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New oral anticoagulants

Laurie Jansky, Pallavi Mukkamala, Deborah Jebakumar, Arundhati Rao, Tove M Goldson, Samuel N Forjuoh
Dabigatran, a new oral anticoagulant, is a direct thrombin inhibitor used as an alternative to warfarin to reduce the risk of stroke and systemic embolism with nonvalvular atrial fibrillation. We report a case of a man who resumed dabigatran after 6 weeks of prior therapy and began experiencing hematuria with worsening kidney function. Renal biopsy with immunofluorescence and electron microscopy showed mesangial deposits consistent with immunoglobulin A nephropathy. With discontinuation of dabigatran and addition of methylprednisolone, the gross hematuria cleared and urine output improved...
July 2018: Proceedings of the Baylor University Medical Center
Matthew Lindeblad, Alexander Lyubimov, Richard van Breemen, Kamil Gierszal, Guy Weinberg, Israel Rubinstein, Douglas L Feinstein
Patients exposed to long acting anticoagulant rodenticides (LAARs) are typically administered large amounts of oral vitamin K1 (VK1) to counteract life-threatening anti-coagulant effects. While VK1 treatment effectively prevents mortality, additional methods are needed to reduce the long duration of VK1 treatment which can last for months at high expense. We developed a model of brodifacoum (BDF) poisoning, one of the most potent LAARs, in adult male New Zealand White (NZW) rabbits. The LD50 for oral BDF was determined to be 192 μg/kg, similar to that calculated for adult rats...
June 12, 2018: Toxicological Sciences: An Official Journal of the Society of Toxicology
Mehmet Akif Topcuoglu, Liping Liu, Dong-Eog Kim, M Edip Gurol
Cardiac embolism continues to be a leading etiology of ischemic strokes worldwide. Although pathologies that result in cardioembolism have not changed over the past decade, there have been significant advances in the treatment and stroke prevention methods for these conditions. Atrial fibrillation remains the prototypical cause of cardioembolic strokes. The availability of new long-term monitoring devices for atrial fibrillation detection such as insertable cardiac monitors has allowed accurate detection of this leading cause of cardioembolism...
May 2018: Journal of Stroke
Xavier Iriart, Vlad Ciobotaru, Claire Martin, Hubert Cochet, Zakaria Jalal, Jean-Benoit Thambo, Astrid Quessard
Atrial fibrillation is the most frequent cardiac arrhythmia, affecting up to 13% of people aged>80 years, and is responsible for 15-20% of all ischaemic strokes. Left atrial appendage occlusion devices have been developed as an alternative approach to reduce the risk of stroke in patients for whom oral anticoagulation is contraindicated. The procedure can be technically demanding, and obtaining a complete left atrial appendage occlusion can be challenging. These observations have emphasized the importance of preprocedural planning, to optimize the accuracy and safety of the procedure...
June 6, 2018: Archives of Cardiovascular Diseases
Michael T Durheim, DaJuanicia N Holmes, Rosalia G Blanco, Larry A Allen, Paul S Chan, James V Freeman, Gregg C Fonarow, Alan S Go, Elaine M Hylek, Kenneth W Mahaffey, Sean D Pokorney, James A Reiffel, Daniel E Singer, Eric D Peterson, Jonathan P Piccini
OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is associated with the development of atrial fibrillation (AF), and may complicate treatment of AF. We examined the association between COPD and symptoms, quality of life (QoL), treatment and outcomes among patients with AF. METHODS: We compared patients with and without a diagnosis of COPD in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, a prospective registry that enrolled outpatients with AF not secondary to reversible causes, from both academic and community settings...
June 6, 2018: Heart: Official Journal of the British Cardiac Society
Máté Pásztor, Dániel Bereczki, Zoltán Szakács, Zsolt May
Introduction - Expanding indications have resulted in an increasing number of patients taking novel oral anticoagulants, posing a major treatment dilemma in acute ischemic stroke. Case presentation - We present a successful intravenous thrombolysis in a dabigatran-treated patient with acute ischemic stroke after the administration of idarucizumab. Discussion - According to current guidelines, systemic thrombolysis is contraindicated under treatment with novel oral anticoagulants (taken within 48 hours). In this scenario, idarucizumab offers a solution by reversing the anticoagulant effect of dabigatran...
July 30, 2017: Ideggyógyászati Szemle
Liliya Sinyavskaya, Alexis Matteau, Sarasa Johnson, Madeleine Durand
PURPOSE: Algorithms to define current exposure to warfarin using administrative data may be imprecise. Study objectives were to characterize dispensation patterns, to measure gaps between expected and observed refill dates for warfarin and direct oral anticoagulants (DOACs). METHODS: Retrospective cohort study using administrative health care databases of the Régie de l'assurance-maladie du Québec. We identified every dispensation of warfarin, dabigatran, rivaroxaban, or apixaban for patients with AF initiating oral anticoagulants between 2010 and 2015...
