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https://www.readbyqxmd.com/read/28751467/recurrent-thrombosis-in-patients-with-antiphospholipid-syndrome-receiving-newer-oral-anticoagulants-a-case-report-and-review-of-literature
#1
Akanksha Joshi, Jason Hong, Chokkalingam Siva
We present the case of a patient with primary APS who had a recurrence of thrombotic event while on treatment with rivaroxaban and had to be restarted on warfarin. The current literature on recurrence of thrombotic events in patients with antiphospholipid syndrome (APS) treated with newer oral anticoagulants (NOAC) is also reviewed. Relevant case reports and case series were identified by searching the Medline database using the key words antiphospholipid syndrome, anticoagulants and names of the NOACs, and data on individual patients was abstracted...
June 2017: Clinical Medicine & Research
https://www.readbyqxmd.com/read/28737523/perioperative-management-of-severe-congenital-protein-c-deficiency
#2
Kentaro Watanabe, Motohiro Kato, Tetsuya Ishimaru, Mitsuteru Hiwatari, Tomonori Suzuki, Yoshihiro Minosaki, Junko Takita, Jun Fujishiro, Akira Oka
: Perioperative care of congenital protein C deficiency has not been well established. Here, we describe a patient with congenital protein C deficiency who underwent laparoscopic fundoplication and gastrostomy at 2 years of age. Preoperatively, we stopped warfarin, administered fresh frozen plasma, and activated protein C. These procedures were performed without bleeding or clotting events, and at 3 days after the procedures, we restarted warfarin. Several episodes of abdominal hemorrhage and purpura fulminans occurred 2-4 weeks postoperatively, and the events were managed conservatively...
July 21, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28639882/management-of-oral-anticoagulation-therapy-after-gastrointestinal-bleeding-whether-to-when-to-and-how-to-restart-an-anticoagulation-therapy
#3
Kazuhiko Kido, Michael J Scalese
OBJECTIVE: To evaluate current clinical evidence for management of oral anticoagulation therapy after gastrointestinal bleeding (GIB) with an emphasis on whether to, when to, and how to resume an anticoagulation therapy. DATA SOURCES: Relevant articles from MEDLINE, Cochrane Library, and EMBASE databases were identified from 1946 through May 20, 2017, using the keywords: gastrointestinal hemorrhage or gastrointestinal bleeding and antithrombotic therapy or anticoagulation therapy or warfarin or dabigatran or rivaroxaban or apixaban or edoxaban...
June 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28480651/the-perioperative-management-of-antithrombotic-therapies-using-enoxaparin
#4
Hun Gyu Hwang, So My Koo, Soo Taek Uh, Yang Ki Kim
Oral anticoagulant therapy is frequently and increasingly prescribed for patients at risk of arterial or venous thromboembolism (VTE). Although elective surgical or invasive procedures have necessitated temporary interruption of anticoagulants, managing these patients has been performed empirically and been poorly investigated. This study was designed to evaluate the adequacy of perioperative anticoagulation using enoxaparin. This was a retrospective, single-center study that evaluated the efficacy and safety of therapeutic-dose enoxaparin for bridging therapy in patients on long-term warfarin at Soonchunhyang University Hospital in Korea between August 2009 and July 2011...
June 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/28272736/reintroduction-of-anti-thrombotic-therapy-after-a-gastrointestinal-haemorrhage-if-and-when
#5
REVIEW
Martin J Scott, Andrew Veitch, Jecko Thachil
Gastrointestinal haemorrhage is a common clinical scenario and, in those using antithrombotic agents, the risk is significantly increased. Management of these patients, in terms of initial resuscitation is well established and numerous guidelines exist in this area. However, few studies have addressed the subsequent dilemma of if and when antithrombotic agents should be reintroduced. Consequently, practice is variable and not necessarily evidenced-based. Overall, for patients that are either anticoagulated or using antiplatelet drugs for secondary prophylaxis, there is a clear benefit to restarting these agents...
April 2017: British Journal of Haematology
https://www.readbyqxmd.com/read/27909200/anticoagulation-use-and-clinical-outcomes-after-major-bleeding-on-dabigatran-or-warfarin-in-atrial-fibrillation
#6
Inmaculada Hernandez, Yuting Zhang, Maria M Brooks, Paul K L Chin, Samir Saba
BACKGROUND AND PURPOSE: Little is known about the clinical outcomes associated with posthemorrhage anticoagulation resumption for atrial fibrillation. This study had 2 objectives: first, to evaluate anticoagulation use after a first major bleed on warfarin or dabigatran and, second, to compare effectiveness and safety outcomes between patients discontinuing anticoagulation after a major bleed and patients restarting warfarin or dabigatran. METHODS: Using 2010 to 2012 Medicare Part D data, we identified atrial fibrillation patients who experienced a major bleeding event while using warfarin (n=1135) or dabigatran (n=404) and categorized them by their posthemorrhage use of anticoagulation...
January 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27697440/re-initiation-of-dabigatran-and-direct-factor-xa-antagonists-after-a-major-bleed
#7
REVIEW
Truman J Milling, Alex C Spyropoulos
Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding...
