201 Outcomes Associated With Andexanet Use in Patients With Factor Xa Inhibitor-Associated Intracranial Hemorrhage: A One-Year Single-Center Analysis

Background: Clinical practice guidelines recommend that cerebral venous thrombosis (CVT) be managed with long-term anticoagulant therapy using warfarin or low-molecular-weight heparin (LMWH) for 3 to 12 months. However, oral factor Xa inhibitors may offer preferable alternative treatment options for these patients. Objective: The primary objective was to determine the effectiveness and safety of rivaroxaban or apixaban compared with warfarin or enoxaparin as long-term anticoagulation therapy for patients with a new diagnosis of CVT. Methods: This was a single-center retrospective review of patients with newly diagnosed CVT who received acute and maintenance anticoagulation treatment. Study groups compared patients who received warfarin, enoxaparin, or an oral factor Xa inhibitor as their maintenance anticoagulant. The primary outcome was recurrent thrombotic events while on anticoagulation. Secondary outcomes included modified Rankin Scale, improved cerebral venous sinus opacification, duration of anticoagulant therapy, bleeding events during anticoagulant therapy, and adverse effects. Results: A total of 119 patients were included in the analysis: warfarin (89), enoxaparin (11), and oral factor Xa inhibitor (19). The risk of recurrent thrombotic events were 11.2%, 0%, and 10.5% in the warfarin, enoxaparin, and oral factor Xa inhibitor treatment groups, respectively ( P = 0.7635). There were no significant between-group differences observed regarding any of the secondary outcomes. Conclusions: Although the sample size is limited, these findings indicate that oral factor Xa inhibitors are a reasonable treatment option for patients with CVT. There was a trend toward more persistent symptoms in patients on warfarin, suggesting a potential improvement in recovery among patients that received an oral factor Xa inhibitor.

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Factor Xa Inhibitor-Related Intracranial Hemorrhage

Circulation ◽

10.1161/circulationaha.120.045769 ◽

2020 ◽

Vol 141 (21) ◽

pp. 1681-1689 ◽

Cited By ~ 10

Author(s):

Nicholas G. Panos ◽

Aaron M. Cook ◽

Sayona John ◽

G. Morgan Jones ◽

Hallie Kelly ◽

...

Keyword(s):

Hospital Mortality ◽

Intracranial Hemorrhage ◽

Thrombotic Event ◽

Factor Xa ◽

High Rate ◽

Factor Xa Inhibitor ◽

Efficacy Evaluation ◽

Full Cohort ◽

Number Of Patients ◽

Hemostatic Efficacy

Background: Since the approval of the oral factor Xa inhibitors, there have been concerns regarding the ability to neutralize their anticoagulant effects after intracranial hemorrhage (ICH). Multiple guidelines suggest using prothrombin complex concentrates (PCCs) in these patients on the basis of research that includes a limited number of patients with ICH. Given this, we aimed to evaluate the safety and efficacy of PCCs for factor Xa inhibitor–related ICH in a large, multicenter cohort of patients. Methods: This was a multicenter, retrospective, observational cohort study of patients with apixaban- or rivaroxaban-related ICH who received PCCs between January 1, 2015, and March 1, 2019. The study had 2 primary analysis groups: safety and hemostatic efficacy. The safety analysis evaluated all patients meeting inclusion criteria for the occurrence of a thrombotic event, which were censored at hospital discharge or 30 days after PCC administration. Patients with intracerebral, subarachnoid, or subdural hemorrhages who had at least 1 follow-up image within 24 hours of PCC administration were assessed for hemostatic efficacy. The primary efficacy outcome was the percentage of patients with excellent or good hemostasis on the basis of the modified Sarode criteria. Secondary outcomes included an evaluation of in-hospital mortality, length of stay, infusion-related reactions, and thrombotic event occurrence during multiple predefined periods. Results: A total of 663 patients were included and assessed for safety outcomes. Of these, 433 patients met criteria for hemostatic efficacy evaluation. We observed excellent or good hemostasis in 354 patients (81.8% [95% CI, 77.9–85.2]). Twenty-five (3.8%) patients had a total of 26 thrombotic events, of which 22 occurred in the first 14 days after PCC administration. One patient had documentation of an infusion-related reaction. For the full cohort of patients, in-hospital mortality was 19.0%, and the median intensive care unit and hospital lengths of stay were 2.0 and 6.0 days, respectively. Conclusions: Administration of PCCs after apixaban- and rivaroxaban-related ICH provided a high rate of excellent or good hemostasis (81.8%) coupled with a 3.8% thrombosis rate. Randomized, controlled trials evaluating the clinical efficacy of PCCs in patients with factor Xa inhibitor–related ICH are needed.

