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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

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

Direct Oral Anticoagulants in Patients with Myeloproliferative Neoplasms: A Single Institution Retrospective Study
Discussion: Our limited data suggests that use of DOACs in patients with MPN is feasible with an acceptable balance between risk of hemorrhage and recurrent thrombosis. Additional data on long term outcomes of DOACs in MPNs are needed.DisclosuresNo relevant conflicts of interest to declare.
Source: Blood - November 21, 2018 Category: Hematology Authors: Deloughery, E. P., McBane, R. D., Ashrani, A. A., Tefferi, A., Slusser, J. P., Pruthi, R. K. Tags: 332. Antithrombotic Therapy Source Type: research

Real World Experience of Direct Oral Anticoagulants with Comparison of Safety Outcomes to the Warfarin Era of Venous Thromboembolism Treatment
Conclusion:This retrospective audit shows that our local safety outcomes are comparable to clinical trials. Low dose anticoagulation and high falls risk (a surrogate marker of frailty) were significant risk factors for both clinically significant bleeding and thrombotic stroke in the DOAC population. These patients are likely frailer with greater co-morbidities and have shared risk factors for bleeding and stroke, suggesting that for these high risk patients, low dose anticoagulation does not negate their risk of complications and careful prescribing and close monitoring remain essential.The sub-comparison between VTE pati...
Source: Blood - November 21, 2018 Category: Hematology Authors: Brook, R., Aswapanyawongse, N., Lim, H. Y., Ho, P. Tags: 331. Pathophysiology of Thrombosis: Poster II 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

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

A specific antidote for dabigatran: functional and structural characterization
Dabigatran etexilate is a direct thrombin inhibitor and used widely as an anticoagulant for the prevention of stroke in patients with atrial fibrillation. However, anticoagulation therapy can be associated with an increased risk of bleeding. Here, we present data on the identification, humanization, and in vitro pharmacology of an antidote for dabigatran (aDabi-Fab). The X-ray crystal structure of dabigatran in complex with the antidote reveals many structural similarities of dabigatran recognition compared with thrombin. By a tighter network of interactions, the antidote achieves an affinity for dabigatran that is ~350 ti...
Source: Blood - May 2, 2013 Category: Hematology Authors: Schiele, F., van Ryn, J., Canada, K., Newsome, C., Sepulveda, E., Park, J., Nar, H., Litzenburger, T. Tags: Plenary Papers, Thrombosis and Hemostasis Source Type: research