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3.
Anaesth Intensive Care ; 47(2): 183-188, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31116016

RESUMO

Dabigatran is an oral anticoagulant used for atrial fibrillation and venous thromboembolism. While an effective antibody reversal agent is available, its cost precludes routine use and the mainstay of preoperative management is timely dabigatran interruption. Unlike warfarin, there are no universally accepted protocols for interruption of dabigatran in the preoperative period and there is uncertainty around the interpretation of standard coagulation tests in the presence of dabigatran. We performed a prospective, observational pilot study in patients presenting for elective surgery to examine: 1) the preoperative plasma dabigatran concentrations on day of surgery associated with the local dabigatran interruption protocol, 2) the potential utility of dabigatran concentrations on day of surgery, and 3) the utility of standard coagulation tests in determining whether dabigatran concentrations were below a 'safe' threshold for surgery. We recruited patients presenting to pre-admission clinics for elective surgery. Dabigatran concentrations below 30 µg/L were considered adequate for proceeding with surgery. Data were obtained and analysed from 21 patients with a median (range) age of 70 (20-86) years. Median (range) dabigatran concentrations on the day of surgery were 5 (0-59) µg/L. Two patients had day of surgery concentrations exceeding 30 µg/L. Of the standard coagulation tests examined, only the thrombin clotting time (TCT) was abnormal for these two patients. Our interruption protocol was associated with safe dabigatran concentrations in most patients on the day of surgery. A minority of patients had dabigatran concentrations above the safe threshold, which were detectable by abnormal TCT results.


Assuntos
Anticoagulantes , Coagulação Sanguínea , Dabigatrana , Anticoagulantes/farmacocinética , Anticoagulantes/uso terapêutico , Antitrombinas , Dabigatrana/farmacocinética , Dabigatrana/uso terapêutico , Humanos , Projetos Piloto , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios , Tempo de Trombina
4.
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
6.
PLoS One ; 14(3): e0211766, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845196

RESUMO

BACKGROUND AND OBJECTIVE: Elderly patients with atrial fibrillation (AF) are known to have a high risk of stroke and bleeding. We investigated the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in octogenarian patients with non-valvular AF compared with warfarin. METHODS: A total of 687 octogenarian patients with AF who were administered NOACs (n = 403) or warfarin (n = 284) for stroke prevention between 2012 and 2016 were included. Thromboembolic (TE) events (stroke or systemic embolism), major bleeding events, and all-cause death were analyzed. RESULTS: The NOACs group (age 83.4±3.2 years, women 52.4%, CHA2DS2-VASc score 5.0±1.8) comprised 141 dabigatran, 158 rivaroxaban, and 104 apixaban users. Most patients from the NOACs group had been prescribed a reduced dose of medication (85.6%). During 14±18 months of follow-up periods, there were 19 TE events and 18 major bleeding events. Patients with NOAC showed a lower risk of TE (1.84 vs. 2.71 per 100 person-years, hazard ration [HR] 0.134, 95% confidence interval [CI] 0.038-0.479, P = 0.002), major bleeding (1.48 vs. 2.72 per 100 person-years, HR 0.110, 95% CI 0.024-0.493, P = 0.001), and all-cause death (2.57 vs. 3.50 per 100 person-years, HR 0.298, 95% CI 0.108-0.824, P = 0.020). CONCLUSION: In octogenarian Asian patients with AF, NOACs might be associated with lower risks of thromboembolic events, major bleeding, and all-cause death than warfarin. Although most patients had received reduced doses, on-label use of NOACs was effective and safe.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Administração Oral , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Dabigatrana/uso terapêutico , Feminino , Seguimentos , Hemorragia/epidemiologia , Humanos , Masculino , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Estudos Retrospectivos , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento , Varfarina/uso terapêutico
7.
Drugs ; 79(6): 621-631, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30905033

