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Donal J Sexton, Declan G de Freitas, Mark A Little, Tomas McHugh, Colm Magee, Peter J Conlon, Conall M O'Seaghdha
We report 2 cases of apixaban use as prophylaxis against thromboembolism in the nephrotic syndrome (NS), and review the existing literature on direct-acting oral anticoagulant (DOAC) use in this scenario. Our cases appear to be the first reported use of apixaban as prophylaxis against thromboembolism in NS. We report our systematic review of the existing literature on direct-acting oral anticoagulant (DOAC) use in NS, and discuss theoretical issues relevant to their therapeutic use in this clinical scenario...
July 2018: KI Reports
Kathrin I Foerster, Andrea Huppertz, Andreas D Meid, Oliver J Müller, Timolaos Rizos, Lisa Tilemann, Walter E Haefeli, Jürgen Burhenne
Plasma concentrations of direct oral anticoagulants (DOAC) vary largely between individuals, while they correlate well with desired and adverse outcomes. Although regular concentration monitoring of DOAC is not recommended, information on DOAC exposure could be useful in situations, when multiple DOAC clearance pathways are impaired or non-adherence is suspected. Self-sampling techniques, like dried blood spots (DBS), would be particularly useful because they enable collecting information in ambulatory patients at relevant points in time of the dosing interval (e...
July 9, 2018: Analytical Chemistry
Agnieszka Janion-Sadowska, Elżbieta Papuga-Szela, Robert Łukaszuk, Magdalena Chrapek, Anetta Undas
AIMS: Thrombocytopenia was one of the exclusion criteria in randomized trials in which non-vitamin K antagonist oral anticoagulants (NOACs) were tested. The safety of NOACs in patients with atrial fibrillation (AF) and thrombocytopenia remains unclear. METHODS: We studied 62 AF patients aged from 53 to 85 (mean 70.5) years with platelet count from 50 to 100×109/L who were treated with rivaroxaban 15 mg once daily (33.9%), dabigatran 110 mg bid (54.8%) or apixaban 2...
June 27, 2018: Journal of Cardiovascular Pharmacology
Dimitrios Farmakis, Periklis Davlouros, Gregory Giamouzis, George Giannakoulas, Athanasios Pipilis, Georgios Tsivgoulis, John Parissis
Direct or new oral anticoagulants (NOACs), including the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, have recently revolutionized the field of antithrombotic therapy for stroke and systemic embolism prevention in nonvalvular atrial fibrillation (NVAF). Randomized controlled trials have shown that these agents have at least comparable efficacy with vitamin K antagonists along with superior safety, at least in what concerns intracranial hemorrhage...
July 5, 2018: Cardiology
Chao-Lun Lai, Ho-Min Chen, Min-Tsun Liao, Ting-Tse Lin
OBJECTIVES: To compare the effectiveness and safety of reduced-dose dabigatran, reduced-dose rivaroxaban, and warfarin in individuals aged 85 and older with atrial fibrillation (AF). DESIGN: Retrospective cohort study. SETTING: Taiwan National Health Insurance claims database, 2011∼2015. PARTICIPANTS: Individuals with AF aged 85 and older (mean 88.6) with incident use of oral anticoagulants between June 1, 2012 and May 31, 2015 (N=4,722; dabigatran 110 mg, n=1,489; rivaroxaban 15 mg/10 mg, n=1,736; warfarin, n=1,497)...
July 4, 2018: Journal of the American Geriatrics Society
Menno V Huisman, Melanie Ferrreira, Martin Feuring, Mandy Fraessdorf, Frederikus A Klok
INTRODUCTION: While Direct Oral Anticoagulants (DOACs) are associated with a better safety profile than warfarin in patients with acute venous thromboembolism (VTE), direct factor Xa-inhibitors involve a higher risk of abnormal uterine bleeding (AUB). We aimed to determine the risk of AUB during anticoagulation with dabigatran compared to warfarin. METHODS: Post-hoc analysis of the pooled RE-COVER studies and the RE-MEDY trial. Incidences of AUB, based on a defined preferred terms search in adverse events, in female patients aged 18-50 years treated with dabigatran were compared with those treated with warfarin...
July 5, 2018: Journal of Thrombosis and Haemostasis: JTH
P Priyanka, J T Kupec, M Krafft, N A Shah, G J Reynolds
Background: Newer oral anticoagulants (NOACs) are being utilized increasingly for the treatment of venous thromboembolism (VTE). NOAC use is the standard of care for stroke prophylaxis in nonvalvular atrial fibrillation and treatment of acute VTE involving extremities and pulmonary embolism. In contrast, most guidelines in the literature support the treatment of acute portal vein thrombosis (PVT) with low molecular weight heparin (LMWH) and vitamin K antagonists (VKA). Literature evaluating NOAC use in the treatment of acute portal vein thrombosis is sparse...
