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Direct oral anticoagulant, DOAC

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https://www.readbyqxmd.com/read/27913856/direct-oral-anticoagulants-an-overview-for-the-interventional-radiologist
#1
Pradesh Kumar, Rajeev Ravi, Gaurav Sundar, Caroline Shiach
The direct oral anticoagulants (DOACs) have emerged as a good alternative for the treatment of thromboembolic diseases, and their use in clinical practice is increasing rapidly. The DOACs act by blocking the activity of one single step in the coagulation cascade. These drugs act downstream in the common pathway of the coagulation cascade by directly antagonising the action of thrombin or factor Xa. The development of DOACs represents a paradigm shift from the oral vitamin K antagonists such as warfarin. This article aims to describe the properties of the currently available DOACs including pharmacology and dosing...
December 2, 2016: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/27913536/reversal-of-direct-oral-anticoagulants-a-practical-approach
#2
Andrew W Shih, Mark A Crowther
Direct oral anticoagulants (DOACs) have at least noninferior efficacy compared with other oral anticoagulants and have ancillary benefits, including overall better safety profiles, lack of the need for routine monitoring, rapid onset of action, and ease of administration. Reversal of these agents may be indicated in certain situations such as severe bleeding and for perioperative management. DOAC-associated bleeding should be risk stratified: patients with moderate or severe bleeding should have the DOAC discontinued and reversal strategies should be considered...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27909544/reducing-the-risk-of-stroke-in-patients-with-nonvalvular-atrial-fibrillation-with-direct-oral-anticoagulants-is-one-of-these-not-like-the-others
#3
REVIEW
Paul P Dobesh Pharm D, John Fanikos Mba R Ph
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and increases risk of stroke by nearly 5-fold. While warfarin has been employed successfully to reduce the risk of stroke in these patients, there are a number of challenges with therapy. These include the need for therapeutic monitoring due to variability in patient response, frequent dose adjustments, numerous drug-drug, drug-food, and drug-disease interactions, and a heightened risk of thrombosis and bleeding due to these issues. Current guidelines recommend that the vitamin K antagonists (VKA) or direct oral anticoagulants (DOACs) should be used for thromboprophylaxis in patients with nonvalvular AF at risk for stroke or systemic embolic events...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27900867/-new-direct-oral-anticoagulants-actual-review
#4
Jana Michalcová, Miroslav Penka, Alena Buliková, Jiřina Zavřelová, Andrea Štěpařová
In recent years the options of anticoagulant/antithrombotic therapy have extended with new - direct oral anticoagulants, comprising direct thrombin inhibitors (dabigatran etexilate) and direct factor Xa inhibitors (rivaroxaban, apixaban). These agents represent another progress towards "the ideal antithrombotic drug", and thus towards a safe and effective antithrombotic therapy. The following article provides actual review and recommendations for clinical practice, including laboratory assessment and management of emergency situations...
2016: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/27900231/efficacy-and-safety-of-direct-oral-anticoagulants-compared-to-warfarin-in-prevention-of-thromboembolic-events-among-elderly-patients-with-atrial-fibrillation
#5
REVIEW
Shilpa D Kailas, Sirisha Reddy Thambuluru
Direct oral anticoagulants (DOACs), previously also known as novel oral anticoagulants (NOACs), have increased the therapeutic options for stroke prevention in atrial fibrillation (AF). Previous studies comparing their relative efficacy and safety do not address age-related differences, such as comorbidities and physical and social boundaries. This review aimed to summarize and compare the clinical and safety outcomes of DOACs and warfarin for stroke prevention in AF in the elderly population (≥ 65 years)...
October 18, 2016: Curēus
https://www.readbyqxmd.com/read/27896681/financial-impact-of-direct-acting-oral-anticoagulants-in-medicaid-budgetary-assessment-based-on-number-needed-to-treat
#6
Kathleen A Fairman, Lindsay E Davis, Courtney R Kruse, David A Sclar
BACKGROUND: Faced with rising healthcare costs, state Medicaid programs need short-term, easily calculated budgetary estimates for new drugs, accounting for medical cost offsets due to clinical advantages. OBJECTIVE: To estimate the budgetary impact of direct-acting oral anticoagulants (DOACs) compared with warfarin, an older, lower-cost vitamin K antagonist, on 12-month Medicaid expenditures for nonvalvular atrial fibrillation (NVAF) using number needed to treat (NNT)...
