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Oral anticoagulants

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https://www.readbyqxmd.com/read/28447415/the-danger-of-relying-on-the-aptt-and-pt-in-patients-on-doac-therapy-a-potential-patient-safety-issue
#1
REVIEW
D M Adcock, R C Gosselin
Prolongation of the activated partial thromboplastin time (APTT) and prothrombin time/international normalized ratio (PT/INR) correlates poorly with plasma concentrations of direct oral anticoagulant agents (DOACS) including direct thrombin and direct Xa inhibitors. It has been repeatedly demonstrated that patients can have normal APTT and PT/INR with a therapeutic plasma concentration of a DOAC. Clinicians can no longer rely on a normal APTT and PT to determine that an anticoagulated patient is safe to undergo an invasive procedure...
May 2017: International Journal of Laboratory Hematology
https://www.readbyqxmd.com/read/28447413/laboratory-measurement-of-the-direct-oral-anticoagulants-indications-and-impact-on-management-in-clinical-practice
#2
REVIEW
C Wright, R Brown, A Cuker
Although the direct oral anticoagulants (DOACs) do not require routine laboratory monitoring, there may be special situations in which measurement of drug levels is desirable. There is a paucity of information on how measurement of DOAC levels is used in clinical practice. We conducted a retrospective cohort study of dabigatran, rivaroxaban, and apixaban levels measured at our institution. Of 9793 patients with an active prescription for dabigatran, rivaroxaban, or apixaban in the electronic medical record during the 2...
May 2017: International Journal of Laboratory Hematology
https://www.readbyqxmd.com/read/28446469/anticoagulation-for-mechanical-heart-valves-will-oral-factor-xa-inhibitors-be-effective
#3
EDITORIAL
Noel C Chan, Jeffrey I Weitz, John W Eikelboom
No abstract text is available yet for this article.
May 2017: Arteriosclerosis, Thrombosis, and Vascular Biology
https://www.readbyqxmd.com/read/28446351/deep-vein-thrombosis-of-the-upper-extremity
#4
Jan Heil, Wolfgang Miesbach, Thomas Vogl, Wolf O Bechstein, Alexander Reinisch
BACKGROUND: Deep venous thrombosis (DVT) arises with an incidence of about 1 per 1000 persons per year; 4-10% of all DVTs are located in an upper extremity (DVT-UE). DVT-UE can lead to complications such as post-thrombotic syndrome and pulmonary embolism and carries a high mortality. METHODS: This review is based on pertinent literature, published from January 1980 to May 2016, that was retrieved by a systematic search, employing the PRISMA criteria, carried out in four databases: PubMed (n = 749), EMBASE (n = 789), SciSearch (n = 0), and the Cochrane Library (n = 12)...
April 7, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28446026/medical-therapy-before-carotid-endarterectomy
#5
Daniele Bissacco, Michele Carmo, Iacopo Barbetta, Raffaello Dallatana, Piergiorgio G Settembrini
We evaluated the evolution of chronic medical therapy in patients admitted for carotid endarterectomy (CEA) over a 13-year period and to analyze the difference in medical treatment between symptomatic and asymptomatic patients. A retrospective study was conducted on patients treated between 2002 and 2015. The use of antiplatelets (acetylsalicylic acid [ASA], ticlopidine, and clopidogrel), oral anticoagulant therapy (OAT), statins and antihypertensives (angiotensin-converting enzyme inhibitors [ACE-I]/angiotensin receptor blockers [ARBs], β-blockers [BB]) administration was evaluated...
January 1, 2017: Angiology
https://www.readbyqxmd.com/read/28444177/single-centre-experience-with-transapical-transcatheter-mitral-valve-implantation%C3%A2
#6
Gry Dahle, Kjell-Arne Rein, Arnt E Fiane
OBJECTIVES: A transcatheter heart valve technique can be used in failed mitral valve repairs with annuloplasty rings, deterioriated bioprostheses and in mitral annular calcification, all serving as 'docking stations' for balloon-expandable valves. Specially designed transcatheter mitral valve platforms are used in ongoing studies for native mitral valve regurgitation. We present our single centre experience with transcatheter mitral valve implantation-transapical approach procedures in eleven patients...
