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Journal articles on the topic 'Anticoagulant drugs'
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Marija, Marinko, Novakovic Aleksandra, Divac Tatjana, Milojevic Predrag, and Nenezic Dragoslav. "New anticoagulant drugs." Medicinski casopis 46, no. 3 (2012): 145–54. http://dx.doi.org/10.5937/mckg46-1612.
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Weitz, Jeffrey I., and Jack Hirsh. "New Anticoagulant Drugs." Chest 119, no. 1 (January 2001): 95S—107S. http://dx.doi.org/10.1378/chest.119.1_suppl.95s.
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Weitz, Jeffrey I., Jack Hirsh, and Meyer M. Samama. "New Anticoagulant Drugs." Chest 126, no. 3 (September 2004): 265S—286S. http://dx.doi.org/10.1378/chest.126.3_suppl.265s.
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Bates, Shannon M., and Jeffrey I. Weitz. "Emerging Anticoagulant Drugs." Arteriosclerosis, Thrombosis, and Vascular Biology 23, no. 9 (September 2003): 1491–500. http://dx.doi.org/10.1161/01.atv.0000084827.77945.66.
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Weitz, Jeffrey I. "Emerging Anticoagulant Drugs." Arteriosclerosis, Thrombosis, and Vascular Biology 27, no. 4 (April 2007): 721. http://dx.doi.org/10.1161/01.atv.0000260470.02821.fe.
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Oates, John A., Alastair J. J. Wood, and Jack Hirsh. "Oral Anticoagulant Drugs." New England Journal of Medicine 324, no. 26 (June 27, 1991): 1865–75. http://dx.doi.org/10.1056/nejm199106273242606.
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Weitz, Jeffrey I., Saskia Middeldorp, William Geerts, and John A. Heit. "Thrombophilia and New Anticoagulant Drugs." Hematology 2004, no. 1 (January 1, 2004): 424–38. http://dx.doi.org/10.1182/asheducation-2004.1.424.
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Abstract Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is the result of an imbalance among procoagulant, anticoagulant and profibrinolytic processes. This imbalance reflects a complex interplay between genetic and environmental or acquired risk factors. Genetic thrombophilic defects influence the risk of a first episode of thrombosis. How these defects influence the risk of recurrence in patients whose first episode of venous thromboembolism was unprovoked is less certain. Thus, when anticoagulants are stopped, patients with unprovoked venous thromboembolism have a risk of recurrence of at least 7% to 10% per year, even in the absence of an underlying thrombophilic defect. Consequently, there is a trend toward longer durations of anticoagulation therapy for these patients, which is problematic given the limitation of existing anticoagulants. This chapter provides an overview of the thrombophilic defects and how they influence the risk of venous thromboembolism. The chapter also details advances in anticoagulant therapy, focusing on new inhibitors of factor Xa and thrombin. In Section I, Dr. Saskia Middeldorp describes the various thrombophilic defects and reviews their relative importance in the pathogenesis of a first episode of venous thromboembolism. She then discusses the influence of these defects on the risk of recurrent thrombotic events in patients with unprovoked venous thromboembolism and in those whose thrombosis occurred in association with a known risk factor, such as surgery. In Section II, Dr. William Geerts reviews the pharmacology of new parenteral and oral factor Xa inhibitors and describes the results of the Phase II and III clinical trials with these agents. He then provides perspective on the potential advantages and drawbacks of these drugs for the prevention and treatment of venous thromboembolism. In Section III, Dr. John Heit focuses on direct thrombin inhibitors. He discusses their mechanism of action and compares and contrasts their pharmacological profiles prior to describing the results of Phase II and III clinical trials. Dr. Heit then provides perspective on the potential advantages and limitations of these drugs relative to existing anticoagulants.
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Fareed, Jawed, Michael J. Moorman, Walter Jeske, and Debra Hoppensteadt. "Defibrotide Interaction With Newer Oral Anticoagulant and Antiplatelet Drugs." Blood 122, no. 21 (November 15, 2013): 4804. http://dx.doi.org/10.1182/blood.v122.21.4804.4804.
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Introduction Defibrotide represents a single stranded mammalian DNA derived agent originally developed for anti-thrombotic and anti-ischemic indications. Defibrotide is currently used to treat or prevent failure of normal blood flow (Veno-occlusive disease, VOD) in the liver of patients who had bone marrow transplants or received drugs such as oral estrogens and mercatopurine. Defibrotide is a polypharmocologic agent with multiple sites of actions, which include anti-inflammatory and vaso-facilitatory effects. The purpose of this investigation is to determine potential interactions of defibrotide and some of the newer oral anticoagulant drugs, such as dabigatran, apixaban and rivaroxaban and antiplatelet drugs such as ticagrelor. Materials & Methods Defibrotide (lot no. DV0601) was obtained in powder form from Gentium s.p.A (Villa Guardia, Italy). The active form of dabigatran was purchased from Selleckcham (Houston, TX). Apixaban and rivaroxaban were obtained commercially and were of synthetic origin. The effect of defibrotide on dabigatran, apixaban, rivaroxaban and ticagrelor, on agonists (epinephrine, ADP, collagen, arachidonic acid and 2.5U thrombin) was measured using platelet aggregation techniques. The platelet rich plasma collected from normal healthy donors (n=15) were also supplemented with each of the individual anticoagulant drugs, alone in a range of 0-1000 ng/ml and in combination with defibrotide at 50-250ug/ml. Such clotting times as the PT, aPTT and Heptest and thrombin generation studies were carried out. In addition, whole blood activated clotting time (celite) studies were carried out by supplementing each of the individual oral anticoagulant agents at 1ug/ml, alone and with defibrotide at 100ug/ml. Results Neither defibrotide nor the newer anticoagulants and ticagrelor produced any effects on the epinephrine, ADP, collagen and arachidonic acid induced aggregation of PRP (p>0.05). However, dabigatran at concentrations of >62.5ng/ml produced inhibition of thrombin induced aggregation, all of the other agents did not have any effect on thrombin. Defibrotide at a concentration 100 ug/ml did not alter the aggregation profile in anticoagulant supplemented PRP. In both the plasma and whole blood anticoagulant assays, dabigatran produced stronger anticoagulant effects (306+30sec) than both apixaban (145+12sec) and rivaroxaban(160+15sec). Defibrotide exhibited minimal effects (135+10sec). Ticagrelor did not have any anticoagulant effect. Defibrotide in combination with dabigatran produced modest augmentation of the anticoagulant responses (360+42sec), however, it had much weaker effects on rivaroxaban (168+18sec) and apixaban(152+14sec). All of the anticoagulants in the TGA produced varying degrees of inhibition of thrombin generation in the following order; dabigatran > rivaroxaban > apixaban. Ticagrelor did not produce any inhibition of thrombin generation. Defibrotide did not produce any effects on TGA at concentrations up to 100ug/ml. When combined with oral anticoagulants, it did not show any augmentation of rivaroxaban and apixaban; however, it enhanced dabigatrans inhibitory effects. Conclusions These results suggest that defibrotide itself has weak or negligible anticoagulant effects in the plasma and whole blood assays. All of the new oral anticoagulants produced varying degrees of assay dependent anticoagulant effects in plasma and whole blood systems. However defibrotide did not show any interactions with apixaban and rivaroxaban, it showed some augmentation of the anticoagulant responses of dabigatran. Ticagrelor did not exhibit any interactions with defibrotide. These studies demonstrate that unlike heparins, defibrotide exhibits minimal interactions with newer oral anticoagulant and antiplatelet drugs. Disclosures: No relevant conflicts of interest to declare.
