Articles de revues : « Oral anticoagulant therapy »

1

HIRSH, Jack. « Oral Anticoagulant Therapy ». Japanese Journal of Thrombosis and Hemostasis 5, n^o 2 (1994) : 114–20. http://dx.doi.org/10.2491/jjsth.5.114.

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MATSUDA, MAMORU. « Oral anticoagulant therapy. » Nihon Naika Gakkai Zasshi 84, n^o 9 (1995) : 1523–27. http://dx.doi.org/10.2169/naika.84.1523.

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Brigden, Malcolm L. « Oral anticoagulant therapy ». Postgraduate Medicine 91, n^o 2 (février 1992) : 285–96. http://dx.doi.org/10.1080/00325481.1992.11701213.

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Smithing, Robert T., et Madeline D. Wiley. « Oral Anticoagulant Therapy ». Nurse Practitioner 20, n^o 9 (septembre 1995) : 70. http://dx.doi.org/10.1097/00006205-199509000-00011.

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Brigden, Malcolm L. « Oral anticoagulant therapy ». Postgraduate Medicine 99, n^o 6 (juin 1996) : 81–102. http://dx.doi.org/10.1080/00325481.1996.11946138.

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Raskob, Gary E. « Oral anticoagulant therapy ». Current Opinion in Hematology 3, n^o 5 (1996) : 361–64. http://dx.doi.org/10.1097/00062752-199603050-00005.

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Ageno, Walter, Alexander S. Gallus, Ann Wittkowsky, Mark Crowther, Elaine M. Hylek et Gualtiero Palareti. « Oral Anticoagulant Therapy ». Chest 141, n^o 2 (février 2012) : e44S-e88S. http://dx.doi.org/10.1378/chest.11-2292.

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Agarwal, Pankaj. « Oral anticoagulant therapy ». Indian Journal of Dental Research 23, n^o 6 (2012) : 836. http://dx.doi.org/10.4103/0970-9290.111278.

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Anand, A. « Oral anticoagulant therapy ». Archives of Internal Medicine 153, n^o 16 (23 août 1993) : 1933a—1933. http://dx.doi.org/10.1001/archinte.153.16.1933a.

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Anand, Ajay. « Oral Anticoagulant Therapy ». Archives of Internal Medicine 153, n^o 16 (23 août 1993) : 1933. http://dx.doi.org/10.1001/archinte.1993.00410160107011.

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Fujii, Takashi, Hidenori Oishi, Kohsuke Teranishi, Kenji Yatomi, Kazumoto Suzuki et Hajime Arai. « Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy ». Interventional Neuroradiology 26, n^o 5 (29 juillet 2020) : 532–38. http://dx.doi.org/10.1177/1591019920947878.

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Purpose Antiplatelet therapy initiated before flow diverter placement is effective for the prevention of ischemic complications. However, the effectiveness of oral anticoagulant treatment is unclear. This retrospective study evaluated the complications and obliteration rates after flow diverter placement in patients taking anticoagulants. Methods A total of 155 cases were treated by Pipeline Flex placement for unruptured large and giant cerebral aneurysms in our hospital between October 2015 and June 2019. The groups of 8 patients taking anticoagulants before operation and 147 patients not taking anticoagulants were compared. Results Clopidogrel oral dose ( P = 0.002) was significantly lower in the anticoagulant group. Delayed aneurysm rupture ( P = 0.002) and additional treatment ( P = 0.009) rates were significantly higher and complete obliteration rate ( P = 0.011) was lower in the anticoagulant group. Conclusions Additional oral anticoagulant administration before flow diverter placement does not reduce ischemic complications compared to dual antiplatelet therapy, but does increase hemorrhagic complications, especially delayed aneurysm rupture. Complete obliteration of the cerebral aneurysm is difficult to achieve in patients taking anticoagulants.

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Manfredini, Mattia, Pier Paolo Poli, Luca Creminelli, Alberto Porro, Carlo Maiorana et Mario Beretta. « Comparative Risk of Bleeding of Anticoagulant Therapy with Vitamin K Antagonists (VKAs) and with Non-Vitamin K Antagonists in Patients Undergoing Dental Surgery ». Journal of Clinical Medicine 10, n^o 23 (25 novembre 2021) : 5526. http://dx.doi.org/10.3390/jcm10235526.

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Objectives: A wide variety of approaches have been proposed to manage anticoagulant drugs in patients undergoing dental surgery; vitamin K antagonists and novel direct oral anticoagulants have been used. The present study aims to explore the existing evidence concerning the management of patients in anticoagulant therapy undergoing oral surgery procedures and to give suggestions related to peri- and post-operative measures. Materials and methods: A comprehensive search of databases was conducted to identify studies that evaluated the relationship between direct oral anticoagulants and dental procedures. The present scoping review was realized in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The publications varied from randomized controlled trials (RCT) to cohort trials. Only articles written in English language and published between 2000 to 2020 were screened. The studies were included if discussing the management of a patient in anticoagulant therapy (warfarin or direct oral anticoagulants) scheduled for tooth extraction. Results: 33 studies were selected and included in the qualitative review. Nineteen considered anticoagulant therapy with warfarin, six considered anticoagulant therapy with new oral anticoagulants and eight compared patients taking warfarin with patients taking direct oral anticoagulants. Conclusions: No case of extractive surgery should alter the posology of the drug: thromboembolic risks derived from discontinuation are heavier than hemorrhagic risks. Clinical relevance: direct oral anticoagulants are safer in terms of bleeding and manageability and bleeding episodes are manageable with local hemostatic measures.

