scholarly journals Rivaroxaban: Expanded Role in Cardiovascular Disease Management—A Literature Review

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Muhammad Ajmal ◽  
Jacob Friedman ◽  
Qurat Ul Ain Riaz Sipra ◽  
Tom Lassar
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Evidence Based ◽  
Peripheral Artery ◽  
Nonvalvular Atrial Fibrillation ◽  
Artery Disease ◽  
Hip And Knee Surgery

Direct oral anticoagulants (DOACs) are widely used for the prevention of stroke in nonvalvular atrial fibrillation, treatment of deep venous thrombosis and pulmonary embolism, and as prophylaxis after hip and knee surgery after approval by the Food and Drug Administration. In the last decade, DOACs were studied for various indications; this review is focused on rivaroxaban, a factor Xa inhibitor, which is used in an expanded evidence-based fashion for coronary artery disease, peripheral artery disease, heart failure, malignancy, and prophylaxis of deep venous thrombosis in acute medical illnesses.

scholarly journals The role of edoxaban in preventing thromboembolic complications in patients with atrial fibrillation

2020 ◽  
pp. 28-43
Author(s):  
O. O. Shakhmatova
Keyword(s):  
Atrial Fibrillation ◽  
Drug Interactions ◽  
Dose Reduction ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Extensive Study ◽  
Thromboembolic Complications ◽  
Nonvalvular Atrial Fibrillation ◽  
Life Threatening

Edoxaban is a selective direct factor Xa inhibitor. Edoxaban in a dose of 60 mg per day is an effective and safe option in the prevention of thromboembolic complications in patients with nonvalvular atrial fibrillation, including in combination therapy in patients after percutaneous coronary interventions. ENGAGE AF-TIMI 48 is currently the most extensive study comparing direct oral anticoagulants and warfarin in patients with atrial fibrillation, both in terms of number of participants and duration of observation. For edoxaban, an adequate approach to dose reduction has been developed in patients with alikely increase in plasma concentration due to renal impairment, low body weight or inter-drug interactions. Such dose reduction does notlead to an increase in the frequency of ischemic complications.Edoxaban is characterized by an optimal safety profile in patients with chronic moderate kidney disease, a small number of drug interactions and a convenient mode of administration. In patients with atrial fibrillation and concomitant ischemic heart disease, the use of Edoxaban is associated with a decrease in the frequency of myocardial infarctions, as well as strokes and episodes of systemic thromboembolism in comparison with warfarin. The drug can be successfully used as anticoagulant support for cardioversion and catheter ablation for atrial fibrillation.Edoxaban intake does not require routinelaboratory control. In case of unexpected situations (life-threatening bleeding, urgent surgical intervention) in patients receiving edoxaban, to assess the degree of anticoagulation should use the determination of anti-Xa activity. Clinical studies of a specific antidote of edoxaban - andexanet alfa are ongoing. Before approval of the specific antidote in severe andlife-threatening bleedings against the background of edoxaban administration, the use of prothrombin complex concentrate should be considered. Data on the effective and safe use of edoxaban in routine clinical practice have been accumulated.

scholarly journals Intracranial Hemorrhage following Lumbar Puncture in a Patient on Apixaban

2019 ◽  
Vol 11 (3) ◽  
pp. 277-283 ◽  
Author(s):  
Priyanka Vijapura ◽  
Michael J. Maniaci
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Lumbar Puncture ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Evidence Based ◽  
Nonvalvular Atrial Fibrillation ◽  
Practice Recommendations ◽  
Diagnostic Lumbar Puncture ◽  
Evidence Based Guidelines

Currently, clinical practice recommendations regarding patients in need of emergent lumbar puncture who are taking direct oral anticoagulants (DOACs) are based upon expert opinion, as evidence-based guidelines are unavailable. We present the case of an 80-year-old Caucasian lady who underwent diagnostic lumbar puncture for presumed meningitis while on therapeutic apixaban for nonvalvular atrial fibrillation. She was subsequently found to have bilateral subdural hematomas. This case report reviews both the current criteria for computerized tomography brain imaging prior to lumbar puncture as well as the bleeding risks of lumbar puncture while on a DOAC.

scholarly journals Treatment of Varicose Veins Affects the Incidences of Venous Thromboembolism and Peripheral Artery Disease

