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Apixaban AND prosthetic

Ertunc Altiok, Nikolaus Marx
BACKGROUND: Much new evidence on oral anticoagulation has come to light in recent years. Non-vitamin-K-dependent oral anti- coagulants (NOAC) have been developed and have been introduced into clinical practice. In this review, we present the current state of the evidence on anticoagulation for various indications with vitamin K antagonists (VKA) and with NOAC. METHODS: This review is based on pertinent articles retrieved by a selective search in PubMed (search terms: anticoagulation, atrial fibrillation, prosthetic valve, thrombosis, pulmonary embolism) and on specialty society recommendations and relevant guidelines from the years 2000-2018...
November 16, 2018: Deutsches Ärzteblatt International
Athina Chasapi, Adam Hobbs, Theodore Velissaris, Benoy N Shah
A 77-year-old male underwent elective bioprosthetic aortic valve replacement (23 mm Carpentier-Edwards Perimount MagnaEase) for severe aortic stenosis. His pre-discharge transthoracic echocardiogram (TTE) was normal. He presented 9 days after surgery with dyspnea and fever. He was in sinus rhythm. Blood cultures were taken and he was commenced on empirical antibiotics for possible infective endocarditis (subsequently all negative). Repeat TTE showed a well-seated prosthesis without regurgitation but elevated gradients (peak/mean gradients 69/48mmHg respectively)...
September 1, 2018: Echo Research and Practice
Athina Chasapi, Adam Hobbs, Theodore Velissaris, Benoy N Shah
No abstract text is available yet for this article.
September 2018: Echo Research and Practice
Perez Agaba, Beau J Kildow, Herman Dhotar, Thorsten M Seyler, Michael Bolognesi
Optimal prophylaxis for prevention of venous thromboembolism (VTE) after total joint arthroplasty (TJA) remains debated. The purpose of this study was to compare postoperative complications in patients receiving different VTE chemoprophylactic regimens. Using a nationwide healthcare database, 72,670 THA patients without a history of VTE were identified. Study cohorts received VTE prophylaxis within 30 days postoperatively. Odds ratios and 95% confidence intervals were used to assess 30-day and 90-day postoperative complications (hematoma, hemorrhage, transfusion, pulmonary embolism (PE), VTE, prosthetic joint infection (PJI), and incision/drainage (I&D))...
December 2017: Journal of Orthopaedics
Kenechukwu Mezue, Chukwudi Obiagwu, Jinu John, Abhishek Sharma, Felix Yang, Jacob Shani
Almost 800,000 new or recurrent strokes occur every year. Atrial fibrillation, the most common cardiac arrhythmia, is a major risk factor for stroke, accounting for 15-20% of ischemic strokes. Apixaban is a direct inhibitor of Factor Xa that was approved in December 2012 by the US Food and Drug Administration (FDA) for the prevention of stroke in patients with non-valvular atrial fibrillation. It is part of a family of novel oral anticoagulants (NOACs) which has advantage over warfarin of less dosing variability, rapid onset of action and no INR monitoring required...
2017: Current Cardiology Reviews
Larisa G Tereshchenko, Charles A Henrikson, Joaquin Cigarroa, Jonathan S Steinberg
BACKGROUND: The goal of this study was to compare the safety and effectiveness of individual antiembolic interventions in nonvalvular atrial fibrillation (AF): novel oral anticoagulants (NOACs) (apixaban, dabigatran, edoxaban, and rivaroxaban); vitamin K antagonists (VKA); aspirin; and the Watchman device. METHODS AND RESULTS: A network meta-analysis of randomized, clinical trials (RCTs) was performed. RCTs that included patients with prosthetic cardiac valves or mitral stenosis, mean or median follow-up <6 months, <200 participants, without published report in English language, and NOAC phase II studies were excluded...
May 20, 2016: Journal of the American Heart Association
Alvaro Avezum, Renato D Lopes, Phillip J Schulte, Fernando Lanas, Bernard J Gersh, Michael Hanna, Prem Pais, Cetin Erol, Rafael Diaz, M Cecilia Bahit, Jozef Bartunek, Raffaele De Caterina, Shinya Goto, Witold Ruzyllo, Jun Zhu, Christopher B Granger, John H Alexander
BACKGROUND: Apixaban is approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. However, the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial included a substantial number of patients with valvular heart disease and only excluded patients with clinically significant mitral stenosis or mechanical prosthetic heart valves. METHODS AND RESULTS: We compared the effect of apixaban and warfarin on rates of stroke or systemic embolism, major bleeding, and death in patients with and without moderate or severe valvular heart disease using Cox proportional hazards modeling...
