Collections Anticoagulation


Anticoagulation for atrial fibrillation, thromboembolism and IHD
Adam J Rose, Arthur L Allen, Tracy Minichello
Because of the recent publication of several important studies, there has been a major change in how we think about perioperative management of anticoagulation. Because of these changes, existing consensus guidelines are suddenly out of date and can no longer be used as is, particularly the 2012 American College of Chest Physicians Antithrombotic Guidelines, version 9. We estimate that well over 90% of patients receiving warfarin therapy should not receive bridging anticoagulation during periprocedural interruptions of therapy, except under unusual circumstances and with appropriate justification...
January 2016: Circulation. Cardiovascular Quality and Outcomes
Yicong Chen, Yuhui Zhao, Ge Dang, Fubing Ouyang, Xinran Chen, Jinsheng Zeng
The risks of stroke or systemic embolism and major bleeding are considered similar between paroxysmal and sustained atrial fibrillation (AF), and warfarin has demonstrated superior efficacy to aspirin, irrespective of the AF type. However, with the advent of novel oral anticoagulants (NOACs) and antiplatelet agents, the optimal antithrombotic prophylaxis for paroxysmal AF remains unclear.We searched Medline, Embase, CENTRAL, and China Biology Medicine up to October week 1, 2015. Randomized controlled trials of AF patients assigned to NOACs, warfarin, or antiplatelets, with reports of outcomes stratified by the AF type, were included...
December 2015: Medicine (Baltimore)
Sophie Liabeuf, Lucie-Marie Scaltieux, Kamel Masmoudi, Bertrand Roussel, Julien Moragny, Michel Andrejak, Valérie Gras-Champel
Various predictive scores for vitamin K antagonist (VKA)-related bleeding have been developed and validated in outpatients and in patients treated for specific indications (when VKAs are used under optimal therapeutic conditions). However, there are few published data on the evaluation of bleeding risk factors in hospitalized, at-risk patients (with a high international normalized ratio [INR]) treated with VKAs. The objective of the present study was to identify the most relevant bleeding risk factors in 906 VKA-treated patients with an INR of 5 or more hospitalized in a French university medical center...
December 2015: Medicine (Baltimore)
Larry R Jackson, Christine Ju, Marjorie Zettler, John C Messenger, David J Cohen, Gregg W Stone, Brian A Baker, Mark Effron, Eric D Peterson, Tracy Y Wang
OBJECTIVES: The purpose of this study was to determine whether bleeding risk varies depending on which P2Y12 receptor inhibitor agent is used. BACKGROUND: Prior studies have shown significant bleeding risk among patients treated with triple therapy (i.e., oral anticoagulant, P2Y12 receptor inhibitor, and aspirin). METHODS: We evaluated patients with acute myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) at 233 hospitals in the United States enrolled in the TRANSLATE-ACS (Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study (April 2010 to October 2012)...
December 21, 2015: JACC. Cardiovascular Interventions
Cyrus R Kumana, Bernard M Y Cheung, David C W Siu, Hung-Fat Tse, Ian J Lauder
BACKGROUND AND OBJECTIVES: Benefits and/or harms (including costs) of non-vitamin K oral anticoagulants (NOACs) versus warfarin therapy need appreciation in relative and absolute terms. METHODS: Accordingly, we derived clinically relevant relative and absolute benefit/harm parameters for NOACs (apixaban, dabigatran, rivaroxaban, edoxaban) compared to warfarin from four clinical trials involving atrial fibrillation (AF) patients. For each trial, we tabulated patient numbers enduring four important outcomes and calculated unadjusted relative risk reduction (RRR) and number needed to treat (NNT)/year values (and 95% confidence intervals) for the NAOC compared to warfarin...
April 2016: Cardiovascular Therapeutics
Nick van Es, Suzanne M Bleker, Ineke T Wilts, Ettore Porreca, Marcello Di Nisio
Venous thromboembolism (VTE) is a frequent complication in patients with cancer and is associated with significant morbidity and mortality. The use of anticoagulants for the prevention and treatment of VTE in this population is challenging given the high risk of both recurrent VTE and bleeding complications. Thromboprophylaxis with subcutaneous low-molecular-weight heparin (LMWH) is recommended in cancer patients hospitalized for an acute medical illness and in those undergoing major surgery. In ambulatory cancer patients with or without central venous catheters, routine thromboprophylaxis is not recommended because of the relatively low benefit-to-risk ratio...
