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https://www.readbyqxmd.com/read/29754667/is-there-a-role-for-pharmacokinetic-pharmacodynamic-guided-dosing-for-novel-oral-anticoagulants
#1
REVIEW
Noel Chan, Philip T Sager, Jack Lawrence, Thomas's Ortel, Paul Reilly, Scott Berkowitz, Dagmar Kubitza, John Eikelboom, Jeffry Florian, Norman Stockbridge, Martin Rose, Robert Temple, Jonathan H Seltzer
The novel direct oral anticoagulants (NOACs) represent a major advance in oral anticoagulant therapy and are replacing vitamin K antagonists as the preferred options for many indications. Given in fixed doses without routine laboratory monitoring, they have been shown to be at least as effective in reducing thromboembolic stroke as dose-adjusted warfarin in phase 3 randomized trials and less likely to cause hemorrhagic stroke. Pharmacokinetic and/or pharmacodynamic subanalyses of the major NOAC trials in patients with atrial fibrillation have established relationships between clinical characteristics, and drug levels and/or pharmacodynamic responses with both efficacy and safety...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29754652/risk-of-cardiovascular-events-and-incident-atrial-fibrillation-in-patients-without-prior-atrial-fibrillation-implications-for-expanding-the-indications-for-anticoagulation
#2
Xiaoxi Yao, Bernard J Gersh, Lindsey R Sangaralingham, Nilay D Shah, Peter A Noseworthy
BACKGROUND: There is growing interest in the role for non-vitamin K antagonist oral anticoagulants (NOACs) in patients without atrial fibrillation (AF). We aimed to provide a comprehensive assessment of the risks of ischemic stroke, myocardial infarction (MI), AF, and major bleeding in patients without previously diagnosed AF. METHODS: Using a large US administrative database, we identified 6,495,875 patients ≥50 years between January 1, 2011, and September 30, 2016, who were not diagnosed with AF and were not treated with oral anticoagulants or nonaspirin antiplatelet agents...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29750067/real-world-effectiveness-and-safety-of-oral-anticoagulation-strategies-in-atrial-fibrillation-a-cohort-study-based-on-a-german-claims-dataset
#3
Sabrina Mueller, Antje Groth, Stefan G Spitzer, Anja Schramm, Andreas Pfaff, Ulf Maywald
Objective: To compare the real-world effectiveness and safety of non-vitamin-K-antagonist oral anticoagulant (NOAC) treatment in atrial fibrillation (AF) patients with a vitamin-K-antagonist (VKA)-based treatment. Methods: This was a retrospective analysis of an anonymized claims dataset from 3 German health insurance funds covering the period from January 01, 2010 to June 30, 2014, with a minimum observation time of 12 months. All continuously insured patients with at least 2 outpatient AF diagnoses and/or 1 inpatient respective diagnosis who received at least 1 outpatient prescription of a NOAC or VKA were included...
2018: Pragmatic and Observational Research
https://www.readbyqxmd.com/read/29740755/optimal-antithrombotic-treatment-of-patients-with-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-triple-therapy-is-too-much
#4
REVIEW
M S Jacobs, R G Tieleman
Patients with atrial fibrillation who undergo a coronary intervention are eligible for both anticoagulation and (dual) antiplatelet therapy ((D)APT). An optimal balance has to be found to reduce the thromboembolic risk (i.e. stroke, systemic embolism and myocardial infarction) and to minimise the increased risk of bleeding with concomitant use of an anticoagulant and (D)APT. Owing to a lack of evidence, the guideline recommendations are predominantly based on expert opinion. Current evidence indicates that the combination of a non-vitamin K oral anticoagulant (NOAC) and clopidogrel is safer than vitamin-K oral antagonists plus DAPT, which increases the risk of bleeding, without clear advantages in regard to efficacy...
May 8, 2018: Netherlands Heart Journal
https://www.readbyqxmd.com/read/29740750/comparing-the-cost-effectiveness-of-non-vitamin-k-antagonist-oral-anticoagulants-with-well-managed-warfarin-for-stroke-prevention-in-atrial-fibrillation-patients-at-high-risk-of-bleeding
#5
Alexa R Hospodar, Kenneth J Smith, Yuting Zhang, Inmaculada Hernandez
BACKGROUND: Several studies have compared the cost effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin using results from clinical trials evaluating NOACs. However, the time in therapeutic range (TTR) of warfarin groups ranged across clinical trials, and all were below the therapeutic goal of 70%. We compared the cost effectiveness of edoxaban 60 mg, apixaban 5 mg, dabigatran 150 mg, dabigatran 110 mg, rivaroxaban 20 mg, and well-managed warfarin with a TTR of 70% in preventing stroke among patients with atrial fibrillation at high risk of bleeding...
