Article
Multidisciplinary Sciences
Carla Moret, Rene Acosta-Isaac, Sergi Mojal, Mariana Corrochano, Blanca Jimenez, Melania Plaza, Juan Carlos Souto
Summary: The study found that direct oral anticoagulants (DOAC) are replacing vitamin K antagonists in preventing thromboembolism in atrial fibrillation patients. However, there are contradicting real-world clinical outcomes reported in different studies. This study presents a clinical model for DOAC management in clinical practice and reviews the literature.
Review
Medicine, General & Internal
David Mocini, Stefania Angela Di Fusco, Edoardo Mocini, Lorenzo Maria Donini, Carlo Lavalle, Andrea Di Lenarda, Carmine Riccio, Pasquale Caldarola, Leonardo De Luca, Michele Massimo Gulizia, Fabrizio Oliva, Domenico Gabrielli, Furio Colivicchi
Summary: DOACs, including dabigatran, rivaroxaban, apixaban, and edoxaban, offer major advantages over VKAs, but concerns remain regarding potential undertreatment in obese patients without specific RCTs comparing the two. Despite limitations, the Italian Association of Hospital Cardiologists has proposed recommendations for the use of DOACs in obese patients based on existing evidence.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Pharmacology & Pharmacy
Shin-Yi Lin, Sung-Chun Tang, Ching-Hua Kuo, Li-Ting Ho, Yen-Bin Liu, Yu-Fong Peng, Li-Kai Tsai, Chih-Fen Huang, Jiann-Shing Jeng
Summary: This study reports on the association between direct oral anticoagulant (DOAC) concentration and clinical outcomes in Asian patients with atrial fibrillation (AF). The proportion of DOAC concentrations falling outside the expected range was higher than reported in clinical trials. Low trough concentration was associated with increased risk of systemic thromboembolism (SSE), while high trough concentration was associated with major bleeding. Measurement of trough DOAC concentration should be considered for patients at risk of concentration deviations.
CLINICAL PHARMACOLOGY & THERAPEUTICS
(2023)
Article
Medicine, General & Internal
Anneka Mitchell, Julia Snowball, Tomas J. Welsh, Margaret C. Watson, Anita McGrogan
Summary: The study found a significant increase in the prescribing of oral anticoagulants for atrial fibrillation patients aged 75 years and older, but disparities still exist based on age and comorbidities. Elderly patients and those with comorbidities such as dementia, history of falls, major bleeds, and fractures were less likely to be prescribed oral anticoagulants.
Article
Cardiac & Cardiovascular Systems
Rahul Aggarwal, Christian T. Ruff, Saverio Virdone, Sylvie Perreault, Ajay K. Kakkar, Michael G. Palazzolo, Marc Dorais, Gloria Kayani, Daniel E. Singer, Eric Secemsky, Jonathan Piccini, Usman A. Tahir, Changyu Shen, Robert W. Yeh
Summary: A clinical risk score was developed and validated to personalize bleeding risk assessment for individuals with atrial fibrillation taking direct-acting oral anticoagulants (DOACs). The risk score showed superior performance compared to existing clinical decision tools and can help stratify patients based on their expected bleeding risk.
Article
Pharmacology & Pharmacy
Tomohiro Aigami, Tomoyuki Ishigo, Ryo Takada, Toshiyuki Yano, Masayuki Koyama, Satoshi Katano, Satoshi Fujii, Masahide Fukudo
Summary: This single-center retrospective cohort study investigated the long-term treatment persistence and associated factors of four direct oral anticoagulants (DOACs) used in Japan. The study found that the persistence rate at 5 years was only 52.9%, and factors such as age, chronic kidney disease, and diabetes were associated with nonpersistence. Additionally, the type of DOACs also influenced persistence, with edoxaban exhibiting the highest level of persistence.
JOURNAL OF CLINICAL PHARMACOLOGY
(2023)
Review
Pharmacology & Pharmacy
Nan-Nan Shen, Chi Zhang, Ying Hang, Zheng Li, Ling-Cong Kong, Na Wang, Jia-Liang Wang, Zhi-Chun Gu
Summary: This study estimated the prevalence of DOAC off-label doses in AF patients, finding a relatively high rate with underdose being predominant. Clinicians in Asia preferred prescribing underdose of DOACs to patients.
