Rivaroxaban in patients with mechanical heart valves: A pilot study

Patients with mechanical heart valves are still not eligible for treatment with direct oral anticoagulants (DOAC). We aimed to conduct a proof-of-principle study investigating the anti-Xa inhibitor rivaroxaban as antithrombotic treatment in patients with recent mechanical aortic valve replacement.
Source: Thrombosis Research - Category: Hematology Authors: Tags: Full Length Article Source Type: research

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RARITAN, NJ, March 28, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson today announced the VOYAGER PAD study met its primary efficacy and principal safety endpoints, demonstrating the XARELTO® (rivaroxaban) vascular dose (2.5 mg twice daily) plus aspirin (100 mg once daily) was superior to aspirin alone in reducing the risk of major adverse limb and cardiovascular (CV) events by 15 percent in patients with symptomatic peripheral artery disease (PAD) after lower-extremity revascularization, with similar rates of TIMI[1] major bleeding. VOYAGER PAD is the only study to show a significant benefit...
Source: Johnson and Johnson - Category: Pharmaceuticals Tags: Innovation Source Type: news
RARITAN, N.J., March 20, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson announced today that it will unveil late-breaking data from its leading cardiovascular and metabolism portfolio during the virtual American College of Cardiology’s 69th Annual Scientific Session together with the World Congress of Cardiology (ACC.20/WCC) on March 28-30, 2020. Notably, four late-breaking abstracts for XARELTO® (rivaroxaban) will be presented, including data from the Phase 3 VOYAGER PAD study in patients with symptomatic peripheral artery disease (PAD) after lower-extremity revascularization.Click to ...
Source: Johnson and Johnson - Category: Pharmaceuticals Source Type: news
CONCLUSIONS: Bleeding and thromboembolic complications were common in MHV prosthesis patients in this study. Long duration of anticoagulation, albeit sub-optimal control, was a risk factor for bleeding and thromboembolic complications in these patients. Therefore, long-term efforts are necessary to address these complications and possibly improve the quality of life of these patients. PMID: 32181794 [PubMed - as supplied by publisher]
Source: Cardiovascular Journal of Africa - Category: Cardiology Authors: Tags: Cardiovasc J Afr Source Type: research
Diagnosis, treatment &management of prosthetic valve thrombosis: the key considerations. Expert Rev Med Devices. 2020 Feb 21;: Authors: Gündüz S, Kalçık M, Gürsoy MO, Güner A, Özkan M Abstract Introduction: Prosthetic heart valve thrombosis is a life-threatening complication after valve replacement surgery. Although subtherapeutic anticoagulation is the main cause, there are many other conventional and esoteric predisposing factors.Areas covered: The etiopathogenesis, diagnosis and management of prosthetic heart valve thrombosis with particular focus on conventional...
Source: Expert Review of Medical Devices - Category: Medical Devices Tags: Expert Rev Med Devices Source Type: research
ConclusionsThis is the largest series to date reporting>30-day follow-up for patients undergoing venous ablation procedures while receiving anticoagulation and the longest follow-up reported of any series. Durability, safety, and efficacy of vein ablation in patients receiving anticoagulation are comparable to those in control patients. Anticoagulation should not be considered a contraindication to endothermal ablation of the GSV or SSV for symptomatic venous reflux.
Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders - Category: Surgery Source Type: research
ConclusionsIn this study, the complex flow field characteristics in the new generation of BMHVs considering aorta flexibility with healthy and calcified annulus were investigated. It was found that the blood flow around the hinges region is in the danger of hemolysis and platelet activation and subsequently thromboembolism. Furthermore, the results show that similar to vessel wall deformation, considering the probable annulus calcification after valve replacement is also essential.
Source: Cardiovascular Engineering and Technology - Category: Cardiology Source Type: research
Rationale: Heart-valve replacement is one of the main surgical methods for various heart-valve diseases. Warfarin is the only oral anticoagulant used for thrombosis prevention after heart-valve replacement. However, warfarin has a narrow therapeutic window, large differences in efficacy between individuals, and can be affected by drugs, food and disease status. Patient concerns: We used the Hamberg model to develop an anticoagulation regimen for a 10-month-old Chinese male after mitral-valve replacement. Diagnoses: Echocardiography revealed mitral malformation with severe regurgitation, patent foramen ovale, thicke...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Conclusion: Our meta-analysis suggests that LMWH not only reduces the risk of thromboembolism in patients with MHV but also does not increase the risk of major bleeding. LMWH may provide safer and more effective bridging anticoagulation than UFH in patients with MHV. It is still necessary to conduct future randomized studies to verify this conclusion.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research
We report a case of successful long‐term anticoagulation with enoxaparin in a patient with a mechanical aortic valve who had a contraindication to warfarin. The patient developed a left thigh hematoma requiring surgical evacuation one month after initiation of weight‐based dosing of e noxaparin. His dose was then titrated based on peak anti–Xa levels (goal 0.6–1.0 IU/mL). He remained free of signs and symptoms of thromboembolic events, valve dysfunction, bleeding complications, or major adverse effects from long‐term enoxaparin use for the next 13 years. Our case provides p romising evidence of the potent...
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - Category: Drugs & Pharmacology Authors: Tags: CASE REPORT Source Type: research
ConclusionsWhereas warfarin suppresses MHV-induced thrombin generation, MHVs induce the generation of factor Xa in concentrations that overwhelm clinically relevant concentrations of rivaroxaban or apixaban. When used in combination, rivaroxaban and dabigatran are more effective than either agent alone suggesting that concomitant inhibition of factor Xa and thrombin is better than inhibition of either clotting enzyme alone.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
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