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Oral anticoagulants

Frans Moll, Iris Baumgartner, Michael Jaff, Chuke Nwachuku, Marco Tangelder, Gary Ansel, George Adams, Thomas Zeller, John Rundback, Michael Grosso, Min Lin, Michele F Mercur, Erich Minar
PURPOSE: To report a randomized study that investigated the safety (risk of major bleeds) and potential efficacy of edoxaban, an oral anticoagulant that targets the major components of arterial thrombi, to prevent loss of patency following endovascular treatment (EVT). METHODS: Between February 2012 and June 2014, 203 patients who underwent femoropopliteal EVT were randomized to receive aspirin plus edoxaban or aspirin plus clopidogrel for 3 months in the Edoxaban in Peripheral Arterial Disease (ePAD) study ( ClinicalTrials...
April 2018: Journal of Endovascular Therapy
Andrea Szegedi, Zoltán Csanádi
The significantly increased incidence of stroke and systemic embolisation caused by atrial fibrillation can be prevented by adequately adjusted anticoagulant therapy. Vitamin K antagonists effectively decrease the risk of thromboembolic events but this effect is influenced by many factors. The development of the new direct oral anticoagulant drugs (DOAC) in the last few years provided new opportunities for us to choose the suitable anticoagulant therapy. According to the results of the ENGAGE AF-TIMI 48 and ENSURE-AF multicenter, randomized trials, edoxaban, the recently introduced DOAC is equally effective as the traditional coumarin therapy, nevertheless, it ensures more tolerable anticoagulation for patients suffering from non-valvular atrial fibrillation...
March 2018: Orvosi Hetilap
Mathieu Kerneis, C Michael Gibson, Gerald Chi, Roxana Mehran, Fahad AlKhalfan, Usama Talib, Seyedmahdi Pahlavani, Mahshid Mir, Christoph Bode, Jonathan L Halperin, Tarek Nafee, Eric D Peterson, Freek W A Verheugt, Peter Wildgoose, Martin van Eickels, Gregory Y H Lip, Keith A A Fox, Marc Cohen
OBJECTIVES: This study sought to assess whether there were significant interactions of procedural access strategies and lesion characteristics with bleeding and ischemic events among atrial fibrillation (AF) patients anticoagulated with rivaroxaban or warfarin following a percutaneous coronary intervention. BACKGROUND: Among stented AF patients, the impact of procedural access strategies or lesion characteristics on antithrombotic safety and efficacy outcomes is unclear...
March 8, 2018: JACC. Cardiovascular Interventions
Richard Godin, Geneviève Roy, James Douketis
Women who are receiving an oral anticoagulant appear to be at higher risk of developing bleeding-related adverse events than men. Physiological bleeding related to the ovulatory cycle poses an ongoing risk for bleeding complications during anticoagulant therapy. Abnormal uterine bleeding and hemorrhagic ovarian cysts are risks specific to women of reproductive age who are treated with anticoagulants. The use of combined oral contraceptives can help minimize such adverse events and would also mitigate the risks of obstetrical complications related to thrombosis and anticoagulation, in addition to avoiding fetal exposure to potentially teratogenic anticoagulants...
March 8, 2018: Thrombosis Research
Janusz Bednarski, Paweł Balsam, Agata Tymińska, Krzysztof Ozierański, Katarzyna Żukowska, Martyna Zaleska, Katarzyna Szepietowska, Kacper Maciejewski, Michał Peller, Anna Praska-Oginska, Inna Zaboyska, Grzegorz Opolski
INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia with a significant risk of morbidity and mortality. Non-vitamin K antagonists (NOAC) are the first line drugs in stroke prevention in AF patients. The oral anticoagulation therapy (OAC) therapy may differ between medical centres. OBJECTIVES The study aimed to compare the clinical characteristic of AF patients treated with OAC between district and academic hospitals. PATIENTS AND METHODS This analysis consisted of 3528 patients from the multicentre, retrospective CRAFT study (NCT02987062): 2666 patients from academic hospital (Group A) and 862 patients from district hospital (Group B)...
