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direct oral anticoagulants guidelines

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https://www.readbyqxmd.com/read/28604569/use-of-four-factor-prothrombin-complex-concentrate-in-the-reversal-of-warfarin-induced-and-nonvitamin-k-antagonist-related-coagulopathy
#1
Hannah Young, Jeremy L Holzmacher, Richard Amdur, Stephen Gondek, Babak Sarani, Mary E Schroeder
: To evaluate the efficacy of international normalized ratio (INR) reversal using four-factor prothrombin complex concentrate (4F-PCC) in nonmedication-induced coagulopathy. We performed a single-site, retrospective cohort study of patients receiving off-label use of 4F-PCC. Cohorts included liver dysfunction if they had acute liver decompensation or cirrhosis without other causative factors of liver failure such as sepsis, coagulopathy of acute sepsis (CAS) if they had documentation of sepsis and no underlying liver disorder, known factor deficiencies, or medication-induced coagulopathy, or warfarin if they were taking warfarin...
June 9, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28604566/novel-oral-anticoagulants-in-the-peri-endoscopic-period
#2
Michael Genualdi, William H Frishman
Millions of patients in the United States are currently prescribed some form of anticoagulation therapy. Recently, novel oral anticoagulants (NOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, have begun to replace warfarin as the drugs of choice for anticoagulation. As the use of these medications becomes more widespread, it is increasingly important for gastroenterologists to understand the risks associated with performing endoscopic procedures on patients who are taking NOACs. In this review, we provide an overview of the NOACs, as well as current guidelines from international societies regarding the management of patients scheduled to undergo endoscopic procedures who are prescribed these medications...
April 6, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28596467/-embolic-stroke-of-undetermined-source
#3
Teruyuki Hirano
A new clinical construct, embolic stroke of undetermined source (ESUS) was established as a therapeutically relevant entity, which are defined as a non-lacunar infarction without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation, especially with direct oral anticoagulant (DOAC). The possible embolic sources include covert atrial fibrillation, arterial stenosis with <50%, low-risk emboligenic cardiac sources, aortic plaque, cancer-associated, and paradoxical embolism...
June 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28594049/venous-thromboembolism-past-present-and-future
#4
Sam Schulman, Walter Ageno, Stavros V Konstantinides
Venous thromboembolism (VTE), the third most frequent acute cardiovascular syndrome, is associated with a considerable disease burden which continues to grow along with the longer life expectancy of the population worldwide. In the past century, parenteral heparin prophylaxis was established for hospitalised patients at elevated risk of VTE. More recently, non-vitamin K antagonist oral anticoagulants (NOACs) with a direct inhibiting effect on factor Xa or thrombin, underwent extensive testing in clinical trials and have been approved for patients undergoing hip or knee replacement...
June 8, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28587584/strategies-to-optimize-dual-antiplatelet-therapy-after-coronary-artery-stenting-in-acute-coronary-syndrome
#5
Bridget Paravattil, Hazem Elewa
The use of aspirin and a P2Y12 receptor antagonist as dual antiplatelet therapy (DAPT) has become the treatment of choice in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention to prevent recurrent thrombotic events. Although DAPT is beneficial for most patients, few patients still experience recurrent thrombotic events and increased bleeding episodes. This article reviews current literature to identify various approaches that may enhance the DAPT benefit-risk ratio in patients with ACS...
July 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28546529/the-safety-of-electrical-cardioversion-under-the-control-of-transesophageal-echocardiography-in-patients-with-atrial-fibrillation-and-inadequate-anticoagulation
#6
Joanna Zaprutko, Artur Baszko, Michał Michalak, Karol Kochman, Radosław Szymański, Jan Kłopocki, Anna Nowicka, Rafał Dankowski, Marek Michalski, Piotr Kałmucki, Andrzej Szyszka
INTRODUCTION    Restoring sinus rhythm in patients with atrial fibrillation (AF)/atrial flutter (AF) requires adequate oral anticoagulation (OAC) prior to direct current cardioversion (DCC). Some patients eligible for DCC are not properly anticoagulated. OBJECTIVES    Assessment of risk factors for thrombus and spontaneous echo contrast (SEC) in the left atrium (LA) as well as the safety profile of DCC under transesophageal echocardiography control (TEE) in patients with inadequate anticoagulation. PATIENTS AND METHODS    From the cohort of 316 patients admitted for DCC, 139 (age 63...
