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Amit Rastogi - One of the best experts on this subject based on the ideXlab platform.
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development and validation of a web based electronic application in managing Antithrombotic agents in patients undergoing gi endoscopy
Gastrointestinal Endoscopy, 2019Co-Authors: Venkat Nutalapati, Krishna Tokala, Madhav Desai, Vijay Kanakadandi, Mojtaba Olyaee, Sravanthi Parasa, Amit RastogiAbstract:Background and Aims Antithrombotic therapy among patients undergoing GI procedures is frequently encountered and can impact the procedure and patient outcomes. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines help to manage these medications before endoscopy depending on the patient’s clinical status and the type of GI procedure. However, currently there is no readily available electronic tool that can assist in decision-making regarding preprocedural management of these agents. Our aim was to develop an electronic application, endoscopy + aid (ENDOAID), to help manage Antithrombotic agents before endoscopy and to perform a validation study to test its accuracy. Methods ENDOAID, a web-based application, was developed using JavaScript software (Oracle Corporation, Redwood Shores, Calif, USA) based on an algorithm to categorize patients and procedures into low and high risk as outlined in the updated ASGE guidelines published in 2016. Once pertinent information regarding a patient’s clinical status and the procedure are entered, the application generates recommendations for the management of Antithrombotic agents based on their cardiovascular risk and published ASGE guidelines. We performed a validation study with 52 patients who were referred to endoscopy and were taking Antithrombotic agents. The patients were divided into groups of 5, and in the simulation each patient had 4 procedures. Different GI procedures were used in the simulation for each group of patients to ensure the entire spectrum of procedures were covered for analysis. Every simulation was then run through ENDOAID. The results from ENDOAID were compared with recommendations based on ASGE guidelines. The latter was derived by consensus between 2 endoscopists (the criterion standard). The personnel using the ENDOAID and those using the ASGE guidelines were different to avoid bias. Any clinical scenario that was unclear or not clearly outlined in ASGE guidelines was discussed with expert endoscopists for a final decision. We evaluated ASGE recommendations and calculated concordance rates between guidelines and ENDOAID results. The Pearson correlation coefficient (r) was calculated to assess the correlation between ENDOAID results to guidelines. Results There was a total of 208 simulated encounters, including 26 procedures. Initial concordance between ENDOAID recommendations and the criterion standard was seen in 206 encounters (99.03%). The 2 encounters that needed further review occurred among patients with Factor V Leiden mutation and deep vein thrombosis from antiphospholipid antibody syndrome and who were undergoing high-risk procedures that had ambiguous guidelines. ENDOAID suggested consultations with an expert before the elective procedure. This suggestion was agreed on by expert endoscopist consensus. Thus, ENDOAID showed a 100% concordance with the ASGE guideline for managing Antithrombotics. There was a high degree of correlation (r = .996, P Conclusions We have developed and validated an easy-to-use web-based application that can help in periprocedural management of Antithrombotics. Such an application has the potential to simplify the management of these agents and potentially prevent procedural delays, cancellations, or unnecessary consults.
Jeffrey I. Weitz - One of the best experts on this subject based on the ideXlab platform.
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Emerging therapies for stroke prevention in atrial fibrillation
European Heart Journal Supplements, 2005Co-Authors: Martin O'donnell, Jeffrey I. Weitz, Giancarlo AgnelliAbstract:Atrial fibrillation (AF) is a major risk factor for stroke. Recent studies show that treatment strategies which combine control of ventricular rate with Antithrombotic therapy are as effective as those strategies aimed at restoring sinus rhythm. Current Antithrombotic therapy regimens in patients with AF involve chronic anticoagulation with dose-adjusted vitamin K antagonists (VKAs), unless patients have a contraindication to these agents or are at low risk for stroke. AF patients at low risk for stroke may benefit from aspirin. Although VKAs are effective, their use is problematic, highlighting the need for new Antithrombotic strategies. This paper will (i) provide an overview of the clinical trials that form the basis for current Antithrombotic guidelines in patients with AF, (ii) highlight the limitations of current Antithrombotic drugs used for stroke prevention, (iii) review the pharmacology of new Antithrombotic drugs under evaluation in AF, (iv) describe ongoing trials with new antiplatelet therapies and idraparinux, and completed studies with ximelagatran in patients with AF, (v) discuss the role of non-pharmacological techniques to reduce the risk of stroke in AF patients, and (vi) provide clinical perspective into the potential role of new Antithrombotic drugs in AF.
