Use Of Direct-acting Anticoagulants Research Articles

Use of direct-acting anticoagulants (DOACs) delays surgery and is associated with increased mortality in hip fracture patients

PurposeTreatment with direct-acting oral anticoagulants (DOACs) is increasing among hip-fracture patients, with accompanying safety concerns regarding spinal anesthesia (SA). The aim of this study was to investigate if DOAC use is associated with increased waiting time before surgery, increased mortality, or other adverse events.MethodsRegistry data on surgically treated hip-fracture cases at a single hospital between 2015 and 2021 were analyzed. Multivariable regression analyses were performed with DOAC-status and choice of anesthesia as exposures, and waiting time, length of stay, transfusion, and mortality as outcomes.Results2885 cases were included, 467 patients (16%) were using DOACs. DOAC users were older (86.3 vs. 82.2 years, p < 0.001), had a higher Charlson Comorbidity Index (2.1 vs. 1.5, p < 0.001) and had longer median time to surgery than non-DOAC cases (36 h vs 17 h, p < 0.001). General anesthesia (GA) was used in 19.3% of DOAC patients and in 3.0% of non-DOAC patients. DOAC-patients had an increased risk of one-month mortality (Adjusted Odds Ratio (AOR) 1.6 (1.1–2.3)) and one-year mortality (AOR 1.4 (1.1–1.8)). There were no differences in risk of blood transfusion. Patients on DOAC operated under GA had a lower risk of one-year mortality (AOR 0.5 (0.3–0.9)), but a similar one-month mortality to DOAC-patients operated under SA.ConclusionDOAC users had a longer waiting time to surgery, indicating postponement of surgery due to concerns of the safety of SA. The clinical practice should be changed to allow earlier surgery for DOAC patients.

Regarding the Use of Direct-Acting Anticoagulants of Animal Origin in Diabetic Retinopathy

Relevance. Diabetic retinopathy occupies one of the leading places in the frame of blindness and low vision. The very first changes in the retina in diabetic retinopathy are disorders of microcirculation and blood supply in the small vessels of the macula. There are few effective drugs that can restore perfusion in the small retina’s vessels. In this connection, it is relevant to search for anticoagulants that allow restoring blood supply in the macular area in diabetic retinopathy in the early stages.The purpose. To analyze the research of a domestic direct-action anticoagulant from animals, a drug of the heparin group Pyavit, both in ophthalmology for diabetic retinopathy and in other fields of medicine. The analysis of publications on eLibrary and PubMed resources for the last 30 years was done, by the keywords: direct-acting anticoagulants, diabetic retinopathy, hirudins, hemodynamics, optical coherence tomography (OCT), hemostasis. The data on the study and application of the drug from its development to its use in diabetic retinopathy, retinal vascular pathology, and pregnancy was analyzed. Researchers have studied the importance of the salivary gland secretion of a medical leech, which is a regulator of the hemostasis system. In 1992 I.P. Baskova patented a new drug Pyavit, which is officially approved for use in medical practice (registration number No. 000363/02). Dosage regimen: 300 mg three times a day for 20 days, and repeat the course through 1–2 months. In ophthalmology, researchers have proven the positive effect of the drug on the retina in diabetic retinopathy with an improvement in visual acuity, retinal thickness according to objective indicators of optical coherence tomography, fluorescence angiography, and hemostasis system.Conclusion. The analysis of scientists’ research allows us to expand knowledge about the positive effect of the drug Piavit on the path of diabetic retinopathy. Based on this review, the authors plan to further study the drug, which will assess the importance and significance of improving microcirculation in the macular area of the retina using the anticoagulant Pyavit to preserve visual functions.

Effect of Previous Anticoagulant Treatment on Risk of COVID-19.

Little is known about the role played by anticoagulants in COVID-19. The aim of this study was to assess the impact of previous anticoagulant treatment on risk of hospitalization due to COVID-19, progression to severe COVID-19 and susceptibility to COVID-19 infection. We conducted a multiple population-based case-control study in northwest Spain, in 2020, to assess (1) risk of hospitalization: cases were all patients admitted due to COVID-19 with PCR confirmation, and controls were a random matched sample of subjects without a positive PCR; (2) progression: cases were hospitalized COVID-19 subjects, and controls were all non-hospitalized COVID-19 patients; and (3) susceptibility: cases were patients with a positive PCR (hospitalized and non-hospitalized), and the controls were the same as for the hospitalization model. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using a generalized linear mixed model. The consumption of antivitamin K and direct-acting anticoagulants apparently was not associated with the risk of progression to severe COVID-19 (OR 0.93 [95% CI 0.74-1.17] and OR 1.04 [95% CI 0.79-1.36], respectively). Antivitamin K anticoagulants were associated with a significantly lower risk of hospitalization (OR 0.77 [95% CI 0.64-0.93]), which, in part, can be explained by a decreased risk of susceptibility to infection (OR 0.83 [95% CI 0.74-0.92]). The use of direct-acting anticoagulants was not associated with the risk of hospitalization, although it also seems to decrease susceptibility (OR 0.85 [95% CI 0.74-0.98]). It has also been observed that low-molecular-weight heparins were associated with an increased risk of progression to severe COVID-19 (OR 1.25 [95% CI 1.01-1.55]). The results of this study have shown that antivitamin K anticoagulants and direct-acting anticoagulants do not increase the risk of progression to more severe stages. Antivitamin K consumption was associated with a lower risk of hospitalization and susceptibility to infection.

