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Anticoagulation therapy in 2015: where we are and where we are going
Abstract Oral anticoagulants are a mainstay for the prevention and treatment of venous and arterial thrombosis. In 2015, the non-vitamin K oral anticoagulants (NOACs) are already replacing warfarin for many indications. Ongoing studies are focused on development of antidotes and specific reversal agents for the NOACs, and assessing their utility for prevention of cardiovascular events in patients with heart failure, coronary or peripheral artery disease, or embolic stroke of unknown source. This paper (a) lists the current indications for the NOACs; (b) reviews the current impact of the NOACs in each of these indi...
Source: Journal of Thrombosis and Thrombolysis - February 19, 2015 Category: Hematology Source Type: research

Current antiplatelet agents: place in therapy and role of genetic testing
Abstract Antiplatelet therapies play a central role in reducing the risk of cardiovascular events such as myocardial infarction and stroke. While aspirin, a cyclo-oxygenase-1 inhibitor has been the cornerstone of antithrombotic treatment for several decades, P2Y12 receptor inhibitors cangrelor, clopidogrel, prasugrel, and ticagrelor and protease-activated receptor-1 antagonist vorapaxar, have emerged as additional therapies to reduce the risk of recurrent cardiovascular events in high-risk patients. Recent clinical trials evaluating the role of these agents and major society guideline updates for use of antiplatel...
Source: Journal of Thrombosis and Thrombolysis - February 21, 2015 Category: Hematology Source Type: research

Thromboembolic complications in inflammatory bowel disease
Abstract Patients with inflammatory bowel disease (IBD) have a 1.5–3.5-fold higher risk of thromboembolism when compared to the non-IBD population and the risk is much more prominent at the time of a flare. Arterial thromboembolism (ischemic stroke, focal white matter ischemia, cardiac ischemia, peripheral vascular disease and mesenteric ischemia) and venous thromboembolism (deep vein thrombosis and pulmonary embolism, cerebral venous sinus thrombosis, retinal, hepatic, portal and mesenteric vein thromboses) belong to the group of underestimated extraintestinal complications in IBD patients, which are associate...
Source: Journal of Thrombosis and Thrombolysis - March 31, 2015 Category: Hematology Source Type: research

Analysis of anticoagulant prescribing in non-valvular atrial fibrillation and development of a clinical tool for guiding anticoagulant selection
This study demonstrated that patients admitted to our hospital were prescribed appropriate therapy the majority of the time; however, 34 % were prescribed inadequate antithrombotic therapy compared to current practice guidelines given their CHA2DS2VASc score. The development of an institution-specific guideline stratifying appropriate use of anticoagulation in this population may increase adherence to national guideline recommendations.
Source: Journal of Thrombosis and Thrombolysis - May 8, 2015 Category: Hematology Source Type: research

Standardized use of novel oral anticoagulants plasma level thresholds in a new thrombolysis decision making protocol
Abstract Acute ischemic stroke (AIS) patients receiving non-vitamin-K antagonist oral anticoagulants (NOAC) are commonly excluded from thrombolytic therapy, as interpretation of coagulation tests remains unclear. We aimed to investigate the applicability of a novel institutional protocol for thrombolysis based on current expert recommendations and NOAC specific coagulation assessment. We included hospitalized AIS patients receiving NOAC for at least 24 h and consecutive AIS patients not receiving NOAC into a prospective study. We performed standard coagulation tests and specific tests for dabigatran, rivaroxaban ...
Source: Journal of Thrombosis and Thrombolysis - May 23, 2015 Category: Hematology Source Type: research

The impact of frequency of patient self-testing of prothrombin time on time in target range within VA Cooperative Study #481: The Home INR Study (THINRS), a randomized, controlled trial
In conclusion, more frequent PST improved TTR and reduced the proportion of poorly managed patients.
Source: Journal of Thrombosis and Thrombolysis - May 29, 2015 Category: Hematology Source Type: research

Preferences for anticoagulation therapy in atrial fibrillation: the patients’ view
The objective of this study was to assess AF patients’ preferences with regard to the attributes of these different treatment options. We conducted a multicenter study among randomly selected physicians. Preferences were assessed by computer-assisted telephone interviews. We used a discrete-choice-experiment (DCE) with four convenience-related treatment dependent attributes (need of bridging: yes/no, interactions with food/nutrition: yes/no, need of INR controls/dose adjustment: yes/no; frequency of intake: once/twice daily) and one comparator attribute (distance to practitioner: <1 km/>15 km). Preferences measur...
Source: Journal of Thrombosis and Thrombolysis - August 11, 2015 Category: Hematology Source Type: research

Relationship between body mass index and left atrial appendage thrombus in nonvalvular atrial fibrillation
Abstract Atrial fibrillation and obesity are two major growing epidemics in the United States and globally. Obese people are at the increased risk of developing atrial fibrillation. The contribution of obesity as an independent risk factor for stroke in the setting of atrial fibrillation remains unclear. We tested the hypothesis that non-valvular atrial fibrillation (NVAF) patients with increased body mass index (BMI) would be at increased risk for the development of left atrial appendage thrombus (LAAT). Consecutive, anticoagulation naïve patients with NVAF referred for a transesophageal echocardiogram (TEE) bet...
Source: Journal of Thrombosis and Thrombolysis - August 18, 2015 Category: Hematology Source Type: research

