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Atrial fibrilation , Dabigatran, apixaban, rivaroxaban

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https://www.readbyqxmd.com/read/28208197/reversal-of-direct-oral-anticoagulants-current-status-and-future-directions
#1
Jeffrey I Weitz
Direct oral anticoagulants (DOACs) are increasingly used for prevention and treatment of venous thromboembolism and for prevention of stroke in patients with nonvalvular atrial fibrillation. In phase III clinical trials that included more than 100,000 patients, the DOACs were at least as effective as vitamin K antagonists (VKAs) and were associated with less serious bleeding, particularly less intracranial bleeding. Real-world evidence supports these outcomes. Despite this, some physicians and patients are concerned about serious bleeding or emergencies unless specific reversal agents for the DOACs are available...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28198201/clinical-implications-of-reversal-agents-for-direct-oral-anticoagulants
#2
Sarah Monagle, John W Eikelboom, Kuan H Ng, Vinai C Bhagirath
Direct oral anticoagulants (DOACs) are effective in preventing and treating venous thromboembolism, and preventing stroke in atrial fibrillation. Until recently, there has been no specific reversal agent for DOACs. Now, a specific antidote for the direct thrombin inhibitor, dabigatran has been approved for use, and antidotes for factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) are being developed. We review the evidence for currently used and emerging reversal strategies, and discuss possible clinical implications, including increased prescription of DOACs, use of DOACs in clinical situations previously felt to pose too great a risk of bleeding, and use of reversal agents beyond currently approved indications...
March 2017: Future Cardiology
https://www.readbyqxmd.com/read/28196815/major-bleeding-complications-and-persistence-with-oral-anticoagulation-in-non-valvular-atrial-fibrillation-contemporary-findings-in-real-life-danish-patients
#3
Morten Lamberts, Laila Staerk, Jonas Bjerring Olesen, Emil Loldrup Fosbøl, Morten Lock Hansen, Louise Harboe, Cinira Lefevre, David Evans, Gunnar Hilmar Gislason
BACKGROUND: The nonvitamin K antagonist oral anticoagulants have recently become available as an alternative to warfarin as stroke prophylaxis in atrial fibrillation, but data on real-life patient experience, including bleeding risk, are lacking. Our objective was to compare major bleeding events and nonpersistence between the nonvitamin K antagonist oral anticoagulant apixaban and other nonvitamin K antagonist oral anticoagulants (dabigatran and rivaroxaban) and warfarin in a contemporary, nation-wide cohort of patients with nonvalvular atrial fibrillation...
February 14, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28191610/italian-intersociety-consensus-on-doac-use-in-internal-medicine
#4
Domenico Prisco, Walter Ageno, Cecilia Becattini, Armando D'Angelo, Giovanni Davì, Raimondo De Cristofaro, Francesco Dentali, Giovanni Di Minno, Anna Falanga, Gualberto Gussoni, Luca Masotti, Gualtiero Palareti, Pasquale Pignatelli, Roberto M Santi, Francesca Santilli, Mauro Silingardi, Antonella Tufano, Francesco Violi
The direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and one direct thrombin inhibitor (dabigatran) provide oral anticoagulation therapy alternatives to Vitamin K antagonists (VKAs). Despite their clear advantages, the DOACs require on the part of the internist a thorough knowledge of their pharmacokinetic and pharmacodynamic characteristics to ensure their correct use, laboratory monitoring and the appropriate management of adverse events...
February 13, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28188243/effectiveness-and-safety-of-reduced-dose-non-vitamin-k-antagonist-oral-anticoagulants-and-warfarin-in-patients-with-atrial-fibrillation-propensity-weighted-nationwide-cohort-study
#5
Peter Brønnum Nielsen, Flemming Skjøth, Mette Søgaard, Jette Nordstrøm Kjældgaard, Gregory Y H Lip, Torben Bjerregaard Larsen
Objective To examine clinical effectiveness and safety of apixaban 2.5 mg, dabigatran 110 mg, and rivaroxaban 15 mg compared with warfarin among patients with atrial fibrillation who had not previously taken an oral anticoagulant.Design Propensity weighted (inverse probability of treatment weighted) nationwide cohort study.Setting Individual linked data from three nationwide registries in Denmark.Participants Patients with non-valvular atrial fibrillation filling a first prescription for an oral anticoagulant from August 2011 to February 2016...
