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Forecasting drug utilization and expenditure in a metropolitan health region.

BackgroundNew pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning), forecasting of drug utilization and expenditure, critical drug evaluation as well as structured programs for the introduction and follow-up of new drugs. The aim of this

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… The subsequent increase in expenditure in 2011 is partly explained by the introduction of dabigatran, rivaroxaban and apixaban [ 23 ]. … fibrillation Eur Heart J 2008 29 155 65 10.1093/eurheartj/ehm575 18096568 Connolly SJ Ezekowitz MD Yusuf S Eikelboom J Oldgren J Parekh A Pogue J Reilly PA Themeles E Varrone J Wang S Alings M Xavier D Zhu J Diaz R Lewis BS Darius H Diener HC Joyner CD Wallentin L RE-LY Steering Committee and Investigators Dabigatran …

Venous thromboembolism in cancer patients: an underestimated major health problem.

Venous thromboembolism (VTE) is a major health problem among patients with cancer, its incidence in this particular population is widely increasing. Although VTE is associated with high rates of mortality and morbidity in cancer patients, its severity is still underestimated by many oncologists. Thromboprophylaxis of VTE now considered as a standard of care is still not prescribed in many institutions; the appropriate treatment of an established VTE is not yet well known by many physicians and nurses in the cancer field. Patients are also not well informed about VTE and its consequences. Many

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… In patients with DVT and cancer who are not treated with LMWH, VKA is suggested over dabigatran or rivaroxaban for long-term therapy (grade 2B). 3. … Dabigatran, a direct thrombin inhibitor, and rivaroxaban and apixaban, two direct factor Xa inhibitors, are the most developed agents. …

Precision medicine and monoclonal antibodies: breach of promise?

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… rheumatoid arthritis Denosumab | 2010 | osteoporosis Belimumab | 2011 | systemic lupus erythematosus Alemtuzumab | 2013 | multiple sclerosis Raxibacumab | 2014 | anthrax infection Siltuximab | 2014 | Castleman disease Vedolizumab | 2014 | ulcerative colitis, Crohn's disease Idarucizumab | 2015 | reversal of dabigatran-induced …

Coagulopathy of hospitalised COVID-19: A Pragmatic Randomised Controlled Trial of Therapeutic Anticoagulation versus Standard Care as a Rapid Response to the COVID-19 Pandemic (RAPID COVID COAG - RAPID Trial): A structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: To determine the effect of therapeutic anticoagulation, with low molecular weight heparin (LMWH) or unfractionated heparin (UFH, … of screening [low or high dose nomogram UFH, LMWH, warfarin, direct oral anticoagulant (any dose of dabigatran, apixaban, rivaroxaban, edoxaban)]; 8) patient prescribed dual antiplatelet therapy, when one of the agents cannot be stopped safely; 9) known bleeding within the last 30 days requiring emergency room presentation or hospitalization; 10) known histo …

Cancer-Associated Thrombosis: A New Light on an Old Story.

Cancer-associated thrombosis (CAT) is a rising and significant phenomenon, becoming the second leading cause of death in cancer patients. Pathophysiology of CAT differs from thrombosis in the non-cancer population. There are additional risk factors for thrombosis specific to cancer including cancer type, histology, and treatment, such as chemotherapy. Recently developed scoring systems use these risk factors to stratify the degree of risk and encourage thromboprophylaxis in intermediate- to high-risk patients. Anticoagulation is safely used for prophylaxis and treatment of CAT. Both of these h

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… They can directly inhibit thrombin (dabigatran etexilate) or factor Xa (apixaban, rivaroxaban, betrixaban) [ 3 ]. Their benefits over LMWH include frequent laboratory monitoring of INR not required, oral administration instead of subcutaneous and fewer food and drug interactions [ 3 , 11 ]. … Dabigatran with LMWH for initial 5 days if above contraindicated. Fondaparinux or VKA may also be used. …

16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends.

