Anticoagulant therapy with fondaparinux in a liver transplant patient with thrombosis and liver fibrosis: a case report

The treatment with fondaparinux is the effective and safe anticoagulant therapy in liver transplant patient on immunosuppressive therapy with arterial thrombosis, and it seems able to reduce liver fibrosis. Although this treatment is not generalizable, further prospective large studies need to confirm this case report

Antithrombotic therapy with rivaroxaban in five patients with paroxysmal nocturnal haemoglobinuria and thrombotic events

Five patients with paroxysmal nocturnal haemoglobinuria and thrombotic complications under oral antithrombotic treatment with vitamin K antagonist were switched to receive the direct oral anticoagulant rivaroxaban an factor Xa inhibitor. In all five patients haematological and biochemical parameters and adverse events were evaluated for a period of twelve months. Therapy with rivaroxaban was well tolerated in all cases and one patient showed a significant reduction of bleeding and transfusion requirement. All patients obtained a significant reduction in days of hospitalization with a consequent improvement in their quality of life after rivaroxaban treatment

The relationships between vitamin K and cognition: a review of current evidence

Vitamin K is a fat-soluble nutrient discovered in 1935 and its role in blood coagulation has been thoroughly explored. In recent years, studies conducted in vitro and on animals highlighted vitamin K involvement in brain cells development and survival. In particular, vitamin K seems to have an antiapoptotic and anti-inflammatory effect mediated by the activation of Growth Arrest Specific Gene 6 and Protein S. Moreover, this vitamin is involved in sphingolipids metabolism, a class of lipids that participate in the proliferation, differentiation, and survival of brain cells. An altered expression in sphingolipids profile has been related to neuroinflammation and neurodegeneration. This review stems from a growing interest in the role of vitamin K in brain functions, especially in cognition, also in view of an expected increase of prevalence of Alzheimer's disease and other forms of dementia. It collects recent researches that show interesting, even though not definitive, evidence of a direct correlation between vitamin K levels and cognitive performance. Moreover, vitamin K antagonists, used worldwide as oral anticoagulants, according to recent studies may have a negative influence on cognitive domains such as visual memory, verbal fluency and brain volume. The aim of this review is to analyze the evidence of clinical studies carried out up to date on the relationship between vitamin K intake and cognitive performances. The involvement of vitamin K antagonists (VKAs) in declining cognitive performances is also addressed separately

Is telephone follow-up useful in preventing post-extraction bleeding in patients on antithrombotic treatment?

The aim of the study was to investigate the usefulness of telephone follow-up in preventing post-extraction bleeding and improving wound healing in patients on chronic antithrombotic treatment. A prospective randomized clinical trial was carried out o

Monocyte value could be a thrombosis marker?

This prospective case-control study suggests that monocyte value is both an inexpensive and easy thrombosis criterion: the value above 500 cells/mm3 correlates with thrombosis at the onset and the value below 400 cells/mm3 correlates with restoration of vessel patency; moreover this difference is similar as that observed with d-Dimer value. However, it is interesting to notice that the d-Dimer rate of change does not correlate proportionally with the restoration of the vessel patency. In addition to this, the d-Dimer mean values are affected by an high error. After checking equipment and procedures to eliminate any potential source of systematic error, measurements of d-Dimer were repeated on the same specimens. However, the great variability of the measured values did not change, suggesting that the d-Dimer does not correlate with the pathology. Further study should analyze a third variable, in conjunction with d-Dimer and monocytes. This third parameter should be a factor well recognized as independent from DTV/PE as much as possible. The variability of this third variable should be affected by variability as well as the d-Dime

Folate status and homocysteine level in Italian patients aged under 60 on oral anticoagulant therapy

