[Spontaneous intraocular hemorrhage under oral anticoagulation : Apixaban in comparison to phenprocoumon].
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Phenprocoumon
Apixaban
Concomitant
Acenocoumarol
Vitreous hemorrhage
Stroke
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Background and Objective: Intracerebral hemorrhage occurs more commonly in Asians than whites. This is to determine whether this racial difference extends to intracerebral hemorrhage associated with the use of warfarin. Methods: From a prospectively conducted stroke registry of 3,476 patients, we identified ten patients who developed intracerebral hemorrhage while on warfarin treatment. Their clinical features and laboratory investigations were compared with those from other published series. Results: The demographic features, indications, duration of warfarin therapy and size of hematoma in our patients were similar to other series. However, the mean INR in our patients was 2.3 which appeared lower than the reported range of 3 - 3.8 in other series. All except one patient had INR below 3. During the same period, 478 patients were hospitalized because of acute ischemic stroke and had atrial fibrillation but were not on warfarin therapy. Conclusion- Intracerebral hemorrhage in Chinese patients occurs at a lower intensity of anticoagulation than in whites. Adding the propensity for intracerebral hemorrhage and increased sensitivity to warfarin, the benefit-to-risk ratio of warfarin for stroke prevention and optimal level of INR in Chinese population may be different from the published data.
Stroke
Intracerebral hematoma
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HEMORRHAGIC RISK OF VITREORETINAL SURGERY IN PATIENTS MAINTAINED ON NOVEL ORAL ANTICOAGULANT THERAPY
In Brief Purpose: To evaluate the frequency and type of perioperative hemorrhagic complications associated with vitreoretinal surgery in patients undergoing systemic treatment with the newer anticoagulant and antiplatelet agents including rivaroxaban, apixaban, dabigatran, and prasugrel. Methods: Retrospective review of a cohort of patients being treated with anticoagulant and antiplatelet drugs, who underwent any vitreoretinal surgical procedure over a 2-year period. Results: Thirty-six eyes of 33 patients were identified who underwent vitreoretinal surgical operations while being treated systemically with anticoagulant and antiplatelet therapy. No eyes suffered perioperative complications of retrobulbar hemorrhage, suprachoroidal hemorrhage, or subretinal hemorrhage. Four eyes (11.1%) experienced postoperative vitreous cavity hemorrhage after which two eyes (5.5%) required repeat surgical intervention and two eyes (5.5%) cleared spontaneously. Conclusion: Although there is a relative risk to such surgery in patients who are taking novel oral anticoagulants, these findings suggest that patients may safely undergo vitreoretinal surgery while maintaining therapy with rivaroxaban, apixaban, dabigatran, and prasugrel. This report describes the frequency and types of perioperative hemorrhagic complications occurring in patients undergoing vitreoretinal surgery while on therapy with newer anticoagulant medications. None of the authors' patients experienced intraoperative hemorrhagic complications.
Vitreoretinal Surgery
Anticoagulant Therapy
Oral anticoagulant
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Purpose: The treatment of Pulmonary Embolism (PE) which is life threatening disease must be planned considering risk – benefit relationship. In this study, patients with PE given thrombolytic therapy, low-molecular-weight heparin and warfarin were monitored for 5 years to compare them in terms of hemorrhage side effect due to therapy. Method: A total of 219 patients were included in the study. 50.2% (n=109) of the patient's were female and 49.8% (n=110) were male, (p=0.20). Clinical findings, radiologic and laboratory parameters were recorded retrospectively. A total of 121 (55.25%) patients were given thrombolytic therapy (Group 1 n=121). Enoxaparin therapy was given to 205 patients (Group 2). During therapy maintenance, warfarin therapy conducted for 159 patients (Group 3). Results: Cerebral hemorrhage observed in 1 case (0.83%) in group 1, 2 case (0.98%) in group 2 and 1 case (0.62%) in group 3 (p>0.05). Gastrointestinal system (GI) bleeding happened 2 cases (1.65%) in group 1 and 2 cases (0.98%) in group 2 (p>0.05). Minor bleeding was observed at similar rates due to the treatments. There was no fatality due to hemorrhage. There is no significant difference in terms of death, recurrence, residuel chronic thrombus and chronic PE in the follow up for five years between rt-PA group (group1) and non rt-PA group (p>0.05). Conclusion: According to our results; major hemorrhage observed similar in thrombolytic, enoxaparin and warfarin therapy. Study results about the rate of cerebral hemorrhage related to thrombolytic therapy was low in contrast to the results reported in some literature before.
