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A Review of and Recommendations for the Management of Patients With Life-Threatening Dabigatran-Associated Hemorrhage: A Single-Center University Hospital Experience
Dabigatran is an oral direct thrombin inhibitor that is approved for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Dabigatran has several advantages over warfarin including predictable pharmacokinetics and pharmacodynamics which eliminates the need for routine laboratory monitoring, superiority over warfarin in preventing stroke, or systemic embolism without having an increased risk of bleeding. However, as with any anticoagulant, there remains a real chance of bleeding, including major or life-threatening hemorrhage. Many physicians feel comfortable managing bleeding complications on o...
Source: Journal of Intensive Care Medicine - October 29, 2015 Category: Intensive Care Authors: Kumar, R., Smith, R. E., Henry, B. L. Tags: Analytic Reviews Source Type: research

Managing reversal of direct oral anticoagulants in emergency situations. Anticoagulation Education Task Force White Paper.
This report is based on findings from the Anticoagulation Education Task Force, which brought together patient groups and professionals representing different medical specialties with an interest in patient safety and expertise in AF, VTE, stroke, anticoagulation, and reversal agents, to discuss the current status of anticoagulation reversal and fundamental changes in management of bleeding associated with DOACs occasioned by the approval of idarucizumab, a specific reversal agent for dabigatran, as well as recent clinical data on specific reversal agents for factor Xa inhibitors. Recommendations are given for when there i...
Source: Thrombosis and Haemostasis - August 3, 2016 Category: Hematology Authors: Ageno W, Büller HR, Falanga A, Hacke W, Hendriks J, Lobban T, Merino J, Milojevic IS, Moya F, van der Worp HB, Randall G, Tsioufis K, Verhamme P, Camm AJ Tags: Thromb Haemost Source Type: research

Bleeding risk in patients with venous thromboembolic events treated with new oral anticoagulants
AbstractNew oral anticoagulants (NOACs) is the preferred treatment in secondary prophylaxis of venous thromboembolic events (VTE). The aim of this study was to investigate possible risk factors associated with major bleeding in VTE-patients treated with NOACs. In this retrospective register-based study we screened the Swedish anticoagulation registerAuricula (during 2012.01.01 –2017.12.31) to find patients and used other national registers for outcomes. Primary endpoint was major bleeding defined as bleeding leading to hospital care. Multivariate Cox-regression analysis was used to reveal risk factors. 18 219 patients wi...
Source: Journal of Thrombosis and Thrombolysis - November 2, 2020 Category: Hematology Source Type: research

Life-threatening epistaxis and red blood cell polyagglutination under dabigatran
Dabigatran is an oral thrombin inhibitor which has been approved for prevention of stroke or embolism in atrial fibrillation patients as an alternative to vitamin K antagonists. Dabigatran has been introduced into clinical practice, although issues like laboratory monitoring, its use in elderly patients, drug and food interactions, and an antidote have not been completely clarified. Severe epistaxis leading to haemorrhagic shock occurred in an 89-year-old woman with atrial fibrillation and moderate renal insufficiency after 10 months of dabigatran 110 mg/b.i.d. Correction of the anaemia with blood transfusions became dif...
Source: Blood Coagulation and Fibrinolysis - May 1, 2014 Category: Hematology Tags: Case Reports Source Type: research

Adherence to dabigatran therapy and longitudinal patient outcomes: Insights from the Veterans Health Administration
Background: Dabigatran is a novel oral anti-coagulant (NOAC) that reduces risk of stroke in patients with non-valvular atrial fibrillation (NVAF). It does not require routine monitoring with laboratory testing which may have an adverse impact on adherence. We aimed to describe adherence to dabigatran in the first year after initiation and assess the association between non-adherence to dabigatran and clinical outcomes in a large integrated healthcare system.Methods: We studied a national cohort of 5,376 patients with NVAF, initiated on dabigatran between October-2010 and September-2012 at all Veterans Affairs hospitals. Ad...
Source: American Heart Journal - April 7, 2014 Category: Cardiology Authors: Supriya Shore, Evan P. Carey, Mintu P. Turakhia, Cynthia A. Jackevicius, Fran Cunningham, Louise Pilote, Steven M. Bradley, Thomas M. Maddox, Gary K. Grunwald, Anna E. Barón, John S. Rumsfeld, Paul D. Varosy, Preston M. Schneider, Lucas N. Marzec, P. Mic Tags: Electrophysiology Source Type: research

Efficacy and safety of novel oral anticoagulants in clinical practice: a report from three centers in Sweden
IntroductionIn clinical trials new oral anticoagulants (NOAC) have proved to be as effective as warfarin for thromboprophylaxis in atrial fibrillation. The aim of this study was to evaluate the efficacy and safety of these drugs in clinical practise.Methods and resultsAll patients treated with new oral anticoagulants at Sk?ne University hospital and Halland County Hospital Halmstad between 2009 and September 2013 was identified in the Swedish national quality registry for atrial fibrillation and anticoagulation (AuriculA). Medical records were reviewed to identify thromboembolism and major bleeding and compared to a warfar...
Source: Thrombosis Journal - December 2, 2014 Category: Hematology Authors: Ashkan LabafMartin CarlwePeter Svensson Source Type: research