August 25, 2015: Circulation
Qinmei Xiong, Gregory Y H Lip
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, which can potentially increases the risk of stroke by five-fold, thus, resulting in high public healthcare burden. Stroke prevention is vital in the management of AF patients. Vitamin K antagonists (VKA, eg, warfarin) have been the mainstay treatment to prevent ischemic stroke and systemic thromboembolism in AF patients for several decades. Despite the efficacy of warfarin, its limitations have recently driven the advent of some new antithrombotic agents, the non-VKA oral anticoagulant (NOACs, including dabigatran, rivaroxaban, apixaban, and edoxaban)...
February 2015: Current Treatment Options in Neurology
James Douketis, Alan David Bell, John Eikelboom, Aaron Liew
OBJECTIVE: To address common "what if" questions that arise relating to the long-term clinical follow-up and management of patients receiving the new oral anticoagulants (NOACs). SOURCES OF INFORMATION: For this narrative review, we searched the PubMed database for recent (January 2008 to week 32 of 2013) clinical studies relating to NOAC use for stroke prevention in atrial fibrillation and for the treatment of acute venous thromboembolism. We used this evidence base to address prespecified questions relating to NOAC use in primary care settings...
November 2014: Canadian Family Physician Médecin de Famille Canadien
Uri Adrian Prync Flato, Thais Buhatem, Thalita Merluzzi, Antonio Carlos Mugayar Bianco
Thromboembolic events commonly occur in critically ill patients, and although they do not consistently present with specific signs and symptoms, they are associated with high morbity and mortality. Antithrombotic agents are the mainstay of the prevention and treatment of venous thromboembolism, and they are also used for stroke prevention in atrial fibrillation, embolism prevention in heart failure, and anticoagulation of prosthetic valves. These drugs have been combined with antiplatelet therapy for the prevention of secondary acute coronary syndrome...
March 2011: Revista Brasileira de Terapia Intensiva
Luis Alejandro Asencio, Jennifer J Huang, Joseph S Alpert
Most patients with mechanical heart valves and many patients with atrial fibrillation will require long-term anticoagulation therapy. For patients with mechanical prosthetic valves, only warfarin is indicated. However, for patients with nonvalvular atrial fibrillation who are at increased risk for embolic stroke, one of the newer antithrombotic medications, such as rivaroxaban, dabigatran, and apixaban, also can be used. Patients with indications for antithrombotic therapy often will have coexisting vascular disease, such as coronary artery disease, requiring concomitant antiplatelet therapy with aspirin alone or more commonly with a dual antiplatelet regimen, aspirin and clopidogrel, or prasugrel or ticagrelor...
July 2014: American Journal of Medicine
Adam Lee, Rohan Rajaratnam
The direct thrombin inhibitors and Factor-Xa inhibitors are novel oral anticoagulants which are gaining rapid acceptance not only as alternatives to warfarin, but also as recommended first line agents for use as stroke prophylaxis in patients with non-valvular atrial fibrillation. There are, however, other patient settings in which anticoagulation is either indicated or has a potential role. Warfarin is still the predominant anticoagulant used for the treatment and prevention of venous thromboembolic events including deep vein thrombosis and pulmonary embolism as well as in patients with mechanical prosthetic heart valves...
January 2014: Heart, Lung & Circulation
Maxime Fournet, Jean-Claude Daubert
New oral anticoagulants (dabigatran, rivaroxaban, apixaban) have as main advantage an easier use (fixed dose therapy, no laboratory monitoring). Switching from vitamine K antagonists (VKA) to new oral anticoagulant is tempting. The indication of dabigatran and rivaroxaban for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation, and the indication of rivaroxaban for the treatment of deep-vein thrombosis and for the long-term prevention of venous thromboembolism are based from large, randomized trials...
September 2013: La Revue du Praticien
M-M Samamaa, J Conard, C Flaujac, S Combe, M-H Horellou
Amongst numerous promising anticoagulant molecules, rivaroxaban (Xarelto(®)), dabigatran (Pradaxa(®)) and apixaban (Eliquis(®)) have been registered outside the USA in the prevention of thromboembolic events in patients undergoing total hip or knee prosthetic replacement. Rivaroxaban however has been granted authorisation by the FDA for the thromboprophylaxis after surgery for total hip or knee surgery. Dabigatran has been granted authorisation by the FDA in non-valvular atrial fibrillation (RE-LY trial) while rivaroxaban is expecting approval in this same indication (ROCKET trial)...
December 2011: Journal des Maladies Vasculaires
Jaime García-Chávez
We can estimated the probability of developing thromboembolic disease and consequently prescribed antithrombotic measures to patients undergoing surgery. The anticoagulants carry the risk of abnormal bleeding, which can sometimes be fatal. Recently, this concept changed with the development of new drugs that retain their antithrombotic activity but decrease their anticoagulant effect; other advantages are: route of administration, predictable bioavailability (generally do not require monitoring), and little interaction with food and other drugs...
July 2011: Revista Médica del Instituto Mexicano del Seguro Social
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