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Condition: Ischemic Stroke
Drug: Pradaxa

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Total 532 results found since Jan 2013.

Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan
Background: Asians with atrial fibrillation carry a higher risk of ischemic stroke than non-Asians even under treatment of nonvitamin K antagonist oral anticoagulants. The purpose of the study was to observe the feasibility of intravenous thrombolytic therapy after administering a reversal agent, idarucizumab, in dabigatran-treated patients with acute ischemic stroke in Taiwan. Methods: Dabigatran-treated patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) after idarucizumab reversal were enrolled in the retrospective nationwide study.
Source: Journal of Stroke and Cerebrovascular Diseases - December 17, 2018 Category: Neurology Authors: Chen-Wen Fang, Yi-Te Tsai, Ping-Chen Chou, Hsi-Ming Chen, Chien-Ming Lu, Chen-Rong Tsao, Chih-Lin Chen, Mu-Chien Sun, Yu-Song Shih, Cheng-Yang Hsieh, Lu-An Chen, Po-Lin Chen, Jung-Tze Yeh, Yi-Heng Li Source Type: research

Intravenous Thrombolysis After Idarucizumab Application in Acute Stroke Patients —A Potentially Increased Sensitivity of Thrombi to Lysis?
Background: Rapid inactivation of dabigatran by its specific inhibitor idarucizamab allows intravenous thrombolysis (IVT) in patients suffering ischemic stroke while being treated with dabigatran. Only limited data of this approach is available and numerous questions regarding efficacy/safety remain to be answered. Herein, we present the findings from the Slovenian national cohort study. Methods: Retrospective analysis of all stroke patients treated with idarucizumab and IVT (n  = 11) in the period from July 2016 to February 2018 from Slovenian region were analyzed.
Source: Journal of Stroke and Cerebrovascular Diseases - December 6, 2018 Category: Neurology Authors: Janja Pretnar Oblak, Miso Sabovic, Senta Frol Source Type: research

NOAC Therapy Is Also Effective and Safe in Patients Older Than 80 Years -- Results of the Prospective Dresden NOAC Registry (NCT01588119)
Conclusions: During long-term FU of more than 2.5 years, this very old population of NOAC recipients demonstrated low rates of cardiovascular or major bleeding complications during active NOAC therapy. Approximately one quarter of the study population died during follow-up, with cardiovascular events being the leading cause of death. Only 11 fatal bleeding events were observed; however, most of the 58 fatal thromboembolic events occurred after anticoagulation was discontinued. This indicates that continued anticoagulation with NOACs may result in a beneficial risk-benefit ratio also in very old patients.DisclosuresBeyer-We...
Source: Blood - November 21, 2018 Category: Hematology Authors: Beyer-Westendorf, J., Tittl, L., Naue, C., Marten, S. Tags: 332. Antithrombotic Therapy: Management of Challenging Patients and Scenarios Source Type: research

Analysis of the Safety Profile of Direct Oral Anticoagulants Using the FDA Adverse Event Reporting System
Conclusion:Our analysis found that among DOACs rates of breakthrough VTE were significantly higher with rivaroxaban, and that reported rates of ischemic stroke were significantly higher with dabigatran. While no DOACs have been compared against each other in prospective trials, post-marketing reports have suggested that different safety profiles exist among DOACs, a finding reiterated by our analysis. The significantly higher rate of VTE reported with rivaroxaban as compared to other DOACs has not previously been described to the best of our knowledge and deserves further analysis. The two methods of comparing the anticoag...
Source: Blood - November 21, 2018 Category: Hematology Authors: Deloughery, E. P., Shatzel, J. J. Tags: 332. Antithrombotic Therapy: Poster II Source Type: research

Dabigatran Versus Rivaroxaban for Secondary Stroke Prevention in Patients with Atrial Fibrillation Rehabilitated in Skilled Nursing Facilities
ConclusionsIn older adults treated with direct-acting oral anticoagulants after ischemic stroke, outcome rates varied considerably by drug and dosage.
Source: Drugs and Aging - November 13, 2018 Category: Geriatrics Source Type: research

Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation
Publication date: Available online 8 November 2018Source: The Lancet NeurologyAuthor(s): David J Seiffge, David J Werring, Maurizio Paciaroni, Jesse Dawson, Steven Warach, Truman J Milling, Stefan T Engelter, Urs Fischer, Bo NorrvingSummaryBackgroundAbout 13–26% of all acute ischaemic strokes are related to non-valvular atrial fibrillation, the most common cardiac arrhythmia globally. Deciding when to initiate oral anticoagulation in patients with non-valvular atrial fibrillation is a longstanding, common, and unresolved clinical challenge. Although the risk of early recurrent ischaemic stroke is high in this population,...
Source: The Lancet Neurology - November 9, 2018 Category: Neurology Source Type: research

Effects of ABCB1 genotypes on the pharmacokinetics and clinical outcomes of new oral anticoagulants: A systematic review and meta-analysis.
Conclusions Cmax was lower in carriers of ABCB1 rs1045642 CC than in those of TT and in carriers of rs2032582 GG than in those of the A/T allele, and AUC0-∞ was lower in carriers of rs1045642 CC than in those of TT. Conversely, ABCB1 rs4148738 genotypes did not affect primary clinical endpoints in dabigatran-administered patients. Future studies should analyze the relationships of ABCB1 genotypes with the pharmacokinetics and clinical outcomes of specific NOACs. PMID: 30338730 [PubMed - as supplied by publisher]
Source: Current Pharmaceutical Design - October 18, 2018 Category: Drugs & Pharmacology Authors: Xie Q, Xiang Q, Mu G, Ma L, Chen S, Zhou S, Hu K, Zhang Z, Cui Y, Jian J Tags: Curr Pharm Des Source Type: research

Acute reversal of dabigatran with Idarucizumab for intravenous thrombolysis as acute stroke treatment
We describe the case of a 73 year old male with AIS and active dabigatran use. Idarucizumab was administered per an approved medical center protocol and the patient was subsequently treated with IV rt-PA. The patient had a severe stroke with no other contraindications to IV rt-PA other than dabigatran use. The patient was administered Idarucizumab and IV rt-PA was given. Within 24 h of treatment, the patient had minimal stroke deficits. Imaging revealed a right middle cerebral artery patchy infarct. The patient was restarted on dabigatran therapy for his atrial fibrillation and was discharged to a skilled nursing facil...
Source: Journal of Clinical Neuroscience - October 9, 2018 Category: Neuroscience Source Type: research

Comparative risks of bleeding, ischemic stroke and mortality with direct oral anticoagulants versus phenprocoumon in patients with atrial fibrillation
ConclusionsWith rivaroxaban, no significant differences were observed compared to phenprocoumon with regard to hospitalized bleedings or ischemic strokes. Dabigatran was associated with fewer bleedings and a similar risk of ischemic strokes compared to phenprocoumon. Apixaban was also associated with fewer bleedings but was unexpectedly associated with more ischemic strokes, possibly reflecting selective prescribing. The association of rivaroxaban with higher all-cause mortality unrelated to bleedings or strokes has been described previously but remains to be explained.
Source: European Journal of Clinical Pharmacology - October 1, 2018 Category: Drugs & Pharmacology Source Type: research

Idarucizumab-facilitated intravenous thrombolysis in acute ischemic stroke: A therapeutic strategy requiring further investigation
Although dabigatran does a better job reducing the risk of cardioembolic stroke than warfarin in patients with non-valvular atrial fibrillation, 0.92 –1.34% of dabigatran users still develop isch emic stroke [1]. The usage of warfarin (even at a suboptimal therapeutic level) increases the risk of hemorrhagic transformation (HT) after intravenous thrombolysis (IT) [2]; therefore, current guidelines advise against performing IT in patients receiv ing any direct oral anti-coagulant (DOAC), including dabigatran [3].
Source: Journal of the Neurological Sciences - September 13, 2018 Category: Neurology Authors: Hsiao Yu-Jen, Tsai Yi-Te, Li-Kai Tsai, Fang Chen-wen Tags: Letter to the Editor Source Type: research

