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https://www.readbyqxmd.com/read/29619276/use-of-anticoagulants-remains-a-significant-threat-to-timely-hip-fracture-surgery
#1
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/29602837/trends-in-initiation-of-direct-oral-anticoagulant-therapies-for-atrial-fibrillation-in-a-national-population-based-cross-sectional-study-in-the-french-health-insurance-databases
#2
Laetitia Huiart, Cyril Ferdynus, Christel Renoux, Amélie Beaugrand, Sophie Lafarge, Léa Bruneau, Samy Suissa, Olivier Maillard, Xavier Ranouil
OBJECTIVE: Unlike several other national health agencies, French health authorities recommended that the newer direct oral anticoagulant (DOAC) agents only be prescribed as second choice for the treatment of newly diagnosed non-valvular atrial fibrillation (NVAF), with vitamin K antagonists (VKA) remaining the first choice. We investigated the patterns of use of DOACs versus VKA in the treatment of NVAF in France over the first 5 years of DOAC availability. We also identified the changes in patient characteristics of those who initiated DOAC treatment over this time period...
March 30, 2018: BMJ Open
https://www.readbyqxmd.com/read/29519352/resolving-concerns-with-the-newer-oral-anticoagulant-medications-is-hepatotoxicity-a-real-concern
#3
EDITORIAL
Mark A Crowther, Wendy Lim
No abstract text is available yet for this article.
March 13, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29514375/venous-thromboembolism-prophylaxis-after-total-knee-arthroplasty
#4
Hayden N Box, Sean Shahrestani, Michael H Huo
Venous thromboembolic disease (VTED) is a major cause of morbidity and mortality after total knee arthroplasty (TKA). Current VTED prophylaxis protocols consist of early mobilization, mechanical compression devices, and pharmacologic agents. Venous phasic flow-regulated below-knee devices are generally favored, but the optimal duration and method of mechanical prophylaxis is unknown. Risk stratification models have been developed to guide pharmacologic prophylaxis. For patients with standard VTED risk profile, aspirin has become increasingly popular...
March 7, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29428146/management-of-perioperative-anticoagulation-for-device-implantation
#5
REVIEW
Merrill H Stewart, Daniel P Morin
Periprocedural management of anticoagulation for cardiac device implantation has evolved over the past 20 years. The traditional paradigm of vitamin K antagonist interruption with heparin bridging has now been shown to be less safe than continuation of vitamin K antagonists at therapeutic levels. Dual antiplatelet therapy during device implantation poses substantial risk but is often necessary. The safest dosing strategy for newer direct oral anticoagulants is still not clear.
March 2018: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/29334815/impact-of-medication-adherence-on-risk-of-ischemic-stroke-major-bleeding-and-deep-vein-thrombosis-in-atrial-fibrillation-patients-using-novel-oral-anticoagulants
#6
Chinmay G Deshpande, Stephen Kogut, Robert Laforge, Cynthia Willey
OBJECTIVES: Our study examined the impact of adherence to novel oral anticoagulants [NOACs - dabigatran and rivaroxaban] on ischemic-stroke (IS), major-bleeding (MB), deep-vein-thrombosis and pulmonary-embolism (DVTPE) risk in a large, nationwide, propensity-matched sample. METHODS: A retrospective cohort study utilized data from a US commercial managed-care database (2010-2012). Adult patients with ≥1 diagnosis of atrial fibrillation/flutter (ICD-9 427.31/32), >1 prescription of NOACs and CHA2 DS2 -VASc score ≥1 were included...
February 15, 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29318007/severe-haematuria-of-lower-urinary-tract-origin-with-low-dose-dabigatran-use-in-three-indian-elderly-patients-unresolved-issues-in-the-safety-of-novel-oral-anticoagulants
#7
Upinder Kaur, Sankha Shubhra Chakrabarti, Sukdev Manna, Indrajeet Singh Gambhir
Dabigatran is a newer oral direct thrombin inhibitor approved by the United States Food and Drug Administration and the European Medicines Agency (EMA). The proper dosage of the drug, the potential for adverse drug reactions and the nature of bleeds with use of this drug as with other novel oral anticoagulants (NOACs), in the elderly population are still areas of uncertainty. Despite the existence of a specific antibody, idarucizumab which is an antidote to dabigatran toxicity, management of dabigatran-induced bleeds is an undefined area especially in resource constrained settings...
