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Effectiveness and Safety of Dabigatran in Atrial Fibrillation Patients with Severe Obesity: a Real-World Retrospective Cohort Study
ConclusionsAmong AF patients with a BMI>40kg/m2 or a weight>120kg in a real-world clinical setting, dabigatran was effective in reducing the risk of thromboembolism and mortality but was associated with an increased risk of bleeding when compared to warfarin. Dabigatran may be a reasonable option for AF patients with severe obesity.
Source: Journal of General Internal Medicine - September 20, 2021 Category: Internal Medicine Source Type: research

The risk of gastrointestinal hemorrhage with non-vitamin K antagonist oral anticoagulants: A network meta-analysis
Conclusion: Individual NOACs had varying profiles of GI bleeding risk. Results of analyses including only RCTs and those including both RCTs and population studies showed similar trends, but also showed several differences.
Source: Medicine - March 19, 2021 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis 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

Does the CHA2DS2-VASc scale sufficiently predict the risk of left atrial appendage thrombus in patients with diagnosed atrial fibrillation treated with non-vitamin K oral anticoagulants?
The CHA2DS2-VASc scale does not include potential risk factors for left atrial appendage thrombus (LAAT) formation such as a form of atrial fibrillation (AF) and impaired kidney function. The real risk of thromboembolic complications in AF patients is still unclear as well as an optimal anticoagulant treatment in males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2. The aim of this study was to compare the predictive value of the CHA2DS2-VASc scale and other scales to estimate the risk of LAAT formation in AF patients treated with non-vitamin K oral anticoagulants (NOACs) and to assess the preva...
Source: Medicine - June 19, 2020 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Dabigatran as an alternative for atrial thrombosis resistant to rivaroxaban: A case report
Rationale: Anti-thrombosis therapy for atrial fibrillation (AF) management and stroke prevention is an important aspect of disease management. Novel oral anticoagulants (NOACs) are recommended by guidelines for AF management. However, if one can switch one NOAC to another when the former showed a poor effect has not been fully determined. Patient concerns: A 52-year-old man was admitted to our center for heart failure and AF with a thrombus in the left atrium. Diagnoses: Cardiomyopathy was diagnosed by cardiac magnetic resonance (CMR) and echocardiography. Interventions: He was prescribed rivaroxaban (20 mg da...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Standard and reduced doses of dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation: a nationwide cohort study
ConclusionsStandard and reduced dose NOACs, respectively, showed no significant risk difference for associated stroke/thromboembolism. Rivaroxaban was associated with higher bleeding risk compared with dabigatran and apixaban and dabigatran was associated with lower intracranial bleeding risk compared with rivaroxaban and apixaban.
Source: Journal of Internal Medicine - September 21, 2017 Category: Internal Medicine Authors: L. Staerk, T. A. Gerds, G. Y. H. Lip, B. Ozenne, A. N. Bonde, M. Lamberts, E. L. Fosb øl, C. Torp‐Pedersen, G. H. Gislason, J. B. Olesen Tags: Original Article Source Type: research

Standard and reduced doses of dabigatran, rivaroxaban, and apixaban for stroke prevention in atrial fibrillation: a nationwide cohort study
ConclusionsStandard and reduced dose NOACs, respectively, showed no significant risk difference for associated stroke/thromboembolism. Rivaroxaban was associated with higher bleeding risk compared with dabigatran and apixaban, and dabigatran was associated with lower intracranial bleeding risk compared with rivaroxaban and apixaban.This article is protected by copyright. All rights reserved.
Source: Journal of Internal Medicine - September 1, 2017 Category: Internal Medicine Authors: Laila Staerk, Thomas A Gerds, Gregory Y H Lip, Brice Ozenne, Anders N Bonde, Morten Lamberts, Emil L Fosb øl, Christian Torp‐Pedersen, Gunnar H Gislason, Jonas B Olesen Tags: Original Article Source Type: research

Perioperative management of new oral anticoagulants in patients undergoing elective surgery at a tertiary hospital
ConclusionConsiderable discordance exists between guideline recommendations and perioperative NOAC management. Assistive tools are required that better align decision making with current best practice.
Source: Internal Medicine Journal - June 7, 2017 Category: Internal Medicine Authors: Henry Wamala, Ian A Scott, Xenia Caney Tags: Original Article Source Type: research

New reversal agent for factor Xa inhibitors shows promise
Commentary on: Siegal DM, Curnette JT, Connolly SJ, et al.. Andexanet alfa for the reversal of Factor Xa inhibitor activity. N Engl J Med 2015;373:2413–24. Context Direct oral anticoagulants (DOACs) have emerged as alternatives to vitamin K-antagonists (eg, warfarin) for the long-term management of stroke prevention for non-valvular atrial fibrillation or venous thromboembolic disease. Favourable side-effect profiles and absence of therapeutic monitoring are important benefits of these newer agents. Warfarin is readily reversed with fresh frozen plasma (FFP) or prothrombin complex concentrates.1 The first reversal ag...
Source: Evidence-Based Medicine - May 22, 2016 Category: Internal Medicine Authors: Ghadimi, K., Welsby, I. J. Tags: Clinical trials (epidemiology), Immunology (including allergy), Drugs: cardiovascular system, Stroke, Venous thromboembolism, Unwanted effects / adverse reactions Therapeutics/Prevention Source Type: research