November 28, 2016: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/27896543/vitamin-k-antagonists-relative-strengths-and-weaknesses-vs-direct-oral-anticoagulants-for-stroke-prevention-in-patients-with-atrial-fibrillation
#7
REVIEW
Andreas Zirlik, Christoph Bode
Vitamin K antagonists (VKAs) have been the mainstay of anticoagulation therapy for more than 50 years. VKAs are mainly used for the prevention of stroke in patients with atrial fibrillation (AF) and the treatment and secondary prevention of venous thromboembolism. In the past 5 years, four new agents-the direct factor Xa inhibitors apixaban, edoxaban and rivaroxaban and the direct thrombin inhibitor dabigatran [collectively known as direct oral anticoagulants (DOACs) or non-VKA oral anticoagulants]-have been approved for these and other indications...
November 28, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27893182/inter-individual-variability-in-dabigatran-and-rivaroxaban-exposure-contribution-of-abcb1-genetic-polymorphisms-and-interaction-with-clarithromycin
#8
I Gouin-Thibault, X Delavenne, A Blanchard, V Siguret, J E Salem, C Narjoz, P Gaussem, P Beaune, C Funck-Brentano, M Azizi, P Mismetti, M A Loriot
BACKGROUND: The direct oral anticoagulants (DOACs) dabigatran and rivaroxaban are both substrates of the P-glycoprotein (P-gp) transporter, encoded by the ABCB1 gene. Rivaroxaban is metabolized by CYP3A4. Inter-individual variability in DOAC exposure and frequent P-gp associated drug-drug interactions have been described in patients. OBJECTIVE: To assess the influence of ABCB1 polymorphisms on the pharmacokinetics (PK) of dabigatran and rivaroxaban, associated or not with clarithromycin, a P-gp and CYP3A4 inhibitor...
November 28, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27884850/comparative-effectiveness-and-safety-of-oral-anticoagulants-for-atrial-fibrillation-in-real-world-practice-a-population-based-cohort-study-protocol
#9
Anne Holbrook, Colin Dormuth, Richard Morrow, Agnes Lee, Sue Troyan, Guowei Li, Eleanor Pullenyegum
INTRODUCTION: Anticoagulants are arguably the most important drug family of all, based on the frequency and duration of their use, and the clinical importance and frequency of benefits and harms. Several direct acting oral anticoagulants (DOACs) have recently joined warfarin for the treatment of atrial fibrillation, with a resultant significant expansion in use of oral anticoagulants (OACs). Our objectives are to compare safety and effectiveness of DOACs versus warfarin in a full population where anticoagulation management is good and to identify which types of patients do better with DOACs versus warfarin and vice versa...
November 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27883351/-rivaroxaban-resistant-right-ventricular-thrombus-successfully-treated-with-vitamin-k-antagonist-in-a-patient-with-dilated-cardiomyopathy
#10
Waldemar Elikowski, Małgorzata Małek-Elikowska, Marek Słomczyński, Teresa Ganowicz-Kaatz, Andrzej Bolewski, Paweł Skrzywanek
: Rivaroxaban, a selective inhibitor of active factor X belongs to the group of direct-acting oral anticoagulants (DOAC), more and more often replacing vitamin K antagonists (VKA) in venous thromboembolic disease and nonvalvular atrial fibrillation. Attempts are also being made to use DOAC to treat locally formed intracardiac thrombi, mainly in the left atrium and its appendage, in atrial fibrillation and in heart failure. Rarely diagnosed local right ventricular thrombus (RVT) may be a complication of dilated cardiomyopathy (DCM)...
