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Novel oral anticoagulant

Tawseef Dar, Mohit K Turagam, Bharath Yarlagadda, Mohmad Tantary, Seth H Sheldon, Dhanunjaya Lakkireddy
Left atrial appendage closure (LAAC) has emerged as a viable option for stroke prevention, especially in those intolerant of or not suitable for long-term oral anticoagulation therapy. This article describes the clinical characteristics, indications, and a proposed referral system for potential LAAC patients. Patient selection remains a challenge because of the paradox between the available randomized data on this intervention and the actual patient population who may gain maximum benefit. Further investigations comparing different LAAC devices with each other and with novel oral anticoagulants are needed...
April 2018: Interventional Cardiology Clinics
Ikjae Lee, Hani Kushlaf
INTRODUCTION: The aim of this study was to evaluate needle electromyography (EMG) practice patterns among electromyographers in patients taking novel oral anticoagulants (NOACs). METHODS: A survey questionnaire was sent to members of the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) via email weblink. Anonymous survey responses were collected through an online website. RESULTS: 58 AANEM members responded, 28 (48%) of whom worked at a teaching hospital and 30 (52%) in a private setting...
March 6, 2018: Muscle & Nerve
Vinayak Nagaraja, Greg Cranney, Virag Kushwaha
In the prevention and treatment of thromboembolic disease, novel oral anticoagulants have emerged as alternatives to warfarin. A major challenge continues to be the reversal of their anticoagulant effect in the case of life-threatening haemorrhagic complications. We report a case of spontaneous splenic rupture treated by splenic artery embolisation in a 77-year-old woman who was anticoagulated with rivaroxaban.
March 5, 2018: BMJ Case Reports
Margaret Smith, Glenn Wakam, Thomas Wakefield, Andrea Obi
Anticoagulation pharmacy has been dramatically altered with US Food and Drug Administration (FDA) approval of 5 direct oral anticoagulants, 1 novel reversal agent and, a second designated for fast-track approval. Trial data surrounding current trends in anticoagulant choice for VTE, reversal, and bridging are constantly redefining practice. Extended therapy for unprovoked VTE has expanded to include low-dose direct oral anticoagulants, aspirin, and the use of the HERDOO2 system to identify women who can stop anticoagulant therapy without increased risk of recurrent VTE...
April 2018: Surgical Clinics of North America
Kevin Fortier, Deepti Shroff, Uday N Reebye
BACKGROUND: Dabigatran, rivaroxaban, apixaban and edoxaban are approved novel oral anticoagulants (NOACs) as alternatives to Vitamin K antagonists (VKA). Physicians are prescribing an ever-increasing amount these drugs to their patients due to various advantages over existing medications. AIMS: The objective of this review is to provide the dental professional with current literature surrounding the emergence of NOACs, as well as various case studies on the subject, in an effort to guide clinical decision making regarding these medications...
February 28, 2018: Gerodontology
Tawseef Dar, Bharat Yarlagadda, James Vacek, Buddhadeb Dawn, Dhanunjaya Lakkireddy
Background: Bleeding complications especially gastrointestinal bleeding remains a major challenge associated with oral anticoagulation therapy (OAT) and often leads clinicians to withdraw oral anticoagulation therapy (OAT) . This exposes patients to risk of stroke and systemic thromboembolism (STE). Novel oral anticoagulants (NOACs) have proved no better when it comes to bleeding events and in fact studies have shown that overall NOACs are associated with higher incidence of gastrointestinal (GI) bleeding compared to warfarin ...
December 2017: Journal of Atrial Fibrillation
Hany S Abed, Michael J Kilborn, Vivien Chen, Raymond W Sy
The incidence and prevalence of atrial fibrillation (AF) is expected to more than double between 2010 and 2030. Accordingly, the use of non-vitamin K oral anticoagulant (NOAC) agents for thromboembolic stroke prevention is anticipated to increase. The development of effective and safe antidotes is needed to address the unmet need for rapid anticoagulation reversal. The immediate role for these novel antidotes is for reversal of NOAC activity in life threatening bleeding and urgent surgical intervention. In addition, reversal agents may play an important role in simplifying bridging protocols in the peri-procedural period for catheter ablation of AF and elective surgery...
December 2017: Journal of Atrial Fibrillation
Ali Khoynezhad
Stroke remains a major complication of atrial fibrillation and third leading cause of death in Western Countries. [1] While Coumadin and novel oral anticoagulants have been efficient in reducing the stoke risk in patients with atrial fibrillation; there is a subset of patients who are not candidates for anticoagulation.[2] The management of these patients is clinical challenge.We describe a patient with history of permanent atrial fibrillation with contra-indication to anticoagulation presenting with and left atrial thrombus...
