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https://www.readbyqxmd.com/read/28074293/-management-of-noak-administration-during-invasive-or-surgical-interventions-when-and-how-to-pause-and-when-to-restart
#1
M Buerke, H M Hoffmeister
Many patients under oral anticoagulation therapy need percutaneous or surgical interventions/operations. For vitamin K antagonists (VKA), there are recommendations regarding preoperative or postoperative administration. Management of the new oral anticoagulants (NOAC) was supposed to be easier - but some aspects must be considered. Due to the different pharmacokinetic profiles of substances such as dabigatran, rivaroxaban, apixaban, and edoxaban, different recommendations are given.Upon periprocedural management, thromboembolic risk has to be considered in patients treated with NOACs...
January 10, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28064150/a-novel-risk-prediction-score-in-atrial-fibrillation-for-a-net-clinical-outcome-from-the-engage-af-timi-48-randomized-clinical-trial
#2
Christina L Fanola, Robert P Giugliano, Christian T Ruff, Marco Trevisan, Francesco Nordio, Michele F Mercuri, Elliott M Antman, Eugene Braunwald
AIMS: The choice between initiating a non-vitamin K antagonist oral anticoagulant (NOAC) and a vitamin K antagonist (VKA) in patients with atrial fibrillation (AF) may be challenging. To assist in this decision, we developed a risk score to identify patients for whom a therapeutic benefit of NOACs over VKA is predicted. METHODS AND RESULTS: ENGAGE AF-TIMI 48 was a randomized clinical trial of edoxaban vs. warfarin in 21 105 patients with AF. Cox proportional hazard models identified factors associated with a serious net clinical outcome (NCO) of disabling stroke, life-threatening bleeding, and all-cause mortality in VKA naïve patients from the warfarin arm...
January 6, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28063671/meta-analysis-of-major-bleeding-events-on-aspirin-versus-vitamin-k-antagonists-in-randomized-trials
#3
P Ambrosi, A Daumas, P Villani, R Giorgi
BACKGROUND AND OBJECTIVES: The relative bleeding risk of aspirin versus vitamin K antagonists (VKA) is unclear. Most of previous meta-analyses included trials with target INR for VKA therapy far beyond usually recommended range (2-3). The aim of this study was to compare the bleeding risk of aspirin and VKA, as indicated by the aggregate body of clinical evidence including data from the recently published WARCEF trial. METHODS: In this meta-analysis we included randomized controlled trials that compared aspirin to VKA (1...
December 27, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28058574/quality-of-life-with-rivaroxaban-in-patients-with-non-valvular-atrial-fibrilation-by-therapeutic-compliance
#4
Emilio Márquez-Contreras, Nieves Martell-Claros, Vicente Gil-Guillén, Mariano De la Figuera-Von Wichmann, Eugenio Sánchez-López, Ines Gil-Gil, Sara Márquez-Rivero
OBJECTIVE: To assess the quality of life (QOL) with rivaroxaban in patients with non-valvular atrial fibrilation (NVAF) related to therapeutic compliance. METHODS: Prospective, longitudinal, multicenter study was developed in 160 Spanish primary or specialized care centers. We included 412 patients treated with rivaroxaban, prescribed for stroke prevention. Three visits were conducted: baseline, 6 and 12 months. Compliance was measured by electronic monitoring systems...
January 6, 2017: Quality of Life Research
https://www.readbyqxmd.com/read/28058458/-vitamin-k-antagonists-is-their-prescription-really-medical-malpractice-%C3%A2-today
#5
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/28056758/thrombotic-management-of-antiphospholipid-syndrome-towards-novel-targeted-therapies
#6
Md Asiful Islam, Fahmida Alam, Kah Keng Wong, Mohammad Amjad Kamal, Siew Hua Gan
Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by thrombosis and/or pregnancy morbidity with persistent levels of antiphospholipid antibodies (aPLs). The development of thrombosis in APS is mediated by aPLs and contributes to the high mortality rate in APS patients. However, although APS has been reported for more than 30 years, there has been no optimal regimen for its prevention or for the management of thrombosis, mainly because the mainstay treatment strategies for managing APS are not targeted towards aPL-mediated thrombotic pathophysiology...
5, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28055147/monitoring-of-treatment-with-vitamin-k-antagonists-recombinant-thromboplastins-are-more-sensitive-to-factor-vii-than-tissue-extract-thromboplastins
#7
Joseph S Biedermann, Antonius M H P van den Besselaar, Moniek P M de Maat, Frank W G Leebeek, Marieke J H A Kruip
BACKGROUND: Differences regarding sensitivity to factor VII (FVII) have been suggested for recombinant human and tissue-extract thromboplastins used for International Normalized Ratio (INR) measurement, but evidence is scarce. Differences in FVII sensitivity are clinically relevant since they can affect INR stability during treatment with vitamin K antagonists (VKA). OBJECTIVES: To determine if commercial thromboplastins react differently to changes in FVII. METHODS: We studied the effect of addition of FVII on the INR in plasma using three tissue-extract (Neoplastin C1+, Hepato Quick, Thromborel S) and three recombinant human (Recombiplastin 2G, Innovin, Coaguchek XS) thromboplastins...
January 5, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28045242/evidence-for-periprocedural-antiplatelet-therapy-heparinization-and-bridging-of-coumarin-therapy-in-carotid-revascularization
#8
Art Brand, Gert J DE Borst
Thromboembolism prevention is a crucial factor determining both the natural outcome and outcome of intervention of stenotic atherosclerotic carotid artery pathology. Roughly 80% of all natural course cerebral ischemic events are caused by thromboembolism, versus 20% due to hemodynamic insufficiency. The risk of periprocedural cerebral (micro) thromboembolization during carotid revascularization is considered to be even higher, with a higher rate in carotid artery stenting (CAS) as compared to carotid endarterectomy (CEA)...
January 3, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28044251/novel-diagnostic-and-therapeutic-frontiers-in-thrombotic-anti-phospholipid-syndrome
#9
REVIEW
Savino Sciascia, Massimo Radin, Mario Bazzan, Dario Roccatello
The anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by vascular thrombosis and/or pregnancy morbidity, associated with a persistent positivity for anti-phospholipid antibodies (aPL). The current classification criteria for APS include three laboratory tests: lupus anti-coagulant (LA), anti-cardiolipin (aCL), and anti-β2 glycoprotein-I (β2GPI). To date, the therapeutic approach for thrombotic APS mainly centers on long-term anti-coagulation with a vitamin K antagonist (VKA). APS management may represent a challenge for the treating physicians...
February 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28039844/low-molecular-weight-heparin-versus-vitamin-k-antagonists-for-the-treatment-of-cancer-associated-thrombosis-a-cost-effectiveness-analysis
#10
Nathan T Connell, Gregory A Abel, Jean M Connors
INTRODUCTION: Cancer-associated venous thromboembolism (VTE) is primarily treated with low-molecular weight heparin (LMWH), a strategy based on studies showing it to be superior to the vitamin K antagonist (VKA) warfarin for preventing VTE recurrence. Subsequent analyses suggest that the magnitude of this benefit might be less than previously determined. Neither patient-focused measures of utility nor the costs of each strategy have been evaluated in the current treatment era. METHODS: This is a cost-effectiveness analysis of VKA and LMWH for the treatment of cancer-associated thrombosis through use of a microsimulation model of outcomes for competing anticoagulation management strategies from a 2014 United States societal perspective...
