scholarly journals Antithrombotic Medication for Cardioembolic Stroke Prevention

2011 ◽  
Vol 2011 ◽  
pp. 1-23 ◽  
Author(s):  
M. Àngels Font ◽  
Jerzy Krupinski ◽  
Adrià Arboix
Keyword(s):  
Atrial Fibrillation ◽  
Dabigatran Etexilate ◽  
Cardioembolic Stroke ◽  
Thrombin Inhibitors ◽  
Dose Titration ◽  
Modern World ◽  
Direct Thrombin Inhibitors ◽  
Nonvalvular Atrial Fibrillation ◽  
Increased Risk ◽  
Clinically Significant

Embolism of cardiac origin accounts for about 20% of ischemic strokes. Nonvalvular atrial fibrillation is the most frequent cause of cardioembolic stroke. Approximately 1% of population is affected by atrial fibrillation, and its prevalence is growing with ageing in the modern world. Strokes due to cardioembolism are in general severe and prone to early recurrence and have a higher long-term risk of recurrence and mortality. Despite its enormous preventive potential, continuous oral anticoagulation is prescribed for less than half of patients with atrial fibrillation who have risk factors for cardioembolism and no contraindications for anticoagulation. Available evidence does not support routine immediate anticoagulation of acute cardioembolic stroke. Anticoagulation therapy's associated risk of hemorrhage and monitoring requirements have encouraged the investigation of alternative therapies for individuals with atrial fibrillation. New anticoagulants being tested for prevention of stroke are low-molecular-weight heparins (LMWH), unfractionated heparin, factor Xa inhibitors, or direct thrombin inhibitors like dabigatran etexilate and rivaroxaban. The later exhibit stable pharmacokinetics obviating the need for coagulation monitoring or dose titration, and they lack clinically significant food or drug interaction. Moreover, they offer another potential that includes fixed dosing, oral administration, and rapid onset of action. There are several concerns regarding potential harm, including an increased risk for hepatotoxicity, clinically significant bleeding, and acute coronary events. Therefore, additional trials and postmarketing surveillance will be needed.

Neurosurgical complications of direct thrombin inhibitors—catastrophic hemorrhage after mild traumatic brain injury in a patient receiving dabigatran

2012 ◽  
Vol 116 (5) ◽  
pp. 1093-1096 ◽  
Author(s):  
Sarah T. Garber ◽  
Walavan Sivakumar ◽  
Richard H. Schmidt
Keyword(s):  
Atrial Fibrillation ◽  
Randomized Clinical Trials ◽  
Dabigatran Etexilate ◽  
Ground Level ◽  
Thrombin Inhibitors ◽  
Thrombin Inhibitor ◽  
Direct Thrombin Inhibitors ◽  
Systemic Embolism ◽  
Nonvalvular Atrial Fibrillation ◽  
Reversal Agent

Dabigatran etexilate is an oral anticoagulant that acts as a direct, competitive thrombin inhibitor. Large randomized clinical trials have shown higher doses of dabigatran (150 mg taken twice daily) to be superior to warfarin in terms of stroke and systemic embolism rates in patients with nonvalvular atrial fibrillation. As a result, in 2010 the US FDA approved the use of dabigatran for the prevention of stroke and systemic embolism in patients with atrial fibrillation. Dabigatran is especially attractive in the outpatient setting because patients do not require routine monitoring with prothrombin times or international normalized ratios. To date, no effective reversal agent for dabigatran in the event of catastrophic hemorrhage has been identified. The authors report a case of an elderly patient, being treated with dabigatran for atrial fibrillation, who presented with a rapidly expanding intracranial hemorrhage after a ground-level fall. This case highlights an impending neurosurgical quandary of complications secondary to this new anticoagulation agent and suggests potential options for management.

