scholarly journals Transitioning Eligible Patients from Warfarin to a Direct Oral Anticoagulant: A Prospective Quality Improvement Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2966-2966
Author(s):  
Kevin Y Wang ◽  
Noreen Syed ◽  
Matt Fanous ◽  
Mohammed Islam ◽  
Michael Liu ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Conflicts Of Interest ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Survey Analysis ◽  
Eligibility Criteria ◽  
P Values ◽  
Burden Scale ◽  
Score Range

Abstract Background: Direct oral anticoagulants (DOACs) are rapidly replacing alternative agents as the preferred choice for anticoagulation. With extended time on the market and expanded guidelines for indications for use, they are now more accessible and affordable. Qualifying patients previously treated with warfarin for long-term anticoagulation may benefit from transitioning to a DOAC. In this prospective quality improvement study, we seek to identify eligible patients and transition them from warfarin to DOAC via shared decision-making and a multidisciplinary approach. Additionally, we will assess changes in quality of life (QOL) through a validated survey. Methods: Identify patients currently on warfarin who are eligible for transition to a DOAC. Eligibility criteria include patients with age >18 years old. Exclusion criteria includes pregnancy, BMI >50 kg/m2, CrCl <15 L/min, patients receiving anticoagulation for APLS or for mechanical heart valves. With the aid of our pharmacy team, we then ensure long-term medication affordability prior to transition. Eligible patients complete a QOL survey pre-transition and 3 months post-transition. The QOL survey is the validated Anti-Clot Treatment Scale (ACTS), which is a 15 question survey which includes a Burden scale composed of 12 questions and a Benefit scale composed of 3 questions and each question is scored from 1 to 5 (1=not at all, 2=a little, 3=moderately, 4=quite a bit, 5=extremely). The Burden scale is reverse scored so that higher ACTS Burden scores indicate greater satisfaction for a score range of 12-60. The Benefit scale is scored conventionally for a score range of 3-15. The Total score is calculated by the addition of the Burden scale and Benefit scale for a score range of 15-75. Paired T-tests were conducted on the Burden scale, Benefit scale, and Total score using GraphPad Prism version 7 (GraphPad Software, La Jolla, CA). P-values were two-tailed, with a p<0.05 considered statistically significant. Results: 25 patients out of 60 were identified as eligible for DOAC transition. Total score, Burden scale, and Benefit scale mean values were 49.5, 39.5, 10 for warfarin and 66.8, 53.5, and 13.3 for DOAC, respectively. Preliminary conducted analysis revealed statistically significant improvements in Total, Burden, and Benefit scores with p-values of 0.0046, 0.0075, and 0.0319 and mean improvements of 17.3, 14, and 3.25, respectively. Conclusion: Transitioning patients from warfarin to a DOAC has been found to decrease both patients' sense of burden while also improving their sense of benefit, as evidenced by the QOL survey analysis. Transitioning patients from warfarin to a DOAC has the potential to decrease need for routine INR monitoring, dietary limitations, and fewer drug interactions. Additionally, it improves patient satisfaction with their healthcare and reduces utilization of healthcare resources. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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.

Resolution of warfarin-induced alopecia with conversion to apixaban

2021 ◽  
Vol 14 (3) ◽  
pp. e240579
Author(s):  
Katherine Leigh Hull ◽  
Richard Gooding ◽  
James O Burton
Keyword(s):  
Hair Loss ◽  
Warfarin Therapy ◽  
Negative Impact ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Hair Follicles ◽  
Dialysis Access ◽  
Close Monitoring ◽  
Patient Reported

Warfarin is frequently prescribed as a long-term anticoagulant in patients with end-stage kidney disease as direct oral anticoagulants undergo renal excretion. Anticoagulation is a rare cause of alopecia in adults and is thought to be due to the promotion of the ‘resting phase’ of hair follicles. In this case report, a prevalent haemodialysis female patient required long-term anticoagulation following a complex pulmonary embolus and dialysis access complications. After commencing warfarin therapy, the patient reported generalised loss and thinning of her hair. All other potential causes were excluded. Cessation of warfarin therapy and conversion to apixaban with close monitoring alleviated the hair loss. Warfarin therapy is a rare cause of alopecia but should be considered in patients on long-term anticoagulation when other diagnoses have been excluded. Hair loss has a profoundly negative impact on patient quality of life and should prompt investigation to determine the underlying cause.

