scholarly journals A dabigatran-antidótum, az intravénás idarucizumab első hazai alkalmazása

2017 ◽  
Vol 158 (10) ◽  
pp. 387-392 ◽  
Author(s):  
Lajos Driesz ◽  
Éva Barabás ◽  
Ildikó Bodócs ◽  
Zoltán Szántó ◽  
György Herr ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Surgical Intervention ◽  
Antibody Fragment ◽  
Thrombin Inhibitor ◽  
The Novel ◽  
Reversal Agent ◽  
Humanized Monoclonal Antibody ◽  
Life Threatening ◽  
Direct Anticoagulants ◽  
Emergency Cholecystectomy

Abstract: At present, the direct thrombin inhibitor dabigatran is the only one amongst the new direct anticoagulants which has an effective, specific reversal agent. The novel agent idarucizumab is a humanized, monoclonal antibody fragment binds to dabigatran within minutes thereby offers an opportunity to induce a safe, long-lasting reverse of the anticoagulant effects of dabigatran. The authors describe the first use of idarucizumab in Hungary (23. 05. 2016) in an old female patient with non-valvular paroxysmal atrial fibrillation of high stroke risk-score and renal dysfunction who was taking dabigatran (2 x 110 mg/day) when an acute abdomen developed requiring emergency cholecystectomy. Patient received the antidote (idarucizumab 2 x 2.5 g/50 ml iv.) two hours before the surgical intervention, and she did not have any uncontrollable, life-threatening bleeding during the surgery. The high activated partial thromboplastin time relating to anticoagulative influence before the surgery normalized completely after administration of the antidote. Antagonizing dabigatran with idarucizumab was feasible and safe without any side effects. The patient received dabigatran therapy again after her recovery. Orv. Hetil., 2017, 158(10), 387–392.

Idarucizumab for Urgent Dabigatran Reversal in Clinical Practice: A Case Series of First Use in Vietnam

MedPharmRes ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. 13-17
Author(s):  
Sy Van Hoang ◽  
Kha Minh Nguyen
Keyword(s):  
Monoclonal Antibody ◽  
Clinical Practice ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Case Series ◽  
Antibody Fragment ◽  
Randomized Control Trials ◽  
Humanized Monoclonal Antibody ◽  
Life Threatening ◽  
Randomized Control

The benefits of non-Vitamin K oral antagonists in prevention or treatment of thrombosis have been studied in many randomized control trials. However, episodes of life-threatening bleeding caused by using novel oral anticoagulants have occurred in clinical practice and necessitate the development of aims for reversal of the anticoagulant effects. We report here three cases in which the use of idarucizumab, a humanized monoclonal antibody fragment, has successfully reversed the anticoagulation effects of dabigatran and produced favorable outcomes.

Managing Life-Threatening Bleeding in Patient with High Plasma Concentration of Dabigatran with Thromboelastogram, Idarucizumab and Renal Replacement Therapy

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Ego A ◽  
◽  
Lheureux O ◽  
Creteur Jacques J ◽  
◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Antibody Fragment ◽  
High Plasma ◽  
Coagulation System ◽  
Thrombin Inhibitor ◽  
Hemorrhagic Complication ◽  
Life Threatening ◽  
Antithrombotic Efficacy

We present a case of patient with spontaneous cardiac tamponade related to a very high 2-plasma concentration of dabigatran, an oral direct-acting thrombin inhibitor. By selectively inhibiting thrombin alone, dabigatran may have antithrombotic efficacy while preserving some other hemostatic mechanisms in the coagulation system and thus potentially mitigating the risk of bleeding. Nonetheless, serious bleeding can occur with dabigatran. We illustrate the management of this life threatening hemorrhagic complication by the combination of cardiac surgery, antagonization of the anticoagulant effect (using Idarucizumab, an humanized monoclonal antibody fragment and continuous renal replacement therapy), and monitoring of the effects on coagulation by thromboelastogram.

