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Direct oral anticoagulant, DOAC

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https://www.readbyqxmd.com/read/29344007/four-factor-prothrombin-complex-concentrate-improves-thrombin-generation-and-prothrombin-time-in-patients-with-bleeding-complications-related-to-rivaroxaban-a-single-center-pilot-trial
#1
Bettina Schenk, Stephanie Goerke, Ronny Beer, Raimund Helbok, Dietmar Fries, Mirjam Bachler
Background: Direct oral anticoagulants (DOACs) pose a great challenge for physicians in life-threatening bleeding events. The aim of this study was to test the efficacy of reversing the DOAC rivaroxaban using four-factor PCC (prothrombin complex concentrate), a non-specific reversing agent. Methods: Patients with life-threatening bleeding events during rivaroxaban treatment were included and administered 25 U kg-1 of PCC. Blood samples were collected immediately prior to as well as after PCC treatment at predefined time intervals...
2018: Thrombosis Journal
https://www.readbyqxmd.com/read/29339702/efficacy-and-safety-of-oral-anticoagulation-in-elderly-patients-with-atrial-fibrillation
#2
Ilaria Cavallari, Giuseppe Patti
Elderly patients with atrial fibrillation are at a higher risk of both ischemic and bleeding events compared with younger patients; therefore, balancing risks and benefits of antithrombotic strategies in this population is crucial. Recent studies have shown that because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of oral anticoagulation is the highest in elderly patients in whom it outweighs the risk of bleeding. Direct oral anticoagulants (DOACs) have been developed as a treatment for the prevention of cardioembolic stroke to overcome some limitations of warfarin, such as the need for frequent monitoring, labile INR values requiring frequent dose adjustment, dietary and drugs interactions, and increased risk of intracranial bleeding...
January 2018: Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/29338293/betrixaban-a-new-oral-factor-xa-inhibitor-for-extended-venous-thromboembolism-prophylaxis-in-high-risk-hospitalized-patients
#3
Scott G Garland, Christina E DeRemer, Steven M Smith, John G Gums
OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of the factor Xa (FXa) inhibitor betrixaban for extended-duration prophylaxis of acute medically ill patients with venous thromboembolism (VTE) risk factors. DATA SOURCES: A MEDLINE/PubMed (January 1990 to October 2017) search was conducted using the following keywords: betrixaban, PRT054021, FXa inhibitor, novel oral anticoagulant, NOAC, direct oral anticoagulant, DOAC, and target specific oral anticoagulant, TSOAC...
January 1, 2018: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29325495/management-of-cancer-associated-venous-thromboembolism-a-case-based-practical-approach
#4
Minna Voigtlaender, Florian Langer
In patients with solid tumours or haematological malignancies, venous thromboembolism (VTE) is a leading cause of death and significantly contributes to morbidity and healthcare resource utilization. Current practice guidelines recommend long-term anticoagulation with low-molecular-weight heparin (LMWH) as the treatment of choice for cancer-associated VTE, based on clinical trial data showing an overall improved safety and efficacy profile of LMWH compared to vitamin K antagonists. However, several open questions remain, e...
January 12, 2018: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/29322630/inter-laboratory-variability-for-the-measurement-of-direct-oral-anticoagulants-results-from-the-external-quality-assessment-scheme
#5
Armando Tripodi, Veena Chantarangkul, Cristina Legnani, Sophie Testa, Alberto Tosetto
BACKGROUND: Tests for direct oral anticoagulants (DOAC) are not widely available. The perception that they are difficult to be run and are subjected to large between-laboratory variation makes their implementation difficult. AIMS: We carried out proficiency-testing surveys for DOAC within the activity of the external quality-assessment scheme of the Italian Federation of Thrombosis Centers. DESIGN: Participants were provided with coded freeze-dried plasmas without or with graded concentrations of the three main DOAC and asked to measure PT, APTT, thrombin time and DOAC concentrations by dedicated tests...