December 22, 2016: Thrombosis Research
https://www.readbyqxmd.com/read/28033245/vkorc1-and-cyp2c9-polymorphisms-related-to-adverse-events-in-case-control-cohort-of-anticoagulated-patients
#11
Silvia Misasi, Giuliana Martini, Oriana Paoletti, Stefano Calza, Giovanni Scovoli, Alessandra Marengoni, Sophie Testa, Luigi Caimi, Eleonora Marchina
Vitamin K antagonists (VKAs) are highly effective but have a narrow therapeutic index and require routine monitoring of the INR. The primary aim of pharmacogenetics (PGx) is to optimize patient care, achieving drug treatments that are personalized according to the genetic profile of each patient. The best-characterized genes involved in VKA PGx involve pharmacokinetics (VKORC1) and pharmacodynamics (CYP2C9) of VKA metabolism. The role of these genes in clinical outcomes (bleeding and thrombosis) during oral anticoagulant (OAC) therapy is controversial...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28029563/-use-of-non-vitamin-k-antagonist-oral-anticoagulants-in-primary-care-actua-study
#12
V Barrios, C Escobar, J M Lobos, J Polo, D Vargas
OBJECTIVES: Approximately 40% of patients with non-valvular auricular fibrillation (NVAF) who receive vitamin K antagonists (VKA) in Primary Care in Spain have poor anticoagulation control. The objective of the study Actuación en antiCoagulación, Tratamiento y Uso de anticoagulantes orales de acción directa (ACOD) en Atención primaria (ACTUA) (Action in Coagulation, Treatment and Use of direct oral anticoagulants [DOACs]) in Primary Care) was to analyse the current situation regarding the use of VKA and non-vitamin K antagonist oral anticoagulants (NOACs) in patients with NVAF in Primary Care in Spain and the possible issues arising from it...
October 28, 2016: Semergen
https://www.readbyqxmd.com/read/28009449/the-efficacy-and-safety-of-direct-oral-anticoagulants-vs-traditional-anticoagulants-in-cirrhosis
#13
Justine Hum, Joseph J Shatzel, Janice H Jou, Thomas G Deloughery
INTRODUCTION: The coagulopathy of cirrhosis is complex, placing patients at risk for both bleeding and thrombosis. Direct oral anticoagulants (DOACs) have equivalent or superior efficacy and safety as compared to vitamin K antagonists (VKA); however, their efficacy and safety in liver cirrhosis has not been studied. To better define this, we evaluated outcomes of cirrhotic patients prescribed DOACS compared to other anticoagulants at our center. METHODS: Retrospective cohort study of cirrhotic patients prescribed therapeutic anticoagulation over a 3 year period for thrombosis or prevention of stroke in patients with atrial fibrillation...
December 23, 2016: European Journal of Haematology
https://www.readbyqxmd.com/read/28004062/optimal-timing-of-vitamin-k-antagonist-resumption-after-upper-gastrointestinal-bleeding-a-risk-modelling-analysis
#14
Ammar Majeed, Niklas Wallvik, Joakim Eriksson, Jonas Hoijer, Matteo Bottai, Margareta Holmström, Sam Schulman
The optimal timing of vitamin K antagonists (VKAs) resumption after an upper gastrointestinal (GI) bleeding, in patients with continued indication for oral anticoagulation, is uncertain. We included consecutive cases of VKA-associated upper GI bleeding from three hospitals retrospectively. Data on the bleeding location, timing of VKA resumption, recurrent GI bleeding and thromboembolic events were collected. A model was constructed to evaluate the 'total risk', based on the sum of the cumulative rates of recurrent GI bleeding and thromboembolic events, depending on the timing of VKA resumption...
December 22, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27998809/explaining-and-reducing-the-variation-in-inter-laboratory-reported-values-for-international-normalised-ratio
#15
Roslyn Bonar, Emmanuel J Favaloro
INTRODUCTION: Monitoring of vitamin K antagonist (VKA) therapy is usually achieved using the International Normalised Ratio (INR). However, despite international standardisation, there remains considerable concern regarding ongoing high levels of inter-laboratory variation, as generated by different laboratories using the same homogeneous plasma sample. Notably, significant discrepancies continue to be evidenced in external quality assessment (EQA) environments, prompting additional investigations to determine causes and to identify potential inconsistencies of practice...
