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apixaban anticoagulant

Laila Staerk, Emil Loldrup Fosbøl, Gregory Y H Lip, Morten Lamberts, Anders Nissen Bonde, Christian Torp-Pedersen, Brice Ozenne, Thomas Alexander Gerds, Gunnar Hilmar Gislason, Jonas Bjerring Olesen
BACKGROUND: Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) are widely used as stroke prophylaxis in non-valvular atrial fibrillation (AF), but comparative data are sparse. PURPOSE: To compare dabigatran, rivaroxaban, and apixaban vs. VKA and the risk of stroke/thromboembolism (TE) and intracranial bleeding in AF. METHODS: Using Danish nationwide registries (2011-15), anticoagulant-naïve AF patients were identified when initiating VKA or an NOAC...
October 14, 2016: European Heart Journal
Jamshed J Dalal, Anil Dhall, Abhay Bhave
Oral vitamin K antagonists (VKA) such as warfarin have been the mainstay of therapy for stroke prevention in patients with non valvular atrial fibrillation (NVAF) while low-molecular-weight heparin, fondaparinux and adjusted-dose warfarin or aspirin have been routinely used for thromboembolism (VTE) prophylaxis in patients undergoing total hip or knee replacement. However, VKAs are associated with considerable limitations, including increased risk of bleeding and narrow therapeutic window. Novel oral anticoagulants (NOACs, now referred as Non Vit K dependent oral anticoagulants), including the direct thrombin inhibitor dabigatran and direct Factor Xa inhibitors such as rivaroxaban and apixaban are now approved alternatives to warfarin for prophylaxis of stroke and systemic embolic events (SEE) in patients with NVAF and treatment and prophylaxis of VTE...
April 2016: Journal of the Association of Physicians of India
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
Joris Komen, Tomas Forslund, Paul Hjemdahl, Morten Andersen, Björn Wettermark
AIMS: To assess the effect of policy interventions, i.e. reimbursement decisions, guidelines, and regional recommendations, on the prescribing of oral anticoagulant treatment in patients with atrial fibrillation (AF). METHODS: Interrupted time series analyses using monthly data on all patients with a recorded diagnosis of AF newly initiated (both switchers and anticoagulant naïve patients) on either warfarin, dabigatran, rivaroxaban or apixaban in the Stockholm region from April 2011 until February 2016...
October 11, 2016: British Journal of Clinical Pharmacology
Francesco Pelliccia, Fabiana Rollini, Giuseppe Marazzi, Cesare Greco, Carlo Gaudio, Dominick J Angiolillo, Giuseppe Rosano
The combination of AF and coronary artery disease not only is a common clinical setting, it is also a complex setting to deal with anticoagulation and antiplatelet therapy, and it is associated with significantly higher mortality rates. Unfortunately, there are no sufficient data available to optimally guide clinical practice in such settings. This review focuses specifically on newer oral anticoagulants (NOACs) associated with dual antiplatelet therapy (DAPT) in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI)...
October 3, 2016: International Journal of Cardiology
Ken Okumura, Masatsugu Hori, Norio Tanahashi, A John Camm
Nonvalvular atrial fibrillation (AF) is a risk factor for stroke in elderly patients. Although warfarin has been used to prevent AF-associated stroke for more than 50 years, non-vitamin K antagonist oral anticoagulants (NOACs) including dabigatran, rivaroxaban, apixaban, and edoxaban recently have been developed to overcome the disadvantages of warfarin. Based on the results of NOAC clinical trials, Savelieva and Camm made recommendations regarding selection of NOACs in patients with nonvalvular AF. Recent accumulating evidence indicates that NOACs work differently in Asian and non-Asian individuals...
October 7, 2016: Clinical Cardiology
Francesco Pelliccia, Salvatore Rosanio, Giuseppe Marazzi, Sara Poggi, Alessandra Tanzilli, Cesare Greco, Carlo Gaudio, Giuseppe Rosano
The high risk of both stroke and major bleeding in atrial fibrillation (AF) patients with chronic kidney disease (CKD) defines an important population for whom the assessment of the balance between the risk of ischemic stroke and of bleeding is essential. The use of novel oral anticoagulants (NOACs) may be a viable option in this population due to their greater net clinical benefit than warfarin, as demonstrated by the results of the clinical phase III trials. NOACs have been found to have a greater net clinical benefit than warfarin in patients at high risk of either stroke (CHADS2≥1 or CHA2DS2-VASc score≥2) or bleeding (HAS-BLED≥3)...
