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Alternative Therapies in Health and... Jun 2024To evaluate the impact of Pender-based health education on outcomes in rivaroxaban-treated lower limb DVT patients.
OBJECTIVE
To evaluate the impact of Pender-based health education on outcomes in rivaroxaban-treated lower limb DVT patients.
METHODS
103 patients with DVT of the lower limbs treated with rivaroxaban admitted to The First Affiliated Hospital of Xi'an Jiaotong University from January 2022 to January 2023 were included in the study and were randomly divided into the conventional group (n=52, receiving routine care with medication instruction, exercise instruction, and psychological care as the main components) and the Pender group (n=51, giving health education based on the Pender health promotion model in addition to conventional care) to compare the recurrence rate of DVT of the lower limbs, DVT of the lower limbs clinical condition, complication rate, quality of life score, coagulation index and nursing satisfaction rate in the two groups.
PRIMARY RESULTS
The recurrence rate of lower limb DVT, circumference of the affected limb, time to get out of bed, and time to reduce swelling in the Pender group were lower (shorter) than those in the conventional group (P < .05); after the intervention, all quality of life scores in the Pender group were higher than those in the conventional group (P < .05).
SECONDARY RESULTS
The complication rate, fibrinogen (FIB) and D-dimer (D-D) levels were lower (shorter) in the Pender group than in the conventional group (P < .05). After the intervention, the levels of activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) were higher in the Pender group than in the conventional group (P < .05).
CONCLUSION
The health education based on the Pender health promotion model is effective in patients with lower limb DVT treated with rivaroxaban, which can effectively reduce recurrence and complications, optimize coagulation indexes, and improve the quality of life and nursing care satisfaction by improving the patients' health cognition and health behaviors, which is of great value in clinical application and promotion.
PubMed: 38870500
DOI: No ID Found -
Clinical and Applied... 2024To examine the effectiveness of rivaroxaban compared to enoxaparin in patients diagnosed with cancer and venous thromboembolism. (Meta-Analysis)
Meta-Analysis Comparative Study Review
OBJECTIVE
To examine the effectiveness of rivaroxaban compared to enoxaparin in patients diagnosed with cancer and venous thromboembolism.
METHODS
A search of Pub Med, Scopus, and Google Scholar, from inception through April 2023 was conducted. Articles comparing rivaroxaban with enoxaparin in patients with cancer and VTE/PE/DVT were included. Review Manager Version 5.2 was utilised for the analysis of the following outcomes; VTE, PE, DVT, major bleeding, and mortality.
RESULTS
A total of 8 articles and 2276 patients were included in the final analysis. Pooled analysis showed that rivaroxaban had a statistically insignificant reduced association with VTE occurrence (RR:0.83, 95% CI:0.58-1.18, P:0.3) as well as a statically insignificant reduction in major bleeding (RR:0.79, 95% CI:0.53-1.18, P:0.25). Analysis showcased that there was an insignificant reduction of mortality rivaroxaban as compared to enoxaparin (RR:0.74, 95% CI: 0.46-1.20, P:0.23).
CONCLUSION
Rivaroxaban can serve as a viable alternative to enoxaparin, with no appreciable drawbacks, for preventing and managing VTE in patients with malignancy.
Topics: Humans; Anticoagulants; Enoxaparin; Hemorrhage; Neoplasms; Recurrence; Rivaroxaban; Venous Thromboembolism
PubMed: 38870350
DOI: 10.1177/10760296241261364 -
Thrombosis and Haemostasis Jun 2024Prethrombin-1 is a Gla-domain lacking enzymatically inactive split product that results from the cleavage of fragment 1 from prothrombin by thrombin in a feedback...
INTRODUCTION
Prethrombin-1 is a Gla-domain lacking enzymatically inactive split product that results from the cleavage of fragment 1 from prothrombin by thrombin in a feedback reaction.
METHODS
A prethrombin-1 preparation derived from human plasma was tested for its hemostatic and thrombogenic properties. Animal models of nail clipping (for rabbits) and tail clipping (for mice) were developed to measure blood loss in FVIII-inhibitor or rivaroxaban anticoagulated rabbits and mice, respectively. A modified Wessler test was used in rabbits to assess the thrombogenic potential by Wessler score and clot weight. Studies were performed in groups of three to six for prethrombin-1 dose escalation and comparison with prothrombin, Beriplex®, FEIBA®, and saline as a control. Data were analyzed using t-statistics or the Mann Whitney U test as applicable.