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Low dose versus standard dose four factor prothrombin complex concentrate for factor‐Xa inhibitor reversal in spontaneous and traumatic intracranial hemorrhage

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy ◽

10.1002/phar.2525 ◽

2021 ◽

Author(s):

Ava E. Cascone ◽

Mitchell J. Daley ◽

Neil Pan ◽

Eimeira Padilla‐Tolentino ◽

Truman J. Milling

Keyword(s):

Intracranial Hemorrhage ◽

Prothrombin Complex Concentrate ◽

Low Dose ◽

Standard Dose ◽

Factor Xa ◽

Factor Xa Inhibitor ◽

Traumatic Intracranial Hemorrhage

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383 Evidence based cardiovascular medication prior and one year after elective aortic valve replacement ? A single center experience

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(04)90292-5 ◽

2004 ◽

Vol 3 (1) ◽

pp. 99

Author(s):

K KNOBLOCH

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Evidence Based ◽

Single Center ◽

Cardiovascular Medication ◽

Single Center Experience ◽

One Year

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One-year clinical follow-up and outcomes in patients after drug-eluting stent implantation for unprotected left main coronary stenosis: A single center study from Turkey

Journal of Clinical and Investigative Surgery ◽

10.25083/2559.5555/5.1/43.50 ◽

2020 ◽

Vol 5 (1) ◽

pp. 43-50

Author(s):

Ibrahim Halil Inanc ◽

◽

Esra Polat ◽

Fatma Yılmaz Coskun

Keyword(s):

Stent Implantation ◽

Coronary Stenosis ◽

Drug Eluting Stent ◽

Single Center ◽

Left Main ◽

Single Center Study ◽

Drug Eluting ◽

One Year ◽

Center Study

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Highly selective diversion with proactive leakage management after low anterior resection for rectal cancer

British Journal of Surgery ◽

10.1093/bjs/znab018 ◽

2021 ◽

Author(s):

K Talboom ◽

I Vogel ◽

R D Blok ◽

S X Roodbeen ◽

C Y Ponsioen ◽

...

Keyword(s):

Low Anterior Resection ◽

Case Series ◽

Fecal Diversion ◽

Single Center ◽

Single Centre ◽

Diverting Stoma ◽

Faecal Diversion ◽

One Year ◽

Diversion Rate

Abstract In this single center case series with nine percent primary diversion, 86 of 94 patients alive and with complete follow-up at one year had a functioning anastomosis. Seventy-five of the initial 99 patients never had a stoma. Meaning: Highly selective fecal diversion in combination with proactive leakage management, low anastomoses can be preserved safely, and the majority of patients will be spared all disadvantages of a diverting stoma. In this single-centre case series, with a primary diversion rate of 9 per cent, 86 of 94 patients who were alive and had complete follow-up at 1 year had a functioning anastomosis. Seventy-five of the initial 99 patients never had a stoma. The results indicate that, with highly selective faecal diversion in combination with proactive leakage management, low anastomoses can be preserved safely, and the majority of patients will be spared the disadvantages of a diverting stoma.

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