Latest & greatest articles for anticoagulation

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Top results for anticoagulation

1. Oral anticoagulation in patients with chronic kidney disease: A systematic review and meta-analysis

Oral anticoagulation in patients with chronic kidney disease: A systematic review and meta-analysis Data regarding the efficacy and safety of warfarin and non-vitamin K antagonist oral anticoagulant (NOAC) among patients with chronic kidney disease (CKD) remain scarce.Systematic review and meta-analysis of studies involving patients with CKD treated with oral anticoagulants were conducted to evaluate the following outcomes: ischemic stroke, intracerebral hemorrhage (ICH), combined ischemic (...) and hemorrhagic stroke (strokecombined), stroke or systemic embolism, mortality, and major bleeding events. CKD was defined based on creatinine clearance (CrCl) ranging from mild (CrCl: 60-89 mL/min), moderate (CrCl: 30-59 mL/min), to severe (CrCl: 15-29 mL/min).Fifteen studies (7 comparing NOAC vs warfarin and 8 comparing warfarin vs no anticoagulant) were identified comprising 78,053 patients. Warfarin (vs no anticoagulant) was associated with reduced risk of ischemic stroke (risk ratio [RR] = 0.68; 95

2019 EvidenceUpdates

2. Resumption of anticoagulant therapy after anticoagulant-related gastrointestinal bleeding: A systematic review and meta-analysis

Resumption of anticoagulant therapy after anticoagulant-related gastrointestinal bleeding: A systematic review and meta-analysis Oral anticoagulation (OAC) is permanently discontinued in up to 50% of patients following a gastrointestinal (GI) bleed. A previous meta-analysis showed a reduced risk of thromboembolism and death, and a non-statistically significant increased risk of re-bleeding associated with resumption. We conducted an updated meta-analysis to determine the risks of recurrent GI

2019 EvidenceUpdates

3. Performing non-neuraxial bedside procedures on patients taking anticoagulants

Performing non-neuraxial bedside procedures on patients taking anticoagulants Blood&Clots Series: Performing non-neuraxial bedside procedures on patients taking anticoagulants - CanadiEM Blood&Clots Series: Performing non-neuraxial bedside procedures on patients taking anticoagulants In , by Calvin Yeh February 19, 2019 All the content from the Blood & Clots series can be found . CanMEDS Roles addressed: Medical expert Case Description You are assessing a patient in the emergency room who (...) is presenting with a unilateral large pleural effusion that is causing hypoxia and shortness of breath. She needs a thoracentesis but her INR is 3.0 due to the Warfarin she takes for atrial fibrillation. How can this procedure be performed safely? What about other common (non-neuraxial) bedside procedures (thoracentesis, NG tube, paracentesis, arthrocentesis) – when is it safe to perform these procedures while on anticoagulants (DOACs, Warfarin)? Main Text Thoracentesis-associated Risk Case series

2019 CandiEM

4. Decreased risk of renal impairment in atrial fibrillation patients receiving non-vitamin K antagonist oral anticoagulants: A pooled analysis of randomized controlled trials and real-world studies

Decreased risk of renal impairment in atrial fibrillation patients receiving non-vitamin K antagonist oral anticoagulants: A pooled analysis of randomized controlled trials and real-world studies Patients with warfarin have a potential risk of warfarin-related nephropathy, which could result in the discontinuation of anticoagulation therapy. The question of whether non-vitamin K antagonist oral anticoagulants (NOACs) use is associated with increased risk of renal impairment in atrial

2019 EvidenceUpdates

5. Open-Label Randomized Trial Comparing Oral Anticoagulation With and Without Single Antiplatelet Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent Implantation

Open-Label Randomized Trial Comparing Oral Anticoagulation With and Without Single Antiplatelet Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent Implantation Despite recommendations in the guidelines and consensus documents, there has been no randomized controlled trial evaluating oral anticoagulation (OAC) alone without antiplatelet therapy (APT) in patients with atrial fibrillation and stable coronary artery disease beyond 1 (...) on Thrombosis and Haemostasis classification. Although the trial was designed to enroll 2000 patients during 12 months, enrollment was prematurely terminated after enrolling 696 patients in 38 months.Mean age was 75.0±7.6 years, and 85.2% of patients were men. OAC was warfarin in 75.2% and direct oral anticoagulants in 24.8% of patients. The mean CHADS2 score was 2.5±1.2. During a median follow-up interval of 2.5 years, the primary end point occurred in 54 patients (15.7%) in the OAC-alone group and in 47