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Tatarsky, B. A., and N. V. Kazyonnova. "Safety and interaction of direct oral anticoagulants with antiarrhythmic drugs." Russian Journal of Cardiology 26, no. 7 (August 8, 2021): 4482. http://dx.doi.org/10.15829/1560-4071-2021-4482.
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The use of direct oral anticoagulants minimized the risks associated with vitamin K antagonist (warfarin) therapy. Currently, direct oral anticoagulants have priority over warfarin for the prevention of thromboembolic events in patients with atrial fibrillation and a number of other conditions requiring anticoagulant therapy. Direct oral anticoagulants along with antiarrhythmic therapy are the accepted strategy for atrial fibrillation treatment. At the same time, the effect of drug-drug interactions (DDI) between direct oral anticoagulants and antiarrhythmic drugs, which have common points of metabolic application, has not been fully elucidated. In order to provide effective and safe anticoagulant and antiarrhythmic therapy in patients with AF, it is important to understand the mechanisms and severity of DDI of direct oral anticoagulants and antiarrhythmic agents. This review discusses the issues of DDI of direct oral anticoagulants and antiarrhythmic drugs used to treat atrial fibrillation.
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Jain, Nishank, and Robert F. Reilly. "Clinical Pharmacology of Oral Anticoagulants in Patients with Kidney Disease." Clinical Journal of the American Society of Nephrology 14, no. 2 (May 25, 2018): 278–87. http://dx.doi.org/10.2215/cjn.02170218.
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Oral anticoagulants are commonly used drugs in patients with CKD and patients with ESKD to treat atrial fibrillation to reduce stroke and systemic embolism. Some of these drugs are used to treat or prevent deep venous thrombosis and pulmonary embolism in patients with CKD who undergo knee and hip replacement surgeries. Warfarin is the only anticoagulant that is approved for use by the Food and Drug Administration in individuals with mechanical heart valves. Each oral anticoagulant affects the coagulation profile in the laboratory uniquely. Warfarin and apixaban are the only anticoagulants that are Food and Drug Administration approved for use in patients with CKD and patients with ESKD. However, other oral anticoagulants are commonly used off label in this patient population. Given the acquired risk of bleeding from uremia, these drugs are known to cause increased bleeding events, hospitalization, and overall morbidity. Each anticoagulant has unique pharmacologic properties of which nephrologists need to be aware to optimally manage patients. In addition, nephrologists are increasingly asked to aid in the management of adverse bleeding events related to oral anticoagulant use in patients with CKD and patients with ESKD. This article summarizes the clinical pharmacology of these drugs and identifies knowledge gaps in the literature related to their use.
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Nieto, Elena, Marcelo Suarez, Ángela Roco, Juan Carlos Rubilar, Francisca Tamayo, Mario Rojo, Gabriel Verón, et al. "Anticoagulation Management With Coumarinic Drugs in Chilean Patients." Clinical and Applied Thrombosis/Hemostasis 25 (January 1, 2019): 107602961983434. http://dx.doi.org/10.1177/1076029619834342.
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Warfarin and acenocoumarol are used in various cardiovascular disorders to improve the prognosis of patients with thromboembolic disease. However, there is a lack of substantial efficacy and safety data on antithrombotic prophylaxis in several countries, particularly in Latin America. The aim of this study was to provide information about the efficacy of anticoagulants in Chilean patients. Data were collected from databases of the Western Metropolitan Health Service, Santiago, Chile. We identified 6280 records of patients receiving anticoagulant treatment. The three most common diagnoses were rhythm disorder (43.7%), venous thrombosis (22%), and valvular prosthesis (10.7%). The majority of patients (98.5%) received acenocoumarol while 1.5% of patients received warfarin, at weekly therapeutic doses of 13.6 mg and 30.4 mg, respectively. For total diagnoses, the median time in the therapeutic range was 50%. However, better results, 66.7%, were observed when a telemedicine strategy was used only in Santiago Province. Our findings emphasize that in Chile, where the number of patients receiving anticoagulant treatment increases every year, telemedicine, by committed teams, improves the use of oral anticoagulants and is able to increase quality indicators of anticoagulant treatment care.
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Kwaan, Hau C., and Meyer M. Samama. "Anticoagulant drugs: an update." Expert Review of Cardiovascular Therapy 2, no. 4 (July 2004): 511–22. http://dx.doi.org/10.1586/14779072.2.4.511.
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Lincoff, A. Michael. "Anticoagulant and antiplatelet drugs." Catheterization and Cardiovascular Interventions 54, no. 4 (2001): 514–20. http://dx.doi.org/10.1002/ccd.1323.
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Pagès, Arnaud, Rémi Sabatier, and Brigitte Sallerin. "Factors Associated With the Choice of Oral Anticoagulant Class in the Older Patients: An Observational Study." Journal of Cardiovascular Pharmacology and Therapeutics 25, no. 4 (April 8, 2020): 332–37. http://dx.doi.org/10.1177/1074248420917811.
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Aim: Oral anticoagulants are the first-line drugs for treating thrombotic disorders related to nonvalvular atrial fibrillation and for treating deep vein thrombosis, diseases that increase in prevalence with age. Older patients have a greater risk of thrombotic and hemorrhagic events and are more prone to drug interactions. Given this backdrop, we wanted to determine the factors associated with the prescription of direct oral anticoagulants and vitamin K antagonists in older patients. Methods: We performed a cross-sectional observational study using a hospital prescription database. The study population consists of 405 older patients who were given oral anticoagulants. The 2 variables of interest were the prescription of 1 of the 2 classes of oral anticoagulants (direct oral anticoagulants vs vitamin K antagonists) and appropriateness of oral anticoagulant prescribing according to Summary of Product Characteristics (potentially inappropriate vs appropriate). Results: The factors associated with direct oral anticoagulant prescribing were the female gender (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.88) and initiation during hospital stay (OR: 2.56, 95% CI: [1.52-4.32]). Stage 4 and 5 chronic kidney diseases (OR: 0.39, 95% CI: [0.19-0.79] and OR: 0.07, 95% CI: [0.01-0.53]) were factors favoring vitamin K antagonist prescription. Being 90 years of age or more (OR: 2.05, 95% CI: [1.06-3.98]) was a factor for potentially inappropriate anticoagulant prescribing. The gastroenterology department (OR: 2.91, 95% CI: [1.05-8.11]) was associated with potentially inappropriate anticoagulant prescribing. Conclusions: Direct oral anticoagulants are the drugs of choice for anticoagulant treatment, including in older adults. The female gender and the initiation during hospital stay increased the chances of being prescribed a direct oral anticoagulant in older adults. Stage 4 and 5 chronic kidney disease increased the likelihood of having a vitamin K antagonist prescribed. Our study also revealed a persistence of potentially inappropriate oral anticoagulant prescriptions in older patients.