FRONTIERS IN PHARMACOLOGY
(2021)
Article
Multidisciplinary Sciences
Carlos Escobar Cervantes, Julio Marti-Almor, Alejandro Isidoro Perez Cabeza, Kevin Bowrin, Aleix Llorac Moix, Mar Genis Girones, David Gasche, Aurelie Millier, Jean Tardu, Mondher Toumi, Jean-Baptiste Briere
Summary: Based on real-world data, rivaroxaban and dabigatran are cost-effective for stroke prevention in patients with non-valvular atrial fibrillation compared to vitamin K antagonist, while apixaban has a lower cost-effectiveness.
Review
Economics
Charles Okafor, Joshua Byrnes, Simon Stewart, Paul Scuffham, Clifford Afoakwah
Summary: This study aimed to evaluate the cost effectiveness of treatment strategies to manage atrial fibrillation (AF) in adults living in low-, middle-, and high-income countries. The findings showed that different strategies were cost-effective in different resource settings. In high-income countries, apixaban and left atrial appendage closure were effective for stroke prevention, while propranolol, catheter ablation, and the convergent procedure were options for rate or rhythm control. In middle-income countries, apixaban and high-dose edoxaban were effective for stroke prevention, and radiofrequency catheter ablation was an option for rhythm control.
Article
Medicine, General & Internal
Woldesellassie M. Bezabhe, Jan Radford, Barbara C. Wimmer, Mohammed S. Salahudeen, Ivan Bindoff, Gregory M. Peterson
Summary: The use of DOACs is associated with a lower risk of osteoporosis compared to warfarin, with each individual DOAC having a significantly lower risk as well.
JOURNAL OF CLINICAL MEDICINE
(2022)
Review
Biochemistry & Molecular Biology
Angela Saviano, Mattia Brigida, Carmine Petruzziello, Marcello Candelli, Maurizio Gabrielli, Veronica Ojetti
Summary: NOACs are a safer alternative to warfarin for the prevention and treatment of thromboembolic cardiovascular conditions. Studies have shown that apixaban has a lower rate of gastrointestinal bleeding compared to dabigatran and rivaroxaban, and gastrointestinal bleeding in patients treated with NOACs is generally less severe than with warfarin. The use of NOACs is increasing and widespread in patients who require anticoagulation, with an overall lower risk of major bleeding events. However, caution is still needed in patients at high risk of gastrointestinal bleeding.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2022)
Article
Multidisciplinary Sciences
Giorgio Ciminata, Claudia Geue, Olivia Wu, Manuela Deidda, Noemi Kreif, Peter Langhorne
Summary: This study aimed to explore the methodological challenges of using real-world evidence (RWE) to estimate comparative effectiveness of anticoagulants in Scotland. The results showed that different methods, such as propensity score (PS) matching, inverse probability weighting (IPW), and covariate adjustment with PS, performed well in different subgroups of the study population.
Review
Biochemistry & Molecular Biology
Natalia A. Shnayder, Marina M. Petrova, Pavel A. Shesternya, Alina V. Savinova, Elena N. Bochanova, Olga V. Zimnitskaya, Elena A. Pozhilenkova, Regina F. Nasyrova
Summary: DOACs, such as dabigatran, rivaroxaban, apixaban, and edoxaban, are commonly used for thromboembolism prevention in various medical fields. The importance of genetic information for predicting pharmacokinetics and risk in patients receiving anticoagulant therapy is increasingly recognized.
Article
Cardiac & Cardiovascular Systems
Nijole Bernaitis, Tony Badrick, Shailendra Anoopkumar-Dukie
Summary: This study found that when patients with atrial fibrillation were switched from warfarin to a non-vitamin K oral anticoagulant (NOAC), the potential for pharmacokinetic (PK) drug interactions significantly reduced but remained around 40%. Identifying and managing potential PK drug interactions with NOACs remains a priority to optimize the clinical benefit of these anticoagulants.
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
(2021)
Article
Cardiac & Cardiovascular Systems
Masaharu Akao, Takeshi Yamashita, Hirotsugu Atarashi, Takanori Ikeda, Yukihiro Koretsune, Ken Okumura, Wataru Shimizu, Shinya Suzuki, Hiroyuki Tsutsui, Kazunori Toyoda, Atsushi Hirayama, Masahiro Yasaka, Takenori Yamaguchi, Satoshi Teramukai, Tetsuya Kimura, Yoshiyuki Morishima, Atsushi Takita, Hiroshi Inoue
Summary: This study examined the relationship between patient comprehension of nonvalvular atrial fibrillation and adherence to anticoagulant therapy with clinical outcomes among Japanese elderly patients. The findings suggest that low comprehension and low adherence were associated with poor clinical outcomes in elderly patients with atrial fibrillation.
