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Direct oral anticoagulant, DOAC

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https://www.readbyqxmd.com/read/29141274/use-of-direct-oral-anticoagulants-in-the-first-year-after-market-entry-of-edoxaban-a-danish-nationwide-drug-utilization-study
#1
Anton Pottegård, Erik L Grove, Maja Hellfritzsch
OBJECTIVES: To describe the early uptake of edoxaban; the fourth direct oral anticoagulant (DOAC) to enter the market. METHODS: Using the Danish nationwide health registries, we identified new users of edoxaban (n = 609) from June 6 (day of marketing) through June 2017. For comparison, we also identified new users of dabigatran (n = 2211), rivaroxaban (n = 19 227), and apixaban (n = 14 736). Users were described regarding indication of use, previous anticoagulant experience, comorbidity, and co-medication...
November 15, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/29126891/early-real-world-experience-with-direct-oral-anticoagulants-in-the-treatment-of-intermediate-high-risk-acute-pulmonary-embolism
#2
Sónia Martins Santos, Susana Cunha, Rui Baptista, Sílvia Monteiro, Pedro Monteiro, Francisco Gonçalves, Mariano Pêgo
INTRODUCTION: Intermediate-high risk pulmonary embolism (IHR-PE) has a poor prognosis, but is under-represented in trials of direct oral anticoagulants (DOACs) in venous thromboembolic disease (VTE). We aimed to assess whether the administration of DOACs was equivalent to the conventional (CONV) treatment of low-molecular weight heparin bridged with warfarin for treating IHR-PE. METHODS: We conducted a retrospective cohort study including 59 consecutive patients admitted with IHR-PE and followed for up to three months after discharge...
November 7, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29126301/coagulation-testing-in-the-core-laboratory
#3
William E Winter, Sherri D Flax, Neil S Harris
Primary hemostasis begins with endothelial injury. VWF, produced by endothelial cells, binds to platelets and links them to subendothelial collagen. Platelet-derived ADP and thromboxane activate non-adhered platelets via their GPIIb/IIIa receptors, allowing these platelets to participate in platelet aggregation. Secondary hemostasis is initiated with the binding of factor VII to extravascular tissue factor (TF). Factors II, VII, IX and X are vitamin K-dependent factors. The role of vitamin K is to assist in the addition of gamma carboxylate groups to glutamic acids in the "GLA" domains of these factors...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29125269/direct-oral-anticoagulants-use-in-elderly-patients-with-non-valvular-atrial-fibrillation-state-of-evidence
#4
Giulia Benedetti, Matteo Neccia, Luciano Agati
Non-valvular atrial fibrillation (NVAF) increases the risk of stroke by three- to five-fold, especially in elderly patients, creating a huge burden on medical system as well as a negative impact on patients lives. Balancing efficacy and bleeding risk is a challenge when considering anticoagulation therapy in elderly patients, because of their frequent high risk of both stroke and bleeding. Real world data reveal the underuse of anticoagulation in the elderly, especially due to physicians' fear of bleeding, often neglecting the thromboembolic risk...
November 10, 2017: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29122733/readmissions-in-anticoagulated-intracranial-hemorrhage-patients-a-retrospective-review
#5
Monica M DiFiori, Laura C Lamb, Lori L Calavan, Christopher H Comey, James M Feeney
OBJECTIVE: The objective of this study was to determine the effect of Direct Oral Anticoagulants (DOACs) when compared to warfarin, on the 30-day readmission rates in patients with traumatic intracranial hemorrhage (ICH). METHODS: We conducted a retrospective review of patients from our hospital's trauma database admitted from June 2011 to October 2015 to our Level II trauma center after sustaining a traumatic ICH while anticoagulated. Patients were stratified based on the anticoagulation drug (DOAC or warfarin) they were prescribed upon admission...
