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Total 228 results found since Jan 2013.

6. Abstract Title: Thrombotic and Bleeding Outcomes Following Perioperative Interruption of DOACs and VKAs in Patients with Non-Valvular Atrial Fibrillation - A Comparative Analysis
Background: Atrial fibrillation (AF) is a common disorder that will affect up to 5.6 million patients in the U.S. by 2050. Both direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), typically warfarin, are used for stroke prevention in AF and such patients frequently undergo invasive procedures, requiring anticoagulant interruption. Temporary interruption of anticoagulants can be associated with significant morbidity and mortality in the form of thromboembolic and bleeding complications.
Source: Thrombosis Research - October 1, 2018 Category: Hematology Authors: Joseph Shaw, Tinghua Zhang, Gregoire Le Gal, James Douketis, Marc Carrier Source Type: research

Pharmacodynamic safety of clopidogrel monotherapy in patients under oral anticoagulation with a vitamin K antagonist undergoing coronary stent implantation.
This study enrolled 100 patients on aspirin plus clopidogrel (DAPT-cohort, without indication for VKA) and 100 patients on clopidogrel monotherapy plus phenprocoumon (OAC-cohort) undergoing elective PCI. Platelet reactivity was assessed by impedance aggregometry on day 1 following PCI. Ischemic (death, stroke, or myocardial infarction) and bleeding (BARC 2-5) events within 12 months were compared in a propensity score adjusted model. Platelet reactivity was not different in the OAC- and DAPT-cohort (187 [127-242] vs. 167 [126-218] AU×min; p = 0.23). Overall, 17 ischemic and 34 bleeding events were recorded during follo...
Source: Platelets - September 14, 2018 Category: Hematology Tags: Platelets Source Type: research

Atrial Fibrillation and Malignancy: The Clinical Performance of Non –Vitamin K Oral Anticoagulants—A Systematic Review
Semin Thromb Hemost DOI: 10.1055/s-0038-1661386Atrial fibrillation (AF) is commonly diagnosed in the setting of active cancer. Because of an increased risk of either thromboembolic events or bleeding, the decision to initiate therapeutic anticoagulation in patients with active cancer can be challenging. Moreover, little is still known about the optimal anticoagulation therapy in the setting of AF and cancer, and no guidelines are as yet available. Considering that nonvitamin K antagonist oral anticoagulants (NOACs) are recommended as alternatives to vitamin K antagonists for stroke prevention in AF patients with CHA2DS2-VA...
Source: Seminars in Thrombosis and Hemostasis - August 17, 2018 Category: Hematology Authors: Russo, Vincenzo Bottino, Roberta Rago, Anna Micco, Pierpaolo Di D' Onofrio, Antonio Liccardo, Biagio Golino, Paolo Nigro, Gerardo Tags: Review Article Source Type: research

Appropriateness of non-vitamin K antagonist oral anticoagulant dose in patients with atrial fibrillation in Israel: A population-based study
The non-vitamin K oral antagonists (NOACs) are at least as effective as warfarin in the prevention of stroke in non valvular atrial fibrillation (NVAF) and are associated with less intracranial hemorrhage. Many patients with NVAF inappropriately do not receive anticoagulants often because of the inconvenience associated with warfarin administration. NOACs have the potential to increase anticoagulation use because they are safer and easier to administer than warfarin. Indeed, the use of anticoagulation in patients with newly diagnosed AF in many countries is increasing as a result of the use of NOACs in preference to warfarin [1].
Source: Thrombosis Research - July 24, 2018 Category: Hematology Authors: Martin H. Ellis, Sari Greenberg Dotan, Ariel Hammerman, Erez Battat, Estela Derazne, Orly Avnery Tags: Letter to the Editors-in-Chief Source Type: research

