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Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research

Anticoagulant choice in antiphospholipid syndrome – associated thrombosis
Background: DOACs have largely replaced VKAs as first-line therapy for venous thromboembolism in patients with adequate renal function. However, there is concern in APS that DOACs may have higher rates of recurrent thrombosis than VKAs when treating thromboembolism. Dr. David Portnoy Study design: Randomized noninferiority trial. Setting: Six teaching hospitals in Spain. Synopsis: Of adults with thrombotic APS, 190 were randomized to receive rivaroxaban or warfarin. Primary outcomes were thrombotic events and major bleeding. Follow-up after 3 years demonstrated new thromboses in 11 patients (11.6%) in the DOAC...
Source: The Hospitalist - December 10, 2021 Category: Hospital Management Authors: Daniel Hickman Tags: Hematology Thrombosis Source Type: research

Dabigatran and Warfarin are Both Used for Stroke-prevention in Patients with AF but their Side effects Differ
NEW YORK (Reuters Health) – Dabigatran and warfarin offer similar stroke-prevention efficacy in patients with atrial fibrillation (AF), but their side effect profiles differ, according to a systematic review and meta-analysis of real-world clinical practice. “There could be many reasons for the differences in our findings, such as differences in the quality of evidence of... [Read More]
Source: The Hospitalist - February 19, 2016 Category: Hospital Management Authors: Will Boggs MD, Reuters Health Tags: Clinical Education Hospitalist Patient Care atrial fibrillation Dabigatran stroke warfarin Source Type: research

Beyond warfarin: A patient‐centered approach to selecting novel oral anticoagulants for stroke prevention in atrial fibrillation
CONCLUSIONSWarfarin continues to play an important role in the prevention of stroke or systemic embolism in NVAF. Among selected patients, the use of NOACs provides equal or superior benefit, without the need for chronic anticoagulation monitoring or ongoing dose titration. Journal of Hospital Medicine 2014. © 2014 Society of Hospital Medicine
Source: Journal of Hospital Medicine - April 9, 2014 Category: Hospital Management Authors: Keval K. Patel, Ali A. Mehdirad, Michael J. Lim, Scott W. Ferreira, Peter C. Mikolajczak, Joshua M. Stolker Tags: Reviews Source Type: research

Edoxaban Effective in Preventing Stroke, Reducing Bleeding and Cardiovascular Death in Patients With Atrial Fibrillation
New study demonstrates that high- and low-dose edoxaban were at least as effective in preventing stroke or systemic embolism (blood clot), while significantly reducing bleeding and cardiovascular death, compared to warfarin.
Source: BWH News - November 19, 2013 Category: Hospital Management Source Type: news