Real-world clinical evidence on rivaroxaban, dabigatran, and apixaban compared with vitamin K antagonists in patients with non-valvular atrial fibrillation: a systematic literature review.
Authors: Briere JB, Bowrin K, Coleman C, Fauchier L, Levy P, Folkerts K, Toumi M, Taieb V, Millier A, Wu O Abstract Introduction Several comparative real-world effectiveness studies on direct oral anticoagulants (DOACs) have been conducted, but an overview of the available evidence remains to be developed, which could provide a better understanding of the value of DOACs relative to vitamin K antagonists (VKAs). Areas covered A systematic literature review was conducted on the available real-world evidence (RWE) of three DOACs (rivaroxaban, dabigatran, and apixaban) compared with VKAs (e.g. warfarin), in patients wi...
Source: Expert Review of Pharmacoeconomics and Outcomes Research - September 2, 2018 Category: Health Management Tags: Expert Rev Pharmacoecon Outcomes Res Source Type: research

Oral anticoagulant use for stroke prevention in atrial fibrillation patients with difficult scenarios
Publication date: September 2018Source: IJC Heart & Vasculature, Volume 20Author(s): Ting-Yung Chang, Jo-Nan Liao, Tze-Fan Chao, Jennifer Jeanne Vicera, Chin-Yu Lin, Ta-Chuan Tuan, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Shih-Ann ChenAbstractAtrial fibrillation (AF) has become the most prevalent arrhythmia and it will increase the risk of ischemic stroke, heart failure, mortality, sudden cardiac death, myocardial infarction, and dementia. Stroke prevention with oral anticoagulant is crucial for management of AF patients. Vitamin K antagonist, which inhibits the clotting factors II, VII, IX and X...
Source: IJC Heart and Vasculature - September 1, 2018 Category: Cardiology Source Type: research

Comparing the Efficacy and Safety of Direct Oral Anticoagulants With Warfarin in the Morbidly Obese Population With Atrial Fibrillation.
Conclusion and Relevance: Apixaban and rivaroxaban may be considered as alternatives to warfarin for atrial fibrillation or flutter in morbidly obese patients. Dabigatran use in morbidly obese patients needs caution until further studies are conducted. PMID: 30130979 [PubMed - as supplied by publisher]
Source: The Annals of Pharmacotherapy - August 22, 2018 Category: Drugs & Pharmacology Authors: Kido K, Ngorsuraches S Tags: Ann Pharmacother Source Type: research

Risk factors for stroke and choice of oral anticoagulant in atrial fibrillation
ConclusionsThe uptake of DOACs was rapid and spurred an increase in new users of oral anticoagulants for atrial fibrillation from 2010 to 2015 in Norway. The mean CHA2DS2-VASc score did not change substantially during this period. Vascular disease, heart failure, and diabetes were associated with initiation of warfarin, and previous stroke, age 65 –74 and female sex with initiation of DOACs.
Source: European Journal of Clinical Pharmacology - August 16, 2018 Category: Drugs & Pharmacology Source Type: research

Extension of Disease Risk Score-Based Confounding Adjustments for Multiple Outcomes Of Interest- An Empirical Evaluation.
Abstract Use of disease risk score (DRS)-based confounding adjustment when estimating treatment effects on multiple outcomes is not well studied. Using an empirical example comparing dabigatran versus warfarin on ischemic stroke and major bleeding risk in 12 sequential monitoring periods (90 days each) using the Truven Marketscan database, we compared two approaches for combining DRS for multiple outcomes: (1) 1:1 matching on prognostic propensity scores (PPS), created using DRS for bleeding and stroke as independent variables in a propensity score (PS) model; and (2) simultaneous 1:1 matching on DRS for bleeding ...
Source: Am J Epidemiol - June 26, 2018 Category: Epidemiology Authors: Desai RJ, Wyss R, Jin Y, Bohn J, Toh S, Cosgrove A, Kennedy A, Kim J, Kim C, Ouellet-Hellstrom R, Karami S, Major JM, Niman A, Wang SV, Gagne JJ Tags: Am J Epidemiol Source Type: research