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https://www.readbyqxmd.com/read/29754512/-stroke-prevention-in-the-elderly-effectiveness-and-safety-of-edoxaban-in-elderly-patients-according-to-the-results-of-the-engage-af-study
#1
László Márk
Atrial fibrillation is the most common clinically relevant arrhythmia frequently causing systemic thromboembolic events. Traditionally vitamin K antagonists had been used for decades to prevent these events. The emerging of the new direct anticoagulants has revolutionized this treatment and a gradual growth and extensive spread of usage is expected. The latest one approved in Hungary, edoxaban, is a factor Xa inhibitor. Once-daily administration and favourable safety profile are major benefits of this drug...
May 2018: Orvosi Hetilap
https://www.readbyqxmd.com/read/29736825/bleeding-events-attributable-to-concurrent-use-of-warfarin-and-other-medications-in-high-risk-elderly-meta-analysis-and-italian-population-based-investigation
#2
Rosanna Irene Comoretto, Federico Rea, Ersilia Lucenteforte, Alessandro Mugelli, Gianluca Trifirò, Silvia Cascini, Giuseppe Roberto, Alessandro Chinellato, Amelia Filippelli, Giovanni Corrao
PURPOSE: The aim of this study was to estimate the proportion of bleedings that occurred among warfarin users attributable to the concomitant use of other medications. A general approach for measuring the impact of the prescriptive inappropriateness on drug adverse outcomes at the population level is described. METHODS: A meta-analysis was conducted to obtain summary relative risks of bleeding associated with concurrent use of warfarin and other medications compared to warfarin use alone...
May 7, 2018: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29619338/three-versus-four-factor-prothrombin-complex-concentrate-for-the-reversal-of-warfarin-induced-bleeding
#3
Tara Holt, Scott Taylor, Prasad Abraham, Wesley Mcmillian, Serena Harris, James Curtis, Tai Elder
Objective: The objective of this study was to evaluate the effectiveness of 3-factor prothrombin complex concentrate (3F-PCC) compared to 4-factor PCC (4F-PCC) in warfarin-associated bleeding. Methods: This multicenter, retrospective, cohort study analyzed data from patients admitted between May 2011 and October 2014 who received PCC for warfarin-associated bleeding. The primary outcome was the rate of international normalized ratio (INR) normalization, defined as an INR ≤1...
January 2018: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/29619276/use-of-anticoagulants-remains-a-significant-threat-to-timely-hip-fracture-surgery
#4
Razvan Taranu, Chelsea Redclift, Patrick Williams, Marina Diament, Anne Tate, Jamie Maddox, Faye Wilson, Will Eardley
Introduction: Hip fracture remains the biggest single source of morbidity and mortality in the elderly trauma population, and any intervention focused on quality improvement and system efficiency is beneficial for both patients and clinicians. Two of the variables contributory to improving care and efficiency are time to theater and length of stay, with the overall goal being to improve care as reflected within the achievement of best practice tariff. One of the biggest barriers to optimizing these variables is preinjury anticoagulation...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/29611105/quality-of-direct-oral-anticoagulant-prescribing-in-elderly-patients-with-non-valvular-atrial-fibrillation-results-from-a-large-urban-health-system
#5
Shakira J Grant, Shawn Kothari, Phyllis A Gimotty, Nalaka S Gooneratne, Adam Cuker
Non-valvular atrial fibrillation (NVAF) is common in older adults. Oral anticoagulation is indicated to reduce the risk of stroke and systemic embolism, but it also poses a risk of bleeding, particularly in the elderly. Direct oral anticoagulants (DOACs) provide an alternative to warfarin and their use in the treatment of AF is growing. We conducted a retrospective cohort study to assess the quality of DOAC prescribing in elderly patients with NVAF in a large academic health system and to compare practice with consensus best practice recommendations...
April 2, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29556685/mortality-among-patients-due-to-adverse-drug-reactions-that-lead-to-hospitalization-a-meta-analysis
#6
Tejas K Patel, Parvati B Patel
PURPOSE: The aim of this study was to estimate the prevalence of mortality among patients due to adverse drug reactions that lead to hospitalisation (fatal ADRAd ), to explore the heterogeneity in its estimation through subgroup analysis of study characteristics, and to identify system-organ classes involved and causative drugs for fatal ADRAd . METHODS: We identified prospective ADRAd -related studies via screening of the PubMed and Google Scholar databases with appropriate key terms...
March 19, 2018: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29523996/new-onset-atrial-fibrillation-an-update
#7
REVIEW
Takeshi Omae, Eiichi Inada
New-onset atrial fibrillation (NOAF) is the most common perioperative complication of heart surgery, typically occurring in the perioperative period. NOAF commonly occurs in patients who are elderly, or have left atrial enlargement, or left ventricular hypertrophy. Various factors have been identified as being involved in the development of NOAF, and numerous approaches have been proposed for its prevention and treatment. Risk factors include diabetes, obesity, and metabolic syndrome. For prevention of NOAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines...