Bafang Li - One of the best experts on this subject based on the ideXlab platform.
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Antithrombotic activity of oral administered low molecular weight fucoidan from laminaria japonica
Thrombosis Research, 2016Co-Authors: Xue Zhao, Jing Hu, Lijuan Zhang, Zhaohui Zhang, Bafang LiAbstract:Abstract Introduction Fucoidans extracted from brown algae have been documented to have excellent Antithrombotic activity when administered by either intravenous or subcutaneous route in animal models. However, it is unknown if the fucoidans also have Antithrombotic activity when administered orally, a highly desirable feature of oral Antithrombotic agents. In the present study, we compared the oral absorption, bioavailability and Antithrombotic activity of two fucoidan fractions from Laminaria japonica with different molecular weight by oral administration in an electricity induced arterial thrombosis model and the underlying molecular mechanisms. Results and conclusions After a single dose of oral administration, the fucoidan content in plasma and urine in rats was assessed using the reverse-phased HPLC analysis of 1-phenyl-3-methyl-5-pyrazolone (PMP)-labeled fucose. The fucose content in the low molecular weight (LMW) fucoidan-treated rats increased up to 2-fold and peaked at 15 h, indicating that the LMW fucoidan had much better absorption and bioavailability than the MMW fucoidan in vivo. Oral administration of the LMW fucoidan at 400 and 800 mg/kg for 30 days inhibited the arterial thrombosis formation effectively induced by electrical shock in rats, accompanied by moderate anticoagulation activity, regulation on TXB 2 and 6-keto-PGF1α, significant antiplatelet activity and effective fibrinolysis. The LMW fucoidan showed better oral absorption and Antithrombotic activity in addition to different Antithrombotic mechanisms compared to those of the medium molecular weight (MMW) fucoidan. Thus, the LMW fucoidan has a potential to become an oral Antithrombotic agent.
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a comparative study of Antithrombotic and antiplatelet activities of different fucoidans from laminaria japonica
Thrombosis Research, 2012Co-Authors: Xue Zhao, Shizhu Dong, Jingfeng Wang, Fang Li, Anjin Chen, Bafang LiAbstract:Abstract Introduction Fucoidans extracted from brown algae represent an intriguing group of natural fucose-enriched sulfated polysaccharide, with excellent anticoagulant, antimetastatic, antiangiogenic and anti-inflammatory activities. In the present study, we compared Antithrombotic activities of four fucoidan fractions with different molecular weight and sulfated ester content from Laminaria japonica in an electrical induced arterial thrombosis and their potential mechanism underlying such activity. Results and Conclusions In vivo middle molecular weight (MMW) fucoidan fractions with molecular weight about 28000 and 35000 exhibited better Antithrombotic activity in electrical induced arterial thrombosis than low molecular weight (LMW) fucoidan LF1 and LF2 (Mw 7600 and 3900). Inhibition of arterial thrombosis occurred at dose of 0.1-0.25 mg/kg for MMW fucoidans, accompanied with moderate anticoagulant activity and significant decrease of whole blood viscosity and hematocrit. The Antithrombotic effects of MMW Fucoidans might be related with promotion of TFPI content and decrease of TXB2 content, without affecting platelet aggregation and 6-keto-PGF1α content in vivo . In contrast, LMW fucoidans showed a correlation among anticoagulant, antiplatelet and Antithrombotic effects in vivo . Antithrombotic action of LF1 and LF2 required high dose of 2.5-10 mg/kg, concomitantly with anticoagulant activity and specific inhibition of platelet aggregation in vivo . Their Antithrombotic effect might be related to their promotion of TFPI and 6-keto-PGF1α, down regulation of TXB2, without affecting hemorheology. These findings suggested that fucoidan fractions with different molecular weight acted on the Antithrombotic action by different mechanism. By comparison, highly sulfated fucoidan LF2 with molecular weight of 3900 seemed to be a more suitable choice of Antithrombotic drug for its Antithrombotic activity accompanied with specific inhibitory activity on platelet aggregation, low anticoagulant activity and low hemorrhagic risk in vivo .
