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Rachel Rosovsky, Geno Merli
The emergence of direct oral anticoagulants (DOACs) represents a major advancement and paradigm shift in the treatment of venous thromboembolism. Currently, dabigatran, rivaroxaban, apixiban, and edoxoban are approved and used routinely for the prevention and treatment of patients with venous thromboembolism. Because each of the DOACs has different doses and dosing regimens, clinicians need to become familiar with their use. This article focuses on the practical considerations of how and when to use the DOACs...
September 2017: Techniques in Vascular and Interventional Radiology
Patricia A Cowper, Shubin Sheng, Renato D Lopes, Kevin J Anstrom, Judith A Stafford, Linda Davidson-Ray, Sana M Al-Khatib, Jack Ansell, Paul Dorian, Steen Husted, John J V McMurray, P Gabriel Steg, John H Alexander, Lars Wallentin, Christopher B Granger, Daniel B Mark
Importance: The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial reported that apixaban therapy was superior to warfarin therapy in preventing stroke and all-cause death while causing significantly fewer major bleeds. To establish the value proposition of substituting apixiban therapy for warfarin therapy in patients with atrial fibrillation, we performed a cost-effectiveness analysis using patient-level data from the ARISTOTLE trial...
May 1, 2017: JAMA Cardiology
Rolando Morales, Eric Ruff, Christopher Patronella, Henry Mentz, Germán Newall, Kristi L Hustak, Paul Fortes, Amelia Bush
BACKGROUND: Preventing venous thromboembolism (VTE) remains an important topic in the plastic surgery community. However, there is little consensus regarding appropriate VTE prophylaxis for patients undergoing common body contouring procedures. OBJECTIVES: This study compared the use of two novel oral anticoagulants (Rivaroxaban and Apixiban) vs low molecular weight heparin (LMWH) for postoperative chemical prophylaxis in body contouring plastic surgery procedures...
April 2016: Aesthetic Surgery Journal
Carlo Rostagno
Despite widespread diffusion of pharmacological prophylaxis, deep venous thrombosis (DVT) is still a common cause of morbidity after major orthopedic surgery (total hip replacement--THR--and total knee replacement--TKR). At present, clear evidence has been provided that pharmacological primary prophylaxis with low molecular weight heparin (LMWH) is associated with a significant decrease in the incidence of venous thromboembolism. The main limitation of LMWH prophylaxis however is the need for parenteral administration with a not negligible drop-out of treatment...
2016: Cardiovascular & Hematological Disorders Drug Targets
Brandon J McMahon, Hau C Kwaan
One of the major advances in the management of thrombosis is arguably the introduction of the new non-vitamin K antagonist oral anticoagulants (NOACs). These are small molecules, designed to directly inhibit specific steps in the coagulation pathway, with dabigatran (Pradaxa), inhibiting thrombin and rivaroxaban (Xarelto), apixiban (Eliquis), edoxaban (Lixiana), and betrixaban being factor Xa inhibitors. They have several advantages over vitamin K antagonists such as warfarin, with more predictable bioavailability, fewer drug interactions, and improved safety, especially intracranial hemorrhage...
March 2015: Seminars in Thrombosis and Hemostasis
Carlo Rostagno
Deep venous thrombosis (DVT) is a common cause of morbidity after orthopedic surgery, both in the early post operative period when pulmonary embolism may complicate in hospital clinical course or occur after discharge and later due to development of post thrombotic syndrome. At present, clear evidence has been provided that pharmacological primary prophylaxis of venous thromboembolism (VTE) is associated with an impressive decrease in the incidence of DVT and related complications. The main limitation of VTE prophylaxis with anticoagulant drug is the risk of bleeding...
September 2013: Cardiovascular & Hematological Agents in Medicinal Chemistry
Fadi E Shamoun, Elvis N Martin, Samuel R Money
Anticoagulants can complicate the approach to the management of patients undergoing operative interventions. We review new anticoagulants that have been introduced recently to the market or that are undergoing investigations for treatment of nonvalvular atrial fibrillation and venous thromboembolism prophylaxis: Dabigatran, rivaroxaban, apixiban, and edoxaban.
March 2013: Surgery
Ilyas Mohammed, Adam Mohmand-Borkowski, James F Burke, Peter R Kowey
Atrial fibrillation (AF) is a common arrhythmia associated with substantial morbidity and mortality, particularly due to thromboembolic strokes, the prevalence of which is expected to rise over the next few decades. This article reviews the complex mechanisms behind thromboembolism, compares the newer risk stratification models for identifying those at risk for stroke or bleeding, and highlights the potential advantages and disadvantages of available therapies. Newer oral anticoagulants like Dabigatran, Rivoroxaban, and Apixiban are discussed...
February 2012: Journal of Cardiovascular Medicine
Thomas G DeLoughery
After years of only oral vitamin K antagonists, there are new many new antithrombotic agents in development and on entering the marketplace. This review will analyze clinical trial results for these new agents-especially dibigatran, rivaroxaban, and apixiban. Also to be discussed are practical aspects of use of these new agents such monitoring, reversal, and use before procedures.
July 2011: American Journal of Hematology
Andrew J Howe, James A Shand, Ian B A Menown
Multiple key cardiology trials have been presented or published over recent months, several with the potential to change clinical practice. In this article, we summarize and place in clinical context new trial findings regarding anticoagulation in the cardiac catheterization laboratory (enoxaparin, fondaparinux and unfractionated heparin), the implications of genetic polymorphisms and functional testing for antiplatelet therapy (clopidogrel and ticagrelor), new oral anticoagulants for use in atrial fibrillation (apixiban and rivaroxaban), optimal pacing strategies and pharmacological agents in heart failure (ivabradine, eplerenone, cardiac resynchronization therapy, telemonitoring and intracoronary bone marrow stem cell infusion)...
May 2011: Future Cardiology
Jerrold H Levy, Marc Azran
PURPOSE OF REVIEW: Patients often receive preoperative therapies that interfere with hemostasis, and can present for surgery with underlying hemostatic disorders because of pre-existing preoperative anticoagulation or antiplatelet therapy. Perioperative bleeding can occur following surgery due to multiple causes; however, the addition of pharmacologic agents creates an acquired defect that complicates the surgical injury and may result in increased blood loss. An understanding of the potential impact of anticoagulation therapies on hemostasis is critical in managing these patients...
June 2010: Current Opinion in Anaesthesiology
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