January 2018: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/29259514/dabigatran-induced-spontaneous-hemopericardium-and-cardiac-tamponade
#8
Qurat-Ul-Ain Jelani, Ram Gordon, Adam Schussheim
Four novel oral anticoagulant agents are currently available for the prevention and treatment of thromboembolic events in patients with nonvalvular atrial fibrillation. We present an unusual case of spontaneous hemopericardium and tamponade in an 87-year-old man with atrial fibrillation who was taking one such agent, dabigatran, as thromboprophylaxis. Our case highlights both a rare bleeding complication of dabigatran use and the effectiveness of idarucizumab, its newly approved reversal agent. Especially in elderly patients, we recommend that clinicians evaluate risk factors, closely monitor patient status, and consider alternatives to the newer anticoagulants when the risk of bleeding is high...
October 2017: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/29226707/managing-anticoagulation-in-patients-receiving-implantable-cardiac-devices
#9
Panagiota Anna Chousou, Peter J Pugh
A substantial proportion of patients who undergo cardiac device implantation receive oral anticoagulation to prevent thromboembolism or antiplatelets to prevent thrombotic events. Anticoagulation and antiplatelets increase the risk of hemorrhagic complications, while discontinuation may increase thromboembolic risk and thrombotic events. With the introduction of non-vitamin K antagonist oral anticoagulant agents and the newer antiplatelet agents such as prasugrel or ticagrelor, the perioperative management of patients has become more challenging...
March 2018: Future Cardiology
https://www.readbyqxmd.com/read/29212638/reversal-strategies-for-newer-oral-anticoagulants
#10
Adam J Singer, Susan Wilson
Nonvitamin K antagonist oral anticoagulants have advantages compared with warfarin, but both types of anticoagulants come with uncertainty about how best to manage life-threatening bleeding events, urgent surgeries, and invasive procedures. Nurse practitioners and physician assistants may need to manage such emergency situations in the critical care setting. Achieving hemostasis quickly is key, and efforts to do so have relied mainly on blood products. Targeted reversal agents are in clinical development and one, idarucizumab, which reverses dabigatran anticoagulation, has been approved...
2017: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/29150698/surgical-techniques-for-left-atrial-appendage-exclusion
#11
REVIEW
Sacha P Salzberg, Maximilian Y Emmert, Etem Caliskan
The increasing prevalence of atrial fibrillation with the aging population and its associated major morbidity and mortality due to thromboembolic stroke have resulted in intensive research on stroke prevention or stroke risk reduction strategies. Several surgical techniques for left atrial appendage (LAA) occlusion have evolved over the past decades. Surgeons have been using different techniques leading to highly variable and, in particular, poor data on outcomes. LAA closure is performed either as a concomitant procedure during open-heart surgery or as a stand-alone surgical procedure as part of minimally invasive (mini-thoracotomy or thoracoscopy) arrhythmia surgery...
December 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/29121410/medication-management-of-patients-undergoing-transcatheter-aortic-valve-replacement
#12
REVIEW
Bethany A Kalich, J Erin Allender, Ian B Hollis
Aortic stenosis (AS) is the most common form of valvular heart disease. A detailed diagnostic workup is necessary to promptly stage and classify disease severity to determine optimal management. Medical therapy and valvuloplasty are options that fail to delay or reverse disease progression. Surgical aortic valve replacement (SAVR) is curative but has significant limitations for some patient populations. A newer option, transcatheter aortic valve replacement (TAVR), has become more widely available to patients with intermediate- or high-operative risk...
January 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29113840/extended-venous-thromboembolism-prophylaxis-after-radical-cystectomy-a-call-for-adherence-to-current-guidelines
#13
REVIEW
Zachary Klaassen, Karan Arora, Hanan Goldberg, Thenappan Chandrasekar, Christopher J D Wallis, Rashid K Sayyid, Neil E Fleshner, Antonio Finelli, Alexander Kutikov, Philippe D Violette, Girish S Kulkarni
PURPOSE: Radical cystectomy is inherently associated with morbidity. We assess the timing and incidence of venous thromboembolism, review current guideline recommendations and provide evidence for considering extended venous thromboembolism prophylaxis in all patients undergoing radical cystectomy. MATERIALS AND METHODS: We searched PubMed® for available literature on radical cystectomy and venous thromboembolism, focusing on incidence and timing, evidence supporting extended venous thromboembolism prophylaxis in patients undergoing radical cystectomy or abdominal oncologic surgery, current guideline recommendations, safety considerations and direct oral anticoagulants...
November 4, 2017: Journal of Urology
https://www.readbyqxmd.com/read/29092122/treatment-of-prosthetic-valve-thrombosis-with-bolus-dose-tenecteplase-an-experience-from-a-developing-country
#14
Rajesh Kumar Jha, Sandeep Bansal, H S Issar, Mayuresh Chaudhary, Sonu Sharma
BACKGROUND: Prosthetic valve thrombosis (PVT) in metallic prosthetic cardiac valves is not an uncommon condition, and has high mortality and morbidity. Although surgery is the traditional choice for PVT therapy, thrombolysis with newer agents has achieved good success rates. Many studies described in the western literature have used tissue plasminogen activators, while studies from developing countries have been largely based on the use of streptokinase and urokinase. Data regarding the use of newer agents such as tenecteplase are scant...
