Treatment of adults with intracranial hemorrhage on apixaban or rivaroxaban with prothrombin complex concentrate products.

To analyze the efficacy and safety of activated prothrombin complex concentrates (aPCC) and four-factor prothrombin complex concentrates (4F-PCC) to prevent hematoma expansion in patients taking apixaban or rivaroxaban with intracranial hemorrhage (ICH). In this multicenter, retrospective study, sixty-seven ICH patients who received aPCC or 4F-PCC for known use of apixaban or rivaroxaban between February 2014 and September 2018 were included. The primary outcome was the percentage of patients who achieved excellent/good or poor hemostasis after administration of aPCC or 4F-PCC. Secondary outcomes included hospital mortality, thromboembolic events during admission, and transfusion requirements. Excellent/good hemostasis was achieved in 87% of aPCC patients, 89% of low-dose 4F-PCC [< 30 units per kilogram (kg)], and 89% of high-dose 4F-PCC (≥ 30 units per kg). There were no significant differences in excellent/good or poor hemostatic efficacy (p = 0.362). No differences were identified in transfusions 6 h prior (p = 0.087) or 12 h after (p = 0.178) the reversal agent. Mortality occurred in five patients, with no differences among the groups (p = 0.838). There were no inpatient thromboembolic events. Both aPCC and 4F-PCC appear safe and equally associated with hematoma stability in patients taking apixaban or rivaroxaban who present with ICH. Prospective studies are needed to identify a superior reversal agent when comparing andexanet alfa to hospital standard of care (4F-PCC or aPCC) and to further explore the optimal dosing strategy for patients with ICH associated with apixaban or rivaroxaban use.

Photodecomposition of dichloromethane catalyzed by tetrachloroferrate(III) supported on a Dowex anion exchange resin.

The FeCl4(-) ion, heterogenized on a Dowex ion exchange resin, catalyzes the aerobic photodecomposition of neat CH2Cl2. Phosgene production was used to characterize the extent of decomposition, although it appears to be a secondary product from the decomposition of chloroform, which is suggested to arise from the reaction of dichloromethanol with hydrogen chloride. The yield of CHCl3 increases when the production of phosgene is suppressed by water or acetonitrile. CuCl4(2-), likewise heterogenized on Dowex, is photocatalytically inactive.

Photodecomposition of chloroform catalyzed by unmodified MCM-41 mesoporous silica.

Unactivated MCM-41 mesoporous silica catalyzes the photodecomposition of chloroform to phosgene and hydrogen chloride under near-UV (λ > 360 nm) irradiation. The rate of photodecomposition increases toward an asymptotic limit as the O(2) partial pressure is increased. Deuterochloroform does not decompose under the same experimental conditions. Low concentrations of both cyclohexane and ethanol quench the photodecomposition, whereas water, up to its solubility limit, does not. Dissolved tetraalkylammonium salts suppress photodecomposition. The data are consistent with a mechanism in which light absorption by an SiO(2) defect yields an electron-deficient oxygen atom, which then abstracts hydrogen from chloroform. The resulting CCl(3) radicals react with oxygen to form a peroxy radical that decomposes, eventually yielding phosgene and hydrogen chloride.

Photocatalysis of chloroform decomposition by the hexachlororuthenate(IV) ion.

Dissolved hexachlororuthenate(IV) effectively catalyzes the photodecomposition of chloroform to hydrogen chloride and phosgene under near-UV (λ > 345 nm) irradiation, whereby RuCl6(2-) is not itself photocatalytically active, but is photochemically transformed into a species that is active, possibly RuCl5 (CHCl3 )(-) . Conversion to a photoactive species during irradiation is consistent with the acceleration of the decomposition rate during the early stages and with the apparent inverse dependence of the decomposition rate on the initial concentration of RuCl6(2-) . The displacement of Cl(-) by CHCl3 in the coordination sphere to create the photoactive species is consistent with the retardation of photodecomposition by both Cl(-) and H2 O. The much smaller photodecomposition rate in CDCl3 suggests that C-H bond dissociation occurs during the primary photochemical event, which is also consistent with the presence of a CHCl3 molecule in the first coordination sphere.