new anticoagulants
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Author(s):  
Paula Rocco Gomes Lima ◽  
Gisele Mara Silva Gonçalves ◽  
Roberta Cunha Matheus Rodrigues ◽  
Ana Railka de Souza Oliveira-Kumakura

ABSTRACT Objective: To characterize the self-reported adherence of patients with cardiovascular diseases to the use of new oral anticoagulants and to identify factors related to adherence to these drugs. Method: This is a descriptive, correlational, and cross-sectional study, carried out with outpatients. The collection of sociodemographic, clinical, and adherence data, through the Measurement of Adherence to Treatments, was made through telephone calls. Descriptive, correlation, and multiple linear regression analyses were used. Results: A total of 120 patients using new anticoagulants for 32.3 months, on average, participated in the study. More than half of the sample consisted of women, who were professionally inactive, with a mean age of 70.1 years and a mean family income of 6.7 minimum wages. The mean adherence score was 5.7, in a possible range between 1 and 6, indicating medication adherence. Inactive employment status, female sex, higher family income, and follow-up at a public outpatient clinic were related to greater adherence to these medications. Conclusion: The patients showed high adherence to new anticoagulants. Employment status, sex, family income, and type of outpatient follow-up were related to medication adherence, and should be considered in the design of interventions for this public.


2021 ◽  
pp. 1-7
Author(s):  
Amir Hadanny ◽  
Zachary T. Olmsted ◽  
Anthony M. Marchese ◽  
Kyle Kroll ◽  
Christopher Figueroa ◽  
...  

OBJECTIVE The incidence of hemorrhage in patients who undergo deep brain stimulation (DBS) and spinal cord stimulation (SCS) is between 0.5% and 2.5%. Coagulation status is one of the factors that can predispose patients to the development of these complications. As a routine part of preoperative assessment, the authors obtain prothrombin time (PT), partial thromboplastin time (PTT), and platelet count. However, insurers often cover only PT/PTT laboratory tests if the patient is receiving warfarin/heparin. The authors aimed to examine their experience with abnormal coagulation parameters in patients who underwent neuromodulation. METHODS Patients who underwent neuromodulation (SCS, DBS, or intrathecal pump implantation) over a 9-year period and had preoperative laboratory values available were included. The authors determined abnormal values on the basis of a clinical protocol utilized at their practice, which combined the normal ranges of the laboratory tests and clinical relevance. This protocol had cutoff values of 12 seconds and 39 seconds for PT and PTT, respectively, and < 120,000 platelets/μl. The authors identified risk factors for these abnormalities and described interventions. RESULTS Of the 1767 patients who met the inclusion criteria, 136 had abnormal preoperative laboratory values. Five of these 136 patients had values that were misclassified as abnormal because they were within the normal ranges at the outside facility where they were tested. Fifty-one patients had laboratory values outside the ranges of our protocol, but the surgeons reviewed and approved these patients without further intervention. Of the remaining 80 patients, 8 had known coagulopathies and 24 were receiving warfarin/heparin. The remaining 48 patients were receiving other anticoagulant/antiplatelet medications. These included apixaban/rivaroxaban/dabigatran anticoagulants (n = 22; mean ± SD PT 13.7 ± 2.5 seconds) and aspirin/clopidogrel/other antiplatelet medications (n = 26; mean ± SD PT 14.4 ± 5.8 seconds). Eight new coagulopathies were identified and further investigated with hematological analysis. CONCLUSIONS New anticoagulants and antiplatelet medications are not monitored with PT/PTT, but they affect coagulation status and laboratory values. Although platelet function tests aid in a subset of medications, it is more difficult to assess the coagulation status of patients receiving novel anticoagulants. PT/PTT may provide value preoperatively.


Author(s):  
Paula Mendonça Leite ◽  
Aline Freitas ◽  
Juliana Amorim ◽  
Rita Carolina Duarte Figueiredo ◽  
Suzan Bertolucci ◽  
...  

