28,127 results match your criteria Warfarin Dosing and VKORC1 CYP2C9


Dimethyl 2,2'-[2,2'-(ethane-1,1-diyl)bis(1-indole-3,2-diyl)]-diacetate: a small molecule capable of nano-scale assembly, inhibiting venous thrombosis and inducing no bleeding side effect.

Int J Nanomedicine 2018 22;13:7835-7844. Epub 2018 Nov 22.

Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, School of Pharmaceutical Sciences, Capital Medical University, Beijing 100069, China,

Background: Due to the discovery that deep venous thrombosis (DVT) inhibitor is of chemotherapeutic importance, the nano-property of dimethyl 2,2'-[2,2'-(ethane-1,1-diyl) bis(1-indole-3,2-diyl)]-diacetate (DEBIC), a recently reported antitumor agent, is worthy of characterization.

Materials And Methods: One-pot reaction was used to prepare DEBIC. Electrospray Ionization (+/-)-Fourier Transform-Ion Cyclotron Resonance-Mass Spectrometer (ESI(+/-)-FT-ICR-MS), quadrupole Collision Induced Dissociation (qCID) and nuclear overhauser effect spectroscopy spectra were used to present the assembly of DEBIC. Read More

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November 2018

Cerebral Venous Thrombosis: An Uncommon Cause of Papilledema on Bedside Ocular Ultrasound.

J Emerg Med 2018 Dec 8. Epub 2018 Dec 8.

Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida.

Background: Cerebral venous thrombosis (CVT) is a rare, difficult-to-diagnose form of venous thromboembolic disease and is considered a type of stroke. Its presentation is highly variable and may be easily confused for more common and less debilitating or life-threatening diagnoses such as migraine, seizure, or idiopathic intracranial hypertension.

Case Report: A 25-year-old woman presented with a complaint of bifrontal throbbing headache and blurry vision. Read More

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December 2018

Cardiac valve calcification and use of anticoagulants: Preliminary observation of a potentially modifiable risk factor.

Int J Cardiol 2018 Nov 29. Epub 2018 Nov 29.

Department of Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy. Electronic address:

Aims: Direct oral anticoagulant (DOAC) has been recently introduced in the clinical practice. Rather than interfering with vitamin K-dependent posttranscriptional modification of various proteins, DOACs selectively inhibit factors involved in the coagulation cascade. In particular, in contrast with Warfarin, Rivaroxabn does not interfere with activation of matrix Gla Protein (MGP), a potent vascular calcification Inhibitor. Read More

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November 2018

A case of acute myocardial infarction during perioperative period of non-cardiac surgery in a patient with antiphospholipid syndrome and a history of coronary artery bypass surgery.

J Cardiol Cases 2014 May 22;9(5):189-191. Epub 2014 Feb 22.

Department of Cardiology and Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.

A 65-year-old woman underwent coronary artery bypass surgery and was diagnosed with antiphospholipid syndrome (APS) at the same time in 1985. She was admitted to our hospital to undergo mastectomy for left breast cancer in 2012. She was put on intravenous infusion of heparin and stopped receiving both antiplatelet agents and warfarin. Read More

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Follow-up in a patient with previous coronary artery bypass grafting with clipping for moderate stenosis of the native artery due to Kawasaki disease.

J Cardiol Cases 2014 Mar 12;9(3):100-103. Epub 2013 Dec 12.

Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.

We report the beneficial outcome of coronary artery bypass grafting (CABG) with aneurysm clipping for Kawasaki disease (KD)-related moderate stenosis of the native coronary artery. A 13-year-old boy developed 90% stenosis of the left anterior descending artery (LAD) and an aneurysm with 50% stenosis of the right coronary artery (RCA) seven years after KD. We grafted the RCA with the right internal thoracic artery (RITA) and clipped the proximal RCA, in addition to conventional grafting of the LAD with the left internal thoracic artery, because we were concerned that competition in flow between the native RCA and the graft might lead to graft occlusion. Read More

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Anaphylactic shock associated with intravenous amiodarone.

