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https://www.readbyqxmd.com/read/28741391/clinical-implications-benefits-and-pitfalls-of-using-and-reversing-non-vitamin-k-antagonist-oral-anticoagulants
#1
Alexandra S Moss, Gerasimos Dimitropoulos, Gregory Y H Lip
The use of non-Vitamin K antagonist oral anticoagulant (NOAC) drugs is increasingly common in clinical practice. As compared to vitamin K antagonists they are more straightforward to initiate, require no hematological monitoring and offer potentially more stable therapeutic indices. Concern has been raised with regard to their safety profiles particularly in the context of acute reversal in major bleeding. Further issues pertain to patient concordance. Areas Covered: This review article aims to provide an overview of the current evidence relating to NOAC safety as well as the management of NOAC-related major bleeding with particular emphasis on reversal agents in use and in development following a selective literature review...
July 25, 2017: Expert Review of Hematology
https://www.readbyqxmd.com/read/28741234/direct-oral-anticoagulants-use-in-antiphospholipid-syndrome-are-these-drugs-an-effective-and-safe-alternative-to-warfarin-a-systematic-review-of-the-literature-response-to-comment
#2
REVIEW
Virginie Dufrost, Jessie Risse, Denis Wahl, Stéphane Zuily
No abstract text is available yet for this article.
August 2017: Current Rheumatology Reports
https://www.readbyqxmd.com/read/28741216/epidemiological-and-outcome-data-in-japanese-patients-with-deep-vein-thrombosis-with-and-without-malignancy
#3
Kensuke Yokoi, Masahiko Hara, Yasunori Ueda, Keiichi Yamamoto, Keiko Ota, Daijiro Kabata, Tetsuhisa Kitamura, Yasushi Sakata, Ayumi Shintani
There are very few epidemiological studies on Japanese patients with deep vein thrombosis (DVT). In particular, mortality rate differences in Japanese DVT patients with and without malignancy have rarely been evaluated. To elucidate these differences, we enrolled 211 patients who had been diagnosed with de-novo acute DVT of the pelvis or lower extremities between January 2012 and December 2015. The clinical characteristics, treatment information, and follow-up data were retrospectively assessed. We compared these variables in patients with (n = 120) and without (n = 91) concomitant malignancies...
July 24, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28741113/approaches-to-prevent-bleeding-associated-with-anticoagulants-current-status-and-recent-developments
#4
REVIEW
Manu Thomas Kalathottukaren, Charles A Haynes, Jayachandran N Kizhakkedathu
Anticoagulants are widely used for the prophylaxis and treatment of cardiovascular disorders and to prevent blood clotting during surgeries. However, the major limitation associated with anticoagulant therapy is bleeding; all the current anticoagulants do have a bleeding risk. The propensity to bleed is much higher among the elderly population and patients with renal insufficiency. Therefore, there is an utmost and urgent clinical need for a highly efficient, nontoxic antidote with excellent anticoagulant reversal activity...
July 24, 2017: Drug Delivery and Translational Research
https://www.readbyqxmd.com/read/28740586/mechanical-valve-thrombosis-on-rivaroxaban-are-novel-anticoagulants-really-an-option
#5
Vishesh Kumar, Shawn Kelly, Amol Raizada, Jimmy Yee, Amornpol Anuwatworn, Adam Stys, Maria Stys
This is a case of a 54-year-old female with a history of mechanical aortic valve replacement who presented in cardiogenic shock. Her primary care provider started her on rivaroxaban for anticoagulation therapy. An urgent transesophageal echocardiogram revealed a significant gradient and thrombosis on one leaflet of the valve that was immobile. Given that she was not a surgical candidate, she underwent thrombolysis. However, she later died due to complications from the thrombotic valve. The utility of target-specific oral anticoagulants has yet to be established in clinical practice...
