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https://www.readbyqxmd.com/read/29346128/management-of-heavy-menstrual-bleeding-during-direct-oral-anticoagulant-therapy-for-recurrent-venous-thromboembolism-a-case-report
#1
Michela Giustozzi, Maria C Vedovati, Giancarlo Agnelli
: A high risk of venous thromboembolism (VTE) recurrence requires extended anticoagulation but limits the options to control heavy menstrual bleeding (HMB) in women of reproductive age. We report the management of HMB in a 48-year-old woman with a history of menometrorrhagia, recurrent VTE and multiple VTE risk factors. Due to the occurrence of HMB during extended rivaroxaban treatment, the presence of a uterine fibroid and the contraindication to interrupt anticoagulation for high risk of VTE recurrence, she received hormonal treatment first with a gonadotropin-releasing hormone agonist and then with progestin...
January 15, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/29338293/betrixaban-a-new-oral-factor-xa-inhibitor-for-extended-venous-thromboembolism-prophylaxis-in-high-risk-hospitalized-patients
#2
Scott G Garland, Christina E DeRemer, Steven M Smith, John G Gums
OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of the factor Xa (FXa) inhibitor betrixaban for extended-duration prophylaxis of acute medically ill patients with venous thromboembolism (VTE) risk factors. DATA SOURCES: A MEDLINE/PubMed (January 1990 to October 2017) search was conducted using the following keywords: betrixaban, PRT054021, FXa inhibitor, novel oral anticoagulant, NOAC, direct oral anticoagulant, DOAC, and target specific oral anticoagulant, TSOAC...
January 1, 2018: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29337837/accidental-rivaroxaban-intoxication-in-a-boy-some-lessons-in-managing-new-oral-anticoagulants-in-children
#3
Julieta Weirthein, Dennis Scolnik, Nili Yanai Milshtein, Tali Capua, Miguel Glatstein
Novel oral anticoagulants offer equivalent or improved therapeutic profiles compared with warfarin, with less risk of bleeding, no interactions with food, and no need for routine laboratory monitoring. Caution must be exercised in using these drugs in certain patient populations, for example, renal insufficiency, those receiving additional antithrombotic therapy, those with questionable compliance, children, and those with a high risk of gastrointestinal bleeding. One of the novel oral anticoagulants, rivaroxaban, is a direct Factor Xa inhibitor, used to reduce risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, deep vein thrombosis, and pulmonary embolism...
January 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29337442/-angiology-and-haemostasis-highlights-on-some-new-data-in-2017
#4
Pierre Fontana, Helia Robert-Ebadi, Françoise Boehlen, Marc Righini
New data support the fact that prophylactic anticoagulation with direct oral anticoagulants is effective and safe for the long-term prevention of venous thromboembolism. This type of treatment is dedicated for a subgroup of patients only, which is described in this article. With regard to major bleedings occurring with these anticoagulants, new data have been added to those already available for idarucizumab, a specific antagonist of dabigatran. Finally, we summarize the data regarding a breakthrough molecule, emicizumab, which could potentially open a new era in the management of people with haemophilia A...
January 10, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29334746/-the-current-role-of-warfarin
#5
Jana Michalcová, Alena Buliková, Jiřina Zavřelová, Marie Prudková, Miroslav Penka
Well-managed warfarin therapy remains an important method of anticoagulation in the 21st century, despite the introduction of new antithrombotics into the clinical practice. The main advantages of warfarin are decades of treatment experience, the possibility to monitor its anticoagulant effect using the INR and the last, but not least, the low cost. Currently, approximately 75 % of anticoagulated patients in the Czech Republic are treated with warfarin and warfarin remains the only option for oral anticoagulant therapy in certain clinical conditions (particularly in patients with valvular atrial fibrillation or mechanical heart valves)...
2018: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/29325634/relationship-of-aging-and-incident%C3%A2-comorbidities-to-stroke-risk-in-patients%C3%A2-with-atrial-fibrillation
#6
Tze-Fan Chao, Gregory Y H Lip, Chia-Jen Liu, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Tzeng-Ji Chen, Shih-Ann Chen
BACKGROUND: When assessing ischemic stroke risk in patients with atrial fibrillation (AF), the CHA2DS2-VASc score is calculated based on the baseline risk factors, and the outcomes are determined after a follow-up period. However, the stroke risk in patients with AF does not remain static, and with time, patients get older and accumulate more comorbidities. OBJECTIVES: This study hypothesized that the "Delta CHA2DS2-VASc score," which reflects the change in score between baseline and follow-up, would be more predictive of ischemic stroke compared with the baseline CHA2DS2-VASc score...