RESULTS
Prethrombin-1 has excellent hemostatic properties in anticoagulated mouse and rabbit bleeding models. Wessler tests suggest that in contrast to activated and nonactivated prothrombin complexes, prethrombin-1 has negligible thrombogenic potential.
CONCLUSION
The thrombin zymogen prethrombin-1 promotes hemostasis with reduced risk of thrombosis. Prethrombin-1 may have potential to become a life-saving treatment for patients who bleed or are at risk of bleeding.
PubMed: 38866044
DOI: 10.1055/s-0044-1787720 -
Scientific Reports Jun 2024This review used traditional and network meta-analyses (NMA) to conduct a comprehensive study of antithrombotic therapies in children with thromboembolic disease. We... (Meta-Analysis)
Meta-Analysis
This review used traditional and network meta-analyses (NMA) to conduct a comprehensive study of antithrombotic therapies in children with thromboembolic disease. We searched the PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov databases from their inception to 26 February, 2023. And we finally included 16 randomized controlled trials. In the prevention of thromboembolic events (TEs), the use of anticoagulants had a low risk of TEs (relative risk (RR) 0.73, 95% CI 0.56 to 0.94) and a high risk of minor bleeding (RR 1.43, 95% CI 1.09 to 1.86) compared with no anticoagulants. In the treatment of TEs, direct oral anticoagulants (DOACs) were not inferior to standard anticoagulation in terms of efficacy and safety outcomes. In NMA, rivaroxaban and apixaban showed the lowest risk for TEs and major or clinically relevant nonmajor bleeding. According to the overall assessment of efficacy and safety, dabigatran may be the best choice for children with thromboembolic disease. The results of our study will provide references and suggestions for clinical drug selection.
Topics: Humans; Child; Thromboembolism; Fibrinolytic Agents; Hemorrhage; Anticoagulants; Treatment Outcome; Pyrazoles; Dabigatran; Rivaroxaban; Randomized Controlled Trials as Topic; Pyridones
PubMed: 38862574
DOI: 10.1038/s41598-024-64334-8 -
Circulation Reports Jun 2024Factor Xa inhibitors, such as rivaroxaban, are increasing the convenience of treatment for deep vein thrombosis (DVT). Limited evidence exists regarding clot evaluation...
Factor Xa inhibitors, such as rivaroxaban, are increasing the convenience of treatment for deep vein thrombosis (DVT). Limited evidence exists regarding clot evaluation at 3 months after treatment for DVT. We retrospectively analyzed the clinical course of symptomatic proximal DVT in patients who received 3 months of anticoagulation treatment at our hospital. Patients treated with the rivaroxaban single-drug approach were classified as group A (n=42). Patients treated with unfractionated heparin (UFH) or subcutaneous fondaparinux followed by vitamin K antagonist comprised group B (n=60) as an historical cohort. The quantitative ultrasound thrombosis (QUT) score was used to quantify clot burden before and after treatment. No significant differences were observed in patient characteristics between the groups. Serum D-dimer levels in both groups significantly improved after treatment. Clot volume assessed using QUT also reduced significantly in both groups. The QUT score in groups A and B improved from 7.5 [4.8, 12.0] to 3.0 [1.8, 5.0; P=0.000] and 7.0 [4.0, 9.8] to 3.0 [2.0, 5.0; P=0.000], respectively. The change in QUT (∆QUT) was significantly greater in group A compared with group B (-4.5 [-8.25, -2.0] vs. -2.0 [-6.0, 0.0]; P=0.005). We were able to demonstrate the effectiveness of DVT treatment using rivaroxaban over a period of 3 months from onset, in terms of clot regression evaluated using the QUT score.
PubMed: 38860185
DOI: 10.1253/circrep.CR-24-0042 -
Neurology Jul 2024Incidence and prevalence of atrial fibrillation (AF), a risk factor of dementia, have been increasing over time. Oral anticoagulation reduces risk of stroke and other...
