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Reversing the effects of the new anti-clotting drugs
The oral anticoagulant warfarin (Coumadin) became available for prescription in 1954. This anti-clotting drug commanded national attention when President Dwight Eisenhower received the drug as part of his treatment following a heart attack. No other oral anticoagulant was successfully developed and marketed in the United States until 2010. Warfarin is a dangerous drug. Along with insulin, it is responsible for the most emergency hospitalizations due to adverse drug reactions. Whereas insulin causes low blood sugar, warfarin is notorious for the complication of major bleeding. Warfarin is plagued by hundreds of drug-drug an...
Source: New Harvard Health Information - December 9, 2015 Category: Consumer Health News Authors: Samuel Z. Goldhaber, MD Tags: Drugs and Supplements Health Heart Health Hypertension and Stroke anti-clotting coumadin deep-vein-thrombosis DVT Source Type: news

New oral anticoagulants for prophylaxis of stroke : Results of an expert conference on practical use in geriatric patients.
This article highlights the outcome of an expert meeting on the practical use of NOAC in elderly patients. An interdisciplinary group of experts discussed the current situation of stroke prevention in geriatric patients and its practical management in daily clinical practice. The topic was examined through focused impulse presentations and critical analyses as the basis for the expert consensus. The key issues are summarized in this paper. The European Society of Cardiology (ESC) guidelines from 2012 for the management of patients with non-valvular AF recommend NOAC as the preferred treatment and vitamin K antagonists (VKA...
Source: Zeitschrift fur Gerontologie und Geriatrie - February 10, 2016 Category: Geriatrics Authors: Bahrmann P, Harms F, Schambeck CM, Wehling M, Flohr J Tags: Z Gerontol Geriatr Source Type: research

Non-Vitamin K Antagonist Oral Anticoagulants and Antiplatelet Therapy for Stroke Prevention in Patients With Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials
Non-vitamin K antagonist oral anticoagulants (NOACs) are frequently used to prevent stroke in patients with atrial fibrillation. These patients are often also on aspirin or other antiplatelet agents. It is possible that treatment with both NOACs and aspirin or other antiplatelet drug may be effective in decreasing stroke, but data are sparse regarding the efficacy and safety of using both agents for stroke prevention. To address these issues, data were pooled from the 4 recent randomized, controlled trials of NOACs: apixaban, rivaroxaban, dabigatran, and edoxaban, which included 42,411 patients; 14,148 (33.4%) were also on...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Successful intravenous thrombolysis for ischemic stroke after reversal of dabigatran anticoagulation with idarucizumab: a case report
ConclusionsOur case report adds to the evidence that idarucizumab administration is safe in the setting of patients with atrial fibrillation treated with dabigatran who develop acute ischemic stroke requiring thrombolysis.
Source: Journal of Medical Case Reports - August 15, 2017 Category: General Medicine Source Type: research

Oral anticoagulant use for stroke prevention in atrial fibrillation patients with difficult scenarios
Publication date: September 2018Source: IJC Heart & Vasculature, Volume 20Author(s): Ting-Yung Chang, Jo-Nan Liao, Tze-Fan Chao, Jennifer Jeanne Vicera, Chin-Yu Lin, Ta-Chuan Tuan, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Shih-Ann ChenAbstractAtrial fibrillation (AF) has become the most prevalent arrhythmia and it will increase the risk of ischemic stroke, heart failure, mortality, sudden cardiac death, myocardial infarction, and dementia. Stroke prevention with oral anticoagulant is crucial for management of AF patients. Vitamin K antagonist, which inhibits the clotting factors II, VII, IX and X...
Source: IJC Heart and Vasculature - September 1, 2018 Category: Cardiology Source Type: research

Number needed to treat based on real-world evidence for non-vitamin K antagonist oral anticoagulants versus vitamin K antagonist oral anticoagulants in stroke prevention in patients with non-valvular atrial fibrillation.
CONCLUSIONS: The NNT calculation, when approached and interpreted properly, is a practical measure of the effectiveness of a treatment. The calculation based on HRs showed that NOACs are safe and effective alternatives to VKAs in real life. PMID: 30969801 [PubMed - as supplied by publisher]
Source: Journal of Medical Economics - April 12, 2019 Category: Health Management Tags: J Med Econ Source Type: research

Non-Vitamin K Antagonist Oral Anticoagulants in Secondary Stroke Prevention in Atrial Fibrillation Patients: An Updated Analysis by Adding Observational Studies
ConclusionBased on current data, the use of NOACs is at least non-inferior to the use of VKAs in AF patients for secondary stroke prevention irrespective of NOAC type.
Source: Cardiovascular Drugs and Therapy - April 14, 2020 Category: Cardiology Source Type: research

