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Cessation of oral anticoagulation is an important risk factor for stroke and mortality in atrial fibrillation patients.
In conclusion, in non-valvular AF patients, cessation of OAC was independently associated with the risk of stroke, adverse cardiovascular events and mortality. Bleeding events and some variables associated with higher bleeding risk are responsible for OAC cessation. PMID: 28331926 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - March 23, 2017 Category: Hematology Authors: Rivera-Caravaca JM, Roldán V, Esteve-Pastor MA, Valdés M, Vicente V, Lip GY, Marín F Tags: Thromb Haemost Source Type: research

Cancer as a risk factor for stroke in atrial fibrillation patients receiving long-term oral anticoagulant therapy
cancer and cerebrovascular disease are among the most common causes of death in the developed countries and are both associated with a steep increase in incidence among the elderly population. Despite being a less frequent neurological complication in cancer patients, compared to metastases or neurotoxicity from anticancer treatment, stroke incidence in cancer patients is high [1]. The pathophysiology of stroke in cancer patients is largely unknown [2] and can be attributed to cardiac or non-cardiac embolism.
Source: Thrombosis Research - June 18, 2015 Category: Hematology Authors: Gentian Denas, Vittorio Pengo, Roberta Joppi, Paolo Prandoni Source Type: research

Efficacy and Safety of Nonvitamin K Oral Anticoagulants in Patients with Atrial Fibrillation and Cancer: A Study-Level Meta-Analysis.
CONCLUSION:  In AF patients with malignancy, NOACs appear at least as effective as VKAs in preventing thrombotic events and reduce intracranial bleeding. NOACs may represent a valid and more practical alternative to VKAs in this setting of high-risk patients. PMID: 31785599 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - November 29, 2019 Category: Hematology Authors: Cavallari I, Verolino G, Romano S, Patti G Tags: Thromb Haemost Source Type: research

Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and cancer a meta-analysis
ConclusionsIn comparison to VKA, DOACs were associated with a significant reduction of the rates of thromboembolic events and major bleeding complications in patients with AF and cancer. Further studies are needed to confirm our results.
Source: Journal of Thrombosis and Thrombolysis - October 12, 2020 Category: Hematology Source Type: research

Anticoagulation prescribing patterns in patients with cancer
The objective of this retrospective cohort was to describe real-world anticoagulation prescribing patterns in cancer patients at a large academic medical center between January 1, 2013 and October 31, 2016. We sought to assess the safety, tolerability, and efficacy of DOACs in patients with cancer for either VTE and/or AF. Patient demographic, clinical characteristics, as well as bleeding and thrombotic events were collected. There were 214 patients in our analysis, of which 71 patients (33%) received a DOAC [apixaban (n  = 22), dabigatran (n = 17), and rivaroxaban (n = 32)]. There were fewer bleeding events an...
Source: Journal of Thrombosis and Thrombolysis - October 19, 2017 Category: Hematology Source Type: research

Exploring unmet needs in venous and arterial thromboembolism with rivaroxaban.
This article will introduce and provide context for these RCTs in the contemporary management of arterial and venous thromboembolism in the following underserved areas: Patients with both NVAF and acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI); patients with embolic stroke of undetermined source (ESUS); patients who require transcatheter aortic valve replacement (TAVR); patients with acute or chronic coronary artery disease (CAD; including those with heart failure [HF]); those at risk of or suffering from cancer-associated thrombosis (CAT) and those requiring long-term anticoagulation. It ...
Source: Thrombosis and Haemostasis - September 13, 2016 Category: Hematology Authors: Cappato R, Welsh R Tags: Thromb Haemost Source Type: research