March 17, 2018: Polish Archives of Internal Medicine
Hisao Otsuki, Junichi Yamaguchi, Kazuho Kamishima, Hiroyuki Arashi, Nobuhisa Hagiwara
Previous reports have focused on cardiovascular and bleeding events in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). However, antithrombotic treatment strategies and clinical outcomes after second-generation drug-eluting stents (DES) implantation in AF patients remain to be determined. We enrolled 244 consecutive AF patients treated with second-generation DES. The study population was derived from multi-center AF registry (including 8 centers in Japan) from 2010 to 2012...
March 16, 2018: Heart and Vessels
Jaclyn Hirschey, Sunetra Bane, Moussa Mansour, Jodi Sperber, Stephen Agboola, Joseph Kvedar, Kamal Jethwani
BACKGROUND: Atrial fibrillation (AFib) is the most common form of heart arrhythmia and a potent risk factor for stroke. Nonvitamin K antagonist oral anticoagulants (NOACs) are routinely prescribed to manage AFib stroke risk; however, nonadherence to treatment is a concern. Additional tools that support self-care and medication adherence may benefit patients with AFib. OBJECTIVE: The aim of this study was to evaluate the perceived usability and usefulness of a mobile app designed to support self-care and treatment adherence for AFib patients who are prescribed NOACs...
March 15, 2018: JMIR Human Factors
Safi U Khan, Muhammad U Khan, Ali Raza Ghani, Ahmad N Lone, Adeel Arshad, Edo Kaluski
Current clinical practice prefers oral anticoagulation (OAC) plus dual antiplatelet therapy (DAPT) in atrial fibrillation (AF) after percutaneous coronary intervention (PCI). We conducted a meta-analysis to test the hypothesis that the superiority of OAC plus DAPT is mainly endorsed by observational studies (OSs); conversely, randomized clinical trials (RCTs) have suggested that OAC plus a single antiplatelet (SAP) agent is a safer and equally effective approach. Nine studies (4 RCTs and 5 OSs) were selected using MEDLINE, EMBASE, and CENTRAL (Inception, October 31, 2017)...
February 14, 2018: American Journal of Cardiology
Lisette Wintgens, Aleksandr Romanov, Karen Phillips, Gabriel Ballesteros, Martin Swaans, Richard Folkeringa, Ignacio Garcia-Bolao, Evgeny Pokushalov, Lucas Boersma
Aims: Long-term freedom from atrial fibrillation (AF) after catheter ablation (CA) and consequently the potential for stroke reduction remain unpredictable. Percutaneous left atrial appendage closure (LAAC) is an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. This study aims to evaluate long-term clinical results of combined CA and LAAC in one single procedure. Methods and results: Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective compilation of independent prospective general LAAC registries at the individual centres...
March 13, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
William F McIntyre, David Conen, Brian Olshansky, Jonathan L Halperin, Emil Hayek, Menno V Huisman, Gregory Y H Lip, Shihai Lu, Jeff S Healey
BACKGROUND: Antithrombotic prophylaxis with oral anticoagulation (OAC) substantially reduces stroke and mortality in patients with atrial fibrillation (AF). HYPOTHESIS: Analysis of data in GLORIA-AF, an international, observational registry of patients with newly-diagnosed AF, can identify factors associated with treatment decisions and outcomes. METHODS: Multivariable regression identified patient, physician, and temporal factors associated with OAC prescription, versus management with antiplatelet drugs or no antithrombotic drugs in North American patients enrolled between November 2011 and February 2014...
March 15, 2018: Clinical Cardiology
Alexander Buchholz, Laura Ueberham, Kaja Gorczynska, Borislav Dinov, Sebastian Hilbert, Nikolaos Dagres, Daniela Husser, Gerhard Hindricks, Andreas Bollmann
BACKGROUND: Apixaban is a non-vitamin K oral anticoagulant and has been approved for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). Current labelling recommends dose reduction based on patients age, weight and renal function. OBJECTIVES: The aim of this study was to analyze adherence to current labeling instructions concerning initial apixaban dosing in clinical practice and to identify factors associated with inappropriate dose reduction...