April 2017: Methodist DeBakey Cardiovascular Journal
https://www.readbyqxmd.com/read/28740396/antithrombotic-prophylaxis-of-atrial-fibrillation-in-an-italian-real-world-setting-a-retrospective-study
#6
Giuliano Ermini, Valentina Perrone, Chiara Veronesi, Luca Degli Esposti, Giuseppe Di Pasquale
OBJECTIVES: The aims of this study were to assess the prevalence of diagnosed atrial fibrillation (AF), the drug use in patients with AF in terms of antithrombotic (AT) strategies used and the compliance with treatment, and to describe the characteristics of patients affected by AF in relation to treatment. METHODS: The data collected were provided from databases of general practitioners (GPs) of the Local Health Unit of Bologna in Italy. From January 1, 2009, to December 31, 2012, all subjects aged ≥18 years followed by the 44 GPs enrolled in the study were evaluated, and the subjects with a diagnosis of AF were included in the analysis...
2017: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/28739563/efficacy-of-new-low-dose-oral-anticoagulants-in-recalcitrant-livedoid-vasculopathy
#7
Fumina Furukawa, Megumi Mizawa, Teruhiko Makino, Tadamichi Shimizu
Livedoid vasculopathy (LV) is a thrombotic skin disease characterised by recurrent painful ulcerations and irreversible scar formation on the lower legs, which is caused by occlusion of the cutaneous microcirculation. Edoxaban is one of new oral anticoagulants. It directly inhibits factor Xa in the coagulation pathway and prevents thrombus formation. A 17-year-old Japanese male presented with a 1-year history of recalcitrant cutaneous ulcers and livedo racemosa on his lower extremities. Initially, the ulcers were treated with antiplatelets therapies; however, he experienced recurrence of ulcerations during summer time...
July 24, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28739270/discrepancies-between-the-use-of-mdrd-4-idms-and-ckd-epi-equations-instead-of-the-cockcroft-gault-equation-in-the-determination-of-the-dosage-of-direct-oral-anticoagulants-in-patients-with-non-valvular-atrial-fibrillation
#8
Alejandro Isidoro Pérez Cabeza, Pedro Antonio Chinchurreta Capote, Jose Antonio González Correa, Francisco Ruiz Mateas, Gabriel Rosas Cervantes, Francisco Rivas Ruiz, Almudena Valle Alberca, Rafael Bravo Marqués
BACKGROUND AND OBJECTIVE: Direct oral anticoagulants (DOACs) require dose adjustment according to estimated clearance creatinine (eClCr) using the Cockcroft-Gault (CG) equation. There are discrepancies with the equations that estimate glomerular filtration rate (eGFR). We analyse how the use of the CKD-EPI and MDRD-4 IDMS equations affect the recommended dosage for ACODs. PATIENTS AND METHODS: Retrospective study of patients with non-valvular atrial fibrillation seen at a cardiology clinic between November 2012 and August 2014...
July 21, 2017: Medicina Clínica
https://www.readbyqxmd.com/read/28738034/cancer-associated-thrombosis-improving-patient-adherence-to-low-molecular-weight-heparin-therapy
#9
Lijun Chen
Although evidence-based treatment guidelines recommend low-molecular-weight heparin (LMWH) monotherapy for cancer-associated thrombosis (CAT), adherence to outpatient treatment guidelines for CAT still needs improvement. One of the challenges that clinicians face in treating CAT with LMWH is patient preference for oral anticoagulants over daily LMWH injections. This article aims to provide oncology nurses with practical advice on patient education to increase patient acceptance of and adherence to LMWH treatment for CAT...
August 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28737102/comparative-effectiveness-of-rivaroxaban-in-the-treatment-of-nonvalvular-atrial-fibrillation
#10
Faye L Norby, Alvaro Alonso
Rivaroxaban is a direct oral anticoagulant (DOAC) approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, a common arrhythmia. In this review, we summarize the effectiveness of rivaroxaban versus warfarin and the DOACs dabigatran, apixaban and edoxaban. The primary focus is on primary evidence from clinical trials, indirect comparison studies and real-world studies. While there are gaps in the literature, the evidence thus far indicates that rivaroxaban is superior to warfarin and similar to dabigatran, apixaban and edoxaban for the prevention of stroke or systemic embolism in patients with nonvalvular atrial fibrillation, although rivaroxaban may be associated with an elevated bleeding risk compared with other DOACs...
