219 research outputs found
Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants
No full textIMPORTANCE International guidelines recommend avoiding intravenous thrombolysis (IVT) in patients with ischemic stroke who have a recent intake of a direct oral anticoagulant (DOAC). OBJECTIVE To determine the risk of symptomatic intracranial hemorrhage (sICH) associated with use of IVT in patients with recent DOAC ingestion. DESIGN, SETTING, AND PARTICIPANTS This international, multicenter, retrospective cohort study included 64 primary and comprehensive stroke centers across Europe, Asia, Australia, and New Zealand. Consecutive adult patients with ischemic stroke who received IVT (both with and without thrombectomy) were included. Patients whose last known DOAC ingestion was more than 48 hours before stroke onset were excluded. A total of 832 patients with recent DOAC use were compared with 32 375 controls without recent DOAC use. Data were collected from January 2008 to December 2021. EXPOSURES Prior DOAC therapy (confirmed last ingestion within 48 hours prior to IVT) compared with no prior oral anticoagulation. MAIN OUTCOMES AND MEASURES The main outcome was sICH within 36 hours after IVT, defined as worsening of at least 4 points on the National Institutes of Health Stroke Scale and attributed to radiologically evident intracranial hemorrhage. Outcomes were compared according to different selection strategies (DOAC-level measurements, DOAC reversal treatment, IVT with neither DOAC-level measurement nor idarucizumab). The association of sICH with DOAC plasma levels and very recent ingestions was explored in sensitivity analyses. RESULTS Of 33 207 included patients, 14 458 (43.5%) were female, and the median (IQR) age was 73 (62-80) years. The median (IQR) National Institutes of Health Stroke Scale score was 9 (5-16). Of the 832 patients taking DOAC, 252 (30.3%) received DOAC reversal before IVT (all idarucizumab), 225 (27.0%) had DOAC-level measurements, and 355 (42.7%) received IVT without measuring DOAC plasma levels or reversal treatment. The unadjusted rate of sICH was 2.5% (95% CI, 1.6-3.8) in patients taking DOACs compared with 4.1% (95% CI, 3.9-4.4) in control patients using no anticoagulants. Recent DOAC ingestion was associated with lower odds of sICH after IVT compared with no anticoagulation (adjusted odds ratio, 0.57; 95% CI, 0.36-0.92). This finding was consistent among the different selection strategies and in sensitivity analyses of patients with detectable plasma levels or very recent ingestion. CONCLUSIONS AND RELEVANCE In this study, there was insufficient evidence of excess harm associated with off-label IVT in selected patients after ischemic stroke with recent DOAC ingestion.Peer reviewe
Characteristics of ICH with Warfarin and DOAC
No full textBackground: Direct oral coagulants (DOAC) have been shown to decrease the frequency of intracerebral hemorrhage (ICH) compared with warfarin. However, the precise characteristics, such as the size and locations of the hemorrhage, and outcome and onset time of ICH in patient taking DOAC are not fully elucidated. Methods: We retrospectively analyzed the characteristics of symptomatic patients with ICH taking either DOAC or warfarin between January 2012 and December 2015. Results: Out of 400 consecutive patients with ICH, 15 patients were DOAC-ICH and 24 patients were warfarin-ICH. DOAC-ICH was observed in 6 patients with 10 mg of rivaroxaban, 5 patients with 15 mg of rivaroxaban, and 1 patient with 10 mg of apixaban, 5 mg of apixaban, 30 mg of edoxaban, and 60 mg of edoxaban. Prothrombin time was well controlled in most of the warfarin-ICH patients (83.3%). The locations of ICH were similar in both groups; however, median ICH volume was significantly smaller in DOAC-ICH patients than in warfarin-ICH patients (P<.01) and ICH around basal ganglia seemed to show great difference between the groups. DOAC-ICH patients showed better neurological outcome at the time of discharge than warfarin patients (P<.01), and the ratio of good prognosis was significantly higher in the DOAC-ICH patients than in the warfarin-ICH patients (P<.01). The onset of warfarin-ICH was frequently observed in the morning and evening, whereas DOAC-ICH did not show any specific onset time. Conclusions: Patients with DOAC-ICH showed smaller ICH volume and better clinical outcomes than patients with warfarin-ICH, and DOAC-ICH did not show any specific onset peak
Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy
No full textIntroduction One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)). Objective To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT. Methods Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated. Results A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11-20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005). Conclusions IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ
Analýza adherence pacientů k léčbě DOAC I
No full textAnalysis of patient adherence to treatment by DOAC I Author: Katarína Rezáková Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Kateřina Malá, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia associated with increased morbidity and mortality. In clinical practice, direct oral anticoagulants (DOAC) are used as an alternative to warfarin to prevent thromboembolic events in patients with AF. The study aimed to analyse the statements of patients with FiP along with data from medical records focusing on aspects related to the use and management of DOAC, including devices and tools to improve adherence to treatment, patients' level of awareness of DOAC and other therapeutic agents used. Methods: The prospective study was conducted from 2020 to 2022 at the University Hospital Brno. Patients aged ≥ 18 years with AF on DOAC therapy (dabigatran, rivaroxaban and apixaban) were included in the study. Data about pharmacotherapy and patients' health status were obtained from medical records and structured interview with the patient. Patients' interviews were performed at time 0, three and six months after patient has entred the study....Analýza adherencie pacientov na liečbu DOAC I Autor: Katarína Rezáková Vedúci diplomovej práce: doc. PharmDr. Josef Malý, Ph.D. Konzultant: PharmDr. Kateřina Malá, Ph.D. Katedra sociálnej a klinickej farmácie, Farmaceutická fakulta v Hradci Králové, Univerzita Karlova Úvod a cieľ: Fibrilácia predsiení (FiP) je najčastejšia supraventrikulárna tachyarytmia spojená s vyššou morbiditou a mortalitou. V klinickej praxi sa používajú priame perorálne antikoagulanciá (DOAC) ako alternatíva k warfarínu na prevenciu tromboembolických príhod u pacientov s FiP. Cieľom tejto práce bolo analyzovať výpovede pacientov s FiP doplnené o dáta zo zdravotníckej dokumentácie s dôrazom na aspekty spojené s užívaním a zaobchádzaním s DOAC vrátane prostriedkov a nástrojov na podporu adherencie k liečbe, ďalej na mieru informovanosti pacientov týkajúcu sa DOAC a ostatné užívané terapeutické prostriedky. Metodika: Prospektívna štúdia prebiehala od roku 2020 do 2022 vo Fakultnej nemocnici Brno. V štúdii boli zahrnutí pacienti vo veku ≥ 18 rokov s FiP na terapii DOAC (dabigatran, rivaroxaban a apixaban). Dáta o farmakoterapii a zdravotnom stave pacientov boli získané zo zdravotníckej dokumentácie a zo štruktúrovaného rozhovoru s pacientom. Rozhovory s pacientami boli vedené v čase 0, tri a šesť mesiacov od vstupu pacienta do...Katedra sociální a klinické farmacieDepartment of Social and Clinical PharmacyFaculty of Pharmacy in Hradec KrálovéFarmaceutická fakulta v Hradci Králov
Analýza adherence pacientů k léčbě DOAC II
No full text6 Abstract Analysis of patient adherence to treatment by DOAC II Author: Natália Janáčková Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Simona Dvořáčková, Ph.D., Mgr. Eliška Mašková Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aim: Dosing interval may be an important factor influencing adherence to direct oral anticoagulant (DOAC) therapy. In terms of adherence, a once-daily regimen appears to be a better alternative. However, there may be a higher risk of treatment failure if the dose is missed. The aim of the practical part of the thesis was to analyse patients' attitudes and experiences with DOACs, complemented by data from medical records, with a focus on aspects related to DOAC dosing. Methods: Data collection for this prospective study was carried out from 2020 to 2022 at the Internal Cardiology Outpatient Clinic of the University Hospital in Brno. Patients aged ≥ 18 years on DOAC treatment with indicated atrial fibrillation (FS) were approached to participate in the study. Each patient underwent a structured interview with a trained pharmacist on the day