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By Eduardo Roque Cardiologista com foco em cardiologia hospitalar e cuidados intensivos. Professor de clínica médica.
Jennifer Cautela, Nathalie Lalevée, Chloé Ammar, Stéphane Ederhy, Michael Peyrol, Philippe Debourdeau, Daniel Serin, Yvan Le Dolley, Nicolas Michel, Morgane Orabona, Jérémie Barraud, Marc Laine, Laurent Bonello, Franck Paganelli, Fabrice Barlési, Franck Thuny
Cardiovascular toxicity is a potentially serious complication that can result from the use of various cancer therapies and can impact the short- and long-term prognosis of treated patients as well as cancer survivors. In addition to their potential acute cardiovascular adverse events, new treatments can lead to late toxicity even after their completion because patients who survive longer generally have an increased exposure to the cancer therapies combined to standard cardiovascular risk factors. These complications expose the patient to the risk of cardiovascular morbi-mortality, which makes managing cardiovascular toxicity a significant challenge...
September 17, 2016: International Journal of Cardiology
Angelique H Sadlon, Dimitrios A Tsakiris
BACKGROUND: Concerns regarding the use of direct oral anticoagulants (DOACs: apixaban, dabigatran, edoxaban, rivaroxaban) in the elderly persist owing to the lack of randomised controlled trials targeting this age group. OBJECTIVES: The aim of this study was to assess the efficacy and safety of DOACs in elderly patients (aged 75 years or more) with atrial fibrillation or venous thromboembolism (VTE), based on already published large randomised trials. METHODS: EMBASE, MEDLINE and the Cochrane Library were searched from inception to June 2015 for phase III trials...
2016: Swiss Medical Weekly
Pasquale Pignatelli, Daniele Pastori, Simona Bartimoccia, Danilo Menichelli, Tommasa Vicario, Cristina Nocella, Roberto Carnevale, Francesco Violi
Anti Xa non-vitamin K oral anticoagulants (anti Xa NOACs) seem to possess antiplatelet effect in vitro, but it is unclear if this occurs also in vivo. Aim of the study was to compare the effect on platelet activation of two anti Xa NOACs, namely apixaban and rivaroxaban, to warfarin, and to investigate the potential underlying mechanism by evaluating soluble glycoprotein GPVI (sGPVI), a protein involved in platelet activation. We performed a cross-sectional including AF patients treated with warfarin (n=30), or apixaban 10mg/day (n=40), or rivaroxaban 20mg/day (n=40)...
September 28, 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Francesco Pelliccia, Fabiana Rollini, Giuseppe Marazzi, Cesare Greco, Carlo Gaudio, Dominick J Angiolillo, Giuseppe Rosano
The combination of AF and coronary artery disease not only is a common clinical setting, it is also a complex setting to deal with anticoagulation and antiplatelet therapy, and it is associated with significantly higher mortality rates. Unfortunately, there are no sufficient data available to optimally guide clinical practice in such settings. This review focuses specifically on newer oral anticoagulants (NOACs) associated with dual antiplatelet therapy (DAPT) in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI)...
October 3, 2016: International Journal of Cardiology
Wesley D Kufel, Adam S Zayac, David F Lehmann, Christopher D Miller
Despite prescribing guidance, limited data exist to describe the use of apixaban in patients with end-stage renal disease (ESRD) requiring hemodialysis (HD). Current apixaban dosing recommendations for this patient population are based largely on a single-dose pharmacokinetic study of eight patients. We describe the clinical application and pharmacodynamic monitoring of apixaban in a 62-year-old 156-kg African-American woman with nonvalvular atrial fibrillation and ESRD requiring hemodialysis who developed calciphylaxis while receiving warfarin therapy...
September 19, 2016: Pharmacotherapy
Paul R Kunk, Jacqueline Brown, Melissa McShane, Surabhi Palkimas, B Gail Macik
Direct oral anticoagulants have been shown safe and effective in the treatment of pulmonary emboli and deep vein thrombi. Their role in the treatment of patients with hypercoagulability is uncertain. We designed a retrospective exploratory analysis of all patients with definite heparin induced thrombocytopenia (HIT) and antiphospholipid syndrome (APS) that were treated with either apixaban or rivaroxaban from September 2011 through November 2015. Patients were reviewed for several clinico-pathologic features, including efficacy and safety...