Idarucizumab, a Humanized, Monoclonal Antibody Fragment for Immediate Reversal of Dabigatran

2015 ◽  
Vol 28 (6) ◽  
pp. 548-554 ◽  
Author(s):  
Marta A. Miyares ◽  
Yara Kuyumjian ◽  
Shannon Eaves ◽  
Eliza Dollard
Keyword(s):  
Monoclonal Antibody ◽  
Anticoagulant Activity ◽  
Antibody Fragment ◽  
The United States ◽  
Mesh Term ◽  
Priority Review ◽  
Reversal Agent ◽  
Humanized Monoclonal Antibody ◽  
Pubmed Database ◽  
License Application

Objective: To evaluate the role of idarucizumab, a humanized monoclonal antibody fragment, as a specific reversal agent for the anticoagulant activity of dabigatran and to review the pharmacology, pharmacokinetic properties, efficacy, and safety of this agent. Methods: A literature search was conducted consisting of a PubMed database using the MeSH term idarucizumab and the key word dabigatran antidote. Studies evaluating the pharmacology, pharmacokinetics, safety, and efficacy of idarucizumab for the reversal of the anticoagulant activity of dabigatran were included. Results: Idarucizumab represents a novel treatment option as it is the only humanized, monoclonal antibody fragment that specifically binds to dabigatran. Studies evaluating reversal of dabigatran-induced anticoagulation have demonstrated immediate, complete, and sustained effects with idarucizumab. Idarucizumab did not overcorrect thrombin generation. Additionally, evaluations have shown that dabigatran can be safely reinitiated 24 hours after the administration of idarucizumab. The United States Food and Drug Administration granted priority review for the biologic license application and accelerated approval for idarucizumab. Conclusion: Idarucizumab represents an encouraging development in the reversal of dabigatran. Its novel mechanism of action, pharmacokinetics, tolerability, and lack of thrombotic events contribute positively to its use in patients who experience bleeding or for those who require emergent surgery or procedures.

Managing Life-Threatening Bleeding in Patient with High Plasma Concentration of Dabigatran with Thromboelastogram, Idarucizumab and Renal Replacement Therapy

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Ego A ◽  
◽  
Lheureux O ◽  
Creteur Jacques J ◽  
◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Antibody Fragment ◽  
High Plasma ◽  
Coagulation System ◽  
Thrombin Inhibitor ◽  
Hemorrhagic Complication ◽  
Life Threatening ◽  
Antithrombotic Efficacy

We present a case of patient with spontaneous cardiac tamponade related to a very high 2-plasma concentration of dabigatran, an oral direct-acting thrombin inhibitor. By selectively inhibiting thrombin alone, dabigatran may have antithrombotic efficacy while preserving some other hemostatic mechanisms in the coagulation system and thus potentially mitigating the risk of bleeding. Nonetheless, serious bleeding can occur with dabigatran. We illustrate the management of this life threatening hemorrhagic complication by the combination of cardiac surgery, antagonization of the anticoagulant effect (using Idarucizumab, an humanized monoclonal antibody fragment and continuous renal replacement therapy), and monitoring of the effects on coagulation by thromboelastogram.

SARS-COV2 virus and Coronavirus disease (COVID-19)

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 977-982
Author(s):  
Mohamed J. Saadh ◽  
Bashar Haj Rashid M ◽  
Roa’a Matar ◽  
Sajeda Riyad Aldibs ◽  
Hala Sbaih ◽  
...  
Keyword(s):  
Close Contact ◽  
Antiviral Agents ◽  
Health Concern ◽  
The Novel ◽  
Global Public Health ◽  
Fatal Disease ◽  
Mild Disease ◽  
Life Threatening ◽  
Novel Coronavirus

SARS-COV2 virus causes Coronavirus disease (COVID-19) and represents the causative agent of a potentially fatal disease that is of great global public health concern. The novel coronavirus (2019) was discovered in 2019 in Wuhan, the market of the wet animal, China with viral pneumonia cases and is life-threatening. Today, WHO announces COVID-19 outbreak as a pandemic. COVID-19 is likely to be zoonotic. It is transmitted from bats as intermediary animals to human. Also, the virus is transmitted from human to human who is in close contact with others. The computerized tomographic chest scan is usually abnormal even in those with no symptoms or mild disease. Treatment is nearly supportive; the role of antiviral agents is yet to be established. The SARS-COV2 virus spreads faster than its two ancestors, the SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), but has lower fatality. In this article, we aimed to summarize the transmission, symptoms, pathogenesis, diagnosis, treatment, and vaccine to control the spread of this fatal disease.

