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https://www.readbyqxmd.com/read/27914497/acute-management-of-stroke-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants-addressing-real-world-anticoagulant-management-issues-in-stroke-aramis-registry-design-and-rationale
#1
Ying Xian, Adrian F Hernandez, Tina Harding, Gregg C Fonarow, Deepak L Bhatt, Robert E Suter, Yosef Khan, Lee H Schwamm, Eric D Peterson
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban) have been increasingly used as alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation. Yet there is substantial lack of information on how patients on NOACs are currently treated when they have an acute ischemic stroke and the best strategies for treating intracerebral hemorrhage for those on chronic anticoagulation with warfarin or a NOAC. These are critical unmet needs for real world clinical decision making in these emergent patients...
December 2016: American Heart Journal
https://www.readbyqxmd.com/read/27913478/thrombosis-in-the-setting-of-obesity-or-inflammatory-bowel-disease
#2
Steven R Lentz
Obesity and inflammatory bowel disease (IBD) are systemic inflammatory disorders that predispose to arterial and venous thrombosis through similar prothrombotic mechanisms. Obesity and IBD are chronic risk factors that lead to a persistently elevated risk of thrombosis, although the thrombotic risk with IBD appears to wax and wane with disease severity. Because of the lack of high-quality evidence to guide management decisions, approaches to the prevention and treatment of thrombosis in patients with obesity or IBD are based on extrapolation from general guidelines for antithrombotic therapy...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27912776/improving-stroke-prevention-therapy-for-patients-with-atrial-fibrillation-in-primary-care-protocol-for-a-pragmatic-cluster-randomized-trial
#3
Theresa M Lee, Noah M Ivers, Sacha Bhatia, Debra A Butt, Paul Dorian, Liisa Jaakkimainen, Kori Leblanc, Dan Legge, Dante Morra, Alissia Valentinis, Laura Wing, Jacqueline Young, Karen Tu
BACKGROUND: The prevalence of atrial fibrillation (AF) is growing as the population ages, and at least 15% of ischemic strokes are attributed to AF. However, many high-risk AF patients are not offered guideline-recommended stroke prevention therapy due to a variety of system, provider, and patient-level barriers. METHODS: We will conduct a pragmatic, cluster-randomized controlled trial randomizing primary care clinics to test a "toolkit" of quality improvement interventions in primary care...
December 3, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27909544/reducing-the-risk-of-stroke-in-patients-with-nonvalvular-atrial-fibrillation-with-direct-oral-anticoagulants-is-one-of-these-not-like-the-others
#4
REVIEW
Paul P Dobesh Pharm D, John Fanikos Mba R Ph
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and increases risk of stroke by nearly 5-fold. While warfarin has been employed successfully to reduce the risk of stroke in these patients, there are a number of challenges with therapy. These include the need for therapeutic monitoring due to variability in patient response, frequent dose adjustments, numerous drug-drug, drug-food, and drug-disease interactions, and a heightened risk of thrombosis and bleeding due to these issues. Current guidelines recommend that the vitamin K antagonists (VKA) or direct oral anticoagulants (DOACs) should be used for thromboprophylaxis in patients with nonvalvular AF at risk for stroke or systemic embolic events...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909516/the-role-of-noacs-in-atrial-fibrillation-management-a-qualitative-study
#5
Katherine Kirley Md Ms, Goutham Rao Md, Victoria Bauer Bs, Christopher Masi Md PhD
Patients with atrial fibrillation (AF) benefit from anticoagulation to reduce stroke risk. However, 30-60% of patients with AF are not anticoagulated. This study explored physicians' reasons for under-treatment of AF, focusing on the role of the novel oral anticoagulants (NOACs). We interviewed primary care physicians and cardiologists involved in AF management in a variety of practice settings. We conducted interviews using a semi-structured format and analyzed the data using the Framework Method. Four themes emerged...
