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https://www.readbyqxmd.com/read/29785661/atrial-fibrillation-in-dialysis-patients-is-there-a-place-for-non-vitamin-k-antagonist-oral-anticoagulants
#1
REVIEW
Elzbieta Mlodawska, Paulina Lopatowska, Jolanta Malyszko, Maciej Banach, Bożena Sobkowicz, Adrian Covic, Anna Tomaszuk-Kazberuk
Atrial fibrillation (AF) occurs approximately in 3% of general population, with greater prevalence in elderly. Non-vitamin K-dependent oral anticoagulant agents (NOACs) according to the current European guidelines are recommended for patients with AF at high risk for stroke as a first-choice treatment. NOACs are not inferior to warfarin or some of them are better than warfarin in reducing the rate of ischemic stroke. Moreover, they significantly reduce the rate of intracranial hemorrhages, major bleedings, and mortality compared with warfarin...
May 21, 2018: International Urology and Nephrology
https://www.readbyqxmd.com/read/29782261/-chronic-kidney-disease-as-basis-of-high-thrombotic-and-bleeding-risk-in-patients-with-atrial-fibrillation-place-of-oral-anticoagulants
#2
A G Obrezan, A Y Zemchenkov
Chronic kidney disease (CKD) aggravates course of practically all diseases by worsening outcomes and hindering adequate treatment. Specificities of renal excretion of various drugs, changes of parameters of their pharmacokinetics and pharmacodynamics, nephrotoxic effects of drugs, tactics of drug therapy in conditions of CKD, terminal stage of kidney failure and dialysis are in the focus of attention of internists. To a greatest degree difficulties of drug therapy in CKD and associated clinical states refer to the group of anticoagulants...
April 2018: Kardiologiia
https://www.readbyqxmd.com/read/29754667/is-there-a-role-for-pharmacokinetic-pharmacodynamic-guided-dosing-for-novel-oral-anticoagulants
#3
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/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
#4
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/29706404/appropriate-doses-of-non-vitamin-k-antagonist-oral-anticoagulants-in-high-risk-subgroups-with-atrial-fibrillation-systematic-review-and-meta-analysis
#5
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/29628941/early-outcome-after-intracranial-hemorrhage-related-to-non-vitamin-k-oral-anticoagulants
#6
Senta Frol, Janja Pretnar Oblak
Background: Intracranial hemorrhage (ICH) is a serious, life-threatening, but fortunately rare complication of non-vitamin K oral anticoagulant (NOAC) therapy. There are limited data on NOAC-related ICH prognosis. Methods: All consecutive patients admitted to a single center due to acute NOAC-related ICH from September 2012 until the beginning of 2017 were included. Risk factors, type of NOAC, and location of ICH were evaluated. Risk for ischemic and bleeding events and clinical status upon admission and at discharge were evaluated using standard scales...
February 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29569500/mechanisms-of-action-and-clinical-use-of-specific-reversal-agents-for-non-vitamin-k-antagonist-oral-anticoagulants
#7
Kristoffer Andresen, Dan Atar, Erik Gjertsen, Waleed Ghanima, Svein Roseth, Odd Erik Johansen
OBJECTIVES: With a steadily growing number of patients with non-valvular atrial fibrillation, anticoagulation use increases. Anticoagulation therapy is associated with increased risk of serious bleeding and an increased complexity in management of patients in need for urgent surgery. We wanted to assess the magnitude of this challenge as well as review current and potential future clinical management strategies. DESIGN: A review of the literature on the magnitude of patients using antigoaculants in potential need for acute restoration of hemostasis was conducted, as well as current status of reversal agents for non-vitamin K antagonist oral anticoagulants (NOACs)...