Hemostasis in the Very Young
Semin Thromb Hemost DOI: 10.1055/s-0038-1660852Hemostasis is a dynamic process that starts in utero. The coagulation system evolves with age, as evidenced by marked physiological differences in the concentration of the majority of hemostatic proteins in early life compared with adulthood. This concept, known as “developmental hemostasis,” has important biological and clinical implications. Overall, impaired platelet function, along with physiologically reduced levels of vitamin K–dependent and contact coagulation factors, may cause poorer clot firmness even in healthy neonates. However, increased activity of von Will...
Source: Seminars in Thrombosis and Hemostasis - June 18, 2018 Category: Hematology Authors: Kenet, Gili Barg, Assaf Arie Nowak-G öttl, Ulrike Tags: Review Article Source Type: research

Can an anticoagulant reduce brain hemorrhage: Invited comment on “Dabigatran reduces endothelial permeability through inhibition of thrombin-induced cytoskeleton reorganization”
During studies of anti-coagulants to prevent cardioembolic stroke, startling data emerged that patients treated with novel oral anti-coagulants (NOACs) appeared to suffer less brain hemorrhage than patients treated with traditional, vitamin-K depleting anticoagulants [1, 2]. That NOACs reduced the bleeding risk did not fit accepted dogma: clinicians imagine that hemorrhage occurs during and following ischemic stroke as the brain undergoes necrosis. In the presence of anti-coagulation, such necrotic bleeding ought to be augmented.
Source: Thrombosis Research - June 11, 2018 Category: Hematology Authors: Patrick D. Lyden Tags: Editorial Source Type: research

Impact of cost on use of non-vitamin K antagonists in atrial fibrillation patients in Ontario, Canada
AbstractCanadian guidelines recommend non vitamin K antagonists (NOACs) in preference to vitamin K antagonists (VKAs) for stroke prevention in patients with atrial fibrillation (AF), but NOACs are more expensive than VKAs. Canada has a universal healthcare system that covers the cost of NOACs for select patient groups. Ability to pay for NOACs may influence their use. We reviewed medical charts of Hamilton General Hospital outpatients under the age of 65 with a new diagnosis of AF who were referred for initiation of OAC therapy. We contacted these patients by phone and asked them to complete a questionnaire regarding their...
Source: Journal of Thrombosis and Thrombolysis - June 5, 2018 Category: Hematology Source Type: research

Four factor prothrombin complex concentrate for warfarin reversal in patients with left ventricular assist devices
AbstractContinuous flow left ventricular assist devices (CF-LVAD) require therapeutic anticoagulation which is often interrupted for procedures or bleeding. Prior to the availability of four factor prothrombin complex concentrate (4F-PCC) in the United States, warfarin was held and its effects reversed by vitamin K or fresh frozen plasma. We evaluated the use of 4F-PCC for temporary warfarin reversal in patients with CF-LVADs and assessed outcomes. This analysis is a retrospective study of CF-LVAD patients who received 4F-PCC for warfarin reversal in the setting of bleeding or need for urgent or elective procedures. Primar...
Source: Journal of Thrombosis and Thrombolysis - May 21, 2018 Category: Hematology Source Type: research

Reversal of dabigatran using idarucizumab: single center experience in four acute stroke patients
AbstractDabigatran is a direct thrombin inhibitor and a non-vitamin-K-antagonizing oral anticoagulant, approved for the prevention of stroke and systemic embolization in atrial fibrillation. Idarucizumab is a humanized monoclonal antibody that was recently approved for antagonizing the anticoagulant effects of dabigatran. Here, we report the use of idarucizumab in four acute stroke patients treated with dabigatran in order to enable intravenous thrombolysis in three patients and emergent trepanation in one patient with space occupying subdural hematoma. Since experience on the optimal management of acute stroke patients un...
Source: Journal of Thrombosis and Thrombolysis - April 9, 2018 Category: Hematology Source Type: research

Perioperative management of a patient with Glanzmann thrombasthenia undergoing a coronary artery bypass graft surgery: a case report
We report herein the successful perioperative management of a 57-year-old man with a type I Glanzmann thrombasthenia undergoing coronary artery bypass graft surgery and right carotid endarterectomy. The patient suffered from several lesions in the three major coronary arteries and in the right carotid necessitating surgery. Prophylactic human leukocyte antigen (HLA)-matched platelets transfusions were continuous administrated before, and through the immediate perioperative period. Posttransfusion platelet recovery was monitored using flow cytometry to determine the percentage of circulating platelet expressing CD61 (β3). ...
Source: Blood Coagulation and Fibrinolysis - April 1, 2018 Category: Hematology Tags: Case Report Source Type: research