February 10, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28131705/permanent-discontinuation-of-non-vitamin-k-oral-anticoagulants-in-real-life-patients-with-non-valvular-atrial-fibrillation
#6
Maria Cristina Vedovati, Paolo Verdecchia, Michela Giustozzi, Gabriella Molini, Serenella Conti, Lucia Pierpaoli, Francesca Valecchi, Adolfo Aita, Giancarlo Agnelli, Cecilia Becattini
BACKGROUND: Persistence to treatment affects clinical outcomes in patients with chronic disease such as atrial fibrillation (AF). METHODS: This prospective cohort study included consecutive non-valvular AF patients prescribed with non-vitamin K oral anticoagulants (NOACs) and investigated for any permanent discontinuation at 1-year of this therapy, as well as any reasons for discontinuation. RESULTS: Overall, 1305 patients were prescribed with dabigatran (N=473), rivaroxaban (N=425) or apixaban (N=407)...
January 19, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28123190/appropriateness-of-apixaban-dosing-to-prevent-stroke-in-patients-with-atrial-fibrillation-a-pilot-study
#7
Stephanie Carlin, Jennifer Pickering, Sam Schulman
BACKGROUND: The ARISTOTLE study investigated apixaban, at a dose of 5 mg PO bid, for the prevention of stroke in patients with atrial fibrillation; however, it has been noted anecdotally that many patients are receiving 2.5 mg PO bid, despite being eligible for the full dosage. A recent study examining the use of dabigatran and rivaroxaban found that many patients were receiving these medications inappropriately; however, a literature search conducted in April 2016 showed that apixaban had not been formally studied in this context...
November 2016: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/28122753/edoxaban-a-direct-oral-anticoagulant
#8
REVIEW
Mara Poulakos, Jacqueline N Walker, Umima Baig, Tosin David
PURPOSE: The pharmacology, pharmacokinetics, pharmacodynamics, clinical efficacy, safety, and place in therapy of edoxaban for prevention of stroke in patients with nonvalvular atrial fibrillation (AF) and treatment of venous thromboembolism (VTE) are reviewed. SUMMARY: Although warfarin has been an established therapy for stroke prevention in AF and VTE, the need for agents with less monitoring requirements, fewer food and drug interactions, and a lower risk of major bleeding led to the development of direct oral anticoagulants (DOACs)...
February 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28100898/new-oral-anticoagulants-turkey-noac-turk-multicenter-cross-sectional-study
#9
Servet Altay, Özlem Yıldırımtürk, Hüseyin Altuğ Çakmak, Lütfü Aşkın, Ümit Yaşar Sinan, Feyzullah Beşli, Ömer Gedikli, Özge Özden Tok
OBJECTIVE: New oral anticoagulants (NOACs) are increasingly used both for prevention of stroke in non-valvular atrial fibrillation (NVAF) and the treatment of venous thromboembolism (VTE). In this study, we aimed to evaluate the current patterns of NOACs treatment in Turkey. Moreover, demographic and clinical parameters and bleeding and/or embolic events under NOACs treatment were analyzed. METHODS: The New Oral Anticoagulants-TURKey (NOAC-TURK) study was designed as a multicenter cross-sectional study...
January 17, 2017: Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/28091833/the-gap-between-indicated-and-prescribed-stroke-prevention-therapies-in-a-high-risk-geriatric-population
#10
Mohammed Shurrab, Eugene Crystal, Denis O'Donnell, Hrishikesh Navare, Paula Neves, Rasha Khatib, Ilan Lashevsky, David Newman
PURPOSE: The use of oral anticoagulation (OAC) in the elderly population with atrial fibrillation (AF) treated in long-term care (LTC) facilities is inconsistent. We examined the magnitude and sources of the gap between indicated and prescribed OAC in the elderly population with AF. METHODS: We retrospectively scanned the electronic medical record (EMR) and pharmacy data of 25 LTC facilities in Ontario, Canada. The diagnosis of AF was drawn from EMR. Different attributable risk factors for possible failure to prescribe OAC were examined...