September 8, 2016: Journal of Thrombosis and Thrombolysis
Marco Alings
Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have emerged as alternatives to VKAs for the prevention of stroke in patients with non-valvular atrial fibrillation. Four NOACS: dabigatran, apixaban, rivaroxaban and edoxaban, have received regulatory approval in Europe from the European Medicines Agency. Numerous factors can influence the decision to prescribe a NOAC, the most important of which are assessment of stroke and bleeding risks. Given the variation in design of the pivotal phase III clinical trials investigating the efficacy and safety of NOACs, and in the absence of head-to-head comparative data, it is impossible to recommend one NOAC over the other...
August 2016: Arrhythmia & Electrophysiology Review
A T Cohen, M Hamilton, A Bird, S A Mitchell, X Li, R Horblyuk, S Batson
[This corrects the article DOI: 10.1371/journal.pone.0160064.].
2016: PloS One
Craig I Coleman, Matthias Antz, Kevin Bowrin, Thomas Evers, Edgar P Simard, Hendrik Bonnemeier, Riccardo Cappato
BACKGROUND: Little data exists regarding the effectiveness and safety of rivaroxaban or apixaban versus warfarin in nonvalvular atrial fibrillation (NVAF) patients treated outside of clinical trials. METHODS: This was a retrospective study using MarketScan claims from January 2012 to October 2014. We included adults, newly initiated on rivaroxaban, apixaban or warfarin, with a baseline CHA2DS2-VASc score ≥2, ≥2 diagnosis codes for NVAF and ≥180 days of continuous medical and prescription benefits...
September 20, 2016: Current Medical Research and Opinion
Daniel K Nishijima, Samuel Gaona, Trent Waechter, Ric Maloney, Troy Bair, Adam Blitz, Andrew R Elms, Roel D Farrales, Calvin Howard, James Montoya, Jeneita M Bell, Victor C Coronado, David E Sugerman, Dustin W Ballard, Kevin E Mackey, David R Vinson, James F Holmes
OBJECTIVE: Prehospital provider assessment of the use of anticoagulant or antiplatelet medications in older adults with head trauma is important. These patients are at increased risk for traumatic intracranial hemorrhage and therefore field triage guidelines recommend transporting these patients to centers capable of rapid evaluation and treatment. Our objective was to evaluate EMS ascertainment of anticoagulant and antiplatelet medication use in older adults with head trauma. METHODS: A retrospective study of older adults with head trauma was conducted throughout Sacramento County...
September 16, 2016: Prehospital Emergency Care
Cecilia Gutierrez, Daniel G Blanchard
Atrial fibrillation is a supraventricular arrhythmia that adversely affects cardiac function and increases the risk of stroke. It is the most common arrhythmia and a major source of morbidity and mortality; its prevalence increases with age. Pulse rate is sensitive, but not specific, for diagnosis, and suspected atrial fibrillation should be confirmed with 12-lead electrocardiography. Because normal electrocardiographic findings do not rule out atrial fibrillation, home monitoring is recommended if there is clinical suspicion of arrhythmia despite normal test results...
September 15, 2016: American Family Physician
Bethany T Samuelson, Adam Cuker, Deborah M Siegal, Mark Crowther, David A Garcia
BACKGROUND: The direct oral anticoagulants (DOACs) are the treatment of choice for most patients with atrial fibrillation and/or non-cancer associated venous thromboembolic disease. While routine monitoring of these agents is not required, assessment of anticoagulant effect may be desirable in special situations. The objective of this study was to systematically review and summarize current evidence regarding laboratory assessment of the anticoagulant effects of dabigatran, rivaroxaban, apixaban and edoxaban...
September 13, 2016: Chest
Fabio Marsico, Milena Cecere, Antonio Parente, Stefania Paolillo, Fabiana de Martino, Santo Dellegrottaglie, Bruno Trimarco, Pasquale Perrone Filardi
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and predisposes to an increased risk of thromboembolic events. Patients affected by AF exhibit an increased risk of stroke compared with those in sinus rhythm, with the most common location of thrombi in the left atrial appendage. Until 2009, warfarin and other vitamin K antagonists were the only class of oral anticoagulants available. More recently, dabigatran, rivaroxaban, apixaban, and edoxaban have been approved by regulatory authorities for prevention of stroke in patients with non-valvular AF...
