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Direct oral anticoagulant

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https://www.readbyqxmd.com/read/28635338/risk-of-stroke-systemic-embolism-major-bleeding-and-associated-costs-in-non-valvular-atrial-fibrillation-patients-who-initiated-apixaban-dabigatran-or-rivaroxaban-compared-with-warfarin-in-the-united-states-medicare-population
#1
Alpesh Amin, Allison Keshishian, Jeffrey Trocio, Oluwaseyi Dina, Hannah Le, Lisa Rosenblatt, Xianchen Liu, Jack Mardekian, Qisu Zhang, Onur Baser, Lien Vo
OBJECTIVE: To compare the risk and cost of stroke/systemic embolism (SE) and major bleeding between each direct oral anticoagulant (DOAC) and warfarin among non-valvular atrial fibrillation (NVAF) patients. METHODS: Patients (≥65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Medicare database from 01/01/2013-12/31/2014. Patients initiating each DOAC were matched 1:1 to warfarin patients using propensity score matching to balance demographics and clinical characteristics...
June 21, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28635328/dietary-implications-for-patients-receiving-long-term-oral-anticoagulation-therapy-for-treatment-and-prevention-of-thromboembolic-disease
#2
Emmanouela Kampouraki, Farhad Kamali
The effectiveness of oral anticoagulation therapy with warfarin (a vitamin K antagonist) in the treatment of thromboembolic disease, including stroke prophylaxis in patients with atrial fibrillation is well recognised. However, warfarin has a narrow therapeutic window and an unpredictable anticoagulation response, which make it difficult to achieve and maintain optimal anticoagulation. Various dietary factors, including sudden changes in eating patterns, can significantly alter anticoagulation control, thereby potentially exposing patients to the risk of bleeding or thromboembolic complications...
June 21, 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/28629627/direct-oral-anticoagulants-in-patients-with-cervical-artery-dissection-and-cerebral-venous-thrombosis-a-case-series-and-review-of-the-literature
#3
Manuel Cappellari, Paolo Bovi
BACKGROUND: To date, very little is known about the effects of direct oral anticoagulants (DOA) use in patients with cervical artery dissection (CAD) and cerebral venous thrombosis (CVT). We present our initial experience with the use of DOA for CAD and CVT and an overview of the published literature. METHODS: From our database, we identified 4 patients who received DOA after CAD and 4 patients after CVT. Also, we analyzed the data reported for 45 patients who received DOA after CAD and 23 after CVT from review of the literature...
June 13, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28625512/first-experience-with-edoxaban-and-atrial-fibrillation-ablation-insights-from-the-engage-af-timi-48-trial
#4
Jan Steffel, Christian T Ruff, Rose A Hamershock, Sabina A Murphy, Roxy Senior, Denis Roy, Hans-Joachim Lanz, Michele F Mercuri, Elliott M Antman, Robert P Giugliano
BACKGROUND: Atrial fibrillation (AF) ablation procedures are increasingly being performed in patients receiving direct oral anticoagulants (DOACs). Experience regarding the safety of edoxaban in this context is limited. In an exploratory analysis we therefore investigated the outcome of patients undergoing transcatheter AF ablation in the ENGAGE AF-TIMI 48 trial. METHODS & RESULTS: During the trial, 193 transcatheter AF ablation procedures were performed in 169 patients...
June 2, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28625215/assessing-coagulation-by-rotational-thromboelastometry-rotem-in-rivaroxaban-anticoagulated-blood-using-hemostatic-agents
#5
Jonathan Bar, Alexa David, Tarek Khader, Mary Mulcare, Christopher Tedeschi
Introduction The use of direct oral anticoagulants (DOACs) such as rivaroxaban (Xarelto) is increasingly common. However, therapies for reversing anticoagulation in the event of hemorrhage are limited. This study investigates the ability of hemostatic agents to improve the coagulation of rivaroxaban-anticoagulated blood, as measured by rotational thromboelastometry (ROTEM). Hypothesis/Problem If a chitosan-based hemostatic agent (Celox), which works independently of the clotting cascade, is applied to rivaroxaban-anticoagulated blood, it should improve coagulation by decreasing clotting time (CT), decreasing clot formation time (CFT), and increasing maximum clot firmness (MCF)...
