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https://www.readbyqxmd.com/read/27917690/pharmacological-management-of-pulmonary-embolism
#1
Bobby Gouin, Helia Robert-Ebadi, Marc Righini, Marc Blondon
Pulmonary embolism (PE) is a common and potentially severe manifestation of venous thromboembolism. Its management has relied on anticoagulation by vitamin K antagonists (VKA) for the past fifty years. Recently, new alternative drugs have been developed and dramatically modified both the treatment of acute PE and its secondary prevention. Areas covered: This review discusses the contemporary pharmacological treatment for PE, with a focus on anticoagulation options for non-high risk PE. In particular, the advent of direct oral anticoagulants (rivaroxaban, apixaban, edoxaban and dabigatran) and modalities for long-term prevention will be described...
December 3, 2016: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/27911120/new-frontiers-in-anticoagulation-non-vitamin-k-oral-anticoagulants-in-stroke-prevention
#2
Valentina Arnao, Marianna Riolo, Antonino Tuttolomondo, Antonio Pinto, Brigida Fierro, Paolo Aridon
Non vitamin-K oral anticoagulants (NOACs) are direct and specific inhibitors of the coagulation factors IIa (dabigatran) and Xa (apixaban, rivaroxaban, edoxaban) which share many pharmacokinetic properties. However, indications are lacking regarding the use of NOACs during thrombolysis, surgery and bleeding events. Areas covered: In this paper, the authors retrospectively analyzed the relevant literature on the NOACs using the PubMed and Google Scholar databases. Expert Commentary: Although warfarin is effective in cardioembolic stroke prevention, easier handling and more favorable risk-benefit profile often render NOACs a more preferable therapy choice for neurologists...
December 2, 2016: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/27909516/the-role-of-noacs-in-atrial-fibrillation-management-a-qualitative-study
#3
Katherine Kirley Md Ms, Goutham Rao Md, Victoria Bauer Bs, Christopher Masi Md PhD
Patients with atrial fibrillation (AF) benefit from anticoagulation to reduce stroke risk. However, 30-60% of patients with AF are not anticoagulated. This study explored physicians' reasons for under-treatment of AF, focusing on the role of the novel oral anticoagulants (NOACs). We interviewed primary care physicians and cardiologists involved in AF management in a variety of practice settings. We conducted interviews using a semi-structured format and analyzed the data using the Framework Method. Four themes emerged...
June 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909486/misleading-advertising-by-attorneys-concerning-noacs-is-adversely-costly-to-our-patients-and-our-society
#4
EDITORIAL
James A, Reiffel M D
Over the past five years, "ambulance-chasing" attorneys have aggressively advertised for patients who have bled on a new oral anticoagulant (NOAC) or their family members. It is an infrequent day when American consumers do not see a TV advertisement saying something like: "Have you or a loved-one had a serious bleeding event while taking [fill in the NOAC]? If so, you may be entitled to monetary compensation. Call XXX, attorneys at law, and we will get you the money you deserve."
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909482/the-cost-effectiveness-of-laa-exclusion
#5
REVIEW
Bahij Kreidieh, Moisés Rodríguez-Mañero, Sergio H Ibarra-Cortez, Paul Schurmann, Miguel Valderrábano
Left atrial appendage (LAA) exclusion strategies are increasingly utilized for stroke prevention in lieu of oral anticoagulants. Reductions in bleeding risk and long-term compliance issues bundled with comparable stroke prevention benefits have made these interventions increasingly attractive. Unfortunately, healthcare funding remains limited. Comparative cost economic analyses are therefore critical in optimizing resource allocation. In this review we seek to discourse the cost economics analysis of LAA exclusion over available therapeutic alternatives (warfarin and the new oral anticoagulants (NOACs))...
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27896543/vitamin-k-antagonists-relative-strengths-and-weaknesses-vs-direct-oral-anticoagulants-for-stroke-prevention-in-patients-with-atrial-fibrillation
#6
REVIEW
Andreas Zirlik, Christoph Bode
Vitamin K antagonists (VKAs) have been the mainstay of anticoagulation therapy for more than 50 years. VKAs are mainly used for the prevention of stroke in patients with atrial fibrillation (AF) and the treatment and secondary prevention of venous thromboembolism. In the past 5 years, four new agents-the direct factor Xa inhibitors apixaban, edoxaban and rivaroxaban and the direct thrombin inhibitor dabigatran [collectively known as direct oral anticoagulants (DOACs) or non-VKA oral anticoagulants]-have been approved for these and other indications...
