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apixaban anticoagulant

Alexander Buchholz, Laura Ueberham, Kaja Gorczynska, Borislav Dinov, Sebastian Hilbert, Nikolaos Dagres, Daniela Husser, Gerhard Hindricks, Andreas Bollmann
BACKGROUND: Apixaban is a non-vitamin K oral anticoagulant and has been approved for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). Current labelling recommends dose reduction based on patients age, weight and renal function. OBJECTIVES: The aim of this study was to analyze adherence to current labeling instructions concerning initial apixaban dosing in clinical practice and to identify factors associated with inappropriate dose reduction...
March 15, 2018: Clinical Cardiology
Luke S Howard
Acute pulmonary embolism (PE) is a relatively common cardiopulmonary emergency that is a major cause of hospitalization and morbidity and is the primary cause of mortality associated with venous thromboembolism (VTE). During the last decade, one of the biggest changes in the management of PE has been the approval of four non-vitamin K antagonist oral anticoagulants (NOACs; apixaban, dabigatran, edoxaban and rivaroxaban) for the treatment of PE and deep vein thrombosis and secondary prevention of VTE. Areas covered: This article reviews the evolving management of PE in the NOAC era and addresses three fundamental questions: who should receive NOACs over conventional heparin/vitamin K antagonist regimens for the treatment of acute PE; whether patients should be treated as inpatients or outpatients; and how long patients should be treated to reduce the risk of recurrence? Expert commentary: The management of PE is changing...
March 15, 2018: Expert Review of Respiratory Medicine
Matej Samoš, Tomáš Bolek, Lucia Stančiaková, Ingrid Škorňová, Peter Bánovčin, František Kovář, Ján Staško, Peter Galajda, Peter Kubisz, Marián Mokáň
: The number of patients with nonvalvular atrial fibrillation (NV-AF) who require long-term anticoagulation and also have a higher risk of bleeding is increasing. Recently, there is no information regarding real on-treatment anti-Xa activity in patients with NV-AF and a higher risk of bleeding who receive oral factor Xa inhibitors. The aim of this study was to determine trough and peak anti-Xa activity in these patients. This single-centre pilot study enrolled 41 patients with NV-AF and a higher risk of bleeding defined as Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly score at least 3 points...
March 13, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Sophie Testa, Oriana Paoletti, Cristina Legnani, Claudia Dellanoce, Emilia Antonucci, Benilde Cosmi, Vittorio Pengo, Daniela Poli, Rossella Morandini, Roberto Testa, Armando Tripodi, Gualtiero Palareti
BACKGROUND: Direct oral anticoagulants(DOACs) are administered at fixed dose without need for dose adjustment by lab testing. A high inter-individual variability in the drug blood levels was shown with all DOACs. To evaluate a possible relationship between DOAC C-trough anticoagulant levels and thromboembolic events,565 consecutivenaïve patients withatrial fibrillation (AF), were enrolled in this study performed within the START-Laboratory Registry. METHODS: DOAC specific measurements [diluted thrombin time (dTT) or anti-FIIa calibrated for dabigatran; anti-FXa calibrated for rivaroxaban or apixaban] at C-trough were performed locally at steady state within 15-25 days from starting treatment...
March 12, 2018: Journal of Thrombosis and Haemostasis: JTH
Amihai Rottenstreich, Netanel Zacks, Geffen Kleinstern, Bruria Hirsh Raccah, Batia Roth, Nael Da'as, Yosef Kalish
The role of drug-level monitoring among patients using direct-acting oral anticoagulant (DOAC) is unclear. We aimed to investigate its 'real-life' utilization and effect on clinical management. A review of records of patients who underwent DOAC level testing during 2013-2017. Overall, 212 patients (median age 77 years) underwent 292 DOAC measurements [apixaban (n = 147), rivaroxaban (n = 102), dabigatran (n = 43)]. Monitoring volume increased by 460% during study period. DOAC level testing was performed during routine follow-up in 51 (17...
March 12, 2018: Journal of Thrombosis and Thrombolysis
John Burn, Munir Pirmohamed
About 1.4 British million people are at risk of strokes due to non-valvular atrial fibrillation (AF) necessitating long-term anticoagulation. The vitamin K antagonist, warfarin, has a long half-life and narrow therapeutic range necessitating regular monitoring and is a common cause of iatrogenic hospital admission. Direct-acting oral anticoagulants (DOACs), dabigatran, rivaroxaban, apixaban and edoxaban are not required to have monitoring but are sensitive to changes in renal function and are associated with poorer adherence...