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Tatarsky, B. A., et N. V. Kazyonnova. « Safety and interaction of direct oral anticoagulants with antiarrhythmic drugs ». Russian Journal of Cardiology 26, n^o 7 (8 août 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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Efimova, O. I., et T. V. Pavlova. « CHOICE OF DIRECT ORAL ANTICOAGULANTS BASED ON THE INDIVIDUAL APPROACH ». Translational Medicine 5, n^o 6 (21 février 2019) : 10–22. http://dx.doi.org/10.18705/2311-4495-2018-5-6-10-22.

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This review article deals with the comparison of different modes of anticoagulant therapy, taking into account the risk profile and the individual characteristics of patients with atrial fibrillation. This paper analyzes the efficacy and safety of direct oral anticoagulants in different clinical situations. Modifiable and unmodifiable bleeding risk factors are evaluated based on the hemorrhagic complication risk assessment scales for patients taking anticoagulants. The evidence base for anticoagulant therapy in the presence of a single episode of atrial fibrillation is represented. Regimens and terms of initiation of anticoagulant therapy after a cardioembolic stroke or transient ischemic attack are considered. In addition, great attention is paid to the problem of early prescription of anticoagulants after intracranial hemorrhage. For patients at high risk of gastrointestinal bleeding or impaired renal function, an optimal strategy for reducing thromboembolic complications is evaluated. Anticoagulant therapy is also evaluated in patients with stable coronary heart disease, including after coronary stenting.

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Ansell, Jack, Jack Hirsh, James Dalen, Henry Bussey, David Anderson, Leon Poller, Alan Jacobson, Daniel Deykin et David Matchar. « Managing Oral Anticoagulant Therapy ». Chest 119, n^o 1 (janvier 2001) : 22S—38S. http://dx.doi.org/10.1378/chest.119.1_suppl.22s.

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Goolsby, Mary Jo. « Managing Oral Anticoagulant Therapy ». Journal of the American Academy of Nurse Practitioners 14, n^o 1 (janvier 2002) : 16–18. http://dx.doi.org/10.1111/j.1745-7599.2002.tb00065.x.

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Loeliger, Emil A. « Oral Anticoagulant Therapy Recommendations ». Chest 105, n^o 1 (janvier 1994) : 327–28. http://dx.doi.org/10.1378/chest.105.1.327b.

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Hirsh, Jack. « Oral Anticoagulant Therapy Recommendations ». Chest 105, n^o 1 (janvier 1994) : 328. http://dx.doi.org/10.1378/chest.105.1.328.

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Baranova, E. I., V. A. Ionin, A. A. Katsap, O. S. Kolesnik et E. V. Lebedeva. « Safety of direct oral anticoagulants in patients with atrial fibrillation and high risk of stroke (review of literature) ». Scientific Notes of the Pavlov University 26, n^o 3 (4 février 2020) : 43–56. http://dx.doi.org/10.24884/1607-4181-2019-26-3-43-56.

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Review discusses the problem of non-vitamin K antagonist oral anticoagulants safety in patients with non-valvular atrial fibrillation. Bleeding risk assessment while applying anticoagulant therapy, preventive methods for major bleeding (intracranial, gastro-intestinal) during this therapy as well as the strategy of treating patients with bleedings occurring on direct oral anticoagulants intake are discussed in this review. Special attention is paid to the choice of direct oral anticoagulant, the importance of specific antagonist of dabigatran – idarucizumab and indications for its clinical application.

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Ortel, Thomas L., et Stephan Moll. « Monitoring oral anticoagulant therapy in patients with lupus anticoagulants ». British Journal of Haematology 101, n^o 2 (mai 1998) : 390–91. http://dx.doi.org/10.1046/j.1365-2141.1998.0738c.x.

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Foletti, Mauro, Thomas Schmutz, Yvan Fleury, Jean-Luc Magnin, Christophe Le Terrier et Youcef Guechi. « Bleeding on oral anticoagulants : overview of reversal strategies ». Swiss Medical Weekly 153, n^o 2 (20 février 2023) : 40036. http://dx.doi.org/10.57187/smw.2023.40036.

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Oral anticoagulants (antivitamin K, direct oral anticoagulants) are routinely prescribed for the prevention or treatment of thromboembolic events, and many patients are now on long-term anticoagulant therapy. However, this complicates the management of urgent surgical conditions or major bleeding. Various strategies have been developed to reverse the anticoagulant effect and this narrative review provides an overview of the wide range of therapies currently available.

