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https://www.readbyqxmd.com/read/28509773/perioperative-management-of-antithrombotic-therapies
#1
Timur Yurttas, Patrick M Wanner, Miodrag Filipovic
PURPOSE OF REVIEW: Perioperative coagulation management is becoming increasingly frequent in the daily routine of the anesthesiologist and with the plethora of new substances on the market also increasingly complex. The perioperative setting poses unique challenges requiring an individualized evaluation and management of antithrombotic therapy. This review shall summarize the newest developments in this domain. RECENT FINDINGS: New data in patients with atrial fibrillation have led to a paradigm change in the perioperative management of antithrombotics...
May 15, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28494694/antagonizing-dabigatran-by-idarucizumab-in-cases-of-ischemic-stroke-or-intracranial-hemorrhage-in-germany-a-national-case-collection
#2
Pawel Kermer, Christoph C Eschenfelder, Hans-Christoph Diener, Martin Grond, Yasser Abdalla, Katharina Althaus, Jörg Berrouschot, Hakan Cangür, Michael Daffertshofer, Sebastian Edelbusch, Klaus Gröschel, Claus G Haase, Andreas Harloff, Valentin Held, Andreas Kauert, Peter Kraft, Arne Lenz, Wolfgang Müllges, Mark Obermann, Someieh Partowi, Jan Purrucker, Peter A Ringleb, Joachim Röther, Raluca Rossi, Niklas Schäfer, Andreas Schneider, Ramona Schuppner, Rüdiger J Seitz, Kristina Szabo, Robert Wruck
Background Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran that reverses its anticoagulant effects within minutes. It may exhibit the potential for patients under dabigatran therapy suffering ischemic stroke to regain eligibility for thrombolysis with rt-PA and may inhibit lesion growth in patients with intracerebral hemorrhage on dabigatran. Aims To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of ischemic stroke or intracranial hemorrhage...
June 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28479184/systemic-thrombolysis-in-acute-ischemic-stroke-after-dabigatran-etexilate-reversal-with-idarucizumab-a-case-report
#3
Derya Tireli, Jun He, Mette Maria Nordling, Troels Wienecke
INTRODUCTION: Idarucizumab is a reversal agent for dabigatran etexilate. By reversing the anticoagulating effect of dabigatran etexilate with idarucizumab (Praxbind), patients presenting with an acute ischemic stroke can now be eligible for thrombolysis. PATIENT: We describe our experience with idarucizumab in a 71-year-old male patient pretreated with dabigatran etexilate. The patient arrived with a hemiparesis, central facial palsy, and dysarthria. METHOD: Dabigatran etexilate was antagonized with idarucizumab, approximately 2...
May 4, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28460624/dabigatran-metabolism-pharmacologic-properties-and-drug-interactions
#4
Nebojsa Antonijevic, Ivana Zivkovic, Ljubica Jovanovic, Dragan Matic, Mladen Kocica, Igor Mrdovic, Vladimir Kanjuh, Milica Culafic
The superiority of dabigatran has been well proven in the standard dosing regimen in prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF) and extended venous thromboembolism (VTE) treatment. Dabigatran, an anticoagulant with a good safety profile, reduces intracranial bleeding in patients with atrial fibrillation and decreases major and clinically relevant non-major bleeding in acute VTE treatment. However, several important clinical issues are not fully covered by currently available directions with regard to dabigatran administration...
April 26, 2017: Current Drug Metabolism
https://www.readbyqxmd.com/read/28459790/late-rebound-of-dabigatran-levels-after-idarucizumab-reversal-in-two-patients-with-severe-renal-failure
#5
Adela Stecher, Nina Vene, Alenka Mavri, Mojca Božič Mijovski, Barbara Krevel, Primož Gradišek
No abstract text is available yet for this article.
June 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28455651/-management-of-hemorrhage-in-patients-treated-with-direct-oral-anticoagulants
#6
REVIEW
O Grottke, H Lier, S Hofer
The introduction of nonvitamin K antagonistic, direct oral anticoagulants (DOAC) made thromboembolic prophylaxis easier for patients. For many physicians, however, there is still uncertainty about monitoring, preoperative discontinuation, and restarting of DOAC therapy. Guidelines for the management of bleeding are provided, but require specific therapeutic skills in the management of diagnostics and therapy of acute hemorrhage. Small clinical studies and case reports indicate that unspecific therapy with prothrombin complex concentrates (PCC) and activated PCC (aPCC) concentrate may reverse DOAC-induced anticoagulation...
April 28, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28447276/increased-dabigatran-plasma-concentration-during-ibrutinib-treatment-a-case-of-cerebral-hemorrhage-and-successful-dabigatran-reversal-by-idarucizumab
#7
R Quintavalla, M Lombardi, P Prandoni, C Manotti, I Tadonio, F Re, P M Ferrini, M I Tassoni, P Rossetti, F Quaini
No abstract text is available yet for this article.
