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1.
J Strength Cond Res ; 35(2): 420-427, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-29927889

RESUMEN

ABSTRACT: Wagle, JP, Cunanan, AJ, Carroll, KM, Sams, ML, Wetmore, A, Bingham, GE, Taber, CB, DeWeese, BH, Sato, K, Stuart, CA, and Stone, MH. Accentuated eccentric loading and cluster set configurations in the back squat: a kinetic and kinematic analysis. J Strength Cond Res 35(2): 420-427, 2021-This study examined the kinetic and kinematic differences between accentuated eccentric loading (AEL) and cluster sets in trained male subjects (age = 26.1 ± 4.1 years, height = 183.5 ± 4.3 cm, body mass = 92.5 ± 10.5 kg, and back squat to body mass ratio = 1.8 ± 0.3). Four load condition sessions consisted of traditionally loaded (TL) "straight sets," TL cluster (TLC) sets, AEL cluster (AEC) sets, and AEL "straight sets" where only the first repetition had eccentric overload (AEL1). An interrepetition rest interval of 30 seconds was prescribed for both TLC and AEC. Concentric intensity for all load conditions was 80% 1 repetition maximum (1RM). Accentuated eccentric loading was applied to repetitions using weight releasers with total eccentric load equivalent to 105% of concentric 1RM. Traditionally loaded cluster had statistically greater concentric outputs than TL. Furthermore, statistically greater eccentric and concentric outputs were observed during AEC compared with TL with the exception of peak power. Statistically greater concentric characteristics were observed in TLC compared with AEL1, but statistically greater eccentric outputs were observed in AEL1. In the 2 cluster set conditions, statistically greater concentric rate of force development (RFDCON) (d = 0.470, p < 0.001) and average velocity (vavg) (d = 0.560, p < 0.001) in TLC compared with AEC were observed. However, statistically greater eccentric work (WECC) (d = 2.096, p < 0.001) and eccentric RFD (RFDECC) (d = 0.424, p < 0.001) were observed in AEC compared with TLC. Overall, eccentric overload demonstrated efficacy as a means of increasing eccentric work and RFD, but not as a means of potentiating concentric output. Finally, interrepetition rest seems to have the largest influence on concentric power output and RFD.


Asunto(s)
Entrenamiento de Fuerza , Adulto , Fenómenos Biomecánicos , Humanos , Masculino , Fuerza Muscular , Músculo Esquelético , Postura , Adulto Joven
2.
Am J Nephrol ; 50(4): 255-261, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31434091

RESUMEN

BACKGROUND: The safety and efficacy of low-molecular-weight heparin in the prevention of extracorporeal dialysis circuit clotting among in-center extended duration nocturnal hemodialysis (INHD) patients are unknown. The aim of this study was to determine the safety and efficacy of 2 doses of tinzaparin, among INHD patients receiving 6-8 h hemodialysis, 3 times per week. METHODS: We conducted a retrospective cohort study to examine antifactor Xa levels at time 0, 2 h, 4 h mid-hemodialysis (mid-HD), 6 h, and at end of each INHD session for 4 weeks and to determine extracorporeal dialysis circuit clotting and bleeding events after switching from unfractionated heparin to tinzaparin, using a standard protocol of tinzaparin delivery at the initiation and midpoint of HD. RESULTS: All 16 patients in The Ottawa Hospital INHD program were converted to tinzaparin and followed for 177 INHD sessions. Mean antifactor Xa level at 2 h of HD was 0.41 ± 0.21 (SD) IU/mL, at 4 h (mid-HD) 0.19 ± 0.17 IU/mL, at 6 h 0.44 ± 0.21 IU/mL, and at dialysis end 0.26 ± 0.14 IU/mL. Antifactor Xa levels were undetectable at the start of INHD, suggesting no tinzaparin accumulation. Five patients required an increase in tinzaparin due to extracorporeal dialysis circuit clotting. There were no bleeding events. One patient required a switch to fondaparinux due to an adverse reaction. CONCLUSION: Tinzaparin was safe and efficacious for most INHD patients without accumulation or bleeding. The conversion from unfractionated heparin to tinzaparin required an increased tinzaparin dose for 31% of INHD patients.


Asunto(s)
Anticoagulantes/farmacología , Diálisis Renal/métodos , Tinzaparina/farmacología , Adulto , Anciano , Coagulación Sanguínea , Ritmo Circadiano , Factor Xa/análisis , Femenino , Hemorragia , Heparina , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Estudios Retrospectivos , Resultado del Tratamiento
3.
BMC Musculoskelet Disord ; 19(1): 26, 2018 01 22.
Artículo en Inglés | MEDLINE | ID: mdl-29357868

