scholarly journals Utilization of apixaban anti-Xa levels in transition from apixaban to warfarin in a patient with chronic renal dysfunction

2021 ◽  
Author(s):  
Brittany Elgersma ◽  
Sara Zochert
Keyword(s):  
Renal Dysfunction ◽  
Factor Xa ◽  
International Normalized Ratio ◽  
Bridging Therapy ◽  
Vein Thrombosis ◽  
Acceptable Range ◽  
Parenteral Agent ◽  
Prolonged Effect ◽  
Final Article ◽  
Deep Vein

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The effect of apixaban on anti–factor Xa (anti-Xa) assays and international normalized ratio (INR) complicates transitions between anticoagulant agents. When switching from apixaban to warfarin, the recommendation is to begin both a parenteral anticoagulant and warfarin at the time of the next apixaban dose and to discontinue the parenteral agent when INR is in an acceptable range. This proves challenging in renal dysfunction, as continued presence of apixaban contributes to both a prolonged effect on the INR and continued therapeutic levels of anticoagulation. Summary This case describes the transition of apixaban to warfarin in a patient with acute on chronic kidney disease and recent deep vein thrombosis, utilizing chromogenic apixaban anti-Xa assays to assess the level of anticoagulation and avoid unnecessary parenteral anticoagulation. Conclusion Utilization of apixaban anti-Xa levels aided in the transition from apixaban to warfarin in a patient with chronic renal failure and avoided need for parenteral bridging therapy.

scholarly journals ORAL ANTICOAGULANTS IN THE TREATMENT OF VENOUS THROMBOEMBOLIC COMPLICATIONS: FOCUS ON APIXABAN

2017 ◽  
pp. 56-62 ◽  
Author(s):  
M. Yu. Gilyarov ◽  
E. V. Konstantinova
Keyword(s):  
Vitamin K ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Vitamin K Antagonist ◽  
Fixed Dose ◽  
Vein Thrombosis ◽  
Venous Thromboembolic ◽  
Deep Vein

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common condition associated with a significant clinical and economic burden. Anticoagulant therapy is the mainstay of treatment for VTE. Current guidelines recommend the use of either low molecular weight heparins or fondaparinux overlapping with and followed by a vitamin K antagonist for the initial treatment of VTE, with the vitamin K antagonist continued when long-term anticoagulation is required. These traditional anticoagulants have practical limitations that have led to the development of direct oral anticoagulants that directly target either Factor Xa or thrombin and are administered at a fixed dose without the need for routine coagulation monitoring. The paper reviews results of the trials of apixaban application for treatment and/or long-term secondary prevention of VTE. The paper analyses effectiveness and safety of apixaban in different groups of patients, as well as features of apixaban application in every day practice.

scholarly journals COAGULOGRAM INDICES IN PATIENTS WITH DEEP VEIN TROMBOSIS, DEPENDING ON THE METHOD OF TREATMENT

2020 ◽  
pp. 81-85
Author(s):  
Ya. M. Popovich ◽  
V. V. Rusin
Keyword(s):  
Deep Vein Thrombosis ◽  
Surgical Treatment ◽  
Anticoagulant Therapy ◽  
Quantitative Estimation ◽  
Treatment Method ◽  
International Normalized Ratio ◽  
Average Concentration ◽  
Vein Thrombosis ◽  
Mechanical Removal ◽  
Deep Vein