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Novikova, Т. N. « The risk of bleeding minimization with direct oral anticoagulants ». Aterotromboz = Atherothrombosis, n^o 1 (13 juillet 2021) : 106–26. http://dx.doi.org/10.21518/2307-1109-2021-11-1-106-126.

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This review is devoted to the safety issues of anticoagulant therapy prescribed for the prevention of stroke and systemic embolism in patients with atrial fibrillation. Direct oral anticoagulants are considered worldwide in accordance with the guidelines for the diagnosis and treatment of atrial fibrillation as the preferred anticoagulant choice for the prevention of stroke and systemic embolism. Direct oral anticoagulants in comparison with vitamin K antagonists generally have similar efficacy, but different safety profiles, primarily, this concerns the risk of large extracranial and, primarily, gastrointestinal hemorrhages. To minimize the risk of bleeding during therapy with direct oral anticoagulants, an individual approach to the choice of the drug for each individual patient is required after assessing the risk of bleeding, searching for a potential bleeding substrate, correcting existing risk factors and eliminating, if possible, the substrate. When choosing an anticoagulant therapy, special attention should be paid to the most vulnerable categories of patients, such as patients of older age groups and patients with concomitant chronic kidney disease. Among the direct oral anticoagulants registered in the Russian Federation, according to meta-analyzes of key randomized clinical trials and real clinical trials, apixaban has the most optimal benefit: risk ratio in a wide range of patients, including vulnerable populations. Dynamic observation, including regular assessment of renal function, control of clinical blood analysis, erythrocyte and platelet levels, after prescribing an individually selected anticoagulant to the patient, ensures the maximum safety of therapy. Small, so-called, annoying bleeding is not a reason for canceling the anticoagulant, but requires a careful search for the causes of bleeding and their correction.

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Jose Vicente Catalá Ripoll, Jose Ángel Monsalve Naharro, Esther Domingo Chiva, Pablo Cuesta Montero et Jose María Jiménez Vizuete. « Terapia antitrombótica en pacientes con hemorragia intracraneal. ¿Revertimos ? » Revista Electrónica AnestesiaR 10, n^o 8 (31 août 2018) : 6. http://dx.doi.org/10.30445/rear.v10i8.599.

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Realizamos una revisión de la guía de práctica clínica de la reversión de la terapia antitrombótica en pacientes con hemorragia intracraneal que hayan recibido terapia antiagregante, anticoagulante o fibrinolítica. Se analizan recomendaciones para la reversión de antagonistas de vitamina K, anticoagulantes orales de acción directa, heparinas no fraccionadas y de bajo peso molecular, trombolíticos y antiagregantes plaquetarios, en el contexto de una hemorragia intracraneal. ABSTRACT Review the clinical practice guidelines for the reversal of antithrombotic therapy in patients with intracranial hemorrhage with antiplatelet, anticoagulant or fibrinolytic therapy. We analyzed the most important recommendations for the reversal of vitamin K antagonists, direct-acting oral anticoagulants, unfractionated and low-molecular-weight heparins, thrombolytics and platelet antiaggregants, in the context of an intracranial hemorrhage.

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Patel, Anand, Richard P. Goddeau Jr et Nils Henninger. « Newer Oral Anticoagulants : Stroke Prevention and Pitfalls ». Open Cardiovascular Medicine Journal 10, n^o 1 (27 mai 2016) : 94–104. http://dx.doi.org/10.2174/1874192401610010094.

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Warfarin is very effective in preventing stroke in patients with atrial fibrillation. However, its use is limited due to fear of hemorrhagic complications, unpredictable anticoagulant effects related to multiple drug interactions and dietary restrictions, a narrow therapeutic window, frequent difficulty maintaining the anticoagulant effect within a narrow therapeutic window, and the need for inconvenient monitoring. Several newer oral anticoagulants have been approved for primary and secondary prevention of stroke in patients with non-valvular atrial fibrillation. These agents have several advantages relative to warfarin therapy. As a group, these direct oral anticoagulants (DOAC), which include the direct thrombin inhibitor, dabigatran, and the factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban), are more effective than dose adjusted warfarin for prevention of all-cause stroke (including both ischemic and hemorrhagic stroke), and have an overall more favorable safety profile. Nevertheless, an increased risk of gastrointestinal bleeding (with the exception of apixaban), increased risk for thrombotic complication with sudden discontinuation, and inability to accurately assess and reverse anticoagulant effect require consideration prior to therapy initiation, and pose a challenge for decision making in acute stroke therapy.

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Mierzwa, Kathleen, Gerlind Schneider et Andreas Müller. « Sudden sensorineural hearing loss during oral anticoagulant therapy ». Journal of Laryngology & ; Otology 118, n^o 11 (novembre 2004) : 872–76. http://dx.doi.org/10.1258/0022215042703778.

