Latest & greatest articles for warfarin

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Top results for warfarin

81. Warfarin Therapy Management

Warfarin Therapy Management Guidelines & Protocols Advisory Committee Warfarin Therapy Management Effective Date: April 1, 2015 Scope This guideline provides recommendations for the long-term management of warfarin therapy in patients aged =19 years in the primary care setting. The guideline describes: 1) warfarin initiation, 2) international normalized ratio (INR) monitoring with optimal ranges, and 3) warfarin dosage adjustment. This guideline assumes the physician has reviewed (...) the indications for warfarin and the duration of therapy as these are not discussed in this guideline. Perioperative management of warfarin is covered in the BCGuidelines.ca – Warfarin Therapy – Management During Invasive Procedures and Surgery. This guideline is part of the BCGuidelines.ca – Stroke and Atrial Fibrillation series. The series includes three other guidelines: Stroke and Transient Ischemic Attack – Acute and Long-Term Management; Atrial Fibrillation – Diagnosis and Management; and Use of Non

2015 Clinical Practice Guidelines and Protocols in British Columbia

82. Warfarin Therapy - Management During Invasive Procedures and Surgery

Warfarin Therapy - Management During Invasive Procedures and Surgery Guidelines & Protocols Advisory Committee Warfarin Therapy – Management During Invasive Procedures and Surgery Effective Date: April 1, 2015 Scope This guideline provides recommendations for the management of warfarin therapy in adults aged = 19 years requiring invasive procedures and surgery. Perioperative management of non-vitamin K antagonist oral anticoagulants can be found in BCGuidelines.ca – Use of NOACs in Non-Valvular (...) Atrial Fibrillation. Non-perioperative management of warfarin is covered in BCGuidelines.ca – Warfarin Therapy Management. Key Recommendations • Warfarin discontinuation prior to invasive procedures is necessary for all interventional procedures except for minor skin procedures, routine dental work, cataract surgery, endoscopies without biopsy, and percutaneous venous access. • For elective procedures, warfarin should be stopped for 5 to 6 days prior to the procedure to allow gradual normalization

2015 Clinical Practice Guidelines and Protocols in British Columbia

83. Meta-analysis of Randomized Controlled Trials of Genotype-Guided vs Standard Dosing of Warfarin (PubMed)

Meta-analysis of Randomized Controlled Trials of Genotype-Guided vs Standard Dosing of Warfarin Warfarin is a widely prescribed anticoagulant, and its effect depends on various patient factors including genotypes. Randomized controlled trials (RCTs) comparing genotype-guided dosing (GD) of warfarin with standard dosing have shown mixed efficacy and safety outcomes. We performed a meta-analysis of all published RCTs comparing GD vs standard dosing in adult patients with various indications (...) of warfarin use.We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and relevant references for English language RCTs (inception through March 2014). We performed the meta-analysis using a random effects model.Ten RCTs with a total of 2,505 patients were included in the meta-analysis. GD compared with standard dosing resulted in a similar % time in therapeutic range (TTR) at ≤ 1 month follow-up (39.7% vs 40.2%; mean difference [MD], -0.52 [95% CI, -3.15 to 2.10]; P = .70

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2015 EvidenceUpdates

84. Report in Brief - Optimal Warfarin Management for Prevention of Thromboembolic Events in Patients with Atrial Fibrillation

Report in Brief - Optimal Warfarin Management for Prevention of Thromboembolic Events in Patients with Atrial Fibrillation Warfarin Management for Thromboembolic Events in Atrial Fibrillation | CADTH.ca Find the information you need Warfarin Management for Thromboembolic Events in Atrial Fibrillation Warfarin Management for Thromboembolic Events in Atrial Fibrillation Published on: August 15, 2011 Project Number: OP0508 Product Line: Result type: Report Warfarin has been the mainstay of oral (...) anticoagulant therapy for more than 60 years. The effectiveness of warfarin for the prevention of stroke in patients with atrial fibrillation is well established. In Canada, an estimated 200,000 to 250,000 people have this condition. Need for Recommendations Managing warfarin therapy is challenging because warfarin interacts with many foods and other drugs. Each patient needs an individualized warfarin dose, which takes time to determine and requires patients to go in for frequent laboratory testing

2015 CADTH - Optimal Use

85. COMPUS Expert Review Committee (CERC) – Warfarin

COMPUS Expert Review Committee (CERC) – Warfarin COMPUS Expert Review Committee (CERC) – Warfarin | CADTH.ca Find the information you need COMPUS Expert Review Committee (CERC) – Warfarin COMPUS Expert Review Committee (CERC) – Warfarin Published on: March 19, 2015 Result type: Report Chair Participating CERC Members Public Members Specialist Members (backup for Dr. Agnes Lee and sharing votes) Chair Lisa Dolovich , BScPhm, PharmD, MSc Dr. Lisa Dolovich is an academic pharmacist with a primary

