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James C Fredenburgh, Peter L Gross, Jeffrey I Weitz
Despite the introduction of direct oral anticoagulants (DOACs), the search for more effective and safer antithrombotic strategies continues. Better understanding of the pathogenesis of thrombosis has fostered two new approaches to achieving this goal. First, evidence that thrombin may be as important as platelets to thrombosis at sites of arterial injury and that platelets contribute to venous thrombosis has prompted trials comparing anticoagulants with aspirin for secondary prevention in arterial thrombosis and aspirin with anticoagulants for primary and secondary prevention of venous thrombosis...
October 25, 2016: Blood
Ming Sheng Lim, Kent Chapman, Priscilla Swanepoel, Anoop K Enjeti
Most studies on the sensitivities of coagulation assays to direct oral anticoagulants (DOACs) are based on normal plasma spiked with anticoagulant in the laboratory. Recent studies have shown that reagent sensitivity varies significantly depending on whether spiked or patient samples are used. The aim of this study was to compare the sensitivities of routine coagulation assays in patient samples and commercial drug specific calibrators using commonly used activated partial thromboplastin time (APTT) and prothrombin time (PT) reagents (i...
October 22, 2016: Pathology
Andrea De Gottardi, Jonel Trebicka, Christoph Klinger, Aurélie Plessier, Susana Seijo, Benedetta Terziroli, Lorenzo Magenta, David Semela, Elisabetta Buscarini, Philippe Langlet, Jan Görtzen, Angela Puente, Beat Müllhaupt, Carmen Navascuès, Filipe Nery, Pierre Deltenre, Fanny Turon, Cornelius Engelmann, Rupen Arya, Karel Caca, Markus Peck-Radosavljevic, Frank W G Leebeek, Dominique Valla, Juan Carlos Garcia-Pagan
BACKGROUND: Direct-acting oral anticoagulants (DOACs) are used in patients with splanchnic vein thrombosis (SVT) and cirrhosis, but evidence for safety and efficacy in this setting is limited. Our aim was to identify indications and reasons for starting or switching to DOACs and to report adverse effects, complications and short-term outcome. METHODS: Data collection including demographic information, laboratory values, treatment and complications through the VALDIG Consortium...
October 25, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
M Viprey, R Jeannin, V Piriou, P Chevalier, C Michel, G Aulagner, J Berthiller, X Armoiry
WHAT IS KNOWN AND OBJECTIVE: The complex dose regimens of the direct-acting oral anticoagulants (DOAC) make their appropriate prescribing highly challenging. Inappropriate prescribing of the DOAC remains poorly addressed. We studied the patterns of DOAC prescription and estimated the prevalence of drug-related problems (DRPs) associated with their use. METHODS: A cross-sectional study was conducted using data from medical records system of the Lyon teaching hospitals...
October 24, 2016: Journal of Clinical Pharmacy and Therapeutics
Jingwen Tan, Shuiqing Liu, Jodi B Segal, G Caleb Alexander, Mara McAdams-DeMarco
BACKGROUND: Patients with end stage renal disease (ESRD), including stage 5 chronic kidney disease (CKD), hemodialysis (HD) and peritoneal dialysis (PD), are at high risk for stroke-related morbidity, mortality and bleeding. The overall risk/benefit balance of warfarin treatment among patients with ESRD and AF remains unclear. METHODS: We systematically reviewed the associations of warfarin use and stroke outcome, bleeding outcome or mortality in patients with ESRD and AF...
October 21, 2016: BMC Nephrology
Pantep Angchaisuksiri
Thrombosis is a common complication in cancer patients. Although the major inherited risk factors for thrombophilia are different between Asians and Caucasians, the main acquired risk factors that are associated with the development of venous thromboembolism (VTE) in Asians appear to be similar to those for Caucasians. Malignancy is the most important acquired risk factor for VTE in Asians. Recent studies have shown that the incidence of VTE is significant in Asian patients with cancer, particularly those in an advanced stage...
2016: Thrombosis Journal
Siavash Piran, Sam Schulman
Venous thromboembolism (VTE), which constitutes pulmonary embolism and deep vein thrombosis, is a common disorder associated with significant morbidity and mortality. Landmark trials have shown that direct oral anticoagulants (DOACs) are as effective as conventional anticoagulation with vitamin K antagonists (VKA) in prevention of VTE recurrence and associated with less bleeding. This has paved the way for the recently published guidelines to change their recommendations in favor of DOACs in acute and long-term treatment of VTE in patients without cancer...