2021 ◽  
Author(s):  
Shyue-Luen Chang ◽  
Sindy Hu ◽  
Yau-Li Huang ◽  
Mei-Ching Lee ◽  
Wen-Hung Chung ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Health Insurance ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Peripheral Artery Disease ◽  
National Health Insurance ◽  
Varicose Veins ◽  
Research Database ◽  
Peripheral Artery ◽  
Artery Disease

Background: Varicose veins are a common problem worldwide. Although it was reported that varicose veins have cosmetic and symptomatic effects and can also lead to an increased risk of incident deep venous thrombosis, pulmonary embolism, and peripheral artery disease, whether varicose vein treatment prevents those serious complications is unknown. Methods: This retrospective cohort study used claims data extracted from the Chang Gung Research Database and National Health Insurance Research Database in Taiwan. The study subjects were patients aged ≥20 years who underwent endovenous thermal ablation (ETA) from 2005 to 2016 and a group of untreated subjects who were matched by sex and year of birth. All patients were followed from the index date to the earliest occurrence of peripheral artery disease, deep venous thrombosis, or pulmonary embolism or death or the end of the study. To avoid possible selection bias, 1:4 propensity score matching was implemented and a Cox proportional-hazards model was applied while controlling for potential confounders. We also collected data on complications within 28 days of ETA. Results: In total, data on 1323 ETA-treated patients with varicose veins were extracted from the Chang Gung Research Database, while data on 149 586 untreated patients with varicose veins were extracted from the National Health Insurance Research Database. Compared with the untreated group, ETA-treated patients had decreased risks of deep venous thrombosis and peripheral artery disease (adjusted hazard ratio, 0.49 [95% CI, 0.32–0.75] and 0.64 [95% CI, 0.49–0.85]). The incidence rates of deep venous thrombosis and pulmonary embolism after ETA (≤28 days) were 0.296% and 0.074%, respectively. Conclusions: ETA treatment of varicose veins was associated with a substantial decrease in the subsequent incidence of thromboembolism and peripheral artery disease compared with that in the absence of treatment. In addition, the incidence rate of postprocedural thromboembolic complications after ETA was low in the Asian population. We suggest that improved disease awareness and appropriate early treatment may help reduce the risk of serious complications.

Direct Oral Anticoagulants

2017 ◽  
Author(s):  
Panna A. Codner ◽  
Michael G Mount
Keyword(s):  
Perioperative Management ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Vitamin K Antagonist ◽  
Direct Thrombin Inhibitor ◽  
Thrombin Inhibitor ◽  
Clinical Use ◽  
Nonvalvular Atrial Fibrillation ◽  
Reversal Agents

Non–vitamin K antagonist oral anticoagulants, also known as direct oral anticoagulants, are a relatively recent class of medications introduced into clinical practice. Due to their safety profiles, fixed dosing, and lack of need for frequent laboratory monitoring, they are becoming preferred to traditional anticoagulation with warfarin in many cases of nonvalvular atrial fibrillation and venous thromboembolism. Currently, four drugs are available: dabigatran, a direct thrombin inhibitor, and rivaroxaban, apixaban, and edoxaban, factor Xa inhibitors. This review covers the pharmacology, monitoring, and reversal agents currently available for these medications. The indications for their use are covered through a review of the major clinical trials that led to their US and European approvals for clinical use. Perioperative management of these medications is discussed. Tables list indications, dosing, and monitoring, as well as bleeding risks and efficacy compared with warfarin.  This review contains 1 figure, 11 tables, and 70 references. Key words: apixaban, dabigatran, direct oral anticoagulant, edoxaban, rivaroxaban

Direct oral anticoagulants decrease treatment failure for acute lower extremity deep venous thrombosis

Vascular ◽  
2021 ◽  
pp. 170853812110422
Author(s):  
Katherine E Hekman ◽  
Calvin L Chao ◽  
Courtney E Morgan ◽  
Irene B Helenowski ◽  
Mark K Eskandari
Keyword(s):  
Lower Extremity ◽  
Treatment Failure ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Primary Treatment ◽  
Prior History ◽  
Duration Of Treatment ◽  
Duplex Imaging

