Browsing by Subject "Anticoagulant"

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    Clinical profile and prognosis in patients on oral anticoagulation before admission for COVID-19
    (Wiley, 2020) Rivera-Caravaca, José Miguel; Núñez-Gil, Iván J.; Vivas, David; Viana-Llamas, María C.; Uribarri, Aitor; Becerra-Muñoz, Víctor Manuel; Trabattoni, Daniela; Fernández Rozas, Inmaculada; Feltes, Gisela; López-Pais, Javier; El-Battrawy, Ibrahim; Macaya, Carlos; Fernández-Ortiz, Antonio; Estrada, Vicente; Marín Ortuño, Francisco; Enfermería
    Background: The coronavirus disease 2019 (COVID-19) shows high morbidity and mortality, particularly in patients with concomitant cardiovascular diseases. Some of these patients are under oral anticoagulation (OAC) at admission, but to date, there are no data on the clinical profile, prognosis and risk factors of such patients during hospitalization for COVID-19. Design: Subanalysis of the international ‘real-world’ HOPE COVID-19 registry. All patients with prior OAC at hospital admission for COVID-19 were suitable for the study. All-cause mortality was the primary endpoint. Results: From 1002 patients included, 110 (60.9% male, median age of 81.5 [IQR 75-87] years, median Short-Form Charlson Comorbidity Index [CCI] of 1 [IQR 1-3]) were on OAC at admission, mainly for atrial fibrillation and venous thromboembolism. After propensity score matching, 67.9% of these patients died during hospitalization, which translated into a significantly higher mortality risk compared to patients without prior OAC (HR 1.53, 95% CI 1.08-2.16). After multivariate Cox regression analysis, respiratory insufficiency during hospitalization (HR 6.02, 95% CI 2.18-16.62), systemic inflammatory response syndrome (SIRS) during hospitalization (HR 2.29, 95% CI 1.34-3.91) and the Short-Form CCI (HR 1.24, 95% CI 1.03-1.49) were the main risk factors for mortality in patients on prior OAC. Conclusions: Compared to patients without prior OAC, COVID-19 patients on OAC therapy at hospital admission showed lower survival and higher mortality risk. In these patients on OAC therapy, the prevalence of several comorbidities is high. Respiratory insufficiency and SIRS during hospitalization, as well as higher comorbidity, pointed out those anticoagulated patients with increased mortality risk.
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    Conformational activation of antithrombin by heparin involves an altered exosite interaction with protease
    (Elsevier; American Society for Biochemistry and Molecular Biology, 2014-12-05) Águila Martínez, Sonia; Izaguirre, Gonzalo; Qi, Lixin; Swanson, Richard; Roth, Ryan; Rezaie, Alireza R.; Gettins, Peter G. W.; Olson, Steven T.; Medicina Interna
    Background: Exosites are known to mediate heparin allosteric activation of antithrombin. Results: Mutagenesis revealed that an exosite differentially contributes to antithrombin reactivity with factors Xa/IXa in unactivated and heparin-activated states. Conclusion: Heparin allosteric activation of antithrombin results from alterations in an exosite interaction with protease induced by core conformational changes. Significance: The findings support our recently proposed model of antithrombin allosteric activation.