scholarly journals Bioptically Proven “Anticoagulation-Related Nephropathy“ Induced by Dual Antiplatelet Therapy

2018 ◽  
Vol 8 (3) ◽  
pp. 216-222 ◽  
Author(s):  
Karolína Krátká ◽  
Martin Havrda ◽  
Eva Honsová ◽  
Ivan Rychlík
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Kidney Injury ◽  
International Normalized Ratio ◽  
Tubular Necrosis ◽  
Coagulation Tests ◽  
Glomerular Lesions ◽  
Excessive Anticoagulation

Anticoagulation-related nephropathy (ARN) is a significant and underdiagnosed complication in patients who receive anticoagulation therapy. It is characterized by acute kidney injury in the setting of excessive anticoagulation defined as an international normalized ratio > 3.0 in patients treated with warfarin. A definitive diagnosis is made by renal biopsy showing acute tubular necrosis with obstruction of the tubuli by red blood cell casts. However, the evidence shows that ARN can occur during treatment with novel oral anticoagulants as well. Although it has been suggested that antiplatelet therapy, such as aspirin, might contribute to coagulopathy (and therefore the hypothetical risk of ARN), there are no reports of ARN induced by antiplatelet therapy according to our knowledge. It is also reported that glomerular lesions (i.e., kidney disease) represent a risk factor for ARN. We present a case of an 82-year-old man who developed biopsy-proven ARN after the administration of dual antiplatelet therapy with no previous anticoagulation treatment and normal coagulation tests.

scholarly journals LONG-TERM OUTCOME WITH ORAL ANTICOAGULANTS WITH OR WITHOUT DUAL ANTIPLATELET THERAPY AFTER AMI: THE FAST-MI 2010 REGISTRY

2017 ◽  
Vol 69 (11) ◽  
pp. 207
Author(s):  
Tabassome Simon ◽  
Etienne Puymirat ◽  
Francois Schiele ◽  
Guillaume Cayla ◽  
Loic Belle ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Oral Anticoagulants ◽  
Term Outcome ◽  
Long Term Outcome

Insights into the role of thrombin in the pathogenesis of recurrent ischaemia after acute coronary syndrome

2014 ◽  
Vol 112 (11) ◽  
pp. 924-931 ◽  
Author(s):  
Jeffrey Weitz
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Recurrent Events ◽  
Dual Antiplatelet Therapy ◽  
Thrombus Formation ◽  
Oral Anticoagulants ◽  
Composite Endpoint ◽  
Medical Emergency ◽  
Recurrent Ischaemia ◽  
Coronary Syndrome

SummaryAcute coronary syndrome (ACS) is a medical emergency. Patients who survive the initial event remain at risk of recurrent cardiovascular events. In most cases, ACS is triggered by thrombosis after rupture of an atherosclerotic plaque. Key to thrombus formation at this site is the generation of thrombin, which not only converts fibrinogen to fibrin but also serves as a potent platelet agonist and induces platelet aggregation at the site of vascular injury. Although dual antiplatelet therapy is more effective for the prevention of recurrent events than aspirin alone after ACS, there remains an approximately 10 % risk of recurrent ischaemic events at one year. Recent studies have evaluated whether the addition of an anticoagulant to antiplatelet therapy reduces the risk of recurrent ischaemia after an ACS event. Rivaroxaban, an oral factor Xa inhibitor, attenuates thrombin generation. When used in conjunction with dual antiplatelet therapy in patients with stabilised ACS, rivaroxaban 2.5 mg twice daily significantly reduced the risk of the composite endpoint of cardiovascular death, myocardial infarction and stroke compared with placebo. Although it increased the risk of bleeding, rivaroxaban was associated with a reduction in mortality; a finding that supports the use of a dual-pathway approach that combines anticoagulant and antiplatelet therapy. This review explores the pathophysiology of ACS to provide perspective on the results of recent clinical trials with novel oral anticoagulants for ACS and to identify their potential role in this setting.

scholarly journals Subcutaneous Hematoma Associated with Manual Cervical Massage during Carotid Artery Stenting

2011 ◽  
Vol 17 (3) ◽  
pp. 386-390 ◽  
Author(s):  
A. Tsurumi ◽  
Y. Tsurumi ◽  
M. Negoro ◽  
K. Yokoyama ◽  
M. Oheda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Antiplatelet Therapy ◽  
Carotid Artery Stenting ◽  
Dual Antiplatelet Therapy ◽  
Anticoagulation Therapy ◽  
Balloon Occlusion ◽  
Cervical Region ◽  
Manual Compression ◽  
Stenotic Lesion ◽  
Distal Side