2016: Thrombosis Journal
Lai Heng Lee
The group of new oral anticoagulants or NOACs, now termed direct oral anticoagulants or DOACs, with their favourable results from large scale phase III clinical trials, represent a major advancement and expanded armamentarium in antithrombotic therapy. Dabigatran, rivaroxaban, apixaban and edoxaban are now in clinical routine use for prevention and treatment of arterial and venous thrombotic diseases as addressed in their clinical trials. Usage of the DOACs is expected to increase as clinicians gain more experience and reassurance with data from the real world studies which are generally consistent with that from clinical trials...
2016: Thrombosis Journal
L Deville, M Konan, A Hij, L Goldwirt, O Peyrony, F Fieux, P Faure, I Madelaine, S Villiers, D Farge-Bancel, C Frère
Direct oral anticoagulants (DAOC) are indicated for the treatment of venous thromboembolism and the prevention of stroke or systemic embolism in patients with non-valvular atrial fibrillation. Given their advantages and friendly use for patient, the prescription of long term DOAC therapy has rapidly increased both as first line treatment while initiating anticoagulation and as a substitute to vitamins K antagonist (VKA) in poorly controlled patients. However, DOAC therapy can also be associated with significant bleeding complications, and in the absence of specific antidote at disposal, treatment of serious hemorrhagic complications under DOAC remains complex...
July 2016: Current Research in Translational Medicine
Molly Howard, Andrew Lipshutz, Breanne Roess, Emily Hawes, Zachariah Deyo, Jena Ivey Burkhart, Stephan Moll, Betsy Bryant Shilliday
Direct Oral Anticoagulants (DOACs) require specific dosing and monitoring to ensure safe and appropriate use. The purpose of this evaluation was to identify patient- and process-related factors that correlate with increased risk of inappropriate prescribing of DOACs. A retrospective chart review was conducted in three outpatient clinics within an academic medical center to identify patients started on DOAC therapy and evaluate the appropriateness of DOAC initiation. Data collected included patient demographics, DOAC medication initiated, dose, indication, baseline laboratory values, concomitant medications, type and specialty of prescriber, and initiation setting...
October 18, 2016: Journal of Thrombosis and Thrombolysis
Magdalena M Watras, Jignesh P Patel, Roopen Arya
Hair loss is associated with the anticoagulants heparin and warfarin. With the recent availability of direct oral anticoagulants (DOACs) it is of clinical interest to know if they are implicated with hair loss and/or whether they could be successfully prescribed for patients who suffer from coumarin- or heparin-related alopecia. Initially reports of heparin- and coumarin-associated alopecia available through PubMed and Medline were explored in order to establish the cause of this side effect. Currently there is a lack of unanimity on why anticoagulants cause alopecia...
March 2016: Drugs—Real World Outcomes
Benilde Cosmi
Idiopathic or unprovoked venous thromboembolism is an event occurring in the absence of any apparent provoking or triggering environmental risk factors, such as surgery, trauma, and immobilization. Areas covered: Unprovoked VTE can be associated with occult cancer, but only limited, and not extensive cancer screening, may be warranted, as the rate of occult cancer is low in such patients. Routine thrombophilia testing is not currently recommended as it does not influence the management of the disease. The duration of anticoagulation for unprovoked VTE after the first three months is still debated as the disease tends to recur regardless of treatment duration...
October 14, 2016: Expert Review of Cardiovascular Therapy
Jessica W Skelley, C Whitney White, Angela R Thomason
To review the use of the direct oral anticoagulant (DOAC) agents in inherited thrombophilia based on the literature. MEDLINE, International Pharmaceutical Abstracts, and Google Scholar searches (1970-May 2016) were conducted for case reports, case series, retrospective cohorts, or clinical trials using the key words: protein C deficiency, protein S deficiency, antithrombin deficiency, activated protein C resistance, Factor V Leiden, hypercoagulable, NOACs, dabigatran, apixaban, rivaroxaban, betrixaban, edoxaban, Xa inhibitor, direct thrombin inhibitor...