November 28, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27895055/role-of-agents-for-reversing-the-effects-of-target-specific-oral-anticoagulants
#7
REVIEW
Tanya R Riley, Mary L Gauthier-Lewis, Chelsea K Sanchez, Janine S Douglas
PURPOSE: The available clinical data on target-specific oral anticoagulant (TSOAC) reversal agents that are currently in development or have been approved by the Food and Drug Administration (FDA) are reviewed. SUMMARY: The development of TSOACs such as dabigatran, rivaroxaban, edoxaban, and apixaban has presented benefits and new challenges. One of the main challenges associated with the use of TSOACs is the lack of suitable agent-specific reversal agents. Several treatment options for the management of life-threatening bleeding events associated with TSOAC use, such as fresh frozen plasma, prothrombin complex concentrates, and recombinant coagulation factor VIIa, have been used, with inconsistent results...
November 28, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/27892890/trial-design-rivaroxaban-for-the-prevention-of-major-cardiovascular-events-after-transcatheter-aortic-valve-replacement-rationale-and-design-of-the-galileo-study
#8
Stephan Windecker, Jan Tijssen, Gennaro Giustino, Ana H C Guimarães, Roxana Mehran, Marco Valgimigli, Pascal Vranckx, Robert C Welsh, Usman Baber, Gerrit-Anne van Es, Peter Wildgoose, Albert A Volkl, Ana Zazula, Karen Thomitzek, Melanie Hemmrich, George D Dangas
BACKGROUND: Optimal antithrombotic treatment after transcatheter aortic valve replacement (TAVR) is unknown and determined empirically. The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. DESIGN: GALILEO is an international, randomized, open-label, event-driven, phase III trial in more than 1,520 patients without an indication for oral anticoagulation who underwent a successful TAVR (ClinicalTrials...
October 31, 2016: American Heart Journal
https://www.readbyqxmd.com/read/27892885/vitamin-k-antagonists-for-stroke-prevention-in-hemodialysis-patients-with-atrial-fibrillation-a-systematic-review-and-meta-analysis
#9
Hans Van Der Meersch, Dirk De Bacquer, An S De Vriese
BACKGROUND: The use of vitamin K antagonists (VKAs) in hemodialysis patients with atrial fibrillation (AF) is controversial. No randomized trials are available and observational studies have yielded conflicting results, engendering a large clinical practice variability and physician uncertainty. An unresolved but highly relevant question is whether AF poses a true risk of ischemic stroke in hemodialysis and whether any form of oral anticoagulation is therefore warranted. METHODS: We conducted a systematic review of studies that compared the incidence of ischemic stroke and bleeding in hemodialysis patients with AF taking VKA and those not taking VKA...
October 4, 2016: American Heart Journal
https://www.readbyqxmd.com/read/27891570/pragmatic-approach-to-manage-new-oral-anticoagulants-in-patients-undergoing-dental-extractions-a-prospective-case-control-study
#10
Isabel Miclotte, Maarten Vanhaverbeke, Jimoh Olubanwo Agbaje, Paul Legrand, Thomas Vanassche, Peter Verhamme, Constantinus Politis
OBJECTIVES: The aim of this study was to validate a standardized pragmatic approach to manage new oral anticoagulants (NOACs) in patients who undergo dental extractions. MATERIALS AND METHODS: This prospective case-control study in patients undergoing dental extraction included 26 patients (mean age 76 years, 57% male) treated with dabigatran, rivaroxaban, or apixaban and 26 matched controls. Regardless of timing of extraction, drug regimen, or renal function, patients were instructed to skip only the dose on the morning of the procedure...