March 15, 2018: Clinical Cardiology
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; whether patients should be treated as inpatients or outpatients; and how long patients should be treated to reduce the risk of recurrence? Expert commentary: The management of PE is changing...
March 15, 2018: Expert Review of Respiratory Medicine
Rik Houben, Floris H B M Schreuder, Kim J Bekelaar, Danny Claessens, Robert J van Oostenbrugge, Julie Staals
Background: The intracerebral hemorrhage (ICH) score is a commonly used prognostic model for 30-day mortality in ICH, based on five independent predictors (ICH volume, location, Glasgow Coma Scale, age, and intraventricular extension). Use of oral anticoagulants (OAC) is also associated with mortality but was not considered in the ICH score. We investigated (a) whether the predictive performance of ICH score is similar in OAC-ICH and non-OAC-ICH and (b) whether addition of OAC use to the ICH score increases the prognostic performance of the score...
2018: Frontiers in Neurology
Arnaud Bisson, Alexandre Bodin, Nicolas Clementy, Anne Bernard, Dominique Babuty, Gregory Y H Lip, Laurent Fauchier
AIMS: We compared thromboembolic (TE) and bleeding risks in patients with atrial fibrillation (AF) according to the new 'Evaluated Heartvalves, Rheumatic or Artificial' (EHRA) valve classification. METHODS: Patients were divided into 3 categories: (i) EHRA type 1 corresponds to the previous 'valvular' AF patients, with either rheumatic mitral valve stenosis or mechanical prosthetic heart valves; (ii) EHRA type 2 includes AF patients with other valvular heart disease (VHD) and valve bioprosthesis or repair; and (iii) 'non-VHD controls' i...
March 7, 2018: International Journal of Cardiology
Thomas C Sauter, Balthasar Eberle, Walter A Wuillemin, Thomas Thiele, Anne Angelillo-Scherrer, Aristomenis K Exadaktylos, Gabor Erdös, Adam Cuker, Michael Nagler
Antithrombotic treatment puts patients at risk of major bleeding. Fast and adequate response to anticoagulant-associated bleeding may not only stop the bleeding but prevent severe complications. However, practical treatment algorithms to guide physicians in emergency situations are lacking. Important principles that arise from management of bleeding in general are (a) implementation of an in-house algorithm, (b) rapid identification and treatment of the bleeding source, (c) adequate fluid resuscitation, (d) consideration of the application of tranexamic acid and (e) appropriate coagulation testing...
March 14, 2018: Swiss Medical Weekly
Francesca Muscente, Gerda Tautermann, Raffaele De Caterina
No abstract text is available yet for this article.
February 2018: Journal of Cardiovascular Medicine
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
O M Jolobe
No abstract text is available yet for this article.
December 2017: Journal of the Royal College of Physicians of Edinburgh
(no author information available yet)
No abstract text is available yet for this article.
March 12, 2018: Medical Letter on Drugs and Therapeutics
Matthew Gaskins, Martin Dittmann, Lisa Eisert, Ricardo Niklas Werner, Corinna Dressler, Christoph Löser, Alexander Nast
BACKGROUND: A survey in 2012 revealed marked heterogeneity in the management of antithrombotic agents in dermatologic surgery in Germany. An evidence-based guideline on this topic was published for the first time in 2014. METHODS: Using the same study sample, we conducted an anonymous survey on the management of antithrombotic agents and familiarity with the guideline. We reported the results as relative frequencies and compared them with those from 2012. RESULTS: We analyzed a total of 208 questionnaires (response rate: 36...
March 2018: Journal der Deutschen Dermatologischen Gesellschaft, Journal of the German Society of Dermatology: JDDG
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