gov (United States)

    Lagunas, R; Gancedo, C

    1983-12-15

    The occurrence of the Pasteur effect in Saccharomyces cerevisiae in several conditions has been examined. In these conditions measurements of a series of metabolites potentially involved in the regulation of the effect were performed. These included, among others, adenine nucleotides, citrate, fructose 2,6-bisphosphate and phosphate. Only phosphate changed in a consistent way, increasing in anaerobiosis when the Pasteur effect occurred. It is concluded that, with the available data, only phosphate may be considered as a regulator of the Pasteur effect in this microorganism.

  12. Phosphate Removal by Anion Binding on Functionalized Nanoporous Sorbents

    Energy Technology Data Exchange (ETDEWEB)

    Chouyyok, Wilaiwan; Wiacek, Robert J.; Pattamakomsan, Kanda; Sangvanich, Thanapon; Grudzien, Rafal M.; Fryxell, Glen E.; Yantasee, Wasanna

    2010-03-26

    Phosphate was captured from aqueous solutions by cationic metal-EDA complexes anchored inside mesoporous silica MCM-41 supports (Cu(II)-EDA-SAMMS and Fe(III)-EDA-SAMMS). Fe-EDA-SAMMS was more effective at capturing phosphate than the Cu-EDA-SAMMS and was further studied for matrix effects (e.g., pH, ionic strength, and competing anions) and sorption performance (e.g., capacity and rate). The adsorption of phosphate was highly pH dependent; it increased with increasing pH from 1.0 to 6.5, and decreased above pH 6.5. The adsorption was affected by high ionic strength (0.1 M of NaCl). In the presence of 1000-fold molar excess of chloride and nitrate anions, phosphate removal by Fe-EDA-SAMMS was not affected. Slight, moderate and large impacts were seen with bicarbonate, sulfate and citrate anions, respectively. The phosphate adsorption data on Fe-EDA-SAMMS agreed well with the Langmuir model with the estimated maximum capacity of 43.3 mg/g. The material displayed rapid sorption rate (99% of phosphate removal within 1 min) and lowering the phosphate content to ~ 10 µg/L of phosphorus, which is lower than the EPA’s established freshwater contaminant level for phosphorous (20 µg/L).

  13. Thromboembolism and anticoagulation after Fontan surgery.

    Science.gov (United States)

    Viswanathan, Sangeetha

    2016-01-01

    This review attempts to answer the common questions faced by a clinician regarding thromboembolism and thromboprophylaxis in patients following Fontan surgery. The review is in an easy to understand question and answer format and discusses the currently available literature on the subject in an attempt to arrive at practical clinically relevant solutions. Patients who have undergone the Fontan operation are at a high risk for thromboembolism. Based on available evidence, there is a strong rationale for thromboprophylaxis. However, it is not clear as to which agent should be administered to prevent thromboembolic events. While the available evidence suggests that antiplatelet agents alone may be as good as oral anticoagulants, there is a need for a large multicenter randomized control trial comparing these two common strategies to deliver a clear verdict.

  14. [New oral anticoagulants - influence on coagulation tests].

    Science.gov (United States)

    Simeon, L; Nagler, M; Wuillemin, W A

    2014-01-01

    The new oral anticoagulants (NOACs) represent alternative antithrombotic agents for prophylaxis and therapy of thromboembolic diseases. They act either by inhibition of the clotting factor Xa or IIa (thrombin). As a consequence, they influence several coagulation assays (for example prothrombin time, activated partial thromboplastin time). Because of the short half-life of these new agents, these changes show great variations in the course of 24 hours. Furthermore, there are significant differences of laboratory results depending on the used reagents. We explain the influence of apixaban, rivaroxaban (factor Xa inhibitors) and dabigatran (thrombin inhibitor) on the most commonly used coagulation assays. Besides we show that this influence depends on the way of action of the drug as well as on the principle of the coagulation assay. Being aware of this relationships helps to interpret the results of coagulation assays under influence of NOACs correctly.

  15. New oral anticoagulants: key messages for clinicians

    Directory of Open Access Journals (Sweden)

    Matteo Giorgi-Pierfranceschi

    2013-12-01

    Full Text Available New oral anticoagulants are an effective and safe alternative to vitamin K antagonists in many fields of clinical practice. The use of the direct inhibitors of activated Factor II (dabigatran and activated Factor X (apixaban and rivaroxaban, both in patients with non-valvular atrial fibrillation (NVAF and those with acute venous thromboembolism (VTE, is of great interest for internal medicine physicians. This paper aims to give practical guidance on management (starting therapy, follow up and bleeding complications of patients treated with dabigatran, rivaroxaban or apixaban for NVAF or acute VTE providing practical tables concerning the phases of therapy, management of complications, drug interaction and dose adjustment if renal impairment occurs.

  16. Thromboembolism and anticoagulation after Fontan surgery.

    Science.gov (United States)

    Viswanathan, Sangeetha

    2016-01-01

    This review attempts to answer the common questions faced by a clinician regarding thromboembolism and thromboprophylaxis in patients following Fontan surgery. The review is in an easy to understand question and answer format and discusses the currently available literature on the subject in an attempt to arrive at practical clinically relevant solutions. Patients who have undergone the Fontan operation are at a high risk for thromboembolism. Based on available evidence, there is a strong rationale for thromboprophylaxis. However, it is not clear as to which agent should be administered to prevent thromboembolic events. While the available evidence suggests that antiplatelet agents alone may be as good as oral anticoagulants, there is a need for a large multicenter randomized control trial comparing these two common strategies to deliver a clear verdict. PMID:27625521

  17. Dissecting the substrate recognition of 3-O-sulfotransferase for the biosynthesis of anticoagulant heparin

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Andrea F.; Xu, Yongmei; Woody, Susan M.; Krahn, Joseph M.; Linhardt, Robert J.; Liu, Jian; Pedersen, Lars C. (NIH); (UNC); (Rensselaer)

    2012-05-29

    Heparin is a polysaccharide-based natural product that is used clinically as an anticoagulant drug. Heparan sulfate 3-O-sulfotransferase (3-OST) is an enzyme that transfers a sulfo group to the 3-OH position of a glucosamine unit. 3-OST is present in multiple isoforms, and the polysaccharides modified by these different isoforms perform distinct biological functions. 3-OST isoform 1 (3-OST-1) is the key enzyme for the biosynthesis of anticoagulant heparin. Here, we report the crystal structure of the ternary complex of 3-OST-1, 3'-phosphoadenosine 5'-phosphate, and a heptasaccharide substrate. Comparisons to previously determined structures of 3-OST-3 reveal unique binding modes used by the different isoforms of 3-OST for distinguishing the fine structures of saccharide substrates. Our data demonstrate that the saccharide substrates display distinct conformations when interacting with the different 3-OST isoforms. Site-directed mutagenesis data suggest that several key amino residues, including Lys259, Thr256, and Trp283 in 3-OST-3 and Arg268 in 3-OST-1, play important roles in substrate binding and specificity between isoforms. These results deepen our understanding of the biosynthetic mechanism of heparan sulfate and provide structural information for engineering enzymes for an enhanced biosynthetic approach to heparin production.

  18. Rational design of anticoagulant drugs using oligosaccharide chemistry.

    Science.gov (United States)

    El Hadri, Ahmed; Petitou, Maurice

    2011-01-01

    For a long time, heparin and low molecular weight heparins have been the drugs of choice for the management of thrombosis. Discovery of the antithrombin binding domain in heparin, a critical element in the anticoagulant activity of this polysaccharide, allowed a rational approach based on medicinal carbohydrate chemistry in the design of new anticoagulants. The fully synthetic pentasaccharide fondaparinux that selectively targets blood coagulation factor Xa was first to be developed as a drug. Fondaparinux was followed by various heparin mimicking oligosaccharides prepared with a view to replace polydisperse heparin and low molecular weight heparins by structurally-defined anticoagulants with no unwanted side-effects. PMID:21469438

  19. Synthetic oligosaccharides as heparin-mimetics displaying anticoagulant properties.

    Science.gov (United States)

    Avci, Fikri Y; Karst, Nathalie A; Linhardt, Robert J

    2003-01-01

    Heparin and low molecular weight heparins are major clinical anticoagulants and the drugs of choice for the treatment of deep venous thrombosis. The discovery of an antithrombin binding domain in heparin focused interest on understanding the mechanism of heparin's antithrombotic/ anticoagulant activity. Various heparin-mimetic oligosaccharides have been prepared in an effort to replace polydisperse heparin and low molecular weight heparins with a structurally-defined anticoagulant. The goal of attaining a heparin-mimetic with no unwanted side-effects has also provided motivation for these efforts. This article reviews structure-activity relationship (SAR) of structurally-defined heparin-mimetic oligosaccharides. PMID:14529394

  20. Emergency management of patients being treated with oral anticoagulants

    Directory of Open Access Journals (Sweden)

    Franco Manzato

    2013-12-01

    Full Text Available Vitamin K antagonists (VKA are among the most widely prescribed drugs in the industrialized world. In fact, for decades, VKA have been the only orally available anticoagulant for the primary and secondary prevention of venous and arterial thrombotic events. Their efficacy has been widely demonstrated in a series of studies carried out in the 1990s. Since the incidences of atrial fibrillation and venous thromboembolism increase exponentially with age, the number of anticoagulated patients is destined to increase. This paper examines anticoagulation therapy management with particular attention to the use of VKA.

  1. Periablative Anticoagulation Strategies in Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Eduardo B. Saad

    2008-12-01

    Full Text Available Atrial fibrillation is associated with thromboembolic events that may cause important impairment on quality of life. Pulmonary vein isolation is the treatment of choice in cases that are refractory to medical therapy. Once sheaths and catheters are manipulated inside the left atrium, anticoagulation with heparin must be used during the procedure to protect patients from thromboembolic phenomena. Different strategies of anticoagulation are used at different centers. This review summarizes the pathophysiology of thrombus formation in the left atrium, defines which patients are under high risk and describes the main strategies used for anticoagulation.

  2. Unplanned pregnancy on a direct oral anticoagulant (Rivaroxaban): A warning.

    Science.gov (United States)

    Myers, B; Neal, R; Myers, O; Ruparelia, M

    2016-03-01

    Direct oral anticoagulants (DOACs or NOACs -non-vitamin K oral anticoagulants), as the name suggests, are oral anticoagulants with a direct inhibitory action either against factor X or factor II (thrombin). Pregnant women were excluded from participating in all the large trials of the DOACs and they are considered contra-indicated in pregnancy and breast feeding. We present a case of inadvertent exposure to rivaroxaban in a woman who presented at 25 weeks' gestation. The management of her pregnancy and delivery is described, and the previous published case reports are reviewed with a discussion about the use of DOACs in woman of childbearing age. PMID:27512489

  3. Intestinal Phosphate Transport

    OpenAIRE

    Sabbagh, Yves; Giral, Hector; Caldas, Yupanqui; Levi, Moshe; Schiavi, Susan C.

    2011-01-01

    Phosphate is absorbed in the small intestine by at least two distinct mechanisms: paracellular phosphate transport which is dependent on passive diffusion and active transport which occurs through the sodium-dependent phosphate co-transporters. Despite evidence emerging for other ions, regulation of the phosphate specific paracellular pathways remains largely unexplored. In contrast, there is a growing body of evidence that active transport through the sodium-dependent phosphate co-transporte...

  4. Competitive and cooperative adsorption of arsenate and citrate on goethite

    Institute of Scientific and Technical Information of China (English)

    SHI Rong; JIA Yongfeng; WANG Chengzhi

    2009-01-01

    The fate of arsenic in natural environments is influenced by adsorption onto metal (hydr)oxides. The extent of arsenic adsorption is strongly affected by coexisting dissolved natural organic acids. Recently, some studies reported that there existed competitive adsorption between arsenate and citrate on goethite. Humic acid is known to interact strongly with arsenate by forming complexes in aqueous solution, hence it is necessary to undertake a comprehensive study of the adsorption of arsenate/citrate onto goethite in the presence of one another. The results showed that at the arsenate concentrations used in this study (0.006--0.27 mmol/L), citrate decreased arsenate adsorption at acidic pH but no effect was observed at alkaline pH. In comparison, citrate adsorption was inhibited at acidic pH, but enhanced at alkaline pH by arsenate. This was probably due to the formation of complex between arsenate and citrate like the case of arsenate with humic acid. These results implied that the mechanism of the adsorption of arsenate and citrate onto goethite in the presence of one another involved not only competition for binding sites, but the cooperation between the two species at the water-goethite interface as well.

  5. Bacillus cereus iron uptake protein fishes out an unstable ferric citrate trimer

    OpenAIRE

    Fukushima, Tatsuya; Sia, Allyson K.; Allred, Benjamin E.; Nichiporuk, Rita; Zhou, Zhongrui; Andersen, Ulla N.; Raymond, Kenneth N.

    2012-01-01

    Citrate is a common biomolecule that chelates Fe(III). Many bacteria and plants use ferric citrate to fulfill their nutritional requirement for iron. Only the Escherichia coli ferric citrate outer-membrane transport protein FecA has been characterized; little is known about other ferric citrate-binding proteins. Here we report a unique siderophore-binding protein from the Gram-positive pathogenic bacterium Bacillus cereus that binds multinuclear ferric citrate complexes. We have demonstrated ...

  6. Considerations for long-term anticoagulant therapy in patients with venous thromboembolism in the novel oral anticoagulant era

    Directory of Open Access Journals (Sweden)

    Toth PP

    2016-02-01

    Full Text Available Peter P Toth1–3 1CGH Medical Center, Sterling, IL, 2Johns Hopkins University School of Medicine, Baltimore, MD, 3University of Illinois School of Medicine, Peoria, IL, USA Background: Patients who have had a venous thromboembolic event are generally advised to receive anticoagulant treatment for 3 months or longer to prevent a recurrent episode. Current guidelines recommend initial heparin and an oral vitamin K antagonist (VKA for long-term anticoagulation. However, because of the well-described disadvantages of VKAs, including extensive food and drug interactions and the need for regular anticoagulation monitoring, novel oral anticoagulants (NOACs have become an attractive option in recent years. These agents are given at fixed doses and do not require routine coagulation-time monitoring. The NOACs are discussed in this review with regard to the needs of patients on long-term anticoagulation. Methods: Current guidelines from Europe and North America that refer to the treatment of deep vein thrombosis and/or pulmonary embolism are included, as well as published randomized Phase III clinical trials of NOACs. PubMed searches were used for sourcing case studies of long-term anticoagulant treatment, and results were filtered for human application and screened for relevance. Conclusion: NOAC-based therapy showed a similar efficacy and safety profile to heparins/VKAs but without the need for regular anticoagulation monitoring or dietary adjustments, and can be taken as a fixed-dose regimen once or twice daily. This represents a significant step forward in facilitating the management of long-term anticoagulation therapy. Furthermore, in the EINSTEIN studies, improved patient satisfaction was documented with the NOAC rivaroxaban, which may result in better adherence to therapy and an overall reduction in the incidence of recurrent venous thromboembolism. Keywords: anticoagulation, patient needs, vitamin K antagonist, direct thrombin inhibitor, direct

  7. Measuring dabigatran with the dilute Russell viper venom confirm assay in an anticoagulation clinic population.

    Science.gov (United States)

    McGlasson, David L; Fritsma, George A

    2016-01-01

    The dabigatran dose-response is predictable; however, it is necessary to measure plasma levels in a variety of clinical conditions. We evaluated a novel dabigatran measure - the 'dilute Russell viper venom confirm (DRVVC) assay' - against current developmental assays and a reference method. We measured plasma dabigatran and compared results from the Stago Sta-Clot DRVVC assay, Stago Ecarin Chromogenic Assay, Biophen Hemoclot Thrombin Inhibitor, and liquid chromatography tandem mass spectrometry. We obtained dabigatran calibrators and controls from Biophen, and performed the coagulation assays using a Stago STA-R Evolution coagulometer. Liquid chromatography tandem mass spectrometry method specimens were performed on an AB Sciex instrument at LabCorp. We enrolled 97 anticoagulation clinic patients (mean age 76 years) who were taking 150 mg dabigatran twice daily. All had creatinine clearances above 30 ml/min; patients were not excluded for concurrent medications or health issues. Citrated blood specimens were processed immediately, and stored at -70°C. We did not correlate collection time with medication time. We employed descriptive statistics, analysis of variance, and the Bland-Altman difference plot to assess the data. The range for all assays was 11.6-917 ng/ml. Analysis of variance generated a P value of 0.1 and Bland-Altman differences were all below 4.0% compared with DRVVC. The DRVVC measures dabigatran with validity comparable to other methods.

  8. Thrombolytic-plus-Anticoagulant Therapy versus Anticoagulant-Alone Therapy in Submassive Pulmonary Thromboembolism (TVASPE Study: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Maryam Taherkhani

    2015-10-01

    Full Text Available Background: The use of thrombolytic agents in the treatment of hemodynamically stable patients with acute submassive pulmonary embolism (PTE remains controversial. We, therefore, conducted this study to compare the effect of thrombolytic plus anticoagulation versus anticoagulation alone on early death and adverse outcome following submassive PTE.Methods: We conducted a study of patients with acute pulmonary embolism and pulmonary hypertension or right ventricular dilatation/dysfunction but without arterial hypotension or shock. The patients were randomly assigned in a single-blind fashion to receive an anticoagulant [Enoxaparin (1 mg/kg twice a day] plus a thrombolytic [Alteplase (100 mg or Streptokinase (1500000 u/2 hours] or an anticoagulant [Enoxaparin (1 mg/kg twice a day] alone. The primary endpoint was in-hospital death or clinical deterioration requiring an escalation of treatment. The secondary endpoints of the study were major bleeding, pulmonary hypertension, right ventricular dilatation at the end of the first week, and exertional dyspnea at the end of the first month.Results: Of 50 patients enrolled, 25 patients were randomly assigned to receive an anticoagulant plus a thrombolytic and the other 25 patients were given an anticoagulant alone. The incidence of the primary endpoints was significantly higher in the anticoagulant-alone group than in the thrombolytic-plus-anticoagulant group (p value = 0.022. At the time of discharge, pulmonary artery pressure was significantly higher in the anticoagulant-alone group than in the thrombolytic- plus-anticoagulant group (p value = 0.018; however, reduction in the right ventricular size or normalization of the right ventricle showed non-significant differences between the two groups. There was no significant difference regarding the New York Heat Association (NYHA functional class between the two groups at the end of the first month (p value = 0.213. No fatal bleeding or cerebral bleeding

  9. Aroma compounds generation in citrate metabolism of Enterococcus faecium: Genetic characterization of type I citrate gene cluster.

    Science.gov (United States)

    Martino, Gabriela P; Quintana, Ingrid M; Espariz, Martín; Blancato, Victor S; Magni, Christian

    2016-02-01

    Enterococcus is one of the most controversial genera belonging to Lactic Acid Bacteria. Research involving this microorganism reflects its dual behavior as regards its safety. Although it has also been associated to nosocomial infections, natural occurrence of Enterococcus faecium in food contributes to the final quality of cheese. This bacterium is capable of fermenting citrate, which is metabolized to pyruvate and finally derives in the production of the aroma compounds diacetyl, acetoin and 2,3 butanediol. Citrate metabolism was studied in E. faecium but no data about genes related to these pathways have been described. A bioinformatic approach allowed us to differentiate cit(-) (no citrate metabolism genes) from cit(+) strains in E. faecium. Furthermore, we could classify them according to genes encoding for the transcriptional regulator, the oxaloacetate decarboxylase and the citrate transporter. Thus we defined type I organization having CitI regulator (DeoR family), CitM cytoplasmic soluble oxaloacetate decarboxylase (Malic Enzyme family) and CitP citrate transporter (2-hydroxy-carboxylate transporter family) and type II organization with CitO regulator (GntR family), OAD membrane oxaloacetate decarboxylase complex (Na(+)-transport decarboxylase enzyme family) and CitH citrate transporter (CitMHS family). We isolated and identified 17 E. faecium strains from regional cheeses. PCR analyses allowed us to classify them as cit(-) or cit(+). Within the latter classification we could differentiate type I but no type II organization. Remarkably, we came upon E. faecium GM75 strain which carries the insertion sequence IS256, involved in adaptative and evolution processes of bacteria related to Staphylococcus and Enterococcus genera. In this work we describe the differential behavior in citrate transport, metabolism and aroma generation of three strains and we present results that link citrate metabolism and genetic organizations in E. faecium for the first time.

  10. Effect of potential renal acid load of foods on urinary citrate excretion in calcium renal stone formers.

    Science.gov (United States)

    Trinchieri, Alberto; Lizzano, Renata; Marchesotti, Federica; Zanetti, Giampaolo

    2006-02-01

    The aim of this study was to investigate the influence of the potential renal acid load (PRAL) of the diet on the urinary risk factors for renal stone formation. The present series comprises 187 consecutive renal calcium stone patients (114 males, 73 females) who were studied in our stone clinic. Each patient was subjected to an investigation including a 24-h dietary record and 24-h urine sample taken over the same period. Nutrients and calories were calculated by means of food composition tables using a computerized procedure. Daily PRAL was calculated considering the mineral and protein composition of foods, the mean intestinal absorption rate for each nutrient and the metabolism of sulfur-containing amino acids. Sodium, potassium, calcium, magnesium, phosphate, oxalate, urate, citrate, and creatinine levels were measured in the urine. The mean daily PRAL was higher in male than in female patients (24.1+/-24.0 vs 16.1+/-20.1 mEq/day, P=0.000). A significantly (P=0.01) negative correlation (R=-0.18) was found between daily PRAL and daily urinary citrate, but no correlation between PRAL and urinary calcium, oxalate, and urate was shown. Daily urinary calcium (R=0.186, P=0.011) and uric acid (R=0.157, P=0.033) were significantly related to the dietary intake of protein. Daily urinary citrate was significantly related to the intakes of copper (R=0.178, P=0.015), riboflavin (R=0.20, P=0.006), piridoxine (R=0.169, P=0.021) and biotin (R=0.196, P=0.007). The regression analysis by stepwise selection confirmed the significant negative correlation between PRAL and urinary citrate (P=0.002) and the significant positive correlation between riboflavin and urinary citrate (P=0.000). Urinary citrate excretion of renal stone formers (RSFs) is highly dependent from dietary acid load. The computation of the renal acid load is advisable to investigate the role of diet in the pathogenesis of calcium stone disease and it is also a useful tool to evaluate the lithogenic potential of

  11. New anticoagulants for the prevention and treatment of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Simon J McRae

    2005-04-01

    Full Text Available Simon J McRae, Jeffrey S GinsbergDepartment of Medicine, McMaster University, Hamilton, ON, CanadaAbstract: Anticoagulant therapy is effective at preventing the development of venous thromboembolism in high-risk patients, and reduces morbidity and mortality in individuals with established thromboembolic disease. Vitamin K antagonists and heparins are currently the most commonly used anticoagulant drugs, but they have practical limitations. Therefore, new antithrombotic agents with predictable dose-responses (thereby decreasing the need for monitoring without compromising efficacy or safety, ideally available in an oral formulation and with a rapidly reversible anticoagulant effect, are needed. New drugs fulfilling some of the above criteria have been developed and have proven to be effective agents for the treatment and prevention of venous thromboembolism.Keywords: venous thromboembolism, anticoagulants, antithrombotic

  12. [Genetic predisposition to bleeding during oral anticoagulants treatment].

    Science.gov (United States)

    Montes Díaz, R; Nantes, O; Molina, E; Zozaya, J; Hermida, J

    2008-01-01

    The degree of anticoagulation obtained during oral anticoagulation therapy with vitamin K antagonists (VKA) varies among patients due to individual and environmental factors. The rate of anticoagulation influences the hemorrhagic risk. Therefore, it is plausible that patients specially sensitive to oral anticoagulants are at higher hemorrhagic risk, specially during the first weeks. The role of a series of polymorphisms of the enzymes involved in the metabolism of VKA or in the vitamin K cycle are reviewed. Three polymorphisms, two in the cytochrome P450 2C9 and one in the VKORC1 enzyme, are responsible for a high portion of the variability observed in the sensitivity to AVK. Although the available literature suggests that these genetic variants could increase the risk of severe hemorrhage, larger, well designed studies are needed to confirm this notion.

  13. [Novel oral anticoagulants and their use in the perioperative setting].

    Science.gov (United States)

    Schellong, Sebastian M; Haas, Sylvia

    2012-04-01

    Novel oral anticoagulants (NOACs) have become available for prevention of venous thromboembolism after major orthopaedic surgery, treatment of venous thromboembolism, and stroke prevention in patients with atrial fibrillation. The thrombin inhibitor Dabigatran has a plasma half life of 11-14 hours which prolongs significantly in renal insufficiency. The two Xa-inhibitors Rivaroxaban and Apixaban have slightly shorter half lifes, and renal elimination is confined to about 30% of active drug. Prior to elective surgery, drug intake needs to be halted. The time period depends on the actual drug half life in that particular situation. Bridging anticoagulation is not necessary. The management of bleeding complications does not differ from that in other anticoagulants. The most uncertainties in clinical practice will arise from the fact that NOACs derange the global clotting tests without any conclusive information about the actual intensity of anticoagulation. PMID:22504623

  14. How to manage new oral anticoagulants in case of surgery

    Directory of Open Access Journals (Sweden)

    Davide Imberti

    2013-12-01

    Full Text Available When a patient receiving new oral anticoagulants (NOACs requires an invasive procedure, the consequences of bleeding if anticoagulation is continued and the risk of thrombosis if it is omitted need to be carefully considered. In addition to the bleeding risk of the procedure, it is of paramount importance to evaluate the renal function, especially for dabigatran that is eliminated predominantly via the renal pathway. NOAC therapy should be stopped for at least 24 h before the intervention, and a longer interruption should be considered in cases of high bleeding risk procedures and/or renal failure. A base-line assessment of coagulation should be performed and intervention should be postponed (if possible if high levels of anticoagulation parameters are found. In the post-surgical period, if oral anticoagulant therapy cannot be re-started, patients should temporarily receive low molecular weight heparins and re-start NOACs as soon as possible.

  15. 枸橼酸钠在血液滤过中的效果观察%Effect observation of sodium citrate in hemofiltration

    Institute of Scientific and Technical Information of China (English)

    刘国英; 熊科俊; 赵琳

    2014-01-01

    目的::观察局部运用低浓度枸橼酸抗凝在行血液滤过中的疗效及安全性。方法:多脏器功能衰竭伴高危出血患者,即行4%枸橼酸钠在体外抗凝。观察血滤器、管路动静脉壶、动脉压、静脉压及跨膜压等情况。结果:20例(76次)高危出血患者在行血液滤过中未出现原有出血症状加重现象,也未出现滤器或管路凝血而终止;未出现低钙高钠代谢性碱中毒等并发症,均达到预期效果。结论:局部枸橼酸钠抗凝行血液滤过技术是一种安全有效的、简单的技术,易于掌握,并且禁忌症少,值得推行。%Objective: To observe efficacy and safety of local use of low concentrations sodium citrate anticoagulation in hemo-filtration. Methods: MOF patients with high-risk bleeding were given 4% sodium citrate for extracorporeal anticoagulation in hemofil-tration. The hemofilter, pipeline artery and vein pots, artery pressure and vein pressure, and transmembrane pressure were observed. Results: 20 cases with high-risk bleeding had no aggravated bleeding during the hemofiltration, and the filter and pipeline did not stop due to coagulation. No complications like low calcium high sodium metabolic alkalosis were found. Therefore, the treatment had the ex-pected effects. Conclusions: The technology of the local use of low concentrations sodium citrate anticoagulation in hemofiltration is safe and effective, easy to learn, and is worth being popularized.

  16. Novel Anticoagulants in Atrial Fibrillation: Monitoring, Reversal and Perioperative Management

    OpenAIRE

    Fadi Shamoun; Hiba Obeid; Harish Ramakrishna

    2015-01-01

    Atrial fibrillation continues to be a significant source of morbidity and mortality worldwide. Effective anticoagulation remains the cornerstone of outpatient and inpatient treatment. The use of the new generation of anticoagulants (NOACs) continues to grow. Recently published data indicate their cost-effectiveness and overall safety in stroke prevention; compared to vitamin K antagonists, they can be prescribed in fixed doses for long-term therapy without the need for coagulation monitoring....

  17. Anticoagulant Rodenticide Intoxication in Animals – A Review

    OpenAIRE

    VALCHEV, Ivan; Binev, Rumen; YORDANOVA, Veska; Nikolov, Yordan

    2008-01-01

    The newest measures for the control of harmful rodent populations are from the anticoagulant rodenticide group, which are divided into 2 subgroups: first and second generations, and indandione derivatives. Non-target organisms are potentially at risk of direct consumption of baits (primary hazard) and of eating poisoned rodents (secondary hazard). Anticoagulant rodenticides inhibit the enzyme vitamin K-dependent carboxylase and thus impair the reactivation of vitamin K1, indirectly affecting ...

  18. Anticoagulants and the propagation phase of thrombin generation.

    Directory of Open Access Journals (Sweden)

    Thomas Orfeo

    Full Text Available The view that clot time-based assays do not provide a sufficient assessment of an individual's hemostatic competence, especially in the context of anticoagulant therapy, has provoked a search for new metrics, with significant focus directed at techniques that define the propagation phase of thrombin generation. Here we use our deterministic mathematical model of tissue-factor initiated thrombin generation in combination with reconstructions using purified protein components to characterize how the interplay between anticoagulant mechanisms and variable composition of the coagulation proteome result in differential regulation of the propagation phase of thrombin generation. Thrombin parameters were extracted from computationally derived thrombin generation profiles generated using coagulation proteome factor data from warfarin-treated individuals (N = 54 and matching groups of control individuals (N = 37. A computational clot time prolongation value (cINR was devised that correlated with their actual International Normalized Ratio (INR values, with differences between individual INR and cINR values shown to derive from the insensitivity of the INR to tissue factor pathway inhibitor (TFPI. The analysis suggests that normal range variation in TFPI levels could be an important contributor to the failure of the INR to adequately reflect the anticoagulated state in some individuals. Warfarin-induced changes in thrombin propagation phase parameters were then compared to those induced by unfractionated heparin, fondaparinux, rivaroxaban, and a reversible thrombin inhibitor. Anticoagulants were assessed at concentrations yielding equivalent cINR values, with each anticoagulant evaluated using 32 unique coagulation proteome compositions. The analyses showed that no anticoagulant recapitulated all features of warfarin propagation phase dynamics; differences in propagation phase effects suggest that anticoagulants that selectively target fXa or

  19. Use of antifibrinolytic mouthwash solution in anticoagulated oral surgery patients

    OpenAIRE

    Dimova, Cena; Evrosimovska, Biljana; Papakoca, Kiro; Georgiev, Zlatko; Angelovska, Bistra; Ristoska, Sonja

    2012-01-01

    Introduction:The ordinary treatment of anticoagulated patients 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, so this issue is still controversial. The aim of the study was to evaluate the antifibrinolitic mouthwash solution (tranexamic acid) as a local haemostatic modality after oral surgery interventions. Methods:To realize the a...

  20. New perspectives and recommendations for anticoagulant therapy post orthopedic surgery

    OpenAIRE

    Marcelo Kropf; Cleidson Alves Bergami; Felipe Dias Leal; Claudia Oliveira Dias Passos; Zilda de Santana Gonsalves; Isabela Laudares Marques; Isabela Azevedo Mota; Marcele Lima Monte Gonçalves

    2011-01-01

    Anticoagulant therapy is essential for the prevention of risks associated with the formation of thrombus in patients after surgery, especially in orthopedics. Recently, new oral anticoagulants were introduced in the therapeutic arsenal. This fact is important, because the current drug of choice in clinical practice is enoxaparin, a low molecular weight heparin. As all injecting drugs, enoxaparin may reduce patients' adherence to treatment by dissatisfaction with and resistance to the administ...

  1. Effects of Organic Anions on Phosphate Adsorption and Desorption from Variable—Charge Clay Minerals and Soil

    Institute of Scientific and Technical Information of China (English)

    HEZHEN-LI; YUANKE-NENG; 等

    1992-01-01

    Effects of citrate and tartrate on phosphate adsorption and desorption from kaolinite,goethite,amorphous Al-oxide and Ultisol were studied.P adsorption was significantly decreased as the concentration of the organic anions increased from 10-5 to 10-1 M.At 0.1 M and pH 7.0,tartrate decreased P adsorption by 27.6%-50.6% and citrate by 37.9-80.4%,depending on the kinds of adsorbent.Little Al and/or Fe were detected in the equilibrium solutions,even at the highest concentration of the organic anions.Effects of the organic anions on phosphate adsorption follow essentially the competitive adsorption mechanism.The selectivity coefficients for competitive adsorption can be used to compare the effectiveness of different organic anions in reducing P adsorption under given gonditions. Phosphate desorption was increased by 3 to 100 times in the presence of 0.001 M citrate or tartrate compared to that in 0.02 M KCl solution alone.However,for all the soil and clay minerals studied the amount of P desorbed by citrate or tartrate was generally lower than or close to that of isotopically exchangeable P.The effect of organic anions on phosphate desorption arises primarily from ligand exchange.