January 16, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28070883/pilot-of-a-computerised-antithrombotic-risk-assessment-tool-version-2-caratv2-0-for-stroke-prevention-in-atrial-fibrillation
#11
Yishen Wang, Beata Bajorek
BACKGROUND: The decision-making process for stroke prevention in atrial fibrillation (AF) requires a comprehensive assessment of risk vs. benefit and an appropriate selection of antithrombotic agents (e.g., warfarin, non-vitamin K antagonist oral anticoagulants [NOACs]). The aim of this pilot-test was to examine the impact of a customised decision support tool - the Computerised Antithrombotic Risk Assessment Tool (CARATV2.0) using antithrombotic therapy on a cohort of patients with AF...
January 10, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28058458/-vitamin-k-antagonists-is-their-prescription-really-medical-malpractice-%C3%A2-today
#12
E Rafflenbeul, J Müller-Ehmsen
Atrial fibrillation and venous thromboembolisms are frequent cardiovascular diseases. Until a few years ago only vitamin K antagonists (VKA) were available for oral anticoagulation as primary and secondary prevention of thrombembolic events. Currently, the non-vitamin K dependent new oral anticoagulants (NOAC) dabigatran, rivaroxaban, apixaban and edoxaban are approved for use. The approval studies, meta-analyses and data from registries provide evidence for the superiority of NOAC vs. VKA with respect to reduction of thrombembolisms and reduced bleeding complications; therefore, in the 2016 European Society of Cardiology (ESC) guidelines the use of NOAC is recommended as first line therapy for anticoagulation in atrial fibrillation (recommendation grade I/evidence level A)...
January 2017: Der Internist
https://www.readbyqxmd.com/read/28057799/prospective-study-of-oral-anticoagulants-and-risk-of-liver-injury-in-patients-with-atrial-fibrillation
#13
Alvaro Alonso, Richard F MacLehose, Lin Y Chen, Lindsay Gs Bengtson, Alanna M Chamberlain, Faye L Norby, Pamela L Lutsey
OBJECTIVE: To assess the risk of liver injury hospitalisation in patients with atrial fibrillation (AF) after initiation of direct oral anticoagulants (DOACs) or warfarin and to determine predictors of liver injury hospitalisation in this population. METHODS: We studied 113 717 patients (mean age 70, 39% women) with AF included in the MarketScan Commercial and Medicare Supplemental databases with a first prescription for oral anticoagulation after 4 November 2011, followed through 31 December 2014...
January 5, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28050755/effect-of-major-gastrointestinal-tract-surgery-on-the-absorption-and-efficacy-of-direct-acting-oral-anticoagulants-doacs
#14
REVIEW
Hakeam A Hakeam, Nasser Al-Sanea
Direct-acting oral anticoagulants (DOACs) have been introduced as alternatives to warfarin for stroke prevention in non-valvular atrial fibrillation and for treatment of venous thromboembolism. Many patients undergoing major gastrointestinal resections or bypass receive anticoagulants for various indications, including the treatment of thrombotic complication of surgery and prevention of visceral vessels events recurrence. DOACs have a wide therapeutic range that allows fixed dosing determined based on studies conducted in healthy subjects with normal absorptive capacity...
January 3, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28043907/gastrointestinal-safety-of-direct-oral-anticoagulants-a-large-population-based-study
#15
Neena S Abraham, Peter A Noseworthy, Xiaoxi Yao, Lindsey R Sangaralingham, Nilay D Shah
BACKGROUND & AIMS: Direct oral anticoagulant (DOAC) agents increase the risk of gastrointestinal (GI) bleeding. We investigated which DOAC had the most favorable GI safety profile and compared differences among these drugs in age-related risk of GI bleeding. METHODS: We conducted a retrospective, propensity-matched study using administrative claims data from the OptumLabs Data Warehouse of privately insured individuals and Medicare Advantage enrollees. We created 3 propensity-matched cohorts of patients with nonvalve atrial fibrillation with incident exposure to dabigatran, rivaroxaban, or apixaban from October 1, 2010 through February 28, 2015...
