Introduction to Direct Oral

Direct oral anticoagulants (DOACs) showed non-inferiority when compared with conventional treatment using subcutaneous low molecular weight heparin (LMWH) and warfarin, but treatment failure is a concern and remains a challenge for physicians.

There is a wide experience using low molecular weight heparin or Fondaparinux, while the use of direct oral anticoagulants, as Rivaroxaban, had less extent.

OBJECTIVE This study aimed to evaluate the safety of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) during daily clinical practice.

The use of direct oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) is robust.

The aim of the study was to assess the external validity of pivotal RCT findings concerning direct oral anticoagulants (DOACs) for the treatment of nonvalvular atrial fibrillation (NVAF) by comparing patients recruited in RCTs to those treated with DOACs registered in a southern Italian local health unit (LHU) in the years 2013–2017.

Direct oral anticoagulants (DOACs) are available for nonvalvular atrial fibrillation patients.

Observational studies assessing direct oral anticoagulant (DOACs) dosage in atrial fibrillation (AF) reported that a lower proportion of patients received high‐dose DOACs compared to those in randomized controlled trials (RCTs).

(2) The aim of the present paper is to systematically summarize current VTE management in patients with neoplasia and to review the current clinical evidence from meta-analyses of randomized controlled trials and guidelines regarding the administration of direct oral anticoagulants (DOACs) for cancer-associated VTE.

The tendency for blood pooling in the left atrium and left atrial appendage (LAA) due to AF was first reported in 1996, and although oral anticoagulation with vitamin K antagonists and direct oral anticoagulants (DOACs) has significantly reduced stroke risk, up to 40% of patients with AF are untreated, due to intolerance, bleeding, or other contraindications.

The increasing use of direct oral anticoagulants and nonpharmacologic methods such as left atrial appendage closure for stroke prevention in these patients has increased clinicians' options for optimal care.

We read with great interest the consensus paper on the use of direct oral anticoagulants (DOACs) in patients with chronic kidney disease (CKD) by Grandone et al.

Recent evidence reveals that the superior benefit-risk profile of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) observed in the general population and in moderate chronic kidney disease can be extended to the hemodialysis population.

Direct oral anticoagulants (DOACs), including dabigatran, rivaroxaban, apixaban and edoxaban, are widely recommended for use in the general population compared to vitamin K antagonists (VKA).

Dabigatran, rivaroxaban, apixaban, edoxaban, and betrixaban are direct oral anticoagulants (DOACs).

In their article “Predictors of post-traumatic complication of mild brain injury in anticoagulated patients: DOACs are safer than VKAs”, Cipriano and colleagues reported, in a cohort of 473 patients on oral anticoagulation therapy (OAT) evaluated in the ED for mild traumatic brain injury (MTBI), a higher incidence of post-traumatic intracranial haemorrhage (ICH) in patients treated with vitamin K antagonists (VKAs) compared to patients treated with direct oral anticoagulants (DOACs) [1].

Oral anticoagulation therapy, nowadays preferably with direct oral anticoagulants (DOACs), represents the cornerstone for ischemic stroke prevention in high-risk patients.

To evaluate the safety of uninterrupted versus interrupted direct oral anticoagulation (DOAC) for patients undergoing catheter ablation (CA) of atrial fibrillation (AF).

Main funding source(s): Daiichi Sankyo  The optimal periprocedural management of direct oral anticoagulants (DOAC), including edoxaban, in patients undergoing catheter-based cardiovascular procedures is unknown, and mainly based on physician opinion and experience.

Background Considering that the current fixed dose of direct oral anticoagulants (DOACs) might have insufficient anticoagulation effect for overweight patients, the aim of this study was to compare the effectiveness and safety of anticoagulation between dabigatran and rivaroxaban in different body mass index (BMI) population.

BACKGROUND Direct oral anticoagulants (DOACs) have been increasingly preferred over warfarin; however, The International Society of Thrombosis and Hemostasis recommended avoiding the use of DOACs in morbidly obese patients (body mass index >40 or weight >120 kg) because of limited clinical data.

RCT evidence has shown that direct oral anti-coagulants (DOACs) are at least as effective and safer in terms of bleeding, compared to vitamin K antagonists (VKAs) in the treatment of acute venous thromboembolism (VTE).

