scholarly journals TCTAP A-094 Clinical Outcomes of Patients Received Lower Dose of Non-vitamin K Antagonist Oral Anticoagulants as a Medical Management for Acute Pulmonary Embolism

2019 ◽  
Vol 73 (15) ◽  
pp. S51
Author(s):  
Jin Sup Park ◽  
Jiyeon Shin ◽  
Han Cheol Lee ◽  
Kwang Soo Cha ◽  
Taek Jong Hong
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Outcomes ◽  
Vitamin K ◽  
Medical Management ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist

Non-Vitamin K Antagonist Oral Anticoagulants in Pulmonary Embolism: An Overview of Systematic Reviews

2020 ◽  
Vol 26 (23) ◽  
pp. 2686-2691 ◽  
Author(s):  
Ioannis Doundoulakis ◽  
Christina Antza ◽  
Haralambos Karvounis ◽  
George Giannakoulas
Keyword(s):  
Pulmonary Embolism ◽  
Vitamin K ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Randomized Clinical Trials ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Language Restriction ◽  
Overview Of Systematic Reviews

Background: Anticoagulation in patients with pulmonary embolism. Objective: To identify how non-vitamin K antagonist oral anticoagulants are associated with multiple outcomes in patients with pulmonary embolism. Methods: We performed a systematic search of systematic reviews via multiple electronic databases from inception to August 19th, 2019, without language restriction. Two authors independently extracted data and assessed the methodological quality of the included systematic reviews using the ROBIS tool. Results: We found twelve systematic reviews. Eleven SRs collected their data from randomized clinical trials and one from observational studies. All the included studies were published between 2014 and 2019 in English. The methodological quality of the 12 systematic reviews was low to high. None of the systematic reviews, which are included in our overview of systematic reviews, has evaluated the overall quality of evidence outcome using the Grading of Recommendations Assessments, Development and Evaluation (GRADE) approach. Conclusion: This is the first effort to summarize evidence about non-vitamin K antagonist oral anticoagulants in an overview of systematic reviews focusing exclusively on patients with pulmonary embolism. The evidence suggests that the non-vitamin K antagonist oral anticoagulants seem to be more effective and safer than a dualdrug approach with LMWH- VKA.

Off-label dosing of non–vitamin K antagonist oral anticoagulants and clinical outcomes in Asian patients with atrial fibrillation

Heart Rhythm ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. 2102-2110
Author(s):  
Yi-Hsin Chan ◽  
Tze-Fan Chao ◽  
Shao-Wei Chen ◽  
Hsin-Fu Lee ◽  
Yung-Hsin Yeh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Off Label ◽  
Asian Patients

P4758Label adherence of non-vitamin K antagonist oral anticoagulants and clinical outcomes in patients with atrial fibrillation: A nationwide study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H T Yu ◽  
P S Yang ◽  
E Jang ◽  
T H Kim ◽  
J S Uhm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Clinical Outcomes ◽  
Vitamin K ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Systemic Embolism ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Dose adjustment of non-vitamin K antagonist oral anticoagulants (NOACs) is indicated in some patients with atrial fibrillation (AF), based on selected patient factors or concomitant medications. Purpose We assessed the frequency of label adherence of NOAC dosing among AF patients and the associations between off-label NOAC dosing and clinical outcomes in real-world clinical practice. Methods We evaluated 53,649 AF patients treated with a NOAC using Korean National Health Insurance Service database during the period from January 2013 to December 2016. NOAC doses were classified as either underdosed or overdosed, consistent with U.S. Food and Drug Administration labeling. Cox proportional hazards regression was performed to investigate the effectiveness and safety outcomes including stroke or systemic embolism, major bleeding, and all-cause mortality. Results Overall, 16,757 NOAC-treated patients (31.2%) were underdosed, 4,492 were overdosed (8.4%), and 32,400 (60.4%) were dosed appropriately according to drug labeling. Compared with patients with label adherence, those who were underdosed or overdosed were older (71±8 and 75±7 years of age vs. 70±9 years of age, respectively; p<0.001), more likely female (39% and 53% vs. 38%, respectively; p<0.001), and had higher CHA2DS2-VASc scores (4.6±1.7 and 5.3±1.7 vs. 4.5±1.8, respectively; p<0.001). NOAC overdosing was associated with increased risk for stroke or systemic embolism (5.76 vs. 4.03 events/100 patient-years, p<0.001), major bleeding (4.77 vs. 2.94 events/100 patient-years, p<0.001), and all-cause mortality (5.43 vs. 3.05 events/100 patient-years, p<0.001) compared with label-adherent use. Figure 1 Conclusion In routine clinical practice, a significant proportion (almost 2 in 5) of AF patients received NOAC doses inconsistent with drug labeling. NOAC overdosing is associated with increased risk for stroke or systemic embolism, major bleeding, and all-cause mortality in Asian patient with AF.

