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The impact of strong inducers on direct oral anticoagulant levels
Direct oral anticoagulants (DOAC) are widely used in clinical practice. They are now recommended over warfarin in eligible patients, for stroke prevention in atrial fibrillation (SPAF) or the treatment of venous thromboembolism1,2. Given their predictable dose response, DOAC have a fixed-dose regimen and do not require routine laboratory monitoring. However, inter-individual variability in DOAC plasma concentrations has been described. In phase 3 trials and registries, low and high DOAC levels were shown to correlate with thromboembolic and bleeding events respectively3,4.
Source: The American Journal of Medicine - June 24, 2021 Category: General Medicine Authors: Anne-Laure Sennesael, Anne-Sophie Larock, Philippe Hainaut, Sarah Lessire, Michael Hardy, Jonathan Douxfils, Anne Spinewine, Fran çois Mullier Tags: Brief Observation Source Type: research

Corrigendum to “Effectiveness and Safety of Oral Anticoagulants in Adults with Non-valvular Atrial Fibrillation Patients and Concomitant Coronary/Peripheral Artery Disease” American Journal of Medicine 131:09 (2018): 1074-1085.e4
There were 33,269 apixaban-warfarin, 9,345 dabigatran-warfarin, and 42,156 rivaroxaban-warfarin matched pairs, with a median follow-up of 4-5 months. Compared with warfarin, apixaban was associated with lower rates of stroke/systemic embolism (hazard ratio [HR] 0.52; 95% confidence interval [95% CI], 0.43-0.62), major bleeding (HR 0.60; 95% CI, 0.55-0.66) and stroke/myocardial infarction/all-cause mortality (HR 0.70; 95%CI, 0.66-0.74); dabigatran was associated with lower rates of major bleeding (HR: 0.73; 95% CI, 0.62-0.85); dabigatran and rivaroxaban were associated with lower rates of stroke/myocardial infarction/all-ca...
Source: The American Journal of Medicine - August 4, 2020 Category: General Medicine Authors: Renato D. Lopes, Jan Steffel, Manuela Di Fusco, Allison Keshishian, Xuemei Luo, Xiaoyan Li, Cristina Masseria, Melissa Hamilton, Keith Friend, Kiran Gupta, Jack Mardekian, Xianying Pan, Onur Baser, W. Schuyler Jones Tags: Corrigendum Source Type: research

Oral anticoagulation in emergency department patients: high rates of off-label doses,no difference in bleeding rates
Patients with oral anticoagulation constitute an increasing proportion in the present medical routine.1 The approval of the first direct oral anticoagulant (DOAC) dabigatran by the U.S. food and drug administration in 2010 for the purpose of stroke prevention in patients with non-valvular atrial fibrillation revolutionized the therapy strategies of this entity since the Vitamin-K antagonists (VKA) warfarin, phenprocoumon and acenocoumarol had been the only available oral anticoagulants for decades.
Source: The American Journal of Medicine - October 23, 2019 Category: General Medicine Authors: Corinne M. Eschler, Bertram K. Woitok, Georg-Christian Funk, Philipp Walter, Volker Maier, Aristomenis K. Exadaktylos, Gregor Lindner Tags: Clinical Research Study Source Type: research

Etiological research using observational data, and net clinical benefit. Simplicity and practicality matter
Atrial fibrillation in an elderly patient requires oral anticoagulant (OAC) treatment, and contemporary international guidelines recommend treatment for atrial fibrillation patients at 75years or older.1,2 Substantial evidence (mostly in favour) of non-vitamin K antagonist oral anticoagulants (NOACs), in comparison with warfarin, has emerged over the past decade. In particular, the benefits from a lower risk of intracranial bleeding and the non-requirement for monitoring of anticoagulant effects have driven the uptake of NOACs as the preferred choice for stroke prevention in atrial fibrillation, although some regional differences are evident.
Source: The American Journal of Medicine - March 4, 2019 Category: General Medicine Authors: Peter Br ønnum Nielsen, Iain Buchan, Gregory Y.H. Lip Tags: Editorial Source Type: research

Comparative stroke, bleeding, and mortality risks in older Medicare patients treated with oral anticoagulants for nonvalvular atrial fibrillation
Non-vitamin K antagonist oral anticoagulants (NOACs) are alternatives to warfarin in patients with nonvalvular atrial fibrillation. Randomized trials compared NOACs to warfarin, but none have compared individual NOACs against each other for safety and effectiveness.
Source: The American Journal of Medicine - January 9, 2019 Category: General Medicine Authors: David J. Graham, Elande Baro, Rongmei Zhang, Jiemin Liao, Michael Wernecke, Marsha E. Reichman, Mao Hu, Onyekachukwu Illoh, Yuqin Wei, Margie R. Goulding, Yoganand Chillarige, Mary Ross Southworth, Thomas E. MaCurdy, Jeffrey A. Kelman Tags: Clinical Research Study Source Type: research

