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A Seeming Paradox: Ischemic Stroke in the Context of Idiopathic Thrombocytopenic Purpura
Nowadays, we have a relatively sophisticated standard approach to a patient with acute ischemic stroke, including the sequence of diagnostic methods and treatment modalities. In practice, however, we are occasionally confronted with a patient whose medical history or comorbidities force us to make a decision without the support of guidelines. One such situation is the occurrence of acute ischemic stroke in a patient with known idiopathic thrombocytopenic purpura, where a tendency to use thrombolysis, anticoagulants, or antiplatelet agents collides with the fear of life-threatening bleeding. In this review, we try to outlin...
Source: Clinical and Applied Thrombosis/Hemostasis - February 2, 2016 Category: Hematology Authors: Mihalov, J., Timarova, G. Tags: Reviews Source Type: research

Comparison of Medical Costs of Patients With Atrial Fibrillation Unsuitable for Warfarin Treatment With Apixaban or Aspirin Based on AVERROES Trial
Conclusions: Based on AVERROES trial results, among patients with AF unsuitable for warfarin therapy, apixaban use was estimated to be associated with a mean medical cost avoidance of US$735 in a patient-year relative to aspirin. The primary driver was the significant reduction in ischemic stroke rate. The medical cost reduction associated with apixaban use was consistent in sensitivity analyses.
Source: Clinical and Applied Thrombosis/Hemostasis - February 27, 2015 Category: Hematology Authors: Amin, A., Deitelzweig, S., Jing, Y., Makenbaeva, D., Wiederkehr, D., Lin, J., Graham, J. Tags: Original Articles Source Type: research

Major Bleeding With Dabigatran and Rivaroxaban in Patients With Atrial Fibrillation: A Real-World Setting
Conclusion: We observed a rate of major bleeding similar to that reported in randomized clinical trials among patients with AF prescribed dabigatran or rivaroxaban.
Source: Clinical and Applied Thrombosis/Hemostasis - August 26, 2014 Category: Hematology Authors: Fontaine, G. V., Mathews, K. D., Woller, S. C., Stevens, S. M., Lloyd, J. F., Evans, R. S. Tags: Original Articles Source Type: research

Oral Anticoagulation Therapy for Elderly Patients With Atrial Fibrillation: Utility of Bleeding Risk Covariates to Better Understand and Moderate Risks
Elderly individuals are prone to nonvalvular atrial fibrillation (AF) with associated risks of arterial thromboembolic disease. Despite definitive guidelines, oral anticoagulant therapy (OAC) is notoriously underutilized in patients with AF. Physicians cite excessive bleeding risk as one reason they omit OAC for their older patients with AF. Improved understanding of the pathophysiology of age-related bleeding may improve risk–benefit assessments for warfarin and newer antithrombotic agents. We reviewed the literature to identify age-related pathophysiological elements that can exacerbate the likelihood of bleeding. ...
Source: Clinical and Applied Thrombosis/Hemostasis - December 12, 2013 Category: Hematology Authors: Forman, D. E., Goyette, R. E. Tags: Original Articles Source Type: research

The Efficacy and Safety of Oral Anticoagulants in Warfarin-Suitable Patients With Nonvalvular Atrial Fibrillation: Systematic Review and Meta-Analysis
The novel oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban have been recently indicated for stroke prevention in patients with atrial fibrillation (AF) . Due to a lack of direct head-to-head trials comparing the NOACs, the current systematic review and network meta-analysis (NMA) were conducted to assess their relative efficacy and safety. Three phase III randomized controlled trials enrolling 50 578 patients were included. Results of the NMA show a clear trend favoring NOACs over warfarin with regard to the key outcomes of stroke/systemic embolism and all-cause mortality, with apixaban also showing a...
Source: Clinical and Applied Thrombosis/Hemostasis - November 14, 2013 Category: Hematology Authors: Mitchell, S. A., Simon, T. A., Raza, S., Jakouloff, D., Orme, M. E., Lockhart, I., Drost, P. Tags: Original Articles Source Type: research

Intracerebral Hemorrhage: A Review of Coagulation Function
Intracerebral hemorrhage (ICH) is associated with a higher mortality rate among stroke subtypes. The amount of hematoma at baseline and subsequent expansion are considered strong independent markers for determining poor clinical outcome. Even though reduction in blood pressure to prevent and control the amount of bleeding in ICH has received considerable amount of attention, the impact of coagulopathy and platelet dysfunction, on the bleeding diathesis has not been extensively investigated. With the increasing use of antiplatelets and/or anticoagulants, given the aging population, a deeper understanding of the interactions...
Source: Clinical and Applied Thrombosis/Hemostasis - November 14, 2013 Category: Hematology Authors: Emiru, T., Bershad, E. M., Zantek, N. D., Datta, Y. H., Rao, G. H. R., Hartley, E. W., Divani, A. A. Tags: Original Articles Source Type: research

Antithrombotic Medication Use and Bleeding Risk in Medically Ill Patients After Hospitalization
Conclusions: Careful consideration of these demonstrated bleed-associated comorbidities before initiating anticoagulation or combining antithrombotic medications in medically ill patients may improve strategies for prevention of postdischarge thromboembolism.
Source: Clinical and Applied Thrombosis/Hemostasis - September 15, 2013 Category: Hematology Authors: Mahan, C. E., Spyropoulos, A. C., Fisher, M. D., Fields, L. E., Mills, R. M., Stephenson, J. J., Fu, A.-C., Klaskala, W. Tags: Original Articles Source Type: research