RESUMEN

BACKGROUND: The main clinical manifestations of hemophilia are muscle and joint bleeding. Recurrent bleeding leads to a degenerative process known as hemophilic arthropathy. The development of inhibitors (antibodies against FVIII/FIX concentrates) is the main complication in the treatment of hemophilia. The objective was to assess the safety and efficacy of manual therapy treatment in a patient with hemophilia and inhibitor. CASE PRESENTATION: A 26-year-old patient with hemophilia B and inhibitor received physiotherapy treatment based on manual therapy for 3 months, with a frequency of 2 sessions per week. The joint status was evaluated using the Hemophilia Joint Health Score; pain was assessed with the Visual Analog Scale; and the range of movement was evaluated using a universal goniometer. The patient developed no joint bleeding in the knees or ankles as a result of the physiotherapy treatment. Following treatment, improvements were noted in the range of movement of knees and ankles, the perception of pain in both knees, and ankle functionality. CONCLUSIONS: Until now, manual therapy using joint traction was contraindicated in patients with hemophilia and inhibitor, as it was feared to cause possible joint bleeding. This is the first case study to address the safety and efficacy of manual therapy in a patient with hemophilia and an inhibitor. The results of this study may help to establish which manual therapy treatments are indicated in patients with hemophilic arthropathy and inhibitors. Thus, a physiotherapy program based on manual therapy may be safe in patients with hemophilia and inhibitor and such therapy may improve joint condition, pain, and joint range of motion in patients with hemophilia and inhibitor. Randomized clinical trials are needed to confirm the results of this case study.


Asunto(s)
Autoanticuerpos/sangre , Hemofilia B/sangre , Hemofilia B/terapia , Manipulaciones Musculoesqueléticas/métodos , Adulto , Factor VIII/metabolismo , Factor X/metabolismo , Hemofilia B/diagnóstico por imagen , Humanos , Masculino , Dimensión del Dolor/métodos , Rango del Movimiento Articular/fisiología , Resultado del Tratamiento
4.
Nephron ; 137(3): 205-211, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28817831

RESUMEN

BACKGROUND/AIMS: Anticoagulation of the extracorporeal circuit is essential for adequate haemodialysis (HD). Low molecular weight heparins (LMWHs) are safe and sufficient towards achieving this goal. In the Netherlands, dosage is based on bodyweight and adjusted based on clinical events. LMWH levels during dialysis can be quantified through measurement of the anti-Xa activity and a target range of 0.5-1.0 IU/mL has been proposed. We aimed to evaluate the practical value of the anti-Xa activity to guide LMWH dosage in HD patients. Additionally, the value of the activated partial thromboplastin time (APTT) was investigated. METHODS: All prevalent adult HD patients of our dialysis clinic were included. APTT and anti-Xa activity were measured before, during and after 2 dialysis sessions. Clinical and dialysis characteristics, including LMWH dosage, were derived from digital patient charts. RESULTS: Our final study cohort consisted of 83 patients. LMWH dosage during dialysis was appropriate for bodyweight in 61% of cases, of which 50% reached an anti-Xa activity within the putative target range of 0.5-1.0 IU/mL. Forty-six percent of patients had an anti-Xa activity >1.0 IU/mL. Anti-Xa levels during and after dialysis were significantly correlated (r = 0.803, p < 0.01). No thrombotic or haemorrhagic complications were observed in this study. Correlation of APTT with anti-Xa activity was poor. CONCLUSION: Anti-Xa activity measurements during dialysis can identify patients in whom LMWH dosage should be lowered in a subsequent dialysis session. Whether such an intervention leads to a decrease in haemorrhagic complications needs to be evaluated in prospective studies.


Asunto(s)
Anticoagulantes/uso terapéutico , Inhibidores del Factor Xa/farmacología , Factor Xa/efectos de los fármacos , Heparina de Bajo-Peso-Molecular/uso terapéutico , Fallo Renal Crónico/terapia , Diálisis Renal , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Fallo Renal Crónico/fisiopatología , Masculino , Persona de Mediana Edad , Países Bajos , Tiempo de Tromboplastina Parcial
5.
Artículo en Inglés | IBECS | ID: ibc-163676

RESUMEN

The present study aimed to cross-validate Holtzworth-Munroe and Stuart’s typology in a Spanish sample of court-referred intimate partner violence batterers. The study also analyzed the typology’s capability to predict treatment attendance, completion, and IPV recidivism two years after the treatment. The sample consisted of 210 batterers court referred to a batterer intervention program. Using cluster analysis, three batterer subtypes were identified in accordance with the original typology: family-only batterers, borderline/dysphoric, and generally violent-antisocial. The typology predicted program attendance, completion, and recidivism. Batterers from the generally violent-antisocial group attended a significantly lower number of sessions, presented the highest dropout levels, and had the highest recidivism rate followed by borderline/dysphoric and family-only batterers. These findings suggest that in order to increase the effectiveness of batterer intervention programs, batterers’ different needs and risk profiles should be taken into account (AU)


