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Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: patient and provider perspectives
ConclusionsMany barriers remain to high risk individuals being prescribed anticoagulation for stroke prevention. There are a number of enabling factors that facilitate prescription and optimize treatment adherence. Nurses should challenge these treatment barriers and seek enabling factors to optimise therapy.This article is protected by copyright. All rights reserved.
Source: Journal of Clinical Nursing - February 7, 2017 Category: Nursing Authors: Caleb Ferguson, Sally C. Inglis, Phillip J. Newton, Sandy Middleton, Peter S. Macdonald, Patricia M. Davidson Tags: Original Article Source Type: research

Researchers identify safer treatment regimen after stroke
The safety of a controversial clot-busting drug has been investigated by researchers, who have shown a modified dosage can reduce serious bleeding in the brain and improve survival rates.
Source: Nursing Times - May 11, 2016 Category: Nursing Source Type: news

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

In people with atrial fibrillation receiving antithrombotics, short-term non-steroidal anti-inflammatory drug exposure increases risk of serious bleeding
Commentary on: Lamberts M, Lip GYH, Hansen ML, et al. Relation of non-steroidal anti-inflammatory drugs to serious bleeding and thromboembolism risk in patients with atrial fibrillation receiving antithrombotic therapy Ann Intern Med 2014;161:690–8. Implications for practice and research Short courses of non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in patients with atrial fibrillation (AF) already taking antithrombotic therapy for stroke prevention since there is an increased risk of serious bleeding and clot formation. Research needs to be carried out on whether combined NSAID and non-v...
Source: Evidence-Based Nursing - December 15, 2015 Category: Nursing Authors: Myat, A. Tags: GI bleeding, Adult nursing, Drugs: cardiovascular system, Pain (neurology), Stroke, Ischaemic heart disease, Pain (palliative care), Pain (anaesthesia), Drugs: musculoskeletal and joint diseases, Arrhythmias Source Type: research

Risks of new anticoagulants.
Authors: Abstract Atrial fibrillation is a major cause of stroke and anticoagulation, with warfarin known to decrease the risk. New oral anticoagulants provide patients with a convenient, fixed-dose alternative to warfarin. These novel drugs have been shown to be as effective at stroke prevention but trials showed an unexpected increase in gastrointestinal bleeding. This retrospective study aimed to quantify this risk by comparing the new drugs dabigatran and rivaroxaban with warfarin. They found no difference for younger patients but risk of bleeding increased with the new drugs in people over the age of 65 and ...
Source: Nursing Older People - June 25, 2015 Category: Nursing Tags: Nurs Older People Source Type: research

New Anticoagulant Approved
* Edoxaban (Savaysa) is a new oral anticoagulant used in the prevention of stroke and blood clots in patients with nonvalvular atrial fibrillation and in the treatment of deep vein thrombosis or pulmonary embolism. It inhibits the action of clotting factor Xa. * The most common adverse effects of edoxaban are anemia, bleeding, rash, and abnormal liver function. Like all anticoagulants, edoxaban carries a risk of bleeding, including major bleeding. Edoxaban shouldn't be used by those who have a creatinine clearance greater than 95 mL/min, indicating renal disease, because a long creatinine clearance increases the risk of ischemic stroke.
Source: AJN - April 24, 2015 Category: Nursing Tags: Drug Watch Source Type: research

Effects of nasogastric catheterization in patients with stroke and dysphagia.
This study aimed to analyze the effects of gastric intubation in patients with stroke and dysphagia. A systematic literature review was performed in six databases, using the keywords stroke and intubation, gastrointestinal. One hundred and twenty studies were found, from which three clinical trials were selected. The results showed different outcomes, including: increased serum albumin level (gastrostomy), poor prognosis and risk of death (gastrostomy), increased treatment failures because of blocking, displacement and reinsertion need of the nasogastric tube, and increased incidence of gastrointestinal bleeding (nasogastr...
Source: Revista Brasileira de Enfermagem - October 1, 2014 Category: Nursing Authors: Cavalcante TF, Araújo TL, Oliveira AR Tags: Rev Bras Enferm 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

Late pregnancy use of selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors is associated with increased risk of postpartum haemorrhage
Commentary on: Palmsten K, Hernández-Díaz S, Huybrechts KF, et al.. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the USA. BMJ 2013;347:f4877. Implications for research and practice Use of antidepressant medication is associated with increased risk for postpartum haemorrhage (PPH). Further research is needed to establish a causal role between antidepressant medication use and PPH. Clinicians should be aware of possible increased risk of postpartum haemorrhage when treating depression during pregnancy. Context Antidepressant medications are commonly...
Source: Evidence-Based Nursing - June 17, 2014 Category: Nursing Authors: Ananth, C. V., Friedman, A. M. Tags: GI bleeding, Health policy, Midwifery, Drugs: CNS (not psychiatric), Stroke, Obesity (nutrition), Pregnancy, Reproductive medicine, Child and adolescent psychiatry (paedatrics), Child health, Anxiety disorders (including OCD and PTSD), Child and adolescen Source Type: research

