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warfarin elderly

Qing-Song Yin, Lin Chen, Rui-Hua Mi, Hao Ai, Jun-Jie Yin, Xiao-Juan Liu, Xu-Dong Wei
BACKGROUND Currently available antithrombotic prophylaxis is not perfectly reliable in elderly patients. The aim of this retrospective study was to evaluate the efficacy and safety of Compound Danshen Tablet (CDT) in preventing thromboembolism in multiple myeloma (MM) patients treated with thalidomide-based regimens. MATERIAL AND METHODS MM patients treated with thalidomide-based regimens were retrospectively reviewed between January 2008 and March 2015. Patients were categorized into 3 cohorts based on thromboembolic prophylaxis used: CDT, Warfarin Tablet, and no prophylaxis...
October 20, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
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
Mustafa Kilickap, Jackie Bosch, John W Eikelboom, Robert G Hart
Atrial fibrillation (AF) is a common cardiac rhythm disturbance and is associated with a 5-fold increased risk of stroke. The most important risk factors for stroke in patients with AF are previous stroke and age ≥ 75 years. Canadian guidelines recommend anticoagulant therapy for patients with AF who are older than the age of 65 years, but the elderly often remain undertreated, primarily because of concerns regarding bleeding. Non-vitamin K oral anticoagulants appear to be safer, at least as efficacious, and more convenient than warfarin, and are a cost-effective alternative for elderly patients with AF...
September 2016: Canadian Journal of Cardiology
Rohan Shah, Manesh R Patel
BACKGROUND: The safety and efficacy of the oral anticoagulant rivaroxaban were studied in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF trial). A number of subanalyses of the ROCKET AF trial have subsequently analyzed the use of rivaroxaban in special patient populations. METHODS: The outcomes of the ROCKET AF trial were reviewed. The use of rivaroxaban in higher risk populations, as determined by the presence of co-morbidities included in the CHADS2 criteria, was analyzed...
August 23, 2016: Therapeutic Advances in Cardiovascular Disease
Samuel Fernandes, Ana Rita Gonçalves, Luís Araújo Correia
A 73-year-old man was admitted to our clinic with sudden left quadrant abdominal pain and hematochezia. There was no history of trauma. He denied other symptoms or taking off-the-counter medication. His medical history was relevant for ischemic and aortic-mitral valve disease with prosthetic valves for which he was medicated with aspirin and warfarin. On physical examination the patient presented normal vital signs with tenderness on palpation of the left side of the abdomen. Laboratory tests revealed moderate anemia (10...
August 2016: Revista Española de Enfermedades Digestivas
Fatima Khan, Hans Huang, Yvonne H Datta
Atrial fibrillation (AF) is a major risk factor for stroke in the elderly population. The use of anticoagulation in patients with AF greatly reduces the risk for stroke, but results in an increased risk of bleeding. Over the past several years, direct oral anticoagulants (DOACs, dabigatran, rivaroxaban, and apixaban) have been used in place of warfarin for stroke prevention in AF. We conducted a retrospective cohort study to assess the safety of DOACs in very elderly patients (75+) managed in a health care system encompassing both community and academic settings...
November 2016: Journal of Thrombosis and Thrombolysis
Sigrid Narum, Odd Brørs, Olav Stokland, Marianne K Kringen
BACKGROUND: Bleeding represents the most well-known and the most feared complications caused by the use of antithrombotic agents. There is, however, limited documentation whether pre-injury use of antithrombotic agents affects outcome after head trauma. The aim of this study was to define the relationship between the use of preinjury antithrombotic agents and mortality among elderly people sustaining blunt head trauma. METHODS: A retrospective cohort analysis was performed on the hospital based trauma registry at Oslo University Hospital...
2016: BMC Emergency Medicine
Giulia Bertozzo, Giacomo Zoppellaro, Serena Granziera, Lucia Marigo, Katia Rossi, Florinda Petruzzellis, Egle Perissinotto, Enzo Manzato, Giovanni Nante, Vittorio Pengo
BACKGROUND: Anticoagulation in elderly patients with non-valvular atrial fibrillation (NVAF) is still a challenge and suspension of warfarin is common. Aim of this study is to analyse the aspects related to warfarin discontinuation in a real world population. METHODS: This was an observational cohort study on Very Elderly NVAF patients naïve to warfarin therapy (VENPAF). Included subjects were at least 80 years old and started warfarin after NVAF diagnosis. Warfarin discontinuation was assessed and reason reported for discontinuation, person who decided to stop treatment, subsequent antithrombotic therapy and mortality, ischemic and bleeding events were collected...
