Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 578
Filtrar
1.
Medicine (Baltimore) ; 99(17): e19890, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332662

RESUMO

RATIONALE: Dabigatran is an anticoagulant medication that has been widely used to prevent strokes caused by atrial fibrillation, deep vein thrombosis, and pulmonary embolism. However, the potential adverse effect of dabigatran of gastrointestinal mucosal injury is often neglected, and even induces esophagitis. PATIENT CONCERNS: A 77-year-old woman was admitted to the hospital with symptoms of progressive retrosternal pain, upper abdominal discomfort, and dysphagia. DIAGNOSIS: Esophagogastroduodenoscopy showed longitudinal sloughing mucosal casts in the distal esophagus. Histological examination showed squamous epithelium with neutrophil infiltration, partial epithelial degeneration, and Helicobacter pylori. Based on a literature review, medical history, and imaging examination, the patient was diagnosed with dabigatran-induced esophagitis. INTERVENTIONS: The patient recovered with standard H. pylori eradication therapy and proton pump inhibitor without discontinuing dabigatran. OUTCOMES: After 2 weeks, the retrosternal pain and dysphagia were relieved and upper abdominal discomfort was attenuated. LESSONS: Our case highlights the importance of physicians' awareness of the clinical and endoscopic characteristics of dabigatran-induced esophagitis and the importance of H. pylori-associated tests and eradication if necessary for patients with long-term dabigatran treatment.


Assuntos
Dabigatrana/efeitos adversos , Esofagite/etiologia , Dor Abdominal/tratamento farmacológico , Dor Abdominal/fisiopatologia , Idoso , Antitrombinas/efeitos adversos , Antitrombinas/uso terapêutico , Dabigatrana/uso terapêutico , Transtornos de Deglutição/tratamento farmacológico , Transtornos de Deglutição/fisiopatologia , Endoscopia do Sistema Digestório/métodos , Esofagite/fisiopatologia , Feminino , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/patogenicidade , Humanos
2.
J Laryngol Otol ; 134(4): 316-322, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32281535

RESUMO

BACKGROUND: Individuals on anticoagulation therapy are at increased risk of bleeding, including epistaxis. There is a lack of available reversal agents for novel oral anticoagulation therapy. OBJECTIVE: This paper reviews the current literature on epistaxis in the context of novel oral anticoagulation use, in order to recommend guidelines on management. METHOD: A comprehensive search of published literature was conducted to identify all relevant articles published up to April 2019. RESULTS: Patients on oral anticoagulation therapy are over-represented in individuals with epistaxis. Those on novel oral anticoagulation therapy were more likely to relapse compared to patients on classic oral anticoagulants or non-anticoagulated patients. Idarucizumab is an effective antidote for bleeding associated with dabigatran use. Recommendations for epistaxis management in patients on novel oral anticoagulation therapy are outlined. CONCLUSION: Clinicians need to be aware of the potential severity of epistaxis and the increased likelihood of recurrence. High-quality studies are required to determine the efficacy and safety of andexanet alfa and ciraparantag, as well as non-specific reversal agents.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antídotos/uso terapêutico , Epistaxe/tratamento farmacológico , Administração Oral , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Antídotos/administração & dosagem , Antitrombinas/efeitos adversos , Antitrombinas/uso terapêutico , Arginina/administração & dosagem , Arginina/análogos & derivados , Arginina/uso terapêutico , Conscientização , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Epistaxe/induzido quimicamente , Epistaxe/epidemiologia , Fator Xa/administração & dosagem , Fator Xa/uso terapêutico , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Primeiros Socorros/normas , Humanos , Masculino , Piperazinas/administração & dosagem , Piperazinas/uso terapêutico , Prevalência , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Rivaroxabana/efeitos adversos , Rivaroxabana/uso terapêutico , Índice de Gravidade de Doença
4.
Am J Health Syst Pharm ; 76(1): 9-12, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31381100