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This study investigated the role of sudden sensorineural hearing loss (SSNHL) as a symptom in oral anticoagulant therapy with vitamin K antagonists (Phenprocoumon; Marcumar®, Falithrom®). Vascular compromise of the cochlea due to thrombosis, embolus, reduced blood flow or vasospasm is one of the four possible pathways that can lead to SSNHL. Oral anticoagulant therapy should prevent thrombosis; if it does not the question arises as to whether the anticoagulation is working, or the wrong hypothesis of vascular compromise has been made. Patients with SSNHL during oral anticoagulant therapy who were admitted tothe ENT Department of the University Hospital in Jena from 1998 to 2001 were included. The pure-tone audiograms and the prothrombin time (PT) values before and after the event of the SSNHL were evaluated. The study found 10 patients with SSNHL during oral anticoagulant therapy. Although the audiograms showed some improvement in the majority of cases, three cases showed almost no improvement in hearing. On admission, half of the patients showed a PT-value higher than 30 per cent and in nine cases a PT-value >30 per cent could be demonstrated at least once duringtesting. It was not possible to demonstrate a relationship between the SSNHL and oral anticoagulation. Vascular compromise cannot be excluded as a cause for sudden hearing loss in patients undergoing oral anticoagulant therapy. It is possible that oral anticoagulants influence the viscosity of the plasma leading to interference with the microcirculation in the inner ear. Further research into this area is currently being conducted.

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Chongprasertpon, Napohn, Aiste Zebrauskaite, John Joseph Coughlan, Abdalla Ibrahim, Samer Arnous, Terence Hennessy et Thomas John Kiernan. « Performing diagnostic radial access coronary angiography on uninterrupted direct oral anticoagulant therapy : a prospective analysis ». Open Heart 6, n^o 1 (mai 2019) : e001026. http://dx.doi.org/10.1136/openhrt-2019-001026.

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PurposeWe sought to assess the safety of performing diagnostic radial access coronary angiography with uninterrupted anticoagulation on patients receiving direct oral anticoagulant therapy.BackgroundDirect oral anticoagulants have become a popular choice for the prevention of thromboembolism. Risk factors for thromboembolism are common among cardiovascular conditions and indications for direct oral anticoagulant therapy as well as coronary angiography often overlap in patients. It has been hypothesised that uninterrupted direct oral anticoagulant therapy would increase haemorrhagic and access site complications, however data in this area is limited.MethodsThis was a prospective observational analysis of 49 patients undergoing elective diagnostic coronary angiography while receiving uninterrupted anticoagulation with direct oral anticoagulants. This population was compared with a control group of 49 unselected patients presenting to the cardiology service for elective diagnostic coronary angiography. Continuous variables were analysed using the independent samples t-test and categorical variables using Pearson’s χ2 test.ResultsThe mean duration of radial compression for the control group was 235.8±62.8 min and for the uninterrupted direct oral anticoagulant group was 258.4±56.5 min. There was no significant difference in mean duration of radial compression (p=0.07; 95% CI=-1.4 to 46.5). There was also no difference in the complication rate between the two groups (p=1).ConclusionsWe observed similar complication rates and radial artery compression time postangiography in both groups. This small prospective observational study suggests that uninterrupted continuation of direct oral anticoagulants during coronary angiography is safe. Larger randomised control studies in this area would be beneficial.

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Jolobe, OMP. « Restarting Oral Anticoagulant Therapy After ». Journal of the Royal College of Physicians of Edinburgh 47, n^o 4 (décembre 2017) : 396–97. http://dx.doi.org/10.1177/147827151704700404.

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KAZAMA, Mutsuyoshi. « Guideline for oral anticoagulant therapy ». Blood & ; Vessel 16, n^o 4 (1985) : 431–39. http://dx.doi.org/10.2491/jjsth1970.16.431.

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&NA;. « Towards optimising oral anticoagulant therapy ». Inpharma Weekly &NA;, n^o 995 (juillet 1995) : 5. http://dx.doi.org/10.2165/00128413-199509950-00003.

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Gregoratos, Gabriel. « Oral Anticoagulant Therapy : Current Issues ». Preventive Cardiology 3, n^o 4 (septembre 2000) : 178–83. http://dx.doi.org/10.1111/j.1520-037x.2000.80377.x.

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VAN DEN BESSELAAR, A. M. H. P. « Control of oral anticoagulant therapy ». European Heart Journal 14, n^o 5 (1 mai 1993) : 723. http://dx.doi.org/10.1093/eurheartj/14.5.723.

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YLI-MAYRY, S., et H. V. HUIKURI. « Control of oral anticoagulant therapy ». European Heart Journal 14, n^o 5 (1 mai 1993) : 723–24. http://dx.doi.org/10.1093/eurheartj/14.5.723-a.

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Majumdar, G., et R. W. Payne. « Quality of oral anticoagulant therapy ». Clinical & ; Laboratory Haematology 7, n^o 2 (juin 1985) : 125–31. http://dx.doi.org/10.1111/j.1365-2257.1985.tb00016.x.

