scholarly journals Dual Pathway Inhibition with Low-Dose Direct Factor Xa Inhibition after Acute Coronary Syndromes—Why Is It Not Used in Clinical Practice?

2018 ◽  
Vol 118 (09) ◽  
pp. 1528-1534 ◽  
Author(s):  
Uwe Zeymer ◽  
Benedikt Schrage ◽  
Dirk Westermann
Keyword(s):  
Clinical Practice ◽  
Secondary Prevention ◽  
Low Dose ◽  
Factor Xa ◽  
Bleeding Complications ◽  
Direct Factor ◽  
Anti Platelet Therapy ◽  
Factor Xa Inhibition ◽  
Dual Pathway ◽  
Pathway Inhibition

AbstractThe optimal anti-thrombotic therapy for secondary prevention after an acute coronary syndrome is still a matter of debate. While current guidelines recommend dual anti-platelet therapy with aspirin and a P2Y12 inhibitor over 12 months especially in patients with stent implantation, the value of prolonged anticoagulation is still controversial. In the ATLAS-TIMI 52 trial, a low-dose direct factor Xa inhibition with rivaroxaban compared with placebo reduced the combined primary endpoint of cardiovascular mortality, myocardial infraction and stroke with an increase in major bleeding complications. This article discusses the value and problems of adding low-dose rivaroxaban to anti-platelet therapy as secondary prevention measure after an acute myocardial infarction. It will describe the pros and cons of intensified anti-platelet therapy versus dual pathway inhibition and give recommendations for different patient groups in clinical practice.

Evaluation of the Use of Low-Dose 4-Factor Prothrombin Complex Concentrate in the Reversal of Direct Oral Anticoagulants in Bleeding Patients

2018 ◽  
Vol 35 (9) ◽  
pp. 903-908 ◽  
Author(s):  
Teresa A. Allison ◽  
Pei Jen Lin ◽  
Jennifer A. Gass ◽  
Kenneth Chong ◽  
Samuel J. Prater ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Prothrombin Complex Concentrate ◽  
Low Dose ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Final Analysis ◽  
Factor Xa Inhibitor ◽  
Direct Factor

Objective: This study investigated the percentage of patients who achieved hemostasis with 4-factor prothrombin complex concentrate (4-factor PCC) 35 U/kg. The primary end point was to determine the effect of 4-factor PCC 35 U/kg on bleeding progression, assessed using computed tomography. Methods: This was a retrospective, observational, single-center study conducted in patients with a major bleed admitted to a level 1 trauma center from May 1, 2013, to June 15, 2015, who received 4-factor PCC 35 U/kg for reversal of a direct factor Xa inhibitor taken prior to admission. Results: Thirty-three patients were included in the study, with 31 patients in the final analysis. The mean (standard deviation) age was 73 (14.8) years; 54.5% of patients were female. Of the 33 patients, 13 presented with a traumatic brain injury, 9 with an aneurysmal subarachnoid hemorrhage, 8 with an intracerebral hemorrhage, 1 with a gastrointestinal bleed, 1 with a hematoma with active extravasation, and 1 with an intra-abdominal bleed. The most frequently used direct factor Xa inhibitor was rivaroxaban (81.8%). Overall, 83.8% of patients achieved hemostasis with 4-factor PCC 35 U/kg. Progression of hemorrhage was observed in 4 patients on repeat computed tomography scan and 1 patient had continued surgical bleeding. No thromboembolic events were reported. Conclusions: Low-dose, 4-factor PCC 35 U/kg appeared to produce hemostasis in a majority of the patients. This may be an effective dosing regimen for anticoagulant reversal of factor Xa inhibitors in clinically bleeding patients.

Direct factor Xa inhibitor edoxaban: from bench to clinical practice

2015 ◽  
Vol 8 (6) ◽  
pp. 707-725 ◽  
Author(s):  
MPA Brekelmans ◽  
S Middeldorp ◽  
M Coppens
Keyword(s):  
Clinical Practice ◽  
Factor Xa ◽  
Factor Xa Inhibitor ◽  
Direct Factor

Postoperative Hypercoagulability, Detection And Measurement Using A Modified Recalcification Time System, Effects Of Low Dose Heparin And Types Of Surgery

