- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Journal: Recommendations for the use of andexanet alfa in the management of bleeding in patients on oral factor Xa inhibitors in Switzerland. (Pubmed Central) - Jul 31, 2023
The present recommendations on the use of andexanet alfa in the management of bleeding in patients on factor Xa inhibitors in Switzerland were developed by a group of Swiss experts from the Working Party Hemostasis of the Swiss Society of Hematology. These recommendations aim to provide support to clinicians in their decision-making in the management of patients with major bleeding receiving factor Xa inhibitors.
- |||||||||| rivaroxaban / Generic mfg., enoxaparin sodium / Generic mfg.
Journal: Pulmonary embolism in an adolescent with COVID-19 pneumonia. (Pubmed Central) - Jul 29, 2023
There are few reports of PE in children with COVID-19. Prompt diagnosis and early anticoagulant treatment are important to avoid life-threatening complications.
- |||||||||| rivaroxaban / Generic mfg., piperacillin sodium/tazobactam sodium / Generic mfg., vancomycin / Generic mfg.
Rare Presentation of Gastric Ulcer as Gastric Pneumatosis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_4698;
Case Description/ An elderly man with atrial fibrillation on Xarelto, HFpEF due to cardiac amyloidosis, and stage IV Merkel cell carcinoma in remission presented with 10 days of vomiting, abdominal pain, and watery non-bloody diarrhea...He was made NPO, NG tube was placed, started on piperacillin-tazobactam and vancomycin as well as IV PPI...Surgical intervention is recommended for gastric perforation and gangrenous or necrotizing gastritis that does not respond to conservative management or ischemia secondary to gastric volvulus. Figure: CT of the abdomen and pelvis showing gastric pneumatosis (top image) and Endoscopy images showing large >50mm cratered gastric ulcer
- |||||||||| rivaroxaban / Generic mfg.
Double-Channel Pylorus: A Rare Complication of Peptic Ulcer Disease (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_4678;
Past medical history was significant for compensated alcoholic cirrhosis, permanent atrial fibrillation on rivaroxaban, chronic pain on chronic opioids, and chronic anemia with unknown source...For symptomatic patients, surgical intervention may be considered. Figure: Figure 1: Double-channel pylorus found on EGD suspicious for a previous peptic ulcer.
- |||||||||| rivaroxaban / Generic mfg.
Metastatic Renal Angiosarcoma to the Small Bowel Causing Recurrent Small Intestinal Bleeds (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_4619;
Case Description/ Here, we discuss a 78-year-old male with past medical history of angiosarcoma of the renal pelvis and atrial fibrillation on Xarelto who presented to the hospital with recurrent gastrointestinal bleeding...D. (200x magnification, ERG immunohistochemical stain) Higher magnification of the positive immunoreactivity of the malignant cells for ERG (endothelial marker).
- |||||||||| Coarsucam (artesunate/amodiaquine) / Sanofi, DNDi
Acute Liver Injury or Acute Liver Failure? A Unique Presentation of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_4394;
Case Description/ A 47-year-old man with Hemoglobin SC (HbSC) disease and recurrent pulmonary emboli (PE) on rivaroxaban presented with malaise and elevated liver enzymes. He recently returned from Ghana and took 3 doses of artesunate-amodiaquine for suspected malaria...He was empirically started on N-acetylcysteine and hepatology was consulted for LT evaluation given concern for ALF...Heparin, diuresis, dobutamine, and red blood cell exchange transfusion were initiated...This case is a unique presentation demonstrating the importance of distinguishing ALF from acute liver injury
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
Upper Gastrointestinal Bleed as First Presentation of Duodenal Mucosal Melanoma (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3960;
Case Description/ A 79-year-old male with a history of atrial fibrillation on Xarelto presented with worsening shortness of breath, dizziness, and progressive melena...Thorough evaluation by dermatology found no cutaneous melanoma and pembrolizumab immunotherapy was initiated by his oncologist...C) 400 power H&E stain (only tumor cells displayed). D) S-100 immunostain at 20x
- |||||||||| rivaroxaban / Generic mfg.
Unraveling the Silent Strangler: Takayasu Arteritis Unleashing Hematochezia (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3949;
He was discharged on rivaroxaban and a preemptive IVC filter...Though temporarily held in active GI bleeding, resumption needs close observation in patients with vasculitis and AVMs. Figure: A: CT GI bleed showing SMA thrombosis; B: CT GI bleed showing IMA thrombosis; C: CT angiogram showing pre-embolization; D: CT angiogram showing post-embolization
- |||||||||| rivaroxaban / Generic mfg.
Gastric Volvulus After Hiatal Hernia Repair (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3307;
Case Description/ Our patient is a 65-year-old male with a history of a hiatal hernia repaired with biologic mesh and chronic deep vein thrombosis on rivaroxaban...(A) CT abdomen with oral contrast showing gastric distention and abnormal twisting of the gastric antrum. (B) Swirled endoscopic appearance of the gastric antrum, consistent with gastric volvulus.
