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Latest & greatest articles for anticoagulation
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on anticoagulation or other clinical topics then use Trip today.
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A systematic review and Bayesian network meta-analysis of risk of intracranial hemorrhage with direct oral anticoagulants Essentials Risk of intracranial hemorrhage (ICH) may differ between direct oral anticoagulants (DOACs). We compared the risk of ICH between DOACs using network meta-analysis. Dabigatran 110 mg and 150 mg were safer than rivaroxaban on Bayesian analysis. Dabigatran 110 mg ranked as the safest DOAC while rivaroxaban ranked last.Background The comparative risk of intracranial (...) hemorrhage (ICH) among direct oral anticoagulants (DOACs) (dabigatran, rivaroxaban, apixaban and edoxaban) remains unclear. Objective To determine the difference in risk of ICH between DOACs Methods Seventeen randomized controlled trials (RCTs) were selected using PubMed/MEDLINE, EMBASE and CENTRAL (Inception, 31 December 2017). Estimates were reported as odds ratio (OR) with 95% credible interval (CR.I) in Bayesian network meta-analysis (NMA), and OR with 95% confidence interval (CI) in traditional meta
Reduced-dose direct oral anticoagulants in the extended treatment of venous thromboembolism: a systematic review and meta-analysis Essentials In venous thromboembolism (VTE), benefits of extended treatment are balanced by bleeding risks. This is a meta-analysis of reduced-dose direct oral anticoagulants (DOACs) in extended treatment. Reduced-dose DOACs are as effective as full anticoagulation with bleeding risks similar to placebo. Reduced-dose DOACs are an attractive option for patients (...) in the extended phase of VTE treatment.Background Extended-duration anticoagulation is beneficial for preventing recurrent venous thromboembolism (VTE). Reduced-dose direct oral anticoagulants (DOACs) may be preferable if they preserve efficacy and cause less bleeding. We conducted a systematic review and meta-analysis of trials comparing reduced-dose DOACs with full-dose DOACs and aspirin or placebo in the extended phase of VTE treatment. Methods A literature search was conducted by use of the MEDLINE
Anticoagulation Top results for anticoagulation - Trip Database or use your Google+ account Liberating the literature ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search numbers in the top search box and pressing the search button. An example search might look like (#1 or #2 (...) ) and (#3 or #4) Loading history... Population: Intervention: Comparison: Outcome: Population: Intervention: Latest & greatest articles for anticoagulation The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms
Antiplatelet and anticoagulant agents for primary prevention of thrombosis in individuals with antiphospholipid antibodies. Antiphospholipid syndrome (APS) is an autoimmune disease characterised by the presence of antiphospholipid (aPL) antibodies that have prothrombotic activity. Antiphospholipid antibodies are associated with an increased risk of pregnancy complications (recurrent miscarriage, premature birth, intrauterine growth retardation) and thrombotic events (both arterial and venous (...) ). The most common thrombotic events include brain ischaemia (stroke or transient ischaemic attack) and deep vein thrombosis. To diagnose APS, the presence of aPL antibodies in two measurements and at least one thrombotic event or pregnancy complication are required. It is unclear if people with positive aPL antibodies but without any previous thrombotic events should receive primary antithrombotic prophylaxis.To assess the effects of antiplatelet or anticoagulant agents versus placebo or no intervention
Anticoagulation for perioperative thromboprophylaxis in people with cancer. The choice of the appropriate perioperative thromboprophylaxis for people with cancer depends on the relative benefits and harms of different anticoagulants.To systematically review the evidence for the relative efficacy and safety of anticoagulants for perioperative thromboprophylaxis in people with cancer.This update of the systematic review was based on the findings of a comprehensive literature search conducted (...) , and thrombocytopenia. We assessed the certainty of evidence for each outcome using the GRADE approach (GRADE Handbook).Of 7670 identified unique citations, we included 20 RCTs with 9771 randomized people with cancer receiving preoperative prophylactic anticoagulation. We identified seven reports for seven new RCTs for this update.The meta-analyses did not conclusively rule out either a beneficial or harmful effect of LMWH compared with UFH for the following outcomes: mortality (risk ratio (RR) 0.82, 95% confidence
Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. To investigate the associations between direct oral anticoagulants (DOACs) and risks of bleeding, ischaemic stroke, venous thromboembolism, and all cause mortality compared with warfarin.Prospective open cohort study.UK general practices contributing to QResearch or Clinical Practice Research Datalink.132 231 warfarin, 7744 dabigatran, 37 863 rivaroxaban, and 18 223 apixaban (...) users without anticoagulant prescriptions for 12 months before study entry, subgrouped into 103 270 patients with atrial fibrillation and 92 791 without atrial fibrillation between 2011 and 2016.Major bleeding leading to hospital admission or death. Specific sites of bleeding and all cause mortality were also studied.In patients with atrial fibrillation, compared with warfarin, apixaban was associated with a decreased risk of major bleeding (adjusted hazard ratio 0.66, 95% confidence interval 0.54
