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https://www.readbyqxmd.com/read/27917690/pharmacological-management-of-pulmonary-embolism
#1
Bobby Gouin, Helia Robert-Ebadi, Marc Righini, Marc Blondon
Pulmonary embolism (PE) is a common and potentially severe manifestation of venous thromboembolism. Its management has relied on anticoagulation by vitamin K antagonists (VKA) for the past fifty years. Recently, new alternative drugs have been developed and dramatically modified both the treatment of acute PE and its secondary prevention. Areas covered: This review discusses the contemporary pharmacological treatment for PE, with a focus on anticoagulation options for non-high risk PE. In particular, the advent of direct oral anticoagulants (rivaroxaban, apixaban, edoxaban and dabigatran) and modalities for long-term prevention will be described...
December 3, 2016: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/27900627/extended-duration-versus-short-duration-pharmacological-thromboprophylaxis-in-acutely-ill-hospitalized-medical-patients-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#2
Aaron Y L Liew, Siavash Piran, John W Eikelboom, James D Douketis
Extended-duration pharmacological thromboprophylaxis, for at least 28 days, is effective for the prevention of symptomatic venous thromboembolism (VTE) in high-risk surgical patients but is of uncertain benefit in hospitalized medical patients. We aimed to evaluate the efficacy and safety of extended-duration thromboprophylaxis in hospitalized medical patients. We conducted a systematic PubMed, Medline and EMBASE literature search until June 2016 and a meta-analysis of randomized controlled trials which compared extended-duration with short-duration thromboprophylaxis in hospitalized medical patients...
November 30, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27892890/trial-design-rivaroxaban-for-the-prevention-of-major-cardiovascular-events-after-transcatheter-aortic-valve-replacement-rationale-and-design-of-the-galileo-study
#3
Stephan Windecker, Jan Tijssen, Gennaro Giustino, Ana H C Guimarães, Roxana Mehran, Marco Valgimigli, Pascal Vranckx, Robert C Welsh, Usman Baber, Gerrit-Anne van Es, Peter Wildgoose, Albert A Volkl, Ana Zazula, Karen Thomitzek, Melanie Hemmrich, George D Dangas
BACKGROUND: Optimal antithrombotic treatment after transcatheter aortic valve replacement (TAVR) is unknown and determined empirically. The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. DESIGN: GALILEO is an international, randomized, open-label, event-driven, phase III trial in more than 1,520 patients without an indication for oral anticoagulation who underwent a successful TAVR (ClinicalTrials...
October 31, 2016: American Heart Journal
https://www.readbyqxmd.com/read/27843361/pulmonary-embolism-new-treatments-for-an-old-problem
#4
REVIEW
John Ryan
Nonvitamin K antagonist oral anticoagulants, previously referred to as novel oral anticoagulants, have emerged in recent years as attractive treatment options for acute pulmonary embolism (PE). However, despite the widespread anticipation by physicians and the approval of rivaroxaban, apixaban, dabigatran, and more recently edoxaban, there is still some reluctance to choose these newer agents over conventional treatment with heparin/vitamin K antagonists. Acute PE puts a considerable strain on emergency departments, and medical staff rely on efficient diagnosis and risk assessment to manage the condition appropriately and economically...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27843040/a-phase-iv-study-of-thromboembolic-and-bleeding-events-following-hip-and-knee-arthroplasty-using-oral-factor-xa-inhibitor
#5
David Gomez, Helen Razmjou, Andrea Donovan, Vikas B Bansal, Jeffrey D Gollish, John J Murnaghan
BACKGROUND: Multiple randomized controlled trials have documented the effectiveness of rivaroxaban in the prevention of venous thromboembolism up to 1-month following total joint arthroplasty. However, the effectiveness and safety of rivaroxaban in the real-world setting, outside of the strict protocols used by randomized clinical trials, are unknown. METHODS: This was a prospective, observational, noninterventional, phase IV study of 3914 consecutive patients who underwent total joint arthroplasty from June 2010 to December 2012...
