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Outcomes associated with under-dosing of rivaroxaban for management of non-valvular atrial fibrillation in real-world Japanese clinical settings
AbstractThe approved dose of oral anticoagulant rivaroxaban for patients with non-valvular atrial fibrillation (NVAF) in Japan is 15  mg once daily (od) in patients whose creatinine clearance is ≥ 50 mL/min, but recent real-world studies have demonstrated that these patients often received less than the recommended dose due to bleeding concerns. The effect of under-dosing on safety and effectiveness outcomes remains uncle ar. We used 1-year follow-up data from the XAPASS, a real-world Japanese prospective, single-arm, observational study. Of the 11,308 patients, 6521 patients who completed a 1-year follow-up and ha...
Source: Journal of Thrombosis and Thrombolysis - August 19, 2019 Category: Hematology Source Type: research

Clinical profile of direct oral anticoagulants versus vitamin K anticoagulants in octogenarians with atrial fibrillation: a multicentre propensity score matched real-world cohort study
AbstractAtrial fibrillation (AF) is the most common arrhythmia in clinical practice and its prevalence increases with age. Few data are available about the clinical performance of direct oral anticoagulant (DOACs) in patients aged  ≥ 80 years with AF. The aim of our propensity score matched cohort study was to compare the safety and efficacy of DOACs versus well-controlled VKA therapy among octogenarians with AF in real life setting. Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation Research Database (NCT03760874), which includes all AF patients followed by the partic...
Source: Journal of Thrombosis and Thrombolysis - August 4, 2019 Category: Hematology Source Type: research

Comparative clinical outcomes between direct oral anticoagulants and warfarin among elderly patients with non-valvular atrial fibrillation in the CMS medicare population
AbstractAtrial fibrillation (AF) prevalence increases with age;>  80% of US adults with AF are aged ≥ 65 years. Compare the risk of stroke/systemic embolism (SE), major bleeding (MB), net clinical outcome (NCO), and major adverse cardiac events (MACE) among elderly non-valvular AF (NVAF) Medicare patients prescribed direct oral anticoagulants (DOACs)vs warfarin. NVAF patients aged ≥ 65 years who initiated DOACs (apixaban, dabigatran, and rivaroxaban) or warfarin were selected from 01JAN2013-31DEC2015 in CMS Medicare data. Propensity score matching was used to balance DOAC and warfarin cohorts. Cox proportion...
Source: Journal of Thrombosis and Thrombolysis - June 29, 2019 Category: Hematology Source Type: research

Efficacy and safety of rivaroxaban on the resolution of left atrial/left atrial appendage thrombus in nonvalvular atrial fibrillation patients
AbstractData on LA/LAA thrombus resolution after rivaroxaban treatment has not been established. The aim of the present study was to compare the efficacy and safety on the resolution of LA/LAA thrombus between rivaroxaban and warfarin in nonvalvular atrial fibrillation (AF) patients. 80 AF patients with LA/LAA thrombus between January 2013 and June 2016 were randomized divided into warfarin group (n  = 40) and rivaroxaban group (n = 40). Compared to warfarin group, thrombin time (TT; p <  0.0001), plasma prothrombin time (PT; p <  0.0001), and activated partial thromboplastin time (APTT; p = 0.001...
Source: Journal of Thrombosis and Thrombolysis - June 4, 2019 Category: Hematology Source Type: research

Creatinine monitoring patterns in the setting of direct oral anticoagulant therapy for non-valvular atrial fibrillation
AbstractGuidelines and experts note that patients with atrial fibrillation require regular renal function monitoring to ensure safe use of direct oral anticoagulants (DOACs). Insufficient monitoring could lead to inappropriate dosing and adverse events. Our objective was  to describe the frequency of insufficient creatinine monitoring among patients on DOACs, and to describe clinical factors associated with insufficient monitoring. We hypothesized that renal impairment would be associated with insufficient monitoring. A retrospective cohort study was performed with data from the Michigan Anticoagulant Quality Improvement ...
Source: Journal of Thrombosis and Thrombolysis - May 19, 2019 Category: Hematology Source Type: research

Patient selection and methods of surgical left atrial appendage exclusion
AbstractThe left atrial appendage (LAA) is a major source of thromboembolism, particularly in patients with atrial fibrillation (AF). LAA exclusion has arisen as a method of stroke prophylaxis in high-risk patients who have failed medical management, in whom medical management is contraindicated, and in those undergoing concomitant cardiac surgery. Percutaneous LAA exclusion with devices such as the Watchman has been described extensively in the cardiology literature, but surgical exclusion is less often discussed. Several techniques exist for surgical LAA exclusion, including appendage excision (removal), internal ligatio...
Source: Journal of Thrombosis and Thrombolysis - May 16, 2019 Category: Hematology Source Type: research

International normalized ratio control and subsequent clinical outcomes in patients with atrial fibrillation using warfarin
AbstractWe explored associations between INR measures and clinical outcomes in patients with AF using warfarin, and whether INR history predicted future INR measurements. We included patients in ARISTOTLE who were randomized to and received warfarin. Among patients who had events, we included those with ≥ 3 INR values in the 180 days prior to the event, with the most recent ≤ 60 days prior to the event, who were on warfarin at the time of event (n = 545). Non-event patients were included in the control group if they had ≥ 180 days of warfarin exposure with ≥ 3 INR measure ments (n = 7259). Th...
Source: Journal of Thrombosis and Thrombolysis - April 9, 2019 Category: Hematology Source Type: research

