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1.
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
3.
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
4.
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
5.
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
8.
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
9.
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
10.
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
11.
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
12.
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
13.
Int J Clin Pract ; 73(4): e13308, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30589161

RESUMO

BACKGROUND: Novel oral anticoagulants are the cornerstone of therapy for non-valvular atrial fibrillation patients to lower the risk of ischaemic stroke. Given the lack of head-to-head comparisons among oral anticoagulants, a Bayesian analysis was used to evaluate their safety and efficacy based on studies from real-world practice. METHODS: The PubMed, Embase, Cochrane and Web of Science databases were searched for relevant studies. Bayesian analyses were conducted to estimate hazard ratios (HR) and 95% credible intervals (CrI) for the safety and efficacy of oral anticoagulants. RESULTS: In the 22 studies included in our analysis, novel oral anticoagulants exhibited a clear advantage over warfarin in preventing ischaemic stroke, haemorrhagic stroke and, especially, intracranial haemorrhage. Incidence of major bleeding was lowest for apixaban, followed by dabigatran, warfarin and rivaroxaban. Gastrointestinal bleeding risk was lowest for apixaban, followed by warfarin, and was slightly lower for dabigatran than for rivaroxaban with no statistical difference (HR 1.05, 95% CrI 0.99-1.11). Ischaemic stroke risk was lowest for rivaroxaban, followed by apixaban, dabigatran and warfarin (HR 1.13, 95% CrI 1.07-1.20). CONCLUSION: In real-world practice, apixaban may represent the optimal treatment in terms of safety and efficacy for patients with non-valvular atrial fibrillation. For patients with high risk of ischaemic events but low bleeding risk, rivaroxaban may be preferable.


Assuntos
Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Idoso , Teorema de Bayes , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Piridonas/efeitos adversos , Piridonas/uso terapêutico , Risco , Rivaroxabana/efeitos adversos , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/etiologia , Varfarina/efeitos adversos , Varfarina/uso terapêutico
14.
J. vasc. bras ; 18: e20180021, 2019.
Artigo em Português | LILACS | ID: biblio-984688

RESUMO

O tromboembolismo venoso (TEV) é uma doença frequente e de alta morbimortalidade, sendo considerada a maior causa evitável de mortalidade em pacientes hospitalizados. Apesar da incidência altíssima de TEV em todos os países e das evidências de que a tromboprofilaxia reduz as complicações tromboembólicas em pacientes clínicos e cirúrgicos, e a custo baixo, persistem grandes dúvidas quanto à segurança desse tipo de intervenção nos pacientes e quanto à tromboprofilaxia ideal. Inúmeros estudos e recomendações baseadas em evidências comprovam a eficácia da profilaxia na prevenção do TEV e/ou da morte dos pacientes, mas ainda hoje ela é subutilizada. Neste artigo, apresentamos uma ampla revisão dos métodos de profilaxia existentes até os dias atuais, publicados em diretrizes e estudos nacionais e internacionais sobre tromboprofilaxia


Venous thromboembolism (VTE) is a common disease with high rates of morbidity and mortality and is considered the number one cause of avoidable mortality among hospitalized patients. Although VTE incidence is extremely high in all countries and there is ample evidence that thromboprophylaxis inexpensively reduces the rate of thromboembolic complications in both clinical and surgical patients, a great deal of doubt remains with respect to patient safety with this type of intervention and in relation to the ideal thromboprophylaxis methods. Countless studies and evidence-based recommendations confirm the efficacy of prophylaxis for prevention of VTE and/or patient deaths, but it remains underutilized to this day. This article presents a wide-ranging review of existing prophylaxis methods up to the present, from guidelines and national and international studies of thromboprophylaxis


Assuntos
Humanos , Masculino , Feminino , Prevenção de Doenças , Tromboembolia Venosa/prevenção & controle , Pacientes Internados , Embolia Pulmonar/terapia , Fatores de Risco , Guias de Prática Clínica como Assunto/normas , Enoxaparina/uso terapêutico , Extremidade Inferior , Inibidores do Fator Xa/uso terapêutico , Rivaroxabana/uso terapêutico , Dabigatrana/uso terapêutico , Hemorragia/complicações , Anticoagulantes/uso terapêutico
15.
Ann Biol Clin (Paris) ; 77(1): 67-78, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30591426