2019 EvidenceUpdates

6. Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation

Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation Discover Portal Discover Portal Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation Published on 6 February 2018 doi: In people with atrial fibrillation needing anticoagulant treatment, deaths were fewer (...) in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin. This study pooled the data in all trials reporting efficacy, safety and cost of anticoagulant prevention of stroke events in people with atrial fibrillation. Researchers used a technique called network meta-analysis to compare

2019 NIHR Dissemination Centre

7. Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation

Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation Discover Portal Discover Portal Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation Published on 18 July 2017 doi: General practice software that generated screen reminders for patients with atrial fibrillation did not increase the proportion taking oral anticoagulants (...) appropriately by six months. This NIHR-funded trial included GPs in 47 surgeries in England and found that at the start only 63% of eligible patients with atrial fibrillation were being prescribed anticoagulants. Six months later the rate had increased to 66% in intervention practices and 64% in those following usual practice, a non-significant difference between the groups. Use of the software was associated with increased diagnosis of transient ischemic attack, which could be due to improved detection

2019 NIHR Dissemination Centre

8. New generation anticoagulants may be safer than warfarin for people with chronic kidney disease

New generation anticoagulants may be safer than warfarin for people with chronic kidney disease New generation anticoagulants may be safer than warfarin for people with chronic kidney disease Discover Portal Discover Portal New generation anticoagulants may be safer than warfarin for people with chronic kidney disease Published on 26 April 2016 doi: Newer generation anticoagulants appear to reduce the risk of bleeding compared with older anticoagulants like warfarin, when used to prevent clots (...) in people who also have mild to moderate chronic kidney disease. This group of drugs, called direct oral anticoagulants, have been well researched in healthy people with atrial fibrillation or at risk of thromboembolism but this was the first review to look at their safety, in terms of bleeding and risk of bleeding within the brain, in people with kidney disease. As a group, these newer drugs appear safer than older anticoagulants such as warfarin. Evidence from the trials comparing individual new

2019 NIHR Dissemination Centre

9. An anticoagulant, bivalirudin, may not be safer than the alternative, heparin, when unblocking arteries in the heart

An anticoagulant, bivalirudin, may not be safer than the alternative, heparin, when unblocking arteries in the heart An anticoagulant, bivalirudin, may not be safer than the alternative, heparin, when unblocking arteries in the heart Discover Portal Discover Portal An anticoagulant, bivalirudin, may not be safer than the alternative, heparin, when unblocking arteries in the heart Published on 14 June 2016 doi: Bivalirudin is currently recommended as an alternative option to heparin to prevent (...) procedures were carried out in the UK. It involves inserting a small tube called a stent into the heart’s arteries, to hold them open. Anticoagulant treatment is needed at the same time to reduce the risk of clotting during and after the procedure. Heparin is the long established anticoagulant, but newer bivalirudin may now be used as an alternative. To date, different trials have produced contradictory evidence comparing the safety and effectiveness of the two anticoagulants when given to patients

2019 NIHR Dissemination Centre

10. Extending anticoagulant treatment beyond three months reduces the risk of recurrent blood clots

Extending anticoagulant treatment beyond three months reduces the risk of recurrent blood clots Extending anticoagulant treatment beyond three months reduces the risk of recurrent blood clots Discover Portal Discover Portal Extending anticoagulant treatment beyond three months reduces the risk of recurrent blood clots Published on 1 March 2016 doi: Warfarin, newer direct oral anticoagulants and aspirin all significantly reduced the rate of recurrent clots in patients treated for more than (...) the standard three months. Aspirin was the least effective and the number of major bleeds and deaths was low in all three groups. This review pooling seven trials found that between six and 36 months 28 in every 1000 people taking warfarin, direct oral anticoagulants or aspirin after a first blood clot developed a second clot. This was significantly fewer than the 97 per 1000 people who developed a second clot while taking placebo. The cost-effectiveness of extending treatment was not assessed. People who

2019 NIHR Dissemination Centre

11. The effective, safe and appropriate use of anticoagulation medicines: A systematic overview of reviews

The effective, safe and appropriate use of anticoagulation medicines: A systematic overview of reviews anticoagulation medicines 18 March 2019 Links Download reports (pdf) Evidence Summary Evidence Report The effective, safe and appropriate use of anticoagulation medicines: A systematic overview of reviews. What do we want to know? Anticoagulation drugs are used to prevent and treat irregular heartbeat (atrial fibrillation, AF), and clotting of blood in veins (venous thromboembolism, VTE (...) ). Until recently, warfarin was the only available drug to manage or prevent these conditions. Recently, novel oral anticoagulants (NOACs) have become available for prescription. To bring together current understanding about these treatments, we sought to address broad research questions: What evidence syntheses have been conducted to address the efficacy and safety of UK-approved oral anticoagulant therapy with respect to warfarin, novel oral anticoagulants, genotyping (i.e. using genetic information