BACKGROUND It is now widely accepted to manage low risk acute venous thromboembolism (VTE) in the outpatient setting with direct oral anticoagulants (DOACs).

Objective To assess anticoagulation (AC) timing and appropriateness in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) due to atrial fibrillation (AF) in a predominantly Hispanic community hospital in the era of direct oral AC (DOAC) and endovascular thrombectomy (EVT).

Limited data support the benefits of direct, non-Vitamin K antagonist oral anticoagulants (direct oral anticoagulants [DOACs]) in acute ischemic stroke (AIS) or transient ischemic attack (TIA) patients with nonvalvular atrial fibrillation (AF) and CSVD.

Direct oral anticoagulants (DOACs, or non-vitamin K antagonist oral anticoagulants [NOACs]) include dabigatran, a direct thrombin inhibitor, and factor Xa inhibitors (rivaroxaban, apixaban, edoxaban, betrixaban).

2 Direct oral anticoagulants (DOACs) commonly used to treat VTE in adults have two mechanisms of action: direct thrombin (activated factor II) inhibition (ie, dabigatran) and activated factor X (Xa) inhibition (ie, rivaroxaban, apixaban, edoxaban, betrixaban).

6% of patients with advanced chronic liver disease and vascular live disease after direct oral anticoagulants (DOACs), and that Child-Pugh class B/C patients experienced more spontaneous bleeding episodes than Child-Pugh class A patients (36.

While direct oral anticoagulants (DOACs) are increasingly used in patients with liver disease, safety data especially in advanced chronic liver disease (ACLD) are limited.

Materials and Methods: An open-label study aimed to investigate the prevalence of spontaneous echo contrast (SEC) and LAT before and after 3 weeks of direct oral anticoagulant (DOAC) treatment.

Methods: An open-label study, aiming to investigate the prevalence of spontaneous echo contrast (SEC) and LAT before and after 3 weeks of direct oral anticoagulant (DOAC) treatment.

Background- The efficacy and safety of oral Anticoagulation (OAC)with either Warfarin or Direct oral anticoagulants (DOACs) as compared with combination therapy of oral anticoagulant and antiplatelet (OAC + APT) in patients with atrial fibrillation and stable coronary artery disease more than 1 year after stenting is not known.

To study the efficacy and safety of direct oral anticoagulant (DOAC) therapy after implantation of cardiac resynchronization therapy (CRT) devices in atrial fibrillation (AF) patients with coronary artery disease (CAD) and dilated cardiomyopathy (DCM).

These include vitamin K antagonists (warfarin) and direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban).

The use of the direct oral anticoagulants dabigatran, rivaroxaban, apixaban and edoxaban (DOACs) offers some major advantages over warfarin and other vitamin K antagonists (VKAs).

BACKGROUND Because anticoagulant drugs for ambulatory patients with cancer-associated venous thromboembolism (CAT) are limited to warfarin and direct oral anticoagulants (DOACs) in Japan, it is important to assess the outcomes of both drugs.

INTRODUCTION Real-world evidence on the effects of direct oral anticoagulants (DOACs) in patients with cancer associated venous thromboembolism (VTE) is limited.

BACKGROUND Although the preliminary evidence seems to confirm a lower incidence of post-traumatic bleeding in patients treated with direct oral anticoagulants (DOACs) compared to those on vitamin K antagonists (VKAs), the recommended management of mild traumatic brain injury (MTBI) in patients on DOACs is the same as those on the older VKAs, risking excessive use of CT in the emergency department (ED).

BACKGROUND AND PURPOSE Mild traumatic brain injury (mTBI) in patients on antiplatelet (AP), anticoagulant (AC) or direct oral anticoagulant (DOAC) medication has become a systematic indication for head CT.

Direct oral anticoagulants (DOACs) have already established benefit over warfarin as a long-term treatment of symptomatic venous thromboembolic disorder like deep vein thrombosis (DVT), and pulmonary embolism (PE) given its equal efficacy and better safety profile.

AIMS We characterized the utilization and long-term treatment persistence of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) and liver disease.