2018: International Journal of Hepatology
Eriko Morishita
Despite the introduction of direct oral anticoagulants (DOAC), the need for more effective and safer antithrombotic strategies exists. Recently, the findings stating that the contact system is important for thrombus formation has identified factor XI as a potential target for new anticoagulants. Approximately 20-30% of patients who develop venous thromboembolism (VTE) also have cancer. To date, the drugs primarily used in the treatment of VTE are heparin in the acute phase and warfarin in the chronic phase...
2018: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Yana Vinogradova, Carol Coupland, Trevor Hill, Julia Hippisley-Cox
OBJECTIVE: To investigate the associations between direct oral anticoagulants (DOACs) and risks of bleeding, ischaemic stroke, venous thromboembolism, and all cause mortality compared with warfarin. DESIGN: Prospective open cohort study. SETTING: UK general practices contributing to QResearch or Clinical Practice Research Datalink. PARTICIPANTS: 132 231 warfarin, 7744 dabigatran, 37 863 rivaroxaban, and 18 223 apixaban users without anticoagulant prescriptions for 12 months before study entry, subgrouped into 103 270 patients with atrial fibrillation and 92 791 without atrial fibrillation between 2011 and 2016...
July 4, 2018: BMJ: British Medical Journal
Björn Alexander Hummel, Sebastian Senger, Christian Schleicher, Hermann Eichler
HISTORY AND CLINICAL FINDINGS:  82-year old male patient suspected of having cerebral hemorrhage under anticoagulation therapy with Dabigatran due to atrial fibrillation. INVESTIGATIONS:  CT scan showed bilateral chronic subdural hematomas with fresh blood in left-subdural hematoma and midline shift. Laboratory analysis shows only a moderately high Dabigatran level but thrombin time was high out of range. DIAGNOSIS:  Fall-related intracerebral haemorrhage and subdural hematoma under anticoagulation therapy...
July 2018: Deutsche Medizinische Wochenschrift
Armando Tripodi, Simon Braham, Barbara Scimeca, Marco Moia, Flora Peyvandi
Direct oral anticoagulants (DOACs) do not require dose adjustment based on laboratory testing. However, it might be necessary to measure their plasma concentrations in the following specific situations: 1) before thrombolytic therapy in patients with stroke; 2) before surgery or invasive procedure; 3) in case of adverse events (thrombosis or hemorrhage); 4) when immediate reversal of anticoagulation is needed; 5) in patients with extreme body weight; 6) when administering additional drugs potentially interfering with DOACs; and 7) when overdosage is suspected regardless of concomitant bleeding...
June 29, 2018: Polish Archives of Internal Medicine
Jorell Gantioqui, Ivan Stevic, Helen Atkinson, Anthony K C Chan
OBJECTIVE: Current recommendations for treating patients with thromboembolism and concomitant thrombocytopenia are based on anecdotal data and expert opinion, rather than clinical studies. Our aim was to use an in-vitro model employing thromboelastography (TEG) to evaluate clot formation as a surrogate indicator of clinical tendency to hemorrhage, and investigate the interactions of plasma at varying concentrations of platelets in the presence of anticoagulants. METHODS: Platelet-rich and platelet-poor plasma isolated from whole blood were mixed together to obtain platelet concentrations ranging from less than 10-150 × 10 platelets/l...
June 29, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Mikkel Bo Brent, Jesper Skovhus Thomsen, Annemarie Brüel
Thrombin is a key component in the coagulation cascade where it converts factor V, VIII, XI, and fibrinogen. In addition to the abundant production of thrombin in the liver, osteoclasts synthesize and secrete thrombin as well. Osteoblasts express thrombin receptors, and it has been reported that thrombin stimulates the expression of RANKL relatively to OPG, resulting in greater osteoclast activation and bone degradation. Pradaxa (dabigatran etexilate, DE) is a new anticoagulant, which has recently been approved for clinical use...
