Abelacimab: A leap forward in anticoagulation with FXI and FXIa Inhibition.

Direct Oral Anticoagulants (DOACs) have revolutionized the treatment of thromboembolic disorders, offering targeted, effective, and safer alternatives to traditional anticoagulants like heparins and vitamin K antagonists (VKAs). Despite their benefits, DOACs have drawbacks, including an increased risk of gastrointestinal bleeding and unsuitability for patients with mechanical heart valves. Recent research has highlighted Factor XI (FXI) as a promising anticoagulation target due to its significant role in pathological thrombosis and minor involvement in normal hemostasis. Abelacimab, an antibody that inhibits FXI, has shown potential in transforming anticoagulation therapy by sparing hemostasis. This review provides a comprehensive analysis of abelacimab, examining its clinical pharmacology and its pharmacokinetic and pharmacodynamic properties. It scrutinizes abelacimab's safety profile and key monitoring parameters. The current evidence supporting its use and potential future research strengthening its position in anticoagulant therapy is also discussed. The objective is to enhance understanding and contribute to discussions around developing safer anticoagulants, particularly for patients at risk for thrombosis.

Association Between Potentially Inappropriate Medications and Hospital Encounters Among Older Adults: A Meta-Analysis.

BACKGROUND: Potentially inappropriate medications (PIMs) are defined by the American Geriatric Society as medications that should be avoided in the elderly in general, or in specific situations. However, PIM use remains high among aging populations and may result in increased utilization of healthcare resources. OBJECTIVE: The aim of this meta-analysis was to evaluate the impact of PIM use on hospital encounters among older adults. METHODS: We searched Medline and Scopus from January 1991 to April 2019 using keywords and MeSH terms related to PIMs. Studies were included if they compared the odds of hospital encounters between PIM and non-PIM groups. Hospital encounters could be either hospital admissions or emergency department (ED) visits. Using random-effects meta-analytic methods, we calculated the pooled odds of any hospital encounter in PIM versus non-PIM users. RESULTS: A total of 21 studies evaluating 3,137,188 patients were included. The proportion of patients on PIMs was > 20% in most (n = 18) studies, median follow up was 12 months, and the mean age of patients ranged from 72 to 86 years. Upon meta-analysis, PIM use was associated with increased odds of both hospital admissions (OR 1.52; 95% CI 1.40-1.65) and ED visits (OR 1.72, 95% CI 1.33-2.24). CONCLUSION: PIM use among older patients was associated with more hospital encounters. These unnecessary encounters likely cause a substantial burden to the healthcare system and patients.

Direct-Thrombin Inhibitor Utilization in Patients With Heparin-Induced Thrombocytopenia and Undergoing Catheter-Directed Thrombolysis: A Summary of Published Case Reports.

BACKGROUND: Catheter-directed thrombolysis (CDT) is one of the emerging venous thromboembolism management modalities. There are fairly limited data regarding the use of direct-thrombin inhibitors (DTIs) in patients with heparin-induced thrombocytopenia and undergoing CDT. OBJECTIVES: The aim of this study was to provide a summary of the available evidence supporting the use of DTIs in patients undergoing CDT. METHODS AND RESULTS: We included 6 case reports in our analysis after searching for peer-reviewed articles and case reports in multiple research engines. Four of the 6 cases used argatroban, and 2 cases used bivalirudin. Alteplase was used in all of the 6 cases. All cases used lower activated partial thromboplastin time target. The average initial dose of alteplase ranged from 0.5 to 3 mg/h. The average duration of CDT was 26 hours (SD, 13 hours). Five patients (83%) survived after the procedure, and no complications were reported. CONCLUSIONS: The use of DTIs might be safe and effective in selected patients with heparin-induced thrombocytopenia and undergoing CDT.