Dabigatran Etexilate: A Review in Nonvalvular Atrial Fibrillation

Drugs ◽  
2017 ◽  
Vol 77 (3) ◽  
pp. 331-344 ◽  
Author(s):  
Hannah A. Blair ◽  
Gillian M. Keating
Keyword(s):  
Atrial Fibrillation ◽  
Dabigatran Etexilate ◽  
Nonvalvular Atrial Fibrillation

Abstract 258: Dabigatran Etexilate is Associated with Shorter Hospital Length of Stay and Lower Hospital Costs Compared to Warfarin in Treatment-Naive, Newly-Diagnosed Nonvalvular Atrial Fibrillation Patients

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Eileen Fonseca ◽  
David R Walker ◽  
Gregory P Hess
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Cost ◽  
Dabigatran Etexilate ◽  
Hospital Costs ◽  
Hospital Length Of Stay ◽  
Total Hospital Cost ◽  
Newly Diagnosed ◽  
Nonvalvular Atrial Fibrillation ◽  
Total Hospital ◽  
Treatment Naïve

Background: Warfarin and dabigatran etexilate (DE) are oral anticoagulants (OAC) used to reduce the risk of stroke among patients with nonvalvular atrial fibrillation (AF). However, DE does not require titration and INR monitoring. This study examined whether hospital length of stay (LOS) and total hospital costs differed between the two therapies among treatment-naive, newly-diagnosed AF patients. Methods: LOS and total hospital costs were evaluated for hospitalizations with a primary or secondary discharge diagnosis of atrial fibrillation (AF) between 1/1/2011-3/31/2012, with DE or warfarin administered during hospitalization, and excluding hospitalizations of patients with valvular AF, previously diagnosed with AF, or previously treated with OAC. Hospitalizations were identified from a Charge Detail Masters database containing 397 qualified hospitals. Samples were propensity score matched using nearest neighbor within a caliper of 0.20 standard deviations of the logit, without replacement and a 2:1 match. Differences in LOS and hospital cost were then estimated using generalized linear models, fitted by generalized estimating equations (clustered by hospital) to account for possible correlation between observations. The hospitalization’s charged amount was multiplied by the hospital’s inpatient cost-to-charge ratio to estimate the total hospital cost. Covariates estimating the propensity score, LOS, and costs included patient age, payer type, CHADS 2 and HAS-BLED scores, use of bridging agents, comorbid conditions, and hospital attributes. As a sensitivity analysis, LOS and costs were estimated with the same parameters and covariates among the raw, unbalanced sample. Results: Matched samples included 1,292 warfarin and 646 DE hospitalizations of treatment-naive, newly diagnosed patients out of 4,619 and 715 hospitalizations, respectively. No covariates used in matching had standardized mean differences > 10% after matching. Two comorbidities (thromboembolism, coronary artery disease) had statistically different distributions after matching (DE: 3% vs. warfarin: 8%, p<0.001 and DE: 40% vs. warfarin: 45%, p=0.048); these were included as model covariates. Among the sample, DE had an estimated 0.7 days shorter stay compared to warfarin (DE: 4.8 days vs. warfarin: 5.5 days, p<0.01) and a $2,031 lower estimated total cost (DE: $14,794 vs warfarin: $16,826, p=0.007). Sensitivity analysis confirmed a shorter DE LOS (DE: 5.5 days vs. warfarin: 6.6 days, delta=1.1 days, p<0.01) and a lower DE hospital cost (DE: $18,362 vs. warfarin: $22,602, delta=$4,240, p<0.01). Conclusions: Among hospitalizations of treatment-naive patients newly diagnosed with nonvalvular AF, the hospitalizations during which DE was administered had a shorter LOS and at least a 12% lower total hospital cost compared to hospitalizations where warfarin was administered.

scholarly journals Sex Differences in the Association Between Liver Fibrosis and Clinical Outcomes in Acute Cardioembolic Stroke Population With Nonvalvular Atrial Fibrillation