J Cardiol Cases 2014 Feb 12;9(2):61-62. Epub 2013 Dec 12.

Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.

A 64-year-old woman was admitted to our emergency department with shortness of breath and palpitation which started 2 h before her admission. She had a history of rheumatic mitral valve disease and was on drug treatment with warfarin and metoprolol. The patient was orthopneic, blood pressure was 108/68 mmHg with an irregular pulse with a heart rate of 158 beats per minute, and respiratory rate was 23 times per minute. Read More

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February 2014
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Local injection of tissue-plasminogen activator using a pulse spray catheter as a treatment option for proximal deep vein thrombosis: A case report.

J Cardiol Cases 2014 Nov 27;10(5):163-166. Epub 2014 Jun 27.

Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, Yokohama, Japan.

A 24-year-old woman was admitted to our hospital with the diagnosis of pulmonary thromboembolism (PTE) and left common iliac vein thrombosis. She had used low-dose contraceptive pill for dysmenorrhea. Otherwise, her laboratory data did not show any other thrombotic risk factors. Read More

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November 2014
1 Read

A case with a huge left ventricular thrombus growing over the posterior papillary muscle and chordae tendinae.

J Cardiol Cases 2014 Jul 1;10(1):31-33. Epub 2014 May 1.

Department of Cardiology, Istanbul Medicine Hospital, Istanbul, Turkey.

We present a case with a giant left ventricular thrombus grown over papillary muscle and chordae tendinae. The patient had declined both surgical and fibrinolytic therapy. After long-term anticoagulation therapy, regression was observed without embolic complication. Read More

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A case of aortic thrombosis and embolism preceding the progression of early esophageal cancer.

J Cardiol Cases 2013 May 12;7(5):e123-e125. Epub 2013 Feb 12.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.

Aortic thrombosis is rare, especially in non-atherosclerotic aortae. A 51-year-old woman presented with intermittent claudication in the right lower extremity. She was diagnosed as having peripheral artery disease on ultrasound. Read More

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Acute pulmonary embolism induced by renal obstruction with benign prostatic hyperplasia: Case report.

J Cardiol Cases 2012 Feb 21;5(1):e39-e43. Epub 2011 Nov 21.

Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.

Background: We report a rare case of acute pulmonary embolism (PE) induced by urinary retention and bladder distention with benign prostatic hyperplasia (BPH).

Case Report: A 76-year-old male with BPH presented to the hospital with anuria of 24 h duration and abdominal distention. Physical examination revealed tenderness and distention of the lower abdomen and a swollen right leg. Read More

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February 2012

Rupture of pseudoaneurysm of the pancreaticoduodenal arcade after acute aortic dissection in a patient on anticoagulant therapy.

J Cardiol Cases 2011 Apr 13;3(2):e103-e105. Epub 2011 Jan 13.

Division of Cardiology, Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.

An 81-year-old woman on anticoagulant therapy after mechanical heart valve replacement was admitted because of acute aortic dissection. Anticoagulant therapy had to be continued with heparin even after admission. Gastrointestinal hemorrhage occurred suddenly and she developed hemorrhagic shock. Read More

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A case of acute coronary syndrome caused by a giant saddle thrombus at left main coronary artery bifurcation.

J Cardiol Cases 2011 Apr 17;3(2):e86-e89. Epub 2011 Feb 17.

Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Kumamoto 861-4193, Japan.

An 87-year-old woman who had metastatic lung cancer presented with intermittent chest discomfort. The emergent coronary angiogram showed a giant saddle thrombus at the left main coronary artery bifurcation without flow limitation. We performed thrombolysis with unfractionated heparin and warfarin under careful observation of the thrombus with a 320-row area detector computed tomography (ADCT). Read More

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Resolution of thrombus in left ventricular outflow tract pseudoaneurysm mimicking periaortic abscess.

J Cardiol Cases 2010 Dec 30;2(3):e128-e131. Epub 2010 Jun 30.

Ahi Evren Chest, Heart and Vascular Surgery Hospital, Trabzon, Turkey.