RESUMO

PURPOSE: A case report of dabigatran-associated coagulopathy that lasted for about 1 week after drug discontinuation despite use of several treatment measures is presented. SUMMARY: Life-threatening hemorrhage can occur in patients receiving dabigatran, a direct-acting oral anticoagulant. Idarucizumab is a newly approved dabigatran antidote that neutralizes the drug's anticoagulant activity. An 80-year-old Caucasian man with a medical history of hypertension, coronary artery disease, congestive heart failure, gout, and atrial fibrillation was hospitalized with acute kidney injury (AKI) caused by bilateral hydronephrosis secondary to distal urethral stricture. The patient had prolonged coagulation parameters and major bleeding. Initial laboratory values revealed anemia, with a hemoglobin concentration of 8.9 g/dL; a serum creatinine concentration of 3.9 mg/dL; a prothrombin time of 15 seconds; an International Normalized Ratio of 1.1; and a platelet count of 142,000 platelets/mm3. Three hemodialysis sessions and administration of fresh frozen plasma (FFP), packed red blood cells, and 2 doses of idarucizumab were required in order to achieve hemostasis 8 days after dabigatran was discontinued. CONCLUSION: A patient with AKI who had been taking dabigatran and developed major bleeding needed 2 doses of idarucizumab in addition to FFP and 3 sessions of hemodialysis in order for hemostasis to be restored. This case suggests that idarucizumab might not produce hemostasis in a timely manner in patients with poor renal function.


Assuntos
Lesão Renal Aguda/terapia , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticoagulantes/efeitos adversos , Dabigatrana/efeitos adversos , Hemorragia/terapia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/complicações , Idoso , Coagulação Sanguínea/efeitos dos fármacos , Testes de Coagulação Sanguínea , Dabigatrana/antagonistas & inibidores , Hemorragia/sangue , Hemorragia/etiologia , Humanos , Masculino , Plasma , Diálise Renal , Resultado do Tratamento
5.
N Z Med J ; 132(1500): 25-28, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31415496

RESUMO

AIM: To assess the impact of anticoagulation on patients having cataract surgery. METHODS: Patients who underwent cataract surgery with phacoemulsification and intraocular lens insertion between 1 January 2015 and 31 December 2015 at Christchurch Hospital were identified and retrospectively audited. The outcome measures were the occurrence of intraoperative and postoperative haemorrhage, and thromboembolic events within two weeks after surgery. A control group was included to assess the outcome measures in a sample of patients who were not on anticoagulants or antiplatelets. RESULTS: Forty-four anticoagulated patients (46 eyes) and 41 controls (46 eyes) were identified. Seventy-four percent of those anticoagulated were on warfarin and 26% were on dabigatran. The incidence of haemorrhagic complications was 18%, 25% and 11% in the warfarin, dabigatran and control groups, respectively, although these differences were not statistically significant. Apart from one vitreous haemorrhage, which may have been present preoperatively, the haemorrhages that occurred were minor and not visually significant. No thromboembolic events were noted in any of the groups. CONCLUSION: There is no statistically significant increase in haemorrhagic complications in cataract surgery patients who were on warfarin or dabigatran. Therefore, continuing the anticoagulation in this setting may be appropriate.


Assuntos
Anticoagulantes/efeitos adversos , Facoemulsificação , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dabigatrana/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Facoemulsificação/efeitos adversos , Facoemulsificação/estatística & dados numéricos , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Tromboembolia/epidemiologia , Varfarina/efeitos adversos
6.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439551

RESUMO

A 58-year-old man presented with necrotising fasciitis and septic shock requiring urgent surgical debridement. Idarucizumab was used preoperatively to reverse the effects of dabigatran, which he was taking for chronic atrial fibrillation. He developed multiorgan failure including an oliguric acute kidney injury and was given continuous venovenous haemodiafiltration. Adjunctive intravenous immunoglobulin therapy was used in addition to his antibiotic therapy for necrotising fasciitis. Significant clinical and laboratory coagulopathy continued for over 12 days with evidence of a persistent dabigatran effect. Here, we discuss the potential impact of the immunoglobulin therapy, the patient's weight on the degree of redistribution of dabigatran seen and the oliguria in the context of an acute kidney injury on the apparent lack of the effectiveness of idarucizumab.