RESUMO

Cancer accounts for 20% of all venous thromboembolism (VTE) worldwide and cancer patients are at four- to sevenfold increased risk of thrombosis compared to non-cancer patients. VTE is also a morbid complication of cancer and its incidence is rising. Thrombosis is also a second leading cause of death in cancer patients. The standard of care management for the prevention and treatment of cancer-associated thrombosis (CAT) remains the administration of low-molecular-weight heparins (LMWHs). In the last decade, five direct oral anticoagulants (DOACs), dabigatran, rivaroxaban, apixaban, edoxaban and betrixaban, have been approved for the treatment and prevention of VTE in the general patient population. In this review, we discuss the results of the already published clinical trials with DOACs in the treatment of CAT and the ongoing clinical trials with DOACs in the prevention and treatment of CAT.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Administração Oral , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/farmacologia , Benzamidas/uso terapêutico , Dabigatrana/uso terapêutico , Heparina de Baixo Peso Molecular , Humanos , Pirazóis/uso terapêutico , Piridinas/uso terapêutico , Piridonas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Rivaroxabana/uso terapêutico , Tiazóis/uso terapêutico
8.
Medicina (Kaunas) ; 55(3)2019 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-30884868

RESUMO

Ischemic stroke is a complex multifactorial disorder. Anticoagulation is a growing research area, with the main goal of preventing systemic embolization and stroke. We report the case of a 41-year-old woman with antiphospholipid syndrome who was unsuccessfully treated with Dabigatran, a new oral anticoagulant, as she developed a major stroke involving the right carotid artery, due to deep venous thrombosis with pulmonary embolism. We therefore suggest a closer monitoring of the safety and efficacy of dabigatran. Moreover, in the presence of multifactorial causes of pro-coagulation, we believe that warfarin should remain the mainstay of oral anticoagulation.


Assuntos
Síndrome Antifosfolipídica/tratamento farmacológico , Antitrombinas/efeitos adversos , Antitrombinas/uso terapêutico , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico , Aborto Espontâneo , Acenocumarol/uso terapêutico , Adulto , Antitrombinas/administração & dosagem , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Angiografia por Tomografia Computadorizada , Dabigatrana/administração & dosagem , Feminino , Seguimentos , Humanos , Vigilância de Produtos Comercializados/métodos , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
9.
Crit Care ; 23(1): 62, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30795779

RESUMO

There is a high degree of uncertainty regarding optimum care of patients with potential or known intake of oral anticoagulants and traumatic brain injury (TBI). Anticoagulation therapy aggravates the risk of intracerebral hemorrhage but, on the other hand, patients take anticoagulants because of an underlying prothrombotic risk, and this could be increased following trauma. Treatment decisions must be taken with due consideration of both these risks. An interdisciplinary group of Austrian experts was convened to develop recommendations for best clinical practice. The aim was to provide pragmatic, clear, and easy-to-follow clinical guidance for coagulation management in adult patients with TBI and potential or known intake of platelet inhibitors, vitamin K antagonists, or non-vitamin K antagonist oral anticoagulants. Diagnosis, coagulation testing, and reversal of anticoagulation were considered as key steps upon presentation. Post-trauma management (prophylaxis for thromboembolism and resumption of long-term anticoagulation therapy) was also explored. The lack of robust evidence on which to base treatment recommendations highlights the need for randomized controlled trials in this setting.


Assuntos
Anticoagulantes/uso terapêutico , Lesões Encefálicas Traumáticas/tratamento farmacológico , Administração Oral , Anticoagulantes/efeitos adversos , Áustria , Lesões Encefálicas Traumáticas/fisiopatologia , Consenso , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Desamino Arginina Vasopressina/farmacologia , Humanos , Comunicação Interdisciplinar , Tempo de Tromboplastina Parcial/métodos , Pirazóis/análise , Pirazóis/sangue , Pirazóis/uso terapêutico , Piridinas/análise , Piridinas/sangue , Piridinas/uso terapêutico , Piridonas/análise , Piridonas/sangue , Piridonas/uso terapêutico , Rivaroxabana/análise , Rivaroxabana/sangue , Rivaroxabana/uso terapêutico , Tiazóis/análise , Tiazóis/sangue , Tiazóis/uso terapêutico , Tromboembolia/prevenção & controle , Tomografia Computadorizada por Raios X/métodos , Ácido Tranexâmico/uso terapêutico , Resultado do Tratamento , Vitamina K/antagonistas & inibidores , Vitamina K/uso terapêutico
10.
Yonsei Med J ; 60(3): 277-284, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30799590

