Explore the vast range of titles available.

In a large trial, the estimated incidence of stroke, systemic embolism, hemorrhage, or death was 2.8 percentage points lower to 0.5 percentage points higher with early than with later use of direct oral anticoagulants.

[This corrects the article DOI: 10.1371/journal.pone.0232354.].

In a randomized trial, patients with severe Covid-19 were assigned to receive either therapeutic-dose anticoagulation or usual-care pharmacologic thromboprophylaxis. At 21 days, therapeutic-dose anticoagulation did not improve hospital survival or the number of days free of cardiovascular or respiratory organ support.

In a randomized trial, patients with moderately severe Covid-19 were assigned to receive either therapeutic-dose anticoagulation or usual-care thromboprophylaxis. At 21 days, therapeutic-dose anticoagulation resulted in a higher probability of survival until hospital discharge without organ support.

INTRODUCTION:Oral anticoagulants play an integral role in the prevention and treatment of cerebral and systemic thromboembolism. Traditionally, this has been managed with vitamin K antagonists, primarily warfarin. Over time, however, the use of direct oral anticoagulants (DOACs) have gained popularity. Unsurprisingly, the initiation of a medication that decreases the blood's ability to clot increases the risk of bleeding. The aim of this study was to examine the incidence of gastrointestinal bleeding (GIB) in patients enrolled in an anticoagulation clinic at a Veterans Affairs (VA) medical center.METHODS:The VA's Computerized Patient Record System was used to create a list of patients seen in the VA anticoagulation (AC) clinic from 10/2010 to 9/2016. A sample of 1997 patients was randomly selected using a web-based program. Based on the formulary at the VA, only warfarin, rivaroxaban, dabigatran, and apixaban were examined. Demographics, indications for anticoagulation, and relevant comorbidities and concomitant medications were recorded.RESULTS:Despite increasing use of DOACs since their introduction in 2011, results of the analysis indicate warfarin was still the most commonly prescribed anticoagulant in our population with 1270/1997 (64%). Rivaroxaban was taken by 28%, apixaban by 13%, and dabigatran by 10%. GIB was seen in 31/1270 patients (1.55%). In those taking warfarin, 28/1270 (2.3%) had GIB (P < 0.001). GIB was seen in 3/552 patients taking rivaroxaban (0.5%, P = 0.024). GIB was seen in 5/256 patients taking apixaban (2%), but this did not reach statistical significance. GIB was seen in 1/198 patients taking dabigatran (0.5%), but this did not reach statistical significance. Factors associated with increased risk of GI bleeding included chronic kidney disease and diabetes mellitus. Patients not on proton pump inhibitors, clopidogrel, and nonsteroidal anti-inflammatory medications had an increased risk of GIB.CONCLUSION:Given similar efficacy of DOACs to warfarin shown in prior studies, the choice of oral anticoagulant rests largely on the safety profile. In a population of patients seen in the VA AC clinic, the most commonly prescribed anticoagulant was warfarin. The risk of GI bleeding was highest in these patients, similar to findings in previous studies. The lowest risk was seen with dabigatran. A data set with more GIB patients would allow multiple logistic regression analysis of the medications and comorbidities identified as risk factors.

In patients undergoing total knee replacement, a single injection of abelacimab (an antibody to factor XI) administered postoperatively was superior to standard care with enoxaparin for the prevention of venous thromboembolism. Bleeding events were rare.

Four new oral anticoagulants compare favourably with warfarin for stroke prevention in patients with atrial fibrillation; however, the balance between efficacy and safety in subgroups needs better definition. We aimed to assess the relative benefit of new oral anticoagulants in key subgroups, and the effects on important secondary outcomes. We searched Medline from Jan 1, 2009, to Nov 19, 2013, limiting searches to phase 3, randomised trials of patients with atrial fibrillation who were randomised to receive new oral anticoagulants or warfarin, and trials in which both efficacy and safety outcomes were reported. We did a prespecified meta-analysis of all 71 683 participants included in the RE-LY, ROCKET AF, ARISTOTLE, and ENGAGE AF–TIMI 48 trials. The main outcomes were stroke and systemic embolic events, ischaemic stroke, haemorrhagic stroke, all-cause mortality, myocardial infarction, major bleeding, intracranial haemorrhage, and gastrointestinal bleeding. We calculated relative risks (RRs) and 95% CIs for each outcome. We did subgroup analyses to assess whether differences in patient and trial characteristics affected outcomes. We used a random-effects model to compare pooled outcomes and tested for heterogeneity. 42 411 participants received a new oral anticoagulant and 29 272 participants received warfarin. New oral anticoagulants significantly reduced stroke or systemic embolic events by 19% compared with warfarin (RR 0·81, 95% CI 0·73–0·91; p<0·0001), mainly driven by a reduction in haemorrhagic stroke (0·49, 0·38–0·64; p<0·0001). New oral anticoagulants also significantly reduced all-cause mortality (0·90, 0·85–0·95; p=0·0003) and intracranial haemorrhage (0·48, 0·39–0·59; p<0·0001), but increased gastrointestinal bleeding (1·25, 1·01–1·55; p=0·04). We noted no heterogeneity for stroke or systemic embolic events in important subgroups, but there was a greater relative reduction in major bleeding with new oral anticoagulants when the centre-based time in therapeutic range was less than 66% than when it was 66% or more (0·69, 0·59–0·81 vs 0·93, 0·76–1·13; p for interaction 0·022). Low-dose new oral anticoagulant regimens showed similar overall reductions in stroke or systemic embolic events to warfarin (1·03, 0·84–1·27; p=0·74), and a more favourable bleeding profile (0·65, 0·43–1·00; p=0·05), but significantly more ischaemic strokes (1·28, 1·02–1·60; p=0·045). This meta-analysis is the first to include data for all four new oral anticoagulants studied in the pivotal phase 3 clinical trials for stroke prevention or systemic embolic events in patients with atrial fibrillation. New oral anticoagulants had a favourable risk–benefit profile, with significant reductions in stroke, intracranial haemorrhage, and mortality, and with similar major bleeding as for warfarin, but increased gastrointestinal bleeding. The relative efficacy and safety of new oral anticoagulants was consistent across a wide range of patients. Our findings offer clinicians a more comprehensive picture of the new oral anticoagulants as a therapeutic option to reduce the risk of stroke in this patient population. None.

In this multicenter trial, the oral factor Xa inhibitor apixaban was compared with enoxaparin and warfarin for the treatment of acute venous thromboembolism. Apixaban was noninferior to enoxaparin and warfarin with respect to efficacy and superior with respect to safety. Venous thromboembolism, with an annual incidence of 1 to 2 cases per 1000 persons in the general population, is the third most common cause of vascular death after myocardial infarction and stroke. 1 Conventional treatment consists of a parenteral anticoagulant, such as enoxaparin, for at least 5 days, and warfarin begun during this time and continued for at least 3 months. 2 Although effective, this regimen presents a challenge because enoxaparin requires daily subcutaneous injections, and warfarin therapy requires coagulation monitoring and dose adjustment. Apixaban is an oral factor Xa inhibitor with a rapid onset of action and predictable pharmacokinetics that allow . . .

Corresponding author's email: hiroya45hayashi@ncvc.go.jp Background: The use of direct oral anticoagulant (DOAC) may provide the stable effect and safety in the early phase of PTE therapy. [...]we evaluated right ventricle / left ventricle (RV/LV) ratio on computed tomography and BNP at admission and discharge.