March 9, 2018: Journal of Anesthesia
https://www.readbyqxmd.com/read/29519547/non-vitamin-k-antagonist-oral-anticoagulants-have-better-efficacy-and-equivalent-safety-compared-to-warfarin-in-elderly-patients-with-atrial-fibrillation-a-systematic-review-and-meta-analysis
#8
In-Soo Kim, Hyun-Jung Kim, Tae-Hoon Kim, Jae-Sun Uhm, Boyoung Joung, Moon-Hyoung Lee, Hui-Nam Pak
BACKGROUND: To evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in elderly patients (aged ≥75 years) with atrial fibrillation (AF), depending on dose and/or renal function. METHODS: After systematically searching the databases (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), 5 phase III randomized controlled trials and reported data according to subgroups of elderly/non-elderly AF patients, comparing any NOACs and warfarin were included...
March 5, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29490992/oral-anticoagulation-in-very-elderly-patients-with-atrial-fibrillation-a-nationwide-cohort-study
#9
Tze-Fan Chao, Chia-Jen Liu, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen
Background -Stroke prevention with oral anticoagulants (OACs) is the cornerstone for the management of atrial fibrillation (AF). However, data about the use of OACs among patients aged ≥90 years are limited. We aimed to investigate the risk of ischemic stroke and intracranial hemorrhage (ICH), and the net clinical benefit (NCB) of OAC treatment for very elderly AF patients (≥90 years). Methods -This study used the "National Health Insurance Research Database" in Taiwan. Risks of ischemic stroke and ICH were compared between 11,064 AF and 14,658 non-AF patients aged ≥90 years without antithrombotic therapy from year 1996 to 2011...
February 28, 2018: Circulation
https://www.readbyqxmd.com/read/29484682/efficacy-and-safety-of-uninterrupted-low-intensity-warfarin-for-cryoballoon-ablation-of-atrial-fibrillation-in-the-elderly-a-pilot-study
#10
Y Xing, B Xu, X Sheng, C Xu, F Peng, Y Sun, S Wang, H Guo
WHAT IS KNOWN AND OBJECTIVE: Uninterrupted warfarin during cryoballoon ablation (CB-A) of atrial fibrillation (AF) has been widely accepted. However, to our knowledge, no previous studies exist investigating the optimal intensity of anticoagulation with warfarin for CB-A. This study aimed to evaluate the efficacy and safety of uninterrupted low-intensity warfarin for CB-A of AF in the elderly. METHODS: Paroxysmal AF patients (age ≥ 70 years) who underwent CB-A were enrolled prospectively...
June 2018: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/29471572/-cardiovascular-medication-in-elderly-patients
#11
Robert H G Schwinger
Elderly people show increased probability to develop atherosclerotic diseases; in consequence heart failure - most often following coronary heart disease - as well as atrial fibrillation is more common. Following guidelines may lead to polypharmacy, i. e. use of more than 5 drugs daily. Thus, drug interactions as well as side effects become more likely; especially in elderly patients reduced kidney function has to be taken into account. Only drugs which have shown to prolong life or to reduce symptoms in controlled clinical trials should be used...
February 2018: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29439272/need-of-emergency-surgery-in-elderly-patients-with-upper-gastrointestinal-bleeding-survival-analysis-during-2009-2015
#12
Sami Miilunpohja, Jussi Kärkkäinen, Juha Hartikainen, Johanna Jyrkkä, Tuomo Rantanen, Hannu Paajanen
BACKGROUND/AIMS: The role of emergency surgery is decreasing in the treatment of patients with upper gastrointestinal bleeding (UGIB). We investigated the need of urgent surgery and outcome of elderly UGIB patients who often have cardiovascular comorbidities with antithrombotic medication. METHODS: All consecutive adult patients who received emergency treatment for suspected gastrointestinal bleeding between January 2009 and December 2011 were registered in an electronic database (n = 1,643)...
February 13, 2018: Digestive Surgery
https://www.readbyqxmd.com/read/29396074/direct-oral-anticoagulant-and-antiplatelet-combination-therapy-hemorrhagic-events-in-coronary-artery-stent-recipients
#13
REVIEW
Kimon Bekelis, Chiang-Hua Chang, David Malenka, Nancy E Morden
Direct oral anticoagulant (DOAC) use is growing as monotherapy and combined with platelet inhibitors. The safety of such combination therapy, especially in comparison to regimens including warfarin, in real world populations remains uncertain. We investigated hemorrhage associated with DOAC and antiplatelet combination therapy in a cohort of elderly coronary artery stent recipients. We employed Medicare data 2010-2013 for a 40% random sample of beneficiaries enrolled in inpatient, outpatient and prescription benefits...
April 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29393514/influence-of-age-on-warfarin-dose-anticoagulation-control-and-risk-of-hemorrhage
#14
Aditi Shendre, Gaurav M Parmar, Chrisly Dillon, Timothy Mark Beasley, Nita A Limdi
OBJECTIVE: We assessed the influence of age on warfarin dose, percentage time in target range (PTTR), and risk of major hemorrhage. DESIGN: Warfarin users recruited into a large prospective inception cohort study were categorized into three age groups: young (younger than 50 yrs), middle aged (50-70 yrs), and elderly (older than 70 yrs). The influence of age on warfarin dose and PTTR was assessed using regression analysis; risk of major hemorrhage was assessed using proportional hazards analysis...