May 9, 2018: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/29736630/variations-in-clinical-management-of-non-vitamin-k-antagonist-oral-anticoagulants-in-patients-with-atrial-fibrillation-according-to-different-equations-for-estimating-renal-function-post-hoc-analysis-of-a-prospective-cohort
#6
Vincenzo Livio Malavasi, Daniele Pettorelli, Elisa Fantecchi, Cristina Zoccali, Giuliana Laronga, Tommaso Trenti, Gregory Yoke Hong Lip, Giuseppe Boriani
Prescription of non-vitamin K antagonist oral anticoagulants (NOACs) requires an assessment of renal function (RF) and the Cockcroft-Gault (CG) equation is traditionally recommended. The objective of the study was to evaluate the potential changes in NOACs management using different equations for estimating RF. In a post hoc analysis of a prospective cohort of patients with atrial fibrillation, we considered different equations: (1) CG for creatinine clearance (CrCl), (2) modification of diet in renal disease (MDRD), (3) CKD-EPI, (4) Berlin Initiative Study 1 (BIS-1) and (5) full age spectrum (FAS), for glomerular filtration rate (GFR)...
May 7, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29728318/non-vitamin-k-dependent-oral-anticoagulants-for-nonvalvular-atrial-fibrillation-in-patients-with-ckd-pragmatic-considerations-for-the-clinician
#7
Gautam R Shroff, Rachel Stoecker, Allyson Hart
Management of atrial fibrillation (AF) in patients with advanced chronic kidney disease (CKD) poses a complex conundrum because of higher risks for both thromboembolic and bleeding complications compared to the general population. This makes it particularly important for clinicians to carefully weigh the risks versus benefits of anticoagulation therapy to determine the individualized net clinical benefit for every patient. During the past few years, 4 non-vitamin K-dependent oral anticoagulant (NOAC) agents have supplemented warfarin in the therapeutic armamentarium for the prevention of systemic thromboembolism in nonvalvular AF...
May 2, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29723895/anticancer-drug-related-nonvalvular-atrial-fibrillation-challenges-in-management-and-antithrombotic-strategies
#8
Antonella Tufano, Maurizio Galderisi, Luca Esposito, Valentina Trimarco, Daniela Sorriento, Guy Gerusalem, Marco Picardi, Patrizio Lancellotti, Fabrizio Pane
Cancer patients may experience nonvalvular atrial fibrillation (AF) as a manifestation of cardiotoxicity. AF may be a direct effect of a neoplasm or, more often, appear as a postsurgical complication, especially after thoracic surgery. AF may also develop as a consequence of anticancer therapy (chemotherapy or radiotherapy), a condition probably underestimated. Cancer patients with AF require a multidisciplinary approach involving oncologists/hematologists, cardiologists, and coagulation experts. An echocardiogram should be performed to detect possible abnormalities of left ventricular systolic and diastolic function, as well as left atrial dilation and the existence of valvular heart disease, to determine pretest probability of sinus rhythm restoration, and identify the best treatment...
May 3, 2018: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/29722003/optimal-long-term-antithrombotic-management-of-atrial-fibrillation-life-cycle-management
#9
REVIEW
R Pisters, A Elvan, H J G M Crijns, M E W Hemels
Optimal antithrombotic management of atrial fibrillation equals balancing between prevention of arterial thromboembolism, predominantly ischaemic stroke, and haemorrhagic complications. Over time different antithrombotic agents and strategies have been developed. At present, non-vitamin K antagonist oral anticoagulants (NOACs) are the first-line therapy for stroke prevention in patients with non-valvular atrial fibrillation (i.e. without a mechanical valve prosthesis or rheumatic heart disease). Considering the impact of the suboptimal adoption of recommended oral anticoagulant therapy, as experienced with the previous first-line vitamin K antagonists, this review focuses on adequate use of NOACs...
