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https://www.readbyqxmd.com/read/29663464/uninterrupted-administration-of-edoxaban-vs-vitamin-k-antagonists-in-patients-undergoing-atrial-fibrillation-catheter-ablation-rationale-and-design-of-the-eliminate-af-study
#1
Stefan H Hohnloser, John Camm, Riccardo Cappato, Hans-Christoph Diener, Hein Heidbuchel, Hans-Joachim Lanz, Lluís Mont, Carlos A Morillo, Rüdiger Smolnik, Ophelia Q P Yin, Josef Kautzner
Patients with atrial fibrillation (AF) are at an approximately 0.5% to 3% increased risk of thromboembolism during and immediately after catheter ablation. Treatment guidelines recommend periprocedural oral anticoagulation plus unfractionated heparin during ablation. Rivaroxaban and dabigatran are the only non-vitamin K oral anticoagulants for which there are randomized controlled trials assessing uninterrupted anticoagulation in patients undergoing catheter ablation of AF. Edoxaban, a direct factor Xa inhibitor, is noninferior vs warfarin for the prevention of stroke or systemic embolism with less major bleeding in patients with nonvalvular AF...
April 17, 2018: Clinical Cardiology
https://www.readbyqxmd.com/read/29661489/comparison-of-the-effects-of-edoxaban-an-oral-direct-factor-xa-inhibitor-on-venous-thromboembolism-between-patients-with-and-without-cancer
#2
Satoshi Ikeda, Seiji Koga, Yuki Yamagata, Masamichi Eguchi, Daisuke Sato, Takahiro Muroya, Tsuyoshi Yonekura, Akira Tsuneto, Tsuyoshi Yoshimuta, Yuji Koide, Hiroaki Kawano, Koji Maemura
BACKGROUND: Venous thromboembolism (VTE) is a frequent and serious complication of cancer. The current guidelines in the USA and Europe recommend low-molecular weight heparin (LMWH) for the treatment of cancer-associated VTE. In Japan, LMWH is not given for the treatment of VTE; instead edoxaban, an oral direct factor Xa inhibitor, was approved for the treatment of VTE in September 2014. However, the efficacy and safety of the factor Xa inhibitor in cancer patients have not been fully elucidated...
April 13, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29657252/periprocedural-complications-in-patients-undergoing-catheter-ablation-of-atrial-fibrillation-without-discontinuation-of-a-vitamin-k-antagonist-and-direct-oral-anticoagulants
#3
Toshiya Kojima, Katsuhito Fujiu, Nobuaki Fukuma, Hiroshi Matsunaga, Tsukasa Oshima, Jun Matsuda, Takumi Matsubara, Yu Shimizu, Gaku Oguri, Eriko Hasumi, Hiroyuki Morita, Issei Komuro
BACKGROUND: Periprocedural anticoagulation is important in catheter ablation (CA) of atrial fibrillation (AF) and there is increasing evidence that uninterrupted vitamin K antagonist (VKA) therapy is superior to interrupted anticoagulation strategies. Since the emergence of direct oral anticoagulants (DOACs), numerous studies have shown promising results for their use in uninterrupted strategies. However, further studies are needed to further define the efficacy and safety of performing AF ablation with uninterrupted factor XA inhibitors or direct thrombin inhibitors...
April 13, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/29627068/role-of-fish-oil-in-post-cardiotomy-bleeding-a-summary-of-the-basic-science-and-clinical-trials
#4
REVIEW
John Alfred Carr
BACKGROUND: Omega-3 fatty acids are widely used. This article reviews the coagulopathic effects of fish oil. METHODS: A review was performed of all English articles that addressed the topic from 1980 to 2017. RESULTS: Fish oil induces an in vitro coagulopathy in humans due to inhibitory effects in platelet-to-platelet adhesion and platelet-stimulated thrombin generation. The effect from fish oil alone is weak, but it is enhanced and may become clinically noticeable in patients taking antiplatelet therapy, and, to a lesser extent, in patients on factor Xa inhibitors and warfarin...
