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Fondaparinux, a clinically approved anticoagulant pentasaccharide for the treatment of thrombotic diseases, displays better efficacy and biosafety than other heparin-based anticoagulant drugs. However, there is no suitable antidote available for fondaparinux to efficiently manage its potential bleeding risks, thereby precluding its widespread use. Herein, we describe a convergent and stereocontrolled approach to efficiently synthesize an aminopentyl-functionalized pentasaccharide, which is further used to prepare fondaparinux-based biotin conjugates and clusters. Biological activity evaluation demonstrates that the anticoagulant activity of the fondaparinux-based biotin conjugate and trimer is, respectively, neutralized by avidin and protamine as effective antidotes. This work suggests that our synthetic biotin conjugate and trimer have potential for the development of neutralizable and safe anticoagulant drugs.
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http://dx.doi.org/10.1021/jacsau.2c00537 | DOI Listing |
BMJ Open
September 2025
Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Introduction: The management of bleeding and coagulation after total knee arthroplasty (TKA) has long been recognised as a significant challenge for orthopaedic surgeons. Despite the notable success of empirical anticoagulation in preventing venous thromboembolism (VTE) following TKA, the increased risk of postoperative bleeding has also raised extensive concern. Ecchymosis, as one of the most common manifestations indicating postoperative bleeding, holds the potential to indicate the balance of bleeding and hypercoagulation.
View Article and Find Full Text PDFThromb Res
September 2025
Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany. Electronic address:
Warfarin is a widely used vitamin K antagonist (VKA) with known pleiotropic effects beyond anticoagulation. Preclinical and case-control evidence suggests that warfarin may affect hematopoiesis, but longitudinal human evidence is lacking. To explore this potential effect, we conducted a post-hoc analysis of participants in the Hokusai-VTE and ENGAGE AF-TIMI 48 trials, which randomized patients to warfarin or the direct oral anticoagulant edoxaban with routine laboratory testing at predefined follow-up visits.
View Article and Find Full Text PDFJAMA Netw Open
September 2025
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock.
Importance: Patients with kidney failure (KF) receiving long-term dialysis have increased incidence of atrial fibrillation (AF). Patients with KF and AF have increased risk of stroke, death, and bleeding compared with age-matched cohorts. In KF, the use of oral anticoagulants (OACs) increases hemorrhage risk, offsetting potential benefits and making left atrial appendage occlusion (LAAO) a potentially promising solution for risk reduction in AF.
View Article and Find Full Text PDFInt J Pharm Pract
September 2025
Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Suthep Road, Suthep, Mueang, Chiang Mai 50200, Thailand.
Objectives: Proton pump inhibitors (PPIs) are commonly used among these patients to prevent upper gastrointestinal bleeding (UGIB) in anticoagulated patients. However, their clinical benefits among patients receiving OACs with a history of UGIB remain inconclusive. This study aimed to summarize the clinical benefits of PPIs for the secondary prevention of recurrent UGIB among patients using OACs.
View Article and Find Full Text PDFBackground: This study aimed to evaluate the predictive value of combining the Padua score with D-dimer levels for identifying lower extremity deep vein thrombosis (DVT) in acute ischemic stroke (AIS) patients undergoing intravenous thrombolysis with alteplase.
Methods: This retrospective study analyzed clinical data from 632 AIS patients who received alteplase treatment at our hospital between September 2019 and October 2023. After applying strict inclusion and exclusion criteria, a total of 172 patients were included in the analysis: 35 patients in the DVT group and 137 patients in the non-DVT group.