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https://www.readbyqxmd.com/read/29922763/gastrointestinal-endoscopy-in-patients-on-direct-oral-anticoagulants-a-consensus-paper-of-the-romanian-society-of-gastroenterology-and-hepatology
#1
Andreea Farcas, Simona Bataga, Cristina Cijevschi, Mircea Diculescu, Daniela Dobru, Eugen Dumitru, Adrian Goldis, Laurentiu Nedelcu, Alina Popescu, Ioan Sporea, Anca Trifan, Simona Valean, Cristian Gheorghe, Dan Lucian Dumitrascu
Management of patients undergoing endoscopy and under treatment with the newer direct oral anticoagulants (DOACs) is a common and a complex clinical issue that gastroenterologists have to face more and more often these days. The increasing use of DOACs in patients requiring both short- and long-term anticoagulation is mostly due to the advantages these agents offer, among which the lack of monitoring requirements and the reduced need of dose adjustments are perhaps the most important ones. Managing these patients in the peri-endoscopic period implies balancing the risk for thrombosis that a certain patient carries and the bleeding risk associated with the endoscopic procedure itself...
June 2018: Journal of Gastrointestinal and Liver Diseases: JGLD
https://www.readbyqxmd.com/read/29877660/efficacy-and-safety-of-oral-anticoagulant-therapy-in-frail-patients-with-atrial-fibrillation
#2
Giuseppe Patti, Ludmilla Mantione, Edoardo Bressi, Antonio Bisignani
Antithrombotic treatment of frail patients with AF presents various challenges. The fear of bleeding often leds to a large underuse of anticoagulant agents in these patients, although more recent data indicate that oral anticoagulation  (especially with the newer, direct anticoagulants) is increasingly used. While there is a need for more real world data, available evidence suggests that non-vitamin K antagonist oral anticoagulants (NOACs) are an effective alternative to warfarin in frail patients with AF for preventing thromboembolic events, with a better safety profile...
June 7, 2018: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/29789047/concerns-for-bleeding-in-the-elderly-with-the-use-of-direct-oral-anticoagulants
#3
Michelle Min, Stephanie Sibicky
Since Food and Drug Administration approval of dabigatran in 2010, direct oral anticoagulants (DOACs) have been alternatives to warfarin for patients who are at risk for cardioembolic complications of nonvalvular atrial fibrillation. Unfortunately, there are limited safety data available on the use of these newer agents in older adults, particularly risks of gastrointestinal, intracranial, and major bleeding (as defined by the International Society on Thrombosis and Haemostasis) in those 75 years of age and older...
May 1, 2018: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/29789046/management-of-venous-thromboembolism-in-the-elderly-a-review-of-the-non-vitamin-k-oral-anticoagulants
#4
Laressa Bethishou, Tania Gregorian, Kimberly Won, Kristina Lopez, Laura V Tsu
Objective To provide an up-to-date review of the available evidence regarding pharmacotherapeutic management of venous thromboembolic events in the geriatric population. Data Sources A PubMed search of articles published through August 2017 was performed using a combination of the following words: apixaban, betrixaban, dabigatran, edoxaban, enoxaparin, geriatric, heparin, idaricizumab, rivaroxaban, and venous thromboembolism. Study Selection/data Extraction Relevant original research, review articles, and guidelines were assessed for the management of elderly patients with venous thromboembolism (VTE)...
May 1, 2018: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/29780621/thromboembolism-prophylaxis-in-orthopaedics-an-update
#5
Dimitrios A Flevas, Panayiotis D Megaloikonomos, Leonidas Dimopoulos, Evanthia Mitsiokapa, Panayiotis Koulouvaris, Andreas F Mavrogenis
Venous thromboembolism (VTE) is a serious complication during and after hospitalization, yet is a preventable cause of in-hospital death.Without VTE prophylaxis, the overall VTE incidence in medical and general surgery hospitalized patients is in the range of 10% to 40%, while it ranges up to 40% to 60% in major orthopaedic surgery. With routine VTE prophylaxis, fatal pulmonary embolism is uncommon in orthopaedic patients and the rates of symptomatic VTE within three months are in the range of 1.3% to 10%.VTE prophylaxis methods are divided into mechanical and pharmacological...
April 2018: EFORT open reviews
https://www.readbyqxmd.com/read/29741099/economic-evaluation-of-prescribing-conventional-and-newer-oral-anticoagulants-in-older-adults
#6
Syed Shahzad Hasan, Chia Siang Kow, Louise E Curley, Darrin L Baines, Zaheer-Ud-Din Babar
Anticoagulants refer to a variety of agents that inhibit one or more steps in the coagulation cascade. Generally, clinical conditions that require the prescribing of an oral anticoagulant increase in frequency with age. However, a major challenge of anticoagulation use among older patients is that this group of patients also experience the highest bleeding risk. To date, economic evaluation of prescribing of anticoagulants that includes the novel or newer oral anticoagulants (NOACs) in older adults has not been conducted and is warranted...
May 9, 2018: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/29619276/use-of-anticoagulants-remains-a-significant-threat-to-timely-hip-fracture-surgery
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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...
April 2018: Journal of Urology
https://www.readbyqxmd.com/read/29092122/treatment-of-prosthetic-valve-thrombosis-with-bolus-dose-tenecteplase-an-experience-from-a-developing-country
#20
Rajesh Kumar Jha, Sandeep Bansal, H S Issar, Mayuresh Chaudhary, Sonu Sharma
BACKGROUND AND AIM OF THE STUDY: 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...
May 2017: Journal of Heart Valve Disease
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