March 2016: Drugs
Nana Valeur, Charlotte Mérie, Morten Lock Hansen, Christian Torp-Pedersen, Gunnar H Gislason, Lars Kober
OBJECTIVE: Guidelines generally recommend oral anticoagulation to be considered the first 3 months after mitral valve repair based on small studies and consensus. However, in several studies no benefit of anticoagulation has been found. METHODS: From the national registries we identified all Danish patients who underwent mitral valve repair during the period between 1997 and 2012. Medication, hospitalisation and mortality data were studied. The association of use of vitamin K antagonists (VKAs) at discharge and risk of stroke/death was evaluated by means of Cox regression, landmark analyses and propensity matched models...
May 2016: Heart
Bobby Yanagawa, Richard P Whitlock, Subodh Verma, Bernard J Gersh
PURPOSE OF REVIEW: The efficacy of anticoagulation for valvular prostheses is the result of a delicate balance between the risk of thromboembolic (TE) events and bleeding. Here, we review data on anticoagulation for valve prostheses with a focus on clinical trials that address key unanswered questions. RECENT FINDINGS: There are several unanswered questions in the field of prosthetic valve anticoagulation, including: optimal TE prophylaxis in the short term for bioprostheses, optimal TE prophylaxis following transcatheter aortic valve implantation, the safety and efficacy of lower levels of anticoagulation with the bileaflet mechanical prosthesis, the role of aspirin for patients with mechanical prostheses, and the management of anticoagulation for mechanical valves in pregnancy...
March 2016: Current Opinion in Cardiology
Kelly M Rudd, Amanda R McFee Winans, Narmadha Panneerselvam
Rivaroxaban, a factor Xa inhibitor, is a direct-acting oral anticoagulant (DOAC) indicated for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and for reducing the risk of DVT and PE recurrence. To our knowledge, no data are presently available to guide DOAC dosing in the postpartum period when pharmacokinetic and pharmacodynamic changes induced by pregnancy have an impact on drug clearance and increase hypercoagulability for a period of 6-8 weeks after delivery. We describe the case of a 35-year-old postpartum woman who presented to the emergency department with a diagnosis of a new multiple segmental PE 5 days after starting rivaroxaban therapy for a diagnosis of DVT...
November 2015: Pharmacotherapy
Ekrem Güler, Gamze Babur Güler, Gültekin Günhan Demir, Suzan Hatipoğlu
Obesity is a significant cause of morbidity and mortality, and it is becoming increasingly prevalent worldwide. Altered pharmacodynamics and pharmacokinetics of drugs in obese patients require dose adjustment according to body weight. New oral anticoagulants (NOACs), which are more frequently used for anticoagulation, are recommended to be used at a fixed dose based on data derived from phase 2 and 3 studies. However, the representation of obese patients [>100 kg or a body mass index (BMI) of >30 kg/m2] in subgroups with a small sample size and reports of various emboli cases under drug treatment have raised suspicions about the adequacy of fixed dose use...
2015: Anatolian Journal of Cardiology
Johannes Thaler, Ingrid Pabinger, Cihan Ay
Venous thromboembolism (VTE), a disease entity comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent and potentially life-threatening event. To date different agents are available for the effective treatment of acute VTE and the prevention of recurrence. For several years, the standard of care was the subcutaneous application of a low molecular weight heparin (LMWH) or fondaparinux, followed by a vitamin K antagonist (VKA). The so-called direct oral anticoagulants (DOAC) were introduced rather recently in clinical practice for the treatment of VTE...
2015: Frontiers in Cardiovascular Medicine
R Durie, M Kohute, C Fernandez, M Knight
WHAT IS KNOWN AND OBJECTIVE: Given the data for four factor prothrombin complex concentrate (PCC) for vitamin K antagonist (VKA) reversal, there is great interest to determine whether PCC can improve patient outcomes in patients with bleeds associated with the newer oral anticoagulants (NOAC). CASE DESCRIPTION: We describe the case of an adult trauma patient anticoagulated with apixaban, presenting with a severe life-threatening bleed. PCC was administered at the maximum dose when the patient was determined to be refractory to supportive care with blood products...
February 2016: Journal of Clinical Pharmacy and Therapeutics
Naamah Jacobs Weltman, Yasmeen Al-Attar, Johnson Cheung, David Philip Bruce Duncan, Ashley Katchky, Amir Azarpazhooh, Lusine Abrahamyan
OBJECTIVES: The management of patients on anticoagulation therapy is challenging. The objective of this study was to conduct a systematic review to establish the effectiveness of hemostatic interventions to prevent postoperative bleeding following dental extractions among patients taking warfarin. METHODS: A systematic review of the literature was conducted using PubMed, EMBASE and the Cochrane Central Register of Controlled Trials databases and applying relevant MeSH terms...