July 29, 2016: Journal of Thrombosis and Haemostasis: JTH
Ziad Hijazi, Stefan H Hohnloser, Ulrika Andersson, John H Alexander, Michael Hanna, Matyas Keltai, Alexander Parkhomenko, José L López-Sendón, Renato D Lopes, Agneta Siegbahn, Christopher B Granger, Lars Wallentin
IMPORTANCE: Renal impairment confers an increased risk of stroke, bleeding, and death in patients with atrial fibrillation. Little is known about the efficacy and safety of apixaban in relation to renal function changes over time. OBJECTIVES: To evaluate changes of renal function over time and their interactions with outcomes during a median of 1.8 years of follow-up in patients with atrial fibrillation randomized to apixaban vs warfarin treatment. DESIGN, SETTING, AND PARTICIPANTS: The prospective, randomized, double-blind Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) clinical trial randomized 18 201 patients with atrial fibrillation to apixaban or warfarin...
July 1, 2016: JAMA Cardiology
Domenico Acanfora, Chiara Acanfora, Pietro Scicchitano, Marialaura Longobardi, Giuseppe Furgi, Gerardo Casucci, Bernardo Lanzillo, Ilaria Dentamaro, Annapaola Zito, Raffaele Antonelli Incalzi, Marco Matteo Ciccone
BACKGROUND AND OBJECTIVES: The new oral anticoagulants (NOACs) are used for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF) and those at risk of deep venous thrombosis. Their rapid onset of action and predictable pharmacokinetic and pharmacodynamic profiles make them the optimal alternative to warfarin in the treatment of these two categories of patients. Unfortunately, however, NOACs cannot be used in patients with valvular AF or valvular cardiac prostheses...
October 2016: Clinical Drug Investigation
Ying Jiao Zhao, Liang Lin, Hui Jun Zhou, Keng Teng Tan, Aik Phon Chew, Chee Guan Foo, Chia Theng Daniel Oh, Boon Peng Lim, Wee Shiong Lim
BACKGROUND: Novel oral anticoagulants (NOACs) expand the treatment options for patients with atrial fibrillation (AF). Their benefits need to be weighed against the risk-benefit ratio in real-world elderly patients, prompting this cost-effectiveness study of NOACs (apixaban, dabigatran, edoxaban and rivaroxaban), warfarin and aspirin for stroke prevention in AF. METHODS: Applying effectiveness estimates from a network meta-analysis involving over 800,000 patients from randomised controlled trials and observation studies, our Markov model projected cost and health outcomes for a cohort of 65-year-old AF patients over a life-time...
October 1, 2016: International Journal of Cardiology
Jir Ping Boey, Alexander Gallus
Half of all patients with acute venous thromboembolism are aged over 70 years; they then face the added hazard of an age-related increase in the incidence of major bleeding. This makes it even more important to weigh the balance of benefit and risk when considering anticoagulant treatment and treatment duration. Traditional treatment with a heparin (usually low molecular weight) followed by a vitamin K antagonist such as warfarin is effective but is often complicated, especially in the elderly. The direct-acting oral anticoagulants (DOACs), i...
July 2016: Drugs & Aging
Anders Gorst-Rasmussen, Gregory Y H Lip, Torben Bjerregaard Larsen
PURPOSE: To evaluate effectiveness and safety of rivaroxaban versus warfarin or dabigatran etexilate in a prospective cohort of routine care non-valvular atrial fibrillation (AF) patients during February 2012 to August 2014. METHODS: We identified in nationwide health registries a cohort of AF patients who were new-users of rivaroxaban 15 mg (R15) or 20 mg (R20); dabigatran 110 mg (D110) or 150 mg (D150); or warfarin. Propensity-adjusted Cox regression was used to compare outcome rates in four settings: 'R15 vs...
May 27, 2016: Pharmacoepidemiology and Drug Safety
Franca Bilora, Angelo Adamo, Fabio Pomerri, Paolo Prandoni
Rivaroxaban is an oral anticoagulant that acts as a direct, competitive factor Xa inhibitor. Large randomized clinical trials have shown that, at a daily dose of 20 mg, Rivaroxaban is at least as effective as dose-adjusted warfarin for the prevention of stroke or other embolic complications in patients with nonvalvular atrial fibrillation (AF). The safety and efficacy of combining Rivaroxaban with an antiplatelet agent for secondary stroke prevention has not been established. We report the case of an elderly patient with permanent AF and coronary heart disease, who had already suffered an ischemic stroke while on warfarin treatment, and was consequently switched to treatment with an association of Rivaroxaban and Aspirin...