Direct acting oral anticoagulants versus low molecular weight heparin for primary thromboprophylaxis in cancer patients

Low molecular weight heparin is currently the standard therapy for the primary prevention of thromboembolic disease in cancer patients. The use of direct-acting anticoagulants could be an alternative, but its efficacy and safety profile in these types of patients remains unclear. We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from identified reviews, analyzed data from primary studies, performed a meta-analysis, and prepared a summary table of results using the GRADE method. We identified four systematic reviews that together included two primary studies, of which both correspond to trials. We conclude that the use of direct-acting oral anticoagulants probably increases the outcome of major bleeding and likely slightly increases the risk of thromboembolic disease. No studies were found that evaluated the outcome of quality of life or mortality.

Selección de lo mejor del año 2020 sobre el tratamiento antitrombótico para el cardiólogo clínico

In recent months, therapeutic novelties have appeared in the area of antithrombotic treatment with important repercussions for our activity. In the field of anticoagulation of atrial fibrillation, the publication of new guidelines that continue prioritizing the use of direct-acting anticoagulants collide with our clinical practice possibilities, due to the limitations imposed by the approval of these drugs. Regarding chronic coronary syndromes, double antithrombotic treatment will become a preferential option for a high percentage of patients; hence it will be very useful to be able to identify them. In patients with peripheral arterial disease, double antithrombotic treatment will also play a very important role. In heart failure, the results are conflicting and the new studies will help us to choose the best candidate. Percutaneous aortic prostheses is an area in continuous growth, but antithrombotic treatment in these patients has not been clarified and important developments have emerged in recent months. Finally, anticoagulation in cancer patients continues to be a challenge in our clinical practice.

Uso de anticoagulantes orales en situaciones clínicas complejas con fibrilación auricular

The present article provides an update on anticoagulant treatment in patients with atrial fibrillation in distinct clinical scenarios requiring particular considerations, such as ischaemic heart disease, electrical cardioversion, pulmonary vein ablation, the presence of valvular disease with or without prosthetic valves, and renal insufficiency, as well as old age and frailty. In patients with non-valvular atrial fibrillation, the presence of renal insufficiency increases both thrombotic and haemorrhagic risk. In mild and moderate stages, direct-acting anticoagulants confer a greater benefit than warfarin, although they usually require dose adjustment. In renal failure/dialysis, there is no solid evidence that warfarin is beneficial and the use of direct-acting anticoagulants is not recommended. Because of its pathophysiology, oral anticoagulation could have a beneficial effect in patients with heart disease. However, vitamin K antagonists have not shown a satisfactory risk-benefit ratio. In contrast, direct-acting anticoagulants, at reduced doses, could have a beneficial effect in this scenario in association with antiplatelet agents.The use of direct-acting anticoagulants prior to electrical cardioversion in patients with non-valvular atrial fibrillation seems to be associated with a risk of cardioembolic events that is at least comparable to that of vitamin K antagonists. Their use avoids delay in the application of electrical cardioversion in patients without adequate INR levels. In the context of their use before and after atrial fibrillation ablation, dabiga-tran and rivaroxaban have demonstrated at least non-inferiority with vitamin K antagonists in terms of safety.In patients with any type or grade of valvular disease and atrial fibrillation, the indication of antithrombo-tic treatment must be evaluated in the same way as in patients with atrial fibrillation and no valvular di-sease. Whenever anticoagulation is required, direct-acting anticoagulants are the treatment of choice in nearly all situations, except in patients with mechanical valves or who have significant rheumatic mitral disease, who should be treated with vitamin K antagonists. The choice of appropriate antithrombotic stra-tegy in frail elderly patients is complex and involves multiple factors beyond assessment of embolic and haemorrhagic risk. Comprehensive geriatric assessment is essential for an individualised final decision. Moreover, any such decision should be consensus-based and periodically reviewed. Direct-acting anticoa-gulants could be the most beneficial alternative in most elderly patients with non-valvular atrial fibrillation.