Atrial Fibrillation and Malignancy: The Clinical Performance of Non –Vitamin K Oral Anticoagulants—A Systematic Review
Semin Thromb Hemost DOI: 10.1055/s-0038-1661386Atrial fibrillation (AF) is commonly diagnosed in the setting of active cancer. Because of an increased risk of either thromboembolic events or bleeding, the decision to initiate therapeutic anticoagulation in patients with active cancer can be challenging. Moreover, little is still known about the optimal anticoagulation therapy in the setting of AF and cancer, and no guidelines are as yet available. Considering that nonvitamin K antagonist oral anticoagulants (NOACs) are recommended as alternatives to vitamin K antagonists for stroke prevention in AF patients with CHA2DS2-VA...
Source: Seminars in Thrombosis and Hemostasis - August 17, 2018 Category: Hematology Authors: Russo, Vincenzo Bottino, Roberta Rago, Anna Micco, Pierpaolo Di D' Onofrio, Antonio Liccardo, Biagio Golino, Paolo Nigro, Gerardo Tags: Review Article Source Type: research

Treatment Failure in Patients Receiving Direct Oral Anticoagulants: Clinical Management and Outcomes from a Single-Center Review of 59 Consecutive Patients
In this study, we sought to characterise DOAC treatment failures in our institution, and to rationalise the subsequent anticoagulation strategies in this setting. All VTE patients starting a DOAC at our centre are followed in a consultant-led clinic. Cases of suspected treatment failure are also referred from other specialities and primary care. Between September 2014 and May 2018, we identified 59 consecutive patients (male/female: 34/25) in whom a DOAC treatment failure was diagnosed, including non-resolution of the presenting complaint, and recurrence of or a new thrombotic event. Patient mean age at DOAC initiation was...
Source: Blood - November 21, 2018 Category: Hematology Authors: McIlroy, G., Smith, N., Lokare, A., Beale, K., Kartsios, C. Tags: 332. Antithrombotic Therapy Source Type: research

Is there a role for low-dose DOACs as prophylaxis?
Authors: Cohen AT, Hunt BJ Abstract The direct oral anticoagulants (DOACs) have transformed the management of thrombotic disorders. Large clinical trials have demonstrated that DOACs can replace vitamin K antagonists (VKAs) in the 2 existing major indications for anticoagulation: the prevention of stroke in atrial fibrillation and the acute treatment and secondary prevention of venous thromboembolism (VTE); this literature is widely known. In this article, we will concentrate on the less well-discussed benefits of the use of DOACs-using low doses as primary and secondary prophylaxis in both venous and arterial thro...
Source: Hematology ASH Education Program - December 7, 2019 Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research

Drug interactions and pharmacogenetic factors contribute to variation in apixaban concentration in atrial fibrillation patients in routine care
In this study, we assessed the impact of interacting medication and pharmacogenetic variation to better explain apixaban concentration differences among 358 Caucasian AF patients. Genotyping (ABCG2,ABCB1,CYP3A4*22,CYP3A5*3) was performed by TaqMan assays, and apixaban quantified by mass spectrometry. The typical patient was on average 77.2  years old, 85.5 kg, and had a serum creatinine of 103.1 µmol/L. Concomitant amiodarone, an antiarrhythmic agent and moderate CYP3A/ABCB1 inhibitor, the impaired-function variantABCG2 c.421C  >  A, and sex predicted higher apixaban concentrations when controlling for age, weig...
Source: Journal of Thrombosis and Thrombolysis - January 18, 2020 Category: Hematology Source Type: research

Novel Bleeding Risk Score for Patients with Atrial Fibrillation on Oral Anticoagulants, including Direct Oral Anticoagulants.
CONCLUSION: In this prospective cohort study of AF patients and predominantly DOAC users, we successfully derived a bleeding risk prediction model with good calibration and discrimination. PMID: 33501722 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - January 27, 2021 Category: Hematology Authors: Adam L, Feller M, Syrogiannouli L, Del-Giovane C, Donzé J, Baumgartner C, Segna D, Floriani C, Roten L, Fischer U, Aeschbacher S, Moschovitis G, Schläpfer J, Shah D, Amman P, Kobza R, Schwenkglenks M, Kühne M, Bonati L, Beer J, Osswald S, Conen D, Auje Tags: J Thromb Haemost Source Type: research