- |||||||||| rivaroxaban / Generic mfg., doxycycline / Generic mfg.
Neuroendocrine Carcinoma (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3269;
Further, these can be subclassified based on location and functional status. This case will highlight the hospital course of a 29-year-old pregnant female with rare metastatic neuroendocrine carcinoma.
- |||||||||| rivaroxaban / Generic mfg.
Curative Resection of T1a Esophageal Inlet Patch Adenocarcinoma With Traction-Assisted Endoscopic Submucosal Dissection (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2779;
Case Description/ A 58-year-old Caucasian male with chronic GERD, morbid obesity, and atrial fibrillation on rivaroxaban, underwent an EGD for subacute dysphagia to solids...Figures E-F: Histopathological examination (H&E, 40x) revealing heterotopic gastric oxyntic glands (E, red box) at one edge of the mass, consistent with inlet patch origin. At the base of the mass, invasive adenocarcinoma (F, at right) encroaching on the thin pink bands of the muscularis mucosa (F, red arrows).
- |||||||||| rivaroxaban / Generic mfg.
Rare Solitary Peutz-Jeghers Type Duodenal Polyp Presenting With Gastrointestinal Bleed (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2484;
Case Description/ A 67-year-old male with a history of atrial fibrillation on Xarelto, chronic systolic heart failure (EF 20%), chronic iron deficiency anemia, type 2 diabetes mellitus and hypothyroidism presented with a one week history of generalized weakness, fatigue, exertional dyspnea and melanotic stools...B: Post EMR appearance of polyp site. C and D: Histology of Peutz-Jeghers type polyp showing connective tissue composed of smooth muscle covered by a hypertrophic epithelium.
- |||||||||| rivaroxaban / Generic mfg., ceftriaxone / Generic mfg.
A Novel Case of Pylephlebitis Secondary to Obstructive Pancreatic Adenocarcinoma (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1998;
Rivaroxaban was started on discharge for portal vein thrombosis...This case gives credence to the possibility and encourages the consideration of pancreatic cancer as a rare cause of septic portal vein thrombosis. Figure: CT scan indicting left portal vein thrombus (figure 1) and main portal vein thrombus (figure 2)
- |||||||||| rivaroxaban / Generic mfg.
Wire-Guided Stent Cannulation for Obtaining Biliary Access During Post-Sphincterotomy Hemorrhage (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1975;
Case Description/ An 84-year-old male with a history of atrial fibrillation on rivaroxaban underwent ERCP with ES and placement of a bile duct stent for a biliary leak that presented two weeks after laparoscopic cholecystectomy...In patients presenting with bleeding, large thrombi may obscure the papilla and prevent access to the biliary orifice. This case showed a novel technique where a previously placed stent was utilized to provide a safe means for biliary access allowing intervention and tamponade of an active hemorrhage status-post ES.
- |||||||||| rivaroxaban / Generic mfg.
A Rare Presentation of Neuroendocrine Tumor in the Terminal Ileum (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1781;
Case Description/ Patient is a 50 year old female with a history of atrial fibrillation on Xarelto, esophageal dysphagia, and pancreatitis who presented with multiple complaints including fatigue, exertional dyspnea, decreased appetite, and intermittent abdominal pain for approximately 2 weeks...In such cases, it is important to maintain a broad differential to allow for timely diagnosis and management to prevent further complications of the disease. Figure: Figures 1 & 2: Colonoscopy findings of mucosal abnormality in the terminal ileum
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS
Recurrent Renal Cell Carcinoma and Hematochezia: An Extraordinary Presentation (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1092;
Relevant medical comorbidities include prior renal cell carcinoma with left radical nephrectomy performed in 2017, transurethral resection of the prostate performed in 2019, Roux-en-Y bypass, and current Xarelto use following a pulmonary embolism in 2021...Medical oncology recommended chemotherapy with Nivolumab, worried that a typical two-agent regimen may worsen bleeding...C) Sigmoid mass biopsy demonstrating recurrent metastatic clear cell renal carcinoma, H&E stain. D) Sigmoid mass biopsy, KRT-CAM-5.2 stain.
- |||||||||| rivaroxaban / Generic mfg.
Disappearing Dysphagia and the Spontaneous IntraEsophageal Hematoma (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_989;
Case Description/ A 73-year-old female with a history of atrial fibrillation, on rivaroxaban, presented with a three-day history of acute dysphagia to solids and liquids...Figure G: CTA chest with esophageal artery contrast blush. Figure H: Arterial blush seen on aortogram with selective catheterization of intercostal artery.
- |||||||||| Savaysa (edoxaban) / Daiichi Sankyo
Journal: Risk Profiles of New Users of Oral Anticoagulants Between 2011 and 2019 in Germany. (Pubmed Central) - Jul 24, 2023
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.
- |||||||||| rivaroxaban / Generic mfg., warfarin / Generic mfg., apixaban / Generic mfg.