Prosthetic valve complications are not uncommon after valve replacement. In this paper we report a female patient who presented with aortic prosthetic valve endocarditis and echocardiographic appearance of periaortic abscess. After 6 weeks of antibiotic therapy, echocardiographic examination revealed resolution of abscess cavity and replacement with a clear blood-filled anechoic sac. Read More

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December 2010

as a Rare Causative Agent for Lemierre's Syndrome.

Case Rep Infect Dis 2018 7;2018:3628395. Epub 2018 Nov 7.

Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA.

Lemierre's syndrome is a rare disease associated with significant morbidity and mortality. It begins with an oropharyngeal infection, which spreads locally to involve the internal jugular vein causing thrombophlebitis, followed by distant spread and metastatic infections. Affected individuals are commonly young adults. Read More

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November 2018

The incidence of left atrial appendage thrombi on transesophageal echocardiography after pretreatment with apixaban for cardioversion in the real-world practice.

PLoS One 2018 7;13(12):e0208734. Epub 2018 Dec 7.

Department of internal medicine, Division of Cardiology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.

The risk of thromboembolisms during the post-cardioversion period is high. For patients with persistent atrial fibrillation (AF), anticoagulation with warfarin (INR 2.0~3. Read More

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December 2018

Analysis of comprehensive pharmacogenomic profiling to impact in-hospital prescribing.

Pharmacogenet Genomics 2018 Dec 6. Epub 2018 Dec 6.

Center for Personalized Therapeutics.

Introduction: In-hospital adverse medication events result in increased morbidity and mortality. Many implicated drugs carry pharmacogenomic information. We hypothesized that comprehensive pre-emptive pharmacogenomic profiling could have high relevance for in-hospital prescribing. Read More

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December 2018

Use of Anti-coagulation Agents after Traumatic Intracranial Hemorrhage.

World Neurosurg 2018 Dec 5. Epub 2018 Dec 5.

Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Texas USA. Electronic address:

Objectives: Anticoagulant therapy (ACT) after traumatic intracranial hemorrhage may lead to progression of hemorrhage, but in the presence of thromboembolic events the clinician must decide if the benefits outweigh the risks. Currently, no data exist to guide therapy in the acute setting.

Patients And Methods: We retrospectively identified all patients admitted to our institution with traumatic intracranial hemorrhage that received intravenous heparin, full dose enoxaparin, or warfarin during their initial hospitalization over a three-year period. Read More

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December 2018

Prospective Evaluation for Hypoattenuated Leaflet Thickening Following Transcatheter Aortic Valve Implantation.

Am J Cardiol 2018 Nov 24. Epub 2018 Nov 24.

Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota. Electronic address:

Prospective investigations for the frequency of hypoattenuated leaflet thickening (HALT) and its clinical implications in transcatheter aortic valve implantation (TAVI) patients are limited. We initiated a prospective screening program of TAVI patients for HALT beginning in July 2015. Eligible patients were evaluated with gated, contrast-enhanced multidetector computed tomography within 30 days of TAVI, and examined for HALT and clinical outcomes. Read More

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November 2018

[Treatment with oral anticoagulants in older patients: Should warfarin still be prescribed?]

Presse Med 2018 Dec 7. Epub 2018 Dec 7.

AP-HP, hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, site Charles Foix, service de gériatrie à orientation cardiologique et neurologique, 94205 Ivry-sur-Seine, France; Sorbonne université, faculté de médecine, 75013 Paris, France.

Vitamin-K antagonists (VKA) have been the standard for oral anticoagulation. However, they carry several problems in older patients: frequent bleeding complications, complex management, risk of interactions with multiple drugs. Two classes of direct oral anticoagulants (DOA) are currently available in France: (a) direct thrombin inhibitors: dabigatran; and (b) direct factor Xa inhibitors: rivaroxaban, apixaban and others. Read More

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December 2018

Relation of the CHADS-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study).

Am J Cardiol 2018 Nov 6. Epub 2018 Nov 6.

Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.

