Discover and read the best of Twitter Threads about #DOACs

Most recents (12)

💥#McMaster #CardiologyGrandRounds by @johneikelboom
🩸 People with #AF are inadequately anticoagulated, largely related to MD hesitancy
🩸#Bleeding risk prediction tools have modest performance
🩸Bleeding risk iproportional to stroke risk, net benefit favours #antocoagulation
🩸Few reasons to withhold #OAC, even in frail, older adults
🩸Across spectrum of #bleeding risk in AF, #stroke risk is higher
🩸#DOACs preferred over warfarin in #nonvalvular #AF
🩸Most #DOACs safe in #CKD, some require dose adjustment
🩸Dabigatran contraindicated in eGFR<30
🩸Limited RCT evidence in #Hemodialysis

#AtrialFibrillation #Anticoagulation
Read 4 tweets
1a) Welcome to a new #accredited #tweetorial on the management of aFXa-DOAC-associated #hemorrhage and specifically the role of coag laboratory testing in these challenging cases.
1b) Our expert author is #pharmacist Craig Beavers, PharmD @beaverspharmd CV Clinical Pharmacy Specialist @UK_COP, and Immediate Past Chair of the @ACCinTouch #ACCCVT Section
2) This 🆓program is accredited for 0.5h CE/#CME for #physicians #physicianassociates #nurses #nurespractitioners #pharmacists and is supported by a grant from AstraZeneca. See statement of accreditation and faculty disclosures at
Read 37 tweets
1a) Welcome to a new #accredited #tweetorial on a very challenging topic: managing #ICH in a patient taking anti-FXa #DOACs! Your expert authors are both #neurointensivists: Richard Choi, DO @rkchoi @christianacare and Casey Albin, MD @caseyalbin @EmoryNeuroCrit ImageImage
1b) #Physicians #Nurses #Pharmacists #physicianassociate #NPs earn 0.5h CE/#CME from @academiccme for following this 🧵 Image
2) This program is supported by an educational grant from AstraZeneca and is intended for #HCPs. Accreditation statement and faculty disclosures at Prior (& future) programs in this space, available for 🆓CE/#CME credit, at….
Read 52 tweets
1) Welcome to an #accredited #tweetorial on a unique emerging (in Ph3 now) option for specifically reversing the #antiplatelet effects of #ticagrelor: it's #bentracimab. Expert faculty is antithrombotic agent reversal guru @md_pollack of @UMMCnews, working to create #AHealthierMS
2) This program is intended for #healthcare professionals and is supported by an educational grant from PhaseBio Pharmaceuticals. Faculty disclosures are listed at, and prior programs are available for 🆓CE/#CME credit at
3) It is an unfortunate fact of life that one cannot prescribe #anticoagulant or #antiplatelet (together, #antithrombotic) therapy without increasing a patient's #bleedingrisk. That is why it should be an individualized risk:benefit decision, ideally . . .
Read 51 tweets
1) Welcome to a new #accredited #tweetorial on managing #VTE at the extremes of weight & renal function. Free CE/#CME credit for following along with expert author @AryaRoopen from King’s Thrombosis Centre at King's College Hospital in London! Only the best for our learners! Image
2) When we think about "special populations" in #VTE, we think weight, age, and #cancer status. @aakonc already addressed the last of those (earn credit still at…). Learn the rest here! Hello to @ProfMakris @bhwords @MiddeldorpS @fniainle @AliTaherMD
3) This educational program is intended for health care providers & is supported by a grant from Bristol Myers Squibb & its Alliance partner Pfizer, Inc. Faculty disclosures at Credit for #physicians #physicianassociates #nurses #NPs #pharmacists
Read 51 tweets
1) Welcome to a new #accredited #tweetorial on a🗝️ topic in #cancer care & #vascular medicine: #VTE (#DVT and #PE). Cancer patients are at⬆️risk from their disease, their comorbidities, & often from their treatment. It's a sticky wicket & @cardiomet_CE is proud to welcome ...
2) ... one of the world's leading authorities on cancer-associated VTE as new faculty both here and on @onc_ce: Dr. Alok Khorana @aakonc of @ClevelandClinic, to talk about advances and best treatment in this space!
3) This educational program is intended for health care providers & is supported by a grant from Bristol Myers Squibb & its Alliance partner Pfizer, Inc. Faculty disclosures are listed at Earn CE/#CME credit from prior programs at
Read 39 tweets
In our @JAMA_current editorial, we tackle a timely question in #CardioTwitter: should we recommend #apixaban or #rivaroxaban as first-line anticoagulant for #Afib?The two #DOACs are not interchangeable for bleeding or stroke. Let's review all RCTs & RWE🧵… Image
Why should you care? Why now? 1) >70% of #Medicare pts on anticoagulation are taking #DOACs, practically replacing warfarin 2) Generic DOACs will enter the market in 2022, massively ⬆️ patient access & use 3) Insurance companies may not cover all DOACs in their formularies 💵💊 Image
RCTs first: in ROCKET-AF (n=14K pts), riva was NON-INFERIOR to warfarin for stroke (per-protocol)🧠, w/ similar rates of major/non-major bleed🩸. In ARISTOTLE (n=18K pts), apixa was SUPERIOR to warfarin for stroke (ITT)🧠 AND w significantly⬇️ major bleed🩸, AND even⬇️mortality. Image
Read 17 tweets
Don’t miss a new accredited #tweetorial launching TOMORROW here on @cardiomet_CE. #Emergencymedicine #thrombosis researcher @md_pollack will be discussing safe, effective management of selected patients with venous thromboembolism (#VTE) from the #emergencydepartment.
It used to be SOOO much more complicated, but since we entered the era of the #DOACs, #lifeisgood! #Physicians #nurses #pharamcists all work together to make it happen, and all can earn CE/#CME here! @AlexSpyropoul @ScottKaatz @RenatoDLopes1 @GenoMerli @aakonc @vic_tapson
1) Welcome to a #tweetorial on the safe and effective management of acute venous #thromboembolism (#VTE) directly from the #emergencydepartment. This program is accredited for 0.50 credits for #physicians #nurses #pharmacists by @academiccme! I am @md_pollack. Image
Read 23 tweets
A #tweetorial on non-variceal upper gastrointestinal bleeding #NVUGIB