March 23, 2018: Scandinavian Cardiovascular Journal: SCJ
https://www.readbyqxmd.com/read/29490992/oral-anticoagulation-in-very-elderly-patients-with-atrial-fibrillation-a-nationwide-cohort-study
#8
Tze-Fan Chao, Chia-Jen Liu, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen
Background -Stroke prevention with oral anticoagulants (OACs) is the cornerstone for the management of atrial fibrillation (AF). However, data about the use of OACs among patients aged ≥90 years are limited. We aimed to investigate the risk of ischemic stroke and intracranial hemorrhage (ICH), and the net clinical benefit (NCB) of OAC treatment for very elderly AF patients (≥90 years). Methods -This study used the "National Health Insurance Research Database" in Taiwan. Risks of ischemic stroke and ICH were compared between 11,064 AF and 14,658 non-AF patients aged ≥90 years without antithrombotic therapy from year 1996 to 2011...
February 28, 2018: Circulation
https://www.readbyqxmd.com/read/29488150/stroke-prevention-with-oral-anticoagulants-summary-of-the-evidence-and-efficacy-measures-as-an-aid-to-treatment-choices
#9
REVIEW
José Francisco Kerr Saraiva
Atrial fibrillation (AF) is an established risk factor for a first or recurrent stroke. Despite proven efficacy in preventing stroke in patients with AF, warfarin is underused, partly due to safety concerns. Recent randomized trials have shown that non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran (a direct thrombin inhibitor) and apixaban, edoxaban, and rivaroxaban (factor Xa inhibitors) are not only non-inferior or superior to warfarin but also demonstrate a decreased risk of cerebrovascular bleeding among patients with AF and moderate to high risk of stroke...
February 27, 2018: Cardiology and Therapy
https://www.readbyqxmd.com/read/29440949/the-prevalence-of-long-term-oral-anticoagulation-therapy-in-a-cardiology-center-in-bucharest-romania
#10
Adelina-Mihaela Sorescu, Tudor Enache, Suzana Guberna
Background and aims: Few studies discuss the prevalence of oral anticoagulation therapy (OAT) in clinical practice, despite their increasing use worldwide. In America, studies established that 20% to 80% of the patients with indication benefit from OAT. In Romania, there is no data regarding the utilization of oral anticoagulants. Thus, this study aims to determine the trends of OAT. Methods: We designed a cross-sectional study of the patients admitted to the Cardiology Department of the "Bagdasar-Arseni" Clinical Emergency Hospital, Bucharest, from the 1st of November 2016 until the 31st of January 2017...
2018: Clujul Medical (1957)
https://www.readbyqxmd.com/read/29372247/association-of-intracerebral-hemorrhage-among-patients-taking-non-vitamin-k-antagonist-vs-vitamin-k-antagonist-oral-anticoagulants-with-in-hospital-mortality
#11
COMPARATIVE STUDY
Taku Inohara, Ying Xian, Li Liang, Roland A Matsouaka, Jeffrey L Saver, Eric E Smith, Lee H Schwamm, Mathew J Reeves, Adrian F Hernandez, Deepak L Bhatt, Eric D Peterson, Gregg C Fonarow
Importance: Although non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used to prevent thromboembolic disease, there are limited data on NOAC-related intracerebral hemorrhage (ICH). Objective: To assess the association between preceding oral anticoagulant use (warfarin, NOACs, and no oral anticoagulants [OACs]) and in-hospital mortality among patients with ICH. Design, Setting, and Participants: Retrospective cohort study of 141 311 patients with ICH admitted from October 2013 to December 2016 to 1662 Get With The Guidelines-Stroke hospitals...
February 6, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29362869/antiplatelet-and-anticoagulant-agents-in-vitreoretinal-surgery-a-prospective-multicenter-study-involving-804-patients
#12
Cyril Meillon, Pierre Henry Gabrielle, Maxime Luu, Ludwig S Aho-Glele, Alain M Bron, Catherine Creuzot-Garcher
PURPOSE: To assess the rate of hemorrhagic complications after vitreoretinal surgery and the influence of antithrombotic agents. METHODS: Hemorrhagic complications of vitreoretinal procedures performed in seven ophthalmologic centers on patients treated or not treated with antiplatelet (AP) or anticoagulant (AC) agents were prospectively collected. Patients' characteristics, surgical techniques, and complications were recorded during surgery and for 1 month after...
