Carbamazepine interaction with direct oral anticoagulants: help from the laboratory for the personalized management of oral anticoagulant therapy

2019 ◽  
Vol 48 (3) ◽  
pp. 528-531 ◽  
Author(s):  
Leonardo Di Gennaro ◽  
Stefano Lancellotti ◽  
Raimondo De Cristofaro ◽  
Erica De Candia
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Carbamazepine Interaction ◽  
Personalized Management

scholarly journals Safety and differences between direct oral anticoagulants and vitamin K antagonists in the risk of post-traumatic intrathoracic bleeding after rib fractures in elderly patients

2021 ◽  
Vol 17 (4) ◽  
Author(s):  
Gianni Turcato ◽  
Arian Zaboli ◽  
Andrea Tenci ◽  
Giorgio Ricci ◽  
Massimo Zannoni ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Vitamin K ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Traumatic Bleeding ◽  
Post Traumatic

Closed chest traumas are frequent consequences of falls in the elderly. The presence of concomitant oral anticoagulant therapy can increase the risk of post-traumatic bleeding even in cases of trauma with non-severe dynamics. There is limited information about the differences between vitamin K antagonists and direct oral anticoagulants in the risk of post-traumatic bleeding. To assess differences in the risk of developing intra-thoracic hemorrhages after chest trauma with at least one rib fracture caused by an accidental fall in patients over 75 years of age taking oral anticoagulant therapy. This study involved data from four emergency departments over two years. All patients on oral anticoagulant therapy and over 75 years of age who reported a closed thoracic trauma with at least one rib fracture were retrospectively evaluated. Patients were divided into two study groups according their anticoagulant therapy. Of the 342 patients included in the study, 38.9% (133/342) were treated with direct oral anticoagulants and 61.1% (209/342) were treated with vitamin K antagonist. A total of 7% (24/342) of patients presented intrathoracic bleeding, while 5% (17/342) required surgery or died as a result for the trauma. Posttraumatic intrathoracic bleeding occurred in 4.5% (6/133) of patients receiving direct oral anticoagulants and 8.6% (18/209) of patients receiving vitamin K antagonist. Logistic regression analysis, revealed no difference in the risk of intrathoracic haemorrhages between the two studied groups. Direct oral anticoagulants therapy presents a risk of post-traumatic intrathoracic haemorrhage comparable to that of vitamin K antagonist therapy.

scholarly journals Performing diagnostic radial access coronary angiography on uninterrupted direct oral anticoagulant therapy: a prospective analysis

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001026 ◽  
Author(s):  
Napohn Chongprasertpon ◽  
Aiste Zebrauskaite ◽  
John Joseph Coughlan ◽  
Abdalla Ibrahim ◽  
Samer Arnous ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Control Group ◽  
Radial Compression ◽  
Direct Oral Anticoagulant ◽  
Diagnostic Coronary Angiography

PurposeWe sought to assess the safety of performing diagnostic radial access coronary angiography with uninterrupted anticoagulation on patients receiving direct oral anticoagulant therapy.BackgroundDirect oral anticoagulants have become a popular choice for the prevention of thromboembolism. Risk factors for thromboembolism are common among cardiovascular conditions and indications for direct oral anticoagulant therapy as well as coronary angiography often overlap in patients. It has been hypothesised that uninterrupted direct oral anticoagulant therapy would increase haemorrhagic and access site complications, however data in this area is limited.MethodsThis was a prospective observational analysis of 49 patients undergoing elective diagnostic coronary angiography while receiving uninterrupted anticoagulation with direct oral anticoagulants. This population was compared with a control group of 49 unselected patients presenting to the cardiology service for elective diagnostic coronary angiography. Continuous variables were analysed using the independent samples t-test and categorical variables using Pearson’s χ2 test.ResultsThe mean duration of radial compression for the control group was 235.8±62.8 min and for the uninterrupted direct oral anticoagulant group was 258.4±56.5 min. There was no significant difference in mean duration of radial compression (p=0.07; 95% CI=-1.4 to 46.5). There was also no difference in the complication rate between the two groups (p=1).ConclusionsWe observed similar complication rates and radial artery compression time postangiography in both groups. This small prospective observational study suggests that uninterrupted continuation of direct oral anticoagulants during coronary angiography is safe. Larger randomised control studies in this area would be beneficial.

Rebound Phenomenon After Discontinuation Of Oral Anticoagulant Therapy?