AMERICAN JOURNAL OF CARDIOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Zhi-Chun Gu, Shou-Rui Huang, Li Dong, Qin Zhou, Jing Wang, Bo Fu, Jin Chen
Summary: The study developed an adapted neural-fuzzy inference system (ANFIS) model using preprocessed balanced data to improve predictive accuracy of warfarin maintenance dosing in Chinese patients undergoing heart valve replacement. The results showed significantly higher prediction accuracy in low-dose and high-dose warfarin groups with the balanced model compared to the imbalanced model, indicating the potential of the ANFIS model in accurately predicting warfarin maintenance dose.
CARDIOVASCULAR DRUGS AND THERAPY
(2022)
Review
Pharmacology & Pharmacy
Nan-Nan Shen, Chi Zhang, Ying Hang, Zheng Li, Ling-Cong Kong, Na Wang, Jia-Liang Wang, Zhi-Chun Gu
Summary: This study estimated the prevalence of DOAC off-label doses in AF patients, finding a relatively high rate with underdose being predominant. Clinicians in Asia preferred prescribing underdose of DOACs to patients.
FRONTIERS IN PHARMACOLOGY
(2021)
Article
Pharmacology & Pharmacy
Chi Zhang, Mang-Mang Pan, Na Wang, Wei-Wei Wang, Zheng Li, Zhi-Chun Gu, Hou-Wen Lin
Summary: The study developed a mobile health tool to aid clinicians and patients with atrial fibrillation in anticoagulation therapy, integrating risk assessment, recommended anticoagulation regimens, and communication between medical professionals and patients. The pilot study showed high self-reported adherence and good satisfaction with anticoagulation among patients with atrial fibrillation.
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY
(2022)
Review
Endocrinology & Metabolism
Fang-Hong Shi, Hao Li, Long Shen, Li Xu, Heng Ge, Zhi-Chun Gu, Hou-Wen Lin, Jun Pu
Summary: Treatment with SGLT2 inhibitors can significantly improve left ventricular function in patients with or without diabetes, especially those with heart failure or undergoing empagliflozin treatment. LV mass, ejection fractions, volumes, and diastolic function were all significantly improved in patients treated with SGLT2 inhibitors. Subgroup analysis further confirmed the improvement of LV function mainly in patients with heart failure or those receiving empagliflozin treatment.
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
(2022)
Article
Medicine, General & Internal
Chi Zhang, Long Shen, Mang-Mang Pan, Ying-Li Zheng, Zhi-Chun Gu, Hou-Wen Lin
Summary: Chinese medical professionals, especially EPs and GPs, lack knowledge and skills in CHA(2)DS(2)-VASc scores and their components. There is an urgent need to improve awareness of the CHA(2)DS(2)-VASc score and its detailed scoring criteria for Chinese medical professionals. Education programs introducing stroke risk evaluation for AF patients and developing referencing scoring tools are necessary.
POSTGRADUATE MEDICINE
(2022)
Review
Pharmacology & Pharmacy
Jia Wang, Zhanchun Feng, Zhongxin Dong, Wanping Li, Chaoyi Chen, Zhichun Gu, Anhua Wei, Da Feng
Summary: In China's hierarchical medical system, many patients seek medical care in different hospitals independently without integrated management. Having a usual primary care provider may reduce the incidence of polypharmacy behaviors.
FRONTIERS IN PHARMACOLOGY
(2022)
Review
Pharmacology & Pharmacy
Li Liu, Fang-Hong Shi, Hua Xu, Yue Wu, Zhi-Chun Gu, Hou-Wen Lin
Summary: Ertugliflozin is effective and well tolerated in patients with type 2 diabetes compared to placebo or other hypoglycemic agents, with the exception of an increased risk of genital mycotic infection.
FRONTIERS IN PHARMACOLOGY
(2022)
Article
Pharmacology & Pharmacy
Fang-Hong Shi, Jiang Yue, Yi-Hong Jiang, Ming-Lan Yang, Zhi-Chun Gu, Jing Ma, Hao Li
Summary: This study investigated the satisfaction of Chinese patients with type 2 diabetes mellitus (T2DM) with sodium-glucose co-transporter-2 (SGLT2) inhibitors treatment. The results showed that patients using SGLT2 inhibitors had higher levels of satisfaction, particularly in glycemic control ability, diabetic symptom's control ability, medication tolerability, and overall satisfaction. However, self-reported adverse events were not associated with satisfaction.
