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Apixaban, rivaroxaban, edoxaban, dabigatran

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https://www.readbyqxmd.com/read/29767545/pharmacogenetics-of-novel-oral-anticoagulants-a-review-of-identified-gene-variants-future-perspectives
#1
Adna Ašić, Damir Marjanović, Jure Mirat, Dragan Primorac
Novel oral anticoagulants (NOACs) are becoming a therapy of choice in everyday clinical practice after almost 50 years during which warfarin and related coumarin derivatives were used as the main anticoagulants. Advantages of NOACs over standard anticoagulants include their predictable pharmacodynamics and pharmacokinetics, stable plasma concentrations and less drug-drug and food-drug interactions. However, pharmacogenetics has its place in administration of NOACs, as considerable interindividual variations have been detected...
May 16, 2018: Personalized Medicine
https://www.readbyqxmd.com/read/29761426/predictors-of-self-reported-adherence-to-direct-oral-anticoagulation-in-a-population-of-elderly-men-and-women-with-non-valvular-atrial-fibrillation
#2
Andrea P Rossi, Roberto Facchinetti, Elena Ferrari, Nicole Nori, Selena Sant, Elena Masciocchi, Elena Zoico, Francesco Fantin, Gloria Mazzali, Mauro Zamboni
There is a general lack of studies evaluating medication adherence with self-report scales for elderly patients in treatment with direct oral anticoagulants (DOACs). The aim of the study was to assess the degree of adherence to DOAC therapy in a population of elderly outpatients aged 65 years or older affected by non-valvular atrial fibrillation (NVAF), using the 4-item Morisky Medication Adherence Scale, and to identify potential factors, including the geriatric multidimensional evaluation, which can affect adherence in the study population...
May 14, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29757786/management-of-venous-thromboembolism-with-non-vitamin-k-oral-anticoagulants-a-review-for-nurse-practitioners-and-pharmacists
#3
Michelle Schmerge, Sally Earl, Carol Kline
BACKGROUND AND PURPOSE: Venous thromboembolism (VTE), comprising deep-vein thrombosis and pulmonary embolism, is associated with significant morbidity and mortality. Non-vitamin K oral anticoagulants (NOACs), including apixaban, betrixaban, dabigatran, edoxaban, and rivaroxaban, are as effective and safe as vitamin K antagonists (VKAs) for primary prophylaxis, treatment, and/or secondary prevention of VTE and present significant advantages in convenience of use. This review provides guidance to nurse practitioners (NPs) and pharmacists on NOAC usage for the management of VTE and examines how traditional anticoagulation clinics can adapt to cater to patients on NOACs...
April 2018: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/29740750/comparing-the-cost-effectiveness-of-non-vitamin-k-antagonist-oral-anticoagulants-with-well-managed-warfarin-for-stroke-prevention-in-atrial-fibrillation-patients-at-high-risk-of-bleeding
#4
Alexa R Hospodar, Kenneth J Smith, Yuting Zhang, Inmaculada Hernandez
BACKGROUND: Several studies have compared the cost effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin using results from clinical trials evaluating NOACs. However, the time in therapeutic range (TTR) of warfarin groups ranged across clinical trials, and all were below the therapeutic goal of 70%. We compared the cost effectiveness of edoxaban 60 mg, apixaban 5 mg, dabigatran 150 mg, dabigatran 110 mg, rivaroxaban 20 mg, and well-managed warfarin with a TTR of 70% in preventing stroke among patients with atrial fibrillation at high risk of bleeding...
May 9, 2018: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/29738377/proton-pump-inhibition-in-patients-treated-with-novel-antithrombotic-drugs-should-we-worry-about-thrombosis
#5
Tomáš Bolek, Matej Samoš, Ingrid Škorňová, Frantisek Kovář, Peter Galajda, Ján Stasko, Peter Kubisz, Marián Mokáň
Proton pump inhibition (PPI) administrated together with antiplatelet and anticoagulant agents reduces the risk of gastrointestinal hemorrhage. Several novel antithrombotic agents have been recently introduced for acute coronary syndrome patients (prasugrel, ticagrelor), or for patients requiring long-term anticoagulation (dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban). In fact, these agents might offer even stronger inhibition of platelets or coagulation compared with older agents; and therefore, the need for gastroprotection might be even stronger when these new agents are used for long-term antithrombotic therapy...