June 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909473/cryoablation-for-the-treatment-of-drug-refractory-symptomatic-atrial-fibrillation-a-regional-medical-center-experience
#6
Robert Tonks Md, Hiba-Tul-Kareem Sayed Md, Ashley Adams Ba, William T Smith Md Facc
INTRODUCTION: PVI is an effective, guideline-based treatment for drug refractory symptomatic AF. Balloon cryoablation has been shown to be a safe and effective method for PVI. In the STOP-AF trial, data was produced from practitioners performing PVI with significant experience at high volume centers. This study evaluates the effectiveness and safety of treating symptomatic, drug refractory AF with PVI via cryoablation after implementation in a regional medical center. METHOD: This represents a retrospective analysis of outcomes after cryoablation treatment for AF in 71 patients over 354...
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27906754/management-of-acute-stroke-in-patients-on-oral-anticoagulants
#7
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/27905699/green-light-vaporization-of-the-prostate-pvp-is-it-an-adult-technique
#8
Aldo Brassetti, Cosimo De Nunzio, Nicolas Barry Delongchamps, Cristian Fiori, Francesco Porpiglia, Andrea Tubaro
INTRODUCTION: Intending to overcome Transurethral resection of the prostate (TURP) in terms of safety maintaining its efficacy profile, have led to the introduction of minimally invasive laser therapies to treat men with lower urinary tract symptoms (LUTS) secondary to Benign prostatic obstruction (BPO), each one with its unique properties. Aim of this review was to analyse and summarize all the existing data regarding the 180 W Xcelerated Performance System (XPS) Potoselective Vaporization of the Prostate (PVP)...
December 1, 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
https://www.readbyqxmd.com/read/27900415/-management-of-anesthesia-in-endovascular-interventions
#9
T Rössel, R Paul, T Richter, S Ludwig, T Hofmockel, A R Heller, T Koch
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach...
November 29, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27899520/is-adherence-to-the-american-college-of-chest-physicians-recommended-anticoagulation-treatment-duration-associated-with-different-outcomes-among-patients-with-venous-thromboembolism
#10
Alex C Spyropoulos, Ron Preblick, Winghan J Kwong, Melissa Lingohr-Smith, Jay Lin
Clinical and economic outcomes associated with venous thromboembolism (VTE) patient adherence to the American College of Chest Physicians (ACCP) anticoagulant (AC) treatment guidelines are incompletely understood. Patients with ≥1 inpatient or ≥2 separate outpatient claims for deep vein thrombosis and/or pulmonary embolism, based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, were identified from the IMS PharMetrics Plus database. Patients had continuous insurance coverage for 12 months before (baseline) and after (follow-up) the index event (first VTE claim) but no baseline VTE claims...
November 28, 2016: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/27899517/endovascular-management-of-cerebral-septic-embolism-three-recent-cases-and-review-of-the-literature
#11
Eugene L Scharf, Tia Chakraborty, Alejandro Rabinstein, Amrendra S Miranpuri
Endovascular management of acute ischemic stroke secondary to septic emboli from bacterial endocarditis is case-specific and outside established guidelines. We report three new cases of an acute ischemic stroke secondary to septic embolus from two different centers. All cases reported here were large vessel occlusions of the middle cerebral artery in anticoagulated patients. In one case the embolus was noted to be firm and aspiration thrombectomy was attempted in lieu of stent retrieval. Thrombolysis in Cerebral Ischemia (TICI) 3 recanalization was achieved and the patient experienced a good outcome with resolution of deficits...
November 29, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27893055/assessment-of-use-vs-discontinuation-of-oral-anticoagulation-after-pulmonary-vein-isolation-in-patients-with-atrial-fibrillation
#12
Sara Själander, Fredrik Holmqvist, J Gustav Smith, Pyotr G Platonov, Milos Kesek, Peter J Svensson, Carina Blomström-Lundqvist, Fariborz Tabrizi, Jari Tapanainen, Dritan Poci, Anders Jönsson, Anders Själander
Importance: Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke. Objectives: To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment...