Antifibrinolytic therapy for preventing oral bleeding in people on anticoagulants undergoing minor oral surgery or dental extractions. Individuals on continuous treatment with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) are at increased risk of bleeding complications during and after oral or dental procedures. Anticoagulant treatment is preferably continued at the same dose, since dose reduction or discontinuation of treatment is associated with an increased risk (...) of thromboembolism. The use of haemostatic measures during or after the procedure (or both) could enable continuation of the oral anticoagulant treatment.We aimed to assess the efficacy of antifibrinolytic agents for preventing bleeding complications in people on oral anticoagulants undergoing minor oral surgery or dental extractions.We searched the Cochrane Cystic Fibrosis and Genetic Disorders Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals
Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications Interventional Spine and Pain Procedures in Patients on Anti... : Regional Anesthesia and Pain Medicine You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Login No user account? Lippincott Journals Subscribers , use your username or email along with your password to log in. Remember me on this computer Register for a free account (...) Procite Reference Manager Save my selection doi: 10.1097/AAP.0000000000000700 CHRONIC AND INTERVENTIONAL PAIN: SPECIAL ARTICLE Free The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines
Anticoagulation for the long-term treatment of venous thromboembolism in people with cancer. Cancer increases the risk of thromboembolic events, especially in people receiving anticoagulation treatments.To compare the efficacy and safety of low molecular weight heparins (LMWHs), direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) for the long-term treatment of venous thromboembolism (VTE) in people with cancer.We conducted a literature search including a major electronic search (...) compared to VKAs (RR 0.58, 95% CI 0.43 to 0.77; RD 53 fewer per 1000, 95% CI 29 fewer to 72 fewer, moderate-certainty evidence).Direct oral anticoagulants versus vitamin K antagonistsFive studies enrolling 982 participants compared DOACs with VKAs. Meta-analysis of four studies may not rule out a beneficial or harmful effect of DOACs compared to VKAs on mortality (RR 0.93, 95% CI 0.71 to 1.21; RD 12 fewer per 1000, 95% CI 51 fewer to 37 more; low-certainty evidence), recurrent VTE (RR 0.66, 95% CI 0.33
Anticoagulation for people with cancer and central venous catheters. Central venous catheter (CVC) placement increases the risk of thrombosis in people with cancer. Thrombosis often necessitates the removal of the CVC, resulting in treatment delays and thrombosis-related morbidity and mortality. This is an update of the Cochrane Review published in 2014.To evaluate the efficacy and safety of anticoagulation for thromboprophylaxis in people with cancer with a CVC.We conducted a comprehensive (...) and harms of unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), vitamin K antagonists (VKA), or fondaparinux or comparing the effects of two of these anticoagulants in people with cancer and a CVC.Using a standardized form, we extracted data and assessed risk of bias. Outcomes included all-cause mortality, symptomatic catheter-related venous thromboembolism (VTE), pulmonary embolism (PE), major bleeding, minor bleeding, catheter-related infection, thrombocytopenia, and health-related
Asian patients versus non-Asian patients in the efficacy and safety of direct oral anticoagulants relative to vitamin K antagonist for venous thromboembolism: A systemic review and meta-analysis The standard for treatment and secondary prevention of venous thromboembolism (VTE) has been vitamin K antagonist (VKA), which might be associated with a higher risk of bleeding particularly in Asian patients. Direct oral anticoagulants (DOAC) have been shown to be safer alternatives for VTE. It remains
A clinical decision support tool for improving adherence to guidelines on anticoagulant therapy in patients with atrial fibrillation at risk of stroke: A cluster-randomized trial in a Swedish primary care setting (the CDS-AF study) Atrial fibrillation (AF) is associated with substantial morbidity, in particular stroke. Despite good evidence for the reduction of stroke risk with anticoagulant therapy, there remains significant undertreatment. The main aim of the current study was to investigate (...) for thromboembolism (according to the CHA2DS2-VASc algorithm) without anticoagulant therapy. The primary endpoint was adherence to guidelines after 1 year. After randomization, there were 22 and 21 primary care clinics in the CDS and control groups, respectively. There were no significant differences in baseline adherence to guidelines regarding anticoagulant therapy between the 2 groups (CDS group 70.3% [5,186/7,370; 95% CI 62.9%-77.7%], control group 70.0% [4,187/6,009; 95% CI 60.4%-79.6%], p = 0.83). After 12
Incident Risk Factors and Major Bleeding in Patients with Atrial Fibrillation Treated with Oral Anticoagulants: A Comparison of Baseline, Follow-up and Delta HAS-BLED Scores with an Approach Focused on Modifiable Bleeding Risk Factors When assessing bleeding risk in patients with atrial fibrillation (AF), risk stratification is often based on the baseline risks. We aimed to investigate changes in bleeding risk factors and alterations in the HAS-BLED score in AF patients. We hypothesized
Direct oral anticoagulant (DOAC) versus low-molecular-weight heparin (LMWH) for treatment of cancer associated thrombosis (CAT): A systematic review and meta-analysis It is unclear if direct oral anticoagulants (DOACs) are effective and safe alternatives to low-molecular-weight heparin (LMWHs) for the treatment of cancer-associated venous thromboembolism (VTE). We aim to synthesize existing literature that compared DOACs versus LMWHs in this high-risk population.We conducted a systematic review
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
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
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
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
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