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Anne-Laure Sennesael, Nadtha Panin, Christelle Vancraeynest, Lionel Pochet, Anne Spinewine, Vincent Haufroid, Laure Elens
Direct oral anticoagulants (DOAC) are substrates for the ABCB1 transporter (also called P-glycoprotein), an active efflux pump. ABCB1 polymorphisms have been previously reported to influence the pharmacokinetics of several drugs such as immunosuppressants and tyrosine kinase inhibitors. Recently, in vivo studies have suggested that genetic variants might contribute to the inter-individual variability in DOAC plasma concentrations. Therefore, we evaluated the in vitro effect of the most common coding ABCB1 single nucleotide polymorphisms (SNP), 1236 C > T-2677G > T-3435C > T, and the coding ABCB1 1199 G > A SNP on the transport activity towards rivaroxaban...
July 12, 2018: Scientific Reports
Vittorio Pengo, Gentian Denas, Giacomo Zoppellaro, Seena Padayattil Jose, Ariela Hoxha, Amelia Ruffatti, Laura Andreoli, Angela Tincani, Caterina Cenci, Domenico Prisco, Tiziana Fierro, Paolo Gresele, Arturo Cafolla, Valeria De Micheli, Angelo Ghirarduzzi, Alberto Tosetto, Anna Falanga, Ida Martinelli, Sophie Testa, Doris Barcellona, Maria Gerosa, Alessandra Banzato
Rivaroxaban is an effective and safe alternative to warfarin in patients with atrial fibrillation and venous thromboembolism. We tested the efficacy and safety of rivaroxaban as compared to warfarin in high-risk patients with thrombotic Antiphospholipid Syndrome. This is a randomized, open-label, multicenter, non-inferiority study with blinded end-point adjudication. Rivaroxaban 20 mg once daily (15 mg once daily based on kidney function) was compared to warfarin (INR target 2.5), for the prevention of thromboembolic events, major bleeding and vascular death in patients with Antiphospholipid Syndrome...
July 12, 2018: Blood
Tomoyuki Naito, Hiroki Hayashi, Takeru Kashiwada, Yoshinobu Saito, Shinji Abe, Kaoru Kubota, Akihiko Gemma
A 41-year-old woman presented complaining of cough and purpura for one month. On her first visit, a blood test demonstrated peripheral blood eosinophilia, but chest radiography showed no abnormalities. However, 2 days after the first visit, she went to the emergency room because of fever and right-sided chest pain. Contrast-enhanced computed tomography of the chest showed pulmonary embolism and air space consolidation. Thrombosis was present in the popliteal vein. Bronchoscopy revealed alveolar hemorrhage and increased eosinophils in the bronchoalveolar lavage fluid, and a skin biopsy demonstrated a perivascular eosinophilic infiltrate...
2018: Respiratory Medicine Case Reports
Cheng-Ta Wu, Bradley Chen, Jun-Wen Wang, Shih-Hsiang Yen, Chung-Cheng Huang
BACKGROUND: Venous thromboembolism (VTE) is a serious complication following total joint replacement. The use of rivaroxaban, a highly selective and direct factor Xa inhibitor, has been used widely as a safe and efficacious way to prevent VTE after total joint replacements. However, little is known about the diagnostic efficacy of plasma D-dimer test on deep vein thrombosis (DVT) in patients using rivaroxaban for thromboprophylaxis. The study is aimed to investigate the trend and the diagnostic efficacy of D-dimer test on DVT in patients with primary total knee arthroplasty (TKA) using rivaroxaban for thromboprophylaxis...
July 11, 2018: Journal of Orthopaedic Surgery and Research
Udit Bhaskar Bhatnagar, Josh Rezkalla, Prince Sethi, Adam Stys
Left ventricular (LV) thrombus is a major complication of acute systolic cardiomyopathy especially after a large anterior myocardial infarction (AMI), and it poses a significant embolic risk, up to five times higher than the general population. Current guidelines for LV thrombi recommend vitamin K antagonist for anticoagulation in contrast to novel oral anticoagulants (NOACs) which have not been studied well in cases of LV thrombus. We present a case of patient with AMI, who was noted to have severe systolic dysfunction and a large LV thrombus which was successfully treated with rivaroxaban therapy with complete resolution of LV thrombus on two months follow-up...
February 2018: South Dakota Medicine: the Journal of the South Dakota State Medical Association
Donal J Sexton, Declan G de Freitas, Mark A Little, Tomas McHugh, Colm Magee, Peter J Conlon, Conall M O'Seaghdha
We report 2 cases of apixaban use as prophylaxis against thromboembolism in the nephrotic syndrome (NS), and review the existing literature on direct-acting oral anticoagulant (DOAC) use in this scenario. Our cases appear to be the first reported use of apixaban as prophylaxis against thromboembolism in NS. We report our systematic review of the existing literature on direct-acting oral anticoagulant (DOAC) use in NS, and discuss theoretical issues relevant to their therapeutic use in this clinical scenario...