April 4, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29611444/combination-oral-antithrombotic-therapy-for-the-treatment-of-myocardial-infarction-recent-developments
#5
Udaya S Tantry, Eliano P Navarese, Aung Myat, Rahul Chaudhary, Paul A Gurbel
There have been significant new developments in the treatment of patients with myocardial infarction with respect to oral antithrombotic agents over the past decade. Recent studies have explored the potential utility of targeting the dual pathway inhibition of platelet function with single or dual antiplatelet agents and the thrombin pathway with direct thrombin inhibitors or factor Xa inhibitors. Areas covered: In this review, the authors focus on the recent developments of oral antithrombotic agents including antiplatelet and antithrombin agents...
April 3, 2018: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/29602894/apixaban-induced-subdural-bleeding-case-presentation-and-literature-review
#6
Eman Alayad, Sami Khairy, Ahmed Aloraidi
Apixaban is a factor Xa inhibitor which is a non-vitamin K dependent oral anticoagulant known tocause the lowest rate of intracranial bleeding among the same kind of inibitors. In this paper, we report a rare case in a 60-year-old man with a history of hypertension and oligodendroglioma on apixaban for deep venous thrombosis who presented to our hospital with decreased level of consciousness and slurred speech with rapid deterioration. We highlight the risk of subdural bleeding requiring immediate neurosurgical intervention due to apixaban, with literature review...
March 30, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29594815/has-time-come-for-the-use-of-direct-oral-anticoagulants-in-the-extended-prophylaxis-of-venous-thromboembolism-in-acutely-ill-medical-patients-no
#7
Francesco Marongiu, Doris Barcellona
Acutely ill hospitalized medical patients are at high risk of venous thromboembolism (VTE). Although thromboprophylaxis in these patients is recommended since 2004 by the American College of Chest Physicians, it is widely underused. The doubt as to whether or not to treat patients at high VTE risk after hospital discharge came from the knowledge that this risk may persist after the hospital admission period. Two meta-analyses comparing extended- versus short-duration prophylaxis are published. The results demonstrate an unfavorable balance between VTE prevention and incidence of major bleeding in patients assigned to extended-duration thromboprophylaxis...
March 28, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29590221/andexanet-alfa-effectively-reverses-edoxaban-anticoagulation-effects-and-associated-bleeding-in-a-rabbit-acute-hemorrhage-model
#8
Genmin Lu, Polly Pine, Janet M Leeds, Francis DeGuzman, Pratikhya Pratikhya, Joyce Lin, John Malinowski, Stanley J Hollenbach, John T Curnutte, Pamela B Conley
INTRODUCTION: Increasing use of factor Xa (FXa) inhibitors necessitates effective reversal agents to manage bleeding. Andexanet alfa, a novel modified recombinant human FXa, rapidly reverses the anticoagulation effects of direct and indirect FXa inhibitors. OBJECTIVE: To evaluate the ability of andexanet to reverse anticoagulation in vitro and reduce bleeding in rabbits administered edoxaban. MATERIALS AND METHODS: In vitro studies characterized the interaction of andexanet with edoxaban and its ability to reverse edoxaban-mediated anti-FXa activity...
2018: PloS One
https://www.readbyqxmd.com/read/29588304/inhibitory-mechanisms-of-very-low-dose-rivaroxaban-in-non-st-elevation-myocardial-infarction
#9
Oliver Borst, Patrick Münzer, Nada Alnaggar, Sascha Geue, Roland Tegtmeyer, Dominik Rath, Michal Droppa, Peter Seizer, Stefan Heitmeier, Johan W M Heemskerk, Lisa K Jennings, Robert F Storey, Dominick J Angiolillo, Bianca Rocca, Henri Spronk, Hugo Ten Cate, Meinrad Gawaz, Tobias Geisler
Very low-dose (VLD) factor Xa (FXa) inhibition, in combination with acetylsalicylic acid (ASA) and clopidogrel, is associated with improved outcomes in patients with acute coronary syndrome (ACS) with a tolerable bleeding risk profile. To date, there are no data documenting platelet inhibition and the anticoagulatory effects of VLD FXa inhibition on top of guideline-adherent dual-antiplatelet therapy (DAPT) in patients with ACS. Patients with non-ST-elevation myocardial infarction (NSTEMI) receiving oral DAPT (ASA + clopidogrel, n = 20; or ASA + ticagrelor, n = 20) were prospectively enrolled in a nonrandomized study...