Stroke prophylaxis in critically-ill patients with new-onset atrial fibrillation
AbstractDespite a high incidence of new onset atrial fibrillation (NOAF) in critically ill patients and its association with short and long-term incidence of stroke, there is limited data assessing anticoagulation on hospital discharge in these patients. We retrospectively reviewed electronic medical records of all adult patients admitted to non-cardiac ICUs at our institution between January 2009 and March 2016. Patients with NOAF were identified and CHA2DS2-VASc score of ICU survivors was calculated. Prescription of oral anticoagulant therapy on hospital discharge was analyzed. A total of 640 (1.7% [38,708 patients]; 95%...
Source: Journal of Thrombosis and Thrombolysis - April 7, 2019 Category: Hematology Source Type: research

Leukoaraiosis is an independent predictor of intracranial hemorrhage in patients with atrial fibrillation
AbstractWe evaluated the predictive value of several clinical, radiological and laboratory parameters on the risk of predict intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF). We conducted a case-control study on a consecutive hospital based series of patients with AF and ICH. A random sample of subjects with AF without ischemic or hemorrhagic stroke was selected from the same hospital in the same period to perform as the control group, with a ratio of two controls per case. All patients underwent the same evaluation protocol. Patients without neuroimaging exams were excluded. During the study period ...
Source: Journal of Thrombosis and Thrombolysis - March 13, 2019 Category: Hematology Source Type: research

Hospitalization affects the anticoagulation patterns of patients with atrial fibrillation
In conclusion, in patients with known AF at high risk for stroke, hospitalization was associated with an increase in OAC uptake, dri ven mainly by NOAC initiation. Three out of 10 patients initiated, switched or discontinued OAC treatment during hospitalization and this was associated with discrete epidemiologic parameters.
Source: Journal of Thrombosis and Thrombolysis - March 3, 2019 Category: Hematology Source Type: research

Interacting medication use and the treatment effects of apixaban versus warfarin: results from the ARISTOTLE Trial
AbstractWarfarin is dependent on multiple hepatic enzymes for metabolism while apixaban is a substrate for P-glycoprotein (P-gp) transport and hepatic CYP3A4 metabolism. The aim of this analysis was to assess the impact of interacting medication use on the treatment effects of apixaban versus warfarin. Outcomes were compared between apixaban and warfarin using Cox proportional hazards modeling according to the use of interacting medications at randomization in ARISTOTLE (n  = 18,201). Interacting medications for apixaban were identified as combined P-gp and 3A4 inhibitors or inducers while interacting medications for w...
Source: Journal of Thrombosis and Thrombolysis - February 21, 2019 Category: Hematology Source Type: research

Effectiveness and safety of non-vitamin-K antagonist oral anticoagulants versus warfarin in atrial fibrillation patients with thrombocytopenia
AbstractPatients with thrombocytopenia were excluded from major clinical trials that investigated non-vitamin-K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF). The aim of this study was to evaluate the effectiveness and safety of NOAC versus warfarin in AF patients with thrombocytopenia. From 2010 to 2017, a cohort study based on electronic medical records of a multi-center healthcare provider in Taiwan and included 8239 anticoagulated AF patients (age 77.0  ± 7.3 years, 48.0% female). Patients were divided into two subgroups: 7872 patients with a normal platelet count and 36...
Source: Journal of Thrombosis and Thrombolysis - December 18, 2018 Category: Hematology Source Type: research

Direct oral anticoagulants in the early phase of non valvular atrial fibrillation-related acute ischemic stroke: focus on real life studies
AbstractStrong evidence for the use of direct oral anticoagulants (DOACs) in the early phase of non valvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) is lacking, because this kind of patients were excluded from phase III randomized clinical trials (RCT) and ad hoc RCTs are ongoing. In the latest years a lot of real life studies on this topic have been published. The aim of our review was to focus on these. We reviewed the PubMed databases searching articles reporting on DOACs starting time within 2 weeks from AIS onset. We selected fifteen studies, eight with retrospective, six with prospective observ...
Source: Journal of Thrombosis and Thrombolysis - November 23, 2018 Category: Hematology Source Type: research

Fatal warfarin-associated intracranial hemorrhage in atrial fibrillation inpatients
In conclusion, most patients had achieved the target INR at the time of ICH, and the primary precipitant of fatal ICH was often a fall. Using DOACs instead of warfarin and implementing structured fall-prevention programs in high-risk patients could further reduce mortality from ICH in AF.
Source: Journal of Thrombosis and Thrombolysis - November 17, 2018 Category: Hematology Source Type: research

Predictors for INR-control in a well-managed warfarin treatment setting
AbstractWarfarin is well studied in patients with non-valvular atrial fibrillation (AF). It has low complication rates for patients achieving individual Time in Therapeutic Range (iTTR)  >  70%. The risk scores SAMe-TT2R2 and PROSPER are designed to predict future TTR, but are derived from a heterogeneous population with generally low iTTR. The aim of this study was to evaluate predictors for high and low iTTR in an AF population in Sweden, where there is a generally good anticoagulation control. A retrospective register study based on Swedish warfarin dosing system AuriculA, including 28,011 AF patients starting tr...
Source: Journal of Thrombosis and Thrombolysis - November 8, 2018 Category: Hematology Source Type: research

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