November 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27569671/re-initiation-of-dabigatran-and-direct-factor-xa-antagonists-after-a-major-bleed
#8
REVIEW
Truman J Milling, Alex C Spyropoulos
Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding...
November 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27543375/elevated-international-normalized-ratio-in-a-patient-taking-warfarin-and-mauby-a-case-report
#9
Maria Sorbera, Tina Joseph, Robert V DiGregorio
We describe a 70-year-old Haitian man who had been taking warfarin for 5 years for atrial fibrillation and pulmonary hypertension. This patient had his international normalized ratio (INR) checked in the pharmacist-run anticoagulation clinic and was followed monthly. Prior to the interaction, his INR was therapeutic for 5 months while taking warfarin 10.5 mg/d. The patient presented with an INR > 8.0. Patient held 4 days of warfarin and restarted on warfarin 8.5 mg/d. Two weeks later, his INR was 2.5. After continuing dose, patient presented 2 weeks later and INR was 4...
August 19, 2016: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27402803/direct-oral-anticoagulants-unique-properties-and-practical-approaches-to-management
#10
REVIEW
Geoffrey D Barnes, Brian Kurtz
Since 2009, four direct oral anticoagulants (DOACs) have been introduced for treatment of venous thromboembolism and stroke prevention in non-valvular atrial fibrillation. While they are currently first-line therapy for a majority of patients, there are a number of clinical situations where warfarin is preferable. In both randomised trials and real-world populations, use of DOACs significantly reduces the risk of intracranial haemorrhage as compared with warfarin. While drug-specific reversal agents are currently only available for dabigatran, andexanet alpha is pending approval for reversal of factor Xa inhibitors, reducing concerns about major bleeding for many patients and providers...
October 15, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27398225/elevated-prothrombin-time-international-normalized-ratio-associated-with-concurrent-administration-of-regorafenib-and-warfarin-in-a-patient-with-advanced-colorectal-cancer
#11
Hironori Kitade, Azusa Hiromasa-Yamasaki, Kengo Hokkoku, Mitsue Mori, Michio Watanabe, Masuo Nakai, Seiji Yano
BACKGROUND: Regorafenib and its metabolites may inhibit the activities of several CYP or UDP-glucuronosyltransferase isoforms, including that of CYP2C9. Therefore, pharmacological agents that are CYP2C9 substrates may show elevated circulating levels and enhanced drug efficacy when concurrently used with regorafenib. Previous studies showed that the area under the plasma concentration-time curve of warfarin, which is the substrate for CYP2C9, increased upon co-administration of regorafenib...
2016: Journal of Pharmaceutical Health Care and Sciences
https://www.readbyqxmd.com/read/27056971/a-case-of-loin-pain-after-cardiac-catheterisation
#12
Debjit Chatterjee, Ambreen Sadiq, Raj Garikipati
CLINICAL INTRODUCTION: A 57-year-old woman with known moderate-to-severe mitral stenosis and atrial fibrillation (AF) presented to the emergency department with acute onset right loin pain after having a coronary angiogram and left and right heart catheterisation through the right femoral route about 28 h ago. The cardiac catheterisation was done after she presented with one episode of troponin-negative chest pain and progressive shortness of breath. She had anterior wall myocardial infarction (MI) 25 years ago, which was thought to be due to coronary artery embolism...
September 1, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/26847285/early-experience-of-novel-oral-anticoagulants-in-catheter-ablation-for-atrial-fibrillation-efficacy-and-safety-comparison-to-warfarin
#13
Dong Geum Shin, Tae Hoon Kim, Jae Sun Uhm, Joung Youn Kim, Boyoung Joung, Moon Hyoung Lee, Hui Nam Pak
PURPOSE: Compared with warfarin, novel oral anticoagulants (NOACs) are convenient to use, although they require a blanking period immediately before radiofrequency catheter ablation for atrial fibrillation (AF). We compared NOACs and uninterrupted warfarin in the peri-procedural period of AF ablation. MATERIALS AND METHODS: We compared 141 patients treated with peri-procedural NOACs (72% men; 58 ± 11 years old; 71% with paroxysmal AF) and 281 age-, sex-, AF type-, and history of stroke-matched patients treated with uninterrupted warfarin...
March 2016: Yonsei Medical Journal
https://www.readbyqxmd.com/read/26721534/elevated-international-normalized-ratio-values-in-a-patient-receiving-warfarin-and-ceftaroline
#14
Nada M Farhat, Lisa S Hutchinson, Michael Peters
PURPOSE: The case of a patient whose International Normalized Ratio (INR) became elevated due to a probable interaction between ceftaroline and warfarin is reported. SUMMARY: A 65-year-old African-American man developed an INR of >18.0 after completing 12 days of ceftaroline therapy for the treatment of cellulitis while taking warfarin therapy. The patient was on warfarin due to his history of deep vein thrombosis of a lower extremity and pulmonary embolism, and his INR was consistently therapeutic for approximately 2 years before ceftaroline therapy...