2015 CADTH - Optimal Use

86. Warfarin Management for Thromboembolic Events in Atrial Fibrillation

Warfarin Management for Thromboembolic Events in Atrial Fibrillation Warfarin Management for Thromboembolic Events in Atrial Fibrillation | CADTH.ca Find the information you need Warfarin Management for Thromboembolic Events in Atrial Fibrillation Warfarin Management for Thromboembolic Events in Atrial Fibrillation Published on: August 15, 2011 Project Number: OP0508 Product Line: Result type: Report Warfarin has been the mainstay of oral anticoagulant therapy for more than 60 years (...) . The effectiveness of warfarin for the prevention of stroke in patients with atrial fibrillation is well established. In Canada, an estimated 200,000 to 250,000 people have this condition. Need for Recommendations Managing warfarin therapy is challenging because warfarin interacts with many foods and other drugs. Each patient needs an individualized warfarin dose, which takes time to determine and requires patients to go in for frequent laboratory testing of their blood to monitor their international normalized

2015 CADTH - Optimal Use

87. Tinzaparin vs Warfarin for Treatment of Acute Venous Thromboembolism in Patients With Active Cancer: A Randomized Clinical Trial. (PubMed)

Tinzaparin vs Warfarin for Treatment of Acute Venous Thromboembolism in Patients With Active Cancer: A Randomized Clinical Trial. Low-molecular-weight heparin is recommended over warfarin for the treatment of acute venous thromboembolism (VTE) in patients with active cancer largely based on results of a single, large trial.To study the efficacy and safety of tinzaparin vs warfarin for treatment of acute, symptomatic VTE in patients with active cancer.A randomized, open-label study with blinded (...) contraindications for anticoagulation, were followed up for 180 days and for 30 days after the last study medication dose for collection of safety data.Tinzaparin (175 IU/kg) once daily for 6 months vs conventional therapy with tinzaparin (175 IU/kg) once daily for 5 to 10 days followed by warfarin at a dose adjusted to maintain the international normalized ratio within the therapeutic range (2.0-3.0) for 6 months.Primary efficacy outcome was a composite of centrally adjudicated recurrent DVT, fatal or nonfatal

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2015 JAMA

88. Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical Evidence

Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical Evidence Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical Evidence | CADTH.ca Find the information you need Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical (...) Evidence Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical Evidence Published on: August 20, 2012 Product Line: , CADTH Technology Overviews Issue: Volume 2, Issue 3 Result type: Report Adapted from . [Optimal Use Report; Volume 1, Issue 2A]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2011. For more information on this project, visit Introduction Atrial fibrillation (AF) is the most common

2015 CADTH - Health Technology Assessment

89. Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical Evidence

Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical Evidence Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical Evidence | CADTH.ca Find the information you need Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical (...) Evidence Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical Evidence Published on: August 20, 2012 Product Line: , CADTH Technology Overviews Issue: Volume 2, Issue 3 Result type: Report Adapted from . [Optimal Use Report; Volume 1, Issue 2A]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2011. For more information on this project, visit Introduction Atrial fibrillation (AF) is the most common

2015 CADTH - Health Technology Assessment

90. Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin (PubMed)

Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin We sought to assess the performance of existing bleeding risk scores, such as the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score or the Outpatient Bleeding Risk Index (OBRI), in patients with heart failure with reduced ejection fraction (...) (HFrEF) in sinus rhythm (SR) treated with warfarin or aspirin. We calculated HAS-BLED and OBRI risk scores for 2,305 patients with HFrEF in SR enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. Proportional hazards models were used to test whether each score predicted major bleeding, and comparison of different risk scores was performed using Harell C-statistic and net reclassification improvement index. For the warfarin arm, both scores predicted bleeding risk

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2015 EvidenceUpdates

91. Impact of polymorphisms of the GGCX gene on maintenance warfarin dose in Chinese populations: Systematic review and meta-analysis. (PubMed)

Impact of polymorphisms of the GGCX gene on maintenance warfarin dose in Chinese populations: Systematic review and meta-analysis. The meta-analysis was conducted to investigate the impact of gamma-glutamyl carboxylase (GGCX) on maintenance warfarin dose. 8 studies were included, focusing on the impact of GGCX single nucleotide polymorphisms (SNPs) on mean daily warfarin dose (MDWD). GGCX (rs699664; AA versus GG, GA versus GG, A versus GG) and GGCX (rs12714145; GA versus GG, AA versus GG (...) , A versus GG) showed no significant differences on mean daily warfarin dose (MDWD). This meta-analysis was the first to report the relationship between GGCX SNPs and MDWD in Chinese populations. No evidence could be found in the relationship between SNPs of GGCX (rs699664 and rs12714145) and maintenance warfarin dose.

