How I manage anticoagulant therapy in older individuals with atrial fibrillation or venous thromboembolism

Anticoagulant therapy is the most effective strategy to prevent arterial and venous thromboembolism, but treating older individuals is challenging, because increasing age, comorbidities, and polypharmacy increase the risk of both thrombosis and bleeding. Warfarin and non–vitamin K antagonist oral anticoagulants are underused and often underdosed in the prevention of stroke in older patients with atrial fibrillation because of concerns about the risk of bleeding. Poor adherence to anticoagulant therapy is also an issue for older patients with atrial fibrillation and those at risk of recurrent pulmonary embolism. In this review, we present 5 clinical cases to illustrate common challenges with anticoagulant use in older patients and discuss our approach to institute safe and effective antithrombotic therapy.
Source: Blood - Category: Hematology Authors: Tags: How I Treat, Free Research Articles, Thrombosis and Hemostasis Source Type: research

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Authors: Gumprecht J, Domek M, Lip GY Abstract Introduction: The non-vitamin K antagonist oral anticoagulants (NOACs) are changing the landscape for stroke prevention in atrial fibrillation (AF) and prevention or treatment of venous thromboembolism (VTE). In patients with AF and concomitant acute coronary syndrome (ACS), the treatment regimen of combined NOACs and P2Y12 inhibitors is gaining popularity. Areas covered: The authors conducted a review of studies published in the last 10 years regarding safety evaluation and effectiveness of apixaban for the treatment of AF and ACS, both alone and in combination with d...
Source: Expert Opinion on Drug Safety - Category: Drugs & Pharmacology Tags: Expert Opin Drug Saf Source Type: research
Abstract Anticoagulation therapy is recommended for preventing, treating, and reducing the recurrence of venous thromboembolism, and preventing stroke in persons with atrial fibrillation. Direct oral anticoagulants are first-line agents for eligible patients for treating venous thromboembolism and preventing stroke in those with nonvalvular atrial fibrillation. Vitamin K antagonists are recommended for patients with mechanical valves and valvular atrial fibrillation. Vitamin K antagonists inhibit the production of vitamin K-related factors and require a minimum of five days overlap with parenteral anticoagulants, ...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
Conclusion: Our findings describe the most reported risk factors for preventability of oral anticoagulant-induced bleedings. These factors may be useful for targeting interventions to improve pharmacovigilance activities in our regional territory and to reduce the burden of medication errors and inappropriate prescription. Introduction Oral anticoagulant therapy is widely used for the prevention of stroke and systemic embolism in patients with atrial fibrillation, or for the prevention and treatment of deep vein thrombosis and pulmonary embolism (Raj et al., 1994; Monaco et al., 2017). Oral anticoagulants can be di...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
AbstractPurpose of ReviewThe anticoagulation strategies for various cardiac-specific pathologies including atrial fibrillation are changing. Applying these strategies in patients with concomitant active cancer requires additional considerations. Here, we review the most recent changes in the anticoagulation management of common cardiac diseases and their application in cancer patients.Recent FindingsThere are a range of indications for therapeutic anticoagulation in cancer patients including venous thromboembolism (VTE), atrial fibrillation/flutter (AF/AFL), prosthetic heart valves, and intracardiac thrombi. Certain cancer...
Source: Current Oncology Reports - Category: Cancer & Oncology Source Type: research
We report a child who presented abnormal coagulation tests after unintended ingestion of 4 tablets of rivaroxaban. The patient was treated with fresh frozen plasma as well as admitted to intensive care and improved several hours later. We discuss his presentation and review of the literature on this topic.
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Illustrative Cases Source Type: research
Conclusion: VTE incidence in our study was significantly higher than reported in general population at similar age. However, the inclusion of more symptomatic and serious HHT patients could be selection bias. The low number of patients, may influence the results. IDA and hospitalization were the most important associated conditions. Most patients tolerated well the anticoagulation therapy.DisclosuresNo relevant conflicts of interest to declare.
Source: Blood - Category: Hematology Authors: Tags: 301. Vascular Wall Biology, Endothelial Progenitor Cells, and Platelet Adhesion, Activation, and Biochemistry Source Type: research
Introduction:The introduction of direct oral anticoagulants (DOAC) has revolutionised the treatment of atrial fibrillation (AF) and venous thromboembolism (VTE). Previous clinical trials have demonstrated that DOACs are non-inferior to warfarin for treatment and prevention of VTE and at least as safe in terms of bleeding risk. However, there is limited data on real-world outcomes. We aim to evaluate the local real-world DOAC use with particular focus on safety and to specifically compare the safety outcomes of the warfarin era vs the DOAC era in the management of VTE.Method:Retrospective evaluation was performed with a tot...
Source: Blood - Category: Hematology Authors: Tags: 331. Pathophysiology of Thrombosis: Poster II Source Type: research
ConclusionsKcentra was used in several off-label clinical settings, with comparable mortality among the coumadin, rivaroxaban and apixaban groups and no identifiable benefit in the setting of cirrhosis, DIC or antiplatelet medications, but with an increased incidence of deep vein thrombosis and stroke.DisclosuresNo relevant conflicts of interest to declare.
Source: Blood - Category: Hematology Authors: Tags: 401. Basic Science and Clinical Practice in Blood Transfusion: Poster III Source Type: research
ConclusionsHospitalization for AF is common and frequently associated with both in ‐hospital complications and re‐admission, which were more commonly observed among women with AF. Further research into epidemiological factors and treatment differences between men and women with AF is warranted.
Source: Clinical Cardiology - Category: Cardiology Authors: Tags: CLINICAL INVESTIGATIONS Source Type: research
This article summarizes the clinical pharmacology of these drugs and identifies knowledge gaps in the literature related to their use. PMID: 29802125 [PubMed - as supplied by publisher]
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
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