New oral anticoagulents use before or after surgery guided by review of clinical trials.
Authors: Abstract Warfarin has been the drug of choice for preventing stroke in patients with atrial fibrillation. Unfortunately, patients on warfarin require continuous monitoring to reduce the risk of bleeding and interactions with other drugs. PMID: 24823561 [PubMed - in process]
Source: Nursing Standard - May 14, 2014 Category: Nursing Tags: Nurs Stand Source Type: research

Review of an article: Protamine does not increase risk of stroke in patients with elective carotid stenting by Jennifer S. McDonald, PhD; David F. Kallmes, MD; Giuseppe Lanzino, MD; Harry J. Cloft, MD, PhD (Stroke 2013;44:2028-30)
The use of the heparin antagonist protamine after percutaneous intervention for carotid stenosis has been a topic of discussion in the literature as the safety of protamine after carotid angioplasty and stenting procedures has been called into question. Protamine sulfate is a cationic protein that binds with heparin to reverse the anticoagulant activity of unfractionated heparin. It is administered to reduce access site bleeding complications after femoral sheath removal, but its use must be balanced with the standard preprocedural anticoagulation undertaken to prevent thromboembolic complications. The purpose of this stu...
Source: Journal of Vascular Nursing - November 18, 2013 Category: Nursing Authors: Laura Nelson Kirk Tags: Research Column Source Type: research

Atrial fibrillation: Stroke prevention in focus
Conclusion: AF is a common and burdensome condition where treatment is complex and not without, risk. Nurses will encounter individuals with AF across a variety of primary and acute care areas, understanding the risk of AF and appropriate therapies is important across all care settings. Treatment, must be individually tailored to the needs of the patient and balanced with the best available evidence.
Source: Australian Critical Care - September 20, 2013 Category: Nursing Authors: Caleb Ferguson, Sally C. Inglis, Phillip J. Newton, Sandy Middleton, Peter S. Macdonald, Patricia M. Davidson Tags: Review Paper Source Type: research

Early ambulation after percutaneous coronary intervention does not increase bleeding risk compared with late ambulation
Commentary on: Tongsai S, Thamlikitkul V. The safety of early versus late ambulation in the management of patients after percutaneous coronary interventions: a meta-analysis. Int J Nurs Stud 2012;49:1084–90. Implications for practice and research Early ambulation after percutaneous coronary intervention (PCI) may facilitate earlier hospital discharge and improve patient comfort. There are a limited number of randomised clinical trials assessing the safety of this strategy. This meta-analysis suggests that earlier ambulation was not associated with an increased risk of adverse bleeding events. Context The number of PC...
Source: Evidence-Based Nursing - June 6, 2013 Category: Nursing Authors: Juergens, C. Tags: Adult nursing, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Cardiothoracic surgery, Vascular surgery Source Type: research

Aspirin given for up to 2 years after initial anticoagulant treatment reduces the risk of venous thromboembolism recurrence without increasing risk of major bleeding
Implications for practice and research The use of aspirin to prevent recurrent venous thromboembolism (VTE) after a first idiopathic event should not currently become a standard practice. Further studies are required before the use of aspirin following anticoagulation with warfarin for a first episode of venous thromboembolism becomes adopted as routine clinical practice. A direct comparison between low-dose aspirin and standard intensity warfarin is required. Context Venous thromboembolism, which encompasses deep vein thrombosis and pulmonary embolism, is a relatively common disorder with an incidence in western countries...
Source: Evidence-Based Nursing - June 6, 2013 Category: Nursing Authors: Watson, H. G. Tags: Editor's choice, Nursing issues, Drugs: cardiovascular system, Stroke, Venous thromboembolism, Pulmonary embolism Source Type: research

Managing Blunt Trauma in Patients Receiving Dabigatran Etexilate: Case Study and Review of the Literature
The objectives of this article are to present a case of life-threatening bleeding in a patient receiving dabigatran etexilate, followed by a review of the current literature and a suggested reversal guideline.
Source: Journal of Emergency Nursing: JEN - April 1, 2013 Category: Nursing Authors: Peter Eamonn Croft, Katherine P. Cabral, Tania D. Strout, Michael R. Baumann, Michael A. Gibbs, Matthew C. DeLaney Tags: Trauma Notebook Source Type: research

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