Drug and Alcohol Rehabilitation: The Laboratory and the New Oral Anticoagulants.

The Laboratory and the New Oral Anticoagulants.

Filed under: Drug and Alcohol Rehabilitation

Clin Chem. 2012 Oct 5;
Tripodi A

BACKGROUND:The new oral anticoagulants (NOAs) dabigatran, rivaroxaban, and apixaban have proved effective and safe when used in clinical trials, without a need to adjust the dose in response to laboratory testing. This demonstrated efficacy does not necessarily mean that the laboratory, considered the mainstay for the management of the old anticoagulants, will no longer play a role in treatment with NOAs.CONTENT:Laboratories are involved in the management of anticoagulants in 2 ways. The first, monitoring, implies laboratory testing to assess the drug’s effect and to adjust the dosage to maintain anticoagulation within the therapeutic interval. This consideration applies to the old drugs. The second way, measurement, implies laboratory evaluations of drug effect to determine whether patients are under- or over-anticoagulated, information that can be useful for decision-making in special circumstances. The latter applies to NOAs.SUMMARY:Measurements of the effect of NOAs are indicated in several situations: (a) patients with adverse events (i.e., thrombotic/hemorrhagic), particularly those who present with overdosage owing to excessive drug intake or decreased clearance; (b) patients undergoing surgical procedures for ensuring that no residual drug remains in the circulation; (c) patients requiring anticoagulation reversal because of life-threatening hemorrhage; (d) patients with renal insufficiency, who are likely to accumulate the drug in the circulation; (e) patients with liver failure, because NOAs are metabolized by the liver; (f) patients taking other drugs that might increase/decrease the effects of NOAs via drug-drug interactions. The choice of tests is based on such characteristics as availability, linearity of the dose- response curve, standardization, and responsiveness to increasing the drug dosage. Practitioners need to be aware that NOAs can interfere with the measurement of common hemostasis parameters.
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Efavirenz, tenofovir and emtricitabine combined with first line tuberculosis treatment in TB-HIV-coinfected Tanzania patients: a pharmacokinetic and safety study.

Filed under: Drug and Alcohol Rehabilitation

Antivir Ther. 2012 Oct 5;
Semvua HH, Mtabho CM, Fillekes Q, van den Boogaard J, Kisonga RM, Mleoh L, Ndaro A, Kisanga ER, van der Ven A, Aarnoutse RE, Kibiki GS, Boeree MJ, Burger DM

OBJECTIVES: To evaluate the effect of rifampicin based tuberculosis (TB) treatment on the pharmacokinetics of efavirenz/tenofovir/emtricitabine in a fixed-dose combination tablet, and vice versa, in Tanzanian TB/HIV co-infected patients. DESIGN: Phase II, open label, multiple doses, pharmacokinetic and safety study. METHODS: This study was conducted in TB/HIV co-infected Tanzanian patients who started TB treatment (rifampicin/isoniazid/pyrazinamide/ethambutol) at week 1 to week 8 and continued with rifampicin and isoniazid for another 16 weeks. Antiretroviral treatment (ART) of efavirenz/tenofovir/emtricitabine in a fixed dose combination tablet was started at week 4 after initiation of TB treatment. A 24-hour pharmacokinetic sampling curve was recorded at week 8 (with TB treatment) and week 28 (ART alone). For TB drugs, blood samples at two and six hours post-dose were taken at week 3 (TB treatment alone) and week 8 (with ART). RESULTS: Twenty-five patients (56% male) completed the study, twenty-one had evaluable pharmacokinetic profiles. The area under the curve AUC(0-24h) of efavirenz, tenofovir and emtricitabine were slightly higher when these drugs were co-administered with TB drugs: geometric mean ratios (90%CI) were 1.08 (0.90-1.30), 1.13 (0.93-1.38) and 1.05 (0.85-1.29) respectively. For TB drugs, equivalence was suggested for peak plasma concentrations when administered with and without efavirenz/tenofovir/emtricitabine. Adverse events were mostly mild and no SAEs or drug discontinuations were reported. CONCLUSION: Co-administration of efavirenz, tenofovir and emtricitabine with a standard first line TB treatment regimen did not significantly alter the pharmacokinetic parameters of these drugs and was tolerated well by Tanzanian TB patients who are co-infected with HIV.
HubMed – drug


Late stent thrombosis of a second-generation drug- eluting stent.

Filed under: Drug and Alcohol Rehabilitation

J Invasive Cardiol. 2012 Oct; 24(10): E225-7
Karjalainen PP, Nammas W, Ylitalo A

A 62-year-old male patient presented with acute non-ST elevation myocardial infarction. He underwent successful percutaneous coronary intervention with implantation of an everolimus-eluting stent in the left anterior descending coronary artery. Six months later, he discontinued clopidogrel. Two weeks later, he presented with unstable angina. Despite the unremarkable electrocardiography, cardiac biomarkers, and coronary angiography, optical coherence tomography revealed a thrombus extending throughout the stent, with uncovered and malapposed stent struts in its proximal part. Thrombectomy was performed. The patient was discharged on dual antiplatelet therapy. Eight months later, the follow-up coronary angiography reassured a patent stent with adequate flow and no evidence of thrombi.
HubMed – drug



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