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Srinivasan, Divyamani, and Bree Watzak. "Anticoagulant Use in Real Time." Journal of Pharmacy Practice 26, no. 3 (November 25, 2012): 270–79. http://dx.doi.org/10.1177/0897190012465950.
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Venous thromboembolism (VTE) encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). Each year, VTE affects about 300 000 to 600 000 people in the United States, and death is the first manifestation in one-fourth of this population.1{Beckman, 2010 #79} Moreover, approximately 10% of the US population has genetic factors that increase their risk for developing thrombosis.1 In addition to inherited disorders, factors that contribute to VTE include prolonged immobilization, trauma, surgery, cancer, and critically ill patients.2 Routine assessment and prophylaxis are recommended in these groups to avoid DVT-related complications.2 Anticoagulants are the mainstay of drugs used in DVT/PE prevention and treatment. Despite the availability of evidence-based guidelines for anticoagulant therapy, there is suboptimal implementation of DVT prophylaxis in hospitalized patients.3 All anticoagulants are “high-alert” drugs, and judicious use is mandatory to prevent bleeding complications.4 This review discusses treatment guidelines, monitoring, side effects, and reversal agents available for some anticoagulant drugs approved for VTE. Dissemination of the knowledge via pharmacy education programs significantly improves the adherence to VTE prophylaxis.5 Understanding the clinical aspects of anticoagulant dispensing as presented in this review is hoped to facilitate implementation of the theoretical knowledge as well as evidence-based guidelines in order to maximize patient benefit.
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Vazquez, Sara R. "Drug-drug interactions in an era of multiple anticoagulants: a focus on clinically relevant drug interactions." Hematology 2018, no. 1 (November 30, 2018): 339–47. http://dx.doi.org/10.1182/asheducation-2018.1.339.
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Abstract Oral anticoagulants are commonly prescribed but high risk to cause adverse events. Skilled drug interaction management is essential to ensure safe and effective use of these therapies. Clinically relevant interactions with warfarin include drugs that modify cytochrome 2C9, 3A4, or both. Drugs that modify p-glycoprotein may interact with all direct oral anticoagulants, and modifiers of cytochrome 3A4 may interact with rivaroxaban and apixaban. Antiplatelet agents, nonsteroidal anti-inflammatory drugs, and serotonergic agents, such as selective serotonin reuptake inhibitors, can increase risk of bleeding when combined with any oral anticoagulant, and concomitant use should be routinely assessed. New data on anticoagulant drug interactions are available almost daily, and therefore, it is vital that clinicians regularly search interaction databases and the literature for updated management strategies. Skilled drug interaction management will improve outcomes and prevent adverse events in patients taking oral anticoagulants.
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Vazquez, Sara R. "Drug-drug interactions in an era of multiple anticoagulants: a focus on clinically relevant drug interactions." Blood 132, no. 21 (November 22, 2018): 2230–39. http://dx.doi.org/10.1182/blood-2018-06-848747.
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Abstract Oral anticoagulants are commonly prescribed but high risk to cause adverse events. Skilled drug interaction management is essential to ensure safe and effective use of these therapies. Clinically relevant interactions with warfarin include drugs that modify cytochrome 2C9, 3A4, or both. Drugs that modify p-glycoprotein may interact with all direct oral anticoagulants, and modifiers of cytochrome 3A4 may interact with rivaroxaban and apixaban. Antiplatelet agents, nonsteroidal anti-inflammatory drugs, and serotonergic agents, such as selective serotonin reuptake inhibitors, can increase risk of bleeding when combined with any oral anticoagulant, and concomitant use should be routinely assessed. New data on anticoagulant drug interactions are available almost daily, and therefore, it is vital that clinicians regularly search interaction databases and the literature for updated management strategies. Skilled drug interaction management will improve outcomes and prevent adverse events in patients taking oral anticoagulants.
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Brouwers, Jacobus R. B. J., Tom Schalekamp, Bob Wilffert, and Maarten Beinema. "Pharmacogenetic differences between warfarin, acenocoumarol and phenprocoumon." Thrombosis and Haemostasis 100, no. 12 (2008): 1052–57. http://dx.doi.org/10.1160/th08-04-0116.
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SummaryCoumarin oral anticoagulant drugs have proven to be effective for the prevention of thromboembolic events. World-wide, warfarin is the most prescribed drug. In Europe, acenocoumarol and phenprocoumon are also administered. Yet it has been proven that variant alleles of theVKORC1 and CYP2C9 genotypes influence the pharmacokinetics and pharmacodynamics of these drugs. The combination of these two variant genotypes is a major cause of the inter-individual differences in coumarin anticoagulant drug dosage. Individuals who test positive for both variant genotypes are at increased risk of major bleeding. The impact of the CYP2C9 andVKORC1 genotype is most significant during the initial period of coumarin anticoagulant therapy. The effect ofVKORC1 allelic variants is relatively similar for all three VKAs. The CYP2C9 polymorphism is associated with delayed stabilisation for coumarin anticoagulants. The effects of CYP2C9 polymorphisms on the pharmacokinetics and anticoagulant response are least pronounced in the case of phenprocoumon. In the long term, patients using phenprocoumon have more often international normalised ratio (INR) values in the therapeutic range, requiring fewer monitoring visits. This leads us to conclude that in the absence of pharmacogenetic testing, phenprocoumon seems preferable for use in long-term therapeutic anti-coagulation. Pharmacogenetic testing before initiating coumarin oral anticoagulants may add to the safety of all coumarin anticoagulants especially in the elderly receiving multiple drugs.
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Kumano, Osamu, Kohei Akatsuchi, and Jean Amiral. "Updates on Anticoagulation and Laboratory Tools for Therapy Monitoring of Heparin, Vitamin K Antagonists and Direct Oral Anticoagulants." Biomedicines 9, no. 3 (March 7, 2021): 264. http://dx.doi.org/10.3390/biomedicines9030264.
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Anticoagulant drugs have been used to prevent and treat thrombosis. However, they are associated with risk of hemorrhage. Therefore, prior to their clinical use, it is important to assess the risk of bleeding and thrombosis. In case of older anticoagulant drugs like heparin and warfarin, dose adjustment is required owing to narrow therapeutic ranges. The established monitoring methods for heparin and warfarin are activated partial thromboplastin time (APTT)/anti-Xa assay and prothrombin time – international normalized ratio (PT-INR), respectively. Since 2008, new generation anticoagulant drugs, called direct oral anticoagulants (DOACs), have been widely prescribed to prevent and treat several thromboembolic diseases. Although the use of DOACs without routine monitoring and frequent dose adjustment has been shown to be safe and effective, there may be clinical circumstances in specific patients when measurement of the anticoagulant effects of DOACs is required. Recently, anticoagulation therapy has received attention when treating patients with coronavirus disease 2019 (COVID-19). In this review, we discuss the mechanisms of anticoagulant drugs—heparin, warfarin, and DOACs and describe the methods used for the measurement of their effects. In addition, we discuss the latest findings on thrombosis mechanism in patients with COVID-19 with respect to biological chemistry.