May 2, 2018: Netherlands Heart Journal
https://www.readbyqxmd.com/read/29718897/optimal-nonvitamin-k-antagonist-oral-anticoagulant-therapy-in-a-warfarin-sensitive-patient-after-left-atrial-appendage-closure-a-case-report
#10
Long Shen, Sha-Sha Fang, Heng Ge, Zhi-Qing Qiao, Zhi-Chun Gu
RATIONALE: Developing an optimal medication strategy poses a challenging task in fragile patients after left atrial appendage closure (LAAC). We report an optimal nonvitamin K antagonist oral anticoagulant (NOAC) therapy in a warfarin-sensitive patient after LAAC. PATIENT CONCERNS: A 77-year-old nonvalvular atrial fibrillation (NVAF) male carrying 2 warfarin-sensitive alleles experienced 2 gum-bleeding with the international normalized ratio (INR) around 3. DIAGNOSES: Persistent NVAF with a history of subtotal gastrectomy and moderate renal insufficiency...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29706404/appropriate-doses-of-non-vitamin-k-antagonist-oral-anticoagulants-in-high-risk-subgroups-with-atrial-fibrillation-systematic-review-and-meta-analysis
#11
In-Soo Kim, Hyun-Jung Kim, Tae-Hoon Kim, Jae-Sun Uhm, Boyoung Joung, Moon-Hyoung Lee, Hui-Nam Pak
BACKGROUND: We evaluated the dose-dependent efficacy, safety, and all-cause mortality of non-vitamin K antagonist oral anticoagulants (NOACs) in "atrial fibrillation (AF) patients who were OAC-naïve," or "AF patients with prior-stroke history" with those who were known to be high-risk subgroups under OAC. METHODS: After a systematic database search (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), five phase-III randomized trials comparing NOACs and warfarin in "OAC-naïve/OAC-experienced," or "with/without prior-stroke history" subgroups were included...
April 26, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29698794/prognostic-and-therapeutic-implications-of-vascular-disease-in-patients-with-atrial-fibrillation
#12
REVIEW
Farhan Shahid, Daniele Pastori, Francesco Violi, Gregory Y H Lip
Atrial fibrillation (AF) is associated with a 5-fold increase in the risk of ischemic stroke, and AF-related stroke patients have a higher mortality and greater morbidity than patients with non-AF related stroke. AF and vascular disease share a close relationship, with the concomitant presence of both disease states leading to a dramatic rise in future cardiovascular events. Indeed, the presence of peripheral artery disease independently predicts stroke in patients with AF. Myocardial infarction (MI) is another well-established risk factor for the development of AF; however, the role of pre-existing AF in MI is less well evidenced, with recent studies showing that this population more frequently develops coronary ischaemic events and has a higher risk of mortality than sinus rhythm patients...
April 23, 2018: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/29696419/bleeding-related-to-dental-treatment-in-patients-taking-novel-oral-anticoagulants-noacs-a-retrospective-study
#13
Eun-Jung Kwak, Sangook Nam, Kyeong-Mee Park, Seo-Yul Kim, Jisun Huh, Wonse Park
OBJECTIVE: Several novel oral anticoagulants (NOACs) are currently prescribed for patients suffering from atrial fibrillation, pulmonary thromboembolism, and venous thrombosis. However, there is no clinical guideline for dental treatment in patients taking NOACs. This study investigated bleeding events related to various dental treatments. MATERIALS AND METHODS: This retrospective study included 120 patients (153 cases) who were prescribed NOACs and received dental procedures in the Department of Advanced General Dentistry at Yonsei University Dental Hospital from January 2014 to June 2017...
April 25, 2018: Clinical Oral Investigations
https://www.readbyqxmd.com/read/29694286/primary-nonadherence-to-oral-anticoagulants-in-patients-with-atrial-fibrillation-real-world-data-from-a-population-based-cohort
#14
Clara L Rodriguez-Bernal, Salvador Peiró, Isabel Hurtado, Aníbal García-Sempere, Gabriel Sanfélix-Gimeno
BACKGROUND: Primary nonadherence (not filling a first prescription) is an important yet unstudied aspect of adherence to oral anticoagulant (OAC) therapy. OBJECTIVE: To estimate the rates of primary nonadherence to OACs and determine associated factors in real-world practice. METHODS: This population-based retrospective cohort study set in the Valencia region of Spain (about 5 million inhabitants) included all patients with atrial fibrillation who were newly prescribed OACs during 2011-2014 (N = 18,715)...