TO THE EDITOR: I enjoyed Dawwas and colleagues' recent article (1) but am concerned that their title, “Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation” [emphasis added], is misleading.

According to this study: Patients with valvular atrial fibrillation who were new users of direct oral anticoagulants had lower rates of ischemic stroke or systemic embolism and major bleeding than new users of warfarin.

He had a history of paroxysmal atrial fibrillation (PAF) and cerebral infarction, treated by direct oral anticoagulant therapy.

Case summary We report the case of a 74-year-old Caucasian man affected by paroxysmal atrial fibrillation with significant bleeding risk (familiar thrombocytopenia, macroscopic haematuria episodes during therapy with direct oral anticoagulants, HAS-BLED risk score: 4) and ischaemic risk as well (CHADSVASC score: 3).

We conducted a retrospective cohort study in the FDA’s Sentinel System (10/2010–09/2015) among females aged 18+ years with venous thromboembolism (VTE), or atrial flutter/fibrillation (AF) who newly initiated a direct oral anticoagulant (DOAC; rivaroxaban, apixaban, dabigatran) or warfarin.

We conducted a retrospective cohort study of Optum’s de-identified Clinformatics® Database of adults with cancer diagnosed between 2009 and 2016 who developed CAT, treated with an outpatient anticoagulant (warfarin, low molecular weight heparin (LMWH), or a direct oral anticoagulant (DOAC)).

However, there is limited evidence comparing methods of thromboprophylaxis, more specifically the administration of a subcutaneous low molecular weight heparin (LMWH) versus a direct oral anticoagulant (DOAC) in women with gynecologic malignancies.

There is limited evidence comparing direct oral anticoagulants (DOACs) and warfarin in solid organ transplant recipients.

Issues discussed are (1) the timing of direct oral anticoagulants start following an ischemic stroke; (2) the comparison of direct oral anticoagulants versus vitamin K antagonists in early secondary stroke prevention; (3) harms of bridging with heparin before direct oral anticoagulants; (4) importance of appropriate direct oral anticoagulants dosing; (5) screening for AF in high-risk populations, including the role of wearables; (6) left atrial appendage occlusion as an alternative to oral anticoagulation; (7) the role of early rhythm-control therapy; (8) effect of lifestyle interventions on AF; (9) AF as a risk factor for dementia.

There was no significant association between direct oral anticoagulants versus vitamin-k antagonists and infections of the urinary tract.

PURPOSE There are limited data regarding the safety of direct oral anticoagulants (DOACs) during breastfeeding.

The ease of use, superior efficacy, and improved side effect profile have made direct oral anticoagulants (DOACs) the preferable anticoagulant for treatment of atrial fibrillation; but there is limited data regarding their safety and efficacy in patients with an LVAD.

Current and emerging treatment options are discussed with special focus on parenteral thrombin inhibitors (argatroban, bivalirudin), parenteral factor Xa inhibitors (danaparoid, fondaparinux) and direct oral anticoagulants (DOACs [rivaroxaban, apixaban, dabigatran]) including dosing strategies for DOACs.

Direct oral anticoagulants (DOACs), namely rivaroxaban, apixaban, dabigatran, and edoxaban, are now included together with warfarin as standards of care for the primary treatment of venous thromboembolism (VTE).

During the past 20 years, we have witnessed the following trends in aspirin usage: (i) a “dropping” trend, characterized by the early discontinuation of low‐dose aspirin from dual antiplatelet therapy or triple antithrombotic therapy (oral anticoagulation plus dual antiplatelet therapy in patients with atrial fibrillation) following an acute coronary syndrome or after percutaneous coronary intervention; (ii) a “combinatorial” trend, featuring the addition of a lower dose of a P2Y12 inhibitor or direct oral anticoagulant drug to low‐dose aspirin for the long‐term treatment of stable patients with atherosclerotic cardiovascular disease; and (iii) a “repurposing” trend, characterized by growing interest in the oncologic community to assess the chemopreventive effect of aspirin against certain types of cancers (particularly of the gastrointestinal tract), both as primary prevention and adjuvant therapy.