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Ko, Darae, Christina L. Cove, and Elaine M. Hylek. "Gaps in translation from trials to practice: Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation." Thrombosis and Haemostasis 111, no. 05 (2014): 783–88. http://dx.doi.org/10.1160/th13-12-1032.
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SummaryWorldwide there is a tremendous need for affordable anticoagulants that do not require monitoring. The advent of the non-warfarin oral anticoagulant drugs represents a major advance for stroke prevention in atrial fibrillation (AF). The objectives of this review are to 1) identify gaps in our current knowledge regarding use of these single target anticoagulant drugs; 2) outline the potential implications of these gaps for clinical practice, and thereby, 3) highlight areas of research to further optimise their use for stroke prevention in AF.
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Scherer, Kathrin, Dimitrios Tsakiris, and Andreas Bircher. "Hypersensitivity Reactions to Anticoagulant Drugs." Current Pharmaceutical Design 14, no. 27 (September 1, 2008): 2863–73. http://dx.doi.org/10.2174/138161208786369768.
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Shetty, H. G. M. "Anticoagulant drugs in the elderly." BMJ 297, no. 6662 (December 10, 1988): 1540. http://dx.doi.org/10.1136/bmj.297.6662.1540-c.
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Kafetz, K. "Anticoagulant drugs in the elderly." BMJ 297, no. 6662 (December 10, 1988): 1540–41. http://dx.doi.org/10.1136/bmj.297.6662.1540-d.
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Iqbal, Omer, Salim Aziz, Debra A. Hoppensteadt, Sarfraz Ahmad, Jeanine M. Walenga, Mamdouh Bakhos, and Jawed Fareed. "Emerging anticoagulant and thrombolytic drugs." Emerging Drugs 6, no. 1 (April 2001): 111–35. http://dx.doi.org/10.1517/14728214.6.1.111.
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Fannin, T. F., and W. J. Gray. "Anticoagulant drugs in the elderly." BMJ 298, no. 6667 (January 21, 1989): 184. http://dx.doi.org/10.1136/bmj.298.6667.184.
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Wickramasinghe, L. S., S. K. Basu, and S. K. Bansal. "Anticoagulant drugs in the elderly." BMJ 298, no. 6671 (February 18, 1989): 460. http://dx.doi.org/10.1136/bmj.298.6671.460-a.
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Blum, Robert A., and Dan Lindfield. "Direct oral anticoagulant drugs (DOAC)." Journal of Cataract & Refractive Surgery 42, no. 1 (January 2016): 171–72. http://dx.doi.org/10.1016/j.jcrs.2015.12.002.
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Karem, Omed Hama, and Karwan Hamza. "ASSESSMENT OF ANTICOAGULANT DRUGS IN ELIGIBLE PATIENTS WITH ATRIAL FIBRILLATION." Journal of Sulaimani Medical College 8, no. 3 (October 15, 2018): 199–204. http://dx.doi.org/10.17656/jsmc.10169.
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Masood, Soofia, Debra Hoppensteadt, Josephine Cunanan, Hussein Khan, Schuharazad Abro, Kimberly Bartosiak, and Jawed Fareed. "Population Based Differences in the Anticoagulant and Antiprotease Responses of Newer and Oral Anticoagulant Drugs." Blood 120, no. 21 (November 16, 2012): 3421. http://dx.doi.org/10.1182/blood.v120.21.3421.3421.
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Abstract Abstract 3421 Introduction: Most of the screening of the newer anticoagulant drugs is usually carried out in normal human blood derived plasma and its products. Therefore endogenous compositional factors in different patient groups which may result in altering the anticoagulant and antiprotease effects of these drugs are not taken into account. Recently an oral anti-IIa agent Dabigatran and an anti-Xa agent namely Rivaroxaban are approved for clinical usage in the US. An additional anti-Xa drug namely Apixaban is approved in Europe and is under review by the US FDA. The pharmacologic properties of these drugs and their mechanism of action are distinct from one another. Therefore their endogenous interactions with blood and vascular sites also differ. The purpose of this study is to evaluate the differential anticoagulant responses of these agents in plasma samples from different patient populations groups such as the liver diseases (LD), acute coronary syndrome (ACS), end stage renal disease (ESRD), sepsis associated coagulopathy (SAC), cancer (C) and diabetes (D) in comparison to normal plasma. Materials and Methods: Plasma samples were collected from healthy normal male and female individuals (n=50) served as a control group. In addition plasma samples from various patient groups such as LD, ESRD, ACS, SAC, C and D and elevated aPTT, intrinsic defect (ID) and elevated PT extrinsic defect (ED) were collected ( n=30–50). These plasma samples were individually supplemented with Dabigatran, Rivaroxaban and Apixaban, at a concentration of 0.125 and 0.25ug/ml. Such tests as PT/INR, aPTT, TT and Heptest times and prothrombinase induced clotting time (PiCT) were measured using standard assays. The same samples were also analyzed for thrombin generation inhibition and anti-Xa and anti-IIa activities. Additionally pooled LD and SAC samples along with normal plasma were supplemented in a graded concentration of 0–1000 ng/ml with each of these anticoagulants. Concentration response curves were constructed for each of these agents in all the tests employed for the anticoagulant, antiprotease and thrombin generation studies. Results: In comparison to the normal plasma, different patient group plasma samples exhibited variable anticoagulant and thrombin generation inhibitory activities. In particular LD patients showed a stronger anticoagulant response with all agents, however Dabigatran produced the most profound effects. While these agents only produced a modest effect in the PT/INR assay, other coagulation tests were significantly elevated, in particular the PiCT tests. In comparison to both Apixaban and Rivaroxaban, Dabigatran produced the most pronounced prolongation of the aPTT, Heptest time, PiCT and TT. The results with Apixaban and Rivaroxaban were comparable. In the intrinsically defected plasma samples a similar trend was noted and Dabigatran produced the most pronounced prolongation in contrast to both Apixaban and Rivaroxaban. Similarly in the extrinsic defective plasma samples the Dabigatran produced the most pronounced prolongation of all of the tests in comparison to Apixaban and Rivaroxaban. The anti-protease (anti-Xa and anti-IIa) activities in different plasma matrices did not differ markedly. Population based differences were noted in other groups such as ACS, ESRD, SAC, C and D. The individual groups of the special patient populations showed wide scatter. The concentration response curves also differed from one population to another population. Conclusion: While all three anticoagulants produced stronger anticoagulant effects in LD, Dabigatran produced most markedly higher elevation of clotting responses. Rivaroxaban and Apixaban produced relatively weaker responses and differed from one another. Interestingly in the thrombin generation inhibition assays, Dabigatran produced relatively weaker effects in both normal and LD. Assay based variations among three agents were pronounced in patient populations. These studies clearly suggest that the anticoagulant and thrombin generation inhibitory effects of newer anticoagulants markedly differ in normal plasma and patient plasmas, however the antiprotease effects are similar. Therefore population based differences in the anticoagulant responses may alter their anticoagulant effects in different patient populations. These variations may account for the differential safety and efficacy of these drugs. Disclosures: No relevant conflicts of interest to declare.