June 2018: Bone Reports
Vincent Willey, Jessica Franchino-Elder, An-Chen Fu, Cheng Wang, Stephen Sander, Hiangkiat Tan, Elizabeth Kraft, Rahul Jain
OBJECTIVES: With the approval of new non-vitamin K antagonist oral anticoagulants for stroke prevention in non-valvular atrial fibrillation (NVAF), it is anticipated that their introduction may change NVAF treatment patterns; however, there is limited supporting real-world evidence. This study investigated guideline-recommended oral anticoagulation (OAC) treatment and persistence in newly diagnosed patients with NVAF to understand demographic and clinical characteristics. DESIGN: Retrospective observational administrative claims study in the USA...
June 30, 2018: BMJ Open
Anke C Fender, Dobromir Dobrev
No abstract text is available yet for this article.
June 13, 2018: International Journal of Cardiology
Munir Pirmohamed
Oral anticoagulants are required for both treatment and prophylaxis in many different diseases. Clinicians and patients now have a choice of oral anticoagulants, including the vitamin K antagonists (of which warfarin is the most widely used and is used as the exemplar in this paper), and direct oral anticoagulants (DOACs: dabigatran, apixaban, rivaroxaban, and edoxaban). This paper explores the recent advances and controversies in oral anticoagulation. While some commentators may favour a complete switchover to DOACs, this paper argues that warfarin still has a place in therapy, and a stratified approach that enables the correct choice of both drug and dose would improve both patient outcomes and affordability...
June 28, 2018: Journal of Personalized Medicine
Christina Ji-Young Lee, Thomas Alexander Gerds, Nicholas Carlson, Anders Nissen Bonde, Gunnar Hilmar Gislason, Morten Lamberts, Jonas Bjerring Olesen, Jannik Langtved Pallisgaard, Morten Lock Hansen, Christian Torp-Pedersen
BACKGROUND: Evidence is conflicting as to the efficacy of direct oral anticoagulation (DOAC) and vitamin K antagonist (VKA) for prevention of myocardial infarction (MI). OBJECTIVES: This study aimed to investigate the risk of MI associated with the use of apixaban, dabigatran, rivaroxaban, and VKA in patients with atrial fibrillation. METHODS: Patients with atrial fibrillation were identified using Danish health care registers and stratified by initial oral anticoagulant treatment...
July 3, 2018: Journal of the American College of Cardiology
Konstantinos C Siontis, Xiaosong Zhang, Ashley Eckard, Nicole Bhave, Doug E Schaubel, Kevin He, Anca Tilea, Austin G Stack, Rajesh Balkrishnan, Xiaoxi Yao, Peter A Noseworthy, Nilay D Shah, Rajiv Saran, Brahmajee K Nallamothu
Background -Patients with end-stage kidney disease (ESKD) on dialysis were excluded from clinical trials of direct oral anticoagulants for atrial fibrillation (AF). Recent data have raised concern regarding the safety of dabigatran and rivaroxaban, but apixaban has not been evaluated despite current labeling supporting its use in this population. The goal of this study was to determine patterns of apixaban use and its associated outcomes in dialysis-dependent ESKD patients with AF. Methods -We performed a retrospective cohort study of Medicare beneficiaries included in the United States Renal Data System (October 2010 to December 2015)...
June 28, 2018: Circulation
Xiao Fei Xing, Nan Nan Liu, Ya Ling Han, Wei Wei Zhou, Ming Liang, Zu Lu Wang
To evaluate the anticoagulation efficacy of dabigatran etexilate for left atrial appendage (LAA) thrombus resolution in patients with atrial fibrillation by transthoracic echocardiography and transesophageal echocardiography, and to investigate the anticoagulation factors.A total of 58 atrial fibrillation patients with LAA thrombus in our hospital were enrolled. After dabigatran etexilate anticoagulation for 3 months, the patients were divided into the effective group and ineffective group according to dissolution of thrombosis...
June 2018: Medicine (Baltimore)
Guowei Li, Gregory Y H Lip, Anne Holbrook, Yaping Chang, Torben B Larsen, Xin Sun, Jie Tang, Lawrence Mbuagbaw, Daniel M Witt, Mark Crowther, Lehana Thabane, Mitchell A H Levine
The non-vitamin K antagonist oral anticoagulants (NOACs) have been increasingly prescribed in clinical practice for stroke prevention in patients with nonvalvular atrial fibrillation (AF). Direct comparisons between NOACs in trials are lacking, leaving an important clinical decision-making gap. We aimed to perform a systematic review and meta-analysis to summarize the evidence of observational studies for direct comparative effectiveness and safety amongst NOACs in patients with AF. Conference proceedings and electronic databases including MEDLINE, CINAHL, EMBASE and PUBMED were systematically searched...
June 8, 2018: European Journal of Epidemiology
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