Background: The direct oral anticoagulants (DOACs) apixaban and rivaroxaban are increasingly prescribed due to convenient oral formulation without the need for routine laboratory monitoring and are now commonly regarded as first line anticoagulants in most cases of venous thromboembolism (VTE). However, the optimal choice of subsequent anticoagulant in instances of first line DOAC failure is [...]

Background: Recent guidelines include aspirin as an option to prevent venous thromboembolism (VTE) in selected patients undergoing hip or knee replacement surgery. However, the efficacy of aspirin after arthroplasty has not been well-defined, particularly in more contemporary patient populations. Objective: To compare rates of post-operative VTE between patients who received aspirin-only versus anticoagulants after hip [...]

Background: Role of vitamin K antagonist (VKA) or Direct Oral anticoagulation (DOAC) for non-valvular atrial fibrillation has widely been discussed. But the literature on anticoagulation therapy for patients with valvular atrial fibrillation (VAF) is limited. Aim of this meta-analysis was to evaluate the outcomes (stroke-vascular events and intracranial bleeding) following DOAC and VKA amongst patients [...]

Background: Factor concentrates such as 4 factor-prothrombin complex concentrate (4F-PCC) are commonly used off-label as reversal agents in factor Xa inhibitor-associated bleeding events. However, there have been limited studies on the efficacy and safety of 4F-PCC use in these settings. We conducted a retrospective observational study of the use of 4F-PCC for major bleeding occurring [...]

Background: Guidelines recommend pharmacologic venous thromboembolism (VTE) prophylaxis for high risk hospitalized medical patients that do not have an elevated bleeding risk.  A systematic review of randomized trials estimates the overall bleeding risk with pharmacologic prophylaxis to be low, at 1/1000 (0.1%).  However, it is unclear if the bleeding events were related to pharmacologic prophylaxis [...]

Background: Over 6 million people in the US have a diagnosis of atrial fibrillation. Given the increased risk for stroke and systemic embolism, many patients are treated with direct oral anticoagulants (DOACs) to reduce their risk. In the major trials comparing to DOACs to warfarin for stroke and systemic embolism prevention in atrial fibrillation, DOACs [...]

Background: Cancer-associated thrombosis (CAT) is a common complication in patients with malignancy. Management of venous thromboembolism (VTE), in these patients, is challenging due to the high risk of recurrence and inherent risk of bleeding in this population. Direct oral anticoagulants (DOACs) have emerged as a treatment options for CAT. As yet there have not been [...]

Background: Venous thromboembolism (VTE) in hospitalized medically ill patients is a leading preventable cause of morbidity and mortality in the United States. About half of VTE events occur following discontinuation of standard-duration in-hospital prophylaxis and hospital discharge. The APEX study evaluated Betrixaban for in-hospital to home VTE prophylaxis and is the first FDA approved anticoagulant [...]

Background: Oral anticoagulation is effective for reduction of risk for stroke and systemic embolism in patients with nonvalvular atrial fibrillation, but there may be uncertainty about how to manage anticoagulation in and following an emergency procedure or after treatment of hemorrhage. In case of an emergency, anticoagulation would ideally be immediately and completely reversed, bringing [...]

Background: Hospitalized patients receiving direct oral anticoagulants (DOACs) sometimes require bridging with unfractionated heparin (UFH). Monitoring UFH with anti-Xa assays has been shown to correlate with better outcomes. However, DOACs interfere with anti-Xa assays resulting in inappropriate UFH dose adjustments that can negatively impact patient care. In 2015, we deployed an electronic health record (EHR) [...]