January 10, 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29320795/direct-oral-anticoagulants-in-end-stage-renal-disease
#6
Adi J Klil-Drori, Vicky Tagalakis
Patients with end-stage renal disease (ESRD) were excluded from pivotal clinical trials with oral anticoagulants. While such patients are at an increased risk of venous and arterial thromboembolism, their risk of bleeding is also elevated. It is thus of little surprise that stroke prevention with vitamin K antagonists (VKAs) in ESRD patients with atrial fibrillation is controversial, with observational evidence ranging from beneficial to harmful. This uncertainty extends to the less studied use of VKAs for venous thromboembolism in ESRD...
January 10, 2018: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/29317937/evaluating-the-potential-for-pharmacists-to-prescribe-oral-anticoagulants-for-atrial-fibrillation
#7
Roopinder K Sandhu, Lisa M Guirguis, Tammy J Bungard, Erik Youngson, Lisa Dolovich, Jamie C Brehaut, Jeff S Healey, Finlay A McAlister
Background: Oral anticoagulant therapy (OAC) to prevent atrial fibrillation (AF)-related strokes remains poorly used. Alternate strategies, such as community pharmacist prescribing of OAC, should be explored. Methods: Approximately 400 pharmacists, half with additional prescribing authority (APA), randomly selected from the Alberta College of Pharmacists, were invited to participate in an online survey over a 6-week period. The survey consisted of demographics, case scenarios assessing appropriateness of OAC (based on the 2014 Canadian Cardiovascular Society AF guidelines) and perceived barriers to prescribing...
January 2018: Canadian Pharmacists Journal: CPJ, Revue des Pharmaciens du Canada: RPC
https://www.readbyqxmd.com/read/29316202/anticoagulant-prophylaxis-and-therapy-in-children-current-challenges-and-emerging-issues
#8
Fiona Newall, Brian Branchford, Christoph Male
This review aims to describe the unique challenges of anticoagulant prophylaxis and treatment in children, and to highlight areas for research for improving clinical outcomes of children with thromboembolic disease. The evidence presented demonstrates the challenges of advancing the evidence-base informing optimal management of thromboembolic disease in children. Recent observational studies have identified risk factors of venous thromboembolism in children, but there are few interventional studies assessing the benefit-risk of using thromboprophylaxis in risk-stratified clinical subgroups...
January 6, 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29305675/efficacy-and-safety-of-outpatient-treatment-with-direct-oral-anticoagulation-in-pulmonary-embolism
#9
REVIEW
R Ghazvinian, A Gottsäter, J L Elf
Anticoagulant treatment of acute pulmonary embolism (PE) has traditionally been hospital-based. The lesser need for monitoring with the increasingly used direct acting oral anticoagulants (DOAC) in comparison to warfarin potentially facilitates outpatient treatment of PE with these drugs. This study aimed to evaluate efficacy and safety of outpatient treatment of PE with DOAC. We extracted data from the Swedish quality registry for patients on oral anticoagulation (AuriculA) for all 245 patients in the southernmost hospital region in Sweden (1...
January 5, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29302288/direct-oral-anticoagulants-and-its-implications-in-dentistry-a-review-of-literature
#10
REVIEW
Neus Lanau, Javier Mareque, Lluis Giner, Michel Zabalza
Background: Four novel direct oral anticoagulants (DOACs) named dabigatran, rivaroxaban, edoxaban and apixaban have been recently introduced to overcome some of the drawbacks of existing anticoagulants. They have less interactions and do not require routine monitoring. However, there is not enough scientific data about the protocol to apply in these patients on DOACs undergoing dental treatment. Thus is necessary to evaluate the potential bleeding risk of these drugs, the possibility of thromboembolic events occurring if they are withdrawn or the need to change to heparin previously...