  2. Adherence to a new oral anticoagulant treatment prescription: dabigatran etexilate

    Directory of Open Access Journals (Sweden)

    L Bellamy

    2009-07-01

    Full Text Available L Bellamy1, N Rosencher1, BI Eriksson21Anaesthesiology Department, Hôpital Cochin (AP-HP, René Descartes University, Paris 75014 France; 2Orthopaedic Department, University Hospital Sahlgrenska/Ostra, Gothenburg, SwedenAbstract: The recent development of new oral anticoagulants, of which dabigatran etexilate is currently at the most advanced stage of development, is the greatest advance in the provision of convenient anticoagulation therapy for many years. A new oral anticoagulation treatment, dabigatran etexilate, is already on the market in Europe. The main interest probably will be to improve the prescription and the adherence to an effective thromboprophylaxis in medical conditions such as atrial fibrillation without bleeding side effects, without the need for monitoring coagulation, and without drug and food interactions such as vitamin K anticoagulant (VKA treatment. Dabigatran is particularly interesting for extended thromboprophylaxis after major orthopedic surgery in order to avoid daily injection for a month. However, oral long-term treatments such as VKA are not systematically associated with a higher compliance level than injected treatments such as low-molecular-weight heparins. Indeed, adherence to an oral treatment, instead of the usual daily injection in major orthopedic surgery, is complex, and based not only on the frequency of dosing but also on patient motivation, understanding, and socio-economic status. New oral anticoagulants may be useful in this way but education and detection of risk factors of nonadherence to treatment are still essential.Keywords: oral anticoagulant, adherence, compliance, education, dabigatran

  3. Anticoagulation with recombinant hirudin and danaparoid sodium in pediatric patients.

    Science.gov (United States)

    Severin, Thomas; Zieger, Barbara; Sutor, Anton H

    2002-10-01

    Patients receiving heparin are at risk of developing heparin-induced thrombocytopenia (HIT). Whereas in HIT I only reversible mild thrombocytopenia occurs within the first days of heparin treatment, HIT II may lead to potentially life-threatening thromboembolic events. Pediatric patients suffering from HIT II have been reported in a study on newborns and in a few reports on children and adolescents. However, thrombotic complications can be as severe in children as they are in adults. In the case of HIT II, the withdrawal of heparin is required and alternative anticoagulation should be started. In contrast to numerous investigations in adult patients, including prospective studies, experience with alternative anticoagulants in pediatric patients is limited. The available data were analyzed according to HIT II complications, alternative anticoagulation, and clinical outcome. In conclusion, HIT II represents a potentially dangerous complication of heparin therapy in pediatric patients also. Alternative anticoagulation applied in pediatric patients mainly included danaparoid sodium and recombinant hirudin. In most patients treated with these anticoagulants, effective anticoagulation and clinical improvement were observed. Because of limited experience, more data are required for optimal management of HIT II in young patients. PMID:12420240

  4. Beyond heparin and warfarin: the new generation of anticoagulants.

    Science.gov (United States)

    Weitz, Jeffrey I; Linkins, Lori-Ann

    2007-03-01

    Heparin and warfarin are widely used for the prevention and treatment of venous and arterial thromboembolism. Although effective, both agents have important limitations; for example, both drugs must be monitored, which is inconvenient for patients and for physicians. Heparin requires parenteral administration and can cause heparin-induced thrombocytopenia, an immune-mediated process that can lead to life-threatening thrombosis. Warfarin also has its limitations. Due to its slow onset of action, warfarin must be overlapped with heparin (or another rapidly acting anticoagulant) when treating patients with established thrombosis or who are at high risk for thrombosis. Warfarin dosing is variable because its activity is influenced by dietary intake of vitamin K, genetic polymorphisms in enzymes that are involved in its metabolism and numerous drug-drug interactions that promote or reduce its activity. New anticoagulants have been developed to overcome these problems. Building on a better understanding of coagulation pathways, advances in structure-based drug design and information derived from natural anticoagulants isolated from hematophagous organisms, most of the new anticoagulants target specific coagulation enzymes. Focussing on drugs that have at least completed Phase II evaluation, this article briefly reviews the coagulation pathways and its natural regulators; outlines the limitations of existing anticoagulants and identifies the opportunities for new ones; highlights the properties of selected new anticoagulants; describes the clinical trial results with these agents; and provides a perspective on their potential strengths and weaknesses. PMID:17302522

  5. [Duration of anticoagulant therapy in venous thromboembolic complications].

    Science.gov (United States)

    Kuznetsov, M R; Leontyev, S G; Neskhodimov, L A; Tolstikhin, V Yu; Khotinskiy, A A

    2016-01-01

    Adequate anticoagulant therapy is a general approach to treatment of deep vein thrombosis. However, the duration of anticoagulant therapy is not strictly specified in everyday clinical practice. The present article deals with various approaches to selecting the duration of therapy with anticoagulants based on the findings of studies, national and foreign clinical guidelines. The minimal duration of therapy for deep vein thrombosis and pulmonary thromboembolism amounts to 3 months in accordance with the national and American recommendations. For some cohorts of patients, continuation of therapy above 3 months is considered: patients with idiopathic thrombosis (the recommended duration of therapy of not less than 6 months), patients having persisting risk factor for relapse of thrombosis on termination of the main therapeutic course, oncological patients (6 month therapy followed by assessing the risk and benefit of continuing therapy with anticoagulants). Prolonged therapy of venous thromboembolism using unfractionated heparin or low-molecular-weight heparin followed by changing over to vitamin K antagonists is associated with decreased risk for thrombosis relapse approximately by 90%, however increasing the risk of haemorrhage. Currently, as an alternative, it is possible to consider administration of novel oral anticoagulants (rivaroxaban, dabigatran, apixaban) which beside high efficacy are associated with less risk of bleeding. The route of administration, no necessity to control the INR, and the minimal number of drug and food interactions make administration of new oral anticoagulants an attractive alternative to therapy with heparins and vitamin K antagonists. PMID:27100556

  6. New anticoagulants for the prevention of venous thromboembolism

    Science.gov (United States)

    Becattini, Cecilia; Lignani, Alessandra; Agnelli, Giancarlo

    2010-01-01

    Anticoagulant drugs have an essential role in the prevention and treatment of thromboembolic diseases. Currently available anticoagulants substantially reduce the incidence of thromboembolic events in a number of clinical conditions. However, these agents have limitations that strengthen the case for the development of new anticoagulants. An ideal anticoagulant should be at least as effective as those currently in use, as well as safe, simple to use, and widely applicable. The majority of new anticoagulants currently under investigation are small molecules with a selective and direct anti-Xa or antithrombin action, allowing oral administration in fixed doses. These new agents are in different phases of clinical development. The anti-Xa agent rivaroxaban and the antithrombin agent dabigatran are already available for the prophylaxis of venous thromboembolism in some countries. Apixaban is in an advanced phase of clinical development and several anti-Xa agents are currently approaching phase III clinical trials. Promising results in terms of efficacy and safety profiles have been obtained with these agents in different clinical conditions. Differences in pharmacokinetics and pharmacodynamics could offer the potential for individualized anticoagulant therapies in the near future. PMID:20531960

  7. Preparation of lead titanate zirconate from metal citrates

    International Nuclear Information System (INIS)

    Lead titanate zirconate (PZT) preparation from its metal constituent citrates have been investigated. Metal citrates were obtained by forced precipitation using a dehydration alcohol mixture. Salt solutions of lead nitrate and octahydrated zirconyl chloride, and titanium tetrachloride were treated separately with citric acid and ammonium hydroxide. Zirconium, titanium and lead oxides resulted from thermal decomposition of corresponding citrates at 5000 C, 4500 C and 2500 C, respectively. Lead titanate (PT) and lead zirconate (P Z) were obtained by calcining at 4500 C and 5000 C, respectively, after adequate heating of citrates mechanically mixed in ethyl ether. PZT samples were obtained with different starting stoichiometry. Rhombohedral PZT-1 53/47 sample was prepared from co precipitating zirconyl ammonium and ammonium lead citrates in presence of ethanolic titanium oxide dispersion, and calcinating at 8000 C. Rhombohedral PZT-q 52/48 sample was obtained from heating at 5000 C for 2 hours a mixture of metal citrates coprecipitated by dehydration mixture of acetone-ethanol-formic acid (2:1:0,06). Tetragonal PZT-m stoichiometry 53/47 sample were obtained by calcining at after 6000 C for 2 hours after heating a mechanically mixed metal citrates. PT phase arose at 4000 C. PZT-m powders obtained in a range of 4000 C-8000 C were isostatically pressed, and sintered at 11000 C and 12000 C in saturated Pb O atmosphere. Rhombohedral sintered PZT was obtained with 7,78 g.cm-3 at 12000 C. (author). 123 refs, 53 figs, 32 tabs

  8. Alkali absorption and citrate excretion in calcium nephrolithiasis

    Science.gov (United States)

    Sakhaee, K.; Williams, R. H.; Oh, M. S.; Padalino, P.; Adams-Huet, B.; Whitson, P.; Pak, C. Y.

    1993-01-01

    The role of net gastrointestinal (GI) alkali absorption in the development of hypocitraturia was investigated. The net GI absorption of alkali was estimated from the difference between simple urinary cations (Ca, Mg, Na, and K) and anions (Cl and P). In 131 normal subjects, the 24 h urinary citrate was positively correlated with the net GI absorption of alkali (r = 0.49, p < 0.001). In 11 patients with distal renal tubular acidosis (RTA), urinary citrate excretion was subnormal relative to net GI alkali absorption, with data from most patients residing outside the 95% confidence ellipse described for normal subjects. However, the normal relationship between urinary citrate and net absorbed alkali was maintained in 11 patients with chronic diarrheal syndrome (CDS) and in 124 stone-forming patients devoid of RTA or CDS, half of whom had "idiopathic" hypocitraturia. The 18 stone-forming patients without RTA or CDS received potassium citrate (30-60 mEq/day). Both urinary citrate and net GI alkali absorption increased, yielding a significantly positive correlation (r = 0.62, p < 0.0001), with the slope indistinguishable from that of normal subjects. Thus, urinary citrate was normally dependent on the net GI absorption of alkali. This dependence was less marked in RTA, confirming the renal origin of hypocitraturia. However, the normal dependence was maintained in CDS and in idiopathic hypocitraturia, suggesting that reduced citrate excretion was largely dietary in origin as a result of low net alkali absorption (from a probable relative deficiency of vegetables and fruits or a relative excess of animal proteins).

  9. Thrombolytic-plus-Anticoagulant Therapy versus Anticoagulant-Alone Therapy in Submassive Pulmonary Thromboembolism (TVASPE Study): A Randomized Clinical Trial

    OpenAIRE

    Maryam Taherkhani; Adineh Taherkhani; SeyedReza Hashemi; Taraneh Faghihi-Langroodi; Roxana Sadeghi; Mohammadreza Beyranvand

    2014-01-01

    Background: The use of thrombolytic agents in the treatment of hemodynamically stable patients with acute submassive pulmonary embolism (PTE) remains controversial. We, therefore, conducted this study to compare the effect of thrombolytic plus anticoagulation versus anticoagulation alone on early death and adverse outcome following submassive PTE.Methods: We conducted a study of patients with acute pulmonary embolism and pulmonary hypertension or right ventricular dilatation/dysfunction but w...

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

    DEFF Research Database (Denmark)

    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...

  11. Changing trends in anti-coagulant therapies. Are heparins and oral anti-coagulants challenged?

    Science.gov (United States)

    Fareed, J; Iqbal, O; Cunanan, J; Demir, M; Wahi, R; Clarke, M; Adiguzel, C; Bick, R

    2008-06-01

    The conventional management of thrombotic and cardiovascular disorders is based on the use of heparin, oral anticoagulants and aspirin. Despite progress in the sciences, these drugs still remain a challenge and mystery. The development of low molecular weight heparins (LMWHS) and the synthesis of heparinomimetics represent a refined use of heparin. Additional drugs will continue to develop. However, none of these drugs will ever match the polypharmacology of heparin. Aspirin still remains the leading drug in the management of thrombotic and cardiovascular disorders. The newer antiplatelet drugs such as adenosine diphosphate receptor inhibitors, GPIIb/IIIa inhibitors and other specific inhibitors have limited effects and have been tested in patients who have already been treated with aspirin. Warfarin provides a convenient and affordable approach in the long-term outpatient management of thrombotic disorders. The optimized use of these drugs still remains the approach of choice to manage thrombotic disorders. The new anticoagulant targets, such as tissue factor, individual clotting factors, recombinant forms of serpins (antithrombin, heparin co-factor II and tissue factor pathway inhibitors), recombinant activated protein C, thrombomodulin and site specific serine proteases inhibitors complexes have also been developed. There is a major thrust on the development of orally bioavailable anti-Xa and IIa agents, which are slated to replace oral anticoagulants. Both the anti-factor Xa and anti-IIa agents have been developed for oral use and have provided impressive clinical results. However, safety concerns related to liver enzyme elevations and thrombosis rebound have been reported with their use. For these reasons, the US Food and Drug Administration did not approve the orally active antithrombin agent Ximelagatran for several indications. The synthetic pentasaccharide (Fondaparinux) has undergone clinical development. Unexpectedly, Fondaparinux also produced major

  12. Bacillus cereus iron uptake protein fishes out an unstable ferric citrate trimer.

    Science.gov (United States)

    Fukushima, Tatsuya; Sia, Allyson K; Allred, Benjamin E; Nichiporuk, Rita; Zhou, Zhongrui; Andersen, Ulla N; Raymond, Kenneth N

    2012-10-16

    Citrate is a common biomolecule that chelates Fe(III). Many bacteria and plants use ferric citrate to fulfill their nutritional requirement for iron. Only the Escherichia coli ferric citrate outer-membrane transport protein FecA has been characterized; little is known about other ferric citrate-binding proteins. Here we report a unique siderophore-binding protein from the gram-positive pathogenic bacterium Bacillus cereus that binds multinuclear ferric citrate complexes. We have demonstrated that B. cereus ATCC 14579 takes up (55)Fe radiolabeled ferric citrate and that a protein, BC_3466 [renamed FctC (ferric citrate-binding protein C)], binds ferric citrate. The dissociation constant (K(d)) of FctC at pH 7.4 with ferric citrate (molar ratio 1:50) is 2.6 nM. This is the tightest binding observed of any B. cereus siderophore-binding protein. Nano electrospray ionization-mass spectrometry (nano ESI-MS) analysis of FctC and ferric citrate complexes or citrate alone show that FctC binds diferric di-citrate, and triferric tricitrate, but does not bind ferric di-citrate, ferric monocitrate, or citrate alone. Significantly, the protein selectively binds triferric tricitrate even though this species is naturally present at very low equilibrium concentrations.

  13. 77 FR 33167 - Citric Acid and Certain Citrate Salts From the People's Republic of China: Preliminary Results of...

    Science.gov (United States)

    2012-06-05

    ... sizes of citric acid, sodium citrate, and potassium citrate in their unblended forms, whether dry or in solution, and regardless of packaging type. The scope also includes blends of citric acid, sodium citrate... form(s) of citric acid, sodium citrate, and potassium citrate constitute 40 percent or more, by...

  14. 76 FR 34048 - Citric Acid and Certain Citrate Salts From the People's Republic of China: Preliminary Results of...

    Science.gov (United States)

    2011-06-10

    ... all grades and granulation sizes of citric acid, sodium citrate, and potassium citrate in their... blends of citric acid, sodium citrate, and potassium citrate; as well as blends with other ingredients, such as sugar, where the unblended form(s) of citric acid, sodium citrate, and potassium...

  15. 76 FR 33219 - Citric Acid and Certain Citrate Salts from the People's Republic of China: Preliminary Results of...

    Science.gov (United States)

    2011-06-08

    ..., sodium citrate, and potassium citrate in their unblended forms, whether dry or in solution, and regardless of packaging type. The scope also includes blends of citric acid, sodium citrate, and potassium... acid, sodium citrate, and potassium citrate constitute 40 percent or more, by weight, of the blend....

  16. 77 FR 47370 - Citric Acid and Certain Citrate Salts from the People's Republic of China: Intent To Rescind...

    Science.gov (United States)

    2012-08-08

    ..., sodium citrate, and potassium citrate in their unblended forms, whether dry or in solution, and regardless of packaging type. The scope also includes blends of citric acid, sodium citrate, and potassium... acid, sodium citrate, and potassium citrate constitute 40 percent or more, by weight, of the blend....

  17. Characterization of cylindrical and strip-shaped tamoxifen citrate-loaded biodegradable implants

    Directory of Open Access Journals (Sweden)

    Jagadeesh G Hiremath

    2011-01-01

    Full Text Available The aim of this study was to prepare tamoxifen citrate (TC-loaded cylindrical and strip-shaped polymeric subdermal implants. The implant was based on poly(ε-caprolactone, a low-melting, biodegradable and biocompatible polymer. Polyethylene glycol (PEG 4000 was used to enhance solubility and release of the drug in the phosphate buffer saline pH 7.4. Implants were prepared by a standardized melt manufacturing method. The prepared implants were evaluated for their physicochemical parameters and drug content in implants by UV spectrophotometric method. PCL-based implants were characterized by Fourier transform infrared spectroscopy (FT-IR, differential scanning calorimetry, X-ray diffraction studies (XRD and scanning electron microscopy (SEM. DSC studies showed that the TC in the implants was in the amorphous state. In vitro drug release studies were performed in methanol:phosphate-buffered saline (pH 7.4 at 37±2°C by using horizontal water bath shaker. Stability study was carried out for 90 days, there was no significant change in drug content and other parameters of the PCL-based formulations.

  18. New oral anticoagulants: an emergency department overview.

    Science.gov (United States)

    Wood, Peter

    2013-12-01

    As of September 2013, three new oral anticoagulants (NOACs) are now available for clinical use on the Pharmaceutical Benefits Scheme in Australia. All three are for stroke prevention in atrial fibrillation, and one will also be available for the treatment of deep venous thrombosis and pulmonary embolism. All have been evaluated in large, multicentre randomised clinical trials. These drugs show at least equivalent efficacy to the current standard of care, the vitamin K antagonist warfarin. Major bleeding rates are overall comparable with warfarin, but there is an important reduction in intracranial bleeding of approximately 50% with all NOAC agents. The NOACs are administered in a simple, fixed dose regimen. There are a few clinically important interactions with other medications or diet. Concerns exist about the potential for irreversible bleeding in the small number of patients in which that occurs. This short report will discuss the pharmacology of these agents, the indications for use, aspects of laboratory monitoring and the management of bleeding with these agents. PMID:24224462

  19. New oral anticoagulants: will they replace warfarin?

    Science.gov (United States)

    Little, James W

    2012-05-01

    Vitamin K antagonists, such as warfarin, are considered to be the treatment of choice to prevent thromboembolic events, but problems, such as the need for frequent dose adjustment and monitoring of coagulation status, as well as multiple drug and food interactions, make their use difficult for both physician and patient. Two new anticoagulants are now being considered as possible replacements of vitamin K antagonists. Dabigatran, an oral direct thrombin inhibitor has already been approved in the USA for prevention of stroke in patients with atrial fibrillation. Rivaroxaban, a factor Xa inhibitor, and dabigatran are licensed in Europe and Canada for short-term thromboprophylaxis after elective hip or knee replacement surgery. The advantages of these drugs are that they are safe and effective, require no monitoring, have a direct mode of action against only one clotting factor (thrombin or factor Xa), have limited drug interactions, and have rapid peak blood levels. Based on the fact that dabigatran has already been approved for use in the USA, it would appear that it has an advantage over rivaroxaban in becoming the replacement drug for vitamin K antagonists. PMID:22668618

  20. Glucose-6-phosphate dehydrogenase

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003671.htm Glucose-6-phosphate dehydrogenase test To use the sharing features on this page, please enable JavaScript. Glucose-6-phosphate dehydrogenase (G6PD) is a type of ...

  1. Theoretical Study on Sulfur Dioxide Absorption with Citrate Solution

    Institute of Scientific and Technical Information of China (English)

    薛娟琴; 洪涛; 王召启; 李林波

    2006-01-01

    The citrate absorption of SO2 is currently one of the most successful and economic methods to harness sulfur dioxide pollution.In order to theoretically elucidate the mechanism of SO2 absorption by citrate solution and provide theoretical instruction for experiments and industrial process, the theory of multi-buffer solution, combined with computer numerical calculation methods, was applied to study the distribution parameters of the components of the citrate solution in the process of SO2 absorption and the following results were obtained: (1) HCi2- and H2Ci- in the citrate solution played the dominant role in the absorption and desorption processes; (2) Through the calculation for the buffer capacity of citrate solution, it was found that the pH of the absorption and desorption solution should be in the range of 2~8, while at pH=4.5 the buffer capacity reached its maximum. Some valuable parameters were obtained, which are instructive to the ensuing experiments and industrial design.

  2. Small-angle neutron scattering studies of mineralization on BSA coated citrate capped gold nanoparticles used as a model surface for membrane scaling in RO wastewater desalination.

    Science.gov (United States)

    Dahdal, Y N; Pipich, V; Rapaport, H; Oren, Y; Kasher, R; Schwahn, D

    2014-12-23

    Bovine serum albumin (BSA) coated on citrate capped gold nanoparticles (BSA-GNPs) was exposed to a simulated wastewater effluent (SSE) in order to study the mineralization and thereby mimic scaling at biofouled membranes of reverse osmosis (RO) wastewater desalination plants. RO is a leading technology of achieving freshwater quality as it has the capability of removing both dissolved inorganic salts and organic contaminants from tertiary wastewater effluents. The aim was to better understand one of the major problems facing this technology which is fouling of the membranes, mainly biofouling and scaling by calcium phosphate. The experiments were performed using the small-angle neutron scattering (SANS) technique. The nanoparticles, GNPs, stabilized by the citrate groups showed 30 Å large particles having a homogeneous distribution of gold and citrate with a gold volume fraction of the order of 1%. On the average two BSA monomers are grafted at 2.4 GNPs. The exposed BSA-GNPs to SSE solution led to immediate mineralization of stable composite particles of the order of 0.2 μm diameter and a mineral volume fraction between 50% and 80%. The volume fraction of the mineral was of the order of 10(-5), which is roughly 3 times larger but an order of magnitude smaller than the maximum possible contents of respectively calcium phosphate and calcium carbonate in the SSE solution. Considering the extreme low solubility product of calcium phosphate, we suggest total calcium phosphate and partially (5-10%) calcium carbonate formation in the presence of BSA-GNPs.

  3. Increased mortality in patients with the lupus anticoagulant: the Vienna Lupus Anticoagulant and Thrombosis Study (LATS).

    Science.gov (United States)

    Gebhart, Johanna; Posch, Florian; Koder, Silvia; Perkmann, Thomas; Quehenberger, Peter; Zoghlami, Claudia; Ay, Cihan; Pabinger, Ingrid

    2015-05-28

    Data on the clinical course of lupus anticoagulant (LA)-positive individuals with or without thrombotic manifestations or pregnancy complications are limited. To investigate mortality rates and factors that might influence mortality, we conducted a prospective observational study of LA-positive individuals. In total, 151 patients (82% female) were followed for a median of 8.2 years; 30 of the patients (20%) developed 32 thromboembolic events (15 arterial and 17 venous events) and 20 patients (13%) died. In univariable analysis, new onset of thrombosis (hazard ratio [HR] = 8.76; 95% confidence interval [CI], 3.46-22.16) was associated with adverse survival. Thrombosis remained a strong adverse prognostic factor after multivariable adjustment for age and hypertension (HR = 5.95; 95% CI, 2.43-14.95). Concomitant autoimmune diseases, anticoagulant treatment at baseline, or positivity for anticardiolipin- or anti-β2-glycoprotein I antibodies were not associated with mortality. In a relative survival analysis, our cohort of LA positives showed a persistently worse survival in comparison with an age-, sex-, and study-inclusion-year-matched Austrian reference population. The cumulative relative survival was 95.0% (95% CI, 88.5-98.8) after 5 years and 87.7% (95% CI, 76.3-95.6) after 10 years. We conclude that occurrence of a thrombotic event is associated with higher mortality in patients with LA. Consequently, the prevention of thromboembolic events in LA positives might improve survival.

  4. Major cerebral events in Staphylococcus aureus infective endocarditis: is anticoagulant therapy safe?

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus V; Snygg-Martin, Ulrika; Olaison, Lars;

    2009-01-01

    OBJECTIVES: To study the impact of anticoagulation on major cerebral events in patients with left-sided Staphylococcus aureus infective endocarditis (IE). METHODS: A prospective cohort study; the use of anticoagulation and the relation to major cerebral events was evaluated separately at onset......-hospital mortality was 23% (95% CI: 17-29%), and there was no significant difference between those with or without anticoagulation. CONCLUSIONS: We found no increased risk of cerebral haemorrhage in S. aureus IE patients receiving anticoagulation. Anticoagulation was associated with a reduced risk of cerebral events...... before initiation of antibiotics. Data support the continuance of anticoagulation in S. aureus IE patients when indicated....

  5. Alkali absorption and citrate excretion in calcium nephrolithiasis

    Science.gov (United States)

    Sakhaee, K.; Williams, R. H.; Oh, M. S.; Padalino, P.; Adams-Huet, B.; Whitson, P.; Pak, C. Y.

    1993-01-01

    The role of net gastrointestinal (GI) alkali absorption in the development of hypocitraturia was investigated. The net GI absorption of alkali was estimated from the difference between simple urinary cations (Ca, Mg, Na, and K) and anions (Cl and P). In 131 normal subjects, the 24 h urinary citrate was positively correlated with the net GI absorption of alkali (r = 0.49, p mEq/day). Both urinary citrate and net GI alkali absorption increased, yielding a significantly positive correlation (r = 0.62, p reduced citrate excretion was largely dietary in origin as a result of low net alkali absorption (from a probable relative deficiency of vegetables and fruits or a relative excess of animal proteins).

  6. Development of macroporous calcium phosphate scaffold processed via microwave rapid drying

    International Nuclear Information System (INIS)

    Porous hydroxyapatite (HA) scaffold has great potential in bone tissue engineering applications. A new method to fabricate macroporous calcium phosphate (CP) scaffold via microwave irradiation, followed by conventional sintering to form HA scaffold was developed. Incorporation of trisodium citrate dihydrate and citric acid in the CP mixture gave macroporous scaffolds upon microwave rapid drying. In this work, a mixture of β-tricalcium phosphate (β-TCP), calcium carbonate (CaCO3), trisodium citrate dihydrate, citric acid and double distilled de-ionised water (DDI) was exposed to microwave radiation to form a macroporous structure. Based on gross eye examinations, addition of trisodium citrate at 30 and 40 wt.% in the CP mixture (β-TCP and CaCO3) without citric acid indicates increasing order of pore volume where the highest porosity yield was observed at 40 wt.% of trisodium citrate addition and the pore size was detected at several millimeters. Therefore, optimization of pore size was performed by adding 3-7 wt.% of citric acid in the CP mixture which was separately mixed with 30 and 40 wt.% of trisodium citrate for comparison purposes. Fabricated scaffolds were calcined at 600 deg. C and washed with DDI water to remove the sodium hydroxycarbonate and sintered at 1250 deg. C to form HA phase as confirmed in the X-ray diffraction (XRD) results. Based on Archimedes method, HA scaffolds prepared from 40 wt.% of trisodium citrate with 3-7 wt.% of citric acid added CP mixture have an open and interconnected porous structure ranging from 51 to 53 vol.% and observation using Scanning electron microscope (SEM) showed the pore size distribution between 100 and 500 μm. The cytotoxicity tests revealed that the porous HA scaffolds have no cytotoxic potential on MG63 osteoblast-like cells which might allow for their use as biomaterials.

  7. Efficacy of preventing hemodialysis catheter infections with citrate lock.

    Science.gov (United States)

    Silva, Jorge; Antunes, Jorge; Carvalho, Telmo; Ponce, Pedro

    2012-10-01

    Prevalent use of tunneled dialysis catheters can reach 30%. Infection remains the most serious catheter-related problem. Catheter locks are increasingly used for prevention, but are not yet recommended either by the Food and Drug Association or European Medicines Agency, on the basis of increasing bacterial resistance or lock toxicity. The aim was to test safety and effectiveness of citrate. A prospective, interventional study was conducted to assess the safety and efficacy of a 30% citrate lock in preventing catheter-related bacteremia (CRB). A total of 157 prevalent tunneled catheters were locked with citrate and prospectively followed during a 1-year period. The primary endpoint was first CRB diagnosed according to two of the diagnostic criteria for Catheter Infection of Centers for Disease Control and Prevention (CDC), namely definite and probable infection. The CDC criterion of possible but not proved infection was not considered. This citrate lock cohort (n = 157) had 10 episodes of CRB. We observed 0.49 CRB episodes/1000 patient-days and the mean infection-free catheter day was 130.6 ± 100.9. No clinically relevant adverse events were observed. No proved tunnel or exit site infection was observed and no patients died because of CRB. Catheter obstruction episodes were reported on 69 occasions out of 14 catheters. These results were compared with an historical cohort from a previous study of catheter locking with low-dose gentamicin and did not show significant difference in efficacy. Citrate lock is effective in preventing CRB. No toxicity was observed. The use of citrate lock may have advantages over antibiotic locks: no reported bacterial resistance, lower industrial cost, and less manipulation. PMID:22515732

  8. Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)?

    Science.gov (United States)

    Fernandes, Carina; Pereira, Pedro; Rodrigues, Miguel

    2015-01-01

    Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome. PMID:25750219

  9. Effect of sildenafil citrate on penile erection of rhesus macaques

    Institute of Scientific and Technical Information of China (English)

    Xun-BinHuang; Cheng-LiangXiong; Cheng-GaoYu; Jie-LingZhou; Ji-YunShen

    2004-01-01

    Aim: To examine the effect of sildenafil citrate on penile erection of male rhesus macaque. Methods:Twenty Macaca mulatta were divided into the sildenafil treated and the control groups of l0 animals each. The penile size, the corpus cavernosal electromyogram (EMG) and the intra-corpus cavernosal pressure (ICP) were determined. Results: The diameter of penis and the ICP were significantly increased and the corpus cavernosal EMG significantly reduced in the sildenafil group. Conclusion: Sildenafil citrate increases the penile size and ICP and reduces the corpus cavernosal EMG in male rhesus macaque. (Asian J Androl 2004 Sep; 6: 233-235)

  10. Novel oral anticoagulants in secondary prevention of stroke.

    Science.gov (United States)

    Diener, H C; Easton, J D; Hankey, G J; Hart, R G

    2013-06-01

    In patients with atrial fibrillation (AF) oral anticoagulation with vitamin-K antagonists (warfarin, phenprocoumon) is effective both for primary and secondary stroke prevention yielding a 60-70% relative reduction in stroke risk compared with placebo, as well as a mortality reduction of 26 percent. Vitamin-K antagonists have a number of well documented shortcomings. Recently the results of randomised trials for three new oral anticoagulants that do not exhibit the limitations of vitamin-K antagonists have been published. These include direct factor Xa inhibitors (rivaroxaban and apixaban) and a direct thrombin inhibitor (dabigatran). The studies (RE-LY, ROCKET-AF, ARISTOTLE, AVERROES) provide promising results for the new agents, including higher efficacy and a significantly lower incidence of intracranial bleeds compared with warfarin or aspirin. The new drugs show similar results in secondary as well as in primary stroke prevention in patients with AF. Apixaban was demonstrated to be clearly superior to aspirin and had the same rate of major bleeding complications. Meta-analyses show that the novel anticoagulants are superior to warfarin for the reduction of stroke, major bleeding and intracranial bleeds. New anticoagulants add to the therapeutic options for patients with AF, and offer a number of advantages over warfarin, for both the clinician and patient, including a favorable bleeding profile and convenience of use. Aspirin is no longer an option in secondary stroke prevention in patients with atrial fibrillation. Consideration of these new anticoagulants will improve clinical decision making. PMID:23953901

  11. Novel oral anticoagulants in secondary prevention of stroke.

    Science.gov (United States)

    Diener, H C; Easton, J D; Hankey, G J; Hart, R G

    2013-06-01

    In patients with atrial fibrillation (AF) oral anticoagulation with vitamin-K antagonists (warfarin, phenprocoumon) is effective both for primary and secondary stroke prevention yielding a 60-70% relative reduction in stroke risk compared with placebo, as well as a mortality reduction of 26 percent. Vitamin-K antagonists have a number of well documented shortcomings. Recently the results of randomised trials for three new oral anticoagulants that do not exhibit the limitations of vitamin-K antagonists have been published. These include direct factor Xa inhibitors (rivaroxaban and apixaban) and a direct thrombin inhibitor (dabigatran). The studies (RE-LY, ROCKET-AF, ARISTOTLE, AVERROES) provide promising results for the new agents, including higher efficacy and a significantly lower incidence of intracranial bleeds compared with warfarin or aspirin. The new drugs show similar results in secondary as well as in primary stroke prevention in patients with AF. Apixaban was demonstrated to be clearly superior to aspirin and had the same rate of major bleeding complications. Meta-analyses show that the novel anticoagulants are superior to warfarin for the reduction of stroke, major bleeding and intracranial bleeds. New anticoagulants add to the therapeutic options for patients with AF, and offer a number of advantages over warfarin, for both the clinician and patient, including a favorable bleeding profile and convenience of use. Aspirin is no longer an option in secondary stroke prevention in patients with atrial fibrillation. Consideration of these new anticoagulants will improve clinical decision making.

  12. Anticoagulant rodenticide poisoning in animals of Apulia and Basilicata, Italy.

    Science.gov (United States)

    Muscarella, Marilena; Armentano, Antonio; Iammarino, Marco; Palermo, Carmen; Amorena, Michele

    2016-06-30

    This study evaluates the presence of anticoagulant rodenticides in animals with a diagnosis of suspected poisoning and in bait samples. The survey was carried out from 2010 to 2012, in 2 regions of South Italy (Puglia and Basilicata) on 300 organs of animals and 90 suspected bait samples. The qualitative and quantitative analyses were conducted using an analytical method based on high‑performance liquid chromatography (HPLC) with fluorimetric detection (FLD) for the simultaneous determination of 8 anticoagulant rodenticides (bromadiolone, brodifacoum, coumachlor, coumafuryl, coumatetralyl, difenacoum, flocoumafen, and warfarin). The presence of anticoagulant rodenticides was detected in 33 organs of animals (11% of the total) and 6 bait samples (7% of the total). The most commonly detected compound was coumachlor (47% of 39 positive samples) followed by bromadiolone (24%), and brodifacoum (11%). The species mostly involved in anticoagulant rodenticide poisoning were dogs and cats. This study emphasizes the relevance of the determinations of anticoagulant rodenticides in cases of suspected poisoning in veterinary practice. PMID:27393877

  13. Pharmacology of new oral anticoagulants: mechanism of action, pharmacokinetics, pharmacodynamics

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2013-12-01

    Full Text Available Due to their mechanism of action, the new oral anticoagulants are named direct oral anticoagulants (DOACs. Dabigatran is a selective, competitive, direct inhibitor of thrombin (Factor IIa while rivaroxaban, apixaban and edoxaban act by directly inhibiting the activated Factor X (FXa in a selective and competitive manner. DOACs have a relatively short half-life and almost immediate anticoagulant activity, and rapidly reach the plasma peak concentration. Therefore, they do not need a phase of overlapping with parenteral anticoagulants. After their withdrawal, their removal is sufficiently rapid, although influenced by renal function. Dabigatran is the only DOACs to be administered as a pro-drug and becomes active after drug metabolization. The route of elimination of dabigatran is primarily renal, whereas FXa inhibitors are mainly eliminated by the biliary-fecal route. The drug interactions of DOACs are mainly limited to drugs that act on P-glycoprotein for dabigatran and on P-glycoprotein and/or cytochrome P3A4 for anti-Xa. DOACs have no interactions with food. Given their linear pharmacodynamics, with a predictable dose/response relationship and anticoagulant effect, DOACs are administered at a fixed dose and do not require routine laboratory monitoring.