RESUMO

PURPOSE: Label adherence for non-vitamin K antagonist oral anticoagulants (NOACs) has not been well evaluated in Asian patients with non-valvular atrial fibrillation (AF). The present study aimed to assess label adherence for NOACs in a Korean AF population and to determine risk factors of off-label prescriptions of NOACs. MATERIALS AND METHODS: In this COmparison study of Drugs for symptom control and complication prEvention of AF (CODE-AF) registry, patients with AF who were prescribed NOACs between June 2016 and May 2017 were included. Four NOAC doses were categorized as on- or off-label use according to Korea Food and Drug Regulations. RESULTS: We evaluated 3080 AF patients treated with NOACs (dabigatran 27.2%, rivaroxaban 23.9%, apixaban 36.9%, and edoxaban 12.0%). The mean age was 70.5±9.2 years; 56.0% were men; and the mean CHA2DS2-VASc score was 3.3±1.4. Only one-third of the patients (32.7%) was prescribed a standard dose of NOAC. More than one-third of the study population (n=1122, 36.4%) was prescribed an off-label reduced dose of NOAC. Compared to those with an on-label standard dosing, patients with an off-label reduced dose of NOAC were older (≥75 years), women, and had a lower body weight (≤60 kg), renal dysfunction (creatinine clearance ≤50 mL/min), previous stroke, previous bleeding, hypertension, concomitant dronedarone use, and anti-platelet use. CONCLUSION: In real-world practice, more than one-third of patients with NOAC prescriptions received an off-label reduced dose, which could result in an increased risk of stroke. Considering the high risk of stroke in these patients, on-label use of NOAC is recommended.


Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Fibrilação Atrial/tratamento farmacológico , Rotulagem de Medicamentos , Adesão à Medicação , Vitamina K/antagonistas & inibidores , Administração Oral , Idoso , Fibrilação Atrial/complicações , Dabigatrana/administração & dosagem , Dabigatrana/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pirazóis/uso terapêutico , Piridinas/uso terapêutico , Piridonas/uso terapêutico , República da Coreia , Fatores de Risco , Rivaroxabana/administração & dosagem , Rivaroxabana/uso terapêutico , Tiazóis/uso terapêutico
11.
Crit Care Nurs Clin North Am ; 31(1): 77-90, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30736937

RESUMO

The purpose of this article is to educate staff nurses and advanced practice nurses the importance of identifying, diagnosing, and making appropriate clinical decisions when treating patients with atrial fibrillation. Atrial fibrillation is a supraventricular arrhythmia characterized by uncoordinated, chaotic electrical activity and deterioration of proper atrial mechanical function, with an irregular ventricular response. Poorly controlled or undiagnosed atrial fibrillation increases the risk of mortality and may decrease quality of life. Identifying and staying abreast of cardiovascular care and current updates in treatment is strongly encouraged as guidelines are revised and updated as new treatments evolve.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/enfermagem , Enfermagem de Cuidados Críticos , Antitrombinas/uso terapêutico , Dabigatrana/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Hemorragia/prevenção & controle , Humanos , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle
12.
Isr J Health Policy Res ; 8(1): 19, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709417

RESUMO

INTRODUCTION: In the past decade, direct-acting oral anticoagulants (DOAC) have been introduced to medical practice for several indications, with a wide range of dosing regimens. As both over- and under-dosing might lead to life-threatening events, development of methods promoting safe and effective utilization of these agents is imperative. The Hadassah Clinical Pharmacy team initiated a hospital-wide program, for monitoring and promoting safe and effective prescription of DOAC during hospitalization. This study describes the types of drug related problems addressed and the program's performance in terms of consultation rates and physician acceptance. METHODS: Electronic medical records throughout the hospital were screened for DOAC orders. All DOAC orders were assessed by a clinical pharmacist for potentially-inappropriate prescribing. When potentially-inappropriate prescribing or a drug-related problem was identified, the clinical pharmacist provided consultation on management options. In specific cases, additional guidance was provided by coagulation and pharmacology specialists. Data on patient characteristics, clinical pharmacist consultations, and physician response was retrospectively retrieved for the first six months of 2017. Characteristics of patients with and without consultations were compared, consultations were categorized by the recommended management of the drug related problem, and physician acceptance rates were evaluated by category. RESULTS: During the evaluated period, 585 patients with DOAC orders were identified. Patients were evenly distributed by gender, and age averaged 78 years. Most patients received apixaban (75%) followed by rivaroxaban (14%) and dabigatran (11%), and most (63%) received "reduced dose" regimens. Clinical pharmacists provided 258 consultations for 210 patients, regarding anticoagulation management, such that more than one in three patients on DOAC had potentially inappropriate prescribing or drug related problems. Consultations included alerts regarding potentially inappropriate DOAC doses and recommendations to increase (29%) or decrease (5%) the dose, potentially inappropriate concomitant antiplatelet agents (20%), need for DOAC level monitoring (23%), and alerts regarding other drug related problems (23%). More than 70% of recommendations were accepted by the attending physician. CONCLUSION: Due to the complexity of DOAC management, potentially-inappropriate prescribing and drug related problems are common. Multidisciplinary collaborative projects including review and consultation by clinical pharmacists are an effective method of improving management of patients on DOAC. TRIAL REGISTRATION: Retrospectively registered at clinicaltrials.gov, NCT03527615 .