We describe a patient with subcutaneous hematoma associated with manual cervical massage during carotid artery stenting. A 73-year-old man with left cervical carotid artery stenosis presented with left amaurosis fugax. We performed carotid artery stenting using distal embolic protection with balloon occlusion. Dual antiplatelet therapy was maintained in the periprocedural period and an anticoagulant agent was administered during the procedure. Because the aspiration catheter became entrapped by the stent, it did not reach the distal side of the stenotic lesion, and manual compression of the cervical region was therefore performed. Immediately afterwards, a subcutaneous hemorrhage occurred in the cervical region. There was no postoperative dyspnea due to enlargement of the hematoma, which was absorbed spontaneously. Cervical subcutaneous hematoma can occur in the cervical region due to cervical massage in patients who are receiving adjuvant antiplatelet therapy and anticoagulation therapy.

scholarly journals Impact of known or new-onset atrial fibrillation on 2-year cardiovascular event rate in patients with acute coronary syndromes: results from the prospective EPICOR Registry

2018 ◽  
Vol 8 (2) ◽  
pp. 121-129 ◽  
Author(s):  
Uwe Zeymer ◽  
Lieven Annemans ◽  
Nicolas Danchin ◽  
Stuart Pocock ◽  
Simon Newsome ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Oral Anticoagulants ◽  
Composite Endpoint ◽  
Coronary Syndrome ◽  
Long Term Follow Up ◽  
New Onset

Background: Atrial fibrillation (AF) is associated with increased morbidity in acute coronary syndrome patients, but impact on outcomes beyond 1 year is unclear. Methods: This was a post-hoc analysis from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry (NCT01171404), a prospective, observational study conducted in Europe and Latin America, which enrolled acute coronary syndrome survivors at discharge. Antithrombotic management patterns, mortality, a composite endpoint of death/new non-fatal myocardial infarction/stroke and bleeding events were assessed after 2 years of follow-up in patients with or without AF. Results: Of 10,568 patients enrolled, 397 (4.7%) had prior AF and 382 (3.6%) new-onset AF during index hospitalisation. Fewer patients with AF underwent percutaneous coronary intervention (52.1% vs. 66.6%; P<0.0001). At discharge, fewer AF patients received dual antiplatelet therapy (71.6% vs. 89.5%; P<0.0001); oral anticoagulant use was higher in AF patients but was still infrequent (35.0% vs. 2.5%; P<0.0001). Use of dual antiplatelet therapy and oral anticoagulants declined over follow-up with over 50% of all AF/no AF patients remaining on dual antiplatelet therapy (55.6% vs. 60.6%), and 23.3% (new-onset AF) to 42.1% (prior AF) on oral anticoagulants at 2 years. At 2 years, mortality, composite endpoint and bleeding rates were higher in AF patients (all P<0.0001) compared to patients without AF. On multivariable analysis, the risk of mortality or the composite endpoint was significant for prior AF ( P=0.003, P=0.001) but not new-onset AF ( P=0.88, P=0.92). Conclusions: Acute coronary syndrome patients with AF represent a high-risk group with increased event rates during long-term follow-up. Prior AF is an independent predictor of mortality and/or ischaemic events at 2 years. Use of anticoagulants in AF after acute coronary syndrome is still suboptimal.

Cancer drugs and the glomerulus

2018 ◽  
Vol 2 (2-3) ◽  
pp. 78-91 ◽  
Author(s):  
Hitesh H Shah ◽  
Nupur N Uppal ◽  
Mark A Perazella
Keyword(s):  
Kinase Inhibitors ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Renal Outcome ◽  
Cancer Drugs ◽  
Glomerular Diseases ◽  
Patients With Cancer ◽  
Tubular Necrosis ◽  
Glomerular Lesions ◽  
Endothelial Growth Factor

Several chemotherapeutics including novel immunotherapies and targeted therapies have recently been approved for the treatment of various cancers. Several nephrotoxicities secondary to treatment with chemotherapeutics have been described in patients with cancer. Acute kidney injury from acute tubular necrosis and acute interstitial nephritis is commonly reported nephrotoxicities following treatment with cancer drugs. Although less common, several glomerular lesions include minimal change disease, collapsing and non-collapsing focal segmental glomerulosclerosis secondary to chemotherapy-related podocyte injury have been reported in the literature. In addition to conventional chemotherapeutics, several novel cancer drugs including immune point check inhibitors, anti-vascular endothelial growth factor inhibitors, and tyrosine kinase inhibitors have also been associated with various glomerular lesions. While the occurrence of glomerular toxicities related to cancer drugs is less common than tubular injury, failure to recognize these associations may lead to poor renal outcome. In this article, we review several chemotherapy-related glomerular diseases including thrombotic microangiopathy.

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