AASLD 1⁄4 American Association for the Study of Liver Disease, aPTT 1⁄4 activated partial thromboplastin time, CI 1⁄4 confidence interval, CVC 1⁄4 central venous catheter, DAPT 1⁄4 dual antiplatelet therapy, DOAC 1⁄4 direct oral anticoagulant, DVT 1⁄4 deep vein thrombosis, FFP 1⁄4 fresh frozen plasma, INR 1⁄4 International Normalized Ratio, LMWH 1⁄4 low molecular weight heparin, NVAF 1⁄4 nonvalvular atrial fibrillation, PEG 1⁄4 percutaneous endoscopic gastrostomy, PT 1⁄4 prothrombin time, RCT 1⁄4 randomized controlled trial, VKA 1⁄4 vitamin K antagonist, VTE 1⁄4 venous thromboembolism.

Intracerebral haemorrhage, deep venous thrombosis and lack of efficacy: 2 case reports In a study of 12 patients, who received prothrombin complex concentrate [4-factor prothrombin complex concentrate] as reversal agent between 1 July 2018 and 30 June 2019 for major bleeding while receiving the direct oral anticoagulants (DOACs), 2 patients including a 78-year-old man [not all ages and sexes stated] were described, of whom one patient developed intracerebral haemorrhage (ICH) during treatment with apixaban for deep venous thrombosis (DVT) or pulmonary embolism (PE) and developed DVT during treatment with reversal agent prothrombin complex concentrate for ICH, and other patient exhibited a lack of efficacy during treatment with reversal agent prothrombin-complex-concentrate for ICH [outcomes not stated; not all dosages and durations of treatments to reactions onsets stated].

Whereas some of the newer direct oral anticoagulants currently do not have widely available reversal options, warfarin has prothrombin complex concentrate (PCC), vitamin K (phytonadione), and fresh frozen plasma (FFP) as options for reversal.

We examined the association between renal function and incident ischaemic stroke or myocardial infarction in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs).

[1] published in the Journal of Hypertension, which investigated the optimal office blood pressure (OBP) level in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs).

Therefore, the risk/benefit profile of the direct oral anticoagulants (DOAC) is of clinical interest.

BACKGROUND In patients with normal renal function or early stage CKD, the risk-benefit profile of direct oral anticoagulants (DOACs) is superior to that of vitamin K antagonists (VKAs).

It was assumed that patients with ESUS had a high rate of occult AF and would benefit from treatment with direct oral anticoagulants, which are at least as effective as vitamin K antagonists for secondary stroke prevention in patients with AF, but with a much lower risk of intracerebral hemorrhage.

We aimed to determine the efficacy and safety of direct oral anticoagulants (DOACs) in secondary stroke prevention in very old patients and to explore the related geriatric functional status of these patients.

Although direct oral anticoagulants are effective and safe in preventing stroke in atrial fibrillation (AF) patients with low body weight, data remain limited in AF patients with extremely low body weight (<50 kg).

Purpose Although direct oral anticoagulants are effective and safe in preventing stroke in atrial fibrillation (AF) patients with low body weight, data remain limited in AF patients with extremely low body weight (< 50 kg).

Background: In routine clinical practice, non-standard doses of direct oral anticoagulants (DOACs) are commonly used in patients with atrial fibrillation (AF).

Background: The efficacy and bleeding complications of direct oral anticoagulant (DOAC) therapy for isolated distal deep vein thrombosis (IDDVT) associated with cancer in routine clinical practice remain unclear.

The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of direct oral anticoagulants (DOACs) in patients with peripheral artery disease (PAD).

Rivaroxaban, indicated for the treatment of atrial fibrillation, deep vein thrombosis, pulmonary embolism, and coronary or peripheral artery disease, is one of the most frequently used direct oral anticoagulants.

The solid organ transplant community is slow to adopt the routine practice of using direct oral anticoagulants.

Direct oral anticoagulants (DOACs) are the recommended first‐line therapy for ischemic stroke prevention in patients with nonvalvular atrial fibrillation (NVAF).

AIMS Measurement of protein S (PS) activity in patients taking direct oral anticoagulants (DOACs) using reagents based on a clotting assay results in falsely high PS activity, thus masking inherited PS deficiency, which is most frequently seen in the Japanese population.

INTRODUCTION Limited data is available on the rates of bleeding and thromboembolic events for patients undergoing low bleeding risk procedures while taking direct oral anticoagulants (DOAC).

