New Anticoagulant Drugs

Weitz, Jeffrey I.; Hirsh, Jack; Samama, M

doi:10.1378/chest.126.3_suppl.265s

Cited by 162 publications

(72 citation statements)

References 123 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At present, the seventh American College of Chest Physicians Consensus Conference on Antithrombotic and Thrombolytic Therapy does not address the treatment of CVC-related PE and RHTE. 41 Heparin is not widely endorsed as a treatment option for RHTE and PE, given its slow onset of action and the imminent threat of significant PE. A large registry and a small RCT support that the mortality of patients with RHTE and PE, treated with intravenous heparin, was no different from that of untreated patients.…”

Section: Prevention Of Cvc Associated Thrombosismentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: Central venous catheters (CVC) are commonly used in critical care. While thrombosis is a well-recognized and frequent complication associated with their use, CVC-related thromboembolic complications, including pulmonary embolism (PE) and right heart thromboembolism (RHTE), occur less frequently and often evade diagnosis. Little information exists to guide clinicians in the diagnosis and management of CVC-related thromboembolic complications. Source:We critically review and synthesize the literature highlighting the incidence of CVC-related thrombosis. We highlight the risk for developing thromboembolic complications and provide approaches to diagnosing and managing RHTE. Principle findings:The incidence of CVC-related thrombosis varies depending on patient, site, instrument, and infusaterelated factors. Central venous catheters-related thrombosis represents an important source of morbidity and mortality for affected patients. Pulmonary embolism occurs in approximately 15% of patients with CVC-related upper extremity deep venous thrombosis (UEDVT). More frequent use of transesophageal echocardiography, in patients with suspected and confirmed PE, has resulted in increased detection of RHTE. While it is recognized that the occurrence of RHTE, in association with PE, increases mortality, the optimal strategy for their management has not been established in a clinical trial. Conclusion:Central venous catheter-related thrombosis occurs frequently and represents an important source of morbidity and mortality for affected patients. Our review supports that surgery and thrombolysis have both been demonstrated to enhance survival in patients with RHTE and PE. However, important patient, clot, and institutional considerations mandate that treatment for patients with RHTE and PE be individualized.

show abstract

Section: Prevention Of Cvc Associated Thrombosismentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…UFH has several important limitations, including its unpredictable anticoagulant effect necessitating careful laboratory monitoring, high protein binding, and inactivation by platelet factor 4. 3 To overcome some of these limitations, newer agents with more predictable anticoagulant effect and with greater anti-factor Xa activity are being evaluated. Factor Xa occupies a pivotal role in the clotting cascade because it is the final common pathway linking the intrinsic and extrinsic systems leading to the generation of thrombin, thus making it an attractive target for the development of new anticoagulant agents.…”

mentioning

confidence: 99%

Randomized, Blinded Trial Comparing Fondaparinux With Unfractionated Heparin in Patients Undergoing Contemporary Percutaneous Coronary Intervention

Mehta

Steg²,

Granger³

et al. 2005

Circulation

Self Cite

106

View full text Add to dashboard Cite

DPhil; for the ASPIRE Investigators* Background-Factor Xa plays a central role in the generation of thrombin, making it a novel target for treatment of arterial thrombosis. Fondaparinux is a synthetic factor Xa inhibitor that has been shown to be superior to standard therapies for the prevention of venous thrombosis. We performed a randomized trial to determine the safety and feasibility of fondaparinux in the percutaneous coronary intervention (PCI) setting. Methods and Results-A total of 350 patients undergoing elective or urgent PCI were randomized in a blinded manner to receive unfractionated heparin (UFH), 2.5 mg fondaparinux IV, or 5.0 mg fondaparinux IV. Randomization was stratified for planned or no planned use of glycoprotein (GP) IIb/IIIa antagonists. The primary safety outcome was total bleeding, which was a combination of major and minor bleeding events. The incidence of total bleeding was 7.7% in the UFH group and 6.4% in the combined fondaparinux groups (hazard ratio, 0.81; 95% confidence interval, 0.35 to 1.84; Pϭ0.61). Bleeding was less common in the 2.5-mg fondaparinux group compared with the 5-mg fondaparinux group (3.4% versus 9.6%, Pϭ0.06). The composite efficacy outcome of all-cause mortality, myocardial infarction, urgent revascularization, or need for a bailout GPIIb/IIIa antagonist was 6.0% in the UFH group and 6.0% in the fondaparinux group, with no significant difference in efficacy among the fondaparinux doses compared with UFH.Coagulation marker analysis at 6 and 12 hours after PCI demonstrated that fondaparinux was superior to UFH in inducing a sustained reduction in markers of thrombin generation, as measured by prothrombin fragment F1.2 (Pϭ0.02). Conclusions-In this pilot study of patients undergoing contemporary PCI, factor Xa inhibition with the synthetic anticoagulant fondaparinux in doses of 2.5 and 5.0 mg was comparable to UFH for clinical safety and efficacy outcomes. These data form the basis for further evaluation of fondaparinux in arterial thrombosis. (Circulation. 2005;111:1390-1397.)

show abstract

“…(3,4) Devido a essas limitações, foram necessárias pesquisas para o desenvolvimento de novas drogas anticoagulantes. (5) Os novos anticoagulantes são classificados pelo seu mecanismo de ação (Quadro 23). Atualmente, o principal uso desses fármacos alternativos é no tratamento de TIH.…”

Section: Medicamentos Alternativos E Novos Fármacosunclassified

“…Aguardam-se os resultados de ensaios clínicos de fase III para se definir o seu papel na prática assistencial. (5) As doses recomendadas para os fármacos alternativos estão descritos no Quadro 24.…”

Section: Outros Fármacos Anticoagulantesunclassified

Medicamentos alternativos e novos fármacos

2010

J. bras. pneumol.

View full text Add to dashboard Cite

New Anticoagulant Drugs

Cited by 162 publications

References 123 publications

A critical review of thromboembolic complications associated with central venous catheters

A critical review of thromboembolic complications associated with central venous catheters

Randomized, Blinded Trial Comparing Fondaparinux With Unfractionated Heparin in Patients Undergoing Contemporary Percutaneous Coronary Intervention

Medicamentos alternativos e novos fármacos

Contact Info

Product

Resources

About