Use of Direct Oral Anticoagulants Among Patients With Limited Income and Resources

Ting, Clara; Fanikos, Christopher; Fatani, Nayyra; Buckley, Leo F.; Fanikos, John

doi:10.1016/j.jacc.2018.11.024

Cited by 13 publications

(12 citation statements)

References 3 publications

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“…In addition, most current warning score systems fail to include or simply dichotomize oxygen saturation values. 53 The SF-TAR-based triggers could be incorporated into automated surveillance systems designed to detect evolving hypoxemic respiratory failure at early time points when gradual escalation in the intensity of respiratory support may mask overt hypoxemia. Although we evaluated SF-TAR only during mechanical ventilation, future work should include longitudinal hypoxemia metrics in patients before invasive mechanical ventilation, as well as in those who never need it.…”

Section: Original Research and Contributionsmentioning

confidence: 99%

Primary Functioning Neuroendocrine Tumor of the Appendix with Hypoglycemia Syndrome: A Case Report and Review of Neuroendocrine Tumors

Layman

Davis-Merritt

Neff

2020

TPJ

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This retrospective, observational cohort study of mechanically ventilated patients at 21 community and 2 academic hospitals demonstrated that in 28,758 derivation cohort admissions, every 10% increase in SpO2/ FiO2 time at risk (SF-TAR) was associated with a 24% increase in adjusted odds of hospital mortality. The SF-TAR can identify ventilated patients at increased risk of death, offering modest improvements compared with single SpO2/FiO2 and P/F ratios. This longitudinal, noninvasive, and broadly generalizable tool may have particular utility for early phenotyping and risk stratification.

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Section: Original Research and Contributionsmentioning

confidence: 99%

Primary Functioning Neuroendocrine Tumor of the Appendix with Hypoglycemia Syndrome: A Case Report and Review of Neuroendocrine Tumors

Layman

Davis-Merritt

Neff

2020

TPJ

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“…[1][2][3] Recently, DOAC prescriptions have surpassed that of warfarin across a broad range of patients and indications. [4][5][6] All 4 DOACs with FDA approval for treatment of AF and VTE have dose adjustments and/or contraindications based on renal function (Supplementary Table 1). [7][8][9][10] Apixaban has additional dosing considerations for age and weight for its AF indication.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Direct Oral Anticoagulant Prescribing in Patients With Moderate to Severe Renal Impairment

Ting

Rhoten

Dempsey

et al. 2021

Clin Appl Thromb Hemost

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Patients with renal impairment require dose adjustments for direct oral anticoagulants (DOACs), though there is uncertainty regarding their use in severe chronic kidney disease. Inappropriately dosed DOACs may increase risk of ischemic events when under-dosed, or risk of bleeding when over-dosed. The purpose of this study was to describe DOAC selection, dosing strategies, and associated clinical outcomes in patients with moderate to severe renal impairment at our institution. This was a single-center retrospective analysis of adult outpatients with moderate to severe renal impairment (estimated creatinine clearance <50 mL/min, including need for hemodialysis) who were prescribed a DOAC by a cardiologist between June 1, 2015 and December 1, 2018. Outcomes evaluated included the percentage of patients who received appropriate and inappropriate DOAC dosing, prescriber reasons for inappropriate DOAC dosing if documented, and incidence of thrombotic and bleeding events. A total of 207 patients were included. Overall, 61 (29.5%) patients received inappropriate dosing, with 43 (70.5%) being under-dosed and 18 (29.5%) being over-dosed as compared to FDA-labeled dosing recommendations for atrial fibrillation or venous thromboembolism (VTE). By a median follow-up duration of 20 months, stroke occurred in 6 (3.3%) patients receiving DOACs for atrial fibrillation, and VTE occurred in 1 (4.3%) patient receiving a DOAC for VTE. International Society on Thrombosis and Haemostasis major or clinically relevant nonmajor bleeding occurred in 25 (12.1%) patients. Direct oral anticoagulants were frequently prescribed at off-label doses in patients with moderate to severe renal impairment, with a tendency toward under-dosing.

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“…These drugs include the antithrombin (Factor IIa) agent dabigatran [5], and the anti-Factor Xa (AFXa) agents apixaban [6], betrixaban [7], edoxaban [8], and rivaroxaban [9]. Like warfarin, NOAC prescriptions have been increasing over time [10,11].…”

Section: Background and Introductionmentioning

confidence: 99%

The safety of oral anticoagulants registry (SOAR): A national, ED-based study of the evaluation and management of bleeding and bleeding concerns due to the use of oral anticoagulants

Pollack¹,

Peacock

Bernstein

et al. 2020

The American Journal of Emergency Medicine

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The Safety of Oral Anticoagulants Registry (SOAR) was designed to describe the evaluation and management of patients with oral anticoagulant (OAC)-related major bleeding or bleeding concerns who present to the emergency department (ED) with acute illness or injury. Patients in the ED are increasingly taking anticoagulants, which can cause bleeding-related complications as well as impact the acute management of related or unrelated clinical issues that prompt presentation. Modifications of emergency evaluation and management due to anticoagulation have not previously been studied. Methods: This was a multicenter observational in-hospital study of patients who were judged to be experiencing an active OAC effect and had (a) an obvious bleeding event or (b) were deemed at risk for serious bleeding spontaneously, after injury, or during an indicated invasive procedure. Diagnostic testing, therapies employed, and clinical outcomes were collected. Results: Thirty-one US hospitals contributed data to SOAR. Of 1513 subjects, acute hemorrhage (AH) qualified 78%, while 22% had a bleeding concern (BC). Warfarin was the index OAC in 37.3%, dabigatran in 13.3%, and an anti-Factor X a in 49.4%. The most common sites of AH were gastrointestinal (51.0%) and intracranial (26.8%). In warfarin-treated patients, the mean (IQR) presenting INR was 3.1 (2.2, 4.8) in AH patients and 3.9 (2.4, 7.2) in BC patients. Three-fifths of SOAR patients were treated with factor repletion or specific reversal agents, and those patients had a longer length of stay. In addition, seven (0.76%) of the treated patients experienced an inhospital thrombotic complication; two of these seven died on the index admission, both of fatal pulmonary embolism. Vitamin K was used and dosed inconsistently in both warfarin and NOAC cohorts. Conclusion: Care of anticoagulated patients in the acute care setting is inconsistent, reflecting the diversity of presentation. As the prevalence of OAC use increases with the aging of the US population, further study and targeted educational efforts are needed to drive more evidence-based care of these patients.

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Use of Direct Oral Anticoagulants Among Patients With Limited Income and Resources

Cited by 13 publications

References 3 publications

Primary Functioning Neuroendocrine Tumor of the Appendix with Hypoglycemia Syndrome: A Case Report and Review of Neuroendocrine Tumors

Primary Functioning Neuroendocrine Tumor of the Appendix with Hypoglycemia Syndrome: A Case Report and Review of Neuroendocrine Tumors

Evaluation of Direct Oral Anticoagulant Prescribing in Patients With Moderate to Severe Renal Impairment

The safety of oral anticoagulants registry (SOAR): A national, ED-based study of the evaluation and management of bleeding and bleeding concerns due to the use of oral anticoagulants

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