The study included 150 patients (men, 69,3%) with AF receiving direct oral anticoagulants in combination with two (89,3%) or one antiplatelet agent (10,7%) after elective PCI.

Subgroup analyses on patients not on anticoagulant therapy (n = 103), patients receiving warfarin (n = 17) and patients receiving direct oral anticoagulant therapy (n = 18) showed no significant changes between the RIPC-patients and controls.

Although direct oral anticoagulants (DOACs) are associated with an overall favourable safety profile, the risk of gastrointestinal bleeding with DOACs compared with vitamin K antagonists (VKAs) remains controversial.

BACKGROUND Although direct oral anticoagulants (DOACs) have been shown to be effective at reducing the risk of stroke in patients with atrial fibrillation/flutter (AF), they are sometimes underdosed off-label to mitigate their associated higher bleeding risk.

BACKGROUND New direct oral anticoagulants (DOACs) are commonly used in the management of atrial fibrillation and VTE.

The introduction of the four new direct oral antagonists (DOAC) has made the perioperative management of anticoagulation much easier.

Patient: Male, 78-year-old Final Diagnosis: Skin necrosis Symptoms: Cough • SOB Medication: — Clinical Procedure: N/A Specialty: Cardiology • Critical Care Medicine • Dermatology • Hematology • General and Internal Medicine • Pharmacology and Pharmacy • Pulmonology Objective: Unusual clinical course Background: Apixaban is one of the newer direct oral anticoagulants (DOACs) being used to manage venous thrombosis.

Newer direct oral anticoagulants (DOACs) should be preferred.

Background Direct oral anticoagulants (DOAC) including edoxaban are increasingly used for stroke prevention in atrial fibrillation.

Background Direct oral anticoagulants (DOAC) are increasingly used worldwide.

Uninterrupted direct oral anticoagulation (DOAC) in AF‐ablation is recommended, proven by randomized trials.

The need for pre‐ or peri‐procedural imaging to rule out the presence of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation (AF) is unclear in the era of uninterrupted direct oral anticoagulant (DOAC) regimen.

Clinical trials comparing direct oral anticoagulants (DOAC) to warfarin excluded patients with a history of bariatric surgery.

BACKGROUND There is no randomized controlled trial comparing direct oral anticoagulants (DOACs) and warfarin following bariatric surgery to date.

Brunetti and Bo1 raised a number of comments to our recently published Forum Article2 on the potential benefits of measuring anticoagulation levels in patients who use direct oral anticoagulants (DOACs).

In turn, the most of experts use direct oral anticoagulants in outpatients even despite no confirmation is for DOAC’s effectiveness from randomized trials in this time.

Based on the results of recent randomized controlled clinical trials, the administration of prophylactic doses of the novel direct oral anticoagulants (DOACs) to ambulatory cancer patients undergoing chemotherapy has the potential to offer an effective and safe protection against VTE, obviating the inconveniences of heparins.

Dabigatran is a novel direct oral anticoagulant agent, whose plasma concentration is closely related to bleeding risk.

INTRODUCTION Although vitamin K antagonists (VKAs) are recommended as first-line anticoagulants for patients with left ventricular thrombus (LVT), accumulating evidence suggests direct oral anticoagulants (DOACs) could be safe alternatives for VKAs.

7 There is currently no treatment fully alleviating these symptoms, although evidence suggests direct oral anticoagulants, in particular rivaroxaban, reduce incidence of PTS compared with vitamin K antagonists.

OBJECTIVES This study evaluated the long-term efficacy of a standard antithrombotic strategy versus half-dose direct oral anticoagulation (DOAC) after Watchman implantation.

East Asians are reportedly at high risk of anticoagulant-related bleeding; therefore, some physicians prefer to prescribe low-dose direct oral anticoagulants (DOACs).

ABSTRACT Patients with atrial fibrillation (AF) on long-term direct oral anticoagulants (DOACs) may be at higher risk of bleeding due to higher anti-Xa or anti-IIa levels.

In this article, we describe a patient with isolated right ventricular noncompaction who presented with submassive pulmonary embolism, which was managed with long-term direct oral anticoagulation.