Este estudio tiene por objeto la validación cruzada de la tipología de Holtzworth-Munroe y Stuart en una muestra española de maltratadores de pareja remitidos por el tribunal. También analiza la capacidad de la tipología de predecir la asistencia al tratamiento, su finalización y las recaídas a los dos años del tratamiento. La muestra constaba de 210 maltratadores derivados por un tribunal a un programa de intervención. Mediante un análisis de clústers se descubrieron tres subtipos de maltratadores, según la tipología original: maltratadores familiares únicamente, límites/disfóricos y generalmente violentos-antisociales. La tipología predijo la asistencia al programa, su finalización y las recaídas. Los maltratadores del grupo generalmente violento-antisocial asistieron a un número de sesiones significativamente menor, mostraban el mayor grado de abandono y el mayor índice de recaídas, seguidos del grupo de límites/disfóricos y de los maltratadores familiares únicamente. Dichos resultados indican que para aumentar la eficacia de los programas de intervención con maltratadores hay que tener en consideración sus diferentes necesidades y los perfiles de riesgo (AU)


Asunto(s)
Humanos , Masculino , Adulto , Maltrato Conyugal/legislación & jurisprudencia , Maltrato Conyugal/psicología , Trastorno de Personalidad Antisocial/mortalidad , Agresión/psicología , Psicometría/legislación & jurisprudencia , Trastorno de la Conducta/psicología , Conducta Social , Análisis de Datos/métodos , Modelos Logísticos , Análisis de Varianza
6.
Pulm Circ ; 4(4): 696-704, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25610605

RESUMEN

The Third International Right Heart Failure Summit (Boston, MA) convened a group of international clinical and scientific experts in pulmonary vascular disease and right heart disease to explore cutting-edge developments in the mechanisms and clinical management of right-sided cardiovascular disease. The symposium was organized into three distinct sessions, the first of which was titled "Pulmonary Hypertension and the Right Ventricle-Thinking outside the Box" and will be the focus of this review. Three internationally renowned experts in pulmonary hypertension and right heart disease-Drs. Stuart Rich, Sean Gaine, and Harm Bogaard-each delivered provocative lectures. The first lecture, by Dr. Rich, was titled "Current Classification for Pulmonary Hypertension-Why Are We Ignoring the Structural Basis of the Disease?" Rich focused on the current classification system of pulmonary hypertension and provided a unique historical perspective. He also addressed the need to evolve the prevailing conceptual framework of our approach to pulmonary vascular diseases and right ventricular dysfunction, including the future design of pulmonary hypertension clinical trials. Dr. Gaine delivered the second lecture, titled "Treatment Algorithm for Pulmonary Hypertension: Tunnel Vision of our Current Approach." Gaine emphasized the tripartite model of pulmonary hypertension management, namely, supportive measures, pharmacologic therapy, and rescue therapy. Specifically, he detailed how each of these entities is changing as our understanding of the unmet needs in the field of pulmonary hypertension is becoming increasingly apparent. Finally, Dr. Bogaard provided a lecture titled "Treating Right Heart Failure: Why Does the Art of Medicine Lead the Science?" Bogaard provided a stimulating review of cutting-edge translational research of right ventricular function and dysfunction. In particular, he described a variety of molecular and cellular changes that occur in the hypertrophied right ventricle and contrasted those changes that may be adaptive from those that are maladaptive and may be potential therapeutic targets.

7.
Nephron Clin Pract ; 123(1-2): 7-12, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23751953

RESUMEN

BACKGROUND: Unfractionated heparin has been traditionally used for anticoagulation during hemodialysis (HD), but more recently low-molecular-weight heparin (LMWH) is being used as an alternative. Anti-Xa activity can be measured as a surrogate of LMWH efficacy. We present 52 patients treated with tinzaparin anticoagulation on HD, confirming that fixed dosing is safe and efficacious with sound pharmacodynamic reason in relation to anti-Xa profiling. METHODS: We undertook a prospective audit in a single dialysis unit. All patients were established on a simple anticoagulation protocol for at least 1 month prior to the audit. Blood anti-Xa activity was measured at time 0, 30, 60 and 120 min into and at the end of HD. Efficacy and safety data were collected on the study day and the two sessions before and after it. RESULTS: Fifty-two patients were included in the efficacy and safety analysis with 43 patients undergoing anti-Xa analysis (9 sampling errors). Using current consensus (an end-HD anti-Xa activity of <0.4 IU/ml), our fixed-dose protocol resulted in satisfactory safety in all patients tested. Of 260 HD sessions, 10 (4%) had reduced tinzaparin efficacy. During 105 dialysis sessions (21 patients) using an arteriovenous fistula, 4 patients had one episode of minor bleeding and there were 6 episodes (2 patients) of post-needle-compression time greater than 15 min. CONCLUSION: Tinzaparin administered thrice weekly as a fixed dose has good efficacy and is well tolerated as an anticoagulant during HD when used according to our protocol.