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Haas. "New anticoagulants – towards the development of an "ideal" anticoagulant." Vasa 38, no. 1 (February 1, 2009): 13–29. http://dx.doi.org/10.1024/0301-1526.38.1.13.
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Currently available anticoagulants, such as unfractionated heparin, low molecular weight heparins and vitamin K antagonists, have proved effective in the prevention and treatment of thromboembolic disorders. However, these drugs have some drawbacks, such as unpredictability (in the case of unfractionated heparin), non-specificity and parenteral mode of administration, which limit their use in the clinical setting. There is a need for new agents with efficacy similar to that of these classes of anticoagulants and none of their associated drawbacks. Advances are being made in the development of more convenient and more specific drugs, with the aim to improve substantially the prevention and management of thromboembolic disorders. This review will emphasize how the development of an ideal anticoagulant, with potential benefits including high efficacy, safety, low levels of bleeding, fixed dosing, rapid onset of action, ability to bind clot-bound coagulation factors and no requirement for therapeutic monitoring, is a considerable challenge. This review will present the most relevant preclinical data, as well as the clinical studies performed to date, for several drug classes. Direct thrombin inhibitors, such as dabigatran etexilate, will be reviewed, as well as indirect (fondaparinux and idraparinux) and direct (rivaroxaban, apixaban, among others) Factor Xa inhibitors, Factor IXa inhibitors and monoclonal antibodies against Factor IX/IXa.
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Vatutin, N. T., G. G. Taradin, G. A. Ignatenko, E. S. Gasendich, A. V. Harchenko, and I. B. Povaljaeva. "Decrease in Efficacy of Warfarin as a Result of Drug-Drug Interaction (Case Report)." Rational Pharmacotherapy in Cardiology 16, no. 1 (March 2, 2020): 40–45. http://dx.doi.org/10.20996/1819-6446-2020-02-01.
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The one of the main aims in modern clinical pharmacology is to provide safe and effective therapy considering a frequent administration of several drugs having different drug-drug interactions. Warfarin belongs to the number of popular anticoagulants which along with its efficiency not infrequently alters anticoagulant characteristics when administered with other drugs and food products. A case of a decrease in the efficacy of warfarin in a patient with mitral stenosis while taking a combined choleretic drug is presented in the article. The components of this choleretic drug (dry animal bile, dry garlic extract, dry nettle extract, activated charcoal) could impair the absorption of warfarin, increase intestinal absorption of vitamin K, and have a negative effect on the anticoagulant effect of warfarin. Management of patients receiving anticoagulants should be performed in accordance with clinical recommendations. Prescription of drugs, including multicomponent ones, without proven efficacy, for such patients should be considering the potential drug interaction.
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Ageno, Walter, and Marco Donadini. "Breadth of complications of long-term oral anticoagulant care." Hematology 2018, no. 1 (November 30, 2018): 432–38. http://dx.doi.org/10.1182/asheducation-2018.1.432.
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Abstract The majority of patients with venous thromboembolism (VTE) have a considerable long-term risk of recurrence and may require extended duration of anticoagulant treatment after the initial 3 to 6 months. The decision to extend treatment is based not only on the individual risk of recurrence, but should also consider the potential complications associated with anticoagulation, taking into account that anticoagulant drugs are among the drugs most frequently associated with hospital admission due to adverse drug reactions. The most feared complication of oral anticoagulants is bleeding, which in some cases may be fatal or may affect critical organs. Case-fatality rates of bleeding have been reported to be ∼3 times higher than case-fatality rates of recurrent VTE. Even when nonserious, bleeding may require medical intervention and/or may impact on patient quality of life or working activity. Factors associated with bleeding during anticoagulant treatment include, among others, advanced age, cancer, renal or liver insufficiency, or concomitant antithrombotic drugs, but no bleeding risk score is sufficiently accurate for use in clinical practice. Not uncommonly, bleeding occurs as a complication of trauma or medically invasive procedures. Nonbleeding complications associated with oral anticoagulants are unusual, and their relevance is extremely uncertain, and include vascular calcification, anticoagulation-related nephropathy, and osteoporosis. Finally, because VTE not uncommonly affects young individuals and the mean age of the population is ∼60 years, the costs associated with extended anticoagulation should not be forgotten. The costs of the drugs need to be balanced against health outcome costs associated with both recurrent VTE and bleeding.
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Fareed, Jawed, Debra Hoppensteadt, Omer Iqbal, Josephine Cunanan, Vinod Bansal, Schuharazad Abro, and Rakesh Wahi. "Defibrotide Interactions with Newer Oral Anticoagulants and Antithrombotic Agents." Blood 120, no. 21 (November 16, 2012): 3411. http://dx.doi.org/10.1182/blood.v120.21.3411.3411.
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Abstract Abstract 3411 Defibrotide is a polydisperse mixture of porcine-derived single-stranded oligonucleotides which has been used for multiple clinical indications. Recent clinical trials of defibrotide indicate that this drug may provide benefits both for the treatment and prophylaxis of hepatic veno-occlusive disease (VOD) in hematopoietic stem cell therapy. In VOD it is believed that defibrotide exerts two distinct effects; 1. Endothelial cell protection and 2. Restoration of the thrombotic-fibrinolytic balance. Although antithrombotic in nature, defibrotide does not produce any systemic anticoagulant effects atthe selected dose of 25 mg/kg/day Conventional oral anticoagulants are routinely not used in veno-occlusive disease however heparin is often used in the management of these patients. More recently, newer oral anticoagulant drugs such as dabigatran, apixiban and rivaroxiban have been approved for the management of post orthopaedic surgical venous thrombosis and stroke prevention in atrial fibrillation. The current study was undertaken to investigate the effect of defibrotide on the anticoagulant and antiprotease effects of the newer oral anticoagulant drugs in the whole blood, plasma and platelet rich plasma based systems. Materials and Methods Native whole blood was drawn from 25 normal healthy individuals and supplemented with 100 μg/mL defibrotide and 250 ng/mL of each of the individual oral anticoagulant drugs alone and with defibrotide. Activated clotting time (ACT) measurements were made on a Hemachron instrument using celite ACT tubes. For the plasma based anticoagulant studies, a fixed concentration of defibrotide of 100 μg/mL was supplemented with defibrotide to pool plasma alone and with each of the individual oral anticoagulantagents in a concentration range of 0–1000 ng/mL. To investigate the effect of defibrotide on agonist induced platelet aggregation platelet rich plasma was prepared with varying amounts of defibrotide (0–100ug/ml). Such agonsits as ADP, epinephrine, collagen and arachodonic acid were used. To test the effects of newer oral anticoagulants, each agent was supplemented at 250–500ng/ml to the defibrotide enriched PRP (100ug/ml) and agonist induced aggregation studies were carried out in comparison to saline and defibrotide control. To test the effect of defibrotide on the conventional oral anticoagulant agents, plasma samples from patients with INR range of 1.5–3.0 were supplemented with 100ug/ml and the PT/INR was re-determined using Innovin® reagent. Results In the whole blood studies apixaban and rivaroxaban did not produce any prolongation of the whole blood ACT. However, dabigatran produced a modest increase in the ACT at 250 ng/mL. In the anticoagulant assays, supplementation of these agents did not result in any prolongation of the PT with defibrotide and newer oral anticoagulants. In the aPTT assay, the apixaban and rivaroxaban did not have any interaction, at a concentration greater than 500 ng/mL. Dabigatran shows a slight interaction in the aPTT assay. Defibrotide, did not produce any alterations of the effect on the agonist (ADP, epinephrine, collagen, arachidonic acid) induced aggregation of platelets in concentrations up to 100 μg/mL. Studies carried out where defibrotide at 100 μg/mL is combined with 250 ng/mL of each of the new anticoagulants does not show any modification of the aggregation responses. Defibrotide supplementation to anti-platelet therapy treated patient's blood collected did not result in any augmentation of the observed inhibitory responses. Defibrotide did not produce any changes in the PT/INR values of plasma samples collected from warfarin treated patients at concentrations of up to 100 μg/ml. Conclusions These studies indicate that in a concentration range of 0–1000 ng/mL the new anticoagulants do not exhibit any significant interactions with defibrotide. Since dabigatran exhibits some anticoagulant effect of its own, minor interactions with defibrotide may be observed. Based on the indications for the new oral anticoagulant drugs, their circulating levels and rapid clearance, it is unlikely that defibrotide will produce any interactions with these drugs. Disclosures: No relevant conflicts of interest to declare.