Journal: Pearls in Anticoagulation Management for Patients With Left Ventricular Assist Devices. (Pubmed Central) - Jul 21, 2023
We found encouraging data on the safety and efficacy of low doses of DOACs as secondary prophylaxis in the onco-hematologic setting; no thrombotic complications were observed, and the incidence of hemorrhagic events was low. No abstract available
- |||||||||| Managing The Patient Taking The New Oral Anticoagulants (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_2782;
3.What is the minimal safe interval for which dabigatran needs to be discontinued prior to neuraxial puncture?4.Knowing this patient will receive IV heparin bolus intraoperatively, what should be the minimum interval between neuraxial procedure and heparinization?5.Does the dose of heparin influence the interval between neuraxial procedure and heparinization?6.How does the timing of heparin influence the relative risk of an epidural hematoma in this situation?7.Assuming that the lumbar drain was being placed on the day of the surgical procedure and it turned out to be traumatic (bloody), what would be the best course of action?...10.Is it possible to reverse the anticoagulant effects of dabigatran?11.Does dabigatran offer any advantages over warfarin for stroke prevention in patients with atrial fibrillation?...17.How long would you withhold apixaban (Eliquis) before proceeding with a neuraxial procedure? 18.Is it possible to reverse the anticoagulant effects of rivaroxaban (or apixaban)?
- |||||||||| Prialt (ziconotide) / Jazz
Lost In Conversion: Intrathecal Opioids To Equivalent Oral Opioids In Chronic Pain Patients (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_2332;
Only three drugs (morphine, baclofen, and ziconotide) are approved by the US Food and Drug Administration (FDA) for use in intrathecal pain pump, but several drugs are used off-label, such as hydromorphone, fentanyl, sufentanyl, ketamine, clonidine, and bupivacaine...This case discusses the use of the combination of long- and short-acting oral opioids in the process of rapid weaning off intrathecal opioids in a patient with an IDDS.CASE HISTORYThe patient is a 66-year-old female with a past medical history significant for pulmonary embolism, deep venous thrombosis (on Xarelto), bipolar disorder, asthma, chronic obstructive pulmonary disease, and chronic low back pain...Her pain is well controlled with oxycontin 30 mg bid and oxycodone 15 mg tid...Will you agree?9)Why did this patient develop granuloma at the tip of intrathecal catheter in the first place? Does it relate to the content of drug or it can happen to anyone with intrathecal drug delivery?10)Your new pain fellow asked if there is anything you can do prevent formation of granuloma in other patients.
- |||||||||| Managing The Patient Taking The New Oral Anticoagulants (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_1838;
3.What is the minimal safe interval for which dabigatran needs to be discontinued prior to neuraxial puncture?4.Knowing this patient will receive IV heparin bolus intraoperatively, what should be the minimum interval between neuraxial procedure and heparinization?5.Does the dose of heparin influence the interval between neuraxial procedure and heparinization?6.How does the timing of heparin influence the relative risk of an epidural hematoma in this situation?7.Assuming that the lumbar drain was being placed on the day of the surgical procedure and it turned out to be traumatic (bloody), what would be the best course of action?...10.Is it possible to reverse the anticoagulant effects of dabigatran?11.Does dabigatran offer any advantages over warfarin for stroke prevention in patients with atrial fibrillation?...17.How long would you withhold apixaban (Eliquis) before proceeding with a neuraxial procedure? 18.Is it possible to reverse the anticoagulant effects of rivaroxaban (or apixaban)?
- |||||||||| Prialt (ziconotide) / Jazz
Lost In Conversion: Intrathecal Opioids To Equivalent Oral Opioids In Chronic Pain Patients (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_368;
Only three drugs (morphine, baclofen, and ziconotide) are approved by the US Food and Drug Administration (FDA) for use in intrathecal pain pump, but several drugs are used off-label, such as hydromorphone, fentanyl, sufentanyl, ketamine, clonidine, and bupivacaine...This case discusses the use of the combination of long- and short-acting oral opioids in the process of rapid weaning off intrathecal opioids in a patient with an IDDS.CASE HISTORYThe patient is a 66-year-old female with a past medical history significant for pulmonary embolism, deep venous thrombosis (on Xarelto), bipolar disorder, asthma, chronic obstructive pulmonary disease, and chronic low back pain...Her pain is well controlled with oxycontin 30 mg bid and oxycodone 15 mg tid...Will you agree?9)Why did this patient develop granuloma at the tip of intrathecal catheter in the first place? Does it relate to the content of drug or it can happen to anyone with intrathecal drug delivery?10)Your new pain fellow asked if there is anything you can do prevent formation of granuloma in other patients.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Test Of Residual Anticoagulation After Neutralization By Andexanet-alpha: Usefulness Of Dielectric Coagulometer (South: Hall F) - Jul 20, 2023 - Abstract #ASA2023ASA_279;
Our newly developed test in DBCM showed usefulness in the evaluation of neutralization of factor-Xa inhibitor by andexanet-alpha. Although neutralization induced by andexanet-alpha resulted in slight prolongation of CT compared with the samples after sufficient cessation of medication, small difference prevents underestimation of the effect of neutralization induced by andexanet-alpha.
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