April 26, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28429198/managing-the-perioperative-patient-on-direct-oral-anticoagulants
#8
Jordan Leitch, Janet van Vlymen
PURPOSE: Patients are increasingly treated with direct oral anticoagulants (DOACs) for the prevention of stroke due to non-valvular atrial fibrillation and for the treatment of venous thromboembolism. When these patients present for urgent or emergent surgical procedures, they present a challenge to the anesthesiologist who must manage perioperative risk due to anticoagulation. The purpose of this module is to review the literature surrounding the perioperative management of DOACs. Timing, laboratory monitoring, and availability of reversal agents are important considerations to optimize patients being treated with DOACs who require emergent surgery...
June 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28426914/recommended-dose-of-idarucizumab-may-not-always-be-sufficient-for-sustained-reversal-of-dabigatran
#9
Alexander Simon, Hans Domanovits, Cihan Ay, Gürkan Sengölge, Jerrold H Lewy, Alexander O Spiel
Idarucizumab is a monoclonal antibody fragment designed for reversing the anticoagulant effects of dabigatran. Administration is recommended as two intravenous boluses of 2.5 g within 15 minutes of each other or as a single 5 g bolus. However, in certain situations a second dose of the drug could be necessary. We report the case of a 77-year old man, treated with dabigatran for paroxysmal atrial fibrillation. He presented at our department with acute renal failure, concomitant massive dabigatran accumulation, and subsequent acute gastrointestinal bleeding...
April 20, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28424818/dose-requirements-for-idarucizumab-reversal-of-dabigatran-in-a-lethal-porcine-trauma-model-with-continuous-bleeding
#10
Markus Honickel, Henri M Spronk, Rolf Rossaint, Christian Stoppe, Joanne van Ryn, Hugo Ten Cate, Oliver Grottke
Idarucizumab is licensed for emergency reversal of dabigatran. A single 5 g dose is usually sufficient, but higher doses may sometimes be required and optimum dosing has not been defined. It was the aim of this study to investigate the effect of idarucizumab, given once or as a split dose, after double trauma in pigs anticoagulated with dabigatran. Dabigatran etexilate (30 mg/kg bid) was given to 18 male pigs orally for 3 days. On day 4, animals were randomised 1:1:1 to receive idarucizumab 60+0, 60+60 or 120+0 mg/kg...
April 20, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28416406/acute-stroke-despite-dabigatran-anticoagulation-treated-with-idarucizumab-and-intravenous-tissue-plasminogen-activator
#11
David Bissig, Rashmi Manjunath, Brittany R Traylor, David P Richman, Kwan L Ng
Dabigatran is a direct thrombin inhibitor used to reduce the risk of stroke in patients with nonvalvular atrial fibrillation. For patients who present with an acute stroke despite dabigatran therapy, clinical data on the use of intravenous tissue plasminogen activator (IV-tPA) is limited. There is an anticipated increased risk of symptomatic intracranial hemorrhage (sICH) when using IV-tPA in patients on dabigatran therapy. In 2015, the humanized monoclonal antibody fragment idarucizumab was approved for rapid (minutes) reversal of anticoagulant effects of dabigatran...
April 14, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28412907/review-of-the-pharmacology-of-the-emerging-possibilities-of-the-direct-oral-anticoagulants-reversal
#12
Matej Samos, Lucia Stanciakova, Ingrid Skornova, Tomas Bolek, Frantisek Kovar, Jan Stasko, Peter Galajda, Marian Mokan, Peter Kubisz
BACKGROUND: Direct oral anticoagulants (DOACs) offer consistent and predictable anticoagulation, oral administration with good patient compliance and a good safety profile. Dabigatran - a direct thrombin inhibitor, apixaban and rivaroxaban - direct factor Xa inhibitors are now largely used for anticoagulation in patients with non-valvular atrial fibrillation and in patients with venous thromboembolism. These agents have emerged as an expediential clinical choice in long-term anticoagulation for an increasing number of patients...
April 13, 2017: Current Drug Metabolism
https://www.readbyqxmd.com/read/28397672/-successful-treatment-of-severe-dabigatran-intoxication-with-idarucizumab-in-a-patient-with-acute-kidney-injury
#13
Christina Gjerlev Poulsen, Morten Bestle, Lene Boesby
In the course of an uncomplicated sigmoidostomy a 63-year-old male who had severe comorbidity developed a critical bleeding due to dabigatran intoxication induced by acute kidney injury. Massive blood transfusions, tranexamic acid, Octaplex and haemodialysis were not effective. Administration of idarucizumab induced immediate clinical and paraclinical improvement. Dabigatran should be carefully administrated in patients who have any degree of renal insufficiency. Idarucizumab may be effective in severe bleeding caused by dabigatran...