Asunto(s)
Algoritmos , Factor Xa/análisis , Heparina de Bajo-Peso-Molecular/administración & dosificación , Heparina de Bajo-Peso-Molecular/sangre , Diálisis Renal/efectos adversos , Trombosis/etiología , Trombosis/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Relación Dosis-Respuesta a Droga , Monitoreo de Drogas/métodos , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Trombosis/sangre , Tinzaparina , Resultado del Tratamiento
8.
Nefrología (Madr.) ; 32(5): 605-612, sept.-oct. 2012. ilus, tab
Artículo en Español | IBECS | ID: ibc-106150

RESUMEN

Introducción: Los sistemas de hemodiálisis tienen capacidad trombogénica, por lo que se utiliza de forma rutinaria la anticoagulación. Su prescripción no se encuentra exenta de riesgos, a pesar de lo cual las recomendaciones respecto a la dosis pautada siguen basándose en criterios muy diversos. Métodos: Se realizó un estudio experimental aleatorizado y cruzado. Seis pacientes realizaron seis sesiones de hemodiafiltración posdilución con el dializador de polisulfona HF80® y anticoagulación habitual con nadroparina, y seis sesiones con el dializador AN69ST® de poliacrilonitrilo con una cubierta de heparina sin el uso de anticoagulación sistémica. Evaluamos cada hora el grado de coagulación del dializador y del circuito extracorpóreo mediante una escala visual y las variaciones en los parámetros de coagulación, entre los que se incluyó el factor anti-Xa. Nuestro objetivo primario fue valorar las variaciones en la actividad del factor anti-Xa en ausencia de diferencias en la tasa de coagulación masiva entre los dos grupos. Resultados: No se coaguló el dializador de forma completa o grado 4 en ninguna de las 36 sesiones realizadas con cada dializador. Se produjo una coagulación parcial del dializador inferior del 25% (grado 1-2) en 32 (88,9%) sesiones con AN69ST® y 35 (97,2%) con el dializador habitual, y superior del 25% (grado 3-4) en 4 (11,1%) sesiones con AN69ST® y en 1 (2,8%) sesión con el dializador con heparina. La coagulación del atrapaburbujas arterial no fue superior al 25% (grados 3 y 4) en ninguna de las sesiones estudiadas, y la cámara venosa en sólo 1 (2,8%) sesión con el dializador habitual y 3 (8,4%) con AN69ST® sin diferencias entre los dos dializadores. El (..) (AU)


Background: Haemodialysis systems are potentially thrombogenic, so anticoagulation is routinely used. Its prescription involves certain risks, despite which the recommendations regarding dosage are still based on very disparate criteria. Methods: We performed a randomised, crossed pilot study. Six patients underwent six sessions of post-dilution haemodiafiltration with a polysulfone HF80® dialyser and standard anticoagulation with nadroparin, and six sessions with heparincoated poliacrylonitrile AN69ST® membrane without the administration of systemic anticoagulation therapy. The coagulation level of the dialyser and extracorporeal circuit was evaluated every hour using a visual scale along with variation in clotting parameters such as anti-Xa factor. Our primary objective was to assess anti-Xa activity in the absence of differences in the rate of massive coagulation between the two groups. Results: No complete or grade 4 dialyser clotting occurred in any of the 36 sessions with either dialyser. Partial clotting of the dialyser occurred below 25% (grade 1-2) in 32 (88.9%) AN69ST® sessions and 35 (97.2%) sessions using the standard dialyser, and partial clotting surpassed 25% (grade 3-4) in 4 (11.1%) AN69ST® sessions and 1 (2.8%) dialysis session with heparin. Arterial chamber blood clotting did not surpass 25% (grade 3 and 4) in any of the studied sessions, and venous chamber coagulation occurred in only 1 (2.8%) session with the usual dialyser and in 3 (8.4%) sessions with the AN69ST®, with no significant differences between the two (..) (AU)


Asunto(s)
Humanos , Insuficiencia Renal Crónica/terapia , Diálisis Renal/instrumentación , Soluciones para Diálisis/farmacología , Hemodiafiltración/métodos , Factor Xa/antagonistas & inhibidores , Heparina/uso terapéutico , Anticoagulantes/uso terapéutico , Hemorragia/prevención & control
9.
Nefrologia ; 32(5): 605-12, 2012.
Artículo en Inglés, Español | MEDLINE | ID: mdl-23013946

RESUMEN

BACKGROUND: Hemodialysis systems are potentially thrombogenic, so it is routinely used anticoagulation. Its prescription is with risks though which the recommendations regarding the scheduled dose are still based on very different criteria. METHODS: We performed a randomized, crossover pilot study. Six patients underwent six sessions of post-dilution hemodiafiltration with polysulfone HF80® dialyzer and standard anticoagulation with nadroparin, and six sessions with heparin-coated poliacrylonitrile AN69ST® membrane without using systemic anticoagulation. Dialyser and the extracorporeal circuit clotting grade was evaluated through visual scale every hour and coagulation parameters like anti-Xa factor. Our endpoint was to assess anti-Xa activity without differences in the rate of massive clotting between the two groups. RESULTS: No complete or grade 4 dialyzer clotting occurred in any of 36 sessions with each dialyzer. A partial lower 25% (grade 1-2) dialyzer clotting was in 32 (89.7%) AN69ST® sessions and 35 (97.2%) with the usual dialyzer and upper 25% (grade 3-4) in 4 (11.1%) AN69ST® sessions and 1 (2.8%) dialysis session with heparin. Arterial chamber blood coagulation was not greater than 25% (grade 3 and 4) in any of the studied sessions and the venous chamber in only 1 (2.8%) session with the usual dialyzer and 3 (8.4%) with no differences AN69ST® between the two dialyzers. The activated partial thromboplastin time at two hours showed differences between techniques related to administration of low molecular weight heparin (33.3 ± 2.7s with polysulfone and 27.5 ± 2.3s in AN69ST®; P < 0.05) which remained significant at the end of the session (29.8 ± 2.1s with polysulfone and 27.2 ± 1.8s with AN69ST®; P < 0.05). Anti-Xa factor activity was maximal two hours after administration of nadroparin, with differences between the two dialyzers (0.46 ± 0.13 IU / ml in dialysis with polysulfone and 0.04 ± 0.04 IU / ml with AN69ST®p<0.005) and went down after 4 hours (0.17 ± 0.12 IU / ml in dialysis with polysulfone and 0.02 ± 0.03 IU / ml in AN69ST®; p<0.05). One patient in dialysis AN69ST®; had an adverse reaction characterized by generalized pruritus and was excluded from the study, by withdrawing the consent in the first session. CONCLUSION: We demonstrate the low thrombogenicity of the AN69ST®; dialyzer that allows post-dilution hemodiafiltration sessions without systemic anticoagulation, and without increasing the frequency of severe clotting events compared to HF80®; dialyzer with nadroparin and with less risk of bleeding by not modifying the anti-Xa factor activity.


