Molecular Recognition at the Active Site of Factor Xa
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From Vitamin K Antagonism to New Oral Anticoagulants: Basic Concepts
Thrombosis From vitamin K antagonism to new oral anticoagulants: basic concepts S. Schulman ABSTRACT Vitamin K antagonists have been used as oral anticoagulants since 1942, but the dose is difficult to Department of Medicine, McMaster predict beween individuals and is also variable over time in most patients. The research to produce University and Thrombosis and improved, target-specific anticoagulants started with the thrombin inhibitor argatroban in 1981. This Atherosclerosis Research Institute, was followed by several injectable thrombin and factor Xa inhibitors, but the ideal drug had to be oral - Hamilton, Canada and Karolinska ly available. It was necessary to map the catalytic site in order to understand how a highly selective Institutet, Stockholm, Sweden inhibitor can be developed. Structure-activity-relationship studies with a variety of analogs were cru - cial to identify compounds that combined potency, selectivity, membrane permeability and long half- Correspondence: life. These efforts from a dozen pharmaceutical companies have now resulted in one thrombin Sam Schulman inhibitor (dabigatran) and four factor Xa inhibitors (rivaroxaban, apixaban, edoxaban and betrixaban) E-mail: [email protected] that are either already used in clinical practice or in final stages of phase III clinical trials. These drugs are orally available and do not require routine laboratory monitoring due to a predictable therapeutic dose for the majority of patients. Additional advantages of these anticoagulants are rapid onset of Hematology Education: effect, faster decrease in effect after discontinuation than with warfarin, and a lower risk for intracra - the education program for the nial bleeding. They appear to have a higher risk of lower intestinal bleeding and there is to date no annual congress of the European widely available coagulation screening test that allows drug level to be assessed for all new agents Hematology Association and no clinically available reversal agent. -
New Oral Anticoagulants Combined with Antiplatelet Therapy in the Treatment of Coronary Heart Disease: an Updated Meta-Analysis
New oral anticoagulants combined with antiplatelet therapy in the treatment of coronary heart disease: an updated meta-analysis Leiling Liu Second Xiangya Hospital Jiahui Hu Second Xiangya Hospital Yating Wang Second Xiangya Hospital Hao Lei Second Xiangya Hospital Danyan Xu ( [email protected] ) Second Xiangya Hospital https://orcid.org/0000-0003-2113-0800 Research Keywords: stable coronary artery disease, acute coronary syndrome, new oral anticoagulants, antiplatelet therapy, meta-analysis Posted Date: August 26th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-64078/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/15 Abstract Objective New oral anticoagulants (NOACs) combined with antiplatelet therapy for acute coronary syndrome (ACS) may reduce ischemic events, but there is no consensus on bleeding risk. Moreover, the effect of NOACs on stable coronary artery disease (CAD) needs to be elucidated. We conducted a meta-analysis, to summarize the ecacy and safety of NOACs combined with antiplatelet therapy in the treatment of stable CAD and ACS. Methods We searched PubMed, Web of Science, and the Cochrane Library, then performed a systematic review of all 17 randomized controlled trials. Results For patients with stable CAD, rivaroxaban combined with antiplatelet therapy signicantly reduced the rate of major adverse cardiovascular events (MACEs) (risk ratio; 95% condence interval: 0.88; 0.81–0.95) and ischemic stroke (0.62; 0.50–0.77), with a relatively low risk of major bleeding (1.72; 1.42–2.07). For patients with ACS, the combination of NOACs could reduce the risk of MACEs (0.91; 0.85–0.97), myocardial infarction (MI) (0.90; 0.83–0.98) and ischemic stroke (0.75; 0.58–0.97), accompanied by increased non–fatal bleeding events and intracranial hemorrhage (3.42; 1.76– 6.65). -
Risk of Drug-Induced Liver Injury with the New Oral Anticoagulants