The effect of dabigatran and rivaroxaban on platelet reactivity and inflammatory markers
Abstract The new oral anticoagulants (NOACs) reduce stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF), but dabigatran may increase risk of coronary ischemic events for unclear reasons. Thus, this study assessed the effects of dabigatran and rivaroxaban on platelet reactivity and inflammatory markers in patients with non-valvular AF. Patients with non-valvular AF planned to begin treatment with NOACs were included. Seventeen patients were prescribed dabigatran and ten rivaroxaban. Platelet function (as assessed by multiple-electrode aggregometry, Impact-R shear-induced platelet de...
Source: Journal of Thrombosis and Thrombolysis - August 23, 2015 Category: Hematology Source Type: research

The changing characteristics of atrial fibrillation patients treated with warfarin
Abstract It has been suggested that direct oral anticoagulants are being preferentially used in low risk atrial fibrillation (AF) patients. Understanding the changing risk profile of new AF patients treated with warfarin is important for interpreting the quality of warfarin delivery through an anticoagulation clinic. Six anticoagulation clinics participating in the Michigan Anticoagulation Quality Improvement Initiative enrolled 1293 AF patients between 2010 and 2014 as an inception cohort. Abstracted data included demographics, comorbidities, medication use and all INR values. Risk scores including CHADS2, CHA2D...
Source: Journal of Thrombosis and Thrombolysis - September 27, 2015 Category: Hematology Source Type: research

PON1 Q192R genetic variant and response to clopidogrel and prasugrel: pharmacokinetics, pharmacodynamics, and a meta-analysis of clinical outcomes
Abstract Clopidogrel and prasugrel are antiplatelet therapies commonly used to treat patients with cardiovascular disease. They are both pro-drugs requiring biotransformation into active metabolites. It has been proposed that a genetic variant Q192R (rs662 A>G) in PON1 significantly alters the biotransformation of clopidogrel and affects clinical outcomes; however, this assertion has limited support. The relationship between this variant and clinical outcomes with prasugrel has not been studied. We genotyped PON1 Q192R in 275 healthy subjects treated with clopidogrel or prasugrel and 2922 patients with an ACS u...
Source: Journal of Thrombosis and Thrombolysis - November 16, 2015 Category: Hematology Source Type: research

Platelet reactivity in patients undergoing transcatheter aortic valve implantation
In conclusion, patients undergoing TAVI for severe aortic stenosis and treated with DAPT have high rates of residual platelet reactivity during the peri-procedural period and up to 1-month thereafter. These findings may have clinical implications for the anti-platelet management of TAVI patients.
Source: Journal of Thrombosis and Thrombolysis - December 22, 2015 Category: Hematology Source Type: research

Repeated early thrombolysis in cervical spinal cord ischemia
We report the first case of an MRI-verified cervical spinal ischemia treated by thrombolysis and review the literature. A 72-year old woman with right-sided motor hemiparesis and trunk ataxia was treated by intravenous thrombolysis with full recovery. Three days later she developed again a severe right-sided sensorimotor hemiparesis and a second off-label intravenous thrombolysis was repeated. Magnetic resonance imaging revealed a right-sided posterior-lateral cervical spinal ischemia. Spinal ischemia may clinically present with a cerebral-stroke-like picture challenging diagnostic and therapeutic procedure. Systemic throm...
Source: Journal of Thrombosis and Thrombolysis - January 13, 2016 Category: Hematology Source Type: research

Why develop antidotes and reversal agents for non-vitamin K oral anticoagulants?
Abstract Over the past several years, non-vitamin K oral anticoagulants (NOACs) have been introduced into clinical practice for the treatment of venous thromboembolism and prevention of stroke in patients with nonvalvular atrial fibrillation. Clinical trials have shown these agents to have similar or less risk of major bleeding as compared to warfarin therapy. Moreover, when patients do experience a major bleeding event administration of advanced factor products is rare, and post-bleed outcomes are similar in those receiving a NOAC compared to those receiving warfarin. However, there are situations where urgent r...
Source: Journal of Thrombosis and Thrombolysis - February 1, 2016 Category: Hematology Source Type: research

Laboratory assessment of anti-thrombotic therapy in heart failure, atrial fibrillation and coronary artery disease: insights using thrombelastography and a micro-titre plate assay of thrombogenesis and fibrinolysis
Abstract As heart failure, coronary artery disease and atrial fibrillation all bring a risk of thrombosis, anti-thrombotic therapy is recommended. Despite such treatment, major cardiovascular events such as myocardial infarction and stroke still occur, implying inadequate suppression of thrombus formation. Accordingly, identification of patients whose haemostasis remains unimpaired by treatment is valuable. We compared indices for assessing thrombogenesis and fibrinolysis by two different techniques in patients on different anti-thrombotic agents, i.e. aspirin or warfarin. We determined fibrin clot formation and f...
Source: Journal of Thrombosis and Thrombolysis - March 4, 2016 Category: Hematology Source Type: research

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