Assuntos
Antitrombinas/efeitos adversos , Dabigatrana/efeitos adversos , Fasciite Necrosante/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Choque Séptico/diagnóstico , Infecções Estreptocócicas/diagnóstico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Diagnóstico Diferencial , Fasciite Necrosante/complicações , Fasciite Necrosante/tratamento farmacológico , Hemorragia Gastrointestinal/induzido quimicamente , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Diálise Renal , Choque Séptico/complicações , Choque Séptico/terapia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico
7.
Crit Care Nurse ; 39(3): e1-e8, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154337

RESUMO

Intracerebral hemorrhage is a major source of morbidity and mortality, accounting for 10% of all strokes. Oral anticoagulation therapy, while necessary to prevent thromboembolic complications, increases the risk of intracerebral hemorrhage and can potentially worsen bleeding in cases of acute hemorrhage. Before the introduction of direct oral anticoagulant agents in 2010, warfarin was the only option for oral anticoagulation. These new agents have an improved safety profile compared with warfarin but require different reversal strategies. Anticoagulation reversal in the setting of acute intracerebral hemorrhage is an evolving field. This article covers the most common direct oral anticoagulant medications, various available anticoagulant reversal strategies, and the latest guidelines for anticoagulation reversal in patients with acute intracranial hemorrhage.


Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Hemorragias Intracranianas/induzido quimicamente , Tromboembolia/prevenção & controle , Administração Oral , Anticoagulantes/farmacocinética , Antitrombinas/administração & dosagem , Antitrombinas/efeitos adversos , Benzamidas/administração & dosagem , Benzamidas/efeitos adversos , Dabigatrana/administração & dosagem , Dabigatrana/efeitos adversos , Humanos , Hemorragias Intracranianas/prevenção & controle , Guias de Prática Clínica como Assunto , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Piridinas/administração & dosagem , Piridinas/efeitos adversos , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Medição de Risco , Rivaroxabana/administração & dosagem , Rivaroxabana/efeitos adversos , Resultado do Tratamento
8.
Drug Des Devel Ther ; 13: 1527-1533, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190734

RESUMO

Atrial fibrillation increases the risk of stroke and death. The vitamin-K antagonist warfarin is recommended for patients with atrial fibrillation, but vitamin-K antagonists are cumbersome to use. Therefore, an effective, safe and convenient new anticoagulant is needed. Dabigatran acts by inhibiting free and fibrin-bound thrombin directly. It is an oral anticoagulant that was approved by the US Food and Drug Administration. The oral anticoagulant dabigatran has been used increasingly due to its good tolerance, predictable pharmacokinetics, effective anticoagulant effects, and absence of requirement of coagulation monitoring. However, an increasing prevalence of adverse events has been reported, some of them quite serious. Therefore, we searched and reviewed the literature on dabigatran with regard to adverse events, and proposed solutions to prevent and reduce the chance of adverse events occurring.


Assuntos
Antitrombinas/efeitos adversos , Dabigatrana/efeitos adversos , Antitrombinas/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Dabigatrana/uso terapêutico , Humanos
9.
Vasc Health Risk Manag ; 15: 139-142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213821