Recent hospital-based cohort studies found the CHADS-VASc score to be associated with ischemic stroke in individuals without atrial fibrillation (AF). Our aim was to determine the distribution of embolic and thrombotic strokes and association with the CHADS-VASc score, among community-dwelling individuals without AF. We included participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996 to 1998) and had no previous AF, stroke, or anticoagulant use (n = 10,671). Read More

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November 2018
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Impact of Body Mass Index on Outcomes in the Edoxaban Versus Warfarin Therapy Groups in Patients Underwent Cardioversion of Atrial Fibrillation (from ENSURE-AF).

Am J Cardiol 2018 Nov 24. Epub 2018 Nov 24.

St. Vincenz-Hospital, Paderborn, Germany; Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany.

In the EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation study (NCT 02072434), edoxaban showed similar efficacy and safety versus enoxaparin-warfarin in patients underwent electrical cardioversion of nonvalvular atrial fibrillation. In this ancillary analysis, we compared the primary efficacy (composite of stroke, systemic embolic event, myocardial infarction, cardiovascular death, and overall study period) and safety (composite of major and clinically relevant nonmajor bleeding, on-treatment) end points in relation to body mass index (BMI; <30 vs ≥30 kg/m). We also compared cardioversion outcomes in relation to BMI. Read More

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November 2018

Relation of Race, Apparent Disability, and Stroke Risk With Warfarin Prescribing for Atrial Fibrillation in Patients Receiving Maintenance Hemodialysis.

Am J Cardiol 2018 Nov 24. Epub 2018 Nov 24.

Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.

Little is known about how warfarin is prescribed for stroke prevention in maintenance dialysis patients with chronic atrial fibrillation (AF). We examined patterns of warfarin use, and associated factors, after AF diagnosis. This retrospective cohort analysis studied US Medicare patients receiving maintenance dialysis January 1, 2008, to June 30, 2010. Read More

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November 2018

Learning a complex dose-response relationship with the computer simulation CoaguSim.

Curr Pharm Teach Learn 2018 Oct 8;10(10):1406-1413. Epub 2018 Aug 8.

Otago Polytechnic, Forth Street, Private Bag 1910, Dunedin, New Zealand. Electronic address:

Background And Purpose: Coagulation is a complex physiological process that includes numerous feedback and feedforward reactions. Learning about coagulation and the use of anticoagulants is complicated by the dynamic and non-linear nature of the processes involved. The purpose of this study was to implement and evaluate the effects of a computer simulation-enabled workshop on students' understanding of the time course of warfarin effect. Read More

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October 2018

Use of electronic health record data from diverse primary care practices to identify and characterize patients' prescribed common medications.

Health Informatics J 2018 Dec 10:1460458218813640. Epub 2018 Dec 10.

University of Washington, USA; Institute of Translational Health Sciences, USA.

We use prescription of statin medications and prescription of warfarin to explore the capacity of electronic health record data to (1) describe cohorts of patients prescribed these medications and (2) identify cohorts of patients with evidence of adverse events related to prescription of these medications. This study was conducted in the WWAMI region Practice and Research Network (WPRN)., a network of primary care practices across Washington, Wyoming, Alaska, Montana and Idaho DataQUEST, an electronic data-sharing infrastructure. Read More

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December 2018

Left Atrial Appendage Closure Device Implantation in Patients with Prior Intracranial Hemorrhage.

Heart Rhythm 2018 Nov 19. Epub 2018 Nov 19.

Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH. Electronic address:

Background: The Watchman™ device (Boston Scientific, MN), used for left atrial appendage closure (LAAC) was approved for stroke prevention in patients with atrial fibrillation (AF) and an appropriate rationale to avoid long-term oral anticoagulation. Patients with AF and prior intracranial hemorrhage (ICH) were excluded from clinical trials due to perceived risks of peri-operative anticoagulation.

Objective: We studied the efficacy and safety of LAAC using Watchman™ in patients with AF and prior ICH. Read More

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November 2018

Rapid and substantial increases in anticoagulant use and expenditure in Australia following the introduction of new types of oral anticoagulants.

PLoS One 2018 6;13(12):e0208824. Epub 2018 Dec 6.