August 2016: Minerva Cardioangiologica
Eri Toda Kato, Robert P Giugliano, Christian T Ruff, Yukihiro Koretsune, Takeshi Yamashita, Robert Gabor Kiss, Francesco Nordio, Sabina A Murphy, Tetsuya Kimura, James Jin, Hans Lanz, Michele Mercuri, Eugene Braunwald, Elliott M Antman
BACKGROUND: Elderly patients with atrial fibrillation are at higher risk of both ischemic and bleeding events compared to younger patients. In a prespecified analysis from the ENGAGE AF-TIMI 48 trial, we evaluate clinical outcomes with edoxaban versus warfarin according to age. METHODS AND RESULTS: Twenty-one thousand one-hundred and five patients enrolled in the ENGAGE AF-TIMI 48 trial were stratified into 3 prespecified age groups: <65 (n=5497), 65 to 74 (n=7134), and ≥75 (n=8474) years...
May 2016: Journal of the American Heart Association
Amartya Kundu, Partha Sardar, Saurav Chatterjee, Wilbert S Aronow, Theophilus Owan, John J Ryan
Novel oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, apixaban and edoxaban have gained a lot of popularity as alternatives to warfarin for anticoagulation in various clinical settings. However, there is conflicting opinion regarding the absolute benefit of NOAC use in elderly patients. Low body mass, altered body composition of fat and muscle, renal impairment and concurrent presence of multiple comorbidities predispose elderly patients to many adverse effects with NOACs that are typically not seen in younger patients...
July 2016: Drugs & Aging
Jehangir N Din, Aengus Murphy, Karen Chu, Patty Forman, Richard D Mildenberger, Eric B Fretz, Imad J Nadra, Anthony Della Siega, Simon D Robinson
BACKGROUND: Although uncommon, radial artery access site complications are likely to become more frequent with the increased adoption of transradial cardiac catheterisation. There is a lack of data regarding the incidence and clinical features of radial artery pseudoaneuryms. We aimed to describe the incidence, clinical features and management of radial artery pseudoaneurysms in a high-volume transradial cardiac catheterisation centre. PATIENTS AND METHODS: We performed a search of the Vancouver Island Health Authority medical imaging database from 1st Jan 2008 to April 2012 looking for all radial and femoral artery pseudoaneuryms occurring after cardiac catheterisation...
2016: VASA. Zeitschrift Für Gefässkrankheiten
Seo Hyon Baik, Inmaculada Hernandez, Yuting Zhang
BACKGROUND: As alternatives to warfarin, 2 novel oral anticoagulants (NOACs), dabigatran and rivaroxaban, were approved in 2010 and 2011 to prevent stroke and other thromboembolic events in patients with atrial fibrillation. It is unclear how patient characteristics are associated with the initiation of anticoagulants. OBJECTIVE: To evaluate how patient demographics, clinical characteristics, types of insurance, and patient out-of-pocket spending affect the initiation of warfarin and 2 NOACs--dabigatran and rivaroxaban...
March 2016: Journal of Managed Care & Specialty Pharmacy
G Y H Lip, T Potpara, G Boriani, C Blomström-Lundqvist
The main priority in atrial fibrillation (AF) management is stroke prevention, following which decisions about rate or rhythm control are focused on the patient, being primarily for management of symptoms. Given that AF is commonly associated with various comorbidities, risk factors such as hypertension, heart failure, diabetes mellitus and sleep apnoea should be actively looked for and managed in a holistic approach to AF management. The objective of this review is to provide an overview of modern AF stroke prevention with a focus on tailored treatment strategies...
May 2016: Journal of Internal Medicine
Ziv Harel, Muhammad Mamdani, David N Juurlink, Amit X Garg, Ron Wald, Zhan Yao, Tara Gomes
BACKGROUND: The novel oral anticoagulants, including dabigatran and rivaroxaban, differ in their degree of renal excretion. METHODS: We conducted a population-based nested case-control study in patients 66 years and older with chronic kidney disease (CKD) (excluding patients undergoing chronic dialysis) who received an oral anticoagulant between April 2006 and March 2013. We calculated odds ratios for hospitalization with a major hemorrhagic event and receipt of dabigatran, rivaroxaban, or warfarin in the preceding 60 days...
August 2016: Canadian Journal of Cardiology
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