Antiphospholipid syndrome (APS), an acquired autoimmune thrombophilia, is characterised by thrombosis and/or pregnancy morbidity in association with persistent antiphospholipid antibodies. The 16th International Congress on Antiphospholipid Antibodies Task Force on APS Treatment Trends reviewed the current status with regard to existing and novel treatment trends for APS, which is the focus of this Task Force report. The report addresses current treatments and developments since the last report, on the use of direct oral anticoagulants in patients with APS, antiplatelet agents, adjunctive ther

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… A prospective cohort study of 176 patients with 51 months follow-up (82 on DOACs [42 on apixaban, 36 on rivaroxaban and 4 on dabigatran] and 94 on VKA) reported annualized recurrent thrombosis rates of 3.3% (3/10 arterial) and 2.5% (2/12 arterial) for DOACs and warfarin, respectively. 25 A retrospective … Efficacy of dabigatran versus warfarin in patients with acute venous thromboembolism in the presence of thrombophilia: Findings from RE-COVER®, RE-COVER™ II, and RE-MEDY™ . Vasc Med 2016 ; 21 : 506 – 514 . 27807306 10.1177/1358863X16668588 31 Kearon C Parpia S Spencer FA , et al . …

Essential Medicinal Chemistry of Essential Medicines.

Since 1977, the World Health Organization publishes a list of essential medicines, i.e., those that satisfy the priority health care needs of the population and are selected with regard to disease prevalence and public health relevance, evidence of clinical efficacy, and safety, as well as comparative costs and cost-effectiveness. The Essential Medicines List (EML) is an invaluable tool for all countries to select those medicines that have an excellent risk/benefit ratio and that are reputed to be of pivotal importance to health. In the present perspective, we describe the chemical composition

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… Finally, in one case (dabigatran etexilate), the INNM refers to both a carbamate moiety and the ethyl ester. 16 Initial Description of Organic Drugs in the EML To understand the limits of our analysis, we first evaluated the therapeutic indications of the drugs in the EML. … It should be noticed that among nature-inspired drugs, 5 compounds are prodrugs that are metabolized to an active species that obeys Lipinski’s rule (e.g., chloramphenicol palmitate, clindamycin palmitate, retinol palmitate, tenofovir disoproxil, dabigatran etexilate) and for this reason are not displayed …

Abstract

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… Most patients were male (58.6%), ≥75 years (63%) and used dabigatran 110 mg (65.21%). The indications of idarucizumab were emergency surgeries in 63.04%; major bleeding in 30.43%, 1 off‐label use, 1 lumbar puncture and 1 suspected stroke. … Conclusion(s) : Our series includes 46 patients treated with idarucizumab to reverse the anticoagulation effect of dabigatran in hospitals of Aragon. …

Contemporary Challenges in Venous Thromboembolism: Evolving Populations and Implications for Management and Risk Stratification.

Venous thromboembolism (VTE) remains a major cause of morbidity and mortality globally. The incidence of VTE continues to increase over time, contributed to by demographic shifts and emerging risk factors, such as novel cancer treatments and exposure to gender-affirming hormonal therapies. While the introduction of direct oral anticoagulants (DOACs) revolutionized VTE management, increasing complexity in select patient cohorts has driven the need for alternative treatment strategies, including pharmacological and interventional approaches. Concurrently, contemporary patient populations have ex

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… Pharmacokinetic studies suggest altered drug exposure with increasing weight for apixaban and dabigatran, with little impact on rivaroxaban [ 70 , 71 , 72 ]. However, the clinical significance of this is unclear, and no DOAC has a clinically validated therapeutic range. … Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis Circulation 2014 129 764 772 10.1161/CIRCULATIONAHA.113.004450 24344086 15. Verhamme P. Yi B.A. Segers A. Salter J. Bloomfield D. Büller H.R. Raskob G.E. Weitz J.I. …

An Exploratory Research to Evaluate the 30 Most Common Pulmonary Embolism Drugs in the Food and Drug Administration Adverse Event Reporting System.

BackgroundsPulmonary embolism (PE) is a common disease and a common cause of death. However, it is currently unclear which clinically common drugs can lead to PE.MethodsWe collected, organized, and analyzed reports from the first quarter of 2018 to the fourth quarter of 2022. We performed disproportionality analysis algorithms to calculate reporting odds ratio (ROR), which could quantify the signal values of different adverse events (AEs).ResultsWe have screened a total of 3091 drugs, with AE containing "PE" and calculated the ROR signal values of the top 30 drugs reported and ranked them. TES

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… Dabigatran (Pradaxa): Deep Vein Thrombosis and Pulmonary Embolism. Warfarin Remains the Standard Drug,” Prescrire International 24, no. 161 (2015): 150. 47. Ali R., Aouida M., Alhaj Sulaiman A., Madhusudan S., and Ramotar D., “Can Cisplatin Therapy Be Improved? …

Peripheral Neuropathy During Concomitant Administration of Proteasome Inhibitors and Factor Xa Inhibitors: Identifying the Likelihood of Drug-Drug Interactions.

