Search

Introduction: Warfarin is an anticoagulant whose efficacy depends on reaching and maintaining an INR (International Normalized Ratio) within therapeutic ranges. Up to 60% of interindividual dose-response variability can be explained by pharmacogenes, in this regard there are no studies in Peru. We studied the effect of the CYP4F2 gene on the dose of warfarin in Peruvian patients. Material and Methods: A descriptive and ambispective observational study was carried out with patients seen in the Grau ESSALUD Hospital Hematology Service, Lima, Peru, selected by non-probabilistic convenience sampling. The inclusion criteria were patients anticoagulated for more than three months and with stable doses of warfarin (same dose for at least three outpatient visits and with an INR in therapeutic ranges of 2.5-3.5). Analysis of the CYP4F2 gene was performed by taking a DNA sample from peripheral blood. Results: 70 patients with a mean age of 69.6 + 13.4, male 38 (54.39%) and female 32 (45.7%) entered the study. The mean dose of warfarin was 31.6 + 15.2 mg/week. The genotypic frequency of the CYP4F2 gene, rs2108622 variant (C>T) was 55 (78%), 13 (19%) and 2 (3%) of CC, CT, TT, respectively. No deviation from the Hardy-Weinberg equilibrium was found in the variants studied (p=0.56). Mean warfarin doses/week of the CC, CT, TT genotypes were 30.34 + 11.98; 36.4 + 25.6 and 36.25 + 1.8 mg/week, respectively (p=0.397). Conclusion: In conclusion, it appears that CYP4F2 gene genotypes do not have a significant effect on warfarin dose. [ABSTRACT FROM AUTHOR]

Assessing the quality of life of anticoagulated patients is important; there is currently no Spanish validation of the Duke Anticoagulation Satisfaction Scale (DASS). Objective: To conduct a linguistic validation and preliminary psychometric properties estimation in Colombian Spanish of the DASS for assessing quality of life in patients anticoagulated with vitamin K antagonists. Materials and method: A validation study of a qualitative scale conducted in a private university hospital in Bogotá, Colombia. This validation had three phases: translation and cultural adaption by a bilingual panel; pilot test including initial application, cognitive interview with patients (n: 5), and clinical review by experts (n:10) and internal consistency assessment of the scale (n: 100). Results: The study yielded a version of DASS in Colombian Spanish that was technically and conceptually equivalent to the English version. The domains of limitations in patient activity, discomfort produced by anticoagulation, and psychological impact had a Cronbach’s Alpha of 0.9. According to expert opinion, most questions had the right relevance (Aiken V coefficient: 0.67-0.87). Conclusion: This is the first version of the DASS published in Spanish. The translation and cultural adaptation process resulted in a scale equivalent to its original version. The internal consistency analysis showed a highly consistent but not redundant scale. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the differences in the clinical results of the use of factor Xa inhibitors/direct oral anticoagulants compared with warfarin in patients with obesity. METHODOLOGY: Systematic review of observational and experimental studies published from 2010 to 2020 in the databases PubMed, Scopus, Web of Science, Lilacs, Scielo, Cochrane Central Register of Trials, under validated search terms: Factor Xa Inhibitors; Anticoagulants; Obesity; Atrial Fibrillation and Venous Thromboembolism. RESULTS: Seven observational studies (n: 9572) and 2 clinical trials (n: 6611) were included, these met most of the methodological quality criteria of the Strobe and Consort checklists, respectively; experimental studies had low to unclear risk of bias. The meta-analysis was performed in the RevMan 5.4 software, calculating risk estimators with 95% confidence intervals. For the major bleeding outcome, a RR of 0.65 was obtained (95% CI: 0.54-0.79; two trials; n: 6611); the analyzes were not statistically significant for the other outcomes. CONCLUSIONS: There are favorable results in the use of factor Xa/direct oral anticoagulants inhibitors compared with warfarin for the clinical outcome of major bleeding. Further experimental research is needed on the clinical outcomes, pharmacokinetics, and pharmacodynamics in obese patients of these drugs. [ABSTRACT FROM AUTHOR]