February 13, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28386620/direct-oral-anticoagulants-doac-management-of-emergency-situations-rationale-and-design-of-the-radoa-registry
#14
Edelgard Lindhoff-Last
The worldwide increase in the aging population and the associated increase in the prevalence of atrial fibrillation and venous thromboembolism as well as the widespread use of direct oral anticoagulants (DOAC) have resulted in an increase of the need for the management of bleeding complications and emergency operations in frail, elderly patients, in clinical practice. When severe bleeding occurs, general assessment should include evaluation of the bleeding site, onset and severity of bleeding, renal function, and concurrent medications with focus on antiplatelet drugs and nonsteroidal anti-inflammatory drugs (NSAID)...
April 6, 2017: Hämostaseologie
https://www.readbyqxmd.com/read/28373761/gastrointestinal-bleeding-in-patients-on-novel-oral-anticoagulants-risk-prevention-and-management
#15
REVIEW
Ka-Shing Cheung, Wai K Leung
Novel oral anticoagulants (NOACs), which include direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitors (rivaroxaban, apixaban and edoxaban), are gaining popularity in the prevention of embolic stroke in non-valvular atrial fibrillation as well as in the prevention and treatment of venous thromboembolism. However, similar to traditional anticoagulants, NOACs have the side effects of bleeding, including gastrointestinal bleeding (GIB). Results from both randomized clinical trials and observations studies suggest that high-dose dabigatran (150 mg b...
March 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28364736/bleeding-complications-and-management-on-anticoagulant-therapy
#16
Sam Schulman
Patients treated with anticoagulants have an unavoidable risk of bleeding complications. There are, for all oral anticoagulants, several potential options for management of major bleeding. The first action is to assess the causative role of the anticoagulant in the current bleeding. Supportive measures have been assessed in several post hoc analyses of the phase III pivotal trials with the non-vitamin K antagonist oral anticoagulants (NOACs). Those results will be reviewed here together with emerging data on the efficacy and safety of the specific antidotes idarucizumab (for dabigatran) and andexanet-α (for factor Xa inhibitors)...
April 1, 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28362649/rapid-and-well-tolerated-action-of-idarucizumab-for-antagonizing-dabigatran-in-a-patient-needing-urgent-thrombolysis-a-case-report
#17
Roberto Facchinetti, Giulia DeGuidi, Federica Pitoni, Giorgio Ricci, Giuseppe Lippi
Dabigatran is a direct oral anticoagulant drug exhibiting clinical benefits over vitamin K antagonists. A procedure for reversing the anticoagulant effect of direct oral anticoagulants may be needed in emergency clinical settings, and is traditionally accomplished by using plasma products or hemostatic physical interventions. Idarucizumab, a specific antidote for dabigatran, has recently become available. This compound can be rapidly administered by intravenous injection and is effective in reversing anticoagulation in few minutes...
March 30, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28360881/hemostasis-in-intracranial-hemorrhage
#18
REVIEW
Deepak Gulati, Dharti Dua, Michel T Torbey
Spontaneous non-traumatic intracerebral hemorrhage (ICH) is associated with high morbidity and mortality throughout the world with no proven effective treatment. Majority of hematoma expansion occur within 4 h after symptom onset and is associated with early deterioration and poor clinical outcome. There is a vital role of ultra-early hemostatic therapy in ICH to limit hematoma expansion. Patients at risk for hematoma expansion are with underlying hemostatic abnormalities. Treatment strategy should include appropriate intervention based on the history of use of antithrombotic use or an underlying coagulopathy in patients with ICH...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28337750/efficacy-and-safety-of-the-drugs-used-to-reverse-direct-oral-anticoagulants-a-systematic-review-and-meta-analysis
#19
REVIEW
Luis Teodoro da Luz, Mylene Marchand, Bartolomeu Nascimento, Homer Tien, Avery Nathens, Prakesh Shah
BACKGROUND: Direct oral anticoagulants (DOACs) are effective and safe for prophylaxis and treatment of thromboembolic phenomena. However, managing DOACs during bleeding emergencies is challenging. A systematic review and meta-analysis was conducted on studies addressing efficacy and safety of the drugs used for reversal of DOACs. STUDY DESIGN AND METHODS: Medline, Embase, Cochrane Library, and ClinicalTrials.gov were searched up to September 2016. Studies that examined clinical and laboratory effects of drugs used to reverse DOACs were included...
March 24, 2017: Transfusion
https://www.readbyqxmd.com/read/28335637/reversing-the-anticoagulation-effects-of-dabigatran
#20
REVIEW
William E Dager, Linda Banares
The standard of care for oral anticoagulation therapy has primarily been warfarin, which is limited by its indirect mechanism-of-action, variable kinetics, tolerability, and routine monitoring concerns. The direct-acting oral anticoagulants (DOACs) have predictable pharmacokinetics and pharmacodynamics, and improved safety and efficacy compared to warfarin for the prevention of stroke in patients with nonvalvular atrial fibrillation and prevention or management of venous thromboembolism. Consequential bleeding is a concern with all anticoagulants...
April 2017: Hospital Practice (Minneapolis)
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