BACKGROUND AND OBJECTIVES
Incidence and prevalence of atrial fibrillation (AF), a risk factor of dementia, have been increasing over time. Oral anticoagulation reduces risk of stroke and other negative outcomes of AF and may reduce dementia health inequities. The objective of this study was to estimate dementia incidence in patients with newly-diagnosed AF and taking an anticoagulant as use of direct oral anticoagulants (DOACs) increased.
METHODS
We used a retrospective cohort design with annual incident AF cohorts of community-dwelling Medicare Fee-for-Service beneficiaries, enrolled in Parts A, B, and D from 2007 to 2017. The sample was limited to beneficiaries aged 67 years and older with incident AF; no prior dementia; and use of anticoagulants warfarin, dabigatran, rivaroxaban, apixaban, or edoxaban in year .
RESULTS
A total of 1,083,338 beneficiaries were included in the study, 58.5% female, with mean (SD) age 77.2 (6.75) years. Among anticoagulated, incident AF cohorts, use of DOACs increased from 10.6% in their first year of availability (2011) to 41.4% in 2017. Among incident AF cohorts taking any oral anticoagulant, 3-year dementia incidence did not change significantly over the cohorts after adjusting for confounders. For example, incidence was 9.1% (95% CI 8.9-9.4) among White persons diagnosed with AF in 2007 and 2008 and 8.9% (95% CI 8.7-9.1) in 2017. Across cohorts, dementia incidence was consistently highest for Black persons, followed by American Indian/Alaska Native and White persons, and lowest for Asian persons. In 2017, 10.9% (95% CI 10.4-11.3) of Black persons in the cohort developed dementia within 3 years, 9.4% (95% CI 8.0-10.9) of American Indian/Alaska Native, 8.9% (95% CI 8.7-9.1) of White, 8.7% (95% CI 8.2-9.1) of Hispanic, and 6.9% (95% CI 6.4-7.4) of Asian persons. Across race/ethnicity, 3-year stroke risk decreased consistently over time; however, the increasing availability of DOACs did not alter the trend.
DISCUSSION
Increased use of DOACs among incident AF cohorts from 2007 to 2017 was not associated with significant declines in dementia or stroke risk. Consideration of similar stroke and dementia risk, as well as differences in cost, is warranted when weighing the risks and benefits of available oral anticoagulants.
Topics: Humans; Atrial Fibrillation; Aged; Female; Male; Dementia; Incidence; Aged, 80 and over; Anticoagulants; Retrospective Studies; United States; Medicare; Administration, Oral; Dabigatran; Rivaroxaban; Cohort Studies; Warfarin
PubMed: 38857466
DOI: 10.1212/WNL.0000000000209568 -
International Journal of Cardiology.... Jun 2024
PubMed: 38854744
DOI: 10.1016/j.ijcha.2024.101387 -
Annals of Vascular Surgery Jun 2024The Vascular Outcomes Study of aspirin (ASA) Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for peripheral artery disease (PAD) trial...
BACKGROUND
The Vascular Outcomes Study of aspirin (ASA) Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for peripheral artery disease (PAD) trial demonstrated the superiority of ASA and low-dose rivaroxaban (Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial dosing) compared with ASA alone in reducing major adverse cardiovascular events and major adverse limb events. We studied the COMPASS discharge prescription patterns in patients with symptomatic PAD who have undergone revascularization in our institution, since the time of publication of the Vascular Outcomes Study of ASA Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD trial.
METHODS
All patients included in this study had documented lower-extremity atherosclerotic PAD and were eligible for COMPASS dosing. Revascularization strategies included endovascular (n = 299), suprainguinal bypass (n = 18), and infrainguinal bypass (n = 36).
RESULTS
COMPASS prescription patterns for the composite of endovascular and surgical strategies demonstrated a consistently low rate over time, without a trend toward increasing use. COMPASS dosing was prescribed as often as antiplatelet monotherapy (33.4% COMPASS vs. 34.6% antiplatelet monotherapy). This low COMPASS prescription rate was driven by significantly lower COMPASS prescriptions following endovascular therapy compared to surgical bypass (28.8% endovascular vs. 59.3% surgical bypass). COMPASS prescriptions following surgical bypass showed better trends; half of suprainguinal bypass patients (50.0%) and two-thirds of infrainguinal bypass patients (63.9%) were discharged on COMPASS. Despite patients with chronic limb-threatening ischemia (CLTI) representing a high-risk limb presentation, COMPASS prescriptions were low (29.8%), as opposed to patients without CLTI, and did not show a trend toward increasing use. In patients who underwent reinterventions throughout the observation period, there was a low conversion rate from ASA alone to COMPASS (3/26, 11.5%).