November 6, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29117993/an-update-on-the-bleeding-risks-associated-with-doacs
#6
(no author information available yet)
The direct oral anticoagulants (DOACs), also referred to as novel (or non-vitamin K antagonist) oral anticoagulants (NOACs), represent a major development in anticoagulation therapy due to their rapid onset of action, predictable dose-response with fixed doses and limited interactions with food and drugs.(1,2) However, these agents have been in widespread clinical use for less than a decade and, compared with extensive experience with warfarin, there is uncertainty relating to optimal laboratory monitoring of anticoagulation, perioperative management and treatment of bleeding...
November 2017: Drug and Therapeutics Bulletin
https://www.readbyqxmd.com/read/29107192/renal-function-and-risk-of-stroke-and-bleeding-in-patients-undergoing-catheter-ablation-for-atrial-fibrillation-comparison-between-uninterrupted-direct-oral-anticoagulants-and-warfarin-administration
#7
Satoshi Yanagisawa, Yasuya Inden, Aya Fujii, Monami Ando, Junya Funabiki, Yosuke Murase, Masaki Takenaka, Noriaki Otake, Yoshihiro Ikai, Yusuke Sakamoto, Rei Shibata, Toyoaki Murohara
BACKGROUND: The effect of uninterrupted oral anticoagulant use in patients with chronic kidney disease (CKD) during catheter ablation for atrial fibrillation (AF) is not fully understood. OBJECTIVE: The present study aimed to evaluate safety and efficacy of periprocedural uninterrupted direct oral anticoagulant (DOAC) use compared with uninterrupted warfarin in patients undergoing catheter ablation for AF, stratified by various renal function groups. METHODS: A total of 2,091 patients were retrospectively included...
October 26, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/29106357/position-paper-on-laboratory-testing-for-patients-on-direct-oral-anticoagulants-a-consensus-document-from-the-siset-fcsa-sibioc-and-sipmel
#8
Armando Tripodi, Walter Ageno, Marcello Ciaccio, Cristina Legnani, Giuseppe Lippi, Cesare Manotti, Rossella Marcucci, Marco Moia, Benedetto Morelli, Daniela Poli, Agostino Steffan, Sophie Testa
Although direct oral anticoagulants (DOAC) do not require dose-adjustment on the basis of laboratory test results, the measurement of their anticoagulant effect is useful in special situations. This position paper issued by the Italian Scientific Societies that are mainly involved in the management of patients on DOAC is aimed at providing guidance to care-givers on which tests should be used and the situations in which testing is useful. The guidance is based on the data from the literature so far available and/or on consensus among experts...
September 13, 2017: Blood Transfusion, Trasfusione del Sangue
https://www.readbyqxmd.com/read/29105079/direct-oral-anticoagulants-versus-warfarin-for-preventing-stroke-and-systemic-embolic-events-among-atrial-fibrillation-patients-with-chronic-kidney-disease
#9
REVIEW
Miho Kimachi, Toshi A Furukawa, Kimihiko Kimachi, Yoshihito Goto, Shingo Fukuma, Shunichi Fukuhara
BACKGROUND: Chronic kidney disease (CKD) is an independent risk factor for atrial fibrillation (AF), which is more prevalent among CKD patients than the general population. AF causes stroke or systemic embolism, leading to increased mortality. The conventional antithrombotic prophylaxis agent warfarin is often prescribed for the prevention of stroke, but risk of bleeding necessitates regular therapeutic monitoring. Recently developed direct oral anticoagulants (DOAC) are expected to be useful as alternatives to warfarin...
November 6, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29096154/meta-analysis-of-safety-and-efficacy-for-direct-oral-anticoagulation-treatment-of-non-valvular-atrial-fibrillation-in-relation-to-renal-function
#10
Rongjun Zou, Jun Tao, Wanting Shi, Minglei Yang, Hongmu Li, Xifeng Lin, Songran Yang, Ping Hua
INTRODUCTION: We performed a meta-analysis of the safety and efficacy of anticoagulation treatment for atrial fibrillation (AF) in relation to renal function. We also examined the change in estimated glomerular filtration rate (eGFR) from baseline and compared the outcomes for patients with stable and worsening renal function. MATERIALS AND METHODS: We selected studies that used randomized controlled trials in which outcomes for direct oral anticoagulants (DOACs) (dabigatran, rivaroxaban, apixaban, or edoxaban) were compared with those for warfarin in AF patients with normal, mild or moderate renal function, except the severe one (creatinine clearance<30)...