  14. Adherence to oral anticoagulant therapy in secondary stroke prevention – impact of the novel oral anticoagulants

    Directory of Open Access Journals (Sweden)

    Luger S

    2015-11-01

    Full Text Available Sebastian Luger,1 Carina Hohmann,2 Daniela Niemann,1 Peter Kraft,3 Ignaz Gunreben,3 Tobias Neumann-Haefelin,2 Christoph Kleinschnitz,3 Helmuth Steinmetz,1 Christian Foerch,1 Waltraud Pfeilschifter1 1Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, 2Department of Neurology, Klinikum Fulda gAG, Fulda, 3Department of Neurology, University Hospital Würzburg, Würzburg, Germany Background: Oral anticoagulant therapy (OAT potently prevents strokes in patients with atrial fibrillation. Vitamin K antagonists (VKA have been the standard of care for long-term OAT for decades, but non-VKA oral anticoagulants (NOAC have recently been approved for this indication, and raised many questions, among them their influence on medication adherence. We assessed adherence to VKA and NOAC in secondary stroke prevention. Methods: All patients treated from October 2011 to September 2012 for ischemic stroke or transient ischemic attack with a subsequent indication for OAT, at three academic hospitals were entered into a prospective registry, and baseline data and antithrombotic treatment at discharge were recorded. At the 1-year follow-up, we assessed the adherence to different OAT strategies and patients’ adherence to their respective OAT. We noted OAT changes, reasons to change treatment, and factors that influence persistence to the prescribed OAT. Results: In patients discharged on OAT, we achieved a fatality corrected response rate of 73.3% (n=209. A total of 92% of these patients received OAT at the 1-year follow-up. We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243 with a statistically nonsignificant tendency toward a weaker adherence to dabigatran. Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence. Conclusion: One-year adherence to OAT after stroke is strong (>90% and patients

  15. NEW ORAL ANTICOAGULANTS IN THE THERAPY OF ANTIPHOSPHOLIPID SYNDROME

    Directory of Open Access Journals (Sweden)

    M. A. Satybaldyeva

    2016-01-01

    Full Text Available The vitamin K antagonist warfarin is an essential medicine from a group of anticoagulants, which is used to treat antiphospholipid syndrome (APS. However, it has a number of disadvantages especially in patients who need longterm and frequently lifetime prevention of thromboses. New oral anticoagulants, such as dabigatran etexilate (Pradaxa®, rivaroxaban (Xarelto®, apixaban (Eliquis and others, have been recently synthesized. Unlike warfarin, they are administered at fixed doses, require neither routine monitoring nor diet, and interact with drugs only in small amounts. The new oral anticoagulants have been approved for certain indications, but the data of performed trials are inapplicable to patients with APS. These medicines are expected to improve quality of life in patients with this condition. 

  16. Pharmacokinetic and pharmacodynamic properties of oral anticoagulants, especially phenprocoumon.

    Science.gov (United States)

    Haustein, K O

    1999-01-01

    Anticoagulants of the cumarin-type (warfarin, phenprocoumon, and acenocoumarol) are drugs for the long-term treatment and prevention of thromboembolic disorders. Because of their narrow therapeutic range, many patients have bleedings of variable severity or have recurrent thrombotic events. For this reason, the study of the pharmacokinetic parameters of phenprocoumon (PPC), considering its influence on blood clotting factors, is of high interest. The elimination kinetics of PPC, its interaction with phytomenadion (vitamin K), and the pharmacokinetic behavior of the anticoagulant under steady-state conditions have been investigated in studies with healthy volunteers and patients taking anticoagulants. The maintenance dose and the plasma levels of PPC were correlated with prothrombin time (PT) in 89 patients treated with PPC. Varying parameters in each patient (e.g., elimination kinetics of PPC, activity of the cumarin-dependent blood-clotting factors, endogenous phytomenadion stores), render it impossible to use a different means of monitoring than that of PT determination. PMID:10327214

  17. A pharmacologic overview of current and emerging anticoagulants.

    Science.gov (United States)

    Nutescu, Edith A; Shapiro, Nancy L; Chevalier, Aimee; Amin, Alpesh N

    2005-04-01

    For over 50 years, anticoagulant options for the treatment and prevention of thrombosis have been limited mainly to traditional agents such as unfractionated heparin and oral vitamin K antagonists such as warfarin. These traditional agents are fraught with limitations that complicate their clinical use. A variety of novel anticoagulants with improved pharmacologic and clinical profiles have recently been introduced or are in development, offering benefits over traditional therapies. Specifically, progress has been made in the development of low-molecular-weight heparins, factor Xa inhibitors, and direct thrombin inhibitors. Because of their convenience and ease of use, some of these novel compounds are competing with the traditional anticoagulants and are needed additions to the antithrombotic arsenal. PMID:15853173

  18. Evaluating the impact of new anticoagulants in the hospital setting

    Directory of Open Access Journals (Sweden)

    Braidy N

    2011-03-01

    Full Text Available The short-comings of current anticoagulants have led to the development of newer, albeit more expensive, oral alternatives.Objective: To explore the potential impact the new anticoagulants dabigatran and rivaroxaban in the local hospital setting, in terms of utilisation and subsequent costing.Method: A preliminary costing analysis was performed based on a prospective 2-week clinical audit (29th June - 13th July 2009. Data regarding current anticoagulation management were extracted from the medical files of patients admitted to Ryde Hospital. To model potential costing implications of using the newer agents, the reported incidence of VTE/stroke and bleeding events were obtained from key clinical trials.Results: Data were collected for 67 patients treated with either warfarin (n=46 or enoxaparin (n=21 for prophylaxis of VTE/stroke. At least two-thirds of all patients were deemed suitable candidates for the use of newer oral anticoagulants (by current therapy: warfarin: 65.2% (AF, 34.8% (VTE; enoxaparin: 100%, (VTE. The use of dabigatran in VTE/stroke prevention was found to be more cost-effective than warfarin and enoxaparin due to significantly lower costs of therapeutic monitoring and reduced administration costs. Rivaroxaban was more cost-effective than warfarin and enoxaparin for VTE/stroke prevention when supplier-rebates (33% were factored into costing.Conclusion: This study highlights the potential cost-effectiveness of newer anticoagulants, dabigatran and rivaroxaban, compared to warfarin and enoxaparin. These agents may offer economic advantages, as well as clinical benefits, in the hospital-based management of anticoagulated patients.

  19. Polymeric architectures of bismuth citrate based on dimeric building blocks

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Four bismuth complexes, (H2En)[Bi2(cit)2(H2O)4/3]·(H2O)x (1), (H2En)3[Bi2(cit)2Cl4]·(H2O)x (2), (HPy)2[Bi2(cit)2(H2O)8/5]·(H2O)x (3) and (H2En)[Bi2(cit)2](H2O)x (4) [cit = citrate4-; En = ethylenediamine; Py = pyridine] have been synthesized and crystallized. The crystal structures reveal that the basic building blocks in all of these complexes are bismuth citrate dimeric units which combine to form polymeric architectures. The embedded protonated ethylenediamine and pyridine moieties in the polymeric frameworks have been identified by X-ray crystallography and solid-state cross polarization/magic angle spinning (CP/MAS) 13C NMR. Based on the framework of complex 1, a structural model of a clinically used antiulcer drug, ranitidine bismuth citrate (RBC) was generated. The behavior of the protonated amine-bismuth citrate complexes in acidic aqueous solution has been studied by electrospray ionization-mass spectrometry (ESI-MS).

  20. Genetics of mesophilic citrate fermenting lactic acid bacteria.

    NARCIS (Netherlands)

    David, S.

    1992-01-01

    A prerequisite for the stabilization of important features, such as aroma production, in starter strains used in dairy fermentations, is an extensive knowledge of the genetic basis of these properties. In this thesis the genetic basis of citrate metabolism in Lactococcus lactis subsp. lactis var. di

  1. Enhanced citrate production through gene insertion in Aspergillus niger

    DEFF Research Database (Denmark)

    Jongh, Wian de; Nielsen, Jens

    2007-01-01

    The effect of inserting genes involved in the reductive branch of the tricarboxylic acid (TCA) cycle on citrate production by Aspergillus niger was evaluated. Several different genes were inserted individually and in combination, i.e. malate dehydrogenase (mdh2) from Saccharomyces cerevisiae, two...

  2. Tumour imaging using technetium-99m-citrate

    International Nuclear Information System (INIS)

    Sixteen patients with soft tissue malignancy or fibroadenoma of the breast (Group A) were imaged using 99mTc-citrate. Majority of the patients (n=14) has new untreated lesions. Appreciable skeletal uptake of the tracer was serendipitously noticed in all cases. One of these had widespread bone metastases seen almost identically in 99mTc-citrate and 99mTc-MDP studies. Accordingly, 10 patients (Group B) having more than 40 malignant lesions on the bone scan underwent 99mTc-citrate study. In group A, accumulation of the tracer was seen in all malignant breast nodules and axillary lymphnode mass (n=4), medullary carcinoma of the thyroid along with its metastasis and a carcinoid (n=4) and an ovarian malignancy. Uptake and outflow pattern could differentiate fibroadenoma (n=3) from carcinoma of the breast. No significant uptake was seen in liver secondaries (n>10), lymphoma lesions (n=5), papillary carcinoma of thyroid, renal cell and embryonal cell carcinoma. In group B patients, the radiotracer accumulated well in the metastatic lesions while there was distinctly lesser uptake in normal/degenerated joints compared to the bone scan. The study shows potential of the tracer in imaging soft tissue malignancies. Bone scanning with 99mTc-citrate is an interesting possibility since mechanism of its uptake appears to be different to 99mTc-MDP. (author)

  3. Ca2+-Citrate Uptake and Metabolism in Lactobacillus casei ATCC 334

    NARCIS (Netherlands)

    Mortera, Pablo; Pudlik, Agata; Magni, Christian; Alarcon, Sergio; Lolkema, Juke S.

    2013-01-01

    The putative citrate metabolic pathway in Lactobacillus casei ATCC 334 consists of the transporter CitH, a proton symporter of the citrate-divalent metal ion family of transporters CitMHS, citrate lyase, and the membrane-bound oxaloacetate decarboxylase complex OAD-ABDH. Resting cells of Lactobacill

  4. 76 FR 19997 - Determination That FENTORA (Fentanyl Citrate) Buccal Tablet, 300 Micrograms, Was Not Withdrawn...

    Science.gov (United States)

    2011-04-11

    ... HUMAN SERVICES Food and Drug Administration Determination That FENTORA (Fentanyl Citrate) Buccal Tablet... determined that FENTORA (fentanyl citrate) buccal tablet, 300 micrograms (mcg), was not withdrawn from sale... drug applications (ANDAs) for fentanyl citrate buccal tablet, 300 mcg, if all other legal...

  5. Enzyme Basis for pH Regulation of Citrate and Pyruvate Metabolism by Leuconostoc oenos

    NARCIS (Netherlands)

    Ramos, Ana; Lolkema, Juke S.; Konings, Wilhelmus; Santos, Helena

    1995-01-01

    Citrate and pyruvate metabolism by nongrowing cells of Leuconostoc oenos was investigated. 13C nuclear magnetic resonance (NMR) spectroscopy was used to elucidate the pathway of citrate breakdown and to probe citrate or pyruvate utilization, noninvasively, in living cell suspensions. The utilization

  6. Regulatory Impact on Thrombosis Treatment, Prevention, and Anticoagulant Use.

    Science.gov (United States)

    Dannemiller, Robert; Ward, Tucker; Fanikos, John

    2016-10-01

    Thromboembolism afflicts millions of patients annually in the United States and is associated with a significant cost burden. Oral anticoagulants provide clinicians with options for management of these diseases and their use continues to grow. Accordingly, regulatory, legislative, and nonprofit organizations have set performance standards with the goal of improving patient outcomes, ensuring patient safety, and reducing costs. Recent efforts in quality improvement have introduced changes surrounding regulatory requirements, surveillance, litigation, and oversight that clinicians should be familiar with. This article summarizes key updates related to the management of anticoagulant therapy as it relates to thrombosis prevention and treatment. PMID:27637311

  7. Quick reference guide to the new oral anticoagulants.

    Science.gov (United States)

    Hurst, Katherine; Lee, Regent; Handa, Ashok

    2016-06-01

    After the commissioning of new oral anticoagulants for the treatment and prevention of thrombosis, these medications are now widely used within clinical settings. Increasing numbers of patients present to the health services on anticoagulant medications, and it is therefore imperative for surgeons to be aware of the new therapeutic treatments available and how patients will benefit from such interventions. This review highlights the most pertinent learning points for surgeons regarding the indications, pharmacokinetics, and perioperative management of these new oral medications, as a quick reference guide. PMID:27113315

  8. How we treat bleeding associated with direct oral anticoagulants

    Science.gov (United States)

    Marano, Giuseppe; Vaglio, Stefania; Pupella, Simonetta; Liumbruno, Giancarlo M.; Franchini, Massimo

    2016-01-01

    Direct oral anticoagulants are at least as effective as vitamin K antagonists for the prevention and treatment of thromboembolism. Unfortunately, differently from vitamin K antagonists, they have the great drawback of lacking specific antidotes in the case of bleeding or emergency situations such as trauma, stroke requiring thrombolysis, and urgent surgery. The progressive development of antidotes for these new drugs, which, it is hoped, will become available in the near future, will allow better and safer management of the rapid reversal of their anticoagulant effect. PMID:27136433

  9. How we treat bleeding associated with direct oral anticoagulants.

    Science.gov (United States)

    Marano, Giuseppe; Vaglio, Stefania; Pupella, Simonetta; Liumbruno, Giancarlo M; Franchini, Massimo

    2016-09-01

    Direct oral anticoagulants are at least as effective as vitamin K antagonists for the prevention and treatment of thromboembolism. Unfortunately, differently from vitamin K antagonists, they have the great drawback of lacking specific antidotes in the case of bleeding or emergency situations such as trauma, stroke requiring thrombolysis, and urgent surgery. The progressive development of antidotes for these new drugs, which, it is hoped, will become available in the near future, will allow better and safer management of the rapid reversal of their anticoagulant effect. PMID:27136433

  10. Novel oral anticoagulants in the treatment of cerebral venous thrombosis.

    Science.gov (United States)

    Feher, Gergely; Illes, Zsolt; Komoly, Samuel; Hargroves, David

    2016-08-01

    Cerebral venous thrombosis (CVT) is an uncommon cause of stroke with extremely diverse clinical features, predisposing factors, brain imaging findings, and outcome. Anticoagulation is the cornerstone of CVT management, however, it is not supported by high-quality evicence. Novel oral anticoagulants (NOACs) have been extensively studied in patients with deep vein thrombosis, pulmonary embolism and non-valvular atrial fibrillation. The aim of our work was to review the available evidence for NOACs in the treatment of CVT. Based on our literature search there is insufficient evidence to support the use of NOACs in CVT, although case series with rivaroxaban and dabigatran have showed promising results. PMID:25994451

  11. Management of acute stroke in patients taking novel oral anticoagulants

    OpenAIRE

    Hankey, Graeme J; Norrving, Bo; Hacke, Werner; Steiner, Thorsten

    2014-01-01

    Each year, 1·0–2·0% of individuals with atrial fibrillation and 0·1–0·2% of those with venous thromboembolism who are receiving one of the novel oral anticoagulants (dabigatran, rivaroxaban, or apixaban) can be expected to experience an acute ischemic stroke. Additionally, 0·2–0·5% of individuals with atrial fibrillation who are receiving one of the novel oral anticoagulants can be expected to experience an intracranial hemorrhage. This opinion piece addresses the current literature and offer...

  12. [Serious surgical complications associated with chronic anticoagulant therapy].

    Science.gov (United States)

    Pitrák, V; Hadacová, I; Hochová, I; Hoch, J

    2001-06-01

    Chronic anticoagulant treatment is administered mostly for cardiological reasons. Cumarin derivatires are used in the majority of cases (Warfarin, Pelentan). It is necessary to monitor this treatment regularly and to control the dose according to the INR value. Different complications can occur; the haemorrhage represents a serious one. The authors discuss several aspects of anticoagulant therapy and possible prevention of the complications. The importance of the problems is demonstrated on the authors' clinical experience--two cases of haemorrhage after Warfarin administration simulating an acute surgical event. PMID:11482149

  13. Novel oral anticoagulants in the treatment of cerebral venous thrombosis

    DEFF Research Database (Denmark)

    Feher, G; Illes, Z; Komoly, S;

    2015-01-01

    Cerebral venous thrombosis (CVT) is an uncommon cause of stroke with extremely diverse clinical features, predisposing factors, brain imaging findings, and outcome. Anticoagulation is the cornerstone of CVT management, however, it is not supported by high-quality evicence. Novel oral anticoagulants...... (NOACs) have been extensively studied in patients with deep vein thrombosis (DVT), pulmonary embolism (PE) and non-valvular atrial fibrillation (NVAF). The aim of our work to review the available evidence for NOACs in the treatment of CVT. Based on our literature search there is insufficient evidence...

  14. Phosphate metabolism and vitamin D

    OpenAIRE

    Fukumoto, Seiji

    2014-01-01

    Phosphate plays many essential roles in our body. To accomplish these functions, serum phosphate needs to be maintained in a certain range. Serum phosphate level is regulated by intestinal phosphate absorption, renal phosphate handling and equilibrium of extracellular phosphate with that in bone or intracellular fluid. Several hormones such as parathyroid hormone, 1,25-dihydroxyvitamin D (1,25(OH)2D) and fibroblast growth factor 23 (FGF23) regulate serum phosphate by modulating intestinal pho...

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

    Directory of Open Access Journals (Sweden)

    D. A. Sychev

    2013-01-01

    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.

  16. Long-term anticoagulation in patients with coronary disease, and future developments.

    NARCIS (Netherlands)

    Verheugt, F.W.A.

    2008-01-01

    PURPOSE OF REVIEW: As anticoagulant therapy is a cornerstone in the early management of acute coronary syndrome, the question remains whether long-term anticoagulation after discharge will further improve outcome. RECENT FINDINGS: Major trials demonstrated benefit from routine oral anticoagulation w

  17. Multinational development of a questionnaire assessing patient satisfaction with anticoagulant treatment: the 'Perception of Anticoagulant Treatment Questionnaire' (PACT-Q©

    Directory of Open Access Journals (Sweden)

    Bousser Marie-Germaine

    2009-02-01

    Full Text Available Abstract Background The side effects and burden of anticoagulant treatments may contribute to poor compliance and consequently to treatment failure. A specific questionnaire is necessary to assess patients' needs and their perceptions of anticoagulant treatment. Methods A conceptual model of expectation and satisfaction with anticoagulant treatment was designed by an advisory board and used to guide patient (n = 31 and clinician (n = 17 interviews in French, US English and Dutch. Patients had either atrial fibrillation (AF, deep venous thrombosis (DVT, or pulmonary embolism (PE. Following interviews, three PACT-Q language versions were developed simultaneously and further pilot-tested by 19 patients. Linguistic validations were performed for additional language versions. Results Initial concepts were developed to cover three areas of interest: 'Treatment', 'Disease and Complications' and 'Information about disease and anticoagulant treatment'. After clinician and patient interviews, concepts were further refined into four domains and 17 concepts; test versions of the PACT-Q were then created simultaneously in three languages, each containing 27 items grouped into four domains: "Treatment Expectations" (7 items, "Convenience" (11 items, "Burden of Disease and Treatment" (2 items and "Anticoagulant Treatment Satisfaction" (7 items. No item was deleted or added after pilot testing as patients found the PACT-Q easy to understand and appropriate in length in all languages. The PACT-Q was divided into two parts: the first part to measure the expectations and the second to measure the convenience, burden and treatment satisfaction, for evaluation prior to and after anticoagulant treatment, respectively. Eleven additional language versions were linguistically validated. Conclusion The PACT-Q has been rigorously developed and linguistically validated. It is available in 14 languages for use with thromboembolic patients, including AF, PE and DVT patients

  18. Lupus anticoagulant (LA in pregnant women with history of recurrent fetal loss

    Directory of Open Access Journals (Sweden)

    Olaniyi JA

    2011-05-01

    Full Text Available Olaniyi JA, Olomu SA, Finomo SADepartment of Haematology, University College Hospital, Ibadan, NigeriaAbstract: The frequency of LA in 50 women with intact pregnancy, age range 26 to 39 years, but with past history of at least 2 lost pregnancies, was determined using coagulation-based assays. Most (68% of the pregnant women were in the first trimester. Venous blood (4.5 mL carefully collected from each of the subjects and also the controls (normal relative donors was put in 0.5 mL of 3.8% citrate (ratio 9:1. The blood was quickly centrifuged at 1500 g; platelet-poor plasma was separated and frozen at -30°C until analyzed. The control plasma was pooled and dispensed in 2 mL aliquots. Partial thromboplastin time with kaolin (PTTk (against the control samples for comparison and kaolin clotting time (KCT were determined on each of the test samples using standard laboratory procedures. Prolonged PTTk was obtained in 36 patients (72%. KCT was obtained through mixtures of patients' plasma with pooled control plasma (P:C at 100:0; 0.8:0.2; 0.6:0.4; 0.5:0.5; 0.4:0.6; 0.2:0.8; 0:100; and lin-lin graph paper was used to plot out each of these dilutions against their respective clotting time in seconds. The interpreted graph showed that 12 (24% had LA, while 3 (6% had LA with cofactor. This high frequency necessitates regular screening for LA in pregnant women with a history of recurrent fetal loss at any gestational age.Keywords: prevalence, pregnancy, recurrent fetal loss, lupus anticoagulant, coagulation-based assays

  19. Discussion about magnesium phosphating

    Directory of Open Access Journals (Sweden)

    P. Pokorny

    2016-07-01

    Full Text Available The paper describes results from recently published research focused on production of non-conventional magnesium phosphate Mg3(PO42・4H2O – bobierrite, or MgHPO4・3H2O – newberyite coating for both magnesium alloys and/or mild steel. This new kind of coating is categorized in the context of current state of phosphating technology and its potential advantages and crystal structure is discussed. At the same time, the suitable comparison techniques for magnesium phosphate coating and conventional zinc phosphate coating are discussed.

  20. DHEA-mediated inhibition of the pentose phosphate pathway alters oocyte lipid metabolism in mice.

    Science.gov (United States)

    Jimenez, Patricia T; Frolova, Antonina I; Chi, Maggie M; Grindler, Natalia M; Willcockson, Alexandra R; Reynolds, Kasey A; Zhao, Quihong; Moley, Kelle H

    2013-12-01

    Women with polycystic ovary syndrome (PCOS) and hyperandrogenism have altered hormone levels and suffer from ovarian dysfunction leading to subfertility. We have attempted to generate a model of hyperandrogenism by feeding mice chow supplemented with dehydroepiandrosterone (DHEA), an androgen precursor that is often elevated in women with PCOS. Treated mice had polycystic ovaries, low ovulation rates, disrupted estrous cycles, and altered hormone levels. Because DHEA is an inhibitor of glucose-6-phosphate dehydrogenase, the rate-limiting enzyme in the pentose phosphate pathway, we tested the hypothesis that oocytes from DHEA-exposed mice would have metabolic disruptions. Citrate levels, glucose-6-phosphate dehydrogenase activity, and lipid content in denuded oocytes from these mice were significantly lower than controls, suggesting abnormal tricarboxylic acid and pentose phosphate pathway metabolism. The lipid and citrate effects were reversible by supplementation with nicotinic acid, a precursor for reduced nicotinamide adenine dinucleotide phosphate. These findings suggest that elevations in systemic DHEA can have a negative impact on oocyte metabolism and may contribute to poor pregnancy outcomes in women with hyperandrogenism and PCOS.

  1. Vitamin K and stability of oral anticoagulant therapy

    NARCIS (Netherlands)

    Rombouts, Eva Karolien

    2011-01-01

    One of the causes of unstable anticoagulation is a variable vitamin K intake. The main objective of this thesis was to test the hypothesis that the INR is particularly sensitive to changes in vitamin K intake when vitamin K status is low, and that patients with a low vitamin K intake would therefore

  2. Complement inhibitory and anticoagulant activities of fractionated heparins

    NARCIS (Netherlands)

    Hennink, W.E.; Klerx, J.P.A.M.; Dijk, H. van; Feijen, J.

    1984-01-01

    Almost monodisperse heparin fractions (w/n < 1.1) were obtained by gel filtration of a commercial heparin. These fractions were assayed for anticoagulant activity (thrombin times and APTT), chromogenic anti-factor Xa activity, inhibitory activity for the human classical complement pathway, carboxyl

  3. Haemorrhage in the labyrinth caused by anticoagulant therapy: case report

    International Nuclear Information System (INIS)

    We report a patient who experienced a severe vertiginous episode with bilateral tinnitus and progressive right-sided hearing loss. She had Marfan's disease and was on anticoagulant treatment. The fluid in the labyrinth gave higher signal than cerebrospinal fluid on T1-weighted images, suggesting haemorrhage. The radiological follow-up is discussed. (orig.)

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

    NARCIS (Netherlands)

    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

  5. Structure and anticoagulant properties of sulfated glycosaminoglycans from primitive Chordates

    Directory of Open Access Journals (Sweden)

    PAVÃO MAURO S. G.

    2002-01-01

    Full Text Available Dermatan sulfates and heparin, similar to the mammalian glycosaminoglycans, but with differences in the degree and position of sulfation were previously isolated from the body of the ascidian Styela plicata and Ascidia nigra. These differences produce profound effects on their anticoagulant properties. S. plicata dermatan sulfate composed by 2-O-sulfatedalpha-L-iduronic acid and 4-O-sulfated N-acetyl-beta-D-galactosamine residues is a potent anticoagulant due to a high heparin cofactor II activity. Surprisingly, it has a lower potency to prevent thrombus formation on an experimental model and a lower bleeding effect in rats than the mammalian dermatan sulfate. In contrast, A. nigra dermatan sulfate, also enriched in 2-O-sulfated alpha-L-iduronic acid, but in this case sulfated at O-6 of the N-acetyl-beta-D-galactosamine units, has no in vitro or in vivo anticoagulant activity, does not prevent thrombus formation but shows a bleeding effect similar to the mammalian glycosaminoglycan. Ascidian heparin, composed by 2-O-sulfated alpha-L-iduronic acid, N- and 6-O-sulfated glucosamine (75% and alpha-L-iduronic acid, N- and 6-O-sulfated glucosamine (25% disaccharide units has an anticoagulant activity 10 times lower than the mammalian heparin, is about 20 times less potent in the inhibition of thrombin by antithrombin, but has the same heparin cofactor II activity as mammalian heparin.

  6. Perioperative anticoagulation for children with prosthetic mechanical valves

    OpenAIRE

    Grech, Victor E.; Rees, P.

    2000-01-01

    The insertion of a mechanical heart valve predisposes to thrombosis and embolism, and for this reason, individuals with mechanical valves who undergo dental/surgical procedures must take special precautions. In this article, we illustrate a protocol for anticoagulation during such procedures in individuals with mechanical valves.

  7. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Verheugt Freek WA

    2001-05-01

    Full Text Available Abstract Thrombosis plays a major role in acute vessel closure both after coronary balloon angioplasty and after stenting. This review will address the role of antiplatelet and anticoagulant therapy in preventing early thrombotic complications after percutaneous coronary intervention. The focus will be on agents that are routinely available and commonly used.

  8. [New anticoagulants for stroke prevention in atrial fibrillation].

    Science.gov (United States)

    Diener, H C; Hajjar, K; Frank, B; Perrey, M

    2012-06-01

    Oral anticoagulation with vitamin K antagonists (warfarin, phenprocoumon) is successful in both primary and secondary stroke prevention for patients with atrial fibrillation (AF), yielding a 60-70% relative reduction in stroke risk compared with placebo and a mortality reduction of 26%. However, these agents have a number of well documented shortcomings. This review describes the current landscape and developments in stroke prevention in patients with AF with special reference to secondary prevention. A number of new drugs for oral anticoagulation that do not exhibit the limitations of vitamin K antagonists are under investigation. These include direct factor Xa inhibitors and direct thrombin inhibitors. Recent studies (RE-LY, ROCKET-AF, AVERROES, ARISTOTLE) provide promising results for these new agents including higher efficacy and significantly lower incidences of intracranial bleeding compared with warfarin. The new substances show similar results in secondary as well as in primary stroke prevention in patients with AF. The new anticoagulants add to the therapeutic options for patients with AF and offer a number of advantages over warfarin for both clinician and patient, including a favorable bleeding profile and convenience of use. Consideration of these new anticoagulants will improve clinical decision-making.

  9. Haemorrhage in the labyrinth caused by anticoagulant therapy: case report

    Energy Technology Data Exchange (ETDEWEB)

    Callonnec, F.; Gerardin, E.; Thiebot, J. [Department of Radiology, Rouen University Hospital, 1 rue de Germont, F-76031 Rouen cedex (France); Marie, J.P.; Andrieu Guitrancourt, J. [Department of Otolaryngology, Rouen University Hospital (France); Marsot-Dupuch, K. [Department of Radiology, St. Antoine, Paris University Hospital (France)

    1999-06-01

    We report a patient who experienced a severe vertiginous episode with bilateral tinnitus and progressive right-sided hearing loss. She had Marfan`s disease and was on anticoagulant treatment. The fluid in the labyrinth gave higher signal than cerebrospinal fluid on T1-weighted images, suggesting haemorrhage. The radiological follow-up is discussed. (orig.) With 2 figs., 11 refs.

  10. Laboratory monitoring of novel oral anticoagulants rivaroxaban and dabigatran

    NARCIS (Netherlands)

    Eerenberg, E.S.; Kamphuisen, P.W.; Sijpkens, M.K.; Meijers, J.C.; Büller, H.R.; Levi, M.

    2013-01-01

    Background: Rivaroxaban and dabigatran are new oral anticoagulants that both have been licensed worldwide for the treatment of atrial fibrillation and rivaroxaban also for venous thrombosis. Both drugs specifically inhibit one coagulation factor, factor Xa and thrombin, respectively, and both compou

  11. Qualitative identification of rodenticide anticoagulants by LC-MS/MS.

    Science.gov (United States)

    Middleberg, Robert A; Homan, Joseph

    2012-01-01

    Rodenticide anticoagulants are used in the control of rodent populations. In addition to accidental ingestions in humans, such agents have also been used for homicidal and suicidal purposes. There are two major groups of rodenticide anticoagulants - hydroxycoumarins and indanediones. Before the advent of LC-MS/MS, analysis for such agents was relegated to such techniques as TLC and HPLC with nonspecific modes of detection. LC-MS/MS has been used to determine any given number of rodenticide anticoagulants in animal tissues, foods, plasma, etc. Use of this technique allows for the simultaneous identification of individual compounds within both classes of rodenticide anticoagulants. The LC-MS/MS method presented allows for simultaneous qualitative identification of brodifacoum, bromadiolone, chlorphacinone, dicumarol, difenacoum, diphacinone, and warfarin in blood, serum, and plasma using ESI in the negative mode. Two transitions are monitored for each analyte after a simple sample preparation. Chromatographic separation is accomplished using a gradient of ammonium hydroxide in water and ammonium hydroxide in methanol. Chloro-warfarin is used as internal standard. PMID:22767114

  12. Treatment of Venous Thromboembolism With New Anticoagulant Agents.

    Science.gov (United States)

    Becattini, Cecilia; Agnelli, Giancarlo

    2016-04-26

    Venous thromboembolism (VTE) is a common disease associated with high risk for recurrences, death, and late sequelae, accounting for substantial health care costs. Anticoagulant agents are the mainstay of treatment for deep vein thrombosis and pulmonary embolism. The recent availability of oral anticoagulant agents that can be administered in fixed doses, without laboratory monitoring and dose adjustment, is a landmark change in the treatment of VTE. In Phase III trials, rivaroxaban, apixaban, edoxaban (antifactor Xa agents), and dabigatran (an antithrombin agent) were noninferior and probably safer than conventional anticoagulation therapy (low-molecular-weight heparin followed by vitamin K antagonists). These favorable results were confirmed in specific patient subgroups, such as the elderly and fragile. However, some patients, such as those with cancer or with intermediate- to high-risk pulmonary embolism, were underrepresented in the Phase III trials. Further clinical research is required before new oral anticoagulant agents can be considered standard of care for the full spectrum of patients with VTE. PMID:27102510

  13. New oral anticoagulants for patients with nonvalvular atrial fibrillation.

    Science.gov (United States)

    Holden, Amber; Azimi, Nassir; Forest, Christopher P

    2015-11-01

    Four new oral anticoagulants have been approved for reducing stroke risk in patients with nonvalvular atrial fibrillation. Compared with warfarin, these agents offer a more predictable dose response with fewer food and drug interactions and no regular blood monitoring, although some of the drugs have an increased risk of major gastrointestinal bleeding. This article reviews the new drugs.

  14. Metformin-clomiphene citrate vs. clomiphene citrate alone: Polycystic ovarian syndrome

    Directory of Open Access Journals (Sweden)

    Aqueela Ayaz

    2013-01-01

    Full Text Available Background: Polycystic ovary syndrome (PCOS is the commonest endocrinopathy in women that is associated with reproductive and metabolic disorders. Objectives: We compared the ovulation and conception rates after the treatment with clomiphene citrate (CC alone and in combination with metformin in infertile patients presented with polycystic ovarian syndrome (PCOS. Materials and Methods: This randomized controlled trial of independent cases and controls was conducted at the Department of Obstetrics and Gynecology, Hera General Hospital, Makkah, Saudi Arabia from February 01 to December 31, 2008. The 42 subjects diagnosed as PCOS were divided into group A and B (21 subjects in each for management with CC + metformin and CC alone, respectively. Group A received 500 mg three times a day of metformin continuously from the first cycle for 6 months or till pregnancy was confirmed. In both groups CC was started at a dose of 50 mg from day-2 till day-6 of the menstrual cycle. The dose of CC was increased to 100 mg in second and 150 mg in third cycle, and then remained 150 mg for the remaining three cycles. With ovulation the dose of CC was unaltered in both groups. Data were analyzed using Statistical Package for the Social Sciences (SPSS version 16. Results: More than 50% females in both groups were had body mass index > 25. Group A achieved high rate of regular cycles, ovulation success, and conception than group B (71.4% vs. 38.1%; P = 0.03, (76.2% vs. 38.1%; P = 0.021, and (66.6% vs. 28.6%; P = 0.01, respectively. Conclusion: Management with metformin + CC increased the ovulation and conception rates.

  15. New Oral Anticoagulants in the Treatment of Pulmonary Embolism: Efficacy, Bleeding Risk, and Monitoring

    Directory of Open Access Journals (Sweden)

    Kelly M. Rudd

    2013-01-01

    Full Text Available Anticoagulation therapy is mandatory in patients with pulmonary embolism to prevent significant morbidity and mortality. The mainstay of therapy has been vitamin-K antagonist therapy bridged with parenteral anticoagulants. The recent approval of new oral anticoagulants (NOACs: apixaban, dabigatran, and rivaroxaban has generated significant interest in their role in managing venous thromboembolism, especially pulmonary embolism due to their improved pharmacokinetic and pharmacodynamic profiles, predictable anticoagulant response, and lack of required efficacy monitoring. This paper addresses the available literature, on-going clinical trials, highlights critical points, and discusses potential advantages and disadvantages of the new oral anticoagulants in patients with pulmonary embolism.

  16. Production of technical-grade sodium citrate from glycerol-containing biodiesel waste by Yarrowia lipolytica.

    Science.gov (United States)

    Kamzolova, Svetlana V; Vinokurova, Natalia G; Lunina, Julia N; Zelenkova, Nina F; Morgunov, Igor G

    2015-10-01

    The production of technical-grade sodium citrate from the glycerol-containing biodiesel waste by Yarrowia lipolytica was studied. Batch experiments showed that citrate was actively produced within 144 h, then citrate formation decreased presumably due to inhibition of enzymes involved in this process. In contrast, when the method of repeated batch cultivation was used, the formation of citrate continued for more than 500 h. In this case, the final concentration of citrate in the culture liquid reached 79-82 g/L. Trisodium citrate was isolated from the culture liquid filtrate by the addition of a small amount of NaOH, so that the pH of the filtrate increased to 7-8. This simple and economic isolation procedure gave the yield of crude preparation containing trisodium citrate 5.5-hydrate up to 82-86%.