2019 EPPI Centre

12. Continued vs. interrupted direct oral anticoagulants at the time of device surgery, in patients with moderate to high risk of arterial thrombo-embolic events (BRUISE CONTROL-2)

Continued vs. interrupted direct oral anticoagulants at the time of device surgery, in patients with moderate to high risk of arterial thrombo-embolic events (BRUISE CONTROL-2) Guidelines recommend warfarin continuation rather than heparin bridging for pacemaker and defibrillator surgery, after the BRUISE CONTROL trial demonstrated an 80% reduction in device pocket haematoma with this approach. However, direct oral anticoagulants (DOACs) are now used to treat the majority of patients (...) -operation, interruption of anticoagulation, or prolonging hospital stay. In the continued arm, the median time between pre- and post-operative DOAC doses was 12 h; in the interrupted arm the median time was 72 h. Clinically significant haematoma occurred in of 7 of 328 (2.1%; 95% CI 0.9-4.3) patients in the continued DOAC arm and 7 of 334 (2.1%; 95% CI 0.9-4.3) patients in the interrupted DOAC arm (P = 0.97). Complications were uncommon, and included one stroke and one symptomatic pericardial effusion

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2019 EvidenceUpdates

13. Efficacy and safety of reduced-dose non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: a meta-analysis of randomized controlled trials

Efficacy and safety of reduced-dose non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: a meta-analysis of randomized controlled trials Non-vitamin K antagonist oral anticoagulants (NOACs) require dose reductions according to patient or clinical factors for patients with atrial fibrillation (AF). In this meta-analysis, we aimed to assess outcomes with reduced-dose NOACs when given as pre-specified in pivotal trials.Aggregated data abstracted from Phase III trials (...) , fatal bleeding, and death regardless of patient eligibility for NOAC dose reduction (interaction P > 0.05 for each).Patients eligible for reduced-dose NOACs were at elevated risk of thromboembolic and haemorrhagic complications when treated with anticoagulants. NOACs, when appropriately dose-adjusted, had an improved benefit-harm profile compared with warfarin. Our findings highlight the importance of prescribing reduced-dose NOACs for indicated patient populations.

2019 EvidenceUpdates

14. Hemorrhagic risk in patients treated with aspirin vs. non-vitamin-K oral anticoagulants at doses approved for atrial fibrillation: systematic review and meta-analysis of randomized controlled trials

Hemorrhagic risk in patients treated with aspirin vs. non-vitamin-K oral anticoagulants at doses approved for atrial fibrillation: systematic review and meta-analysis of randomized controlled trials Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears

2019 PROSPERO

15. Extracorporeal membrane oxygenation without therapeutic anticoagulation in adult patients: a systematic review of the current literature

Extracorporeal membrane oxygenation without therapeutic anticoagulation in adult patients: a systematic review of the current literature Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration

2019 PROSPERO

16. Risk of major bleeding during extended oral anticoagulation in patients with first unprovoked venous thromboembolism: systematic review and meta-analysis

Risk of major bleeding during extended oral anticoagulation in patients with first unprovoked venous thromboembolism: systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content

2019 PROSPERO

17. Oral implants and risk of bleeding in patients taking antiplatelet or oral anticoagulation therapy. A systematic review

Oral implants and risk of bleeding in patients taking antiplatelet or oral anticoagulation therapy. A systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any

2019 PROSPERO

18. Anticoagulants for thromboprophylaxis in ambulatory patients with cancer

Anticoagulants for thromboprophylaxis in ambulatory patients with cancer Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation

2019 PROSPERO

19. Adherence to oral anticoagulants for treatment of atrial fibrillation in the Middle East: a systematic review

Adherence to oral anticoagulants for treatment of atrial fibrillation in the Middle East: a systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files

2019 PROSPERO

20. Catheter assisted thrombolysis plus anticoagulation or anticoagulation alone for treating patients with iliofemoral vein thrombosis: a meta-analysis of randomized trials

Catheter assisted thrombolysis plus anticoagulation or anticoagulation alone for treating patients with iliofemoral vein thrombosis: a meta-analysis of randomized trials Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability

2019 PROSPERO