November 28, 2016: Clinical Oral Investigations
https://www.readbyqxmd.com/read/27890386/2016-guidelines-of-the-taiwan-heart-rhythm-society-and-the-taiwan-society-of-cardiology-for-the-management-of-atrial-fibrillation
#11
Chern-En Chiang, Tsu-Juey Wu, Kwo-Chang Ueng, Tze-Fan Chao, Kuan-Cheng Chang, Chun-Chieh Wang, Yenn-Jiang Lin, Wei-Hsian Yin, Jen-Yuan Kuo, Wei-Shiang Lin, Chia-Ti Tsai, Yen-Bin Liu, Kun-Tai Lee, Li-Jen Lin, Lian-Yu Lin, Kang-Ling Wang, Yi-Jen Chen, Mien-Cheng Chen, Chen-Chuan Cheng, Ming-Shien Wen, Wen-Jone Chen, Jyh-Hong Chen, Wen-Ter Lai, Chuen-Wang Chiou, Jiunn-Lee Lin, San-Jou Yeh, Shih-Ann Chen
Atrial fibrillation (AF) is the most common sustained arrhythmia. Both the incidence and prevalence of AF are increasing, and the burden of AF is becoming huge. Many innovative advances have emerged in the past decade for the diagnosis and management of AF, including a new scoring system for the prediction of stroke and bleeding events, the introduction of non-vitamin K antagonist oral anticoagulants and their special benefits in Asians, new rhythm- and rate-control concepts, optimal endpoints of rate control, upstream therapy, life-style modification to prevent AF recurrence, and new ablation techniques...
November 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/27888051/absence-of-oral-anticoagulation-and-subsequent-outcomes-among-outpatients-with-atrial-fibrillation
#12
Paul L Hess, Sunghee Kim, Gregg C Fonarow, Laine Thomas, Daniel E Singer, James V Freeman, Bernard J Gersh, Jack Ansell, Peter R Kowey, Kenneth W Mahaffey, Paul S Chan, Benjamin A Steinberg, Eric D Peterson, Jonathan P Piccini
BACKGROUND: Prior studies have shown a treatment gap in oral anticoagulation (OAC) use among patients with atrial fibrillation yet have incompletely characterized factors associated with failure to treat and subsequent outcomes in contemporary practice. METHODS: Using data collected between June 2010 and August 2011 from 174 ambulatory care sites in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we identified factors associated with absence of OAC via stratified logistic regression...
November 22, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27869892/-anmco-position-paper-use-of-new-oral-anticoagulants-for-the-treatment-and-prevention-of-pulmonary-thromboembolism
#13
Iolanda Enea, Loris Roncon, Michele Massimo Gulizia, Michele Azzarito, Cecilia Becattini, Amedeo Bongarzoni, Franco Casazza, Claudio Cuccia, Carlo D'Agostino, Matteo Rugolotto, Marco Vatrano, Eugenio Vinci, Paride Fenaroli, Dario Formigli, Paolo Silvestri, Federico Nardi, Maria Cristina Vedovati, Marino Scherillo
The new oral anticoagulants (NOACs) have radically changed the approach to the treatment and prevention of thromboembolic pulmonary embolism. The authors of this position paper face, in succession, issues concerning NOACs, including 1) their mechanism of action, pharmacodynamics and pharmacokinetics; 2) the use in the acute phase with the "double drug single dose" approach or with "single drug double dose"; 3) the use in the extended phase with demonstrated efficacy and with low incidence of bleeding events; 4) the encouraging use of NOACs in particular subgroups of patients such as those with cancer, the ones under- or overweight, with renal insufficiency (creatinine clearance >30 ml/min), the elderly (>75 years); 5) they propose a possible laboratory clinical pathway for follow-up; 6) carry out an examination on the main drug interactions, their potential bleeding risk, and the way to deal with some bleeding complications...
September 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/27861421/current-and-emerging-uses-of-insertable-cardiac-monitors-evaluation-of-syncope-and-monitoring-for-atrial-fibrillation
#14
Todd T Tomson, Rod Passman
Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shownd their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Recent trials have demonstrated that a substantial proportion of patients with cryptogenic stroke have AF detected only by the prolonged monitoring provided by ICMs...
November 17, 2016: Cardiology in Review
https://www.readbyqxmd.com/read/27860249/left-atrial-appendage-closure-initial-experience-with-the-ultraseal-device
#15
Ander Regueiro, Mathieu Bernier, Gilles O'Hara, Kim O'Connor, Jean-Michel Paradis, Jonathan Beaudoin, Tania Rodriguez-Gabella, Jean Champagne, Josep Rodés-Cabau
OBJECTIVES: We report the initial experience of percutaneous left atrial appendage (LAA) closure with the Ultraseal device. BACKGROUND: LAA closure is an alternative to oral anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) and high risk of bleeding. The Ultraseal device is a new LAA closure prosthesis that consists of a distal soft bulb and a proximal sail attached by an articulating joint that allows a high degree of device conformability to the different variations of the LAA anatomy...