November 25, 2016: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/27882517/cost-effectiveness-of-apixaban-versus-warfarin-or-aspirin-for-stroke-prevention-in-patients-with-atrial-fibrillation-a-greek-perspective
#11
Kostas Athanasakis, Nadia Boubouchairopoulou, Eleftheria Karampli, Filippos Tarantilis, Paraskevi Savvari, Aikaterini Bilitou, John Kyriopoulos
BACKGROUND: Strokes attributed to atrial fibrillation (AF) represent a major cause of adult disability and a great burden to society and healthcare systems. OBJECTIVES: Our objective was to assess the cost effectiveness of apixaban, a direct acting oral anticoagulant (DOAC), versus warfarin or aspirin for patients with AF in the Greek healthcare setting. METHODS: We used a previously published Markov model to simulate clinical events for patients with AF treated with apixaban, the vitamin K antagonist (VKA) warfarin, or aspirin...
November 23, 2016: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/27882374/cancer-associated-venous-thromboembolism-burden-mechanisms-and-management
#12
Cihan Ay, Ingrid Pabinger, Alexander T Cohen
Venous thromboembolism (VTE) is a significant health problem in the general population but especially in cancer patients. In this review, we discuss the epidemiology and burden of the disease, the pathophysiology of cancer-associated VTE, and the clinical treatment options for both primary prevention and acute treatment. Overall, the development of VTE in cancer patients is related to increases in morbidity, mortality, and medical costs. However, the incidence of cancer-associated VTE varies due to patient-related factors (e...
November 24, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27872767/diffuse-alveolar-hemorrhage-associated-with-edoxaban-therapy
#13
Kenichi Nitta, Hiroshi Imamura, Akihiro Yashio, Satoko Kashima, Katsunori Mochizuki
Introduction. The main adverse effect of anticoagulant therapy is bleeding, and major bleeding, including intracranial, gastrointestinal, and retroperitoneal bleeding, has been reported as an adverse effect of edoxaban, a direct oral anticoagulant (DOAC). Bleeding during systemic anticoagulation with edoxaban presents a therapeutic conundrum, because there is currently no safe or efficacious reversal agent to stop major bleeding. Case Report. A 51-year-old woman had multiple traumatic injuries, including lower limb fractures...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27868333/to-measure-or-not-to-measure-direct-oral-anticoagulants-before-surgery-or-invasive-procedures-comment
#14
R Selby, Z Shah, L Black, J Ongteco, S Kulkarni, D Piraino
With interest, we read a recent publication by Armando Tripodi, aimed at discussing whether direct oral anticoagulants (DOACs) should be measured prior to surgical or invasive procedures [1]. Although specific assays for the assessment of anticoagulant activity of the direct oral anticoagulants (dabigatran and the oral factor Xa inhibitors) have been developed and are easy to perform on automated coagulation analyzers [1-3], they are currently not available in the majority of Ontario laboratories. Since the APTT is readily available at most of our laboratories, we studied the effect of different dabigatran concentrations on the APTT, using six different APTT reagents and performed on three coagulation analyzer platforms...
November 21, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27868324/to-measure-or-not-to-measure-direct-oral-anticoagulants-before-surgery-or-invasive-procedures-reply
#15
Armando Tripodi
I read with interest the Letter by Selby et al [1] on sensitivity of commonly used APTT reagents in Ontario Canada to increasing dabigatran concentrations published recently in the Journal. The Letter is dealing with the Forum on the need to measure direct oral anticoagulants (DOAC) before surgery or invasive procedures and subsequent correspondence recently published by the Journal [2-4]. I wish to make the following comments. Selby et al [1] investigated six APTT reagents on three common coagulometers by testing in vitro spiked (fixed concentrations of dabigatran) plasmas and found that the prolongation of the APTT was related to the dabigatran concentration, although with some between-reagent variability...
