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Role of Hypertension and Other Clinical Variables in Prognostication of Patients Presenting to the Emergency Department With Major Bleeding Events.

BACKGROUND: Clinical variables including hypertension could be linked with major bleeding events and death beyond vitamin K antagonist (warfarin) or direct oral anti-coagulants (DOACs) treatment strategy. METHODS: Subgroup analysis of major bleeding (primary endpoint) associated with clinical variables, site of bleeding, ongoing antithrombotics, reversal treatment or blood transfusion, outcomes (secondary endpoints) was performed in patients with bleeding events submitted to hard 5:1 propensity-score matching for hypertension. RESULTS: Enrolled patients were 2,792 (mean age, 65.6 ± 19.9 year

Antiplatelet agents and anticoagulants for hypertension.

BACKGROUND: Elevated systemic blood pressure results in high intravascular pressure but the main complications, coronary heart disease (CHD) … ufficiently evaluated in patients with high blood pressure. Newer antithrombotic oral drugs such as dabigatran, rivaroxaban, apixaban and endosaban are yet to be tested in patients with high blood pressure.Further trials of antithrombotic therapy including with newer agents and complete documentation of all benefits and harms are required in patients with el …

Direct-Acting Oral Anticoagulant Therapy in Cancer Patients-A Review.

Venous thromboembolism (VTE) is an important aspect in cancer patients. There are various pharmacological methods used for thrombotic event treatment. DOACs (direct-acting oral anticoagulants) are gaining popularity among both physicians and researchers and are slowly starting to replace VKAs (vitamin K antagonists), thus becoming a substitute or alternative option for LMWHs (low-molecular-weight heparins). In this article, we present DOACs' main therapeutic advantages and disadvantages in patients with cancer. The only major concern with using DOACs is the higher risk of bleeding; however, th

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… Dabigatran etexilate is a factor IIa inhibitor. It is produced in the form of a prodrug that must be transformed into its active form by microsomal carboxylesterases in the liver. Due to its poor availability (around 6%), there is a need for the administration of high dabigatran dosages [ 39 ]. … The half-life of dabigatran particles is 12–17 h, with the highest serum concentration achievable between 1 and 2 h after admission. It is important to mention that dabigatran is mainly eliminated by the kidneys; therefore, it is contraindicated in patients with renal failure [ 40 ]. …

Use of Chronic Oral Anticoagulation and Associated Outcomes Among Patients Undergoing Percutaneous Coronary Intervention.

BACKGROUND: Contemporary rates of oral anticoagulant (OAC) therapy and associated outcomes among patients undergoing percutaneous coronary intervention (PCI) have been poorly described. METHODS AND RESULTS: Using data from an integrated health care system from 2009 to 2014, we identified patients on OACs within 30 days of PCI. Outcomes included in-hospital bleeding and mortality. Of 9566 PCIs, 837 patients (8.8%) were on OACs, and of these, 7.9% used non-vitamin K antagonist agents. OAC use remained stable during the study (8.1% in 2009, 9.0% in 2014; P=0.11), whereas use of non-vitamin K ant

Treatment of cancer-associated venous thromboembolism in the age of direct oral anticoagulants.

Anticoagulation for cancer-associated venous thromboembolism (VTE) can be challenging due to complications-including bleeding and potential drug-drug interactions with chemotherapy-associated with vitamin K antagonists and inconvenience of low-molecular-weight heparin (LMWH). Direct oral anticoagulants (DOACs) could partially overcome these issues, but until recently there were no large clinical trials assessing their efficacy and safety in cancer patients. This review summarizes clinical treatment guidelines, prior clinical and real-world evidence for anticoagulant choice, recent clinical tri

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… Apixaban, rivaroxaban, and edoxaban are substrates of cytochrome 450 3A4 (CYP3A4) to varying degrees—edoxaban is minimally metabolized by CYP3A4—and of P-glycoprotein (P-gp), and the prodrug dabigatran etexilate is also a P-gp substrate [ 61 , 62 ]. … Circ J 2018 ; 82 ( 5 ): 1262 – 1270 . 29576597 10.1253/circj.CJ-17-1128 29 Schulman S , Goldhaber SZ , Kearon C et al Treatment with dabigatran or warfarin in patients with venous thromboembolism and cancer . …

Assessment of bleeding risk of interventional techniques: a best evidence synthesis of practice patterns and perioperative management of anticoagulant and antithrombotic therapy.