April 24, 2018: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/29735612/signal-detection-for-bleeding-associated-with-the-use-of-direct-oral-anticoagulants
#6
Kobi T Nathan, Kelly M Conn, Robbert P van Manen, Jack E Brown
PURPOSE: The potential link between serious or life-threatening bleeding and the use of direct oral anticoagulants (DOACs) was evaluated. METHODS: Qualitative and quantitative reviews of case reports of bleeding events involving dabigatran, rivaroxaban, apixaban, edoxaban, and warfarin through March 31, 2017, were performed. A disproportionality analysis was conducted for each DOAC using an empirical Bayesian approach based on the relative reporting rate. Subanalyses were performed to assess (1) bleeding events (including mortality and life-threatening events) associated with DOACs among all adverse-event reports and (2) warfarin-related bleeding events...
May 7, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29723935/a-systematic-review-and-bayesian-network-meta-analysis-of-risk-of-intracranial-hemorrhage-with-direct-oral-anticoagulants
#7
Zachary Wolfe, Safi U Khan, Fahad Nasir, Charumathi Raghu Subramanian, Bradley Lash
BACKGROUND: The comparative risk of intracranial hemorrhage (ICH) among direct oral anticoagulants (DOACs) (dabigatran, rivaroxaban, apixaban, and edoxaban) remains unclear. OBJECTIVE: To determine the difference in risk of ICH between DOACs. METHODS: 17 randomized controlled trials (RCTs) were selected using PubMed/MEDLINE, EMBASE, CENTRAL (Inception - 31 December 2017). Estimates were reported as odds ratio (OR) with 95% credible interval (CR...
May 3, 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29723893/causes-of-death-in-patients-with-venous-thromboembolism-anticoagulated-with-direct-oral-anticoagulants-a-systematic-review-and-meta-analysis
#8
Antonio Gómez-Outes, Ana Isabel Terleira-Fernández, Ramón Lecumberri, Mª Luisa Suárez-Gea, Gonzalo Calvo-Rojas, Emilio Vargas-Castrillón
Death is more frequent than nonfatal recurrent venous thromboembolism (VTE) and major bleeding after acute VTE. The analysis of the causes of death is fundamental to explore new strategies to reduce mortality rates in these patients. The authors performed a meta-analysis to analyze mortality and independently adjudicated causes of death in anticoagulated patients due to VTE, and to evaluate potential differences between different anticoagulant schemes. They searched MEDLINE and CENTRAL, from January 1, 2000, to January 31, 2017, and performed additional searches in Web sites of regulatory agencies, clinical trial registers, and conference proceedings...
May 3, 2018: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/29710221/what-surgeons-should-know-about-non-vitamin-k-oral-anticoagulants-a-review
#9
Atul Verma, Andrew C T Ha, James T Rutka, Subodh Verma
Importance: Non-vitamin K oral anticoagulants (NOACs) are increasingly prescribed for patients to treat or prevent arterial or venous thromboembolism. The following 4 NOAC agents are approved by the US Food and Drug Administration for clinical use: dabigatran etexilate, apixaban, edoxaban tosylate, and rivaroxaban. A good understanding of these agents' pharmacologic properties is important for surgeons given their marked differences compared with warfarin sodium. This review highlights key practical issues surrounding the use of NOACs in the perioperative setting...
April 18, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29679144/antithrombotic-therapy-in-patients-with-non-valvular-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-should-we-change-our-practice-after-the-pioneer-af-pci-and-re-dual-pci-trials
#10
D Duerschmied, J Brachmann, H Darius, N Frey, H A Katus, W Rottbauer, A Schäfer, H Thiele, C Bode, Uwe Zeymer
The number of patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) is increasing. Since these patients have a CHA2 DS2 -VASc score of 1 or higher, they should be treated with oral anticoagulation to prevent stroke. However, combination therapy with oral anticoagulation for prevention of embolic stroke and dual platelet inhibition for prevention of coronary thrombosis significantly increases bleeding complications. The optimal combination, intensity and duration of antithrombotic combination therapy is still not known...