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2015 Meta gene

92. Bleeding, Recurrent Venous Thromboembolism, and Mortality Risks During Warfarin Interruption for Invasive Procedures (PubMed)

Bleeding, Recurrent Venous Thromboembolism, and Mortality Risks During Warfarin Interruption for Invasive Procedures The risk of bleeding and recurrent venous thromboembolism (VTE) among patients receiving long-term warfarin sodium therapy for secondary VTE prevention who require temporary interruption of anticoagulant therapy for surgery or invasive diagnostic procedures has not been adequately described.To describe the rates of clinically relevant bleeding and recurrent VTE among patients (...) in whom warfarin therapy is interrupted for invasive procedures and compare these rates among patients who did and did not receive bridge therapy.A retrospective cohort study was conducted at Kaiser Permanente Colorado, an integrated health care delivery system. Patients in whom warfarin therapy was interrupted for invasive diagnostic or surgical procedures between January 1, 2006, and March 31, 2012, were identified via queries of administrative data sets. A total of 1812 procedures in 1178 patients

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2015 EvidenceUpdates

93. Comparison of the Usefulness of Enoxaparin Versus Warfarin for Prevention of Left Ventricular Mural Thrombus After Anterior Wall Acute Myocardial Infarction (PubMed)

Comparison of the Usefulness of Enoxaparin Versus Warfarin for Prevention of Left Ventricular Mural Thrombus After Anterior Wall Acute Myocardial Infarction Left ventricular (LV) thrombus is one of the most common complications in patients with anterior acute myocardial infarction (AMI) and LV dysfunction. Although anticoagulation is frequently prescribed, data regarding the appropriate drug, duration, risks, and effect on echocardiographic indices of thrombus are lacking. Moreover, given (...) the difficulty in obtaining adequate anticoagulation with warfarin, it is possible that short-term treatment with a more predictable agent would be effective. We randomized 60 patients at high risk of developing LV mural thrombus (anterior acute myocardial infarction with Q waves and ejection fraction≤40%) to receive either enoxaparin 1 mg/kg (maximum 100 mg) subcutaneously every 12 hours for 30 days or traditional anticoagulation (intravenous heparin followed by oral warfarin for 3 months). Clinical

2015 EvidenceUpdates

94. Genetics and the clinical response to warfarin and edoxaban: findings from the randomised, double-blind ENGAGE AF-TIMI 48 trial. (PubMed)

Genetics and the clinical response to warfarin and edoxaban: findings from the randomised, double-blind ENGAGE AF-TIMI 48 trial. Warfarin is the most widely used oral anticoagulant worldwide, but serious bleeding complications are common. We tested whether genetic variants can identify patients who are at increased risk of bleeding with warfarin and, consequently, those who would derive a greater safety benefit with a direct oral anticoagulant rather than warfarin.ENGAGE AF-TIMI 48 (...) was a randomised, double-blind trial in which patients with atrial fibrillation were assigned to warfarin to achieve a target international normalised ratio of 2·0-3·0, or to higher-dose (60 mg) or lower-dose (30 mg) edoxaban once daily. A subgroup of patients was included in a prespecified genetic analysis and genotyped for variants in CYP2C9 and VKORC1. The results were used to create three genotype functional bins (normal, sensitive, and highly sensitive responders to warfarin). This trial is registered

2015 Lancet

95. Warfarin: Point-of-Care INR Monitoring

Warfarin: Point-of-Care INR Monitoring © 2015 Thrombosis Canada Page 1 of 3 WARFARIN: POINT-OF-CARE INR MONITORING OBJECTIVE: To provide an overview of point-of-care (POC) international normalized ratio (INR) monitoring. BACKGROUND: A POC device is a small portable instrument that measures clotting time from a fingerstick blood sample. Most POC devices report the result as an INR. POC INR devices vary in their ease of use due to: differences in blood sample volume required, the technique (...) of application of the blood sample to the meter, the need for external quality control testing, refrigeration of test strips, and meter portability. HOW ARE POC DEVICES USED? For both adults and children, use of a POC INR device provides a simple and convenient way to manage warfarin anticoagulation in both the office / clinic setting and at home. The POC INR device requires a drop of blood in order to produce an INR result within one minute. This enables timely warfarin dose adjustments and allows prompt