Summary. Despite a satisfactory number of research which dedicated on coagulogram changes in patients with DVT, they are rarely used in clinical practice for the diagnosis of thrombosis, more often for the correction of anticoagulant therapy. The aim of research. Estimate the changes of coagulogram indices in patients with deep vein thrombosis, depending on the type of treatment performed. Materials and methods. Has been performed the quantitative estimation of coagulogram indices in 721 patients with deep vein thrombosis. Depending on the treatment method, the patients were divided into two groups: І – 382 (53 %) patients, which performed the surgical treatment with the following prescription the anticoagulant therapy; ІІ – 339 (47 %) patients, which performed only the anticoagulant therapy. Results. Has been observed more expression of hypocoagulation in patients of I group for the essesment the most of the coagulogram indices: the level of D-dimer was 14.1 % lower than in II group, the average concentration of thrombocyte was 7.8 %, the prothrombin index was 7.1 %, the international normalized ratio by 3.8 %, the level of hematocrit by 2.4 %, platelet count by 1.9 % lower than in patients ІІ group. More expression the prolongation of activated thromboplastin time, activated recalcification time and prothrombin time for 37.9 %, 10.6 % and 4.8 %, respectively, was observed in I group compared with the patients II group. At the same time, the level of fibrinogen in the I group was 9.1 % higher compared with the patients II group. Conclusions. Hypocoagulation changes of haemostasis in patients which performed the surgical treatment for deep vein thrombosis, compared to patients with isolated anticoagulant therapy, suggest that mechanical removal of thrombotic masses promotes faster normalization of indices hemostasis.

Rivaroxaban in der Prävention und Therapie thromboembolischer Erkrankungen

2012 ◽  
Vol 32 (03) ◽  
pp. 195-202
Author(s):  
T. Helbing ◽  
C. Bode ◽  
M. Moser
Keyword(s):  
Low Dose ◽  
Factor Xa ◽  
Coagulation Factor ◽  
Replacement Surgery ◽  
Vein Thrombosis ◽  
Hip Replacement Surgery ◽  
Coronary Syndrome ◽  
Prevention And Treatment ◽  
Deep Vein ◽  
Routine Coagulation

SummaryRivaroxaban (Xarelto®) is a new anticoagulant for the prevention and treatment of thromboembolic disorders. Rivaroxaban inhibits coagulation factor Xa directly, has high oral bioavailability, shows low propensity for drug-drug interactions and requires no routine coagulation monitoring. In patients undergoing elective knee or hip replacement surgery rivaroxaban (10 mg/d) is highly effective to prevent venous thromboembolism. In patients with non-valvular atrial fibrillation rivaroxaban (20 mg/d) has been approved to prevent stroke or systemic embolism. The favourable benefit-risk profile of rivaroxaban in the treatment of deep vein thrombosis (DVT) was shown in EINSTEIN-DVT and led to its clinical approval (twice daily 15 mg for 3 weeks, followed by 20mg/d). Based on ATLASACS-TIMI-51 which has shown that rivaroxaban (2.5 mg twice daily) reduced thrombotic cardiovascular events and mortality in patients with a recent acute coronary syndrome, the approval of low dose rivaroxaban has been submitted for this indication.Taken together, rivaroxaban may become an effective alternative to standard anticoagulants in the prevention and treatment of thromboembolic disorders.

Anticoagulation Treatment in Venous Thromboembolism: Options and Optimal Duration

2021 ◽  
Vol 27 ◽  
Author(s):  
Stavrianna Diavati ◽  
Marios Sagris ◽  
Dimitrios Terentes-Printzios ◽  
Charalambos Vlachopoulos
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Anticoagulation Therapy ◽  
Factor Xa ◽  
Coagulation Cascade ◽  
Clinical Genetic ◽  
Vein Thrombosis ◽  
Anticoagulation Treatment ◽  
Molecular Pathophysiology ◽  
Deep Vein

: Venous thromboembolism (VTE), clinically presenting as deep-vein thrombosis (DVT) or pulmonary embolism (PE), constitutes a major global healthcare concern with severe complications, long-term morbidity and mortality. Although several clinical, genetic and acquired risk factors for VTE have been identified, the molecular pathophysiology and mechanisms of disease progression remain poorly understood. Anticoagulation has been the cornerstone of therapy for decades, but there still are uncertainties regarding primary and secondary VTE prevention, as well as optimal therapy duration. In this review we discuss the role of factor Xa in coagulation cascade and the different choices of anticoagulation therapy based on patients’ predisposing risk factors and risk of event recurrence. Further, we compare newer agents to traditional anticoagulation treatment, based on most recent studies and guidelines.

