- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Journal: Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors. (Pubmed Central) - Mar 29, 2023
P3
A search was undertaken up to October 2022 to identify PK/PD studies of apixaban, dabigatran, edoxaban, and rivaroxaban, that included older adults aged ? In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients.
- |||||||||| warfarin / Generic mfg.
Retrospective data, Journal: Direct Oral Anticoagulants and Warfarin Safety in Rural Patients with Obesity. (Pubmed Central) - Mar 28, 2023
In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients. In patients with atrial fibrillation and class III obesity, regarding safety, DOACs appear to be non-inferior to warfarin during the first six to 12 months of therapy in our rural population - consistent with other analyses; however, the lack of thrombosis events limited the efficacy analysis.
- |||||||||| rivaroxaban / Generic mfg.
Trial completion, Enrollment change, Trial primary completion date: R2MI: Rivaroxaban in Type 2 Myocardial Infarctions (clinicaltrials.gov) - Mar 27, 2023
P2/3, N=8, Completed,
DOACs seem to be effective and safe for long-term anticoagulation in patients with BCS, but confirmation by larger prospective studies is needed. Recruiting --> Completed | N=100 --> 8 | Trial primary completion date: Dec 2022 --> May 2022
- |||||||||| rivaroxaban / Generic mfg.
A Rare Case of Systemic Thrombolysis Failure in Massive Pulmonary Embolism Requiring Catheter-directed Intervention (Walter E. Washington Convention Center, Area J, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8314;
The patient was discharged on Rivaroxaban...The estimated failure rate of STT is nearly 12%, however, is no randomized trial directing treatment algorithms following failed STT. Rescue therapies, such as CDT and surgical embolectomy, should be decided on individual patient risk until further studies are conducted to quantify the risk-benefit ratio.
- |||||||||| Adempas (riociguat) / Bayer, Merck (MSD), Nplate (romiplostim) / Amgen, Kyowa Kirin, Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
"Between Scylla and Charybdis" - Severe Right Ventricular Dysfunction Due to Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and Life Threatening Thrombocytopenia (Walter E. Washington Convention Center, Area J, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8307;
After extensive multidisciplinary team discussions, he underwent Pulmonary thromboendarterectomy (PTE) and Inferior vena caval stent placement. Outcome- Followup Ventilation Perfusion (V/Q) scan showed no evidence of pulmonary embolism, platelet counts improved significantly,pulmonary pressures improved remarkably on RHC and 4 years later, he continues to do well.Discussion - Managing this patient with life threatening hemoptysis, RV failure, cardiogenic shock cardiorenal syndrome and multiorgan dysfunction in the setting of significant thrombotic burden,requiring intense parenteral anticoagulation, features suggestive of catastrophic Anti Phospholipid Syndrome( CAPS ),was extremely daunting and to complicate things further, there was worsening of thrombocytopenia with high risk of further bleeding.A focused, aggressive multidisciplinary approach with timely surgical intervention led to successful outcome.
- |||||||||| tadalafil / Generic mfg.
The Straw That Broke the Camel (Walter E. Washington Convention Center, Area J, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8295;
The intima of the pulmonary artery is theorized to be predisposed to tearing and shear stress in the setting of significant increases in pulmonary arterial pressure due to the lower pressures typically present in the PA. We are aware of few case reports of PAD occurring following oral phosphodiesterase-5 inhibitor discontinuation in patients with severe PH, COPD, and previous pulmonary venous thromboembolic disease.
- |||||||||| Hemorrhagic Pericardial Effusion and Atrial Fibrillation as Initial Presentation of COVID-19: A Case Report (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8029;
She was started on Diltiazem for rate control...She was discharged home on Xarelto and metoprolol for atrial fibrillation and to complete a 3 months course of colchicine and ibuprofen...Although they are known for being rare complications of COVID-19, patients can develop atrial fibrillation and hemorrhagic pericardial effusion in the absence of myocarditis and lung involvement. Physicians should maintain a high level of clinical suspicion for these complications in the setting of a COVID-19 infection.
- |||||||||| rivaroxaban / Generic mfg., aspirin / Generic mfg., enoxaparin sodium / Generic mfg.