Increasing Use of Anticoagulants in Germany and Its Impact on Hospitalization for Tooth Extraction

2021 ◽  
Author(s):  
Olga von Beckerath ◽  
Knut Kröger ◽  
Frans Santosa ◽  
Ayat Nasef ◽  
Bernd Kowall ◽  
...  
Keyword(s):  
Tooth Extraction ◽  
Hospital Admissions ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Annual Number ◽  
Hospitalization Rates ◽  
Defined Daily Doses ◽  
Hospital Referral ◽  
History Of

Abstract Objectives This article aimed to compare nationwide time trends of oral anticoagulant prescriptions with the time trend of hospitalization for tooth extraction (TE) in Germany from 2006 through 2017. Patients and Methods We derived the annual number of hospital admissions for TE from the Nationwide Hospital Referral File of the Federal Bureau of Statistics and defined daily doses (DDD) of prescribed anticoagulants in outpatients from reports of the drug information system of the statutory health insurance. Results From 2005 to 2017, annual oral anticoagulation (OAC) treatment rates increased by 143.7%. In 2017, direct oral anticoagulants (DOACs) represented 57.1% of all OAC treatments. The number of cases hospitalized for TE increased by 28.0 only. From all the cases hospitalized for TE in Germany in 2006, 14.2% had a documented history of long-term use of OACs. This proportion increased to 19.6% in 2017. Age-standardized hospitalization rates for all TE cases with long-term use of OACs increased from 6.6 in 2006 to 10.5 cases per 100,000 person-years in 2014 and remained almost unchanged thereafter. Conclusion Our comparison showed that the large increase in OAC treatment rates in general from 2006 to 2017 had only a small impact on hospitalized TE cases with long-term use of OAC which flattens since 2014.

scholarly journals Variability in the management of line-related upper extremity deep vein thrombosis

2019 ◽  
Vol 34 (8) ◽  
pp. 552-558 ◽  
Author(s):  
Rafael Cires-Drouet ◽  
Jashank Sharma ◽  
Tara McDonald ◽  
John D Sorkin ◽  
Brajesh K Lal
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Exact Test ◽  
Medical Specialists ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Question Survey

Objectives Central-venous devices are risk-factors for upper extremity deep vein thrombosis. We surveyed physicians to identify practice-patterns and adherence to American College of Chest Physicians guidelines. Methods The 13-question survey obtained physician-demographics and treatment-choices. Respondents were grouped into surgical and medical specialists. Data were reported as ratios and percentages, and compared using Fisher’s exact test. Results We received 143 responses from physicians; 65% treated one-to-two new cases/month. Most physicians (69.2%) used anticoagulation; 36.4% retained the catheter and 32.9% removed it. Medical-specialists retained catheters more often than surgeons ( p = 0.027). For recurrences, 84% repeated anticoagulation; 50.3% retained the catheter. A majority anticoagulated upper-extremity deep-vein thrombosis in long-term catheters for three months only (55.1%). Direct oral anticoagulants were used frequently (43.6%). Only 10% believed that existing guidelines were appropriate and only 2.8% followed all guidelines. Conclusion There is great variability in treatment-decisions for upper-extremity deep-vein thrombosis. The existing guidelines are considered inadequate and not followed by most physicians.

scholarly journals Direct Oral Anticoagulants or Standard Anticoagulant Therapy in Fragile Patients with Venous Thromboembolism

TH Open ◽  
2019 ◽  
Vol 03 (01) ◽  
pp. e67-e76 ◽  
Author(s):  
Juan López-Núñez ◽  
Ricard Pérez-Andrés ◽  
Pierpaolo Di Micco ◽  
Sebastian Schellong ◽  
Covadonga Gómez-Cuervo ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Anticoagulant Therapy ◽  
Major Bleeding ◽  
Lower Risk ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Term Therapy ◽  
Composite Outcome ◽  
Long Term Therapy

Background The efficacy and safety of the direct oral anticoagulants (DOACs) in fragile patients (age ≥ 75 years and/or creatinine clearance levels ≤ 50 mL/min and/or body weight ≤ 50kg) with venous thromboembolism (VTE) has not been evaluated. Methods We used the RIETE database to compare the rates of the composite of VTE recurrences or major bleeding during anticoagulation in fragile patients with VTE, according to the use of DOACs or standard anticoagulant therapy. Results From January 2013 to April 2018, 24,701 patients were recruited. Of these, 10,054 (41%) were fragile. Initially, 473 fragile patients (4.7%) received DOACs and 8,577 (85%) low-molecular-weight heparin (LMWH). For long-term therapy, 1,298 patients (13%) received DOACs and 5,038 (50%) vitamin K antagonists (VKAs). Overall, 95 patients developed VTE recurrences and 262 had major bleeding. Patients initially receiving DOACs had a lower rate of the composite outcome (hazard ratio [HR]: 0.32; 95% confidence interval [CI]: 0.08–0.88) than those on LMWH. Patients receiving DOACs for long-term therapy had a nonsignificantly lower rate of the composite outcome (HR: 0.70; 95% CI: 0.46–1.03) than those on VKAs. On multivariable analysis, patients initially receiving DOACs had a nonsignificantly lower risk for the composite outcome (HR: 0.36; 95% CI: 0.11–1.15) than those on LMWH, while those receiving DOACs for long-term therapy had a significantly lower risk (HR: 0.61; 95% CI: 0.41–0.92) than those on VKAs. Conclusions Our data suggest that the use of DOACs may be more effective and safe than standard therapy in fragile patients with VTE, a subgroup of patients where the risk for bleeding is particularly high.

scholarly journals Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Dana Prídavková ◽  
Matej Samoš ◽  
Tomáš Bolek ◽  
Ingrid Škorňová ◽  
Jana Žolková ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Clinical Course ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Current Data ◽  
Thrombin Inhibitor

Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF), and T2D patients with AF-associated stroke seem to have worse clinical outcome and higher risk of unfavorable clinical course compared to individuals without this metabolic disorder. Long-term anticoagulation is indicated in majority of T2D patients with AF to prevent adverse AF-associated embolic events. Direct oral anticoagulants (DOACs), direct oral thrombin inhibitor dabigatran, and direct oral factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, have emerged as a preferred choice for long-term prevention of stroke in AF patients offering potent and predictable anticoagulation and a favorable pharmacology with low risk of interactions. This article reviews the current data regarding the use of DOACs in individuals with T2D and AF.

