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Direct oral anticoagulant

Hui Yin Lim, Harshal Nandurkar, Prahlad Ho
The advent of direct oral anticoagulants (DOACs) has revolutionized anticoagulation management in both stroke prevention and venous thromboembolism (VTE) treatment/prevention. Clinical trials and secondary real-world data have shown that DOACs have similar efficacy and, in some cases, improved bleeding safety profiles compared with vitamin K antagonists. Together with benefits of patient convenience, this has shifted the risk-benefit ratio toward long-term anticoagulation. However, current VTE risk assessment models are based on vitamin K antagonists and do not take into account the new paradigm of DOACs...
March 20, 2018: Seminars in Thrombosis and Hemostasis
Megan Z Roberts, G Eric Gaskill, Julie Kanter-Washko, T Rogers Kyle, Brittany C Jones, Nicole M Bohm
Patients with sickle cell disease (SCD) experience initial and recurrent venous thromboembolism (VTE) more commonly and at a younger age than the general population, and it confers a higher mortality for patients with SCD. However, limited evidence is available to guide anticoagulant use for VTE treatment in this population. The primary objective of this study is to characterize the effectiveness and safety of direct oral anticoagulants (DOAC) and warfarin for VTE treatment among patients with SCD. This single-center retrospective study includes adult patients with SCD who were diagnosed with VTE...
March 19, 2018: Journal of Thrombosis and Thrombolysis
Andrea Szegedi, Zoltán Csanádi
The significantly increased incidence of stroke and systemic embolisation caused by atrial fibrillation can be prevented by adequately adjusted anticoagulant therapy. Vitamin K antagonists effectively decrease the risk of thromboembolic events but this effect is influenced by many factors. The development of the new direct oral anticoagulant drugs (DOAC) in the last few years provided new opportunities for us to choose the suitable anticoagulant therapy. According to the results of the ENGAGE AF-TIMI 48 and ENSURE-AF multicenter, randomized trials, edoxaban, the recently introduced DOAC is equally effective as the traditional coumarin therapy, nevertheless, it ensures more tolerable anticoagulation for patients suffering from non-valvular atrial fibrillation...
March 2018: Orvosi Hetilap
Thomas C Sauter, Balthasar Eberle, Walter A Wuillemin, Thomas Thiele, Anne Angelillo-Scherrer, Aristomenis K Exadaktylos, Gabor Erdös, Adam Cuker, Michael Nagler
Antithrombotic treatment puts patients at risk of major bleeding. Fast and adequate response to anticoagulant-associated bleeding may not only stop the bleeding but prevent severe complications. However, practical treatment algorithms to guide physicians in emergency situations are lacking. Important principles that arise from management of bleeding in general are (a) implementation of an in-house algorithm, (b) rapid identification and treatment of the bleeding source, (c) adequate fluid resuscitation, (d) consideration of the application of tranexamic acid and (e) appropriate coagulation testing...
March 14, 2018: Swiss Medical Weekly
Matthew Gaskins, Martin Dittmann, Lisa Eisert, Ricardo Niklas Werner, Corinna Dressler, Christoph Löser, Alexander Nast
BACKGROUND: A survey in 2012 revealed marked heterogeneity in the management of antithrombotic agents in dermatologic surgery in Germany. An evidence-based guideline on this topic was published for the first time in 2014. METHODS: Using the same study sample, we conducted an anonymous survey on the management of antithrombotic agents and familiarity with the guideline. We reported the results as relative frequencies and compared them with those from 2012. RESULTS: We analyzed a total of 208 questionnaires (response rate: 36...
March 2018: Journal der Deutschen Dermatologischen Gesellschaft, Journal of the German Society of Dermatology: JDDG
Geoffrey D Barnes, Erin Mouland
Peri-procedural management of oral anticoagulants can be complex and confusing for many providers. It involves a careful balance of a patient's thromboembolic risk and bleeding risk. For every patient chronically taking an oral anticoagulant who will be undergoing an elective procedure, a four step approach may be considered when creating a plan for the oral anticoagulant.(Writing Group M, 20161 ) Does the oral anticoagulant need to stop for the procedure?(Periprocedural Management of Anticoagulation Writing C, Doherty JU, Gluckman TJ, et al...