BACKGROUND: Interventional pain management is a specialty that utilizes invasive procedures to diagnose and treat chronic pain. Patients und … ar thromboembolic fatalities. There is limited evidence in reference to newer antithrombotic agents dabigatran (Pradaxa) and rivaroxaban (Xarelto) to discontinue to avoid bleeding and epidural hematomas during interventional techniques and to continue to avoid cerebrovascular and cardiovascular thromboembolic events. RECOMMENDATIONS: The recommendations der …

Management of Venous Thromboembolism for Patients With Hematologic Malignancies.

Advanced practitioners are an integral part of the cancer care team. Therefore, it is imperative they are knowledgeable of risk factors associated with venous thromboembolism in the oncology setting, including signs or symptoms and management.

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… Direct thrombin inhibitors include dabigatran (Pradaxa), which is orally administered; lepirudin, argatroban, and bivalirudin, which are given intravenously; and desirudin (Iprivask), which is subcutaneously delivered. … The bioavailability of dabigatran can be increased by chilling or crushing the pellets, and it is renally eliminated. Dabigatran itself is not an anticoagulant but is converted to its active agent. …

Structured benefit-risk evaluation for medicinal products: review of quantitative benefit-risk assessment findings in the literature.

A favorable benefit-risk profile remains an essential requirement for marketing authorization of medicinal drugs and devices. Furthermore, prior subjective, implicit and inconsistent ad hoc benefit-risk assessment methods have rightly evolved towards more systematic, explicit or "structured" approaches. Contemporary structured benefit-risk evaluation aims at providing an objective assessment of the benefit-risk profile of medicinal products and a higher transparency for decision making purposes. The use of a descriptive framework should be the preferred starting point for a structured benefit-

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… Dabigatran had the highest performance score for primary and secondary stroke prevention. … Tervonen et al. 20 | Stroke prevention in patients with non-valvular atrial fibrillation | Oral anticoagulants • Apixaban • Dabigatran • Edoxaban • Rivaroxaban • Warfarin | Rank-order centroid weights | Dabigatran had the highest overall value, followed by apixaban, edoxaban and rivaroxaban. …

Research progress on bleeding risk assessment models in anticoagulant therapy.

Balancing thromboembolic prevention against bleeding complications remains a critical challenge in anticoagulant therapy. While established bleeding risk assessment models (RAMs) such as HAS-BLED and HEMORR2HAGES were initially developed for warfarin-treated patients, their applicability to non-vitamin K antagonist oral anticoagulant (NOAC) users and venous thromboembolism (VTE) populations remained uncertain. This review synthesized recent advancements in bleeding risk stratification for atrial fibrillation (AF) and VTE patients, focusing on model performance, drug-specific adaptations, and e

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… VTE-BLEED The VTE-BLEED was developed based on data from the RECOVER (dabigatran vs. warfarin, n = 2,539) and RECOVER II (dabigatran vs. warfarin, n = 2,589) trials. … Lv M Jiang S Wu T Huang N Chen X Chen C A new model to predict the risk of major gastrointestinal bleeding in patients on direct oral anticoagulants (dabigatran and rivaroxaban) . Br J Clin Pharmacol . ( 2023 ) 89 ( 1 ): 253 – 60 . 10.1111/bcp.15491 35971682 13. …

Crosslink between atrial fibrillation and cancer: a therapeutic conundrum.