RESUMO

Idarucizumab (Praxbind) is a humanized antibody fragment, that reversibly and with high affinityties up dabigatran (Pradaxa). Anticoagulation reversal is achieved immediately, and with no procoagulant effect. It is administered intravenously and clearance is renal. The main clinical application of idarucizumab is to antagonize bleeding related to dabigatran, especially if it occurs at critical sites, such as nervous system (central or peripheral), intraocular, pericardial, retroperitoneal or pulmonary. Other indications are: i) dabigatran-induced anticoagulation reversal in the need for emergency surgery or procedures at high risk of bleeding; and ii) second-line treatment in bleedings that persist despite local hemostasis procedures. In this narrative review, we comprehensively address clinical indications for idarucizumab, summing up evidence derived from a systematic literature review, but also from case reports.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antitrombinas/efeitos adversos , Coagulação Sanguínea/efeitos dos fármacos , Coagulantes/uso terapêutico , Dabigatrana/efeitos adversos , Hemorragia/prevenção & controle , Anticorpos Monoclonais Humanizados/efeitos adversos , Coagulantes/efeitos adversos , Medicina Baseada em Evidências , Hemorragia/induzido quimicamente , Humanos , Resultado do Tratamento
10.
BMJ Case Rep ; 12(5)2019 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-31061182

RESUMO

We report the experience of reversing dabigatran prior to administering systemic thrombolysis for acute ischaemic cerebellar stroke, which was well tolerated with no haemorrhagic complications after thrombolysis. Given the increasingly common use of dabigatran for atrial fibrillation, the use of idarucizumab to reverse of dabigatran is a novel treatment that should be considered as an important adjunct to facilitate thrombolysis for ischaemic strokes and minimise haemorrhagic complications.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Isquemia Encefálica/tratamento farmacológico , Dabigatrana/efeitos adversos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Idoso , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/patologia , Humanos , Masculino , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
N Engl J Med ; 380(20): 1906-1917, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-31091372

RESUMO

BACKGROUND: Cryptogenic strokes constitute 20 to 30% of ischemic strokes, and most cryptogenic strokes are considered to be embolic and of undetermined source. An earlier randomized trial showed that rivaroxaban is no more effective than aspirin in preventing recurrent stroke after a presumed embolic stroke from an undetermined source. Whether dabigatran would be effective in preventing recurrent strokes after this type of stroke was unclear. METHODS: We conducted a multicenter, randomized, double-blind trial of dabigatran at a dose of 150 mg or 110 mg twice daily as compared with aspirin at a dose of 100 mg once daily in patients who had had an embolic stroke of undetermined source. The primary outcome was recurrent stroke. The primary safety outcome was major bleeding. RESULTS: A total of 5390 patients were enrolled at 564 sites and were randomly assigned to receive dabigatran (2695 patients) or aspirin (2695 patients). During a median follow-up of 19 months, recurrent strokes occurred in 177 patients (6.6%) in the dabigatran group (4.1% per year) and in 207 patients (7.7%) in the aspirin group (4.8% per year) (hazard ratio, 0.85; 95% confidence interval [CI], 0.69 to 1.03; P = 0.10). Ischemic strokes occurred in 172 patients (4.0% per year) and 203 patients (4.7% per year), respectively (hazard ratio, 0.84; 95% CI, 0.68 to 1.03). Major bleeding occurred in 77 patients (1.7% per year) in the dabigatran group and in 64 patients (1.4% per year) in the aspirin group (hazard ratio, 1.19; 95% CI, 0.85 to 1.66). Clinically relevant nonmajor bleeding occurred in 70 patients (1.6% per year) and 41 patients (0.9% per year), respectively. CONCLUSIONS: In patients with a recent history of embolic stroke of undetermined source, dabigatran was not superior to aspirin in preventing recurrent stroke. The incidence of major bleeding was not greater in the dabigatran group than in the aspirin group, but there were more clinically relevant nonmajor bleeding events in the dabigatran group. (Funded by Boehringer Ingelheim; RE-SPECT ESUS ClinicalTrials.gov number, NCT02239120.).


