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Assessment of delayed bleeding after endoscopic submucosal dissection of early-stage gastrointestinal tumors in patients receiving direct oral anticoagulants 被引量:2
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作者 Mitsushige Sugimoto Masaki Murata Takashi Kawai 《World Journal of Gastroenterology》 SCIE CAS 2023年第19期2916-2931,共16页
Delayed bleeding is a major and serious adverse event of endoscopic submucosal dissection(ESD)for early-stage gastrointestinal tumors.The rate of post-ESD bleeding for gastric cancer is higher(around 5%-8%)than that f... Delayed bleeding is a major and serious adverse event of endoscopic submucosal dissection(ESD)for early-stage gastrointestinal tumors.The rate of post-ESD bleeding for gastric cancer is higher(around 5%-8%)than that for esophagus,duodenum and colon cancer(around 2%-4%).Although investigations into the risk factors for post-ESD bleeding have identified several procedure-,lesion-,physician-and patient-related factors,use of antithrombotic drugs,especially anticoagulants[direct oral anticoagulants(DOACs)and warfarin],is thought to be the biggest risk factor for post-ESD bleeding.In fact,the post-ESD bleeding rate in patients receiving DOACs is 8.7%-20.8%,which is higher than that in patients not receiving anticoagulants.However,because clinical guidelines for management of ESD in patients receiving DOACs differ among countries,it is necessary for endoscopists to identify ways to prevent post-ESD delayed bleeding in clinical practice.Given that the pharmacokinetics(e.g.,plasma DOAC level at both trough and T_(max))and pharmacodynamics(e.g.,anti-factor Xa activity)of DOACs are related to risk of major bleeding,plasma DOAC level and anti-FXa activity may be useful parameters for monitoring the anti-coagulate effect and identifying DOAC patients at higher risk of post-ESD bleeding. 展开更多
关键词 direct oral anticoagulants Gastrointestinal tumors Endoscopic submucosal dissection Delayed bleeding Adverse events anticoagulants
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Direct oral anticoagulants for the treatment of splanchnic vein thrombosis:A state of art
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作者 Giovanni Monaco Luca Bucherini +3 位作者 Bernardo Stefanini Fabio Piscaglia Francesco Giuseppe Foschi Luca Ielasi 《World Journal of Gastroenterology》 SCIE CAS 2023年第33期4962-4974,共13页
Splanchnic vein thrombosis(SVT)is a manifestation of venous thromboembolism in an unusual site.Portal,mesenteric,and splenic veins are the most common vessels involved in SVT which occurs mainly in patients with liver... Splanchnic vein thrombosis(SVT)is a manifestation of venous thromboembolism in an unusual site.Portal,mesenteric,and splenic veins are the most common vessels involved in SVT which occurs mainly in patients with liver cirrhosis,although non-cirrhotic patients could be affected as well.Thrombosis of hepatic veins,also known as Budd-Chiari syndrome,is another manifestation of SVT.Prompt diagnosis and intervention are mandatory in order to increase the recalization rate and reduce the risk of thrombus progression and hypertensive complications.Traditional anticoagulation with heparin and vitamin-K antagonists is the treatment of choice in these cases.However,recent studies have shown promising results on the efficacy and safety of direct oral anticoagulants(DOACs)in this setting.Available results are mainly based on retrospective studies with small sample size,but first clinical trials have been published in the last years.This manuscript aims to provide an updated overview of the current evidence regarding the role of DOACs for SVT in both cirrhotic and non-cirrhotic patients. 展开更多
关键词 Splanchnic vein thrombosis Portal vein thrombosis Budd-Chiari syndrome direct oral anticoagulants
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临床药师参与1例心力衰竭、心肌梗死合并房颤患者的药物治疗
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作者 受国徽 苏会源 李波霞 《海峡药学》 2024年第3期95-98,共4页
目的梳理复杂治疗方案后的抗栓方案,重整抗栓药物和疗程,纠正不合理用药,促进合理用药。方法临床药师介入1例心力衰竭、多次因心肌梗死植入多枚支架,合并房颤,行射频消融和左心耳封堵患者的药物治疗,重整抗栓药物方案,并全程监控治疗药... 目的梳理复杂治疗方案后的抗栓方案,重整抗栓药物和疗程,纠正不合理用药,促进合理用药。方法临床药师介入1例心力衰竭、多次因心肌梗死植入多枚支架,合并房颤,行射频消融和左心耳封堵患者的药物治疗,重整抗栓药物方案,并全程监控治疗药物,就不合理用药提出警示。结果患者明显好转,住院及出院随访期间未发生不良事件。结论临床药师的参与有助于精细化管理患者的药物治疗方案,并及时纠正不合理用药,更好的为患者服务。 展开更多
关键词 心力衰竭 心肌梗死 PCI支架植入术 直接口服抗凝药物(DOAC direct oral anticoagulants) 利伐沙班 新活素(注射用重组人脑利钠肽) 沙库巴曲缬沙坦
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Systemic right ventricle complications in levo-transposition of the great arteries: A case report and review of literature