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Galvin, G. P. « Quality of oral anticoagulant therapy ». Clinical & ; Laboratory Haematology 8, n^o 3 (septembre 1986) : 268–69. http://dx.doi.org/10.1111/j.1365-2257.1986.tb00107.x.

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Schalekamp, T., et A. de Boer. « Pharmacogenetics of Oral Anticoagulant Therapy ». Current Pharmaceutical Design 16, n^o 2 (1 janvier 2010) : 187–203. http://dx.doi.org/10.2174/138161210790112737.

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Barcellona, Doris, Lara Fenu et Marina Minozzi. « Oral anticoagulant therapy and telemedicine ». Internal and Emergency Medicine 1, n^o 2 (juillet 2006) : 166–67. http://dx.doi.org/10.1007/bf02936549.

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Zoman, Hamad Al, Samer Al Jetaily, Asirvatham Alwin Robert, Jagan Kumar Baskaradoss, Abdulaziz Al-Suwyed, Sebastian Ciancio et Sultan Al Mubarak. « Flapless Dental Implant Surgery for Patients on Oral Anticoagulants—The “WarLess Procedure” : A Report of 2 Cases ». Journal of Oral Implantology 39, S1 (1 mai 2013) : 264–70. http://dx.doi.org/10.1563/aaid-joi-d-11-00105.

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Patients with prosthetic heart valves are maintained on lifelong oral anticoagulant therapy. The optimal anticoagulant management of such patients during surgical dental procedures has been debated for a long time. Compared with conventional dental implant placement, a minimally invasive flapless approach has the potential to reduce bleeding and minimize surgical time, postoperative pain, soft tissue inflammation, and crestal bone. The purpose of these case reports is to show the clinical predictability of dental implant placement using a minimally invasive flapless approach without reducing the dosage of anticoagulants for patients on lifelong anticoagulant therapy. In this study, a 45-year-old woman and a 58-year-old man who had undergone cardiac surgery and were currently under a full therapeutic level of anticoagulation therapy (warfarin) were treated with flapless dental implant surgery without reducing their anticoagulant dosage. Postoperative clinical and radiographic assessment showed no abnormality, minimal signs of inflammation, and excellent healing. The combination of minimally invasive flapless dental implant surgery with no interruption in the normal dose of the anticoagulant medications could be an improved method for placing dental implants in patients on long-term anticoagulant therapy.

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Ginsberg, Jeffrey S., Jack Hirsh, D. Christoper Turner, Mark N. Levine et Robert Burrows. « Risks to the Fetus of Anticoagulant Therapy During Pregnancy ». Thrombosis and Haemostasis 61, n^o 02 (1989) : 197–203. http://dx.doi.org/10.1055/s-0038-1646558.

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SummaryThe use of anticoagulants during pregnancy is problematic because of the potential adverse effects to the mother and the fetus. Heparin does not cross the placenta, and thus, it was surprising that a recent report concluded that heparin therapy during pregnancy was as risky as oral anticoagulant therapy. Therefore, we performed a literature review of fetal/infant outcomes following anticoagulant therapy during pregnancy. We examined 186 reports which described fetal/infant outcomes in 1,325 pregnancies associated with anticoagulant therapy. The rates of adverse fetal/infant outcomes including death, prematurity and congenital malformations following treatment with heparin, oral anticoagulants, or both were calculated. The previously described high rate of adverse feta/infant outcomes with heparin- treated patients, could be accounted for by the frequent use of heparin in pregnancies with comorbid conditions independently associated with adverse outcomes and by reports of uncomplicated prematurity. After excluding such pregnancies, outcomes in heparin-treated patients are similar to the normal population.

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Rombouts, Eva K., Frits R. Rosendaal et Felix J. M. van der Meer. « Subtherapeutic oral anticoagulant therapy : Frequency and risk factors ». Thrombosis and Haemostasis 101, n^o 03 (2009) : 552–56. http://dx.doi.org/10.1160/th08-09-0626.

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SummarySubtherapeutic anticoagulation levels increase both the risk and severity of thromboembolism. The aim of this study was to determine the cumulative incidence of subtherapeutic international normalised ratios (INRs) and to identify risk factors associated with a low INR. We performed a cohort study in 7,419 patients from a Dutch anticoagulation clinic. Patients who started a first treatment with oral anticoagulants between January 2000 and December 2005 and who were stably anticoagulated (4 consecutive INRs in the therapeutic range) were included. Within the cohort a nested case control study was performed to identify risk factors of subtherapeutic INRs and to determine how often a subtherapeutic INR is the result of medical interference in case of invasive procedures, hospital admissions, haemorrhage or overanticoagulation. In patients with a stable anticoagulation, the median time to a first low INR was 40 weeks. A subtherapeutic INR occurred twice as often in patients using acenocoumarol as in those using phenprocoumon (hazard ratio [HR] 2.1, 95% confidence interval [95%CI]:2.0 – 2.3) and was more common in patients with a high therapeutic range compared to a low therapeutic range (HR 1.8, 95%CI:1.5 – 2.2). Occurrence of a low INR also depended on indication for anticoagulant therapy, with the highest risk in patients who used anticoagulants as prophylaxis and the lowest risk in patients with mechanical heart valves. In 30% of cases the subtherapeutic INR was preceded by an event necessitating vitamin K or discontinuation of the anticoagulant drug.