November 23, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27890386/2016-guidelines-of-the-taiwan-heart-rhythm-society-and-the-taiwan-society-of-cardiology-for-the-management-of-atrial-fibrillation
#13
Chern-En Chiang, Tsu-Juey Wu, Kwo-Chang Ueng, Tze-Fan Chao, Kuan-Cheng Chang, Chun-Chieh Wang, Yenn-Jiang Lin, Wei-Hsian Yin, Jen-Yuan Kuo, Wei-Shiang Lin, Chia-Ti Tsai, Yen-Bin Liu, Kun-Tai Lee, Li-Jen Lin, Lian-Yu Lin, Kang-Ling Wang, Yi-Jen Chen, Mien-Cheng Chen, Chen-Chuan Cheng, Ming-Shien Wen, Wen-Jone Chen, Jyh-Hong Chen, Wen-Ter Lai, Chuen-Wang Chiou, Jiunn-Lee Lin, San-Jou Yeh, Shih-Ann Chen
Atrial fibrillation (AF) is the most common sustained arrhythmia. Both the incidence and prevalence of AF are increasing, and the burden of AF is becoming huge. Many innovative advances have emerged in the past decade for the diagnosis and management of AF, including a new scoring system for the prediction of stroke and bleeding events, the introduction of non-vitamin K antagonist oral anticoagulants and their special benefits in Asians, new rhythm- and rate-control concepts, optimal endpoints of rate control, upstream therapy, life-style modification to prevent AF recurrence, and new ablation techniques...
November 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/27888051/absence-of-oral-anticoagulation-and-subsequent-outcomes-among-outpatients-with-atrial-fibrillation
#14
Paul L Hess, Sunghee Kim, Gregg C Fonarow, Laine Thomas, Daniel E Singer, James V Freeman, Bernard J Gersh, Jack Ansell, Peter R Kowey, Kenneth W Mahaffey, Paul S Chan, Benjamin A Steinberg, Eric D Peterson, Jonathan P Piccini
BACKGROUND: Prior studies have shown a treatment gap in oral anticoagulation (OAC) use among patients with atrial fibrillation yet have incompletely characterized factors associated with failure to treat and subsequent outcomes in contemporary practice. METHODS: Using data collected between June 2010 and August 2011 from 174 ambulatory care sites in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we identified factors associated with absence of OAC via stratified logistic regression...
November 22, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27887785/thromboelastography-teg%C3%A2-demonstrates-that-tinzaparin-4500-international-units-has-no-detectable-anticoagulant-activity-after-caesarean-section
#15
S Griffiths, C Woo, V Mansoubi, A Riccoboni, A Sabharwal, S Napier, M Columb, M Laffan, G Stocks
BACKGROUND: Low molecular weight heparin is routinely used for thromboprophylaxis in pregnancy and the puerperium. Consensus guidelines recommend waiting 10-12h after administration of a thromboprophylactic dose of low molecular weight heparin before performing a neuraxial block or removing an epidural catheter. Thromboelastography (TEG®) has been reported to be sensitive to the effects of enoxaparin 4h after administration. The purpose of this study was to use TEG to examine coagulation changes in the first 10h after a thromboprophylactic dose of tinzaparin in an attempt to ratify the current consensus guidelines about timing of neuraxial blockade and epidural catheter removal...
October 8, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27880998/recurrent-acute-portal-vein-thrombosis-in-liver-cirrhosis-treated-by-rivaroxaban
#16
Hyeyoung Yang, Seo Ree Kim, Myeong Jun Song
Cirrhosis can occur with the development of portal vein thrombosis (PVT). PVT may aggravate portal hypertension, and it can lead to hepatic decompensation. The international guideline recommends for anticoagulation treatment to be maintained for at least 3 months in all patients with acute PVT. Low-molecular-weight-heparin and changing to warfarin is the usual anticoagulation treatment. However, warfarin therapy is problematic due to a narrow therapeutic window and the requirement for frequent dose adjustment, which has prompted the development of novel oral anticoagulants for overcoming these problems...