Evaluating anticoagulation sensitivity among elderly patients managed with an institution’s heparin protocol using initial anti-factor Xa levels

2020 ◽  
Vol 77 (Supplement_1) ◽  
pp. S13-S18
Author(s):  
Adley Lemke ◽  
Jean Kohs ◽  
Lynn Weber
Keyword(s):  
Elderly Patients ◽  
Retrospective Cohort ◽  
Elderly Population ◽  
Factor Xa ◽  
The Elderly ◽  
Target Level ◽  
P Values ◽  
Vein Thrombosis ◽  
Coronary Syndrome ◽  
Deep Vein

Abstract Purpose The purpose of this study was to assess an institution’s heparin protocols in elderly and nonelderly adult populations to see if a response difference was observed. Methods This was a retrospective cohort study of hospitalized adults who were prescribed unfractionated heparin due to surgery, acute coronary syndrome (ACS), or deep vein thrombosis/pulmonary embolism (DVT/PE) from February 11, 2016, through August 1, 2017. Patients were divided into nonelderly adults 18 to 69 years of age and elderly patients 70 years of age or older. The anti-factor Xa (anti-Xa) level after protocol initiation was compared to the institution’s goal range of 0.3 to 0.7 IU/mL. Outcomes of each protocol in the elderly population were compared to outcomes in their nonelderly counterparts to determine if there was a difference in heparin response. Results A total of 325 patients were included in the analysis, comprising 150 elderly and 175 nonelderly adults. Elderly patients had a higher initial anti-Xa levels than did their nonelderly adult counterparts in the ACS, DVT/PE, and surgery protocols, with P values of 0.02, <0.001, and 0.01, respectively. Only the ACS protocol demonstrated increased frequency of above-target-level anti-Xa levels in the elderly (P = 0.03). Conclusion Elderly patients had significantly higher initial anti-Xa levels than did nonelderly adult patients across all protocols. This study identifies the need to further study elderly patients’ increased heparin sensitivity to determine if a separate dosing protocol is needed.

scholarly journals Treatment of Proximal Deep-Vein Thrombosis With the Oral Direct Factor Xa Inhibitor Rivaroxaban (BAY 59-7939)

Circulation ◽  
2007 ◽  
Vol 116 (2) ◽  
pp. 180-187 ◽  
Author(s):  
Giancarlo Agnelli ◽  
Alexander Gallus ◽  
Samuel Z. Goldhaber ◽  
Sylvia Haas ◽  
Menno V. Huisman ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Factor Xa ◽  
Proximal Deep Vein Thrombosis ◽  
Factor Xa Inhibitor ◽  
Direct Factor ◽  
Vein Thrombosis ◽  
Deep Vein

scholarly journals New anticoagulants for the treatment of venous thromboembolism

2016 ◽  
Vol 42 (2) ◽  
pp. 146-154 ◽  
Author(s):  
Caio Julio Cesar dos Santos Fernandes ◽  
José Leonidas Alves Júnior ◽  
Francisca Gavilanes ◽  
Luis Felipe Prada ◽  
Luciana Kato Morinaga ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Vitamin K Antagonists ◽  
Factor Xa ◽  
Thrombin Inhibitors ◽  
Direct Thrombin Inhibitors ◽  
Vein Thrombosis ◽  
New Anticoagulants ◽  
Acute Pulmonary Thromboembolism ◽  
Deep Vein

Worldwide, venous thromboembolism (VTE) is among the leading causes of death from cardiovascular disease, surpassed only by acute myocardial infarction and stroke. The spectrum of VTE presentations ranges, by degree of severity, from deep vein thrombosis to acute pulmonary thromboembolism. Treatment is based on full anticoagulation of the patients. For many decades, it has been known that anticoagulation directly affects the mortality associated with VTE. Until the beginning of this century, anticoagulant therapy was based on the use of unfractionated or low-molecular-weight heparin and vitamin K antagonists, warfarin in particular. Over the past decades, new classes of anticoagulants have been developed, such as factor Xa inhibitors and direct thrombin inhibitors, which significantly changed the therapeutic arsenal against VTE, due to their efficacy and safety when compared with the conventional treatment. The focus of this review was on evaluating the role of these new anticoagulants in this clinical context.

