Safety and interaction of direct oral anticoagulants with antiarrhythmic drugs

The use of direct oral anticoagulants minimized the risks associated with vitamin K antagonist (warfarin) therapy. Currently, direct oral anticoagulants have priority over warfarin for the prevention of thromboembolic events in patients with atrial fibrillation and a number of other conditions requiring anticoagulant therapy. Direct oral anticoagulants along with antiarrhythmic therapy are the accepted strategy for atrial fibrillation treatment. At the same time, the effect of drug-drug interactions (DDI) between direct oral anticoagulants and antiarrhythmic drugs, which have common points of metabolic application, has not been fully elucidated. In order to provide effective and safe anticoagulant and antiarrhythmic therapy in patients with AF, it is important to understand the mechanisms and severity of DDI of direct oral anticoagulants and antiarrhythmic agents. This review discusses the issues of DDI of direct oral anticoagulants and antiarrhythmic drugs used to treat atrial fibrillation

Thrombocytopenia Induced by Direct Oral Anticoagulants: a Clinical Case and Literature Review

The last decade has dramatically changed the strategy of anticoagulant therapy in patients with atrial fibrillation. Direct oral anticoagulants have replaced vitamin K antagonists: either direct thrombin blockers (dabigatran) or factor IIa blockers (apixaban, rivaroxaban, edoxaban). According to the regulatory domestic and foreign documents, the use of direct oral anticoagulants in patients with atrial fibrillation has priority in comparison with vitamin K antagonists, since they have a predictable anticoagulant effect, the possibility of taking fixed doses without the need for routine anticoagulant monitoring, rapid onset and termination of action, relatively low potential for food and drug interactions. Direct oral anticoagulants are used for the prevention of thromboembolic complications in patients with atrial fibrillation, for the prevention of deep vein thrombosis in patients who have undergone surgery on the knee or hip joints, for emergency treatment and secondary prevention of deep vein thrombosis and pulmonary embolism. Alertness to side effects tends to focus on the likelihood of bleeding, with the possibility of other side effects of direct oral anticoagulants receiving less attention or going unnoticed. These mainly include liver damage, kidney damage and a number of other rare adverse reactions. The finding of isolated thrombocytopenia in patients taking direct oral anticoagulants may be associated with a high risk of life-threatening bleeding. The article analyzes published data on the occurrence of thrombocytopenia associated with the intake of direct oral anticoagulants, and presents a clinical case of thrombocytopenia while taking apixaban

Wigner function quantum molecular dynamics

Classical molecular dynamics (MD) is a well established and powerful tool in various fields of science, e.g. chemistry, plasma physics, cluster physics and condensed matter physics. Objects of investigation are few-body systems and many-body systems as well. The broadness and level of sophistication of this technique is documented in many monographs and reviews, see for example \cite{Allan,Frenkel,mdhere}. Here we discuss the extension of MD to quantum systems (QMD). There have been many attempts in this direction which differ from one another, depending on the type of system under consideration. One direction of QMD has been developed for condensed matter systems and will not discussed here, e.g. \cite{fermid}. In this chapter we are dealing with unbound electrons as they occur in gases, fluids or plasmas. Here, one strategy is to replace classical point particles by wave packets, e.g. \cite{fermid,KTR94,zwicknagel06} which is quite successful. At the same time, this method struggles with problems related to the dispersion of such a packet and difficulties to properly describe strong electron-ion interaction and bound state formation. We, therefore, avoid such restrictions and consider a completely general alternative approach. We start discussion of quantum dynamics from a general consideration of quantum distribution functions.Comment: 18 pages, based on lecture at Hareaus school on computational phyics, Greifswald, September 200

TACTICS OF PRENATAL CARE OF A YOUNG PATIENT WITH INHERITED LONG QT SYNDROME AND IMPLANTED CARDIOVERTER-DEFIBRILLATOR

Ase report. This clinical case illustrates the example of prenatal care of a young woman with verified long QT syndrome (LQTS) type 2 with implanted cardioverter-defibrillator (ICD). In the course of pregnancy she had physiological sinus tachycardia, though the life-threatening ventricular arrhythmias and ICD shocks were not registered. On the 38th week of pregnancy the woman underwent the planned caesarean delivery (due to obstetrics indications) with live child. In the post-partum period she continued to experience recurrent VF episodes terminated after the adequate ICD shocks. Life-threatening arrhythmias were triggered by group PVC registered in the settings of persistent bradycardia. At the moment the number of the adequate ICD shocks reduced supported by betablocker therapy, the patient remains on continued standard monitoring. Discussion. Numerous cases of favourable course and even benefits in clinical and functional status during pregnancy in patients with LQTS are reported. This fact can be conditioned by the positive influence of physiological hemodynamical changes and hypersympathicotonia during pregnancy especially on the bradydependent arrhytmias. Conclusion. Pregnancy in patients with inherited LQTS and implanted ICDs is not always contraindicated and treatment tactics depends on certain clinical situation. Algorithms of pharmacological and shock therapy during pregnancy in women with ICD are corrected individually