May 2017: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/29064044/management-of-elective-surgery-and-emergent-bleeding-with-direct-oral-anticoagulants
#15
REVIEW
Scott Kaatz, Charles E Mahan, Asaad Nakhle, Kulothungan Gunasekaran, Mahmoud Ali, Robert Lavender, David G Paje
PURPOSE OF REVIEW: The purpose of this review was to offer practical management strategies for when patients receiving direct oral anticoagulants require elective surgery or present with bleeding complications. RECENT FINDINGS: Clinical practice guidelines are now available on the timing of periprocedural interruption of treatment with the newer direct oral anticoagulants based on their pharmacodynamics and pharmacokinetics and based on findings from cohort studies and clinical trials...
October 24, 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/29055399/new-digital-adherence-devices-could-prevent-millions-of-strokes-from-atrial-fibrillation-by-the-end-of-the-next-century
#16
Philip Boehme, Peter Wienand, Maximilian Herrmann, Hubert Truebel, Thomas Mondritzki
The effectiveness and safety of a pharmacologic intervention is highly dependent on patient's capability to follow the recommended treatment regimen. Non-adherence to pharmacologic treatments is associated with worsening conditions including hospitalization and death. This is a significant burden to healthcare systems on a global scale with non-adherence rates being as high (or higher) as 50% in the first treatment year. The most common causes for non-adherence are forgetfulness, busy lifestyle or complexity and changes in therapeutic schedules...
October 2017: Medical Hypotheses
https://www.readbyqxmd.com/read/29034832/new-advances-in-atrial-fibrillation-management-the-role-of-apixaban
#17
Giuseppe Mc Rosano, Ilaria Spoletini, Walter Gianni, Cristiana Vitale
Prevention of stroke is a pivotal intervention in the management of patients with atrial fibrillation (AF) at increased risk of systemic embolism. Because of the difficulties of safely implementing Vitamin K Antagonists in all patients, there has been a growing interest in improving the pharmacological management of AF, with newer antithrombotic agents. The new oral anticoagulants (NOACs) have been developed to overcome the limitations and improve the efficacy of the conventional oral anticoagulant drugs. Among the NOACs, apixaban - a very specific antagonist of activated factor Xa - has pharmacokinetic and pharmacodynamic properties that allow significant efficacy in AF management...
October 12, 2017: Current Drug Targets
https://www.readbyqxmd.com/read/28979172/reversing-factor-xa-inhibitors-clinical-utility-of-andexanet-alfa
#18
REVIEW
Scott Kaatz, Hardik Bhansali, Joseph Gibbs, Robert Lavender, Charles E Mahan, David G Paje
Approximately half of patients started on an oral anticoagulant in the USA now receive one of the newer direct oral anticoagulants (DOACs). Although there is an approved reversal agent for the direct thrombin inhibitor dabigatran, a specific reversal agent for the anti-factor Xa (FXa) DOACs has yet to be licensed. Unlike the strategy to reverse the only oral direct thrombin inhibitor with idarucizumab, which is a humanized monoclonal antibody fragment, a different approach is necessary to design a single agent that can reverse multiple anti-FXa medications...
2017: Journal of Blood Medicine
https://www.readbyqxmd.com/read/28828987/perioperative-management-of-anticoagulants
#19
Joan M Irizarry-Alvarado, Lynsey A Seim
BACKGROUND: The prevalence of anticoagulant use has increased in the United States. Medical providers have the responsibility to explain to patients the management of anticoagulant regimens before an invasive procedure. The pharmacologic characteristics of these medications-specifically, their half-lives-are important in timing an interruption of anticoagulant therapy. OBJECTIVE: The authors review the current guidelines and recommendations for therapeutic interruption of anticoagulants and the involved pharmacologic factors...
August 21, 2017: Current Clinical Pharmacology
https://www.readbyqxmd.com/read/28790786/direct-acting-oral-anticoagulant-bench-to-bedside
#20
REVIEW
D S Chadha, P Bharadwaj
Vitamin K antagonists are an effective group of oral anticoagulants. However because of genetic variability in their metabolism and multiple food and drug interactions, these drugs have narrow therapeutic window with unpredictable anticoagulant effects requiring constant monitoring. Several newer direct acting oral anticoagulants have been approved for prevention of stroke in patients with nonvalvular atrial fibrillation and treatment or prevention of venous thromboembolism. The direct acting oral anticoagulants include the direct thrombin inhibitor (dabigatran) and the factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban)...
July 2017: Medical Journal, Armed Forces India
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