January 16, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29325349/-introduction-and-interpretation-of-guidelines-on-thromboprophylaxis-in-the-perioperative-period-of-urological-surgery
#7
X Wang, Z Y Liu
Venous thromboembolism had drawn great attention of global experts, as it is the third leading cause of cardiovascular-associated death, ranking after coronary heart disease and stroke. Numerous health care organizations had introduced guidelines for thromboprophylaxis during the perioperative period in their own fields. The paper reviewed the available guidelines pertaining to urological surgery from America Urological Association, American College of Chest Physicians and European Association of Urology. Compared with the first two guidelines, the European Association of Urology guideline is a milestone which recommended the most detailed prophylactic measures for the procedure-specific and patient-specific according to the evidence-based medicine...
January 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/29307469/overview-of-vte-treatment-in-cancer-according-to-clinical-guidelines
#8
Agnes Y Y Lee
Evidence-based clinical practice guidelines are available to provide guidance to clinicians in managing patients living with cancer-associated venous thromboembolism (VTE). While most are developed using rigorous methods and grounded by systematic reviews of the literature, their recommendations do differ because of differences in their grading criteria and interpretation of the data. This can be confusing to practicing clinicians. Also, guidelines are often out of date and cannot keep pace with publications because of the lengthy processes and extensive resources required for completion...
January 3, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29304263/the-prevalence-of-adverse-ocular-hemorrhagic-events-in-patients-utilizing-oral-anticoagulant-and-antiplatelet-therapy-in-routine-clinical-practice
#9
Dattanand M Sudarshana, Eleni K Konstantinou, Sruthi Arepalli, Fabiana Q Silva, Andrew P Schachat, Justis P Ehlers, Rishi P Singh
BACKGROUND AND OBJECTIVE: Previous literature assessing ocular hemorrhagic complications of anticoagulant/antiplatelet medications in routine clinical practice is limited. This study evaluates the prevalence of spontaneous ocular hemorrhagic events associated with anticoagulation/antiplatelet therapy. PATIENTS AND METHODS: A retrospective study was performed to identify patients taking anticoagulants (rivaroxaban [Xarelto; Janssen Pharmaceuticals, Beerse, Belgium], bivalirudin [Angiomax; The Medicines Company, Parsippany, NJ], lepirudin [Refludan; Bayer HealthCare Pharmaceuticals, Berlin, Germany], dabigatran [Pradaxa; Boehringer Ingelheim, Ingelheim am Rhein, Germany], and argatroban) and antiplatelet agents (clopidogrel [Plavix; Bristol-Myers Squibb, New York City, NY], prasugrel [Effient; Lilly Medical, Indianapolis, IN], and ticagrelor [Brilinta; AstraZeneca, Cambridge, UK]) who presented for an eye examination...
January 1, 2018: Ophthalmic Surgery, Lasers & Imaging Retina
https://www.readbyqxmd.com/read/29301756/outcomes-of-patients-with-atrial-fibrillation-newly-recommended-for-oral-anticoagulation-under-the-2014-american-heart-association-american-college-of-cardiology-heart-rhythm-society-guideline
#10
Matthew P Gray, Samir Saba, Yuting Zhang, Inmaculada Hernandez
BACKGROUND: In March 2014, the American Heart Association updated their guidelines for the management of oral anticoagulation (OAC) in atrial fibrillation, recommending OAC for all patients with CHA2DS2-VASc ≥2. Previously, only patients with CHADS2 ≥2 were recommended for anticoagulation. This study compared effectiveness and safety outcomes of OAC among patients who would receive OAC using the 2014 guidelines but not the 2011 guidelines. METHODS AND RESULTS: Using claims data from a 5% sample of 2013-2014 Medicare beneficiaries, we identified patients with initially diagnosed atrial fibrillation between 2013 and 2014 and selected those who would receive OAC under the 2014 guidelines but not the 2011 guidelines (those with CHA2DS2-VASc score ≥2 or CHADS2 score <2)...
