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Efficacy and safety of direct oral anticoagulants vs vitamin K antagonists in patients with atrial fibrillation and end-stage renal disease on hemodialysis: A systematic review and meta-analysis
CONCLUSIONS: Among AF patients with ESRD on chronic hemodialysis, the risk of ischemic stroke, ischemic stroke or systemic embolism, minor bleeding, major bleeding, and all-cause mortality is similar in patients treated with DOACs compared to VKAs. Given that the meta-analysis of RCTs on gastrointestinal bleeding did not confirm the results of the meta-analysis of the observational studies, it cannot be concluded that gastrointestinal bleeding is lower among DOAC-treated patients.PROTOCOL REGISTRATION: PROSPERO CRD42023391966.PMID:37648582 | DOI:10.1016/j.ejim.2023.08.020
Source: European Journal of Internal Medicine - August 30, 2023 Category: Internal Medicine Authors: Ioannis Kyriakoulis Anastasia Adamou Iliana Stamatiou David Dimitris Chlorogiannis Ioannis Kardoutsos Despoina Koukousaki George Ntaios Source Type: research

A new strategy for anticoagulation: The factor XI inhibitors
Eur J Intern Med. 2023 Aug 4:S0953-6205(23)00284-4. doi: 10.1016/j.ejim.2023.08.001. Online ahead of print.ABSTRACTDirect oral anticoagulants (DOACs) are currently the first-choice therapy for the prevention of cardioembolic events in patients with atrial fibrillation and for the treatment of venous thromboembolism (VTE) due to their more favorable efficacy to safety profile in comparison to vitamin K antagonists (VKA). DOACs did not show a clinical benefit when used for in stroke prevention in patients with mechanic or rheumatic valves or in those who underwent transcatheter aortic valve implantation (TAVI), in the treatm...
Source: European Journal of Internal Medicine - August 6, 2023 Category: Internal Medicine Authors: Maria Cristina Vedovati Cecilia Becattini Giancarlo Agnelli Source Type: research

Delaying clinical events among patients with non-valvular atrial fibrillation treated with oral anticoagulants: Insights from the ARISTOPHANES study
CONCLUSIONS: Over 12 months after initiation, apixaban and dabigatran conferred progressive increases in event free time for stroke/SE and MB vs warfarin, whereas rivaroxaban conferred an increase in stroke/SE-free time but a loss in MB-free time vs warfarin.PMID:36456387 | DOI:10.1016/j.ejim.2022.10.021
Source: European Journal of Internal Medicine - December 1, 2022 Category: Internal Medicine Authors: Steven Deitelzweig Allison Keshishian Amiee Kang Aaron Jenkins Nipun Atreja Patricia Schuler Jenny Jiang Huseyin Yuce Xiaoxi Sun Gregory Y H Lip Source Type: research

Anticoagulation resumption after intracranial hemorrhage in patients treated with VKA and DOACs.
CONCLUSIONS: A trend toward fewer ICH recurrences was detected among DOACs patients in comparison to the previously reported rate of patients on warfarin. PMID: 32522446 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - June 6, 2020 Category: Internal Medicine Authors: Poli D, Antonucci E, Vignini E, Martinese L, Testa S, Simioni P, Pengo V, Pignatelli P, Falanga A, Masciocco L, Barcellona D, Ciampa A, Chiarugi P, Paparo C, Ageno W, Palareti G, START2 Registry investigators Tags: Eur J Intern Med Source Type: research

Mortality in patients with intracerebral hemorrhage associated with antiplatelet agents, oral anticoagulants or no antithrombotic therapy.
In conclusion, preceding treatment with antithrombotic is associated with the severity of ICH. Age, previous stroke and clinical severity at presentation were independent predictors of in-hospital death in patients with ICH. PMID: 31955918 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - January 15, 2020 Category: Internal Medicine Authors: Franco L, Paciaroni M, Enrico ML, Scoditti U, Guideri F, Chiti A, De Vito A, Terruso V, Consoli D, Vanni S, Giossi A, Manina G, Nitti C, Re R, Sacco S, Cappelli R, Beyer-Westendorf J, Pomero F, Agnelli G, Becattini C Tags: Eur J Intern Med Source Type: research

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence.
Abstract Atrial fibrillation is more frequent in older patients, who have a higher risk of cardioembolic stroke and thromboembolism. Oral anticoagulant therapy is the standard of treatment for stroke prevention; however, under-prescription is still very common in older patients. The reasons underlying this phenomenon have not been systematically investigated, and true contraindications only partially account for it. An intimate skepticism on the real benefit-risk balance of oral anticoagulant therapy in the oldest patients seems to derive from the fact that most studies supporting it were conducted decades ago and...
Source: European Journal of Internal Medicine - March 24, 2017 Category: Internal Medicine Authors: Bo M, Grisoglio E, Brunetti E, Falcone Y, Marchionni N Tags: Eur J Intern Med Source Type: research

Vitamin K and non-vitamin K antagonists oral anticoagulants for non-valvular atrial fibrillation in real-life.
CONCLUSION: Patients given rivaroxaban and apixaban in clinical practice have a higher thrombotic and hemorrhagic risk in comparison with patients given dabigatran or VKAs. A considerable proportion of patients receive reduced doses of NOACs. PMID: 27394924 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - July 5, 2016 Category: Internal Medicine Authors: Giustozzi M, Vedovati MC, Verdecchia P, Pierpaoli L, Verso M, Conti S, Cianella F, Marchesini E, Filippucci E, Agnelli G, Becattini C Tags: Eur J Intern Med Source Type: research

Challenges and misconceptions in the aetiology and management of atrial fibrillation-related strokes.
Abstract Strokes, whether ischaemic or haemorrhagic, are the most feared complications of atrial fibrillation (AF) and its treatment. Vitamin K antagonists have been the mainstay of stroke prevention. Recently, direct oral anticoagulants have been introduced. The advantages and disadvantages of these treatment strategies have been extensively discussed. In this narrative review, we discuss dilemmas faced by primary care clinicians in the context of stroke and transient ischaemic attack (TIA) in patients with AF. We discuss the classification of stroke, the different types of stroke seen with AF, the prognosis of A...
Source: European Journal of Internal Medicine - July 8, 2015 Category: Internal Medicine Authors: Thijs V, Butcher K Tags: Eur J Intern Med Source Type: research

Decision making for oral anticoagulants in atrial fibrillation: The ATA-AF study.
CONCLUSIONS: Oral anticoagulants are more frequently used in CARD than in MED, plausibly due to greater complexity of MED patients. Stratification of thrombotic and hemorrhagic risk significantly drives the choice for VKA. However the fraction of patients in whom prescription or non-prescription is based on other individual characteristics is not negligible. PMID: 23684591 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - May 16, 2013 Category: Internal Medicine Authors: Gussoni G, Di Pasquale G, Vescovo G, Gulizia M, Mathieu G, Scherillo M, Panuccio D, Lucci D, Nozzoli C, Fabbri G, Colombo F, Riva L, Baldo CI, Maggioni AP, Mazzone A, ATA-AF Steering Committee and Investigators Tags: Eur J Intern Med Source Type: research