Multisystem Inflammatory Syndrome in a 50-year-old Adult Male (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7913;
Aspirin, low molecular weight heparin, and rivaroxaban have all been utilized for thromboprophylaxis in our case. While further study is needed for treatment, the use of IVIG, anticoagulation, and glucocorticoids on management proved to be successful in our case.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
A Rare Presentation of a Rare Non-Langerhans Cell Histiocytosis (Walter E. Washington Convention Center, Area L, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_5839;
Case presentation: Patient is a 55-year-old female with medical history significant for COPD, type 2 diabetes mellites, hypertension, ischemic heart disease, DVT with pulmonary embolism on rivaroxaban, recurrent cellulitis...Treatment with steroids or rituximab were discussed if the patient were to be symptomatic later...If the patient were to have become symptomatic or have a local recurrence, then systemic treatment with steroids & chemotherapy can be considered based on the current consensus recommendations. Hence our patient is being monitored every 6 months.
- |||||||||| Adempas (riociguat) / Bayer, Merck (MSD)
VA ECMO as a Bridge to Pulmonary Thromboendarterectomy in a Patient With Cardiogenic Shock Due to CTEPH (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_5282;
One month prior to the current presentation, he was admitted to another hospital with hemoptysis, and he was switched from rivaroxaban to warfarin for recurrent VTE...He was started on riociguat and intravenous remodulin...His TTE showed normal RV size and function, without an appreciable tricuspid valve jet.Summary Pre-operative VA ECMO as a bridge to PTE for CTEPH has rarely been reported and is associated with high mortality1,2. Our report describes the successful use of VA ECMO as salvage and a bridge to PTE in a 45-year-old man with a history of recurrent VTE who developed cardiogenic shock due to CTEPH.
- |||||||||| rivaroxaban / Generic mfg., enoxaparin sodium / Generic mfg.
A Great Red Herring: A Rare Case of Primary Pulmonary Artery Sarcoma (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_5276;
PPAS is a very rare aggressive malignancy with a median survival of 1.5 months if untreated.2 It mimics PE or CTEPH at presentation and on imaging, leading to frequent misdiagnosis.1 A high index of suspicion for atypical presentation, including unprovoked subacute progression of PE despite adequate anticoagulation and absence of hypercoagulability state, warrants further investigation.3 Symptoms favoring PPAS include digital clubbing, weight loss, and asthenia, in addition to dyspnea, chest pain, coughing, and hemoptysis.1,4 D-dimer, BNP, ESR, and CRP are also typically elevated.1 Echocardiography and CTA identify intraluminal filling defect in the pulmonary outflow tract and the PA vasculature, respectively.1,4 Magnetic resonance imaging is useful in tissue characterization, and PET also shows high metabolic activity in PPAS compared to PE.3,5 Definitive tissue diagnosis is necessary. Multimodal treatment involves neoadjuvant chemotherapy with surgical resection, which includes endarterectomy, tumor debulking, or palliative PA stenting.6 Successful surgery increases survival to 8-36 months.7.
- |||||||||| rivaroxaban / Generic mfg.
Wall Eclipsing Sign: Pulmonary Artery Intimal Sarcoma (PAIS) Mimicking PE (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_5275;
He was treated with intrapulmonary TPA followed by right PA percutaneous thrombectomy with 50% residual thrombus burden and subsequently discharged home on Rivaroxaban...Surgery is the definitive treatment strategy and patients who undergo curative resection have a longer overall survival than those who undergo incomplete resection. Aggressive adjuvant therapies are given to improve postoperative long-term survival.
- |||||||||| rivaroxaban / Generic mfg., vancomycin / Generic mfg., ceftriaxone / Generic mfg.
Flail Posterior Mitral Leaflet From Infective Endocarditis: An Unusual Case of Diffuse Alveolar Hemorrhage (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_5274;
Right upper lobe predominant opacities are classic and thought secondary to the directionality of MR towards the upper right pulmonary vein. Lastly, in the context of fever and leukocytosis, infective mitral valve endocarditis should be considered as an underlying contributor.
- |||||||||| rivaroxaban / Generic mfg., trimethoprim/sulfamethoxazole / Generic mfg., doxycycline / Generic mfg.
Some Supplements Are Detriments of Health: A Case of Lysine Induced Eosinophilic Pneumonia (Walter E. Washington Convention Center, Room 103 A-B (Street Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_3508;
Although this is rare, we wanted to highlight that with the large movements towards health supplements, a myriad of them are poorly studied, unregulated and can be associated with significant health risks. Given their significant impact on our patient we also encourage routine thorough the history of supplementations and to always consider them as a differential in the right clinical context.
- |||||||||| colchicine / Generic mfg.