Assuntos
Anticoagulantes/uso terapêutico , Sobremedicalização/prevenção & controle , Farmacêuticos/tendências , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Revisão de Uso de Medicamentos , Feminino , Humanos , Israel , Masculino , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Piridonas/efeitos adversos , Piridonas/uso terapêutico , Estudos Retrospectivos , Rivaroxabana/efeitos adversos , Rivaroxabana/uso terapêutico
14.
Thromb Haemost ; 119(1): 14-38, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30597497

RESUMO

Non-vitamin K antagonist oral anticoagulants (NOACs) include dabigatran, which inhibits thrombin, and apixaban, betrixaban, edoxaban and rivaroxaban, which inhibit factor Xa. In large clinical trials comparing the NOACs with the vitamin K antagonist (VKA) warfarin, dabigatran, apixaban, rivaroxaban and edoxaban were at least as effective for stroke prevention in atrial fibrillation and for treatment of venous thromboembolism, but were associated with less intracranial bleeding. In addition, the NOACs are more convenient to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. Consequently, the NOACs are now replacing VKAs for these indications, and their use is increasing. Although, as a class, the NOACs have a favourable benefit-risk profile compared with VKAs, choosing among them is complicated because they have not been compared in head-to-head trials. Therefore, selection depends on the results of the individual trials, renal function, the potential for drug-drug interactions and preference for once- or twice-daily dosing. In addition, several 'special situations' were not adequately studied in the dedicated clinical trials. For these situations, knowledge of the unique pharmacological features of the various NOACs and judicious cross-trial comparison can help inform prescription choices. The purpose of this position article is therefore to help clinicians choose the right anticoagulant for the right patient at the right dose by reviewing a variety of special situations not widely studied in clinical trials.


Assuntos
Anticoagulantes/uso terapêutico , Cardiopatias/complicações , Trombina/antagonistas & inibidores , Vitamina K/antagonistas & inibidores , Administração Oral , Anticorpos Monoclonais Humanizados/uso terapêutico , Arginina/análogos & derivados , Arginina/uso terapêutico , Fibrilação Atrial/prevenção & controle , Benzamidas/uso terapêutico , Biomarcadores/metabolismo , Coagulação Sanguínea , Ensaios Clínicos como Assunto , Dabigatrana/uso terapêutico , Esquema de Medicação , Fator Xa/uso terapêutico , Cardiopatias/tratamento farmacológico , Humanos , Piperazinas/uso terapêutico , Pirazóis/uso terapêutico , Piridinas/uso terapêutico , Piridonas/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Risco , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Tiazóis/uso terapêutico , Tromboembolia Venosa/tratamento farmacológico , Varfarina/uso terapêutico
15.
Heart Vessels ; 34(6): 1002-1013, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30599063