FRONTIERS IN PHARMACOLOGY
(2022)
Article
Cardiac & Cardiovascular Systems
Zhi-Chun Gu, Jia Wang, Chi Zhang, Bin Zhao, Zhi-Ling Li
Summary: Insights from multi-source medical data confirm that the use of non-vitamin K antagonist oral anticoagulants (NOACs) is not associated with an increased risk of hepatic impairment in patients with non-valvular atrial fibrillation (NVAF).
REVIEWS IN CARDIOVASCULAR MEDICINE
(2022)
Article
Pharmacology & Pharmacy
Chi Zhang, Er-Li Ma, Bing-Long Liu, Bin Wu, Zhi-Chun Gu, Hou-Wen Lin
Summary: This study aims to develop a two-level framework for the clinical comprehensive evaluation of drugs. Six first-level indicators will be evaluated according to the Chinese Guideline for Clinical Comprehensive Evaluation of Drugs. The framework will be validated using the Delphi method and Analytic Hierarchy Process (AHP), and scoring criteria for each component will be determined. This will assist evidence-based decision making.
FRONTIERS IN PHARMACOLOGY
(2022)
Review
Pharmacology & Pharmacy
Meng-Fei Dai, Si-Tong Guo, Yi-Jun Ke, Bao-Yan Wang, Feng Yu, Hang Xu, Zhi-Chun Gu, Wei-Hong Ge
Summary: This study found that chronic oral anticoagulation does not reduce the risk of all-cause mortality and ICU admission in COVID-19 patients. Both direct oral anticoagulants and vitamin K antagonists showed no improvement in patient outcomes compared to no anticoagulation therapy.
FRONTIERS IN PHARMACOLOGY
(2022)
Article
Oncology
Qi Wei, Yang Wang, Yong-Bo An, Zheng-Yang Yang, Yi-Shan Liu, Xiao Zhang, Zhi-Chun Gu, Hong-Wei Yao
Summary: This study aims to comprehensively evaluate the incidence and prevention of VTE after colorectal cancer surgery in China, and provide guidance for the prevention of VTE that is suitable for the national conditions.
TRANSLATIONAL CANCER RESEARCH
(2022)
Article
Public, Environmental & Occupational Health
Yang-Xi Liu, Ya Yang, Ke-Jia Le, Zai-Li Zhang, Min Cui, Han Zhong, Zhi-Chun Gu
Summary: Publications on surgical antimicrobial stewardship (AMS) management have increased in recent decades, with the USA being the most prolific. Epidemiological investigations of surgical-related infections, antibiotic prescriptions, and antibiotic resistance are fast-developing research trends.
FRONTIERS IN PUBLIC HEALTH
(2022)
Article
Health Care Sciences & Services
Fengying Zhang, Yan Liu, Weijie Ma, Shengming Zhao, Jin Chen, Zhichun Gu
Summary: This study systematically assessed previous studies on nonlinear machine learning algorithms for warfarin dose prediction, finding poor methodological quality and a high risk of bias in most studies. External validity and model reproducibility were lacking. The study suggests future research should focus on external validity, diminish bias, and improve clinical relevance.
JOURNAL OF PERSONALIZED MEDICINE
(2022)
Article
Medicine, General & Internal
Yi-Dan Yan, Ying Zhao, Chi Zhang, Jie Fu, Ying-Jie Su, Xiang-Li Cui, Er-Li Ma, Bing-Long Liu, Zhi-Chun Gu, Hou-Wen Lin
Summary: The use of immune checkpoint inhibitors (ICIs) in advanced lung cancer can lead to adverse events, particularly immune-related adverse events (irAEs). This study comprehensively assessed the toxicity profile in advanced lung cancer patients using multi-source medical data. The findings revealed that ICI-based regimens with chemotherapy increased the risk of treatment-related adverse events compared to those without chemotherapy. PD-L1 + CTLA-4 + CT combination therapy was associated with the highest risk of grade 1-5 irAEs. Myocarditis, pneumonitis, and hepatitis had high fatality rates. The results can be used to improve clinical treatment strategies for ICI treatment in advanced lung cancer.