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Direct-Acting Oral Anticoagulants in Critically Ill Patients

Published on Sep 1, 2019in Chest9.657
· DOI :10.1016/j.chest.2019.05.025
Parth Rali2
Estimated H-index: 2
(TU: Temple University),
A. Gangemi1
Estimated H-index: 1
(TU: Temple University)
+ 2 AuthorsLisa K. Moores22
Estimated H-index: 22
(USU: Uniformed Services University of the Health Sciences)
Abstract
The direct-acting oral anticoagulants (DOACs) have been increasingly used over vitamin K antagonists in recent years because they do not require monitoring and have an immediate anticoagulation effect. In general, DOACs have exhibited a better safety profile and noninferiority for prophylaxis and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation compared with vitamin K antagonists in the non-ICU population; whether this finding holds true in patients who are critically ill remains unknown. The current review addresses the role of DOACs in special ICU populations, use of these agents for VTE prophylaxis, perioperative management of DOACs, drug monitoring, and potential drug interactions of DOACs in critically ill patients. Adverse events and available reversal agents for DOACs are also discussed.
  • References (115)
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References115
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#1Jacob V. Weber (OHSU: Oregon Health & Science University)H-Index: 1
#2Ali Olyaei (OSU: Oregon State University)H-Index: 3
Last. Joseph J. Shatzel (OHSU: Oregon Health & Science University)H-Index: 8
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5 CitationsSource
#1Jacklyn M. Engelbart (Roy J. and Lucille A. Carver College of Medicine)H-Index: 1
#2Anne Zepeski (UIHC: University of Iowa Hospitals and Clinics)H-Index: 1
Last. Brett A. Faine (UIHC: University of Iowa Hospitals and Clinics)H-Index: 6
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Abstract Background The incidence of patients who present with life-threatening bleeding complications has been increasing as the use of direct oral anticoagulation (DOAC) has increased. Therefore, effective reversal agents are urgently needed. Current guidelines recommend the use of prothrombin complex concentrates (PCCs) and activated PCCs (aPCC) for reversal of DOAC anticoagulant activity in the setting of traumatic and non-traumatic intracranial hemorrhage (ICH). However, little data is avai...
3 CitationsSource
#1Melissa Santibanez (Cornell University)H-Index: 2
#2Christine Lesch (NewYork–Presbyterian Hospital)H-Index: 6
Last. Karen Berger (Cornell University)H-Index: 3
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Abstract Purpose Current guidelines favor 4F-PCC over plasma for warfarin reversal. Uncertainty remains on its thrombotic risk and hemostatic effectiveness when used for direct-acting oral anticoagulants (DOACs), transplants, massive transfusion protocols (MTP), and non-anticoagulated patients. This study sought to evaluate the tolerability and effectiveness of 4F-PCC in a real-world setting. Materials and methods This was a retrospective study of adults who received 4F-PCC from March 2014 to De...
5 CitationsSource
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#2Robby Nieuwlaat (McMaster University)H-Index: 35
Last. Gordon H. Guyatt (McMaster University)H-Index: 201
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Background: Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the use of anticoagulants in the management of VTE. These guidelines assume the choice of anticoagulant has already been made. Methods: ASH formed a multidisciplinary gui...
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#2Jeff S. Healey (Population Health Research Institute)H-Index: 62
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#2Noémie KraaijpoelH-Index: 6
Last. Nick van EsH-Index: 17
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Abstract Introduction Anticoagulant treatment in patients with liver cirrhosis is challenging. The aim of this systematic review was to evaluate clinical outcomes of direct oral anticoagulant (DOAC) therapy in cirrhosis patients. Materials and methods A systematic search was performed in MEDLINE, Embase, and conference proceedings up to November 7th, 2017, for studies that evaluated the efficacy and safety of DOACs in cirrhosis patients with venous thromboembolism (VTE), splanchnic vein thrombos...
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#1Amgad Mentias (UIHC: University of Iowa Hospitals and Clinics)H-Index: 2
#2Ghanshyam Palamaner Subash Shantha (UIHC: University of Iowa Hospitals and Clinics)H-Index: 15
Last. Mary Vaughan Sarrazin (Roy J. and Lucille A. Carver College of Medicine)H-Index: 20
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Importance Comparative effectiveness and safety of oral anticoagulants in patients with atrial fibrillation (AF) and multiple chronic conditions (MCC) are unknown. Objective To determine whether there are differences in efficacy and safety of dabigatran, rivaroxaban, and warfarin regarding stroke prevention and bleeding rates, respectively, in elderly patients with AF with MCC. Design, Setting, and Participants This retrospective comparative effectiveness analysis included data from the populati...
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Abstract Background Patients who are hospitalized for medical illness remain at risk for venous thromboembolism after discharge, but the role of extended thromboprophylaxis in the treatment of such patients is a subject of controversy. Methods In this randomized, double-blind trial, medically ill patients who were at increased risk for venous thromboembolism on the basis of a modified International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score of 4 or higher (scores range...
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#2Cyrus A. KholdaniH-Index: 5
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