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https://www.readbyqxmd.com/read/28056795/bleeding-outcomes-associated-with-rivaroxaban-and-dabigatran-in-patients-treated-for-atrial-fibrillation-a-systematic-review-and-meta-analysis
#1
Pravesh Kumar Bundhun, Mohammad Zafooruddin Sani Soogund, Abhishek Rishikesh Teeluck, Manish Pursun, Akash Bhurtu, Wei-Qiang Huang
BACKGROUND: Warfarin is commonly used as a secondary prevention of stroke in patients with atrial fibrillation (AF). However, limitations have been observed even with the use of this medication. Recently, several newer direct oral anticoagulants (DOACs) have been approved for use by the food and drug administrations. Unfortunately, these newer drugs have seldom been compared directly with each other. Therefore, this study aimed to compare the bleeding events associated with rivaroxaban and dabigatran in patients treated for non-valvular AF...
January 6, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28039855/use-of-oral-anticoagulant-therapy-in-older-adults-with-atrial-fibrillation-after-acute-ischemic-stroke
#2
Emer R McGrath, Alan S Go, Yuchiao Chang, Leila H Borowsky, Margaret C Fang, Kristi Reynolds, Daniel E Singer
OBJECTIVES: To explore barriers to anticoagulation in older adults with atrial fibrillation (AF) at high risk of stroke and to identify opportunities for interventions that might increase use of oral anticoagulants (OACs). DESIGN: Retrospective cohort study. SETTING: Two large community-based AF cohorts. PARTICIPANTS: Individuals with ischemic stroke surviving hospitalization (N = 1,405, mean age 79). MEASUREMENTS: Using structured chart review, reasons for nonuse of OAC were identified, and 1-year poststroke survival was assessed...
December 30, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28025962/the-cost-savings-of-newer-oral-anticoagulants-in-atrial-fibrillation-related-stroke-prevention%C3%A2
#3
Norliana Masbah, Mary Macleod
BACKGROUND: Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fibrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial. AIM: This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings...
December 27, 2016: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28024166/an-east-asian-perspective-on-the-interaction-between-proton-pump-inhibitors-and-clopidogrel
#4
Duowu Zou, Khean-Lee Goh
Both proton pump inhibitors (PPIs) and clopidogrel are widely prescribed in the Asia-Pacific population. PPIs are the mainstay therapeutic agents for prophylaxis against aspirin gastropathy and for ARDs (Acid Related Disorders) including gastroesophageal reflux disease (GERD). They are also co-prescribed with oral anticoagulant agents (OAAs)and with dual-antiplatelet therapy (DAPT) for the treatment and prevention of gastrointestinal (GI) bleeding. Clopidogrel belongs to the drug class of thienopyridines, and is currently the most widely prescribed OAA either alone or in combination with aspirin...
December 26, 2016: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28000318/dawn-of-the-direct-acting-oral-anticoagulants-trends-in-oral-anticoagulant-prescribing-in-wales-2009-2015
#5
M B Protty, J Hayes
WHAT IS KNOWN AND OBJECTIVE: Oral anticoagulants (OACs) have been used for decades for the long-term prevention of arterial and venous thromboembolic disease. These include warfarin and the newer direct-acting OACs (DOACs). Data on 'real-life' prescribing patterns for DOACs are limited. In this commentary, we report the prescribing patterns for OACs in Wales, as a representative country within the UK. COMMENT: A retrospective analysis of anonymized OAC prescribing data in Wales from June 2009 to December 2015...
December 21, 2016: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/27843361/pulmonary-embolism-new-treatments-for-an-old-problem
#6
REVIEW
John Ryan
Nonvitamin K antagonist oral anticoagulants, previously referred to as novel oral anticoagulants, have emerged in recent years as attractive treatment options for acute pulmonary embolism (PE). However, despite the widespread anticipation by physicians and the approval of rivaroxaban, apixaban, dabigatran, and more recently edoxaban, there is still some reluctance to choose these newer agents over conventional treatment with heparin/vitamin K antagonists. Acute PE puts a considerable strain on emergency departments, and medical staff rely on efficient diagnosis and risk assessment to manage the condition appropriately and economically...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27842767/drug-hepatotoxicity-newer-agents
#7
REVIEW
Chalermrat Bunchorntavakul, K Rajender Reddy
Idiosyncratic hepatotoxicity is one of the most common reasons for an approved drug being restricted. This article focuses on hepatotoxicity of selected and recently introduced agents, such as, tyrosine kinase inhibitors, monoclonal antibodies, novel oral anticoagulants, newer antiplatelets, antibiotics, anti-diabetics, anti-epileptics, anti-depressants, anti-psychotics and anti-retrovirals. Overall, the incidence of clinically relevant hepatotoxicity from newer agents seems to be lower than that of the older agents...