2018: Open Heart
Jonaz Font, Mathilda Simeon, Christophe Simard, Stéphane Allouche, Anne-Flore Plane, Virginie Ferchaud, Marie Brionne, René Rouet, Marie Nowoczyn, Alain Manrique, Paolo Emilio Puddu, Paul Milliez, Joachim Alexandre
Whether oral anti-coagulants, vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulant (NOACs) frequently prescribed to atrial fibrillation (AF) patients, do themselves have a pro- or anti-arrhythmic effect have never been addressed. Transmembrane action potentials were recorded in an acute rabbit model of superfused pulmonary veins (PVs) sleeves preparations using standard microelectrode technique. Fluindione 10 μmol/L (n = 6) increased the AP (action potential) duration (APD), induced a significantly Vmax depression (from 95±14 to 53±5 V/s, P < 0...
March 11, 2018: Fundamental & Clinical Pharmacology
Andrew Bromley, Anna Plitt
Venous thromboembolism (VTE), which includes both deep vein thrombosis and pulmonary embolism (PE), is a very common disorder with high risk for recurrence and is associated with significant morbidity and mortality. The non-vitamin K oral anticoagulants (NOACs), which include dabigatran, rivaroxaban, apixaban, and edoxaban, have been shown to be noninferior to conventional anticoagulant therapy for the prevention of recurrent VTE and are associated with more favorable bleeding risk. Evidence from the treatment of VTE with traditional therapy (low molecular weight heparin and vitamin K antagonists) implies that extended or indefinite treatment reduces risk of recurrence...
March 10, 2018: Cardiology and Therapy
Jordanne Feldberg, Param Patel, Ashley Farrell, Sylvia Sivarajahkumar, Karen Cameron, Jennifer Ma, Marisa Battistella
Background: There is a lack of clear benefit and a potential risk of bleeding with direct oral anticoagulant (DOAC) use in chronic kidney disease (CKD) and dialysis patients with atrial fibrillation. The objective of this study was to evaluate how treatment with DOACs affects stroke and bleeding outcomes compared with warfarin or aspirin. Methods: We conducted a systematic review of randomized controlled trials, cohort studies and case series, and searched electronic databases from 1946 to 2017...
March 2, 2018: Nephrology, Dialysis, Transplantation
Inês Mourato Nunes, Ana Isabel Pedroso, Ramiro Carvalho, Armindo Ramos
Pathological or spontaneous splenic rupture is a rare but well-recognised complication of haematological malignancies. The authors present a clinical report of a 78-year-old woman with known clinical history of chronic lymphocytic leukaemia and atrial fibrillation under anticoagulation with apixaban which has spontaneous splenic rupture. Pathological examination revealed lymph node and splenic infiltration due to chronic lymphocytic leukaemia. The diagnosis of splenic rupture must be considered in all patients with haematological malignancies who experience acute abdomen...
March 5, 2018: BMJ Case Reports
Ayako Kukida, Yasushi Takasaki, Mio Nakata, Tasuku Nishihara, Sakiko Kitamura, Sonoko Fujii, Yuji Watanabe, Toshihiro Yorozuya
RATIONALE: Although an inferior vena cave (IVC) filter is placed to prevent fatal pulmonary embolism (PE), several complications associated with an IVC filter have been reported. We describe a case with symptomatic PE, of which the origin was an occlusive IVC thrombus that developed from the placement of an IVC filer after a laparoscopy-assisted total gastrectomy (LATG). PATIENT CONCERNS: A 71-year-old man underwent LATG under general anesthesia alone. He had an IVC filter implanted 13 years ago...
January 2018: Medicine (Baltimore)
Majed S Al Yami, Sawsan Kurdi, Ivo Abraham
Background: Standard-duration (7-10 days) thromboprophylaxis with low molecular weight heparin, low dose unfractionated heparin, or fondaparinux in hospitalized medically ill patients is associated with ~50% reduction in venous thromboembolism (VTE) risk. However, these patients remain at high risk for VTE post-discharge. The direct oral anticoagulants (DOACs) apixaban, rivaroxaban and betrixaban have been evaluated for extended-duration (30-42 days) thromboprophylaxis in this population...
2018: Journal of Blood Medicine
Maja Hellfritzsch, Lotte Rasmussen, Jesper Hallas, Anton Pottegård
INTRODUCTION: Knowledge on adverse effects (AEs) related to non-vitamin K antagonist oral anticoagulants (NOACs) in real-world populations is sparse. OBJECTIVE: Our objective was to identify signals of potential AEs in patients with atrial fibrillation (AF) initiating NOAC treatment using a hypothesis-free screening approach. METHODS: Using the nationwide Danish registries, we identified patients with AF initiating dabigatran, rivaroxaban, or apixaban between 2011 and 2015 (n = 50,627)...
