Anticoagulation Drugs - the Current State of the Art最新文献

Examination of Laboratory for Monitoring Heparin Anticoagulant Therapy 监测肝素抗凝治疗的实验室检查

Anticoagulation Drugs - the Current State of the Art Pub Date : 2019-09-27 DOI: 10.5772/intechopen.88401

Y. Hernaningsih, E. B. Maulidan

{"title":"Examination of Laboratory for Monitoring Heparin Anticoagulant Therapy","authors":"Y. Hernaningsih, E. B. Maulidan","doi":"10.5772/intechopen.88401","DOIUrl":"https://doi.org/10.5772/intechopen.88401","url":null,"abstract":"Heparin-derivative anticoagulants include unfractionated heparin (UFH), low molecular weight heparin (LMWH), pentasaccharide (fondaparinux), and ultralow molecular weight heparin (ULMWH). Heparin contains an active pentasaccharide sequence that binds to antithrombin (AT). This bond produces conformational changes that accelerate its binding with AT and inactivation of coagulation factors XIIa, XIa, Xa, and IXa and thrombin (IIa). Thrombin and factor Xa are the most sensitive to inhibition by the heparin-AT complex, and the strength of inhibiting thrombin is ten times more sensitive than factor Xa. The UFH anticoagulant response is monitored using activated partial thromboplastin time (APTT), a measurement that is sensitive to inhibition of thrombin and factor Xa. Protamine titration examination is the standard for measuring UFH concentrations in plasma. Recommendations from the American College of Chest Physicians (ACCP) suggest that the APTT target range for the UFH therapy is equivalent to 0.2–0.4 IU/mL with protamine titration or 0.35–0.7 IU/mL with an anti-Xa examination. A new examination is thrombodynamics (TD), measuring the level of development of clots. This method is considered most able to mimic the coagulation process that occurs in vivo compared to other examinations.","PeriodicalId":437341,"journal":{"name":"Anticoagulation Drugs - the Current State of the Art","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122527460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pharmacological Review of Anticoagulants 抗凝血药物的药理研究进展

Anticoagulation Drugs - the Current State of the Art Pub Date : 2019-09-04 DOI: 10.5772/intechopen.88407

Hobart Ng Tsai

引用次数: 2

Knowledge, Adherence, and Quality of Life among Warfarin Therapy Users 华法林治疗使用者的知识、依从性和生活质量

Anticoagulation Drugs - the Current State of the Art Pub Date : 2019-07-29 DOI: 10.5772/INTECHOPEN.86371

L. Matalqah

引用次数: 3

Update on Mechanisms, Pathogenicity, Heterogeneity of Presentation, and Laboratory Diagnosis of Heparin-Induced Thrombocytopenia 肝素诱导的血小板减少症的机制、致病性、异质性和实验室诊断的最新进展

Anticoagulation Drugs - the Current State of the Art Pub Date : 2019-06-01 DOI: 10.5772/INTECHOPEN.86475

J. Amiral, A. Vissac

{"title":"Update on Mechanisms, Pathogenicity, Heterogeneity of Presentation, and Laboratory Diagnosis of Heparin-Induced Thrombocytopenia","authors":"J. Amiral, A. Vissac","doi":"10.5772/INTECHOPEN.86475","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86475","url":null,"abstract":"Heparin-induced thrombocytopenia (HIT) is the most life-threatening adverse effect of heparin therapy and is provoked by the development of drug-dependent antibodies. It occurs more frequently in patients with cardiac or orthopedic surgery or severe circulatory diseases, and the risk depends on the patient pathological status. As heparin is an anticoagulant used for treating thrombotic events or their risk, this iatrogenic complication has a paradoxal effect as it can induce thromboembolic diseases, frequently associated to severe morbidity or fatal outcomes. Diagnosis involves clinical evaluation of disease probability and laboratory tools for testing the presence of heparin-dependent antibodies with immunoassays or their capability to activate platelets with functional assays. Antibodies developed when stoichiometric complexes of platelet factor 4 (PF4) with heparin are formed during therapy. In few cases non-platelet factor 4 antigens can be involved. Antibodies can remain asymptomatic, but pathogenicity occurs in the presence of high concentrations of IgG isotype antibodies, with high avidity: they target and activate platelets or endothelial cells exposing heparin-PF4 (HPF4) complexes and produce thrombocytopenia and sometimes thrombosis. Risk factors which favor the development of antibodies and their pathological effect are discussed. The present understanding of mechanisms underlying disease development and diagnostic strategies of this heparin adverse effect is presented.","PeriodicalId":437341,"journal":{"name":"Anticoagulation Drugs - the Current State of the Art","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121583022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3