Thrombophilia defines inherited and acquired conditions associated with an increased thrombotic risk, which predispose to venous thromboembolism (VTE), cardiopulmonary bypass (CPB) and stroke. Thromboembolic events have long been treated with the most commonly used anticoagulant drug, heparin that is rapidly replaced by low molecular weight heparin (LMWH). A variety of point-of-care (POC) coagulation platforms have been commercially available for many years now, providing more control over the patient’s anticoagulation management such as heparin and warfarin. While the measurement for anticoagulation by POC devices has relied mainly on the clotting time tests, innovative platelet function tests, and factor-specific assays based on …show more content…
While the prevention of a thrombotic event achieved by an anticoagulant, over- or under-dosing can give rise to excessive bleeding or severe clotting respectively, therefore closely link therapy with monitoring is essential. Several techniques have been developed to address the disadvantages of large sample volumes, by multiplexing of the assays in which various parameters or analytes are measured concurrently from a single sample.
While laboratories became unable to provide results in time frames needed to allow rapid turnaround that would allow timely intervention of anticoagulant therapy, the requirement for POC coagulation monitoring techniques became essential (Harris, Castro-López and Killard, 2013).
In this review, I will focus on the availability of POC diagnostic tests for monitoring the anticoagulant therapy for thrombophilia. I will first describe the conventional clot-based assays and then, I will attempt to address current advances in microfluidic POC tests used for monitoring thromboembolic-related events and highlight new fluorescence-based anti-Factor Xa (FXa) microfluidic POC assay platform for monitoring both unfractionated and low molecular weight heparins and fluorescence-based blood coagulation assay platform for monitoring activated partial thromboplastin time (aPTT). Also, I will
During the blood test, for example, the presence of clots in the blood sample can artificially increase the drug concentration on the report since blood is a heterogeneous mixture, which often forms clots. The possibility of blood clotting cannot be ignored because it occurs very frequently for many reasons, such as certain
Coumadin (non specific name: warfarin) is an anticoagulant, or blood diminishing drug, that is endorsed to numerous patients who are at danger for creating blood clusters that could bring about heart assaults or strokes. Warfarin is near the most astounding purpose recently and simultaneous investigations of medications that provoke ER visits and occurring an expansion in healing center based offices with the affirmation of patients. Anticoagulation treatment stances perils to patients and over and over prompts unfavorable solution events in light of complex dosing, fundamental ensuing watching, and clashing patient consistence. As a result, various patients who meet current evidence based principles for warfarin treatment are not being managed
There are many people that suffer from venous thromboembolism. Venous thromboembolism includes both deep vein thrombosis and pulmonary embolism. This is the third most common cause of vascular death after a myocardial infarction, also known as a heart attack, and stroke. This article examines the possibility of either full or low intensity anticoagulation therapy versus aspirin. This was a randomized study that consisted of 3,396 individuals who have venous thromboembolism. These individuals either received rivaroxaban, which is an anticoagulant, or 100 mg of aspirin once a day. The individuals in this study completed 6-12 months of anticoagulation therapy and were eligible for inclusion in the study if they were 18 years of age or older. The
In an article published in JACC: Cardiovascular Interventions, Doctors Madan, Halvorsen, Di Mario, Tan, Westerhout, Cantor, Le May, and Borgia explored whether patients experienced greater risk of undergoing angiography after the administration of fibrinolytic therapy. They concluded that there was not a serious risk of bleeding or death if they receive angiography within four hours of undergoing fibrinolytic therapy (Madan et al., 2015). They also suggest that the patient be moved a center that can perform PCI within 2 hours after fibrinolysis. This article suggests that although fibrinolysis can be success a patient should receive PCI treatment.
Preventing errors relating to commonly used anticoagulants. (2008). Joint Commission perspectives. Joint Commission on Accreditation of Healthcare Organizations, 28(11), 13-15.
