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Incidence of thrombotic complications related to weight-based dosing of activated prothrombin complex concentrate (aPCC) for reversal of apixaban and rivaroxaban in obese patients
AbstractFactor eight inhibitor bypassing activity (aPCC) is recommended as a non-specific reversal agent for direct oral anticoagulants (DOACs) according to the 2017 American College of Cardiology (ACC) guidelines for reversal of anticoagulation. Factor eight inhibitor bypassing activity carries a black box warning for thrombotic events such as stroke, pulmonary embolism, deep vein thrombosis, and myocardial infarction, particularly at high doses. This was a retrospective, single-center, cohort investigation that included patients who received a weight-based dose of aPCC for reversal of apixaban and rivaroxaban between Jan...
Source: Journal of Thrombosis and Thrombolysis - November 17, 2021 Category: Hematology Source Type: research

Metal ion chelation enhances tissue plasminogen activator (tPA)-induced thrombolysis: an in vitro and in vivo study
AbstractStroke is the third leading cause of death in the United States and the leading cause of adult disability. Despite enormous research efforts including many clinical trials, tissue plasminogen activator (tPA) remains the only FDA-approved treatment for acute ischemic stroke. Unfortunately, only 1 –3% of stroke patients in the US receive this therapy because of the narrow time window and severe side effects for using tPA. The most deadly and damaging side effect is the risk of intracranial bleeding or hemorrhage. For that reason, the dose of tPA and its overall administration are under tigh t control, which may com...
Source: Journal of Thrombosis and Thrombolysis - November 10, 2021 Category: Hematology Source Type: research

Comparison of biodegradable and newer generation durable polymer drug-eluting stents with short-term dual antiplatelet therapy: a systematic review and Bayesian network meta-analysis of randomized trials comprising of 43,875 patients
This study compares the safety and efficacy profiles of DP-DES and BP-DES based on short-term (1–3 months), intermediate-term (4–6 months) and standard DAPT (6–12 months) durations. A searc h was conducted on Embase and Medline for Randomized Controlled Trials (RCTs) comparing stent types, and DAPT durations. Primary endpoints include cardiac death, myocardial infarction (MI), definite stent thrombosis, stroke, target vessel revascularization (TVR) and major bleeding. Network analysis was conducted to summarize the evidence. A total of 15 RCTs involving 43,875 patients were included. DP-DES was associated with sig...
Source: Journal of Thrombosis and Thrombolysis - January 4, 2022 Category: Hematology Source Type: research

Prevalence of recommended anticoagulation by guidelines preadmission and its impact on the incidence of acute myocardial infarction (AMI) and in-hospital outcomes after AMI in atrial fibrillation patients
This study was designed to explore the prevalence of recommended anticoagulation by guidelines before admission and its impact on the incidence of acute myocardial infarction (AMI) and the AMI associated in-hospital outcomes in patients with atrial fibrillation (AF). 10,725 patients with AF at their first hospitalizations in our hospitals were retrospectively reviewed, with a prevalence of recommended anticoagulation preadmission 24.41% (Number = 2618). They had lower risk of AMI incidence (Adjusted OR 0.66, 95%CI 0.54 –0.81, p <  0.001) compared to those without recommended anticoagulation after multivariate logist...
Source: Journal of Thrombosis and Thrombolysis - January 24, 2022 Category: Hematology Source Type: research

Predictors of symptomatic intracranial hemorrhage after endovascular treatment for acute large vessel occlusion: data from ANGEL-ACT registry
AbstractSymptomatic intracranial hemorrhage (SICH) is a catastrophic complication of endovascular treatment (EVT) for large vessel occlusion (LVO). We aimed to investigate the incidence and predictors of SICH after EVT. Patients were selected from the ANGEL-ACT registry. We diagnosed SICH according to the Heidelberg Bleeding Classification. Logistic regression analyses were performed to determine the independent predictors of SICH. Of the 1283 patients, SICH was observed in 116 patients (9.0%). On multivariable analysis, admission National Institutes of Health Stroke Scale (NIHSS)  >  12 (odds ratio [OR] = 1.86,...
Source: Journal of Thrombosis and Thrombolysis - August 1, 2022 Category: Hematology Source Type: research

Effectiveness and safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation and advanced kidney disease
ConclusionAmong patients with AF and AKD, DOACs were linked to a lower risk of ischemic events, and apixaban was linked to a lower risk of any ischemia and any bleeding than warfarin.
Source: Journal of Thrombosis and Thrombolysis - July 15, 2023 Category: Hematology Source Type: research

Screening for clinically relevant drug-drug interactions between direct oral anticoagulants and antineoplastic agents: a pharmacovigilance approach
ConclusionNo signal of DDIs between DOACs and antineoplastic agents was detected, except for DOAC-neratinib. Most DDIs between DOACs and antineoplastic agents may not be clinically relevant. The DDIs between DOACs and neratinib should be further examined in future research.
Source: Journal of Thrombosis and Thrombolysis - August 10, 2023 Category: Hematology Source Type: research

