Latest & greatest articles for anticoagulation

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Top results for anticoagulation

21. Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation

Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation Patients with nonvalvular atrial fibrillation commonly have comorbidities requiring concurrent use of oral anticoagulants and antiplatelets. There are no real-world data on the comparative safety of concomitant antithrombotic treatments in the era of direct oral anticoagulant (DOACs). Thus, we compared the incidence of intracranial hemorrhage (...) (HR 0.46; 95% CI, 0.24-0.91) and other major bleeding (HR 0.68; 95% CI, 0.51-0.91) compared with concomitant VKA-antiplatelet use.Concomitant DOAC-antiplatelet use was associated with a similar risk of gastrointestinal bleeding, and a lower risk of intracranial hemorrhage and other major bleeding than concomitant VKA-antiplatelet use. These findings could inform physician decision-making in patients requiring concomitant treatment with oral anticoagulants and antiplatelets.Copyright © 2018

2019 EvidenceUpdates

22. Effect of anticoagulant treatment on pain in distal deep vein thrombosis: an ancillary analysis from the cactus trial

Effect of anticoagulant treatment on pain in distal deep vein thrombosis: an ancillary analysis from the cactus trial Essentials Management of patients with calf deep vein thrombosis remains controversial. We conducted a post-hoc analysis of a placebo controlled LMWH randomized clinical trial. Pain was assessed using visual analogue scale at inclusion, one and six weeks. There was no difference in pain control between the two arms. SUMMARY: Background The optimal management of distal deep vein (...) thrombosis (DVT) is highly debated. The only available placebo-controlled trial suggested the absence of clear benefit of anticoagulation. Many physicians feel that, beyond preventing thromboembolic complications, anticoagulation with low-molecular-weight heparin (LMWH) has the potential to improve pain control. Objectives To analyze whether LMWHs decrease pain in patients with distal deep vein thrombosis. Patients and methods Two-hundred and fifty-two patients included in a multicenter, placebo

2019 EvidenceUpdates

23. Antiplatelet Therapy versus Anticoagulation after Surgical Bioprosthetic Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Antiplatelet Therapy versus Anticoagulation after Surgical Bioprosthetic Aortic Valve Replacement: A Systematic Review and Meta-Analysis  The optimal antithrombotic therapy after surgical bioprosthetic aortic valve replacement (BAVR) is uncertain. We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) comparing antiplatelet therapy and anticoagulation in patients with surgical BAVR. We searched Cochrane CENTRAL, MEDLINE and EMBASE (...) from inception to 3 November 2017 for studies evaluating antiplatelet therapy versus anticoagulation early after surgical BAVR. We performed title and abstract screening, full-text review, risk of bias evaluation and data collection independently and in duplicate. We evaluated overall quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, and pooled data using a random effects model. We identified 2 RCTs (n = 397) and 5 observational studies (n

2019 EvidenceUpdates

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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) (Full text)

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

2019 EvidenceUpdates PubMed

34. 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

35. Anticoagulants for the treatment of venous thromboembolism in patients with cancer: a pairwise and network meta-analysis of randomized trials

Anticoagulants for the treatment of venous thromboembolism in patients with cancer: a pairwise and network 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 for the content

2019 PROSPERO

36. Bleeding risk and history of comorbidities in patients with atrial fibrillation treated with oral anticoagulation: a meta-analysis

Bleeding risk and history of comorbidities in patients with atrial fibrillation treated with oral anticoagulation: a 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 of this registration record

2019 PROSPERO

37. What is the clinical and cost effectiveness of discontinuing anticoagulation in people whose atrial fibrillation has resolved?

What is the clinical and cost effectiveness of discontinuing anticoagulation in people whose atrial fibrillation has resolved? 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

38. Symptomatic intracranial hemorrhage (and mortality) after endovascular treatment for acute ischemic stroke in patients with prior oral anticoagulant therapy (direct oral anticoagulants vs vitamin K antagonists): a systematic review and meta-analysis

Symptomatic intracranial hemorrhage (and mortality) after endovascular treatment for acute ischemic stroke in patients with prior oral anticoagulant therapy (direct oral anticoagulants vs vitamin K antagonists): a 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

2019 PROSPERO

39. Safety and efficacy of direct oral anticoagulants (DOAC) in chronic liver disease

Safety and efficacy of direct oral anticoagulants (DOAC) in chronic liver disease 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

2019 PROSPERO

40. A systematic review and narrative synthesis of the use of antiplatelet/anticoagulant agents in patients undergoing endovascular revascularization for peripheral arterial disease

A systematic review and narrative synthesis of the use of antiplatelet/anticoagulant agents in patients undergoing endovascular revascularization for peripheral arterial disease 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