And an overview of why we do what we do

To warm up, which of the following is the most common cause of NVUGIB?

#gitwitter #livertwitter #medtwitter #MedEd


PUD it is...

Btw wt do we mean by "upper"?

This is defined as a bleeding source proximal to the Ligament of Treitz, also known as the suspensory muscle of duodenum, the landmark that separates the duodenum & jejunum Image
Back to PUD, there are actually many well established causes and some associated factors related to its development, the most important being:

💊 Drugs - NSAIDs/aspirin, direct chemical/erosive agents etc
🦠 Bugs - H. pylori
♋ Thugs (if I may) - Neoplasm Image
Read 25 tweets
Ever wonder if all #DOACs were created equal? #GITwitter #livertwitter #MedTwitter

Let's start with a poll followed by a #tweetorial on direct oral anticoagulants. First things first, which is your go-to choice of #DOAC ? (COI: none):
These agents work "directly" to anti-coagulate and since they are hardly "new' anymore the term #NOAC has become obsolete. Dabigatran is a direct thrombin inhibitor (factor IIa), whereas the others are factor Xa inhibitors (note the Xa in their names)

In general they share many characteristics such as a quick onset of action, shorter half-lives, potential for drug-drug interactions (CYP3A4 & P-gp) and renal elimination (except apixaban) when compared with warfarin…
Read 18 tweets
Kicking off multidisciplinary Research Consensus Panel (RCP) to finally investigate the ❓: what is the optimal medical therapy (OMT) following venous recan? Follow #VenousRCP throughout the day to learn more and contribute! #SIRFoundation @SIRRFS @SIR_ECS @JVIRmedia
🔴 Pathophysiology of venous thromboembolism #VTE
🟠Venous recanalization & stenting
🟡The mystery of medical therapy following recanalization
🟢Patency & outcome measures
🔵Economics & cost-effectiveness of treatment
🟣Future directions
🔴 ✅#VTE affects ~100 of every 100,000 people yearly in the US
✅Incidence of VTE ⬆️⬆️ exponentially with age, especially after 40
#Endovascular recan is a common tx; post-tx algorithms vary widely
✅More #epidemiology info @CircAHA
Read 24 tweets
This population-based, multicentre, 10-year study of the use of oral #anticoagulants for #stroke prophylaxis for ~0.5M patients with #AFib found that their prescription for patients with #AF at high risk of stroke increased by nearly 60%.
Between 2009 & 2018, 3352 individual General Practices provided a total of 5968 uploads into the GRASP-AF database. From the first upload per General Practice, there were an estimated 450 518 patients with #AFib from a total of 24 644 210 people.
Over the study period the prevalence of AF was 1.8% [95% CI 1.7–1.9%], which increased from 1.6% (1.5–1.7%) in 2009 to 2.4% (2.3–2.5%) in 2018 (P-trend < 0.001). Image
Read 17 tweets

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