October 4, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27806307/rivaroxaban-versus-standard-anticoagulation-for-symptomatic-venous-thromboembolism-remotev-observational-study-analysis-of-6-month-outcomes
#6
Sébastien Gaertner, Elena-Mihaela Cordeanu, Salah Nouri, Alix-Marie Faller, Anne-Sophie Frantz, Corina Mirea, Pascal Bilbault, Patrick Ohlmann, Isabelle Le Ray, Dominique Stephan
BACKGROUND: This study aimed to provide safety and efficacy data of rivaroxaban in routine patient care in a non-selected symptomatic venous thromboembolism (VTE) population. METHODS AND RESULTS: REMOTEV is a prospective, non-interventional study of patients with acute symptomatic VTE, treated with oral rivaroxaban, VKA or parenteral heparin/fondaparinux alone for at least 3months and who are followed up for 6months. From Nov. 2013 to July 2015, 499 consecutive patients were retained for baseline analysis and 445 for safety analysis...
October 19, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27793500/management-and-outcomes-of-bleeding-events-in-patients-in-the-emergency-department-taking-warfarin-or-a-non-vitamin-k-antagonist-oral-anticoagulant
#7
Adam J Singer, Adam Quinn, Neil Dasgupta, Henry C Thode
BACKGROUND: Most comparisons of bleeding patients who are taking warfarin or a non-vitamin K oral anticoagulant (NOAC) have been limited to admitted patients and major bleeding events in well-controlled, clinical trial settings. OBJECTIVES: We describe the clinical characteristics, interventions, and outcomes in patients who are taking warfarin or a NOAC who presented to the emergency department (ED) with any bleeding event. METHODS: We conducted a structured, retrospective, observational study of nonvalvular atrial fibrillation, pulmonary embolism, or deep vein thrombosis warfarin- or NOAC-treated patients presenting with any bleeding event to a large, academic ED between January 2012 and March 2015...
October 25, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27792638/shorter-hospital-stays-and-lower-costs-for-rivaroxaban-compared-with-warfarin-for-venous-thrombosis-admissions
#8
Jay M Margolis, Steven Deitelzweig, Jeffrey Kline, Oth Tran, David M Smith, Brahim Bookhart, Concetta Crivera, Jeff Schein
BACKGROUND: Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, results in a substantial healthcare system burden. This retrospective observational study compared hospital length of stay (LOS) and hospitalization costs for patients with venous thromboembolism treated with rivaroxaban versus those treated with warfarin. METHODS AND RESULTS: Hospitalizations for adult patients with a primary diagnosis of deep vein thrombosis or pulmonary embolism who were initiated on rivaroxaban or warfarin were selected from MarketScan's Hospital Drug Database between November 1, 2012, and December 31, 2013...
October 6, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27780397/healthcare-costs-associated-with-rivaroxaban-or-warfarin-use-for-the-treatment-of-venous-thromboembolism
#9
Craig I Coleman, Christopher Baugh, Concetta Crivera, Dejan Milentijevic, Sheng-Wei Wang, Lang Lu, Winnie W Nelson
INTRODUCTION: Rivaroxaban has been shown to have similar efficacy but less major bleeding than warfarin in randomized trials of patients experiencing venous thromboembolism (VTE). This report sought to assess healthcare costs up to 12-months following an index VTE in patients prescribed either rivaroxaban or warfarin. MATERIALS AND METHODS: This study analyzed claims from the MarketScan Commercial Claims and Encounters Database from November 2011-July 2015. It selected adults newly-diagnosed with VTE (deep vein thrombosis [DVT] or pulmonary embolism [PE]) if they had an outpatient prescription claim for rivaroxaban or warfarin within 7-days of the index event...