2021 ◽  
Author(s):  
Lei Yang ◽  
Ke Gao ◽  
Xin-Ye Yao ◽  
Yong-lan Tang ◽  
Wan-Ying Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Liver Fibrosis ◽  
Clinical Outcomes ◽  
Cardioembolic Stroke ◽  
Advanced Fibrosis ◽  
Short Term ◽  
Nonvalvular Atrial Fibrillation ◽  
Severe Stroke ◽  
Advanced Liver Fibrosis ◽  
The Impact

Abstract Background: Liver cirrhosis is a confirmed risk factor for worse clinical outcomes of stroke, however the contribution of liver fibrosis to cardioembolic stroke (CES) and its short-term outcomes are poorly understood. This study aimed to investigate whether liver fibrosis is associated with more severe stroke, worse short-term clinical outcomes of acute CES, due to nonvalvular atrial fibrillation (NVAF), as well as the impact of sex on the association. Methods: Using data of 522 patients with NVAF admitted within 48 hours after acute symptom of CES onset. We calculated Fibrosis-4 score (FIB-4) and defined liver fibrosis as: likely advanced fibrosis (FIB-4>3.25), indeterminate (FIB-4, 1.45-3.25), unlikely advanced fibrosis (FIB-4<1.45). We invested the impact of liver fibrosis degree on stroke severity on admission, major disability at discharge and all cause death at 90 days stratified by sex. Results: Among 522 acute CES patients with NVAF, the mean FIB-4 on admission reflected intermediate fibrosis, whereas liver enzymes were largely normal. After adjusting for possible confounders, multivariate analyses revealed that likely advanced liver fibrosis was associated with severe stroke (OR=2.21, 95% CI: 1.04-3.54), major disability at discharge (OR=4.59, 95% CI: 1.88-11.18), and 90-days mortality (HR=1.25, 95% CI: 1.10-1.56). Further grouped by sex, these associations were stronger in males but not significant in females.Conclusions: In patients with largely normal liver enzyme, likely advanced liver fibrosis is associated with severe stroke, major disability and all cause death after acute CES due to NVAF; the association unfolded more obvious in males, but not for females.

scholarly journals Analysis of Influencing Factors of Compliance with Non-Vitamin K Antagonist Oral Anticoagulant in Patients with Nonvalvular Atrial Fibrillation and Correlation with the Severity of Ischemic Stroke

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Li Zhu ◽  
Xiaodan Zhang ◽  
Jing Yang
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Influencing Factors ◽  
Clinical Supervision ◽  
Vitamin K ◽  
Pearson Correlation ◽  
Anticoagulation Therapy ◽  
Vitamin K Antagonist ◽  
Nonvalvular Atrial Fibrillation ◽  
Increased Risk

Nonvalvular atrial fibrillation (NVAF) is associated with an increased risk of stroke and thrombus, and anticoagulant therapy is a key link in the prevention of stroke. At present, the anticoagulation rate of atrial fibrillation in China is low, and there are many factors affecting the adherence of patients with atrial fibrillation to anticoagulation. Non-vitamin K antagonist oral anticoagulants (NOACs) are anticoagulant with high application value due to their high safety and low risk of intracranial hemorrhage, stroke, and death. However, the compliance of NOACs is poor, and the current situation of anticoagulants in China is not optimistic. In this study, a total of 156 patients with NVAF who received NOAC anticoagulation therapy in our hospital from January 2018 to January 2019 were retrospectively analyzed. The results showed that education background, place of residence, number of complications, CHA2DS2-VASc score, and HAS-BLED score were independent influencing factors for NOACS compliance of NVAF patients. Also, the Pearson correlation analysis showed that there was a negative correlation (r = −0.465, P < 0.001 ) between NOAC compliance and severity of ischemic stroke in patients with NVAF. Therefore, clinical supervision and management of patients with NVAF after NOACs should be strengthened to improve the compliance of patients with NVAF after NOACs, reduce the damage of ischemic stroke, and improve their prognosis.

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