September 10, 2016: Journal of Thrombosis and Thrombolysis
Rohan Shah, Anne Hellkamp, Yuliya Lokhnygina, Richard C Becker, Scott D Berkowitz, Günter Breithardt, Werner Hacke, Jonathan L Halperin, Graeme J Hankey, Keith A A Fox, Christopher C Nessel, Kenneth W Mahaffey, Jonathan P Piccini, Daniel E Singer, Manesh R Patel
BACKGROUND: We aimed to investigate the relationship between aspirin use and clinical outcomes in patients enrolled in Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF), in particular, those with known coronary artery disease (CAD). METHODS: Patients in ROCKET AF, comparing rivaroxaban and warfarin, were analyzed. Aspirin use was assessed at baseline...
September 2016: American Heart Journal
Alicia B Lichvar, Cody A Moore, Christopher R Ensor, John F McDyer, Jeffrey J Teuteberg, Michael A Shullo
CONTEXT: Anticoagulation therapy is common in thoracic transplant recipients. Direct oral anticoagulants (DOACs) are alternatives to warfarin therapy, but characterization of their use in solid organ transplant is absent. OBJECTIVE: The primary objective of this study was to describe a thoracic transplant patient population initiated on DOAC therapy. Secondary objectives were to assess adverse reactions, venous thromboembolism (VTE) recurrence, and drug-drug interactions during DOAC therapy...
September 2016: Progress in Transplantation
K M Musgrave, J Powell
There is limited guidance available to clinicians regarding the management of antithrombotic therapy during epistaxis, whilst there has been an increase in the use of anticoagulation and antiplatelet therapy. In addition, the introduction of direct oral anticoagulants (DOACs), such as dabigatran and rivaroxaban, over the last decade has significantly increased the complexity of managing the anticoagulated epistaxis patient. We undertook a systemic literature review investigating potential management strategies for each class of anti-thrombotic therapy during epistaxis...
September 4, 2016: Rhinology
Hisham Badreldin, Hunter Nichols, Jessica Rimsans, Danielle Carter
Treatment of venous thromboembolism (VTE) has been confined to parenteral agents and oral vitamin K antagonists for decades; however, with the approval of the direct oral anticoagulants (DOACs), clinicians now have more options. This study aims to evaluate the real world prescribing practices of all oral anticoagulants for VTE at a single center. A retrospective cohort analysis of all adult patients diagnosed with acute onset VTE was conducted. Of the 105 patients included in the analysis, 45 (43 %) patients received warfarin and 60 (57 %) patients received a DOAC...
September 3, 2016: Journal of Thrombosis and Thrombolysis
Zaheer Ahmed, Seemeen Hassan, Gary A Salzman
Warfarin was the only oral anticoagulant available for the treatment of venous thromboembolism for about half a century until the recent approval of novel oral agents dabigatran, rivoraxaban and apixaban. This presents new classes of medications less cumbersome to use. They do not require frequent laboratory monitoring or have nurmerous drug interactions. On the other hand it also poses a challenge to the physicians deciding which agent to use in specific patient populations, how to predict the bleeding risk compared to warfarin and between the different novel agents and how to manage bleeding with relatively recent discovery of few potential antidotes...
April 2016: Current Drug Therapy
Rahul Trikha, Peter R Kowey
OBJECTIVES: Dabigatran, rivaroxaban, apixaban, and edoxaban are nonvitamin K antagonist oral anticoagulants (NOACs) approved for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Phase-3 clinical trials demonstrated NOACs were as effective as warfarin in the prevention of stroke or systemic embolism and associated with decreased incidences of intracranial bleeding. Additionally, NOACs provide quicker onset of action, simpler dosing, more predictable pharmacokinetic profiles, and decreased food and drug interactions compared with warfarin...
September 6, 2016: Cardiology
Michael D Ezekowitz, Charles V Pollack, Paul Sanders, Jonathan L Halperin, Judith Spahr, Nilo Cater, William Petkun, Andrei Breazna, Paulus Kirchhof, Jonas Oldgren
BACKGROUND: Stroke prevention in anticoagulation-naïve patients with atrial fibrillation undergoing cardioversion has not been systematically studied. OBJECTIVE: To determine outcomes in anticoagulation-naïve patients (defined as those receiving an anticoagulant for <48 hours during the index episode of atrial fibrillation) scheduled for cardioversion. METHODS: This is a randomized, prospective, open-label, real-world study comparing apixaban to heparin plus warfarin...
September 2016: American Heart Journal
2016-09-08 18:52:47
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