June 19, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28623609/administration-of-direct-oral-anticoagulants-in-patients-with-myeloproliferative-neoplasms
#6
Jean-Christophe Ianotto, Marie-Anne Couturier, Hubert Galinat, Dominique Mottier, Christian Berthou, Gaëlle Guillerm, Eric Lippert, Aurélien Delluc
Direct oral anticoagulants (DOACs) have been approved to treat and prevent thrombotic events. However, they are not yet labeled for use in patients with active cancers. Myeloproliferative neoplasms (MPNs) are clonal chronic disorders with a high incidence of thrombotic events, for which low-dose aspirin (LDA) is the standard drug treatment. We analyzed efficacy and safety of DOACs prescription in patients treated for MPNs. An MPN database, the OBENE registry, was established at our institution. We collected biological and clinical data from diagnosis to last follow-up for every patient included in this study...
June 16, 2017: International Journal of Hematology
https://www.readbyqxmd.com/read/28615214/safety-and-efficacy-of-rivaroxaban-in-patients-with-cardiac-implantable-electronic-devices-observations-from-the-rocket-af-trial
#7
George C Leef, Anne S Hellkamp, Manesh R Patel, Richard C Becker, Scott D Berkowitz, Günter Breithardt, Jonathan L Halperin, Graeme J Hankey, Werner Hacke, Christopher C Nessel, Daniel E Singer, Keith A A Fox, Kenneth W Mahaffey, Jonathan P Piccini
BACKGROUND: Although implantation of cardiac implantable electronic devices (CIEDs) in patients receiving warfarin is well studied, limited data are available on the use of oral factor Xa inhibitors in this setting. METHODS AND RESULTS: Using data from Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) (n=14 264), we compared baseline characteristics and clinical outcomes in patients with atrial fibrillation randomized to rivaroxaban versus warfarin who did and did not undergo CIED implantation or revision...
June 14, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28607611/report-of-periprocedural-oral-anticoagulants-in-catheter-ablation-for-atrial-fibrillation-the-japanese-catheter-ablation-registry-of-atrial-fibrillation-j-caraf
#8
Yuji Murakawa, Akihiko Nogami, Morio Shoda, Koichi Inoue, Shigeto Naito, Koichiro Kumagai, Yasushi Miyauchi, Teiichi Yamane, Norishige Morita, Hideo Mitamura, Ken Okumura, Kenzo Hirao
BACKGROUND: To obtain a perspective of the current status of catheter ablation for the cure of atrial fibrillation, the Japanese Heart Rhythm Society conducted a nationwide survey: the Japanese Catheter Ablation Registry of Atrial Fibrillation. In this report, we aimed to evaluate the periprocedural use of direct oral anticoagulants with respect to thromboembolic or bleeding complications. METHODS: Using an online questionnaire, the Japanese Heart Rhythm Society requested electrophysiology centers in Japan to register the relevant data of patients who underwent atrial fibrillation ablation over selected five-months from 2011 to 2014...
June 2017: Journal of Arrhythmia
https://www.readbyqxmd.com/read/28604569/use-of-four-factor-prothrombin-complex-concentrate-in-the-reversal-of-warfarin-induced-and-nonvitamin-k-antagonist-related-coagulopathy
#9
Hannah Young, Jeremy L Holzmacher, Richard Amdur, Stephen Gondek, Babak Sarani, Mary E Schroeder
: To evaluate the efficacy of international normalized ratio (INR) reversal using four-factor prothrombin complex concentrate (4F-PCC) in nonmedication-induced coagulopathy. We performed a single-site, retrospective cohort study of patients receiving off-label use of 4F-PCC. Cohorts included liver dysfunction if they had acute liver decompensation or cirrhosis without other causative factors of liver failure such as sepsis, coagulopathy of acute sepsis (CAS) if they had documentation of sepsis and no underlying liver disorder, known factor deficiencies, or medication-induced coagulopathy, or warfarin if they were taking warfarin...