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Group A
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Anticoagulant Therapy
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Abstract Purpose To compare the risk of haemorrhagic complications in elective macular surgery between patients with no antithrombotic (AT) treatment (defined as patients with no history of AT therapy or who discontinued AT therapy) and patients who continued AT treatment during the surgery. Methods E‐case report forms were prospectively recorded in a database before vitreoretinal surgery and 1 month after. Data on patient characteristics, surgical techniques, haemorrhagic complications and antithrombotic status were collected. Patients with retinal detachment, proliferative diabetic retinopathy and previous retinal haemorrhage were excluded. Results A total of 748 procedures (single procedure in one eye per patient) were performed between January and May 2019. Among them, 202 patients (27.0%) were treated with antithrombotic therapy at the time of surgery: 19.5% with antiplatelet agents ( n = 146), 6.3% with anticoagulants ( n = 47) including 3.2% ( n = 24) patients treated with novel oral anticoagulants, 0.8% ( n = 6) with anticoagulants and antiplatelet agents, and 0.4% ( n = 3) with heparin. Overall, 92 patients (12.3%) developed one or more haemorrhagic complications, of which 63 (11.5%) and 29 (14.4%) were in the non‐AT and AT group, respectively. The multivariate logistic regression model showed no difference between AT treatment groups regarding ocular bleeding complications (odds ratio [OR] 1.2, 95% confidence interval (CI) [0.7–2.2], p = 0.54). Conclusion No cases of uncontrolled or severe perioperative haemorrhage in patients continuing antithrombotic agents were reported in this selected population. For the majority of the patients taking antiplatelets or anticoagulants, these agents could be safely continued during macular surgery.
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Abstract Apixaban in patients with impaired renal function is supported by limited data. Landmark clinical trials evaluating apixaban in patients with atrial fibrillation and/or acute venous thromboembolism excluded patients with creatinine clearance (CrCl) <25 mL/min. This multicenter, retrospective chart review was conducted to evaluate the safety and effectiveness of apixaban compared with warfarin in patients with CrCl <25 mL/min. Included patients were newly initiated on apixaban or warfarin for at least 45 days with a CrCl <25 mL/min. Patients were evaluated for thrombosis and bleeding outcomes 6 months following initiation of anticoagulation. The primary outcome was the time to first bleeding or thrombosis event. A total of 128 patients met inclusion criteria in the apixaban group and 733 patients in the warfarin group. Time to first bleeding or thrombosis event was significantly different between the apixaban and warfarin groups. Cox proportional hazards model was conducted to control for potential confounding factors for the primary outcome. After controlling for atrial fibrillation and coronary artery bypass grafting, risk of thrombotic and bleeding events was lower in the apixaban group (hazard ratio, 0.47; 95% confidence interval, 0.25-0.92). There was not a statistical difference between time to thrombosis (83 days vs 54 days, P = .648), rate of thrombosis (5.5% vs 10.3%, P = .08), time to bleeding (46 days vs 54 days, P = .886), or rate of bleeding (5.5% vs 10.9%, P = .06). The severity of bleeding and thrombotic events was not different between groups. Apixaban may serve as a reasonable alternative compared with warfarin in patients with severe renal dysfunction.
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To investigate the effectiveness, safety, and outcomes of lower limb events for non-vitamin K antagonist oral anticoagulants (NOACs) vs. warfarin among atrial fibrillation (AF) patients with concomitant peripheral artery disease (PAD).In this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, a total of 5768 and 2034 consecutive AF patients with PAD patients taking NOACs or warfarin were identified from 1 June 2012 to 31 December 2017, respectively. We used propensity score stabilized weighting to balance covariates across study groups. In the cohort, there were 89% patients were taking low-dose NOAC (dabigatran 110 mg twice daily, rivaroxaban 10-15 mg daily, apixaban 2.5 mg twice daily, or edoxaban 30 mg daily). Non-vitamin K antagonist oral anticoagulant was associated with a comparable risk of ischaemic stroke, and a lower risk of acute myocardial infarction [hazard ratio (HR): 0.61, 95% confidence interval (CI): 0.42-0.87; P = 0.007], lower extremity thromboembolism (HR: 0.56, 95% CI: 0.44-0.72; P < 0.0001), revascularization procedure (HR: 0.58, 95% CI: 0.47-0.72; P < 0.0001), lower limb amputation (HR: 0.32, 95% CI: 0.23-0.46; P < 0.0001), and all major bleeding (HR: 0.64, 95% CI: 0.50-0.80; P = 0.0001) than warfarin after weighting. The advantage of NOACs over warfarin persisted in high-risk subgroups including patients of ≥75 years of age, diabetes, renal impairment, or use of concomitant antiplatelet agent.This population-based study indicated that NOACs were associated with a comparable risk of ischaemic stroke, and a significantly lower risk of major adverse limb events and major bleeding than warfarin among AF patients with concomitant PAD. Therefore, thromboprophylaxis with NOACs may be considered for such patients.
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Concomitant
Stroke
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