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dabigatran, rivaroxaban, apixaban

Luke S Howard
Acute pulmonary embolism (PE) is a relatively common cardiopulmonary emergency that is a major cause of hospitalization and morbidity and is the primary cause of mortality associated with venous thromboembolism (VTE). During the last decade, one of the biggest changes in the management of PE has been the approval of four non-vitamin K antagonist oral anticoagulants (NOACs; apixaban, dabigatran, edoxaban and rivaroxaban) for the treatment of PE and deep vein thrombosis and secondary prevention of VTE. Areas covered: This article reviews the evolving management of PE in the NOAC era and addresses three fundamental questions: who should receive NOACs over conventional heparin/vitamin K antagonist regimens for the treatment of acute PE; whether patients should be treated as inpatients or outpatients; and how long patients should be treated to reduce the risk of recurrence? Expert commentary: The management of PE is changing...
March 15, 2018: Expert Review of Respiratory Medicine
Sophie Testa, Oriana Paoletti, Cristina Legnani, Claudia Dellanoce, Emilia Antonucci, Benilde Cosmi, Vittorio Pengo, Daniela Poli, Rossella Morandini, Roberto Testa, Armando Tripodi, Gualtiero Palareti
BACKGROUND: Direct oral anticoagulants(DOACs) are administered at fixed dose without need for dose adjustment by lab testing. A high inter-individual variability in the drug blood levels was shown with all DOACs. To evaluate a possible relationship between DOAC C-trough anticoagulant levels and thromboembolic events,565 consecutivenaïve patients withatrial fibrillation (AF), were enrolled in this study performed within the START-Laboratory Registry. METHODS: DOAC specific measurements [diluted thrombin time (dTT) or anti-FIIa calibrated for dabigatran; anti-FXa calibrated for rivaroxaban or apixaban] at C-trough were performed locally at steady state within 15-25 days from starting treatment...
March 12, 2018: Journal of Thrombosis and Haemostasis: JTH
Amihai Rottenstreich, Netanel Zacks, Geffen Kleinstern, Bruria Hirsh Raccah, Batia Roth, Nael Da'as, Yosef Kalish
The role of drug-level monitoring among patients using direct-acting oral anticoagulant (DOAC) is unclear. We aimed to investigate its 'real-life' utilization and effect on clinical management. A review of records of patients who underwent DOAC level testing during 2013-2017. Overall, 212 patients (median age 77 years) underwent 292 DOAC measurements [apixaban (n = 147), rivaroxaban (n = 102), dabigatran (n = 43)]. Monitoring volume increased by 460% during study period. DOAC level testing was performed during routine follow-up in 51 (17...
March 12, 2018: Journal of Thrombosis and Thrombolysis
John Burn, Munir Pirmohamed
About 1.4 British million people are at risk of strokes due to non-valvular atrial fibrillation (AF) necessitating long-term anticoagulation. The vitamin K antagonist, warfarin, has a long half-life and narrow therapeutic range necessitating regular monitoring and is a common cause of iatrogenic hospital admission. Direct-acting oral anticoagulants (DOACs), dabigatran, rivaroxaban, apixaban and edoxaban are not required to have monitoring but are sensitive to changes in renal function and are associated with poorer adherence...
2018: Open Heart
Andrew Bromley, Anna Plitt
Venous thromboembolism (VTE), which includes both deep vein thrombosis and pulmonary embolism (PE), is a very common disorder with high risk for recurrence and is associated with significant morbidity and mortality. The non-vitamin K oral anticoagulants (NOACs), which include dabigatran, rivaroxaban, apixaban, and edoxaban, have been shown to be noninferior to conventional anticoagulant therapy for the prevention of recurrent VTE and are associated with more favorable bleeding risk. Evidence from the treatment of VTE with traditional therapy (low molecular weight heparin and vitamin K antagonists) implies that extended or indefinite treatment reduces risk of recurrence...
