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The effect of management models on thromboembolic and bleeding rates in anticoagulated patients: an ecological study
AbstractThe primary  study objective is to compare the outcomes of patients taking oral anticoagulant medications in two distinct populations treated according to different management models (comprehensive vs. usual care). (Design: regional prospective cohort study; setting: hospital admission data from two regions). Eligible partecipants were patients taking oral anticoagulant drugs (vitamin K antagonist or direct oral anticoagulants), residents in the Vicenza and Cremona districts from February 1st, 2016 to June 30th, 2017. Patients were identified by accessing the administrative databases of patient drug prescripti...
Source: Internal and Emergency Medicine - July 14, 2019 Category: Emergency Medicine Source Type: research

Accidental Rivaroxaban Intoxication in a Boy: Some Lessons in Managing New Oral Anticoagulants in Children
We report a child who presented abnormal coagulation tests after unintended ingestion of 4 tablets of rivaroxaban. The patient was treated with fresh frozen plasma as well as admitted to intensive care and improved several hours later. We discuss his presentation and review of the literature on this topic.
Source: Pediatric Emergency Care - March 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Direct Oral Anticoagulant or Warfarin Related Major Bleeding
Recent years have marked the development of antithrombotic agents besides warfarin in the prevention of stroke in patients with atrial fibrillation. Initial studies have demonstrated equal or lower mortality following major bleeding related to Direct Oral Anticoagulants (DOACs) when compared with warfarin despite the lack of reversal agents early on. A major limitation of these studies was a low rate of warfarin reversal (
Source: The Journal of Emergency Medicine - November 1, 2017 Category: Emergency Medicine Authors: Tara Garland Tags: Abstract Source Type: research

Anticoagulation therapy among patients presenting to the emergency department with symptomatic atrial fibrillation – the FinFib2 study
Conclusion: These data showed that OAC was prescribed frequently to patients with symptomatic AF and risk factors for stroke. However, in patients using warfarin, international normalized ratio was not at the therapeutic level in a large proportion of the patients with previously diagnosed AF.
Source: European Journal of Emergency Medicine - August 30, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Management of Factor Xa inhibitor-associated life-threatening major hemorrhage: A retrospective multi-center analysis
This study describes a cohort of patients with FXa inhibitor-associated life-threatening bleeding events, their clinical characteristics, interventions and outcomes.
Source: The American Journal of Emergency Medicine - August 19, 2017 Category: Emergency Medicine Authors: Truman J. Milling, Carol L. Clark, Charles Feronti, Shlee S. Song, Sam S. Torbati, Gregory J. Fermann, Jeffrey Weiss, Dony Patel Source Type: research

Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients
AbstractDabigatran etexilate (DE) is a direct thrombin inhibitor, which has been approved for the treatment of non-valvular atrial fibrillation (AF), and for the prevention and treatment of venous thromboembolism (VTE). Despite large randomized clinical trials and independent observational studies providing robust data concerning DE safety and efficacy, some physicians still perceive mild-to-moderate renal impairment and old age as a relative contraindication to its use. In this article, we review the available scientific evidence supporting the use of DE in these clinical situations. Patients with AF and chronic kidney di...
Source: Internal and Emergency Medicine - April 24, 2017 Category: Emergency Medicine Source Type: research

Direct oral anticoagulants: a practical guide for the emergency physician
The direct oral anticoagulants (DOACs) are the mainstay for stroke prophylaxis in nonvalvular atrial fibrillation and treatment of acute venous thrombosis. They are attractive alternatives to warfarin because of their efficacy, ease of prescription and safety profile. The emergency department has gained expertise in the management of DOAC bleeding complications, but has been slower to adopt prescription decisions. Emergency clinicians are in a unique position to identify patients who are prescribed DOACs and are at high risk of impending bleeding. This is a practical guide for the emergency clinician on how to prescribe DO...
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Review Articles Source Type: research

The Severity of Bleeding and Mortality in Trauma Patients Taking Dabigatran
Dabigatran, a direct thrombin inhibitor, has been shown to be more effective than warfarin in the prevention of stroke in patients with atrial fibrillation. Until recently, it lacked a reversal agent, and its contribution to the risk of transfusion in injured patients is unknown.
Source: The Journal of Emergency Medicine - June 26, 2016 Category: Emergency Medicine Authors: Zachary D.W. Dezman, Angela C. Comer, Gordon S. Smith, Mayur Narayan, John R. Hess, Jon Mark Hirshon Tags: Brief Report Source Type: research