April 20, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29672182/oral-anticoagulant-use-in-cardiovascular-disorders-a-perspective-on-present-and-potential-indications-for-rivaroxaban
#11
A John Camm, Keith A A Fox
BACKGROUND: Four nonvitamin K antagonist oral anticoagulants (NOACs) have been approved for use in various cardiovascular indications. The direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors apixaban, edoxaban, and rivaroxaban are now increasingly used in clinical practice. For some of these agents, available data from real-world studies support the efficacy and safety data in phase III clinical trials. OBJECTIVES: This review aims to summarize the current status of trials and observational studies of oral anticoagulant use over the spectrum of cardiovascular disorders (excluding venous thrombosis), provide a reference source beyond stroke prevention for atrial fibrillation (AF) and examine the potential for novel applications in the cardiovascular field...
April 19, 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29664236/use-of-non-vitamin-k-antagonist-oral-anticoagulants-2008-2016-a-danish-nationwide-cohort-study
#12
Simone Haastrup, Maja Hellfritzsch, Lotte Rasmussen, Anton Pottegård, Erik Lerkevang Grove
We aimed to provide detailed utilization data on the total use of non-vitamin K antagonist oral anticoagulants (NOACs) since their introduction in 2008. Using the nationwide Danish National Prescription Registry, we identified all individuals filling prescriptions for NOACs 2008-2016. We reported the development in incident and prevalent users and explored baseline characteristics and treatment persistence according to treatment indication. A total of 126,691 NOAC users were identified within the Danish population of 5...
April 17, 2018: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/29627150/postoperative-bleeding-risk-of-direct-oral-anticoagulants-after-oral-surgery-procedures-a-systematic-review-and-meta-analysis
#13
REVIEW
C Bensi, S Belli, D Paradiso, G Lomurno
Direct oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban; DOACs) have been introduced to improve safety and superior therapeutic value compared to their predecessors such as warfarin or enoxaparin. The aim of this systematic review and meta-analysis was to assess the postoperative bleeding risk of DOACs during oral surgery procedures. Systematic searches were performed in electronic databases including PubMed, Scopus, Web of Science and Cochrane Library. Thirteen studies were included in the qualitative synthesis: two retrospective case-control studies, five prospective case-control studies, three cross-sectional studies, two case series and a case report; while only six studies were statistically analysed...
April 4, 2018: International Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29626281/hospital-length-of-stay-in-patients-initiated-on-direct-oral-anticoagulants-versus-warfarin-for-venous-thromboembolism-a-real-world-single-center-study
#14
Hisham Badreldin
This study was conducted to describe the real-world hospital length of stay in patients treated with all of the U.S. Food and Drug Administration approved direct oral anticoagulants (DOACs) versus warfarin for new-onset venous thromboembolism (VTE) at a large, tertiary, academic medical center. A retrospective cohort analysis of all adult patients diagnosed with acute onset VTE was conducted. Of the 441 patients included, 261 (57%) patients received DOACs versus 180 (41%) patients received warfarin. In the DOAC group, a total of 92 (35%) patients received rivaroxaban, followed by 83 (32%) patients received apixaban, 50 (19%) patients received dabigatran, and 36 (14%) patients received edoxaban...
April 6, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29622509/impact-of-bmi-on-clinical-outcomes-of-noac-therapy-in-daily-care-results-of-the-prospective-dresden-noac-registry-nct01588119
#15
L Tittl, S Endig, S Marten, A Reitter, I Beyer-Westendorf, J Beyer-Westendorf
Direct acting non-Vitamin K antagonist oral anticoagulants (NOAC) are characterized by a fixed dosing regimen. Despite the potential for relative underdosing due to large distribution volumes, dose adjustments for patients with high body mass index (BMI) are not recommended. Since efficacy and safety data in obese patients are scarce, we evaluated the impact of BMI on clinical outcomes in daily care patients treated with NOAC for stroke prevention in atrial fibrillation or venous thromboembolism. Using prospectively collected data from a non-interventional registry, cardiovascular (CV), major bleeding events (MB) and all-cause mortality were evaluated according to BMI classes...