February 2017: Clinics in Liver Disease
https://www.readbyqxmd.com/read/27723533/new-oral-anticoagulants-and-dual-antiplatelet-therapy-focus-on-apixaban
#8
REVIEW
Francesco Pelliccia, Fabiana Rollini, Giuseppe Marazzi, Cesare Greco, Carlo Gaudio, Dominick J Angiolillo, Giuseppe Rosano
The combination of AF and coronary artery disease not only is a common clinical setting, it is also a complex setting to deal with anticoagulation and antiplatelet therapy, and it is associated with significantly higher mortality rates. Unfortunately, there are no sufficient data available to optimally guide clinical practice in such settings. This review focuses specifically on newer oral anticoagulants (NOACs) associated with dual antiplatelet therapy (DAPT) in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI)...
December 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27692605/anti-xa-bioassays-for-the-laboratory-measurement-of-direct-factor-xa-inhibitors-in-plasma-in-selected-patients
#9
REVIEW
Jean Amiral, Claire Dunois, Cédric Amiral, Jerard Seghatchian
In the past decade Direct Oral Anti-Coagulants (DOACs), targeting Thrombin or Factor Xa, have enormously facilitated the daily treatment of all relevant patients, including those requiring lifelong therapy. These DOACs have considerable advantages over the use of oral Vitamin K Antagonist (VKA) treatments, in view of having little interferences with food and other medications and also not requiring adjustment for age, gender or weight, with some well-defined exceptions. In this current What's Happening Section we focus on measurements of DiXaIs in plasma using anti-Xa assays, with the objective of providing a tribute to Professor Michel Meyer Samama, who was not only a real leader in this field but, in the past, both authors benefited from his wisdom, as a teacher who dedicated his scientific and professional life (among many other interests in hemostasis, thrombosis and fibrinolysis) to develop and promote methods and strategies for laboratory monitoring of anticoagulants...
October 2016: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/27685458/an-update-on-the-pharmaceutical-management-of-thrombosis
#10
Benilde Cosmi
Anticoagulants such as heparins and vitamin K antagonists (VKA) are effective for thrombosis prevention and treatment, but are associated with the risk of bleeding and other limitations, spurring the search for improved drugs. Areas covered: to evaluate the newer anticoagulants, focusing on those tested in phase III clinical trials such as direct oral anticoagulants (DOACs), antisense oligonucleotides (ASO) and warfarin analogues. DOACs such as dabigatran, rivaroxaban, apixaban and edoxaban are licensed for stroke prevention in atrial fibrillation and treatment of venous thromboembolism, dabigatran, rivaroxaban and apixaban for postoperative thromboprophylaxis in patients undergoing elective hip or knee arthroplasty and rivaroxaban for secondary prevention of acute coronary syndromes...
October 12, 2016: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/27659886/ischemic-and-bleeding-events-in-patients-with-myocardial-infarction-undergoing-percutaneous-coronary-intervention-who-require-oral-anticoagulation-insights-from-the-canadian-observational-antiplatelet-study
#11
Steven Sra, Mary K Tan, Shamir R Mehta, Harold N Fisher, Jean-Pierre Déry, Robert C Welsh, Mark J Eisenberg, Christopher B Overgaard, Barry F Rose, Anthony J Della Siega, Asim N Cheema, Brian Y L Wong, Mark A Henderson, Sohrab Lutchmedial, Shahar Lavi, Shaun G Goodman, Andrew T Yan
BACKGROUND: Since the introduction of newer, more potent P2Y12 receptor inhibitors (P2Y12ris), practice patterns and associated clinical outcomes in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) and also requiring oral anticoagulation (OAC) have not been fully characterized. METHODS: The Canadian Observational Antiplatelet Study was a prospective, multicenter, longitudinal, observational study (26 hospitals, December 2011 to May 2013) describing P2Y12ri treatment patterns and outcomes in patients with ST-elevation and non-ST-elevation MI undergoing PCI...