October 26, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29090608/patients-preferences-for-new-versus-old-anticoagulants-a-mixed-method-vignette-based-study
#11
Beata Bajorek, Brooke Saxton, Elizabeth Anderson, Clara K Chow
BACKGROUND: For both patients and clinicians, differences between older and new anticoagulants have major implications for treatment selection, day-to-day management of therapy and adherence. AIMS: To explore patients' preferences for warfarin versus direct oral anticoagulant (DOAC) therapy. METHODS: Mixed-method study involving anticoagulated older patients admitted to hospital. Part A comprised a vignette-based questionnaire; patients were asked whether they preferred Medicine A (warfarin) or Medicine B (DOAC)...
October 1, 2017: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29088960/acute-subdural-hematoma-in-patients-on-oral-anticoagulant-therapy-management-and-outcome
#12
Sae-Yeon Won, Daniel Dubinski, Markus Bruder, Adriano Cattani, Volker Seifert, Juergen Konczalla
OBJECTIVE Isolated acute subdural hematoma (aSDH) is increasing in older populations and so is the use of oral anticoagulant therapy (OAT). The dramatic increase of OAT-with direct oral anticoagulants (DOACs) as well as with conventional anticoagulants-is leading to changes in the care of patients who present with aSDH while receiving OAT. The purpose of this study was to determine the management and outcome of patients being treated with OAT at the time of aSDH presentation. METHODS In this single-center, retrospective study, the authors analyzed 116 consecutive cases involving patients with aSDH treated from January 2007 to June 2016...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29080863/temporal-trends-in-the-use-and-comparative-effectiveness-of-direct-oral-anticoagulant-agents-versus-warfarin-for-nonvalvular-atrial-fibrillation-a-canadian-population-based-study
#13
Amy Y X Yu, Shaun Malo, Lawrence W Svenson, Stephen B Wilton, Michael D Hill
BACKGROUND: Direct oral anticoagulants (DOACs) are noninferior to warfarin for stroke prevention in atrial fibrillation (AF). We aimed to determine the population risk of stroke and death in incident AF, stratified by anticoagulation status and type, and the temporal trends of oral anticoagulation practice in the post-DOAC approval period. METHODS AND RESULTS: We conducted a population-based cohort study of incident nonvalvular AF cases using administrative health data in Alberta, Canada...
October 28, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29079069/spontaneous-spinal-epidural-hematoma-in-a-patient-on-rivaroxaban-case-report-and-literature-review
#14
Raed Ismail, Elie Zaghrini, Eveline Hitti
BACKGROUND: Spinal hematomas (SHs) are rare yet potentially debilitating causes of acute back pain. Although spontaneous SHs have been described in the setting of anticoagulation with warfarin or enoxaparin, few cases of spontaneous SH on direct oral anticoagulants (DOACs) have been reported. CASE REPORT: We report a case of spontaneous spinal epidural hematoma in a patient on rivaroxaban. A 72-year-old man on rivaroxaban and aspirin presented with a 4-day history of nontraumatic back pain...
October 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29072911/the-design-of-small-molecule-active-site-inhibitors-of-the-s1a-family-proteases-as-procoagulant-and-anticoagulant-drugs
#15
Peter M Fischer
Vitamin K antagonists (VKA) have long been the default drugs for anticoagulant management in venous thrombosis. While efficacious, they are difficult to use due to interpatient dose-response variability and the risks of bleeding. The approval of fondaparinux, a heparin-derived factor Xa (fXa) inhibitor, provided validation for the development of direct oral anticoagulants (DOAC), and currently such inhibitors of thrombin and fXa are in clinical use. These agents can be used without regular coagulation monitoring but the inherent risk of bleeding complications associated with blocking the common coagulation pathway remains...
