Hospital practice (1995)
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Hospital practice (1995) · Feb 2013
ReviewBleeding risk assessment in patients with atrial fibrillation who are taking oral anticoagulants.
Prevention of thromboembolism is the key priority in the management of patients with atrial fibrillation (AF). Clinical decisions on antithrombotic management should be based on the balance between an individual's thromboembolic and hemorrhagic risk. The HAS-BLED score is a simple and user-friendly tool for the assessment of bleeding risk. ⋯ Patients at high risk for stroke (CHA2DS2-VASc score ≥ 2) and hemorrhage (HAS-BLED score ≥ 3) seem to gain significant benefit from oral anticoagulants. As a general rule, oral anticoagulants should be considered for all patients with AF, except those at very low risk for stroke (CHA2DS2-VASc score of 0) and those at extremely high risk for bleeding. The newer oral anticoagulants (eg, dabigatran, rivaroxaban, and apixaban) are promising alternatives to vitamin K antagonists for the prevention of stroke in patients with nonvalvular AF.
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Hospital practice (1995) · Feb 2013
Evaluation of the utility of the Wells score in predicting pulmonary embolism in patients admitted to a spine surgery service.
A retrospective medical chart review of 4179 patients admitted to the spine surgery service. ⋯ The results of the CTPA did not show a significant correlation with the Wells score or the reason for the test. Our findings indicate the need to develop a predictive scoring system that assesses the risk of PE and assists in the decision-making process for ordering CTPA in spine surgery patients.
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Hospital practice (1995) · Feb 2013
ReviewNovel oral anticoagulants: a review of the literature and considerations in special clinical situations.
Novel oral anticoagulants (OACs), including dabigatran etexilate, rivaroxaban, and apixaban, are available alternative anticoagulant therapy to vitamin K antagonists. The US Food and Drug Administration (FDA) has approved dabigatran, rivaroxaban, and apixaban for the treatment of appropriate patients for specific clinical indications. Therapeutic advantages of prescribing the new OACs are related to their predictable pharmacokinetic and pharmacodynamic properties. ⋯ Dabigatran, rivaroxaban, and apixaban are all approved agents for stroke prevention in patients with nonvalvular atrial fibrillation in the United States and Europe. Among these agents, rivaroxaban is the only FDA-approved drug for the treatment of venous thromboembolism. This article reviews the major clinical trials that investigated the efficacy and safety of the new OACs and the use of these agents in special clinical situations.
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Hospital practice (1995) · Feb 2013
ReviewA new era of oral anticoagulation in atrial fibrillation: implications in clinical practice.
For > 50 years, vitamin K antagonists were the only available oral drugs for the prevention of thromboembolism in patients with atrial fibrillation. Recently, new oral anticoagulants (the direct thrombin inhibitor dabigatran and the direct activated factor X (factor Xa) inhibitors rivaroxaban and apixaban) have completed phase 3 clinical trials for the same indications. ⋯ We focus primarily on the balance between thromboembolic and hemorrhagic risk and the implications of such risks in clinical practice. Bleeding and thromboembolic risk estimation tools and their roles in the correct utilization of new oral anticoagulation are also discussed.
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Hospital practice (1995) · Feb 2013
ReviewNovel oral anticoagulants for stroke prevention in patients with atrial fibrillation.
Patients with atrial fibrillation (AF) face an elevated risk of stroke compared with patients who have normal sinus rhythm. Warfarin, an oral vitamin K antagonist, is a highly effective therapeutic agent to reduce stroke risk in patients with AF; however, use of warfarin is complicated by variable patient dose response due to genetic factors and multiple food-drug and drug-drug interactions. ⋯ More recently, the US Food and Drug Administration (FDA) approved 2 oral activated factor X inhibitors, rivaroxaban and apixaban, for stroke prevention in patients with AF based on clinical trial evidence of their safety and efficacy. In this article, we provide an overview of the 3 novel oral anticoagulants for treating patients with AF and discuss the latest findings from subgroup analyses.