July 2018: KI Reports
Joseph Naoum, Amani Mohsen, Jihad Daher, Toufic Eid
Ovarian vein thrombosis (OVT) is a rare serious diagnosis especially if extending to inferior vein cava (IVC). We present a case of 36-year- old female who was diagnosed with right OVT reaching the inferior vein cava following a supra-cervical hysterectomy that was performed in the postpartum period due to excessive bleeding from uterine fibroids. Using the new generation anti-coagulant "rivaroxaban" for six months followed by maintenance regimen of aspirin and sulodexide, complete resolution of the clot was noticed without any adverse event while using this regimen...
July 2018: Saudi Pharmaceutical Journal: SPJ: the Official Publication of the Saudi Pharmaceutical Society
Kathrin I Foerster, Andrea Huppertz, Andreas D Meid, Oliver J Müller, Timolaos Rizos, Lisa Tilemann, Walter E Haefeli, Jürgen Burhenne
Plasma concentrations of direct oral anticoagulants (DOAC) vary largely between individuals, while they correlate well with desired and adverse outcomes. Although regular concentration monitoring of DOAC is not recommended, information on DOAC exposure could be useful in situations, when multiple DOAC clearance pathways are impaired or non-adherence is suspected. Self-sampling techniques, like dried blood spots (DBS), would be particularly useful because they enable collecting information in ambulatory patients at relevant points in time of the dosing interval (e...
July 9, 2018: Analytical Chemistry
Agnieszka Janion-Sadowska, Elżbieta Papuga-Szela, Robert Łukaszuk, Magdalena Chrapek, Anetta Undas
AIMS: Thrombocytopenia was one of the exclusion criteria in randomized trials in which non-vitamin K antagonist oral anticoagulants (NOACs) were tested. The safety of NOACs in patients with atrial fibrillation (AF) and thrombocytopenia remains unclear. METHODS: We studied 62 AF patients aged from 53 to 85 (mean 70.5) years with platelet count from 50 to 100×109/L who were treated with rivaroxaban 15 mg once daily (33.9%), dabigatran 110 mg bid (54.8%) or apixaban 2...
June 27, 2018: Journal of Cardiovascular Pharmacology
Shinichiro Uchiyama, Hirotsugu Atarashi, Hiroshi Inoue, Takanari Kitazono, Takeshi Yamashita, Wataru Shimizu, Takanori Ikeda, Masahiro Kamouchi, Koichi Kaikita, Koji Fukuda, Hideki Origasa, Hiroaki Shimokawa
The EXPAND Study examined the real-world efficacy and safety of rivaroxaban for the prevention of stroke and systemic embolism (SE) in Japanese patients with non-valvular atrial fibrillation (NVAF). In this sub-analysis, we compared the differences in efficacy and safety between patients with and those without history of stroke or transient ischemic attack (TIA). This multicenter, prospective, non-interventional, observational, cohort study was conducted at 684 medical centers in Japan. A total of 7141 NVAF patients aged ≥ 20 years [mean age 71...
July 6, 2018: Heart and Vessels
Menno V Huisman, Frederikus A Klok
Venous thromboembolism (VTE) in acute medically ill patients is a leading cause of in-hospital morbidity and mortality. A majority of these VTE events occur post-discharge, and patients remain at increased VTE risk for up to 3 months post-discharge. Recent clinical trials of extended-duration thromboprophylaxis with enoxaparin, rivaroxaban, and apixaban in acute medically ill patients did not demonstrate a net clinical benefit compared with in-hospital thromboprophylaxis, and were shown to be associated with higher risks of major bleeding...
May 2018: European Heart Journal Supplements: Journal of the European Society of Cardiology
Paulus Kirchhof, Ghazi Radaideh, Young-Hoon Kim, Fernando Lanas, Sylvia Haas, Pierre Amarenco, Alexander G G Turpie, Miriam Bach, Marc Lambelet, Susanne Hess, A John Camm
BACKGROUND: The efficacy of direct oral anticoagulants (DOACs) for stroke prevention in patients with atrial fibrillation (AF) has been established in clinical trials. However, well-conducted, prospective, real-world observational studies of the safety and effectiveness of DOACs are needed. OBJECTIVES: This study sought to assess the real-world safety profile of rivaroxaban through a pooled analysis of patients with AF enrolled in the XANTUS (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation) program worldwide...
July 10, 2018: Journal of the American College of Cardiology
C Michael Gibson, Bennett Levitan, William J Gibson, Megan K Yee, Sabina A Murphy, Zhong Yuan, Anjan K Chakrabarti, Michael Lee, Eugene Braunwald
BACKGROUND: Net clinical outcome analyses of acute coronary syndrome (ACS) mingle fatal or irreversible events with survivable or reversible events that vary significantly in clinical impact. OBJECTIVES: A comparison of efficacy and safety limited to fatal or irreversible ischemic and adverse or seriously harmful events is one way to assess net clinical outcome and risk-benefit overall, given the fact that these events have a similar clinical impact. METHODS: In the ATLAS ACS 2-TIMI 51 (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction) trial of rivaroxaban in the secondary prevention of events among patients with ACS treated with aspirin plus clopidogrel or ticlopidine (clopidogrel/ticlopidine) or aspirin alone, fatal and irreversible efficacy events including nonbleeding cardiovascular death, myocardial infarction, and ischemic stroke were compared to fatal or irreversible safety events, including fatal and intracranial bleeding...