November 17, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27824417/-anticoagulation-and-new-therapeutic-options-in-atrial-fibrillation
#16
Karl Mischke
Oral anticoagulation plays an essential role in the treatment of patients with atrial fibrillation as it is indicated for most patients to reduce the risk of stroke. It is prudent to assess the risks of stroke and bleeding using the CHA2DS2-VASc and HAS-BLED scores. Oral anticoagulation is indicated in general for all patients with valvular atrial fibrillation (atrial fibrillation in moderate to severe mitral stenosis or mechanical prosthetic valve) as well as for patients with a CHA2DS2-VASc-Score of 1 - 2 points or higher...
October 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27817212/the-factor-xa-inhibitor-edoxaban-for-the-prevention-of-stroke-and-systemic-embolism-in-patients-with-atrial-fibrillation
#17
Joan Minguet, Helen M Sims, Katherine H Smith, Peter Bramlage
With the rising prevalence of nonvalvular atrial fibrillation (NVAF) in the general population, the development of new drugs for prevention of thromboembolic events is essential. Non-vitamin K antagonist oral anticoagulants (NOACs) have been shown to present a number of advantages over conventionally used agents, such as predictable pharmacokinetics and no requirement for continuous anticoagulant monitoring. The most recently approved NOAC for the NVAF indication is edoxaban. Several subgroup analyses from the edoxaban phase III ENGAGE AF-TIMI 48 trial have now been published, alongside meta-analysis data comparing the four currently approved NOACs...
November 17, 2016: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/27811198/the-efficacy-and-safety-of-edoxaban-for-vte-prophylaxis-post-orthopedic-surgery-a-systematic-review
#18
Lamia AlHajri, Sima Jabbari, Hind AlEmad, Khawla AlMahri, Maryam AlMahri, Noora AlKitbi
BACKGROUND: Venous thromboembolism (VTE) is a common complication that manifests during and/or after hospitalization, as well as postsurgeries including orthopedic surgeries. Edoxaban is a new oral direct factor Xa inhibitor that has been recently approved for treating VTE in patients who have already been treated with a parenteral anticoagulant and for the prevention of stroke and non-central nervous system systemic embolism in patients with nonvalvular atrial fibrillation. OBJECTIVES: The purpose of this systematic review was to evaluate the safety and efficacy of edoxaban for VTE prophylaxis after lower limb orthopedic surgery...
November 2, 2016: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/27800191/successful-left-atrial-appendage-occlusion-with-the-new-generation-amulet%C3%A2-device-after-late-occurring-embolization-of-an-amplatzer%C3%A2-cardiac-plug-in-a-patient-with-repetitive-strokes
#19
Marco R Schroeter, Wolfgang Schillinger
The Amplatzer Cardiac Plug (ACP) is one of the most commonly used devices for percutaneous left atrial appendage (LAA) closure in order to prevent a stroke in patients with atrial fibrillation and contraindication for long-term oral anticoagulation therapy. We have previously described a patient who had experienced an embolization of the ACP device about 12 months after implantation and the device could be percutaneously retrieved. A few years later, he suffered from a posterior stroke and a stroke located in the brainstem as well as a transischemic attack (TIA)...
2016: Case Reports in Cardiology
https://www.readbyqxmd.com/read/27785089/minimizing-bleeding-risk-in-patients-receiving-direct-oral-anticoagulants-for-stroke-prevention
#20
REVIEW
Jeffrey Steven Habert
Many primary care physicians are wary about using direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation (AF). Factors such as comorbidities, concomitant medications, and alcohol misuse increase concerns over bleeding risk, especially in elderly and frail patients with AF. This article discusses strategies to minimize the risk of major bleeding events in patients with AF who may benefit from oral anticoagulant therapy for stroke prevention. The potential benefits of the DOACs compared with vitamin K antagonists, in terms of a lower risk of intracranial hemorrhage, are discussed, together with the identification of reversible risk factors for bleeding and correct dose selection of the DOACs based on a patient's characteristics and concomitant medications...
2016: International Journal of General Medicine
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