Beyond Stroke Prevention in Atrial Fibrillation: Exploring Further Unmet Needs with Rivaroxaban.
This article provides an update on three randomized controlled trials of rivaroxaban, a direct, oral factor Xa inhibitor, that are complete or are ongoing, in these unmet areas of stroke prevention: oPen-label, randomized, controlled, multicentre study explorIng twO treatmeNt stratEgiEs of Rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in patients with Atrial Fibrillation who undergo Percutaneous Coronary Intervention (PIONEER AF-PCI) trial; the New Approach riVaroxaban Inhibition of factor Xa in a Global trial vs Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE E...
Source: Thrombosis and Haemostasis - March 22, 2018 Category: Hematology Authors: Gibson CM, Hankey GJ, Nafee T, Welsh RC Tags: Thromb Haemost Source Type: research

The Rivaroxaban Program and the Management of Unmet Needs in Thromboembolic Disease.
Abstract Rivaroxaban is a non-vitamin K antagonist oral anticoagulant that acts as a direct factor Xa inhibitor, and is widely used for the prevention and treatment of thromboembolic disorders. As further knowledge gaps are identified in thrombosis management, the rivaroxaban research program has expanded in an attempt to elucidate the wider benefits of rivaroxaban. An increased understanding of the interactions taking place within the coagulation cascade may support a broader role for rivaroxaban (2.5 mg twice daily [bid] or 5 mg bid) in the setting of vascular protection, either alone or in combination with ...
Source: Thrombosis and Haemostasis - March 22, 2018 Category: Hematology Authors: Camm AJ Tags: Thromb Haemost Source Type: research

Direct Oral Anticoagulants and the Paradigm Shift in the Management of Venous Thromboembolism
Semin Thromb Hemost DOI: 10.1055/s-0038-1637750The advent of direct oral anticoagulants (DOACs) has revolutionized anticoagulation management in both stroke prevention and venous thromboembolism (VTE) treatment/prevention. Clinical trials and secondary real-world data have shown that DOACs have similar efficacy and, in some cases, improved bleeding safety profiles compared with vitamin K antagonists. Together with benefits of patient convenience, this has shifted the risk–benefit ratio toward long-term anticoagulation. However, current VTE risk assessment models are based on vitamin K antagonists and do not take into acc...
Source: Seminars in Thrombosis and Hemostasis - March 20, 2018 Category: Hematology Authors: Lim, Hui Yin Nandurkar, Harshal Ho, Prahlad Tags: Review Article Source Type: research

Impact of pre-admission treatment with non-vitamin K oral anticoagulants on stroke severity in patients with acute ischemic stroke
ConclusionsWe report a positive impact of pre-admission NOAC on ischemic stroke severity, which is particularly remarkable in light of the increased prevalence of prior stroke and lower rates of thrombolysis in this patient population.
Source: Journal of Thrombosis and Thrombolysis - February 23, 2018 Category: Hematology Source Type: research

Direct oral anti-coagulants compared to vitamin-K antagonists in cardioversion of atrial fibrillation: an updated meta-analysis
AbstractPharmacological or electrical cardioversion allows immediate symptoms improvement in the setting of paroxysmal or persistent atrial fibrillation (AF), although the periprocedural risk of systemic embolism should be considered. Recently, there was a great interest on the safety and efficacy of direct oral anticoagulants (DOACs) when used for the cardioversion of non-valvular AF. We performed a random-effects meta-analysis of patients undergoing both electrical and pharmacologic cardioversion for non-valvular AF in the RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE AF-TIMI 48, X-VeRT, ENSURE-AF, and EMANATE trials. We assessed ...
Source: Journal of Thrombosis and Thrombolysis - February 5, 2018 Category: Hematology Source Type: research