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Novel Oral Anticoagulants in Patients with Continuous Flow Left Ventricular Assist Devices
The gold standard for anticoagulation in patients with continuous flow left ventricular assist device (CF-LVADs) is warfarin. However, many patients fail warfarin therapy due to thromboembolic and bleeding events. Warfarin requires regular monitoring and dosage adjustments, and is associated with significant patient time outside recommended therapeutic INR range. Novel oral anticoagulation (NOAC) has been shown to be non-inferior compared to warfarin in stroke prevention with less intracranial hemorrhage in patients with atrial fibrillation.
Source: The Journal of Heart and Lung Transplantation - March 16, 2019 Category: Transplant Surgery Authors: V. Parikh, U. Parikh, A.M. Ramirez, H. Lamba, J. George, S. Fedson, F. Cheema, A. Civitello, A. Nair, A. Shafii, G. Loor, T. Rosengart, O. Frazier, J. Morgan, R. Delgado Tags: 1072 Source Type: research

Comparative effectiveness, safety, and costs of rivaroxaban and warfarin among morbidly obese patients with atrial fibrillation
ConclusionsMorbidly obese AF patients treated with rivaroxaban had comparable risk of ischemic stroke/systemic embolism and major bleeding as those treated with warfarin, but lower healthcare resource utilization and costs.
Source: American Heart Journal - February 21, 2019 Category: Cardiology Source Type: research

Cerebrovascular Accidents During Mechanical Circulatory Support Clinical Sciences
Conclusions—Stroke is a major cause of morbidity and mortality in patients on LVAD support. Chronic obstructive pulmonary disease increases the risk of ischemic stroke, whereas dialysis may increase the risk of hemorrhagic stroke. Although any stroke increases mortality, post-LVAD hemorrhagic stroke was associated with higher mortality compared with ischemic stroke.
Source: Stroke - April 23, 2018 Category: Neurology Authors: Saef Izzy, Daniel B. Rubin, Firas S. Ahmed, Feras Akbik, Simone Renault, Katelyn W. Sylvester, Henrikas Vaitkevicius, Jennifer A. Smallwood, Michael M. Givertz, Steven K. Feske Tags: Heart Failure, Complications, Quality and Outcomes, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research

A Review of the Use of Direct Oral Anticoagulant Use in Orthotopic Heart Transplantation Recipients
Over 60 years ago, the vitamin K antagonist (VKA) warfarin was approved and remained the only oral anticoagulation agent until recently [1]. Currently, within North America and Europe there are four DOACs available. Dabigatran, first approved in Europe and Canada in 2008, then in the United States of America in 2010, followed by rivaroxaban, apixaban, and most recently edoxaban. The introduction of direct oral anticoagulants (DOACs) has been a major advancement and these agents are the preferred to VKAs for many indications [2 –5], including stroke prevention in nonvalvular atrial fibrillation (NVAF), acute treatment and...
Source: Transplantation Reviews - April 16, 2018 Category: Transplant Surgery Authors: Rosaleen Boswell, Glen J. Pearson Tags: Review article Source Type: research

Anticoagulation therapy for a LVAD patient with acquired warfarin resistance
AbstractAnticoagulation therapy with warfarin is essential for postoperative management in patients with left ventricular assist device (LVAD). In this manuscript, we report the case of a patient who developed warfarin resistance after LVAD implantation. Although we administered a novel anticoagulant drug in addition to warfarin and aspirin therapy, the patient developed a major stroke. The patient needed continuous intravenous heparinization until heart transplantation for approximately 2  years. Meticulous management of anticoagulation therapy is essential for a LVAD with warfarin resistance. To our best knowledge, our ...
Source: Journal of Artificial Organs - March 27, 2017 Category: Transplant Surgery Source Type: research

Managing Anticoagulation in LVAD Patients: The Harefield Experience
Anticoagulation management in patients with Left Ventricular Assist devices (LVAD) continues to be a challenge. Patients and their clinicians are faced with the daily challenge of needing adequate anticoagulation versus the bleeding risks that are associated with anticoagulation.Warfarin is the recommended oral anticoagulant for all currently available LVAD devices.Warfarin is known to be a difficult medication to manage due to its narrow therapeutic window, and its many interactions .Dlott et al (2014) describe in Circulation the overall time in therapeutic range for patients on warfarin as 53.7%, Time in therapeutic rang...
Source: The Journal of Heart and Lung Transplantation - March 25, 2017 Category: Transplant Surgery Authors: R. Hards, G. Edwards, C. Kavanagh, M. Hedger, A.R. Simon Source Type: research

Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.
Authors: Robson A, Sturman J, Williamson P, Conboy P, Penney S, Wood H Abstract This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer. Recommendations • Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. (R) • Patients with hypertens...
Source: Journal of Laryngology and Otology - November 15, 2016 Category: ENT & OMF Tags: J Laryngol Otol Source Type: research

Effectiveness and Safety of Dabigatran, Rivaroxaban, and Apixaban Versus Warfarin in Nonvalvular Atrial Fibrillation Health Services and Outcomes Research
Conclusions In patients with nonvalvular atrial fibrillation, apixaban was associated with lower risks of both stroke and major bleeding, dabigatran was associated with similar risk of stroke but lower risk of major bleeding, and rivaroxaban was associated with similar risks of both stroke and major bleeding in comparison to warfarin.
Source: JAHA:Journal of the American Heart Association - June 12, 2016 Category: Cardiology Authors: Yao, X., Abraham, N. S., Sangaralingham, L. R., Bellolio, M. F., McBane, R. D., Shah, N. D., Noseworthy, P. A. Tags: Atrial Fibrillation, Secondary Prevention, Anticoagulants, Transplantation, Cerebrovascular Disease/Stroke Health Services and Outcomes Research Source Type: research

