New oral anticoagulants: a practical guide on prescription, laboratory testing and peri‐procedural/bleeding management

Tran, Huyen; Joseph, Joanne; Young, Laura; McRae, Simon; Curnow, Jennifer; Nandurkar, Harshal; Wood, Peter; McLintock, Claire

doi:10.1111/imj.12448

Cited by 143 publications

(144 citation statements)

References 38 publications

Supporting

Mentioning

138

Contrasting

Unclassified

Order By: Relevance

“…3 In case an anti-Xa assay is not accessible, several authors have outlined alternative strategies to estimate the intensity of anticoagulation in rivaroxaban-treated patients based on routine coagulation testing. Although a normal PT does not rule out the presence of rivaroxaban, 4,18,22 it has been suggested that intact hemostasis can be expected. 23 Normal PT values measured with sensitive reagents are probably sufficient to expect acceptable coagulation in case of urgent surgery.…”

Section: Coagulation Testing In Rivaroxaban-treated Patientsmentioning

confidence: 99%

“…23 Normal PT values measured with sensitive reagents are probably sufficient to expect acceptable coagulation in case of urgent surgery. 22 Furthermore, thrombolysis for ischemic stroke may be considered in patients on rivaroxaban if PT and aPTT are normal after individual risk assessment. 2,24 However, NOACspecific sensitivity varies between test reagents, and general recommendations are therefore problematic.…”

Section: Coagulation Testing In Rivaroxaban-treated Patientsmentioning

confidence: 99%

See 1 more Smart Citation

Point-of-Care Testing of Coagulation in Patients Treated With Non–Vitamin K Antagonist Oral Anticoagulants

Ebner

Peter

Spencer

et al. 2015

Stroke

View full text Add to dashboard Cite

5POCT specific to NOAC are currently unavailable, but influences of NOAC on established coagulation POCT have been reported. [6][7][8][9][10] Data based on artificially spiked blood samples from healthy volunteers suggest a high correlation for the Background and Purpose-Specific coagulation assays for non-vitamin K antagonist oral anticoagulants (NOAC) are relatively slow and often lack availability. Although specific point-of-care tests (POCT) are currently not available, NOAC are known to affect established coagulation POCT. This study aimed at determining the diagnostic accuracy of the CoaguChek POCT to rule out relevant concentrations of rivaroxaban, apixaban, and dabigatran in real-life patients. Methods-We consecutively enrolled 60 ischemic stroke patients newly started on NOAC treatment and obtained blood samples at 6 prespecified time points. Samples were tested using the CoaguChek POCT, laboratory-based coagulation assays (prothrombin time and activated partial thromboplastin time, anti-Xa test and Hemoclot), and liquid chromatography-tandem mass spectrometry for direct determination of NOAC concentrations. Results-Three hundred fifty-six blood samples were collected. The CoaguChek POCT strongly correlated (r=0.82 P<0.001) with rivaroxaban concentrations but did not accurately detect dabigatran or apixaban. If used to estimate the presence of low rivaroxaban concentrations, POCT was superior to predictions based on normal prothrombin time and activated partial thromboplastin time values even if sensitive reagents were used. POCT-results ≤1.0 predicted rivaroxaban concentrations <32 and <100 ng/mL with a specificity of 90% and 96%, respectively. Conclusions-If anti-Xa test is not available, we propose the use of the

show abstract

Section: Coagulation Testing In Rivaroxaban-treated Patientsmentioning

confidence: 99%

Section: Coagulation Testing In Rivaroxaban-treated Patientsmentioning

confidence: 99%

Point-of-Care Testing of Coagulation in Patients Treated With Non–Vitamin K Antagonist Oral Anticoagulants

Ebner

Peter

Spencer

et al. 2015

Stroke

View full text Add to dashboard Cite

show abstract

“…factor VIII inhibitor bypass activity (FEIBA), or recombinant factor VIIa (rVIIa) as well as antifibrinolytic therapy (tranexamic acid) can be used . Renal replacement therapy should be considered for dabigatran which is dialyzable [42][43][44][45][46].…”

