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Efficacy and Safety Considerations With Dose-Reduced Direct Oral Anticoagulants: A Review
CONCLUSIONS AND RELEVANCE: Dose adjustment and low-intensity treatment are 2 different forms of dose-reduced DOACs. Dose adjustment is mostly relevant for AF and should be done based on the approved criteria. Dose adjustment of DOACs should not be used for acute VTE treatment in most cases. In contrast, low-intensity DOACs may be used for primary or secondary VTE prevention for studied and approved indications. Attention should be given to routine practice patterns to align the daily clinical practice with existing evidence of safety and efficacy.PMID:35648414 | DOI:10.1001/jamacardio.2022.1292
Source: Atherosclerosis - June 1, 2022 Category: Cardiology Authors: Behnood Bikdeli Farbod Zahedi Tajrishi Parham Sadeghipour Azita H Talasaz John Fanikos Giuseppe Lippi Deborah M Siegal John W Eikelboom Manuel Monreal David Jimenez Jean M Connors Walter Ageno Geoffrey D Barnes Gregory Piazza Dominick J Angiolillo Sahil A Source Type: research

Fatal Adverse Events of Dabigatran Combined With Aspirin in Elderly Patients: An Analysis Using Data From VigiBase
Conclusion: The fatal adverse events associated with the combined use of dabigatran and aspirin in elderly patients were mainly serious bleeding events, which often occurred within 1 month. Most of these cases had medication errors and most of the patients had multiple diseases, medications, or other conditions at the same time that increase the risk of bleeding. It is suggested that prescription of dabigatran and aspirin in elderly patients should go along with alertness for medication errors, care for correct dose or control of other bleeding risk factors, and the combined medication time should be as short as possible ...
Source: Frontiers in Pharmacology - December 22, 2021 Category: Drugs & Pharmacology Source Type: research

The resolution of carotid arterial thrombus by oral anticoagulation after IV thrombolysis for chemotherapy-induced stroke: A case report
Rationale: Cancer-related stroke has been regarded as an emerging subtype of ischemic event. Acute treatment for this subtype may include the antiplatelet agents, anticoagulants, or endovascular intervention. Patient concerns: A 63-year-old woman with sudden-onset right hemiparesis and conscious change was sent to our emergency department. The patient had underlying sigmoid adenocarcinoma and received chemotherapy FOLFIRI (FOL, folinic acid; F, fluorouracil; and IRI, irinotecan) with targeted therapy cetuximab following lower anterior resection since the diagnosis was made. Diagnoses: Brain magnetic resonance angio...
Source: Medicine - August 28, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Anticoagulation: Updated Guidelines for Outpatient Management.
Abstract Anticoagulation therapy is recommended for preventing, treating, and reducing the recurrence of venous thromboembolism, and preventing stroke in persons with atrial fibrillation. Direct oral anticoagulants are first-line agents for eligible patients for treating venous thromboembolism and preventing stroke in those with nonvalvular atrial fibrillation. Vitamin K antagonists are recommended for patients with mechanical valves and valvular atrial fibrillation. Vitamin K antagonists inhibit the production of vitamin K-related factors and require a minimum of five days overlap with parenteral anticoagulants, ...
Source: American Family Physician - September 30, 2019 Category: Primary Care Authors: Wigle P, Hein B, Bernheisel CR Tags: Am Fam Physician Source Type: research

Efficacy and safety of oral anticoagulants in atrial fibrillation patients with cancer —a network meta-analysis
AbstractThere are no guideline recommendations for the use of anticoagulant therapy in atrial fibrillation (AF) patients with cancer, which creates uncertainty about the optimal antithrombotic treatment in these patients. We conducted a network meta-analysis for the first time to assess the efficacy and safety of anticoagulant drugs in patients with AF and concurrent cancer. The PubMed, EMBASE, and Cochrane databases were searched up to March 2019. A search was made for the main anticoagulant drugs (warfarin, dabigatran, apixaban, rivaroxaban, and edoxaban). Outputs were presented as odds ratios (ORs), their corresponding ...
Source: Heart Failure Reviews - August 12, 2019 Category: Cardiology Source Type: research