May 25, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28540489/endoscopy-in-patients-on-antiplatelet-agents-and-anticoagulants
#7
REVIEW
Andrew M Veitch
Management of patients on anticoagulant or antiplatelet therapy undergoing endoscopy presents a balance of risks between haemorrhage due to the procedure, and thrombosis due to discontinuation of antithrombotic therapy. Haemorrhage is usually controllable endoscopically, but thrombosis could, on occasion, result in myocardial infarction or stroke, with permanent disability or death. For elective procedures, there is adequate time to plan best management of antithrombotic therapy. International guidelines have been published, but recommendations are based on limited evidence and consultation with appropriate medical specialists, and the patient is important...
May 25, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28515674/perioperative-management-of-patients-on-direct-oral-anticoagulants
#8
REVIEW
Virginie Dubois, Anne-Sophie Dincq, Jonathan Douxfils, Brigitte Ickx, Charles-Marc Samama, Jean-Michel Dogné, Maximilien Gourdin, Bernard Chatelain, François Mullier, Sarah Lessire
Direct oral anticoagulants (DOACs) have been licensed worldwide for several years for various indications. Each year, 10-15% of patients on oral anticoagulants will undergo an invasive procedure and expert groups have issued several guidelines on perioperative management in such situations. The perioperative guidelines have undergone numerous updates as clinical experience of emergency management has increased and perioperative studies including measurement of residual anticoagulant levels have been published...
2017: Thrombosis Journal
https://www.readbyqxmd.com/read/28509773/perioperative-management-of-antithrombotic-therapies
#9
Timur Yurttas, Patrick M Wanner, Miodrag Filipovic
PURPOSE OF REVIEW: Perioperative coagulation management is becoming increasingly frequent in the daily routine of the anesthesiologist and with the plethora of new substances on the market also increasingly complex. The perioperative setting poses unique challenges requiring an individualized evaluation and management of antithrombotic therapy. This review shall summarize the newest developments in this domain. RECENT FINDINGS: New data in patients with atrial fibrillation have led to a paradigm change in the perioperative management of antithrombotics...
May 15, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28508916/direct-oral-anticoagulants-for-the-treatment-of-cancer-associated-venous-thromboembolism-what-do-we-know-so-far
#10
Minna Voigtlaender, Florian Langer
Cancer patients with venous thromboembolism (VTE) are at increased risk for both bleeding and VTE recurrence. Anticoagulation with low-molecular-weight heparin (LMWH) is the standard of care during the initial and long-term treatment phase (i.e. during the first 3 - 6 months of therapy) based on its overall beneficial safety and efficacy profile compared to vitamin K antagonists (VKAs). The direct oral anticoagulants (DOACs) rivaroxaban, apixaban, edoxaban, and dabigatran are approved for the treatment of acute VTE, and the combined six phase-3 trials have included > 1500 patients with active cancer, as defined by variable selection criteria...
May 16, 2017: Hämostaseologie
https://www.readbyqxmd.com/read/28506981/contemporary-trends-in-oral-anticoagulant-prescription-in-atrial-fibrillation-patients-at-low-to-moderate-risk-of-stroke-after-guideline-recommended-change-in-use-of-the-chads2-to-the-cha2ds2-vasc-score-for-thromboembolic-risk-assessment-analysis-from-the-national
#11
David F Katz, Thomas M Maddox, Mintu Turakhia, Anil Gehi, Emily C O'Brien, Steven A Lubitz, Alexander Turchin, Gheorghe Doros, Lanyu Lei, Paul Varosy, Lucas Marzec, Jonathan C Hsu
BACKGROUND: Use of the CHA2DS2-VASc score instead of the CHADS2 score for thromboembolic risk stratification and initiation of oral anticoagulation (OAC) was recommended in the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation (AF) guidelines. We sought to define the proportion of patients with AF qualifying for and receiving OAC in contemporary practice by applying the CHA2DS2-VASc score to patients with a low CHADS2 score. METHODS AND RESULTS: Among patients with AF enrolled in the American College of Cardiology National Cardiovascular Data Registry's outpatient Practice Innovation and Clinical Excellence registry (2008-2014) CHADS2 score of 0 or 1, we calculated the impact of adoption of the CHA2DS2-VASc score on the proportion of patients with an indication for OAC...