CONCLUSIONS
In this observational study, one-third of patients were undertreated by prescription of antiplatelet monotherapy, indicating that there is significant room for medical optimization. This is especially true of patients undergoing endovascular treatment, including the high-risk subgroup of patients with CLTI. We highlight the importance of dual pathway antithrombotic therapy in patients eligible for COMPASS dosing to optimize best current evidence medical therapy.
PubMed: 38851315
DOI: 10.1016/j.avsg.2024.04.005 -
Current Medical Research and Opinion Jun 2024In patients with atrial fibrillation (AF), direct oral anticoagulants (DOACs) have been utilized as an alternative to warfarin, which is known to have several...
BACKGROUND
In patients with atrial fibrillation (AF), direct oral anticoagulants (DOACs) have been utilized as an alternative to warfarin, which is known to have several limitations. This study aimed to clarify the selection criteria for anticoagulants, considering both individual patient factors and the differences between various drugs.
METHODS
This study conducted a web-based questionnaire from September 20, 2023 to October 3, 2023, among physicians who were members of a cardiology-specific website.
RESULTS
In total, 172 respondents were enrolled in this study. Edoxaban was the most frequently selected anticoagulant (39.1%), followed by apixaban (32.7%) and rivaroxaban (16.8%). Logistic regression analysis revealed that increased concern for adherence enhanced the frequency of selecting edoxaban (odds ratio [OR] = 2.42; = 0.047), with the opposite trend observed for dabigatran (OR = 0.404; = 0.029). The selection of apixaban is related to whether the patient is able to maintain a regular lifestyle, including adherence to medication schedules (OR = 1.874; = 0.031). Furthermore, detailing activities from a medical representative, especially regarding a new indication, were found to influence drug selection for rivaroxaban (OR = 2.422; = 0.047).
CONCLUSION
This study revealed that edoxaban is the most frequently selected anticoagulant. Although prescribing cardiologists select drugs based on background factors, adherence to medication and information from medical representatives were also crucial factors in the selection process.
PubMed: 38850517
DOI: 10.1080/03007995.2024.2365999 -
Clinical and Translational Science Jun 2024The evidence of rivaroxaban's pharmacokinetics in obese compared with non-obese populations remains inconclusive. We aimed to compare the pharmacokinetic profile of... (Comparative Study)
Comparative Study
The evidence of rivaroxaban's pharmacokinetics in obese compared with non-obese populations remains inconclusive. We aimed to compare the pharmacokinetic profile of rivaroxaban between obese and non-obese populations under fed state. Participants who met the study's eligibility criteria were assigned into one of two groups: obese (body mass index ≥35 kg/m) or non-obese (body mass index 18.5-24.9 kg/m). A single dose of rivaroxaban 20 mg was orally administered to each participant. Nine blood samples over 48 h, and multiple urine samples over 18 h were collected and analyzed for rivaroxaban concentration using ultra-performance liquid chromatography coupled with tandem mass detector. Pharmacokinetic parameters were determined using WinNonlin software. Thirty-six participants were recruited into the study. No significant changes were observed between obese and non-obese participants in peak plasma concentration, time to reach peak plasma concentration, area under the plasma concentration-time curve over 48 h or to infinity, elimination rate constant, half-life, apparent volume of distribution, apparent clearance, and fraction of drug excreted unchanged in urine over 18 h. Rivaroxaban's exposure was similar between the obese and non-obese subjects, and there were no significant differences in other pharmacokinetic parameters between the two groups. These results suggest that dose adjustment for rivaroxaban is probably unwarranted in the obese population.
Topics: Humans; Rivaroxaban; Male; Obesity; Female; Adult; Factor Xa Inhibitors; Middle Aged; Administration, Oral; Body Mass Index; Area Under Curve; Half-Life; Young Adult
PubMed: 38847347
DOI: 10.1111/cts.13853