March 2018: Graefe's Archive for Clinical and Experimental Ophthalmology
https://www.readbyqxmd.com/read/29171208/real-world-data-and-recommended-dosage-of-non-vitamin-k-oral-anticoagulants-for-korean-patients
#13
REVIEW
Boyoung Joung
Regulatory approvals of non-vitamin K antagonist oral anticoagulants (NOACs) have been based on large randomized phase III trials evaluating dabigatran, rivaroxaban, apixaban, or edoxaban relative to warfarin for atrial fibrillation (AF). The results of the trials showed that all NOACs were at least non-inferior to warfarin in the prevention of stroke/thromboembolism and showed lower rates of intracranial bleeding than those associated with warfarin. However, the trials were designed differently, varied in the inclusion/exclusion criteria, and used either one dose or a low/high dose of the NOAC drug...
November 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/29117605/-new-oral-anticoagulants-noac-in-stroke-treatment
#14
Clemens Küpper, Lars Kellert, Steffen Tiedt, Frank Arne Wollenweber
Since 2011, new oral anticoagulants (NOAC) can be prescribed for prevention of cardio-embolic ischemic strokes in addition to vitamin K antagonists. NOAC are indicated in patients with non-valvular atrial fibrillation. Although its use is a matter of debate in Germany, the neurological and cardiological societies recommend the use of NOAC over and above vitamin K antagonists due to a better benefit-to-risk ratio attributed to it, especially because of the lower risk of intracranial hemorrhage in NOAC use. A specific antidote is commercially available for the direct thrombin inhibitor dabigatran only...
February 2018: Fortschritte der Neurologie-Psychiatrie
https://www.readbyqxmd.com/read/29029621/uncertainty-on-the-effectiveness-and-safety-of-rivaroxaban-in-premenopausal-women-with-atrial-fibrillation-empirical-evidence-needed
#15
Herbert J A Rolden, Angela H E M Maas, Gert Jan van der Wilt, Janneke P C Grutters
BACKGROUND: Novel anticoagulations (NOACs) are increasingly prescribed for the prevention of stroke in premenopausal women with atrial fibrillation. Small studies suggest NOACs are associated with a higher risk of abnormal uterine bleeds than vitamin K antagonists (VKAs). Because there is no direct empirical evidence on the benefit/risk profile of rivaroxaban compared to VKAs in this subgroup, we synthesize available indirect evidence, estimate decision uncertainty on the treatments, and assess whether further research in premenopausal women is warranted...
October 13, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28974629/effectiveness-and-safety-of-non-vitamin-k-antagonist-oral-anticoagulants-in-asian-patients-with-atrial-fibrillation
#16
MULTICENTER STUDY
Myung-Jin Cha, Eue-Keun Choi, Kyung-Do Han, So-Ryoung Lee, Woo-Hyun Lim, Seil Oh, Gregory Y H Lip
BACKGROUND AND PURPOSE: There are limited real-world data comparing the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in Asians with nonvalvular atrial fibrillation. We aimed to compare the effectiveness and safety between NOACs and warfarin users in the Korean atrial fibrillation population, with particular focus on high-risk patients. METHODS: Using the Korean National Health Insurance Service database, we analyzed the risk of ischemic stroke, intracranial hemorrhage (ICH) events, and all-cause death in NOAC users (n=11 611 total, n=5681 taking rivaroxaban, n=3741 taking dabigatran, and n=2189 taking apixaban) compared with propensity score-matched warfarin users (n=23 222) among patients with high-risk atrial fibrillation (CHA2 DS2 -VASc score ≥2) between 2014 and 2015...