March 10, 2018: Progress in Cardiovascular Diseases
Sophie Testa, Oriana Paoletti, Cristina Legnani, Claudia Dellanoce, Emilia Antonucci, Benilde Cosmi, Vittorio Pengo, Daniela Poli, Rossella Morandini, Roberto Testa, Armando Tripodi, Gualtiero Palareti
BACKGROUND: Direct oral anticoagulants(DOACs) are administered at fixed dose without need for dose adjustment by lab testing. A high inter-individual variability in the drug blood levels was shown with all DOACs. To evaluate a possible relationship between DOAC C-trough anticoagulant levels and thromboembolic events,565 consecutivenaïve patients withatrial fibrillation (AF), were enrolled in this study performed within the START-Laboratory Registry. METHODS: DOAC specific measurements [diluted thrombin time (dTT) or anti-FIIa calibrated for dabigatran; anti-FXa calibrated for rivaroxaban or apixaban] at C-trough were performed locally at steady state within 15-25 days from starting treatment...
March 12, 2018: Journal of Thrombosis and Haemostasis: JTH
Anne-Céline Martin, Sarah Lessire, Isabelle Leblanc, Anne-Sophie Dincq, Ivan Philip, Isabelle Gouin-Thibault, Anne Godier
BACKGROUND: Guidelines recommend to perform atrial fibrillation (AF) catheter ablation without interruption of direct oral anticoagulant (DOAC) and to administer unfractionated heparin (UFH) for an activated clotting time (ACT) ≥300 seconds, by analogy with vitamin K antagonist (VKA). Nevertheless, pharmacological differences between DOAC and VKA, especially regarding ACT sensitivity and UFH response, prevent extrapolation from VKA to DOAC. HYPOTHESIS: The level of anticoagulation at the time of the procedure in uninterrupted DOAC-treated patients is unpredictable, and would complicate intra-procedural UFH administration and monitoring...
March 13, 2018: Clinical Cardiology
Amihai Rottenstreich, Netanel Zacks, Geffen Kleinstern, Bruria Hirsh Raccah, Batia Roth, Nael Da'as, Yosef Kalish
The role of drug-level monitoring among patients using direct-acting oral anticoagulant (DOAC) is unclear. We aimed to investigate its 'real-life' utilization and effect on clinical management. A review of records of patients who underwent DOAC level testing during 2013-2017. Overall, 212 patients (median age 77 years) underwent 292 DOAC measurements [apixaban (n = 147), rivaroxaban (n = 102), dabigatran (n = 43)]. Monitoring volume increased by 460% during study period. DOAC level testing was performed during routine follow-up in 51 (17...
March 12, 2018: Journal of Thrombosis and Thrombolysis
John Burn, Munir Pirmohamed
About 1.4 British million people are at risk of strokes due to non-valvular atrial fibrillation (AF) necessitating long-term anticoagulation. The vitamin K antagonist, warfarin, has a long half-life and narrow therapeutic range necessitating regular monitoring and is a common cause of iatrogenic hospital admission. Direct-acting oral anticoagulants (DOACs), dabigatran, rivaroxaban, apixaban and edoxaban are not required to have monitoring but are sensitive to changes in renal function and are associated with poorer adherence...
2018: Open Heart
Kori Leblanc, William M Semchuk, John Papastergiou, Blair Snow, Leilany Mandlsohn, Vinay Kapoor, Lisa M Guirguis, James D Douketis, William Geerts, David J Gladstone
No abstract text is available yet for this article.
March 2018: Canadian Pharmacists Journal: CPJ, Revue des Pharmaciens du Canada: RPC
Fabian Plank, Christoph Beyer, Guy Friedrich, Markus Stühlinger, Florian Hintringer, Wolfgang Dichtl, Matthias Wildauer, Gudrun Feuchtner
OBJECTIVE: Vitamin K antagonists (VKA) are associated with increased vascular calcification which may lead to an elevated cardiovascular risk. If the direct anticoagulants (DOACs) have similar negative vascular effects is unknown. We evaluated the influence of different anticoagulation strategies on coronary artery disease (CAD) using coronary computed tomography angiography (CTA). METHODS: Overall 702 consecutive patients with non-valvular atrial fibrillation (AF) who underwent CTA for AF ablation planning were enrolled and stratified according to their anticoagulation into VKA, DOAC (all agents) and a control group without oral anticoagulation...