Abstract Objectives Warfarin is the most widely used anticoagulant in the world, but it has several limitations including its narrow therapeutic range, need for dose adjustment and high potential for interactions. The simultaneous use of other drugs or even medicinal plants and certain foods could interfere with its therapeutic activity. In this context, this study aims to investigate the in vitro anticoagulant potential and phytochemical constitution of 17 plants selected from a previous clinical cross-sectional study (2014), that investigated the habits of plant utilization among patients taking warfarin. Methods Ethanol extracts and essential oils were evaluated, in vitro, as to their effect in the prothrombin time (PT) and activated partial thromboplastin time (aPTT) tests. Four species that presented aPTT >50 s were selected for phytochemical evaluation. Results Thirteen of the 17 plants selected demonstrated a significant anticoagulant effect in at least one of the evaluated parameters. Citrus sinensis (PT=14.75 and aPTT=53.15), Mentha crispa (aPTT=51.25), Mikania laevigata (PT=14.90 and aPTT=52.10), and Nasturtium officinale (aPTT=50.55) showed greater anticoagulant potential compared to normal plasma pool (PT=12.25 and aPTT=37.73). Chemical profiles of these four species were obtained, and certain compounds were identified: rosmarinic acid from M. crispa and isoorientin from N. officinale. Conclusions Thus, the results of this study could be a useful indicator for clinical practice towards the possibility of interaction between these plants and anticoagulants, although further clinical research is needed taking into consideration the limitations of in vitro studies. These findings also suggest that further research into the action of these plants could be of real clinical value in identifying potential alternative anticoagulant therapies.


2021 ◽  
Author(s):  
Letícia Luísa Mattos ◽  
Amanda Mendes Clemente Vilella

Background: Cerebral venous thrombosis (CVT) is still documented as a rare disease that affects less than 1% of the population, mainly young women. Symptoms are nonspecific, easily confused with less severe pathologies, with a primary focus on headache, which requires attention and knowledge from professionals. The diagnosis is made possible by the use of complementary exams, when the diagnosis is made early, it is of high recovery. In case of late diagnosis or incorrect treatment, the sequelae may be irreversible. Objectives and methodology: to analyze the use of new anticoagulants (NOACs) in relation to treatment with warfarin in cases of CVT, through narrative review. Studies from the years 2015-2020 were used in the following databases: Pubmed, Scielo and Medline. Results: Studies from the last 5 years, composed mainly of case reports and multicentric analyzes, report non-inferiority of the outcome when treatments are compared or better outcome with NOACs due to the lower risk of bleeding. However, the European Stroke Organization in its last guideline (2017) does not recommend the use, especially during the acute phase. Conclusions: CVT can affect patients of various ages, so knowledge of the best therapy is essential. Currently, the use of warfarin and heparin is still recommended for acute cases, assessing the risk of complications such as bleeding. In view of the possible safety of new anticoagulants in view of the risk of hemorrhagic complications, further studies of non-inferiority in relation to warfarin are necessary so that the best approach is employed for these patients.


2020 ◽  
Vol 8 ◽  
Author(s):  
Joppe G. F. Drop ◽  
Enno D. Wildschut ◽  
Sabrina T. G. Gunput ◽  
Matthijs de Hoog ◽  
C. Heleen van Ommen