Asunto(s)
Anticoagulantes/administración & dosificación , Coagulación Sanguínea/efectos de los fármacos , Factor Xa/análisis , Heparina/administración & dosificación , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Diálisis Renal , Anciano , Estudios Cruzados , Inhibidores del Factor Xa , Femenino , Humanos , Masculino , Proyectos Piloto , Diálisis Renal/instrumentación , Diálisis Renal/métodos
10.
Am J Vet Res ; 73(4): 556-61, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22452504

RESUMEN

OBJECTIVE: To establish practical doses and administration frequencies of fondaparinux for cats that would approximate human therapeutic peak and trough plasma anti-factor Xa activities for thromboprophylaxis (TP) and thrombosis treatment (TT) protocols. ANIMALS: 6 healthy adult purpose-bred cats. PROCEDURES: Dosage protocols for TP and TT were selected on the basis of a single compartment pharmacokinetic model incorporating data from humans but modified to account for the higher body weight-normalized cardiac output of cats. Fondaparinux was administered at 0.06 mg/kg, SC, every 12 hours (TP) for 7 days in one session, and 0.20 mg/kg, SC, every 12 hours (TT) for 7 days in another, with a minimum of 1 week separating the sessions. Plasma anti-factor Xa activity was measured before fondaparinux administration (day 1) and at 2 (peak) and 12 (trough) hours after drug administration on days 1 and 7. Platelet aggregation and thromobelastographic (TEG) parameters were also measured 2 hours after drug administration on day 7. RESULTS: Peak plasma anti-factor Xa activities on day 7 for TP (median, 0.59 mg/L; range, 0.36 to 0.77 mg/L) and TT (median, 1.66 mg/L; range, 1.52 to 2.00 mg/L) protocols were within therapeutic ranges for humans. However, only the TP protocol achieved trough anti-factor Xa activity considered therapeutic in humans (median, 0.19 mg/L; range, 0.00 to 0.37 mg/L) on day 7. There were significant changes in the TEG parameters at peak for the TT protocol, suggesting a hypocoagulable state. No significant changes in platelet aggregation were evident for either protocol. CONCLUSIONS AND CLINICAL RELEVANCE: A fondaparinux dosage of 0.06 or 0.20 mg/kg, SC, every 12 hours, was sufficient to achieve a peak plasma anti-factor Xa activity in cats that has been deemed therapeutic in humans. This study provided preliminary data necessary to perform fondaparinux dose-determination and clinical efficacy studies.


Asunto(s)
Anticoagulantes/farmacocinética , Gatos , Polisacáridos/farmacocinética , Animales , Anticoagulantes/administración & dosificación , Anticoagulantes/sangre , Plaquetas/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Factor Xa/efectos de los fármacos , Factor Xa/metabolismo , Femenino , Fondaparinux , Masculino , Polisacáridos/administración & dosificación , Polisacáridos/sangre , Tromboelastografía/veterinaria
11.
ASAIO J ; 51(4): 348-51, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16156297

RESUMEN

Binding polyanionic unfractionated heparin over the modified AN69 polyacrylonitrile membrane, the surface electronegativity of which has been neutralized by polyethyleneimine (AN69-ST), renders the membrane more hemocompatible. This property was tested in two groups of long-term hemodialysis patients. Results were rated as massive or partial clotting of a dialyzer at the end of the session. Group I patients were included in a prospective, cross-over study comparing standard dialysis with hemodialysis without systemic administration of unfractionated heparin (n = 12, 123 sessions). In all instances, priming was made with 2 I saline containing 5,000 IU/l heparin. Only patchy or partial clotting was observed in 11% and 39% of the sessions with standard and heparin-free administration, respectively. Group II patients were included in an open, observational pilot study testing the effects of the heparin-coated membrane, without systemic administration of heparin, in patients at high risk of bleeding (n = 68, 331 sessions). Massive clotting was observed in six sessions only (less than 2%) and normal or slightly patchy dialyzers were found in 88% of the sessions. It is concluded that the dialysis AN69 ST membrane, after adequate priming at bedside, can be used without systemic administration of heparin for hemodialysis in patients at high risk of bleeding.


