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Source: The American Journal of Medicine
Condition: Bleeding

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Total 34 results found since Jan 2013.

Above the threshold time of coagulation: delayed diagnosis of acquired hemophilia A
A man in his 80 ’s presented to our hospital's emergency department with left hip pain after falling while transferring from a wheelchair on a visit day. He had been taking clopidogrel for> 10 years after atherothrombotic stroke and apixaban 2.5 mg b.i.d. for 2 years since he was diagnosed with deep vein thrombosis. The patient had no coagulation abnormalities when he started apixaban therapy and had never experienced bleeding events. His medical history included cervical spondylosis surgery, right femoral neck fracture, hypertension, and benign prostatic hypertrophy.
Source: The American Journal of Medicine - February 23, 2023 Category: General Medicine Authors: Mayu Kikuchi, Yukinori Harada, Ayano Hamai, Sachi Takaoka Tags: Diagnostic dilemma Source Type: research

Impact of Bleeding on Myocardial Infarction, Stroke, and Death During 12 Months Dual Antiplatelet Therapy After Acute Coronary Syndrome
Bleeding remains a complication during dual antiplatelet therapy (DAPT) for acute coronary syndrome (ACS). Some data suggest a link between bleeding and worsened vascular outcomes. However, this association is unclear, due to omitting of minor bleedings when applying conservative scales. In contrast, the Platelet Inhibition and Outcomes (PLATO) trial classification used broad realistic capturing of all bleedings.
Source: The American Journal of Medicine - August 14, 2022 Category: General Medicine Authors: Victor L. Serebruany, Jean-Fran çois Tanguay, Wiktor Kuliczkowski, Eric Heidel, Moo Hyun Kim, Dan Atar Tags: Clinical Research Study Source Type: research

Impact of Bleeding on Myocardial Infarction, Stroke and Death During 12-months Dual Antiplatelet Therapy After Acute Coronary Syndrome
One of the largest controversies of modern antithrombotic strategies is the uncertain relation among the potency and duration of dual antiplatelet therapy (DAPT) with associated bleeding rates1-3, and whether or not bleeding impacts mortality, myocardial infarction (MI) and stroke risks4-6. Some data from clinical trials1-5 and registries7,8 suggest that such a link is valid, however, this association is not established partly due to capturing of exclusively major or/and catastrophic events while omitting minor and minimal episodes, and applying restrictive bleeding scales9.
Source: The American Journal of Medicine - August 14, 2022 Category: General Medicine Authors: Victor L. Serebruany, Jean-Francois Tanguay, Wiktor Kuliczkowski, Eric Heidel, Moo Hyun Kim, Dan Atar Tags: Clinical Research Study Source Type: research

The impact of strong inducers on direct oral anticoagulant levels
Direct oral anticoagulants (DOAC) are widely used in clinical practice. They are now recommended over warfarin in eligible patients, for stroke prevention in atrial fibrillation (SPAF) or the treatment of venous thromboembolism1,2. Given their predictable dose response, DOAC have a fixed-dose regimen and do not require routine laboratory monitoring. However, inter-individual variability in DOAC plasma concentrations has been described. In phase 3 trials and registries, low and high DOAC levels were shown to correlate with thromboembolic and bleeding events respectively3,4.
Source: The American Journal of Medicine - June 24, 2021 Category: General Medicine Authors: Anne-Laure Sennesael, Anne-Sophie Larock, Philippe Hainaut, Sarah Lessire, Michael Hardy, Jonathan Douxfils, Anne Spinewine, Fran çois Mullier Tags: Brief Observation Source Type: research

Long-term Clinical Outcomes of Underdosed Direct Oral Anticoagulants in patients with Atrial Fibrillation and Atrial Flutter
Although direct oral anticoagulants (DOACs) have been shown to be effective at reducing the risk of stroke in patients with atrial fibrillation/flutter (AF), they are sometimes underdosed off-label to mitigate their associated higher bleeding risk. We sought to evaluate frequency and clinical outcomes of inappropriate underdosing of DOACS in patients with AF.
Source: The American Journal of Medicine - January 11, 2021 Category: General Medicine Authors: Hasan Ashraf, Pradyumna Agasthi, Anusha Shanbhag, Ramila A. Mehta, Pattara Rattanawong, Mohamed Allam, Sai Harika Pujari, Farouk Mookadam, William K. Freeman, Komandoor Srivathsan, Dan Sorajja, Win-Kuang Shen, Peter A. Noseworthy, Eric H. Yang, Hicham Z. Tags: Clinical Research Study Source Type: research