October 2016: American Heart Journal
https://www.readbyqxmd.com/read/27640616/-direct-oral-anticoagulants-in-cardiology
#12
Róbert Gábor Kiss
Antithrombotic drug therapy is a main cornerstone - sometimes a fairly uneven cornerstone - of today's clinical practice. Patients treated with antithrombotic drugs appear sometimes unawaited at those of our colleagues, who are not necessarily experts of this narrow field. Furthermore, new and newer molecules of antiplatelet and anticoagulant medicines have come into practice, frequently in combination. This dramatic development has been important to patients; pharmacological - and recently nonpharmacological - antithrombotic treatment has paved the way to improve current modalities in cardiology...
September 2016: Orvosi Hetilap
https://www.readbyqxmd.com/read/27640182/the-critical-care-management-of-spontaneous-intracranial-hemorrhage-a-contemporary-review
#13
REVIEW
Airton Leonardo de Oliveira Manoel, Alberto Goffi, Fernando Godinho Zampieri, David Turkel-Parrella, Abhijit Duggal, Thomas R Marotta, R Loch Macdonald, Simon Abrahamson
Spontaneous intracerebral hemorrhage (ICH), defined as nontraumatic bleeding into the brain parenchyma, is the second most common subtype of stroke, with 5.3 million cases and over 3 million deaths reported worldwide in 2010. Case fatality is extremely high (reaching approximately 60 % at 1 year post event). Only 20 % of patients who survive are independent within 6 months. Factors such as chronic hypertension, cerebral amyloid angiopathy, and anticoagulation are commonly associated with ICH. Chronic arterial hypertension represents the major risk factor for bleeding...
September 18, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27624772/warfarin-and-newer-agents-what-the-oral-surgeon-needs-to-know
#14
REVIEW
Martin B Steed, Matthew T Swanson
The new direct oral anticoagulants-dabigatran etexilate, rivaroxaban, and apixaban- have predictable pharmacokinetic and pharmacodynamic profiles and are alternatives to warfarin. However, many surgeons are wary of these drugs, as there is limited evidence on how to manage bleeding in patients taking them, and only recently has a specific antidote been developed to reverse their anticoagulant effect. Management of the newer agents requires careful adherence to primary measures of bleeding care, knowledge of their mechanism of action, and familiarity with the unapproved and untested reversal strategies that may be required in patients with life-threatening bleeding...
November 2016: Oral and Maxillofacial Surgery Clinics of North America
https://www.readbyqxmd.com/read/27621674/percutaneous-left-atrial-appendage-closure-devices-safety-efficacy-and-clinical-utility
#15
REVIEW
Martin J Swaans, Lisette Is Wintgens, Arash Alipour, Benno Jwm Rensing, Lucas Va Boersma
Atrial fibrillation (AF) is the most common arrhythmia treated in the clinical practice. One of the major complications of AF is a thromboembolic cerebral ischemic event. Up to 20% of all strokes are caused by AF. Thromboembolic cerebral ischemic event in patients with AF occurs due to atrial thrombi, mainly from the left atrial appendage (LAA). Prevention of clot formation with antiplatelet agents and especially oral anticoagulants (vitamin K antagonists or newer oral anticoagulants) has been shown to be effective in reducing the stroke risk in patients with AF but has several drawbacks with (major) bleedings as the most important disadvantage...
2016: Medical Devices: Evidence and Research
https://www.readbyqxmd.com/read/27593686/stroke-risk-stratification-schemes-in-atrial-fibrillation-in-the-era-of-non-vitamin-k-anticoagulants-misleading-and-obsolete-at-least-for-the-low-risk-patients
#16
Antonis S Manolis, Theodora A Manolis, Antonis A Manolis, Helen Melita
The thromboembolic risk of atrial fibrillation (AF) is significantly mitigated by oral anticoagulation (OAC) therapy, albeit at an increasing bleeding risk. The general principle is that the expected protective benefit of OAC must not exceed the potential harm conferred by possible bleeding. Over the recent years, the CHA2DS2-VASc score has been proven to be superior to other scores in identifying 'low risk' AF patients. However, even this latest score does not incorporate all possible risk factors causing a high thromboembolic risk, while the individual components of the CHA2DS2-VASc score do not seem to carry equal thromboembolic risk...