2015 Thrombosis Interest Group of Canada

96. Warfarin: Management of Out-of-Range INRs

Warfarin: Management of Out-of-Range INRs © 2015 Thrombosis Canada Page 1 of 6 WARFARIN: MANAGEMENT OF OUT-OF-RANGE INRS OBJECTIVE: To provide practical strategies supported by the best available evidence for managing out-of- range international normalized ratios (INRs) for patients on long-term warfarin therapy. BACKGROUND: ? Warfarin can be challenging to manage due to its narrow therapeutic range, variable dose- response among different patients and common interactions with drugs, diet (...) and other factors. ? In patients who are taking warfarin, thromboembolic events and bleeding are strongly related to the time in therapeutic range (TTR). This is the proportion of treatment time that the INR is within the target therapeutic range (typically 2.0 to 3.0). ? Clinicians may underdose warfarin due to a perceived greater risk of harm from bleeding associated with supratherapeutic INR values. However, subtherapeutic anticoagulation has been shown to increase the frequency and severity

2015 Thrombosis Interest Group of Canada

97. Warfarin: Common Causes and Management Strategies for High INRs

Warfarin: Common Causes and Management Strategies for High INRs © 2015 Thrombosis Canada Page 1 of 3 WARFARIN: COMMON CAUSES AND MANAGEMENT STRATEGIES FOR HIGH INRS OBJECTIVE: To provide a summary of the most common causes of and management strategies for high international normalized ratios (INRs) for patients on long-term warfarin therapy. COMMON CAUSES OF HIGH INRS MANAGEMENT STRATEGIES DRUG INTERACTIONS ? Temporary drug interaction: temporary warfarin hold or dose reduction ? Chronic drug (...) interaction: reduce maintenance dose and increase frequency of INR tests until new stable INR is acheived ? Although many drugs may interact with warfarin, avoidance of either warfarin or the interacting drug is usually not required ALTERED HEALTH STATES ? Fever, acute illness, diarrhea, reduced food intake ? Uncontrolled hyperthyroidism ? CHF exacerbation ? Temporarily reduce the dose and increase the frequency of INR testing until the patient’s health stabilizes MALNUTRITION ? (vitamin K deficiency

2015 Thrombosis Interest Group of Canada

98. Edoxaban vs. warfarin in vitamin K antagonist experienced and naive patients with atrial fibrillation (PubMed)

Edoxaban vs. warfarin in vitamin K antagonist experienced and naive patients with atrial fibrillation Edoxaban is an oral, once-daily factor Xa inhibitor that is non-inferior to well-managed warfarin in patients with atrial fibrillation (AF) for the prevention of stroke and systemic embolic events (SEEs). We examined the efficacy and safety of edoxaban vs. warfarin in patients who were vitamin K antagonist (VKA) naive or experienced.ENGAGE AF-TIMI 48 randomized 21 105 patients with AF (...) at moderate-to-high risk of stroke to once-daily edoxaban vs. warfarin. Subjects were followed for a median of 2.8 years. The primary efficacy endpoint was stroke or SEE. As a pre-specified subgroup, we analysed outcomes for those with or without prior VKA experience (>60 consecutive days). Higher-dose edoxaban significantly reduced the risk of stroke or SEE in patients who were VKA naive [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.56-0.90] and was similar to warfarin in the VKA experienced

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2015 EvidenceUpdates

99. The association between kidney function and major bleeding in older adults with atrial fibrillation starting warfarin treatment: population based observational study. (PubMed)

The association between kidney function and major bleeding in older adults with atrial fibrillation starting warfarin treatment: population based observational study. To determine rates of major bleeding by level of kidney function for older adults with atrial fibrillation starting warfarin.Retrospective cohort study.Community based, using province wide laboratory and administrative data in Alberta, Canada.12,403 adults aged 66 years or more, with atrial fibrillation who started warfarin (...) bleeding (intracranial, upper and lower gastrointestinal, or other).Of 12,403 participants, 45% had an eGFR <60 mL/min/1.73 m(2). Overall, 1443 (11.6%) experienced a major bleeding episode over a median follow-up of 2.1 (interquartile range: 1.0-3.8) years. During the first 30 days of warfarin treatment, unadjusted and adjusted rates of major bleeding were higher at lower eGFR (P for trend <0.001 and 0.001, respectively). Adjusted bleeding rates per 100 person years were 63.4 (95% confidence interval

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2015 BMJ

100. Cohort study: Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin to dabigatran increased their rate of recurrent stroke/transient ischaemic attack compared with those on warfarin

Cohort study: Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin to dabigatran increased their rate of recurrent stroke/transient ischaemic attack compared with those on warfarin Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin to dabigatran increased their rate of recurrent stroke/transient ischaemic attack compared with those on warfarin | BMJ Evidence (...) OR managers of institutional accounts Username * Password * your user name or password? You are here Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin to dabigatran increased their rate of recurrent stroke/transient ischaemic attack compared with those on warfarin Article Text Aetiology/Harm Cohort study Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin

2015 Evidence-Based Medicine (Requires free registration)