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作者 Mohamed Ramzi Almajed Abdulla Almajed +2 位作者 Naoshin Khan Mark S Obri Karthikeyan Ananthasubramaniam 《World Journal of Cardiology》 2023年第10期542-552,共11页
BACKGROUND Congenitally corrected levo-transposition of the great arteries(L-TGA)is a congenital heart disease in which the ventricles and great arteries are transposed from their typical anatomy.In L-TGA,the double d... BACKGROUND Congenitally corrected levo-transposition of the great arteries(L-TGA)is a congenital heart disease in which the ventricles and great arteries are transposed from their typical anatomy.In L-TGA,the double discordance,atrioventricular and ventriculoarterial,create an acyanotic milieu which allows patients to survive their early decades,however,progressive systemic right ventricle(sRV)dys-function creates complications later in life.sRV dysfunction and remodeling predisposes patients to intracardiac thrombus(ICT)formation.CASE SUMMARY A 40-year-old male with L-TGA presented with symptoms of acute decom-pensated heart failure.In childhood,he had surgical repair of a ventricular septal defect.In adulthood,he developed sRV dysfunction,systemic tricuspid valve(sTV)regurgitation,and left-bundle branch block for which he underwent cardiac resynchronization therapy.Transthoracic echocardiogram showed a sRV ejection fraction of 40%,severe sTV regurgitation,and a newly identified sRV ICT.ICT was confirmed by ultrasound-enhancing agents and transesophageal echocardio-graphy.Our patient was optimized with guideline-directed medical therapy and diuresis.Anticoagulation was achieved with a vitamin K antagonist(VKA)and he was later referred for evaluation by advanced heart failure and heart transplant services.CONCLUSION Anticoagulation with VKA is the mainstay of treatment in the absence of conclusive data supporting direct oral anticoagulant use in ICT in patients with congenital heart disease.This case illustrates the natural history of L-TGA and highlights the importance of surveillance and monitoring with dedicated cardiac imaging to identify complications. 展开更多
关键词 Levo-transposition of the great arteries Systemic right ventricle Congenital heart disease Intracardiac thrombus ANTICOAGULATION direct oral anticoagulant Case report
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Effectiveness and safety of apixaban and rivaroxaban vs warfarin in patients with atrial fibrillation and chronic kidney disease
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作者 Sylvie Perreault Laurie-Anne Boivin Proulx +2 位作者 Aurélie Lenglet Ziad A Massy Marc Dorais 《World Journal of Nephrology》 2023年第5期132-146,共15页
BACKGROUND Randomized controlled trials(RCTs)of direct oral anticoagulants(DOACs)included a low proportion of atrial fibrillation(AF)patients with chronic kidney disease(CKD),and suggested that DOACs are safe and effe... BACKGROUND Randomized controlled trials(RCTs)of direct oral anticoagulants(DOACs)included a low proportion of atrial fibrillation(AF)patients with chronic kidney disease(CKD),and suggested that DOACs are safe and effective in patients with mild-to-moderate CKD.In a metanalysis of RCTs and observational studies,DOACs were associated with better efficacy(vs warfarin)in early CKD and had similar efficacy and safety profiles in patients with stages IV-V CKD.But few studies have provided data on the safety and effectiveness of each DOAC vs warfarin in patients with stage III CKD.The effectiveness and safety of DOACs in those patients are still subject to debate.AIM To assess and compare the effectiveness and safety of apixaban and rivaroxaban vs warfarin in this patient population.METHODS A cohort of patients with an inpatient or outpatient code for AF and stage III CKD who were newly prescribed apixaban and rivaroxaban was created using the administrative databases from the Quebec province of Canada between 2013 and 2017.The primary effectiveness outcome was a composite of ischemic stroke,systemic embolism,and death,whereas the primary safety outcome was a composite of major bleeding within a year of DOAC vs warfarin initiation.Treatment groups were compared in an under-treatment analysis using inverse probability of treatment weighting and Cox proportional hazards.RESULTS A total of 8899 included patients filled out a new oral anticoagulation therapy claim;3335 for warfarin and 5564 for DOACs.Compared with warfarin,15 mg and 20 mg rivaroxaban presented a similar effectiveness and safety composite risk.Apixaban 5.0 mg was associated with a lower effectiveness composite risk[Hazard ratio(HR)0.76;95%confidence interval(CI):0.65-0.88]and a similar safety risk(HR 0.94;95%CI:0.66-1.35).Apixaban 2.5 mg was associated with a similar effectiveness composite(HR 1.00;95%CI:0.79-1.26)and a lower safety risk(HR 0.65;95%CI:0.43-0.99.Although,apixaban 5.0 mg was associated with a better effectiveness(HR 0.76;95%CI:0.65-0.88),but a similar safety risk profile(HR 0.94;95%CI:0.66-1.35).The observed improvement in the effectiveness composite for apixaban 5.0 mg was driven by a reduction in mortality(HR 0.61;95%CI:0.43-0.88).CONCLUSION In comparison with warfarin,rivaroxaban and apixaban appear to be effective and safe in AF patients with stage III CKD. 展开更多