scholarly journals Comparison of non-vitamin K antagonist oral anticoagulants and warfarin on clinical outcomes in atrial fibrillation patients with renal dysfunction

EP Europace ◽  
2015 ◽  
Vol 17 (suppl 2) ◽  
pp. ii69-ii75 ◽  
Author(s):  
Ki Hong Lee ◽  
Hyung Wook Park ◽  
Jeong Gwan Cho ◽  
Nam Sik Yoon ◽  
Sung Soo Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Dysfunction ◽  
Clinical Outcomes ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist

scholarly journals Acute treatment of venous thromboembolism

Blood ◽  
2020 ◽  
Vol 135 (5) ◽  
pp. 305-316 ◽  
Author(s):  
Cecilia Becattini ◽  
Giancarlo Agnelli
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Vitamin K ◽  
Acute Pulmonary Embolism ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Anticoagulant Treatment ◽  
Specific Patient ◽  
Long Term Outcome ◽  
Patient Disposition

Abstract All patients with venous thromboembolism (VTE) should receive anticoagulant treatment in the absence of absolute contraindications. Initial anticoagulant treatment is crucial for reducing mortality, preventing early recurrences, and improving long-term outcome. Treatment and patient disposition should be tailored to the severity of clinical presentation, to comorbidities, and to the potential to receive appropriate care in the outpatient setting. Direct oral anticoagulants (DOACs) used in fixed doses without laboratory monitoring are the agents of choice for the treatment of acute VTE in the majority of patients. In comparison with conventional anticoagulation (parenteral anticoagulants followed by vitamin K antagonists), these agents showed improved safety (relative risk [RR] of major bleeding, 0.61; 95% confidence interval [CI], 0.45-0.83) with a similar risk of recurrence (RR, 0.90; 95% CI, 0.77-1.06). Vitamin K antagonists or low molecular weight heparins are still alternatives to DOACs for the treatment of VTE in specific patient categories such as those with severe renal failure or antiphospholipid syndrome, or cancer, respectively. In addition to therapeutic anticoagulation, probably less than 10% of patients require reperfusion by thrombolysis or interventional treatments; those patients are hemodynamically unstable with acute pulmonary embolism, and a minority of them have proximal limb-threatening deep vein thrombosis (DVT). The choice of treatment should be driven by the combination of evidence from clinical trials and by local expertise. The majority of patients with acute DVT and a proportion of selected hemodynamically stable patients with acute pulmonary embolism can be safely managed as outpatients.

scholarly journals Bariatric Surgery can Lower the Efficacy of DOACs

2020 ◽  
Author(s):  
Zouheir Ibrahim Bitar ◽  
Ossama Sajeh Maadarani ◽  
Mohamed Jaber Mohsen ◽  
Nawal Usamah Alkazemi
Keyword(s):  
Bariatric Surgery ◽  
Pulmonary Embolism ◽  
Sleeve Gastrectomy ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Antithrombotic Drug ◽  
History Of ◽  
Shed Light

A 39-year-old woman who was taking the contraceptive pill was admitted with right leg deep venous thrombosis (DVT). She was started on apixaban tablets, but after 8 days developed proximal progression of the DVT and pulmonary embolism. Her medical history later showed a history of sleeve gastrectomy. The patient responded to a vitamin K antagonist after heparin. The failure of the antithrombotic drug shed light on the efficacy and changed pharmacodynamics of direct oral anticoagulants (DOACs) after bariatric surgery in the absence of commercially available blood monitoring tests.

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