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Use of direct oral anticoagulants for stroke prevention in elderly patients with nonvalvular atrial fibrillation
ConclusionsDOACs are at least as effective as warfarin for stroke prevention in elderly patients with NVAF. Compared with warfarin, DOACs were associated with reduced risk of intracranial hemorrhage, while some DOACs demonstrated an increase in other bleeding events (e.g., gastrointestinal). The faster onset and offset of action and fewer food and drug interactions of DOACs may be an advantage over warfarin for some patients. Implications for practiceDOACs are an alternative to warfarin with overall equivalent safety and efficacy in elderly patients with NVAF, and may be preferable for some. Stroke risk must always be bala...
Source: Journal of the American Academy of Nurse Practitioners - August 14, 2017 Category: Nursing Authors: Lynn B. Oertel, Annemarie E. Fogerty Tags: REVIEW ‐ SPONSORED Source Type: research

Nonvitamin K antagonist oral anticoagulants in everyday practice: Stroke prevention in atrial fibrillation and treatment of venous thromboembolism
ConclusionsAll four NOACs are equivalent to or better than warfarin for the treatment of VTE and stroke prevention in AF, and may reduce the risk of bleeding complications, particularly intracranial bleeding. Implications for practiceNOACs may benefit some patients by avoiding the numerous food or drug interactions and frequent laboratory monitoring associated with warfarin. Adherence to proper dosing is critical for NOAC efficacy and safety.
Source: Journal of the American Academy of Nurse Practitioners - December 17, 2015 Category: Nursing Authors: Barbara A. Bentz Tags: REVIEW Source Type: research

New oral anticoagulants for patients with nonvalvular atrial fibrillation
This article reviews the new drugs.
Source: Journal of the American Academy of Physician Assistants - October 27, 2015 Category: Primary Care Tags: CME: Cardiology Source Type: research

Development of apixaban: a novel anticoagulant for prevention of stroke in patients with atrial fibrillation
The factor Xa inhibitor apixaban is one of the novel anticoagulants to emerge as alternatives to long‐standing standards of care that include low‐molecular‐weight heparin and warfarin. The development of apixaban reflects a strategy to optimize the clinical pharmacology profile, dosing posology, trial designs, and statistical analyses across multiple indications, and to seek alignment with global health authorities. The primary objective of dose selection was to maintain balance between efficacy and bleeding risk. Twice‐daily dosing of apixaban, rather than once daily, was chosen to lower peak concentrations and re...
Source: Annals of the New York Academy of Sciences - November 5, 2014 Category: Science Authors: Michael S. Hanna, Puneet Mohan, Robert Knabb, Elora Gupta, Charles Frost, John H. Lawrence Tags: Original Article Source Type: research

Dabigatran etexilate: An alternative to warfarin for patients with nonvalvular atrial fibrillation
ConclusionsSignificant evidence from the PETRO and RE‐LY trials and postmarketing analyses of dabigatran etexilate indicate that this direct thrombin inhibitor is as efficacious as warfarin in ischemic stroke prevention. In fact, the studies found that patients taking dabigatran etexilate had fewer incidences of ischemic stroke and intracranial hemorrhage than those taking warfarin. Risk for major gastrointestinal bleeding appears to be higher than that for warfarin. Implications for practicePatients taking dabigatran etexilate do not require blood work to assess international normalized ratio (INR) levels. Because this ...
Source: Journal of the American Academy of Nurse Practitioners - July 25, 2014 Category: Nursing Authors: Katie A. Scott, Karen A. Amirehsani Tags: CLINICAL PRACTICE Source Type: research

Summary of evidence-based guideline update: Prevention of stroke in nonvalvular atrial fibrillation: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Objective: To update the 1998 American Academy of Neurology practice parameter on stroke prevention in nonvalvular atrial fibrillation (NVAF). How often do various technologies identify previously undetected NVAF? Which therapies reduce ischemic stroke risk with the least risk of hemorrhage, including intracranial hemorrhage? The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review; modified Delphi process recommendation formulation. Major conclusions: In patients with recent cryptogenic stroke, cardiac rhythm monitoring probabl...
Source: Neurology - February 24, 2014 Category: Neurology Authors: Culebras, A., Messe, S. R., Chaturvedi, S., Kase, C. S., Gronseth, G. Tags: All Cerebrovascular disease/Stroke SPECIAL ARTICLE Source Type: research

Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Objective: To assess evidence regarding periprocedural management of antithrombotic drugs in patients with ischemic cerebrovascular disease. The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review with practice recommendations. Results and recommendations: Clinicians managing antithrombotic medications periprocedurally must weigh bleeding risks from drug continuation against thromboembolic risks from discontinuation. Stroke patients undergoing dental procedures should routinely continue aspirin (Level A). Stroke patients underg...
Source: Neurology - May 27, 2013 Category: Neurology Authors: Armstrong, M. J., Gronseth, G., Anderson, D. C., Biller, J., Cucchiara, B., Dafer, R., Goldstein, L. B., Schneck, M., Messe, S. R. Tags: Ultrasound, All Medical/Systemic disease, All Neuro-ophthalmology, All Cerebrovascular disease/Stroke, All Trauma SPECIAL ARTICLE Source Type: research

Rivaroxaban: a novel oral anticoagulant for the prevention and treatment of several thrombosis‐mediated conditions
The development of rivaroxaban (XARELTO®) is an important new medical advance in the field of oral anticoagulation. Thrombosis‐mediated conditions constitute a major burden for patients, healthcare systems, and society. For more than 60 years, the prevention and treatment of these conditions have been dominated by oral vitamin K antagonists (such as warfarin) and the injectable heparins. Thrombosis can lead to several conditions, including deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke, and/or death. Prevention and treatment of thrombosis with an effective, convenient‐to‐use oral anticoagula...
Source: Annals of the New York Academy of Sciences - May 23, 2013 Category: Science Authors: Troy C. Sarich, Gary Peters, Scott D. Berkowitz, Frank Misselwitz, Christopher C. Nessel, Paul Burton, Nancy Cook‐Bruns, Anthonie W.A. Lensing, Lloyd Haskell, Elisabeth Perzborn, Dagmar Kubitza, Kenneth T. Moore, Sanjay Jalota, Juergen Weber, Guohua Pan Tags: Original Article Source Type: research