Objective Optimal medical therapy for acute lower extremity deep venous thrombosis (DVT) remains an enigma. While clinical trials demonstrate non-inferiority with an oral anti-Xa inhibitor, or direct oral anticoagulant (DOAC), versus combined low–molecular weight heparin (LMWH) and oral vitamin K antagonist (VKA), the most effective regimen remains to be determined. Methods This study is a single-center retrospective cohort study from October 2014 to December 2015 of patients with a diagnosis of acute DVT and subsequent serial lower extremity venous duplex. Demographics, medical history, medications, serial ultrasound findings, as well as the primary anticoagulant used for treatment were collected and analyzed by two independent data extractors. Treatment failure was defined as any new DVT or progression of an existing DVT within 3 months of diagnosis of the index clot. Risk factors for treatment failure were assessed using standard odds ratios and Fischer’s exact test. Results Among 496 patients with an acute lower extremity DVT, 54% ( n = 266) were men, mean age was 61 years, 35% ( n = 174) involved the popliteal or more proximal segments, and 442 had documentation of the primary treatment for DVT: 20% ( n = 90) received nothing; 20% ( n = 92) received an oral VKA; 34% ( n = 149) received a DOAC; 20% ( n = 90) received LMWH; and 5% ( n = 21) received another class of anticoagulant. Within 3 months, 21% ( n=89 out of 427) had treatment failure defined as any new DVT or progression of prior DVT. Patients treated with a DOAC were less likely to experience treatment failure when compared with any other treatment (odds ratio 0.43; 95% confidence intervals [0.23, 0.79]; p = 0.0069) and when compared with traditional oral VKA (OR 0.44; 95% CI [0.21, 0.92]; p = 0.029). None of prior history of DVT, pulmonary embolism, thrombophilia, renal insufficiency, hepatic insufficiency, cancer, or antiplatelet therapy correlated with treatment failure. Treatment outcome did not correlate with being on any anticoagulation versus none ( p = 0.74), nor did it correlate with the duration of treatment (<3 months versus ≥3 months) ( p = 0.42). Proximal and distal DVTs showed no difference in treatment failure (19% versus 22%, respectively; p = 0.43). Conclusion In summary, the use of a DOAC for acute lower extremity DVT yielded better overall outcomes and fewer treatment failures at 3 months as compared to traditional oral VKA therapy based on serial duplex imaging.

scholarly journals Anticoagulation in Peripheral Artery Disease: Are We There Yet?

2020 ◽  
Vol 3 ◽  
Author(s):  
Alessandro Cannavale ◽  
Mariangela Santoni ◽  
Giuseppe Cannavale ◽  
Fabrizio Fanelli
Keyword(s):  
Peripheral Artery Disease ◽  
Controlled Trial ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Peripheral Artery ◽  
Unfractioned Heparin ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Artery Disease ◽  
Randomised Controlled

Thromboembolism in patients with peripheral artery disease (PAD) represents a common cause of morbidity and mortality. In this article, the authors analyse the use of anticoagulants for patients with PAD. Anticoagulants have been used to reduce the risk of venous thromboembolism, but have recently been applied to the arterial circulation. Heparins were introduced to reduce short-term major adverse limb events in patients undergoing arterial revascularisation. Low molecular weight heparins have allowed easier management and carry a lower risk of bleeding than unfractioned heparin. Vitamin K anticoagulants have been tested in trials that included patients with PAD, showing an increased risk of bleeding when compared with aspirin alone, but longer patency rates for venous surgical bypass, although the evidence remains weak. Those anticoagulants are currently recommended only in patients with PAD who need anticoagulation for other diseases. Direct oral anticoagulants have only recently been investigated for use in patients with PAD. Promising results from low dose rivaroxaban plus aspirin have been recently outlined by a randomised controlled trial and supported by international guidelines.

scholarly journals Development of New Deep Venous Thrombosis While on Apixaban

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Munish Sharma ◽  
Sabarina Ramanathan ◽  
Koroush Khalighi
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Oral Anticoagulants ◽  
Interindividual Variation ◽  
Laboratory Monitoring ◽  
Routine Laboratory ◽  
Plasma Drug ◽  
Nonvalvular Atrial Fibrillation ◽  
Drug Levels ◽  
Multicenter Trials

The efficacy of novel oral anticoagulants (NOACs) in preventing deep venous thrombosis (DVT) has been established in large multicenter trials. Predictable pharmacokinetics, avoidance of routine laboratory monitoring, and lesser drug interactions have made NOACs safer and more tolerable treatment option in comparison to warfarin. However, cases of treatment failure mainly due to interindividual variation in plasma drug levels can be seen rarely. In this report we describe a case of acute DVT of right lower extremity in a patient who was on apixaban for prevention of venous thromboembolism (VTE) due to underlying nonvalvular atrial fibrillation (NVAF).

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