National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.

Objectives: To quantify changes in anticoagulant use in Australia since the introduction of Non-vitamin K antagonist anticoagulants (NOACs) and to estimate government expenditure.

Design: Interrupted-time-series analysis quantifying anticoagulant dispensing, before and after first Pharmaceutical Benefits Scheme (PBS) NOAC listing in August 2009 for venous thromboembolism prevention; and expanded listing for stroke prevention in non-valvular atrial fibrillation (AF) in August 2013, up to June 2016. Estimated government expenditure on PBS-listed anticoagulants. Read More

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December 2018

Transient Q-waves in an infant with asymptomatic myocardial infarction due to Kawasaki disease.

Cardiol Young 2018 Dec 6:1-4. Epub 2018 Dec 6.

Department of Pediatrics,Shinshu University School of Medicine,Asahi 3-1-1, Matsumoto,Japan.

Giant coronary artery aneurysms are a complication of Kawasaki disease and can be fatal if associated with thrombosis. We describe the clinical outcome of a boy with Kawasaki disease who exhibited "supergiant" coronary artery aneurysms at the age of 14 months and, despite treatment with anticoagulant and antiplatelet medication, developed a left coronary artery thrombosis and presented following a myocardial infarction at 2 years old. Although his symptoms were minimal, the myocardial infarction was identified by abnormal Q-waves and giant negative T-waves in precordial leads of routine electrocardiography. Read More

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December 2018
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Emergent surgical treatment of lethal valve dysfunction during pregnancy in a last-trimester patient.

Saudi Med J 2018 Dec;39(12):1249-1252

Department of Cardiovascular Surgery, Selcuk University, Konya, Turkey. E-mail.

A mechanical heart valve thrombosis during pregnancy is one of the most lethal conditions to experience due to its detrimental effects on both mother and fetus. Cardiac surgery during pregnancy is reserved for cases where medical treatment fails due to harmful maternal and fetal effects. A 24-year-old female in the 38th week of pregnancy was admitted to the emergency room with aggravated dyspnea, tachypnea, and palpitations. Read More

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December 2018

Abstract 4: Safety of Intravenous Thrombolysis Among Patients Taking Direct Oral Anticoagulants: A Systematic Review and Meta-analysis.

Stroke 2018 Jan;49(Suppl_1):A4

Dept of Neurology, Danville, PA.

Introduction: Direct oral anticoagulants (DOACs) are increasingly being administered for atrial fibrillation and stroke prevention. The risk of symptomatic hemorrhagic transformation (sHT) following intravenous thrombolysis (IVT) among stroke patients who take DOACs is not clear.

Methods: We conducted a systematic review of literature through six different resources-PubMed, Scopus, Embase, Clinicaltrial. Read More

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January 2018

Cost-effectiveness of rivaroxaban versus warfarin for treatment of nonvalvular atrial fibrillation in patients with worsening renal function.

Int J Cardiol 2018 Nov 19. Epub 2018 Nov 19.

Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, United States of America; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, United States of America.

Background: Nonvalvular atrial fibrillation (NVAF) is highly prevalent and increases the risks of cardiovascular events. In a recent subgroup analysis, treatment response was shown to vary for patients exhibiting worsening renal function (WRF) on-treatment. It is important to understand the cost-effectiveness of novel oral anticoagulant (NOAC) use in this population. Read More

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November 2018
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CYP2C9*61, a rare missense variant identified in a Puerto Rican patient with low warfarin dose requirements.

Pharmacogenomics 2018 Dec 6. Epub 2018 Dec 6.

Department of Pharmaceutical Sciences, School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, Puerto Rico.

Warfarin continues to be the mainstay therapy for preventing thrombus formation. Although pharmacogenetic algorithms have shown higher predictability of the optimal warfarin dose and lower occurrence of bleeding episodes, they often do not include ethno-specific genetic variants relevant to non-Europeans. This case report describes a rare missense variant at exon 9 of CYP2C9 (rs202201137; c. Read More

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December 2018

Efficacy of dual antiplatelet therapy for preventing recurrence of arterial thrombosis in patients with antiphospholipid syndrome.