January 4, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29299960/closure-of-patent-foramen-ovale-in-cryptogenic-stroke-has-the-story-come-to-an-end
#11
Jean-Louis Mas, Gilles Chatellier
Contrasting with three randomized trials that failed to show any superiority of patent foramen ovale closure over antithrombotic therapy, two trials recently reported lower rates of stroke recurrence among patients assigned to patent foramen ovale closure than among those assigned to antiplatelet therapy. In addition, one of the initially negative trials concluded in favor of patent foramen ovale closure after an extended follow-up period. A better selection of patients, the use of reference treatment groups that included patients who received antiplatelet therapy alone (rather than antiplatelet drugs or oral anticoagulants, according to physician preference), and a longer follow-up of patients, may explain the divergent findings across studies...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29285754/oral-anticoagulation-in-people-with-cancer-who-have-no-therapeutic-or-prophylactic-indication-for-anticoagulation
#12
REVIEW
Lara A Kahale, Maram B Hakoum, Ibrahim G Tsolakian, Charbel F Matar, Maddalena Barba, Victor E D Yosuico, Irene Terrenato, Francesca Sperati, Holger Schünemann, Elie A Akl
BACKGROUND: Oral anticoagulants may improve the survival of people with cancer through both an antitumor effect and antithrombotic effect, yet increase the risk of bleeding. OBJECTIVES: To evaluate the efficacy and safety of oral anticoagulants in ambulatory people with cancer undergoing chemotherapy, hormonal therapy, immunotherapy or radiotherapy, but otherwise have no standard therapeutic or prophylactic indication for anticoagulation. SEARCH METHODS: We conducted a comprehensive literature search in February 2016 that included a major electronic search of Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 1), MEDLINE (Ovid) and Embase (Ovid); handsearching of conference proceedings; checking of references of included studies; a search for ongoing studies; and using the 'related citation' feature in PubMed...
December 29, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29260237/-anticoagulation-in-geriatric-patients-with-atrial-fibrillation-with-what-and-for-whom-no-more
#13
REVIEW
P Bahrmann, M Christ
Based on established risk scores, such as the CHA2DS2-VASc score, the indications for oral anticoagulation are given for patients over 65 years old with atrial fibrillation and even more so for patients over 75 years old. Before beginning anticoagulation a geriatric assessment for evaluation of the cognitive ability, the activities of daily living and the risk of falling should be made because of the known complications of anticoagulation. Geriatric patients with non-valvular atrial fibrillation (AF) are increasingly being treated with non-vitamin K antagonist oral anticoagulants (NOAC) to prevent ischemic stroke...
December 19, 2017: Herz
https://www.readbyqxmd.com/read/29249247/-what-s-new-in-instrumental-dermatology
#14
V Chaussade
This "What's new in instrumental dermatology" dedicated skin surgeryis based upon a 2015-2017 literature analysis. The excision of skin cancers is an important part of surgical dermatology. Will artificial intelligence and new drug be able to face the increasing need for therapy? Wrong-site surgery is due to multiple factors. Photographs of biopsy site and short time between biopsy and surgery decrease postponement of surgery and wrong-site surgery. Noninvasive imaging technologies are improving and help to delineate skin tumors and increase the probability of complete tumor removal...
December 2017: Annales de Dermatologie et de Vénéréologie
https://www.readbyqxmd.com/read/29242919/association-of-novel-oral-antithrombotics-with-the-risk-of-intraocular-bleeding
#15
Katherine E Uyhazi, Todd Miano, Wei Pan, Brian L VanderBeek
Importance: Novel oral anticoagulation and antiplatelet therapies have become a mainstay of treatment for thromboembolic disease. However, the safety profile of these medications has not been completely characterized. Objective: To determine the risk of developing intraocular hemorrhages with novel oral antithrombotic therapy compared with that of traditional antithrombotic agents. Design, Setting, and Participants: In this retrospective cohort study, a large national insurance claims database was used to generate 2 parallel analyses...
December 14, 2017: JAMA Ophthalmology
https://www.readbyqxmd.com/read/29228158/percutaneous-left-atrial-appendage-occlusion-in-atrial-fibrillation-patients-with-a-contraindication-to-oral-anticoagulation-a-focused-review
#16
Marin Nishimura, Shiv Sab, Ryan R Reeves, Jonathan C Hsu
Stroke is the most feared complication of atrial fibrillation (AF). Although oral anticoagulation with non-vitamin K antagonist and non-vitamin K antagonist oral anticoagulants (NOACs) have been established to significantly reduce risk of stroke, real-world use of these agents are often suboptimal due to concerns for adverse events including bleeding from both patients and clinicians. Particularly in patients with previous serious bleeding, oral anticoagulation may be contraindicated. Left atrial appendage occlusion (LAAO), mechanically targeting the source of most of the thrombi in AF, holds an immense potential as an alternative to OAC in management of stroke prophylaxis...