Native valve disease in patients with non-valvular atrial fibrillation on warfarin or rivaroxaban
Conclusions We found that patients with AF and AS on oral anticoagulants may have distinctly different efficacy and safety outcomes than patients with MR or AR or no SVD. Trial registration number NCT00403767; Post-results.
Source: Heart - June 9, 2016 Category: Cardiology Authors: Breithardt, G., Baumgartner, H., Berkowitz, S. D., Hellkamp, A. S., Piccini, J. P., Lokhnygina, Y., Halperin, J. L., Singer, D. E., Hankey, G. J., Hacke, W., Becker, R. C., Nessel, C. C., Mahaffey, K. W., Califf, R. M., Fox, K. A. A., Patel, M. R., for th Tags: Open access, Drugs: cardiovascular system, Interventional cardiology, Aortic valve disease, Mitral valve disease Valvular heart disease Source Type: research

How to define valvular atrial fibrillation?
Abstract Atrial fibrillation (AF) confers a substantial risk of stroke. Recent trials comparing vitamin K antagonists (VKAs) with non-vitamin K antagonist oral anticoagulants (NOACs) in AF were performed among patients with so-called "non-valvular" AF. The distinction between "valvular" and "non-valvular" AF remains a matter of debate. Currently, "valvular AF" refers to patients with mitral stenosis or artificial heart valves (and valve repair in North American guidelines only), and should be treated with VKAs. Valvular heart diseases, such as mitral regurgitation, aortic stenosis (AS) and aortic insufficiency, do...
Source: Archives of Cardiovascular Diseases - July 13, 2015 Category: Cardiology Authors: Fauchier L, Philippart R, Clementy N, Bourguignon T, Angoulvant D, Ivanes F, Babuty D, Bernard A Tags: Arch Cardiovasc Dis Source Type: research

Left Ventricular Assist Devices vs. the Total Artificial Heart: Which Causes More Cerebrovascular Accidents?
More recently, the continuous flow left ventricular assist devices (LVADs) have been more commonly used in patients (pts) with severe left heart failure. However, these devices also have risk for strokes, both ischemic and hemorrhagic. The Total Artificial Heart (TAH) has also been used in patients with biventricular heart failure at our single institution. Both continuous flow LVADs and TAH patients are systemically anti-coagulated with warfarin and aspirin. We sought to compare stroke rates between the LVAD patients and TAH pts.
Source: The Journal of Heart and Lung Transplantation - April 1, 2015 Category: Transplant Surgery Authors: C. Runyan, F. Arabia, L. Czer, M. Kittleson, E. Passano, F. Liou, J. Yabuno, H. Henry, D.H. Chang, J. Kobashigawa, J. Moriguchi Source Type: research

Individualized antithrombotic therapy.
Conclusion: An extensive therapeutic arsenal to interfere with clot formation requires an individualized approach considering the disease condition and co-morbidities of the patient, the anticoagulants' and patientcharacteristics. This review builds on and extens previous publications of the authors on this topic. PMID: 25597592 [PubMed - as supplied by publisher]
Source: Hamostaseologie - January 19, 2015 Category: Hematology Authors: Lüscher TF, Steffel J Tags: Hamostaseologie Source Type: research

Clinical characteristics and outcomes with rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AF trial
Conclusions Many patients with ‘non-valvular atrial fibrillation’ have significant valve lesions. Their risk of stroke is similar to that of patients without SVD after controlling for stroke risk factors. Efficacy of rivaroxaban vs. warfarin was similar in patients with and without SVD; however, the observed risk of bleeding was higher with rivaroxaban in patients with SVD but was the same among those without SVD. Atrial fibrillation patients with and without SVD experience the same stroke-preventive benefit of oral anticoagulants.
Source: European Heart Journal - December 14, 2014 Category: Cardiology Authors: Breithardt, G., Baumgartner, H., Berkowitz, S. D., Hellkamp, A. S., Piccini, J. P., Stevens, S. R., Lokhnygina, Y., Patel, M. R., Halperin, J. L., Singer, D. E., Hankey, G. J., Hacke, W., Becker, R. C., Nessel, C. C., Mahaffey, K. W., Fox, K. A. A., Calif Tags: Atrial fibrillation Source Type: research

Systemic Inflammation Exacerbates Stroke in Patients with Left Ventricular Assist Device (P4.235)
CONCLUSIONS:In LVAD patients, total prevention of cerebrovascular complications cannot be accomplished only by adjusting warfarin dosage to meet the therapeutic range. However, recognition of increased CRP and appropriate management of inflammation prior to the stroke onset may enable us to avoid its aggravation and secure patient’s opportunity for heart transplantation.Disclosure: Dr. Ohtomo has nothing to disclose. Dr. Iwata has received personal compensation for activities with Janssen Pharmaceuticals, Eisai Inc., Daiichi Pharmaceutical Corp., Ono Pharmaceutical, and Takeda Pharmaceutical Co. Ltd. Dr. Iwata has re...
Source: Neurology - April 9, 2014 Category: Neurology Authors: Ohtomo, R., Iwata, A., Kinoshita, O., Shimizu, J., Ono, M., Tsuji, S. Tags: Cerebrovascular Disease and Interventional Neurology: Cardiac Source Type: research

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