COVID-19 is a zoonotic viral disease caused by the SARS-CoV-2 virus. Its abrupt outbreak has caused a tremendous challenge to public health systems due to the rapid spread of the virus. In this sense, a great deal of work has been focused on finding substances from herbal plants to be used against this virus. In order to investigate the molecular interactions between natural metabolites from Algerian herbal plants and the SARS-CoV-2 protease Mpro, computational docking and molecular dynamics were used, also the drug likeness degree and in silico ADMET prediction were carried out in this study. warfarin and catalponol preferentially binds to a pocket of the SARS-Cov-2 Mpro active site that is made up of residues His 41 to Glu 166 and Leu 27 to His 163 with a relatively low binding energy of -7.1 and -6.6 kcal/mol respectively. Dynamic molecular assay further established that only warfarin managed to stay in the active site. The results suggest that warfarin may be an interesting candidate for development as a medical treatment of COVID-19 and more research is proposed, without disregarding its toxicity which deserves to be well studied. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of pharmacotherapeutic follow-up on bleeding, time in therapeutic range (TTR), thrombotic events, general adverse events, hospitalizations, drug interactions and average number of medications used in patients taking warfarin in the Brazilian public healthcare system. Methods: A randomized clinical trial was conducted with individuals divided into two groups (intervention group [pharmacotherapeutic follow-up] and control group) who received at-home visits over an eight-month period. Results: 38 individuals (21 in the intervention group and 17 in the control group) concluded the study. Fewer number of cases of bleeding was found in the group that received pharmacotherapeutic follow-up, but no significant association was found between these variables. No significant association was found between pharmacotherapeutic follow-up and TTR. The intervention group had a greater frequency in the therapeutic range for capillary INR but not for laboratory INR. Reductions were found in the intervention group with regards to general adverse events, the use of medications and drug interactions, whereas no reduction was found in hospitalizations. Conclusions: Based on the findings of the present study, pharmacotherapeutic follow-up did not exert an influence on bleeding or TTR. However, reductions were found in adverse events and drug interactions, which can contribute to the rational use of medicines and could result in lower care costs for patients requiring blood thinners. [ABSTRACT FROM AUTHOR]

Introduction: spontaneous epidural hematoma is a rare condition that may be accompanied by spinal cord compression. It can be caused by several factors, one of which is poor control of oral anticoagulants. Patient information: 57-year-old female patient, with a history of mitral valve insufficiency, with anticoagulant treatment with warfarin, who was taken to the Emergency Room of the "Arnaldo Milián Castro" Hospital due to numbness in both lower limbs; physical examination revealed asymmetric paraparesis, exalted osteotendinous aquilean and patellar reflexes (+2), left Babinsky reflex and dorsal sensory level 6-7. Conclusions: spinal epidural hematoma is a disease causing acute spinal cord compression that requires immediate diagnosis and urgent surgical treatment. [ABSTRACT FROM AUTHOR]

Oral anticoagulants have been a great ally for physicians in thromboembolic events because they represent a great challenge in their management, causing a high number of deaths in developed countries. Several drugs have been created, such as vitamin K antagonists, that require strict monitoring, over time, molecules known as the direct oral anticoagulants have been developed, these have allowed their administration to be safer and not have to carry out such strict controls. This paper reviews bibliography on the characteristics and therapeutic adherence of direct oral anticoagulants and how they impact thrombotic events. Literature review was carried out, searching for original articles and systematic reviews in PubMed and ScienceDirect. We selected 80 articles, included 52 that fulfilled the stated objective, from these the description of the present text was developed in which aspects related to the epidemiology, pharmacology and adherence of direct oral anticoagulants are developed. Direct oral anticoagulants are drugs that are increasingly prescribed by specialists because they provide greater patient safety but require adequate adherence by these patients to achieve the expected therapeutic effect. [ABSTRACT FROM AUTHOR]

Background: Warfarin is an oral anticoagulant which is widely used in the prevention and treatment of thromboembolic events, to which multiple adverse effects are attributed; nevertheless, descriptions of hypersensitivity reactions to this medication are rare. Case report: A 59-year-old patient with a history of mesenteric thrombosis, who had previously received long-term treatment with warfarin. Upon discontinuation of the medication, the patient experienced a recurrence of thrombosis at a hepatosplenic level, with a subsequent hypersensitivity reaction upon administration of the coumarin. It was decided that treatment with warfarin should be continued as it was considered the best therapeutic option, which is why a rapid desensitization protocol was carried out. Conclusion: Hypersensitivity reactions to warfarin are rare; we propose the option of a desensitization protocol for patients who require this medication as long as the clinical benefit is considered greater than the reaction. [ABSTRACT FROM AUTHOR]

The effects of anticoagulants are known as treatment or prophylaxis of thrombotic events, allowing to establish an individualized therapy according to their needs. A descriptive cross-sectional, non-randomized study was carried out in 138 hospitalized patients of legal age in a fourth-level care institution with therapeutic and prophylactic anticoagulant treatment, addressing the type of drug indicated, periodicity, side effects, laboratory controls, pharmacological interactions and causality of adverse reactions. It was found that the anticoagulant with the highest frequency of use was enoxaparin (68%), the most used control was the prothrombin time (60.39%), pharmacological interactions were identified in 47.1%, being the most frequent with acetylsalicylic acid (29.7% of the total number of interactions), the most frequent adverse reactions were of a hematological nature (58.3%); and the causality assessment of adverse reactions was 4.2% probable. The study showed that the most used anticoagulant was enoxaparin. The pharmacological interactions of anticoagulants were very frequent, especially with warfarin. The most frequent adverse reactions were those of hemorrhagic type; and the causality assessment was of possible category for most of these adverse reactions. [ABSTRACT FROM AUTHOR]