RESUMO

Some experimental studies have shown that direct oral anticoagulants (DOACs) have anti-inflammatory effects. However, the interval changes in inflammatory markers in patients with non-valvular atrial fibrillation (AF) who receive DOACs remain unknown. Between July 2013 and April 2014, a total of 187 AF patients randomly assigned to receive rivaroxaban (n = 91) or dabigatran (n = 96) were assessed for eligibility. The levels of the following inflammatory markers were serially evaluated: high-sensitivity C-reactive protein, pentraxin-3, interleukin (IL)-1ß, IL-6, IL-18, tumor necrosis factor-α, monocyte chemotactic protein-1, growth and differentiation factor-15, and soluble thrombomodulin (sTM). The aim in this study was to evaluate the anti-inflammatory effects of rivaroxaban and dabigatran in patients with AF, in addition to the impact of markers on bleeding events. Finally, 117 patients (rivaroxaban: n = 55, dabigatran: n = 62) were included in the analysis at 12 months. Although the interval changes in sTM levels tended to be greater in the dabigatran group [0.3 (0-0.7) vs. 0.5 (0-1.0) FU/ml, p = 0.061], there were no significant differences in the interval changes in any inflammatory marker between 2 groups. There were no significant differences in bleeding events between 2 groups. The interval changes in sTM levels were significantly greater in patients with bleeding compared with those without [0.8 (0.5-1.3) vs. 0.4 (- 0.1-0.8) FU/ml, p = 0.017]. There were no significant differences in the interval changes in any inflammatory marker between rivaroxaban and dabigatran treatments in patients with AF. The increased levels of sTM after DOACs treatment might be related to bleeding events.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Dabigatrana/uso terapêutico , Hemorragia/induzido quimicamente , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Idoso , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Dabigatrana/efeitos adversos , Feminino , Hemorragia/epidemiologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Análise de Regressão , Rivaroxabana/efeitos adversos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/etiologia
16.
J Thromb Thrombolysis ; 47(3): 403-408, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30600427

RESUMO

There are no clear and consistent guidelines on how to utilize DOAC assays, and reports on the use of DOAC levels in clinical practice is limited. The objective of this study was to analyze why DOAC levels are ordered, how the results affect clinical decision-making, and to determine if DOAC assays are utilized appropriately. This was a retrospective chart review study analyzing 150 dabigatran, rivaroxaban, and apixaban levels performed at a single institution. The majority of DOAC assays were ordered in situations or special patient populations where confirming absence or detecting presence of drug may be useful. The most common indication for ordering assays was prior to an invasive procedure. Most DOAC levels were timed appropriately but peak levels were most likely to be incorrectly ordered. Clinical decisions following level results depended on indication for ordering and were most commonly used to determine whether or not to proceed with an invasive procedure. The results of our study suggest while DOAC assays are generally ordered for useful indications, there is still a lack of understanding of when levels should be drawn and how to interpret DOAC assay results.


Assuntos
Monitoramento de Medicamentos/métodos , Inibidores do Fator Xa/sangue , Padrões de Prática Médica/normas , Anticoagulantes/sangue , Anticoagulantes/farmacologia , Anticoagulantes/uso terapêutico , Dabigatrana/sangue , Dabigatrana/farmacologia , Dabigatrana/uso terapêutico , Tomada de Decisões , Inibidores do Fator Xa/farmacologia , Inibidores do Fator Xa/uso terapêutico , Feminino , Humanos , Masculino , Pirazóis/sangue , Pirazóis/farmacologia , Pirazóis/uso terapêutico , Piridonas/sangue , Piridonas/farmacologia , Piridonas/uso terapêutico , Estudos Retrospectivos , Rivaroxabana/sangue , Rivaroxabana/farmacologia , Rivaroxabana/uso terapêutico , Procedimentos Cirúrgicos Operatórios/métodos
17.
Clin Drug Investig ; 39(4): 355-362, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30697670

RESUMO

BACKGROUND AND OBJECTIVES: Warfarin-related nephropathy is an unexplained acute kidney injury, and may occur in patients with supratherapeutic INR, in the absence of overt bleeding. Similar findings have been observed in rats treated with dabigatran etexilate. We conducted a prospective study in dabigatran etexilate-treated patients to assess the incidence of dabigatran-related nephropathy and to investigate the possible correlation between dabigatran plasma concentration (DPC) and worsening renal function. METHOD: One hundred and seven patients treated long term with dabigatran etexilate for non-valvular atrial fibrillation (NVAF) were followed up for 90 days. DPC, serum creatinine (SCr) and serum cystatin C were prospectively measured. Ninety five patients had complete follow-up data and were evaluable for primary endpoint. RESULTS: Eleven patients had supratherapeutic DPC, defined as DPC higher than 200 ng/ml at study enrolment, but at the end of follow-up no patient showed a persistent increase in SCr. No patients experienced acute kidney injury. CONCLUSIONS: Our study shows that no persistent renal detrimental effect is associated with dabigatran treatment. An increase in SCr during dabigatran treatment is reversible and it seems to be unrelated to dabigatran itself.