October 12, 2016: Journal of Thrombosis and Thrombolysis
H Cohen, D R Arachchillage, S Middeldorp, J Beyer-Westendorf, R Abdul-Kadir
We thank Dr Desborough and colleagues for their response to the recently published guidance from the SSC of the ISTH on the management of direct oral anticoagulants (DOACs) in women of childbearing potential [1,2]. We have carefully examined their view and seriously considered their proposal regarding the recommendation of this guidance as detailed below. We hereby, provide a detailed response to their letter. This article is protected by copyright. All rights reserved.
October 12, 2016: Journal of Thrombosis and Haemostasis: JTH
Vivencio Barrios, Jaime Masjuan
The majority of patients with atrial fibrillation should receive oral anticoagulation to reduce the risk of stroke. The limitations of vitamin K antagonists have led to an underuse of anticoagulants in clinical practice which has been associated with a higher risk of stroke, hospitalizations and healthcare costs. Direct oral anticoagulants (DOACs) overcome some of the limitations of vitamin K antagonists and may therefore increase the use of oral anticoagulants in clinical practice. Since no head-to-head trials have been performed, only indirect comparisons can be made among them...
October 12, 2016: Future Cardiology
S Louw, N P Saragas, P N Ferrao, T F Chirwa, B F Jacobson
BACKGROUND: Low-molecular-weight heparin and vitamin K antagonists such as warfarin are the gold standard for prohylaxis and treatment of venous thromboembolic disease (VTED). Direct oral anticoagulants (DOACs) result in predictable anticoagulation with significantly reduced inter- and intra-patient variability. DOAC absorption is rapid, with a short half-life and relatively few drug interactions. DOACs are effective and safe at fixed doses without activity monitoring. However, specific situations may require assessment of accurate drug activity...
September 8, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Peter Gavorník, Andrej Dukát, Ľudovít Gašpar, Gabriela Gubo, Naďa Hučková
Until recently, vitamin K antagonists (VKA; predominantly warfarin) were the only oral anticoagulants for primary and secondary prevention of venous thromboembolism. Prevention and therapy with novel, direct, non-VKA oral anticoagulant agents (NOACs; DOACs: dabigatran, rivaroxaban, apixaban, edoxaban), have recently become available as an alternative to VKA. NOACs have been shown to be non-inferior or superior to VKA in clinical trials. Available results suggest that real world safety of NOACs is mostly consistent with results observed in clinical trials...
2016: Vnitr̆ní Lékar̆ství
Paul A Reilly, Joanne van Ryn, Oliver Grottke, Stephan Glund, Joachim Stangier
The direct oral anticoagulants (DOACs) provide a number of clinical advantages over vitamin K antagonists for the treatment of thromboembolism, including improved efficacy and safety, as well as no need for regular monitoring of anticoagulant effect. However, as with all anticoagulants, bleeding complications may occur, and anticoagulant reversal may be required in specific clinical situations, such as in patients experiencing spontaneous or traumatic bleeds, or in anticoagulated patients requiring emergency surgery or other invasive procedures...
September 28, 2016: American Journal of Emergency Medicine
Hannah Cohen, Deepa R J Arachchillage, Jan Beyer-Westendorf, Saskia Middeldorp, Rezan A Kadir
Direct oral anticoagulants (DOACs) provide an effective, safe, and convenient therapeutic alternative to warfarin and other vitamin K antagonists (VKAs), and are now established for a wide range of indications. The use of DOACs in women merits special consideration due to two main situations: first, in relation to fertility, pregnancy, and lactation in women of reproductive age; second, because of their bleeding risk, leading to abnormal uterine and/or other genital tract bleeding. This review focuses on these two clinical situations, including approaches to management in the context of available information...
October 5, 2016: Seminars in Thrombosis and Hemostasis
Ralf Ulrich Trappe, Marianne Sinn, Hanno Riess
There is only limited data for the use of direct oral anticoagulants (DOACs) in tumor patients and no data from prospective randomised trials comparing DOACs to the current standard care: low molecular weight heparine (LMWH). Therefore, DOACs must be used with caution and should be restricted to tumor patients with (1) contraindications for LMWH (e.g. HIT II, phobia of syringe) or (2) to the situations of prolonged anticoagulation after initial therapy with LMWH. Cancer-associated disorders as well as side effects of chemotherapy as nausea and emesis have to be considered as well as potential substance-specific interactions...
September 2016: Deutsche Medizinische Wochenschrift
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