Objectives - Direct oral anticoagulants (DOACs) have been analysed in clinical trials and real world data studies as their use in clinical practice has increased over the recent years. This study aimed to compare DOACs and warfarin in patients with non valvular atrial fibrillation (NVAF) focusing particularly on stroke prevention efficacy and side effects. Methods - We reviewed 150 patients' notes from a single Scottish medical practice between October 2015-October 2017. The statistical methods were cox regression analysis and Chi square test. Results - The mean CHA2DS2-VASc score was 1.89 for DOACs group and 2.05 for warfarin group. Ischaemic stroke while on anticoagulants occurred in one patient in DOACs group compared to five patients in the warfarin group (p=0.291). Side effects such as minor bleeding occurred in 11 patients in the DOACs group contrasting 29 cases in the warfarin group (p=0.024). Major bleeding was reported in three patients in each anticoagulant group (p=0.711). Conclusion - Minor bleeding events were significantly lower in DOACs group compared to warfarin group. In this real-world sample of NVAF patients, effectiveness and risks of DOACs versus warfarin were similar in regard to ischaemic stroke and major bleeding. [ABSTRACT FROM AUTHOR]

Anticoagulant therapy is a treatment used clinically since the 1950s. Currently, despite the appearance of new drugs, warfarin remains the most widely used one. The need for frequent monitoring, in addition to the interaction with drugs and foods, as well as the need to transform the everyday life of people who consume it, modify the cultural practices of these patients, and may affect aspects such as adherence. General objective: Describe the cultural practices transformed by people who are part of an anticoagulation program in warfarin therapy. Methodology: Qualitative study type micro ethnography, carried out in Bogotá, Colombia. Results: We had the participation of 10 informants who, associated with the use of warfarin, transformed cultural practices around knowledge, everyday life and emotions. [ABSTRACT FROM AUTHOR]

We present a case of a male patient with a history of controlled arterial hypertension, dilated cardiomyopathy, atrial fibrillation treated with warfarin and aortic coarctation in follow-up, with a two-day history of hemoptysis and minimal effort dyspnea, which progresses to vomiting in tassels of coffee, severe respiratory distress and deterioration of neurological status, so it is intubated immediately and transferred to our institution. Chest x-ray with alveolar infiltrates. In the chest tomography with a crazy paving pattern and consolidations suggestive of pulmonary hemorrhage due to his clinical history [ABSTRACT FROM AUTHOR]

Oral anticoagulant treatment is a treatment indicated for the prevention of thromboembolic complications, and should be withdrawn before any invasive procedure or surgical intervention. The perioperative management of patients receiving antithrombotic treatment is based on the risk assessment of thromboembolism and perioperative hemorrhage. The suspension of this treatment prior to surgery and the use or not of bridging therapy with low molecular weight heparin should be assessed individually according to the characteristics of the patient and the type of procedure or surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine the quality of oral anticoagulation control and the possible factors associated with time to reach therapeutic range. Methods: Retrospective study with a control group in patients ≥65 years old with nonvalvular atrial fibrillation who had indication for oral anticoagulation at Hospital Cayetano Heredia from 2011 to 2013. Time to therapeutic range (TTR) was determined by the Rosendal's method, an optimal control was defined as TTR ≥60%. A multivariate analysis was performed. Results: Median age was 82.23 years; 74 (51.75%) were females; 140 patients had indication for anticoagulation; 94 (67.14%) started warfarin; 28 (19.72%) had optimal control and 66 did not (46.48%). Age ≥ 75 years (OR 25.5; CI: 7.39-155.8) and no low degree of instruction (OR 25.5; CI: 7.39-155.8) were associated with sub optimal control, while functional independence (OR 4.3; CI: 2.16- 9.47), no cognitive deterioration (OR 7.8; CI: 3.53-20.19) and female gender (OR 3; CI: 1.62-5.81) were associated with optimal control. Conclusions: A great percentage of patients with indications for oral anticoagulation and at low risk of bleeding did not start it, and 50% of those who started it had suboptimal control. Older patients with comorbidities who used multiple medications had sub optimal control, while females and functional independence were associated with optimal control. [ABSTRACT FROM AUTHOR]