Coagulation assessment with the new generation of oral anticoagulants
Long-term oral anticoagulant (OAC) therapy is used for the treatment and prevention of thrombosis and thromboembolism. As OAC use is so widespread, emergency physicians are likely to encounter patients on anticoagulant therapy in the emergency department (ED) on a regular basis, either for the same reasons as the population in general or as a result of the increased bleeding risk that OAC use entails. The vitamin K antagonist warfarin has been the standard OAC for several decades, but recently, the newer agents dabigatran etexilate, rivaroxaban and apixaban (collectively, novel OACs, non-vitamin K OACs, or simply ‘NO...
Source: Emergency Medicine Journal - May 18, 2016 Category: Emergency Medicine Authors: Pollack, C. V. Tags: Open access, Drugs: cardiovascular system, Stroke, Venous thromboembolism Review Source Type: research

Why switch from warfarin to NOACs?
Abstract Several patients with non-valvular atrial fibrillation treated with warfarin or other vitamin-K antagonists (VKA) might benefit from switching to an oral non vitamin-K antagonist anticoagulant (NOAC). In the absence of randomised comparative trials of switching to NOACs versus maintaining VKA treatment, several considerations argue in favour of a switching strategy. First, there is conclusive evidence that haemorrhagic strokes and intracranial bleedings are much fewer in number with NOACs than with warfarin. The risk of intracranial bleeding is 52 % lower with NOACS than with warfarin, with extremes rang...
Source: Internal and Emergency Medicine - March 14, 2016 Category: Emergency Medicine Source Type: research

Time trends in intracranial bleeding and new oral anticoagulant prescription
Conclusion We found an increasing number of patients treated for intracranial bleeding over time. Warfarin accounted for a disproportionate number of intracranial bleeds and the new oral anticoagulants, fewer than expected.
Source: Emergency Medicine Journal - November 23, 2015 Category: Emergency Medicine Authors: Hogg, K., Stiell, I., Bahl, B. Tags: Drugs: cardiovascular system, Stroke RCEM FREE PAPERS Source Type: research

Management of Bleeding Complications in Patients Taking Direct Oral Anticoagulants at a Large Tertiary Academic Medical Center
Abstract Direct oral anticoagulants (DOACs) offer a fixed-dose alternative to warfarin for stroke prevention in patients with atrial fibrillation. However, there is minimal evidence to guide the management of bleeding in patients taking a DOAC. We retrospectively evaluated the acute management of major bleeding in this patient population at a large, tertiary academic medical center. We evaluated various strategies of management including dialysis, transfusions, pharmacologic agents, surgical intervention, and reinitiation of anticoagulation. We also assessed length of intensive care unit and hospital stay, mor...
Source: Current Emergency and Hospital Medicine Reports - June 13, 2015 Category: Emergency Medicine Source Type: research

To treat or not to treat very elderly naïve patients with atrial fibrillation with vitamin K antagonists (VKA): results from the VENPAF cohort
Abstract Despite the recommendations in the guidelines, physicians still underuse warfarin in very elderly patients with non-valvular atrial fibrillation (NVAF). The risks of stroke and major bleeding both increase with age, but it is still not clear whether the beneficial effects of vitamin K antagonists (VKA) in preventing stroke outweigh the related bleeding risks in fragile, very elderly patients. The bleeding rates reported in real-world observational studies differ considerably. The aim of this study was to retrospectively assess the incidence of major bleeding in VKA-naïve patients over 80 years old w...
Source: Internal and Emergency Medicine - April 21, 2015 Category: Emergency Medicine Source Type: research

Direct oral anticoagulants in the secondary prevention of stroke and transient ischemic attack in patients with atrial fibrillation
Abstract In patients with non-valvular atrial fibrillation (NVAF) and history of transient ischemic attack (TIA) or stroke, the rate of vascular events is higher in comparison to patients without history of stroke or TIA. A meta-analysis of direct oral anticoagulants (DOACs) studies, including only patients with history of stroke or TIA, report a significant reduction of 15 % in the rates of composite of stroke and systemic embolism in patients treated with DOACs, compared to those treated with warfarin. Furthermore, a reduction of 14 % for major bleeding, as well as a 56 % reduction for hemorrhagic stroke over...
Source: Internal and Emergency Medicine - April 11, 2015 Category: Emergency Medicine Source Type: research

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