  17. Modeling intracerebral hemorrhage growth and response to anticoagulation.

    Directory of Open Access Journals (Sweden)

    Charles H Greenberg

    Full Text Available The mechanism for hemorrhage enlargement in the brain, a key determinant of patient outcome following hemorrhagic stroke, is unknown. We performed computer-based stochastic simulation of one proposed mechanism, in which hemorrhages grow in "domino" fashion via secondary shearing of neighboring vessel segments. Hemorrhages were simulated by creating an initial site of primary bleeding and an associated risk of secondary rupture at adjacent sites that decayed over time. Under particular combinations of parameters for likelihood of secondary rupture and time-dependent decay, a subset of lesions expanded, creating a bimodal distribution of microbleeds and macrobleeds. Systematic variation of the model to simulate anticoagulation yielded increases in both macrobleed occurrence (26.9%, 53.2%, and 70.0% of all hemorrhagic events under conditions simulating no, low-level, and high-level anticoagulation and final hemorrhage size (median volumes 111, 276, and 412 under the same three conditions, consistent with data from patients with anticoagulant-related brain hemorrhages. Reversal from simulated high-level anticoagulation to normal coagulation was able to reduce final hemorrhage size only if applied relatively early in the course of hemorrhage expansion. These findings suggest that a model based on a secondary shearing mechanism can account for some of the clinically observed properties of intracerebral hemorrhage, including the bimodal distribution of volumes and the enhanced hemorrhage growth seen with anticoagulation. Future iterations of this model may be useful for elucidating the effects of hemorrhage growth of factors related to secondary shearing (such as small vessel pathology or time-dependent decay (such as hemostatic agents.

  18. Characteristics of ambulatory anticoagulant adverse drug events: a descriptive study

    Directory of Open Access Journals (Sweden)

    Eckstrand Julie

    2010-02-01

    Full Text Available Abstract Background Despite the high frequency with which adverse drug events (ADEs occur in outpatient settings, detailed information regarding these events remains limited. Anticoagulant drugs are associated with increased safety concerns and are commonly involved in outpatient ADEs. We therefore sought to evaluate ambulatory anticoagulation ADEs and the patient population in which they occurred within the Duke University Health System (Durham, NC, USA. Methods A retrospective chart review of ambulatory warfarin-related ADEs was conducted. An automated trigger surveillance system identified eligible events in ambulatory patients admitted with an International Normalized Ratio (INR >3 and administration of vitamin K. Event and patient characteristics were evaluated, and quality/process improvement strategies for ambulatory anticoagulation management are described. Results A total of 169 events in 167 patients were identified from December 1, 2006-June 30, 2008 and included in the study. A median supratherapeutic INR of 6.1 was noted, and roughly half of all events (52.1% were associated with a bleed. Nearly 74% of events resulted in a need for fresh frozen plasma; 64.8% of bleeds were classified as major. A total of 59.2% of events were at least partially responsible for hospital admission. Median patient age was 68 y (range 36-95 y with 24.9% initiating therapy within 3 months prior to the event. Of events with a prior documented patient visit (n = 157, 73.2% were seen at a Duke clinic or hospital within the previous month. Almost 80% of these patients had anticoagulation therapy addressed, but only 60.0% had a follow-up plan documented in the electronic note. Conclusions Ambulatory warfarin-related ADEs have significant patient and healthcare utilization consequences in the form of bleeding events and associated hospital admissions. Recommendations for improvement in anticoagulation management include use of information technology to assist

  19. The Australian national reactive phosphate rock project - Aims, experimental approach, and site characteristics

    International Nuclear Information System (INIS)

    Field-based cutting trials were established across Australia in a range of environments to evaluate the agronomic effectiveness of 5 phosphate rocks, and 1 partially acidulated phosphate rock, relative to either single super-phosphate or triple superphosphate. The phosphate rocks differed in reactivity, as determined by the degree of carbonate substitution for phosphate in the apatite structure and solubility of phosphorus present in the fertilizers in 2% formic acid, 2% citric acid and neutral ammonium citrate. Sechura (Bayovar) and North Carolina phosphate rocks were highly reactive (>70% solubility in 2% formic acid), whilst Khouribja (Moroccan) and Hamrawein (Egypt) phosphate rock were moderately reactive. Duchess phosphate rock from Queensland was relatively unreactive (2, from 4.0 to 5.1, and Colwell extractable phosphorus ranged from 3 to 47 μg/g prior to fertilizer application. Two core experiments were established at each site. The first measured the effects of phosphate rock reactivity on agronomic effectiveness, while the second core experiment measured the effects of the degree of water solubility of the phosphorus source on agronomic effectiveness. The National Reactive Phosphate Rock Project trials provided the opportunity to confirm the suitability of accepted procedures to model fertilizer response and to develop new approaches for comparing different fertilizer responses. The Project also provided the framework for subsidiary studies such as the effect of fertilizer source on soil phosphorus extractability; cadmium and fluorine concentrations in herbage; evaluation of soil phosphorus tests; and the influence of particle size on phosphate rock effectiveness. The National Reactive Phosphate Rock Project presents a valuable model for a large, Australia-wide, collaborative team approach to an important agricultural issue. The use of standard and consistent experimental methodologies at every site ensured that maximum benefit was obtained from data

  20. 77 FR 33399 - Citric Acid and Certain Citrate Salts From the People's Republic of China: Preliminary Results of...

    Science.gov (United States)

    2012-06-06

    ... Certain Citrate Salts from Canada and the People's Republic of China: Antidumping Duty Orders, 74 FR 25703... Administrative Review, 77 FR 1455 (January 10, 2012). \\10\\ See Citric Acid and Certain Citrate Salts from the... acid, sodium citrate, and potassium citrate in their unblended forms, whether dry or in solution,...

  1. 77 FR 56188 - Citric Acid and Certain Citrate Salts from the People's Republic of China: Notice of Rescission...

    Science.gov (United States)

    2012-09-12

    ... the order includes all grades and granulation sizes of citric acid, sodium citrate, and potassium... also includes blends of citric acid, sodium citrate, and potassium citrate; as well as blends with other ingredients, such as sugar, where the unblended form(s) of citric acid, sodium citrate,...

  2. 78 FR 34642 - Citric Acid and Certain Citrate Salts From the People's Republic of China: Preliminary Results of...

    Science.gov (United States)

    2013-06-10

    ... dihydrate and anhydrous forms of sodium citrate, otherwise known as citric acid sodium salt, and the monohydrate and monopotassium forms of potassium citrate.\\1\\ Sodium citrate also includes both trisodium... monosodium salt, respectively. Citric acid and sodium citrate are classifiable under 2918.14.0000 and...

  3. Radioactivity of phosphate mineral products

    OpenAIRE

    Mitrović Branislava; Vitorović Gordana; Stojanović Mirjana; Vitorović Duško

    2011-01-01

    The phosphate industry is one of the biggest polluters of the environment with uranium. Different products are derived after processing phosphoric ore, such as mineral and phosphate fertilizers and phosphate mineral supplements (dicalcium-and monocalcium phosphate) for animal feeding. Phosphate mineral additives used in animal food may contain a high activity of uranium. Research in this study should provide an answer to the extent in which phosphate minera...

  4. Subclinical abortions in patients treated with clomiphene citrate

    International Nuclear Information System (INIS)

    Using radioimmunoassay for human chorionic gonadotrophin beta-subunit, 39 treatment cycles of clomiphene citrate therapy were studied prospectively for incidence of subclinical abortions. Eight treatment cycles resulted in clinically recognizable pregnancies and three other treatment cycles ended up with subclinical abortions. The plasma progesterone levels in patients with subclinical abortions at the 13th day after ovulation were lower than those in patients with normal pregnancies. (author)

  5. Silver-YBCO composite through citrate gel decomposition

    International Nuclear Information System (INIS)

    Silver-YBCO composite containing upto 75% silver has been prepared by thermal decomposition of citrate gel. In this paper the morphological and structural changes taking place during the decomposition of the gel in the range 100--900 degrees C are presented. Heat treatment at 915 degrees C of the composite powder containing Ag2O above a critical limit has been found to impart superconductivity without any external oxygen annealing. The mechanical and microstructural features of the sintered composite are presented

  6. Renal Localization of {sup 67}Ga Citrate in Noninfectious Nephritis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Wook; Jeong, Min Soo; Rhee, Sunn Kgoo; Kim, Sam Yong; Shin, Young Tai; Ro, Heung Kyu [Chungnam University College of Medicine, Deajeon (Korea, Republic of)

    1992-07-15

    {sup 67}Ga citrate scan has been requested for detection or follow-up of inflammatory or neoplastic disease. Visualization of {sup 67}Ga citrate in the kidneys at 48 and 72 hr post injection is usually interpreted as evidence of renal pathology. But precise mechanisms of abnormal {sup 67}Ga uptake in kidneys were unknown. We undertook a study to determine the clinical value of {sup 67}Ga citrate imaging of the kidneys in 68 patients with primary or secondary nephropathy confirmed by renal biopsy and 66 control patients without renal disease. Renal uptake in 48 to 72 hr images was graded as follows: Grade 0=background activity;1=faint uptake greater than background; 2=definite uptake, but less than lumbar vertebrae;3 same uptake as lumbar vertebrae, but less than liver; 4=same or higher uptake than liver. The results were as follows. 1) 42 of 68(62%) patients with noninfectious nephritis showed grade 2 or higher {sup 67}Ga renal uptake but only 10 percent of control patients showed similar uptake. 2) In 14 patients with systemic lupus erythematosus, 8 of 9 (89%) patients with lupus nephritis exhibited marked renal uptake. 3) 36 of 41 patients (88%) with combined nephrotic syndrome showed Grade 2 or higher renal uptake. 4) Renal {sup 67}Ga uptake was correlated with clinical severity of nephrotic syndrome determined by serum albumin level, 24 hr urine protein excretion and serum lipid levels. 5) After complete remission of nephrotic syndrome, renal uptake in all 8 patients who were initially Grade 3 or 4, decreased to Grade 1 or 0. In conclusion, we think that the mechanism of renal {sup 67}Ga uptake in nephrotic syndrome might be related to the pathogenesis of nephrotic syndrome. In systemic lupus erythematosus, {sup 67}Ga citrate scan is useful in predicting renal involvement.

  7. Electrodeposition of iron-molybdenum coatings from citrate electrolyte

    OpenAIRE

    Ved, M. V.; Sakhnenko, N. D.; Karakurkchi, A. V.; Zyubanova, S. I.

    2014-01-01

    Specifi c features of the electrodeposition of iron–molybdenum coatings from a citrate electrolyte based on iron(III) sulfate and sodium molybdate in dc and unipolar pulsed modes were studied. It was demonstrated that bright compact coatings with varied content of molybdenum can be produced by varying the relative concentrations of salts of the alloy-forming components and the solution pH. The current density ranges providing the high efficiency of the galvanostastic electrolysis were determi...

  8. Electrodeposition of iron-molybdenum-tungsten coatings from citrate electrolytes

    OpenAIRE

    Karakurkchi, A. V.; Ved, M. V.; Sakhnenko, N. D.; Yermolenko, I. Yu.

    2015-01-01

    Specific features of the electrodeposition of iron–molybdenum–tungsten coatings from citrate electrolytes based on iron(III) sulfate in the dc mode and with a unipolar pulsed current were studied. It was shown that varying the relative concentrations of salts of alloy-forming metals and the solution pH makes it possible to obtain lustrous compact coatings with low porosity and various contents of high-melting components. The effect of temperature on the coating composition and current efficie...

  9. Sildenafil citrate and uteroplacental perfusion in fetal growth restriction

    Directory of Open Access Journals (Sweden)

    Marzieh Vahid Dastjerdi

    2012-01-01

    Full Text Available Background: To determine whether the phosphodiesterase type 5 inhibitor, Sildenafil citrate, affects uteroplacental perfusion. Materials and Methods: Based on a randomized double-blinded and placebo-controlled trial, forty one pregnant women with documented intrauterine growth retardation at 24-37 weeks of gestation were evaluated for the effect of a single dose of Sildenafil citrate on uteroplacental circulation as determined by Doppler ultrasound study of the umbilical and middle cerebral arteries. Statistical analysis included χ2 -test to compare proportions, and independent-samples t-test and paired student′s t-test to compare continuous variables. Results: Sildenafil group fetuses demonstrated a significant decrease in systolic/diastolic ratios (0.60 [SD 0.40] [95% Cl 0.37-0.84], P=0.000, and pulsatility index (0.12 [SD 0.15] [95% Cl 0.02-0.22], P=0.019 for the umbilical artery and a significant increase in middle cerebral artery pulsatility index (MCA PI (0.51 [SD 0.60] [95% Cl 0.16-0.85], P=0.008. Conclusion: Doppler velocimetry index values reflect decreased placental bed vascular resistance after Sildenafil. Sildenafil citrate can improve fetoplacental perfusion in pregnancies complicated by intrauterine growth restriction. It could be a potential therapeutic strategy to improve uteroplacental blood flow in pregnancies with fetal growth restriction (FGR.

  10. PHOSPHATE MANAGEMENT: FY2010 RESULTS OF PHOSPHATE PRECIPITATION TESTS

    Energy Technology Data Exchange (ETDEWEB)

    Hay, M.; King, W.

    2011-04-04

    The Phosphate Management program seeks to develop treatment options for caustic phosphate solutions resulting from the caustic leaching of the bismuth phosphate sludge. The SRNL subtask investigated the precipitation of phosphate salts from caustic solutions through addition of fluoride and by crystallization. The scoping tests examined the: precipitation of phosphate by the addition of sodium fluoride to form the sodium fluorophosphate double salt, Na{sub 7}F(PO{sub 4}){sub 2} {center_dot} 19H{sub 2}O, crystallization of phosphate by reducing the temperature of saturated phosphate solutions, and combinations of precipitation and crystallization. A simplified leachate simulant was used in the study produced by dissolving sodium phosphate in 1 M to 3.5 M sodium hydroxide solutions. The results show that all three processes; precipitation with sodium fluoride, crystallization, and combined precipitation/crystallization can be effective for removing large amounts of phosphate from solution. The combined process of precipitation/crystallization showed >90% removal of phosphate at all hydroxide concentrations when cooling a non-saturated phosphate solution from 65 C to 25 C. Based on the measured solubility of sodium phosphate, pH adjustment/caustic addition will also remove large amounts of phosphate from solution (>80%). For all three processes, the phosphate concentration in the caustic solution must be managed to keep the phosphate from becoming too concentrated and thereby potentially forming a solid mass of sodium phosphate after an effective phosphate removal process.

  11. TRANSPORT OF CITRATE CATALYZED BY THE SODIUM-DEPENDENT CITRATE CARRIER OF KLEBSIELLA-PNEUMONIAE IS OBLIGATORILY COUPLED TO THE TRANSPORT OF 2 SODIUM-IONS

    NARCIS (Netherlands)

    LOLKEMA, JS; ENEQUIST, H; VANDERREST, ME

    1994-01-01

    Aerobically grown Escherichia coli GM48 harboring plasmid pKScitS that codes for the sodium-dependent citrate carrier from Klebsiella pneumoniae (CitS) allows initial-rate measurements of citrate uptake in whole cells. The cation stoichiometry and selectivity of CitS was studied using this experimen

  12. Transport of citrate catalyzed by the sodium-dependent citrate carrier of Klebsiella pneumoniae is obligatorily coupled to the transport of two sodium ions

    NARCIS (Netherlands)

    Lolkema, Juke S.; Enequist, Hans; Rest, Michel E. van der

    1994-01-01

    Aerobically grown Escherichia coli GM48 harboring plasmid pKScitS that codes for the sodium-dependent citrate carrier from Klebsiella pneumoniae (CitS) allows initial-rate measurements of citrate uptake in whole cells. The cation stoichiometry and selectivity of CitS was studied using this experimen

  13. CitI, a Transcription Factor Involved in Regulation of Citrate Metabolism in Lactic Acid Bacteria†

    Science.gov (United States)

    Martin, Mauricio G.; Magni, Christian; de Mendoza, Diego; López, Paloma

    2005-01-01

    A large variety of lactic acid bacteria (LAB) can utilize citrate under fermentative conditions. Although much information concerning the metabolic pathways leading to citrate utilization by LAB has been gathered, the mechanisms regulating these pathways are obscure. In Weissella paramesenteroides (formerly called Leuconostoc paramesenteroides), transcription of the citMDEFCGRP citrate operon and the upstream divergent gene citI is induced by the presence of citrate in the medium. Although genetic experiments have suggested that CitI is a transcriptional activator whose activity can be modulated in response to citrate availability, specific details of the interaction between CitI and DNA remained unknown. In this study, we show that CitI recognizes two A+T-rich operator sites located between citI and citM and that the DNA-binding affinity of CitI is increased by citrate. Subsequently, this citrate signal propagation leads to the activation of the cit operon through an enhanced recruitment of RNA polymerase to its promoters. Our results indicate that the control of CitI by the cellular pools of citrate provides a mechanism for sensing the availability of citrate and adjusting the expression of the cit operon accordingly. In addition, this is the first reported example of a transcription factor directly functioning as a citrate-activated switch allowing the cell to optimize the generation of metabolic energy. PMID:16030208

  14. 柠檬酸铅在柠檬酸钠溶液中溶解行为%Dissolution behavior of lead citrate in sodium citrate solution

    Institute of Scientific and Technical Information of China (English)

    何东升; 李巧双; 杨典奇; 杨聪; 王贤晨; 杨家宽

    2014-01-01

    Lead citrate was prepared by the reaction of lead oxide and citrate. The effects of dissolution time, dissolution tempera-ture, sodium citrate concentration, and the addition amount of citric acid on the dissolution rate of lead citrate in sodium citrate solution were investigated. Experimental results show that, dissolution temperature, sodium citrate concentration, and the addition amount of citric acid are the main influencing factors. Increasing the dissolution temperature or the sodium citrate concentration can significantly improve the dissolution rate of lead citrate. The dissolution rate of lead citrate has a positive linear relation with the dissolution tempera-ture, and the fitted linear equation is Y=0.76+0.63T. Adding citric acid can inhibit the dissolution of lead citrate.%通过氧化铅与柠檬酸反应制备了柠檬酸铅,考察了溶解时间、溶解温度、柠檬酸钠浓度和柠檬酸加入量对柠檬酸铅在柠檬酸钠溶液中溶解率的影响.结果表明:温度、柠檬酸钠浓度及柠檬酸加入量是主要影响因素,升高温度和提高柠檬酸钠浓度可显著提高柠檬酸铅溶解率;温度和溶解率呈正线性关系,拟合的线性方程为Y=0.76+0.63T;加入柠檬酸则对柠檬酸铅溶解有抑制作用.

  15. Standard characterization of phosphate rock samples from the FAO/IAEA phosphate project

    International Nuclear Information System (INIS)

    Phosphate rocks (PR) are phosphate-bearing minerals that vary widely in their inherent characteristics and consequently their agronomic potential. In the framework of a FAO/IAEA networked research project, the evaluation of the agronomic effectiveness of natural and modified PR products under a variety of soil climate and crop management conditions was carried out. The characterization of phosphate rocks is the first and essential step in evaluating their suitability for direct application. If several PR sources are utilized, standardized methods should be used for comparison purposes to determine their agronomic potential. This paper describes the standard characterization of phosphate rock products utilized in the project, in particular the mineralogical and crystallographic analyses, physical analyses, chemical composition and solubility in conventional reagents. A total of 28 phosphate rock samples from 15 countries were collected and analyzed in specialized laboratories. The data on mineralogy, chemical composition and solubility in conventional reagents are closely interrelated. An arbitrary classification of the reactivity of the PR samples was made based on the solubility indices in conventional reagents. On another hand, the results of the crystallographic parameters, calculated indices of absolute solubility, specific surface and porosity reflect the variability of the physical state and the sample pre-conditioning treatment of the analyzed products. A proper characterization of phosphate rock samples should provide the maximum of basic information that can be obtained in a cost-effective manner in normal chemical laboratories. Based on the results of this characterization, the following determinations are recommended: a description of the sample, major elemental (total P, Ca, Mg) composition, solubility in conventional reagents (neutral ammonium citrate, citric and formic acid) and particle size analysis. The classification of PR samples for direct

  16. Genetic determinants of response and adverse effects following vitamin K antagonist oral anticoagulants

    Directory of Open Access Journals (Sweden)

    Parameshwar S.

    2016-06-01

    Full Text Available Background: Vitamin K antagonist anticoagulants (warfarin/acenocoumarol are commonly used anticoagulants that require careful clinical management to balance the risks of over anticoagulation and bleeding with those of under anticoagulation and clotting. Genetic variants of the enzyme that metabolizes vitamin K antagonist anticoagulant, cytochrome P-450 2C9 (CYP2C9, and of a key pharmacologic target of vitamin K antagonists anticoagulant, vitamin K epoxide reductase (VKORC1, contribute to differences in patients responses to various anticoagulant doses. Methods: In thirty patients on oral vitamin K antagonist anticoagulant therapy, presented with either clotting manifestations (valve thrombosis, pulmonary embolism and DVT or prolonged INR/bleeding manifestations, we assessed CYP2C9 genotypes, VKORC1 haplotypes, clinical characteristics, response to therapy (as determined by the international normalized ratio [INR], and bleeding events. Results: Of the thirty patients, thirteen patients INR was high and four patients presented with major bleeding and four with minor bleeding manifestations. Out of thirteen patients with high INR, ten patients showed CYP2C9 polymorphism ( 1/ 3 and 2/ 3 of poor metabolizer genotype. Most of the high INR patients were recently started on oral vitamin K antagonist anticoagulant. Most patients presented with clotting manifestations with below therapeutic INR are noncompliant with anticoagulants. Conclusions: The results of this study suggest that the CYP2C9 polymorphisms are associated with an increased risk of over anticoagulation and of bleeding events among patients on vitamin K antagonists' anticoagulant setting. Screening for CYP2C9 variants may allow clinicians to develop dosing protocols and surveillance techniques to reduce the risk of adverse drug reactions in patients receiving vitamin K antagonist anticoagulants. However the cost-effectiveness of genotyping of patients must be considered. [Int J Res Med Sci

  17. The enhanced anticoagulation for graphene induced by COOH(+) ion implantation.

    Science.gov (United States)

    Liu, Xiaoqi; Cao, Ye; Zhao, Mengli; Deng, Jianhua; Li, Xifei; Li, Dejun

    2015-01-01

    Graphene may have attractive properties for some biomedical applications, but its potential adverse biological effects, in particular, possible modulation when it comes in contact with blood, require further investigation. Little is known about the influence of exposure to COOH(+)-implanted graphene (COOH(+)/graphene) interacting with red blood cells and platelets. In this paper, COOH(+)/graphene was prepared by modified Hummers' method and implanted by COOH(+) ions. The structure and surface chemical and physical properties of COOH(+)/graphene were characterized by scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), and contact angle measurement. Systematic evaluation of anticoagulation, including in vitro platelet adhesion assays and hemolytic assays, proved that COOH(+)/graphene has significant anticoagulation. In addition, at the dose of 5 × 10(17) ions/cm(2), COOH(+)/graphene responded best on platelet adhesion, aggregation, and platelet activation.

  18. Self-management of oral anticoagulant therapy in two centers

    DEFF Research Database (Denmark)

    Nilsson, Hanna; Grove, E; Larsen, Torben Bjerregaard;

    Self-management of oral anticoagulant therapy in two centers: 11.000 patient-years of follow-up H Nilsson1,2,3, EL Grove2, TB Larsen3, M Maegaard1, TD Christensen1 1Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus; 2Department...... of Cardiology, Aarhus University Hospital, Aarhus; 3Department of Cardiology, Aalborg Hospital & Department of Health Science and Technology, Aalborg University, Aalborg, Denmark haana_86@hotmail.com Objectives: Patient-self-management (PSM) of oral anticoagulant therapy with vitamin K antagonists have...... demonstrated efficacy in randomized clinical trials. An important question remains about its clinical effectiveness. We hypothesized that implementation of PSM in everyday clinical practice could improve the quality of treatment. The aim of this study was to evaluate the effectiveness of PSM in everyday...

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

    Science.gov (United States)

    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

  20. [Bilateral renal infarction after discontinuation of anticoagulant therapy].

    Science.gov (United States)

    Lavoignet, Charles-Éric; Le Borgne, Pierrick; Ugé, Sarah; Veneziano, Rinaldo; Brunhuber, Claudia; Kam, Claire; Bilbault, Pascal

    2016-07-01

    Acute renal infarction is an uncommon and often under diagnosed condition mostly because of misleading symptoms. Accurate data regarding clinical presentation, laboratory tests, diagnostic and treatment are lacking. Detection is often delayed or missed because of non-specific clinical presentation. The mechanisms of acute renal infarction are various, mainly embolic or thrombotic. Abdominal CT scan remains the most valuable exam to confirm the diagnosis. Therapeutic guidelines for the treatment of renal embolism have not been well established. The standard treatment strategy includes anticoagulation with or without thrombolysis. Despite the uncertainty regarding management, the renal outcome remains favorable. Some patients do develop some degree of renal insufficiency during the acute episode. We report here the case of a 73-year-old woman with bilateral acute renal infarction after discontinuation of anticoagulant therapy.

  1. Generic switching of warfarin and risk of excessive anticoagulation

    DEFF Research Database (Denmark)

    Hellfritzsch, Maja; Rathe, Jette; Stage, Tore Bjerregaard;

    2015-01-01

    PURPOSE: Generic switching of warfarin was recently repealed in Denmark, as adverse drug reaction (ADR) reports suggested risk of excessive anticoagulation following switches from branded to generic warfarin. We investigated this putative association in a formalized pharmacoepidemiological analysis....... METHODS: We conducted a nationwide cohort study based on Danish healthcare registries, including data from the introduction of generic warfarin until the repeal (January 2011-April 2015). We followed Danish warfarin users over time and compared the rate of incident hospitalizations due to excessive...... anticoagulation (i.e. increased INR or any bleeding requiring hospitalization) in periods following a recent switch to generic warfarin to the rate in periods without a recent switch. RESULTS: We included 105 751 warfarin users, filling a total of 1 539 640 prescriptions for warfarin (2.5% for generic warfarin...

  2. [Use of direct oral anticoagulants in the elderly].

    Science.gov (United States)

    Mickley, Frank; Geigenmüller, Grit; Schinköthe, Claudia

    2015-12-01

    Equal safety and efficacy of direct oral anticoagulants as compared to vitamin K antagonists have been shown in elderly and very old patients. The use of these seem to have certain advantages in this special patient cohort: higher drug safety, no need for lab monitoring, less drug-drug interactions and a lower rate of intracranial hemorrhages. However, more data is needed to quantify the exact bleeding risk for geriatric patients. Elderly patients suffer quite frequently from significant comorbidities, such as renal failure, dementia, vision loss etc., which might put them at higher risk to suffer from medication side effects, especially bleeding complications. Routine clinical examinations combined with monitoring of renal function are therefore of paramount importance. Regarding these precautions the use of the new oral anticoagulants in the elderly is hence quite justified and rising. PMID:26625228

  3. The Anticoagulation Effects of Glycosaminoglycan from Mactra veneriformis

    Directory of Open Access Journals (Sweden)

    Yue Wang

    2015-07-01

    Full Text Available In this study, the anticoagulation effect of glycosaminoglycan from Mactra veneriformis was studied. The results showed that glycosaminoglycan mainly exerted anticoagulation via antithrombin III. Glycosaminoglycan could passivate the function of heparin cofactor II inhibiting thrombin activity. Glycosaminoglycan significantly reduced the activities of coagulation factor II, V, VII, X, VIII, IX, XI, XII as well as fibrinogen content in the plasma (p<0.05, p<0.01. Besides, glycosaminoglycan could extend blood recalcification time in rats by shielding Ca2+ in plasma and significantly reduced Ca2+ concentration in rats and mice serum (p<0.05, p<0.01. Glycosaminoglycan reduced the Ca2+ concentration in serum in a more intensive way than that of heparin sodium (p<0.05, p<0.01.

  4. Coagulant and anticoagulant activities in Jatropha curcas latex.

    Science.gov (United States)

    Osoniyi, Omolaja; Onajobi, Funmi

    2003-11-01

    Jatropha curcas Linn. (Euphorbiaceae), a medicinal plant commonly grown in the Tropics, is traditionally used as a haemostatic. Investigation of the coagulant activity of the latex of Jatropha curcas showed that whole latex significantly (Platex, however, prolonged the clotting time: at high dilutions, the blood did not clot at all. This indicates that Jatropha curcas latex possesses both procoagulant and anticoagulant activities. Prothrombin time (PT) and activated partial thromboplastin time (APTT) tests on plasma confirm these observations. Solvent partitioning of the latex with ethyl acetate and butanol led to a partial separation of the two opposing activities: at low concentrations, the ethyl acetate fraction exhibited a procoagulant activity, while the butanol fraction had the highest anticoagulant activity. The residual aqueous fraction had no significant effect on the clotting time of blood and the PT but slightly prolonged the APTT.

  5. Predictors of recurrent venous thromboembolism and bleeding on anticoagulation.

    Science.gov (United States)

    Menapace, Laurel A; McCrae, Keith R; Khorana, Alok A

    2016-04-01

    The impact of venous thromboembolism (VTE) in the cancer population remains substantial despite significant advances in detecting and treating thrombotic events. While there is extensive literature regarding predictors of first VTE event in cancer patients as well as a validated predictive score, less data exist regarding recurrent VTE in cancer cohorts and associated predictive variables. A similar paucity of data in regard to bleeding events in cancer patients receiving anticoagulation has been observed. This review article will highlight clinical risk factors as well as predictive biomarkers associated with recurrent VTE and bleeding in cancer patients receiving therapeutic anticoagulation. Predictive risk assessment models for cancer-associated recurrent VTE and bleeding are also discussed. PMID:27067987

  6. New oral anticoagulants in non-valvular atrial fibrillation.

    Science.gov (United States)

    Francia, Pietro; Adduci, Carmen; Santini, Daria; Musumeci, Beatrice; Tocci, Giuliano

    2013-06-01

    Atrial fibrillation (AF) is associated with an increased risk of embolic stroke. Dose-adjusted vitamin K antagonists (VKAs) to a target international normalized ratio (INR) range of 2.0-3.0 reduce the risk of ischemic stroke and are currently recommended in all patients with AF at moderate-high risk for stroke or systemic embolism. However, VKAs have several drawbacks, including unpredictable anticoagulant response, food and drug interactions, need for regular laboratory monitoring and dose adjustment. These limitations prompted the introduction of new oral anticoagulants (NOA) that target thrombin and factor Xa, key-enzymes in the coagulation pathway. NOA have predictable pharmacodynamics, allowing fixed dosing without the need of laboratory monitoring, and have few drug and food interactions. The present review focuses on pharmacological properties, safety, and appropriate clinical use of dabigatran, rivaroxaban and apixaban.

  7. Metal-phosphate binders

    Science.gov (United States)

    Howe, Beth Ann [Lewistown, IL; Chaps-Cabrera, Jesus Guadalupe [Coahuila, MX

    2009-05-12

    A metal-phosphate binder is provided. The binder may include an aqueous phosphoric acid solution, a metal-cation donor including a metal other than aluminum, an aluminum-cation donor, and a non-carbohydrate electron donor.

  8. Dysregulation of phosphate metabolism and conditions associated with phosphate toxicity

    OpenAIRE

    Brown, Ronald B; Razzaque, Mohammed S

    2015-01-01

    Phosphate homeostasis is coordinated and regulated by complex cross-organ talk through delicate hormonal networks. Parathyroid hormone (PTH), secreted in response to low serum calcium, has an important role in maintaining phosphate homeostasis by influencing renal synthesis of 1,25-dihydroxyvitamin D, thereby increasing intestinal phosphate absorption. Moreover, PTH can increase phosphate efflux from bone and contribute to renal phosphate homeostasis through phosphaturic effects. In addition,...

  9. New oral anticoagulants in the prevention of stroke

    OpenAIRE

    Konrad Jarząbek; Dawid Bąkowski; Beata Wożakowska-Kapłon

    2013-01-01

    Atrial fibrillation is associated with a few folds higher risk of stroke. Traditional vitamin K antagonists used in the prevention of stroke in patients with non-valvular atrial fibrillation are often not efficient enough due to their interactions with a broad range of substances including medicines or food ingridients and problems with monitoring the treatment. New oral anticoagulants pose an alternative for the vitamin K antagonists. They are equally efficient in the prevention of stroke, ...