March 10, 2018: Cardiology and Therapy
Jordanne Feldberg, Param Patel, Ashley Farrell, Sylvia Sivarajahkumar, Karen Cameron, Jennifer Ma, Marisa Battistella
Background: There is a lack of clear benefit and a potential risk of bleeding with direct oral anticoagulant (DOAC) use in chronic kidney disease (CKD) and dialysis patients with atrial fibrillation. The objective of this study was to evaluate how treatment with DOACs affects stroke and bleeding outcomes compared with warfarin or aspirin. Methods: We conducted a systematic review of randomized controlled trials, cohort studies and case series, and searched electronic databases from 1946 to 2017...
March 2, 2018: Nephrology, Dialysis, Transplantation
Maja Hellfritzsch, Lotte Rasmussen, Jesper Hallas, Anton Pottegård
INTRODUCTION: Knowledge on adverse effects (AEs) related to non-vitamin K antagonist oral anticoagulants (NOACs) in real-world populations is sparse. OBJECTIVE: Our objective was to identify signals of potential AEs in patients with atrial fibrillation (AF) initiating NOAC treatment using a hypothesis-free screening approach. METHODS: Using the nationwide Danish registries, we identified patients with AF initiating dabigatran, rivaroxaban, or apixaban between 2011 and 2015 (n = 50,627)...
March 1, 2018: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
Nicholas Farina, James T Miller
Direct oral anticoagulants are becoming increasingly popular in outpatient use. These medications have lacked specific reversal agents. However, this is changing. The Federal Food and Drug Administration approved idarucizumab for reversal of dabigatran in 2016, and another agent, andexanet alfa, is currently in clinical trials for reversal of rivaroxaban and apixaban. This article examines the efficacy and safety of these emerging reversal agents, as well as other historical agents for reversal of direct oral anticoagulants...
April 2018: Critical Care Nursing Quarterly
Nazarena Cataldo, Valeria Pegoraro, Claudio Ripellino, Valentino Bertasi, Roberta Di Turi, Maurizio Pastorello, Marco Gambera
Riassunto. Il presente studio intende confrontare il rischio di non persistenza e l'utilizzo delle risorse sanitarie nei pazienti con fibrillazione atriale non valvolare (FANV) naïve al trattamento con antagonisti della vitamina K (AVK) o con nuovi anticoagulanti orali (NAO). Partendo dai database amministrativi di cinque ASL italiane, sono stati selezionati e inclusi nello studio tutti i pazienti con almeno una dimissione ospedaliera per FANV dal 2011 al 2014. Tra questi, i nuovi utilizzatori di AVK o NAO nel 2014 sono stati identificati e seguiti a partire dalla data della prima prescrizione al verificarsi di uno qualsiasi dei seguenti eventi: interruzione della terapia superiore a 90 giorni, passaggio o aggiunta di una molecola differente rispetto a quella prescritta alla data indice, morte del paziente, fine del follow-up (dicembre 2015)...
February 2018: Recenti Progressi in Medicina
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
José Francisco Kerr Saraiva
Atrial fibrillation (AF) is an established risk factor for a first or recurrent stroke. Despite proven efficacy in preventing stroke in patients with AF, warfarin is underused, partly due to safety concerns. Recent randomized trials have shown that non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran (a direct thrombin inhibitor) and apixaban, edoxaban, and rivaroxaban (factor Xa inhibitors) are not only non-inferior or superior to warfarin but also demonstrate a decreased risk of cerebrovascular bleeding among patients with AF and moderate to high risk of stroke...
February 27, 2018: Cardiology and Therapy
Jackie Pratt, Philip Crispin
OBJECTIVES: To evaluate the dilute Russell viper venom time (DRVVT) for the detection of direct-acting oral anticoagulants (DOACs) and to investigate the effect of DOACS on coagulation assays. METHODS: Patients on DOACs and controls had plasma levels determined by an anti-Xa assay and dilute thrombin clotting time. Levels were correlated with the DRVVT as well as thrombin clotting time (TCT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, protein C, protein S and antithrombin levels...
February 27, 2018: European Journal of Haematology
Carolin Hoyer, Alexandra Filipov, Eva Neumaier-Probst, Kristina Szabo, Anne Ebert, Angelika Alonso
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) have gained increasing importance for stroke prevention in patients with non-valvular atrial fibrillation (AF). With changing prescription practice, among other factors, clinicians can expect to see rising numbers of patients with ischemic stroke and pre-existing NOAC therapy. Few data exist regarding a potential impact of NOAC on stroke severity and outcome. AIMS: To evaluate the impact of pre-admission NOAC therapy on ischemic stroke severity...