RESUMO

Many neutralizing agents of anticoagulant effect of factor Xa or thrombin inhibitors (xabans and dabigatran, respectively) have been developed since the commercialization of direct oral anticoagulants (DOAC) in 2008. Idarucizumab is a specific antidote of dabigatran commercialised since 2016. An antidote of xabans, andexanet-α, was very recently approved by the Food and Drug Administration (FDA). Other antidotes of DOAC are under pre-clinical or clinical development; the most advanced being the aripazine in addition to γ-thrombine S195A and GDFXa-α2M complex. Prothrombin complex concentrates activated or not, are part of the pro-hemostatic agents suggested for DOAC handling in case of haemorrhage or preceeding urgent surgery or invasive procedures. Other pro-hemostatic agents (FXaI16L, FX (a)-C, superFVa) are in pre-clinical stage. The efficacy of these different agents in DOAC reversal and mortality reduction is still controversal in the light of the sparse results of in vitro, ex vivo, pre-clinical and clinical studies.


Assuntos
Anticoagulantes/administração & dosagem , Antídotos/classificação , Antídotos/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Administração Oral , Anticoagulantes/efeitos adversos , Anticoagulantes/farmacologia , Antitrombinas/uso terapêutico , Dabigatrana/uso terapêutico , Fator Xa/administração & dosagem , Fator Xa/farmacologia , Fator Xa/uso terapêutico , Inibidores do Fator Xa/classificação , Hemorragia/sangue , Hemorragia/complicações , Hemorragia/tratamento farmacológico , Humanos , Proteínas Recombinantes/uso terapêutico , Rivaroxabana/uso terapêutico
17.
Medicine (Baltimore) ; 97(51): e13623, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572474

RESUMO

RATIONALE: Anti-thrombosis therapy for atrial fibrillation (AF) management and stroke prevention is an important aspect of disease management. Novel oral anticoagulants (NOACs) are recommended by guidelines for AF management. However, if one can switch one NOAC to another when the former showed a poor effect has not been fully determined. PATIENT CONCERNS: A 52-year-old man was admitted to our center for heart failure and AF with a thrombus in the left atrium. DIAGNOSES: Cardiomyopathy was diagnosed by cardiac magnetic resonance (CMR) and echocardiography. INTERVENTIONS: He was prescribed rivaroxaban (20 mg daily) as treatment, and dabigatran (150 mg twice daily) was used when the thrombus was found to be non-response to rivaroxaban. OUTCOMES: The rivaroxaban did not diminish the atrial thrombus, and dabigatran was given instead which finally eliminated the thrombus. LESSONS: Individualized responsiveness to NOACs should be considered and paid more attention to during clinical practice.


Assuntos
Antitrombinas/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Dabigatrana/uso terapêutico , Cardiopatias/tratamento farmacológico , Trombose/tratamento farmacológico , Fibrilação Atrial/etiologia , Resistência a Medicamentos , Átrios do Coração , Cardiopatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Rivaroxabana/uso terapêutico , Trombose/complicações
18.
Medicine (Baltimore) ; 97(46): e12841, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30431565

RESUMO

BACKGROUND: Dabigatran is a kind of oral anticoagulant and there was little review only about dabigatran and warfarin used in patients with atrial fibrillation. This meta-analysis only assesses the dabigatran and warfarin used in patients with atrial fibrillation. DESIGN: Cochrane Library, PubMed, Clinical Trials.gov, CNKI, and WanFang databases were searched. The primary endpoint was the incidence of stroke and the second endpoints were the incidence of bleeding and embolic events. RESULTS: Six RCTs and 20086 patients were included in our meta-analysis. No significant difference was obtained between 110 mg dabigatran and warfarin on the endpoint of stroke (risk ratio (RR), 0.90; 95% confidence interval [CI], 0.71-1.12; P = .34; I = 0%) and embolic events p (RR, 0.89; 95% CI, 0.71-1.12; P = .32; I = 0%). However, the 110 mg dabigatran associated lower incidence of bleeding (RR, 0.81; 95% CI, 0.69-0.95; P = .01; I = 0%) compare with warfarin. When compared with 150 mg dabigatran, warfarin associated with lower rate of stroke (RR, 0.96; 95% CI, 0.83-1.12; P = .62; I = 0%) and embolic events (RR, 0.67; 95% CI, 0.53-0.86; P = .001; I = 0%) but similar in the incidence of bleeding (RR, 0.67; 95% CI, 0.53-0.86; P = .001; I = 0%). CONCLUSION: No significant difference was obtained between 110 mg dabigatran and warfarin in the incidence of stroke and embolic events. However, the 110 mg dabigatran associated lower incidence of bleeding compare with warfarin. When compared with 150 mg dabigatran, warfarin associated with lower incidence of stroke and embolic events but similar in the incidence of bleeding.