Anticoagulants for Stroke Prevention in Atrial Fibrillation in Elderly Patients
AbstractIschaemic stroke and systemic embolism are the major potentially preventable complications of atrial fibrillation (AF) leading to severe morbidity and mortality. Anticoagulation using vitamin K antagonists (VKA) or non-vitamin K oral anticoagulants (NOACs) is mandatory for stroke prevention in AF. Following approval of the four NOACs dabigatran, rivaroxaban, apixaban, and edoxaban, the use of VKA is declining steadily. Increasing age with thresholds of 65 and 75  years is a strong risk factor when determining annual stroke risk in AF patients. Current recommendations such as the “2016 Guidelines for the manageme...
Source: Cardiovascular Drugs and Therapy - April 28, 2020 Category: Cardiology Source Type: research

IJERPH, Vol. 19, Pages 11939: Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs? & mdash;Results of the Polish Atrial Fibrillation (POL-AF) Registry
Conclusions: A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction.
Source: International Journal of Environmental Research and Public Health - September 21, 2022 Category: Environmental Health Authors: Anna Szyszkowska Łukasz Kuźma Beata Wo żakowska-Kapłon Iwona Gorczyca-G łowacka Olga Jelonek Beata Uzi ębło-Życzkowska Pawe ł Krzesiński Maciej W ójcik Robert B łaszczyk Monika Gawa łko Agnieszka Kap łon-Cieślicka Tomasz Tokarek Renata Rajt Tags: Article Source Type: research

Cost-effectiveness of dabigatran for stroke prevention in atrial fibrillation in Switzerland.
CONCLUSIONS: Dabigatran can be considered cost-effective in comparison with vitamin K antagonists in the Swiss context. The higher drug cost of dabigatran is compensated by savings in INR monitoring, lower cost of clinical events and QALY-gains. PMID: 23300013 [PubMed - in process]
Source: Swiss Medical Weekly - January 13, 2013 Category: Journals (General) Authors: Pletscher M, Plessow R, Eichler K, Wieser S Tags: Swiss Med Wkly Source Type: research

Efficacy and Safety of Apixaban in Patients After Cardioversion for Atrial Fibrillation Insights From the ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation)
ConclusionsMajor cardiovascular events after cardioversion of atrial fibrillation are rare and comparable between warfarin and apixaban. (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation [ARISTOTLE]; NCT00412984)
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - March 17, 2014 Category: Cardiology Source Type: research

PM198 Antithrombotic Treatment in Relation to Age and Stroke Risk in Patients With Newly Diagnosed Atrial Fibrillation (Gloria-AF Phase II)
Vitamin K antagonists (VKAs) or the non-VKA oral anticoagulants (NOACs) are recommended for prevention of stroke in patients with atrial fibrillation (AF) and additional stroke risk factors. Phase II of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) started after approval of dabigatran etexilate, the first NOAC available for stroke prevention in patients with AF.
Source: CVD Prevention and Control - May 27, 2016 Category: Cardiology Authors: J. Halperin, M. Huisman, H.-C. Diener, S. Dubner, C. Ma, K. Rothman, J. Healey, K. Zint, C. Teutsch, G. Lip Tags: Poster Abstract Source Type: research

Early real-world evidence of persistence on oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a cohort study in UK primary care
Conclusions Observed differential prescribing of OACs can result in channelling bias in comparative effectiveness research. Persistence patterns changed over follow-up time, but there are indications of improved persistence rates with apixaban over other OACs in the UK. A larger study with longer follow-up is needed to corroborate findings. This study is registered on ClinicalTrials.gov (NCT02488421).
Source: BMJ Open - September 25, 2016 Category: Journals (General) Authors: Johnson, M. E., Lefevre, C., Collings, S.-L., Evans, D., Kloss, S., Ridha, E., Maguire, A. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice Research Source Type: research

Standard and reduced doses of dabigatran, rivaroxaban, and apixaban for stroke prevention in atrial fibrillation: a nationwide cohort study
ConclusionsStandard and reduced dose NOACs, respectively, showed no significant risk difference for associated stroke/thromboembolism. Rivaroxaban was associated with higher bleeding risk compared with dabigatran and apixaban, and dabigatran was associated with lower intracranial bleeding risk compared with rivaroxaban and apixaban.This article is protected by copyright. All rights reserved.
Source: Journal of Internal Medicine - September 1, 2017 Category: Internal Medicine Authors: Laila Staerk, Thomas A Gerds, Gregory Y H Lip, Brice Ozenne, Anders N Bonde, Morten Lamberts, Emil L Fosb øl, Christian Torp‐Pedersen, Gunnar H Gislason, Jonas B Olesen Tags: Original Article Source Type: research