Patient Characteristics and Risk of Bleeding With Dabigatran
To the Editor We appreciate the interesting study by Hernandez et al on the risk of bleeding with dabigatran in patients with atrial fibrillation. These are important data to an ongoing controversy. However, we would appreciate an author comment regarding the external validity of the study. To what extent is this sample of Medicare beneficiaries representative of the general population of patients with atrial fibrillation? Comparing the characteristics of patients in the RE-LY Study and the Danish population-based study, it seems that these are not effortlessly comparable. In the study by Hernandez et al, patients are cons...
Source: JAMA Internal Medicine - July 1, 2015 Category: Internal Medicine Source Type: research

Evidence suggests dabigatran is an effective and safe treatment for patients with VTE requiring early parenteral therapy
Commentary on: Schulman S, Kakkar AK, Goldhaber SZ, et al.. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 2014;129:764–72. Context Until recently, an initial course of parenteral anticoagulation followed by vitamin K antagonist (VKA) was the standard of care for the treatment of venous thromboembolism (VTE). In the past few years, direct oral anticoagulants (DOAC) have been found to be non-inferior to VKA.1–3 The RE-COVER study found dabigatran to be non-inferior to warfarin, with a reduced risk for clinically relevant bleeding.4 In order to confirm these...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Granziera, S., Cohen, A. T. Tags: Drugs: cardiovascular system, Stroke, Venous thromboembolism, Radiology, Pulmonary embolism, Clinical diagnostic tests Therapeutics Source Type: research

Novel anticoagulants in patients with mechanical heart valves
Commentary on: Eikelboom JW, Connolly SJ, Brueckmann M, et al.. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med 2013;369:1206. Context Novel anticoagulants (including the direct thrombin inhibitor dabigatran etixilate) and oral factor Xa inhibitors have similar or superior efficacy and safety to warfarin for reducing thromboembolic stroke in patients with atrial fibrillation, and for prevention of deep venous thrombosis. Eikelboom and colleagues set out to examine whether these novel anticoagulants could be used as an alternative to warfarin in patients with mechanical heart valves. Method...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Stewart, R. A. H. Tags: Drugs: cardiovascular system, Stroke, Venous thromboembolism Therapeutics Source Type: research

Randomised controlled trial: extended-duration dabigatran is non-inferior to warfarin and more effective than placebo for symptomatic VTE
Commentary on: Schulman S, Kearon C, Kakkar AK, et al.. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med 2013;368:709–718. RE-MEDY and RE-SONATE trials. Context In patients with idiopathic deep vein thrombosis (DVT) or pulmonary embolism (PE), extending the duration of warfarin beyond the initial 3–6 months of anticoagulation significantly reduces the risk for recurrence.1 2 Dabigatran is an oral direct-thrombin inhibitor that has been shown to be as effective as warfarin in the first 6 months after a venous thromboembolism (VTE).3 However, its efficacy and safe...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Liem, T. K., DeLoughery, T. G. Tags: EBM Aetiology, Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Venous thromboembolism, Pulmonary embolism Source Type: research

Practical use of dabigatran etexilate for stroke prevention in atrial fibrillation
Summary Atrial fibrillation (AF) is associated with an increased risk of thromboembolism, and is the most prevalent factor for cardioembolic stroke. Vitamin K antagonists (VKAs) have been the standard of care for stroke prevention in patients with AF since the early 1990s. They are very effective for the prevention of cardioembolic stroke, but are limited by factors such as drug–drug interactions, food interactions, slow onset and offset of action, haemorrhage and need for routine anticoagulation monitoring to maintain a therapeutic international normalised ratio (INR). Multiple new oral anticoagulants have been develope...
Source: International Journal of Clinical Practice - April 5, 2013 Category: Internal Medicine Authors: K. Huber, S. J. Connolly, A. Kher, F. Christory, G.‐A. Dan, R. Hatala, R. G. Kiss, B. Meier, B. Merkely, B. Pieske, T. Potpara, J. Stępińska, N. Vene Klun, D. Vinereanu, P. Widimský Tags: Consensus Source Type: research

Implications of new anticoagulants in primary practice
Conclusion:  Rivaroxaban, apixaban and dabigatran etexilate offer the possibility of simplified prevention and treatment strategies for thromboembolic disorders in the outpatient setting.
Source: International Journal of Clinical Practice - January 11, 2013 Category: Internal Medicine Authors: A. Perez, L. H. Eraso, G. J. Merli Tags: SYSTEMATIC REVIEW Source Type: research