June 9, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28604566/novel-oral-anticoagulants-in-the-peri-endoscopic-period
#10
Michael Genualdi, William H Frishman
Millions of patients in the United States are currently prescribed some form of anticoagulation therapy. Recently, novel oral anticoagulants (NOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, have begun to replace warfarin as the drugs of choice for anticoagulation. As the use of these medications becomes more widespread, it is increasingly important for gastroenterologists to understand the risks associated with performing endoscopic procedures on patients who are taking NOACs. In this review, we provide an overview of the NOACs, as well as current guidelines from international societies regarding the management of patients scheduled to undergo endoscopic procedures who are prescribed these medications...
April 6, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28601546/influences-of-obesity-and-bariatric-surgery-on-the-clinical-and-pharmacologic-profile-of-rivaroxaban
#11
REVIEW
Kenneth Todd Moore, Dino Kröll
The health implications of obesity are myriad and multifaceted. Physiologic changes associated with obesity can affect the absorption, distribution, metabolism, and excretion of administered drugs, thereby altering their pharmacologic profiles. In 2016, the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis published recommendations regarding the use of direct oral anticoagulants (DOACs) in obese patients. This guidance provides uniform recommendations for all DOACs, yet data suggest that individual agents may be affected to different degrees by obesity...
June 7, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28601413/causes-and-predictors-of-death-in-atrial-fibrillation-patients-initiating-treatment-with-direct-oral-anticoagulants
#12
César Caro Martínez, José M Andreu Cayuelas, Ginés Elvira Ruiz, Helena Albendín Iglesias, Arcadio García Alberola, Sergio Manzano Fernández
No abstract text is available yet for this article.
June 7, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28596467/-embolic-stroke-of-undetermined-source
#13
Teruyuki Hirano
A new clinical construct, embolic stroke of undetermined source (ESUS) was established as a therapeutically relevant entity, which are defined as a non-lacunar infarction without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation, especially with direct oral anticoagulant (DOAC). The possible embolic sources include covert atrial fibrillation, arterial stenosis with <50%, low-risk emboligenic cardiac sources, aortic plaque, cancer-associated, and paradoxical embolism...
June 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28594049/venous-thromboembolism-past-present-and-future
#14
Sam Schulman, Walter Ageno, Stavros V Konstantinides
Venous thromboembolism (VTE), the third most frequent acute cardiovascular syndrome, is associated with a considerable disease burden which continues to grow along with the longer life expectancy of the population worldwide. In the past century, parenteral heparin prophylaxis was established for hospitalised patients at elevated risk of VTE. More recently, non-vitamin K antagonist oral anticoagulants (NOACs) with a direct inhibiting effect on factor Xa or thrombin, underwent extensive testing in clinical trials and have been approved for patients undergoing hip or knee replacement...
June 8, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28593681/initial-anticoagulation-in-patients-with-pulmonary-embolism-thrombolysis-unfractionated-heparin-lmwh-fondaparinux-or-doacs
#15
REVIEW
Jenneke Leentjens, Mike Peters, Anne C Esselink, Yvo Smulders, Cornelis Kramers
The initial treatment of hemodynamically stable patients with pulmonary embolism (PE) has dramatically changed since the introduction of low molecular weight heparins (LMWHs). With the recent discovery of the direct oral anticoagulant drugs (DOACs), initial treatment of PE will be simplified even further. In several large clinical trials it has been demonstrated that DOACs are non-inferior to standard therapy for the initial treatment of PE, and because of their practicability they are becoming the agents of first choice...