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Konkle, Barbara A. "Monitoring target-specific oral anticoagulants." Hematology 2014, no. 1 (December 5, 2014): 329–33. http://dx.doi.org/10.1182/asheducation-2014.1.329.
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Abstract Target-specific oral anticoagulants are approved for use for the prevention of stroke in atrial fibrillation and for the prevention and treatment of venous thrombosis without the need for laboratory monitoring. However, there are clinical settings in which laboratory measurement of anticoagulant effect is needed. These may include patients with life-threatening bleeding or those requiring emergency surgery, in the setting of renal or hepatic failure, or patients with thrombosis on therapy. This chapter reviews the use of laboratory testing to assess the anticoagulant effect of these drugs. In addition, because these drugs can interfere with other laboratory testing, available data on these interactions are presented.
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Bajalan, M., T. C. Biggs, S. Jayaram, J. Mainwaring, and R. Salib. "A guide to new anticoagulant medications for ENT surgeons." Journal of Laryngology & Otology 129, no. 12 (December 2015): 1167–73. http://dx.doi.org/10.1017/s0022215115002765.
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AbstractObjectives:This study aimed to ascertain otolaryngologists’ current knowledge of new (e.g. apixaban, rivaroxaban) and old (e.g. warfarin) anticoagulant medications, and to provide an educational overview of new anticoagulants for use by surgeons.Methods:A questionnaire survey was distributed across the Wessex region, UK, to ascertain the levels of knowledge of and confidence in managing patients taking various anticoagulants. In total, 50 questionnaires were completed (41 by trainees and 9 by consultants). A literature review of new anticoagulant medications was then conducted.Results:In general, there was poor clinical and pharmacokinetic knowledge of newly licensed anticoagulant medications. Respondents were more confident in the use of older vs newer forms of anticoagulants. This was true across all grades of doctors, but particularly at the senior level. All respondents stated that they would like to see an educational resource on anticoagulants.Conclusion:Knowledge of newly licensed anticoagulation medications is poor. This study has produced an educational resource for the management of anticoagulant agents. A thorough knowledge of these drugs is essential for the acute management of bleeding patients and in peri-operative surgical planning.
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Dopsaj, Violeta. "Practical issues in measuring the anticoagulant effect of direct oral anticoagulants." Arhiv za farmaciju 70, no. 5 (2020): 297–309. http://dx.doi.org/10.5937/arhfarm2005297d.
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The classical oral anticoagulants are increasingly being replaced in clinical practice by new antithrombotic drugs, which act by enabling direct inhibition of coagulation factor IIa (FIIa) or factor Xa (FXa). These drugs have multiple acronyms, including NOACs (new, non-vitamin K antagonist) or DOACs (direct oral anticoagulants), and currently include dabigatran (FIIa inhibitor), and rivaroxaban, apixaban, and edoxaban (FXa inhibitors). These drugs are approved for stroke prevention in patients with non-valvular atrial fibrillation and the prevention and treatment of venous thromboembolism. The "mantra" that DOACs do not require laboratory monitoring is not entirely correct because laboratory testing for drug effects is needed in many situations, because they influence hemostasis tests and in situations in which urgent measurement of DOACs is required. This should be very important to consider in the clinical situation for numbers of indications and increasing numbers of patients on DOACs therapy. The main aim of this article is to provide practical issues to general laboratory testing for DOACs, as well as to help avoid diagnostic errors associated with hemostasis testing. The assays for DOAC quantification must be available in medical centers on a whole day basis, to facilitate optimal drug management in conditions when things go wrong or in urgent cases of immediate reversal of anticoagulation or appropriate administration of a specific antidote.
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Kalinina, Nadezhda. "Anticoagulant group tender review." Remedium Journal about the Russian market of medicines and medical equipment, no. 11-12 (2020): 31–32. http://dx.doi.org/10.21518/1561-5936-2020-11-12-31-32.
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In the context of a pandemic, the pharmaceutical industry strives to take all appropriate steps not only to maintain continuity of production, but to ensure uninterrupted procurement and supplies of drugs and medical products. Today, the drugs that are also used to treat coronavirus infection are under the spotlight – the demand for antibiotics, antivirals and anticoagulants has increased. At the same time, there are also issues associated with the “regulatory guillotine”, which complicate the procurement process of essential drugs.
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Falanga, Anna, and Andrea Piccioli. "Effect of anticoagulant drugs in cancer." Current Opinion in Pulmonary Medicine 11, no. 5 (September 2005): 403–7. http://dx.doi.org/10.1097/01.mcp.0000174247.23009.06.
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Wildsmith, J. A. W., and J. H. McClure. "Anticoagulant drugs and central nerve blockade." Anaesthesia 46, no. 8 (August 1991): 613–14. http://dx.doi.org/10.1111/j.1365-2044.1991.tb09705.x.
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Mehta, S. "Anticoagulant drugs and central nerve blockade." Anaesthesia 47, no. 1 (January 1992): 70. http://dx.doi.org/10.1111/j.1365-2044.1992.tb01962.x.
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Riess, H., A. Loew, and G. Himmelreich. "Secondary osteoporosis induced by anticoagulant drugs?" Der Orthopäde 30, no. 7 (July 2001): 451–55. http://dx.doi.org/10.1007/s001320170077.
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Mehta, Sweta. "Patients on new oral anticoagulant drugs." British Journal of Oral and Maxillofacial Surgery 55, no. 10 (December 2017): e113. http://dx.doi.org/10.1016/j.bjoms.2017.08.083.