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Radulescu, Vlad. « Anticoagulation Therapy in Children ». Seminars in Thrombosis and Hemostasis 43, n^o 08 (27 mars 2017) : 877–85. http://dx.doi.org/10.1055/s-0036-1598004.

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AbstractVenous thromboembolism (VTE) is very uncommon in children and adolescents compared with older adults, though its incidence has significantly increased over the past two decades. Given the rarity of the condition, the data on pediatric VTE lag behind the adult experience and consequently the management of VTE in children is, in large part, modeled on the adult strategies. This approach has certain limitations, given that young children have developmental particularities of the hemostatic system and differences in the pharmacokinetics and pharmacodynamics of various anticoagulant agents. The most commonly used anticoagulants in children continue to be the heparins and the vitamin K antagonists. Direct intravenous thrombin inhibitors, argatroban, bivalirudin, have very limited pediatric use. The non–vitamin K antagonist oral anticoagulant drugs (novel oral anticoagulants) present potential advantages in terms of efficacy, safety, and convenience, though pediatric data are limited to preclinical and small phase I trials. There are several ongoing phase I, II, and III trials for dabigatran rivaroxaban, apixaban, and edoxaban, the results of which are likely to change the future management of pediatric thromboses.

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Quenet, Sara, Andréa Buchmüller-Cordier, Jacqueline Reynaud, Brigitte Tardy-Poncet, Christine Thirion, Hervé Decousus, Patrick Mismetti et Silvy Laporte. « Compliance and stability of INR of two oral anticoagulants with different half-lives : a randomised trial ». Thrombosis and Haemostasis 89, n^o 03 (2003) : 458–67. http://dx.doi.org/10.1055/s-0037-1613374.

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SummaryThe aim of the study was to assess the respective roles of the half-life of elimination of oral anticoagulants and patient education as causes of instability of anticoagulation level in patients on oral anticoagulant therapy. Patients were randomised to receive either warfarin (long half-life) or acenocoumarol (short half-life) and either intensive or standard education, according to a factorial design. Instability of oral anticoagulant therapy was evaluated by the percentage of INRs and the time within the target range, and the variability between successive measurements. Compliance was assessed by means of electronic pill bottles. Eighty-six patients were included. Apart from the variability index, instability was similar between groups. Correlations between compliance and instability were observed only in the acenocoumarol group. No difference was found between the education groups. In patients starting oral anticoagulant therapy, dose determination may be the most important factor contributing to instability.

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Ivanovic, Branislava, Bosiljka Vujisic-Tesic, Dragan Simic et Danica Cvetkovic-Matic. « Nonoclusive thrombosis of mechanical mitral valve prosthesis caused by inadequate treatment of anticoagulant therapy resistance ». Vojnosanitetski pregled 65, n^o 11 (2008) : 851–54. http://dx.doi.org/10.2298/vsp0811851i.

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Background. Oral anticoagulants have been used in the prevention of thromboembolic complications for over six decades. A rare, but possible problem in the application of these medications could be resistance to them. Case report. We presented a patient with nonocclusive thrombosis of the mechanical mitral prosthesis due to inadequately treated resistance to peroral anticoagulant therapy. Resistance to oral anticoagulant medications was proven by an increased dosage of warfarin up to 20 mg and, after that, acenokumarol to 15 mg over ten days which did not lead to an increase in the international normalized ratio (INR) value over 1.2. On the basis of information that she did not take food rich in vitamin K or medications which could reduce effects of oral anticoagulants, and that she did not have additional illnesses and conditions that could cause an inadequate response to anticoagulant therapy, it was circumstantially concluded that this was a hereditary form of resistance. Because of the existing mechanical prosthetics on the mitral position, low molecular heparin has been introduced into the therapy. The patient reduced it on her own initiative, leading to nonocclusive valvular thrombosis. Conclusion. When associated complications like absolute arrhithmia does not exist, the finding of resistance to oral anticoagulant agents is an indication for the replacement of a mechanical prosthetic with a biological one which has been done in this patients.

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Girton, Mark, Mary Acker et Lindsay Bazydlo. « Lupus anticoagulant testing for patients on direct oral anticoagulants ». American Journal of Clinical Pathology 158, Supplement_1 (1 novembre 2022) : S12—S13. http://dx.doi.org/10.1093/ajcp/aqac126.021.

