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https://www.readbyqxmd.com/read/27920714/idarucizumab-as-antidote-to-intracerebral-hemorrhage-under-treatment-with-dabigatran
#1
Valentin Held, Philipp Eisele, Christoph C Eschenfelder, Kristina Szabo
BACKGROUND AND PURPOSE: Non-vitamin K anticoagulants (NOAC) such as dabigatran have become important therapeutic options for the prevention of stroke. Until recently, there were only nonspecific agents to reverse their anticoagulant effects in a case of emergency. Idarucizumab, an antibody fragment targeting dabigatran, is the first specific antidote for a NOAC to be approved, but real-world experience is limited. METHODS: We report two cases of patients on dabigatran with acute intracerebral hemorrhage who received idarucizumab...
September 2016: Case Reports in Neurology
https://www.readbyqxmd.com/read/27917717/reversal-agents-for-oral-antiplatelet-and-anticoagulant-treatment-during-bleeding-events-current-strategies
#2
Peter Raimondi, Elaine M Hylek, Konstantinos N Aronis
There is an increasing prevalence of cardiovascular diseases that warrant antithrombotic therapy. Antithrombotic therapy includes antiplatelet agents and anticoagulation therapy with vitamin K antagonists (VKAs) or non-Vitamin K oral anticoagulants (NOACs). Antithrombotic therapy is associated with increased rates of bleeding. In this review we summarize the evidence and provide strategies for the management of severe bleeding in the setting of antithrombotic therapy. There is limited data on the management of bleeding in the setting of antiplatelet therapy...
December 5, 2016: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/27911120/new-frontiers-in-anticoagulation-non-vitamin-k-oral-anticoagulants-in-stroke-prevention
#3
Valentina Arnao, Marianna Riolo, Antonino Tuttolomondo, Antonio Pinto, Brigida Fierro, Paolo Aridon
Non vitamin-K oral anticoagulants (NOACs) are direct and specific inhibitors of the coagulation factors IIa (dabigatran) and Xa (apixaban, rivaroxaban, edoxaban) which share many pharmacokinetic properties. However, indications are lacking regarding the use of NOACs during thrombolysis, surgery and bleeding events. Areas covered: In this paper, the authors retrospectively analyzed the relevant literature on the NOACs using the PubMed and Google Scholar databases. Expert Commentary: Although warfarin is effective in cardioembolic stroke prevention, easier handling and more favorable risk-benefit profile often render NOACs a more preferable therapy choice for neurologists...
December 2, 2016: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/27909542/which-factors-influence-resident-physicians-to-prescribe-noacs-to-patients-with-non-valvular-atrial-fibrillation
#4
Zardasht Oqab Md Frcpc, William F McIntyre Md Frcpc, Wilma M Hopman Ma, Adrian Baranchuk Md Facc Frcp
The Canadian Cardiovascular Society and the European Society of Cardiology recommend the use of non-vitamin K antagonists (NOAC) in preference to warfarin for stroke prevention in most patients with non-valvular atrial fibrillation (AF). The aim of this study was to identify factors that predict selection of a NOAC by resident physicians when faced with patients with non-valvular AF. A web-based survey was distributed to residents across Canada to learn the attitudes and behaviours regarding stroke, bleeding risk and choices of therapy in different clinical scenarios involving the same patient and one additional co-morbidity...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27906754/management-of-acute-stroke-in-patients-on-oral-anticoagulants
#5
Jan C Purrucker, Thorsten Steiner
PURPOSE OF REVIEW: An increasing number of patients are receiving oral anticoagulants. Since non-vitamin K antagonist oral anticoagulants (NOACs) were approved, primary prevention of ischemic stroke has become simpler. However, managing ischemic stroke and intracerebral hemorrhage while on oral anticoagulation (OAC) has become more complex. This review covers the latest developments in managing ischemic and hemorrhagic stroke in patients receiving vitamin K antagonists (VKA) and NOACs...
November 30, 2016: Current Opinion in Neurology
https://www.readbyqxmd.com/read/27903938/post-noac-portuguese-observational-study-of-intracranial-hemorrhage-on-non-vitamin-k-antagonist-oral-anticoagulants
#6
Cláudia Marques-Matos, José Nuno Alves, João Pedro Marto, Joana Afonso Ribeiro, Ana Monteiro, José Araújo, Fernando Silva, Fátima Grenho, Miguel Viana-Baptista, João Sargento-Freitas, João Pinho, Elsa Azevedo
BACKGROUND: There is a lower reported incidence of intracranial hemorrhage with non-vitamin K antagonist oral anticoagulants compared with vitamin K antagonist. However, the functional outcome and mortality of intracranial hemorrhage patients were not assessed. AIMS: To compare the outcome of vitamin K antagonists- and non-vitamin K antagonist oral anticoagulants-related intracranial hemorrhage. METHODS: We included consecutive patients with acute non-traumatic intracranial hemorrhage on oral anticoagulation therapy admitted between January 2013 and June 2015 at four university hospitals...
