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https://www.readbyqxmd.com/read/29453305/frequency-and-outcomes-of-reduced-dose-non-vitamin-k-antagonist-anticoagulants-results-from-orbit-af-ii-the-outcomes-registry-for-better-informed-treatment-of-atrial-fibrillation-ii
#1
Benjamin A Steinberg, Peter Shrader, Karen Pieper, Laine Thomas, Larry A Allen, Jack Ansell, Paul S Chan, Michael D Ezekowitz, Gregg C Fonarow, James V Freeman, Bernard J Gersh, Peter R Kowey, Kenneth W Mahaffey, Gerald V Naccarelli, James A Reiffel, Daniel E Singer, Eric D Peterson, Jonathan P Piccini
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) are indicated for stroke prevention in atrial fibrillation (AF) but require lower doses in certain patients. We sought to describe the frequency, appropriateness (according to Food and Drug Administration labeling), and outcomes of patients prescribed reduced doses of NOACs in community practice. METHODS AND RESULTS: We analyzed data from the ORBIT-AF II (The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II) registry, a prospective, national, observational registry of AF patients...
February 16, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29451510/-under-reporting-of-adverse-drug-reactions-a-problem-that-also-involves-medicines-subject-to-additional-monitoring-preliminary-data-from-a-single-center-experience-on-novel-oral-anticoagulants
#2
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
https://www.readbyqxmd.com/read/29441513/evaluation-of-indications-for-reduced-dose-noacs-in-hospitalized-atrial-fibrillation-patients
#3
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
https://www.readbyqxmd.com/read/29440949/the-prevalence-of-long-term-oral-anticoagulation-therapy-in-a-cardiology-center-in-bucharest-romania
#4
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)
https://www.readbyqxmd.com/read/29435797/phacoemulsification-cataract-surgery-in-patients-receiving-novel-oral-anticoagulant-medications
#5
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
https://www.readbyqxmd.com/read/29434159/successful-application-of-edoxaban-in-the-treatment-of-venous-thromboembolism-recurrence-in-a-patient-with-non-small-cell-lung-cancer-after-tumor-shrinkage
#6
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
https://www.readbyqxmd.com/read/29427461/thromboembolism-prophylaxis-in-patients-with-philadelphia-negative-myeloproliferative-neoplasms-clinical-practice-among-nordic-specialists
#7
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
https://www.readbyqxmd.com/read/29425981/spontaneous-cervical-spinal-epidural-hematoma-associated-with-dabigatran-a-case-report
#8
Quentin Mathais, Pierre Esnault, Maximilien Cruc, Cedric Bernard, Bertrand Prunet, Pierre Emmanuel Gaillard
BACKGROUND: While spontaneous spinal epidural hematomas are rare, one of the identified risk factors is vitamin K antagonist therapy. CASE DESCRIPTION: We present a case of a spontaneous spinal epidural hematoma occurring in a patient under treatment with dabigatran, a non-vitamin K oral anticoagulant. The initial hemiparesis symptom was misleading and was retrospectively identified as Brown Sequard syndrome. Immediate dabigatran antagonism with idarucizumab followed by posterior cervical laminectomy permitted a complete neurological recovery at day 4...
February 6, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29423910/kidney-function-monitoring-and-non-vitamin-k-oral-anticoagulant-dosage-in-atrial-fibrillation
#9
Jose Manuel Andreu Cayuelas, Cesar Caro Martínez, Pedro Jose Flores Blanco, Gines Elvira Ruiz, Helena Albendin Iglesias, Juan Jose Cerezo Manchado, Jose Luis Bailen Lorenzo, James Louis Januzzi, Arcadio García Alberola, Sergio Manzano-Fernández
BACKGROUND: Clinical practice guidelines recommend regular kidney function monitoring in atrial fibrillation patients on non-vitamin K oral anticoagulants (NOAC), however information regarding compliance with these recommendations in daily life conditions is scarce. We sought to determine the compliance with kidney function monitoring recommendations in nonvalvular atrial fibrillation (NVAF) patients starting NOAC and its implication on the appropriateness of NOAC dosage. MATERIAL AND METHODS: Retrospective analysis of a multicentre registry including consecutive NVAF patients who started NOAC (n = 692)...
