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Edoxaban: How Does the Newest Agent Fit into the DOAC Landscape?
Edoxaban is the most recently approved factor Xa inhibitor within the class of direct oral anticoagulants (DOACs). Like other DOACs, edoxaban was approved by the US Food and Drug Administration for treatment of venous thromboembolism and prevention of stroke in patients with nonvalvular atrial fibrillation. Similar to other DOACs, edoxaban has fewer drug –drug interactions than warfarin and does not require routine laboratory monitoring. Unlike other DOACs, edoxaban has yet to be approved for secondary or postoperative venous thromboembolism thromboprophylaxis.
Source: The American Journal of Medicine - April 5, 2017 Category: General Medicine Authors: Caitlin M. Gibson, Shannon W. Finks Tags: Review Source Type: research

Edoxaban: Defining place in therapy for the newest direct acting oral anticoagulant
Edoxaban is the most recently approved factor Xa inhibitor within the class of direct oral anticoagulants (DOACs). Like other DOACs, edoxaban was approved by the FDA for treatment of venous thromboembolism and prevention of stroke in patients with non-valvular atrial fibrillation. Similar to other DOACs, edoxaban has fewer drug-drug interactions than warfarin and does not require routine laboratory monitoring. Unlike other DOACs, edoxaban has yet to be approved for secondary or postoperative venous thromboembolism thromboprophylaxis.
Source: The American Journal of Medicine - April 5, 2017 Category: Journals (General) Authors: Caitlin M. Gibson, Shannon W. Finks Tags: Review Source Type: research

Migrating susceptibility vessel sign in posterior circulation stroke
A 95-year-old woman with atrial fibrillation was admitted with acute onset of disturbed consciousness. On admission, neurological deficits rapidly improved and completely disappeared. The prothrombin time-international normalized ratio (PT-INR) was 1.4 although she was medicated with warfarin (2.5 mg/day). Brain magnetic resonance (MR) imaging with diffusion-weighted imaging (DWI) findings on admission were normal, but MR angiography (MRA) detected basilar-top occlusion and susceptibility-weighted imaging (SWI) confirmed the susceptibility vessel sign at the basilar top (Fig.
Source: The American Journal of Medicine - March 11, 2016 Category: Journals (General) Authors: Teppei Komatsu, Hidetaka Mitsumura, Satoshi Matsushima, Yasuyuki Iguchi Tags: Clinical Communication to the Editor Source Type: research

Migrating Susceptibility Vessel Sign in Posterior Circulation Stroke
A 95-year-old woman with atrial fibrillation was admitted with acute onset of disturbed consciousness. On admission, neurological deficits rapidly improved and completely disappeared. The prothrombin time –international normalized ratio was 1.4 although she was medicated with warfarin (2.5 mg/day). Brain magnetic resonance (MR) imaging with diffusion-weighted imaging (DWI) findings on admission were normal, but MR angiography (MRA) detected basilar-top occlusion, and susceptibility-weighted imaging (SWI) confirmed the susceptibility vessel sign at the basilar top (Figure, A and E).
Source: The American Journal of Medicine - March 10, 2016 Category: Journals (General) Authors: Teppei Komatsu, Hidetaka Mitsumura, Satoshi Matsushima, Yasuyuki Iguchi Tags: AJM online Source Type: research

Evaluation of the HAS-BLED, ATRIA, and ORBIT Bleeding Risk Scores in Patients with Atrial Fibrillation Taking Warfarin
Various bleeding risk prediction schemes, such as the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized Ratio, Elderly, Drugs/alcohol (HAS-BLED), Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA), and Outcomes Registry for Better Informed Treatment (ORBIT) scores, have been proposed in patients with atrial fibrillation. We compared the relative predictive values of these bleeding risk scores for clinically relevant bleeding and the relationship of ATRIA and ORBIT scores to the quality of anticoagulation control on warfarin, as reflected by...
Source: The American Journal of Medicine - October 16, 2015 Category: Journals (General) Authors: Keitaro Senoo, Marco Proietti, Deirdre A. Lane, Gregory Y.H. Lip Tags: Clinical research study Source Type: research

Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: A nationwide cohort study
This study revealed, that in clinical practice, vitamin K antagonist-experienced patients with a history of stroke or transient ischemic attack who switch to dabigatran therapy may have an increased rate of a recurrent stroke compared to patients persisting with vitamin K antagonist therapy.
Source: The American Journal of Medicine - September 1, 2014 Category: Journals (General) Authors: Torben Bjerregaard Larsen, Lars Hvilsted Rasmussen, Anders Gorst-Rasmussen, Flemming Skjøth, Deirdre A. Lane, Gregory Y.H. Lip Source Type: research

SAMe-TTR Score, Time in Therapeutic Range, and Outcomes in Anticoagulated Patients with Atrial Fibrillation
Oral anticoagulation is highly effective in preventing stroke and mortality in nonvalvular atrial fibrillation patients. However, the efficacy and safety of vitamin K antagonists (the main oral anticoagulation drug used) strongly depends upon the quantity of anticoagulation control, as reflected by the average percentage of the time in therapeutic range of international normalized ratio 2.0-3.0. An easy, simple prediction of which atrial fibrillation patients are likely to do well on vitamin K antagonists (with good average time in therapeutic range) could guide decision-making between using vitamin K antagonists (eg, warf...
Source: The American Journal of Medicine - May 22, 2014 Category: Journals (General) Authors: Pilar Gallego, Vanessa Roldán, Francisco Marin, José Gálvez, Mariano Valdés, Vicente Vicente, Gregory Y.H. Lip Tags: Clinical research study Source Type: research

AFib Treatment: General Population
Abstract: When primary care physicians are presented with a patient with atrial fibrillation (AFib), there are two concerns. (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). One is the choice of strategy to treat the AFib, ie, whether to use rate control or a rhythm control strategy (to keep patients in sinus rhythm). The second concern is preventing the principal risk associated with AFib: stroke and systemic embolism. The focus of this review is stroke prevention, concentrating on risk assessment and traditional versus the new oral anticoagulation agents. For the past se...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: Steven A. Rothman Tags: CME multimedia activities Source Type: research

Novel Oral Anticoagulants
Abstract: Warfarin has a proven record as an oral anticoagulant; almost every study, however, has found that it is not prescribed for 40–60% of patients who are eligible and should receive it, and of those who do receive it, serum warfarin levels only achieved a time in therapeutic range (TTR) equal to INR 2–3 about 55–60% of the time (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). This means that only about 1 in 4 patients are adequately anticoagulated with warfarin, and thus there is a large unmet need for achieving better anticoagulation in these patients. Although...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: James A. Reiffel Tags: CME multimedia activities Source Type: research

New versus Traditional Approaches to Oral Anticoagulation in Patients with Atrial Fibrillation
Abstract: For clinicians, atrial fibrillation (AFib) is not a disease that will probably be “cured” at some point during their professional lifetime. (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). AFib is a condition that occurs in association with aging, affecting as many as 1 in 10 patients by the time they reach age 85, and therefore all physicians who read The American Journal of Medicine should be aware of AFib—its etiology, how to recognize it, and with some idea of how it is treated. Perhaps the most important aspect of AFib, however, is as a risk factor for...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: James A. Reiffel Tags: CME multimedia activities Source Type: research

The Assassin: Chagas Cardiomyopathy
A 35-year-old Salvadoran woman had been hospitalized for heart failure multiple times over a 5-year period, yet the etiology of her disease remained elusive. She also had a history of stroke. Again, she presented to the emergency department with shortness of breath, chest pain, and fatigue. Although these symptoms were chronic, they had been increasing for 3 weeks prior to admission. The patient denied fevers, chills, cough, or gastrointestinal complaints. She had no history of smoking, alcohol consumption, or illicit drug use. Her medications included carvedilol, furosemide, and warfarin.
Source: The American Journal of Medicine - July 19, 2013 Category: Journals (General) Authors: Uppinder K. Mattu, Gagan D. Singh, Jeffrey A. Southard, Ezra A. Amsterdam Tags: Diagnostic dilemma Source Type: research

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