  10. Direct oral anticoagulants: a guide for daily practice.

    Science.gov (United States)

    Fontana, Pierre; Robert-Ebadi, Helia; Bounameaux, Henri; Boehlen, Françoise; Righini, Marc

    2016-01-01

    In recent years, small oral compounds that specifically block activated coagulation factor X (FXa) or thrombin (FIIa) have become alternatives to the anticoagulants that had been used for several decades. As of today, these direct oral anticoagulants (DOACs) include dabigatran etexilate (thrombin inhibitor) and apixaban, edoxaban and rivaroxaban (inhibitors of FXa). While there is no doubt that DOACs represent a major step forward in the management of patients with venous thromboembolic disease and atrial fibrillation, new challenges have arisen. They need to be addressed with the necessary pragmatism on the basis of evidence. Indeed, a better understanding of the management of these last-generation antithrombotics will favour safer use and increase confidence of the practitioner for the prescription of these drugs. The aim of this article is to present practical suggestions for the prescription and use of these drugs in everyday clinical practice, based on clinical experience and recently updated recommendations of the European Heart Rhythm Association and the American College of Chest Physicians among other scientific organisations. We address issues such as pharmacokinetics, dosing, side effects, limitations of use, drug interactions, switching from and to other anticoagulants, renal function, concomitant administration of antiplatelet agents and perioperative use. We also address the issue of monitoring and reversal, taking advantage of the most recent development in this latter area. Rather than being one additional set of recommendations, our narrative review aims at assisting the practicing physician in his or her daily handling of these novel anticoagulant compounds, based on frequently asked questions to the authors, a group of experienced specialists in the field who have, however, no commitment to issue guidelines. PMID:26964028

  11. The in-vitro anticoagulant effect of rivaroxaban in neonates.

    Science.gov (United States)

    Attard, Chantal; Monagle, Paul; Kubitza, Dagmar; Ignjatovic, Vera

    2014-04-01

    The use of anticoagulants in neonates is increasing because of the medical advances improving the long-term survival of very sick infants who are at risk of venous thromboembolism (VTE). Current anticoagulation therapy in neonates is less than ideal, because of the physiological differences compared to children and adults regarding the pathophysiology of thrombosis and pharmacology of the drug. Limitations associated with conventional anticoagulants have prompted the development of novel drugs that specifically target the key proteins in the coagulation system. Rivaroxaban is the first oral, direct Factor Xa inhibitor available for the prevention of VTE in adults. Its predictable pharmacokinetic profile, high oral bioavailability and once-daily dosing make rivaroxaban an optimal anticoagulant that warrants investigation in neonates. This study was designed to determine whether there are age-related differences in the pharmacodynamic effects of rivaroxaban in vitro amongst neonates. Neonatal and adult plasma pools were created and spiked with increasing concentrations of rivaroxaban (0-500 ng/ml). Commercially available prothrombin time (PT), activated partial thromboplastin time (aPTT) and anti-Factor Xa assays as well as a sub-sampling thrombin generation assay were used to measure the rivaroxaban effect. A dose-dependent response was observed for PT, aPTT and lag time in both the age groups. Rivaroxaban caused a significant increase in the clotting time for PT and aPTT as well as an increase in lag time (as measured by thrombin generation) in neonates when compared with adults. In-vivo studies are required to confirm the consistency of dose-response in neonates. PMID:24418940

  12. Hydrous iron oxide modified diatomite as an active filtration medium for phosphate capture.

    Science.gov (United States)

    Wang, Zhe; Lin, Yan; Wu, Deyi; Kong, Hainan

    2016-02-01

    A simple method to functionalize diatomite with hydrous iron oxide was attempted and its performance as a new active filtration material to remove and recover phosphate from water was investigated under varying solution conditions. The Langmuir phosphate adsorption capacity increased from 0.6 mgP/g for raw diatomite to 4.89, 14.71, 25.02 mgP/g for hydrous iron oxide modified diatomite (HIOMD), depending on the amount of iron loaded. Loading of hydrous iron oxide caused the increase in true and bulk density and a decline in filtration rate, but to a lesser extent. It was shown that the HIOMD product with suitable iron content could retain a good filtration performance with a greatly increased adsorption capacity for phosphate. The phosphate adsorption increased by decreasing pH and by increasing ionic strength at high pH levels. The adsorption process was interpreted by ligand exchange. Coexisting oxyanions of sulfate, nitrate, citrate, carbonate, silicate and humic acid showed different effects on phosphate fixation but it was presumed that their influence at their concentrations and pH levels commonly encountered in effluent or natural waters was limited, i.e., HIOMD had a reasonably good selectivity. Results in repeated adsorption, desorption and regeneration experiment showed that the adsorbed phosphate could be recovered and the material could be reused after regeneration. The column test showed that HIOMD could be potentially utilized as an adsorption filtration medium for phosphate removal and recovery from water.

  13. Electroconvulsive therapy and anticoagulation after pulmonary embolism: a case report

    Directory of Open Access Journals (Sweden)

    Julio Cesar Lazaro

    2014-07-01

    Full Text Available Introduction Electroconvulsive therapy (ECT is considered the most effective treatment for catatonia regardless its underlying condition. The rigid fixed posture and immobility observed in catatonia may lead to several clinical complications, of which, pulmonary embolism (PE is one of the most severe. The rapid improvement of the psychiatric condition in catatonia-related PE is essential, since immobility favors the occurrence of new thromboembolic events and further complications. In that scenario, ECT should be considered, based on a risk-benefit analysis, aiming at the faster resolution of the catatonia. Methods Case report and literature review. Results A 66-years-old woman admitted to the psychiatric ward with catatonia due to a depressive episode presented bilateral PE. Clinically stable, but still severely depressed after a trial of antidepressants, she was treated with ECT in the course of full anticoagulation with enoxaparin. After five ECT sessions, her mood was significantly better and she was walking and eating spontaneously. She did not present complications related either to PE or to anticoagulation. After the eighth ECT session, she evolved with hypomania, which was managed with oral medication adjustments. The patient was completely euthymic at discharge. Conclusion The case we presented provides further evidence to the anecdotal case reports on the safety of ECT in the course of concomitant full anticoagulant therapy after PE, and illustrates how, with the proper precautions, the benefits of ECT in such condition might outweigh its risks.

  14. Strategies for urgent reversal of target-specific oral anticoagulants.

    Science.gov (United States)

    Davis, Estella M; Uhlmeyer, Erin M; Schmidt, David P; Schardt, Greg L

    2014-12-01

    The direct thrombin inhibitor dabigatran and factor Xa inhibitors rivaroxaban and apixaban are US Food and Drug Administration (FDA)-approved target-specific oral anticoagulants (TSOACs) that have emerged onto the market for use in some indications similar to those for warfarin; in addition, edoxaban is seeking FDA approval. Similar indications include reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation for all 3 agents, for the prevention of deep vein thrombosis that may lead to pulmonary embolism in patients undergoing hip or knee surgery for rivaroxaban and apixaban, and for the treatment and prevention of deep vein thrombosis and pulmonary embolism. As anticoagulants, they are all associated with a risk of bleeding, and, unfortunately, there are no approved antidotes for reversal of these agents. A number of small studies in human subjects and in human/animal models exposed to TSOACs have evaluated the use of activated charcoal, hemodialysis for dabigatran, or clotting factor concentrates for their ability to neutralize the anticoagulant effects or reduce drug concentrations of TSOACs. Clotting factor concentrates that have been used include prothrombin complex concentrates and recombinant factor VII. This review examines studies and case reports evaluating these strategies for expedited or emergent reversal of TSOACs. PMID:25485923

  15. Novel oral anticoagulants for heparin-induced thrombocytopenia.

    Science.gov (United States)

    Skelley, Jessica W; Kyle, Jeffrey A; Roberts, Rachel A

    2016-08-01

    To review the use of the novel oral anticoagulant (NOAC) agents for the treatment of heparin-induced thrombocytopenia (HIT) from relevant clinical trial data. A MEDLINE, International Pharmaceutical Abstracts, ClinicalTrials.gov, and Google-Scholar searches (1966-March 2016) were conducted using the keywords: thrombocytopenia, NOACs, dabigatran, apixaban, rivaroxaban, edoxaban, Xa inhibitor, direct thrombin inhibitor. Articles evaluating the new oral anticoagulants for thrombocytopenia published in English and using human subjects were selected. Eight clinical trials were identified. References cited in identified articles were used for additional citations. Approximately 12 million hospitalized patients each year are exposed to heparin for thromboprophylaxis. HIT, an immune-mediated, prothrombotic adverse reaction is a potential complication of heparin therapy. As a result, heparin products must be immediately withdrawn and replaced by alternative anticoagulants to compensate for the thrombotic risk associated with HIT. Limitations exist with the only currently FDA approved heparin alternative, argatroban. NOACs have been considered as potential alternatives to traditional agents based on their pharmacologic activity. Case reports have indicated positive results in patients, with clinical outcomes and tolerability supporting the use of the NOACs as alternative agents in the treatment of HIT. Positive results have been reported for the use of NOACs in the treatment of HIT. Further robust studies are needed for definitive decision making by clinicians. PMID:27102287

  16. Anticoagulation in chronic kidney disease patients-the practical aspects.

    Science.gov (United States)

    Hughes, Stephen; Szeki, Iren; Nash, Michael J; Thachil, Jecko

    2014-10-01

    There is an increasing awareness about the risks of arterial and venous thromboembolism (TE) in hospital patients and general public which has led to consideration of thrombosis prevention measures in earnest. Early recognition of the symptoms of TE disease has led to timely administration of antiplatelet and anticoagulant drugs, translating to better outcome in many of these patients. In this respect, patients with chronic kidney disease (CKD) represent a special group. They indeed represent a high-risk group for thrombosis both in the cardiovascular territory and also in the venous circulation. At the same time, abnormalities in the platelet membranes put them at risk of bleeding which is significantly more than other patients with chronic diseases. Anticoagulation may be ideal to prevent the former, but the co-existing bleeding risk and also that the commonly used drugs for inhibiting coagulation are eliminated by renal pathways pose additional problems. In this review, we try to explain the complex thrombotic-haemorrhagic state of chronic kidney disease patients, and practical considerations for the management of anticoagulation in them with a focus on heparins. PMID:25878775

  17. Selection of an aptamer antidote to the anticoagulant drug bivalirudin.

    Directory of Open Access Journals (Sweden)

    Jennifer A Martin

    Full Text Available Adverse drug reactions, including severe patient bleeding, may occur following the administration of anticoagulant drugs. Bivalirudin is a synthetic anticoagulant drug sometimes employed as a substitute for heparin, a commonly used anticoagulant that can cause a condition called heparin-induced thrombocytopenia (HIT. Although bivalrudin has the advantage of not causing HIT, a major concern is lack of an antidote for this drug. In contrast, medical professionals can quickly reverse the effects of heparin using protamine. This report details the selection of an aptamer to bivalirudin that functions as an antidote in buffer. This was accomplished by immobilizing the drug on a monolithic column to partition binding sequences from nonbinding sequences using a low-pressure chromatography system and salt gradient elution. The elution profile of binding sequences was compared to that of a blank column (no drug, and fractions with a chromatographic difference were analyzed via real-time PCR (polymerase chain reaction and used for further selection. Sequences were identified by 454 sequencing and demonstrated low micromolar dissociation constants through fluorescence anisotropy after only two rounds of selection. One aptamer, JPB5, displayed a dose-dependent reduction of the clotting time in buffer, with a 20 µM aptamer achieving a nearly complete antidote effect. This work is expected to result in a superior safety profile for bivalirudin, resulting in enhanced patient care.

  18. New anticoagulants in the treatment of stroke:future promise

    Institute of Scientific and Technical Information of China (English)

    Emre Kumral; Tuba Cerraho(g)lu (S)irin

    2013-01-01

    Recent evidence is leading to the replacement of vitamin K antagonists,the efficacy of which in preventing stroke in patients with atrial fibrillation (AF) is well established,with better tolerated and more manageable new anticoagulant drugs,with a lower risk of intracranial bleeding,no clear interactions with food,fewer interactions with medications,and no need for frequent laboratory monitoring and dose adjustments.Among new anticoagulants,dabigatran etexilate is a direct,competitive inhibitor of thrombin.It was evaluated for patients with AF in the RE-LY trial,showing lower rates of stroke and systemic embolism at a dose of 150 mg twice daily with similar rates of major hemorrhage compared with warfarin; and non-inferiority compared with warfarin for the prevention of stroke and systemic embolism at a dose of 110 mg twice daily,with lower rates of major bleeding.Beside dabigatran,oral factor X a inhibitors are also emerging for the prevention of thromboembolic events in AF.Despite the obvious advantages of these new oral anticoagulants over vitamin K antagonists,further information is still needed on how to prioritize the patients deriving the greatest benefit from these novel agents on the basis of patient characteristics or drug pharmacokinetics.There is also a need for assessing their long-term efficacy and safety over decades in the real-world setting.

  19. Improvements of anticoagulant activities of silk fibroin films with fucoidan

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Fucoidan (FC),an effective anticoagulant constituent extracted from brown algae,was introduced into silk fibroin (SF) for improving its blood compatibility.The SF and SF/FC blend films were characterized by attenuated total reflectance Fourier-transform infrared (ATR-FTIR),X-ray photoelectron spectroscopy (XPS),scanning electron microscopy (SEM) and dynamic contact angle determinator (CA).The in vitro anticoagulant activities of the films were evaluated by activated partial thromboplastin time (APTT),thrombin time (TT) and prothrombin time (PT) measurements.The endothelial cell attachment and proliferation viability on the film were assessed by micropipette aspiration technique and MTT assay,respectively.The testing results indicated that the introduction of FC increased the roughness,hydrophilicity and sulfate component of the film surface without impeding the formation of β-sheet conformation in SF.More important,FC brought excellent anticoagulant activity and better endothelial cell affinity to SF.The SF/FC blend film was hopeful to be used as blood-contacting biomaterials.

  20. [Influence of anticoagulants on the appearance of chronic subdural hematoma].

    Science.gov (United States)

    Krupa, Mariusz; Moskała, Marek; Składzień, Tomasz; Grzywna, Ewelina

    2009-01-01

    In recent years in the Department of Neurotraumatology in Cracow it has been noticed the frequent connection between appearance of chronic subdural hematoma (CSDH) and treatment by anticoagulant medications. The aim of this study is to draw attention to the problem of insufficient control of anticoagulants consumption, especially by patients treated for cardiovascular system diseases that increases the risk of bleeding and CSDH development. The paper is based on data from questionnaires that was sent to patients with CSDH, cured in the Department of Neurotraumatology form 2004 to 2005. Analyzed was the group of 51 patients with chronic subdural hematoma; 37 individuals (72.5%) confirmed taking acetylsalicylic acid in the period of 3 months before admission to the Department, 9 (17.6%) patients answered that they were taking low-molecular weight heparin. One patient (1.9%) was taking chronically derivative of cumarin. The authors would inform that anticoagulant treatment might favour increase of chronic subdural hematoma incidence. It's especially important, because the average life expectancy has been prolonged in Poland and there are more people taking acetylsalicylic acid. This can be an epidemiological problem in future. PMID:20043584

  1. Phosphate taxis in Pseudomonas aeruginosa.

    OpenAIRE

    Kato, J.; Ito, A.; Nikata, T; Ohtake, H

    1992-01-01

    Pseudomonas aeruginosa was shown to be attracted to phosphate. The chemotactic response was induced by phosphate starvation. The specificity of chemoreceptors for phosphate was high so that no other tested phosphorus compounds elicited a chemotactic response as strong as that elicited by phosphate. Competition experiments showed that the chemoreceptors for phosphate appeared to be different from those for the common amino acids. Mutants constitutive for alkaline phosphatase showed the chemota...

  2. Genetic disorders of phosphate regulation

    OpenAIRE

    Gattineni, Jyothsna; Baum, Michel

    2012-01-01

    Regulation of phosphate homeostasis is critical for many biological processes, and both hypophosphatemia and hyperphosphatemia can have adverse clinical consequences. Only a very small percentage (1%) of total body phosphate is present in the extracellular fluid, which is measured by routine laboratory assays and does not reflect total body phosphate stores. Phosphate is absorbed from the gastrointestinal tract via the transcellular route [sodium phosphate cotransporter 2b (NaPi2b)] and acros...

  3. Forsterite Carbonation in Wet Supercritical CO2 and Sodium Citrate

    Science.gov (United States)

    Qiu, L.; Schaef, T.; Wang, Z.; Miller, Q.; McGrail, P.

    2013-12-01

    Lin Qiu1*, Herbert T. Schaef2, Zhengrong Wang1, Quin R.S. Miller3, BP McGrail2 1. Yale University, New Haven, CT, USA 2. Pacific Northwest National Laboratory, Richland, WA, USA 3. University of Wyoming, Laramie, WY, USA Geologic reservoirs for managing carbon emissions (mostly CO2) have expanded over the last 5 years to include unconventional formations including basalts and fractured shales. Recently, ~1000 metric tons of CO2 was injected into the Columbia River Basalt (CRB) in Eastern Washington as part of the Wallula Pilot Project, Big Sky Regional Carbon Partnership. Based on reservoir conditions, the injected CO2 is present as a supercritical fluid that dissolves into the formation water over time, and reacts with basalt components to form carbonate minerals. In this paper, we discuss mineral transformation reactions occurring when the forsterite (Mg2SiO4) is exposed to wet scCO2 in equilibrium with pure water and sodium citrate solutions. Forsterite was selected as it is an important olivine group mineral present in igneous and mafic rocks. Citrate was selected as it has been shown to enhance mineral dissolution and organic ligands are possible degradation products of the microbial communities present in the formational waters of the CRB. For the supercritical phase, transformation reactions were examined by in situ high pressure x-ray diffraction (HXRD) in the presence of supercritical carbon dioxide (scCO2) in contact with water and sodium citrate solutions at conditions relevant to carbon sequestration. Experimental results show close-to-complete dissolution of forsterite in contact with scCO2 equilibrated with pure water for 90 hours (90 bar and 50°C). Under these conditions, thin films of water coated the mineral surface, providing a mechanism for silicate dissolution and transport of cations necessary for carbonate formation. The primary crystalline component initially detected with in situ HXRD was the hydrated magnesium carbonate, nesquehonite [Mg

  4. Renal uptake of /sup 67/Ga-citrate in renal amyloidosis due to Familiar Mediterranean Fever

    Energy Technology Data Exchange (ETDEWEB)

    Banzo-Marraco, J.; Abos-Olivares, M.D.; Iribar-Ibabe, M.C.; Prats-Rivera, E.; Banzo-Marraco, J.I.; Teijeiro-Vidal, J.; Nerin-Mora, E.; Nerin de la Puerta, I.

    1981-06-01

    Renal uptake of /sup 67/Ga-citrate is described in a patient with biopsy-proven amyloidosis of the kidneys, due to Familiar Mediterranean Fever. After administration 150 MBq (4mCi) /sup 67/Ga-citrate, scans were done at 48, 72, and 120 h. Intense uptake was noted in both kidneys. A renal biopsy done 5 days after the /sup 67/Ga-citrate scan revealed a pattern typical of amyloidosis. Gallium scanning can be useful in patients with fever of unknown origin. Renal amyloidosis can be considered when renal uptake of /sup 67/Ga-citrate associated with nephrotic syndrome is observed.

  5. Engineering genetically encoded nanosensors for real-time in vivo measurements of citrate concentrations.

    Directory of Open Access Journals (Sweden)

    Jennifer C Ewald

    Full Text Available Citrate is an intermediate in catabolic as well as biosynthetic pathways and is an important regulatory molecule in the control of glycolysis and lipid metabolism. Mass spectrometric and NMR based metabolomics allow measuring citrate concentrations, but only with limited spatial and temporal resolution. Methods are so far lacking to monitor citrate levels in real-time in-vivo. Here, we present a series of genetically encoded citrate sensors based on Förster resonance energy transfer (FRET. We screened databases for citrate-binding proteins and tested three candidates in vitro. The citrate binding domain of the Klebsiella pneumoniae histidine sensor kinase CitA, inserted between the FRET pair Venus/CFP, yielded a sensor highly specific for citrate. We optimized the peptide linkers to achieve maximal FRET change upon citrate binding. By modifying residues in the citrate binding pocket, we were able to construct seven sensors with different affinities spanning a concentration range of three orders of magnitude without losing specificity. In a first in vivo application we show that E. coli maintains the capacity to take up glucose or acetate within seconds even after long-term starvation.

  6. Comparison of the efficiency of clomiphene citrate and letrozole in combination with metformin in moderately obese clomiphene citrate - resistant polycystic ovarian syndrome patients

    Directory of Open Access Journals (Sweden)

    Bjelica Artur

    2016-01-01

    Full Text Available Introduction. Polycystic ovary syndrome is the most common endocrinopathy in women of reproductiveage. Therapy for those who want to get pregnant involves ovulation induction using clomiphene citrate, metformin, letrozole and gonadotropins. Objective. The aim of the study was to compare the efficacy of combinations of clomiphene citrate-metformin and letrozole-metformin in obese patients who are resistant to clomiphene citrate alone. Methods. The investigation was conducted as a retrospective study involving 60 moderately obese patients with polycystic ovary syndrome. Thirty-one of them received the clomiphene citrate-metformin, and 29 letrozole-metformin therapy. Stimulation was carried out for the procedures of intrauterine insemination (IUI. Results. The age of patients, duration of infertility, and body mass index in both groups were similar. There was statistically significant difference in the thickness of the endometrium in favor of the group having the letrozole-metformin therapy (8.9 ± 1.7 mm compared with the group receiving the clomiphene citrate-metformin treatment (6.3 ± 1.3 mm. The number of follicles was not statistically significantly different. Pregnancy rate in the first cycle of IUI in the clomiphene citrate group was 6.4%, and 17.2% in the letrozole group, which also was not statistically different. After the third IUI cycle, the pregnancy rate was significantly higher in the letrozole group (20.6%, while in the clomiphene citrate group it was (9.6%. Conclusion. This retrospective study demonstrated the advantages of the use of letrozole over clomiphene citrate in combination with metformin in moderately obese patients with polycystic ovary syndrome who are resistant to stimulation with clomiphene citrate alone.

  7. Stroke prevention in atrial fibrillation: established oral anticoagulants versus novel anticoagulants-translating clinical trial data into practice.

    Science.gov (United States)

    Ezekowitz, Michael D; Spahr, Judy; Ghosh, Pradeepto; Corelli, Kathryn

    2014-09-01

    Anticoagulation for stroke prevention in atrial fibrillation (AF) is effective. Pivotal trials RE-LY, ROCKET AF, ARISTOTLE, and ENGAGE-AF TIMI 48 tested novel agents against warfarin (W). In RE-LY, an open-label trial, dabigatran 150 mg BID (D150) was superior (35%) and 110 mg BID (D110) was noninferior to W. D150 reduced ischemic strokes by 25% and intracerebral bleeds by 74%, but increased major GI bleeds by 0.5 % per year. In ROCKET AF, a double-blind study, rivaroxaban 20 mg daily, downtitrated to 15 mg daily (if CrCl was 80; weight, 1.5 mg) was superior for safety (31%), efficacy (21%), and all-cause mortality (11%). In ENGAGE-AF TIMI 48, edoxaban 60 mg once daily (30 mg once daily if CrCl 30-50 ml/min, weight <60 kg, or concomitant verapamil or quinidine) was noninferior to W for efficacy, but reduced major bleeding (20%). To translate clinical trials to practice, understanding the disease and each anticoagulant is essential. For all novel agents, rapid anticoagulation, absence of monitoring, and a short half-life differentiate them from W. Bleed rates were either noninferior or lower than for W, without an antidote. Patient compliance is critical. Knowledge of renal function is essential and maintaining patients on therapy is key. PMID:24880227

  8. Methodology of citrate-based biomaterial development and application

    Science.gov (United States)

    Tran, M. Richard

    Biomaterials play central roles in modern strategies of regenerative medicine and tissue engineering. Attempts to find tissue-engineered solutions to cure various injuries or diseases have led to an enormous increase in the number of polymeric biomaterials over the past decade. The breadth of new materials arises from the multiplicity of anatomical locations, cell types, and mode of application, which all place application-specific requirements on the biomaterial. Unfortunately, many of the currently available biodegradable polymers are limited in their versatility to meet the wide range of requirements for tissue engineering. Therefore, a methodology of biomaterial development, which is able to address a broad spectrum of requirements, would be beneficial to the biomaterial field. This work presents a methodology of citrate-based biomaterial design and application to meet the multifaceted needs of tissue engineering. We hypothesize that (1) citric acid, a non-toxic metabolic product of the body (Krebs Cycle), can be exploited as a universal multifunctional monomer and reacted with various diols to produce a new class of soft biodegradable elastomers with the flexibility to tune the material properties of the resulting material to meet a wide range of requirements; (2) the newly developed citrate-based polymers can be used as platform biomaterials for the design of novel tissue engineering scaffolding; and (3) microengineering approaches in the form thin scaffold sheets, microchannels, and a new porogen design can be used to generate complex cell-cell and cell-microenvironment interactions to mimic tissue complexity and architecture. To test these hypotheses, we first developed a methodology of citrate-based biomaterial development through the synthesis and characterization of a family of in situ crosslinkable and urethane-doped elastomers, which are synthesized using simple, cost-effective strategies and offer a variety methods to tailor the material properties to

  9. MODERN APPROACHES TO ANTICOAGULANT THERAPY DURING CATHETER ABLATION TREATMENT OF NON-VALVULAR ATRIAL FIBRILLATION

    OpenAIRE

    E. A. Belikov; K. V. Davtyan; O. N. Tkacheva

    2015-01-01

    Prevention of thromboembolic complications in patients with atrial fibrillation during catheter pulmonary veins isolation is discussed. This subject review is presented with special consideration to new anticoagulants.

  10. Anticoagulation to prevent stroke in atrial fibrillation and its implications for managed care.

    Science.gov (United States)

    Singer, D E

    1998-03-12

    Nonrheumatic atrial fibrillation (AFib) is the most potent common risk factor for stroke, raising the risk of stroke 5-fold. Six randomized trials of anticoagulation in AFib consistently demonstrated a reduction in the risk of stroke by about two-thirds. In these trials, anticoagulation in AFib was quite safe. In contrast, randomized trials indicate that aspirin confers only a small reduction in risk of stroke, at best. Pooled data from the first set of randomized trials indicate that prior stroke, hypertension, diabetes, and increasing age are independent risk factors for future stroke with AFib. Individuals AFib increases greatly at INR levels AFib depend on maintaining the INR between 2.0-3.0. Cost-effectiveness studies indicate that anticoagulation for AFib is among the most efficient preventive interventions in adults. Importantly, the benefits of anticoagulation in AFib accrue immediately. The implications for managed care organizations are that anticoagulation for AFib should be encouraged in their covered populations, and that dedicated anticoagulation services should be developed to promote system-wide control of anticoagulation intensity. Quality measures would include the proportion of patients with AFib who are anticoagulated, and the percentage of time patients' INR levels are between 2.0-3.0. Managed care organizations can benefit from recent research on anticoagulation for AFib; they have a responsibility to support future research and development efforts. PMID:9525571

  11. Phosphate control in dialysis

    Directory of Open Access Journals (Sweden)

    Cupisti A

    2013-10-01

    Full Text Available Adamasco Cupisti,1 Maurizio Gallieni,2 Maria Antonietta Rizzo,2 Stefania Caria,3 Mario Meola,4 Piergiorgio Bolasco31Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 2Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy; 3Territorial Department of Nephrology and Dialysis, ASL Cagliari, Italy; 4Sant'Anna School of Advanced Studies, University of Pisa, Pisa, ItalyAbstract: Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease–mineral and bone disorder (CKD–MBD management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive–convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200–300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source

  12. Formulation, Characterization and Physicochemical Evaluation of Potassium Citrate Effervescent Tablets

    Directory of Open Access Journals (Sweden)

    Fatemeh Fattahi

    2013-02-01

    Full Text Available Purpose: The aim of this study was to design and formulation of potassium citrate effervescent tablet for reduction of calcium oxalate and urate kidney stones in patients suffering from kidney stones. Methods: In this study, 13 formulations were prepared from potassium citrate and effervescent base in different concentration. The flowability of powders and granules was studied. Then effervescent tablets were prepared by direct compression, fusion and wet granulation methods. The prepared tablets were evaluated for hardness, friability, effervescent time, pH, content uniformity. To amend taste of formulations, different flavoring agents were used and then panel test was done by using Latin Square method by 30 volunteers. Results: Formulations obtained from direct compression and fusion methods had good flow but low hardness. Wet granulation improves flowability and other physicochemical properties such as acceptable hardness, effervescence time ≤3 minutes, pH<6, friability < 1%, water percentage < 0.5% and accurate content uniformity. In panel test, both of combination flavors; (orange - lemon and (strawberry - raspberry had good acceptability. Conclusion: The prepared tablets by wet granulation method using PVP solution had more tablet hardness. It is a reproducible process and suitable to produce granules that are compressed into effervescent tablets due to larger agglomerates.

  13. Phosphate Mines, Jordan

    Science.gov (United States)

    2008-01-01

    Jordan's leading industry and export commodities are phosphate and potash, ranked in the top three in the world. These are used to make fertilizer. The Jordan Phosphate Mines Company is the sole producer, having started operations in 1935. In addition to mining activities, the company produces phosphoric acid (for fertilizers, detergents, pharmaceuticals), diammonium phosphate (for fertilizer), sulphuric acid (many uses), and aluminum fluoride (a catalyst to make aluminum and magnesium). The image covers an area of 27.5 x 49.4 km, was acquired on September 17, 2005, and is located near 30.8 degrees north latitude, 36.1 degrees east longitude. The U.S. science team is located at NASA's Jet Propulsion Laboratory, Pasadena, Calif. The Terra mission is part of NASA's Science Mission Directorate.

  14. Molecular mechanisms of crystallization impacting calcium phosphate cements

    Science.gov (United States)

    Giocondi, Jennifer L.; El-Dasher, Bassem S.; Nancollas, George H.; Orme, Christine A.

    2010-01-01

    The biomineral calcium hydrogen phosphate dihydrate (CaHPO4·2H2O), known as brushite, is a malleable material that both grows and dissolves faster than most other calcium minerals, including other calcium phosphate phases, calcium carbonates and calcium oxalates. Within the body, this ready formation and dissolution can play a role in certain diseases, such as kidney stone and plaque formation. However, these same properties, along with brushite’s excellent biocompatibility, can be used to great benefit in making resorbable biomedical cements. To optimize cements, additives are commonly used to control crystallization kinetics and phase transformation. This paper describes the use of in situ scanning probe microscopy to investigate the role of several solution parameters and additives in brushite atomic step motion. Surprisingly, this work demonstrates that the activation barrier for phosphate (rather than calcium) incorporation limits growth kinetics and that additives such as magnesium, citrate and bisphosphonates each influence step motion in distinctly different ways. Our findings provide details of how, and where, molecules inhibit or accelerate kinetics. These insights have the potential to aid in designing molecules to target specific steps and to guide synergistic combinations of additives. PMID:20308110

  15. 78 FR 34648 - Citric Acid and Certain Citrate Salts: Preliminary Results of Countervailing Duty Administrative...

    Science.gov (United States)

    2013-06-10

    ... International Trade Administration Citric Acid and Certain Citrate Salts: Preliminary Results of Countervailing... review of the countervailing duty (CVD) order on citric acid and citrate salts from the People's Republic... (202) 482-1503. Scope of the Order The merchandise subject to the order is citric acid and...

  16. 78 FR 34338 - Citric Acid and Certain Citrate Salts From Canada: Preliminary Results of Antidumping Duty...

    Science.gov (United States)

    2013-06-07

    ...: Antidumping Duty Orders, 74 FR 25703 (May 29, 2009) (Citric Acid Duty Orders). Methodology The Department has... International Trade Administration Citric Acid and Certain Citrate Salts From Canada: Preliminary Results of... administrative review of the antidumping duty order on citric acid and certain citrate salts (citric acid)......

  17. Antiproliferative Effects of Zinc-Citrate Compound on Hormone Refractory Prostate Cancer

    Institute of Scientific and Technical Information of China (English)

    Sung Hoo Hong; Yong Sun Choi; Hyuk Jin Cho; Ji Youl Lee; Joon Chul Kim; Tae Kon Hwang; Sae Woong Kim

    2012-01-01

    Objective:To investigate the antiproliferative effects of zinc-citrate compound on hormone refractory prostate cancer (HRPC).Methods:HRPC cell line (DU145) and normal prostate cell line (RWPE-1) were treated with zinc,citrate and zinc-citrate compound at different time intervals and concentrations to investigate the effect of zinc-citrate compound.Mitochondrial (m)-aconitase activity was determined using aconitase assay.DNA laddering analysis was performed to investigate apoptosis of DU145 cells.Molecular mechanism of apoptosis was investigated by Western blot analys s of P53,P21waf1,Bcl-2,Bcl-xL and Bax,and also caspase-3 activity analysis.Results:Treatment with zinc-citrate compound resulted in a time- and dose-dependent decrease in cell number of DU145 cells in comparison with RWPE-1.M-aconitase activity was significantly decreased.DNA laddering analysis indicated apoptosis of DU145 cells.Zinc-citrate compound increased the expression of P21waf1 and P53,and reduced the express on of Bcl-2 and Bcl-xL proteins but induced the expression of Bax protein.Zinc-citrate compound induced apoptosis of DU145 cells by activation of the caspase-3 pathway.Conclusion:Zinc-citrate compound can induce apoptotic cell death in DU145,by caspase-3 activation through up-regulation of apoptotic proteins and down-regulation of antiapoptotic proteins.

  18. Bioavailability of zinc and phosphorus in calcareous soils as affected by citrate exudation

    NARCIS (Netherlands)

    Duffner, A.; Hoffland, E.; Temminghoff, E.J.M.

    2012-01-01

    Aims Zinc (Zn) and phosphorus (P) deficiency often occurs at the same time and limits crop production in many soils. It has been suggested that citrate root exudation is a response of plants to both deficiencies. We used white lupin (Lupinus albus L.) as a model plant to clarify if citrate exuded by

  19. Addition of senna improves quality of colonoscopy preparation with magnesium citrate

    Institute of Scientific and Technical Information of China (English)

    Stergios Vradelis; Evangelos Kalaitzakis; Yalda Sharifi; Otto Buchel; Satish Keshav; Roger W Chapman; Barbara Braden

    2009-01-01

    AIM: To prospectively investigate the effectiveness and patient's tolerance of two low-cost bowel cleansing preparation protocols based on magnesium citrate only or the combination of magnesium citrate and senna. METHODS: A total of 342 patients who were referred for colonoscopy underwent a colon cleansing protocol with magnesium citrate alone ( n = 160) or magnesium citrate and senna granules ( n = 182). The colonoscopist rated the overall efficacy of colon cleansing using an established score on a 4-point scale. Patients were questioned before undergoing colonoscopy for side effects and symptoms during bowel preparation. RESULTS: The percentage of procedures rescheduled because of insufficient colon cleansing was 7% in the magnesium citrate group and 4% in the magnesium citrate/senna group ( P = 0.44). Adequate visualization of the colonic mucosa was rated superior under the citramag/senna regimen ( P = 0.004). Both regimens were well tolerated, and did not significantly differ in the occurrence of nausea, bloating or headache. However, abdominal cramps were observed more often under the senna protocol (29.2%) compared to the magnesium citrate only protocol (9.9%, P < 0.0003). CONCLUSION: The addition of senna to the bowel preparation protocol with magnesium citrate significantly improves the cleansing outcome.

  20. MECHANISM AND ENERGETICS OF A CITRATE-TRANSPORT SYSTEM OF KLEBSIELLA-PNEUMONIAE

    NARCIS (Netherlands)

    VANDERREST, ME; ABEE, T; MOLENAAR, D; KONINGS, WN

    1991-01-01

    The citrate-transport determinant of plasmid pES1 from Klebsiella pneumoniae [Schwarz, E. & Oesterhelt, D. (1985) EMBO J. 4, 1599 - 1603] has been subcloned in Escherichia coli DH1. Uptake of citrate in E. coli membrane vesicles via this uptake system is an electrogenic process, although the pH grad

  1. Mechanism of Citrate Metabolism by an Oxaloacetate Decarboxylase-Deficient Mutant of Lactococcus lactis IL1403

    NARCIS (Netherlands)

    Pudlik, Agata M.; Lolkema, Juke S.