February 9, 2018: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/29421803/portuguese-observational-study-of-ischaemic-stroke-in-patients-medicated-with-non-vitamin-k-antagonist-oral-anticoagulants
#10
José Beato-Coelho, João Pedro Marto, José Nuno Alves, Cláudia Marques-Matos, Sofia Calado, José Araújo, Luís Cunha, João Pinho, Elsa Azevedo, Miguel Viana-Baptista, João Sargento-Freitas
INTRODUCTION: Clinical trials and subsequent meta-analyses showed advantages of non-vitamin K antagonists oral anticoagulants (NOACs) over vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation. The impact of preadmission anticoagulation in acute ischaemic stroke (AIS) has not been established. OBJECTIVE: To compare functional outcome of patients with AIS with preadmission NOACs vs. VKAs. METHODS: A retrospective analysis was conducted on consecutive AIS patients under oral anticoagulation (VKAs or NOACs) admitted in 4 Portuguese hospitals within a period of 30 months...
February 8, 2018: European Neurology
https://www.readbyqxmd.com/read/29407632/what-have-we-learned-from-real-world-noac-studies-in-venous-thromboembolism-treatment
#11
REVIEW
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
https://www.readbyqxmd.com/read/29407620/point-of-care-testing-poct-to-assess-drug-concentration-in-patients-treated-with-non-vitamin-k-antagonist-oral-anticoagulants-noacs
#12
S Padayattil Jose, A Banzato, P Carraro, A Haleh, K Rossi, G Nante, G Denas, G Zoppellaro, V Pengo
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) do not need routine laboratory monitoring but measurement of drug concentration is important in emergency conditions. Specific laboratory tests are not readily available or not implemented in every hospital. Point-of-Care Tests (POCT) may bridge this gap and be used as a bedside solution. OBJECTIVES: Feasibility of POCT to assess plasma levels of dabigatran, rivaroxaban and apixaban. PATIENTS/METHODS: Activated Coagulation Time-Low Range (ACT - LR) using a portable Hemochron Signature Elite for dabigatran and prothrombin time (expressed as INR) by Coaguchek XS Pro for rivaroxaban and apixaban were obtained at trough and peak in 136 consecutive patients taking NOACs (70 on dabigatran, 45 on rivaroxaban and 20 on apixaban)...
January 30, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29402281/combining-value-of-information-analysis-and-ethical-argumentation-in-decisions-on-participation-of-vulnerable-patients-in-clinical-research
#13
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
https://www.readbyqxmd.com/read/29397950/triple-antithrombotic-therapy-for-patients-with-atrial-fibrillation-undergoing-percutaneous-coronary-intervention
#14
REVIEW
Mathieu Kerneis, Usama Talib, Tarek Nafee, Yazan Daaboul, Seyedmahdi Pahlavani, Anmol Pitliya, M M Furqan, Sudarshana Datta, Hassan A Kazmi, Ahmed Younes, C Michael Gibson
Dual antiplatelet therapy (DAPT) has been the cornerstone of antithrombotic management for patients undergoing percutaneous coronary intervention (PCI). However, approximately 10% of these patients have concomitant atrial fibrillation (AF) and require chronic oral anticoagulant (OAC) in addition to DAPT. This traditional "triple therapy" has been associated with a three to four-fold increased risk of bleeding. The safety of non-vitamin K OAC (NOAC)-based strategies, using a NOAC plus a P2Y12 inhibitor, has been compared to vitamin K antagonist (VKA)-based triple therapy in the PIONEER AF-PCI and REDUAL PCI randomized trials, both of which have demonstrated that NOAC-based strategies are safer and provide an attractive alternative to VKA-based triple therapy among AF patients who undergo PCI...
February 2, 2018: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29387335/contemporary-utilization-of-antithrombotic-therapy-for-stroke-prevention-in-patients-with-atrial-fibrillation-an-audit-in-an-australian-hospital-setting
#15
Ekta Yogeshkumar Pandya, Elizabeth Anderson, Clara Chow, Yishen Wang, Beata Bajorek
Background: To document antithrombotic utilization in patients with nonvalvular atrial fibrillation (NVAF), particularly, recently approved NOACs (nonvitamin K antagonist oral anticoagulants) and warfarin; and identify factors predicting the use of NOACs versus warfarin. Methods: A retrospective audit was conducted in an Australian hospital. Data pertaining to inpatients diagnosed with atrial fibrillation (AF) admitted between January and December 2014 were extracted...
February 2018: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/29383733/impact-of-missing-attenuation-and-scatter-corrections-on-99m-tc-maa-spect-3d-dosimetry-for-liver-radioembolization-using-the-patient-relative-calibration-methodology-a-retrospective-investigation-on-clinical-images
#16
Francesca Botta, Mahila Ferrari, Carlo Chiesa, Sara Vitali, Francesco Guerriero, Maria Chiara De Nile, Marta Mira, Leda Lorenzon, Massimiliano Pacilio, Marta Cremonesi
PURPOSE: To investigate the clinical implication of performing pre-treatment dosimetry for 90 Y-microspheres liver radioembolization on 99m Tc-MAA SPECT images reconstructed without attenuation or scatter correction and quantified with the patient relative calibration methodology. METHODS: 25 patients treated with SIR-Spheres® at Istituto Europeo di Oncologia and 31 patients treated with TheraSphere® at Istituto Nazionale Tumori were considered. For each acquired 99m Tc-MAA SPECT, four reconstructions were performed: with attenuation and scatter correction (AC_SC), only attenuation (AC_NoSC), only scatter (NoAC_SC) and without corrections (NoAC_NoSC)...