May 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29694285/real-world-health-care-costs-based-on-medication-adherence-and-risk-of-stroke-and-bleeding-in-patients-treated-with-novel-anticoagulant-therapy
#15
Chinmay G Deshpande, Stephen Kogut, Cynthia Willey
BACKGROUND: With the lack of real-world evidence, the challenge for drug reimbursement policy decision makers is to understand medication adherence behavior among users of novel oral anticoagulants (NOACs) and its effect on overall cost savings. No study has examined and quantified the burden of cost in high-risk patients taking NOAC therapy. OBJECTIVE: To examine the association of cost with adherence, comorbidity, and risk of stroke and bleeding in patients taking NOACs (rivaroxaban and dabigatran)...
May 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29692734/non-vitamin-k-antagonist-oral-anticoagulants-vs-warfarin-at-risk-of-fractures-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#16
Zhi-Chun Gu, Ling-Yun Zhou, Long Shen, Chi Zhang, Jun Pu, Hou-Wen Lin, Xiao-Yan Liu
Warfarin is a traditional oral anticoagulant for preventing thrombotic events in patients with atrial fibrillation (AF) and venous thromboembolism. Along with the widespread clinical use, the potential association between warfarin use and fracture risk have been addressed gradually. Non-vitamin K antagonist oral anticoagulants (NOACs), targeting thrombin or Xa factor, have been recommended as an optimal alternative due to their favorable property of thromboembolism prophylaxis and reduced bleeding risk. However, evidence of the fracture risk with NOACs use is limited...
2018: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/29688434/-ten-commandments-of-the-ehra-guide-for-the-use-of-noacs-in-af
#17
Jan Steffel, Hein Heidbuchel
No abstract text is available yet for this article.
April 21, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29679301/contemporary-antithrombotic-treatment-in-patients-with-non-valvular-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-rationale-and-design-of-the-greek-antiplatelet-atrial-fibrillation-grape-af-registry
#18
Ioanna Xanthopoulou, Vasiliki-Maria Dragona, Periklis Davlouros, Costas Tsioufis, Efstathios Iliodromitis, Dimitrios Alexopoulos
BACKGROUND: Approximately 5 to 7% of patients undergoing percutaneous coronary intervention (PCI) for the treatment of coronary artery disease require chronic oral anticoagulation (OAC) on top of aspirin and a P2Y12 receptor antagonist, mainly due to non-valvular atrial fibrillation (AF). The advent of non-vitamin K antagonist oral anticoagulants (NOACs) increased treatment options, while there is cumulative evidence that dual combination of a NOAC and a P2Y12 receptor antagonist attenuates risk of bleeding, compared to traditional triple therapy, consisting of a vitamin K antagonist (VKA), aspirin, and a P2Y12 receptor antagonist, without significantly compromising efficacy...
April 20, 2018: Cardiovascular Drugs and Therapy
https://www.readbyqxmd.com/read/29679144/antithrombotic-therapy-in-patients-with-non-valvular-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-should-we-change-our-practice-after-the-pioneer-af-pci-and-re-dual-pci-trials
#19
D Duerschmied, J Brachmann, H Darius, N Frey, H A Katus, W Rottbauer, A Schäfer, H Thiele, C Bode, Uwe Zeymer
The number of patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) is increasing. Since these patients have a CHA2 DS2 -VASc score of 1 or higher, they should be treated with oral anticoagulation to prevent stroke. However, combination therapy with oral anticoagulation for prevention of embolic stroke and dual platelet inhibition for prevention of coronary thrombosis significantly increases bleeding complications. The optimal combination, intensity and duration of antithrombotic combination therapy is still not known...
April 20, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29672182/oral-anticoagulant-use-in-cardiovascular-disorders-a-perspective-on-present-and-potential-indications-for-rivaroxaban
#20
A John Camm, Keith A A Fox
BACKGROUND: Four nonvitamin K antagonist oral anticoagulants (NOACs) have been approved for use in various cardiovascular indications. The direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors apixaban, edoxaban, and rivaroxaban are now increasingly used in clinical practice. For some of these agents, available data from real-world studies support the efficacy and safety data in phase III clinical trials. OBJECTIVES: This review aims to summarize the current status of trials and observational studies of oral anticoagulant use over the spectrum of cardiovascular disorders (excluding venous thrombosis), provide a reference source beyond stroke prevention for atrial fibrillation (AF) and examine the potential for novel applications in the cardiovascular field...
April 19, 2018: Current Medical Research and Opinion
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