3.) The founders of The Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines are:
For decades, Warfarin has remained the anticoagulant of choice for the prevention of cardiac thromboembolic disease in atrial fibrillation patients and in the treatment of deep vein thrombosis and pulmonary embolism. VKAs are clinically effective as an antithrombotic agent in Atrial Fibrillation, as dose adjusted warfarin has been proven to cut the risk of stroke by 64% (95% CI, 49%-74%) and all-cause death rate by 26% (95% CI, 3%-43%) . In order to attain optimal anticoagulation effect of warfarin, frequent plasma level monitoring of International Normalized Ratio (INR) is required to maintain it in therapeutic range (INR 2-3) but maintaining the INR in therapeutic range is challenging and for many patients is achieved only approximately 55% of the time . Thus, this finding counteracts the potential benefits of warfarin and increases its risks. A combination of factors like an inconvenience for patients and clinicians to use warfarin, large variability in plasma level of the drug affected by ethnicity and genetic polymorphism [4,5], interactions with various foods and drugs and the potential for serious hemorrhage e.g. Intracranial bleeding, have limited the widespread use of warfarin as an effective anticoagulant in nonvalvular atrial fibrillation (NVAF) . Keeping in mind these facts about
For many year’s patients with atrial fibrillation have been treated with anticoagulants such as Warfarin to prevent strokes and embolisms. Unfortunately, Warfarin must be closely monitored and that is an irritant for some patients. In October 2010, the FDA approved a new generational anticoagulant drug called Dabigatran (Pradaxa). This alternate medication gives patients the benefit of no dietary restrictions since dabigatran is not affected by certain foods. Another benefit of taking dabigatran is a monthly blood test is not required to measure its effectiveness, so for this particular reason many patients switch from taking other anticoagulants to dabigatran (Talati & White, 2011). Since this medication does not require close monitoring, some wonder if is it truly a better option or can more harm than good come from taking it. While the benefits of using dabigatran have shown significant improvement over warfarin, there are still risks associated with using dabigatran.
A: Potentiates the action of antithrombin III and thereby inactivates thrombin (as well as activated coagulation factors IX, X, XI, XII, and plasmin) and prevents the conversion of fibrinogen to fibrin; heparin also stimulates release of lipoprotein lipase (lipoprotein lipase hydrolyzes triglycerides to glycerol and free fatty acids)
In a hospital setting, anticoagulants and antiplatelets are widely prescribed by physicians because of their greater benefits in changing the physiological homeostasis of the cardiovascular system. Anticoagulants and antiplatelets play a fundamental role in the treatment of cardiovascular diseases as they are very effective at counteracting the different symptoms cardiovascular diseases present.
Bleeding is one of warfarins most serious and harmful effects as major and fatal bleeding can be experienced by patients. A meta analysis of 33 studies concluded “The clinical impact of anticoagulant-related major bleeding in patients with venous thromboembolism is considerable” therefore the effects of bleeding should be taken into account by health care professionals when choosing whether to prescribe warfarin to a patient or to continue anti-coagulant therapy using warfarin in individual patients. In addition to bleeding another complication of warfarin is its narrow therapeutic index which makes it difficult to ensure patients stay within the required anticoagulation range. An analysis of 6454 patients taking warfarin for atrial fibrillation
Rotational Thromboelastometry (ROTEM, TEM Innovations GmbH, Munich, Germany) and thromboelastography (TEG, Haemoscope, Braintree, MA) are whole blood coagulation analyzers that measure viscoelastic changes of the entire clotting process. Compared to the prothrombin time (PT/INR) and partial thromboplastin time (aPTT), which measure coagulation factor function, TEG/ROTEM can evaluate platelet function, clot strength, and fibrinolysis, (de Laz, Nascimento, & Rizoli, 2013). This additional information can help guide resuscitation efforts by classifying bleeding due to coagulopathy. As a result, the need for platelets, cryoprecipitate (fibrinogen, Factor VIII, von Willebrand factor, &
Exclusion criteria for the study included: Patient refusal to consent (absolute), infection in the patients back near the proposed site of the injection, coagulation disorder :-( defined as PT: > 18 sec, PTT: >40 sec, I.N.R: > 1.5, clotting time: >8 min, platelet disorder: platelet count: < 100.000, bleeding time: >4 min, HELLP Syndrome: - (defined as Hemolysis, Elevated Liver enzymes, Low Platelet count), receiving any anticoagulant drugs, preexisting neurological disease or psychic patients, history of cardiac and respiratory system failure, known allergy to local anesthetics drugs, coexisting renal disease and eclamptic patients.
,platelet count at cutoff less than 74000 mm3 is significant in prediction of variceal bleeding risk with sensitivity 82.5% and specificity 55%. and platelet count/spleen diameter ratio (PC/SD) at cutoff 851.6 is significant in prediction of variceal bleeding risk with sensitivity 45% and specificity 90%.(table 5)