October 1, 2016: International Journal of Cardiology
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
Navkaranbir S Bajaj, Rajat Kalra, Nirav Patel, Taimoor Hashim, Hemant Godara, Sameer Ather, Garima Arora, Tilak Pasala, Thomas T Whitfield, David C McGiffin, Mustafa I Ahmed, Steven G Lloyd, Nita A Limdi, Pankaj Arora
BACKGROUND: Multiple novel oral anticoagulants and left atrial appendage closure devices (WATCHMAN) have been tested against dose-adjusted vitamin K antagonists in randomized controlled trials for stroke prophylaxis in non-valvular atrial fibrillation. No direct comparisons of these strategies are available from randomized controlled trials. We conducted the current analyses by combining efficacy and safety characteristics of all FDA approved stroke prophylaxis treatment strategies for patients with non-valvular atrial fibrillation...
2016: PloS One
E Pandya, B V Bajorek
WHAT IS KNOWN AND OBJECTIVE: The importance of 'shared decision-making' is much emphasized in recent clinical guidelines regarding stroke management in atrial fibrillation (AF), more so following the inclusion of non-vitamin K oral anticoagulants (NOACs) among the treatment options. It is important that patients are navigated through balanced and unbiased information about the available treatment options, so as to understand the risk and benefits associated with the therapies, and to enable them to accordingly communicate their concerns and views with their clinicians prior to therapy selection...
October 5, 2016: Journal of Clinical Pharmacy and Therapeutics
John Eikelboom, Geno Merli
The risk of bleeding in the setting of anticoagulant therapy continues to be re-evaluated following the introduction of a new generation of direct oral anticoagulants (DOACs). Interruption of DOAC therapy and supportive care may be sufficient for the management of patients who present with mild or moderate bleeding, but in those with life-threatening bleeding, a specific reversal agent is desirable. We review the phase 3 clinical studies of dabigatran, rivaroxaban, apixaban, and edoxaban in patients with nonvalvular atrial fibrillation, in the context of bleeding risk and management...
September 29, 2016: American Journal of Emergency Medicine
Pasquale Pignatelli, Daniele Pastori, Simona Bartimoccia, Danilo Menichelli, Tommasa Vicario, Cristina Nocella, Roberto Carnevale, Francesco Violi
Anti Xa non-vitamin K oral anticoagulants (anti Xa NOACs) seem to possess antiplatelet effect in vitro, but it is unclear if this occurs also in vivo. Aim of the study was to compare the effect on platelet activation of two anti Xa NOACs, namely apixaban and rivaroxaban, to warfarin, and to investigate the potential underlying mechanism by evaluating soluble glycoprotein GPVI (sGPVI), a protein involved in platelet activation. We performed a cross-sectional including AF patients treated with warfarin (n=30), or apixaban 10mg/day (n=40), or rivaroxaban 20mg/day (n=40)...
September 28, 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Jan Beyer-Westendorf, Franziska Michalski, Luise Tittl, Susann Hauswald-Dörschel, Sandra Marten
BACKGROUND: Observational data and results from post-hoc analyses in clinical trials suggest that direct oral factor Xa inhibitors might increase menstrual bleeding intensity in women of reproductive age, but the extent of this effect is unknown. We aimed to investigate the management and outcomes of vaginal bleeding complications during therapy with direct oral factor Xa inhibitors in a case series of women of reproductive age. METHODS: To identify individuals for inclusion in this case series, we searched two sources of prospectively collected data from women of reproductive age treated with direct oral factor Xa inhibitors: the non-interventional Dresden NOAC Registry (NCT01588119), which is based in the administrative district of Dresden (Saxony, Germany), and all locally archived data from phase 3 trials of direct oral factor Xa inhibitors done at University Hospital Carl Gustav Carus Dresden...
