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Dabigatran etexilate: management in acute ischemic stroke.
Abstract A 54-year-old man treated with dabigatran experienced new onset of a stroke with a score of 9 on the National Institutes of Health Stroke Scale. Administration of recombinant tissue plasminogen activator (rtPA) was not recommended because of the dabigatran therapy. Angiography showed occlusion of the left middle cerebral artery by an embolic thrombus. Suction thrombectomy achieved flow through the inferior division of the artery. Computed tomography of the head showed possible intracranial hemorrhage, and dabigatran reversal was attempted with prothrombin complex concentrate and recombinant factor VIIa. C...
Source: American Journal of Critical Care - March 1, 2013 Category: Nursing Authors: Javedani PP, Horowitz BZ, Clark WM, Lutsep HL Tags: Am J Crit Care Source Type: research

Use of direct oral anticoagulants for stroke prevention in elderly patients with nonvalvular atrial fibrillation
ConclusionsDOACs are at least as effective as warfarin for stroke prevention in elderly patients with NVAF. Compared with warfarin, DOACs were associated with reduced risk of intracranial hemorrhage, while some DOACs demonstrated an increase in other bleeding events (e.g., gastrointestinal). The faster onset and offset of action and fewer food and drug interactions of DOACs may be an advantage over warfarin for some patients. Implications for practiceDOACs are an alternative to warfarin with overall equivalent safety and efficacy in elderly patients with NVAF, and may be preferable for some. Stroke risk must always be bala...
Source: Journal of the American Academy of Nurse Practitioners - August 14, 2017 Category: Nursing Authors: Lynn B. Oertel, Annemarie E. Fogerty Tags: REVIEW ‐ SPONSORED Source Type: research

Nonvitamin K antagonist oral anticoagulants in everyday practice: Stroke prevention in atrial fibrillation and treatment of venous thromboembolism
ConclusionsAll four NOACs are equivalent to or better than warfarin for the treatment of VTE and stroke prevention in AF, and may reduce the risk of bleeding complications, particularly intracranial bleeding. Implications for practiceNOACs may benefit some patients by avoiding the numerous food or drug interactions and frequent laboratory monitoring associated with warfarin. Adherence to proper dosing is critical for NOAC efficacy and safety.
Source: Journal of the American Academy of Nurse Practitioners - December 17, 2015 Category: Nursing Authors: Barbara A. Bentz Tags: REVIEW Source Type: research

Moving Beyond Warfarin-Are We Ready?: A Review of the Efficacy and Safety of Novel Anticoagulant Agents Compared to Warfarin for the Management of Atrial Fibrillation in Older Adults.
Abstract Atrial fibrillation (AF) is one of the most common cardiac arrhythmias seen in clinical practice. Stroke risk in patients diagnosed with AF increases from 1.5% in the fifth decade of life to 23.5% in patients older than 80, emphasizing the need for effective and appropriate therapies. Over the past 50 years, vitamin K antagonists-namely warfarin (Coumadin(®))-have been the mainstay for stroke prevention. The introduction of dabigatran (Pradaxa(®)), rivaroxaban (Xarelto(®)), and apixaban (Eliquis(®)) has caused both patients and providers to question whether better alternatives to warfarin therapy exis...
Source: Journal of Gerontological Nursing - June 12, 2013 Category: Nursing Authors: Ogbonna KC, Clifford KM Tags: J Gerontol Nurs Source Type: research

Dabigatran etexilate: An alternative to warfarin for patients with nonvalvular atrial fibrillation
ConclusionsSignificant evidence from the PETRO and RE‐LY trials and postmarketing analyses of dabigatran etexilate indicate that this direct thrombin inhibitor is as efficacious as warfarin in ischemic stroke prevention. In fact, the studies found that patients taking dabigatran etexilate had fewer incidences of ischemic stroke and intracranial hemorrhage than those taking warfarin. Risk for major gastrointestinal bleeding appears to be higher than that for warfarin. Implications for practicePatients taking dabigatran etexilate do not require blood work to assess international normalized ratio (INR) levels. Because this ...
Source: Journal of the American Academy of Nurse Practitioners - July 25, 2014 Category: Nursing Authors: Katie A. Scott, Karen A. Amirehsani Tags: CLINICAL PRACTICE Source Type: research

Risks of new anticoagulants.
Authors: Abstract Atrial fibrillation is a major cause of stroke and anticoagulation, with warfarin known to decrease the risk. New oral anticoagulants provide patients with a convenient, fixed-dose alternative to warfarin. These novel drugs have been shown to be as effective at stroke prevention but trials showed an unexpected increase in gastrointestinal bleeding. This retrospective study aimed to quantify this risk by comparing the new drugs dabigatran and rivaroxaban with warfarin. They found no difference for younger patients but risk of bleeding increased with the new drugs in people over the age of 65 and ...
Source: Nursing Older People - June 25, 2015 Category: Nursing Tags: Nurs Older People Source Type: research

Managing Blunt Trauma in Patients Receiving Dabigatran Etexilate: Case Study and Review of the Literature
The objectives of this article are to present a case of life-threatening bleeding in a patient receiving dabigatran etexilate, followed by a review of the current literature and a suggested reversal guideline.
Source: Journal of Emergency Nursing: JEN - April 1, 2013 Category: Nursing Authors: Peter Eamonn Croft, Katherine P. Cabral, Tania D. Strout, Michael R. Baumann, Michael A. Gibbs, Matthew C. DeLaney Tags: Trauma Notebook Source Type: research

Dabigatran versus warfarin in patients with atrial fibrillation.
Abstract Atrial fibrillation is associated with an increased risk of ischaemic stroke and mortality. Guidelines recommend non-vitamin K antagonist oral anticoagulants, or novel oral anticoagulants, as first choice of drug. While they do not require the meticulous dose adjustments that are required for warfarin, a clinical evaluation of appropriate dose is still necessary. Age and chronic kidney disease in patients with atrial fibrillation increase the risk of bleeding during anti-thrombotic treatment. PMID: 28664799 [PubMed - in process]
Source: Nursing Older People - June 30, 2017 Category: Nursing Authors: Sander R Tags: Nurs Older People Source Type: research

Stop Bleeding! Oral  Anticoagulation and Options for Reversal
Direct oral anticoagulants (DOACs) are widely used medications for stroke prevention in nonvalvular atrial fibrillation (AF), and for deep vein thrombosis treatment and prevention. The IMS Institute for Healthcare Informatics analyzed outpatient anticoagulant use in the United States between 2009 and 2014 and found that there has been a steady increase in DOAC use following their initial approval in 2010.1 DOACs include the direct thrombin inhibitor dabigatran, and the factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, and recently approved betrixaban.
Source: The Journal for Nurse Practitioners - November 29, 2017 Category: Nursing Authors: Archna Jariwala, Kori Hamman Tags: Prescription Pad Source Type: research