March 6, 2018: International Journal of Cardiology
Flavia Mayer, Ursula Kirchmayer, Paola Coletta, Nera Agabiti, Valeria Belleudi, Giovanna Cappai, Mirko Di Martino, Sebastian Schneeweiss, Marina Davoli, Elisabetta Patorno
BACKGROUND: Real-time monitoring is used to the ends of postmarketing observational research on newly marketed drugs. We implemented a pilot near-real-time monitoring program on the test case of oral anticoagulants. Specifically, we evaluated the safety and effectiveness of direct oral anticoagulants compared to vitamin K antagonists in nonvalvular atrial fibrillation secondary prevention during 2013-2015 in the Lazio Region, Italy. METHODS AND RESULTS: A cohort study was conducted using a sequential propensity-score-matched new user parallel-cohort design...
March 10, 2018: Journal of the American Heart Association
Wesley T O'Neal, Pratik B Sandesara, J'Neka S Claxton, Richard F MacLehose, Lin Y Chen, Lindsay G S Bengtson, Alanna M Chamberlain, Faye L Norby, Pamela L Lutsey, Alvaro Alonso
BACKGROUND: Differences in anticoagulation rates and direct oral anticoagulant use by provider specialty may identify an area of practice improvement to reduce future stroke events in patients with atrial fibrillation (AF). METHODS AND RESULTS: We examined anticoagulant prescription fills in 388 045 (mean age, 68±15 years; 59% male) patients with incident AF from the MarketScan databases between 2009 and 2014. Provider specialty and filled anticoagulant prescriptions around the time of AF diagnosis (3 months before through 6 months after) were obtained from outpatient services and pharmacy claims...
March 10, 2018: Journal of the American Heart Association
Amihai Rottenstreich, Yosef Kalish
No abstract text is available yet for this article.
March 2, 2018: Thrombosis Research
A L Sennesael, A S Larock, B Devalet, V Mathieux, F Verschuren, X Muschart, O Dalleur, J M Dogné, A Spinewine
AIMS: To determine the preventability of serious adverse drug reactions (ADR) related to the use of direct oral anticoagulants (DOAC), and to explore contributing factors to preventable ADRs. Results were compared with vitamin K antagonists (VKA). METHODS: We conducted a prospective observational study in the emergency departments of two teaching hospitals from July 2015 to January 2016. Patients admitted with a thrombotic or bleeding event while under DOAC or VKA were included...
March 9, 2018: British Journal of Clinical Pharmacology
Melissa M Cushing, James Kelley, Ellen Klapper, David F Friedman, Ruchika Goel, Nancy M Heddle, Courtney K Hopkins, Julie Katz Karp, Monica B Pagano, Ajay Perumbeti, Glenn Ramsey, John D Roback, Joseph Schwartz, Beth H Shaz, Philip C Spinella, Claudia S Cohn, Claudia S Cohn, Melissa M Cushing, James Kelley, Ellen Klapper
BACKGROUND: The AABB compiles an annual synopsis of the published literature covering important developments in the field of Transfusion Medicine. For the first time, an abridged version of this work is being made available in TRANSFUSION, with the full-length report available as an Appendix S1 (available as supporting information in the online version of this paper). STUDY DESIGN AND METHODS: Papers published in 2016 and early 2017 are included, as well as earlier papers cited for background...
March 9, 2018: Transfusion
Alessandro Cipriano, Alessio Pecori, Alessandra Eugenia Bionda, Michele Bardini, Francesca Frassi, Francesco Leoli, Valentina Lami, Lorenzo Ghiadoni, Massimo Santini
Prognosis after mild traumatic brain injury (MTBI) on oral anticoagulant therapy (OAT) is uncertain. We evaluated the rate of immediate and delayed traumatic intracranial hemorrhage (ICH) comparing vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs) and the safety of a clinical management protocol. In this single-center prospective observational study, we enrolled 220 patients on OAT with MTBI. After a first negative CT scan, asymptomatic patients underwent a close neurological observation; if neurologically stable, they were discharged without a second CT scan and followed up for 1 month...
March 8, 2018: Internal and Emergency Medicine
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
Jordanne Feldberg, Param Patel, Ashley Farrell, Sylvia Sivarajahkumar, Karen Cameron, Jennifer Ma, Marisa Battistella
Background: There is a lack of clear benefit and a potential risk of bleeding with direct oral anticoagulant (DOAC) use in chronic kidney disease (CKD) and dialysis patients with atrial fibrillation. The objective of this study was to evaluate how treatment with DOACs affects stroke and bleeding outcomes compared with warfarin or aspirin. Methods: We conducted a systematic review of randomized controlled trials, cohort studies and case series, and searched electronic databases from 1946 to 2017...
March 2, 2018: Nephrology, Dialysis, Transplantation
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