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Vaidyanathan, Deepika, Asher Williams, Jonathan S. Dordick, Mattheos A. G. Koffas, and Robert J. Linhardt. "Engineered heparins as new anticoagulant drugs." Bioengineering & Translational Medicine 2, no. 1 (November 21, 2016): 17–30. http://dx.doi.org/10.1002/btm2.10042.
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Kapil, Nikhil, Yvonne H. Datta, Naila Alakbarova, Eric Bershad, Magdy Selim, David S. Liebeskind, Ornina Bachour, Gundu H. R. Rao, and Afshin A. Divani. "Antiplatelet and Anticoagulant Therapies for Prevention of Ischemic Stroke." Clinical and Applied Thrombosis/Hemostasis 23, no. 4 (July 26, 2016): 301–18. http://dx.doi.org/10.1177/1076029616660762.
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Ischemic stroke represents one of the leading causes of death and disability in both the United States and abroad, particularly for patients with prior ischemic stroke or transient ischemic attack (TIA). A quintessential aspect of secondary stroke prevention is the use of different pharmacological agents, mainly antiplatelets and anticoagulants. Antiplatelets and anticoagulants exhibit their effect by blocking the activation pathways of platelets and the coagulation cascade, respectively. Clinical trials have demonstrated the safety and efficacy of antiplatelets for noncardioembolic stroke prevention, while anticoagulants are more often used for cardioembolic stroke prevention. Commonly used antiplatelets include aspirin, clopidogrel, and aggrenox (aspirin plus extended-release dipyridamole). Furthermore, commonly used anticoagulants include warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban. Each of these drugs has a unique mechanism of action, and they share some common adverse events such as gastrointestinal bleeding and intracranial hemorrhage in more serious cases. Consequently, physicians should carefully assess the benefits and risks of using different antiplatelet or anticoagulant therapies when managing patients with previous ischemic stroke or TIA. This review discuses the published literature on major clinical trials assessing the efficacy of different antiplatelet and anticoagulant drugs under varying circumstances and the subsequent guidelines that have been developed by the American Heart Association/American Stroke Association. Additionally, the role of imaging in stroke prevention is discussed.
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Martins Almeida, Renata, and Gilson Soares Feitosa. "Uso em Longo Prazo de Anticoagulantes Orais na Cardiologia." Revista Científica Hospital Santa Izabel 4, no. 1 (May 11, 2020): 14–27. http://dx.doi.org/10.35753/rchsi.v4i1.68.
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Os anticoagulantes orais são medicações amplamente utilizadas na cardiologia. Durante muito tempo, a varfarina foi a única opção disponível no mercado para esta terapia, tendo ainda hoje papel singular em determinadas situações. Porém, com o surgimento dos anticoagulantes orais de ação direta (DOACs), no século XXI, o tratamento anticoagulante vem apresentando grande avanço, dispondo de novas opções terapêuticas que ofertam mais segurança e efetividade à terapia. Diversos cenários da cardiologia requerem o seu uso e, recentemente, muitos estudos têm sido realizados a fim de esclarecer os riscos e benefícios de sua empregabilidade, a segurança e eficácia dos fármacos disponíveis em variadas situações clínicas, bem como a interação dessas drogas com outras medicações amplamente utilizadas na cardiologia. Dessa forma, os DOACs vêm cada vez mais ganhando espaço nos diversos cenários, apresentando maior segurança, menor perfil de interações medicamentosas e alimentares, maior comodidade posológica, acarretando maior adesão dos pacientes à terapia, além de melhor eficácia, se comparados à varfarina. É importante ressaltar que o uso dessa nova classe de droga está reservado a situações específicas, tendo em vista que não mostrou benefício em determinadas situações e, em outras situações, essas drogas precisam ser estudadas para terem seu uso validado na prática clínica. O objetivo dessa revisão é promover uma atualização, à luz dos principais e mais robustos ensaios clínicos publicados até o momento, sobre o uso dos anticoagulantes orais nos diversos cenários da cardiologia, abordando as suas principais indicações, contraindicações, assim como o tempo de uso dessa terapia e orientações posológicas em cada situação, com base nas melhores e mais atuais evidências sobre o tema.
Oral anticoagulants are medications widely used in cardiology. For a long time, warfarin was the only option available on the market for this therapy, and today it still has a unique role in some cases. However, with the emergence of direct oral anticoagulants (DOACs) in the 21st century, anticoagulant treatment has had a big breakthrough, constituting a new therapeutic option that offers more safety and effectiveness for anticoagulant therapy. Several cardiology scenarios require its uses. Recently, many studies have been carried out in order to clarify the risks and benefits of their use, the safety and efficiency of the drugs available in many clinical situations, and the interaction of these drugs with other medications commonly used in cardiology. Thus, DOACs are increasingly finding spaces in several settings, presenting safety, a lower profile of drug and food interactions, a better dosage convenience, adhesion of patients to the therapy, and efficiency when compared to warfarin. The use of this new class of drugs is reserved for specific situations, considering that it didn’t show any benefits in some conditions, and in many situations, these drugs need to be studied to have their use validated in clinical practice. The purpose of this review is to promote an update of the use of oral anticoagulants in many cardiology scenarios, considering the most robust clinical trials published to date to discuss the main indications, contraindications, as well as, time of use and dosage guidelines in each situation.
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Iqbal, Omer, Debra Hoppensteadt, Daniel Fareed, and Jawed Fareed. "Synthetic Anti-Xa Drugs Can Be Used for Parenteral Anticoagulation but Not Fondaparinux." Blood 104, no. 11 (November 16, 2004): 4088. http://dx.doi.org/10.1182/blood.v104.11.4088.4088.
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Abstract Targeting at the level of factor Xa and/or prothrombinase complex by synthetic anti-Xa agents such as JTV-803 (Akros Pharma, Princeton, NJ), DX-9065a (Daiichi Pharmaceuticals, Tokyo, Japan), and Fondaparinux (Sanofi-Synthelabo, Toulouse, France) represents an important approach in anticoagulant therapy. Factor Xa is an essential component of the prothrombinase complex and leads to the generation of thrombin. Synthetic heparin pentasaccharide, Fondaparinux (Arixtra®) has been approved by the United States Food and Drug Administration for the prophylaxis of deep vein thrombosis in patients undergoing hip and knee replacement surgeries. There is a rapid stride in the development of newer synthetic inhibitors of factor Xa such as DX-9065a, and JTV-803 in various thrombotic indications. In order to evaluate the parenteral anticoagulant potential of these synthetic factor Xa inhibitors, we used the Hemochron (celite) activated clotting time (ACT) assay. DX-9065a at a final concentration of 5 and 10 μg/ml increased the ACTs to 250 and 300 seconds, respectively. Similar anticoagulant potential was noticed with JTV-803. These findings suggest that these agents may be useful as parenteral anticoagulants during interventional cardiologic procedures, surgical anticoagulation and for the prevention of vascular access occlusion. Fondaparinux requiring antithrombin (AT) for its anticoagulant effect does not increase the celite ACT to the extent as other synthetic factor Xa inhibitors. Fondaparinux even at a final concentration of 100 μg/ml increase the ACT to about 200 seconds and hence are not suitable to be used as parenteral anticoagulants. The concentrations of JTV-803, DX-9065a and fondaparinux required to increase the ACT to near 250 seconds are 6.2, 5 and 125 μg/ml, respectively. While fondaparinux is AT-dependent, the synthetic anti-Xa agents are AT-independent in their actions. The antithrombin sparing effect of direct anti-Xa agents may contribute to an additional anticoagulant effect as reflected by increased ACT levels. Furthermore, there are some other advantages of direct anti-Xa agents when compared to fondaparinux. While direct anti-Xa agents may be used for patients with AT deficiency, fondaparinux being AT-dependent, may not. The inhibition of the clot-bound and prothrombinase-bound factor Xa are additional advantages of direct Xa inhibitors when compared to fondaparinux. Fondaparinux being AT-dependent and upon complexation with AT is not capable of inhibiting the clot-bound factor Xa. Oral Xa inhibitors are being developed and when available patients may have an ideal transition from a parenteral anti-Xa agent to an oral Xa inhibitor. The results clearly suggest that synthetic factor Xa inhibitors except fondaparinux may be used as parenteral anticoagulants. Large-scale clinical studies are warranted to evaluate these findings.