Rheumatology (Oxford) 2018 Nov 30. Epub 2018 Nov 30.

Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.

Objective: Warfarin is regarded as the standard treatment for preventing thrombotic events in APS, but the recurrence rate is still high. Dual antiplatelet therapy (DAPT) has been shown to be effective for the prevention of acute coronary syndrome or stroke. The objective of this study was to evaluate the efficacy of DAPT for the prevention of thrombosis recurrence in APS patients with history of arterial thrombosis. Read More

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November 2018

[Optimization of Nasal Drug Absorption from Powder Formulations: The Feasibility of Controlling Drug Absorption by the Use of Pharmaceutical Excipients].

Authors:
Akiko Tanaka

Yakugaku Zasshi 2018 ;138(12):1467-1472

Department of Biopharmaceutics, Kyoto Pharmaceutical University.

Nasal application of powder formulations has garnered attention because of its significant potential for systemic drug delivery. Because a powder drug must first diffuse from the formulation and dissolve in the nasal cavity fluid before transepithelial permeation, dissolution and diffusion are distinct but important factors for nasal drug absorption. Since the formulation is directly administered onto the nasal mucosal surface, the effect of excipients on drug absorption may be significant. Read More

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January 2018

Role of the anticoagulant monitoring service in 2018: beyond warfarin.

Authors:
Nathan P Clark

Hematology Am Soc Hematol Educ Program 2018 Nov;2018(1):348-352

Kaiser Permanente Colorado, Aurora, CO; and Department of Clinical Pharmacy, Colorado University Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO.

The direct oral anticoagulants (DOACs) have a wide therapeutic index, few drug interaction, no dietary interactions and do not require dose adjustment according to the results of routine coagulation testing. Despite these advantages over warfarin, the DOACs remain high risk medications. There is evidence that non-adherence, off-label dosing and inadequate care transitions during DOAC therapy increase the risk of bleeding and thromboembolic complications. Read More

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November 2018

Drug-drug interactions in an era of multiple anticoagulants: a focus on clinically relevant drug interactions.

Authors:
Sara R Vazquez

Hematology Am Soc Hematol Educ Program 2018 Nov;2018(1):339-347

Pharmacy Services Department, University of Utah Health, Salt Lake City, UT.

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. Read More

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November 2018
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Patients Prescribed Direct-acting Oral Anticoagulants Have Low Risk of Post-Polypectomy Complications.

Clin Gastroenterol Hepatol 2018 Nov 29. Epub 2018 Nov 29.

Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, CA, United States.

Background & Aims: Use of direct-acting oral anticoagulants (DOACs) is increasing, but little is known about the associated risks in patients undergoing colonoscopy with polypectomy. We aimed to determine the risk of post-polypectomy complications in patients prescribed DOACs.

Methods: We performed a retrospective analysis using the Clinformatics Data Mart Database (a de-identified administrative database from a large national insurance provider) to identify adults who underwent colonoscopy with polypectomy or endoscopic mucosal resection (EMR) from January 1, 2011, through December 31, 2015. Read More

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November 2018
3 Reads

A Case Series of Asymptomatic Hemodialysis Catheter-Related Right Atrial Thrombi That Are Incidentally Detected Prior to Kidney Transplantation.

Transplant Proc 2018 Sep 7. Epub 2018 Sep 7.

Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address:

A hemodialysis (HD) catheter-related right atrial thrombus (RAT) is rarely encountered prior to kidney transplantation (KT) but necessitates a decision about whether to anticoagulate and/or delay the surgery. There is controversy surrounding the clinical implications of a RAT in this situation. It is sometimes considered fatal but other opinions consider it to be benign, especially when incidentally detected. Read More

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September 2018
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Electroconvulsive Therapy While Receiving Oral Anticoagulation for Deep Venous Thrombosis: Report on Eight Cases and a Review of the Literature.

Psychosomatics 2018 Nov 7. Epub 2018 Nov 7.