December 30, 2016: Gastroenterology
https://www.readbyqxmd.com/read/28029411/atrial-fibrillation-and-heart-failure-factors-influencing-the-choice-of-oral-anticoagulant
#16
REVIEW
Louise A E Brown, Christopher J Boos
Atrial fibrillation (AF) and heart failure (HF) frequently coexist. AF is identified in approximately one third of patients with HF and is linked to increased morbidity and mortality than from either condition alone. AF is relatively more common in HF with preserved ejection fraction (HFpEF) than with reduced ejection fraction (HFrEF). Nevertheless, the risk of stroke and systemic embolism (SSE) is significantly increased with both HF types and the absolute risk is heavily influenced by the presence and severity of associated additional stroke risk factors...
September 30, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28007305/non-vitamin-k-antagonist-oral-anticoagulants-in-atrial-fibrillation-patients-with-chronic-kidney-disease-a-systematic-review-and-network-meta-analysis
#17
Giuseppe Andò, Piera Capranzano
BACKGROUND: Currently there is lack of head-to-head comparisons between different Non-Vitamin K Antagonist Oral Anticoagulants (NOACs), especially in more risky subgroups, as those with chronic kidney disease (CKD). METHODS: We assessed the relative efficacy and safety of the four NOACs on the market in a systematic review and network meta-analysis of patients with atrial fibrillation (AF) and moderate CKD enrolled in the phase 3 randomized trials. A Bayesian framework was used to perform the network meta-analysis...
March 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28004413/direct-oral-anticoagulant-use-in-nonvalvular-atrial-fibrillation-with-valvular-heart-disease-a-systematic-review
#18
REVIEW
Ryan E Owens, Rajesh Kabra, Carrie S Oliphant
Direct oral anticoagulants (DOACs) are indicated for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF), which, according to the American College of Cardiology/American Heart Association/Heart Rhythm Society atrial fibrillation (AF) guidelines, excludes patients with rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair. However, the data regarding use of DOACs in AF patients with other types of valvular heart disease (VHD) are unclear. We aimed to summarize and evaluate the literature regarding the safety and efficacy of DOAC use in NVAF patients with other types of VHD...
December 22, 2016: Clinical Cardiology
https://www.readbyqxmd.com/read/28003013/oral-antiplatelet-and-anticoagulant-agents-in-the-prevention-and-management-of-ischemic-stroke
#19
Shreya Shrestha, Shannon Coy, Kimon Bekelis
Despite numerous advances over the last 50 years, stroke continues to be a leading cause of death and disability worldwide. The treatment and prevention of stroke has undergone extensive study, and significant advances in medical management have occurred within the past decade principally with the development of new classes of orally active anticoagulant drugs. Here we review these recent breakthroughs and the varying roles of anticoagulants and antiplatelet agents in the prevention and management of different ischemic stroke subtypes, as well as describe the benefits and ongoing challenges to incorporating the novel oral anticoagulants (NOACs) into clinical management guidelines...
December 21, 2016: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28002996/oral-antiplatelet-and-anticoagulant-agents-in-the-prevention-and-management-of-ischemic-stroke
#20
Shreya Shrestha, Shannon Coy, Kimon Bekelis
Despite numerous advances over the last 50 years, stroke continues to be a leading cause of death and disability worldwide. The treatment and prevention of stroke has undergone extensive study, and significant advances in medical management have occurred within the past decade principally with the development of new classes of orally active anticoagulant drugs. Here we review these recent breakthroughs and the varying roles of anticoagulants and antiplatelet agents in the prevention and management of different ischemic stroke subtypes, as well as describe the benefits and ongoing challenges to incorporating the novel oral anticoagulants (NOACs) into clinical management guidelines...
December 21, 2016: Current Pharmaceutical Design
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