(Press-News.org) A recently-published study found that while internal bleeding may be uncommon as a result of taking blood thinners such as Xarelto® (rivaroxaban) and Eliquis® (apixaban), the normal coagulation tests physicians use to check for the side effect of bleeding may not be reliable.
The study, published online in Annals of Emergency Medicine, found that in cases reported to Poison Centers, the routine labs used to monitor for clotting factors, such as prothrombin time (PT), PTT or INR commonly ordered to help diagnose internal bleeding may be elevated in a minority of cases, but appear unreliable to measure the risk of internal bleeding in patients.
"Blood thinners are helpful drugs and we do not want people to stop taking them," said Henry Spiller, D.ABAT, a co-author of the study, toxicologist, and director of the Central Ohio Poison Center at Nationwide Children's Hospital. "We may need to get better about how we monitor patients on these drugs."
This retrospective study collected data from more than 800 hospitals and eight regional poison centers covering nine states. Of the 223 patients involved in the study, bleeding was reported in only 15 (7 percent), and coagulation tests were normal in most patients with bleeding (PT 83 percent, PTT 83 percent and INR 44 percent).
The PT was shown to be elevated in volunteer studies with rivaroxaban and also elevated in massive overdose. However results of the PT after use of blood thinners varied with different components. The effects of medications on the PTT are short lived and varies based on the reagents used. In patients with bleeding, PT and PTT were elevated in 1 of 4 with rivaroxaban and none with apixaban. In the single case with measured serum rivaroxaban concentration, the PT was recorded as 126.3 seconds. Without specific clarification of methodology and reagent use, the PT and PTT may not reliably predict risk of bleeding after rivaroxaban or apixaban ingestion.
The measurement of INR with rivaroxaban has been questioned because the INR does not correct for the variations in the PT based on which reagent was used. The INR was elevated in only 21 percent of patients tested with rivaroxaban and in no patients with apixaban. In patients with bleeding, the INR was elevated in 5 of 8 with rivaroxaban but in none with apixaban. Without specific clarification of methodology and reagent use, the INR may also be an unreliable test after rivaroxaban or apixaban ingestion. The use of activated clotting time also appears to be insensitive after Xa inhibitor use.
"One way to overcome the variation in these tests is to use anti-factor Xa chromogenic assays to measure Xa plasma concentrations; however these are not widely available," said Spiller. "And a potential drawback with measuring anti-factor Xa concentrations and plasma rivaroxaban and apixaban concentrations is that the turnaround time for results may be too long to guide a treatment plan."
INFORMATION:
The Central Ohio Poison Center provides state-of-the-art poison prevention, assessment and treatment to residents in 64 of Ohio's 88 counties. The center services are available to the public, medical professionals, industry, and human service agencies. The Poison Center handles more than 42,000 poison exposure calls annually, and confidential, free emergency poisoning treatment advice is available 24/7. To learn more about the Poison Center, visit http://www.bepoisonsmart.org.
Astronauts aboard the International Space Station captured an image of Hurricane Danny moving through the Central Atlantic Ocean. Satellite data indicates that Danny is a small Category 2 hurricane, in which hurricane-force winds only extend 15 miles from the eye.
A NASA GOES Project animation of visible and infrared imagery of Hurricane Danny was created at NASA's Goddard Space Flight Center in Greenbelt, Maryland to show the development and movement of the storm. The animation shows the eastern and central Atlantic Ocean from Aug. 18 to 21, 2015.
Forecaster Cangialosi ...
"Flocking" or "swarming" behavior is omnipresent in the living world, observed in birds, fish, and even bacteria. Strikingly similar collective action can also be seen in biomolecules within and between cells. Such self-organization processes are the basis of life - without them no living cell would exist - yet they are not well understood. New insights into how this action is coordinated at the biomolecular level are emerging from studies of a model system based on actin filaments. Experimental evidence proves the inadequacy of widely accepted explanations, according to ...
AMHERST, Mass. - Inspired by natural "snapping" systems like Venus flytrap leaves and hummingbird beaks, a team led by physicist Christian Santangelo at the University of Massachusetts Amherst has developed a way to use curved creases to give thin curved shells a fast, programmable snapping motion. The new technique avoids the need for complicated materials and fabrication methods when creating structures with fast dynamics.
The advance should help materials scientists and engineers who wish to design structures that can rapidly switch shape and properties, says Santangelo. ...
ANN ARBOR--People who have not found their perfect fit in a career can take heart: There is more than one way to attain passion for work.
Contrary to popular wisdom, a love-at first-sight experience is not necessary when evaluating a potential job, according to a new University of Michigan study.
"The good news is that we can choose to change our beliefs or strategies to cultivate passion gradually or seek compatibility from the outset, and be just as effective in the long run at achieving this coveted experience," said Patricia Chen, a doctoral psychology student and ...
Researchers from North Carolina State University and the University of North Carolina at Chapel Hill have discovered how two important proofreader proteins know where to look for errors during DNA replication and how they work together to signal the body's repair mechanism.
When a cell prepares to divide, the DNA splits first, the double helix "unzipping" into two separate backbones. New nucleotides - adenine, cytosine, guanine or thymine - are filled into the gaps on the other side of the backbone, pairing with their counterparts (adenine with thymine and cytosine with ...
In human cells, shortened telomeres, the protective caps at the ends of chromosomes, are both a sign of aging and contribute to it. Scientists at Emory University School of Medicine have found that the dietary supplement alpha lipoic acid (ALA) can stimulate telomerase, the enzyme that lengthens telomeres, with positive effects in a mouse model of atherosclerosis.
The discovery highlights a potential avenue for the treatment for chronic diseases.
The results were published Thursday, August 20 in Cell Reports.
"Alpha-lipoic acid has an essential role in mitochondria, ...
(Boston)--Poor sleep may impact treatment and recovery in veterans with Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI). A review of extensive research on sleep in TBI and PTSD has found that sleep-focused interventions can improve treatment outcomes in veterans.
Led by researchers at Boston University School of Medicine (BUSM) and VA Boston Healthcare System, the review article currently appears online in the journal of Clinical Psychology Review.
Sleep difficulty is a primary symptom of both PTSD and TBI and has been found to affect the severity ...
People who fear relationship conflicts are just as happy when they are single or in a relationship, according to new research published by the Society for Personality and Social Psychology.
"It's a well-documented finding that single people tend to be less happy compared to those in a relationship, but that may not be true for everyone. Single people also can have satisfying lives," said lead researcher Yuthika Girme, a psychology doctoral candidate at the University of Auckland in New Zealand.
In a survey of more than 4,000 New Zealand residents, a nationally ...
Water pollution has been a historical and stubborn problem in the water resource management. Several water pollution accidents continually occurred all over the world, threatening the safety of industry, agriculture and drinking water for resident's life (see Figure 1). An innovative and efficient approach was identified to study the complicated mechanism of water pollution in alluvial rivers.
The article titled "Numerical Simulation of Pollution Process Due to Resuspension of Bed Materials Adsorbing Pollutants in Alluvial Rivers" was recently published in Science China ...
Researchers at the University of Strathclyde are developing groundbreaking plasma based light amplifiers that could replace traditional high power laser amplifiers.
The research group at the Glasgow-based University are leading efforts to take advantage of plasma, the ubiquitous medium that makes up most of the universe, to make the significant scientific breakthrough.
The next generation of high power lasers should be able to crack the vacuum to produce real particles from the sea of virtual particles. Example of these types of lasers can be found at the Extreme Light ...