May 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28478715/safety-outcomes-of-apixaban-compared-with-warfarin-in-patients-with-end-stage-renal-disease
#12
Stefanie C Sarratt, Ross Nesbit, Robert Moye
BACKGROUND: Current guidelines make no specific recommendations on the selection of direct oral anticoagulants for the prevention and treatment of venous thromboembolism in patients with end-stage renal disease (ESRD) receiving hemodialysis. Based on these guidelines, warfarin remains the anticoagulant of choice in these patients. OBJECTIVE: To compare bleeding rates in patients receiving apixaban or warfarin with ESRD undergoing chronic hemodialysis. METHODS: This was a single-center, retrospective, institutional review board-approved cohort analysis...
June 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28475278/anticoagulation-bridge-therapy-in-patients-with-atrial-fibrillation-recent-updates-providing-a-rebalance-of-risk-and-benefit
#13
Candice L Garwood, Bianca Korkis, Domenico Grande, Claudia Hanni, Amy Morin, Lynette R Moser
In 2011 we reviewed clinical updates and controversies surrounding anticoagulation bridge therapy in patients with atrial fibrillation (AF). Since then, options for oral anticoagulation have expanded with the addition of four direct oral anticoagulant (DOAC) agents available in the United States. Nonetheless, vitamin K antagonist (VKA) therapy continues to be the treatment of choice for patients who are poor candidates for a DOAC and for whom bridge therapy remains a therapeutic dilemma. This literature review identifies evidence and guideline and consensus statements from the last 5 years to provide updated recommendations and insight into bridge therapy for patients using a VKA for AF...
May 5, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28455651/-management-of-hemorrhage-in-patients-treated-with-direct-oral-anticoagulants
#14
REVIEW
O Grottke, H Lier, S Hofer
The introduction of nonvitamin K antagonistic, direct oral anticoagulants (DOAC) made thromboembolic prophylaxis easier for patients. For many physicians, however, there is still uncertainty about monitoring, preoperative discontinuation, and restarting of DOAC therapy. Guidelines for the management of bleeding are provided, but require specific therapeutic skills in the management of diagnostics and therapy of acute hemorrhage. Small clinical studies and case reports indicate that unspecific therapy with prothrombin complex concentrates (PCC) and activated PCC (aPCC) concentrate may reverse DOAC-induced anticoagulation...
April 28, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28446351/deep-vein-thrombosis-of-the-upper-extremity
#15
Jan Heil, Wolfgang Miesbach, Thomas Vogl, Wolf O Bechstein, Alexander Reinisch
BACKGROUND: Deep venous thrombosis (DVT) arises with an incidence of about 1 per 1000 persons per year; 4-10% of all DVTs are located in an upper extremity (DVT-UE). DVT-UE can lead to complications such as post-thrombotic syndrome and pulmonary embolism and carries a high mortality. METHODS: This review is based on pertinent literature, published from January 1980 to May 2016, that was retrieved by a systematic search, employing the PRISMA criteria, carried out in four databases: PubMed (n = 749), EMBASE (n = 789), SciSearch (n = 0), and the Cochrane Library (n = 12)...
April 7, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28423431/-treatment-and-secondary-prevention-of-venous-thromboembolism-change-in-oral-anticoagulation
#16
Thomas-Maria Helms, Dietrich Gulba, Ingo Ahrens, Andreas Schäfer, Johannes Hankowitz, Peter Kuhlencordt, Hans-Peter Lipp, Sigrid Nikol, Hanno Riess, Tom Stargardt, Peter Bramlage
With the recent approval of the fourth direct non vitamin K dependent oral anticoagulant (NOAC) edoxaban the range of available NOACs for the treatment of venous thromboembolism (VTE) has expanded. Shortly thereafter, two updated guidelines for the prevention and treatment of VTE have been published. In these NOACs are listed as equal anticoagulants to low-molecular weight heparin (LMWH), or fondaparinux (FDX), and VKA for the initial or maintenance treatment of VTE. All NOACs are approved for the maintenance therapy after VTE and two NOACs (rivaroxaban and apixaban) for the initial treatment in addition in an increased dose...