Background: Despite advances in technology and clinical experience, the incidence of hemostatic complications, including bleeding and thrombosis, remains high in children supported with extracorporeal membrane oxygenation (ECMO). These hemostatic complications are important to prevent, since they are associated with increased morbidity and mortality. This systematic literature review aims to outline the most important risk factors for hemostatic complications in children undergoing ECMO treatment, to summarize the reported alternative anticoagulant drugs used in pediatric ECMO and to describe studied associations between coagulation tests and hemostatic complications.Methods: A literature search was performed in Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar in February 2020. Included studies were studies evaluating children (&lt;18 years old) treated with ECMO, and studies evaluating risk factors for hemostatic complications, alternative anticoagulants, or the association between coagulation tests and hemostatic complications.Results: Out of 1,152 articles, 35 studies were included. Thirteen out of 49 risk factors were investigated in three or more studies. Most consistent results were found regarding ECMO duration and pH. However, evidence for risk factors was equivocal in the majority of studies, which is explained by the variability of populations studied, definitions of hemostatic complications, ECMO circuits, anticoagulation protocols, transfusion triggers and monitoring of anticoagulation. Five studies described alternative anticoagulants, including bivalirudin (n = 3), argatroban (n = 1) and FUT (n = 1). Higher anti-factor Xa levels were associated with less clotting events in one of nine studies, investigating the association between tests and hemostatic complications. Two studies revealed an association between anti-factor Xa assay-based protocols and a decreased number of transfusions, bleedings and need for circuit change.Conclusion: Studies regarding risk factors showed conflicting results and a few retrospective studies reported the use of new anticoagulants and data on coagulation tests in relation to hemostatic complications. To decrease hemostatic complications in ECMO children, prospective multicenter studies are needed with clear bleeding and thrombotic definitions, and the best possible standardization of ECMO circuits used, anticoagulation protocols, and transfusion triggers.


2020 ◽  
Vol 20 (2) ◽  
pp. 51-58
Author(s):  
Monika Białecka ◽  
◽  
Anna Machoy-Mokrzyńska ◽  
Anna Pierzchlińska ◽  
◽  
...  

Lumbar puncture is an important invasive procedure often used in the diagnosis of neurological disorders. Generally, lumbar puncture is a safe procedure, with a very low incidence of serious complications, the risk of which, however, may increase in the group of patients on anticoagulant therapy (anticoagulants and platelet anti-aggregation agents). This applies to both the risk of haemorrhagic complications and the risk of thrombotic events during temporary discontinuation of anticoagulants. This paper presents the current knowledge on the management in patients receiving anticoagulants (vitamin K antagonists, new anticoagulants, heparins, fondaparinux) and platelet anti-aggregation agents (P2Y12 platelet receptor antagonists, glycoprotein IIb/IIIa inhibitors, acetylsalicylic acid) who require lumbar puncture. Furthermore, we present the issue of bridging therapy in patients at a high risk of thrombotic complications. In the case of neurological indications for a lumbar puncture in a patient on anticoagulants or anti-aggregation therapy, the urgency of the procedure and the risk of adverse effects should be assessed and other diagnostic methods should be considered in the first place. If there is a need for an urgent lumbar puncture, treatment modification or the use of drugs to reverse the anticoagulant or anti-aggregation effect may be necessary. Each case must be treated individually, considering medical and family history, comorbidities and other medications taken by the patient. Most of the available recommendations related to the presented problem have been developed by anaesthetic associations. There is a need to popularise the principles of management in patients on anticoagulants who require lumbar puncture due to neurological disorders.


2020 ◽  
Vol 30 (16) ◽  
pp. 127072
Author(s):  
Zahid Hussain ◽  
Andrew J. Cooke ◽  
Santhosh Neelamkavil ◽  
Lindsay Brown ◽  
Emma Carswell ◽  
...  