    2011-01-01

    Citrate metabolism in resting cells of Lactococcus lactis IL1403(pFL3) results in the formation of two end products from the intermediate pyruvate, acetoin and acetate (A. M. Pudlik and J. S. Lolkema, J. Bacteriol. 193:706-714, 2011). Pyruvate is formed from citrate following uptake by the transport

  2. A review of oral anticoagulants in patients with atrial fibrillation.

    Science.gov (United States)

    Greenspon, Arnold J

    2012-11-01

    There is a high prevalence of atrial fibrillation in the United States, particularly in the elderly population. Patients with atrial fibrillation are at an increased risk of stroke and anticoagulant therapy is recommended. However, many eligible patients are not receiving therapy due to limitations and concerns related to the use of the vitamin K antagonist warfarin, such as slow onset of action, variable drug metabolism, risk of bleeding, and requirement for monitoring. Novel oral anticoagulants (NOACs) have been developed and may be used as an alternative to warfarin. This review article summarizes the current clinical trial data for warfarin compared with the NOACs dabigatran (direct thrombin inhibitor), and rivaroxaban and apixaban (factor Xa inhibitors). Dabigatran (150 mg twice daily) demonstrated superiority in reducing the stroke or systemic embolism rate compared with warfarin (1.53% vs 1.69%; P bleeding was similar for dabigatran and warfarin (3.32% per year vs 3.57% per year; P = 0.32). Rivaroxaban (20 mg once daily) demonstrated noninferiority in reducing the stroke or systemic embolism rate compared with warfarin (2.1% vs 2.4%; P bleeding and clinically relevant nonmajor bleeding (14.9% per year vs 14.5% per year; P = 0.44). Apixaban (5 mg twice daily) demonstrated superiority compared with warfarin in preventing stroke or systemic embolism (1.27% vs 1.60%; P = 0.01). Apixaban significantly reduced major bleeding compared with warfarin (2.13% per year vs 3.09% per year; P anticoagulants may be a suitable alternative to warfarin for different patient populations due to minimal drug interactions, lower bleeding risk, and no monitoring requirement. PMID:23322134

  3. Evaluating the Initiation of Novel Oral Anticoagulants in Medicare Beneficiaries

    Science.gov (United States)

    Baik, Seo Hyon; Hernandez, Inmaculada; Zhang, Yuting

    2016-01-01

    BACKGROUND As alternatives to warfarin, 2 novel oral anticoagulants (NOACs), dabigatran and rivaroxaban, were approved in 2010 and 2011 to prevent stroke and other thromboembolic events in patients with atrial fibrillation. It is unclear how patient characteristics are associated with the initiation of anticoagulants. OBJECTIVE To evaluate how patient demographics, clinical characteristics, types of insurance, and patient out-of-pocket spending affect the initiation of warfarin and 2 NOACs—dabigatran and rivaroxaban. METHODS We used pharmacy claims data from a 5% random sample of Medicare beneficiaries to identify patients who were newly diagnosed with atrial fibrillation between October 1, 2010, and October 31, 2012, and who were prescribed an oral anticoagulant within 60 days of diagnosis. We identified key predictors of initiation of NOACs using a multinomial logistic regression model with generalized logit link. RESULTS Patients who were black and who had a history of acute myocardial infarction, stroke or transient ischemic attack, chronic kidney disease, or congestive heart failure were significantly associated with lower odds of receiving NOACs compared with warfarin. Age greater than 65 years, a history of hypertension, and use of nonsteroidal anti-inflammatory drugs were positively associated with the initiation of NOACs. Rivaroxaban was most likely to be initiated among women, followed by warfarin and dabigatran. Individuals receiving a low-income subsidy were more likely to initiate warfarin than NOACs, even though they paid little copayment. Individuals with supplemental Part D drug coverage, such as national Programs for All-Inclusive Care for the Elderly or employer-sponsored plans, were more likely to initiate NOACs compared with warfarin. CONCLUSIONS We found that race, sex, type of Part D plans, and some clinical conditions were associated with the initiation of NOACs relative to warfarin. But patient demographic and clinical characteristics did

  4. The stability of citrate-capped silver nanoparticles in isotonic glucose solution for intravenous injection.

    Science.gov (United States)

    Park, Kwangsik; Lee, Yeonjin

    2013-01-01

    Citrate-capped silver nanoparticles (AgNP) are widely used in industry, consumer products, and medical appliances. However, information on the environmental toxicity and human health is not comprehensive. Further, the physicochemical properties of AgNP make it difficult to test toxicity, as nanosized particles, due to their size, may increase by aggregation or agglomeration in some administration vehicles. In this study, stability of AgNP was investigated in different types of isotonic solutions, which is important for in vitro testing or toxicokinetic studies using intravenous (iv) injection. Size, morphology, zeta potential, and ion formation were investigated in isotonic solutions for the physicochemical characterization of AgNP. Aggregation and precipitation of AgNP were observed in phosphate-buffered saline or 0.9% NaCl, while AgNP were stable without aggregation or precipitation in 5% glucose in isotonic solution. The average size of AgNP in 5% glucose was approximately 10 nm at different temperatures of 10, 25, or 36°C and at varying concentrations from 10 to 1000 ppm. It is noteworthy that this is almost the same size distribution as that in the water-based suspension of AgNP supplied by the manufacturer. Zeta potential ranged from -40 to -60 mV, suggesting that the repulsion forces of AgNP are not disturbed to a sufficient degree to aggregate while osmolarity is in the isotonic range of 290 ± 10 mOsm/kg in 5% glucose solution. Data suggest that AgNP in a 5% glucose solution may be used in the toxicity test via iv injection without adverse consequences in blood. PMID:24283395

  5. CURRENT POSSIBILITIES OF ANTICOAGULANT THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    M. Yu. Gilyarov

    2015-01-01

    Full Text Available Clinical medicine develops towards increasingly more specialization; however, there are diseases faced by physicians of different specialties. The most common cardiac arrhythmia after extrasystoles is atrial fibrillation (AF that increases the risk of cardiac embolism, primarily ischemic stroke, by several times. Identification of the causes of stroke and systemic embolisms has given rise to the creation of clinical scales to assess the risk of their development. According to current guidelines, the long­term use of oral anticoagulants (for an indefinite time is the best way to prevent cardiac embolic complications with medications in AF. This approach outperforms both monotherapy with acetyl­-salicylic acid alone and in combination with clopidogrel. The administration of anticoagulants is warranted in patients having risk factors for stroke, no matter what the clinical type of AF (paroxysmal, constant, or persistent. Until quite recently, oral anticoagulant therapy has implied the use of drugs from a group of vitamin K antagonists (VKAs, among which warfarin is at the forefront; however, the pharmacodynamic and pharmacokinetic features of the drug substantially complicate its practical application. The results of a number of large randomized controlled trials have shown that novel oral anticoagulants (NOACs may be used along with VKAs in patients with non­valvular AF (i. e. in the absence of mitral stenosis or mechanical cardiac valvular prostheses. As com­ pared with warfarin, NOACs have advantages: a much less interaction with foods and drugs and no need for continuous monitoring using coagulation tests and for drug dose adjustment (although the dose should be corrected in renal dysfunctions. When prescribing therapy with VKAs or NOACs, a risk for hemorrhagic complications should be defined. The patient should be informed of the advantages and disadvantages of each therapy option in order to take into account the real possibilities of

  6. Conservatively managed pineal apoplexy in an anticoagulated patient

    Energy Technology Data Exchange (ETDEWEB)

    Werder, Gabriel M. [William Beaumont Hospital, Department of Radiology, 3600 West Thirteen Mile Road, Royal Oak, MI 48073 (United States); St Christopher Iba Mar Diop College of Medicine, Luton (United Kingdom)], E-mail: gabriel_werder@yahoo.com; Razdan, Rahul S.; Gagliardi, Joseph A.; Chaddha, Shashi K.B. [St Vincent' s Medical Center, Bridgeport, CT (United States)

    2008-02-15

    We present a case of pineal apoplexy in an anticoagulated and hypertensive 56-year-old Hispanic male. At presentation, the patient's international normalized ratio (INR) was 10.51 and his blood pressure was 200/130 mmHg. His presenting symptoms included acute onset of headache, chest pain, nausea, vomiting, vertigo, and visual disturbance. Neuroimaging demonstrated hemorrhage into a morphologically normal pineal gland. Under conservative management, the patient experienced gradual resolution of all symptoms excluding the disturbance of upward gaze.

  7. Non-Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation.

    Science.gov (United States)

    Plitt, Anna; Ruff, Christian T; Giugliano, Robert P

    2016-10-01

    For more than 50 years, vitamin K antagonists (VKAs) have been the standard of care for treatment of atrial fibrillation (AF). However, the numerous limitations of VKAs have led to the development of non-VKA oral anticoagulants (NOACs). There are 4 NOACs currently approved for prevention of thromboembolism in patients with nonvalvular AF. This article provides an overview of AF, summarizes basic properties of NOACs, and reviews the landmark trials. Current data on use of NOACs in special populations and specific clinical scenarios are also presented. Lastly, recommendations from experts on controversial topics of bleeding management and reversal are described. PMID:27637305

  8. Noncompaction and embolic myocardial infarction: the importance of oral anticoagulation.

    Science.gov (United States)

    Pulignano, Giovanni; Tinti, Maria Denitza; Tolone, Stefano; Musto, Carmine; De Lio, Lucia; Pino, Paolo Giuseppe; Minardi, Giovanni; Violini, Roberto; Uguccioni, Massimo

    2015-01-01

    Left ventricular noncompaction (LVNC) is characterized by left ventricular (LV) hypertrabeculations and is associated with heart failure, arrhythmias and embolism. We report the case of a 67-year-old LVNC patient, under oral anticoagulation (OAC) therapy for apical thrombosis. After she discontinued OAC, the thrombus involved almost the whole of the left ventricle; in a few months her condition worsened, requiring hospitalization, and despite heparin infusion she experienced myocardial infarction (MI), caused by embolic occlusion of the left anterior descending artery. Although infrequent as a complication of LVNC, and usually attributable to microvascular dysfunction, in this case MI seems due to coronary thromboembolism from dislodged thrombotic material in the left ventricle.

  9. Anticoagulation after anterior myocardial infarction and the risk of stroke.

    Directory of Open Access Journals (Sweden)

    Jacob A Udell

    Full Text Available BACKGROUND: Survivors of anterior MI are at increased risk for stroke with predilection to form ventricular thrombus. Commonly patients are discharged on dual antiplatelet therapy. Given the frequency of early coronary reperfusion and risk of bleeding, it remains uncertain whether anticoagulation offers additional utility. We examined the effectiveness of anticoagulation therapy for the prevention of stroke after anterior MI. METHODS AND FINDINGS: We performed a population-based cohort analysis of 10,383 patients who survived hospitalization for an acute MI in Ontario, Canada from April 1, 1999 to March 31, 2001. The primary outcome was four-year ischemic stroke rates compared between anterior and non-anterior MI patients. Risk factors for stroke were assessed by multivariate Cox proportional-hazards analysis. Warfarin use was determined at discharge and followed for 90 days among a subset of patients aged 66 and older (n = 1483. Among the 10,383 patients studied, 2,942 patients survived hospitalization for an anterior MI and 20% were discharged on anticoagulation therapy. Within 4 years, 169 patients (5.7% were admitted with an ischemic stroke, half of which occurred within 1-year post-MI. There was no significant difference in stroke rate between anterior and non-anterior MI patients. The use of warfarin up to 90 days was not associated with stroke protection after anterior MI (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.37-1.26. The use of angiotensin-converting-enzyme inhibitors (HR, 0.65; 95% CI, 0.44-0.95 and beta-blockers (HR, 0.60; 95% CI, 0.41-0.87 were associated with a significant decrease in stroke risk. There was no significant difference in bleeding-related hospitalizations in patients who used warfarin for up to 90 days post-MI. CONCLUSION: Many practitioners still consider a large anterior-wall MI as high risk for potential LV thrombus formation and stroke. Among a cohort of elderly patients who survived an anterior

  10. Facile synthesis of Ag2S nanoparticles functionalized by carbon-containing citrate shell

    Science.gov (United States)

    Sadovnikov, S. I.; Gusev, A. I.; Gerasimov, E. Yu.; Rempel, A. A.

    2015-12-01

    Silver sulfide nanoparticles with non-toxic citrate shell are synthesized by chemical bath deposition from aqueous mixtures of silver nitrate and sodium sulfide in the presence of sodium citrate used as a complexing and stabilizing agent. The prepared nanoparticles have Ag2S core with monoclinic crystal structure functionalized by a carbon-containing citrate shell. By varying the concentrations of reagents it was possible to prepare core-shell nanoparticles with pre-assigned size of Ag2S core from 10 and 50 nm and pre-assigned thickness from 1.5 to 10 nm of citrate shell. A probable mechanism of formation of carbon-containing citrate shell on Ag2S core has been proposed.

  11. Radiolabeled porphyrin versus gallium-67 citrate for the detection of human melanoma in athymic mice

    International Nuclear Information System (INIS)

    We performed the biodistribution and imaging studies of 111In and 67Ga labeled tetra(4-N-methylpyridyl) porphine, (T4NMPYP), and compared it to that of 67Ga citrate in athymic mice bearing a human melanoma xenograft. The biodistribution results of both 111In and 67Ga labeled T4NMPYP (3, 6, 24, and 48 hours) were similar but differed from that of 67Ga citrate (48 hours). The optimum tumor uptake of both radiolabeled porphyrins was at 6 hours postinjection and was lower than the tumor uptake of 67Ga citrate at 48 hours postinjection. Kidney was the only organ showing higher uptake of radiolabeled porphyrin compared to that of 67Ga citrate. The imaging studies performed with 111In T4NMPYP and 67Ga citrate correspond to the biodistribution results. Osteomyelitis present in one mouse showed good localization of 111In T4NMPYP. 15 refs., 3 figs., 5 tabs

  12. Inflammation is strongly associated with lupus anticoagulant positivity, indepentent of know autoimmune disease and recent venous or arterial thrombosis

    DEFF Research Database (Denmark)

    Just, Søren Andreas; Nybo, Mads; Laustrup, Helle;

    2014-01-01

    Inflammation is strongly associated with lupus anticoagulant positivity, indepentent of know autoimmune disease and recent venous or arterial thrombosis......Inflammation is strongly associated with lupus anticoagulant positivity, indepentent of know autoimmune disease and recent venous or arterial thrombosis...

  13. Glucose-6-phosphate dehydrogenase deficiency

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000528.htm Glucose-6-phosphate dehydrogenase deficiency To use the sharing features on this page, please enable JavaScript. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a condition ...

  14. Research on Uncrystallized Phosphating Film

    Institute of Scientific and Technical Information of China (English)

    TANG En-jun; XING Ze-kuan

    2004-01-01

    This article excogitated a kind of uncrystallized phosphating film bears wearing capacity goodly by adding Ca2 + in normal phosphating solution. This technology is very useful to protect steel parts working in oil from abrasion.

  15. Remote loading of doxorubicin into liposomes driven by a transmembrane phosphate gradient.

    Science.gov (United States)

    Fritze, Andreas; Hens, Felicitas; Kimpfler, Andrea; Schubert, Rolf; Peschka-Süss, Regine

    2006-10-01

    This study examines a new method for the remote loading of doxorubicin into liposomes. It was shown that doxorubicin can be loaded to a level of up to 98% into large unilamellar vesicles composed of egg phosphatidylcholine/cholesterol (7/3 mol/mol) with a transmembrane phosphate gradient. The different encapsulation efficiencies which were achieved with ammonium salts (citrate 100%, phosphate 98%, sulfate 95%, acetate 77%) were significantly higher as compared to the loading via sodium salts (citrate 54%, phosphate 52%, sulfate 44%, acetate 16%). Various factors, including pH-value, buffer capacity, solubility of doxorubicin in different salt solutions and base counter-flow, which likely has an influence on drug accumulation in the intraliposomal interior are taken into account. In contrast to other methods, the newly developed remote loading method exhibits a pH-dependent drug release property which may be effective in tumor tissues. At physiological pH-value doxorubicin is retained in the liposomes, whereas drug release is achieved by lowering the pH to 5.5 (approximately 25% release at 25 degrees C or 30% at 37 degrees C within two h). The DXR release of liposomes which were loaded via a sulfate gradient showed a maximum of 3% at pH 5.5.

  16. Model‐Based Assessment of Plasma Citrate Flux Into the Liver: Implications for NaCT as a Therapeutic Target

    OpenAIRE

    Z. Li; Erion, DM; Maurer, TS

    2016-01-01

    Cytoplasmic citrate serves as an important regulator of gluconeogenesis and carbon source for de novo lipogenesis in the liver. For this reason, the sodium‐coupled citrate transporter (NaCT), a plasma membrane transporter that governs hepatic influx of plasma citrate in human, is being explored as a potential therapeutic target for metabolic disorders. As cytoplasmic citrate also originates from intracellular mitochondria, the relative contribution of these two pathways represents critical in...

  17. Treatment Changes among Users of Non-Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Hellfritzsch, Maja; Husted, Steen Elkjaer; Grove, Erik Lerkevang;

    2016-01-01

    Patients with atrial fibrillation discontinuing anticoagulant therapy are left unprotected against ischaemic stroke. Further, switching between oral anticoagulants may be associated with a transiently increased risk of bleeding or thromboembolism. However, there is a paucity of real-life data on ...

  18. Recurrent venous thromboembolism in anticoagulated patients with cancer : management and short-term prognosis

    NARCIS (Netherlands)

    Schulman, S.; Zondag, M.; Linkins, L.; Pasca, S.; Cheung, Y. W.; De Sancho, M.; Gallus, A.; Lecumberri, R.; Molnar, S.; Ageno, W.; Le Gal, G.; Falanga, A.; Hulegardh, E.; Ranta, S.; Kamphuisen, P.; Debourdeau, P.; Rigamonti, V.; Ortel, T. L.; Lee, A.

    2015-01-01

    BackgroundRecommendations for management of cancer-related venous thromboembolism (VTE) in patients already receiving anticoagulant therapy are based on low-quality evidence. This international registry sought to provide more information on outcomes after a breakthrough VTE in relation to anticoagul

  19. Hemorrhagic shock as a complication of anticoagulant therapy following the mitral valve replacement

    OpenAIRE

    Zah, Tajana; Ivančan, Višnja; TONKOVIĆ, DINKO; Krznarić, Željko; Klinar, Igor; Majerić Kogler, Višnja

    2007-01-01

    This report describes a case of the hemorrhagic shock in a patient on the anticoagulant therapy supplementing implanted mechanical prosthetic heart valve replacing the mitral valve. The association between hemorrhagic shock, mechanical prosthetic heart valve and anticoagulant therapy is briefly discussed.

  20. D-dimer testing to determine the duration of anticoagulation therapy

    NARCIS (Netherlands)

    G. Palareti; B. Cosmi; C. Legnani; A. Tosetto; C. Brusi; A. Iorio; V. Pengo; A. Ghirarduzzi; C. Pattacini; S. Testa; A.W.A. Lensing; A. Tripodi

    2006-01-01

    BACKGROUND: The optimal duration of oral anticoagulation in patients with idiopathic venous thromboembolism is uncertain. Testing of D-dimer levels may play a role in the assessment of the need for prolonged anticoagulation. METHODS: We performed D-dimer testing 1 month after the discontinuation of

  1. Lupus anticoagulants and the risk of a first episode of deep venous thrombosis

    NARCIS (Netherlands)

    De Groot, PG; Lutters, B; Derksen, RHWM; Lisman, T; Meijers, JCM; Rosendaal, FR

    2005-01-01

    We have determined lupus anticoagulants, anti-beta(2) glycoprotem I (beta(2)GPI) and antiprothrombin antibodies in the Leiden Thrombophilia Study, a population-based case-control study designed to determine risk factors for deep venous thrombosis (DVT). Lupus anticoagulant (LAC) was measured in 473

  2. 76 FR 17835 - Citric Acid and Certain Citrate Salts From the People's Republic of China: Extension of Time...

    Science.gov (United States)

    2011-03-31

    ... International Trade Administration A-570-937] Citric Acid and Certain Citrate Salts From the People's Republic... order on citric acid and certain citrate salts (``citric acid'') from the People's Republic of China.... See Citric Acid and Certain Citrate Salts from the People's Republic of China: Notice of Extension...

  3. 77 FR 22560 - Citric Acid and Certain Citrate Salts From the People's Republic of China: Extension of Time...

    Science.gov (United States)

    2012-04-16

    ... International Trade Administration Citric Acid and Certain Citrate Salts From the People's Republic of China... acid and certain citrate salts (``citric acid'') from the People's Republic of China (``PRC'').\\1\\ On...). \\2\\ See Citric Acid and Certain Citrate Salts From the People's Republic of China: Extension of...

  4. 77 FR 9891 - Citric Acid and Certain Citrate Salts from the People's Republic of China: Amended Final Results...

    Science.gov (United States)

    2012-02-21

    ... International Trade Administration Citric Acid and Certain Citrate Salts from the People's Republic of China... antidumping duty order on citric acid and certain citrate salts (``citric acid'') from the People's Republic... Act of 1930, as amended (``the Act''). \\1\\ See Citric Acid and Certain Citrate Salts from the...

  5. NUCLEOTIDE-SEQUENCE AND FUNCTIONAL-PROPERTIES OF A SODIUM-DEPENDENT CITRATE TRANSPORT-SYSTEM FROM KLEBSIELLA-PNEUMONIAE

    NARCIS (Netherlands)

    VANDERREST, ME; SIEWE, RM; ABEE, T; SCHWARZ, E; OESTERHELT, D; KONINGS, WN

    1992-01-01

    The gene of the sodium-dependent citrate transport system from Klebsiella pneumoniae (citS) is located on plasmid pES3 (Schwarz, E., and Oesterhelt, D. (1985) EMBO J. 4, 1599-1603) and encodes a 446-amino acid protein. Transport of citrate via this citrate transport protein (CitS) is dependent on th

  6. Managing new oral anticoagulants in the perioperative and intensive care unit setting.

    Science.gov (United States)

    Levy, Jerrold H; Faraoni, David; Spring, Jenna L; Douketis, James D; Samama, Charles M

    2013-06-01

    Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with any anticoagulant (including the known principles for warfarin) should be considered. This review summarizes the available data regarding the management of bleeding with novel oral anticoagulation agents. Hemodialysis is a therapeutic option for dabigatran-related bleeding, while in vitro studies showed that prothrombin complex concentrates are reported to be useful for rivaroxaban-related bleeding. Additional clinical studies are needed to determine the best method for reversal of the novel oral anticoagulation agents when bleeding occurs. PMID:23416382

  7. Neonatal renal vein thrombosis: role of anticoagulation and thrombolysis--an institutional review.

    Science.gov (United States)

    Bidadi, Behzad; Nageswara Rao, Amulya A; Kaur, Dominder; Khan, Shakila P; Rodriguez, Vilmarie

    2016-02-01

    Neonatal renal vein thrombosis (NRVT) is a rare thromboembolic complication in the neonatal period, and sequelae from renal dysfunction can cause significant morbidity. The authors retrospectively reviewed 10 patients with NRVT treated at their institution. The majority of the cohort were male (n = 9), preterm (n = 6), and had unilateral NRVT (n = 6). Six patients received thrombolysis and/or anticoagulation, and 4 patients received supportive care only. Two of the 6 patients treated with anticoagulation who had bilateral NRVT and anuria received thrombolysis with low-dose tissue plasminogen activator. Thrombolysis was not associated with any major adverse events, and both patients had marked improvement of renal function. Eight patients subsequently developed renal atrophy (3 received anticoagulation, 2 received thrombolysis with anticoagulation, and 3 received supportive care). Anticoagulation/thrombolysis did not appear to prevent renal atrophy. The role of thrombolysis needs to be further studied and considered in the setting of bilateral NRVT and acute renal failure.

  8. Interference from lupus anticoagulant on von Willebrand factor measurement in splenic marginal zone lymphoma

    DEFF Research Database (Denmark)

    Vinholt, Pernille J; Nybo, Mads

    2015-01-01

    We present a case concerning a patient with splenic marginal zone lymphoma (SMZL) and isolated prolonged activated partial thromboplastin time (aPTT) caused by lupus anticoagulant. Von Willebrand factor (VWF) activity and antigen were immeasurable by latex particle immunoturbidimetric assays......, and several coagulation factor levels were decreased. However, VWF activity and antigen were normal when analyzed by other methods. Also, coagulation factor levels were normal if an aPTT reagent with low lupus anticoagulant sensitivity or a chromogenic method was applied. Altogether, the initial findings were...... because of lupus anticoagulant interference and in fact, the patient had normal VWF activity and coagulation status. Interference of lupus anticoagulant in clot-based assays is well known but has not previously been described in VWF assays. This is furthermore the first report in which lupus anticoagulant...

  9. Contrastive analysis of the re-inspection results by several methods in 38 cases of patients with pseudo-throm-bocytopenia caused by EDTA-K2 anticoagulation%38例EDTA-K2抗凝剂引起血小板假性减少患者四种方法复检结果对比分析

    Institute of Scientific and Technical Information of China (English)

    黄亮; 刘祉琳

    2015-01-01

    目的:对比分析EDTA-K2抗凝剂引起血小板假性减少患者用枸橼酸钠抗凝静脉血、肝素锂静脉抗凝血、末梢血、手工显微镜计数法、涂片法进行复检结果对比及分析。方法:对38例 EDTA-K2抗凝、血液分析仪mindrayBC-5180测定血小板明显减低,涂片染色镜检均发现血小板聚集且体表检查无出血、淤点、淤斑等症状符合诊断为EDTA依赖性血小板减少症患者,采用①枸橼酸钠抗凝静脉血、肝素锂抗凝静脉血复检血小板;②采末梢指血用不含任何抗凝剂的稀释液稀释后用血细胞分析仪测定血小板;③手工显微镜计数法计数血小板;④每例患者分别制作抗凝标本和末梢指血合格涂片用瑞氏-姬姆萨染液染色后显微镜镜检。结果:38例EDTA依赖性血小板减少症患者35例能用枸橼酸钠、肝素锂抗凝标本同时纠正,两者纠正数值和手工显微镜计数法、末梢指血计数结果相接近,血涂片镜检观察血小板呈散在分布;2例用肝素锂抗凝标本能纠正枸橼酸钠抗凝标本不能纠正,手工显微镜计数法、末梢指血计数结果和肝素锂抗凝标本纠正结果相接近而和枸橼酸钠抗凝标本不符,血涂片镜检肝观察肝素钠抗凝血血小板呈散在分布而枸橼酸钠抗凝血成片聚集;1例枸橼酸钠、肝素锂抗凝标本均不能纠正,两者纠正结果和手工显微镜计数法、末梢指血计数结果不符,血涂片血小板均出现成片聚集。结论:大多数EDTA依赖性血小板减少患者能用枸橼酸钠、肝素锂抗凝标本加以纠正,极少数不能纠正的可以采集患者末梢指血直接置于不含任何抗凝剂的稀释液中用血细胞分析仪计数血小板值或用手工显微镜计数法计数血小板值。%Objective To contrastive analyze the re-inspection results using sodium citrate anticoagulated venous blood,intravenous anti-coagulant heparin lithium

  10. Effect of Nb on barium titanate prepared from citrate solutions

    Directory of Open Access Journals (Sweden)

    Stojanović Biljana D.

    2002-01-01

    Full Text Available The influence of the addition of dopants on the microstructure development and electrical properties of BaTiO3 doped with 0.2, 0.4, 0.6, 0.8 mol% of Nb and 0.01 mol% of Mn based compounds was studied. Doped barium titanate was prepared using the polymeric precursor method from citrate solutions. The powders calcined at 700°C for 4 hours were analysed by infrared (IR spectroscopy to verify the presence of carbonates, and by X-ray diffraction (XRD for phase formation. The phase composition, microstructure and dielectric properties show a strong dependence on the amount of added niobium.

  11. Use of Blemaren citrate formula in gout patients with nephrolithiasis

    Directory of Open Access Journals (Sweden)

    M S Eliseev

    2008-01-01

    Results. After completion of a course of Blemaren therapy, there was an 8% reduction in the mean serum UA levels, which correlated with an increase in its daily excretion (by an average of 20%. The highest increase in UA excretion was observed in 20 patients with baseline hypoex-cretion (<700 mg/day: from 226,3 (range 201,6-436,8 to 635,0 (range 272,2-705,6 mg/day (p = 0,01. UA excretion substantially unchanged in patients with normal uricosuria (>700 mg/day. Side effects that could cause the agent to be discontinued were absent. Conclusion. The Blemaren citrate formula used in gout patients with nephrolithiasis causes a significant increase in the renal excretion of UA (p = 0,01, normalizes its metabolic parameters, and shows a high safety, without worsening hepatic and renal functions and electrolyte metabolism.

  12. [Stroke Associated with Atrial Fibrillation and Novel Oral Anticoagulants (NOACs)].

    Science.gov (United States)

    Ieko, Masahiro

    2014-10-01

    Atrial fibrillation (AF) increases the risk of stroke and death by an embolus formed in the left atrium. Thrombus formation over the endocardium of the left atrial appendage is caused by a reduction of physiological coagulation inhibitors, such as thrombomodulin, in patients with AF. Therefore, prevention with anticoagulants is important, with warfarin treatment routinely given. Recently, novel oral anticoagulants (NOACs), a direct thrombin inhibitor (TDI), and factor Xa inhibitors (Xa-INHs) have been used for prevention in place of warfarin. However, since the half-life of NOACs is short, there are peak and trough plasma concentrations. Thus, even though thrombin formation is adequately controlled at the peak in NOAC therapy, such formation may occur at the trough, increasing the risk of thrombosis. TDI inhibits the amplification phase and Xa-INHs inhibit the propagation phase (prothrombinase complex) of the coagulation reaction, resulting in the control of thrombin bursts. In a meta-analysis of NOACs vs. warfarin treatment, the former significantly reduced stroke or systemic embolic events by 19% as compared with warfarin, mainly driven by a reduction in hemorrhagic stroke, while their administration also significantly reduced all-cause mortality by 10% and intracranial hemorrhage by 52%. Although frequent monitoring is not necessary in NOAC therapy, some clinical examinations for determining the effect and bleeding risk are required, as it was recently reported that some patients with AF who received NOAC therapy experience cerebral infarction or serious bleeding. PMID:27526540

  13. Practical aspects of new oral anticoagulant use in atrial fibrillation.

    Science.gov (United States)

    Undas, Anetta; Pasierski, Tomasz; Windyga, Jerzy; Crowther, Mark

    2014-01-01

    Dabigatran, a direct thrombin inhibitor and 2 factor Xa inhibitors, rivaroxaban and apixaban, are target-specific oral anticoagulants (TSOACs) approved for prevention of stroke or systemic embolism in patients with nonvalvular atrial fibrillation (AF). Published data suggest that all 3 agents are at least as efficacious as dose‑adjusted warfarin in stroke prevention. Because of their greater specificity, rapid onset of action, and predictable pharmacokinetics, TSOACs have some advantages over vitamin K antagonists, which facilitates their use in clinical practice. The current review addresses the practical questions relating to the use of TSOACs in AF patients based on the available data and personal experience. We discuss topics such as patient selection, renal impairment, drug interactions, switching between anticoagulants, laboratory monitoring, and the risk of bleeding along with its management. We will focus on the aspects of the optimization of treatment with TSOACs in stroke prevention. The understanding of these practical issues by clinicians and patients is of key importance for the safe and effective use of TSOACs in everyday practice. PMID:24556890

  14. Comparative study of two portable systems for oral anticoagulant monitoring.

    Science.gov (United States)

    Vacas, Marta; Lafuente, Pedro José; Unanue, Iciar; Iriarte, José Antonio

    2004-01-01

    Portable prothrombin time (PT) monitors offer the potential for both simplifying and improving oral anticoagulation management. It is necessary to evaluate their concordance and correlation with other PT systems. Our objective was to evaluate the concordance and clinical correlation of two portable PT determination systems, ProTime (ITC) and CoaguChek S (Roche Diagnostics). In all, 20 healthy individuals and 60 anticoagulated patients stabilized over 3 months in a therapeutic International Normalized Ratio (INR) range between 2-3.5 were studied. A drop of capillary blood was obtained simultaneously from two different fingers of each patient and applied to the monitor's application zone. The mean INR of the patients' blood samples of the two monitors differed by 0.01 units (2.32+/-0.63 for Pro Time and 2.33+/-0.68 for CoaguChek). The percentage of simple concordance and the kappa index were 88.3 and 75.9%, respectively. The coefficient of correlation was 0.922. The mean difference (bias) between the monitors was 0.01. The portable PT monitors evaluated presented a high percentage of concordance in INR results.

  15. Stabilization of the E* Form Turns Thrombin into an Anticoagulant

    Energy Technology Data Exchange (ETDEWEB)

    Bah, Alaji; Carrell, Christopher J.; Chen, Zhiwei; Gandhi, Prafull S.; Di Cera, Enrico; (WU-MED)

    2009-07-31

    Previous studies have shown that deletion of nine residues in the autolysis loop of thrombin produces a mutant with an anticoagulant propensity of potential clinical relevance, but the molecular origin of the effect has remained unresolved. The x-ray crystal structure of this mutant solved in the free form at 1.55 {angstrom} resolution reveals an inactive conformation that is practically identical (root mean square deviation of 0.154 {angstrom}) to the recently identified E* form. The side chain of Trp215 collapses into the active site by shifting >10 {angstrom} from its position in the active E form, and the oxyanion hole is disrupted by a flip of the Glu192-Gly193 peptide bond. This finding confirms the existence of the inactive form E* in essentially the same incarnation as first identified in the structure of the thrombin mutant D102N. In addition, it demonstrates that the anticoagulant profile often caused by a mutation of the thrombin scaffold finds its likely molecular origin in the stabilization of the inactive E* form that is selectively shifted to the active E form upon thrombomodulin and protein C binding.

  16. Anticoagulation, ferrotoxicity and the future of translational lung cancer research.

    Science.gov (United States)

    Zacharski, Leo R

    2016-06-01

    Numerous studies have shown that elements of coagulation reactions mediate tumor cell proliferation, motility (invasiveness), tissue remodeling and metastasis. Coagulation activation is virtually a universal feature of human malignancy that differs from the clotting response to injury in that it is self-perpetuating rather than self-attenuating. Coagulation activation participates in tumor matrix deposition and local inflammation, and predicts subsequent cancer risk and adverse cancer outcomes. Several clinical trials of anticoagulants have shown improved outcomes in small cell carcinoma of the lung (SCCL) that have been correlated with assembly on the tumor cells of an intact coagulation pathway. However, variable efficacy of anticoagulant therapy has raised doubts about the coagulation hypothesis. Recently, initiators of coagulation and fibrinolytic pathways have been identified that mediate tumor inception and progression. Notable among these is oxidative stress driven by iron-catalyzed reactive oxygen species that may be the basis for local coagulation activation, tumor matrix deposition, inflammation and aberrant properties characteristic of the malignant phenotype. Recognition of important biological characteristics of individual tumor types, disease stage, choice of standard therapy including chemotherapy and the iron status of the host may clarify mechanisms. All of these are subject to modification based on controlled clinical trial design. Further tests of the coagulation hypothesis may lead to novel, low cost and relatively non-toxic approaches to treatment of malignancy including lung cancer that contrast with certain current cancer treatment paradigms. PMID:27413710

  17. New anticoagulants for the prevention of stroke in atrial fibrillation.

    Science.gov (United States)

    Höchtl, Thomas; Huber, Kurt

    2012-02-01

    Oral anticoagulation in atrial fibrillation is obligatory to lower the risk of spontaneous cerebrovascular and systemic thromboembolism. For this purpose, vitamin K antagonists (coumarins) have been recommended as the most effective drugs for a long time. However, problems with the practical use of these agents, e.g. the need for frequent and regular coagulation controls, the inter-individual differences in maintaining a stable therapeutic range, as well as drug or food interactions, have led to the search and investigation of alternative compounds characterized by a more simple use (e.g. without regular controls of therapeutic levels), high efficacy, as well as low risk of bleeding. The direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban and apixaban have recently been investigated to prove whether they fulfill the high expectancy of an ideal anticoagulant with respect to a more favorable efficacy/safety profile and without the need for coagulation controls, thereby improving quality of life. Dabigatran (RE-LY) achieved an impressive reduction in stroke and non-central nervous system (non-CNS) embolism (110 mg: 1.5%/year; 150 mg: 1.1%/year) in contrast to warfarin (1.7%/year; P = 0.34 and P AVERROES). This review gives a summary of the current knowledge about these agents and their potential future importance.