November 30, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27894493/optimal-reversal-of-novel-anticoagulants-in-trauma
#7
REVIEW
Jason Weinberger, Mark Cipolle
The incidence of patients with trauma on novel oral anticoagulants (NOACs) for the treatment of thromboembolic disorders is increasing. In severe bleeding or hemorrhage into critical spaces, urgent reversal of this underlying pharmacologic coagulopathy becomes paramount. Optimal reversal strategy for commonly used NOACs is still evolving. Basic tenets of evaluation of patients with trauma and resuscitation remain the same. Clinical outcomes data in bleeding human patients with trauma are lacking, but are needed to establish efficacy and safety in these treatments...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27803506/role-of-novel-oral-anticoagulants-in-the-treatment-of-antiphospholipid-syndrome
#8
C Whitney White, Angela R Thomason, Katie Boyd
Background: Antiphospholipid syndrome (APS) is an autoimmune disease characterized by thrombosis or pregnancy loss with persistent positive antibodies. Standard treatment for APS with history of thromboembolism is heparin or low-molecular-weight heparin followed by a vitamin K antagonist (VKA). Novel oral anticoagulants (NOACs) could be effective in patients with APS, but none carry indications for treatment related to APS. Clinical Evidence: Five case reports or series with rivaroxaban and dabigatran suggest thrombotic events occur most often in the higher risk population (arterial thrombosis and/or triple positive antibodies) or in patients who had recurrent VTEs on warfarin therapy...
October 2016: Hospital Pharmacy
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
#9
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/27777713/medication-error-when-switching-from-warfarin-to-rivaroxaban-leading-to-spontaneous-large-ecchymosis-of-the-abdominal-and-chest-wall
#10
Flavio Egger, Federica Targa, Ivan Unterholzner, Russell P Grant, Markus Herrmann, Christian J Wiedermann
Non-vitamin K oral anticoagulant (NOAC) therapy may be inappropriate if prescription was incorrect, the patient's physiological parameters change, or interacting concomitant medications are erroneously added. The aim of this report was to illustrate inappropriate NOAC prescription in a 78-year-old woman with non-valvular atrial fibrillation and borderline renal dysfunction who was switched from warfarin to rivaroxaban and subsequently developed bruising with hemorrhagic shock and acute on chronic renal failure...
August 8, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27773018/gastrointestinal-bleeding-on-noacs-impact-of-reversal-agents
#11
Catherine Tang, Anita Ghevondian, Chris Ward
No abstract text is available yet for this article.
February 2016: Pathology
https://www.readbyqxmd.com/read/27727040/idarucizumab-for-reversal-of-dabigatran-associated-bleeding-misnomer-or-miracle
#12
Luke Miller, Jason A Ferreira, Calvin Tucker
BACKGROUND: The development of novel oral anticoagulants (NOACs) has revolutionized oral anticoagulation. Rapid incorporation of NOACs into general practice has heightened the demand for directed reversal agents. Idarucizumab is a targeted reversal agent that is approved for the urgent reversal of the anticoagulant effects of dabigatran. While it is a welcome addition to reversal strategies of dabigatran, a number of clinical questions exist regarding its place in therapy. OBJECTIVE: We describe controversies regarding the use of idarucizumab therapy in patients with dabigatran-associated bleeding...
October 8, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27716952/new-oral-anticoagulants-in-nonvalvular-atrial-fibrillation
#13
Fatima Urooj, Abhishek Kulkarni, Dwight Stapleton, Edo Kaluski
The choice of an oral anticoagulant (OAC) for patients with nonvalvular atrial fibrillation (NVAF) is a major and complex clinical decision taking into account the individual risk-benefit ratio and bearing in mind the chronicity of therapy. This review focuses on the safety and efficacy of new oral anticoagulants (NOACs) compared with conventional vitamin K antagonists (VKA) in patients with NVAF. Current data suggest that NOACs are at least as effective and safe as VKAs for most NVAF subjects. The NOACs do not mandate dietary restrictions and regular pharmacodynamic monitoring, and they seem to have lesser incidence of intracranial or fatal bleeding when compared with VKAs...