High Fluctuation Between Anticoagulants, Frequent Off-Label Dosing, and No Difference Concerning Outcomes: Results of a Real-Life Cohort Study
Recently published studies indicated a high proportion of patients taking direct oral anticoagulants (DOACs) are off-label under- or overdosed. The present study aimed at investigating whether off-label dosages are corrected over time and whether off-label doses are associated with differences in bleeding rates, ischemic stroke, or venous thromboembolism.
Source: The American Journal of Medicine - October 24, 2020 Category: General Medicine Authors: Corinne M. Eschler, Ana Antelo, Georg-Christian Funk, Aristomenis K. Exadaktylos, Gregor Lindner Tags: Clinical Research Study Source Type: research

Corrigendum to “Effectiveness and Safety of Oral Anticoagulants in Adults with Non-valvular Atrial Fibrillation Patients and Concomitant Coronary/Peripheral Artery Disease” American Journal of Medicine 131:09 (2018): 1074-1085.e4
There were 33,269 apixaban-warfarin, 9,345 dabigatran-warfarin, and 42,156 rivaroxaban-warfarin matched pairs, with a median follow-up of 4-5 months. Compared with warfarin, apixaban was associated with lower rates of stroke/systemic embolism (hazard ratio [HR] 0.52; 95% confidence interval [95% CI], 0.43-0.62), major bleeding (HR 0.60; 95% CI, 0.55-0.66) and stroke/myocardial infarction/all-cause mortality (HR 0.70; 95%CI, 0.66-0.74); dabigatran was associated with lower rates of major bleeding (HR: 0.73; 95% CI, 0.62-0.85); dabigatran and rivaroxaban were associated with lower rates of stroke/myocardial infarction/all-ca...
Source: The American Journal of Medicine - August 4, 2020 Category: General Medicine Authors: Renato D. Lopes, Jan Steffel, Manuela Di Fusco, Allison Keshishian, Xuemei Luo, Xiaoyan Li, Cristina Masseria, Melissa Hamilton, Keith Friend, Kiran Gupta, Jack Mardekian, Xianying Pan, Onur Baser, W. Schuyler Jones Tags: Corrigendum Source Type: research

Regular Bleeding Risk Assessment Associated with Reduction in Bleeding Outcomes: The mAFA-II Randomized Trial
The mobile atrial fibrillation application (mAFA-II) randomized trial reported that a holistic management strategy supported by mobile health reduced atrial fibrillation-related adverse outcomes. The present study aimed to assess whether regular reassessment of bleeding risk using the Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol (HAS-BLED) score would improve bleeding outcomes and oral anticoagulant (OAC) uptake.
Source: The American Journal of Medicine - April 11, 2020 Category: General Medicine Authors: Yutao Guo, Deirdre A. Lane, Yundai Chen, Gregory Y.H. Lip, mAF-App II Trial investigators Tags: Clinical Research Study Source Type: research

Regular bleeding risk assessment associated with reduction in bleeding outcomes: The mAFA II randomised trial
Oral anticoagulants (OAC) are highly effective for the prevention of stroke in patients with atrial fibrillation.1,2 However, bleeding events are a detrimental side effect of OAC use, even despite the reduced risk of intracranial haemorrahge with the use of non –vitamin K antagonist oral anticoagulants (NOACs) with major bleeding rates at 2% to 4% and any bleeding of 11%-18% per year.3 Some of these bleeding events are non-clinically relevant bleeding, and overall there is a positive net clinical benefit for using OACs for stroke prevention for the major ity of atrial fibrillation patients.
Source: The American Journal of Medicine - April 11, 2020 Category: General Medicine Authors: Yutao Guo, Deirdre A. Lane, Yundai Chen, Gregory Y.H. Lip, mAF-App II Trial investigators Source Type: research