Assuntos
Antitrombinas/administração & dosagem , Dabigatrana/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Idoso , Antitrombinas/efeitos adversos , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Dabigatrana/efeitos adversos , Método Duplo-Cego , Feminino , Hemorragia/induzido quimicamente , Humanos , Incidência , Embolia Intracraniana/tratamento farmacológico , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Recidiva , Prevenção Secundária , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade
13.
Turk Neurosurg ; 29(4): 470-477, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31124572

RESUMO

AIM: To investigate the effect of dabigatran, a new oral anticoagulant, on human primary cell cultures isolated from intact intervertebral disc tissue. MATERIAL AND METHODS: Cell cultures were prepared from tissues obtained from six cases who had undergone surgery due to spinal trauma. Dabigatran, an active pharmacological agent, was applied to intact annulus fibrosus (AF)/nucleus pulposus (NP) primary cell cultures from the study group. After performing cell viability, toxicity, and proliferation tests on all cultures in the control and study groups, the surface morphologies of the samples were evaluated. Subsequently, chondroadherin (CHAD), cartilage oligomeric matrix protein (COMP), and matrix metalloproteinase (MMP)-13 and -19 expressions were measured via a real-time polymerase chain reaction (RT-PCR). Data were analyzed statistically. RESULTS: In the proliferation assays performed on the 20th day of the study, cells in the dabigatran-supplemented group were reported to have lost 46.37% more viability than those in the control group. Expressions of all genes examined except MMP-13 were evaluated in the control group by time, but in contrast to the control group results, COMP and MMP-19 gene expressions decreased in the dabigatran-treated group. No CHAD or MMP-13 expression was noted in these cultures. CONCLUSION: The potential for a systemically applied drug to accumulate in tissue and negatively affect surrounding tissues and microstructures must be emphasized.


Assuntos
Anticoagulantes/efeitos adversos , Dabigatrana/efeitos adversos , Disco Intervertebral/efeitos dos fármacos , Trombose/prevenção & controle , Administração Oral , Adolescente , Adulto , Anticoagulantes/administração & dosagem , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/fisiologia , Dabigatrana/administração & dosagem , Proteínas da Matriz Extracelular/metabolismo , Feminino , Expressão Gênica , Humanos , Disco Intervertebral/metabolismo , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/metabolismo , Degeneração do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Cultura Primária de Células/métodos , Trombose/metabolismo , Adulto Jovem
15.
J Thromb Thrombolysis ; 47(4): 487-494, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30955142

RESUMO

Anticoagulants are prescribed for prevention of thromboembolic events (TE) of atrial fibrillation (AF), however, their effects have a negative impact on disastrous bleeding outcomes. Idarucizumab was developed to reverse the anticoagulation effects of dabigatran. This study aimed to retrospectively investigate the clinical efficacy and safety of idarucizumab in the setting of progressive emergent bleeding events associated with catheter ablation (CA). Dabigatran is given uninterruptedly as an anticoagulant in patients undergoing CA of AF. The capacity of idarucizumab to reverse the anticoagulant effects of dabigatran in patients with cardiac tamponade associated with CA was examined by measuring the activated partial thromboplastin time (aPTT), active clotting time (ACT), and prothrombin international normalizing ratio (PT-INR). The primary endpoint was effective hemostasis. This analysis included 21 patients receiving idarucizumab, given for restoration of hemostasis. In all 21 patients, hemostasis was restored at a median of 205.6 ± 14.8 min. Normal intraoperative cessation of bleeding was reported in 16 patients, and completion of hemostasis was also ascertained in the remaining four within 5 h. No TEs occurred within 72 h after the idarucizumab administration. Despite a significant reduction in the aPTT and ACT, no significant change was observed in PT-INR after administering idarucizumab. In emergency situations, idarucizumab was able to reverse dabigatran within a relatively short period without any serious adverse events.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Fibrilação Atrial/terapia , Tamponamento Cardíaco/tratamento farmacológico , Ablação por Cateter/efeitos adversos , Dabigatrana/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/efeitos adversos , Fibrilação Atrial/fisiopatologia , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/fisiopatologia , Dabigatrana/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Clin Cardiol ; 42(5): 506-512, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30937935