2015: Canadian Dental Association Journal
Jan C Purrucker, Kirsten Haas, Timolaos Rizos, Shujah Khan, Marcel Wolf, Michael G Hennerici, Sven Poli, Christoph Kleinschnitz, Thorsten Steiner, Peter U Heuschmann, Roland Veltkamp
IMPORTANCE: Intracerebral hemorrhage (ICH) is the most devastating adverse event in patients receiving oral anticoagulation. There is only sparse evidence regarding ICH related to the use of non-vitamin K antagonist oral anticoagulant (NOAC) agents. OBJECTIVE: To evaluate the early clinical and radiological course, acute management, and outcome of ICH related to NOAC use. DESIGN, SETTING, AND PARTICIPANTS: Prospective investigator-initiated, multicenter observational study...
February 2016: JAMA Neurology
A L Marshall, M Levine, M L Howell, Y Chang, E Riklin, B A Parry, R T Callahan, I Okechukwu, A M Ayres, B V Nahed, J N Goldstein
UNLABELLED: ESSENTIALS: Fresh frozen plasma (FFP) may be associated with a dose-based risk of pulmonary complications. Patients received FFP for warfarin reversal at a large academic hospital over a 3-year period. Almost 20% developed pulmonary complications, and the risk was highest after > 3 units of FFP. The risk of pulmonary complications remained significant in multivariable analysis. BACKGROUND: Fresh frozen plasma (FFP) is often administered to reverse warfarin anticoagulation...
February 2016: Journal of Thrombosis and Haemostasis: JTH
Waldemar E Wysokinski, Robert D McBane
No abstract text is available yet for this article.
July 24, 2012: Circulation
Felicita Andreotti, Bianca Rocca, Steen Husted, Ramzi A Ajjan, Jurrien ten Berg, Marco Cattaneo, Jean-Philippe Collet, Raffaele De Caterina, Keith A A Fox, Sigrun Halvorsen, Kurt Huber, Elaine M Hylek, Gregory Y H Lip, Gilles Montalescot, Joao Morais, Carlo Patrono, Freek W A Verheugt, Lars Wallentin, Thomas W Weiss, Robert F Storey
No abstract text is available yet for this article.
December 7, 2015: European Heart Journal
Gregory Y H Lip, Felicita Andreotti, Laurent Fauchier, Kurt Huber, Elaine Hylek, Eve Knight, Deirdre Lane, Marcel Levi, Francisco Marín, Gualtiero Palareti, Paulus Kirchhof
In this executive summary of a Consensus Document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in atrial fibrillation (AF) patients. The main aim of the document was to summarise 'best practice' in dealing with bleeding risk in AF patients when approaching antithrombotic therapy, by addressing the epidemiology and size of the problem, and review established bleeding risk factors...
December 2011: Thrombosis and Haemostasis
Stephen Andrew LaHaye, Sabra Lynn Gibbens, David Gerald Andrew Ball, Andrew George Day, Jonas Bjerring Olesen, Allan Cameron Skanes
AIMS: The availability of new antithrombotic agents, each with a unique efficacy and bleeding profile, has introduced a considerable amount of clinical uncertainty with physicians. We have developed a clinical decision aid in order to assist clinicians in determining an optimal antithrombotic regime for the prevention of stroke in patients who are newly diagnosed with non-valvular atrial fibrillation. METHODS AND RESULTS: The CHA(2)DS(2)-VASc and HAS-BLED scoring systems were used to assess patients' baseline risks of stroke and major bleeding, respectively...
September 2012: European Heart Journal
Matthew W Sherwood, James D Douketis, Manesh R Patel, Jonathan P Piccini, Anne S Hellkamp, Yuliya Lokhnygina, Alex C Spyropoulos, Graeme J Hankey, Daniel E Singer, Christopher C Nessel, Kenneth W Mahaffey, Keith A A Fox, Robert M Califf, Richard C Becker
BACKGROUND: During long-term anticoagulation in atrial fibrillation, temporary interruptions (TIs) of therapy are common, but the relationship between patient outcomes and TIs has not been well studied. We sought to determine reasons for TI, the characteristics of patients undergoing TI, and the relationship between anticoagulant and outcomes among patients with TI. METHODS AND RESULTS: In the 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), a randomized, double-blind, double-dummy study of rivaroxaban and warfarin in nonvalvular atrial fibrillation, baseline characteristics, management, and outcomes, including stroke, non-central nervous system systemic embolism, death, myocardial infarction, and bleeding, were reported in participants who experienced TI (3-30 days) for any reason...
May 6, 2014: Circulation
2015-06-01 22:37:00
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