  18. Procoagulants and anticoagulants in fetal blood. A literature survey.

    Directory of Open Access Journals (Sweden)

    Waldemar Uszyński

    2010-05-01

    Full Text Available In intrauterine life, hemostasis is maintained by the same components as in extrauterine life (blood platelets, coagulation and fibrinolysis systems, involvement of the vascular wall; in the fetus, however, these components show significant differences of a quantitative/qualitative nature. In the present study, we surveyed the literature on the coagulation system in the fetus. We focused on the velocity of development of the coagulation system, being reflected in the increased concentration of all procoagulants and anticoagulants (a rise from approximately 20% in the middle of pregnancy to about 60% or more in the period of labor; exceptions: factors V, VIII and XIII which in the labor period reach the adult level and screening test results (prothrombin time, aPTT - activated prothrombin time, and thrombin time. Reference values were given for the 19-38 weeks of pregnancy and the labor term. Biochemical features of fetal fibrinogen and PIVKA factors were also discussed. The role of activated protein C (APC in the maintenance of balance between procoagulants and anticoagulants was postulated as well as the role of APC in the formation of thrombin activatable fibrinolysis inhibitor (TAFI.

  19. [Anticoagulant rodenticide poisoning in dogs in The Netherlands].

    Science.gov (United States)

    Robben, J H; Mout, H C; Kuijpers, E A

    1997-09-01

    The occurrence, the diagnosis, and the treatment of anticoagulant rodenticide poisoning in dogs in the Netherlands was evaluated by a survey among Dutch veterinarians carried out by the National Poisons Control Center (NPCC). The survey included information on 54 dogs, 32 being treated by veterinarians who consulted the NPCC and 22 that were admitted to the Utrecht University Clinic for Companion Animals (UUCCA). The poisons that were suspected were brodifacoum (n = 19), bromadiolone (n = 14), difenacoum (n = 8), difethialone (n = 6) and chlorophacinone (n = 1). In 6 dogs the identity of the poison was unknown. Of 31 dogs with hemorrhages, 2 died shortly after presentation to practitioners and 2 died shortly after admission to the UUCCA. Signs of bleeding occurred especially in poisoning by brodifacoum (n = 16). In all but one of the dogs without hemorrhages, the intake of poison had taken place within 24 hours before presentation. The method of treatment varied, with the induction of vomiting and the use of vitamin K mentioned most. The choice of therapy was determined by the length of time after intake of the poison, the clinical signs and whether or not an anticoagulant toxicosis was suspected at the time of the initial examination. These findings provide the basis for discussion of several aspects of diagnosis and treatment. PMID:9534772

  20. Anticoagulation, ferrotoxicity and the future of translational lung cancer research

    Science.gov (United States)

    2016-01-01

    Numerous studies have shown that elements of coagulation reactions mediate tumor cell proliferation, motility (invasiveness), tissue remodeling and metastasis. Coagulation activation is virtually a universal feature of human malignancy that differs from the clotting response to injury in that it is self-perpetuating rather than self-attenuating. Coagulation activation participates in tumor matrix deposition and local inflammation, and predicts subsequent cancer risk and adverse cancer outcomes. Several clinical trials of anticoagulants have shown improved outcomes in small cell carcinoma of the lung (SCCL) that have been correlated with assembly on the tumor cells of an intact coagulation pathway. However, variable efficacy of anticoagulant therapy has raised doubts about the coagulation hypothesis. Recently, initiators of coagulation and fibrinolytic pathways have been identified that mediate tumor inception and progression. Notable among these is oxidative stress driven by iron-catalyzed reactive oxygen species that may be the basis for local coagulation activation, tumor matrix deposition, inflammation and aberrant properties characteristic of the malignant phenotype. Recognition of important biological characteristics of individual tumor types, disease stage, choice of standard therapy including chemotherapy and the iron status of the host may clarify mechanisms. All of these are subject to modification based on controlled clinical trial design. Further tests of the coagulation hypothesis may lead to novel, low cost and relatively non-toxic approaches to treatment of malignancy including lung cancer that contrast with certain current cancer treatment paradigms.

  1. 21 CFR 184.1434 - Magnesium phosphate.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Magnesium phosphate. 184.1434 Section 184.1434 Food... Specific Substances Affirmed as GRAS § 184.1434 Magnesium phosphate. (a) Magnesium phosphate includes both magnesium phosphate, dibasic, and magnesium phosphate, tribasic. Magnesium phosphate, dibasic...

  2. Genome-wide identification of citrus ATP-citrate lyase genes and their transcript analysis in fruits reveals their possible role in citrate utilization.

    Science.gov (United States)

    Hu, Xiao-Mei; Shi, Cai-Yun; Liu, Xiao; Jin, Long-Fei; Liu, Yong-Zhong; Peng, Shu-Ang

    2015-02-01

    ATP-citrate lyase (ACL, EC4.1.3.8) catalyzes citrate to oxaloacetate and acetyl-CoA in the cell cytosol, and has important roles in normal plant growth and in the biosynthesis of some secondary metabolites. We identified three ACL genes, CitACLα1, CitACLα2, and CitACLβ1, in the citrus genome database. Both CitACLα1 and CitACLα2 encode putative ACL α subunits with 82.5 % amino acid identity, whereas CitACLβ1 encodes a putative ACL β subunit. Gene structure analysis showed that CitACLα1 and CitACLα2 had 12 exons and 11 introns, and CitACLβ1 had 16 exons and 15 introns. CitACLα1 and CitACLβ1 were predominantly expressed in flower, and CitACLα2 was predominantly expressed in stem and fibrous roots. As fruits ripen, the transcript levels of CitACLα1, CitACLβ1, and/or CitACLα2 in cultivars 'Niuher' and 'Owari' increased, accompanied by significant decreases in citrate content, while their transcript levels decreased significantly in 'Egan No. 1' and 'Iyokan', although citrate content also decreased. In 'HB pummelo', in which acid content increased as fruit ripened, and in acid-free pummelo, transcript levels of CitACLα2, CitACLβ1, and/or CitACLα1 increased. Moreover, mild drought stress and ABA treatment significantly increased citrate contents in fruits. Transcript levels of the three genes were significantly reduced by mild drought stress, and the transcript level of only CitACLβ1 was significantly reduced by ABA treatment. Taken together, these data indicate that the effects of ACL on citrate use during fruit ripening depends on the cultivar, and the reduction in ACL gene expression may be attributed to citrate increases under mild drought stress or ABA treatment.

  3. Calcium Phosphate Biomaterials: An Update

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Current calcium phosphate (CaP) biomaterials for bone repair, substitution, augmentation and regeneration include hydroxyapatite ( HA ) from synthetic or biologic origin, beta-tricalcium phosphate ( β-TCP ) , biphasic calcium phosphate (BCP), and are available as granules, porous blocks, components of composites (CaP/polymer) cements, and as coatings on orthopedic and dental implants. Experimental calcium phosphate biomaterials include CO3- and F-substituted apatites, Mg-and Zn-substituted β-TCP, calcium phosphate glasses. This paper is a brief review of the different types of CaP biomaterials and their properties such as bioactivity, osteoconductivity, osteoinductivity.

  4. Biochemical Characterization of Phosphate Degrading Pseudomonas Cichorii Isolated From Forest Soils In Seshachalam Hills

    Directory of Open Access Journals (Sweden)

    G Prasada Babu

    2013-03-01

    Full Text Available Pseudomonas cichoriiisolates were obtained from forest soils in Seshachalm hills using selective medium. The isolates were screened for phosphate activity and all the isolates were gram negative and showed bright fluorescence under UV light. The cultural and biochemical characteristics confirmed that the isolates were P.cichorii. Carbohydrates utilization profiles confirmed that the isolates were able to utilize Lactose, Xylose, Fructose, Glycerol, Trehalose, Mannitol and Ribose. However, the isolates were unable to utilize glucose and sucrose. The isolates showed positive results for levan production, oxidase and HCN. However they were negative for citrate utilization, ONPG and Gelatin hydrolysis.

  5. Effect of sodium citrate on preparation of nano-sized cobalt particles by organic colloidal process

    Institute of Scientific and Technical Information of China (English)

    Huaping ZHU; Hao LI; Huiyu SONG; Shijun LIAO

    2009-01-01

    Nano-sized cobalt particles with the diameter of 2 nm were prepared via an organic colloidal process with sodium formate, ethylene glycol and sodium citrate as the reducing agent, the solvent and the complexing agent, respectively. The effects of sodium citrate on the yield, crystal structure, particle size and size distribution of the prepared nano-sized cobalt particles were then investigated. The results show that the average particle diameter decreases from 200 nm to 2 nm when the molar ratio of sodium citrate to cobalt chloride changes from 0 to 6. Furthermore, sodium citrate plays a crucial role in the controlling of size distribution of the nano-sized particles. The size distribution of the particle without sodium citrate addition is in range from tens of nanometers to 300 or 400 nm, while that with sodium citrate addition is limited in the range of (2±0.25) nm. Moreover, it is found that the addition of sodium citrate as a complex agent could decrease the yield of the nano-sized cobalt particle.

  6. Layered metal uranyl phosphates

    International Nuclear Information System (INIS)

    HUO2PO4·4H2O (HUP) forms a laminar intercalate with butylamine, c = 29.30(5) angstrom, which accepts cationic metals in exchange for the n-butylammonium ions. Hydrated uranyl metal phosphates M(UO2PO4)2·nH2O (M=Mn,Co,Ni,Cu,Zn,Cd) are obtained by ionic exchange and were studied by thermal analysis and X-ray diffraction. The tetragonal structures of all these product compounds are derived from HUP. The diffuse electronic reflectance spectra of every sample show characteristic UO22+ absorption bands. In the spectra of the Co, Ni and Cu phosphates there are other bands in the 500-800 nm zone compatible with their observed aquocation transitions

  7. The effect of individual phosphate emulsifying salts and their selected binary mixtures on hardness of processed cheese spreads

    Directory of Open Access Journals (Sweden)

    František Buňka

    2013-07-01

    Full Text Available Normal 0 false false false CS JA X-NONE The aim of this work was to observe the effects of emulsifying salts composed of trisodium citrate and sodium phosphates with different chain length (disodium phosphate (DSP, tetrasodium diphosphate (TSPP, pentasodium triphosphate (PSTP and sodium salts of polyphosphates with 5 different mean length (n ≈ 5, 9, 13, 20, 28 on hardness of processed cheese spreads. Hardness of processed cheese spreads with selected binary mixtures of the above mentioned salts were also studied. Measurements were performed after 2, 9 and 30 days of storage at 6 °C. Hardness of processed cheese increased with increase in chain length of individually used phosphates.  Majority of applied binary mixtures of emulsifying salts had not significant influence on hardness charges in processed cheese spreads. On the other hand, a combination of phosphates salts (DSP with TSPP was found, which had specific effect on hardness of processed cheese spreads. Textural properties of samples with trisodium citrate were similar compared to samples with DSP.

  8. Combined oral administration of bovine collagen peptides with calcium citrate inhibits bone loss in ovariectomized rats.

    Directory of Open Access Journals (Sweden)

    JunLi Liu

    Full Text Available Collagen peptides (CPs and calcium citrate are commonly used as bone health supplements for treating osteoporosis. However, it remains unknown whether the combination of oral bovine CPs with calcium citrate is more effective than administration of either agent alone.Forty 12-week-old Sprague-Dawley rats were randomly divided into five groups (n = 8 for once-daily intragastric administration of different treatments for 3 months at 3 months after ovariectomy (OVX as follows: sham + vehicle; OVX + vehicle; OVX + 750 mg/kg CP; OVX + CP-calcium citrate (75 mg/kg; OVX + calcium citrate (75 mg/kg. After euthanasia, the femurs were removed and analyzed by dual energy X-ray absorptiometry and micro-computed tomography, and serum samples were analyzed for bone metabolic markers.OVX rats supplemented with CPs or CP-calcium citrate showed osteoprotective effects, with reductions in the OVX-induced decreases in their femoral bone mineral density. Moreover, CP-calcium citrate prevented trabecular bone loss, improved the microarchitecture of the distal femur, and significantly inhibited bone loss with increased bone volume, connectivity density, and trabecular number compared with OVX control rats. CP or CP-calcium citrate administration significantly increased serum procollagen type I N-terminal propeptide levels and reduced serum bone-specific alkaline phosphatase, osteocalcin, and C-telopeptide of type I collagen levels.Our data indicate that combined oral administration of bovine CPs with calcium citrate inhibits bone loss in OVX rats. The present findings suggest that combined oral administration of bovine CPs with calcium citrate is a promising alternative for reducing bone loss in osteopenic postmenopausal women.

  9. Dysregulation of phosphate metabolism and conditions associated with phosphate toxicity.

    Science.gov (United States)

    Brown, Ronald B; Razzaque, Mohammed S

    2015-01-01

    Phosphate homeostasis is coordinated and regulated by complex cross-organ talk through delicate hormonal networks. Parathyroid hormone (PTH), secreted in response to low serum calcium, has an important role in maintaining phosphate homeostasis by influencing renal synthesis of 1,25-dihydroxyvitamin D, thereby increasing intestinal phosphate absorption. Moreover, PTH can increase phosphate efflux from bone and contribute to renal phosphate homeostasis through phosphaturic effects. In addition, PTH can induce skeletal synthesis of another potent phosphaturic hormone, fibroblast growth factor 23 (FGF23), which is able to inhibit renal tubular phosphate reabsorption, thereby increasing urinary phosphate excretion. FGF23 can also fine-tune vitamin D homeostasis by suppressing renal expression of 1-alpha hydroxylase (1α(OH)ase). This review briefly discusses how FGF23, by forming a bone-kidney axis, regulates phosphate homeostasis, and how its dysregulation can lead to phosphate toxicity that induces widespread tissue injury. We also provide evidence to explain how phosphate toxicity related to dietary phosphorus overload may facilitate incidence of noncommunicable diseases including kidney disease, cardiovascular disease, cancers and skeletal disorders. PMID:26131357

  10. Changes in phosphorylation of adenosine phosphate and redox state of nicotinamide-adenine dinucleotide (phosphate) in Geobacter sulfurreducens in response to electron acceptor and anode potential variation

    KAUST Repository

    Rose, Nicholas D.

    2015-12-01

    © 2015 Elsevier B.V. Geobacter sulfurreducens is one of the dominant bacterial species found in biofilms growing on anodes in bioelectrochemical systems. The intracellular concentrations of reduced and oxidized forms of nicotinamide-adenine dinucleotide (NADH and NAD+, respectively) and nicotinamide-adenine dinucleotide phosphate (NADPH and NADP+, respectively) as well as adenosine triphosphate (ATP), adenosine diphosphate (ADP), and adenosine monophosphate (AMP) were measured in G. sulfurreducens using fumarate, Fe(III)-citrate, or anodes poised at different potentials (110, 10, -90, and -190mV (vs. SHE)) as the electron acceptor. The ratios of CNADH/CNAD+ (0.088±0.022) and CNADPH/CNADP+ (0.268±0.098) were similar under all anode potentials tested and with Fe(III)-citrate (reduced extracellularly). Both ratios significantly increased with fumarate as the electron acceptor (0.331±0.094 for NAD and 1.96±0.37 for NADP). The adenylate energy charge (the fraction of phosphorylation in intracellular adenosine phosphates) was maintained near 0.47 under almost all conditions. Anode-growing biofilms demonstrated a significantly higher molar ratio of ATP/ADP relative to suspended cultures grown on fumarate or Fe(III)-citrate. These results provide evidence that the cellular location of reduction and not the redox potential of the electron acceptor controls the intracellular redox potential in G. sulfurreducens and that biofilm growth alters adenylate phosphorylation.

  11. Citrate-selective electrochemical μ-sensor for early stage detection of prostate cancer

    OpenAIRE

    Azzouzi, Sawsen; Patra, Hirak K.; Ben Ali, Mounir; Abbas, Mohammed Nooredeen; Dridi, Cherif; Errachid, Abdelhamid; Turner, Anthony P. F.

    2016-01-01

    The extremely specialised anatomical function of citrate inside the prostate, make it one of the preferred biomarkers for early stage detection of prostate cancer. However, current detection methods are seriously limited due to the very low citrate concentrations that need to be measured in order to follow disease progression. In the present work, we report a novel citrate-selective μ-sensor based on iron (III) phthalocyanine chloride-C-monoamido-Poly-n-Butyl Acrylate (Fe(III)MAPcCl-P-n-BA) m...

  12. Uranium extraction from ores with lemon juice; II,b. uranium recovery from pregnant lemon juice liquors obtained by attacking phosphate ore and suggested flowsheet

    International Nuclear Information System (INIS)

    In order to recover uranium from the pregnant liquors obtained by attacking Safaga phosphate and Qatrani phosphatic sandstone ore materials with lemon juice, methylation for acidic fraction-salt separation has been carried out. Afterwards, separation of uranium from the associated calcium (mainly present in lemon juice liquors as citrate) has been performed by making-use of the wide difference in their water solubility. The solutions containing the separated uranium were then subjected to evaporation till dryness whereby the precipitated uranyl citrate was calcined at 500 degree C to obtain the yellow orange oxide powder (UO3). On the basis of one ton ore treatment, a flowsheet for uranium recovery from the two ore materials has been suggested

  13. Model‐Based Assessment of Plasma Citrate Flux Into the Liver: Implications for NaCT as a Therapeutic Target

    Science.gov (United States)

    Erion, DM; Maurer, TS

    2016-01-01

    Cytoplasmic citrate serves as an important regulator of gluconeogenesis and carbon source for de novo lipogenesis in the liver. For this reason, the sodium‐coupled citrate transporter (NaCT), a plasma membrane transporter that governs hepatic influx of plasma citrate in human, is being explored as a potential therapeutic target for metabolic disorders. As cytoplasmic citrate also originates from intracellular mitochondria, the relative contribution of these two pathways represents critical information necessary to underwrite confidence in this target. In this work, hepatic influx of plasma citrate was quantified via pharmacokinetic modeling of published clinical data. The influx was then compared to independent literature estimates of intracellular citrate flux in human liver. The results indicate that, under normal conditions, NaCT inhibition will have a limited impact on hepatic citrate concentrations across species. PMID:27069776

  14. Model-Based Assessment of Plasma Citrate Flux Into the Liver: Implications for NaCT as a Therapeutic Target.

    Science.gov (United States)

    Li, Z; Erion, D M; Maurer, T S

    2016-03-01

    Cytoplasmic citrate serves as an important regulator of gluconeogenesis and carbon source for de novo lipogenesis in the liver. For this reason, the sodium-coupled citrate transporter (NaCT), a plasma membrane transporter that governs hepatic influx of plasma citrate in human, is being explored as a potential therapeutic target for metabolic disorders. As cytoplasmic citrate also originates from intracellular mitochondria, the relative contribution of these two pathways represents critical information necessary to underwrite confidence in this target. In this work, hepatic influx of plasma citrate was quantified via pharmacokinetic modeling of published clinical data. The influx was then compared to independent literature estimates of intracellular citrate flux in human liver. The results indicate that, under normal conditions, NaCT inhibition will have a limited impact on hepatic citrate concentrations across species. PMID:27069776

  15. Usefulness of transoesophageal echocardiography before cardioversion in patients with atrial fibrillation and different anticoagulant regimens

    Science.gov (United States)

    Maltagliati, A; Galli, C A; Tamborini, G; Calligaris, A; Doria, E; Salehi, R; Pepi, M

    2006-01-01

    Objectives To evaluate the prevalence of atrial thrombi in patients with atrial fibrillation undergoing different anticoagulation regimens before cardioversion; to evaluate the usefulness of transoesophageal echocardiography (TOE) guided cardioversion to prevent thromboembolic complications; and to correlate the presence of atrial thrombi with clinical and echocardiographic data. Methods 757 consecutive patients admitted as candidates for cardioversion of atrial fibrillation were enrolled in the study. They were divided into four groups: effective conventional oral anticoagulation, short term anticoagulation, ineffective oral anticoagulation or subtherapeutic anticoagulation, and effective oral anticoagulation with a duration of < 3 weeks for various clinical reasons. All patients underwent TOE before cardioversion; in the presence of atrial thrombi or extreme left atrial echo contrast, cardioversion was postponed. The incidence of thromboembolic events was evaluated after cardioversion. Results Atrial thrombi were detected in 48 of the 757 (6.3%) patients. No significant differences in the percentage of atrial thrombosis were found in the four study groups. Patients with atrial thrombosis were older and had a higher percentage of mitral prosthetic valves, lower left ventricular ejection fraction, more severe atrial spontaneous echo contrast, and lower Doppler left atrial appendage velocities. 648 patients were scheduled for cardioversion. Cardioversion was successful in 89% of patients without any major thromboembolic event. Conclusions The prevalence of atrial thrombosis before cardioversion despite different treatments with anticoagulants is about 7% and a TOE guided approach may prevent the risk of embolic events. PMID:16284221

  16. Therapeutic anticoagulation can be safely accomplished in selected patients with traumatic intracranial hemorrhage

    Directory of Open Access Journals (Sweden)

    Byrnes Matthew C

    2012-07-01

    Full Text Available Abstract Introduction Therapeutic anticoagulation is an important treatment of thromboembolic complications, such as DVT, PE, and blunt cerebrovascular injury. Traumatic intracranial hemorrhage has traditionally been considered to be a contraindication to anticoagulation. Hypothesis Therapeutic anticoagulation can be safely accomplished in select patients with traumatic intracranial hemorrhage. Methods Patients who developed thromboembolic complications of DVT, PE, or blunt cerebrovascular injury were stratified according to mode of treatment. Patients who underwent therapeutic anticoagulation with a heparin infusion or enoxaparin (1 mg/kg BID were evaluated for neurologic deterioration or hemorrhage extension by CT scan. Results There were 42 patients with a traumatic intracranial hemorrhage that subsequently developed a thrombotic complication. Thirty-five patients developed a DVT or PE. Blunt cerebrovascular injury was diagnosed in four patients. 26 patients received therapeutic anticoagulation, which was initiated an average of 13 days after injury. 96% of patients had no extension of the hemorrhage after anticoagulation was started. The degree of hemorrhagic extension in the remaining patient was minimal and was not felt to affect the clinical course. Conclusion Therapeutic anticoagulation can be accomplished in select patients with intracranial hemorrhage, although close monitoring with serial CT scans is necessary to demonstrate stability of the hemorrhagic focus.

  17. Anticoagulant factor V: factors affecting the integration of novel scientific discoveries into the broader framework.

    Science.gov (United States)

    LaBonte, Michelle L

    2014-09-01

    Since its initial discovery in the 1940s, factor V has long been viewed as an important procoagulant protein in the coagulation cascade. However, in the later part of the 20th century, two different scientists proposed novel anticoagulant roles for factor V. Philip Majerus proposed the first anticoagulant function for factor V in 1983, yet ultimately it was not widely accepted by the broader scientific community. In contrast, Björn Dahlbäck proposed a different anticoagulant role for factor V in 1994. While this role was initially contested, it was ultimately accepted and integrated into the scientific framework. In this paper, I present a detailed historical account of these two anticoagulant discoveries and propose three key reasons why Dahlbäck's anticoagulant role for factor V was accepted whereas Majerus' proposed role was largely overlooked. Perhaps most importantly, Dahlbäck's proposed anticoagulant role was of great clinical interest because the discovery involved the study of an important subset of patients with thrombophilia. Soon after Dahlbäck's 1994 work, this patient population was shown to possess the factor V Leiden mutation. Also key in the ultimate acceptance of the second proposed anticoagulant role was the persistence of the scientist who made the discovery and the interest in and ability of others to replicate and reinforce this work. This analysis of two different yet similar discoveries sheds light on factors that play an important role in how new discoveries are incorporated into the existing scientific framework. PMID:24853975

  18. Concentrations of anticoagulant rodenticides in stoats Mustela erminea and weasels Mustela nivalis from Denmark.

    Science.gov (United States)

    Elmeros, Morten; Christensen, Thomas Kjær; Lassen, Pia

    2011-05-15

    Anticoagulant rodenticides are widely used to control rodent populations but they also pose a risk of secondary poisoning in non-target predators. Studies on anticoagulant rodenticide exposure of non-target species have mainly reported on frequency of occurrence. They have rarely analyzed variations in residue concentrations. We examine the occurrence and concentrations of five anticoagulant rodenticides in liver tissue from 61 stoats (Mustela erminea) and 69 weasels (Mustela nivalis) from Denmark. Anticoagulant rodenticides were detected in 97% of stoats and 95% of weasels. 79% of the animals had detectable levels of more than one substance. Difenacoum had the highest prevalence (82% in stoats and 88% in weasels) but bromadiolone was detected in the highest concentrations in both stoat (1.290 μg/g ww) and weasel (1.610 μg/g ww). Anticoagulant rodenticide concentrations were highest during autumn and winter and varied with sampling method. Anticoagulant rodenticide concentrations were higher in stoats and weasels with unknown cause of death than in specimens killed by physical trauma. There was a negative correlation between anticoagulant rodenticide concentrations and body condition. Our results suggest that chemical rodent control in Denmark results in an extensive exposure of non-target species and may adversely affect the fitness of some stoats and weasels. PMID:21477845

  19. Bio-inspired citrate-functionalized apatite thin films crystallized on Ti-6Al-4V implants pre-coated with corrosion resistant layers.

    Science.gov (United States)

    Delgado-López, José Manuel; Iafisco, Michele; Rodríguez-Ruiz, Isaac; Gómez-Morales, Jaime

    2013-10-01

    In this paper the crystallization of a bioinspired citrate-functionalized apatite (cit-Ap) thin film (thickness about 2μm) on Ti-6Al-4V supports pre-coated with bioactive and corrosion resistant buffer layer of silicon nitride (Si3N4), silicon carbide (SiC) or titanium nitride (TiN) is reported. The apatitic coatings were produced by a new coating technique based on the induction heating of the implants immersed in a flowing calcium-citrate-phosphate solution at pH11. The influence of the buffer layers and the surface roughness of the substrate on the chemical-physical features and adhesion of the cit-Ap films were investigated. The best plasticity, compactness and adherence properties have been found in the Ap layer grown on Si3N4, followed by the Ap grown on SiC and TiN, respectively. The adhesion property was likely related to the roughness of the buffered substrates, whereas the compactness and plasticity were closely related to the operating conditions during the Ap crystallization (flow rate of the solution and increase of temperature) rather than to the nature of the buffer layer.

  20. Cerebrovascular Accident due to Thyroid Storm: Should We Anticoagulate?

    Directory of Open Access Journals (Sweden)

    Alex Gonzalez-Bossolo

    2016-01-01

    Full Text Available Thyroid storm is a life-threatening condition that occurs secondary to an uncontrolled hyperthyroid state. Atrial fibrillation is a cardiovascular complication occurring in up to 15% of patients experiencing thyroid storm, and if left untreated this condition could have up to a 25% mortality rate. Thyroid storm with stroke is a rare presentation. This case report details a left middle cerebral artery (MCA stroke with global aphasia and thyroid storm in a 53-year-old Hispanic male patient. Although uncommon, this combination has been reported in multiple case series. Although it is well documented that dysfunctional thyroid levels promote a hypercoagulable state, available guidelines from multiple entities are unclear on whether anticoagulation therapy is appropriate in this situation.

  1. Use of Oral Anticoagulation Therapy in Atrial Fibrillation after Stroke

    DEFF Research Database (Denmark)

    Jespersen, Stine Funder; Christensen, Louisa M; Christensen, Anders;

    2013-01-01

    predictors of OAC. Results. 17.1% (n = 9,482) of ischemic stroke patients had AF. OAC prescription rates were increasing, and in 2011 46.6% were prescribed OAC, 42.5% had a contraindication, and 3.7% were not prescribed OAC without a stated contraindication. Younger age, less severe stroke, and male gender......Background. The knowledge is still sparse about patient related factors, influencing oral anticoagulation therapy (OAC) rates, in stroke patients with atrial fibrillation (AF). Aims. To assess the use of OAC in ischemic stroke patients diagnosed with AF and to identify patient related factors...... influencing the initiation of OAC. Methods. In the nationwide Danish Stroke Registry we identified 55,551 patients admitted with acute ischemic stroke from 2003 to 2011. Frequency analysis was used to assess the use of OAC in patients with AF, and logistic regression was used to determine independent...

  2. Role of Antiplatelet Therapy and Anticoagulation in Nonischemic Cardiomyopathy.

    Science.gov (United States)

    Carazo, Matthew; Berger, Jeffrey S; Reyentovich, Alex; Katz, Stuart D

    2016-01-01

    Heart failure continues to be a leading cause of morbidity and mortality throughout the United States. The pathophysiology of heart failure involves the activation of complex neurohormonal pathways, many of which mediate not only hypertrophy and fibrosis within ventricular myocardium and interstitium, but also activation of platelets and alteration of vascular endothelium. Platelet activation and vascular endothelial dysfunction may contribute to the observed increased risk of thromboembolic events in patients with chronic heart failure. However, current data from clinical trials do not support the routine use of chronic antiplatelet or oral anticoagulation therapy for ambulatory heart failure patients without other indications (atrial fibrillation and/or coronary artery disease) as the risk of bleeding seems to outweigh the potential benefit related to reduction in thromboembolic events. In this review, we consider the potential clinical utility of targeting specific pathophysiological mechanisms of platelet and vascular endothelial activation to guide clinical decision making in heart failure patients. PMID:26501990

  3. A vacuolar phosphate transporter essential for phosphate homeostasis in Arabidopsis

    OpenAIRE

    Liu, Jinlong; Yang, Lei; Luan, Mingda; Wang, Yuan; Zhang, Chi; Zhang, Bin; Shi, Jisen; Zhao, Fu-Geng; Lan, Wenzhi; Luan, Sheng

    2015-01-01

    Phosphate is an essential nutrient for plant growth, and inorganic phosphate (Pi) is stored largely in the vacuole of plant cells. Thus, vacuolar Pi maintains homeostasis of cytosolic Pi to ensure an optimal Pi supply for plants under variable Pi status in the soil. This study uncovered in Arabidopsis a vacuolar phosphate transporter, VPT1, that mediates vacuolar Pi sequestration. Lack of VPT1 caused growth defects under both low-Pi and high-Pi conditions, implicating VPT1 in plant adaptation...

  4. The impact of citrate introduction at UK syringe exchange programmes: a retrospective cohort study in Cheshire and Merseyside, UK

    Directory of Open Access Journals (Sweden)

    Wareing Michelle

    2007-12-01

    Full Text Available Abstract Background In 2003, it became legal in the UK for syringe exchange programmes (SEPs to provide citrate to injecting drug users to solubilise heroin. Little work has been undertaken on the effect of policy change on SEP function. Here, we examine whether the introduction of citrate in Cheshire and Merseyside SEPs has altered the number of heroin/crack injectors accessing SEPs, the frequency at which heroin/crack injectors visited SEPs and the number of syringes dispensed. Methods Eleven SEPs in Cheshire and Merseyside commenced citrate provision in 2003. SEP-specific data for the six months before and six months after citrate was introduced were extracted from routine monitoring systems relating to heroin and crack injectors. Analyses compared all individuals attending pre and post citrate and matched analyses only those individuals attending in both periods (defined as 'longitudinal attenders'. Non-parametric tests were used throughout. Results Neither new (first seen in either six months period nor established clients visited SEPs more frequently post citrate. New clients collected significantly less syringes per visit post citrate, than pre citrate (14.5,10.0; z = 1.992, P Conclusion The introduction of citrate did not negatively affect SEP attendance. 'Longitudinal attenders' visited SEPs more frequently post citrate, providing staff with greater opportunity for intervention and referral. As the number of syringes they collected each visit remained unchanged the total number of clean syringes made available to this group of injectors increased very slightly between the pre and post citrate periods. However, new clients collected significantly less syringes post citrate than pre citrate, possibly due to staff concerns regarding the amount of citrate (and thus syringes to dispense safely to new clients. These concerns should not be allowed to negatively impact on the number of syringes dispensed.

  5. In vitro anticoagulation monitoring of low-molecular-weight heparin

    Institute of Scientific and Technical Information of China (English)

    WANG Jian-qi; SHI Xu-bo; YANG Jin-gang; HU Da-yi

    2009-01-01

    Background Although low-molecular-weight heparin has replaced unfractionated heparin to become the primary anticoagulation drug for treatment of acute coronary syndrome, there is no convenient bedside monitoring method. We explored the best laboratory monitoring method of low-molecular-weight heparins (enoxapadn, dalteparin, and nadroparin) by use of the Sonoclot coagulation analyzer to monitor the activated clotting time.Methods Atotal of 20 healthy volunteers were selected and 15 ml of fasting venous blood samples were collected and incubated. Four coagulants, kaolin, diatomite, glass bead, and magnetic stick, were used to determine the activated clotting time of the low-molecular-weight heparins at different in vitro anti-Xa factor concentrations. A correlation analysis was made to obtain the regression equation. The activated clotting time of the different low-molecular-weight heparins with the same anti-Xa factor concentration was monitored when the coagulant glass beads were applied. Results The activated clotting time measured using the glass beads, diatomite, kaolin, and magnetic stick showed a linear correlation with the concentration of nadroparin (r= 0.964, 0.966, 0.970, and 0.947, respectively). The regression equation showed that the linear slopes of different coagulants were significantly different (glass beads 230.03 s/IU,diatomite 89.91 s/IU, kaolin 50.87 s/IU, magnetic stick could not be calculated). When the concentration of the anti-Xa factor was the same for different low-molecular-weight heparins, the measured activated clotting time was different after the application of the glass bead coagulant.Conclusions The glass bead coagulant is most feasible for monitoring the in vitro anticoagulation activity of nadroparin.The different effects of different low-molecular-weight heparins on the activated clotting time may be related to the different anti-Ila activities.