April 21, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28441899/clinical-and-financial-outcomes-evaluation-of-multimodal-pharmacist-warfarin-management-of-a-statewide-urban-and-rural-population
#7
James C Lee, Kathleen E Horner, Michelle L Krummel, Deanna L McDanel
PURPOSE: To evaluate the efficacy, safety, and indirect financial outcomes of pharmacist face-to-face warfarin management with telephone-based distance management utilizing local laboratories or patient self-testing (PST). METHODS: A retrospective analysis of a clinic population of 336 patients on established warfarin therapy distributed statewide in rural and urban settings over a 6-month period was conducted. Participants were stratified into face-to-face management, telephone-based management utilizing local laboratory testing, and telephone-based management utilizing PST...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28441352/high-throughput-determination-of-sodium-danshensu-in-beagle-dogs-by-the-lcms-ms-method-employing-liquid-liquid-extraction-based-on-96-well-format-plates
#8
Jingjing Jiang, Xin Zhao, Xiuxiu Li, Shengyuan Wu, Shidan Yu, Yuefen Lou, Guorong Fan
Sodium Danshensu (sodium d-(+)-β-(3,4-dihydroxyphenyl) lactate), one of the water-soluble ingredients in Salvia miltiorrhiza, exhibits potent relaxation of the coronary artery and anticoagulation effection. A high-throughput, rapid, and sensitive method combining liquid chromatography with electrospray ionization tandem mass spectrometry to determine the sodium danshensu in beagle dog plasma was developed and validated, using gallic acid as an internal standard (IS). Acidified plasma samples were extracted using 96-well liquid-liquid extraction, and were eluted on a CNW Athena C18 column (3 μm, 2...
April 25, 2017: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
https://www.readbyqxmd.com/read/28440204/apixaban-metabolism-pharmacologic-properties-and-drug-interaction
#9
Peter Kubisz, Lucia Stanciakova, Miroslava Dobrotova, Matej Samos, Marian Mokan, Jan Stasko
BACKGROUND: Apixaban is an oral, potent, highly selective, reversible and direct inhibitor of activated coagulation factor X, that is the end point of the intrinsic and extrinsic coagulation pathway. Additionally, apixaban has the capacity to indirectly inhibit thrombin-induced platelet aggregation. This new oral anticoagulant represents an immediate-release form of peroral drug with quick dissolution, linear pharmacokinetics, good bioavailability and rapid onset and offset of action...
April 24, 2017: Current Drug Metabolism
https://www.readbyqxmd.com/read/28439702/a-comparison-of-apixaban-and-dabigatran-etexilate-for-thromboprophylaxis-following-hip-and-knee-replacement-surgery
#10
Adriane Mayer, Philipp Schuster, Bernd Fink
INTRODUCTION: Patients who have undergone hip or knee replacement surgery are exposed to a high risk of developing a post-operative venous thromboembolus and so have a need for an effective, medication-based, thrombosis prophylaxis. New orally active anticoagulants have been available for a few years now. These specific substances directly block either thrombin (e.g., dabigatran etexilate) or Factor Xa (e.g., apixaban). It is not clear whether there are any efficacy differences between these two substances because there have never been any head-to-head studies carried out...
April 24, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28439617/-stroke-prophylaxis-in-atrial-fibrillation-when-how-and-for-whom
#11
T Maurer, C Sohns
In patients suffering from atrial fibrillation (AF), modern antithrombotic therapy and anticoagulation strategies should be individualized based on shared decision making including patient preferences and the absolute and relative risks of stroke and bleeding. Estimation of the individual risk for stroke is still based on the CHA2DS2-VASc score. Based on the most recent guidelines for the management of AF, oral anticoagulation therapy should be considered for men with a CHA2DS2-VASc score ≥1 and women with a score ≥2, balancing the expected stroke reduction, risk of bleeding and patient preference...
April 24, 2017: Herz
https://www.readbyqxmd.com/read/28439571/four-year-cross-sectional-study-of-bleeding-risk-in-dental-patients-on-direct-oral-anticoagulants
#12
Itai Zeevi, Dror M Allon, Eli Rosenfeld, Gal Avishai, Leon Gilman, Joseph Nissan, Gabi Chaushu
OBJECTIVE: New oral anticoagulants, or "direct oral anticoagulants" (DOACs), have been used worldwide in recent years. An evidence-based enigma regarding dental patients using DOACs still exists. METHOD AND MATERIALS: This was a 4-year, cross-sectional study on individuals receiving DOAC therapy, treated in a single maxillofacial center. A bleeding event was the outcome parameter. Potential contributing risk factors were evaluated. RESULTS: Of a total of 111 patients, 72 underwent a total of 305 oral procedures in 115 sessions...
April 24, 2017: Quintessence International
https://www.readbyqxmd.com/read/28439135/assessment-of-direct-oral-anticoagulant-prescribing-and-monitoring-pre-and-post-implementation-of-a-pharmacy-protocol-at-a-community-teaching-hospital
#13
Christina Miele, Mary Taylor, Aditi Shah
Background: Direct oral anticoagulants (DOACs) have become popular alternatives to vitamin K antagonists for the treatment and prevention of thromboembolic diseases; however, there are limited data regarding the appropriate use of DOACs in clinical practice. To ensure safety and efficacy of these medications, it is important that decisions regarding their use in patients rely on the available evidence. Objective: The purpose of this study was to evaluate the appropriateness of DOAC prescribing in adult patients before and after the implementation of a pharmacist-driven DOAC protocol...