June 7, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28587908/elevating-4-hydroxycoumarin-production-through-alleviating-thioesterase-mediated-salicoyl-coa-degradation
#16
Xiaolin Shen, Monika Mahajani, Jia Wang, Yaping Yang, Qipeng Yuan, Yajun Yan, Yuheng Lin
Acyl-CoAs are essential intermediates in the biosynthetic pathways of a number of industrially and pharmaceutically important molecules. When these pathways are reconstituted in a heterologous microbial host for metabolic engineering purposes, the acyl-CoAs may be subject to undesirable hydrolysis by the host's native thioesterases, resulting in a waste of cellular energy and decreased intermediate availability, thus impairing bioconversion efficiency. 4-hydroxycoumarin (4HC) is a direct synthetic precursor to the commonly used oral anticoagulants (e...
June 3, 2017: Metabolic Engineering
https://www.readbyqxmd.com/read/28587584/strategies-to-optimize-dual-antiplatelet-therapy-after-coronary-artery-stenting-in-acute-coronary-syndrome
#17
Bridget Paravattil, Hazem Elewa
The use of aspirin and a P2Y12 receptor antagonist as dual antiplatelet therapy (DAPT) has become the treatment of choice in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention to prevent recurrent thrombotic events. Although DAPT is beneficial for most patients, few patients still experience recurrent thrombotic events and increased bleeding episodes. This article reviews current literature to identify various approaches that may enhance the DAPT benefit-risk ratio in patients with ACS...
July 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28585903/dabigatran-following-acute-transient-ischemic-attack-and-minor-stroke-ii-datas-ii
#18
Kuan H Ng, Mukul Sharma, Oscar Benavente, Laura Gioia, Thalia S Field, Michael D Hill, Shelagh B Coutts, Kenneth Butcher
Rationale Patients with transient ischemic attack or minor stroke are at high risk of early recurrent cerebrovascular events. Anticoagulation with heparin or warfarin acutely after ischemic stroke is at least as efficacious as aspirin for preventing recurrent events but is associated with an increased risk of clinical worsening due to hemorrhagic transformation. Aim and hypothesis We aim to demonstrate the safety of early anticoagulation with dabigatran, an oral direct thrombin inhibitor, in acute cerebrovascular syndrome patients...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28585189/modulatory-role-of-nurr1-activation-and-thrombin-inhibition-in-the-neuroprotective-effects-of-dabigatran-etexilate-in-rotenone-induced-parkinson-s-disease-in-rats
#19
Esraa A Kandil, Rabab H Sayed, Lamiaa A Ahmed, Mai A Abd El Fattah, Bahia M El-Sayeh
Recently, it has been shown that both decreased nuclear receptor-related 1 (Nurr1) expression and thrombin accumulation are involved in the degeneration of dopaminergic neurons in Parkinson's disease (PD). The new anticoagulant dabigatran etexilate (DE) is a direct thrombin inhibitor that owns benzimidazole group, which has been proposed to activate Nurr1. In the present study, we examined the neuroprotective effects of DE in rotenone model of PD. Rotenone was injected subcutaneously at a dose of 1.5 mg/kg every other day for 21 days...
June 5, 2017: Molecular Neurobiology
https://www.readbyqxmd.com/read/28581331/exploring-indications-for-the-use-of-direct-oral-anticoagulants-and-the-associated-risks-of-major-bleeding
#20
Truman J Milling, Jennifer Frontera
Thrombosis is a leading cause of morbidity and mortality in the United States. Arterial and venous thromboses are implicated in the pathogenesis of major disorders, including myocardial infarction, ischemic stroke, and venous thromboembolism. Over the past decade, direct oral anticoagulants (DOACs) (eg, direct thrombin inhibitor and factor Xa [FXa] inhibitors) have been adopted as alternatives to warfarin due to their clinical advantages and efficacy for the treatment of thrombosis. As with all anticoagulants, treatment with DOACs is associated with a risk of major bleeding, including life-threatening gastrointestinal bleeds and intracranial hemorrhages (ICHs)...
April 2017: American Journal of Managed Care
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