March 14, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29608110/fitting-the-right-non-vitamin-k-antagonist-oral-anticoagulant-to-the-right-patient-with-non-valvular-atrial-fibrillation-an-evidence-based-choice
#16
Yanguang Li, Daniele Pastori, Gregory Yh Lip
Atrial fibrillation (AF) is the most prevalent arrhythmia and is associated with an increased risk of ischemic stroke (IS) and systemic embolism (SE). Stroke prevention is a key element for the overall management of AF patients. The non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran, rivaroxaban, apixaban and edoxaban, are at least as effective as warfarin in reducing IS/SE with a lower rate of major bleeding. Various analyses from the large Phase III randomised trials demonstrated different efficacy and safety of NOACs in specific subgroups of patients...
April 2, 2018: Annals of Medicine
https://www.readbyqxmd.com/read/29578938/quantification-of-apixaban-dabigatran-edoxaban-and-rivaroxaban-in-human-serum-by-uhplc-ms-ms-method-development-validation-and-application
#17
Sofia Lindahl, Roar Dyrkorn, Olav Spigset, Solfrid Hegstad
BACKGROUND: Direct oral anticoagulants (DOACs) are prescribed for anticoagulation in patients with atrial fibrillation and venous thromboembolic disease. Fixed doses are recommended, but measuring their serum drug concentrations as a basis for dose adjustments may be useful in some clinical settings. METHODS: A UHPLC-MS/MS method for the analysis of the DOACs apixaban, dabigatran, edoxaban, and rivaroxaban in human serum was developed and validated. A 100-µL serum sample was handled using a pipetting robot...
March 23, 2018: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/29576106/emergency-care-of-patients-receiving-non-vitamin-k-antagonist-oral-anticoagulants
#18
REVIEW
J W Eikelboom, S Kozek-Langenecker, A Exadaktylos, A Batorova, Z Boda, F Christory, I Gornik, G Kėkštas, A Kher, R Komadina, O Koval, G Mitic, T Novikova, E Pazvanska, S Ratobilska, J Sütt, A Winder, D Zateyshchikov
Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, edoxaban) have been introduced in several clinical indications. Although NOACs have a favourable benefit-risk profile and can be used without routine laboratory monitoring, they are associated-as any anticoagulant-with a risk of bleeding. In addition, treatment may need to be interrupted in patients who need surgery or other procedures. The objective of this article, developed by a multidisciplinary panel of experts in thrombosis and haemostasis, is to provide an update on the management of NOAC-treated patients who experience a bleeding episode or require an urgent procedure...
April 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29569146/anticoagulation-in-atrial-fibrillation-with-heart-failure
#19
REVIEW
Lei Zhao, William Y S Wang, Xinchun Yang
Heart failure (HF) and atrial fibrillation (AF) frequently coexist, and they can beget one another due to similar factors and shared pathophysiology. These pathophysiologic changes promote the episodes of AF, while they in turn predispose to the exacerbation of HF. In this review, we will discuss pathophysiological mechanisms shared by AF and HF. Patients with concomitant HF and AF are at a particularly high risk of thromboembolism, which contribute to even worse symptoms and poorer prognosis. Vitamin K antagonists (VKA) (warfarin) were the traditional medication in AF patients for the prevention of stroke, whereas the advance of novel non-VKA oral anticoagulants (NOACs) (dabigatran, apixaban, rivaroxaban, and edoxaban) is challenging these standard prescriptions...
March 22, 2018: Heart Failure Reviews
https://www.readbyqxmd.com/read/29542359/non-vitamin-k-antagonist-oral-anticoagulants-for-pulmonary-embolism-who-where-and-for-how-long
#20
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; should patients be treated as inpatients or outpatients; and how long should patients be treated to reduce the risk of recurrence? Expert commentary: The management of PE is changing...
May 2018: Expert Review of Respiratory Medicine
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