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Lucà, Fabiana, Simona Giubilato, Stefania Angela Di Fusco, Angelo Leone, Stefano Poli, Carmelo Massimiliano Rao, Annamaria Iorio, et al. "The Combination of Oral Anticoagulant and Antiplatelet Therapies: Stay One Step Ahead." Journal of Cardiovascular Pharmacology and Therapeutics 25, no. 5 (May 11, 2020): 391–98. http://dx.doi.org/10.1177/1074248420923528.
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Antithrombotic drugs, which include antiplatelets and anticoagulants, are effective in prevention and treatment of many cardiovascular disorders such as acute coronary syndromes, stroke, and venous thromboembolism and are among the drugs most commonly prescribed worldwide. The advent of direct oral anticoagulants, which are safer alternatives to vitamin K antagonists and do not require laboratory monitoring, has revolutionized the treatment of nonvalvular atrial fibrillation and venous thromboembolism. The combination of oral anticoagulant and antiplatelet therapy is required in many conditions of great clinical impact such as the coexistence of atrial fibrillation and coronary artery disease, with indication to percutaneous coronary intervention. However, strategies that combine anticoagulant and antiplatelet therapies lead to a significant increase in bleeding rates and it is crucial to find the right combination in the single patient in order to optimize the ischemic and bleeding risk. The aim of this review is to explore the evidence and controversies regarding the optimal combination of anticoagulant and antiplatelet therapy through the consideration of past dogmas and new perspectives from recent clinical trials and to propose a tailored therapeutic approach, according to specific clinical scenarios and individual patient characteristics. In particular, we separately explored the clinical settings of stable and acute coronary syndromes and percutaneous revascularization in patients with atrial fibrillation.
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Li, Jiajia, Qing Liang, and GuangChun Sun. "Interaction between Traditional Chinese Medicine and Anticoagulant/Antiplatelet Drugs." Current Drug Metabolism 20, no. 9 (October 4, 2019): 701–13. http://dx.doi.org/10.2174/1389200220666190827160212.
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Background: Traditional Chinese medicine (TCM) has been used for medical purposes since the ancient time and has gradually gained recognition worldwide. Nowadays, patients with thrombus presiding to anticoagulant/ antiplatelet drugs prefer taking TCM. However, an increasing number of studies on herb–drug interactions have been shown. Nevertheless, findings are frequently conflicting and vague. In this review, we discuss the herb–drug interactions between TCM and anticoagulant/antiplatelet drugs to provide guidance on concomitant ingestion with anticoagulant/antiplatelet drugs. Methods: We undertook a structured search of medicine and drug databases for peer-reviewed literature using focused review questions. Results: Danshen, Ginkgo, Ginger, H. Perforatum, SMY and Puerarin injection had directional regulation effects on the efficacy of anticoagulant drugs by altering the CYPs, pharmacokinetic indexs and hemorheological parameters. H. Perforatum inhibited the efficacy of Clopidogrel by enhancing the CYP3A4 activity and Ginkgo increased the efficacy of Ticlopidine. Additionally, Renshen, the formulae except SMY and injections except Puerarin injection could increase or decrease the efficacy of anticoagulant/antiplatelet drugs via regulating the CYPs, platelet aggregation, hemorheological parameters and others. Conclusion: Some cases have reported that TCMs may increase the bleeding risk or has no effect on coagulation when anticoagulant/antiplatelet drugs are concurrently used. However, pharmacokinetic studies have presented either consistent or slightly varying results. So it is difficult to ascertain whether the concurrent use of TCM may increase or reduce the pharmacologic effects of anticoagulant/antiplatelet drugs with adverse reactions. Therefore, herb–drug interactions of TCM and anticoagulant/antiplatelet drugs should be further explored and defined.
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Eibinger, Nicolas, Sascha Halvachizadeh, Barbara Hallmann, Franz Josef Seibert, Paul Puchwein, Till Berk, Rolf Lefering, Kai Sprengel, Hans Christoph Pape, and Kai Oliver Jensen. "Is the Regular Intake of Anticoagulative Agents an Independent Risk Factor for the Severity of Traumatic Brain Injuries in Geriatric Patients? A Retrospective Analysis of 10,559 Patients from the TraumaRegister DGU®." Brain Sciences 10, no. 11 (November 12, 2020): 842. http://dx.doi.org/10.3390/brainsci10110842.
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The purpose of this study was to assess anticoagulant medication as an independent factor influencing the occurrence of a severe traumatic brain injury in geriatric patients. Data were collected from the TraumaRegister DGU® between January 2015 and December 2018. We included patients with an age of ≥65 years with a blunt TBI; an AISHead ≥2 but no other relevant injuries. Patients were divided into five subgroups: no anticoagulant medication, anti-platelet drugs, vitamin K antagonists, direct-oral-anticoagulants, and heparinoids. Separation between moderate TBI (AISHead 2–3) and severe TBI (AISHead ≥ 4) and multivariable regression analysis were performed. The average age of 10,559 included patients was 78.8 years with a mean ISS of 16.8 points and a mortality of 22.9%. The most common cause of injury was a low fall of <3 m with 72.8%. With increasing age, the number of patients without any anticoagulant therapy decreased from 65.9% to 29.9%. The intake of coagulation medication increased mortality significantly. Severe TBI was observed in 51% of patients without medication and ranged from 61 to 67% with anticoagulant drugs. After adjusting for confounding variables, the intake of VKA or DOACs was significantly associated with an increased risk of severe TBI. The use of anticoagulant medication is an independent factor and is associated with an increased severity of TBI depending on the type of medication used.
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Tufano, Antonella, Paola Contaldi, Massimo Franchini, Giovanni Minno, and Antonio Coppola. "Oral Anticoagulant Drugs and the Risk of Osteoporosis: New Anticoagulants Better than Old?" Seminars in Thrombosis and Hemostasis 41, no. 04 (February 19, 2015): 382–88. http://dx.doi.org/10.1055/s-0034-1543999.
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