Section: How Can We Manage Bleeding With Odi?mentioning

confidence: 99%

Oral Direct Anticoagulants in Thrombosis Management in Anti-Phospholipid Syndrome: Unanswered Questions

G¹

2015

J Hematol Thrombo Dis

View full text Add to dashboard Cite

Anti-phospholipid syndrome comprises a broad spectrum of manifestations with thrombotic events as a serious issue. The current mainstay of treatment for thrombotic anti-phospholipid syndrome is heparin followed by long-term anticoagulation with vitamin K antagonists. Vitamin K antagonists' management in this group of patients is frequently cumbersome, requires close monitoring and may affect patient's quality of life. There is also a high recurrence rate in high risk patients. The introduction of the oral direct inhibitors of coagulation for the management for thromboembolism is currently established for several indications.These agents are fixed dose with predictable anticoagulant effect and do not interact with dietary constituents and have few drug interactions. They have a rapid onset of action and don't routinely require monitoring. The shortcomings of vitamin K antagonists and the advantages of the oral direct inhibitors encouraged their trial in antiphospholipid syndrome. Case series of their use paved the road for designing clinical trials aiming to study their potential role in this important group of patients.In this article, we reviewed the literature regarding the current state of oral direct anticoagulants in thrombosis management in general, cited the case series results and presented the ongoing clinical trials that are currently underway. We also raise some practical points relevant to their application in specific situations. It is premature to pass comments on their applicability, but the seriousness of the issue

show abstract

“…While the direct oral anticoagulants do demonstrate lower risk for intracranial hemorrhage, both major and non-major bleeding events have been reported in patients receiving these medications [11,12], and their management remains a cause of major concern [13]. Until now, most of the data on DOAC therapy is derived from clinical trials with limited postmarketing evaluations, and the focus has been on the comparison of bleeding risk between DOAC therapy and warfarin [14,15].…”

Section: Introductionmentioning

confidence: 99%

Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice

Edupuganti¹

2017

AJCEM

View full text Add to dashboard Cite

Dabigatran, apixaban and rivaroxaban are direct oral anticoagulants (DOACs) recently approved for patients with venous thromboembolism. Therapy-induced hemorrhage remains a major complication in these patients. This study retrospectively reviews the hemorrhagic complications associated with DOACs in the general practice and the related clinical implications. The electronic medical charts of 2255 patients with prolonged PTT tests during August 2015 to April 2016 at William Beaumont Health System -Troy were retrospectively reviewed. Patients with prolonged PTT and simultaneously receiving DOAC's were identified. Hemorrhagic complications associated with DOAC therapy and the related clinical information were analyzed. 517 (22.9%) patients were identified receiving DOAC therapy. Among these, DOAC therapyassociated hemorrhages were recorded in 85 patients (16.4%). Apixaban had a significantly lower incidence of hemorrhage (8.8%) than rivaroxaban (21.0%) and dabigatran (27.9%). The most common hemorrhage was GI bleeding (7.0% overall); its incidence was significantly higher in dabigatran (18.6%) than apixaban (4.1%) and rivaroxaban (7.4%); but no significant difference between apixaban and rivaroxaban (p>0.05). GI bleeding produced anemia in 13 patients who received additional treatments with occasional blood transfusions. Since GI bleeding is the most common bleeding complication and may cause anemia in patients receiving DOAC therapy, routine studies for GI bleeding should be encouraged to reduce the complications of GI bleeding. Apixaban has significantly lower incidence of bleeding complications, it may be a better choice in patients with increased bleeding risk overall. However, apixaban may not improve the bleeding risk in patients with GI bleeding associated with rivaroxaban.

show abstract

New oral anticoagulants: a practical guide on prescription, laboratory testing and peri‐procedural/bleeding management

Cited by 143 publications

References 38 publications

Point-of-Care Testing of Coagulation in Patients Treated With Non–Vitamin K Antagonist Oral Anticoagulants

Point-of-Care Testing of Coagulation in Patients Treated With Non–Vitamin K Antagonist Oral Anticoagulants

Oral Direct Anticoagulants in Thrombosis Management in Anti-Phospholipid Syndrome: Unanswered Questions

Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice

Contact Info

Product

Resources

About