Kazuma Fujimoto - One of the best experts on this subject based on the ideXlab platform.
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management of patients on Antithrombotic agents undergoing emergency and elective endoscopy joint asian pacific association of gastroenterology apage and asian pacific society for digestive endoscopy apsde practice guidelines
Gut, 2018Co-Authors: Francis K L Chan, Kheanlee Goh, Nageshwar D Reddy, Kazuma Fujimoto, Seiji Hokimoto, Younghoon Jeong, Takanari Kitazono, Hong Sik Lee, Varocha Mahachai, Kelvin K F TsoiAbstract:This Guideline is a joint official statement of the Asian Pacific Association of Gastroenterology (APAGE) and the Asian Pacific Society for Digestive Endoscopy (APSDE). It was developed in response to the increasing use of Antithrombotic agents (antiplatelet agents and anticoagulants) in patients undergoing gastrointestinal (GI) endoscopy in Asia. After reviewing current practice guidelines in Europe and the USA, the joint committee identified unmet needs, noticed inconsistencies, raised doubts about certain recommendations and recognised significant discrepancies in clinical practice between different regions. We developed this joint official statement based on a systematic review of the literature, critical appraisal of existing guidelines and expert consensus using a two-stage modified Delphi process. This joint APAGE-APSDE Practice Guideline is intended to be an educational tool that assists clinicians in improving care for patients on Antithrombotics who require emergency or elective GI endoscopy in the Asian Pacific region.
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questionnaire based survey on gastrointestinal bleeding and management of Antithrombotic agents during endoscopy among asian countries
Digestion, 2018Co-Authors: Nanae Tsuruoka, Kazuma Fujimoto, Ryuichi Iwakiri, Yasuhisa Sakata, Takeshi Kamiya, Takashi Joh, Kengo Tokunaga, Shinichi Takahashi, Yoshikazu Kinoshita, Kazuhiko UchiyamaAbstract:OBJECTIVE Guidelines on the management of Antithrombotic therapy for endoscopic procedures vary among countries. Differences in the management of Antithrombotic agents for endoscopic procedures between Western and Eastern countries have already been reported. However, no study has investigated the differences among Asian countries. The aim of this study was to examine the differences in the etiology of gastrointestinal bleeding and management of Antithrombotic agents during endoscopic procedures between Japan and other Asian countries (OAC). METHODS Questionnaires regarding gastrointestinal bleeding in clinical practice and management of Antithrombotic agents during endoscopy were distributed to members of the International Gastroenterology Consensus Symposium Study Group. We analyzed the questionnaire answers and compared the results between Japan and OAC. RESULTS The cause of and treatment methods for gastrointestinal bleeding differed between Japan and OAC. In Japan, the trend was to continue drugs at the time of biopsy and endoscopic therapy. Even in cases of discontinuation, the drug withdrawal period was as short as <3 days. Thrombotic complications caused by the withdrawal of Antithrombotic agents were observed more frequently in Japan (34.78%) than in OAC (22.46%; p = 0.016). CONCLUSION Due to differences in guidelines and complications associated with discontinuation of drugs, the Antithrombotic withdrawal period in Japan tended to be shorter than that in OAC.