Efficacy and Safety of Direct Oral Anticoagulants in Extremes Weights

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 12-13
Author(s):  
Julie Huang ◽  
Jamie Chin ◽  
Alexander Hindenburg ◽  
Lilia Davenport ◽  
Debra Willner
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Conflicts Of Interest ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Primary Endpoints ◽  
Design And Methods ◽  
Anticoagulated Patients

Background: The clinical use of Direct oral anticoagulants (DOACs), as opposed to warfarin, has become more prevalent in patients with extremes in body weight. However, both the International Society on Thrombosis and Haemostasis' (ISTH) and anti-thrombotic therapy guidelines state that DOACs should be avoided in patients with a body mass index (BMI) >40 kg/m2, weight >120 kg, or weight < 50 kg. The purpose of this study was to analyze the efficacy and safety of DOACs in extremes of weight compared to patients treated with warfarin. Warfarin may be a safer and more effective oral anticoagulant for patients in extremes of weight, due to the availability of dosing based on INR. DOAC standard dosing may either overdose/underdose in patients with low/high BMI respectively. Study Design and Methods: A retrospective, single-institution study evaluated patients with extreme weights receiving a DOAC or warfarin for either venous thromboembolism (VTE) or atrial fibrillation/atrial flutter between October 2016 and October 2020. Inclusion criteria consisted of patients admitted to NYU Langone Hospitals continued on a DOAC or warfarin for VTE or atrial fibrillation/atrial flutter with BMI < 18 kg/m2 or BMI > 30 kg/m2. Patients newly initiated on oral anticoagulation or received anticoagulation other than atrial fibrillation/atrial flutter or VTE were excluded. Primary endpoints include incidence of VTE or bleeding events in anticoagulated patients who meet extreme weight criteria. Disclosures No relevant conflicts of interest to declare.

The Effectiveness and Safety of Direct Oral Anticoagulants (DOACs) Vs. Traditional Anticoagulants in Patients with Cirrhosis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5015-5015
Author(s):  
Justin Hum ◽  
Janice Jou ◽  
Thomas G. Deloughery ◽  
Joseph Shatzel
Keyword(s):  
Major Bleeding ◽  
Conflicts Of Interest ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Complications ◽  
Efficacy And Safety ◽  
Recurrent Thrombosis ◽  
Bleeding Events ◽  
Cirrhotic Patients

Abstract Introduction: The coagulopathy associated with cirrhosis is complex and places patients at risk for both bleeding and thrombosis. Direct oral anticoagulants (DOACs) have been shown to have superior efficacy and safety compared to vitamin K antagonists; however their efficacy and safety in cirrhotic patients is not clear. The aim of this study is to retrospectively compare the effectiveness and bleeding complications of DOACs as compared to traditional anticoagulants in cirrhotic patients. Methods: This study was a retrospective review of patients treated at a single academic center between 2012-2015 who were prescribed a DOAC (apixaban or rivaroxaban), or a traditional anticoagulant (warfarin or low molecular weight heparin), with an ICD-9 code for the diagnosis of cirrhosis. The primary outcomes of interest are recurrent thrombosis or stroke (efficacy failure), or bleeding events (safety failure). Major bleeds were characterized as fatal bleeding, symptomatic bleeding in critical organ area, or bleeding causing a fall in hemoglobin level >2 or leading to transfusion of 2+ units of packed red blood cells. Results: During the study period, 27 cirrhotic patients were prescribed a DOAC and 18 were prescribed a traditional anticoagulant (either LMWH or warfarin). Both groups had similar total bleeding events (8 DOAC vs. 10 traditional anticoagulation, p = 0.12). There were significantly less major bleeding episodes in the DOAC group, (1 (4%) vs. 5 (28%), p = 0.03) and less intracranial bleeding (3 (17% ) vs. 0 (0%) p=0.06). Recurrent thrombosis or stroke occurred in 1 (4%) patient in the DOAC group and 1 (6%) patient in the traditional group (p = 1.0). Conclusions: Anticoagulation with DOACs in cirrhotic patients may be as safe as traditional anticoagulants with respect to bleeding events. Patients with cirrhosis at our center prescribed DOACs had less major bleeding events, while maintaining efficacy at preventing stroke or recurrent thrombosis. Table Table. Disclosures No relevant conflicts of interest to declare.

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