December 2017: Journal of Atrial Fibrillation
Xuefeng Hu, Ying Xiao, Chuan Yu, Yinglin Zuo, Wen Yang, Xinan Wang, Baohua Gu, Jing Li
Factor Xa (FXa) is a serine protease that plays key roles in linking the intrinsic and extrinsic coagulation pathways to the final common pathway. DJT06001 is an oral, highly specific and direct FXa inhibitor for the prevention and treatment of thromboembolic diseases. We characterized the compound in vitro and studied its in vivo activity in rat thrombosis models, as well as bleeding risk and Pharmacokinetics and Pharmacodynamics (PK/PD) relationship. DJT06001 inhibited free FXa with an inhibitory constant (Ki) of 0...
February 21, 2018: European Journal of Pharmacology
Anna Patrignani, Giorgia Palmieri, Nino Ciampani, Vincenzo Moretti, Antonio Mariani, Lucia Racca
BACKGROUND: Spontaneous reporting system is the most widely used method by pharmacovigilance centers. Its "voluntary nature" represents the main cause of adverse drug reaction (ADR) under-reporting phenomena. The aim of this study was to point out the issue of ADR under-reporting from doctors, particularly serious ADRs and adverse reactions caused by medicinal products subject to additional monitoring, such as novel oral anticoagulants (NOACs). METHODS: Only serious ADRs were analyzed, defined as death, life-threatening ADR, hospitalization (initial or prolonged), disability (significant or permanent), congenital anomaly...
January 2018: Giornale Italiano di Cardiologia
Olga Jelonek, Iwona Gorczyca, Michał Bączek, Paweł Kośmider, Beata Wożakowska-Kapłon
BACKGROUND: Prevention of thromboembolic complications is a priority in patients with atrial fibrillation (AF). The use of non-vitamin K antagonist oral anticoagulants (novel oral anticoagulants, NOAC) is more common, and some patients have indications for a reduced dose of NOAC. AIM: The aim of the study was to evaluate the frequency of NOACs being prescribed to AF patients and to compare the groups of AF patients receiving standard and reduced doses of NOACs. METHODS: The study was conducted in a population of 1,327 patients diagnosed with AF and hospitalized at an institution of the highest referral level in cardiology in years 2015-2016...
February 14, 2018: Kardiologia Polska
Adelina-Mihaela Sorescu, Tudor Enache, Suzana Guberna
Background and aims: Few studies discuss the prevalence of oral anticoagulation therapy (OAT) in clinical practice, despite their increasing use worldwide. In America, studies established that 20% to 80% of the patients with indication benefit from OAT. In Romania, there is no data regarding the utilization of oral anticoagulants. Thus, this study aims to determine the trends of OAT. Methods: We designed a cross-sectional study of the patients admitted to the Cardiology Department of the "Bagdasar-Arseni" Clinical Emergency Hospital, Bucharest, from the 1st of November 2016 until the 31st of January 2017...
2018: Clujul Medical (1957)
Janice J C Cheung, Shasha Liu, Kenneth K W Li
INTRODUCTION: An increasing number of patients are taking novel oral anticoagulant (NOAC) medication, making perioperative management in phacoemulsification surgery an important issue. This study reports the haemorrhagic complications of NOAC in phacoemulsification surgery. DESIGN: Retrospective case study over a 4-year period. METHODS: Consecutive cases receiving NOAC during the time of phacoemulsification were reviewed. Patients were either advised to continue medications (continued group) or withhold medications before surgery (withheld group)...
February 13, 2018: International Ophthalmology
Tetsuaki Shoji, Hidenori Mizugaki, Yasuyuki Ikezawa, Megumi Furuta, Yuta Takashima, Hajime Kikuchi, Houman Goudarzi, Hajime Asahina, Junko Kikuchi, Eiki Kikuchi, Jun Sakakibara-Konishi, Naofumi Shinagawa, Ichizo Tsujino, Masaharu Nishimura
This report describes the case of a 66-year-old man with non-small cell lung cancer and venous thromboembolism (VTE). Unfractionated heparin (UFH) was initially used to control VTE before chemotherapy. However, switching UFH to warfarin or edoxaban, a novel oral anticoagulant (NOAC), failed. Chemotherapy was then administered to control the tumor which was thought to have been the main cause of VTE, which had been treated by UFH. After tumor shrinkage was achieved by chemotherapy, we were able to successfully switch from UFH to edoxaban...