Simulation of wavepacket tunneling of interacting identical particles

We demonstrate a new method of simulation of nonstationary quantum processes, considering the tunneling of two {\it interacting identical particles}, represented by wave packets. The used method of quantum molecular dynamics (WMD) is based on the Wigner representation of quantum mechanics. In the context of this method ensembles of classical trajectories are used to solve quantum Wigner-Liouville equation. These classical trajectories obey Hamilton-like equations, where the effective potential consists of the usual classical term and the quantum term, which depends on the Wigner function and its derivatives. The quantum term is calculated using local distribution of trajectories in phase space, therefore classical trajectories are not independent, contrary to classical molecular dynamics. The developed WMD method takes into account the influence of exchange and interaction between particles. The role of direct and exchange interactions in tunneling is analyzed. The tunneling times for interacting particles are calculated.Comment: 11 pages, 3 figure

Особенности клинического течения заболеваний органов дыхания у лиц, участвующих в ликвидации аварии Чернобыльской АЭС

The aerosol radiation damage of airways was registered among Chernobyl catastrophe liquidators. There are few scientific data of aerosol radiation damage of airways. 9 liquidators — males at the age of 33—43 — were examined in our institute. They worked in highly dusted atmosphere that caused the inhalation of radioactive dust. The chronic obstructive bronchitis was diagnosed in 4 cases and chronic bronchitis with purulent sputum- in 4 cases and bronchial asthma — in 1 case. All patients were healthy before 1986. The first symptoms of the disease were found in 3 cases when the patients worked on atomic station in 1986 and in 6 cases — 3—6 years later. The specific feature of the disease was torpide inflammatory process with progressive respiratory failure. The pulmonary function testing demonstrated the obstructive abnormalities and the reduction of diffusing lung capacity. The examination of BAL discovered- the macrophages with polygonal optically dense particles in their cytoplasm. X-ray spectral analysis showed the existence of Np, FR, Pm, Pa, Pu in these particles. Thus, we suppose that inhaled radionuclides may play a significant role in the genesis of respiratory abnormalities for this patients category.Авария на Чернобыльской АЭС явилась одной из самых крупных экологических катастроф в мире за последние десятилетия с поражением обширных территорий страны и населения, проживающего на них. Наряду с воздействием проникающей радиации возникло аэрозольное радионуклидное поражение органов дыхания у лиц, находящихся в зоне загрязнения окружающей среды и, особенно, у ликвидаторов аварии. В доступной литературе данные о клинике, диагностике и лечении патологии бронхолегочной системы при таком виде поражения практически отсутствуют. В НИИ Пульмонологии М3 РФ обследовано 9 мужчин в возрасте от 33 до 43 лет, участвующих в ликвидации последствий катастрофы на ЧАЭС в 1986 году. Выполняемые работы были связаны с высокой запыленностью воздуха, что обусловило преимущественно ингаляционный путь проникновения радионуклидов в организм. Средняя паспортизированная доза облучения составила 22 Р. У 4 больных выявлен хронический обструктивный бронхит, у 4 — хронический гнойно-обструктивный бронхит, у 1 — бронхиальная астма. Все пациенты до 1986 года были практически здоровы. Первые симптомы заболевания у 3 больных возникли во время работы на ЧАЭС, у 6 — в сроки от 3 до 6 лет спустя. Особенностью заболевания у всех больных являлся вялотекущий воспалительный процесс с нарастающими признаками дыхательной недостаточности. При обследовании выявлен обструктивный тип нарушения и снижения диффузионной способности легких. При исследовании клеточного состава БАЛ в цитоплазме большинства альвеолярных макрофагов зарегистрированы оптически плотные полигональные включения. При рентгеноспектральном анализе в составе этих включений у 5 больных обнаружены прометий, франций, протактиний, нептуний, плутоний. Таким образом, предполагается роль ингаляционных радионуклидов в генезе выявленной патологии органов дыхания