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characteristics of patients with non variceal upper gastrointestinal bleeding taking Antithrombotic agents
Digestive Endoscopy, 2015Co-Authors: Daisuke Yamaguchi, Kazuma Fujimoto, Nanae Tsuruoka, Yasuhisa Sakata, Ryo Shimoda, Toru Higuchi, Hiroyuki Sakata, Ryuichi IwakiriAbstract:Background and Aim The present study aimed to clarify the features and management of non-variceal upper gastrointestinal bleeding (UGIB) in Japanese patients taking Antithrombotic agents. Methods We retrospectively investigated the medical records of 560 patients who underwent emergency endoscopy for UGIB from 2002 to 2013. The patients were divided into two groups: group A, Antithrombotic agent use; and group NA, no Antithrombotic agent use. We compared clinical characteristics, comorbidities, and causes of UGIB between the groups. We also investigated management with Antithrombotics. Results Of 560 patients with UGIB, 27.5% were taking Antithrombotics, and this proportion gradually increased during the study period. Mean hemoglobin levels on admission were significantly lower in group A (8.0 ± 1.7 g/dL) than in group NA (8.9 ± 2.9 g/dL) (P < 0.001). Patients in group A developed more gastric ulcers and multiple ulcers than did patients in group NA. Incidence of Forrest Ia-type bleeding was lower in group A than in group NA (P < 0.001), and the rate of endoscopic hemostasis was significantly higher in group A (98.7%) than in group NA (94.3%) (P = 0.022). After the release of the 2012 Japan Gastroenterological Endoscopy Society guidelines, the Antithrombotic agent cessation periods were significantly shortened (P < 0.001). Conclusions Among patients with UGIB, those taking Antithrombotics exhibited more severe clinical signs. However spurting hemorrhage was rare. Antithrombotics may be resumed early after endoscopic hemostasis.
Shigeaki Kato - One of the best experts on this subject based on the ideXlab platform.
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degarelix treatment is compatible with diabetes and Antithrombotic therapy in patients with prostate cancer
Research and Reports in Urology, 2017Co-Authors: Suguru Tokiwa, Hiroaki Shimmura, Shuehei Nomura, Ryota Watanabe, Minoru Kurita, Naoto Yoshida, Kaori Yamashita, Yoshitaka Nishikawa, Alexander Kouzmenko, Shigeaki KatoAbstract:Introduction Therapeutically induced androgen deficiency (AD) is a standard treatment for patients with prostate cancer, but it is often associated with various adverse effects (AEs) that may lead to discontinuation. Some AEs may depend on the patient's health condition, while others may be due to complications of the drug delivery method. Degarelix is a gonadotropin-releasing hormone (GnRH) antagonist widely used for the treatment of androgen-dependent prostate cancer. This study aimed to ascertain the following: 1) the compatibility of degarelix treatment with diabetes and 2) any specific causal associations of degarelix injections with increased blood clotting and Antithrombotic therapy requirements. Patients and methods The medical records of 162 patients with prostate cancer who had undergone degarelix treatment were retrospectively examined. The association of a medical history of diabetes and anticoagulant co-treatment with degarelix treatment discontinuation was analyzed statistically. Results Rapid and significant decreases in prostate-specific antigen (PSA) levels during the course of degarelix treatment were detected for patients with prostate cancer regardless of clinical state. During the 27 months of treatment, 68 subjects (48%) ceased degarelix treatment, owing to several reasons, mainly financial issues. Among these subjects, 19 had diabetes, while 35 were treated with Antithrombotics. Extensive statistical analysis indicated that there were no causal associations between degarelix treatment discontinuation and preexisting diabetes or Antithrombotic therapy. Conclusion Our study suggests that preexisting diabetes and Antithrombotic therapy were not significant factors for the discontinuation of degarelix treatment in patients with prostate cancer.