Treatment Failure in Patients Receiving Direct Oral Anticoagulants: Clinical Management and Outcomes from a Single-Center Review of 59 Consecutive Patients
In this study, we sought to characterise DOAC treatment failures in our institution, and to rationalise the subsequent anticoagulation strategies in this setting. All VTE patients starting a DOAC at our centre are followed in a consultant-led clinic. Cases of suspected treatment failure are also referred from other specialities and primary care. Between September 2014 and May 2018, we identified 59 consecutive patients (male/female: 34/25) in whom a DOAC treatment failure was diagnosed, including non-resolution of the presenting complaint, and recurrence of or a new thrombotic event. Patient mean age at DOAC initiation was...
Source: Blood - November 21, 2018 Category: Hematology Authors: McIlroy, G., Smith, N., Lokare, A., Beale, K., Kartsios, C. Tags: 332. Antithrombotic Therapy Source Type: research

Causes of Death in Patients with Venous Thromboembolism Anticoagulated with Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis
Semin Thromb Hemost DOI: 10.1055/s-0038-1642644Death is more frequent than nonfatal recurrent venous thromboembolism (VTE) and major bleeding after acute VTE. The analysis of the causes of death is fundamental to explore new strategies to reduce mortality rates in these patients. The authors performed a meta-analysis to analyze mortality and independently adjudicated causes of death in anticoagulated patients due to VTE, and to evaluate potential differences between different anticoagulant schemes. They searched MEDLINE and CENTRAL, from January 1, 2000, to January 31, 2017, and performed additional searches in Web sites o...
Source: Seminars in Thrombosis and Hemostasis - May 3, 2018 Category: Hematology Authors: G ómez-Outes, Antonio Terleira-Fern ández, Ana Isabel Lecumberri, Ram ón Su árez-Gea, Mª Luisa Calvo-Rojas, Gonzalo Vargas-Castrill ón, Emilio Tags: Review Article Source Type: research

Anticoagulation prescribing patterns in patients with cancer
The objective of this retrospective cohort was to describe real-world anticoagulation prescribing patterns in cancer patients at a large academic medical center between January 1, 2013 and October 31, 2016. We sought to assess the safety, tolerability, and efficacy of DOACs in patients with cancer for either VTE and/or AF. Patient demographic, clinical characteristics, as well as bleeding and thrombotic events were collected. There were 214 patients in our analysis, of which 71 patients (33%) received a DOAC [apixaban (n  = 22), dabigatran (n = 17), and rivaroxaban (n = 32)]. There were fewer bleeding events an...
Source: Journal of Thrombosis and Thrombolysis - October 19, 2017 Category: Hematology Source Type: research

Approach to the new oral anticoagulants in family practice: Part 2: addressing frequently asked questions.
CONCLUSION: Management of "what if" scenarios for patients taking NOACs have been proposed, but additional study is needed to address these issues, especially periprocedural management and bleeding. PMID: 25392439 [PubMed - as supplied by publisher]
Source: Canadian Family Physician Medecin de Famille Canadien - November 1, 2014 Category: Primary Care Authors: Douketis J, Bell AD, Eikelboom J, Liew A Tags: Can Fam Physician Source Type: research

Recurrent Ischemic Stroke in a Patient with the Trousseau Syndrome Treated with Dabigatran
A 70-year-old man with multiple ischemic strokes was diagnosed with cardiac embolism and treated with dabigatran. Three months later, he suddenly developed vertigo and vomiting. Magnetic resonance imaging, showed recurrent lesions and blood tests revealed hypercoagulability, hypoproteinemia, and elevated cytokeratin 19 fragments that serve as a tumor marker of lung cancer. Chest computed tomography showed there were small nodules in bilateral lungs and swollen mediastinal lymph nodes. A conclusive diagnosis was impossible because the patient declined invasive procedures. We suspected primary lung cancer and diagnosed conco...
Source: Journal of Stroke and Cerebrovascular Diseases - February 21, 2014 Category: Neurology Authors: Kosuke Yoshida, Takashi Kimura, Yoko Aburakawa, Yasuhiro Suzuki, Kenji Kuroda, Osamu Yahara Tags: Case Reports Source Type: research