November 2017: Journal of Clinical and Experimental Dentistry
https://www.readbyqxmd.com/read/29297662/venous-thromboembolism-role-of-pharmacists-and-managed-care-considerations
#11
Tuesdy Horner, Charles E Mahan
Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism. Anticoagulation is used in patients with VTE to reduce the risk of recurrent VTE and VTE-related death. The overall incidence of VTE is 1 to 2 per 1000 person-years. Long-term mortality for patients with VTE is poor, with 25% of patients not surviving 7 days and nearly 40% not surviving the first year. Coagulation disorders demand effective anticoagulant therapy to avoid complications, especially recurrent VTE and VTE-related death...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29297661/the-role-of-direct-oral-anticoagulants-in-the-management-of-venous-thromboembolism
#12
Taylor Steuber
Appropriate treatment of venous thromboembolism (VTE) is critical to minimizing long-term morbidity and mortality. The emergence of direct oral anticoagulants (DOACs) has provided clinicians with expanded therapeutic options for patients with VTE, and as a result, updated practice guidelines released by the American College of Chest Physicians favor DOACs over traditional anticoagulants, such as warfarin. The newest DOAC, betrixaban, received FDA approval in 2017, with an indication for VTE prophylaxis in hospitalized adults...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29296905/sociodemographic-factors-in-patients-continuing-warfarin-vs-those-transitioning-to-direct-oral-anticoagulants
#13
Jordan K Schaefer, Suman L Sood, Brian Haymart, Xiaokui Gu, Xiaowen Kong, Eva Kline-Rogers, Steven Almany, Jay Kozlowski, Gregory D Krol, Scott Kaatz, James B Froehlich, Geoffrey D Barnes
Clinical factors and patient preferences are important for selecting oral anticoagulants for venous thromboembolism (VTE) and atrial fibrillation (AF). The relative association of sociodemographic factors with anticoagulant use is unknown. We evaluated a prospective cohort to compare sociodemographic variables in patients who continued on warfarin for AF or VTE to those who transitioned to 1 of the direct oral anticoagulants (DOACs). Adult patients, newly started on warfarin, were enrolled through 6 anticoagulation clinics across Michigan...
December 12, 2017: Blood Advances
https://www.readbyqxmd.com/read/29285754/oral-anticoagulation-in-people-with-cancer-who-have-no-therapeutic-or-prophylactic-indication-for-anticoagulation
#14
REVIEW
Lara A Kahale, Maram B Hakoum, Ibrahim G Tsolakian, Charbel F Matar, Maddalena Barba, Victor E D Yosuico, Irene Terrenato, Francesca Sperati, Holger Schünemann, Elie A Akl
BACKGROUND: Oral anticoagulants may improve the survival of people with cancer through both an antitumor effect and antithrombotic effect, yet increase the risk of bleeding. OBJECTIVES: To evaluate the efficacy and safety of oral anticoagulants in ambulatory people with cancer undergoing chemotherapy, hormonal therapy, immunotherapy or radiotherapy, but otherwise have no standard therapeutic or prophylactic indication for anticoagulation. SEARCH METHODS: We conducted a comprehensive literature search in February 2016 that included a major electronic search of Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 1), MEDLINE (Ovid) and Embase (Ovid); handsearching of conference proceedings; checking of references of included studies; a search for ongoing studies; and using the 'related citation' feature in PubMed...
December 29, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29279522/comparison-of-direct-oral-anticoagulants-and-warfarin-in-the-treatment-of-deep-venous-thrombosis-in-the-chronic-phase
#15
Shingo Wakakura, Fumihiko Hara, Tadashi Fujino, Asami Hamai, Hiroshi Ohara, Takayuki Kabuki, Masahiko Harada, Takanori Ikeda
We assessed the efficacy and safety of direct oral anticoagulants (DOACs) for the treatment of deep venous thrombosis (DVT) in the chronic phase through comparison with conventional warfarin therapy.A total of 807 consecutive patients who were diagnosed with having DVT in the chronic phase were included (484 patients to warfarin therapy and 323 patients to DOAC therapy). The condition of leg veins was assessed 3 to 6 months after starting the therapies by ultrasound examination. Major bleeding and mortality during the therapies were followed-up...
December 27, 2017: International Heart Journal
https://www.readbyqxmd.com/read/29274758/efficacy-and-safety-outcomes-of-direct-oral-anticoagulants-and-amiodarone-in-patients-with-atrial-fibrillation
#16
Florentino Lupercio, Jorge Romero, Bradley Peltzer, Carola Maraboto, David Briceno, Pedro Villablanca, Kevin Ferrick, Jay N Gross, Soo Kim, John Fisher, Luigi Di Biase, Andrew Krumerman
BACKGROUND: Direct oral anticoagulants (DOACs) and amiodarone are widely used in the treatment of non-valvular atrial fibrillation. The DOACs are P-glycoprotein (P-gp) and cytochrome p-450 (CYP3A4) substrates. DOAC levels may be increased by the concomitant use of potent dual P-gp/CYP3A4 inhibitors such as amiodarone, which can potentially translate into adverse clinical outcomes. We aimed to assess the efficacy and safety of drug-drug interaction by the concomitant use of DOACs and amiodarone...
