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Flavio Egger, Federica Targa, Ivan Unterholzner, Russell P Grant, Markus Herrmann, Christian J Wiedermann
Non-vitamin K oral anticoagulant (NOAC) therapy may be inappropriate if prescription was incorrect, the patient's physiological parameters change, or interacting concomitant medications are erroneously added. The aim of this report was to illustrate inappropriate NOAC prescription in a 78-year-old woman with non-valvular atrial fibrillation and borderline renal dysfunction who was switched from warfarin to rivaroxaban and subsequently developed bruising with hemorrhagic shock and acute on chronic renal failure...
August 8, 2016: Clinics and Practice
Catherine Tang, Anita Ghevondian, Chris Ward
No abstract text is available yet for this article.
February 2016: Pathology
Yoshinari Enomoto, Varuna K Gadiyaram, Carola Gianni, Rodney P Horton, Chintan Trivedi, Sanghamitra Mohanty, Luigi Di Biase, Amin Al-Ahmad, J David Burkhardt, Arvin Narula, Gwen Janczyk, Matthew J Price, Rizwan Afzal, Moustapha Atoui, Matthew Earnest, Vijay Swarup, Shephal K Doshi, Sarina van der Zee, Rebecca Fisher, Dhanunjaya R Lakkireddy, Douglas N Gibson, Andrea Natale, Vivek Reddy
BACKGROUND: In the stroke prevention trials of left atrial appendage closure (LAAC) with the Watchman device, a post-implantation anti-thrombotic regimen of 6 weeks of warfarin was employed. OBJECTIVE: Because of the clinical complexity of warfarin use, we studied the relative feasibility and safety of instead employing non-warfarin oral anticoagulants (NOACs) during the peri- and initial post-implantation period after Watchman implantation. METHODS: This is a retrospective multicenter study of consecutive patients undergoing Watchman implantation and receiving peri- and post-procedural NOACs or warfarin...
October 19, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Stefan Reers, Tolga Agdirlioglu, Michael Kellner, Matthias Borowski, Holger Thiele, Johannes Waltenberger, Michael Reppel
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran or rivaroxaban are alternatives to vitamin K antagonists (VKAs) for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) and atrial flutter (AFL). Incidences of risk factors for left atrium (LA) and left atrial appendage (LAA) thrombus formation, such as dense spontaneous echo contrast (SEC), low LAA velocity (LAAV) <20 cm/s under treatment with dabigatran and rivaroxaban in comparison with VKAs are unknown...
October 21, 2016: European Journal of Medical Research
Lai Heng Lee
The group of new oral anticoagulants or NOACs, now termed direct oral anticoagulants or DOACs, with their favourable results from large scale phase III clinical trials, represent a major advancement and expanded armamentarium in antithrombotic therapy. Dabigatran, rivaroxaban, apixaban and edoxaban are now in clinical routine use for prevention and treatment of arterial and venous thrombotic diseases as addressed in their clinical trials. Usage of the DOACs is expected to increase as clinicians gain more experience and reassurance with data from the real world studies which are generally consistent with that from clinical trials...
2016: Thrombosis Journal
April Robinson, Delilah McCarty, Janine Douglas
Acute coronary syndrome (ACS) is a cardiovascular condition with a multifactorial pathophysiology that includes atherosclerotic plaques, platelet activation and thrombin production, among others. Thrombin production and the prothrombotic state of ACS patients have provided a role for anticoagulants to treat patients during the acute event and has led to subsequent research for the post-acute state. Warfarin has an indication for ACS, however, it is restricted to specific patients and many factors limit its use...
October 7, 2016: Therapeutic Advances in Cardiovascular Disease
Benjamin White, Rachel Rosovsky, Blair Alden Parry, Christopher Kabrhel
Pulmonary embolism (PE) and venous thromboembolism (VTE) are common diagnoses in the emergency department (ED), with significant potential morbidity and mortality. As a result, historically nearly all patients with PE have been admitted to the hospital for observation and treatment. In recent years, the ability to rapidly and accurately risk stratify patients with VTE according to their risk of short-term clinical deterioration has supported outpatient treatment, and non-vitamin K antagonist oral anticoagulants (NOACs) have further facilitated this approach...
