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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.
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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Acenocoumarol is extensively metabolised, although the metabolites appear to be pharmacologically inactive in man. 29% is excreted in the faeces and 60% in the urine, with less than 0.2% of the dose being renally excreted unchanged.
Circulating uncarboxylated matrix Gla protein in patients with atrial fibrillation or heart failure with preserved ejection fraction
Published in Archives of Physiology and Biochemistry, 2022
Neshe Ferahova Nazifova-Tasinova, Atanas Angelov Atanasov, Milena Gincheva Pasheva, Yoto Trifonov Yotov, Daniela Ivanova Gerova, Deyana Georgieva Vankova, Miglena Nikolaeva Todorova, Diana Georgieva Ivanova, Yoana Dimitrova Kiselova-Kaneva, Bistra Tzaneva Galunska
Different levels of the circulating ucMGP according to CAC score were established, and these are presented on Figure 3(a,b). Although the differences in ucMGP levels between the CAC-groups were non-significant, a clear trend for an increase in ucMGP with the elevation of CAC was observed (Figure 3(a)). The median of the circulating ucMGP (3.07µg/mL; IQR 1.76 − 8.12µg/mL) was the lowest for the patients without coronary calcium (CAC score 0AU), higher (4.85µg/mL; IQR 1.14 − 6.80µg/mL) for those with CAC 1–99AU and highest (5.04µg/mL; IQR 1.82–9.06µg/mL) for the patients with highest CAC score (CAC score ≥100AU). When the patients on Acenocoumarol medication were excluded, a decrease in ucMGP in the most severe CAC group was observed. Then, the median-circulating ucMGP for the group with highest CAC score was 4.23µg/mL (IQR 1.48 − 8.11µg/ml) (Figure 3(b)). No significant correlations between circulating ucMGP and the CAC score were found.
Bleeding and mortality risk in patients implanted with mechanical prosthetic heart valves with and without thrombocytopenia. Insights from the nationwide PLECTRUM registry
Published in Platelets, 2022
Danilo Menichelli, Daniela Poli, Emilia Antonucci, Flavio Giuseppe Biccirè, Gualtiero Palareti, Pasquale Pignatelli, Daniele Pastori
On the other hand, MPHVs require lifelong treatment with oral anticoagulants to prevent valve thrombosis or systemic embolism [5]. Considering that direct oral anticoagulants are not approved for MPHV patients [6], the only therapeutic options are represented by the vitamin K antagonists (VKAs), namely warfarin and acenocoumarol. These VKAs need frequent checks of the international normalized ratio (INR) for the monitoring of the anticoagulation quality, as assessed by the time in therapeutic range (TiTR) [5]. Previous study showed that the TiTR in this patient population is generally suboptimal, especially in patients with MPHV at the mitral site or those who are kept at an INR range above 2–3 [7]. Among VKAs, warfarin may be preferred over acenocoumarol to maintain anticoagulation stability [8].
A comparison of front-line oral anticoagulants for the treatment of non-valvular atrial fibrillation: effectiveness and safety of direct oral anticoagulants in the FANTASIIA registry
Published in Expert Opinion on Pharmacotherapy, 2022
María Asunción Esteve-Pastor, José Miguel Rivera-Caravaca, Martín Ruiz-Ortiz, Javier Muñiz, Inmaculada Roldán-Rabadán, Déborah Otero, Raquel López-Gálvez, Ángel Cequier, Vicente Bertomeu-Martínez, Lina Badimón, Manuel Anguita, Gregory Y.H. Lip, Francisco Marín
Our study has several limitations. This study reflects clinical characteristics of Spanish (Caucasian) population and results might not be extrapolated to other populations. Despite warfarin was used in pivotal clinical trials as comparator for DOACs, we used acenocoumarol because is the most frequently used VKA used in Spain. Acenocoumarol has a shorter half-life in comparison with warfarin (10 vs 36 h), and this may explain the differences observed in anticoagulation control. We also recognize as a limitation that we cannot balance the baseline characteristics by a propensity score matching to perform a realistic direct comparison. Although we did not compare differences between DOACs, we compared the differences between DOACs and real-world VKA-treated patients from the FANTASIIA registry. We have used pooled HR and OR (for meta-analysis) of full dose of apixaban, rivaroxaban and edoxaban, that could influence the comparison of the results with VKA patients. Indeed, this is an indirect comparison using data from recent four high-quality meta-analysis. We selected those trials due their quality assessed by the Newcastle-Ottawa scale. However, we cannot exclude potential biases linked to the inherent methodology of the meta-analyses.