October 26, 2017: Journal of Medicinal Chemistry
https://www.readbyqxmd.com/read/29068809/advances-in-managing-and-preventing-thromboembolic-disease-in-cancer-patients
#16
Anthony Maraveyas, Iqtedar Muazzam, Simon Noble, George Bozas
PURPOSE OF REVIEW: To update on new data for low-molecular weight heparins (LMWHs) and the direct oral anticoagulants (DOACs) for the treatment and prevention of cancer-associated thrombosis (CAT), to discuss progress with the risk-adaptive management scores (RAMS) and update on increased dose primary thromboprophylaxis (IDPTP). RECENT FINDINGS: In a pooled meta-analysis of 1132 cancer patients who received DOACs vs. vitamin K analogues (VKAs), recurrence of venous thromboembolism (VTE) was reduced from 6...
December 2017: Current Opinion in Supportive and Palliative Care
https://www.readbyqxmd.com/read/29064182/anti-thrombotic-therapy-for-atrial-fibrillation-in-patients-with-chronic-kidney-disease-current-views
#17
REVIEW
Rugheed Ghadban, Greg Flaker, Natraj Katta, Martin A Alpert
Chronic kidney disease (CKD) occurs in approximately one-third of patients with non-valvular atrial fibrillation (AF). The presence of CKD, particularly advanced CKD, confers increased risk of both thromboembolism and major bleeding in this group of patients who are already at risk for ischemic stroke and systemic embolism and at risk of bleeding due to anticoagulation. Studies assessing the effect of warfarin on risk of ischemic stroke, systemic embolism, and major bleeding have produced disparate results, particularly in patients with advanced CKD including those treated with hemodialysis...
October 2017: Hemodialysis International
https://www.readbyqxmd.com/read/29063899/clinicians-related-determinants-of-anticoagulation-therapy-and-prophylaxis-in-nigeria
#18
Raphael Anakwue, Theresa Nwagha, Ogba J Ukpabi, Ndudim Obeka, Emmanuel Onwubuya, Uwa Onwuchekwa, Benjamin Azubuike, Innocent Okoye
BACKGROUND: Thromboembolic and hypercoagulable diseases are common life-threatening but treatable problems in hospital practice. Fortunately, anticoagulation is an efficacious management practice indicated for arterial, venous, and intracardiac thromboembolism. Clinicians in developing countries may have gaps in their knowledge of anticoagulation therapy/prophylaxis which could affect their clinical decision. OBJECTIVES: The study examined the knowledge and attitude of clinicians to anticoagulation therapy/prophylaxis in some tertiary hospitals in Nigeria...
October 2017: Annals of African Medicine
https://www.readbyqxmd.com/read/29055248/simultaneous-quantification-of-direct-oral-anticoagulants-currently-used-in-anticoagulation-therapy
#19
Kathrin I Foerster, Andrea Huppertz, Oliver J Müller, Timolaos Rizos, Lisa Tilemann, Walter E Haefeli, Jürgen Burhenne
Direct oral anticoagulants (DOACs) are among the most effective options to prevent serious thromboembolic events in patients with atrial fibrillation. Coagulation assays are used to assess DOAC activity, but lack the possibility to quantify drugs with concurrent pharmacodynamic effect. We developed a selective multi-drug assay to analyze apixaban, betrixaban, dabigatran, edoxaban, edoxaban M4, and rivaroxaban with ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC/MS/MS) in plasma fulfilling all requirements of the FDA und EMA guidelines for bioanalytical method validation...
October 16, 2017: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/29054780/safe-burr-hole-surgery-for-chronic-subdural-hematoma-using-dabigatran-with-idarucizumab
#20
Nobuhiko Arai, Yutaka Mine, Hiroshi Kagami, Michiyuki Maruyama, Jun Daiko, Makoto Inaba
BACKGROUND: Chronic subdural hematoma (CSDH) is a common intracranial hematoma. The number of patients who undergo anticoagulant therapy including a direct oral anticoagulant (DOAC) is expected to increase. Recently, idarucizumab, the antidote for dabigatran, which is a DOAC, has been developed. We successfully treated CSDH with dabigatran using emergency burr hole surgery and idarucizumab. CASE DESCRIPTION: A 79-year-old Japanese man severely hit his head and visited the emergency room (ER)...
October 17, 2017: World Neurosurgery
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