Asunto(s)
Anticoagulantes/metabolismo , Heparina/metabolismo , Membranas Artificiales , Diálisis Renal/instrumentación , Resinas Acrílicas , Materiales Biocompatibles , Coagulación Sanguínea , Estudios Cruzados , Ensayo de Inmunoadsorción Enzimática , Factor Xa/metabolismo , Inhibidores del Factor Xa , Humanos , Tiempo de Tromboplastina Parcial , Proyectos Piloto , Polietileneimina , Estudios Prospectivos , Diálisis Renal/métodos , Trombina/biosíntesis , Factores de Tiempo
12.
Int J Clin Pharmacol Ther ; 43(7): 335-8, 2005 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-16035376

RESUMEN

The anticoagulant effects of two LMWHs, tinzaparin sodium and bemiparin sodium, were compared during two study dialysis (SD) sessions (SD1 with tinzaparin and SD2 with bemiparin) in ten chronic hemodialysis patients. Prior to SD1, patients had received 3,500 IU of tinzaparin in each dialysis session for two weeks. After SD1, they were switched to 3,500 IU of bemiparin for two weeks and the second study dialysis session (SD2) was carried out. Patients used the same dialyzers during the whole study period and no changes were made in any of the other hemodialysis parameters. Blood samples for the measurement of PT, aPTT and anti-Xa activity were taken before the study dialysis sessions (sample 0), and again at two and four hours after the initiation of dialysis (samples 2-h and 4-h, respectively). PT values showed no change between the SD1 and SD2 sessions, but aPTT values were significantly higher in the 2-h and 4-h samples of the SD1 session compared to corresponding values in SD2 samples (p < 0.005). Anti-Xa activity was higher in the 2-h and 4-h samples of the SD2 session compared to the SD 1 session (p = 0.005 and p = 0.012, respectively). At four hours, only patients receiving bemiparin had a mean anti-Xa activity higher than 0.40 IU/mg (mean 0.51 +/- 0.76). However, fibrin/clot formation in the extracorporeal circuit during each study period as assessed by visual inspection, did not differ significantly between sessions. It is concluded that the anticoagulant profile of bemiparin sodium during hemodialysis treatment is superior to that of tinzaparin.


Asunto(s)
Heparina de Bajo-Peso-Molecular/uso terapéutico , Enfermedades Renales/terapia , Diálisis Renal/métodos , Adulto , Coagulación Sanguínea/efectos de los fármacos , Enfermedad Crónica , Esquema de Medicación , Factor Xa/fisiología , Inhibidores del Factor Xa , Femenino , Fibrinolíticos/administración & dosificación , Fibrinolíticos/uso terapéutico , Heparina de Bajo-Peso-Molecular/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial/métodos , Tiempo de Protrombina/métodos , Factores de Tiempo , Tinzaparina , Resultado del Tratamiento
13.
Nephron ; 92(3): 589-600, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12372942

RESUMEN

BACKGROUND: To compare standard heparin (SH) and low molecular weight heparin (LMWH) in terms of anticoagulation, platelet activation and lipid metabolism, we selected 54 patients who had been on 4-hour hemodialysis three times weekly for at least 12 months, without bleeding disorders or dyslipidemic diseases. 28 were on hemodialysis with Polysulfone low-flux, 26 were on hemodiafiltration with Polysulfone high-flux. All patients underwent EPO. METHODS: During the first 18 months, we administered SH 1,500 IU on starting dialysis and 1,500 +/- 500 IU in continuous intradialytic infusion per session. In the following 18 months, we administered LMWH 64.6 IU/kg on starting dialysis in a single arterious bolus. We assessed aPTT, anti-factor Xa activity, TAT and FPA, beta-TG and PF4. Blood samples were taken monthly at times 0, 30, 60, 180 and 240 min, as well as 1, 4 and 20 h after dialysis end. Predialysis cholesterol, HDL, LDL, triglycerides and lipoprotein(a) were checked monthly. RESULTS: During both LMWH and SH sessions no clotting or major bleeding complications were observed. APTT with LMWH was lower than that found with SH (p < 0.001); aFXa using LMWH was higher than when using SH (p < 0.001); TAT and FPA were lower in LMWH sessions (p < 0.01) than in SH sessions. We also detected lower beta-TG (p < 0.05) and PF4 levels (p < 0.05) using LMWH than using SH. As regards lipids, we only observed a significant decrease in triglycerides after 18 months of LMWH treatment. CONCLUSIONS: Routine use of LMWH during hemodialysis affords a safe and effective alternative to SH, and causes reduced platelet activation.