December 14, 2016: Thrombosis Research
https://www.readbyqxmd.com/read/27995007/direct-new-oral-anticoagulants-follow-up-guidelines-and-bleeding-complications-in-general-practice-a-survey-of-swiss-general-internal-medicine-practitioners
#16
Thomas C Sauter, Carlo Melis, Wolf E Hautz, Meret E Ricklin, Aristomenis K Exadaktylos
BACKGROUND: The present study investigated how much Swiss general internal medicine practitioners (GPs) know about new direct oral anticoagulants (NOACs), particularly the relevant guidelines, follow-up tests, dosing adjustments, indications and complications. We conducted a paper-based survey of GPs, performed in Bern, Switzerland. Our questionnaire assessed the physicians' preference for NOACs rather than vitamin K antagonists (VKA), prevalence and choice of NOAC, clinical follow-up including follow-up blood testing, and bleeding complications...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27989533/the-use-of-direct-oral-anticoagulants-in-56-patients-with-antiphospholipid-syndrome
#17
Katarzyna Malec, Tadeusz Góralczyk, Anetta Undas
INTRODUCTION: Antiphospholipid syndrome (APS) is a common acquired thrombophilia associated with a high thrombotic risk, in which vitamin K antagonists (VKA) represent the mainstay of therapy. Case series involving up to 35 patients with APS suggested limited efficacy and safety of direct oral anticoagulants (DOACs). MATERIAL AND METHODS: In the prospective case series we followed 56 consecutive patients with APS (44 women and 12 men, aged from 22 to 64years), including 33 (60%) associated with systemic lupus erythematosus (SLE) and 16 (28...
December 14, 2016: Thrombosis Research
https://www.readbyqxmd.com/read/27980542/antithrombotic-management-in-patients-with-percutaneous-coronary-intervention-requiring-oral-anticoagulation
#18
REVIEW
Jarosław Zalewski, Anetta Undas
The dynamic evolution of therapeutic options including the use of vitamin K antagonists (VKA), non-vitamin K oral anticoagulants (NOAC), more potent antiplatelet drugs as well as new generation drug-eluting stents could lead to the view that the current recommendations on the management of patients with percutaneous coronary intervention (PCI) requiring oral anticoagulation do not keep up with the results of several clinical studies published within the last 5 years. In the present overview, we summarize the recent advances in antithrombotic management used in atrial fibrillation patients undergoing PCI for stable coronary artery disease or acute coronary syndrome (ACS)...
2016: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/27977592/comparing-the-clinical-outcomes-in-patients-with-atrial-fibrillation-receiving-dual-antiplatelet-therapy-and-patients-receiving-an-addition-of-an-anticoagulant-after-coronary-stent-implantation-a-systematic-review-and-meta-analysis-of-observational-studies
#19
Nabin Chaudhary, Pravesh Kumar Bundhun, He Yan
BACKGROUND: Data regarding the clinical outcomes in patients with atrial fibrillation (AF) receiving dual antiplatelet therapy (DAPT) and an anticoagulant in addition to DAPT (DAPT + vitamin K antagonist [VKA]) after coronary stent implantation are still controversial. Therefore, in order to solve this issue, we aim to compare the adverse clinical outcomes in AF patients receiving DAPT and DAPT + VKA after percutaneous coronary intervention and stenting (PCI-S). METHODS: Observational studies comparing the adverse clinical outcomes such as major bleeding, major adverse cardiovascular events, stroke, myocardial infarction, all-cause mortality, and stent thrombosis (ST) in AF patients receiving DAPT + VKA therapy, and DAPT after PCI-S have been searched from Medline, EMBASE, and PubMed databases...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27935987/patient-reported-treatment-satisfaction-with-rivaroxaban-for-stroke-prevention-in-atrial-fibrillation-a-french-observational-study-the-safari-study
#20
Olivier Hanon, Edouard Chaussade, Pierre Gueranger, Elise Gruson, Sabrina Bonan, Alain Gay
BACKGROUND: For antithrombotic treatments, Patient Reported Outcomes (PRO) and patient satisfaction with treatment are essential data for physicians because of the strong relationship between patient satisfaction and adherence to treatment. The impact of rivaroxaban on patient satisfaction and quality of life was not sufficiently documented in phase III studies. There is a need for further data in this field especially in real life conditions. METHODS: The SAFARI study is composed of patients with non-valvular atrial fibrillation (AF), previously treated with vitamin K antagonist (VKA) and switched to rivaroxaban...
2016: PloS One
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