1981 ◽  
Author(s):  
J Harenberg ◽  
R Haas ◽  
R Zimmermann
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
In Vitro Release ◽  
Oral Anticoagulant Treatment ◽  
Thrombin Activity ◽  
Rebound Phenomenon

Duration and discontinuation of oral anticoagulant therapy in the prophylaxis of recurrent thrombembolic diseases is often discussed. After stopping of the therapy an elevated incidence of rethromboses are observed. Therefore we determined fibrinopeptide A (FPA) as the most sensitive parameter of thrombin activity in vivo in patients treated with phenprocoumon in order to get information on the effectivity of the oral anticoagulant therapy and on the rebound phenomenon after discontinuation of the treatment.In 136 outpatients a significant relation between FPA and the effectivity of the anticoagulant therapy was observed: 2.7 ng/ml plasma (mean, thrombotest values < 5%), 3.5 ng/ml (5%-15%) and 4.1 ng/ml (>15%, p < 0.01). Normal FPA were 1.4ng/ml. In 11 patients with low FPA the oral anticoagulants were discontinued. FPA was determined in weekly intervalls. Within four weeks a continous increase of FPA from 1.6 ng/ml (median) to 3.8 ng/ml was observed. After eight weeks FPA was 8.2 ng/ ml (p < 0.05). The in vitro release of FPA after 10 min incubation of blood increased from 3.4ng/ml to 72 ng/ml after eight weeks (p < 0.05, normal release up to 5 ng/ml).The data indicate the clinical relevance and the different therapeutic implications of the determination of FPA in patients treated with phenprocoumon. They further give the first criterion, which outlines the effectivity of an oral anticoagulation therapy by reducing the thrombin activity in vivo. They give some evidence for a rebound like phenomenon after discontinuation of the oral anticoagulant treatment.

scholarly journals Are Patients on Oral Anticoagulation Therapy Aware of its Effects? A Cross-sectional Study from Karachi, Pakistan

2020 ◽  
Author(s):  
Ibrahim Zahid ◽  
Syed Wajih Ul Hassan ◽  
Nida Sehar Bhurya ◽  
Sheena Nadeem Alam ◽  
Bakht Hussain Shah ◽  
...  
Keyword(s):  
Side Effects ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Herbal Medicines ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Life Threatening

Abstract Objective: Oral anticoagulants are one of the most frequently used medications. However, these drugs have a range of side effects including potential life-threatening complications. Little is known regarding the awareness of its side effect profile amongst the patients in Pakistan. Therefore, the aim of this study was to assess the knowledge of oral anticoagulant therapy and its side effects among its users. Results: The mean age was 48.9 ± 15.2 years. Mean scores of the participants for knowledge regarding oral anticoagulants and knowledge specific to warfarin were 49.9 ± 16.2% and 14.6 ± 16.4% respectively. Most notably, the majority of the patients (65.7%) did not know what side effects to be wary of or how to reduce their occurrence; and most of them were unaware of the interaction between oral anticoagulant drugs and over-the-counter substances such as aspirin, herbal medicines and alcohol. Knowledge of International Normalised Ratio (INR) was extremely poor with more than 75% of the population not being aware of the target INR range during warfarin therapy. Higher level of education was significantly associated with better knowledge scores. On the whole, knowledge of oral anticoagulant therapy and INR monitoring is extremely poor among oral anticoagulant users.

scholarly journals New Cancer Diagnosis After Bleeding in Anticoagulated Patients With Atrial Fibrillation

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Sergio Raposeiras Roubín ◽  
Emad Abu Assi ◽  
Cristina Barreiro Pardal ◽  
María Cespón Fernandez ◽  
Isabel Muñoz Pousa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Cancer Diagnosis ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Bleeding Events ◽  
Using Data ◽  
Anticoagulated Patients

Background Bleeding is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulant therapy, and may be the first manifestation of underlying cancer. We sought to investigate to what extent bleeding represents the unmasking of an occult cancer in patients with AF treated with oral anticoagulants. Methods and Results Using data from CardioCHUVI‐AF (Retrospective Observational Registry of Patients With Atrial Fibrillation From Vigo's Health Area), 8753 patients with AF aged ≥75 years with a diagnosis of AF between 2014 and 2017 were analyzed. Of them, 2171 (24.8%) experienced any clinically relevant bleeding, and 479 (5.5%) were diagnosed with cancer during a follow‐up of 3 years. Among 2171 patients who experienced bleeding, 198 (9.1%) were subsequently diagnosed with cancer. Patients with bleeding have a 3‐fold higher hazard of being subsequently diagnosed with new cancer compared with those without bleeding (4.7 versus 1.4 per 100 patient‐years; adjusted hazard ratio [HR], 3.2 [95% CI, 2.6–3.9]). Gastrointestinal bleeding was associated with a 13‐fold higher hazard of new gastrointestinal cancer diagnosis (HR, 13.4; 95% CI, 9.1–19.8); genitourinary bleeding was associated with an 18‐fold higher hazard of new genitourinary cancer diagnosis (HR, 18.1; 95% CI, 12.5–26.2); and bronchopulmonary bleeding was associated with a 15‐fold higher hazard of new bronchopulmonary cancer diagnosis (HR, 15.8; 95% CI, 6.0–41.3). For other bleeding (nongastrointestinal, nongenitourinary, nonbronchopulmonary), the HR for cancer was 2.3 (95% CI, 1.5–3.6). Conclusions In patients with AF treated with oral anticoagulant therapy, any gastrointestinal, genitourinary, or bronchopulmonary bleeding was associated with higher rates of new cancer diagnosis. These bleeding events should prompt investigation for cancers at those sites.