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Abstract As use of direct factor Xa inhibitor (direct oral anticoagulant; DOAC) therapy increases, a modified lupus anticoagulant (LAC) testing method was studied to remove interfering DOACs, allowing clinicians to evaluate patients for antiphospholipid syndrome (APS) without altering anticoagulation treatment. We evaluated the use of DOAC-StopTM on our LAC testing panel with two assays: dilute Russell viper venom time (dRVVT), a factor X activator, and Silica Clotting Time (SCT), an intrinsic coagulation pathway activator. The plasma specimens were pretreated with DOAC-STOPTM beads by mixing on a rocking platform for 5 minutes and centrifugation at 5000 rpm for 5 minutes. The treated plasma supernatant was used for each step of the assay including the screen, confirm (addition of phospholipid), 50:50 mix (addition of reagent plasma with coagulation factors) and confirm 50:50 mix. The total ratio (ratio between screen and confirm ratios relative to mean of normal ranges) was calculated and used per the package insert in the positive or negative interpretation of each LAC testing panel. The study included patients with one or more of the following characteristics identified during coagulation sign-out and chart review: no evidence of a LAC (NELAC), evidence of a LAC, and whether on apixaban or rivaroxaban therapy. The effectiveness of DOAC removal was characterized with an apixaban spiking experiment for NELAC and LAC patient specimens which showed no change in LAC testing panel interpretation before and after DOAC-STOPTM treatment. A second experiment with apixaban-spiked NELAC samples demonstrated removal of anti-factor Xa activity upon comparison of pre- and post-treatment with DOAC-STOPTM. Of 10 patients taking rivaroxaban, nine had positive dRVVT interpretations; eight of these specimens changed to negative interpretations after DOAC-STOPTM treatment. For SCT, two positive interpretations remained positive, while two of the remaining eight negatives became positive after treatment. Of nine patients taking apixaban, two had positive dRVVT interpretations, one of which became negative post-treatment. Of the seven negative interpretations, one became positive post-treatment. For SCT, three were positive pre-treatment and seven were negative with no change post-treatment. Providing a LAC testing option for patients on DOACs may be of benefit to patients and clinicians in APS assessment, eliminating the risk of suspending anticoagulation therapy. Our study shows DOAC-STOPTM effectively removes DOAC interference in the majority of patient specimens studied, though LAC testing and interpretation in the setting of a high-complexity patient population on DOAC therapy remains challenging with occasional false positives and false negatives.

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Spyropoulos, Alex C., et James D. Douketis. « How I treat anticoagulated patients undergoing an elective procedure or surgery ». Blood 120, n^o 15 (11 octobre 2012) : 2954–62. http://dx.doi.org/10.1182/blood-2012-06-415943.

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Abstract The periprocedural management of patients receiving long-term oral anticoagulant therapy remains a common but difficult clinical problem, with a lack of high-quality evidence to inform best practices. It is a patient's thromboembolic risk that drives the need for an aggressive periprocedural strategy, including the use of heparin bridging therapy, to minimize time off anticoagulant therapy, while the procedural bleed risk determines how and when postprocedural anticoagulant therapy should be resumed. Warfarin should be continued in patients undergoing selected minor procedures, whereas in major procedures that necessitate warfarin interruption, heparin bridging therapy should be considered in patients at high thromboembolic risk and in a minority of patients at moderate risk. Periprocedural data with the novel oral anticoagulants, such as dabigatran, rivaroxaban, and apixaban, are emerging, but their relatively short half-life, rapid onset of action, and predictable pharmacokinetics should simplify periprocedural use. This review aims to provide a practical, clinician-focused approach to periprocedural anticoagulant management.

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Cascalho Serra, Isaura da Conceição, Lurdes da Conceição Afonso Nobre Ribeiro, Maria Laurência Grou Parreirinha Gemito et Felismina Rosa Parreira Mendes. « Therapeutic management of users with oral anticoagulant therapy ». Enfermería Global 15, n^o 1 (9 janvier 2016) : 10. http://dx.doi.org/10.6018/eglobal.15.1.206711.

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Objetivo: Caracterizar a los usuarios con terapia anticoagulante oral; conocer el régimen de tratamiento y estimar los costes de evaluación de la International Normalized Ratio (INR). Metodologia: Estudio descriptivo, transversal, exploratorio, con 83 usuarios con terapia anticoagulante oral de un Centro de Salud de Alentejo. Los datos fueron recolectados con la aplicación de cuestionario construido para este fin. Resultados: Se concluyó que 50,6% informaron no saber qué es la coagulación; 49,4% lo que son anticoagulantes orales; 63,9% las complicaciones de la terapia anticoagulante oral. 27,7% conoce los alimentos que interfieren con esta terapia y 51,8% declara saber qué hacer en caso de lesión, cirugía o de la extracción de un diente. El costo de la evaluación de RNI (Razón Normalizada Internacional) en laboratorio es mayor que en los centros de salud. Conclusiones: Existen lagunas en el conocimiento sobre el proceso de coagulación, la interferencia de alimentación y el régimen. La descentralización de la consulta de enfermería puede reducir los costos, mejorar la accesibilidad y la gestión del régimen terapéutico.