Assuntos
Antitrombinas/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Dabigatrana/uso terapêutico , Rim/efeitos dos fármacos , Rim/fisiologia , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/farmacologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Dabigatrana/farmacologia , Feminino , Seguimentos , Humanos , Testes de Função Renal/tendências , Masculino , Estudos Prospectivos
19.
Turk Kardiyol Dern Ars ; 47(1): 4-9, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30628896

RESUMO

OBJECTIVE: It is not known whether direct-acting oral anticoagulants (DOACs), such as dabigatran, apixaban, and rivaroxaban increase the risk of bleeding complications during or after coronary catheterization. The aim of this study was to investigate the safety of uninterrupted DOAC treatment during diagnostic radial coronary angiography (CAG). METHODS: This study included 160 patients who underwent diagnostic radial cardiac catheterization. The 60 patients in the group who were using a DOAC (apixaban, rivaroxaban, or dabigatran) were enrolled in a Group A. Post-procedure results from patients in Group A were compared with those of an age- and sex-matched control group (Group B) that included 100 patients who underwent radial CAG who did not use a DOAC. RESULTS: There was no significant difference in the procedure and compression times, creatinine level, or presence of hypertension, diabetes mellitus, smoking, alcohol use, vascular disease, or congestive heart failure between the 2 groups. During the 1 -month follow-up period, only 1 radial occlusion was registered in the control group (Group B). There was no case of a large hematoma (>5 cm or extending to the forearm), dissection, fistula, perforation, or compartment syndrome. Hematomas smaller than 5 cm were seen in 2 patients (1 in each group). No thrombotic events were observed during follow-up examinations. CONCLUSION: Performing radial CAG with uninterrupted DOAC treatment appears to carry no risk of increased early or short-term complications. The simple, uninterrupted DOAC strategy is comfortable, easy, and safe.


Assuntos
Anticoagulantes , Cateterismo Cardíaco , Angiografia Coronária , Idoso , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/estatística & dados numéricos , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Feminino , Hematoma/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Piridonas/efeitos adversos , Piridonas/uso terapêutico , Rivaroxabana/efeitos adversos , Rivaroxabana/uso terapêutico , Trombose/epidemiologia
20.
Pathology ; 51(3): 292-300, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30665674

RESUMO

We and others have previously highlighted the potential problems with testing of lupus anticoagulants (LA) in patients on anticoagulant therapy, including most recently as related to the direct oral anticoagulants (DOACs). Thus, current DOACs in use (e.g., dabigatran, a direct thrombin inhibitor, and apixaban and rivaroxaban, both direct Xa inhibitors), affect a wide variety of coagulation assays, including those used in LA investigation. The Russell viper venom time (RVVT) assay in particular, key to the investigation of LA, is highly sensitive to DOACs. LA is a marker of thrombophilia, and patients who have had a thrombosis may be placed on a DOAC. Thus, there is a high likelihood that LA testing will be requested on patients whilst they are on DOACs. In the current report, we have assessed data from our facility for the past two and a half years for all LA tests performed by RVVT testing, and have evaluated this data with respect to patient anticoagulant status. In total, there were 7170 test requests for RVVT associated testing during the period of data capture. Most LA-RVVT screen results (5008; ∼70%) were within normal limits, thereby excluding LA by RVVT method in most of the patient cohort. All DOACs led to a prolongation in both RVVT screen and confirm assays. However, rivaroxaban affected the screen more than the confirm, leading to higher RVVT ratios, whereas apixaban affected the confirm more than the screen, leading to lower RVVT ratios. LA testing in the presence of DOACs also led to lower intra-patient consistency in LA test results. We conclude that ex-vivo data appears to confirm the potential for false positive (with rivaroxaban) and potential for false negative (with apixaban) identification of LA in patients on DOAC treatment. We also make some recommendations in regards to such testing.


Assuntos
Anticoagulantes/farmacologia , Síndrome Antifosfolipídica/diagnóstico , Testes de Coagulação Sanguínea , Coagulação Sanguínea/efeitos dos fármacos , Inibidor de Coagulação do Lúpus/análise , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/sangue , Dabigatrana/farmacologia , Dabigatrana/uso terapêutico , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Tempo de Protrombina , Rivaroxabana/farmacologia , Rivaroxabana/uso terapêutico , Trombofilia/sangue , Trombofilia/tratamento farmacológico
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