Severity of Gastrointestinal Bleeding in Patients Treated with Direct-Acting Oral Anticoagulants
Direct-acting oral anticoagulants (DOACs), which have gained approval for stroke prevention in non-valvular atrial fibrillation and treatment of venous thromboembolism, have become increasingly preferred over warfarin given their predictable pharmacodynamics, lack of required monitoring, and superior outcomes. DOACs have been shown to be associated with an increased frequency of gastrointestinal bleeding compared to warfarin, but the severity and characteristics of gastrointestinal bleeding in these patients is poorly understood.
Source: The American Journal of Medicine - November 22, 2017 Category: General Medicine Authors: Mark M. Brodie, Jill C. Newman, Tyler Smith, Don C. Rockey Tags: Clinical Research Study Source Type: research

Efficacy and Safety of Apixaban Versus Warfarin in Patients with Atrial Fibrillation and a History of Cancer: Insights From the ARISTOTLE Trial
• Cancer and atrial fibrillation frequently coexist, yet there are few data to guide care in this population.• No significant associations between history of cancer and the risk of stroke/systemic embolism, major bleeding, or mortality were observed.• The safety and efficacy of apixaban versus warfarin appear to be preserved among patients with and without active cancer.
Source: The American Journal of Medicine - July 21, 2017 Category: General Medicine Authors: Chiara Melloni, Allison Dunning, Christopher B. Granger, Laine Thomas, Michel G. Khouri, David A. Garcia, Elaine M. Hylek, Michael Hanna, Lars Wallentin, Bernard J. Gersh, Pamela S. Douglas, John H. Alexander, Renato D. Lopes Tags: Clinical Research Study Source Type: research

Renal function considerations for stroke prevention in atrial fibrillation
Renal impairment increases risk of stroke and systemic embolic events and bleeding in patients with atrial fibrillation. Direct oral anticoagulants have varied dependence on renal elimination, magnifying the importance of appropriate patient selection, dosing, and periodic kidney function monitoring. In randomized controlled trials of nonvalvular atrial fibrillation, direct oral anticoagulants were at least as effective and associated with less bleeding compared with warfarin. Each direct oral anticoagulant was associated with reduced risk of stroke and systemic embolic events and major bleeding compared with warfarin in n...
Source: The American Journal of Medicine - May 11, 2017 Category: General Medicine Authors: John Fanikos, Allison E. Burnett, Charles E. Mahan, Paul P. Dobesh Tags: Review Source Type: research

Evaluation of the HAS-BLED, ATRIA, and ORBIT Bleeding Risk Scores in Patients with Atrial Fibrillation Taking Warfarin
Various bleeding risk prediction schemes, such as the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized Ratio, Elderly, Drugs/alcohol (HAS-BLED), Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA), and Outcomes Registry for Better Informed Treatment (ORBIT) scores, have been proposed in patients with atrial fibrillation. We compared the relative predictive values of these bleeding risk scores for clinically relevant bleeding and the relationship of ATRIA and ORBIT scores to the quality of anticoagulation control on warfarin, as reflected by...
Source: The American Journal of Medicine - October 16, 2015 Category: Journals (General) Authors: Keitaro Senoo, Marco Proietti, Deirdre A. Lane, Gregory Y.H. Lip Tags: Clinical research study Source Type: research

AFib Treatment: General Population
Abstract: When primary care physicians are presented with a patient with atrial fibrillation (AFib), there are two concerns. (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). One is the choice of strategy to treat the AFib, ie, whether to use rate control or a rhythm control strategy (to keep patients in sinus rhythm). The second concern is preventing the principal risk associated with AFib: stroke and systemic embolism. The focus of this review is stroke prevention, concentrating on risk assessment and traditional versus the new oral anticoagulation agents. For the past se...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: Steven A. Rothman Tags: CME multimedia activities Source Type: research

Novel Oral Anticoagulants
Abstract: Warfarin has a proven record as an oral anticoagulant; almost every study, however, has found that it is not prescribed for 40–60% of patients who are eligible and should receive it, and of those who do receive it, serum warfarin levels only achieved a time in therapeutic range (TTR) equal to INR 2–3 about 55–60% of the time (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). This means that only about 1 in 4 patients are adequately anticoagulated with warfarin, and thus there is a large unmet need for achieving better anticoagulation in these patients. Although...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: James A. Reiffel Tags: CME multimedia activities Source Type: research