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Decision-making about the use of non-vitamin K oral anticoagulant therapies for patients with atrial fibrillation
Abstract Until recently, vitamin K antagonists, warfarin being the most commonly used agent in the United States, have been the only oral anticoagulant therapies available to prevent stroke in patients with atrial fibrillation (AF). In the last 5 years four new, non-vitamin K oral anticoagulants, the so-called NOACs or novel oral anticoagulants, have come to market and been approved by the Federal Drug Administration. Despite comparable if not superior efficacy in preventing AF-related stroke, and generally lower risks of major hemorrhage, particularly intracranial bleeding, the uptake of these agents has been s...
Source: Journal of Thrombosis and Thrombolysis - February 1, 2016 Category: Hematology Source Type: research

Platelet reactivity in patients undergoing transcatheter aortic valve implantation
In conclusion, patients undergoing TAVI for severe aortic stenosis and treated with DAPT have high rates of residual platelet reactivity during the peri-procedural period and up to 1-month thereafter. These findings may have clinical implications for the anti-platelet management of TAVI patients.
Source: Journal of Thrombosis and Thrombolysis - December 22, 2015 Category: Hematology Source Type: research

The changing characteristics of atrial fibrillation patients treated with warfarin
Abstract It has been suggested that direct oral anticoagulants are being preferentially used in low risk atrial fibrillation (AF) patients. Understanding the changing risk profile of new AF patients treated with warfarin is important for interpreting the quality of warfarin delivery through an anticoagulation clinic. Six anticoagulation clinics participating in the Michigan Anticoagulation Quality Improvement Initiative enrolled 1293 AF patients between 2010 and 2014 as an inception cohort. Abstracted data included demographics, comorbidities, medication use and all INR values. Risk scores including CHADS2, CHA2D...
Source: Journal of Thrombosis and Thrombolysis - September 27, 2015 Category: Hematology Source Type: research

Analysis of anticoagulant prescribing in non-valvular atrial fibrillation and development of a clinical tool for guiding anticoagulant selection
This study demonstrated that patients admitted to our hospital were prescribed appropriate therapy the majority of the time; however, 34 % were prescribed inadequate antithrombotic therapy compared to current practice guidelines given their CHA2DS2VASc score. The development of an institution-specific guideline stratifying appropriate use of anticoagulation in this population may increase adherence to national guideline recommendations.
Source: Journal of Thrombosis and Thrombolysis - May 8, 2015 Category: Hematology Source Type: research

Anticoagulation therapy in 2015: where we are and where we are going
Abstract Oral anticoagulants are a mainstay for the prevention and treatment of venous and arterial thrombosis. In 2015, the non-vitamin K oral anticoagulants (NOACs) are already replacing warfarin for many indications. Ongoing studies are focused on development of antidotes and specific reversal agents for the NOACs, and assessing their utility for prevention of cardiovascular events in patients with heart failure, coronary or peripheral artery disease, or embolic stroke of unknown source. This paper (a) lists the current indications for the NOACs; (b) reviews the current impact of the NOACs in each of these indi...
Source: Journal of Thrombosis and Thrombolysis - February 19, 2015 Category: Hematology Source Type: research

Patient-reported health preferences of anticoagulant-related outcomes
This study aimed to use direct measures to elicit patient-reported utilities (i.e., preferences) for anticoagulant-related outcomes. A cross-sectional survey was administered to 100 patients taking warfarin in an anticoagulation clinic. Utilities for six long-term and four short-term anticoagulant-related health states were elicited by the visual analogue scale (VAS) and standard gamble (SG) methods. Health states with the highest SG-derived mean utility values were “well on rivaroxaban” (mean ± SD = 0.90 ± 0.15), “well on warfarin” (0.86 ± 0.17), and “well on dabigatran” (0.83 ± 0.18). Approximat...
Source: Journal of Thrombosis and Thrombolysis - February 11, 2015 Category: Hematology Source Type: research

Practical aspects of treatment with target specific anticoagulants: initiation, payment and current market, transitions, and venous thromboembolism treatment
Abstract Target specific anticoagulants (TSOACs) have recently been introduced to the US market for multiple indications including venous thromboembolism (VTE) prevention in total hip and knee replacement surgeries, VTE treatment and reduction in the risk of stroke in patients with non-valvular atrial fibrillation (NVAF). Currently, three TSOACs are available including rivaroxaban, apixaban, and dabigatran with edoxaban currently under Food and Drug Administration review for VTE treatment and stroke prevention in NVAF. The introduction of these agents has created a paradigm shift in anticoagulation by considerably...
Source: Journal of Thrombosis and Thrombolysis - January 21, 2015 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

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

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