March 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28437881/in-reply-to-new-oral-anticoagulants-and-pituitary-apoplexy
#14
Sebastian Senger, Stefan Linsler
No abstract text is available yet for this article.
April 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28437880/new-oral-anticoagulants-and-pituitary-apoplexy
#15
Francesco Doglietto, Elena Roca, Giuseppe La Rocca, Alberto Schreiber, Andrea Bolzoni Villaret, Piero Nicolai, Marco Maria Fontanella
No abstract text is available yet for this article.
April 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28435279/use-of-direct-oral-anticoagulants-for-the-prevention-and-treatment-of-thromboembolic-disease-in-patients-with-reduced-renal-function-a-short-review-of-the-clinical-evidence
#16
REVIEW
Kristine C Willett, Amanda M Morrill
BACKGROUND: The use of direct oral anticoagulants (DOACs) is restricted by the limitations of clinical trials guiding therapy for patients with renal impairment, as many of these trials excluded patients with severe renal impairment. There are currently four agents available: dabigatran, rivaroxaban, apixaban, and edoxaban. The purpose of this review was to 1) describe current recommended dosing for each DOAC and published postmarketing data, including case reports, on the use of these agents in the renally impaired; and 2) discuss patient adherence and satisfaction and the cost of these agents...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/28434017/recurrent-epistaxis-predicting-risk-of-30-day-readmission-derivation-and-validation-of-rhino-ooze-score
#17
A Addison, C Paul, R Kuo, A Lamyman, P Martinez-Devesa, R Hettige
BACKGROUND: To derive and validate a predictive scoring tool (RHINO-ooze score) with good sensitivity and specificity in identifying patients with epistaxis at high risk of 30 day readmission and to enable risk stratification for possible definitive intervention. METHODS: Using medical databases, we searched for factors influencing recurrent epistaxis. The information ascertained together with our analysis of retrospective data on patients admitted with epistaxis between October 2013 and September 2014, was used as the derivation cohort to develop the predictive scoring model (RHINO-ooze score)...
April 23, 2017: Rhinology
https://www.readbyqxmd.com/read/28433989/oral-contraceptives-after-bariatric-surgery
#18
Joël Schlatter
OBJECTIVE: Bariatric surgery offers a highly effective mode of treatment for obese patients. Some procedures such as bypass cause an alteration in normal gastrointestinal tract with possible consequences for the uptake of orally administered drugs. METHODS: We assessed the literature to ascertain whether the use of oral drugs and especially oral contraceptives is effective and adequate after bariatric surgery. RESULTS: The bioavailability of drugs could be affected by the solubility and pH of the modified medium after bariatric surgery and by the loss of gastrointestinal transporters...
April 22, 2017: Obesity Facts
https://www.readbyqxmd.com/read/28431413/novel-oral-anticoagulants-and-trauma-the-results-of-a-prospective-american-association-for-the-surgery-of-trauma-multi-institutional-trial
#19
Leslie Kobayashi, Galinos Barmparas, Patrick Bosarge, Carlos V Brown, Marko Bukur, Matthew M Carrick, Richard D Catalano, Jan Holly-Nicolas, Kenji Inaba, Stephen Kaminski, Amanda L Klein, Tammy Kopelman, Eric J Ley, Ericca M Martinez, Forrest O Moore, Jason Murry, Raminder Nirula, Douglas Paul, Jacob Quick, Omar Rivera, Martin Schreiber, Raul Coimbra
BACKGROUND: The number of anticoagulated trauma patients is increasing. Trauma patients on warfarin have been found to have poor outcomes, particularly after intracranial hemorrhage (ICH). However, the effect of novel oral anticoagulants (NOAs) on trauma outcomes is unknown. We hypothesized that patients on NOAs would have higher rates of ICH, ICH progression, and death compared with patients on traditional anticoagulant and antiplatelet agents. METHODS: This was a prospective observational trial across 16 trauma centers...
May 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28429198/managing-the-perioperative-patient-on-direct-oral-anticoagulants
#20
Jordan Leitch, Janet van Vlymen
PURPOSE: Patients are increasingly treated with direct oral anticoagulants (DOACs) for the prevention of stroke due to non-valvular atrial fibrillation and for the treatment of venous thromboembolism. When these patients present for urgent or emergent surgical procedures, they present a challenge to the anesthesiologist who must manage perioperative risk due to anticoagulation. The purpose of this module is to review the literature surrounding the perioperative management of DOACs. Timing, laboratory monitoring, and availability of reversal agents are important considerations to optimize patients being treated with DOACs who require emergent surgery...
April 20, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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