March 1, 2018: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
Nicholas Farina, James T Miller
Direct oral anticoagulants are becoming increasingly popular in outpatient use. These medications have lacked specific reversal agents. However, this is changing. The Federal Food and Drug Administration approved idarucizumab for reversal of dabigatran in 2016, and another agent, andexanet alfa, is currently in clinical trials for reversal of rivaroxaban and apixaban. This article examines the efficacy and safety of these emerging reversal agents, as well as other historical agents for reversal of direct oral anticoagulants...
April 2018: Critical Care Nursing Quarterly
Kevin Fortier, Deepti Shroff, Uday N Reebye
BACKGROUND: Dabigatran, rivaroxaban, apixaban and edoxaban are approved novel oral anticoagulants (NOACs) as alternatives to Vitamin K antagonists (VKA). Physicians are prescribing an ever-increasing amount these drugs to their patients due to various advantages over existing medications. AIMS: The objective of this review is to provide the dental professional with current literature surrounding the emergence of NOACs, as well as various case studies on the subject, in an effort to guide clinical decision making regarding these medications...
February 28, 2018: Gerodontology
José Francisco Kerr Saraiva
Atrial fibrillation (AF) is an established risk factor for a first or recurrent stroke. Despite proven efficacy in preventing stroke in patients with AF, warfarin is underused, partly due to safety concerns. Recent randomized trials have shown that non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran (a direct thrombin inhibitor) and apixaban, edoxaban, and rivaroxaban (factor Xa inhibitors) are not only non-inferior or superior to warfarin but also demonstrate a decreased risk of cerebrovascular bleeding among patients with AF and moderate to high risk of stroke...
February 27, 2018: Cardiology and Therapy
Jackie Pratt, Philip Crispin
OBJECTIVES: To evaluate the dilute Russell viper venom time (DRVVT) for the detection of direct-acting oral anticoagulants (DOACs) and to investigate the effect of DOACS on coagulation assays. METHODS: Patients on DOACs and controls had plasma levels determined by an anti-Xa assay and dilute thrombin clotting time. Levels were correlated with the DRVVT as well as thrombin clotting time (TCT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, protein C, protein S and antithrombin levels...
February 27, 2018: European Journal of Haematology
Carolin Hoyer, Alexandra Filipov, Eva Neumaier-Probst, Kristina Szabo, Anne Ebert, Angelika Alonso
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) have gained increasing importance for stroke prevention in patients with non-valvular atrial fibrillation (AF). With changing prescription practice, among other factors, clinicians can expect to see rising numbers of patients with ischemic stroke and pre-existing NOAC therapy. Few data exist regarding a potential impact of NOAC on stroke severity and outcome. AIMS: To evaluate the impact of pre-admission NOAC therapy on ischemic stroke severity...
February 23, 2018: Journal of Thrombosis and Thrombolysis
Daniel Caldeira, Raquel Rodrigues, Daisy Abreu, Ana Marta Anes, Mário M Rosa, Joaquim J Ferreira
OBJECTIVE: In this pharmacovigilance study, we aimed to determine the incidence of spontaneously reported suspected adverse drug reactions (ADRs) related to oral anticoagulants: non-vitamin K antagonist oral anticoagulants (NOACs; apixaban, dabigatran, edoxaban, rivaroxaban) and vitamin K antagonists (VKA) Research design and methods: In this retrospective observational study, we extracted all the individual case safety reports related to oral anticoagulants recorded in the Portuguese Pharmacovigilance Database (January 2010 to April 2015)...
February 20, 2018: Expert Opinion on Drug Safety
Lara M Groetzinger, Taylor J Miller, Ryan M Rivosecchi, Roy E Smith, Mark T Gladwin, Belinda N Rivera-Lebron
BACKGROUND: Little data exist on the use of direct oral anticoagulant (DOAC) factor Xa inhibitors for submassive pulmonary embolism (PE) after catheter-directed thrombolysis (CDT). The objective of this evaluation was to determine whether the transition from parenteral anticoagulation to DOACs for submassive PE after CDT would decrease hospital length of stay (LOS) compared to warfarin. METHODS: A retrospective review of patients diagnosed with submassive PE who underwent CDT was conducted from January 1, 2012, to February 28, 2017...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
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