Oral anticoagulation in emergency department patients: high rates of off-label doses,no difference in bleeding rates
Patients with oral anticoagulation constitute an increasing proportion in the present medical routine.1 The approval of the first direct oral anticoagulant (DOAC) dabigatran by the U.S. food and drug administration in 2010 for the purpose of stroke prevention in patients with non-valvular atrial fibrillation revolutionized the therapy strategies of this entity since the Vitamin-K antagonists (VKA) warfarin, phenprocoumon and acenocoumarol had been the only available oral anticoagulants for decades.
Source: The American Journal of Medicine - October 23, 2019 Category: General Medicine Authors: Corinne M. Eschler, Bertram K. Woitok, Georg-Christian Funk, Philipp Walter, Volker Maier, Aristomenis K. Exadaktylos, Gregor Lindner Tags: Clinical Research Study Source Type: research

The Effect of Preexisting Anticoagulation on Cerebrovascular Events in Left-Sided Infective Endocarditis
The objective of this study was to evaluate the effect of anticoagulation on stroke occurrence and bleeding complications in patients with left-sided infective endocarditis.
Source: The American Journal of Medicine - September 4, 2019 Category: General Medicine Authors: Kyle A. Davis, Glen Huang, S. Allan Petty, Walter A. Tan, Diego Malaver, James E. Peacock Tags: Clinical Research Study Source Type: research

The effect of pre-existing anticoagulation on cerebrovascular events in left-sided infective endocarditis
The objective of this study was to evaluate the effect of anticoagulation on stroke occurrence and bleeding complications in patients with left-sided infective endocarditis.
Source: The American Journal of Medicine - September 4, 2019 Category: General Medicine Authors: Kyle A. Davis, Glen Huang, S. Allan Petty, Walter A. Tan, Diego Malaver MSA, James E. Peacock Tags: Clinical Research Study Source Type: research

Etiological research using observational data, and net clinical benefit. Simplicity and practicality matter
Atrial fibrillation in an elderly patient requires oral anticoagulant (OAC) treatment, and contemporary international guidelines recommend treatment for atrial fibrillation patients at 75years or older.1,2 Substantial evidence (mostly in favour) of non-vitamin K antagonist oral anticoagulants (NOACs), in comparison with warfarin, has emerged over the past decade. In particular, the benefits from a lower risk of intracranial bleeding and the non-requirement for monitoring of anticoagulant effects have driven the uptake of NOACs as the preferred choice for stroke prevention in atrial fibrillation, although some regional differences are evident.
Source: The American Journal of Medicine - March 4, 2019 Category: General Medicine Authors: Peter Br ønnum Nielsen, Iain Buchan, Gregory Y.H. Lip Tags: Editorial Source Type: research

Effectiveness and safety of off-label dose-reduced direct oral anticoagulants in atrial fibrillation
Direct oral anticoagulants (DOACs) reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation but may result in serious bleeding complications. Off-label dose-reduced use of DOAC to mitigate bleeding is common in routine clinical practice although data regarding its consequences on patient outcomes is limited. Therefore, our objective was to evaluate the effectiveness and safety of off-label dose-reduced versus per-label standard-dose DOAC treatment.
Source: The American Journal of Medicine - February 15, 2019 Category: General Medicine Authors: Ronen Arbel, Ruslan Sergienko, Ariel Hammerman, Sari Greenberg-Dotan, Erez Batat, Orly Avnery, Martin H. Ellis Source Type: research

Comparative stroke, bleeding, and mortality risks in older Medicare patients treated with oral anticoagulants for nonvalvular atrial fibrillation
Non-vitamin K antagonist oral anticoagulants (NOACs) are alternatives to warfarin in patients with nonvalvular atrial fibrillation. Randomized trials compared NOACs to warfarin, but none have compared individual NOACs against each other for safety and effectiveness.
Source: The American Journal of Medicine - January 9, 2019 Category: General Medicine Authors: David J. Graham, Elande Baro, Rongmei Zhang, Jiemin Liao, Michael Wernecke, Marsha E. Reichman, Mao Hu, Onyekachukwu Illoh, Yuqin Wei, Margie R. Goulding, Yoganand Chillarige, Mary Ross Southworth, Thomas E. MaCurdy, Jeffrey A. Kelman Tags: Clinical Research Study Source Type: research