关键词 Atrial fibrillation Chronic kidney disease direct oral anticoagulant EFFECTIVENESS SAFETY WARFARIN
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Burden of venous thromboembolism in patients with pancreatic cancer 被引量:3
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作者 Corinne Frere 《World Journal of Gastroenterology》 SCIE CAS 2021年第19期2325-2340,共16页
Pancreatic cancer(PC)is a devastating malignancy with fewer than 10%of patients being alive at 5 years after diagnosis.Venous thromboembolism(VTE)occurs in approximatively 20%of patients with PC,resulting in increased... Pancreatic cancer(PC)is a devastating malignancy with fewer than 10%of patients being alive at 5 years after diagnosis.Venous thromboembolism(VTE)occurs in approximatively 20%of patients with PC,resulting in increased morbidity,mortality and significant health care costs.The management of VTE is particularly challenging in these frail patients.Adequate selection of the most appropriate anticoagulant for each individual patient according to the current international guidelines is warranted for overcoming treatment challenges.The International Initiative on Thrombosis and Cancer multi-language web-based mobile application(downloadable for free at www.itaccme.com)has been developed to help clinicians in decision making in the most complex situations.In this narrative review,we will discuss the contemporary epidemiology and burden of VTE in PC patients,the performances and limitations of current risk assessment models to predict the risk of VTE,as well as evidence from recent clinical trials for the primary prophylaxis and treatment of cancer-associated VTE that support updated clinical practice guidelines. 展开更多
关键词 Pancreatic cancer Venous thromboembolism Low-molecular weight heparin direct oral anticoagulant Multi-language mobile application Risk-assessment models THROMBOPROPHYLAXIS
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Dabigatran,rivaroxaban,and apixaban are superior to warfarin in Asian patients with non-valvular atrial fibrillation:An updated metaanalysis 被引量:4
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作者 Wei-Jia Li Paraschos Archontakis-Barakakis +7 位作者 Leonidas Palaiodimos Dimitrios Kalaitzoglou Lazaros Tzelves Apostolos Manolopoulos Yu-Chiang Wang Stefanos Giannopoulos Robert Faillace Damianos G Kokkinidis 《World Journal of Cardiology》 2021年第4期82-94,共13页
BACKGROUND Most of the randomized clinical trials that led to the wide use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation(AF)originated from western countrie... BACKGROUND Most of the randomized clinical trials that led to the wide use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation(AF)originated from western countries.AIM To systematically review and quantitatively synthesize the real-world data regarding the efficacy and safety of dabigatran,rivaroxaban,and apixaban compared to warfarin for stroke prevention in Asian patients with non-valvular AF.METHODS Medline,Cochrane,and ClinicalTrial.gov databases were reviewed.A randomeffect model meta-analysis was used and I-square was utilized to assess the heterogeneity.The primary outcome was ischemic stroke.The secondary outcomes were all-cause mortality,major bleeding,intracranial hemorrhage,and gastrointestinal bleeding.RESULTS Twelve studies from East Asia or Southeast Asia and 441450 patients were included.Dabigatran,rivaroxaban,and apixaban were associated with a significant reduction in the incidence of ischemic stroke[hazard ratio(HR)=0.78,95%confidence interval(CI):0.65-0.94;HR=0.79,95%CI:0.74-0.85,HR=0.70,95%CI:0.62-0.78;respectively],all-cause mortality(HR=0.68,95%CI:0.56-0.83;HR=0.66,95%CI:0.52-0.84;HR=0.66,95%CI:0.49-0.90;respectively),and major bleeding(HR=0.61,95%CI:0.54-0.69;HR=0.70,95%CI:0.54-0.90;HR=0.58,95%CI:0.43-0.78;respectively)compared to warfarin.CONCLUSION Dabigatran,rivaroxaban,and apixaban appear to be superior to warfarin in both efficacy and safety in Asians with non-valvular AF. 展开更多
关键词 Novel oral anticoagulant direct oral anticoagulant Atrial fibrillation Asian population DABIGATRAN RIVAROXABAN APIXABAN WARFARIN
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