Asunto(s)
Anticoagulantes/administración & dosificación , Heparina de Bajo-Peso-Molecular/administración & dosificación , Heparina/administración & dosificación , Fallo Renal Crónico/terapia , Diálisis Renal , Anciano , Antitrombina III/análisis , Coagulación Sanguínea/efectos de los fármacos , Estudios Cruzados , Factor Xa/metabolismo , Inhibidores del Factor Xa , Femenino , Fibrinopéptido A/análisis , Hemodiafiltración , Humanos , Fallo Renal Crónico/sangre , Lípidos/sangre , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Péptido Hidrolasas/análisis , Activación Plaquetaria/efectos de los fármacos , Factor Plaquetario 4/análisis , beta-Tromboglobulina/análisis
14.
Nephrol Dial Transplant ; 16(5): 987-93, 2001 May.
Artículo en Inglés | MEDLINE | ID: mdl-11328905

RESUMEN

BACKGROUND: A single bolus of dalteparin at the start of haemodialysis (HD) may prevent clot formation, but subclinical activation of platelets and coagulation may still occur. Consequently, the relationship between clinical clotting events and activation markers of platelets and coagulation before and during HD is of interest. METHODS: The effect of tapered doses of dalteparin during 84 HD sessions (4-4.5 h) was prospectively examined in 12 patients. Six of the patients were treated with warfarin. The initial dalteparin dose was reduced to 50% if no clotting was observed. Clinical clotting was evaluated by inspection of the air trap every hour and by inspection of the dialyser after each session. Anti-FXa activity was measured for assessment of dalteparin activity. Markers of activated plasma coagulation, (thrombin-antithrombin (TAT) and prothrombin fragment 1+2 (PF1+2)) and a marker of platelet activation (beta-thromboglobulin, beta-TG), were measured before the start of and after 3 and 4 h of dialysis. Ten pre-dialytic patients with chronic renal failure served as a control group. A total of 230 measurements of each parameter were performed. RESULTS: An anti-FXa activity above 0.4 IU/ml at the end of HD inhibits overt clot formation for 4 h. This was obtained by an intravenous dalteparin dose of about 5000 IU. TAT and PF1+2 correlated to clinical clotting episodes (r=0.50 and 0.47, P<0.001). beta-TG was not significantly correlated to clinical clotting. All parameters increased during the sessions (TAT, PF1+2, beta-TG, P<0.001). When measurements during clinical clotting episodes were disregarded, all parameters were still markedly increased. Warfarin-treated patients had lower TAT and PF1+2. Dialysis patients had higher beta-TG values than pre-dialytic patients. CONCLUSION: Despite clinically effective anticoagulation, obtained by dalteparin administration, platelets and coagulation are activated by HD, resulting in a potentially thrombophilic state. Warfarin treatment reduces clinical clot formation and subclinical activation of coagulation.


Asunto(s)
Anticoagulantes/uso terapéutico , Coagulación Sanguínea/efectos de los fármacos , Dalteparina/uso terapéutico , Proteínas de Plantas , Activación Plaquetaria/efectos de los fármacos , Diálisis Renal , Adulto , Anciano , Anticuerpos/análisis , Anticoagulantes/administración & dosificación , Antitrombina III , Proteínas de Unión al ADN/sangre , Dalteparina/administración & dosificación , Relación Dosis-Respuesta a Droga , Factor Xa/inmunología , Humanos , Inyecciones Intravenosas , Persona de Mediana Edad , Fragmentos de Péptidos/sangre , Péptido Hidrolasas/sangre , Estudios Prospectivos , Precursores de Proteínas/sangre , Protrombina , Warfarina/uso terapéutico , beta-Tromboglobulina/análisis
15.
Clin Nephrol ; 52(5): 322-5, 1999 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-10584996

RESUMEN

AIM: In an open, crossover, randomized study in hemodialysis patients, we investigated possible differences of the effect of the low molecular weight heparin (LMWH) nadroparin/fraxiparine in relation to the route of administration. PATIENTS AND METHODS: The effect of nadroparin, administered by the venous line or by the arterial line after priming of the extracorporeal circuit with a part of the total dose administered, was compared with administration of the same dose by the arterial line as recommended by the manufacturer. Twelve stable, chronic hemodialysis patients were studied during 3 dialysis sessions for each treatment option. Concomitant medication was kept constant. RESULTS: Results obtained after administration of nadroparin by the venous line were comparable to those obtained after administration by the arterial line. When a part of the dose was added to the priming solution, the anti-Xa activity, measured after 2 hours of dialysis, was somewhat lower (p = 0.09). There was also a tendency towards longer manual compression time in this group. There was no difference in hemoglobin, serum urea and creatinine before the study and at the end of each treatment option. CONCLUSION: We therefore conclude that the safety and efficacy of administration of LMWH by the arterial and by the venous route are identical. There is no need for addition of a small dose of LMWH to the priming fluid.


