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Nutritional Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Chelsea Kesty, Madeline Hooper, Erin McClure, Emily Chea, Cynthia Bartus
Overview: All neonates are born with low levels of vitamin K. Approximately 8–31% of healthy adults are vitamin K deficient. Severe deficiencies with clinically significant bleeding are limited to individuals taking vitamin K antagonists, such as warfarin, and those with malabsorption syndromes. Adults can acquire vitamin K deficiency through diseases of fat malabsorption (e.g., celiac disease and cystic fibrosis), inadequate dietary intake (typically seen in vegans), antibiotic regimens (that decrease gut bacteria responsible for vitamin K production), or vitamin K–inhibiting anticoagulation therapy.
Anticoagulation in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Rachel A. Newman, Ather Mehboob, Judith H. Chung
Warfarin use is less frequent in pregnancy. As mentioned, the primary drawback is its ability to cross the placenta, resulting in known fetal teratogenicity and increased risk of hemorrhage. It is also challenging because of the narrow therapeutic window and frequent monitoring. As it is a vitamin K antagonist, patients need to comply to avoid food rich in vitamin K (leafy green vegetables, broccoli, liver, etc.).
Fibrinolytic Enzymes for Thrombolytic Therapy
Published in Peter Grunwald, Pharmaceutical Biocatalysis, 2019
Swaroop S. Kumar, Sabu Abdulhameed
Anticoagulants like coumarin derivatives were discovered in 1939 by the identification of dicumarol from spoiled sweet clover hay which is a vitamin K antagonist by Link and Campbell (Stahmann et al., 1941). Further studies on coumarin derivatives led to the discovery of warfarin which was initially used as rodenticide and later approved for clinical use as anticoagulant. It was the first oral thrombin inhibitor and found useful in preventing embolic strokes (Aguilar and Hart, 2005). Limitations of these vitamin K antagonists were bleeding complications, interaction with food, necrosis, and hair loss (Dantas et al., 2004; Ansell et al., 2008; Pirmohamed, 2006). Even though other coumarin derivatives such as phenprocoumon and acenocoumarol also were used as anticoagulants, warfarine is the most common vitamin K antagonist in practice and remains as affordable in cardiovascular disease management.
Atrial fibrillation, diabetes and anticoagulation with direct oral anticoagulants: time to reconsider duration of the disease to evaluate the bleeding risk?
Published in Acta Cardiologica, 2021
Atrial fibrillation (AF) is the most common chronic aging related arrythmia worldwilde [1] and is known for a long time to be associated with a significant increase of stroke (4- to 5-fold) [2]. To prevent these events, lifelong oral anticoagulation is indicated in the majority of the patient presenting AF. Initially, patients were treated by a vitamin K antagonist such as warfarin. Although these treatments reduce the risk of stroke, compared to control therapy, they increase the risk of bleeding [3]. Moreover, vitamin K antagonists are difficult to use in daily clinical practice because of several interactions with food and drugs, because they require regular biological monitoring leading to an inaccurate anticoagulation in numerous patients [4]. Since 2010, four non-vitamin K antagonist direct oral anticoagulants (DOACs) have been successively approved and are nowadays recommended instead of warfarin for the majority of patients with AF [5].
Residual risk reduction opportunities in patients with chronic coronary syndrome. Role of dual pathway inhibition
Published in Expert Review of Clinical Pharmacology, 2020
José R. González-Juanatey, Manuel Almendro-Delia, Juan Cosín-Sales, Sergi Bellmunt-Montoya, Juan José Gómez-Doblas, Vincent Riambau, Xavier García-Moll, Javier García-Alegría, José Luis Hernández, Francisco S. Lozano, Carmen Suarez Fernández
The subsequent question is whether all anticoagulants have a positive effect on preventing ischemic events among patients with CCS, or only some of them. Vitamin K antagonists act on the anticoagulation cascade through the inhibition of the vitamin K-dependent clotting factors. Different studies have shown that after myocardial infarction, warfarin, in combination with aspirin or given alone, is superior to aspirin alone in reducing the incidence of MACE but with a marked higher risk of serious bleeding and without reducing mortality [30–32]. In the RE-DEEM study, dabigatran, an oral direct thrombin inhibitor, reduced coagulation activity in patients with a recent myocardial infarction but was associated with a dose-dependent increase in bleeding events [33]. In the RE-LY trial, compared with warfarin, there was a trend towards a higher risk of myocardial infarction among patients with nonvalvular atrial fibrillation treated with dabigatran [34,35]. These results could be partially explained by the fact that dabigatran attenuates thrombin generation to a lesser extent than warfarin and also because dabigatran increases platelet reactivity by enhancing the thrombin receptor density on platelets [36,37].
Psychometric validation of anti-clot treatment scale and treatment satisfaction questionnaire for medication version II in Japanese patients with atrial fibrillation
Published in Journal of Medical Economics, 2019
Emi Watanabe-Fujinuma, Benjamin F. Banderas, Yukihiro Koretsune, Koichiro Kumagai, Shinichiro Uchiyama, Takeshi Yamashita, Masahiro Yasaka, Sayako Akiyama, Jean-Baptiste Briere, Gavin Dickie, Stefan J. Cano
One of the recommended therapies, vitamin-K antagonists, requires regular monitoring due to narrow therapeutic window, and careful management of dietary intake and use of concurrent medications, owing to inherent variability caused by interactions with these factors. These characteristics could pose a daily challenge to patients in order to maintain long-term medication adherence8. Alternatively, direct oral-anticoagulants (DOACs) do not require regular monitoring of coagulation status and have fewer interactions with food and medications. With their effectiveness and safety in improving clinical outcomes established9–12, it is of great interest to measure other aspects of treatment characteristics, such as treatment satisfaction, which may also be important to the patients. In fact, it is essential to assess treatment satisfaction with medication, as this has been reported to impact medication compliance13, natural history of disease course14, and treatment outcomes15–17. To our knowledge, few prior studies have assessed patient satisfaction with DOACs18,19 compared to warfarin20,21, and none in Japanese AF patients.