Atrial fibrillation (AF) is more common in patients with malignancies than in general population. The pathophysiological processes include the pro-inflammatory condition and the exaggerated inflammatory reaction to chemotherapy, radiotherapy, and surgery interventions. Thus, it is pivotal to decrease morbidity and mortality in this group by providing appropriate care and prevention. In this subset, the risk of thromboembolic and bleeding events is high and the common risk score such as CHA2DS2-VASc and HAS-BLED employed in non-oncologic patients have limited evidence in cancer patients. A pauc

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… Furthermore, dabigatran had a similar IS/SE risk compared to apixaban and lower major bleeding compared to rivaroxaban. … Additionally, in comparison with dabigatran, patients managed by apixaban showed a reduced risk of IS/SE compared to rivaroxaban users [ 79 ]. …

Abstract

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[Update in hospital internal medicine (2007): a selection].

This paper summarizes several important studies published during the previous year that have an impact on the practice of inpatient internal medicine, because they either modify or reinforce current practices. The selected domains include the treatment of thrombo-embolic disease, the role of implantable defibrillators in left cardiac failure, the management of cerebro-vascular disease, of community-acquired pneumonia, and of type 2 diabetes, as well as the prevention of spontaneous bacterial peritonitis in cirrhosis and of osteoporosis fractures. Some data stimulating our reflection on the int

Hematology

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… treatment, dabigatran 150 mg PO BID after 5 days heparin For atrial fibrillation, dabigatran 150 mg PO BID Complications —bleeding Monitor —aPTT is unreliable Dose adjust dabigatran —ClCr < 30 ml/min a Novel oral anticoagulants a Novel oral anticoagulants Class/Drugs | Mechanism | Indications | Usual … VTE treatment, dabigatran 150 mg PO BID after 5 days heparin For atrial fibrillation, dabigatran 150 mg PO BID | Complications —bleeding Monitor —aPTT is unreliable Dose adjust dabigatran —ClCr < 30 ml/min Related Topics DVT (p. 176) Hypercoagulable States (p. 173) Pulmonary Embolism (p. 10) Warfarin-Induced …

Combined anticoagulation and antiplatelet therapy for high-risk patients with atrial fibrillation: a systematic review.

BACKGROUND: Previous research suggests uncertainty whether or not there is any additional benefit in adding antiplatelet therapy (APT) to an … adjusted-dose warfarin (INR 2.0-3.0). However, given the emergence of newer anticoagulation agents (dabigatran, rivaroxaban and apixaban) this prioritisation may need to be revisited in the future to reflect current best clinical practice. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations.

OBJECTIVE: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic sp … thromboembolic fatalities. • There is limited evidence in reference to newer antithrombotic agents dabigatran (Pradaxa) and rivaroxan (Xarelto) to discontinue to avoid bleeding and epidural hematomas and are continued during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic events. CONCLUSIONS: Evidence is fair to good fo …

Bleeding events in Asian patients with cancer-associated thrombosis: a 10-year single-centre experience.

UNLABELLED: Malignancy is a well-recognised major risk factor for venous thromboembolism (VTE). While anticoagulation is the cornerstone of management for cancer-associated thrombosis (CAT), its use is associated with an increased risk of bleeding. This study aimed to determine the incidence of bleeding, patterns of anticoagulant use, and bleeding outcomes, and to identify factors associated with bleeding events during the first 6 months of CAT treatment. We conducted a retrospective study on cancer patients in Hospital Canselor Tuanku Muhriz (HCTM) who were diagnosed with pulmonary embolism (

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… Doses of the DOACs were administered as per international guideline standards: rivaroxaban 15 mg BD for 21 days, then 20 mg once daily (OD); dabigatran 150 mg twice daily (BD); and edoxaban 60 mg OD. … Table 2 Bleeding events in CAT treated with anticoagulants a: Rivaroxaban, apixaban, dabigatran, edoxaban; b: LMWH, fondaparinux; c: warfarin CRNMB: Clinically Relevant Non-Major Bleeding Variables | | Major Bleeding, (%) n = 17 | CRNMB, (%) n = 34 | χ2 | p - value Type of malignancy | | | | | …

Primary prevention of venous thromboembolism in medical and surgical oncology patients.