July 24, 2017: Journal of Comparative Effectiveness Research
https://www.readbyqxmd.com/read/28736561/recent-advances-in-stroke-prevention-in-patients-with-atrial-fibrillation-and-end-stage-renal-disease
#11
REVIEW
Federico Ronco, Patrizio Mazzone, Leila Hosseinian, Simonetta Genovesi
BACKGROUND: Chronic kidney disease (CKD) is associated with a high prevalence of atrial fibrillation (AF), but in this population the risk/benefit ratio of anticoagulant therapy with vitamin K antagonists (VKA) for thromboprophylaxis is uncertain. SUMMARY: In end-stage renal disease (ESRD) patients undergoing hemodialysis, VKA seem less effective in stroke prevention than in the general population, with an increased risk of major bleeding. Recently, novel oral anticoagulant agents (NOACs) have proven to be effective for stroke prevention in AF and have demonstrated an improved safety profile compared to VKA...
June 2017: Cardiorenal Medicine
https://www.readbyqxmd.com/read/28736385/thromboembolic-risk-bleeding-outcomes-and-effect-of-different-antithrombotic-strategies-in-very-elderly-patients-with-atrial-fibrillation-a-sub-analysis-from-the-prefer-in-af-prevention-of-thromboembolic-events-european-registry-in-atrial-fibrillation
#12
Giuseppe Patti, Markus Lucerna, Ladislav Pecen, Jolanta M Siller-Matula, Ilaria Cavallari, Paulus Kirchhof, Raffaele De Caterina
BACKGROUND: Increasing age predisposes to both thromboembolic and bleeding events in patients with atrial fibrillation; therefore, balancing risks and benefits of antithrombotic strategies in older populations is crucial. We investigated 1-year outcome with different antithrombotic approaches in very elderly atrial fibrillation patients (age ≥85 years) compared with younger patients. METHODS AND RESULTS: We accessed individual patients' data from the prospective PREFER in AF (PREvention oF thromboembolic events-European Registry in Atrial Fibrillation), compared outcomes with and without oral anticoagulation (OAC), and estimated weighed net clinical benefit in different age groups...
July 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28736052/-new-oral-anticoagulants-in-coronary-artery-disease
#13
Guillaume Cayla, Florence Leclercq, Luc Cornillet, Bertrand Ledermann, Laurent Schmutz, Benoit Lattuca
Antiplatelet therapy is essential for the prevention of recurrent cardiovascular events in stable and unstable coronary artery disease. Oral anticoagulants have been rarely used for treatment of coronary artery disease. The new direct oral anticoagulants offer various molecules and dosages and may be used in coronary artery disease. Dedicated studies are currently being conducted to confirm the optimal doses and the ideal association of antithrombotic drugs in different settings of coronary artery disease.
July 20, 2017: La Presse Médicale
https://www.readbyqxmd.com/read/28735494/trends-in-use-of-warfarin-and-direct-oral-anticoagulants-in-atrial-fibrillation-in-norway-2010-to-2015
#14
Lars J Kjerpeseth, Hanne Ellekjær, Randi Selmer, Inger Ariansen, Kari Furu, Eva Skovlund
PURPOSE: Since 2011, several direct oral anticoagulants (DOACs; dabigatran, rivaroxaban, apixaban) have been introduced as alternatives to warfarin for stroke prophylaxis in atrial fibrillation. We wanted to investigate changes in utilization of oral anticoagulants for atrial fibrillation in Norway following the introduction of DOACs. METHODS: Using nationwide registries, we identified all adults with pharmacy dispensings for warfarin or DOACs between January 2010 and December 2015 in Norway, and used ambulatory reimbursement codes to identify atrial fibrillation as indication...
July 22, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28735353/non-vitamin-k-oral-anticoagulants-noacs-and-their-reversal
#15
REVIEW
Sujan T Reddy, T C Cossey, Sean I Savitz, James C Grotta
PURPOSE OF REVIEW: An 80-year-old man presents with an acute right hemiparesis and National Institutes of Health Stroke Scale (NIHSS) of 25, 14 h after taking dabigatran. Activated partial thromboplastin time (aPTT) is 42.8 s. Arteriogram demonstrates left internal carotid artery thrombosis. What is the appropriate management of this patient with acute ischemic stroke while on a NOAC? RECENT FINDINGS: Idarucizumab is a reversal agent approved for dabigatran, and two more reversal agents, andexanet alfa and aripazine, are currently in development for NOACs...