scholarly journals The bowel and beyond: extracolonic findings from CT colonography

2021 ◽  
Author(s):  
Gerard Lambe ◽  
Peter Hughes ◽  
Louise Rice ◽  
Caoimhe McDonnell ◽  
Mark Murphy ◽  
...  
Keyword(s):  
Ct Colonography ◽  
Surgical Intervention ◽  
Potential Significance ◽  
Age And Gender ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Extracolonic Findings ◽  
The Difference ◽  
Clinically Significant ◽  
And Gender

AbstractCT colonography has emerged as the investigation of choice for suspected colorectal cancer in patients when a colonoscopy in incomplete, is deemed high risk or is declined because of patient preference. Unlike a traditional colonoscopy, it frequently reveals extracolonic as well as colonic findings. Our study aimed to determine the prevalence, characteristics and potential significance of extracolonic findings on CT colonography within our own institution. A retrospective review was performed of 502 patients who underwent CT colonography in our institution between January 1, 2010 and January 4, 2015. Of 502 patients, 60.63% had at least one extracolonic finding. This was close to other similar-sized studies (Kumar et al. Radiology 236(2):519–526, 2005). However, our rate of E4 findings was significantly higher than that reported in larger studies at 5.3%(Pooler et al. AJR 206:313–318, 2016). The difference may be explained by our combination of symptomatic/screening patients or by the age and gender distribution of our population. Our study lends support to the hypothesis that CT colonography may be particularly useful in identifying clinically significant extracolonic findings in symptomatic patients. CT colonography may allow early identification of extracolonic malignancies and life-threatening conditions such as an abdominal aortic aneurysm at a preclinical stage when they are amenable to medical or surgical intervention. However, extracolonic findings may also result in unnecessary investigations for subsequently benign findings.

Safety and Efficacy of Argatroban in the Management of Heparin-Induced Thrombocytopenia

2011 ◽  
Vol 4 ◽  
pp. CMBD.S5118 ◽  
Author(s):  
Bernd Saugel ◽  
Roland M. Schmid ◽  
Wolfgang Huber
Keyword(s):  
Arterial Thrombosis ◽  
Pharmacokinetic Profile ◽  
The United States ◽  
Heparin Therapy ◽  
Direct Thrombin Inhibitor ◽  
Thrombin Inhibitor ◽  
Heparin Induced Thrombocytopenia ◽  
Safety And Efficacy ◽  
Increased Risk ◽  
Life Threatening

Heparin-induced thrombocytopenia (HIT) is a life-threatening adverse reaction to heparin therapy that is characterized by thrombocytopenia and an increased risk of venous and arterial thrombosis. According to guidelines, in patients with strongly suspected or confirmed HIT all sources of heparin have to be discontinued and an alternative, nonheparin anticoagulant for HIT treatment must immediately be started. For both the prophylaxis of thrombembolic events in HIT and the treatment of HIT with thrombosis the direct thrombin inhibitor argatroban is approved in the United States. The objective of this review is to describe the mechanism of action and the pharmacokinetic profile of argatroban, to characterize argatroban regarding its safety and therapeutic efficacy and to discuss its place in therapy in HIT.

The Challenges of Biomedical Waste Management During the Ongoing Coronavirus Disease-19 (COVID-19) Pandemic: The Current Scenario

2021 ◽  
Vol 13 ◽  
Author(s):  
Sabitha Vadakedath ◽  
Venkataramana Kandi ◽  
Tarun Kumar Suvvari ◽  
L V Simhachalam Kutikuppala ◽  
Vikram Godishala ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Complex Nature ◽  
The Novel ◽  
Waste Collection ◽  
Biomedical Waste ◽  
Infected People ◽  
Life Threatening ◽  
Current Scenario ◽  
Constant Observation ◽  
Novel Coronavirus