September 5, 2016: Current Drug Targets
https://www.readbyqxmd.com/read/27571335/-anmco-aiac-sici-gise-sic-sicch-consensus-document-percutaneous-left-atrial-appendage-occlusion-in-patients-with-nonvalvular-atrial-fibrillation-indications-patient-selection-competences-organization-and-operator-training
#17
Gavino Casu, Michele Massimo Gulizia, Giulio Molon, Patrizio Mazzone, Andrea Audo, Giancarlo Casolo, Emilio Di Lorenzo, Michele Portoghese, Christian Pristipino, Renato Pietro Ricci, Sakis Themistoclakis, Luigi Padeletti, Claudio Tondo, Sergio Berti, Jacopo Andrea Oreglia, Gino Gerosa, Marco Zanobini, Gian Paolo Ussia, Giuseppe Musumeci, Francesco Romeo, Roberto Di Bartolomeo
Atrial fibrillation (AF) is the most common arrhythmia and its prevalence is increasing due to the progressive aging of the population. About 20% of strokes are attributable to AF and AF patients are at 5-fold increased risk of stroke. The mainstay of treatment of AF is the prevention of thromboembolic complications with oral anticoagulation therapy. Drug treatment for many years has been based on the use of vitamin K antagonists, but recently newer and safer molecules have been introduced (dabigatran etexilate, rivaroxaban, apixaban and edoxaban)...
July 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/27570387/factors-influencing-nonadministration-of-thrombolytic-therapy-in-early-arrival-strokes-in-a-university-hospital-in-hyderabad-india
#18
Lalitha Pidaparthi, Anitha Kotha, Venkat Reddy Aleti, Abhijeet Kumar Kohat, Mridula R Kandadai, Suryaprabha Turaga, Jabeen A Shaik, Suvarna Alladi, Meena A Kanikannan, Borgohain Rupam, Subhash Kaul
BACKGROUND: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. OBJECTIVE: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. MATERIALS AND METHODS: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included...
July 2016: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/27517038/venous-thromboembolism-in-cancer-an-update-of-treatment-and-prevention-in-the-era-of-newer-anticoagulants
#19
REVIEW
Waqas Qureshi, Zeeshan Ali, Waseem Amjad, Zaid Alirhayim, Hina Farooq, Shayan Qadir, Fatima Khalid, Mouaz H Al-Mallah
Cancer patients are at major risk of developing venous thromboembolism (VTE), resulting in increased morbidity and economic burden. While a number of theories try to explain its pathophysiology, its risk stratification can be broadly done in cancer-related, treatment-related, and patient-related factors. Studies report the prophylactic use of thrombolytic agents to be safe and effective in decreasing VTE-related mortality/morbidity especially in postoperative cancer patients. Recent data also suggest the prophylactic use of low molecular weight Heparins (LMWHs) and Warfarin to be effective in reducing VTEs related to long-term central venous catheter use...
2016: Frontiers in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27432042/a-comprehensive-overview-of-direct-oral-anticoagulants-for-the-management-of-venous-thromboembolism
#20
REVIEW
Anthony J Comerota, Eduardo Ramacciotti
Venous thromboembolism (VTE) is a prevalent, potentially fatal health problem. Although standard anticoagulant therapy is effective when compared with the newer direct oral anticoagulants (DOACs), it has disadvantages. Heparin and its derivatives must be administered parenterally, whereas use of oral vitamin K antagonists is complicated by unpredictable pharmacokinetics and pharmacodynamics, drug-food and drug-drug interactions and the requirement for frequent laboratory monitoring. Randomized phase 3 trials have demonstrated that patients receive similarly effective anticoagulation with the DOACs dabigatran, edoxaban, rivaroxaban and apixaban when compared with warfarin, with similar or reduced risk of bleeding...
July 2016: American Journal of the Medical Sciences
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