March 27, 2018: Blood Advances
https://www.readbyqxmd.com/read/29569500/mechanisms-of-action-and-clinical-use-of-specific-reversal-agents-for-non-vitamin-k-antagonist-oral-anticoagulants
#10
Kristoffer Andresen, Dan Atar, Erik Gjertsen, Waleed Ghanima, Svein Roseth, Odd Erik Johansen
OBJECTIVES: With a steadily growing number of patients with non-valvular atrial fibrillation, anticoagulation use increases. Anticoagulation therapy is associated with increased risk of serious bleeding and an increased complexity in management of patients in need for urgent surgery. We wanted to assess the magnitude of this challenge as well as review current and potential future clinical management strategies. DESIGN: A review of the literature on the magnitude of patients using antigoaculants in potential need for acute restoration of hemostasis was conducted, as well as current status of reversal agents for non-vitamin K antagonist oral anticoagulants (NOACs)...
March 23, 2018: Scandinavian Cardiovascular Journal: SCJ
https://www.readbyqxmd.com/read/29566417/treatment-challenges-in-venous-thromboembolism-an-appraisal-of-rivaroxaban-studies
#11
Alok A Khorana, Jeffrey I Weitz
Venous thromboembolism (VTE) presents a continuing clinical burden to healthcare systems and there are patient groups for whom VTE management is challenging. Depending on the patient profile, the optimal duration of anticoagulation for VTE treatment can be unclear. EINSTEIN CHOICE was a Phase III, randomized, double-blind trial that compared the safety and efficacy of two once-daily (od) doses of the direct, oral factor Xa inhibitor rivaroxaban (20 and 10 mg) with acetylsalicylic acid (ASA; 100 mg daily) for prevention of recurrent VTE...
March 22, 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29566416/beyond-stroke-prevention-in-atrial-fibrillation-exploring-further-unmet-needs-with-rivaroxaban
#12
C M Gibson, G J Hankey, T Nafee, R C Welsh
With improved life expectancy and the aging population, the global burden of atrial fibrillation (AF) continues to increase, and with AF comes an estimated fivefold increased risk of ischaemic stroke. Prophylactic anticoagulant therapy is more effective in reducing the risk of ischaemic stroke in AF patients than acetylsalicylic acid or dual-antiplatelet therapy combining ASA with clopidogrel. Non-vitamin K antagonist oral anticoagulants are the standard of care for stroke prevention in patients with non-valvular AF...
March 22, 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29566415/the-rivaroxaban-program-and-the-management-of-unmet-needs-in-thromboembolic-disease
#13
A John Camm
Rivaroxaban is a non-vitamin K antagonist oral anticoagulant that acts as a direct factor Xa inhibitor, and is widely used for the prevention and treatment of thromboembolic disorders. As further knowledge gaps are identified in thrombosis management, the rivaroxaban research program has expanded in an attempt to elucidate the wider benefits of rivaroxaban. An increased understanding of the interactions taking place within the coagulation cascade may support a broader role for rivaroxaban (2.5 mg twice daily [bid] or 5 mg bid) in the setting of vascular protection, either alone or in combination with an antiplatelet agent...
March 22, 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29566413/rivaroxaban-a-new-treatment-paradigm-in-the-setting-of-vascular-protection
#14
Rupert Bauersachs, Faiez Zannad
The pathophysiology of atherosclerosis involves a diseased endothelium, lipid accumulation and low-grade inflammation. In later stages of coronary artery disease (CAD) and peripheral arterial disease (PAD), plaque rupture may induce atherothrombosis caused by fibrin formation and platelet activation, leading to vessel occlusion with subsequent organ damage such as myocardial infarction, stroke or limb ischaemia. Because of the high disease burden associated with CAD and PAD, there is a need for continuous vascular protection beyond currently available treatments including antiplatelet agents...