  6. Exposure pathways of anticoagulant rodenticides to nontarget wildlife.

    Science.gov (United States)

    Elliott, John E; Hindmarch, Sofi; Albert, Courtney A; Emery, Jason; Mineau, Pierre; Maisonneuve, France

    2014-02-01

    Second-generation anticoagulant rodenticides are widely reported to contaminate and poison nontarget wildlife, primarily predatory birds and mammals. Exposure pathways, however, have not been well defined. Here, we examined potential movement of rodenticides from deployment of bait to exposure of small mammals and other biota. At two adjacent working farms, we placed baits containing either brodifacoum or bromadiolone. We monitored movement of those compounds to the surrounding environment by collecting small mammals, birds, and invertebrates. Similar collections were made at a third agricultural setting without active bait deployment, but located among intensive livestock production and regular rodenticide use by farmers. Livers and whole invertebrate samples were analyzed for rodenticides using a sensitive LC-MSMS method. Norway rats (Rattus norvegicus) from both baited and non-baited farms had residues of brodifacoum or bromadiolone, implicating rats as an important exposure pathway to wildlife. Among 35 analyzed nontarget small mammals, a single vole had high hepatic residues (18.6 μ/g), providing some indication of a small mammal pathway. One song sparrow (Melospiza melodia) sample from a baited farm contained 0.073 μg/g of brodifacoum in liver, while 0.39 μg/g of diphacinone was measured in a pool of carrion beetles (Dermestes spp.) from the non-baited farm area, implicating avian and invertebrate components in exposure pathways. Regurgitated pellets of barn owl (Tyto alba) selected randomly from baited farms contained no detectable rodenticide residues, while 90% of owl pellets collected from a variety of farms, and selected for the presence of rat fur, contained detectable anticoagulant residues. We recorded behavior of a captive sample of a representative songbird, the house sparrow (Passer domesticus); they readily entered bait stations and fed on (unloaded) bait. PMID:24048882

  7. Chemically sulfated natural galactomannans with specific antiviral and anticoagulant activities.

    Science.gov (United States)

    Muschin, Tegshi; Budragchaa, Davaanyam; Kanamoto, Taisei; Nakashima, Hideki; Ichiyama, Koji; Yamamoto, Naoki; Shuqin, Han; Yoshida, Takashi

    2016-08-01

    Naturally occurring galactomannans were sulfated to give sulfated galactomannans with degrees of substitution of 0.7-1.4 per sugar unit and molecular weights of M¯n=0.6×10(4)-2.4×10(4). Sulfated galactomannans were found to have specific biological activities in vitro such as anticoagulant, anti-HIV and anti-Dengue virus activities. The biological activities were compared with those of standard dextran and curdlan sulfates, which are polysaccharides with potent antiviral activity and low cytotoxicity. It was found that sulfated galactomannans had moderate to high anticoagulant activity, 13.4-36.6unit/mg, compared to that of dextran and curdlan sulfates, 22.7 and 10.0unit/mg, and high anti-HIV and anti-Dengue virus activities, 0.04-0.8μg/mL and 0.2-1.1μg/mL, compared to those curdlan sulfates, 0.1μg/mL, respectively. The cytotoxicity on MT-4 and LCC-MK2 cells was low. Surface plasmon resonance (SPR) of sulfated galactomannans revealed strong interaction with poly-l-lysine as a model compound of virus proteins, and suggested that the specific biological activities might originate in the electrostatic interaction of negatively charged sulfate groups of sulfated galactomannans and positively charged amino groups of surface proteins of viruses. These results suggest that sulfated galactomannans effectively prevented the infection of cells by viruses and the degree of substitution and molecular weights played important roles in the biological activities. PMID:27154517

  8. CcpA-independent regulation of expression of the Mg2+-citrate transporter gene citM by arginine metabolism in Bacillus subtilis

    NARCIS (Netherlands)

    Warner, JB; Magni, C; Lolkema, JS; Warner, Jessica B.

    2003-01-01

    Transcriptional regulation of the Mg2+ -citrate transporter, CitM, the main citrate uptake system of Bacillus subtilis, was studied during growth in rich medium. Citrate in the growth medium was required for induction under all growth conditions. In Luria-Bertani medium containing citrate, citM expr

  9. Problems in the scintigraphic detection of osteomyelitis. [/sup 99m/Tc-phosphate compounds; /sup 67/Ga-citrates

    Energy Technology Data Exchange (ETDEWEB)

    Gilday, D.L.

    1980-06-01

    Bone imaging has played a major role in the early detection of pediatric osteomyelitis. The single gamma camera view (rather than whole body imaging) successfully delineates the growth zones of the long bones and can detect subtle changes in these regions. If a high suspicion of osteomyelitis is entertained despite a normal bone scan, gallium imaging should be employed. Cases have been reported in which delayed scans were normal but the blood pool image was not.

  10. [Effect of citrate, tartrate, succinate and phosphate ions on the penetration of phosphorus-labelled anions into erythrocytes].

    Science.gov (United States)

    Gomulkievich, Ia; Popdimitrova, N; Kunchev, N; Zlatarev, G

    1980-01-01

    Membrane permeability for different ions may successfully be evaluated under conditions of ionic equilibrium, which provides osmotic equilibrium in the cell and steadiness of its volume. The present investigation was promoted on red cells of experimental animals under conditions of ionic equilibrium, using P32 with up to 30 microCi activity. Unidirectional penetration of ions in the red cells was studied. The speed constant K0 was derived from the graphic relation InA=f(t) as an angular coefficient at the starting moment. The type of ions was shown to influence K0 value, which was maximal in the presence of tartarate ions in the suspension medium and minimal in the presence of succinate ions. This study demonstrated that the activation energy does not depend on the ions in the solution. The results are highly suggestive of the existence of differences in the mechanism of penetration of different ions through the red cell membrane.

  11. Analysis thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis in the lower extremities

    Institute of Scientific and Technical Information of China (English)

    刘心; 张梅; 刘陕西; 祈光裕; 刘亚民

    2003-01-01

    Objective: To explore the effect of thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis of lower extremity. Methods: The clinical data of 106 patients at the early stage of deep vein thrombosis (DVT) in the lower extremities treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results: The thrombolytic effect was significant. After treatment, the deep veins were recanalized without regurgitation in 75.3% of the patients. The total effective rate was 100%. Only three patients had hemorrhagic complication, but none of the patients died. Conclusion: Thrombolysis with anticoagulation treatment is an effective and safe method for DVT at the early stage.

  12. Therapeutic Anticoagulant Does not Modify Thromboses Rate Vein after Venous Reconstruction Following Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Mehdi Ouaïssi

    2008-01-01

    confluent SMV (n=12; type III (n=1 resulted from a primary end-to-end anastomosis above confluent and PTFE graph was used for reconstruction for type IV (n=2. Curative anticoagulant treatment was always indicated after type IV (n=2 resection, and after resection of type II when the length of venous resection was longer than ≥2 cm. Results. Venous thrombosis rate reached: 0%, 41%, and 100% for type I, II, IV resections, respectively. Among them four patients received curative anticoagulant treatment. Conclusion. After a portal vein resection was achieved in the course of a PD, curative postoperative anticoagulation does not prevent efficiently the onset of thrombosis.

  13. Pyridoxal phosphate-dependent neonatal epileptic encephalopathy

    OpenAIRE

    Bagci, S.; Zschocke, J.; Hoffmann, G F; Bast, T.; Klepper, J; Müller, A.; Heep, A; Bartmann, P.; Franz, A R

    2009-01-01

    Pyridox(am)ine-5′-phosphate oxidase converts pyridoxine phosphate and pyridoxamine phosphate to pyridoxal phosphate, a cofactor in many metabolic reactions, including neurotransmitter synthesis. A family with a mutation in the pyridox(am)ine-5′-phosphate oxidase gene presenting with neonatal seizures unresponsive to pyridoxine and anticonvulsant treatment but responsive to pyridoxal phosphate is described. Pyridoxal phosphate should be considered in neonatal epileptic encephalopathy unrespons...

  14. Integrated assessment of the phosphate industry

    International Nuclear Information System (INIS)

    The phosphate industry in the United States includes three major activities, namely, mining and milling of phosphate rock, phosphate product manufacture, and phosphate product use. Phosphatic materials contain uranium, thorium, and their decay products in greater than background amounts. This assessment of the radiological impacts associated with the redistribution of radioactive components of phosphate materials may provide insight into the effects of uranium extraction from phosphate materials for use in the nuclear fuel cycle

  15. 77 FR 4895 - New Animal Drugs; Chloramphenicol, Diethylcarbamazine Citrate, Hygromycin B, Methoxyflurane...

    Science.gov (United States)

    2012-02-01

    ... Drugs; Chloramphenicol, Diethylcarbamazine Citrate, Hygromycin B, Methoxyflurane, Neomycin Sulfate... Affiliate of IGI, ane, prednisolone, Inc., Box 209, tetracaine, Harding Hwy., neomycin sulfate). Buena, NJ 08310. NADA 044-655 NEOMYCANE Ophthalmic Evsco Ointment (neomycin Pharmaceuticals, an...

  16. Electrodeposition and characterisation of Ni/Cu nanostructured multilayers from citrate solutions

    CERN Document Server

    Meuleman, W R A

    2002-01-01

    A study of the effect of chemical and electrochemical parameters such as solution composition, pH, and current and potential waveforms on magnetic metal multi-layers plated from citrate electrolytes was carried out. Until now, magnetic multilayers have usually been electrodeposited mainly form sulfamate electrolytes; far less information is available on Cu-Ni multilayers obtained from citrate electrolytes. Since copper is deposited at its diffusion limiting current during multilayer deposition from citrate electrolytes, a rotating disc electrode study was carried out. It was found that the apparent diffusion coefficient changes significantly depending on the citrate ion concentration and pH, indicating the importance of metal speciation. In order to identify the rate controlling species, speciation calculations were carried out in order to model the dependence of the limiting current on the solution composition. The model is based on the assumption that complexes in solution are either labile or inert. A vert...

  17. Dietary sodium citrate supplementation enhances rehydration and recovery from rapid body mass loss in trained wrestlers.

    Science.gov (United States)

    Timpmann, Saima; Burk, Andres; Medijainen, Luule; Tamm, Maria; Kreegipuu, Kairi; Vähi, Mare; Unt, Eve; Oöpik, Vahur

    2012-12-01

    This study assessed the effects of dietary sodium citrate supplementation during a 16 h recovery from 5% rapid body mass loss (RBML) on physiological functions, affective state, and performance in trained wrestlers. Sixteen wrestlers performed an upper body intermittent sprint performance (UBISP) test under three conditions: before RBML, after RBML, and after a 16 h recovery from RBML. During recovery, the subjects ate a prescribed diet supplemented with sodium citrate (600 mg·kg(-1); CIT group, N = 8) or placebo (PLC group, N = 8) and drank water ad libitum. RBML reduced (p sodium citrate increases blood buffering capacity and PV and stimulates BM regain during a 16 h recovery from RBML in trained wrestlers. However, sodium citrate does not improve UBISP nor does it have an impact on the affective state.

  18. Fingerprinting of sildenafil citrate and tadalafil tablets in pharmaceutical formulations via X-ray fluorescence (XRF) spectrometry.

    Science.gov (United States)

    Ortiz, Rafael S; Mariotti, Kristiane C; Schwab, Nicolas V; Sabin, Guilherme P; Rocha, Werickson F C; de Castro, Eustáquio V R; Limberger, Renata P; Mayorga, Paulo; Bueno, Maria Izabel M S; Romão, Wanderson

    2012-01-25

    The production of counterfeited drugs is a criminal problem that carries serious risks to public health in the worldwide. In Brazil, Viagra and Cialis are the most counterfeit medicines, being used to inhibit the phosphodiesterase type 5 (PDE-5), treating thus, problems related to erectile dysfunction. X-ray fluorescence (XRF) is a suitable technique to control the quality of new pharmaceutical formulations and distinguish between authentic and counterfeit tablets. XRF has advantageous features like multielemental capability, good detectivity, high precision, short analysis times, and is nondestructive, which makes it suitable to be extended to a great variety of samples. In this work, the inorganic fingerprinting chemical of forty-one commercial samples (Viagra, Cialis, Lazar, Libiden, Maxfil, Plenovit, Potent 75, Rigix, V-50, Vimax and Pramil) and fifty-six counterfeit samples (Viagra and Cialis) were obtained from XRF data. XRF presented an excellent analytical methodology for semi-quantitative determination of active ingredient (in case of sildenafil citrate that presents S in its structure) and excipients such as calcium phosphate, titanium oxide and iron oxide (P, Ca, Ti and Fe). The matrix data were allied to chemometric methods (Principal Component Analysis and Hierarchical Cluster Analysis) to classify the tablets investigated between authentic and counterfeit, grouping the samples into of seven groups: A, B, C, D and E (counterfeit group) and F and G (authentic group). PMID:22014651

  19. QbD-Driven Development and Validation of a HPLC Method for Estimation of Tamoxifen Citrate with Improved Performance.

    Science.gov (United States)

    Sandhu, Premjeet Singh; Beg, Sarwar; Katare, O P; Singh, Bhupinder

    2016-09-01

    The current studies entail Quality by Design (QbD)-enabled development of a simple, rapid, sensitive and cost-effective high-performance liquid chromatographic method for estimation of tamoxifen citrate (TMx). The factor screening studies were performed using a 7-factor 8-run Taguchi design. Systematic optimization was performed employing Box-Behnken design by selecting the mobile phase ratio, buffer pH and oven temperature as the critical method parameters (CMPs) identified from screening studies, thus evaluating the critical analytical attributes (CAAs), namely, peak area, retention time, theoretical plates and peak tailing as the parameters of method robustness. The optimal chromatographic separation was achieved using acetonitrile and phosphate buffer (pH 3.5) 52:48 v/v as the mobile phase with a flow rate 0.7 mL/min, an oven temperature 40°C and UV detection at 256 nm. The method was validated as per the ICH recommended conditions, which revealed high degree of linearity, accuracy, precision, sensitivity and robustness over the existing liquid chromatographic methods of the drug. Also the method was applied for the estimation of TMx in nanostructured formulations, which indicated no significant change in the retention time. In a nutshell, the studies demonstrated successful development of the HPLC method of TMx with improved understanding of the relationship among the influential variables for enhancing the method performance. PMID:27226463

  20. Silicon Injection Granulomata: 67Ga Citrate Findings in Free Silicon Buttock Augmentation.

    Science.gov (United States)

    Strauss, Sara; Chun, Kwang; Benchekroun, Mohammed Taoudi; Akamnonu, Olisaemeka; Freeman, Leonard

    2016-06-01

    Ga citrate is frequently used in the workup of fever of unknown origin. Here, we report a case of avid Ga-citrate in bilateral gluteal regions of a patient with a history of free silicon injection buttock augmentation referred for suspected diagnosis of sarcoidosis. CT findings were equivocal for inflammation/infection in the buttock region, and nuclear scintigraphy allowed for more definitive diagnosis. PMID:26953658

  1. Triplet heterotopic pregnancy following ovulation induction with clomiphene citrate: a case report and review of literature

    OpenAIRE

    Maheswari S; Seetha Panicker

    2013-01-01

    Heterotopic pregnancy, though rare is a combined pregnancy in which synchronous intrauterine and extra uterine pregnancy occur. An estimated incidence of between 1/8000 to 1/30,000 has been reported following spontaneous conception. After artificial reproductive techniques, the incidence is as high as 1/100 and after ovulation induction with clomiphene citrate, it is around 1/900. We are reporting a case of 26 year old gravida 2 who conceived after ovulation induction with clomiphene citrate ...

  2. Facile Synthesis of Gold Nanoplates by Citrate Reduction of AuCl4- at Room Temperature

    Institute of Scientific and Technical Information of China (English)

    Lan HUANG; Zhi Rui GUO; Meng WANG; Ning GU

    2006-01-01

    Single-crystalline, regular-edged gold nanoplates are synthesized through chemical reduction of AuCl4- by a suitable amount of citrate at room temperature, without additional capping agents or surfactants. The suitable molar ratio of sodium citrate to HAuCl4, low reaction temperature and the presence of natural light are critical factors for the formation of the regularly shaped nanoplates.

  3. Phosphate Test 2.0

    OpenAIRE

    Stalder, Etienne; Zumbuehl, Andreas

    2014-01-01

    The accurate measurement of the phosphate content of a liposomal suspension is important when working with differential scanning calorimetry. Standard phosphate tests date back several decades and require extended hands-on time. Here, we present a rapid version of a phosphate test taking advantage of microwave-assisted chemical digestion and multiwell plate reading technology allowing for the fast and accurate testing of many samples in parallel.

  4. Pseudohypernatremia secondary to trisodium citrate (Citra-LockTM)

    Science.gov (United States)

    Milliere, Janice; Corriveau, Daryl; Parmar, Malvinder S.

    2016-01-01

    Introduction Hypernatremia is common among hospitalized patients especially in the intensive care units and presents an independent risk factor for mortality. Mild hypernatremia is often asymptomatic but severe hypernatremia causes central nervous system dysfunction with initial non-specific symptoms of encephalopathy that may progress to seizures, coma and death, if left untreated. Severe hypernatremia is a medical emergency and requires emergent medical attention. Materials and methods A haemodialysis patient who arrived for his scheduled haemodialysis treatment had monthly blood work drawn and was reported to have severe hypernatremia with serum sodium concentration of 183 mmol/L. The possibility of technique or laboratory error was considered and systematically evaluated. Results The serum sodium measurement using another analyser showed similar value of 182 mmolL. A repeat serum sodium level on a sample drawn 2 h later showed normal value of 139–140 mmol/L. A step-wise evaluation of the complete procedure from blood collection to analysis of the sample revealed this to be spuriously elevated serum sodium concentration secondary to contamination of the sample during sample collection with trisodium citrate, a catheter-lock solution, commonly used in dialysis units to maintain patency of dialysis catheters. Conclusions Spuriously elevated plasma sodium concentration (pseudohypernatremia) of mild degree is common but severe pseudohypernatremia is rare and the possibility of sample contaminations or laboratory error should be considered. Vigilance is required by both the medical and the laboratory staff to resolve such issues in a timely fashion to avoid unintended consequences. PMID:27346973

  5. Anticaries effect of dentifrices with calcium citrate and sodium trimetaphosphate

    Science.gov (United States)

    DELBEM, Alberto Carlos Botazzo; BERGAMASCHI, Maurício; RODRIGUES, Eliana; SASSAKI, Kikue Takebayashi; VIEIRA, Ana Elisa de Mello; MISSEL, Emilene Macario Coimbra

    2012-01-01

    Because of the growing concerns regarding fluoride ingestion by young children and dental fluorosis, it is necessary to develop new dentifrices. Objective The aim of this study was to evaluate the effect of dentifrices with calcium citrate (Cacit) and sodium trimetaphosphate (TMP) on enamel demineralization. Material and Methods Enamel blocks (n=70), previously selected through surface hardness analysis, were submitted to daily treatment with dentifrices diluted in artificial saliva and to a pH-cycling model. The fluoride concentration in dentifrices was 0, 250, 450, 550, 1,000 and 1,100 µg F/g. CrestTM was used as a positive control (1,100 mg F/g). Cacit (0.25%) and TMP (0.25%) were added to dentifrices with 450 and 1,000 µg F/g. Surface hardness was measured again and integrated loss of subsurface hardness and fluoride concentration in enamel were calculated. Parametric and correlation tests were used to determine difference (p0.05). Conclusions Dentifrices with 450 and 1,000 µg F/g, Cacit and TMP were as effective as a gold standard one. PMID:22437685

  6. /sup 67/Ga citrate scintiscanning in active inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Rheingold, O.J.; Tedesco, F.J.; Block, F.E.; Maldonado, A.; Miale, A. Jr.

    1979-05-01

    Twenty-five hospitalized patients were studied prospectively with /sup 67/Ga citrate (GA) abdominal scintillation scanning in an attempt to define its role in the evaluation of patients with active inflammatory bowel disease (IBD). There were nine patients with ulcerative colitis (UC), seven with Crohn's disease (CD), and nine controls. In four patients, two with UC and two with CD, a tissue/plasma radioactivity ratio was obtained and compared to normals. All the UC patients had positive GA scans and only one of seven of the CD patients had a positive scan. There were no false positive scans. Scans performed after a 3- or 5-day delay were more accurate than 6-hr scans alone. Well-delineated colinic radioactivity 6 hr after injection which persists for 3 to 5 days indicates the presence of UC in patients with IBD, while a negative scan is more consistent with active CD. Colonic uptake at 6 hr which clears by 48 or 72 hr is not indicative of UC. This procedure aided in following the course of UC, delineating the extent of disease, and in differentiating active CD from an intraabdominal abscess. Tissues from UC patients had increased tissue/plasma ratioactivity ratios while tissues from CD patients had normal or decreased ratios which were consistent with the imaging data.

  7. Self nanoprecipitating preconcentrate of tamoxifen citrate for enhanced bioavailability.

    Science.gov (United States)

    Kapse, Sonali V; Gaikwad, Rajiv V; Samad, Abdul; Devarajan, Padma V

    2012-06-15

    We disclose a self nanoprecipitating preconcentrate (SNP) of tamoxifen citrate (TMX), which forms TMX loaded polymeric nanoparticles, on dilution with aqueous media. SNP comprised TMX, polymer (Kollidon SR) and surfactant/s dissolved in a pharmaceutically acceptable vehicle. Binary surfactant mixtures of Aerosol OT (AOT) with Tween 80 revealed synergistic reduction in surface tension to enable both high entrapment efficiency (EE) and low particle size (PS). Synergism of the surfactants was confirmed by molecular interaction parameter(β(σ)). Combination of AOT and Tween 80 resulted in EE (∼85%) and PS (nanoparticles in situ was reproducible under most experimental conditions and exhibited pH independent behavior. Dilution volume (>80mL) influenced both PS and EE while dilution temperature influenced only PS. Marginal increase in size was evident at the end of 1h nevertheless was not of concern as TMX SNP exhibited near complete release in 1h. DSC and XRD studies revealed amorphous nature of TMX in nanoparticles. FTIR imaging confirmed uniform distribution of TMX in nanoparticles. ESEM and TEM revealed spherical nanoparticles. Biodistribution studies of (99m)Tc labeled TMX SNP in rats revealed no significant absorption however oral pharmacokinetics revealed enhanced oral bioavailability of TMX (165%) compared to TMX suspension. SNP presents a new in situ approach, for design of drug loaded polymeric nanoparticles. PMID:22414426

  8. Anticaries effect of dentifrices with calcium citrate and sodium trimetaphosphate

    Directory of Open Access Journals (Sweden)

    Alberto Carlos Botazzo Delbem

    2012-02-01

    Full Text Available Because of the growing concerns regarding fluoride ingestion by young children and dental fluorosis, it is necessary to develop new dentifrices. OBJECTIVE: The aim of this study was to evaluate the effect of dentifrices with calcium citrate (Cacit and sodium trimetaphosphate (TMP on enamel demineralization. MATERIAL AND METHODS: Enamel blocks (n=70, previously selected through surface hardness analysis, were submitted to daily treatment with dentifrices diluted in artificial saliva and to a pH-cycling model. The fluoride concentration in dentifrices was 0, 250, 450, 550, 1,000 and 1,100 µg F/g. CrestTM was used as a positive control (1,100 mg F/g. Cacit (0.25% and TMP (0.25% were added to dentifrices with 450 and 1,000 µg F/g. Surface hardness was measured again and integrated loss of subsurface hardness and fluoride concentration in enamel were calculated. Parametric and correlation tests were used to determine difference (p0.05. CONCLUSIONS: Dentifrices with 450 and 1,000 µg F/g, Cacit and TMP were as effective as a gold standard one.

  9. USE OF TRANSDERMAL GEL OF SILDENAFIL CITRATE IN SEXUAL DYSFUNCTION

    Directory of Open Access Journals (Sweden)

    Harshid Patel , Amit Maniyar and Hiren Patel*

    2012-11-01

    Full Text Available Premature Ejaculation (PE is one of the most common forms of Sexual Dysfunction and is thought to affect up to 30 % of men. This is the most frequently encountered sexual complaint of men and couples. The physical problem associated with premature ejaculation can be simply described as “over-sensitivity” of the penis. Psychological causes of PE are often associated with “performance anxiety” – anxiety relating to sexual intercourse. The most common treatment today is the oral treatment with phosphodiesterase -5 (PDE-5 inhibitors. There are currently three different inhibitors available Sildenafil, Vardenafil, and Tadalafil. Sildenafil citrate is a drug of choice used in the treatment of premature ejaculation disorder. It was licensed for use in the United States in 1998; Sildenafil has shown in studies that it improves ED in men regardless of disease etiology, severity of disease, or even age. Transdermal gel has gained more and more importance because the gel based formulations are better percutaneously absorbed than creams and ointment bases. Transdermal drug delivery systems are defined as self-contained, discrete dosage forms which, when applied to the intact skin, deliver the drug, through the skin, at a controlled rate to the systemic circulation. Present Status - A review by Barry in 2001 showed, the transdermal route has vied with oral treatment as the most successful innovative research area in drug delivery.

  10. Preparation and Quality Control of 68Ga-Citrate for PET Applications

    Directory of Open Access Journals (Sweden)

    Ayuob Aghanejad

    2015-07-01

    Full Text Available Objective(s: In nuclear medicine studies, gallium-68 (68Ga citrate has been recently known as a suitable infection agent in positron emission tomography (PET. In this study, by applying an in-house produced 68Ge/68Ga generator, a simple technique for the synthesis and quality control of 68Ga-citrate was introduced; followed by preliminary animal studies. Methods: 68GaCl3 eluted from the generator was studied in terms of quality control factors including radiochemical purity (assessed by HPLC and RTLC, chemical purity (assessed by ICP-EOS, radionuclide purity (evaluated by HPGe, and breakthrough. 68Ga-citrate was prepared from eluted 68GaCl3 and sodium citrate under various reaction conditions. Stability of the complex was evaluated in human serum for 2 h at 370C, followed by biodistribution studies in rats for 120 min. Results: 68Ga-citrate was prepared with acceptable radiochemical purity (>97 ITLC and >98% HPLC, specific activity (4-6 GBq/mM, chemical purity (Sn, FeConclusion: This study demonstrated the possible in-house preparation and quality control of 68Ga-citrate, using a commercially available 68Ge/68Ga generator for PET imaging throughout the country.

  11. Is it safe to prescribe clomiphene citrate without ultrasound monitoring facilities?

    LENUS (Irish Health Repository)

    Coughlan, C

    2010-05-01

    The majority of triplet and higher order multiple pregnancies now result from ovulation induction\\/superovulation rather than in vitro fertilisation. However, clomiphene citrate is still widely prescribed by gynaecologists and general practitioners who do not have access to ultrasound monitoring. The objective of our study was to determine the prevalence of multifollicular development with different doses of clomiphene citrate. A retrospective review of transvaginal ultrasound monitoring of 425 cycles in 182 women receiving clomiphene citrate from January 2002 to December 2003, was studied. Three or more follicles of >or= 14 mm were identified in 58 cycles (14%). Patients received 50 mg of clomiphene citrate in 52 of these 58 cycles and 25 mg in the remaining six. One patient was noted to have developed five follicles and 10 patients developed four follicles. One patient developed six follicles, despite receiving only 25 mg clomiphene citrate daily. It was concluded that a significant number of women (14%) developed three or more follicles, despite receiving low doses of clomiphene citrate.

  12. Comparison of different anticoagulation methods in blood purification in severe patients%重症患者血液净化不同抗凝方式的比较

    Institute of Scientific and Technical Information of China (English)

    何润芝; 邓湘辉

    2015-01-01

    目的:比较重症患者血液净化中不同抗凝方式:低分子肝素抗凝(A 组)、局部枸橼酸抗凝(B 组)的效果及安全性。方法:回顾性分析我科自2014年10月至2015年03月行血液净化的27例重症患者资料,其中 A 组19例,B 组8例,比较两组患者在血液净化效果(血液净化前后血清肌酐下降值),安全性(出血、凝血事件,凝血功能)及死亡率等方面的差异。结果:两组患者在溶质清除率(血液净化前后血清肌酐下降值)、凝血功能方面无统计学差异,皆无明显出血事件,死亡率(A:26.32%与 B:37.5%)差异可能与原发病有关,凝血事件方面 B 组优于 A 组。结论:血液净化中用局部枸橼酸抗凝安全、可行、有效,局部枸橼酸抗凝在重症患者尤其是高危出血风险的患者中具有良好的应用前景。%Objective:To compare the effects and safety of different anticoagulant Methods low molecular weight heparin(A group)and regional citrate anti-coagulation (B group)in severe patients in blood purification.Methods:We analyzed retrospectively 27 cases of critically ill patients in our department from Oc-tober in 2014 to March in 2015 for blood purification,including 19 cases of A group,8 cases of B group ,the purification effects (the decline in value of serum creatinine before and after blood purification ),safety (hemorrhage,coagulant events,blood coagulate function ) and the mortality of two groups were compared.Results:There was no significant difference in two groups in the solute clearance rate (the decline in value of serum creatinine before and after blood purification),and blood coagulate function.There were no hemorrhage.Differences of mortality(A:26.32% and B:37.5%)may be related to the primary dis-ease.B group surpass than A group in coagulant events.Conclusion:Blood purification with regional citrate anticoagulation is safe,feasible,effective,there was a good

  13. A second mechanism for aluminum resistance in wheat relies on the constitutive efflux of citrate from roots.

    Science.gov (United States)

    Ryan, Peter R; Raman, Harsh; Gupta, Sanjay; Horst, Walter J; Delhaize, Emmanuel

    2009-01-01

    The first confirmed mechanism for aluminum (Al) resistance in plants is encoded by the wheat (Triticum aestivum) gene, TaALMT1, on chromosome 4DL. TaALMT1 controls the Al-activated efflux of malate from roots, and this mechanism is widespread among Al-resistant genotypes of diverse genetic origins. This study describes a second mechanism for Al resistance in wheat that relies on citrate efflux. Citrate efflux occurred constitutively from the roots of Brazilian cultivars Carazinho, Maringa, Toropi, and Trintecinco. Examination of two populations segregating for this trait showed that citrate efflux was controlled by a single locus. Whole-genome linkage mapping using an F(2) population derived from a cross between Carazinho (citrate efflux) and the cultivar EGA-Burke (no citrate efflux) identified a major locus on chromosome 4BL, Xce(c), which accounts for more than 50% of the phenotypic variation in citrate efflux. Mendelizing the quantitative variation in citrate efflux into qualitative data, the Xce(c) locus was mapped within 6.3 cM of the microsatellite marker Xgwm495 locus. This linkage was validated in a second population of F(2:3) families derived from a cross between Carazinho and the cultivar Egret (no citrate efflux). We show that expression of an expressed sequence tag, belonging to the multidrug and toxin efflux (MATE) gene family, correlates with the citrate efflux phenotype. This study provides genetic and physiological evidence that citrate efflux is a second mechanism for Al resistance in wheat.

  14. Dental Procedures in Patients with Atrial Fibrillation and New Oral Anticoagulants

    OpenAIRE

    Tsolka, Pepie

    2014-01-01

    This review discusses the basic pharmacology of new oral anticoagulants that are used for prevention of thromboembolism in patients with atrial fibrillation. It presents available evidence, and provides recommendations for the management of patients requiring invasive procedures in dental practice.

  15. Quality of anticoagulation therapy in neurological patients in a tertiary care hospital in north India

    Directory of Open Access Journals (Sweden)

    Prabhat Singh

    2016-01-01

    Interpretation & conclusions: It may be concluded that stable therapeutic INR is difficult to maintain in neurological patients. Optimal modification of diet, drug and dose of oral anticoagulant may help in stabilization of INR.

  16. Risk stratification, perioperative and periprocedural management of the patient receiving anticoagulant therapy.

    Science.gov (United States)

    Oprea, Adriana D; Noto, Christopher J; Halaszynski, Thomas M

    2016-11-01

    As a result of the aging US population and the subsequent increase in the prevalence of coronary disease and atrial fibrillation, therapeutic use of anticoagulants has increased. Perioperative and periprocedural management of anticoagulated patients has become routine for anesthesiologists, who frequently mediate communication between the prescribing physician and the surgeon and assess the risks of both thromboembolic complications and hemorrhage. Data from randomized clinical trials on perioperative management of antithrombotic therapy are lacking. Therefore, clinical judgment is typically needed regarding decisions to continue, discontinue, bridge, or resume anticoagulation and regarding the time points when these events should occur in the perioperative period. In this review, we will discuss the most commonly used anticoagulants used in outpatient settings and discuss their management in the perioperative period. Special considerations for regional anesthesia and interventional pain procedures will also be reviewed. PMID:27687455

  17. Primary prevention of ischaemic stroke in atrial fibrillation: new oral anticoagulant drugs for all?

    Science.gov (United States)

    Foley, James; Kirchhof, Paulus; Lip, Gregory Y H

    2014-05-01

    Atrial fibrillation (AF) confers a 4.5% risk of stroke per year. The risk of stroke increases with various risk factors and until recently, warfarin has been the gold standard of thromboembolism prophylaxis in AF for many years. The dosage of warfarin requires regular adjustment dependent on the INR, to keep within a narrow therapeutic range of 2.0- 3.0. The INR can be altered by concomitant drugs, foods and alcohol and requires inconvenient blood monitoring. Underanticoagulation places patients at risk of stroke, whilst over-anticoagulation confers significant bleeding risk. Consequently approximately half who would benefit from oral anticoagulation do not have it prescribed. Novel oral anticoagulants with predictable pharmacokinetics and improved efficacy and safety profiles are currently being developed for stroke prevention in AF. Three novel oral anticoagulants have just completed Phase III trials for stroke prevention, all with impressive results; the direct thrombin inhibitor, dabigatran and the oral factor Xa inhibitors, rivaroxaban and apixaban. PMID:24846226

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Anticoagulation dilemma in a high-risk patient with On-X valves

    Directory of Open Access Journals (Sweden)

    Ami M Karkar

    2015-01-01

    Full Text Available Thromboembolism continues to be a major concern in patients with mechanical heart valves, especially in those with unsatisfactory anticoagulation levels. The new On-X valve (On-X Life Technologies, Austin, TX, USA has been reported as having unique structural characteristics that offer lower thrombogenicity to the valve. We report a case where the patient received no or minimal systemic anticoagulation after placement of On-X mitral and aortic valves due to development of severe mucosal arterio-venous malformations yet did not show any evidence of thromboembolism. This case report reinforces the findings of recent studies that lower anticoagulation levels may be acceptable in patients with On-X valves and suggests this valve may be particularly useful in those in whom therapeutic levels of anticoagulation cannot be achieved due to increased risk of bleeding.

  20. Bleeding Risk, Management and Outcome in Patients Receiving Non-VKA Oral Anticoagulants (NOACs).

    Science.gov (United States)

    Werth, Sebastian; Breslin, Tomás; NiAinle, Fionnuala; Beyer-Westendorf, Jan

    2015-08-01

    Modern direct-acting anticoagulants are rapidly replacing vitamin K antagonists (VKA) in the management of millions of patients worldwide who require anticoagulation. These drugs include agents that inhibit activated factor X (FXa) (such as apixaban and rivaroxaban) or thrombin (such as dabigatran), and are collectively known today as non-VKA oral anticoagulants (NOACs). Since bleeding is the most common and most dangerous side effect of long-term anticoagulation, and because NOACs have very different mechanisms of action and pharmacokinetics compared with VKA, physicians are naturally concerned about the lack of experience regarding frequency, management and outcome of NOAC-associated bleeding in daily care. This review appraises trial and registry (or "real-world") data pertaining to bleeding complications in patients taking NOACs and VKA and provides practical recommendations for the management of acute bleeding situations. PMID:25940651