Backgrounds: Proteasome inhibitors (PI) cause toxic peripheral neuropathy (PN), which is one of the dose-limiting adverse events of these treatments. Recent preclinical studies find that factor Xa inhibitor (FXaI), rivaroxaban, promotes PN in animals receiving oxaliplatin. Cancer patients can receive combined therapy of PI and FXaI. This study aimed to identify and characterize the interaction signals for the concomitant use of PI and FXaI resulting in PN. Methods: Reports from the United States FDA Adverse Event Reporting System (FAERS) were extracted from the first quarter of 2004 to the fir

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… Direct Comparison of Dabigatran, Rivaroxaban, and Apixaban for Effectiveness and Safety in Nonvalvular Atrial Fibrillation. Chest 150 (6), 1302–1312. 10.1016/j.chest.2016.07.013 Oshima Y., Tanimoto T., Yuji K., Tojo A. (2018). …

Oral Communication abstracts

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Sex Differences in Cancer-Associated Thrombosis.

Cancer-associated thrombosis (CAT) is a major cause of morbidity and mortality in oncology, arising from complex interactions between tumor biology, host factors, and anticancer therapies. Growing evidence indicates that biological sex and gender-related factors modulate both thrombotic risk and clinical expression of venous thromboembolism (VTE) in patients with cancer. In this narrative review, we summarize current epidemiological, biological, and clinical data on sex- and gender-related differences in CAT across solid and hematologic malignancies. Men generally exhibit a higher overall inci

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… Compared to men, women have been reported to experience 25% greater exposure to dabigatran and 15% greater exposure to apixaban, based on area under the curve (AUC) measurements. … Less abnormal uterine bleeding with dabigatran than warfarin in women treated for acute venous thromboembolism. J. Thromb. Haemost. 2018;16:1775–1778. doi: 10.1111/jth.14226. 122. Samuelson Bannow B. Management of heavy menstrual bleeding on anticoagulation. Hematol. Am. Soc. Hematol. Educ. …

Исследование по вопросу о факторах риска и стратегиях лечения глубокого веинского тромбоза у пациентов с множественной миеломой.

Множественная миелома (ММ) — злокачественная опухоль, появляющаяся из плазменных клеток, и в последние годы в нашей стране наблюдается значительная тенденция к росту ее распространения. Венозный тромбоэмболизм (VTE) является относительно распространенным осложнением у нескольких пациентов с миэломой (MM). Венозный тромбоэмболизм включает в себя тромбоз глубокой вены (ДВТ) и легочную эмболию (ПЕ), при этом во время лечения пациенты подвергаются высокому риску ДВТ. Исследования показали, что прокоагуляционное состояние MM, подстрекательская реакция и использованные терапевтические препараты знач

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… DOACs include direct thrombin (IIa) inhibitors (such as dabigatran) and factor Xa inhibitors (such as rivaroxaban, apixaban, and edoxaban). …

Managing thrombosis in cancer patients.

Venous thromboembolism is a major complication in cancer patients. The basis for the strong association between cancer and thrombosis remains incompletely understood, and the optimal approaches to both the treatment and the prevention of cancer-associated thrombosis are evolving. Here we review several important topics related to cancer-associated thromboembolism, including the pathogenesis, prevention, and management of this disease. Wherever possible, we include evidence from clinical trials, including the results of recently published trials that compared direct oral anticoagulants to low-m

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… CI, confidence interval; LMWH, low‐molecular‐weight heparin; M‐H, Mantel‐Haenszel; VKA, vitamin K antagonists Direct oral anticoagulants Four DOACs have been approved for the treatment of DVT and/or PE, including dabigatran, rivaroxaban, apixaban, and edoxaban. …

Thrombotic complications in patients with cancer: Advances in pathogenesis, prevention, and treatment-A report from ICTHIC 2021.