January 15, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/26657301/periprocedural-warfarin-reversal-with-prothrombin-complex-concentrate
#15
Meera Sridharan, Waldemar E Wysokinski, Rajiv Pruthi, Lance Oyen, William D Freeman, Alejandro A Rabinstein, Robert D McBane
INTRODUCTION: Approximately 10% of chronically anticoagulated patients require an invasive procedure annually. One in 10 procedures is emergent and requires prompt anticoagulation reversal. The study objective is to determine the safety and efficacy of a 3 factor prothrombin complex concentrate (PCC) for periprocedural anticoagulation reversal. MATERIALS AND METHODS: Consecutive patients receiving 3 factor PCC for warfarin reversal for either urgent/emergent invasive procedures or major bleeding were analyzed...
March 2016: Thrombosis Research
https://www.readbyqxmd.com/read/26307599/endoscopic-mucosal-resection-of-early-oesophageal-neoplasia-in-patients-requiring-anticoagulation-is-it-safe
#16
Said Al-Mammari, Richard Owen, John Findlay, Andreas Koutsoumpas, Richard Gillies, Robert Marshall, Adam A Bailey, Nick Maynard, Bruno Sgromo, Barbara Braden
BACKGROUND AND AIM: Endoscopic mucosal resection (EMR) has become the standard treatment for early oesophageal neoplasia. The mucosal defect caused by EMR usually takes several weeks to heal. Despite guidelines on high-risk endoscopic procedures in patients on anticoagulation, evidence is lacking whether EMR is safe in such patients. We investigated the immediate and delayed bleeding risk in patients undergoing diagnostic or therapeutic oesophageal EMR comparing patients requiring warfarin anticoagulation with a control group...
June 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/26018236/thromboembolic-events-recurrent-bleeding-and-mortality-after-resuming-anticoagulant-following-gastrointestinal-bleeding-a-meta-analysis
#17
REVIEW
Chatree Chai-Adisaksopha, Christopher Hillis, Manuel Monreal, Daniel M Witt, Mark Crowther
Gastrointestinal (GI) bleeding commonly complicates anticoagulant therapy. We aimed to systematically review the published literature to determine the risk of thromboembolism, recurrent GI bleeding and mortality for patients on long-term anticoagulation who experience GI bleeding based on whether anticoagulation therapy was resumed. We performed a systematic review of phase III randomised controlled trials and cohort studies in patients with atrial fibrillation or venous thromboembolism who received oral anticoagulant...
October 2015: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/25845131/factors-that-affect-rate-of-inr-decline-after-warfarin-discontinuation
#18
James K Burmester, Richard L Berg, John R Schmelzer, Joseph J Mazza, Steven H Yale
BACKGROUND: Despite vast literature on warfarin, optimal strategies for temporarily discontinuing and restarting warfarin have not been established. To improve warfarin discontinuation processes, we investigated known medical and genetic factors that influence stable warfarin dose to determine how well they predict the time until patients become subtherapeutic after discontinuing warfarin. METHODS: This was a retrospective cohort study of patients who temporarily discontinued warfarin before an elective procedure andhad at least 2 international normalized ratio (INR) values available during the discontinuation period...
February 2015: WMJ: Official Publication of the State Medical Society of Wisconsin
https://www.readbyqxmd.com/read/25836998/-perioperative-management-of-lung-cancer-patients-with-atrial-fibrillation-being-treated-by-antiplatelet-or-anticoagulant-therapy
#19
Shinya Ishikawa, Yoshitaka Kasai, Natsumi Matsuura, Shintaro Tarumi, Jun Nakano, Masaya Okuda, Masashi Goto, Dagu Ryu, Tetsuhiko Go, Hiroyasu Yokomise
In an aging society, the high incidence of surgery for the patients with ischemic heart disease(IHD)or atrial fibrillation(Af) under antiplatelet or anticoagulant therapy is a great problem. Interruption of antiplatelet or anticoagulant oral agents in the perioperative period may increase the risk of coronary or cerebral events. We retrospectively reviewed the surgical outcomes for lung cancer patients with IHD or Af. We reviewed 135 patients with lung cancer(41~88 years;97 men) who had preoperative oral administration of antiplatelet or anticoagulant drugs for IHD or Af between 2005 and 2012 at 2 centers, and analyzed retrospectively the perioperative medications and complications...
April 2015: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/25788517/impact-of-video-technology-on-efficiency-of-pharmacist-provided-anticoagulation-counseling-and-patient-comprehension
#20
RANDOMIZED CONTROLLED TRIAL
Sarah J Moore, Elizabeth A Blair, David R Steeb, Brent N Reed, J Heyward Hull, Jo Ellen Rodgers
BACKGROUND: Discharge anticoagulation counseling is important for ensuring patient comprehension and optimizing clinical outcomes. As pharmacy resources become increasingly limited, the impact of informational videos on the counseling process becomes more relevant. OBJECTIVE: To evaluate differences in pharmacist time spent counseling and patient comprehension (measured by the Oral Anticoagulation Knowledge [OAK] test) between informational videos and traditional face-to-face (oral) counseling...
June 2015: Annals of Pharmacotherapy
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