November 25, 2016: Clinical and Molecular Hepatology
https://www.readbyqxmd.com/read/27878663/prevention-and-treatment-of-venous-thromboembolism-in-patients-with-solid-brain-neoplasms-results-of-a-survey-among-italian-physicians
#17
Nicola Mumoli, Stefano Barco, Marco Cei, Matteo Giorgi-Pierfranceschi, Mauro Campanini, Andrea Fontanella, Walter Ageno, Francesco Dentali
The decision concerning the introduction of primary and secondary prophylaxis of venous thromboembolism (VTE) in patients with solid brain neoplasms and brain metastases is often challenging due to the concomitant increased risk of intracranial hemorrhage and to limited evidence from available literature. A standardized questionnaire composed of nine multiple-choice questions regarding primary VTE prevention in non-surgical patients during high-risk conditions and VTE secondary prevention in patients with a solid brain neoplasm or cerebral metastases was sent via electronic mail to all the members (n = 2420) of the Italian Federation of the Internal Medicine Hospital Executives' Associations (FADOI) in June 2015...
November 23, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27878507/the-scope-and-value-of-an-anticoagulation-stewardship-program-at-a-community-teaching-hospital
#18
Maura K Wychowski, Christina I Ruscio, Peter A Kouides, Ronald L Sham
To report the impact of an inpatient anticoagulation stewardship program at a community hospital to promote optimal anticoagulant use. The anticoagulation team (ACT) stewardship program consists of two clinical pharmacists and hematologists to provide oversight of anticoagulants, high cost reversal agents including prothrombin complex concentrate (PCC, Kcentra™), and heparin-induced thrombocytopenia (HIT) management. Intervention data and number of charts reviewed were collected. Average cost avoidance data was applied to ACT interventions to estimate cost savings...
November 22, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27875375/management-of-venous-thromboembolism-in-myeloproliferative-neoplasms
#19
Tiziano Barbui, Valerio De Stefano
PURPOSE OF REVIEW: Venous thromboembolism is frequent in chronic myeloproliferative neoplasms (MPN). The current strategy for its management includes cytoreductive therapy and antithrombotic prophylaxis, but many issues remain uncertain. In this review, the risk factors and prevention of recurrences will be discussed. RECENT FINDINGS: Around one-third of patients with polycythemia vera and essential thrombocythemia experience a major thrombosis at diagnosis or during follow-up...
November 21, 2016: Current Opinion in Hematology
https://www.readbyqxmd.com/read/27869893/-anmco-position-paper-recommendations-for-the-follow-up-of-patients-with-pulmonary-thromboembolism
#20
Carlo D'Agostino, Pietro Zonzin, Iolanda Enea, Michele Massimo Gulizia, Walter Ageno, Piergiuseppe Agostoni, Michele Azzarito, Cecilia Becattini, Amedeo Bongarzoni, Francesca Bux, Franco Casazza, Nicoletta Corrieri, Michele D'Alto, Nicola D'Amato, Andrea Maria D'Armini, Maria Grazia De Natale, Giovanni Di Minno, Giuseppe Favretto, Lucia Filippi, Valentina Grazioli, Gualtiero Palareti, Raffaele Pesavento, Loris Roncon, Laura Scelsi, Antonella Tufano
Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is the third most common cause of cardiovascular death. The management of the acute phase of VTE is well described in several papers and guidelines, whereas the management of the follow-up of the patients affected from VTE is less defined. This position paper of the Italian Association of Hospital Cardiologists (ANMCO) tries to fill the gap using currently available evidence and the opinion of the experts to suggest the most useful way to manage patients in the chronic phase...
September 2016: Giornale Italiano di Cardiologia
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