Low bleeding acceptance is associated with increased death risk in patients with atrial fibrillation on oral anticoagulation
AbstractBleeding is the most feared complication of anticoagulation. We sought to investigate whether the bleeding risk acceptance has a prognostic value during long-term follow-up in the era of direct oral anticoagulants (DOACs) among patients with atrial fibrillation (AF). We studied 167 consecutive AF outpatients [aged 68.8 SD 10.6 years; 141 (84.4%) on DOACs]. The bleeding acceptance was assessed based on the Bleeding Ratio defined as the declared maximum number of major bleedings that a patient would be willing to accept to prevent one major stroke. We recorded cerebrovascular ischemic events, major or clinically rele...
Source: Journal of Thrombosis and Thrombolysis - August 19, 2023 Category: Hematology Source Type: research

Dual antiplatelet therapy with or without oral anticoagulation in the postdischarge management of acute coronary syndrome patients with an indication for long term anticoagulation: a systematic review
Abstract Currently, there is a lack of consensus among guidelines for the postdischarge treatment of patients presenting with acute coronary syndrome (ACS) who have a long-term indication for anticoagulation. We conducted a systematic review comparing the safety and effectiveness of dual antiplatelet therapy (DAPT) and triple therapy (TT; defined as DAPT plus an oral anticoagulant) in patients with ACS and a long-term indication for anticoagulation. We searched for clinical studies in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews published between January 1995 and September 2013. Each investiga...
Source: Journal of Thrombosis and Thrombolysis - September 25, 2014 Category: Hematology Source Type: research

Switching from clopidogrel to prasugrel in patients having coronary stent implantation
Abstract There are very few clinical data concerning the safety of switching from clopidogrel to prasugrel in patients undergoing coronary stenting. However, in the daily activity, clinicians face the decision of switching patients at high-risk of thrombotic events from clopidogrel to prasugrel. Thus, we sought to evaluate clinical events in patients undergoing coronary stent implantation and prasugrel therapy with (SWITCH group) or without (NAÏVE group) prior clopidogrel therapy. A total of 454 patients with stable or unstable coronary artery disease, aged 70 ± 10 years, underwent non-emergent stent implant...
Source: Journal of Thrombosis and Thrombolysis - September 25, 2014 Category: Hematology Source Type: research

Serial clopidogrel dose adjustment after platelet function testing improves outcome of acute coronary syndrome patients undergoing percutaneous coronary intervention with high on-treatment platelet reactivity
Abstract High on-treatment platelet reactivity (HTPR) on clopidogrel correlates with adverse outcomes in patients treated with percutaneous coronary intervention (PCI). Whether HTPR is a modifiable risk factor for future events is not clear. We evaluated the effect of serial clopidogrel dose adjustment based on platelet function testing (PFT) during 12 months of dual antiplatelet therapy (DAPT) using Multiplate® analyzer in patients with HTPR after PCI in acute coronary syndrome on clinical outcome. Eighty-seven patients were randomized to interventional (n = 43) and control group (n = 44). Blood samples fo...
Source: Journal of Thrombosis and Thrombolysis - October 2, 2014 Category: Hematology Source Type: research

Selecting an oral anticoagulant for patients with nonvalvular atrial fibrillation
Abstract While the use of warfarin has been the cornerstone of thromboembolism prevention in patients with atrial fibrillation (AF), its limitations have led to the introduction of a new generation of direct-acting oral anticoagulants. Evidence from large phase III clinical trials, observational studies and pharmacokinetic analyses can guide clinicians to select the most effective and safest form of anticoagulation for patients with nonvalvular AF. This manuscript describes the main pharmacologic, clinical and epidemiological characteristics of each new oral anticoagulant and their use in selected clinical scenari...
Source: Journal of Thrombosis and Thrombolysis - November 22, 2014 Category: Hematology Source Type: research

Management of anticoagulation and antiplatelet therapy in patients with left ventricular assist devices
Abstract Left ventricular assist devices (LVADs) have increased the survival of patients with advanced heart failure fourfold. Despite these advances, significant bleeding and thrombotic complications occur. Hemorrhage requiring surgery has been reported in up to 30 % of adults and 50 % of children after LVAD placement. LVAD thrombosis and embolic stroke lead to significant long-term morbidity. Adults are treated with antithrombotic therapy to prevent thrombotic complications, but the amount and intensity of treatment differs between institutions. The goal international normalized ratio for warfarin therapy vari...
Source: Journal of Thrombosis and Thrombolysis - December 31, 2014 Category: Hematology Source Type: research

Novel oral anticoagulants in patients undergoing cardioversion for atrial fibrillation
Abstract Recent trials on novel oral anticoagulants (NOAC) in patients undergoing cardioversion showed that NOACs are as safe and effective as treatment with vitamin K antagonists in patients with atrial fibrillation undergoing electric or pharmacological cardioversion. We conducted an EMBASE and MEDLINE search for studies in which patients undergoing cardioversion were assigned to treatment with NOACs versus VKAs. We identified one prospective randomized study and three post hoc analysis of randomized trials which enrolled 2,788 controls that received NOACs and 1,729 patients that received VKAs. NOACs and VKA...
Source: Journal of Thrombosis and Thrombolysis - December 27, 2014 Category: Hematology Source Type: research

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