October 20, 2016: Seminars in Thrombosis and Hemostasis
Sam Schulman
During the past 7 years, results from phase III trials comparing nonvitamin antagonist K oral anticoagulants (NOACs) with vitamin K antagonists (VKAs) or with placebo, including 34,900 patients, have been published. Recent guidelines have been updated and now suggest treatment with NOACs rather than with VKA. Other updates in the guidelines concern the initial thrombolytic treatment for selected patients with deep vein thrombosis or pulmonary embolism as well as the possibility of withholding anticoagulation for minimal venous thromboembolism...
October 20, 2016: Seminars in Thrombosis and Hemostasis
Giulia Renda, Fabrizio Ricci, Raffaele De Caterina
BACKGROUND: Non-vitamin K oral anticoagulants (NOACs) are now proven alternatives to vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF). However, there are few data on the efficacy and safety of their use around cardioversion, where the risk of thromboembolic events is heightened. METHODS: We performed a random-effects meta-analysis of patients undergoing both electrical and pharmacological cardioversion for AF in the RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE AF-TIMI 48, X-VeRT and ENSURE-AF trials...
October 14, 2016: American Journal of Medicine
Özcan Başaran, Volkan Dogan, Osman Beton, Mehmet Tekinalp, Ahmet Cağri Aykan, Ezgi Kalaycioğlu, Ismail Bolat, Onur Taşar, Özgen Şafak, Macit Kalcik, Mehmet Yaman, Sinan İnci, Bernas Altintaş, Sedat Kalkan, Cevat Kirma, Murat Biteker
This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry ( identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines...
August 2016: Medicine (Baltimore)
Michał Mazurek, Menno V Huisman, Gregory Y H Lip
BACKGROUND: Recent improvements in atrial fibrillation diagnosis and management have prompted the initiation of various registries, predominantly to assess adherence to new guidelines, but also to address the pending questions of safety and effectiveness of newly introduced management options in 'real world' clinical practice settings. In this review we appraise antithrombotic treatment patterns for stroke prevention in atrial fibrillation registries. METHODS AND RESULTS: We searched PubMed, Science Direct and the Cochrane databases for registries focusing on stroke thromboprophylaxis in atrial fibrillation...
October 13, 2016: American Journal of Medicine
Laila Staerk, Emil Loldrup Fosbøl, Gregory Y H Lip, Morten Lamberts, Anders Nissen Bonde, Christian Torp-Pedersen, Brice Ozenne, Thomas Alexander Gerds, Gunnar Hilmar Gislason, Jonas Bjerring Olesen
BACKGROUND: Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) are widely used as stroke prophylaxis in non-valvular atrial fibrillation (AF), but comparative data are sparse. PURPOSE: To compare dabigatran, rivaroxaban, and apixaban vs. VKA and the risk of stroke/thromboembolism (TE) and intracranial bleeding in AF. METHODS: Using Danish nationwide registries (2011-15), anticoagulant-naïve AF patients were identified when initiating VKA or an NOAC...
October 14, 2016: European Heart Journal
Chrisanna Dobrowolski, Edward G Clark, Manish M Sood
The worldwide prevalence of chronic kidney disease is 10-15 % of the adult population, is rising and increases susceptibility to venous thromboembolism (VTE). In this narrative review we discuss the underlying evidence behind the association of VTE/CKD and examine the role of worsening CKD stage, proteinuria, and the risk of recurrent VTE. As CKD may alter therapeutic options we discuss the role of emerging therapies, the non-vitamin K oral anticoagulants (NOAC), in the treatment of VTE.
October 13, 2016: Journal of Thrombosis and Thrombolysis
Jamshed J Dalal, Anil Dhall, Abhay Bhave
Oral vitamin K antagonists (VKA) such as warfarin have been the mainstay of therapy for stroke prevention in patients with non valvular atrial fibrillation (NVAF) while low-molecular-weight heparin, fondaparinux and adjusted-dose warfarin or aspirin have been routinely used for thromboembolism (VTE) prophylaxis in patients undergoing total hip or knee replacement. However, VKAs are associated with considerable limitations, including increased risk of bleeding and narrow therapeutic window. Novel oral anticoagulants (NOACs, now referred as Non Vit K dependent oral anticoagulants), including the direct thrombin inhibitor dabigatran and direct Factor Xa inhibitors such as rivaroxaban and apixaban are now approved alternatives to warfarin for prophylaxis of stroke and systemic embolic events (SEE) in patients with NVAF and treatment and prophylaxis of VTE...
