Antithrombotika und Antihämorrhagika

Wille, Hans

doi:10.1007/978-3-662-63825-5_17

Cited by 4 publications

(5 citation statements)

References 120 publications

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“…In a study on complications in Mohs surgery, Bordeaux et al 19 observed patients with at least one AP/AC drug in 46%, and in a multicenter study by Koenen et al 4 the proportion was 42.82% and thus comparable to our population. Wille 10 showed a 3.8‐fold higher prescription rate of DOAC versus VKA in Germany, corresponding to 2.4‐fold higher rate in our study population, while apixaban and rivaroxaban dominating DOAC in the general population (43% and 34%) and in our population (46.5% and 43.0%).…”

Section: Discussionmentioning

confidence: 42%

“…While some studies are available for conventional AP/ AC-medication, there is a great lack for evidence-based decisions in dermatosurgery when dealing with DOAC perioperatively. 9,10 Patient adherence to preoperative recommendations for management of AP/AC cannot be assumed. Although guideline recommendations exist, they often do not correspond to the real-life setting.…”

Section: Discussionmentioning

confidence: 99%

“…There is still a lack of valid recommendations for dermatosurgery, especially when dealing with DOAC, the latest group of AP/AC drugs 9 . Direct oral anticoagulants are taking an increasingly large part in the growing total number of prescriptions in Germany 10 . Their effect unfolds through the direct inhibition of either factor Xa (apixaban, rivaroxaban and edoxaban) or thrombin (dabigatran), and they are characterized by a rapidly rising plasma concentration and short half‐lives of approximate 10–18 h 11 .…”

Section: Introductionmentioning

confidence: 99%

“…9 Direct oral anticoagulants are taking an increasingly large part in the growing total number of prescriptions in Germany. 10 Their effect unfolds through the direct inhibition of either factor Xa (apixaban, rivaroxaban and edoxaban) or thrombin (dabigatran), and they are characterized by a rapidly rising plasma concentration and short half-lives of approximate 10-18 h. 11 It can therefore be assumed that they do not significantly alter the risk of bleeding after 24 h; moreover, in case of life-threatening bleeding, antagonizing drugs are now available. 12,13 Although the risk of bleeding is considered low in dermatosurgery compared with other surgical specialties, the decision between suspending and postponing intake becomes particularly acute when using micrographic-controlled surgery, where procedures may be performed on several days in a row without final wound closure in between.…”

mentioning

confidence: 99%

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Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery—A prospective observational study

Höper,

Rosen,

Kofler

et al. 2023

Acad Dermatol Venereol

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BackgroundPerioperative management of antiplatelet and anticoagulant (AP/AC) therapy is a matter of balancing the risks of bleeding and thromboembolic events. Reliable data for dermatosurgery are still lacking, especially for direct oral anticoagulants (DOAC).ObjectivesThe aim was to prospectively evaluate the influence of AP/AC‐medication on bleeding risk in dermatosurgery with focus on exact intervals between DOAC intake and procedure performed on post‐operative bleeding.MethodsPatients with or without AP/AC‐therapy were included in the study without randomization. Exact times of DOAC‐intake, procedure performed and post‐operative bleeding were documented. Data collection was prospectively and standardized done by one person.ResultsWe evaluated 1852 procedures in 675 patients. Post‐operative bleeding occurred after 15.93% (n = 295) of all procedures, but only a few of them were severe (1.57%, n = 29). Compared to patients without AP/AC‐medication, severe post‐operative bleeding occurred significantly more often under dual antiplatelet therapy (11.76%, n = 2; p = 0.0166) and bridging of either vitamin K antagonist (9.09%, n = 2; p = 0.0270) or DOAC (15.38%, n = 2; p = 0.0099). There was no significant difference in the frequency of severe bleeding regarding to the preoperative DOAC‐free period.ConclusionsAlthough AP/AC‐therapy is associated with a significant higher rate of post‐operative bleeding, no life‐threatening bleeding was recorded. Long preoperative pausing or bridging of DOAC does not lead to significantly less severe bleeding events.

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery—A prospective observational study

Höper,

Rosen,

Kofler

et al. 2023

Acad Dermatol Venereol

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“…8 Their use in clinical practice is increasing rapidly. 9 Given that there is no RCT comparing all four DOACs, a direct head-to-head comparison investigating safety and effectiveness based on observational data would be of general interest. Even though there are meta-analyses of existing studies comparing DOACs, the heterogeneity between studies is a limitation of such indirect comparisons and in addition, there were no data on edoxaban.…”

Section: Introductionmentioning

confidence: 99%

Risk Profiles of New Users of Oral Anticoagulants Between 2011 and 2019 in Germany

Voss¹,

Kollhorst²,

Platzbecker³

et al. 2023

CLEP

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Purpose Over the last decade, the use of direct oral anticoagulants (DOACs) has strongly increased. We aimed to describe and compare risk profiles including potential changes over time among persons with non-valvular atrial fibrillation initiating treatment with different DOACs or phenprocoumon (vitamin K antagonist) between 2011 and 2019 in Germany. Patients and Methods Using the German Pharmacoepidemiological Research Database (GePaRD; claims data of ~20% of the German population), we identified persons with a first dispensing of phenprocoumon or a DOAC and a diagnosis of non-valvular atrial fibrillation between August 2011 and December 2019. We described the morbidity of included patients prior to treatment initiation, stratified by year of treatment initiation. Results Overall, we included 448,028 new users (phenprocoumon: N = 118,117, rivaroxaban: N = 130,997, apixaban: N = 130,300, edoxaban: N = 38,128, dabigatran: N = 30,486). Comparing new DOAC users in 2019, the proportion with prior ischemic stroke was highest for dabigatran (17%) and lowest for rivaroxaban (8%). The proportion with prior major bleeding was also highest for dabigatran (25%) and lowest for edoxaban (20%). New users of apixaban were oldest and, eg, showed the highest prevalence of congestive heart failure. Changes over time were most pronounced for phenprocoumon. For example, among persons initiating phenprocoumon in 2012 vs 2019, the proportion with prior major bleeding increased from 18% to 35%; the proportion with renal disease increased from 20% to 36% and the proportion with liver disease from 18% to 24%. Conclusion This study demonstrated differences in risk profiles between new users of different oral anticoagulants and substantial changes over time among new phenprocoumon users. These differences have to be considered in head-to-head comparisons of these drugs based on observational data, especially regarding potential unmeasured confounding.

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