February 2, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29381974/stroke-risks-and-patterns-of-warfarin-therapy-among-atrial-fibrillation-patients-post-radiofrequency-ablation-a-real-world-experience
#15
Juan Zhang, Xingpeng Liu, Xiaoqing Liu, Xiandong Yin, Yanjiang Wang, Xiaoying Lu, Xinchun Yang
We assessed the thromboembolic risks of atrial fibrillation (AF) patients who had undergone radiofrequency ablation (RFA) using the CHADS2-VASc risk scoring system and further investigated the patterns of warfarin use for thromboprophylaxis according to patient thromboembolic risk scores.In this study, we analyzed the stroke risks of patients who had undergone RFA for AF at our hospital between March 2014 and June 2016 using the CHADS2, CHADS2-VASc, and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years) (HAS-BLED) scoring systems...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29363999/all-cause-stroke-systemic-embolism-and-major-bleeding-related-health-care-costs-among-elderly-patients-with-nonvalvular-atrial-fibrillation-treated-with-oral-anticoagulants
#16
Steve Deitelzweig, Xuemei Luo, Kiran Gupta, Jeffrey Trocio, Jack Mardekian, Tammy Curtice, Patrick Hlavacek, Melissa Lingohr-Smith, Brandy Menges, Jay Lin
In this study, all-cause, stroke/systemic embolism (SE)-related, and major bleeding (MB)-related health-care costs among elderly patients with nonvalvular atrial fibrillation (NVAF) initiating treatment with different oral anticoagulants (OACs) were compared. Patients ≥65 years of age initiating OACs, including apixaban, rivaroxaban, dabigatran, and warfarin, were identified from the Humana Research Database between January 1, 2013, and September 30, 2015. Propensity score matching was used to separately match the different OAC cohorts with the apixaban cohort...
May 2018: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29339702/efficacy-and-safety-of-oral-anticoagulation-in-elderly-patients-with-atrial-fibrillation
#17
Ilaria Cavallari, Giuseppe Patti
Elderly patients with atrial fibrillation are at a higher risk of both ischemic and bleeding events compared with younger patients; therefore, balancing risks and benefits of antithrombotic strategies in this population is crucial. Recent studies have shown that because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of oral anticoagulation is the highest in elderly patients in whom it outweighs the risk of bleeding. Direct oral anticoagulants (DOACs) have been developed as a treatment for the prevention of cardioembolic stroke to overcome some limitations of warfarin, such as the need for frequent monitoring, labile INR values requiring frequent dose adjustment, dietary and drugs interactions, and increased risk of intracranial bleeding...
January 2018: Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/29339167/comparison-of-anticoagulant-therapy-for-atrial-fibrillation-novel-oral-anticoagulants-versus-vitamin-k-antagonists
#18
REVIEW
Sean T Chen, Manesh R Patel
In patients with non-valvular atrial fibrillation (NVAF), oral anticoagulation is important for prevention of stroke and systemic embolism (SE). While Vitamin K antagonists (VKAs) have historically been the standard of care, these medications are limited by numerous food and drug interactions with onerous requirements for frequent monitoring and dose adjustments. Over the past decade, several novel oral anticoagulants (NOACs) have been developed to directly inhibit factor IIa/thrombin (dabigatran) or activated factor X (apixaban, rivaroxaban, edoxaban)...
January 2018: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29335863/integrative-medicine-on-optimizing-clopidogrel-and-aspirin-therapy
#19
REVIEW
Hui Chen
This article reviews the available published data on optimizing clopidogrel and aspirin therapy using translational and integrative medicine. Translational and evidence-based medical studies show that the CYP2C19 gene mutation (CYP2C19*2 and CYP2C19*3) could affect > 50% of the Chinese population, and that this mutation is closely associated with clopidogrel resistance and an increased risk of major adverse cardiovascular events, particularly stent thrombosis in patients following percutaneous coronary intervention (PCI)...
January 15, 2018: Chinese Journal of Integrative Medicine
https://www.readbyqxmd.com/read/29304513/nonvitamin-k-antagonist-oral-anticoagulants-use-in-patients-with-atrial-fibrillation-and-bioprosthetic-heart-valves-prior-surgical-valve-repair-a-multicenter-clinical-practice-experience
#20
Vincenzo Russo, Emilio Attena, Carmine Mazzone, Francesca Esposito, Valentina Parisi, Ciro Bancone, Anna Rago, Gerardo Nigro, Raffaele Sangiuolo, Antonio D' Onofrio
This is an observational study to investigate the efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with bioprosthetic valves or prior surgical valve repair in clinical practice. A total of 122 patients (mean age: 74.1 ± 13.2; 54 females) with bioprosthetic heart valve or surgical valve repair and AF treated with NOACs were included in the analysis. The mean CHA2 DS2 -VASc (Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, prior Stroke or transient ischemic attack, Vascular disease) and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR [international normalized ratio], Elderly, Drugs or alcohol) score values were 3...
January 5, 2018: Seminars in Thrombosis and Hemostasis
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