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3 results on '"L Winters, Jeffrey"'

1. Plasma exchange in the intensive care unit: a narrative review

Author

R Bauer, Philippe, Ostermann, Marlie, Russell, Lene, Robba, Chiara, L Ferreyro, Sascha David Bruno, Cid, Joan, Castro, Pedro, P Juffermans, Nicole, Montini, Luca, Pirani, Tasneem, Van De Louw, Andry, Nielsen, Nathan, Wendon, Julia, C Brignier, Anne, Schetz, Miet, T Kielstein, Jan, L Winters, Jeffrey, Azoulay, Elie, Investigators, Nine-I, Luca Montini (ORCID:0000-0003-4602-5134), R Bauer, Philippe, Ostermann, Marlie, Russell, Lene, Robba, Chiara, L Ferreyro, Sascha David Bruno, Cid, Joan, Castro, Pedro, P Juffermans, Nicole, Montini, Luca, Pirani, Tasneem, Van De Louw, Andry, Nielsen, Nathan, Wendon, Julia, C Brignier, Anne, Schetz, Miet, T Kielstein, Jan, L Winters, Jeffrey, Azoulay, Elie, Investigators, Nine-I, and Luca Montini (ORCID:0000-0003-4602-5134)

Abstract

In this narrative review, we discuss the relevant issues of therapeutic plasma exchange (TPE) in critically ill patients. For many conditions, the optimal indication, device type, frequency, duration, type of replacement fluid and criteria for stopping TPE are uncertain. TPE is a potentially lifesaving but also invasive procedure with risk of adverse events and complications and requires close monitoring by experienced teams. In the intensive care unit (ICU), the indications for TPE can be divided into (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy, (2) relative, for which TPE is a recognized second-line treatment (alone or combined) and (3) rescue therapy, where TPE is used with a limited or theoretical evidence base. New indications are emerging and ongoing knowledge gaps, notably regarding the use of TPE during critical illness, support the establishment of a TPE registry dedicated to intensive care medicine.

Published
2022

2. Plasma exchange treatment for CNS inflammatory demyelinating disease

Author

G Weinshenker Brian, Fujihara Kazuo, Nakashima Ichiro, B. Mark Keegan, and L. Winters Jeffrey

Subjects
Neuromyelitis optica, business.industry, medicine.medical_treatment, Multiple sclerosis, Pharmacology, medicine.disease, Fingolimod, Transplantation, chemistry.chemical_compound, Tolerability, chemistry, Myriocin, Immunology, medicine, Plasmapheresis, business, Adverse effect, medicine.drug
Abstract

Fingolimod was first synthesized in the early 1990s as part of an extensive program of chemical derivatization of myriocin, with the goal of creating a novel immunosuppressant that would be more potent and less toxic in vivo. Fingolimod's mechanism of action in multiple sclerosis (MS) is not known with certainty. Fingolimod was initially developed to prevent allograt rejection after demonstration that it was effective in a variety of animal transplantation models, including kidney, heart, pancreatic islet cells and skin. Fingolimod was approved by the Food and Drug Administration (FDA) to reduce relapses and disability progression in relapsing forms of MS. Fingolimod's generally good safety profile and tolerability, including oral route of administration, make fingolimod an attractive treatment option for patients with relapsing forms of MS. Better delineation of the mechanisms leading to both the beneficial and adverse effects of fingolimod is necessary to develop more effective and better-tolerated compounds.

Published
2011
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3. Effect of plasma exchange on antifactor Xa activity of enoxaparin and serum levetiracetam levels.

Author

J., Peters Bradley, Mikaela, Hofer, E., Daniels Craig, and L., Winters Jeffrey

Subjects
*ANTICONVULSANTS, *BLOOD coagulation factors, *DERMATOMYOSITIS, *DRUG monitoring, *INTERSTITIAL lung diseases, *PLASMA exchange (Therapeutics), *RESPIRATORY insufficiency, *DISEASE complications, *ENOXAPARIN, *THERAPEUTICS
Abstract

Purpose. The effect of therapeutic plasma exchange (TPE) on antifactor Xa activity in a patient treated with enoxaparin and levetiracetam is reported. Summary. A 52-year-old woman was treated with levetiracetam and prophylactic enoxaparin while receiving TPE to manage respiratory failure due to anti-MDA5 antibody-associated interstitial lung disease (ILD) with dermatomyositis. Due to a scant amount of evidence regarding the management of these medications in TPE, therapeutic monitoring principles were used to assess the effect TPE had on these medications. A pre-TPE antifactor Xa activity level and levetiracetam serum assay, a post-TPE antifactor Xa activity level and levetiracetam serum assay, levetiracetam serum assays at 1 and 6 hours after the patient received her next dose, and a levetiracetam assay of the waste plasma from the TPE were collected for therapeutic drug monitoring and pharmacokinetic calculations. Utilizing standard population pharmacokinetic data, the expected antifactor Xa activity without TPE was 0.14 IU/mL. This concentration was significantly higher than the undetectable concentration (<0.1 IU/mL) that was drawn immediately after TPE, suggesting significant removal of antifactor Xa activity. The measured levetiracetam level did not significantly differ from the expected post-TPE levetiracetam level that was calculated using patientspecific pharmacokinetic data. Conclusion. In a patient receiving TPE to manage anti-MDA5 antibody ILD associated with dermatomyositis and a prior seizure, TPE significantly altered enoxaparin antifactor Xa activity as evidenced by the undetectable antifactor Xa activity level drawn after TPE. Alternatively, TPE had a minimal effect on the clearance of levetiracetam as evidenced by the post-TPE level and fraction elimination of only 5% of total body stores. [ABSTRACT FROM AUTHOR]

Published
2018
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