October 26, 2016: Journal of Medical Economics
https://www.readbyqxmd.com/read/27757790/hospital-length-of-stay-and-costs-among-pulmonary-embolism-patients-treated-with-rivaroxaban-versus-parenteral-bridging-to-warfarin
#10
Erin R Weeda, Philip S Wells, W Frank Peacock, Gregory J Fermann, Christopher W Baugh, Veronica Ashton, Concetta Crivera, Peter Wildgoose, Jeff R Schein, Craig I Coleman
We sought to compare length-of-stay (LOS), total hospital costs, and readmissions among pulmonary embolism (PE) patients treated with rivaroxaban versus parenterally bridged warfarin. We identified adult PE (primary diagnostic code = 415.1x) patients in the Premier Database (11/2012-9/2015), and included those with ≥1 PE diagnostic test on days 0-2. Rivaroxaban users (allowing ≤2 days of prior parenteral therapy) were 1:1 propensity score matched to patients parenterally bridged to warfarin. LOS, total costs, and readmission for venous thromboembolism (VTE) or major bleeding within the same or subsequent 2 months were compared between cohorts...
October 18, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27751675/pulmonary-embolism-inpatients-treated-with-rivaroxaban-had-shorter-hospital-stays-and-lower-costs-compared-with-warfarin
#11
Jay M Margolis, Steven Deitelzweig, Jeffrey Kline, Oth Tran, David M Smith, Concetta Crivera, Brahim Bookhart, Jeff Schein
PURPOSE: Using real-world data, this study compares inpatient length of stay (LOS) and costs for patients with a primary diagnosis of pulmonary embolism (PE) initiating treatment with oral anticoagulation with rivaroxaban versus warfarin. METHODS: Hospitalizations from MarketScan's Hospital Drug Database were selected from November 1, 2012, through December 31, 2013, for adults with a primary diagnosis of PE initiating treatment with rivaroxaban or warfarin. Warfarin patients were matched 1:1 to rivaroxaban patients using exact and propensity score matching...
November 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27747717/warfarin-and-rivaroxaban-duplication-a-case-report-and-medication-error-analysis
#12
Julie A Fusco, Eric J Paulus, Alexandra R Shubat, Sharminara Miah
A 62-year-old African American man received unintentional duplicate anticoagulation therapy with warfarin 5 mg and rivaroxaban 20 mg daily for the treatment of recurrent pulmonary embolism. The patient presented to the anticoagulation clinic 6 days after hospital discharge with an International Normalized Ratio (INR) of 2.3 and he was instructed to continue warfarin 5 mg daily. Seven days later, he returned to the clinic with an INR >8.0 using a point-of-care device. He denied any signs or symptoms of bleeding...
December 2015: Drug Saf Case Rep
https://www.readbyqxmd.com/read/27703586/venous-thromboembolism-current-diagnostic-and-treatment-modalities
#13
Marijan Bosevski, Elizabeta Srbinovska-Kostovska
BACKGROUND: Pulmonary embolism and deep venous thrombosis, known as venous thromboembolism (VTE), are associated with a high proportion of morbidity and mortality. AIM: Aim of this review is to emphasise current diagnostic and therapeutic modalities for VTE. RESULTS: No differences have been noticed in European and American guidelines in diagnostic approach of this disorder. Today there is enough clinical information for the use of heparin (either, unfractionated or low molecular) and vitamin K antagonists in the treatment of acute and chronic phases of VTE...
September 15, 2016: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/27696084/safe-and-effective-use-of-rivaroxaban-for-treatment-of-cancer-associated-venous-thromboembolic-disease-a-prospective-cohort-study
#14
Simon Mantha, Eva Laube, Yimei Miao, Debra M Sarasohn, Rekha Parameswaran, Samantha Stefanik, Gagandeep Brar, Patrick Samedy, Jonathan Wills, Stephen Harnicar, Gerald A Soff
Low-molecular weight heparin (LMWH) has been the standard of care for treatment of venous thromboembolism (VTE) in patients with cancer. Rivaroxaban was approved in 2012 for the treatment of pulmonary embolism (PE) and deep vein thrombosis (DVT), but no prior studies have been reported specifically evaluating the efficacy and safety of rivaroxaban for cancer-associated thrombosis (CAT). Under a Quality Assessment Initiative (QAI), we established a Clinical Pathway to guide rivaroxaban use for CAT and now report a validation analysis of our first 200 patients...