2020 ◽  
Vol 1 (2) ◽  
pp. 6
Author(s):  
Abed Nego Okthara Sebayang

ABSTRACT Atrial Fibrillation (AF) is an arrhythmia characterized by disorganization of atrial depolarization resulting in the impaired mechanical function of the atrium. Management of AF aims to prevent complications of ischemic stroke and systemic embolism, carried out by the administration of anticoagulant, warfarin, but warfarin has many side effects. New Oral Anticoagulants (NOAC) can be used as alternatives in preventing complications of AF.New anticoagulants such as dabigatran, rivaroxaban, and apixaban have better effects than other anticoagulants such as warfarin and have major side effects of bleeding and minimal relevant bleeding. Based on a national survey in Denmark to see a balance between stroke and intracranial bleeding, CHA2DS2-VASc 1 scores were only apixaban and both dabigatran doses (110 mg bid and 150 mg bid) which provided better clinical benefits than warfarin, but if the CHA2DS2- score VASc ≥2 of all NOACs is superior to warfarin. Atrial fibrillation can cause ischemic stroke and systemic embolism. New Oral Anticoagulant (NOACs) can be used as a solution to prevent complications from AF with minimal side effects. It is expected that the presence of new anticoagulants can reduce the rate of ischemic stroke and ischemic embolism due to AF with minimal side effects of bleeding and other side effects. Keywords: Anticoagulant,  Atrial Fibrillation, NOAC, Warfarin   ABSTRAK Atrial Fibrilasi (AF) adalah suatu aritmia yang ditandai dengan disorganisasi dari depolarisasi atrium sehingga berakibat pada gangguan fungsi mekanik atrium. Penatalaksanaan AF bertujuan mencegah komplikasiyakni stroke iskemik dan emboli sistemik, dilakukan dengan cara pemberian anti-koagulan yakni warfarin. Pemberian warfarin  memiliki banyak efek samping.  Novel Oral Anti Coagulants (NOAC) dapat dijadikan alternatif  dalam mencegah komplikasi AF. Anti-koagulan baru seperti dabigatran, rivaroxaban dan apixaban memiliki efektifitas yang lebih baik daripada anti-koagulan lainnya seperti warfarin dan memiliki efek samping perdarahan mayor dan perdarahan relevan yang minimal. Berdasarkan survei nasional di Denmark untuk melihat keseimbangan antara stroke dan perdarahan intra-kranial didapatkan bila skor Congestive heart failure, Hypertension, Age ≥75 years (skor 2), Diabetes mellitus, Stroke history (skor 2), peripheral Vascular disease, Age between 65 to 74 years, Sex Category (female) dan “C” adalah adanya disfungsi ventrikel kiri sedang hingga berat (Left Ventricular Ejection Fraction/LVEF ≤ 40%)  CHA2DS2-VASc  1 hanya apixaban dan kedua dosis dabigatran (110 mg b.i.ddan 150 mg b.i.d) yang memberikan manfaat klinis yang lebih baik daripada warfarin, tetapi apabila skor CHA2DS2-VASc ≥2 seluruh NOAC lebih superior dibanding warfarin.AF dapat menyebabkan stroke iskemik dan emboli sistemik.NOAC dapat dijadikan solusi untuk mencegah komplikasi dari AF dengan efek samping yang minimal. Diharapkan dengan hadirnya anti-koagulan baru dapat menurunkan angka stroke iskemik dan emboli iskemik akibat AF dengan efek samping perdarahan dan efek samping lainnya yang minimal. Kata Kunci: Antikoagulan, Atrial Fibrilasi, NOAC, Warfarin


Blood ◽  
2020 ◽  
Vol 135 (5) ◽  
pp. 351-359 ◽  
Author(s):  
Jeffrey I. Weitz ◽  
Noel C. Chan

Abstract Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cause of vascular death after heart attack and stroke. Anticoagulation therapy is the cornerstone of VTE treatment. Despite such therapy, up to 50% of patients with DVT develop postthrombotic syndrome, and up to 4% of patients with PE develop chronic thromboembolic pulmonary hypertension. Therefore, better therapies are needed. Although direct oral anticoagulants are more convenient and safer than warfarin for VTE treatment, bleeding remains the major side effect, particularly in cancer patients. Factor XII and factor XI have emerged as targets for new anticoagulants that may be safer. To reduce the complications of VTE, attenuation of thrombin activatable fibrinolysis inhibitor activity is under investigation in PE patients to enhance endogenous fibrinolysis, whereas blockade of leukocyte interaction with the vessel wall is being studied to reduce the inflammation that contributes to postthrombotic syndrome in DVT patients. Focusing on these novel antithrombotic strategies, this article explains why safer anticoagulants are needed, provides the rationale for factor XII and XI as targets for such agents, reviews the data on the factor XII– and factor XI–directed anticoagulants under development, describes novel therapies to enhance fibrinolysis and decrease inflammation in PE and DVT patients, respectively, and offers insights into the opportunities for these novel VTE therapies.


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