December 8, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29224646/association-of-insurance-type-with-receipt-of-oral-anticoagulation-in-insured-patients-with-atrial-fibrillation-a-report-from-the-american-college-of-cardiology-ncdr-pinnacle-registry
#17
MULTICENTER STUDY
Celina M Yong, Yuyin Liu, Patricia Apruzzese, Gheorghe Doros, Christopher P Cannon, Thomas M Maddox, Anil Gehi, Jonathan C Hsu, Steven A Lubitz, Salim Virani, Mintu P Turakhia
BACKGROUND: It is poorly understood whether insurance type may be a major contributor to the underuse of oral anticoagulation (OAC) among patients with atrial fibrillation (AF), particularly for novel oral anticoagulants (NOACs). METHODS: We performed a retrospective cohort registry study of patients with insurance, AF, CHA2DS2-VASc ≥2, and at least one outpatient encounter recorded in the ACC NCDR's PINNACLE Registry between January 1, 2011 and December 31, 2014...
January 2018: American Heart Journal
https://www.readbyqxmd.com/read/29224364/new-anticoagulants-for-venous-thromboembolism-and-atrial-fibrillation-what-the-future-holds
#18
Gerasimos Dimitropoulos, S M Zubair Rahim, Alexandra Sophie Moss, Gregory Y H Lip
The field of anticoagulation has seen impressive progress over the last decade. The introduction of the Non Vitamin K Oral Anticoagulants (NOACs) has revolutionized practice surrounding thromboprophylaxis, treatment of thromboembolic disease and stroke prevention in atrial fibrillation (AF). However, the search for the 'holy grail' of anticoagulation, an agent that combines optimal efficacy with minimal bleeding diathesis, continues. Areas covered: In this paper we aim to summarize the current evidence from pre-clinical studies and early phase clinical trials, presenting the pharmacodynamic and pharmacokinetic properties as well as the safety and efficacy profiles of the most important antithrombotic agents in development...
December 14, 2017: Expert Opinion on Investigational Drugs
https://www.readbyqxmd.com/read/29223431/international-trends-in-clinical-characteristics-and-oral-anticoagulation-treatment-for-patients-with-atrial-fibrillation-results-from-the-garfield-af-orbit-af-i-and-orbit-af-ii-registries
#19
MULTICENTER STUDY
Benjamin A Steinberg, Haiyan Gao, Peter Shrader, Karen Pieper, Laine Thomas, A John Camm, Michael D Ezekowitz, Gregg C Fonarow, Bernard J Gersh, Samuel Goldhaber, Sylvia Haas, Werner Hacke, Peter R Kowey, Jack Ansell, Kenneth W Mahaffey, Gerald Naccarelli, James A Reiffel, Alexander Turpie, Freek Verheugt, Jonathan P Piccini, Ajay Kakkar, Eric D Peterson, Keith A A Fox
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the world. We aimed to provide comprehensive data on international patterns of AF stroke prevention treatment. METHODS: Demographics, comorbidities, and stroke risk of the patients in the GARFIELD-AF (n=51,270), ORBIT-AF I (n=10,132), and ORBIT-AF II (n=11,602) registries were compared (overall N=73,004 from 35 countries). Stroke prevention therapies were assessed among patients with new-onset AF (≤6 weeks). RESULTS: Patients from GARFIELD-AF were less likely to be white (63% vs 89% for ORBIT-AF I and 86% for ORBIT-AF II) or have coronary artery disease (19% vs 36% and 27%), but had similar stroke risk (85% CHA2DS2-VASc ≥2 vs 91% and 85%) and lower bleeding risk (11% with HAS-BLED ≥3 vs 24% and 15%)...
December 2017: American Heart Journal
https://www.readbyqxmd.com/read/29222248/direct-oral-anticoagulants-now-also-for-prevention-and-treatment-of-cancer-associated-venous-thromboembolism
#20
REVIEW
Ingrid Pabinger, Julia Riedl
Data on specific studies in cancer patients using direct oral anticoagulants (DOACs) for the prevention and treatment of venous thromboembolism (VTE) are still scarce. For preventing VTE with DOACs, current experience is still very limited, so definite conclusions cannot yet be drawn. However, DOACs have so far been compared with vitamin K antagonists (VKAs) in patients with acute VTE in 5 studies, and several hundreds of patients included in these studies had either active cancer, a history of cancer, or a new occurrence of cancer during the course of disease...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
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