November 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28973247/association-between-use-of-non-vitamin-k-oral-anticoagulants-with-and-without-concurrent-medications-and-risk-of-major-bleeding-in-nonvalvular-atrial-fibrillation
#17
Shang-Hung Chang, I-Jun Chou, Yung-Hsin Yeh, Meng-Jiun Chiou, Ming-Shien Wen, Chi-Tai Kuo, Lai-Chu See, Chang-Fu Kuo
Importance: Non-vitamin K oral anticoagulants (NOACs) are commonly prescribed with other medications that share metabolic pathways that may increase major bleeding risk. Objective: To assess the association between use of NOACs with and without concurrent medications and risk of major bleeding in patients with nonvalvular atrial fibrillation. Design, Setting, and Participants: Retrospective cohort study using data from the Taiwan National Health Insurance database and including 91 330 patients with nonvalvular atrial fibrillation who received at least 1 NOAC prescription of dabigatran, rivaroxaban, or apixaban from January 1, 2012, through December 31, 2016, with final follow-up on December 31, 2016...
October 3, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28956288/pharmacological-and-non-pharmacological-treatments-for-stroke-prevention-in-patients-with-atrial-fibrillation
#18
REVIEW
Laura Ueberham, Nikolaos Dagres, Tatjana S Potpara, Andreas Bollmann, Gerhard Hindricks
Atrial fibrillation (AF) is associated with significant risk of stroke and other thromboembolic events, which can be effectively prevented using oral anticoagulation (OAC) with either vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, or edoxaban. Until recently, VKAs were the only available means for OAC treatment. NOACs had similar efficacy and were safer than or as safe as warfarin with respect to reduced rates of hemorrhagic stroke or other intracranial bleeding in the respective pivotal randomized clinical trials (RCTs) of stroke prevention in non-valvular AF patients...
October 2017: Advances in Therapy
https://www.readbyqxmd.com/read/28950374/non-vitamin-k-antagonist-oral-anticoagulants-in-patients-with-atrial-fibrillation-and-valvular-heart-disease-systematic-review-and-meta-analysis
#19
Daniel Caldeira, Cláudio David, João Costa, Joaquim J Ferreira, Fausto J Pinto
The non-vitamin K antagonist oral anticoagulants (NOACs) were approved for non-valvular atrial fibrillation (AF) but this term may be misnomer. Thus, the term non-mechanical and rheumatic mitral valvular (non-MARM) AF was proposed to exclude patients with valvular heart disease (VHD) without contraindications for NOACs. We aimed to review the efficacy and safety of NOACs in patients with AF and VHD compared to Vitamin K Antagonists (VKA). We performed a systematic review with meta-analysis (PROSPERO CRD42015024837) including data from randomized controlled trials (RCTs) retrieved in November 2016...
April 1, 2018: European Heart Journal. Cardiovascular Pharmacotherapy
https://www.readbyqxmd.com/read/28844514/comparison-of-the-cha-2-ds-2-vasc-chads-2-has-bled-orbit-and-atria-risk-scores-in-predicting-non-vitamin-k-antagonist-oral-anticoagulants-associated-bleeding-in-patients-with-atrial-fibrillation
#20
COMPARATIVE STUDY
Xiaoxi Yao, Bernard J Gersh, Lindsey R Sangaralingham, David M Kent, Nilay D Shah, Neena S Abraham, Peter A Noseworthy
The increasing adoption of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF) necessitates a reassessment of bleeding risk scores. Because known risk factors for bleeding are largely the same as for stroke, we hypothesize that stroke risk scores could also be used to identify patients with high bleeding risks. We aimed to compare the performance of 2 stroke risk scores (Congestive Heart failure, hypertension, Age ≥75 [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65-74, and Sex [female] [CHA2 DS2 -VASc] and Cardiac failure, Hypertension, Age, Diabetes, Stroke [Doubled] [CHADS2 ]) and 3 bleeding risk scores (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or predisposition, labile INR, elderly [...
November 1, 2017: American Journal of Cardiology
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