of study entry and again after 3 and 6 months. Two validated and three supplementary questionnaires were used in the interview. Patients' attitudes, experiences...5 Abstrakt Analýza adherencie pacientov na liečbu DOAC II Autor: Natália Janáčková Vedúci diplomovej práce: doc. PharmDr. Josef Malý, Ph.D. Konzultant: PharmDr. Simona Dvořáčková, Ph.D., Mgr. Eliška Mašková Katedra sociálnej a klinickej farmácie, Farmaceutická fakulta v Hradci Králové, Univerzita Karlova Úvod a cieľ: Dávkovací interval môže predstavovať významný faktor ovplyvňujúci adherenciu k liečbe priamymi orálnymi antikoagulanciámi (DOAC; Direct Oral Anticoagulant). Vzhľadom na adherenciu, režim 1-krát denne sa javí ako lepšia alternatíva. Avšak pri vynechaní dávky môže hroziť vyššie riziko zlyhania liečby. Cieľom praktickej časti práce bolo analyzovať postoje a skúsenosti pacientov s DOAC doplnené o dáta zo zdravotníckej dokumentácie s dôrazom na aspekty spojené s dávkovaním DOAC. Metodika: Zber dát do tejto prospektívnej štúdie prebiehal od roku 2020 do 2022 v internej kardiologickej ambulancii Fakultnej nemocnice Brno. K účasti na štúdii boli oslovovaní pacienti vo veku ≥ 18 rokov a liečbou DOAC s indikovanou fibriláciou siení (FS). S každým pacientom absolvoval poučený farmaceut štrukturovaný rozhovor v ďeň vstupu do štúdie a ďalej za 3 resp. 6 mesiacov. Pri rozhovore boli využívané dva validované a tri doplňujúce dotazníky. Boli zisťované postoje, skúsenosti a spokojnosť pacientov s liečbou DOAC,...Katedra sociální a klinické farmacieDepartment of Social and Clinical PharmacyFaculty of Pharmacy in Hradec KrálovéFarmaceutická fakulta v Hradci Králov
Analýza adherence pacientů k léčbě DOAC I
No full textAnalýza adherencie pacientov na liečbu DOAC I Autor: Katarína Rezáková Vedúci diplomovej práce: doc. PharmDr. Josef Malý, Ph.D. Konzultant: PharmDr. Kateřina Malá, Ph.D. Katedra sociálnej a klinickej farmácie, Farmaceutická fakulta v Hradci Králové, Univerzita Karlova Úvod a cieľ: Fibrilácia predsiení (FiP) je najčastejšia supraventrikulárna tachyarytmia spojená s vyššou morbiditou a mortalitou. V klinickej praxi sa používajú priame perorálne antikoagulanciá (DOAC) ako alternatíva k warfarínu na prevenciu tromboembolických príhod u pacientov s FiP. Cieľom tejto práce bolo analyzovať výpovede pacientov s FiP doplnené o dáta zo zdravotníckej dokumentácie s dôrazom na aspekty spojené s užívaním a zaobchádzaním s DOAC vrátane prostriedkov a nástrojov na podporu adherencie k liečbe, ďalej na mieru informovanosti pacientov týkajúcu sa DOAC a ostatné užívané terapeutické prostriedky. Metodika: Prospektívna štúdia prebiehala od roku 2020 do 2022 vo Fakultnej nemocnici Brno. V štúdii boli zahrnutí pacienti vo veku ≥ 18 rokov s FiP na terapii DOAC (dabigatran, rivaroxaban a apixaban). Dáta o farmakoterapii a zdravotnom stave pacientov boli získané zo zdravotníckej dokumentácie a zo štruktúrovaného rozhovoru s pacientom. Rozhovory s pacientami boli vedené v čase 0, tri a šesť mesiacov od vstupu pacienta do...Analysis of patient adherence to treatment by DOAC I Author: Katarína Rezáková Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Kateřina Malá, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia associated with increased morbidity and mortality. In clinical practice, direct oral anticoagulants (DOAC) are used as an alternative to warfarin to prevent thromboembolic events in patients with AF. The study aimed to analyse the statements of patients with FiP along with data from medical records focusing on aspects related to the use and management of DOAC, including devices and tools to improve adherence to treatment, patients' level of awareness of DOAC and other therapeutic agents used. Methods: The prospective study was conducted from 2020 to 2022 at the University Hospital Brno. Patients aged ≥ 18 years with AF on DOAC therapy (dabigatran, rivaroxaban and apixaban) were included in the study. Data about pharmacotherapy and patients' health status were obtained from medical records and structured interview with the patient. Patients' interviews were performed at time 0, three and six months after patient has entred the study....Katedra sociální a klinické farmacieDepartment of Social and Clinical PharmacyFaculty of Pharmacy in Hradec KrálovéFarmaceutická fakulta v Hradci Králov
Analysis of patient adherence to treatment by DOAC IV.