June 5, 2018: Pharmacoepidemiology and Drug Safety
Silvia Calabria, Emanuele Forcesi, Letizia Dondi, Antonella Pedrini, Aldo Pietro Maggioni, Nello Martini
PURPOSE: This observational study was aimed to identify patients who experienced non-deferrable surgery and/or uncontrolled severe bleeding following dabigatran administration and then are potentially eligible to the use of the specific antidote idarucizumab in a real-world setting. METHODS: From the big Italian real-world database ARCO, a cohort of adult patients treated with dabigatran and hospitalized due to diagnoses attributable to urgent interventions and/or major bleeding was selected in 2014...
June 4, 2018: Cardiovascular Drugs and Therapy
Carlos Treceño-Lobato, María-Isabel Jiménez-Serranía, Raquel Martínez-García, Francisco Corzo-Delibes, Luis H Martín Arias
The aim of this study was to evaluate the adverse drug reaction (ADR) incidence rate and new signals thereof for classic compared with new anticoagulants in real-life ambulatory settings. The authors performed an observational cross-sectional study in two cohorts of surveyed patients treated with vitamin K antagonists (VKAs; acenocoumarol or warfarin) or nonvitamin K antagonist oral anticoagulants (NOACs; apixaban, edoxaban, rivaroxaban, dabigatran etexilate). Descriptive, clinical, and ADRs data were reported and analyzed through a bivariate analysis (odds ratio [OR]) to compare the ADRs incidence rate and an adaptation of Bayesian methodology (false discovery rate [FDR] < 0...
June 4, 2018: Seminars in Thrombosis and Hemostasis
Jean-Yves Le Heuzey, Jean-Pierre Bassand, Jean-Baptiste Berneau, Paolo Cozzolino, Lucia D'Angiolella, Bernard Doucet, Lorenzo G Mantovani, Michel Martelet, Joseph Mouallem, Jean-Joseph Muller, Karen Pieper
BACKGROUND: GARFIELD-AF is a non-interventional worldwide study of adults with atrial fibrillation. AIMS: To analyse the characteristics of the 1399 patients recruited in France from August 2010 to July 2015, their 1-year outcomes and healthcare resource utilization. METHOD: Patients aged ≥18 years with newly diagnosed atrial fibrillation (≤6 weeks' duration) and ≥1 stroke risk factor were eligible. Patient demographics, medical history and antithrombotic treatment were recorded at baseline...
May 31, 2018: Archives of Cardiovascular Diseases
Oscar M P Jolobe
No abstract text is available yet for this article.
May 30, 2018: QJM: Monthly Journal of the Association of Physicians
Jonathan Balakumar, Ruben Santiago, Mark Supino
Dabigatran etexilate mesylate is a direct thrombin inhibitor used for reducing the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Dabigatran belongs to a new generation of oral agents for anticoagulation - the direct oral anticoagulants (DOACs). The DOACs also include the factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. In the case of major or life-threatening bleeding and/or the need for emergent invasive procedures, a reversal agent is needed if a patient is taking one of these medications...
November 2017: Clinical practice and cases in emergency medicine
Richard J Miron, Michael A Pikos
Regenerative therapies with platelets have been widely used in medicine over the past two decades as a means to speed revascularization to damaged/defective tissues. Within the oral cavity, the sinus is one of the least vascularized areas with healing times typically increased to augment lost or missing bone. As a result, attempts have been proposed to combine platelet concentrates with various biomaterials to accelerate new blood flow to these tissues and ultimately facilitate new bone regeneration. While platelet-rich plasma (PRP) was introduced as a first-generation platelet concentrate, more recently platelet-rich fibrin (PRF) has been developed with anticoagulant removal from centrifugation protocols...
June 2018: Compendium of Continuing Education in Dentistry
Debu Tripathy, Seock-Ah Im, Marco Colleoni, Fabio Franke, Aditya Bardia, Nadia Harbeck, Sara A Hurvitz, Louis Chow, Joohyuk Sohn, Keun Seok Lee, Saul Campos-Gomez, Rafael Villanueva Vazquez, Kyung Hae Jung, K Govind Babu, Paul Wheatley-Price, Michelino De Laurentiis, Young-Hyuck Im, Sherko Kuemmel, Nagi El-Saghir, Mei-Ching Liu, Gary Carlson, Gareth Hughes, Ivan Diaz-Padilla, Caroline Germa, Samit Hirawat, Yen-Shen Lu
BACKGROUND: In MONALEESA-2, ribociclib plus letrozole showed improved progression-free survival compared with letrozole alone as first-line treatment for postmenopausal patients with hormone receptor (HR)-positive, HER2-negative, advanced breast cancer. MONALEESA-7 aimed to assess the efficacy and safety of ribociclib plus endocrine therapy in premenopausal women with advanced, HR-positive breast cancer. METHODS: This phase 3, randomised, double-blind, placebo-controlled trial was done at 188 centres in 30 countries...