Venous thromboembolism (VTE) is a common complication in cancer patients, resulting in deep vein thrombosis (DVT) or pulmonary embolism (PE), and is responsible for high morbidity and mortality. This article discusses evidence and future perspectives on pathogenesis and prevention and treatment of thrombotic complications in patients with cancer. In April 2021, international basic researchers and clinicians met for the virtual edition of the 10th International Conference on Thrombosis & Hemostasis Issues in Cancer. Pathogenic mechanisms, markers and scores for risk assessment, diagnosis and th

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… Dabigatran etexilate for the treatment of acute venous thromboembolism in children (DIVERSITY): a randomised, controlled, open‐label, phase 2b/3, non‐inferiority trial. Lancet Haematol. 2021;8(1):e22–e33. doi: 10.1016/S2352-3026(20)30368-9 76. Male C, Lensing AWA, Palumbo JS, et al. …

Preventing Venous Thromboembolism in Ambulatory Patients with Cancer: A Narrative Review.

Venous thromboembolism (VTE) is frequent among patients with cancer. Ambulatory cancer patients starting chemotherapy have a 5% to 10% risk of cancer associated thrombosis (CAT) within the first year after cancer diagnosis. This risk may vary according to patient characteristics, cancer location, cancer stage, or the type of chemotherapeutic regimen. Landmark studies evaluating thrombophrophylaxis with low molecular weight heparin (LMWH) for ambulatory cancer patients have shown a relative reduction in the rate of symptomatic VTE of about one half. However, the absolute risk reduction is modes

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… Use of DOAC for VTE Prevention DOAC act by direct inhibition of factor Xa (rivaroxaban, apixaban, edoxaban) or factor IIa (dabigatran). Their major advantage is oral administration without requiring monitoring. …

Innovations in chemotherapy and radiation therapy: Implications and opportunities for the Asia-Pacific Rim.

New cases of invasive cancer in the United States occur among nearly 1.5 million people annually. In 2007, more than 1,500 people died per day with this diagnosis. Cancer is responsible for nearly one in every four deaths reported in the country. Enormous amounts of money and research have been, and are being spent, in an attempt to improve these numbers. While prevention and early detection remain the key to long-term success, treatment in the neo-adjuvant, adjuvant and metastatic settings still centre around two main treatment modalities - radiation therapy and chemotherapy. This article wil

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… Table 6 Examples of Future Oncology Drug Development Drug | Mechanism of Action | Disease Denosumab [ 78 ] | Monoclonal Ab to RANKL | Bone loss secondary to AIs Romiplostim [ 79 ] | Small molecule agonist of c-mpl | ITP Eltrombopag [ 79 ] | TPO stimulating peptide | ITP Dabigatran [ 80 ] | Oral direct …

Predicting biomarkers in laryngeal squamous cell carcinoma based on the cytokine-cytokine receptor interaction pathway.

ObjectiveTo analyze and validate differential genes in the cytokine-cytokine receptor interaction CCRI pathway in laryngeal squamous cell carcinoma (LSCC) using bioinformatics and Mendelian randomization (MR) to find potential biomarkers for LSCC.MethodsFive sets of LSCC-related gene chips were downloaded from the GEO database, and four sets of combined datasets were randomly selected as the test set and one set as the validation set to screen for differential genes in the CCRI pathway; two-way Mendelian randomization was performed to analyze the causal relationship between cytokine receptor a

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… Direct thrombin inhibitor dabigatran compromises pulmonary endothelial integrity in a murine model of breast cancer metastasis to the lungs; the role of platelets and inflammation-associated haemostasis Front. …

Thrombosis in multiple myeloma: risk stratification, antithrombotic prophylaxis, and management of acute events. A consensus-based position paper from an ad hoc expert panel.

The introduction of new therapeutic agents for multiple myeloma (MM), including proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies, has improved the outcomes of patients but, in parallel, has changed the frequency and epidemiology of thrombotic events. Thrombosis is now a significant cause of morbidity and mortality in MM patients, and optimal thromboprophylaxis is far from being reached. Moving from the recognition that the above issue represents an unmet clinical need, an expert panel assessed the scientific literature and composed a framework of recommendations for imp

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… DOAC (apixaban, edoxaban, rivaroxaban, and dabigatran) have emerged as the preferred treatment option for VTE in the general population. 59 Recently, factor Xa-inhibitors (the so-called xabans: edoxaban, apixaban, and rivaroxaban) have been tested head-to-head against LMWH in four studies on the treatment …