February 9, 2018: Internal Medicine
O W Bjerrum, J Samuelsson, W Ghanima, M Kauppila, C L Andersen
BACKGROUND: Patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) have higher risks of developing thromboembolisms compared to the general population. International guidelines on the management of MPNs therefore include recommendations concerning thromboembolism prophylaxis. In clinical practice strict adherence to guidelines may be challenging and dependent on factors such as physician experience, outpatient clinic setting and access to therapy, however, no data exist on physician adherence or patient compliance to thromboembolism prophylaxis in MPNs...
February 10, 2018: European Journal of Haematology
Farzaneh Ashrafi, Najmeh Rezaie, Sarah Mousavi
Objective: Dabigatran etexilate is a novel oral anticoagulant with several advantages over warfarin such as no need for routine monitoring and fewer drug interactions. This drug was added to our hospital's formulary in 2012. The objective of this study was to assess the rational drug use of dabigatran at a large teaching hospital. Methods: A prospective cross-sectional study was performed from November to June 2015 at Alzahra teaching hospital, Isfahan, Iran. All patients who received at least one dose of dabigatran were eligible for inclusion...
October 2017: Journal of Research in Pharmacy Practice
Zhouling Xie, Yongbing Tian, Xiao Lv, Xuan Xiao, Meimiao Zhan, Kai Cheng, Shiyu Li, Chenzhong Liao
Anticoagulants have exhibited a critical role in the prevention and/or treatment of thrombotic diseases. Up to now, kinds of novel oral anticoagulants, inhibiting plasma serine proteases in the coagulation cascade, have been developed to overcome the clinical limitations of classical anticoagulants (like warfarin and heparins). Some of them, such as Apixaban, Rivaroxaban, Edoxaban, and Dabigatran, have been approved by FDA in recent years. This review summarizes the discovery and optimization of representative novel oral anticoagulants with the aim to improve selectivity and bioavailability of compounds...
February 25, 2018: European Journal of Medicinal Chemistry
Shannon M Fernando, Peter M Reardon, Dar Dowlatshahi, Shane W English, Kednapa Thavorn, Peter Tanuseputro, Jeffrey J Perry, Erin Rosenberg, Eelco F Wijdicks, Daren K Heyland, Kwadwo Kyeremanteng
OBJECTIVES: Spontaneous intracranial hemorrhage, including subarachnoid hemorrhage and intracerebral hemorrhage, is associated with significant morbidity and mortality. Although many of these patients will require ICU admission, little is known regarding their outcomes and the costs incurred. We evaluated this population in order to identify outcomes and cost patterns. DESIGN: Retrospective cohort analysis of a health administrative database. SETTING: Two ICUs within a single hospital system...
February 5, 2018: Critical Care Medicine
Gert J van der Wilt, Janneke P C Grutters, Angela H E M Maas, Herbert J A Rolden
BACKGROUND: The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs...
February 5, 2018: BMC Medical Ethics
David J Seiffge, Georg Kägi, Patrik Michel, Urs Fischer, Yannick Béjot, Susanne Wegener, Marialuisa Zedde, Guillaume Turc, Charlotte Cordonnier, Peter S Sandor, Gilles Rodier, Andrea Zini, Manuel Cappellari, Sabine Schädelin, Alexandros A Polymeris, David Werring, Sebastian Thilemann, Ilaria Maestrini, Eivind Berge, Christopher Traenka, Jochen Vehoff, Gian Marco De Marchis, Monika Kapauer, Nils Peters, Gaia Sirimarco, Leo H Bonati, Marcel Arnold, Philippe A Lyrer, Emmanuel De Maistre, Andreas Luft, Dimtrios A Tsakiris, Stefan T Engelter
OBJECTIVE: Information about Rivaroxaban plasma levels (RivLev) may guide treatment decisions in patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) taking rivaroxaban. METHODS: In a multicenter registry-based study (Novel-Oral-Anticoagulants-In-Stroke-Patients collaboration;NOACISP; of patients with stroke while taking rivaroxaban, we compared RivLev in patients with AIS and ICH. We determined how many AIS-patients had RivLev≤100ng/ml, indicating possible eligibility for thrombolysis and how many ICH-patients had RivLev≥75ng/ml, possibly eligible for the use of specific reversal agents...
February 2, 2018: Annals of Neurology
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