Health care delivery, economics and global health ORIGINAL ARTICLE Risk of drug-induced liver injury with the new oral anticoagulants: systematic review and meta-analysis Daniel Caldeira,1,2 Márcio Barra,1,2 Ana Teresa Santos,1,2 Daisy de Abreu,1,2 Fausto J Pinto,3 Joaquim J Ferreira,1,2 João Costa1,2,4,5 ▸ Additional material is ABSTRACT only emerged with postmarketing experience published online only. To view Objective In recent years, safety alerts have been because hepatic adverse drug reactions due to car- please visit the journal online (http://dx.doi.org/10.1136/ made warning of the risk of serious drug-induced liver diovascular drugs are relatively uncommon, but heartjnl-2013-305288). injury (DILI) caused by cardiovascular drugs. The new potentially serious, and premarketing clinical trials 1 oral anticoagulants (NOACs) have now reached the are underpowered to detect differences between Clinical Pharmacology Unit, fi Instituto de Medicina market. However, safety concerns have been raised treatment arms. These recent high pro le cases of Molecular, Lisbon, Portugal about their hepatic safety. Therefore we aimed to serious liver adverse reactions associated with car- 2Laboratory of Clinical evaluate NOAC liver-related safety. diovascular drugs have amplified the need for Pharmacology and Methods Systematic review and meta-analysis of phase careful premarketing analysis of DILI risk asso- Therapeutics, Faculty of Medicine, University of Lisbon, III randomised controlled trials (RCTs). Medline and ciated safety. Lisboa, Portugal CENTRAL were searched to September 2013. Reviews In the last 5 years, new oral anticoagulants (NOACs), 3Cardiology Department, and reference lists were also searched. -
Coagulation Factors Directly Cleave SARS-Cov-2 Spike and Enhance Viral Entry
bioRxiv preprint doi: https://doi.org/10.1101/2021.03.31.437960; this version posted April 1, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Coagulation factors directly cleave SARS-CoV-2 spike and enhance viral entry. Edward R. Kastenhuber1, Javier A. Jaimes2, Jared L. Johnson1, Marisa Mercadante1, Frauke Muecksch3, Yiska Weisblum3, Yaron Bram4, Robert E. Schwartz4,5, Gary R. Whittaker2 and Lewis C. Cantley1,* Affiliations 1. Meyer Cancer Center, Department of Medicine, Weill Cornell Medical College, New York, NY, USA. 2. Department of Microbiology and Immunology, Cornell University, Ithaca, New York, USA. 3. Laboratory of Retrovirology, The Rockefeller University, New York, NY, USA. 4. Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA. 5. Department of Physiology, Biophysics and Systems Biology, Weill Cornell Medicine, New York, NY, USA. *Correspondence: [email protected] bioRxiv preprint doi: https://doi.org/10.1101/2021.03.31.437960; this version posted April 1, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Summary Coagulopathy is recognized as a significant aspect of morbidity in COVID-19 patients. The clotting cascade is propagated by a series of proteases, including factor Xa and thrombin. Other host proteases, including TMPRSS2, are recognized to be important for cleavage activation of SARS-CoV-2 spike to promote viral entry. Using biochemical and cell-based assays, we demonstrate that factor Xa and thrombin can also directly cleave SARS-CoV-2 spike, enhancing viral entry. -
Low Molecular Weight Heparin Versus Other Anti-Thrombotic Agents For
Lu and Lin BMC Musculoskeletal Disorders (2018) 19:322 https://doi.org/10.1186/s12891-018-2215-3 RESEARCH ARTICLE Open Access Low molecular weight heparin versus other anti-thrombotic agents for prevention of venous thromboembolic events after total hip or total knee replacement surgery: a systematic review and meta-analysis Xin Lu and Jin Lin* Abstract Background: Venous thromboembolism (VTE) is an important complication following total hip replacement (THR) and total knee replacement (TKR) surgeries. Aim of this study was to comprehensively compare the clinical outcomes of low-molecular-weight heparin (LMWH) with other anticoagulants in patients who underwent TKR or THR surgery. Methods: Medline, Cochrane, EMBASE, and Google Scholar databases were searched for eligible randomized controlled studies (RCTs) published before June 30, 2017. Meta-analyses of odds ratios were performed along with subgroup and sensitivity analyses. Results: Twenty-one RCTs were included. In comparison with placebo, LMWH treatment was associated with a lower risk of VTE and deep vein thrombosis (DVT) (P values < 0.001) but similar risk of pulmonary embolism (PE) (P =0.227)in THR subjects. Compared to factor Xa inhibitors, LMWH treatment was associated with higher risk of VTE in TKR subjects (P < 0.001), and higher DVT risk (P < 0.001) but similar risk of PE and major bleeding in both THR and TKR. The risk of either VTE, DVT, PE, or major bleeding was similar between LMWH and direct thrombin inhibitors in both THR and TKR, but major bleeding was lower with LMWH in patients who underwent THR (P =0.048). Conclusion: In comparison with factor Xa inhibitors, LMWH may have higher risk of VTE and DVT, whereas compared to direct thrombin inhibitors, LMWH may have lower risk of major bleeding after THR or TKR. -
Horizons in Novel Oral Anticoagulation Therapy In
maco har log P y: r O la u p c e n s a A v Shihadeh et al., Cardiol Pharmacol 2015, 4:4 c o c i e d r s a s Open Access C Cardiovascular Pharmacology: DOI: 10.4172/2329-6607.1000155 ISSN: 2329-6607 Review Article OpenOpen Access Access Horizons in Novel Oral Anticoagulation Therapy in Concomitant Acute Coronary Syndromes and Atrial Fibrillation Leydimar Anmad Shihadeh, Diego Fernández-Rodríguez*, Javier Lorenzo-González and Julio Hernández-Afonso Cardiology Department, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, Spain Abstract Thrombus formation and coronary artery occlusion, in acute coronary syndromes, occur as a result of an atherosclerotic plaque rupture/erosion and the subsequent activation of platelets and coagulation factors. Also, cardioembolic events, in atrial fibrillation, are related to the thrombus formation and the systemic arterial embolization secondary to the blood stasis in left atrium. Antiplatelet treatments in acute coronary syndromes and long-term oral anticoagulation in atrial fibrillation have improved prognosis by reducing ischemic events but both treatments are associated with an increase in the risk of bleeding. Furthermore, thrombin and activated factor X are the key elements in the coagulation cascade and novel oral anticoagulants act by inhibiting these coagulation factors, generating a double effect: the reduction of ischemic events and the increment in hemorrhagic events. To date, the clinical benefit of novel oral anticoagulants, in patients presenting acute coronary syndromes and atrial fibrillation, has not well studied. For that reason, the objective of this manuscript is to explain basic clinical trials testing novel oral anticoagulants in patients with acute coronary syndromes and ongoing trials evaluating the use of new oral anticoagulants in population with acute coronary syndromes and atrial fibrillation: the PIONEER AF-PCI (Rivaroxaban), the RT-AF (Rivaroxaban) and the REDUAL-PCI (Dabigatran) trials. -
Heparin EDTA Patent Application Publication Feb
US 20110027771 A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2011/0027771 A1 Deng (43) Pub. Date: Feb. 3, 2011 (54) METHODS AND COMPOSITIONS FORCELL Publication Classification STABILIZATION (51) Int. Cl. (75)75) InventorInventor: tDavid Deng,eng, Mountain rView, V1ew,ar. CA C09KCI2N 5/073IS/00 (2006.01)(2010.01) C7H 2L/04 (2006.01) Correspondence Address: CI2O 1/02 (2006.01) WILSON, SONSINI, GOODRICH & ROSATI GOIN 33/48 (2006.01) 650 PAGE MILL ROAD CI2O I/68 (2006.01) PALO ALTO, CA 94304-1050 (US) CI2M I/24 (2006.01) rsr rr (52) U.S. Cl. ............ 435/2; 435/374; 252/397:536/23.1; (73) Assignee: Arts Health, Inc., San Carlos, 435/29: 436/63; 436/94; 435/6: 435/307.1 (21) Appl. No.: 12/847,876 (57) ABSTRACT Fragile cells have value for use in diagnosing many types of (22) Filed: Jul. 30, 2010 conditions. There is a need for compositions that stabilize fragile cells. The stabilization compositions of the provided Related U.S. Application Data inventionallow for the stabilization, enrichment, and analysis (60) Provisional application No. 61/230,638, filed on Jul. of fragile cells, including fetal cells, circulating tumor cells, 31, 2009. and stem cells. 14 w Heparin EDTA Patent Application Publication Feb. 3, 2011 Sheet 1 of 17 US 2011/0027771 A1 FIG. 1 Heparin EDTA Patent Application Publication Feb. 3, 2011 Sheet 2 of 17 US 2011/0027771 A1 FIG. 2 Cell Equivalent/10 ml blood P=0.282 (n=11) 1 hour 6 hours No Composition C Composition C Patent Application Publication Feb. -
Study Protocol
Protocol 3-001 Confidential 28APRIL2017 Version 4.1 Asahi Kasei Pharma America Corporation Synopsis Title of Study: A Randomized, Double-Blind, Placebo-Controlled, Phase 3 Study to Assess the Safety and Efficacy of ART-123 in Subjects with Severe Sepsis and Coagulopathy Name of Sponsor/Company: Asahi Kasei Pharma America Corporation Name of Investigational Product: ART-123 Name of Active Ingredient: thrombomodulin alpha Objectives Primary: x To evaluate whether ART-123, when administered to subjects with bacterial infection complicated by at least one organ dysfunction and coagulopathy, can reduce mortality. x To evaluate the safety of ART-123 in this population. Secondary: x Assessment of the efficacy of ART-123 in resolution of organ dysfunction in this population. x Assessment of anti-drug antibody development in subjects with coagulopathy due to bacterial infection treated with ART-123. Study Center(s): Phase of Development: Global study, up to 350 study centers Phase 3 Study Period: Estimated time of first subject enrollment: 3Q 2012 Estimated time of last subject enrollment: 3Q 2018 Number of Subjects (planned): Approximately 800 randomized subjects. Page 2 of 116 Protocol 3-001 Confidential 28APRIL2017 Version 4.1 Asahi Kasei Pharma America Corporation Diagnosis and Main Criteria for Inclusion of Study Subjects: This study targets critically ill subjects with severe sepsis requiring the level of care that is normally associated with treatment in an intensive care unit (ICU) setting. The inclusion criteria for organ dysfunction and coagulopathy must be met within a 24 hour period. 1. Subjects must be receiving treatment in an ICU or in an acute care setting (e.g., Emergency Room, Recovery Room). -
New Oral Anticoagulants in Atrial Fibrillation and Acute Coronary
Journal of the American College of Cardiology Vol. 59, No. 16, 2012 © 2012 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2012.02.008 STATE-OF-THE-ART PAPER New Oral Anticoagulants in Atrial Fibrillation and Acute Coronary Syndromes ESC Working Group on Thrombosis—Task Force on Anticoagulants in Heart Disease Position Paper Coordinating Committee: Raffaele De Caterina, MD, PHD,* Steen Husted, MD, DSC,† Lars Wallentin, MD, PHD,‡ Task Force Members: Raffaele De Caterina, MD, PHD,* Steen Husted, MD, DSC,† Lars Wallentin, MD, PHD,‡ Felicita Andreotti, MD, PHD,§ Harald Arnesen, MD,ʈ Fedor Bachmann, MD,¶ Colin Baigent, MD,# Kurt Huber, MD,** Jørgen Jespersen, MD, DSC,†† Steen Dalby Kristensen, MD,† Gregory Y. H. Lip, MD,‡‡ João Morais, MD,§§ Lars Hvilsted Rasmussen, MD, PHD,ʈʈ Agneta Siegbahn, MD, PHD,‡ Freek W. A. Verheugt, MD,¶¶ Jeffrey I. Weitz, MD## Chieti, Pisa, and Rome, Italy; Aarhus, Esbjerg, and Aalborg, Denmark; Uppsala, Sweden; Oslo, Norway; Lausanne, Switzerland; Oxford and Birmingham, United Kingdom; Amsterdam, the Netherlands; Hamilton, Ontario, Canada; Vienna, Austria; and Leiria, Portugal Until recently, vitamin K antagonists were the only available oral anticoagulants, but with numerous limitations that prompted the introduction of new oral anticoagulants targeting the single coagulation enzymes thrombin (dabigatran) or factor Xa (apixaban, rivaroxaban, and edoxaban) and given in fixed doses without coagulation monitoring. Here we review the pharmacology and the results of clinical trials with these new agents in stroke prevention in atrial fibrillation and secondary prevention after acute coronary syndromes, providing perspectives on their future incorporation into clinical practice. -
Efficacy and Toxicity of Factor Xa Inhibitors
Efficacy and Toxicity of Factor Xa Inhibitors Maryna Bondarenko, Christophe Curti, Marc Montana, Pascal Rathelot, Patrice Vanelle To cite this version: Maryna Bondarenko, Christophe Curti, Marc Montana, Pascal Rathelot, Patrice Vanelle. Efficacy and Toxicity of Factor Xa Inhibitors. Journal of Pharmacy and Pharmaceutical Sciences, Canadian Society for Pharmaceutical Sciences, 2013, 16, pp.74 - 88. 