September 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28734880/dual-versus-single-antiplatelet-regimen-with-or-without-anticoagulation-in-transcatheter-aortic-valve-replacement-indirect-comparison-and-meta-analysis
#16
Monica Verdoia, Lucia Barbieri, Matteo Nardin, Harry Suryapranata, Giuseppe De Luca
INTRODUCTION AND OBJECTIVES: There is uncertainty on the correct management of antithrombotic therapies after transcatheter aortic valve replacement (TAVR), with dual antiplatelet therapy (DAPT) being currently recommended on an empirical basis. The aim of the present meta-analysis was to assess the safety and effectiveness of DAPT in patients undergoing TAVR. METHODS: Studies comparing different antithrombotic regimens after TAVR were included. The primary endpoint was 30-day overall mortality...
July 19, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28733910/a-review-study-to-evaluate-holmium-yag-laser-lithotripsy-with-flexible-ureteroscopy-in-patients-on-ongoing-oral-anticoagulant-therapy
#17
Bulent Altay, Bulent Erkurt, Selami Albayrak
The objective of this study was to evaluate the safety and efficacy of flexible ureteroscopy (FURS) and holmium:YAG laser lithotripsy for the treatment of upper urinary tract stones in patients on active oral anticoagulants. The records of 1081 patients who underwent flexible ureteroscopic holmium:YAG (Ho:YAG) laser lithotripsy for upper ureteral and renal calculi from 1999 to 2015 were retrospectively reviewed. A total of 84 patients on continuous oral anticoagulation or antiplatelet therapy (warfarin, aspirin, or clopidogrel) were identified...
July 22, 2017: Lasers in Medical Science
https://www.readbyqxmd.com/read/28733071/long-term-stroke-and-bleeding-risk-in-patients-with-atrial-fibrillation-treated-with-oral-anticoagulants-in-contemporary-practice-providing-evidence-for-shared-decision-making
#18
Peter A Noseworthy, Xiaoxi Yao, Bernard J Gersh, Ian Hargraves, Nilay D Shah, Victor M Montori
BACKGROUND: Oral anticoagulation is recommended as a lifelong therapy for most patients with atrial fibrillation (AF). However, data on long-term outcomes in clinical practice on these drugs are scarce, particularly for the recently approved agents. We aimed to describe differences in characteristics between patients in everyday practice and those enrolled in the pivotal trials, and to report long-term outcomes on oral anticoagulation in practice. METHODS: We performed a retrospective cohort analysis using a large U...
July 14, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28730948/nonvitamin-k-antagonist-oral-anticoagulants-versus-warfarin-in-patients-with-atrial-fibrillation-and-previous-stroke-or-transient-ischemic-attack-an-updated-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#19
George Ntaios, Vasileios Papavasileiou, Hans-Chris Diener, Konstantinos Makaritsis, Patrik Michel
Background In a previous systematic review and meta-analysis, we assessed the efficacy and safety of nonvitamin-K antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and stroke or transient ischemic attack. Since then, new information became available. Aim The aim of the present work was to update the results of the previous systematic review and meta-analysis. Methods We searched PubMed until 24 August 2016 for randomized controlled trials using the following search items: "atrial fibrillation" and "anticoagulation" and "warfarin" and "previous stroke or transient ischemic attack...
August 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28730690/incorporating-comprehensive-management-of-direct-oral-anticoagulants-into-anticoagulation-clinics
#20
Insaf Mohammad, Bianca Korkis, Candice L Garwood
Anticoagulation clinics emerged as a means to optimize warfarin effectiveness and minimize bleeding risks. Anticoagulation clinics have traditionally been warfarin-based models due to the need for frequent blood level monitoring, drug interactions, dietary considerations, and periprocedural management with warfarin. These models have demonstrated improved anticoagulation control and reduced bleeding complications for patients taking warfarin. Direct oral anticoagulants (DOACs) emerged with the perception of improved convenience due to the lack of blood level monitoring and lack of dietary considerations...
July 21, 2017: Pharmacotherapy
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