1981 ◽  
Author(s):  
P B Lundquist ◽  
J Swedenborg
Keyword(s):  
Healthy Volunteers ◽  
Low Dose ◽  
Factor Xa ◽  
Inhibition Test ◽  
Time System ◽  
Arterial Grafts ◽  
Dose Heparin ◽  
Factor Xa Inhibition ◽  
Recalcification Time ◽  
Low Dose Heparin

The purpose of the study was to demonstrate postoperative hypercoagulability and its possible prevention by low dose heparin (LDH). Healthy volunteers (with LDH), patients undergoing cholecystectomy (with & without LDH) and patients undergoing arterial reconstructive surgery with synthetic grafts (with LDH), were tested. All were tested 1, 3 & 5 hrs after LDH.Overall coagulability was determined by using platelet free plasma and a modified recalcification time system with a nefelometer to detect first fibrin formation. Recalcification times were measured before (T0) and after (TA) plasma activation against glass, in vitro. Heparin levels were determined with the Factor Xa inhibition test using a chromogenic substrate (CoatestR, Kabi).T0 and TA were prolonged after LDH in healthy volunteers. Cholecystectomy caused shortening of T0 and TA. This could be prevented by LDH, raising T0 to level recorded after LDH in normals. Patients receiving synthetic arterial grafts showed no prolongation of T0 and TA after surgery with LDH, but rather a shortening. These patients showed hypercoagulability in spite of LDH.It is concluded that postoperative hypercoagulability can be traced with the presented method and counteracted by LDH in patients undergoing cholecystectomy but not in patients receiving synthetic arterial grafts. All patients on LDH had similar heparin levels, determined with the Factor Xa inhibition test. Vascular surgery with synthetic grafting and Cholecystectomy seem to induce two different kinds of hypercoagulability, where the former is thought to be induced by the foreign surface. Subcutaneous heparin therapy (LDH) results in poor inhibition of surface induced coagulation, in vivo.

scholarly journals Dual Pathway Inhibition for Vascular Protection in Patients with Atherosclerotic Disease: Rationale and Review of the Evidence

2020 ◽  
Vol 120 (08) ◽  
pp. 1147-1158 ◽  
Author(s):  
Jeffrey Ian Weitz ◽  
Dominick J. Angiolillo ◽  
Tobias Geisler ◽  
Stefan Heitmeier
Keyword(s):  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Standard Of Care ◽  
Atherosclerotic Disease ◽  
Vascular Protection ◽  
Coronary Syndrome ◽  
Plaque Disruption ◽  
Dual Pathway ◽  
Artery Disease ◽  
Pathway Inhibition

AbstractDespite advances in secondary prevention strategies in patients with cardiovascular disease, the residual risk of recurrent atherothrombotic events remains high. Dual-antiplatelet therapy is the standard of care for secondary prevention in patients with acute coronary syndrome (ACS), whereas single antiplatelet therapy, generally with aspirin, is the standard of care for secondary prevention in stable patients with coronary artery disease (CAD), peripheral artery disease (PAD), or cerebrovascular disease. However, atherosclerotic plaque disruption not only triggers platelet activation but also results in thrombin generation because of tissue factor exposure. Therefore, blocking both pathways by combining antiplatelet therapy with an anticoagulant, or dual pathway inhibition (DPI), has the potential to be more effective than inhibiting either pathway alone. The benefit of DPI has been demonstrated in the ATLAS ACS 2-TIMI 51, COMPASS, and VOYAGER PAD trials, where the combination of rivaroxaban vascular dose (2.5 mg twice daily) plus aspirin significantly reduced the risk of atherothrombotic events compared with aspirin across a broad range of patients, including those with recent ACS, those with chronic CAD and/or PAD, and patients with PAD who have undergone peripheral revascularization. This article provides the rationale for this regimen in more detail, including why the DPI regimen with the rivaroxaban vascular dose was developed for vascular protection in a broad spectrum of patients with atherosclerotic disease.

scholarly journals First Experience With Direct Factor Xa Inhibition in Patients With Stable Coronary Disease

Circulation ◽  
2002 ◽  
Vol 105 (20) ◽  
pp. 2385-2391 ◽  
Author(s):  
Christopher K. Dyke ◽  
Richard C. Becker ◽  
Neal S. Kleiman ◽  
Judith S. Hochman ◽  
Edwin G. Bovill ◽  
...  
Keyword(s):  
Coronary Disease ◽  
Factor Xa ◽  
Direct Factor ◽  
Factor Xa Inhibition
Sign in / Sign up

Export Citation Format

Share Document