Barriers to patient self-testing of prothrombin time: national survey of anticoagulation practitioners.

Oral anticoagulation with warfarin requires routine monitoring of prothrombin time, expressed as the international normalized ratio (INR). Patient self-testing for INR is common in Europe but not in the United States. In order to determine the frequency of INR self-testing among patients whose anticoagulant therapy is managed in U.

Guidelines for implementation of patient self-testing and patient self-management of oral anticoagulation. International consensus guidelines prepared by International Self-Monitoring Association for Oral Anticoagulation.

Aims: This document provides health care professionals involved in initiating and monitoring oral anticoagulation therapy with guidelines for the provision of safe and effective patient self-testing/patient self-management of oral anticoagulation.

Methods And Results: The consensus group has critically reviewed the literature and compared the results of usual care (UC) vs. anticoagulation clinic and patient self-management/patient self-testing (PSM/PST).

Extended anticoagulation therapy for the primary and secondary prevention of venous thromboembolism.

Extending the period of anticoagulation is an active area of investigation in both primary and secondary prevention of venous thromboembolic disease. In orthopaedic surgery, particularly in patients undergoing hip surgery, there is a growing interest in using extended anticoagulation beyond that traditionally given in the postoperative period using low-molecular weight heparin, oral anticoagulants, or newer agents such as fondaparinux sodium. Most studies show a benefit to extending anticoagulation without a considerable increase in major bleeding.

Current options in the prevention of thromboembolic disease.

Significant advances in the pharmacological prophylaxis of venous thromboembolism have occurred since warfarin and unfractionated heparin were introduced for this indication nearly 60 years ago. Despite these advances, coumarin derivatives such as warfarin remain the only orally active anticoagulants available for prophylaxis in venous thromboembolism. Although administered orally, coumarin derivatives are not convenient to use, because they have narrow therapeutic indexes and require routine coagulation monitoring and dose adjustment.

Low molecular weight heparin for the prophylaxis of thromboembolism in women with prosthetic mechanical heart valves during pregnancy.

Increased thromboembolic events occur in women with mechanical prosthetic valves during pregnancy, and selecting an effective and safe anticoagulant is still a challenge. Low molecular weight heparin (LMWH) is a promising alternative, but a recent warning and label change about its use in patients with mechanical prosthetic valves has caused confusion among physicians. The aim of the present study was to review the risks of maternal and fetal complications with mechanical heart valves treated with LMWH during pregnancy.

Impact of oral direct thrombin inhibitors on anticoagulation clinics.

Objectives: To characterize the services and activities performed by anticoagulation clinics (ACCs) across the United States, examine the anticipated impact that oral direct thrombin inhibitors (DTIs) will have on the clinical services of ACCs, and elicit possible management strategies to realign services provided by ACCs and opportunities for restructuring clinical services.

Methods: A survey was developed in consultation with content experts in the field, pretested by several ACC providers, and subsequently refined. Surveys were mailed to 400 randomly selected ACC-based providers.

Severe global DNA hypomethylation blocks differentiation and induces histone hyperacetylation in embryonic stem cells.

It has been reported that DNA methyltransferase 1-deficient (Dnmt1-/-) embryonic stem (ES) cells are hypomethylated (20% CpG methylation) and die through apoptosis when induced to differentiate. Here, we show that Dnmt[3a-/-,3b-/-] ES cells with just 0.6% of their CpG dinucleotides behave differently: the majority of cells within the culture are partially or completely blocked in their ability to initiate differentiation, remaining viable while retaining the stem cell characteristics of alkaline phosphatase and Oct4 expression.

The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.

This article concerning the pharmacokinetics and pharmacodynamics of vitamin K antagonists (VKAs) is part of the Seventh American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines. The article describes the antithrombotic effect of VKAs, the monitoring of anticoagulation intensity, the clinical applications of VKA therapy, and the optimal therapeutic range of VKAs, and provides specific management recommendations. Grade 1 recommendations are strong, and indicate that the benefits do, or do not, outweigh the risks, burdens, and costs.

New anticoagulants and their potential impact on the treatment of thromboembolic disease.

Traditional anticoagulants have drawbacks that make them complex to manage, limit their usefulness, and increase the possibility of adverse events. New anticoagulants are being developed that directly target a single coagulation factor. The agents have improved pharmacokinetics and pharmacodynamics and may not need coagulation monitoring.

Management of thrombosis in the cancer patient.

The treatment of venous thromboembolism in the cancer patient presents many challenges. The safety and efficacy of anticoagulation in these patients are still evolving. The clinical scenario is often unique to each patient and dictates careful consideration of the method of anticoagulation.

Interpretation with hindsight.

In his 1965 paper 'DNA content of tumours: cytophotometric measurements', Sandritter was for the first time able to relate tumour DNA content to the pathology and progression of a small number of tumours. In subsequent publications, these observations were extended to the progression of a much more comprehensive range of tumours. The interpretation of Sandritter's paper below follows the increasing sophistication of methodologies for tumour DNA content through the existing publications and evaluates the conclusions and hypotheses Sandritter proposed in the light of the contemporary account.

Optimizing the efficacy and safety of oral anticoagulant therapy: high-quality dose management, anticoagulation clinics, and patient self-management.

Despite its widespread use, oral anticoagulation therapy suffers from a number of problems that lead to underuse and inadequate treatment. Problems include its narrow therapeutic index, the influence of many concomitant conditions or comorbidities, and the need for high-quality dose management. Poor management of oral anticoagulation is a prime factor influencing the occurrence of adverse events.

Quality assessment of anticoagulation dose management: comparative evaluation of measures of time-in-therapeutic range.

Background: The results of clinical trials often hinge on the quality of oral anticoagulation management, yet the quality of such management is frequently not mentioned or measured. Time-in-therapeutic range (TTR) is one measure of quality of anticoagulation dose management, but various methodologies exist for measuring TTR.

Objective: This study was initiated to compare three commonly used methodologies for measuring TTR to see how they compare within the same cohort of patients.

Feasibility and patients' acceptance of Home Automated Telemanagement of oral anticoagulation therapy.

We developed the Home Automated Telemanagement (HAT) system for patients on oral anticoagulation therapy. It consists of a home unit, HAT server, and clinician unit. Patients at home use a palmtop or a laptop connected with a prothrombin time (PT) monitor.

Expression of a novel homeobox gene Ehox in trophoblast stem cells and pharyngeal pouch endoderm.

Ehox is an X-linked paired like homeobox gene identified from a differentiating embryonic stem (ES) cell cDNA library and is expressed at low levels in the preimplantation blastocyst and in ES cells in vitro. In embryos at 6.5 days post coitum (dpc), Ehox expression was restricted to the extraembryonic ectoderm which correlates with high-level expression in cultures of trophoblast stem cells.

Quantitative developmental anatomy of definitive haematopoietic stem cells/long-term repopulating units (HSC/RUs): role of the aorta-gonad-mesonephros (AGM) region and the yolk sac in colonisation of the mouse embryonic liver.

In the developing mouse embryo the first definitive (transplantable-into-the-adult) haematopoietic stem cells/long-term repopulating units (HSC/RUs) emerge in the AGM region and umbilical vessels on 10-11 days post coitum (d.p.c.