January 31, 2018: Medical Physics
https://www.readbyqxmd.com/read/29377448/incidence-of-intracardiac-thrombus-formation-prior-to-electrical-cardioversion-in-respect-to-the-mode-of-oral-anticoagulation
#17
Benjamin Schaeffer, Lea Rüden, Tim Salzbrunn, Hans O Pinnschmidt, Ruken Özge Akbulak, Julia Magdalena Moser, Mario Jularic, Christian Meyer, Christian Eickholt, Arian Sultan, Jakob Lüker, Daniel Steven, Stephan Willems, Boris Alexander Hoffmann
AIMS: To evaluate the incidence of newly diagnosed intracardiac thrombi (ICT) in respect to the mode of OAC in patients undergoing cardioversion (CV). METHODS AND RESULTS: We prospectively assessed transesophageal echocardiography (TEE) and OAC therapy prior to CV in AF patients with ≥48h duration scheduled for CV. A total of 60 first-time ICT (4.7%) were diagnosed in 1286 TEE, with highest rate in patients without OAC (9.6% vs. OAC 4.1% p = 0.009) and an apparently lower rate in non-vitamin K antagonist anticoagulants (NOAC) therapy compared to vitamin K antagonist (VKA) (2...
January 29, 2018: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/29372411/-s1%C3%A2-guideline-austrian-consensus-for-anticoagulation-in-the-context-of-atrial-fibrillation-ablation
#18
Martin Martinek, Marianne Gwechenberger, Daniel Scherr, Clemens Steinwender, Markus Stühlinger, Helmut Pürerfellner, Franz Xaver Roithinger, Lukas Fiedler
In summary, uninterrupted oral antikoagulation can be recommended, with different recommendation classes and levels of evidence, for both, VKA and NOAC therapy, in the framework of PVI. Even with low CHA2DS2 VASc scores, OAK is indicated 3-4 weeks before and 8 weeks after the procedure. Periinterventional bridging with heparins should be avoided due to increased bleeding events.The present Consensus provides recommendations on the current state of knowledge and has been prepared exclusively by members of the Rhythmology Working Group of the Austrian Cardiological Society who have great practical experience in catheter ablation and peri-interventional OAK in patients with atrial fibrillation...
January 25, 2018: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/29372247/association-of-intracerebral-hemorrhage-among-patients-taking-non-vitamin-k-antagonist-vs-vitamin-k-antagonist-oral-anticoagulants-with-in-hospital-mortality
#19
Taku Inohara, Ying Xian, Li Liang, Roland A Matsouaka, Jeffrey L Saver, Eric E Smith, Lee H Schwamm, Mathew J Reeves, Adrian F Hernandez, Deepak L Bhatt, Eric D Peterson, Gregg C Fonarow
Importance: Although non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used to prevent thromboembolic disease, there are limited data on NOAC-related intracerebral hemorrhage (ICH). Objective: To assess the association between preceding oral anticoagulant use (warfarin, NOACs, and no oral anticoagulants [OACs]) and in-hospital mortality among patients with ICH. Design, Setting, and Participants: Retrospective cohort study of 141 311 patients with ICH admitted from October 2013 to December 2016 to 1662 Get With The Guidelines-Stroke hospitals...
January 25, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29371284/comparative-effectiveness-of-novel-oral-anticoagulants-in-uk-patients-with-non-valvular-atrial-fibrillation-and-chronic-kidney-disease-a-matched-cohort-study
#20
Simone Y Loo, Janie Coulombe, Sophie Dell'Aniello, James M Brophy, Samy Suissa, Christel Renoux
OBJECTIVES: To evaluate the effectiveness and safety of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) among patients with non-valvular atrial fibrillation (NVAF), particularly those with chronic kidney disease (CKD). DESIGN: Population-based matched cohort study. SETTING: Over 670 primary care practices in the UK, contributing to the Clinical Practice Research Datalink. PARTICIPANTS: Up to 6818 adult patients newly treated with NOACs between 2011 and 2016, matched 1:1 to new users of VKAs on age, sex and high-dimensional propensity score...
January 24, 2018: BMJ Open
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