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Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

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Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Venous Thrombosis III: Interprofessional Care01:29

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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
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Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors01:20

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Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
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Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
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Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Direct oral anticoagulants in hypercoagulable states.

Paul R Kunk1, Jacqueline Brown2, Melissa McShane2

  • 1Division of Hematology-Oncology, Department of Medicine, University of Virginia Health System, PO Box 800716, Charlottesville, VA, 22908-0716, USA. Prk5r@virginia.edu.

Journal of Thrombosis and Thrombolysis
|September 16, 2016
PubMed
Summary

Direct oral anticoagulants like apixaban and rivaroxaban show promise for treating heparin-induced thrombocytopenia (HIT) and antiphospholipid syndrome (APS). This study found them safe and effective in a small patient cohort.

Keywords:
Antiphospholipid syndromeApixabanDirect oral anticoagulantHeparin induced thrombocytopeniaRivoraxaban

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Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Direct oral anticoagulants (DOACs) are established for venous thromboembolism.
  • Their efficacy and safety in hypercoagulable states like heparin-induced thrombocytopenia (HIT) and antiphospholipid syndrome (APS) remain uncertain.
  • Warfarin, a traditional anticoagulant, has limitations including a narrow therapeutic window and drug/food interactions.

Purpose of the Study:

  • To evaluate the safety and efficacy of apixaban and rivaroxaban in patients with definite HIT or APS.
  • To explore the use of DOACs as alternatives for patients intolerant or refractory to warfarin.

Main Methods:

  • Retrospective analysis of 23 patients with definite HIT (12) or APS (11) treated with apixaban or rivaroxaban.
  • Data collected included clinico-pathologic features, efficacy (recurrent thrombosis), and safety (bleeding events).
  • Median follow-up was 7 months (range 2-39 months).

Main Results:

  • Zero patients experienced recurrent thrombotic events.
  • Two patients (in the HIT group) developed major bleeding, necessitating anticoagulation discontinuation.
  • Sixteen patients received apixaban (70%), and seven received rivaroxaban (30%).

Conclusions:

  • Apixaban and rivaroxaban appear to be safe and effective anticoagulants in this small cohort of patients with HIT and APS.
  • DOACs represent a viable treatment option for patients with HIT or APS who cannot tolerate, fail, or refuse warfarin.
  • Individualized treatment decisions are recommended based on patient-specific factors.