Colchicine For Pleuritic Chest Pain Secondary to Pulmonary Infarction Caused by Pulmonary Embolism (Walter E. Washington Convention Center, Room 140 A-B (Street Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_3254;
Given their significant impact on our patient we also encourage routine thorough the history of supplementations and to always consider them as a differential in the right clinical context. Patient was started on a heparin drip initially eventually transitioned to levenox and was discharged on Xarelto...Acute pain management service was taken on board, pain did not respond to IV opioids and patient was stared ketamine drip with mild improvement in pain...Our patient
- |||||||||| rivaroxaban / Generic mfg., dabigatran etexilate / Generic mfg.
Journal: Just DOAC: Use of direct-acting oral anticoagulants in pediatrics. (Pubmed Central) - Mar 24, 2023
Additional long-term, postauthorization studies are warranted to further elucidate safety and efficacy in clinical scenarios excluded in clinical trials. Additional data on safety, efficacy, and dosing strategies for reversal agents are also necessary, especially as the use of DOACs becomes more common in the pediatric population.
- |||||||||| rivaroxaban / Generic mfg., warfarin / Generic mfg.
Journal: Management, control, and decision making in unexpected recurrent venous thromboembolism in COVID-19: a case report. (Pubmed Central) - Mar 24, 2023
NOACs were associated with a significantly lower risk of dementia compared with VKAs, likely driven by apixaban and edoxaban use. In the case of unexpected recurrent venous thromboembolism in coronavirus disease 2019, especially when patients are taking rivaroxaban or other new oral anticoagulants, such drugs should be substituted by warfarin, with routine follow-up, to maintain the value of prothrombin time and international normalized ratio within the therapeutic range.
- |||||||||| Journal: Interactions Between Direct Oral Anticoagulants (DOACs) and Antiseizure Medications: Potential Implications on DOAC Treatment. (Pubmed Central) - Mar 24, 2023
For apixaban and rivaroxaban, rifampicin had a greater effect on the area under the concentration-time curve than on peak concentration...The European Society of Cardiology recommends avoiding this combination, as well as the combination of DOACs with levetiracetam and valproic acid, owing to a risk of low DOAC concentrations...Our comparative analysis suggests DOAC plasma concentration monitoring as a possible strategy to guide dosing owing to the predictable correlation between DOACs' plasma concentration and effect. Patients taking concomitant enzyme-inducing antiseizure medications are at risk for low DOAC concentrations and subsequently, treatment failure and thus can benefit from DOAC concentration monitoring to prophylactically identify this risk.
- |||||||||| Bevyxxa (betrixaban) / AstraZeneca
A NATIONWIDE ANALYSIS OF THE IMPACT OF DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH COMPENSATED CIRRHOSIS AND PORTAL VEIN THROMBOSIS (South Hall A, Poster Hall - McCormick Place) - Mar 23, 2023 - Abstract #DDW2023DDW_3387;
Patients with compensated cirrhosis and acute PVT were divided into three cohorts; first cohort was patients who received DOACs (dabigatran, rivaroxaban, apixaban, edoxoban, betrixaban); second cohort was patients on enoxaparin or warfarin; third cohort were patients not receiving any anticoagulation. In a large nationwide study, patients with compensated cirrhosis with an acute PVT and receiving DOACs had a lower rate of EVB bleeding and decompensation when compared to those receiving LMWH, VKAs, or not any anticoagulation.
- |||||||||| Savaysa (edoxaban) / Daiichi Sankyo
SAFETY AND EFFICACY OF DIRECT ORAL ANTICOAGULANTS IN THE TREATMENT OF PORTAL VEIN THROMBOSIS IN PATIENTS WITH CIRRHOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS (South Hall A, Poster Hall - McCormick Place) - Mar 23, 2023 - Abstract #DDW2023DDW_3385;
Based on this meta-analysis, direct oral anticoagulants appear to be effective and safe in the treatment of portal vein thrombosis in patients with cirrhosis, majority being CTP class A and B. Nevertheless, based on this data, patients must be counseled about the 17% bleeding risk and the 25% treatment failure rate. Future studies are warranted to help predict clinical variables associated with bleeding and treatment failure to better risk-stratify treatment of PVT with DOACs in patients with cirrhosis.
- |||||||||| rivaroxaban / Generic mfg., aspirin / Generic mfg.
Journal: A hybrid automated event adjudication system for clinical trials. (Pubmed Central) - Mar 20, 2023
The automated event adjudication system in combination with human adjudicators provides a streamlined and efficient approach to event adjudication in clinical trials. To immediately apply automated event adjudication, one can first consider the automated event adjudication system and involve human assistance for cases unconfirmed by the former.
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