: The novel Coronavirus (SARS-CoV-2) that has emerged and spread throughout the world causing CoV disease-19 (COVID-19) has since its discovery affected not only humans and animals but also the environment. Because of the highly infectious nature of the virus, and the respiratory aerosol transmission route, face masks and personal protective equipment have become mandatory for public and healthcare workers, respectively. Also, the complex nature of the pathogenicity of the virus, wherein, it has been associated with mild, moderate, and severe life-threatening infections, has warranted increased laboratory testing and placing the infected people in isolation and under constant observation in quarantine centers or at dedicated hospitals. Some infected people, who are generally healthy, and do not show symptoms have been placed in home quarantines. At this juncture, there has been increased amount of biomedical waste (BMW), and infectious general waste along with plastic disposable recyclable and non-recyclable waste. The increased BMW along with the potentially hazardous plastic waste collection, segregation, transport, and disposal has assumed increased significance during the ongoing pandemic. Therefore, this review attempts to investigate the current scenario of BMW management and strategies to minimize BMW and prevent potential environmental pollution.

Hemoperitoneum in a Peritoneal Dialysis Patient: Ruptured Ectopic Pregnancy

2018 ◽  
Vol 38 (6) ◽  
pp. 455-456 ◽  
Author(s):  
Orly F. Kohn ◽  
Sandra Culbertson ◽  
Yolanda T. Becker
Keyword(s):  
Differential Diagnosis ◽  
Peritoneal Dialysis ◽  
Ectopic Pregnancy ◽  
Dialysis Patient ◽  
Surgical Intervention ◽  
Peritoneal Dialysis Patient ◽  
Dialysis Patients ◽  
Childbearing Age ◽  
Life Threatening ◽  
High Index Of Suspicion

Hemoperitoneum is a well-recognized complication in female peritoneal dialysis (PD) patients of childbearing age. Bloody effluent is commonly of minor nature, presenting during menstruation or midcycle, resolving after a few rapid exchanges without a need for further intervention. One must remain vigilant, however, and consider a broader differential diagnosis when hemoperitoneum is persistent or severe, as it indicates a serious and potentially life-threatening etiology. We report 2 episodes of hemoperitoneum in a PD patient occurring more than 1.5 years apart, with different underlying etiologies. The more dramatic second episode was due to a ruptured ectopic pregnancy, a condition which had not been reported as a cause of hemoperitoneum in dialysis patients to date and requires a high index of suspicion and prompt surgical intervention.

scholarly journals History and Perspective of Immunotherapy for Pythiosis

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1080
Author(s):  
Hanna Yolanda ◽  
Theerapong Krajaejun
Keyword(s):  
Surgical Intervention ◽  
Primary Source ◽  
T Helper ◽  
T Helper 1 ◽  
Antimicrobial Drugs ◽  
Pythium Insidiosum ◽  
T Helper 2 ◽  
Genome Data ◽  
Life Threatening ◽  
Similar Survival

The fungus-like microorganism Pythium insidiosum causes pythiosis, a life-threatening infectious disease increasingly reported worldwide. Antimicrobial drugs are ineffective. Radical surgery is an essential treatment. Pythiosis can resume post-surgically. Immunotherapy using P. insidiosum antigens (PIA) has emerged as an alternative treatment. This review aims at providing up-to-date information of the immunotherapeutic PIA, with the focus on its history, preparation, clinical application, outcome, mechanism, and recent advances, in order to promote the proper use and future development of this treatment modality. P. insidiosum crude extract is the primary source of immunotherapeutic antigens. Based on 967 documented human and animal (mainly horses) pythiosis cases, PIA immunotherapy reduced disease morbidity and mortality. Concerning clinical outcomes, 19.4% of PIA-immunized human patients succumbed to vascular pythiosis instead of 41.0% in unimmunized cases. PIA immunotherapy may not provide an advantage in a local P. insidiosum infection of the eye. Both PIA-immunized and unimmunized horses with pythiosis showed a similar survival rate of ~70%; however, demands for surgical intervention were much lesser in the immunized cases (22.8% vs. 75.2%). The proposed PIA action involves switching the non-protective T-helper-2 to protective T-helper-1 mediated immunity. By exploring the available P. insidiosum genome data, synthetic peptides, recombinant proteins, and nucleic acids are potential sources of the immunotherapeutic antigens worth investigating. The PIA therapeutic property needs improvement for a better prognosis of pythiosis patients.

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