BACKGROUND: Folate deficiency occurs frequently and the related hyper-homocysteinaemia is considered a risk factor for thrombosis. We investigated folate status and homocysteine (Hcy) concentration in patients under 60 years on oral anticoagulant therapy (OAT) for previous venous or arterial thrombosis and in healthy blood donors. PATIENTS AND METHOD: Thirty-nine patients (mean age 35.2 years) on OAT for longer than 6 months and forty 44 healthy blood donors (mean age 36.0 years) were evaluated. Diet, serum folate (SF), red blood cell folate (RCF), homocysteinaemia, vitamin B12 levels and the mutation C677T of methylenetetrahydrofolate-reductase (MTHFR) gene were determined. RESULTS: The mean SF and Hcy concentrations were significantly higher in patients compared with blood donors (SF = 17.7 versus 10.5 nmol/L, P < 0.0001; Hcy = 11.7 versus 8.9 micromol/L, P = 0.009). Twelve out of 39 patients and 7 out of 44 blood donors were homozygous for the mutation C677T of MTHFR gene. Among the remaining subjects, non-homozygous for the mutation, the patients (27) had mean SF and Hcy levels significantly higher than the (37) blood donors (SF = 18.1 versus 10.8 nmol/L, P < 0.0001; Hcy = 10.3 versus 7.9 micromol/L P < 0.0006). CONCLUSION: Italian patients aged under 60 years on OAT and non-homozygous for the mutation C677T of MTHFR gene, had SF and Hcy concentrations significantly higher than the control group

The use of a chitosan-derived hemostatic agent for postextraction bleeding control in patients on antiplatelet treatment

The current approach for tooth extraction in patients receiving antiplatelet treatment requires the use of local hemostatic agents without previous thromboembolic treatment interruption. The aim of the present study was to evaluate the effectiveness of an extra-alveolar hemostatic agent, the HemCon Dental Dressing (HDD), in controlling postsurgical bleeding

The effectiveness of a new method using an extra-alveolar hemostatic agent after dental extractions in older patients on oral anticoagulation treatment: an intrapatient study

Objective. The present study aimed to evaluate the effectiveness of a new adhesive agent, HemCon® Dental Dressing (HDD), in patients receiving oral anticoagulant treatment (OAT), undergoing non-surgical tooth extractions, without interruption or reduction of OAT, compared to that of a common local haemostatic agent. Study design. Twenty patients on OAT with an International Normalized Ratio (INR) ranging between 1.6 and 3.5 were recruited. In the same session each patient was subjected to the extraction of two teeth: in the test site the HDD was applied, while in the control site a common haemostatic sponge (CollaPlug, Zimmer Dental®) was used. Results. The mean application time was significantly lower in the test group than in the control group and this difference is statistically significant. The mean post-operative pain was significantly lower in the test group than in the control group the morning after surgery and at the time of suture removal. Post-extraction socket healing was significantly better in the test group than in the control one. Conclusions. Tooth extraction in OAT patients with an INR lower than 3.5 is a safe procedure without OA regimen discontinuation. The HDD seems to reduce post-operative side effects and obtain a rapid and soft tissue healing

Vitamin K Concentration and Cognitive Status in Elderly Patients on Anticoagulant Therapy: A Pilot Study

Objectives. Recent studies have suggested that vitamin K may exert significant effects on the central nervous system. The present study investigates the relationship between vitamin K plasmatic levels and cognitive functions in elderly patients on oral anticoagulant therapy (OAT). Design. At the Thrombosis Centre of Haematology, “Sapienza” University of Rome, 85 patients on OAT, aged between 75 and 92, were randomly enrolled in the study. Patients were on OAT with vitamin K antagonists (VKAs). Vitamin K1 concentrations were determined using standardized High-Performance Liquid Chromatography (HPLC). Cognitive functions were assessed using the Milan Overall Dementia Assessment (MODA). Results. MODA scores are positively correlated to vitamin K1 concentration. Patients with vitamin K1 below 0.100 μg/L and between 0.100 and 0.400 μg/L showed a mean MODA score of 79 ± 5 and 82 ± 3, respectively. Patients with vitamin K1 above 0.400 μg/L had a significantly greater MODA score (89 ± 1). After binning the data into bicentiles, MODA scores are shown to be linearly dependent on vitamin K1 concentrations (). Even long-term OAT (>10 years) does not affect MODA scores. Education seems to exert a greater role on the cognitive status in comparison with aging. Conclusions. The study shows a positive association between vitamin K1 concentration and cognitive status in elderly patients (≥75 years) on OAT. The relationship between vitamin K1 concentration and MODA scores is described by a linear model. Cognitive status is not influenced by the duration of OAT but by the years of education