Asunto(s)
Anticoagulantes/administración & dosificación , Nadroparina/administración & dosificación , Diálisis Renal , Adulto , Anciano , Creatinina/sangre , Estudios Cruzados , Factor Xa/análisis , Femenino , Hemoglobinas/análisis , Humanos , Inyecciones Intraarteriales , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Urea/sangre
16.
Intensive Crit Care Nurs ; 11(6): 341-3, 1995 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-8574086

RESUMEN

'Stuart had been with us in the ICU for 4 weeks; weaning attempts from his artificial ventilation were difficult, leaving him frightened, exhausted and despondent. Depression, hopelessness and apathy were beginning to take a hold on him ... until one day something changed everything. A way had been found to help him escape, temporarily, from his intensive care situation. Three days later Stuart was breathing spontaneously and was being prepared for discharge from the ICU.' In this paper potential benefits of reminiscence sessions with patients in a critical care unit are discussed. Background and context are reviewed, leading to some suggestions for practice.


Asunto(s)
Cuidados Críticos/psicología , Memoria , Terapia por Relajación , Estrés Psicológico/prevención & control , Humanos , Masculino , Estrés Psicológico/psicología
17.
J Mal Vasc ; 12 Suppl B: 108-10, 1987.
Artículo en Francés | MEDLINE | ID: mdl-2834480

RESUMEN

Anti-Xa and anti-IIa activity were evaluated in 42 patients with chronic renal insufficiency, in an open randomized trial, to determine optimal dose of PK 10169 for prevention of coagulation in extracorporeal circuit during hemodialysis sessions. PK 10169 was given as single doses of 0.75, 1 and 1.25 mg/kg at start of dialysis, into the arterial line. All dialysis sessions were continued over the 4 hours provided for without the need for further injections. A linear relation existed between anti-Xa and anti-IIa activity measured at end of dialysis and the dose injected (p less than 0.001). Efficacy and tolerance were assessed clinically and biologically and were rated excellent at the 3 dose levels, the best tolerance/efficacy ratio being at the 1 mg/kg dosage.


Asunto(s)
Heparina de Bajo-Peso-Molecular/administración & dosificación , Diálisis Renal , Adulto , Ensayos Clínicos como Asunto , Relación Dosis-Respuesta a Droga , Factor X/análisis , Factor X/antagonistas & inhibidores , Femenino , Humanos , Masculino , Protrombina/análisis , Protrombina/antagonistas & inhibidores , Distribución Aleatoria
18.
J Mal Vasc ; 12 Suppl B: 85-9, 1987.
Artículo en Francés | MEDLINE | ID: mdl-2834499

RESUMEN

Current evaluation of biological activity of low molecular weight heparins (LMWH) is dependent solely on technics determining Xa inhibition. Comparison of these technics was carried out during 2 studies of the use of CY 222 during hemodialysis. In the first study, 66 plasma samples from 11 patients treated with 200 or 250 U A Xa IC kg/i.v. at start of session (sample collections at 2-4 h) were tested using a chronometric technic (Hepaclot Stago-plasma diluted to 1/3) and 2 chromogenic technics on microplates using C.B.S. 31-39 substrates (Stachrom-modified Stago: incubation time 90" for a wide range) and S 2222 (Coatest-modified Kabi: incubation time 180"). In the second, 28 plasma samples from 7 patients (sample collection 2-4 h, TO following session; anticoagulation CY 222 10,000-15,000-20,000 U A Xa IC) were studied by 2 chronometric methods: Hepaclot (Stago) and Heptest (Hemachem). Standardization was with CY 222 in each case (results expressed as U A Xa IC). Mean blood heparin in the first study was 2.39 +/- 0.7 with Hepaclot, 2.50 +/- 0.55 with Stachrom and 1.94 +/- 0.37 with Coatest. Student's test failed to show any difference between results with Strachrom and Hepaclot (t = 1.48 NS) whereas the difference was very significant between Hepaclot and Coatest and Stachrom and Coatest (p less than 10(-9).(ABSTRACT TRUNCATED AT 250 WORDS)


Asunto(s)
Pruebas de Coagulación Sanguínea , Factor X/antagonistas & inhibidores , Heparina de Bajo-Peso-Molecular/farmacología , Diálisis Renal , Pruebas de Coagulación Sanguínea/métodos , Pruebas de Coagulación Sanguínea/normas , Heparina/sangre , Humanos
19.
J Prosthet Dent ; 55(1): 52-8, 1986 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-3456048

RESUMEN

Denar and Stuart pantographic tracings were obtained at 10 separate appointments with one patient. Twenty pantographic recordings were transferred to the Stuart fully adjustable articulator. One pantograph from each appointment was used to set the articulator. The second pantograph of each appointment was mounted on the articulator without altering the setting adjustments and compared to the first pantograph of the previous 10 sessions. Overlay tracings were generated on the articulator as a permanent record of how accurately the articulator had been set and to compare measurements to the nearest 0.1 mm. Each working and orbiting path tracing was measured at four locations with a total of 960 measurements. Paired and Student t tests determined statistically significant differences. Mean data showed a 0.007 mm difference between Stuart and Denar recordings and was not statistically significant. Of the 12 lines on each set of tracings, the right vertical working path revealed significant data. Of the 48 measuring sites, the right vertical working path and the left vertical orbiting path displayed noteworthy data.


Asunto(s)
Equipo Dental , Registro de la Relación Maxilomandibular , Mandíbula/fisiología , Articuladores Dentales , Humanos , Movimiento
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