April 2016: Journal of the Association of Physicians of India
Jessica W Skelley, C Whitney White, Angela R Thomason
To review the use of the direct oral anticoagulant (DOAC) agents in inherited thrombophilia based on the literature. MEDLINE, International Pharmaceutical Abstracts, and Google Scholar searches (1970-May 2016) were conducted for case reports, case series, retrospective cohorts, or clinical trials using the key words: protein C deficiency, protein S deficiency, antithrombin deficiency, activated protein C resistance, Factor V Leiden, hypercoagulable, NOACs, dabigatran, apixaban, rivaroxaban, betrixaban, edoxaban, Xa inhibitor, direct thrombin inhibitor...
October 12, 2016: Journal of Thrombosis and Thrombolysis
Joris Komen, Tomas Forslund, Paul Hjemdahl, Morten Andersen, Björn Wettermark
AIMS: To assess the effect of policy interventions, i.e. reimbursement decisions, guidelines, and regional recommendations, on the prescribing of oral anticoagulant treatment in patients with atrial fibrillation (AF). METHODS: Interrupted time series analyses using monthly data on all patients with a recorded diagnosis of AF newly initiated (both switchers and anticoagulant naïve patients) on either warfarin, dabigatran, rivaroxaban or apixaban in the Stockholm region from April 2011 until February 2016...
October 11, 2016: British Journal of Clinical Pharmacology
Luke Miller, Jason A Ferreira, Calvin Tucker
BACKGROUND: The development of novel oral anticoagulants (NOACs) has revolutionized oral anticoagulation. Rapid incorporation of NOACs into general practice has heightened the demand for directed reversal agents. Idarucizumab is a targeted reversal agent that is approved for the urgent reversal of the anticoagulant effects of dabigatran. While it is a welcome addition to reversal strategies of dabigatran, a number of clinical questions exist regarding its place in therapy. OBJECTIVE: We describe controversies regarding the use of idarucizumab therapy in patients with dabigatran-associated bleeding...
October 8, 2016: Journal of Emergency Medicine
Özcan Başaran, Osman Beton, Volkan Doğan, Mehmet Tekinalp, Ahmet Çağrı Aykan, Ezgi Kalaycıoğlu, İsmail Bolat, Onur Taşar, Özgen Şafak, Macit Kalçık, Mehmet Yaman, İbrahim Altun, Mustafa Özcan Soylu, Cevat Kırma, Murat Biteker
OBJECTIVE: Data regarding stroke prevention strategies in non-valvular atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs). This study aimed to evaluate real-life stroke prevention strategies for NVAF patients in the era of non-VKA oral anticoagulants (NOACs). METHODS: We established a cross-sectional, multicenter, nationwide registry of NVAF patients. All consecutive atrial fibrillation (AF) patients and without mechanical heart valves or rheumatic mitral stenosis (but including those with any degree of mitral regurgitation) were enrolled in the ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study; ClinicalTrials...
October 2016: Anatolian Journal of Cardiology
Francesco Pelliccia, Fabiana Rollini, Giuseppe Marazzi, Cesare Greco, Carlo Gaudio, Dominick J Angiolillo, Giuseppe Rosano
The combination of AF and coronary artery disease not only is a common clinical setting, it is also a complex setting to deal with anticoagulation and antiplatelet therapy, and it is associated with significantly higher mortality rates. Unfortunately, there are no sufficient data available to optimally guide clinical practice in such settings. This review focuses specifically on newer oral anticoagulants (NOACs) associated with dual antiplatelet therapy (DAPT) in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI)...
October 3, 2016: International Journal of Cardiology
Ken Okumura, Masatsugu Hori, Norio Tanahashi, A John Camm
Nonvalvular atrial fibrillation (AF) is a risk factor for stroke in elderly patients. Although warfarin has been used to prevent AF-associated stroke for more than 50 years, non-vitamin K antagonist oral anticoagulants (NOACs) including dabigatran, rivaroxaban, apixaban, and edoxaban recently have been developed to overcome the disadvantages of warfarin. Based on the results of NOAC clinical trials, Savelieva and Camm made recommendations regarding selection of NOACs in patients with nonvalvular AF. Recent accumulating evidence indicates that NOACs work differently in Asian and non-Asian individuals...
October 7, 2016: Clinical Cardiology
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