March 22, 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29564837/prothrombin-complex-concentrate-for-major-bleeding-on-factor-xa-inhibitors-a-prospective-cohort-study
#15
Sam Schulman, Peter L Gross, Bruce Ritchie, Susan Nahirniak, Yulia Lin, Lani Lieberman, Marc Carrier, Mark A Crowther, Indy Ghosh, Alejandro Lazo-Langner, Michelle Zondag
Oral factor Xa inhibitors are increasingly used for anticoagulation, but there is no approved reversal agent. Prothrombin complex concentrate (PCC) for the management of Xa-inhibitor-associated bleeding has been described in small case series and one cohort study. Patients on apixaban or rivaroxaban, suffering a major bleed, were treated at nine Canadian hospitals as per existing hospital protocol with a fixed dose of PCC 2,000 units and subsequently recruited for a 30-day follow-up. The treating physician evaluated the haemostatic effectiveness as observed during the first day as good, moderate or poor/none, using an assessment guide...
March 21, 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29564687/prothrombin-complex-concentrate-for-reversal-of-direct-factor-xa-inhibitors-prior-to-emergency-surgery-or-invasive-procedure-a-retrospective-study
#16
Siavash Piran, Caroline Gabriel, Sam Schulman
Direct oral factor Xa (FXa) inhibitors are widely used for anticoagulation but a targeted antidote is not available. Four-factor prothrombin complex concentrate (4FPCC) has been shown in observational studies to support hemostasis in most patients with major bleeding related to FXa inhibitors with an acceptable rate of thromboembolic events. However, the effectiveness of 4FPCC for reversal of FXa inhibitors prior to emergency surgery or invasive procedures is unclear. A retrospective chart review was performed in patients that received 4FPCC at Hamilton General Hospital from 2015 to 2017...
March 21, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29562231/hepatocyte-secreted-dpp4-in-obesity-promotes-adipose-inflammation-and-insulin-resistance
#17
Devram S Ghorpade, Lale Ozcan, Ze Zheng, Sarah M Nicoloro, Yuefei Shen, Emily Chen, Matthias Blüher, Michael P Czech, Ira Tabas
Obesity-induced metabolic disease involves functional integration among several organs via circulating factors, but little is known about crosstalk between liver and visceral adipose tissue (VAT). In obesity, VAT becomes populated with inflammatory adipose tissue macrophages (ATMs). In obese humans, there is a close correlation between adipose tissue inflammation and insulin resistance, and in obese mice, blocking systemic or ATM inflammation improves insulin sensitivity. However, processes that promote pathological adipose tissue inflammation in obesity are incompletely understood...
March 29, 2018: Nature
https://www.readbyqxmd.com/read/29543384/extended-venous-thromboembolism-prophylaxis-in-medically-ill-patients
#18
Brandon Cave, Augustus Hough, Paul P Dobesh
Prophylaxis for venous thromboembolism (VTE) in hospitalized acutely ill medical patients is a well-established practice. Despite the increased use of inpatient prophylaxis, the duration of hospitalization is typically shorter than the duration of VTE prophylaxis provided in clinical trials. In addition, VTE events after hospitalization are not unusual, with the majority of events occurring within 30 days of hospital discharge. Therefore, the 30-day time period post discharge has been identified as a stage in which patients are still at high-risk of developing VTE...
March 15, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29538002/anti-xa-activity-in-oral-factor-xa-inhibitor-treated-patients-with-atrial-fibrillation-and-a-higher-risk-of-bleeding-a-pilot-study
#19
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
https://www.readbyqxmd.com/read/29532595/factor-xa-and-viia-inhibition-by-tissue-factor-pathway-inhibitor-is-prevented-by-a-monoclonal-antibody-to-its-kunitz-1-domain
#20
Cecilia Augustsson, Anders Svensson, Birgitte Kjaer, Tzu-Yuan Chao, Xia Wenjuan, Berit Olsen Krogh, Jens Breinholt, Jes Thorn Clausen, Ida Hilden, Helle Heibroch Petersen, Lars Christian Petersen
BACKGROUND: Initiation of coagulation is induced by binding of activated factor VII (FVIIa) to tissue factor (TF) and activation of factor X (FX) in a process regulated by tissue factor pathway inhibitor (TFPI). TFPI contains three Kunitz-type protease inhibitor domains (K1-K3) of which K1 and K2 block the active sites of FVIIa and FXa respectively. OBJECTIVE: To produce a monoclonal antibody (mAb) directed towards K1, to characterize the binding epitope, and to study its effect on TFPI inhibition...
March 12, 2018: Journal of Thrombosis and Haemostasis: JTH
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