October 7, 2016: Clinical Cardiology
https://www.readbyqxmd.com/read/27697119/-reversal-strategies-for-non-vitamin-k-antagonist-oral-anticoagulants
#14
Frederik Uttenthal Larsen, Anne-Mette Hvas, Erik Lerkevang Grove
Non-vitamin K oral anticoagulants (NOACs) are alternatives to vitamin K antagonists and provide consistent anticoagulation with equal or better clinical outcome and no need for routine monitoring. Bleeding is a feared complication of anticoagulants. Until recently, no specific agent has been available for reversal of NOACs. Idarucizumab binds dabigatran for rapid reversal of its activity without procoagulant effects. Andexanet alpha (expected release in 2016) and PER977 are antidotes under clinical development...
October 3, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/27695508/reversal-agents-of-non-vitamin-k-dependent-anticoagulants-a-rapid-review-of-the-changing-horizon
#15
Supreet Kaur, Abhishek Kumar, Robert G Lerner, Wilbert S Aronow
The newer non-vitamin K dependent anticoagulants (NOACs) have provided a new tool in the armamentarium of physicians treating nonvalvular atrial fibrillation and thromboembolism. Slowly, but steadily, there has been an increased preference of NOACs over vitamin K antagonists. However, the major limiting factor and the concern that precluded their use was lack of reversal in emergent situations. With the advent of reversal agents such as idarucizumab, andexanet alfa and PER977, this gap is also being filled...
October 1, 2016: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/27659071/nonvitamin-k-antagonist-oral-anticoagulant-activity-challenges-in-measurement-and-reversal
#16
REVIEW
Karen S Brown, Hamim Zahir, Michael A Grosso, Hans J Lanz, Michele F Mercuri, Jerrold H Levy
BACKGROUND: Four nonvitamin K antagonist oral anticoagulants (NOACs) are approved for the prevention of stroke in patients with nonvalvular atrial fibrillation and for the treatment of venous thromboembolism. These include the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. Bleeding is a complication for all anticoagulants and concerns regarding bleeding risk and the suitability of effective reversal strategies may be a barrier to their prescription...
September 23, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27637305/non-vitamin-k-antagonist-oral-anticoagulants-in-atrial-fibrillation
#17
REVIEW
Anna Plitt, Christian T Ruff, Robert P Giugliano
For more than 50 years, vitamin K antagonists (VKAs) have been the standard of care for treatment of atrial fibrillation (AF). However, the numerous limitations of VKAs have led to the development of non-VKA oral anticoagulants (NOACs). There are 4 NOACs currently approved for prevention of thromboembolism in patients with nonvalvular AF. This article provides an overview of AF, summarizes basic properties of NOACs, and reviews the landmark trials. Current data on use of NOACs in special populations and specific clinical scenarios are also presented...
October 2016: Hematology/oncology Clinics of North America
https://www.readbyqxmd.com/read/27626268/-antidotes-to-novel-direct-oral-anticoagulants
#18
N G Khorev, A P Momot, V O Kon'kova
During the last 10 years, several novel direct oral anticoagulants (NOACs) have entered the clinical arena and were registered in the Russian Federation for use in patients presenting with atrial fibrillation, venous thrombosis, and pulmonary artery thromboembolism. NOACs are classified into two groups: direct thrombin inhibitor (notably dabigatran) and factor Xa inhibitors (including rivaroxaban, apixaban, and edoxaban). Their disadvantage is lack of specific antidotes in case of an emergency situation (injury, infarction, stroke requiring thrombolysis, urgent operation)...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/27595409/practical-considerations-for-the-nonvitamin-k-antagonist-oral-anticoagulants
#19
Rahul Trikha, Peter R Kowey
OBJECTIVES: Dabigatran, rivaroxaban, apixaban, and edoxaban are nonvitamin K antagonist oral anticoagulants (NOACs) approved for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Phase-3 clinical trials demonstrated NOACs were as effective as warfarin in the prevention of stroke or systemic embolism and associated with decreased incidences of intracranial bleeding. Additionally, NOACs provide quicker onset of action, simpler dosing, more predictable pharmacokinetic profiles, and decreased food and drug interactions compared with warfarin...
September 6, 2016: Cardiology
https://www.readbyqxmd.com/read/27545637/-new-oral-anticoagulants-noac-in-nephrology
#20
Antonio Bellasi, Luca Di Lullo, Gianvincenzo Melfa, Claudio Minoretti, Carlo Ratti, Carlo Campana, Maurizio Volpi, Stefano Mangano, Biagio Di Iorio, Mario Cozzolino
The new or direct oral anticoagulants [new oral anticoagulants (NOAC) or direct oral anticoagulants (DOAC)] were launched in the Italian market in 2013. Although these compounds share common pharmacological indications with vitamin K antagonists (warfarin or acenocumarol), they have different mechanisms of action, do not require a constant anticoagulant monitoring but are more efficacious and safer than vitamin K antagonists. The use of these molecules (Dabigatran, Apixaban, Rivaroxaban, Betrixaban, Edoxaban) is constantly rising in daily practice...
July 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
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