RESUMO

Atrial fibrillation (AF) is associated with a risk for cognitive impairment and dementia, which is more pronounced in patients with a history of clinical stroke. Observational trials suggest that the implementation and quality of long-term anticoagulation impact dementia risk. Emerging evidence suggests that direct oral anticoagulants may improve long-term risk of dementia in AF patients. This manuscript describes the rational and trial design of the the Cognitive Decline and Dementia in Atrial Fibrillation Patients (CAF) Trial. CAF investigates if AF patients randomized to dabigatran etexilate will have long-term higher cognition scores and lower rates of dementia compared in the long term to dose-adjusted warfarin (International Normalized Ratio [INR]: 2.0-3.0). As of 27 February 2019, a total of 120 subjects will be enrolled at one investigational site in the United States and will be followed for 2 years after study enrollment. To date, 97 have been enrolled. The average age is 74.2 years, 53% are male, and 9% had a prior stroke. In this Vanguard study, patients will be followed for 2 years after study enrollment. These prospective, randomized data will inform the understanding of two anticoagulants in AF patients as it relates to risk of cognitive decline and dementia. Cranial imaging and biomarkers collected will assist in understanding mechanisms of brain injury.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Cognição/efeitos dos fármacos , Disfunção Cognitiva/prevenção & controle , Dabigatrana/administração & dosagem , Demência/prevenção & controle , Varfarina/administração & dosagem , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Dabigatrana/efeitos adversos , Demência/diagnóstico , Demência/epidemiologia , Demência/psicologia , Feminino , Humanos , Incidência , Coeficiente Internacional Normatizado , Masculino , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Varfarina/efeitos adversos
17.
Am Heart J ; 212: 13-22, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30928824

RESUMO

BACKGROUND: In the RE-DUAL PCI trial of patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI), dabigatran dual therapy (110 or 150 mg bid, plus clopidogrel or ticagrelor) reduced International Society on Thrombosis and Haemostasis bleeding events compared with warfarin triple therapy, with noninferiority in overall thromboembolic events. This analysis assessed outcomes in relation to patient bleeding and stroke risk profiles, based on the modified HAS-BLED and CHA2DS2-VASc scores. METHODS: The primary endpoint, major bleeding event (MBE) or clinically relevant nonmajor bleeding event (CRNMBE), was compared across study arms in patients categorized by modified HAS-BLED score 0-2 or ≥3. The composite endpoint of death, thromboembolic event, and unplanned revascularization rates was compared in patients categorized by CHA2DS2-VASc score 0-1, 2, or ≥3. RESULTS: Risk of MBE or CRNMBE was lower with dabigatran dual therapy (both doses) versus warfarin triple therapy, irrespective of modified HAS-BLED category (treatment-by-subgroup interaction P-value 0.584 and 0.273 for dabigatran 110 and 150 mg dual therapy, respectively, vs warfarin). Risk of the composite thromboembolic endpoint was similar across CHA2DS2-VASc categories and consistent with overall study results (interaction P-value 0.739 and 0.075 for dabigatran 110 and 150 mg dual therapy, respectively, vs warfarin). Higher HAS-BLED scores were associated with higher risks of bleeding in AF patients after PCI in a treatment-independent analysis. CONCLUSION: Dabigatran dual therapy reduced bleeding events irrespective of bleeding risk category and demonstrated similar efficacy regardless of stroke risk category when compared with warfarin triple therapy.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/prevenção & controle , Dabigatrana/efeitos adversos , Hemorragia/induzido quimicamente , Intervenção Coronária Percutânea , Acidente Vascular Cerebral/induzido quimicamente , Varfarina/efeitos adversos , Idoso , Anticoagulantes/uso terapêutico , Clopidogrel/efeitos adversos , Clopidogrel/uso terapêutico , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Dabigatrana/uso terapêutico , Quimioterapia Combinada , Estudos de Equivalência como Asunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Tromboembolia/prevenção & controle , Ticagrelor/efeitos adversos , Ticagrelor/uso terapêutico , Varfarina/uso terapêutico
19.
Biomed Res Int ; 2019: 5473240, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30895193