Duration of Oral Anticoagulant Therapy after Proximal Deep Vein Thrombosis: a Decision Analysis

1994 ◽  
Vol 71 (03) ◽  
pp. 286-291 ◽  
Author(s):  
François P Sarasin ◽  
Henri Bounameaux
Keyword(s):  
Deep Vein Thrombosis ◽  
Decision Analysis ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryThe optimal duration of oral anticoagulant therapy following proximal deep vein thrombosis (DVT) in the lower limbs remains controversial. To compare the risk benefit tradeoffs for different treatment durations (6 to 24 weeks) we constructed a Markov-based decision analysis model which explicitly balances the time-dependent declining risk of recurrent thrombosis and pulmonary embolism against the risk of major hemorrhagic complications. Specifically, we determined the threshold below which the risk of recurrent DVT exceeds the risk of major hemorrhage if anticoagulant therapy is discontinued, and above which the benefits provided by oral anticoagulants are outweighed by their risk.Our model shows that for patients with a low hemorrhagic risk (0.5%/month), the benefit yielded by oral anticoagulants breaks off beyond the 4th month of therapy, while patients with moderate (1%/month) to high (2%/month) bleeding risk will no longer benefit from the therapy after 3 or 2.5 months, respectively.In conclusion, our model supports the validity of the usually recommended duration of 3 months of oral anticoagulation after proximal vein thrombosis in the lower limbs, but suggests that this duration should be modulated between 2.5 and 4 months depending upon individual bleeding risk. Since clinical trials can hardly handle the complexity of the addressed issue, such a model may prove very helpful in daily clinical practice.

scholarly journals Are Patients on Oral Anticoagulation Therapy Aware of its Effects? A Cross-sectional Study from Karachi, Pakistan

2020 ◽  
Author(s):  
Ibrahim Zahid ◽  
Syed Wajih Ul Hassan ◽  
Nida Sehar Bhurya ◽  
Sheena Nadeem Alam ◽  
Bakht Hussain Shah ◽  
...  
Keyword(s):  
Side Effects ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Herbal Medicines ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Life Threatening

Abstract Objective: Oral anticoagulants are one of the most frequently used medications. However, these drugs have a range of side effects including potential life-threatening complications. Little is known regarding the awareness of its side effect profile amongst the patients in Pakistan. Therefore, the aim of this study was to assess the knowledge of oral anticoagulant therapy and its side effects among its users. Results: The mean age was 48.9± 15.2 years. Median scores of the participants for knowledge regarding oral anticoagulants and warfarin were 48.7 (8.3-91.7) and 10.3 (0.0-70.0) respectively. Of 207 patients, most notably, 65.7% did not know what side effects to be wary of or how to reduce their occurrence; and most patients were unaware of the interaction between oral anticoagulant drugs and over-the-counter substances such as aspirin, herbal medicines and alcohol. Knowledge of International Normalised Ratio (INR) was extremely poor with more than 75% of the population not being aware of the target INR range during warfarin therapy. Higher level of education was significantly associated with better knowledge scores. Overall, knowledge of oral anticoagulant therapy and INR monitoring is extremely poor among oral anticoagulant users.

scholarly journals Spontaneous rupture and hematoma of the sartorius muscle secondary to rivaroxaban therapy

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
Javier Ardebol ◽  
Mario Cahueque ◽  
Carlos Sanchez
Keyword(s):  
Anticoagulant Therapy ◽  
Spontaneous Rupture ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Sartorius Muscle ◽  
Factor X ◽  
Intracranial Hematomas

Abstract Spontaneous muscular hematomas are quite rare as they occur mush less frequently than intracranial hematomas and gastrointestinal bleeding in patients under oral anticoagulant therapy. Coumarins, such as warfarin or acitrom, are the most widely prescribed oral anticoagulants agents and have been associated more with the development of hematomas than direct factor X inhibitors, such as rivaroxaban [ 1]. Few reports have linked oral anticoagulation therapy with the development of muscular hematomas; however, clinical cases regarding the involvement of the sartorius muscle remain limited. Patients with advanced age, under oral anticoagulant therapy with pain and ecchymosis in the thigh region, should undergo radiological evaluation utilizing ultrasonography, computed tomography or magnetic resonance imaging to establish an accurate diagnosis. The following case consists of a patient that while resting presented with a spontaneous rupture and hematoma of the sartorius muscle secondary to rivaroxaban use. During follow-up, the patient recovered completely.

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