December 21, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29274228/prior-authorization-and-canadian-public-utilization-of-direct-acting-oral-anticoagulants
#17
Lulu Gao, Mina Tadrous, Sandra Knowles, Muhammad Mamdani, J Michael Paterson, David Juurlink, Tara Gomes
PURPOSE: Provincial public drug formularies in Canada have different mechanisms for reimbursement of direct-acting oral anticoagulants (DOACs). We investigate how these differences influence DOAC utilization and expenditure across the country. METHODS: We conducted a population-based, cross-sectional study of all out-patient prescriptions for OACs dispensed to public beneficiaries between January 1, 2010, and June 30, 2015. We calculated quarterly rates of OAC use and expenditures stratified by OAC type and province...
November 2017: Healthcare Policy, Politiques de Santé
https://www.readbyqxmd.com/read/29274044/expanding-anticoagulation-management-services-to-include-direct-oral-anticoagulants
#18
REVIEW
Katelyn W Sylvester, Clara Ting, Andrea Lewin, Peter Collins, John Fanikos, Samuel Z Goldhaber, Jean M Connors
Despite the ease of use of direct oral anticoagulants (DOACs), these agents remain high risk medications and their clinical efficacy can be impacted by factors such as patient adherence, drug procurement barriers, bleeding leading to discontinuation, and prescribing that deviates from approved dosing regimens. Clinical monitoring of patients on DOACs should be performed by clinicians who specialize in anticoagulation and are familiar with the nuances of DOAC dosing, monitoring, and other components of anticoagulation management including peri-procedural management and care transitions...
December 22, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29251769/incidence-of-thromboembolic-and-bleeding-events-in-patients-with-newly-diagnosed-nonvalvular-atrial-fibrillation-an-asian-multicenter-retrospective-cohort-study-in-singapore
#19
Xue Ting Wee, Lih Maan Ho, Han Kiat Ho, Joyce Yu-Chia Lee, Chun Wei Yap, Henry William, Linus Chong En Chan, Hooi Ching Tay, Cynthia Eei Mei Goh, Doreen Su-Yin Tan
BACKGROUND: Real-world effectiveness and safety of antithrombotics in nonvalvular atrial fibrillation (NVAF) patients in Singapore has not been thoroughly studied. HYPOTHESIS: Users of various antithrombotics experience a significantly different risk of stroke and major bleed compared with warfarin users. METHODS: This multicenter retrospective cohort study included patients age ≥ 21 years newly diagnosed with NVAF between July 2012 and September 2015...
December 18, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/29248859/impact-of-age-comorbidity-and-polypharmacy-on-the-efficacy-and-safety-of-edoxaban-for-the-treatment-of-venous-thromboembolism-an-analysis-of-the-randomized-double-blind-hokusai-vte-trial
#20
Thomas Vanassche, Peter Verhamme, Philip S Wells, Annelise Segers, Walter Ageno, Marjolein P A Brekelmans, Cathy Z Chen, Alexander T Cohen, Michael A Grosso, Andria P Medina, Michele F Mercuri, Shannon M Winters, George Zhang, Jeffrey I Weitz, Gary E Raskob, Harry R Büller
BACKGROUND: Many patients with venous thromboembolism (VTE) are elderly, have multiple comorbidities and take several concomitant medications. Physicians may prefer warfarin over direct oral anticoagulants (DOACs) in such patients because comparative data are lacking. This analysis was designed to determine the effects of advanced age, comorbidities, and polypharmacy on the efficacy and safety of edoxaban and warfarin in patients with VTE. METHODS: Using data from the Hokusai-VTE study, we report rates of recurrent VTE and of clinically relevant bleeding by age category (<65, 65-75, and ≥75; <80 versus ≥80years), and by number of comorbidities (0, 1-2, >2) and concomitant medications (<3, 3-5, >5)...
December 13, 2017: Thrombosis Research
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