September 30, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27670439/erratum-to-barco-et-al-home-treatment-of-patients-with-lowrisk-pulmonary-embolism-with-the-oral-factor-xa-inhibitor-rivaroxaban-rationale-and-design-of-the-hot-pe-trial-thromb-haemost-2016-116-191-197
#15
https://www.readbyqxmd.com/read/27667112/non-vitamin-k-oral-anticoagulants-versus-vitamin-k-antagonists-in-the-treatment-of-venous-thromboembolic-disease
#16
Christos Voukalis, Gregory Y H Lip, Eduard Shantsila
INTRODUCTION: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the western world. The approval of non-vitamin K oral anticoagulants (NOACs) as antithrombotic alternatives to vitamin K antagonists (VKAs) has offered more treatment options to physicians for the prevention of VTE recurrence, fatal pulmonary embolism (PE) and long-term complications. Four NOACs (dabigatran, rivaroxaban, apixaban and edoxaban) that have been approved for the treatment of acute VTE following large phase III trials, where NOACs demonstrated similar efficacy and superior safety profile compared to VKAs...
October 2016: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/27663190/the-efficacy-of-combined-use-of-rivaroxaban-and-tranexamic-acid-on-blood-conservation-in-minimally-invasive-total-knee-arthroplasty-a-double-blind-randomized-controlled-trial
#17
Jun-Wen Wang, Bradley Chen, Po-Chun Lin, Shih-Hsiang Yen, Chung-Cheng Huang, Feng-Chih Kuo
BACKGROUND: Tranexamic acid (TXA) was reportedly to decrease postoperative blood loss after standard total knee arthroplasty (TKA). However, the blood-conservation effect of TXA in minimally invasive TKA, in particular, receiving a direct oral anticoagulant was unclear. The aim of the study was to investigate the efficacy of combined use of TXA and rivaroxaban on postoperative blood loss in primary minimally invasive TKA. METHODS: In a prospective, randomized, controlled trial, 198 patients were assigned to placebo (98 patients, normal saline injection) and study group (100 patients, 1g TXA intraoperative injection) during primary unilateral minimally invasive TKA...
August 27, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27623684/spotlight-on-real-world-evidence-for-the-treatment-of-dvt-xalia
#18
Walter Ageno, Alexander G G Turpie
Venous thromboembolism (VTE), comprising both deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a serious and common cardiovascular disease associated with the risk of chronic complications, recurrent VTE events and even death. The treatment landscape has, in recent years, seen a paradigm shift from the use of traditional anticoagulants (low-molecular-weight heparin [LMWH] overlapping with and followed by a vitamin K antagonist [VKA]) to non-VKA oral anticoagulants (NOACs). This class of agents, encompassing direct factor Xa inhibitors and direct thrombin inhibitors have shown non-inferior efficacy and better safety to standard of care in randomised controlled trials (RCTs)...
September 14, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27618975/a-pharmacoeconomic-study-of-traditional-anticoagulation-versus-direct-oral-anticoagulation-for-the-treatment-of-venous-thromboembolism-in-the-emergency-department
#19
Stephanie Law, Daljit Ghag, Eric Grafstein, Robert Stenstrom, Devin Harris
OBJECTIVES: Patients with venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [PE]) are commonly treated as outpatients. Traditionally, patients are anticoagulated with low-molecular-weight heparin (LMWH) and warfarin, resulting in return visits to the ED. The direct oral anticoagulant (DOAC) medications do not require therapeutic monitoring or repeat visits; however, they are more expensive. This study compared health costs, from the hospital and patient perspectives, between traditional versus DOAC therapy...
September 2016: CJEM
https://www.readbyqxmd.com/read/27581829/direct-oral-anticoagulants-and-venous-thromboembolism
#20
REVIEW
Massimo Franchini, Pier Mannuccio Mannucci
Venous thromboembolism (VTE), consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban) and thrombin inhibitors (e.g. dabigatran etexilate)...
September 2016: European Respiratory Review: An Official Journal of the European Respiratory Society
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