Assuntos
Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Fibrilação Atrial/complicações , Dabigatrana/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico , Adulto , Idoso , Fibrilação Atrial/patologia , Embolia/epidemiologia , Embolia/etiologia , Embolia/prevenção & controle , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
19.
J. vasc. bras ; 17(4)out.-dez. 2018. graf, tab
Artigo em Português | LILACS | ID: biblio-969128

RESUMO

A number of limitations of standard therapy with warfarin for deep vein thrombosis (DVT) have been established. This overview of systematic reviews presents the baseline results for efficacy and safety of the new direct oral anticoagulants (DOACs) thrombin inhibitors, and activated factor X (Xa) inhibitors in patients with DVT. Searches were run on PubMed and the Cochrane Database of Systematic Reviews. Twenty-three studies were retrieved, and one systematic review was judged eligible. This review scored maximum according to AMSTAR criteria and included 7,596 patients for analysis of thrombin inhibitors and 16,356 patients for analysis of factor Xa inhibitors. The results of the meta-analysis indicate that DOACs are similar for DVT treatment when compared to standard treatment with warfarin. The incidence of major bleeding is somewhat lower in patients treated with factor Xa inhibitors and similar to standard therapy when treated with direct thrombin inhibitors


A terapia padrão com varfarina para a trombose venosa profunda (TVP) tem uma série de limitações já estabelecidas. Essa revisão de revisões sistemáticas elenca os principais resultados de eficácia e segurança dos anticoagulantes orais diretos (DOACs), inibidores da trombina e do fator X ativado (Xa), em pacientes com TVP. A pesquisa foi realizada nas bases PubMed e Cochrane Database of Systematic Reviews. Foram recuperados 23 estudos, e uma revisão sistemática foi considerada elegível. Essa revisão atingiu escore máximo no AMSTAR e incluiu 7.596 pacientes para análise dos inibidores da trombina e 16.356 pacientes para a análise dos inibidores do fator Xa. Os resultados da metanálise indicam que os DOACs apresentam eficácia similar à terapia padrão no tratamento da TVP. A incidência de sangramento maior é um pouco menor nos pacientes tratados com os inibidores do fator Xa e similar à terapia padrão no tratamento com inibidores diretos da trombina


Assuntos
Humanos , Masculino , Feminino , Revisão , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Varfarina/uso terapêutico , Heparina/uso terapêutico , Trombina , Fatores de Risco , Interações de Medicamentos , Tromboembolia Venosa/terapia , Inibidores do Fator Xa/uso terapêutico , Rivaroxabana/uso terapêutico , Dabigatrana/uso terapêutico , Hemorragia
20.
J Thromb Thrombolysis ; 46(4): 521-527, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30196343

RESUMO

Data are limited on the effects of drug interactions on direct-acting oral anticoagulant (DOAC) levels. We evaluated the effects of the use of interacting drugs on DOAC levels in patients with atrial fibrillation (AF). We reviewed data of AF patients tested for DOAC levels in 2013-2017. The primary outcomes were drug levels exceeding the expected steady-state range, and in the highest quartile. A multivariate analysis was performed to evaluate the correlation of treatment by the use of interacting drugs, CYP3A4 and P-glycoprotein (P-gp) inhibitors, with the primary outcomes. Overall, 147 patients underwent DOAC level measurement [dabigatran (n = 31), rivaroxaban (n = 29), apixaban (n = 87)]. Thirty-three (22.4%) had drug levels exceeding the expected range. Seventy-nine (53.7%) patients were treated with at least one interacting drug. In multivariate analysis, the concomitant use of interacting drugs was an independent predictor for drug levels exceeding the expected range (OR 3.3, 95% CI 1.20-9.05). The defined daily dose of the interacting drug correlated positively with DOAC levels (r = 0.29, P = 0.001). Co-treatment with interacting drugs was associated with extremely high levels of dabigatran, (OR 16.6, 95% CI 1.29-215.18) but not of the other DOAC examined. Concomitant use of interacting drugs is associated with high DOAC levels in patients with AF. Further investigation is warranted to establish the differences between specific DOAC, evaluate the effect on patient outcomes, and characterize the role of DOAC monitoring in this setting.


Assuntos
Anticoagulantes/sangue , Fibrilação Atrial/tratamento farmacológico , Interações de Medicamentos , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/antagonistas & inibidores , Administração Oral , Adulto , Idoso , Inibidores do Citocromo P-450 CYP3A , Dabigatrana/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Estudos Retrospectivos , Rivaroxabana/uso terapêutico
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