May 24, 2018: Lancet Oncology
Hongliu Yang, Feng Chen, He Jiao, Han Luo, Yang Yu, Hyokyoung G Hong, Yi Li, Ping Fu, Tianlei Cui
OBJECTIVES: Catheter-related right atrial thrombosis (CRAT) is an underreported but potentially life-threatening complication associated with the use of tunneled-cuffed catheters among hemodialysis (HD) patients. Because little is known about the evidence-based guidelines for the optimal management of CRAT among HD patients, this article reports findings based on 20 patients diagnosed with CRAT after catheter replacement and anticoagulation treatment. METHODS: The article retrospectively reviews the hospital records of 20 HD patients treated in the West China Hospital with diagnosis of CRAT from March 2013 to May 2016...
May 24, 2018: Journal of Vascular Surgery
Sara Själander, Vilhelm Sjögren, Henrik Renlund, Bo Norrving, Anders Själander
INTRODUCTION: New oral anticoagulants are non-inferior compared with warfarin regarding stroke prevention in atrial fibrillation, with similar or decreased risk of bleeding. However, it is unclear whether high TTR warfarin is as effective and safe as NOACs. Our objective was to investigate efficacy and safety of apixaban, dabigatran or rivaroxaban compared with warfarin in clinical practice. MATERIALS AND METHODS: Nationwide retrospective cohort study based on Swedish quality registries...
May 17, 2018: Thrombosis Research
Toshiya Ohtsuka, Takahiro Nonaka, Motoyuki Hisagi, Mikio Ninomiya, Ai Masukawa, Takahiro Ota
BACKGROUND: Left atrial appendage (LAA) closure can be an alternative to oral anticoagulation to prevent cardiogenic thromboembolisms in non-valvular atrial fibrillation. OBJECTIVE: We retrospectively evaluated safety, completeness and mid-term prevention of our thoracoscopic stapler-and-loop technique for LAA closure. METHODS: Patients operated on between Oct 2008 and Feb 2017 were reviewed. Endoscopic stapler and ligation-loops were employed...
May 24, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Chris Boulias, Farooq Ismail, Chetan P Phadke, Stephen Bagg, Isabelle Bureau, Stephane Charest, Robert Chen, Albert Cheng, Karen Ethans, Milo Fink, Heather Finlayson, Sivakumar Gulasingam, Meiqi Guo, Muriel Haziza, Hossein Hosseini, Omar Khan, Michael Lang, Timothy Lapp, Robert Leckey, Rodney Li Pi Shan, Nathania Liem, Alexander Lo, Mark Mason, Stephen McNeil, Sonja McVeigh, Thomas Miller, Patricia B Mills, Pierre Naud, Colleen O'Connell, Marc Petitclerc, Julie Prevost, Rajiv Reebye, Denyse Richardson, Lalith Satkunam, Satyendra Sharma, Christine Short, Genevieve Sirois, Milan Unarket, Theodore Wein, Kathryn Wilkins, Paul Winston
OBJECTIVE: To create a consensus statement on the considerations for treatment of anticoagulated patients with botulinum toxin A (BoNTA) intramuscular injections for limb spasticity. DESIGN: We used the Delphi method. SETTING: A multi-question electronic survey. PARTICIPANTS: Thirty-nine Canadian physicians who use BoNTA injections for spasticity management in their practice. INTERVENTIONS: After the survey was sent, there were email discussions to facilitate an understanding of the issues underlying the responses...
May 24, 2018: Archives of Physical Medicine and Rehabilitation
Robert J H Miller, Derek S Chew, Saman Rezazadeh, Sheila Klassen, Payam Pournazari, Eddy Lang, F Russell Quinn
Atrial fibrillation and atrial flutter (AF/AFL) are associated with an increased risk of stroke and systemic embolism. However, many patients are not started on guideline-recommended oral anticoagulation (OAC). We determined factors associated with initiation of OAC in eligible patients presenting to emergency departments. This retrospective cohort included patients with electrocardiogram (ECG)-documented AF/AFL presenting to 4 urban emergency departments in 2015. Presenting diagnoses, admission status, and comorbidities were determined by chart review...
June 2018: Canadian Journal of Cardiology
Harald Breivik, Hilde Norum, Christian Fenger-Eriksen, Seppo Alahuhta, Gísli Vigfússon, Owain Thomas, Michael Lagerkranser
BACKGROUND AND AIMS: Central neuraxial blocks (CNB: epidural, spinal and their combinations) and other spinal pain procedures can cause serious harm to the spinal cord in patients on antihaemostatic drugs or who have other risk-factors for bleeding in the spinal canal. The purpose of this narrative review is to provide a practise advisory on how to reduce risk of spinal cord injury from spinal haematoma (SH) during CNBs and other spinal pain procedures. Scandinavian guidelines from 2010 are part of the background for this practise advisory...
April 25, 2018: Scandinavian Journal of Pain
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