Management of Bleeding Complications in Patients Taking Direct Oral Anticoagulants at a Large Tertiary Academic Medical Center
Abstract Direct oral anticoagulants (DOACs) offer a fixed-dose alternative to warfarin for stroke prevention in patients with atrial fibrillation. However, there is minimal evidence to guide the management of bleeding in patients taking a DOAC. We retrospectively evaluated the acute management of major bleeding in this patient population at a large, tertiary academic medical center. We evaluated various strategies of management including dialysis, transfusions, pharmacologic agents, surgical intervention, and reinitiation of anticoagulation. We also assessed length of intensive care unit and hospital stay, mor...
Source: Current Emergency and Hospital Medicine Reports - June 13, 2015 Category: Emergency Medicine Source Type: research

Prescribing patterns of target-specific oral anticoagulants: an academic hospital perspective
Target-specific oral anticoagulants have been rapidly adopted into clinical practice for stroke prophylaxis and venous thromboembolism treatment, raising concerns about off-label prescribing practices. We conducted a retrospective review of consecutive patients prescribed dabigatran, rivaroxaban or apixaban prior to inpatient hospitalization over an 18-month period to examine the off-label prescribing frequency, contraindications and related complications. Chart review included baseline demographics, hospital admitting service, outpatient prescribing service, renal function, therapeutic indication, echocardiographic findin...
Source: Blood Coagulation and Fibrinolysis - September 29, 2015 Category: Hematology Tags: Original Articles Source Type: research

Acute myocardial infarction after switching from warfarin to dabigatran.
We present a case of an acute MI and cardiac arrest in a patient with chronic AF who had been recently switched from warfarin to dabigatran. Urgent coronary angiography, at St. Michael's hospital (Toronto, Canada), revealed evidence of thromboembolism to the distal posterior descending artery. The patient was treated medically and switched back from dabigatran to warfarin. He did well and was discharged after an uneventful stay in the coronary care unit. PMID: 25830002 [PubMed]
Source: Oman Medical Journal - December 12, 2015 Category: Middle East Health Tags: Oman Med J Source Type: research

A Case of Fatal Bleeding Following Emergency Surgery on an Ascending Aorta Intramural Hematoma in a Patient Taking Dabigatran
INTRAMURAL HEMATOMA (IMH) is an acute aortic syndrome. More frequently—in 60% to 70% of cases—IMH involves the descending aorta (type B), whereas the involvement of the ascending aorta and aortic arch accounts for 30% and 10% of the cases, respectively. Hospital mortality of type-A IMH is similar to type-A aortic dissection. Cardiocirculatory shock secondary to cardiac tamponade, together with stroke, coma, and impaired coronary perfusion, are important predictive factors of postoperative mortality.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 13, 2016 Category: Anesthesiology Authors: Giulia Beatrice Crapelli, Paolo Bianchi, Giuseppe Isgrò, Andrea Biondi, Carlo de Vincentiis, Marco Ranucci Tags: Case Report Source Type: research

All bleeding stops — but does idarucizumab (Praxbind) make it stop faster?
3.5 out of 5 stars Persistent life-threatening hemorrhage after administration of idarucizumab. Alhashem HM et al. Am J Emerg Med 2016 June 30 [Epub ahead of print] Reference Dabigatran (Pradaxa) is a direct thrombin inhibitor approved for stroke and embolism prophylaxis in patients with non-valve-related atrial fibrillation. When it was first released in 2008, a major disincentive to widespread use was the lack of a reliable reversal agent to treat major bleeds, or to administer before necessary invasive procedures. In October 2015, the U.S. Food and Drug Administration approved idarucizumab (Praxbind), a monoclonal ant...
Source: The Poison Review - July 27, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical anticoagulant hemorrhage idarucizumab pradaxa praxbind reversal agent Source Type: news

Italian intersociety consensus on DOAC use in internal medicine
AbstractThe direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and one direct thrombin inhibitor (dabigatran) provide oral anticoagulation therapy alternatives to Vitamin K antagonists (VKAs). Despite their clear advantages, the DOACs require on the part of the internist a thorough knowledge of their pharmacokinetic and pharmacodynamic charac...
Source: Internal and Emergency Medicine - February 12, 2017 Category: Emergency Medicine Source Type: research

Reversal of Direct Oral Anticoagulants: Current Status and Future Directions
Semin Respir Crit Care Med 2017; 38: 040-050 DOI: 10.1055/s-0036-1597831Direct oral anticoagulants (DOACs) are increasingly used for prevention and treatment of venous thromboembolism and for prevention of stroke in patients with nonvalvular atrial fibrillation. In phase III clinical trials that included more than 100,000 patients, the DOACs were at least as effective as vitamin K antagonists (VKAs) and were associated with less serious bleeding, particularly less intracranial bleeding. Real-world evidence supports these outcomes. Despite this, some physicians and patients are concerned about serious bleeding or emergencie...
Source: Seminars in Respiratory and Critical Care Medicine - February 15, 2017 Category: Respiratory Medicine Authors: Weitz, Jeffrey I. Tags: Review Article Source Type: research

Use of idarucizumab for dabigatran reversal in patients with non-valvular atrial fibrillation undergoing emergency surgical repair of strangulated femoral hernia
We report a case of a 61-year-old woman with history of NVAF on dabigatran, presented to the emergency department with a strangulated right femoral hernia causing small bowel obstruction, where idarucizumab was administered before surgery. The patient had received her last dose of dabigatran 4 hours before presenting to the emergency department and her activated partial thromboplastin time was over the upper limit of reference. Surgery followed about one hour after the administration of idarucizumab and surgeon reported normal perioperative haemostasis. The patient had a normal recovery, received parenteral anticoagulation...
Source: Hellenic Journal of Surgery - April 1, 2017 Category: Surgery Source Type: research

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