The perioperative management of patients receiving antithrombotic therapy based on vitamin K antagonists (VKA) or new oral anticoagulants (NACOs), represent a dilemma in daily practice for anesthesiologists because of the multiple circumstances we face in such clinical scenarios in emergency surgeries. Today, millions of patients worldwide use anticoagulants for the prevention or treatment of a variety of entities particularly from cardiovascular causes. According to recent epidemiological studies in the US, more than 250,000 patients annually admitted to emergency surgeries are under this therapeutic (1) scheme. If not treated properly, the potential risk of bleeding is imminent, increasing mortality. It is of great importance to acknowledge the evidence and provide strategies for the approach of perioperative management. [ABSTRACT FROM AUTHOR]

Cardiovascular disease remains a major cause of morbidity and mortality worldwide. Current medical practice takes into account information based on population studies and benefits observed in large populations or cohorts. However, individual patients present great differences in both toxicity and clinical efficacy that can be explained by variations in adherence, unknown drug to drug interactions and genetic variability. The latter seems to explain from 20% up to 95% of patient to patient variability. Treating patients with cardiovascular disorders faces the clinician with the challenge to include genomic analysis into daily practice. There are several examples within cardiovascular disease of treatments that can vary in toxicity or clinical usefulness based on genetic changes. One of the main factors affecting the efficacy of Clopidogrel is the phenotype associated with polymorphisms in the gene CYP 2C9. Furthermore, regarding oral anticoagulants, changes in CYP2C9 and VKORC1 play an important role in changing the clinical response to anticoagulation. When analyzing statin treatment, one of their main toxicities (myopathy) can be predicted by the SLCO1B1 polymorphism. The potential for prediction of toxicity and clinical efficacy from the use of genetic analysis warrants further studies aiming towards its inclusion in daily clinical practice. [ABSTRACT FROM AUTHOR]

Background: Dietary vitamin K intake has been considered a major factor that influences stability of oral anticoagulation (OA) with coumarins. Few studies have evaluated the relationship between amounts of dietary vitamin K intake and stability of anticoagulation. Objective: To assess whether high dietary vitamin K intake is associated to stability of International Normalized Ratio (INR) of the prothrombin time. Methods: We performed a sub-analysis of a randomized clinical trial involving outpatients from the anticoagulation clinic of a university hospital. INR and vitamin K intake were prospectively collected at baseline, 15, 30, 60 and 90 days after randomization. Patients were considered with a stable anticoagulation when their INR coefficient of variation was less than 10%. Dietary vitamin K intake was assessed by a food frequency questionnair and a score of intake was derived. Results: We studied 132 patients on chronic OA (57 ± 13 years; 55% males); 23 patients (17%) were achieved stable anticoagulation. Stable and unstable patients had no significant differences in baseline characteristics. The dietary vitamin K score over the entire follow-up for stable patients was significantly lower than that for unstable patients (p = 0.012). Discussion: Our findings suggest that INR stability could be achieved with relatively low amounts of dietary vitamin K. [ABSTRACT FROM AUTHOR]

There are several excellent alternatives to warfarin on the horizon for atrial fibrillation. Results from the trials, as well as pharmacokinetic data from the edoxaban studies, suggest that dose selection, based on pharmacokinetic and pharmacodynamic properties, is a critical component in the development of novel anticoagulants. Greater flexibility in dosing with edoxaban and the opportunity for dose adjustment throughout the ENGAGE AF-TIMI 48 trial may be advantageous in the competitive field of novel oral anticoagulants. [ABSTRACT FROM AUTHOR]

El Consorcio Internacional de Farmacogenetica de la Warfarina (IWPC) realizó un estudio en 4 continentes buscando determinar el algoritmo predictivo de la dosis terapéutica. Adicionalmente, en Colombia se publicaron tres algoritmos (Palacio, Isaza y Cifuentes). En consecuencia, se compara su valor predictivo para sugerir un algoritmo para predecir la dosis terapéutica de Warfarina en población mestiza colombiana. Mediante regresión lineal simple, se compararon las dosis reales en la población estudiada por Cifuentes, con predicha por los algoritmos IWPC, Isaza y Palacio. Para entender los resultados, se compararon los algoritmos predictivos con el más explicativo obtenido mediante regresión lineal múltiple por Cifuentes en el Hospital Militar Central. IWPC mostró mayor exactitud de predicción, seguido de Palacio e Isaza (R2= 0,45, 0,35 y 0,29 respectivamente). Todos los algoritmos predictores incluyeron las variantes 1639G>A en VKORC1 y *2/*3 en CYP2C9 además de Edad en concordancia con el algoritmo explicativo. El único algoritmo con variables asociadas al Sexo fue IWPC: Talla y Peso (p<0,001). Se sugiere la utilidad del algoritmo IWPC, favoreciendo el alto poder estadístico para determinar coeficientes y variables relevantes. [ABSTRACT FROM AUTHOR]