April 19, 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28412908/news-in-the-indications-of-non-vitamin-k-oral-anticoagulants-according-to-the-guidelines-of-the-american-college-of-chest-physicians-2016
#17
Gabriela Cesarman-Maus, Guillermo J. Ruiz-Argüelles
Antithrombotic guidelines published by the Chest Journal, the official publication of the American College of Chest Physicians (ACCP), are continuously updated as clinically relevant information accumulates. The Evidence-Based Clinical Practice Guidelines on antithrombotic therapy and prevention of thrombosis were published in 2012. This year, the topic that has been updated pertains to antithrombotic therapy, specifically addressing prophylaxis and treatment of venous thromboembolic (VTE) disease. In this paper, I focus on these guidelines regarding the indications or lack thereof for the use of Non-vitamin K-antagonist Oral Anticoagulants (NOACS), also referred to as Direct-acting Oral Anticoagulants (DOACS)...
April 13, 2017: Current Drug Metabolism
https://www.readbyqxmd.com/read/28400546/management-of-bleeding-or-urgent-interventions-in-patients-treated-with-direct-oral-anticoagulants-doacs-2017-management-proposals-in-poland
#18
Piotr Pruszczyk, Anna Tomaszuk-Kazberuk, Agnieszka Słowik, Rafał Drwila, Grażyna Rydzewska, Krzysztof J Filipiak, Zbigniew Gaciong, Jarosław Kaźmierczak, Wojciech Marczyński, Jerzy Windyga, Adam Kobayashi, Janina Stepińska
Direct oral anticoagulants (DOACs) - apixaban, dabigatran, edoxaban and rivaroxaban - are mainly used in the prevention of thromboembolic complications in atrial fibrillation patients and in the treatment of venous thromboembolism. As compared to vitamin K antagonists (VKAs), they are characterized by at least similar efficacy and better safety profiles, especially with respect to intracranial hemorrhages. DOACs are more convenient therapeutic agents. The European Society of Cardiology 2016 guidelines clearly favor DOACs over VKAs in AF patients...
March 15, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28343849/oral-anticoagulant-therapy-for-older-patients-with-atrial-fibrillation-a-review-of-current-evidence
#19
REVIEW
Mario Bo, Enrica Grisoglio, Enrico Brunetti, Yolanda Falcone, Niccolò Marchionni
Atrial fibrillation is more frequent in older patients, who have a higher risk of cardioembolic stroke and thromboembolism. Oral anticoagulant therapy is the standard of treatment for stroke prevention; however, under-prescription is still very common in older patients. The reasons underlying this phenomenon have not been systematically investigated, and true contraindications only partially account for it. An intimate skepticism on the real benefit-risk balance of oral anticoagulant therapy in the oldest patients seems to derive from the fact that most studies supporting it were conducted decades ago and included younger patients, with overall better functional and clinical status...
March 24, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28328524/paramagnetic-micro-particles-as-a-tool-for-rapid-quantification-of-apixaban-dabigatran-edoxaban-and-rivaroxaban-in-human-plasma-by-uhplc-ms-ms
#20
Martin H J Wiesen, Cornelia Blaich, Thomas Streichert, Guido Michels, Carsten Müller
BACKGROUND: Assessment of the anticoagulant activity of direct oral anticoagulants (DOACs) is justified in special clinical situations. Here, we evaluated two independent extraction methods and developed a multi-analyte ultra-high performance liquid chromatography tandem mass (UHPLC-MS/MS) method for the quantification of apixaban, dabigatran, edoxaban and rivaroxaban in human plasma. METHODS: Routine extraction based on protein precipitation with acetonitrile and subsequent centrifugation was compared to sample clean-up using commercial paramagnetic micro-particles and subsequent magnetic depletion...
March 22, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
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