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KADYSEVA, E. R. « Pharmacoeconomic aspects of the use of anticoagulants in a multi-speciality hospital ». Practical medicine 20, n^o 6 (2022) : 58–60. http://dx.doi.org/10.32000/2072-1757-2022-6-58-60.

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The article presents the dynamics of the consumption of oral anticoagulants and direct-acting anticoagulants for 2019–2021 in the Republic Clinical Hospital of the Republic of Tatarstan. Currently, anticoagulant therapy is very popular among clinicians. It is known that the economic component plays a rather important role in health care. The purpose — to analyze the costs of anticoagulant drugs in a multi-speciality hospital in 2019–2021. Material and methods. An analysis was made of the share of costs of direct-acting anticoagulants and oral anticoagulants in the total cost of medicines by years in a multi-speciality hospital using the Apteka 1C software. Results. There is a clear trend towards increased consumption of direct-acting anticoagulants and oral anticoagulants. The peak of consumption was observed in 2020 and 2021. Conclusions. The use of oral anticoagulants reduces direct costs compared to standard prophylaxis with direct anticoagulants.

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Konkle, Barbara A. « Monitoring target-specific oral anticoagulants ». Hematology 2014, n^o 1 (5 décembre 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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DIACONU, Camelia, Giorgiana DEDIU, Mădălina ILIE et Mihaela Adela IANCU. « Treatment with new oral anticoagulants in the family medicine practice ». Romanian Journal of Medical Practice 10, n^o 4 (31 décembre 2015) : 329–32. http://dx.doi.org/10.37897/rjmp.2015.4.4.

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Vitamin K antagonists represented for more than 50 years the only oral anticoagulant treatment option, though encumbered by numerous food and drug interactions, with direct impact on the safety and efficacy of this treatment. The frequent complications of anticoagulant treatment with vitamin K antagonists led to the need for the emergence of new oral anticoagulants (NOAC). The main NOACs used today are dabigatran, rivaroxaban and apixaban. NOAC have a number of advantages over antivitamin K anticoagulants: fewer drug interactions, no food interactions, rapid onset of the anticoagulant action, rapid clearance, no need for INR monitoring. NOAC therapy must be individualized according to patient age, comorbidities and medical history, renal function, concomitant medications. Given that clinical experience with NOAC is still limited in practice, physicians (including family physicians) must monitor these patients and need to pay attention and report any side effects.

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Greenlee, Katie M. « New Oral Anticoagulants ». Journal of Pharmacy Practice 15, n^o 4 (août 2002) : 369–76. http://dx.doi.org/10.1177/089719002129041359.

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The risk of bleeding, narrow therapeutic index, and need for routine monitoring make oral anticoagulation with warfarin a less than ideal oral anticoagulant. Intravenous therapies such as heparin are not orally bioavailable and have a narrow therapeutic index and high risk of bleeding. New oral antico agulants currently under investigation may have more ideal characteristics for long-term administration. The mechanism of thrombogenesis, limitations of current therapy, and new investigational oral anticoagulants are discussed.

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Kim, Stephanie, Jennifer Namba, Aaron M. Goodman, Thi Nguyen et Ila M. Saunders. « Safety and efficacy of direct oral anticoagulants for venous thromboembolism and stroke prophylaxis in patients with hematologic malignancies ». Journal of Oncology Pharmacy Practice 26, n^o 2 (29 mai 2019) : 351–60. http://dx.doi.org/10.1177/1078155219848810.

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Purpose Low-molecular-weight heparins are currently the recommended antithrombotic therapy for treatment and prevention of malignancy-related venous thromboembolism. Currently, the evidence evaluating direct oral anticoagulants versus low-molecular-weight heparins or a vitamin K antagonist in cancer patients with hematologic malignancies is limited. We evaluated the safety and efficacy of direct oral anticoagulants for venous thromboembolism treatment or stroke prevention for non-valvular atrial fibrillation in patients with hematologic malignancies. Methods This was a retrospective evaluation of adult patients with hematologic malignancies who received at least one dose of the Food and Drug Administration-approved direct oral anticoagulant for venous thromboembolism treatment or stroke prevention. We determined the frequency of major bleeding events, non-major bleeding events, stroke, systemic embolism, appropriateness of initial direct oral anticoagulant doses, holding practices prior to procedures, and the rate of all-cause mortality. An analysis was also performed to compare the incidence of bleeding between patients with a history of hematopoietic stem cell transplant to non-transplant patients. Results A total of 103 patients were identified, with the majority of patients receiving rivaroxaban for venous thromboembolism treatment. Major bleeding events occurred in four patients and no fatal bleeding events occurred. Non-major bleeding occurred in 29 patients, most commonly epistaxis and bruising. Two patients experienced a systemic embolism while on direct oral anticoagulant therapy. Conclusion Direct oral anticoagulants may be a safe and effective alternative for anticoagulation therapy in patients with hematologic malignancies. However, larger prospective studies comparing direct oral anticoagulants to low-molecular-weight heparins or vitamin K antagonists are warranted to compare efficacy and safety outcomes in this patient population.

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