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Gastrointestinal Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Gareth Davies, Chris Black, Keeley Fairbrass
Sedation is the major risk, especially in the elderly, and those with low BMIs, COPD or sleep apnoea. Patients with atlantoaxial subluxation (usually caused by rheumatoid arthritis) should have their neck supported in a hard collar. Avoid routine procedures within 6 weeks of myocardial infarction (MI) or cataract surgery. For routine diagnostic endoscopy, there is no need to stop aspirin or other antiplatelet agents; warfarin can be continued with an INR check before the procedure. Direct oral anticoagulants such as apixaban are omitted on the day. For therapeutic procedures, the risks of bleeding are higher and individual consideration is required.
Questions for part B
Published in Henry J. Woodford, Essential Geriatrics, 2022
A 74-year-old woman was admitted to hospital with a sudden onset of right-sided weakness. An urgent CT scan showed a left intracerebral haematoma. She is taking apixaban for atrial fibrillation. Which would be the best strategy to rapidly reverse the anticoagulant effect of apixaban?Andexanet alfaFresh frozen plasmaIdarucizumabProthrombin complex concentrateTranexamic acid
Epidural and Intrathecal Analgesia
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Apixaban is another DOAC similar to rivaroxaban with the same recommendations of a three-day interval between last dose and neuraxial blockade and only restarted six hours after removal of an epidural catheter.
Delayed periorbital hemorrhage in oculoplastic surgery patients on oral anticoagulants
Published in Orbit, 2021
Lilly H. Wagner, Elizabeth A. Bradley, Isaiah Giese, Viraj J. Mehta, Stuart R. Seiff
Case 2: An 87-year-old female presented to the emergency department (ED) after a fall, and was found to have a right open globe injury as well as extensive right periorbital lacerations. She had a history of atrial fibrillation and was on apixaban for anticoagulation. The globe repair was performed the same night, as well as a partial repair of the eyelid lacerations. Complete closure of the lateral canthal wound segments was deferred, to avoid exerting pressure on the globe. The patient resumed apixaban on postoperative day 4, and returned later that day to the emergency room with severe bleeding from the periorbital lacerations. She required one unit of packed red blood cells and was taken to the operating room for wound revision and cauterization of bleeding vessels. Apixaban was held for 5 days after this intervention, and the patient experienced no further complications.
Surgical intervention in patients with proximal femoral fractures confirmed positive for COVID-19—a report of 2 cases
Published in Acta Orthopaedica, 2020
Suk Kyoon Song, Won Kee Choi, Myung Rae Cho
Both patients had a considerably long waiting time before surgery. The procedures for diagnosing COVID-19 and preoperative cardiopulmonary risk assessment were the main causes of delay. In particular, the first patient had to halt apixaban for 2 days in order to reduce bleeding risk. Apixaban is recommended to be discontinued 48 hours before high-bleeding-risk procedures such as major orthopedic surgery (Mandernach et al. 2015). (We discussed this matter with the department of cardiology.) The second patient initially was admitted to a local clinic for other causes and later referred to our hospital after the fracture event. It took several days to assess comorbidities and preoperative risks. We would have postponed surgery if the risks of COVID-19 were more severe than the risks of surgical delay (e.g., severe or bilateral pneumonia, high oxygen demand).
A comprehensive evaluation of apixaban in the treatment of venous thromboembolism
Published in Expert Review of Hematology, 2020
Jennifer L Koehl, Bryan D. Hayes, Hanny Al‐Samkari, Rachel Rosovsky
Apixaban is a highly selective (>30 000‐fold selectivity over other coagulation proteases), reversible and potent (Ki = .08 nm) direct factor Xa inhibitor which prevents the conversion of prothrombin to thrombin, the final enzyme in the coagulation cascade that is responsible for fibrin clot formation. Apixaban inhibits both free and clot bound factor Xa [17–19], as well as prothrombinase activity [17,18]. It has no direct effect on platelet aggregation, but it indirectly inhibits aggregation induced by thrombin. More specifically, the direct inhibition of factor Xa differs from the direct inhibition of thrombin as the former preserves hemostatic function by attenuating the generation, but not the activity of thrombin [20]. As a result, apixaban has no direct effects on the actual activity of thrombin, rather indirectly inhibits this process by reducing thrombin generation [21,22] which in turn decreases fibrin clot development.