RESUMO

Background: Combination of dual antiplatelet (DAPT) and oral anticoagulation therapy is required to decrease cardioembolic stroke and stent thrombosis risk in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS). We compared the safety and efficacy of dabigatran etexilate with vitamin K antagonist (VKA), in combination with DAPT (aspirin plus clopidogrel) treatment in AF patients who underwent percutaneous coronary intervention (PCI) with stenting for ACS. Methods: Consecutive nonvalvular AF patients who received twice-daily dabigatran 110 mg (n = 389) or VKA (n = 510) and DAPT were included. Primary endpoints were major bleeding (safety) and the composite of ischemic stroke, systemic embolism, and myocardial infarction (efficacy). The secondary efficacy endpoint was hospitalization for cardiovascular disease. Results: After propensity score matching, comparative treatment groups comprised 175 dabigatran recipients and 175 VKA recipients. The cumulative incidence of major bleeding was lower in the dabigatran group (2.3%) compared with the VKA group (10.3%) with a hazard ratio (HR) of 4.81 [95% confidence interval (CI) 1.6-14.2, p < 0.005]. The cumulative incidence of thromboembolic events with dabigatran was slightly higher (8.0%) than with VKA (6.85%), but not statistically significantly so (0.8, 0.39-1.8; p = 0.6). Cumulative incidence of hospitalization for cardiovascular disease was lower with dabigatran (10.3%) compared with VKA (20.6%) treatment (2.2, 1.25-3.8; p < 0.006). Conclusion: Dabigatran at the dose used for stroke prevention appears safer than VKA and maintains a similar efficacy profile, when used with DAPT, in AF patients who have undergone PCI with stenting for ACS.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Vitamina K/antagonistas & inibidores , Idoso , Quimioterapia Combinada , Feminino , Hemorragia/etiologia , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Masculino , Adesão à Medicação , Projetos Piloto , Probabilidade , Pontuação de Propensão , Tromboembolia/etiologia , Resultado do Tratamento
20.
BMC Cardiovasc Disord ; 19(1): 64, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30890131

RESUMO

BACKGROUND: Differences in adherence may represent drug properties (e.g. dosing interval) or patient experiences while on treatment. Adherence to direct oral anticoagulants (DOACs) in nonvalvular atrial fibrillation (NVAF) is important to maintain effectiveness over the course of treatment. METHODS: This was a retrospective cohort study using 2009-2015 Truven Health MarketScan Databases. New initiators of dabigatran, rivaroxaban, and apixaban with NVAF were identified. Twelve months of continuous enrollment before treatment was required to assess demographics and medical history. Proportion of days cover (PDC) was used to measure adherence at 3, 6, 9 and 12-month. Gaps in therapy and treatment switches were also evaluated. Logistic regression was used to compare high adherence (PDC ≥0.80). RESULTS: A total of 14,864 dabigatran, 16,005 rivaroxaban, and 8078 apixaban users were identified. Apixaban users had the highest adherence overall, with mean PDC at 3, 6, 9, and 12-months of 0.83, 0.76, 0.72, and 0.69, while dabigatran had the lowest adherence of 0.78, 0.67, 0.61, and 0.57. Adherence to DOACs increased with increased stroke risk scores. Adherence was also higher when first days supplied was > 30 days compared to 30 days and when filled via mail order pharmacies. Switching was highest among dabigatran users. Apixaban users were the most likely to have high adherence versus dabigatran (OR = 1.73, 95% CI = 1.60-1.88) and versus rivaroxaban (OR = 1.24, 95% CI = 1.14-1.34) at 12-months. CONCLUSIONS: Apixaban users had the highest overall adherence despite twice-daily dosing versus once-daily dosing for rivaroxaban. These findings can be useful for formulary decision-making and when assessing treatment options.


Assuntos
Antitrombinas/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Dabigatrana/administração & dosagem , Inibidores do Fator Xa/administração & dosagem , Adesão à Medicação , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Rivaroxabana/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Dabigatrana/efeitos adversos , Bases de Dados Factuais , Esquema de Medicação , Substituição de Medicamentos , Inibidores do Fator Xa/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Estudos Retrospectivos , Rivaroxabana/efeitos adversos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA