warfarin and Acute-Phase-Reaction

Japanese Guidelines for the Management of Stroke 2015 was published. Here, we describe several points revised from the 2009 edition about "Cerebral infarction and transient ischemic attack (TIA)". The revision points are as follows; 1. Extension of possible time window of intravenous recombinant tissue-plasminogen activator treatment (from within 3 hours to within 4.5 hours); 2. Antiplatelet therapy in acute stage (dual antiplatelet therapy (DAPT) for non-cardioembolic ischemic stroke or TIA); 3. Endovascular recanalization therapy in acute stage; 4. Antiplatelet therapy in chronic stage (Cilostazol is recommended similar to aspirin or clopidogrel); 5. Non-vitamin K antagonist oral anticoagulants (NOACs) for non-valvular atrial fibrillation (NVAF) stroke or TIA patients; 6. Management of TIA. We explain the revised points of the guideline in the text.

Topics: Acute-Phase Reaction; Anticoagulants; Cerebral Infarction; Dabigatran; Endovascular Procedures; Factor Xa Inhibitors; Humans; Ischemic Attack, Transient; Japan; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Recombinant Proteins; Recurrence; Rivaroxaban; Tissue Plasminogen Activator; Warfarin

Antithrombotic therapy for the acute stage of cerebral infarction consists of thrombolysis, anticoagulant therapy and antiplatelet therapy, and their indications depend on the clinicopathological type of lesion, time after onset, and severity of illness. Tissue plasminogen activator has been approved in the United States for use in cerebral infarction within 3 hours after onset. The usefulness of heparin as anticoagulant therapy at the acute stage of cerebral infarction was not proved by the International Stroke Trial due to hemorrhagic complication. A selective thrombin inhibitor (argatroban) is used in Japan for atherothrombotic cerebral infarction within 48 hours after onset. A selective thromboxane A2 synthetase inhibitor (sodium ozagrel) had been approved for cerebral thrombosis within 5 days after onset. Aspirin (160-300 mg/day) is effective, but slightly, in the acute stage of cerebral infarction by the International Stroke Trial and Chinese Acute Stroke Trial. To prevent recurrence of stroke in the chronic stage of cerebral infarction, antiplatelet therapy (with aspirin or ticlopidine) is used for atherothrombotic cerebral infarction, and anticoagulant therapy with warfarin for cardioembolic cerebral infarction.

Topics: Acute-Phase Reaction; Anticoagulants; Aspirin; Atrial Fibrillation; Cerebral Infarction; Heparin; Humans; Platelet Aggregation Inhibitors; Secondary Prevention; Thrombolytic Therapy; Time Factors; Tissue Plasminogen Activator; Warfarin

Arterial media calcification refers to the pathological deposition of calcium phosphate crystals in the arterial wall. This pathology is a common and life-threatening complication in chronic kidney disease, diabetes and osteoporosis patients. Recently, we reported that the use of a TNAP inhibitor, SBI-425, attenuated arterial media calcification in a warfarin rat model. Employing a high-dimensionality unbiased proteomic approach, we also investigated the molecular signaling events associated with blocking arterial calcification through SBI-425 dosing. The remedial actions of SBI-425 were strongly associated with (i) a significant downregulation of inflammatory (acute phase response signaling) and steroid/glucose nuclear receptor signaling (LXR/RXR signaling) pathways and (ii) an upregulation of mitochondrial metabolic pathways (TCA cycle II and Fatty Acid β-oxidation I). Interestingly, we previously demonstrated that uremic toxin-induced arterial calcification contributes to the activation of the acute phase response signaling pathway. Therefore, both studies suggest a strong link between acute phase response signaling and arterial calcification across different conditions. The identification of therapeutic targets in these molecular signaling pathways may pave the way to novel therapies against the development of arterial media calcification.

Topics: Acute-Phase Reaction; Alkaline Phosphatase; Animals; Calcinosis; Proteomics; Rats; Vascular Calcification; Warfarin

To determine whether antithrombotic therapy with warfarin is effective and safe in patients who developed venous thromboembolism in the acute stage of polytrauma, which is associated with bleeding risk.. A retrospective study of 11 patients (8 males, 3 females; mean age, 39.8 years; injury severity score, 30.1; no fatalities) with deep venous thromboembolism and/or pulmonary embolism who were medicated with heparin and warfarin during their iCU stay.. Thrombosis was diagnosed at an average of 11.8 days after admission. Thrombus formation was confirmed in pulmonary arteries in 5 cases and in deep veins in 9 cases. Diagnosis was based on Doppler ultrasound findings in 6 cases and on computed tomography findings in 5 cases. anticoagulant therapy was used in 10 cases, but not in 1 case with cerebral contusion. approximately 33 days after starting anticoagulant therapy, thrombi had disappeared or were reduced in size in 9 of 10 patients with no complications observed.. Heparin and warfarin therapy cleared deep vein and pulmonary artery thrombosis after polytrauma without any bleeding complications. Further studies are necessary to determine the safe anticoagulant dosage and duration for rapid thrombus removal.

Topics: Acute-Phase Reaction; Adult; Anticoagulants; Female; Heparin; Humans; Male; Middle Aged; Multiple Trauma; Pulmonary Embolism; Retrospective Studies; Treatment Outcome; Venous Thromboembolism; Warfarin; Young Adult