No full textAnalysis of patient adherence to treatment by DOAC IV Author: Leona Strnadová Tutor: PharmDr. Eliška Kolmanová, Ph.D. Consultant: PharmDr. Kateřina Malá, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: The prevalence of atrial fibrillation (FiS) and thromboembolic disease (TEN) is increasing worldwide. With the rising average life expectancy, this trend is expected to become more persistent. In the prevention of TEN in patients with FiS, the gold standard is oral anticoagulants - warfarin and direct oral anticoagulants (DOAC). The aim of the thesis was to analyze the attitudes and perceptions of patients with a history of warfarin use toward their current DOAC therapy. The study further sought to specify the perceived benefits and limitations of this treatment and to assess patient behaviors potentially influencing anticoagulant therapy. Methods: This thesis is part of a project focused on patient adherence to DOAC therapy, conducted between 2020 and 2022 at the Internal Cardiology Outpatient Clinic of University Hospital Brno. The prospective study included patients aged 18 years and older, diagnosed with FiS, and treated with DOAC (dabigatran, rivaroxaban, or apixaban) for a minimum duration of 3 months. Data were...Analýza adherence pacientů k léčbě DOAC IV Autor: Leona Strnadová Vedoucí diplomové práce: PharmDr. Eliška Kolmanová, Ph.D. Konzultant: PharmDr. Kateřina Malá, Ph.D. Katedra sociální a klinické farmacie, Farmaceutické fakulta v Hradci Králové, Univerzita Karlova Úvod a cíl: Prevalence fibrilace síní (FiS) a tromboembolické nemoci (TEN) celosvětově roste. S prodlužující se střední délkou života můžeme očekávat, že tento trend bude mít trvalejší charakter. V prevenci TEN u pacientů s FiS jsou zlatým standardem perorální antikoagulancia - warfarin a přímá perorální antikoagulancia (DOAC; Direct Oral Anticoagulant). Cílem této práce bylo analyzovat postoje a názory pacientů, kteří v minulosti užívali warfarin, na jejich současnou antikoagulační terapii DOAC. Dále bylo cílem blíže specifikovat vnímané benefity a limity současné léčby a hodnotit aspekty chování pacientů s možným vlivem na antikoagulační terapii. Metodika: Diplomová práce je součástí projektu zaměřeného na adherenci pacientů k terapii DOAC realizovaného mezi lety 2020 až 2022 na interní kardiologické ambulanci Fakultní nemocnice Brno. Do prospektivní studie byli zahrnuti pacienti ve věku 18 let a starší, s diagnózou FiS, léčení DOAC (dabigatranem, rivaroxabanem a apixabanem) v minimální délce 3 měsíce. Nástrojem pro analýzu dat této části...Katedra sociální a klinické farmacieDepartment of Social and Clinical PharmacyFarmaceutická fakulta v Hradci KrálovéFaculty of Pharmacy in Hradec Králov
Analysis of patient adherence to treatment by DOAC I
No full textAnalysis of patient adherence to treatment by DOAC I Author: Katarína Rezáková Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Kateřina Malá, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia associated with increased morbidity and mortality. In clinical practice, direct oral anticoagulants (DOAC) are used as an alternative to warfarin to prevent thromboembolic events in patients with AF. The study aimed to analyse the statements of patients with FiP along with data from medical records focusing on aspects related to the use and management of DOAC, including devices and tools to improve adherence to treatment, patients' level of awareness of DOAC and other therapeutic agents used. Methods: The prospective study was conducted from 2020 to 2022 at the University Hospital Brno. Patients aged ≥ 18 years with AF on DOAC therapy (dabigatran, rivaroxaban and apixaban) were included in the study. Data about pharmacotherapy and patients' health status were obtained from medical records and structured interview with the patient. Patients' interviews were performed at time 0, three and six months after patient has entred the study...
Analysis of patient adherence to treatment by DOAC IV.
No full textAnalysis of patient adherence to treatment by DOAC IV Author: Leona Strnadová Tutor: PharmDr. Eliška Kolmanová, Ph.D. Consultant: PharmDr. Kateřina Malá, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: The prevalence of atrial fibrillation (FiS) and thromboembolic disease (TEN) is increasing worldwide. With the rising average life expectancy, this trend is expected to become more persistent. In the prevention of TEN in patients with FiS, the gold standard is oral anticoagulants - warfarin and direct oral anticoagulants (DOAC). The aim of the thesis was to analyze the attitudes and perceptions of patients with a history of warfarin use toward their current DOAC therapy. The study further sought to specify the perceived benefits and limitations of this treatment and to assess patient behaviors potentially influencing anticoagulant therapy. Methods: This thesis is part of a project focused on patient adherence to DOAC therapy, conducted between 2020 and 2022 at the Internal Cardiology Outpatient Clinic of University Hospital Brno. The prospective study included patients aged 18 years and older, diagnosed with FiS, and treated with DOAC (dabigatran, rivaroxaban, or apixaban) for a minimum duration of 3 months. Data were..
Analysis of patient adherence to treatment by DOAC II
No full text6 Abstract Analysis of patient adherence to treatment by DOAC II Author: Natália Janáčková Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Simona Dvořáčková, Ph.D., Mgr. Eliška Mašková Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aim: Dosing interval may be an important factor influencing adherence to direct oral anticoagulant (DOAC) therapy. In terms of adherence, a once-daily regimen appears to be a better alternative. However, there may be a higher risk of treatment failure if the dose is missed. The aim of the practical part of the thesis was to analyse patients' attitudes and experiences with DOACs, complemented by data from medical records, with a focus on aspects related to DOAC dosing. Methods: Data collection for this prospective study was carried out from 2020 to 2022 at the Internal Cardiology Outpatient Clinic of the University Hospital in Brno. Patients aged ≥ 18 years on DOAC treatment with indicated atrial fibrillation (FS) were approached to participate in the study. Each patient underwent a structured interview with a trained pharmacist on the day of study entry and again after 3 and 6 months. Two validated and three supplementary questionnaires were used in the interview. Patients' attitudes, experiences..
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