Adjusted Versus Fixed Doses of the Low-Molecular-Weight Heparin Fragmin in the Treatment of Deep Vein Thrombosis

1994 ◽  
Vol 71 (05) ◽  
pp. 698-702 ◽  
Author(s):  
M Alhenc-Gelas ◽  
C Jestin-Le Guernic ◽  
J F Vitoux ◽  
A Kher ◽  
M Aiach ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Factor Xa ◽  
Heparin Therapy ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
Group A ◽  
Group B ◽  
Deep Vein

SummaryTreatment monitoring based on a laboratory parameter increases the efficacy and safety of standard heparin therapy, but it is not known if this also applies to low-molecular-weight heparin (LMWH) therapy of acute deep vein thrombosis (DVT). In a prospective randomized trial involving 122 consecutive patients, group A (58 patients) received a weight adjusted dose of Fragmin (100 IU/kg) subcutaneously twice a day throughout the treatment period (10 days ± 1), while in group B (64 patients) the dosage was based on the results of an anti factor Xa (anti Xa) amidolytic assay to obtain a target concentration from 0.5 to 1 IU/ml. AntiXa and antithrombin activities were also measured retrospectively on frozen plasma from all patients. The two regimens were comparable in terms of hemorrhagic complications (4 in group A and 3 in group B). Bilateral ascending phlebography was performed before inclusion and at the end of LMWH treatment. Treatment efficacy, based on Marder’s score, did not differ between the two groups (p = 0.3). Dosage adjustment to between 0.5 to 1IU anti-Xa/ml does not therefore appear to improve the efficacy or safety of LMWH tieatment. However, correlations between the change in Marder’s score and both anti-Xa (p <0.001) and antithrombin activity (p <0.001) were observed, suggesting a relationship between the degree of FXa or thrombin inhibition and antithrombotic activity.

TREATMENT OF PROXIMAL DEEP VEIN THROMBOSIS (DVT) OF THE LOWER LIMBS BY CY 216* (LMWH) VERSUS UNFRACTIONATED HEPARIN (UFH)

1987 ◽  
Author(s):  
P Duroux
Keyword(s):  
Body Weight ◽  
Deep Vein Thrombosis ◽  
Factor Xa ◽  
Lower Limbs ◽  
Proximal Deep Vein Thrombosis ◽  
Bleeding Complications ◽  
Antithrombotic Agent ◽  
Randomised Study ◽  
Vein Thrombosis ◽  
Deep Vein

Preliminary clinical data showed CY 216 could be effective in the treatment of established DVT. Thus, we undertook an European collaborative controlled randomised study to assess the efficacy and tolerance of this new antithrombotic agent.140 patients presenting a proximal DVT of less than 5 days confirmed by phlebogram, are randomly allocated into 2 groups, one treated by UFH with constant pump infusion, at doses daily adapted to laboratory tests, the other one by CY 216 at a mean daily dosage of 450 aXa IC u** calculated at onset of treatment on body weight, administered daily by 2 sub-cutaneous injections during 10 days, without dosage adaptation whatever the lab. tests results.The efficacy is assessed on comparison on both phlebograms (Harder and Arnessen Indexes) and lung Scans performed before inclusion and after end of treatment. In addition, tolerance is appreciated on the incidence of bleeding complications. Furthermore, incidence of clinical DVT recurrence is assessed at 12th week.The present study is still in progress, 130 patients are included ; the preliminary results tend to show that CY 216 at fixed doses, body weight adapted, is an effective and safe treatment of proximal deep vein thrombosis.* CY 216 : FraxiparineR Choay** Axa IC u : anti-factor Xa Institut Choay unit.

Sign in / Sign up

Export Citation Format

Share Document