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Contemporary Antiplatelet and Anticoagulant Therapies for Secondary Stroke Prevention: A Narrative Review of Current Literature and Guidelines
Curr Neurol Neurosci Rep. 2023 Apr 11. doi: 10.1007/s11910-023-01266-2. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: Stroke is a leading cause of death and disability worldwide. The annual incidence of new or recurrent stroke is approximately 795,000 cases per year in the United States, of which 87% are ischemic in nature. In addition to the management of modifiable high-risk factors to reduce the risk of recurrent stroke, antithrombotic agents (antiplatelets and anticoagulants) play an important role in secondary stroke prevention. This review will discuss the published literature on the use of antiplatelets and antic...
Source: Atherosclerosis - April 10, 2023 Category: Cardiology Authors: Kunal Bhatia Lindsey M Ladd Kelsey H Carr Mario Di Napoli Jeffrey L Saver Louise D McCullough Maryam Hosseini Farahabadi Diana L Alsbrook Archana Hinduja Jorge G Ortiz Garcia Sara Y Sabbagh Alibay Jafarli Afshin A Divani Source Type: research

Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research

Outcomes Associated with Apixaban Use in End-Stage Kidney Disease Patients with Atrial Fibrillation in the United States.
Conclusions -Among ESKD patients with AF on dialysis, apixaban use may be associated with lower risk of major bleeding compared with warfarin, with a standard 5 mg twice a day dose also associated with reductions in thromboembolic and mortality risk. PMID: 29954737 [PubMed - as supplied by publisher]
Source: Circulation - June 28, 2018 Category: Cardiology Authors: Siontis KC, Zhang X, Eckard A, Bhave N, Schaubel DE, He K, Tilea A, Stack AG, Balkrishnan R, Yao X, Noseworthy PA, Shah ND, Saran R, Nallamothu BK Tags: Circulation Source Type: research

Dabigatran - the First Approved DTI for SPAF.
Authors: Trailokya A, Hiremath JS Abstract Atrial fibrillation (AF) is commonly occurring arrhythmia in clinical practice. AF is easy to recognize but difficult to treat. Stroke is the most devastating complication of AF and is associated with a huge disease burden on the society. Effective stroke prevention is a priority for patients with AF. Two-thirds of strokes due to AF are preventable with suitable anticoagulant therapy. VKA like warfarin, acenocoumarol remains the gold standard for stroke prevention in AF (SPAF). However, it is associated with numerous limitations such as a high risk of drug-drug, drug-food ...
Source: Journal of the Association of Physicians of India - October 25, 2018 Category: General Medicine Tags: J Assoc Physicians India Source Type: research

Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation : A Multinational Population-Based Cohort Study
CONCLUSION: Among patients with AF, apixaban use was associated with lower risk for GIB and similar rates of ischemic stroke or systemic embolism, ICH, and all-cause mortality compared with dabigatran, edoxaban, and rivaroxaban. This finding was consistent for patients aged 80 years or older and those with chronic kidney disease, who are often underrepresented in clinical trials.PRIMARY FUNDING SOURCE: None.PMID:36315950 | DOI:10.7326/M22-0511
Source: Annals of Internal Medicine - October 31, 2022 Category: Internal Medicine Authors: Wallis C Y Lau Carmen Olga Torre Kenneth K C Man Henry Morgan Stewart Sarah Seager Mui Van Zandt Christian Reich Jing Li Jack Brewster Gregory Y H Lip Aroon D Hingorani Li Wei Ian C K Wong Source Type: research

Comparison of the Ecarin Chromogenic Assay and Diluted Thrombin Time for Quantification of Dabigatran Concentrations
ConclusionsFor detection of levels below 50 ng/mL both tests have specificities of at least 96%, suggesting that they accurately detect even low levels of drug. Therefore, regardless of whether a chromogenic or clot‐based platform is preferred, the STA‐ECA‐II and dTT are useful tests for measuring dabigatran concentrations. Unfortunately, neither test is licensed by the United States Food and Drug Administration. Although approved in other jurisdictions, the dTT and STA‐ECA‐II are not widely or rapidly available in most hospitals. Therefore, cooperation between regulators and hospitals is urgently needed to rende...
Source: Journal of Thrombosis and Haemostasis - October 4, 2017 Category: Hematology Authors: Iqbal H. Jaffer, Noel Chan, Robin Roberts, James C. Fredenburgh, John W. Eikelboom, Jeffrey I. Weitz Tags: Original Article ‐ Coagulation Source Type: research

Comparison of the Ecarin Chromogenic Assay and Diluted Thrombin Time for Quantification of Dabigatran Concentrations.
CONCLUSIONS: For detection of levels below 50 ng/mL both tests have specificities of at least 96%, suggesting that they accurately detect even low levels of drug. Therefore, regardless of whether a chromogenic or clot-based platform is preferred, the STA-ECA-II and dTT are useful tests for measuring dabigatran concentrations. Unfortunately, neither test is licensed by the United States Food and Drug Administration. Although approved in other jurisdictions, the dTT and STA-ECA-II are not widely or rapidly available in most hospitals. Therefore, cooperation between regulators and hospitals is urgently needed to render these ...
Source: Thrombosis and Haemostasis - October 4, 2017 Category: Hematology Authors: Jaffer IH, Chan N, Roberts R, Fredenburgh JC, Eikelboom JW, Weitz JI Tags: J Thromb Haemost Source Type: research

Variation in the Use of Warfarin and Direct Oral Anticoagulants in Atrial Fibrillation and Associated Cost Implications
Atrial fibrillation is the most common arrhythmia in the United States and affects between 2.7 million and 6.1 million adults in the United States, with a lifetime risk of up to 1 in 4 adults over age 40 and a prevalence that is projected to double over the next 25 years.1,2 Though warfarin has long been the cornerstone of therapy to reduce the risk of stroke, several new direct oral anticoagulants (DOACs) have recently become available, beginning with FDA approval of dabigatran in October 2010, and followed by rivaroxaban in 2011, apixaban in 2014, and most recently edoxaban in 2015.
Source: The American Journal of Medicine - October 3, 2018 Category: General Medicine Authors: Benjamin A. Rodwin, Joseph A. Salami, Erica S. Spatz, Javier Valero-Elizondo, Salim S. Virani, Ron Blankstein, Michael J. Blaha, Khurram Nasir, Nihar R. Desai Tags: Clinical Research Study Source Type: research

Clinical Outcome Following Reinstitution of Anticoagulation after Major Gastrointestinal Bleed: A Single Institutional Analysis
Conclusion: Given the rising national trend on the use of anticoagulants for various medical necessities, it is imperative that a safe and efficient process be devised on reinstitution of anticoagulation post MGIB to guide Clinicians. Although our study represents a single institutional analysis, it concurs with recent studies that early resumption of anticoagulant following stabilization of MGIB is associated with lower thromboembolic events. Timing for resumption depends largely on the medical reason for anticoagulation; reinstitution by day 7 appear safe for patients on mechanical valve whereas after day 12 maybe approp...
Source: Blood - November 21, 2018 Category: Hematology Authors: Ezekwudo, D. E., Gaikazian, S., Anusim, N., Konde, A. S., Zakalik, D., Huben, M. T., Stender, M., Anderson, J., Jaiyesimi, I. Tags: 332. Antithrombotic Therapy: Poster I Source Type: research

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