July 10, 2018: Journal of the American College of Cardiology
Dimitrios Farmakis, Periklis Davlouros, Gregory Giamouzis, George Giannakoulas, Athanasios Pipilis, Georgios Tsivgoulis, John Parissis
Direct or new oral anticoagulants (NOACs), including the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, have recently revolutionized the field of antithrombotic therapy for stroke and systemic embolism prevention in nonvalvular atrial fibrillation (NVAF). Randomized controlled trials have shown that these agents have at least comparable efficacy with vitamin K antagonists along with superior safety, at least in what concerns intracranial hemorrhage...
July 5, 2018: Cardiology
Chao-Lun Lai, Ho-Min Chen, Min-Tsun Liao, Ting-Tse Lin
OBJECTIVES: To compare the effectiveness and safety of reduced-dose dabigatran, reduced-dose rivaroxaban, and warfarin in individuals aged 85 and older with atrial fibrillation (AF). DESIGN: Retrospective cohort study. SETTING: Taiwan National Health Insurance claims database, 2011∼2015. PARTICIPANTS: Individuals with AF aged 85 and older (mean 88.6) with incident use of oral anticoagulants between June 1, 2012 and May 31, 2015 (N=4,722; dabigatran 110 mg, n=1,489; rivaroxaban 15 mg/10 mg, n=1,736; warfarin, n=1,497)...
July 4, 2018: Journal of the American Geriatrics Society
P Priyanka, J T Kupec, M Krafft, N A Shah, G J Reynolds
Background: Newer oral anticoagulants (NOACs) are being utilized increasingly for the treatment of venous thromboembolism (VTE). NOAC use is the standard of care for stroke prophylaxis in nonvalvular atrial fibrillation and treatment of acute VTE involving extremities and pulmonary embolism. In contrast, most guidelines in the literature support the treatment of acute portal vein thrombosis (PVT) with low molecular weight heparin (LMWH) and vitamin K antagonists (VKA). Literature evaluating NOAC use in the treatment of acute portal vein thrombosis is sparse...
2018: International Journal of Hepatology
Yana Vinogradova, Carol Coupland, Trevor Hill, Julia Hippisley-Cox
OBJECTIVE: To investigate the associations between direct oral anticoagulants (DOACs) and risks of bleeding, ischaemic stroke, venous thromboembolism, and all cause mortality compared with warfarin. DESIGN: Prospective open cohort study. SETTING: UK general practices contributing to QResearch or Clinical Practice Research Datalink. PARTICIPANTS: 132 231 warfarin, 7744 dabigatran, 37 863 rivaroxaban, and 18 223 apixaban users without anticoagulant prescriptions for 12 months before study entry, subgrouped into 103 270 patients with atrial fibrillation and 92 791 without atrial fibrillation between 2011 and 2016...
July 4, 2018: BMJ: British Medical Journal
Helmi Khadra, Roostam Kholmatov, Dominique Monlezun, Emad Kandil
BACKGROUND: A feared complication of thyroid fine needle aspiration (FNA) is bleeding diathesis and hematoma at the biopsy site. Patients are often advised to discontinue antithrombotic/anticoagulant (AT/AC) medications prior to the procedure. The aim of this study is to examine the risk of bleeding in patients on AT/AC medications undergoing cervical ultrasound (US) guided FNA. METHODS: A retrospective chart review of 803 patients who underwent US-guided FNA of thyroid nodules over 8 years by a single endocrine surgeon was undertaken...
July 3, 2018: Cytopathology: Official Journal of the British Society for Clinical Cytology
Giovanna Elmi, Attilia M Pizzini, Mauro Silingardi
After the anticoagulant withdrawal, a substantial proportion of patients with venous thromboembolism will develop recurrent events. Whether to consider an extended treatment depends on the risk of recurrence and bleeding risk. The assessment of the individual risk profile remains a difficult task. Several basal and post-basal factors modulate the risk of recurrence and may help clinicians to select patients who can benefit from the extended therapy. During the year 2017, new evidence regarding the post-basal factors was provided by the Morgagni and Scope studies...
January 1, 2018: Vascular
Jorell Gantioqui, Ivan Stevic, Helen Atkinson, Anthony K C Chan
OBJECTIVE: Current recommendations for treating patients with thromboembolism and concomitant thrombocytopenia are based on anecdotal data and expert opinion, rather than clinical studies. Our aim was to use an in-vitro model employing thromboelastography (TEG) to evaluate clot formation as a surrogate indicator of clinical tendency to hemorrhage, and investigate the interactions of plasma at varying concentrations of platelets in the presence of anticoagulants. METHODS: Platelet-rich and platelet-poor plasma isolated from whole blood were mixed together to obtain platelet concentrations ranging from less than 10-150 × 10 platelets/l...
June 29, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
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