November 21, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27861316/development-of-an-uhplc-uv-method-for-quantification-of-direct-oral-anticoagulants-apixaban-rivaroxaban-dabigatran-and-its-prodrug-dabigatran-etexilate-in-human-serum
#16
Sebastian Boehr, Ekkehard Haen
BACKGROUND: Direct oral anticoagulants (DOACs) currently have no indication for monitoring even though there are data that imply that individual dosing can improve and add safety to the therapy. METHODS: An ultra-high performance liquid chromatography (UHPLC) method with ultra violet (UV) detection has been developed and validated for apixaban, dabigatran, dabigatran etexilate, and rivaroxaban. Protein precipitation with methanol (1:3 vol/vol) was used as sample preparation...
November 16, 2016: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/27861314/effect-of-the-direct-oral-anticoagulants-rivaroxaban-and-apixaban-on-the-disposition-of-calcineurin-inhibitors-in-transplant-recipients
#17
Thomas Vanhove, Isabel Spriet, Pieter Annaert, Johan Maertens, Johan Van Cleemput, Robin Vos, Dirk Kuypers
BACKGROUND: Calcineurin inhibitors (CNIs) and direct oral anticoagulants (DOACs) share certain metabolic pathways, but whether DOACs influence CNI exposure has not been assessed. METHODS: A single-center retrospective analysis was performed including 39 organ recipients treated with the combination of a CNI and rivaroxaban (n = 29) or apixaban (n = 10). Dose-corrected CNI trough concentrations (C0/D) during 200 days before and after DOAC initiation were recorded (n = 261), together with covariates known to influence CNI disposition such as steroid dose and hematocrit...
November 17, 2016: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/27861189/oral-anticoagulation-for-stroke-prevention-amongst-atrial-fibrillation-patients-with-valvular-heart-disease-an-update
#18
Andrew C T Ha, Atul Verma, Subodh Verma
PURPOSE OF REVIEW: The majority of evidence on the safety and efficacy of oral anticoagulation for stroke prevention amongst patients with atrial fibrillation is derived from those without significant valvular heart disease. This article will review current knowledge, areas of uncertainty and controversy, and ongoing research on oral anticoagulation for stroke prevention amongst patients with valvular heart disease. RECENT FINDINGS: The rates of stroke, systemic embolism, and major bleeding were similar for patients with and without significant native valvular disease when treated with direct oral anticoagulants (DOACs) or vitamin K antagonists...
November 18, 2016: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/27859621/direct-oral-anticoagulant-considerations-in-solid-organ-transplantation-a-review
#19
REVIEW
David M Salerno, Demetra Tsapepas, Apostolos Papachristos, Jae-Hyung Chang, Spencer Martin, Mark A Hardy, Jaclyn McKeen
For more than sixty years, warfarin was the only oral anticoagulation agent available for use in the United States. In many recent clinical trials, several direct oral anticoagulants (DOACs) demonstrated similar efficacy with an equal or superior safety profile; with some other notable benefits. The DOACs have lower inter- and intra-patient variability, much shorter half-lives, and less known drug-drug and drug-food interactions as compared to warfarin. Despite these demonstrated benefits, the use of DOACs have not gained uniform acceptance because of lack of supportive data in special patient populations, including recipients of solid organ transplants maintained on immunosuppression...
November 16, 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27843050/major-bleeding-with-vitamin-k-antagonists-or-direct-oral-anticoagulants-in-real-life
#20
Cecilia Becattini, Laura Franco, Jan Beyer-Westendorf, Luca Masotti, Cinzia Nitti, Simone Vanni, Giorgia Manina, Sergio Cattinelli, Roberto Cappelli, Rodolfo Sbrojavacca, Fulvio Pomero, Sandra Marten, Giancarlo Agnelli
BACKGROUND: Limited data are available on major bleeding (MB) occurring during treatment with vitamin K (VKAs) or direct oral anticoagulants (DOACs) outside clinical trials. METHODS: Patients hospitalized for MB while on treatment with VKAs or DOACs were included in a multicenter study to compare clinical presentation, management and outcome of bleeding. The primary study outcome was death at 30days. RESULTS: Between September 2013 and September 2015, 806 patients were included in the study, 76% on VKAs and 24% on DOACs...
November 9, 2016: International Journal of Cardiology
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