10.18433/J33P49. hal-01423391 HAL Id: hal-01423391 https://hal.archives-ouvertes.fr/hal-01423391 Submitted on 29 Dec 2016 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. J Pharm Pharmaceut Sci (www.cspsCanada.org) 16(1) 74 - 88, 2013 Efficacy and Toxicity of Factor Xa Inhibitors Maryna Bondarenko1, Christophe Curti2,3, Marc Montana3,4, Pascal Rathelot2,3, Patrice Vanelle2,3 1Assistance Publique - Hôpitaux de Marseille (AP-HM), Service de la pharmacie à usage intérieur de l’hôpital Nord, Marseille, France, 2Aix-Marseille Université, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Marseille, France, 3Assistance Publique - Hôpitaux de Marseille (AP-HM), Service Central de la Qualité et de l’Information Pharmaceutiques, Marseille, France, 4Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncopharma, Marseille, France. Received, December 18, 2012; Revised, February 4, 2013; Accepted, February 13, 2013; Published, February 15, 2013. -
CHAPTER 1 General Introduction
CHAPTER 1 General Introduction Chapter 1 1.1 General Introduction Drugs are defined as chemical substances that are used to prevent or cure diseases in humans and animals. Drugs can also act as poisons if taken in excess. For example paracetamol overdose causes coma and death. Apart from the curative effect of drugs, most of them have several unwanted biological effects known as side effects. Aspirin which is commonly used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever and as an anti-inflammatory medication, may also cause gastric irritation and bleeding. Also many drugs, such as antibiotics, when over used develop resistance to the patients, microorganisms and virus which are intended to control by drug. Resistance occurs when a drug is no longer effective in controlling a medical condition.1 Thus, new drugs are constantly required to surmount drug resistance, for the improvement in the treatment of existing diseases, the treatment of newly identified disease, minimise the adverse side effects of existing drugs etc. Drugs are classified in number of different ways depending upon their mode of action such as antithrombotic drugs, analgesic, antianxiety, diuretics, antidepressant and antibiotics etc.2 Antithrombotic drugs are one of the most important classes of drugs which can be shortly defined as ―drugs that reduce the formation of blood clots‖. The blood coagulation, also known as haemostasis is a physiological process in which body prevents blood loss by forming stable clot at the site of injury. Clot formation is a coordinated interplay of two fundamental processes, aggregation of platelets and formation of fibrin. -
Spontaneous Spinal Epidural Hematoma Associated with Apixaban Therapy: a Report of Two Cases
Open Access Case Report DOI: 10.7759/cureus.11446 Spontaneous Spinal Epidural Hematoma Associated With Apixaban Therapy: A Report of two Cases Frank M. Mezzacappa 1 , Daniel Surdell 1 , William Thorell 1 1. Neurological Surgery, University of Nebraska Medical Center, Omaha, USA Corresponding author: Frank M. Mezzacappa, [email protected] Abstract Spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity that can result in severe neurological deficit and warrants emergent neurosurgical evaluation and management. The exact etiology of this entity remains unknown, but certain risk factors exist, including the use of anticoagulant medications. There are few published reports of the association of SSEH with direct factor Xa inhibitors. We aimed to present 2 cases of SSEH in patients on chronic apixaban therapy. To the best of our knowledge, there is only 1 other report of SSEH in the setting of apixaban therapy. A comparison between the cases suggests the importance of rapid recognition and management of SSEH in order to achieve favorable neurological outcomes. Categories: Emergency Medicine, Neurosurgery, Orthopedics Keywords: spontaneous spinal epidural hematoma, apixaban, case report, eliquis Introduction Spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity that can result in severe neurological deficit [1,2]. An exact etiology for this phenomenon remains unknown to this point, but may be the result of rupture of the epidural venous plexus [3]. Early identification is important in order to improve the chance of a favorable neurological outcome. Knowledge of risk factors, such as anticoagulation use, can assist with prompt recognition of the condition [1]. The novel oral anticoagulant medications are increasing in use due their ease of use and efficacy, but there are few reports of SSEH associated with these medications to this point.