October 2016: Lancet Haematology
Benilde Cosmi
Anticoagulants such as heparins and vitamin K antagonists (VKA) are effective for thrombosis prevention and treatment, but are associated with the risk of bleeding and other limitations, spurring the search for improved drugs. Areas covered: to evaluate the newer anticoagulants, focusing on those tested in phase III clinical trials such as direct oral anticoagulants (DOACs), antisense oligonucleotides (ASO) and warfarin analogues. DOACs such as dabigatran, rivaroxaban, apixaban and edoxaban are licensed for stroke prevention in atrial fibrillation and treatment of venous thromboembolism, dabigatran, rivaroxaban and apixaban for postoperative thromboprophylaxis in patients undergoing elective hip or knee arthroplasty and rivaroxaban for secondary prevention of acute coronary syndromes...
October 12, 2016: Expert Opinion on Pharmacotherapy
Angelique H Sadlon, Dimitrios A Tsakiris
BACKGROUND: Concerns regarding the use of direct oral anticoagulants (DOACs: apixaban, dabigatran, edoxaban, rivaroxaban) in the elderly persist owing to the lack of randomised controlled trials targeting this age group. OBJECTIVES: The aim of this study was to assess the efficacy and safety of DOACs in elderly patients (aged 75 years or more) with atrial fibrillation or venous thromboembolism (VTE), based on already published large randomised trials. METHODS: EMBASE, MEDLINE and the Cochrane Library were searched from inception to June 2015 for phase III trials...
2016: Swiss Medical Weekly
Sigrun Halvorsen, Waleed Ghanima, Ingunn Fride Tvete, Cecilie Hoxmark, Pål Falck, Oddvar Solli, Christian Jonasson
: Aims We aimed to evaluate bleeding risk in clinical practice in patients with atrial fibrillation (AF) being prescribed dabigatran, rivaroxaban or apixaban compared with warfarin.Methods Using nationwide registries (Norwegian Patient Registry and Norwegian Prescription Database), we identified AF patients with a first prescription of oral anticoagulants (OAC) between January 2013 and June 2015. Patients were followed until discontinuation or switching of OAC, death or end of follow-up...
September 27, 2016: European Heart Journal. Cardiovascular Pharmacotherapy
Michelle E Johnson, Cinira Lefèvre, Shuk-Li Collings, David Evans, Sebastian Kloss, Essra Ridha, Andrew Maguire
OBJECTIVES: To examine the characteristics and persistence in patients newly initiated with oral anticoagulants (OACs) for stroke prevention in non-valvular atrial fibrillation (NVAF). DESIGN: Cohort study in Clinical Practice Research Datalink. SETTING: UK primary care. PARTICIPANTS: 15 242 patients with NVAF newly prescribed apixaban, rivaroxaban, dabigatran or vitamin K antagonists (VKAs) between 1 December 2012 and 31 October 2014...
September 26, 2016: BMJ Open
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
Yong Wang, Xiaoqing Sun, Di Yang, Zhuang Guo, Xuxu Fan, Minhua Nie, Feng Zhang, Yue Liu, Yue Li, Yulin Wang, Ping Gong, Yajing Liu
Four series of novel and potent FXa inhibitors possessing the 1,2,4-triazole moiety and pyrrole moiety as P2 binding element and dihydroimidazole/tetrahydropyrimidine groups as P4 binding element were designed, synthesized, and evaluated for their anticoagulant activity in human and rabbit plasma in vitro. Most compounds showed moderate to excellent activity. Compounds 14a, 16, 18c, 26c, 35a, and 35b were further examined for their inhibition activity against human FXa in vitro and rat venous thrombosis in vivo...
November 1, 2016: Bioorganic & Medicinal Chemistry
(no author information available yet)
Since 2011, data on patients exposed to direct oral anticoagulants (DOAs) while undergoing invasive procedures have accumulated. At the same time, an increased hemorrhagic risk during perioperative bridging anticoagulation without thrombotic risk reduction has been demonstrated. This has led the GIHP to update their guidelines published in 2011. For scheduled procedures at low bleeding risk, it is suggested that patients interrupt DOAs the night before irrespective of type of drug and to resume therapy six hours or more after the end of the invasive procedure...
September 19, 2016: Anaesthesia, Critical Care & Pain Medicine
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