February 23, 2018: Journal of Thrombosis and Thrombolysis
Daniel Caldeira, Raquel Rodrigues, Daisy Abreu, Ana Marta Anes, Mário M Rosa, Joaquim J Ferreira
OBJECTIVE: In this pharmacovigilance study, we aimed to determine the incidence of spontaneously reported suspected adverse drug reactions (ADRs) related to oral anticoagulants: non-vitamin K antagonist oral anticoagulants (NOACs; apixaban, dabigatran, edoxaban, rivaroxaban) and vitamin K antagonists (VKA) Research design and methods: In this retrospective observational study, we extracted all the individual case safety reports related to oral anticoagulants recorded in the Portuguese Pharmacovigilance Database (January 2010 to April 2015)...
February 20, 2018: Expert Opinion on Drug Safety
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
Robert C Gosselin, Dorothy M Adcock, Shannon M Bates, Jonathan Douxfils, Emmanuel J Favaloro, Isabelle Gouin-Thibault, Cecilia Guillermo, Yohko Kawai, Edelgard Lindhoff-Last, Steve Kitchen
This guidance document was prepared on behalf of the International Council for Standardization in Haematology (ICSH) for providing haemostasis-related guidance documents for clinical laboratories. This inaugural coagulation ICSH document was developed by an ad hoc committee, comprised of international clinical and laboratory direct acting oral anticoagulant (DOAC) experts. The committee developed consensus recommendations for laboratory measurement of DOACs (dabigatran, rivaroxaban, apixaban and edoxaban), which would be germane for laboratories assessing DOAC anticoagulation...
February 12, 2018: Thrombosis and Haemostasis
Nathan A Franklin, Ashley Ali, Richard K Hurley, Hassan R Mir, Michael J Beltran
OBJECTIVE: Evaluate the pre-hospital use of Direct Oral Anticoagulant (DOAC) agents on the outcomes of early surgical fixation of a geriatric hip fracture. DESIGN: Case-Control. SETTING: Two academic level 1 trauma centers. INTERVENTION: Early (<48h) surgical fixation of a geriatric proximal femur fracture. PATIENTS: 19 patients receiving Pradaxa (Dabigatran), Eliquis (Apixaban), or Xarelto (Rivaroxaban) who underwent surgery between 2010 and 2015 and 74 control patients...
February 9, 2018: Journal of Orthopaedic Trauma
Oliver Königsbrügge, Günter Weigel, Peter Quehenberger, Ingrid Pabinger, Cihan Ay
The effect of direct oral anticoagulants (DOACs) on turbidimetric measurements of plasma clot formation and susceptibility to fibrinolysis may facilitate a comparison between different classes of anticoagulants in plasma samples. We obtained 424 citrate plasma samples from 226 atrial fibrillation patients on anticoagulation and 24 samples without anticoagulation serving as controls. As comparators, we measured the international normalized ratio (INR) for phenprocoumon samples (N = 166), anti-Xa for low molecular weight heparin (LMWH) samples (N = 42), and DOAC levels with mass spectrometry (dabigatran N = 40, rivaroxaban N = 110, apixaban N = 42)...
February 7, 2018: Clinical and Experimental Medicine
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
Jan Beyer-Westendorf
Venous thromboembolism (VTE) remains a substantial clinical and health-economic burden worldwide and effective anticoagulant treatment is necessary immediately after VTE is suspected to reduce short- and long-term VTE related morbidity and mortality. For decades, low molecular weight heparin (LMWH), fondaparinux and Vitamin K antagonists (VKAs) have been the standard of anticoagulant therapy for VTE patients but these treatment options had clinically relevant drawbacks and limitations. The introduction of non-VKA oral anticoagulants (NOACs) that specifically inhibit either thrombin or factor Xa have resolved many of these drawbacks because these new compounds exhibit a rapid onset and offset of action, fewer food and drug interactions and a predictable anticoagulant effect...
January 26, 2018: Thrombosis Research
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