University of Yamanashi, Faculty of Medicine, Department of Neuropsychiatry and Clinical Ethics, Yamanashi, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. Electronic address:

Background: Electroconvulsive therapy (ECT) is indicated for critical psychiatric conditions, which themselves constitute a risk for deep venous thrombosis (DVT) owing to prolonged immobility, dehydration, and venous stasis.

Objective: We describe challenging instances of ECT implementation while taking direct oral anticoagulants (DOACs).

Method: We report on 8 patients receiving DOACs for DVT who were successfully treated with ECT at the University of Yamanashi Hospital. Read More

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November 2018
1 Read

Use of oral anticoagulants in complex clinical situations with atrial fibrillation.

Med Clin (Barc) 2018 Jun;150 Suppl 1:8-24

Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España. Electronic address:

The present article provides an update on anticoagulant treatment in patients with atrial fibrillation in distinct clinical scenarios requiring particular considerations, such as ischaemic heart disease, electrical cardioversion, pulmonary vein ablation, the presence of valvular disease with or without prosthetic valves, and renal insufficiency, as well as old age and frailty. In patients with non-valvular atrial fibrillation, the presence of renal insufficiency increases both thrombotic and haemorrhagic risk. In mild and moderate stages, direct-acting anticoagulants confer a greater benefit than warfarin, although they usually require dose adjustment. Read More

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Cost-Utility Analysis of Apixaban versus Warfarin in Atrial Fibrillation Patients with Chronic Kidney Disease.

Value Health 2018 Dec 24;21(12):1365-1372. Epub 2018 Jul 24.

Section of Decision Sciences, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Background: Warfarin use for stroke prevention in atrial fibrillation (AF) patients with chronic kidney disease is debated. Apixaban was shown to be safer than warfarin, with superior reduction in the risk of stroke, systemic embolism, mortality, and major bleeding irrespective of kidney function.

Objectives: To evaluate the cost-utility of apixaban compared with warfarin in AF patients at different levels of kidney function. Read More

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December 2018
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Cost Implications of Anticoagulation Strategies After Percutaneous Coronary Intervention Among Patients With Atrial Fibrillation (A PIONEER-AF PCI Analysis).

Am J Cardiol 2018 Nov 6. Epub 2018 Nov 6.

Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Massachusetts. Electronic address:

The PIONEER AF-PCI trial demonstrated that in atrial fibrillation patients who underwent intracoronary stenting, either rivaroxaban 15 mg daily plus P2Y inhibitor monotherapy (Group 1) or 2.5 mg rivaroxaban twice daily plus dual antiplatelet therapy (DAPT) (Group 2) was associated with fewer recurrent hospitalizations, primarily for bleeding and cardiovascular events, compared with standard-of-care vitamin K antagonist and DAPT (Group 3). Associated costs are unknown. Read More

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November 2018
1 Read

Efficacy and safety of prothrombin complex concentrate in patients treated with rivaroxaban or apixaban compared to warfarin presenting with major bleeding.

Br J Haematol 2018 Dec 4. Epub 2018 Dec 4.

Department of Haematology, Imperial College Healthcare NHS Trust Imperial College London, London, UK.

This retrospective study investigated the efficacy and safety of prothrombin complex concentrates (PCCs) for management of major bleeding events (MBE) in 344 patients receiving the anticoagulants rivaroxaban, apixaban or warfarin during the period January 2016 to April 2018. Median (range) PCC dose was 2000 units (1000-4500). Intracranial haemorrhage (ICH) was the most common indication (137/344, 39·8%) for PCC use followed by gastrointestinal bleeding (93/344, 27%). Read More

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December 2018

Association of Oral Anticoagulants and Proton Pump Inhibitor Cotherapy With Hospitalization for Upper Gastrointestinal Tract Bleeding.

JAMA 2018 Dec;320(21):2221-2230

Division of Rheumatology, Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee.

Importance: Anticoagulant choice and proton pump inhibitor (PPI) cotherapy could affect the risk of upper gastrointestinal tract bleeding, a frequent and potentially serious complication of oral anticoagulant treatment.