Recent data suggest that patients with a malignancy have a seven-fold increased risk for venous thromboembolism (VTE) compared with those without cancer, suggesting that these patients may benefit from thromboprophylaxis. Mechanisms for the prevention of thromboembolism can be divided into two broad categories: mechanical and pharmacological. Although generally used in combination with pharmacotherapy, little evidence exists for the efficacy of mechanical modalities either in the broader population of patients at risk for VTE or for patients with cancer specifically. A recent study using gradu

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… Dabigatran, an oral, direct thrombin inhibitor, has been evaluated as a thromboprophylactic modality in patients undergoing hip ( Eriksson et al , 2007a ) and knee ( Eriksson et al , 2007b ) surgery and has been shown to be at least as effective as enoxaparin for the prevention of VTE in these high-risk … Lancet 370 : 949 –956 17869635 10.1016/S0140-6736(07)61445-7 Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, Kälebo P, Christiansen AV, Hantel S, Hettiarachchi R, Schnee J, Büller HR, RE-MODEL Study Group ( 2007b ) Oral dabigatran etexilate vs subcutaneous enoxaparin for the prevention …

Aptamers: Potential Diagnostic and Therapeutic Agents for Blood Diseases.

Aptamers are RNA/DNA oligonucleotide molecules that specifically bind to a targeted complementary molecule. As potential recognition elements with promising diagnostic and therapeutic applications, aptamers, such as monoclonal antibodies, could provide many treatment and diagnostic options for blood diseases. Aptamers present several superior features over antibodies, including a simple in vitro selection and production, ease of modification and conjugation, high stability, and low immunogenicity. Emerging as promising alternatives to antibodies, aptamers could overcome the present limitations

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… ) | DGB-1, DBG-2, DBG-4, and DBG-5 | ssDNA aptamers | Direct oral anticoagulants (dabigatran) | Pre-clinical studies (proof of concept) for monitoring direct oral anticoagulants (dabigatran) | [ 74 , 75 ] Refrigerated platelets (for platelet transfusion) | Anti-VWF aptamer | von Willebrand factor | Refrigerated … Mapping the binding region of aptamer targeting small molecule: Dabigatran etexilate, an anti-coagulant. Talanta. 2020;218:121132. doi: 10.1016/j.talanta.2020.121132. 76. Chen W., Voos K.M., Josephson C.D., Li R. …

Cancer-associated venous thromboembolism: Treatment and prevention with rivaroxaban.

Cancer-associated venous thromboembolism (VTE) is a frequent, potentially life-threatening event that complicates cancer management. Anticoagulants are the cornerstone of therapy for the treatment and prevention of cancer-associated thrombosis (CAT); factor Xa-inhibiting direct oral anticoagulants (DOACs; apixaban, edoxaban, and rivaroxaban), which have long been recommended for the treatment of VTE in patients without cancer, have been investigated in this setting. The first randomized comparisons of DOACs against low-molecular-weight heparin for the treatment of CAT indicated that DOACs are

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… To date, most of the evidence has been limited to studies of rivaroxaban, 61 , 62 , 63 , 64 , 65 , 66 , 67 whereas real‐world evidence for apixaban in CAT is limited 68 and for dabigatran and edoxaban is currently lacking. … A study of dabigatran etexilate as primary treatment of malignancy associated venous thromboembolism. 2017. [Accessed 17 July 2019] Available from https://clinicaltrials.gov/ct2/show/NCT03240120 60. Alliance Foundation Trials LLC, Patient‐Centered Outcomes Research Institute . …

Current Data and Future Perspectives on Patients with Atrial Fibrillation and Cancer

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… ) | Major | Increased plasma availability of dabigatran | Ibrutinib inhibits P-glycoprotein Modifiable risk factors, such as hypertension and obesity, continue to be underdiagnosed and undertreated in cancer patients [ 35 ]. … An additional study of 40,271 individuals with AF and cancer using retrospective data from Medicare and other commercial claim databases revealed that apixaban was associated with a lower risk of stroke/systemic embolism and significant bleeding compared to warfarin, although dabigatran and rivaroxaban …