Objectives: To compare the incidence of hospitalization for upper gastrointestinal tract bleeding in patients using individual anticoagulants with and without PPI cotherapy, and to determine variation according to underlying gastrointestinal bleeding risk.

Design, Setting, And Participants: Retrospective cohort study in Medicare beneficiaries between January 1, 2011, and September 30, 2015. Read More

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December 2018

Warning on Warfarin Monitoring.

Authors:
Rebecca Voelker

JAMA 2018 Dec;320(21):2193

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December 2018

Antithrombotic Regimens in Patients With Percutaneous Coronary Intervention Whom an Anticoagulant Is Indicated: A Systematic Review and Network Meta-Analysis.

Front Pharmacol 2018 19;9:1322. Epub 2018 Nov 19.

Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.

Patients undergoing percutaneous coronary intervention (PCI) who require anticoagulant therapy are at increased risk of bleeding. The optimal regimen for these patients is uncertain. This study aimed to compare safety and efficacy of antithrombotic regimens used in patients undergoing PCI with concomitant anticoagulant therapy. Read More

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November 2018
4 Reads

Oral semaglutide for the treatment of type 2 diabetes.

Expert Opin Pharmacother 2018 Nov 30:1-9. Epub 2018 Nov 30.

a Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA.

Introduction: Glucagon-like peptide-1 (GLP-1) receptor agonists are highly potent antihyperglycemic drugs that impose low risk of hypoglycemia and also result in body weight reduction. Currently, all approved members of the class require administration by injection. Areas covered: This manuscript reviews oral semaglutide-an experimental GLP-1 receptor agonist in phase-3 clinical development. Read More

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November 2018
2 Reads

Comparative effectiveness and safety of standard or reduced dose dabigatran versus rivaroxaban in non-valvular atrial fibrillation.

Clin Pharmacol Ther 2018 Nov 30. Epub 2018 Nov 30.

Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France.

Dabigatran and rivaroxaban at standard (SD) or reduced doses (RD) have been compared to warfarin in non-valvular atrial fibrillation (NVAF), but not to each other. This was a new user study of SD and RD dabigatran or rivaroxaban for NVAF in the French healthcare database, matched on gender, age, date of first dispensing, and high-dimensional propensity score, followed 2 years. Hazard ratios [95% Confidence Intervals] of stroke or systemic embolism (SSE), major bleeding (MB) or death, were computed. Read More

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November 2018
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Comparison of Drug Switching and Discontinuation Rates in Patients with Nonvalvular Atrial Fibrillation Treated with Direct Oral Anticoagulants in the United States.

Adv Ther 2018 Nov 29. Epub 2018 Nov 29.

Bristol-Myers Squibb, Lawrenceville, NJ, USA.

Introduction: Continuous usage of direct oral anticoagulants (DOACs) among nonvalvular atrial fibrillation (NVAF) patients is essential to maintain stroke prevention. We examined switching and discontinuation rates for the three most frequently initiated DOACs in NVAF patients in the USA.

Methods: Patients who initiated apixaban, rivaroxaban, or dabigatran (index event/date) were identified from the Pharmetrics Plus claims database (Jan 1, 2013-Sep 30, 2016, includes patients with commercial and Medicare coverage) and grouped into cohorts by index DOAC. Read More

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November 2018
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Pre-stroke warfarin enhancement of collateralization in acute ischemic stroke: a retrospective study.

BMC Neurol 2018 Nov 29;18(1):194. Epub 2018 Nov 29.

Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.

Background: Warfarin therapies not only are used to prevent stroke in patients with high risk of cardioembolism such as patients with atrial fibrillation (AF) and rheumatic heart disease (RHD), but also was associated with lower stroke severity and more favorable functional outcomes in patients with acute ischemic stroke due to middle cerebral artery occlusion. It was speculated that pre-stroke warfarin may promote collateralization and result in reduced stroke severity. This study aimed to investigate the association between pre-stroke warfarin use and leptomeningeal collaterals in patients with acute ischemic stroke due to occlusion of the middle cerebral artery. Read More

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November 2018
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