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Latest & greatest articles for warfarin
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Preoperative discontinuation of Warfarin for dental surgery not indicated for most patients UTCAT2600, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Preoperative Discontinuation of Warfarin for Dental Surgery Not Indicated for Most Patients Clinical Question In patients being treated with warfarin, should anticoagulant treatment routinely be interrupted before undergoing dental extractions or is local hemostasis (...) an adequate method to reduce risk of excessive bleeding? Clinical Bottom Line Patients being therapeutically anti-coagulated with warfarin (at an International Normalized Ratio (INR) of less than 4), can undergo dental extractions without discontinuation of anticoagulant therapy considering proper local hemostatic measures are used. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Rodriguez-Cabrera/2011
An update of consensus guidelines for warfarin reversal An update of consensus guidelines for warfarin reversal | The Medical Journal of Australia mja-search search Use the for more specific terms. Title contains Body contains Date range from Date range to Article type Author's surname Volume First page doi: 10.5694/mja__.______ Search Reset close Individual Login Purchase options Connect person_outline Login keyboard_arrow_down Individual Login Purchase options menu search Advertisement (...) close An update of consensus guidelines for warfarin reversal Huyen A Tran, Sanjeev D Chunilal, Paul L Harper, Huy Tran, Erica M Wood and Alex S Gallus, on behalf of the Australasian Society of Thrombosis and Haemostasis Med J Aust 2013; 198 (4): 198-199. || doi: 10.5694/mja12.10614 Published online: 4 March 2013 Topics Abstract , Therefore, strategies to manage over-warfarinisation and warfarin during invasive procedures are important. , Despite the associated bleeding risk, warfarin remains
Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis Dabigatran etexilate, a new thrombin inhibitor, has been shown to be comparable to warfarin in patients with atrial fibrillation (AF). However, there is a limited body of evidence on the efficacy and safety of using dabigatran among patients undergoing AF catheter ablation.A random effects meta-analysis was performed of controlled trials (...) comparing dabigatran and warfarin in paroxysmal/persistent AF patients undergoing catheter ablation.Data sources included Medline, Embase, and Cochrane (from inception to April 2013). Three independent reviewers selected studies comparing warfarin to dabigatran. Descriptive and quantitative information was extracted from each selected study, regarding periprocedural all cause mortality, thromboembolic events and major bleeding, as well as modalities of periprocedural anticoagulation bridging.After
Dabigatran versus warfarin in patients with mechanical heart valves. Dabigatran is an oral direct thrombin inhibitor that has been shown to be an effective alternative to warfarin in patients with atrial fibrillation. We evaluated the use of dabigatran in patients with mechanical heart valves.In this phase 2 dose-validation study, we studied two populations of patients: those who had undergone aortic- or mitral-valve replacement within the past 7 days and those who had undergone (...) such replacement at least 3 months earlier. Patients were randomly assigned in a 2:1 ratio to receive either dabigatran or warfarin. The selection of the initial dabigatran dose (150, 220, or 300 mg twice daily) was based on kidney function. Doses were adjusted to obtain a trough plasma level of at least 50 ng per milliliter. The warfarin dose was adjusted to obtain an international normalized ratio of 2 to 3 or 2.5 to 3.5 on the basis of thromboembolic risk. The primary end point was the trough plasma level
Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism. Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear.In a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received heparin, to receive edoxaban at a dose of 60 mg once daily, or 30 mg once daily (e.g., in the case of patients with creatinine clearance (...) of 30 to 50 ml per minute or a body weight below 60 kg), or to receive warfarin. Patients received the study drug for 3 to 12 months. The primary efficacy outcome was recurrent symptomatic venous thromboembolism. The principal safety outcome was major or clinically relevant nonmajor bleeding.A total of 4921 patients presented with deep-vein thrombosis, and 3319 with a pulmonary embolism. Among patients receiving warfarin, the time in the therapeutic range was 63.5%. Edoxaban was noninferior
Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation Harrington AR, Armstrong EP, Nolan PE, Malone DC Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion (...) on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary This study evaluated the cost-effectiveness of new oral anticoagulants, for stroke prevention, in patients with nonvalvular atrial fibrillation, compared with warfarin. The authors concluded that the anticoagulants were more cost-effective than warfarin, and apixaban was preferred. The study
Warfarin initiation nomograms for venous thromboembolism. Venous thromboembolism (VTE) is a common condition in hospital patients. Considerable controversy is ongoing regarding optimal initial warfarin dosing for patients with acute deep venous thrombosis (DVT) and pulmonary embolism (PE). Achieving a therapeutic international normalized ratio (INR) with warfarin as soon as possible is important because this minimizes the duration of parenteral medication necessary to attain immediate (...) anticoagulation, and it potentially decreases the cost and inconvenience of treatment. Although a 5-mg loading-dose nomogram tends to prevent excessive anticoagulation, a 10-mg loading-dose nomogram may achieve a therapeutic INR more quickly.To evaluate the efficacy of a 10-mg warfarin nomogram compared with a 5-mg warfarin nomogram among patients with VTE.The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched January 2013) and the Cochrane
Genetic variants associated with warfarin dose in African-American individuals: a genome-wide association study. VKORC1 and CYP2C9 are important contributors to warfarin dose variability, but explain less variability for individuals of African descent than for those of European or Asian descent. We aimed to identify additional variants contributing to warfarin dose requirements in African Americans.We did a genome-wide association study of discovery and replication cohorts. Samples from African (...) -American adults (aged ≥18 years) who were taking a stable maintenance dose of warfarin were obtained at International Warfarin Pharmacogenetics Consortium (IWPC) sites and the University of Alabama at Birmingham (Birmingham, AL, USA). Patients enrolled at IWPC sites but who were not used for discovery made up the independent replication cohort. All participants were genotyped. We did a stepwise conditional analysis, conditioning first for VKORC1 -1639G→A, followed by the composite genotype of CYP2C9*2
Novel oral anticoagulants in atrial fibrillation: a meta-analysis of large, randomized, controlled trials vs warfarin Novel oral anticoagulants in atrial fibrillation: a meta-analysis of large, randomized, controlled trials vs warfarin Novel oral anticoagulants in atrial fibrillation: a meta-analysis of large, randomized, controlled trials vs warfarin Dogliotti A, Paolasso E, Giugliano RP CRD summary This review concluded that novel oral anticoagulants seemed to be superior to warfarin (...) , for reducing the composite of stroke or systemic embolism, lowering all-cause mortality, and halving the number of haemorrhagic strokes, in patients with atrial fibrillation. Despite some limitations to the trials and the review, the conclusions are likely to be reliable. Authors' objectives To compare novel oral anticoagulants and warfarin, to determine which is superior for preventing strokes or systemic emboli. Searching MEDLINE, EMBASE, and The Cochrane Library were searched, without language
Point-of-Care Testing of the International Normalized Ratio (INR) for Patients Taking Warfarin or Other Vitamin K Antagonists Point-of-Care Testing of the International Normalized Ratio (INR) for Patients Taking Warfarin or Other Vitamin K Antagonists | CADTH.ca Find the information you need Point-of-Care Testing of the International Normalized Ratio (INR) for Patients Taking Warfarin or Other Vitamin K Antagonists Point-of-Care Testing of the International Normalized Ratio (INR) for Patients (...) Taking Warfarin or Other Vitamin K Antagonists Published on: April 18, 2013 Project Number: OP0515 Product Line: Result type: Report CADTH has undertaken an optimal use project to assess the clinical and economic impact of point-of-care (POC) testing of the international normalized ratio (INR) for patients taking warfarin or other vitamin K antagonists. Patients with atrial fibrillation, prosthetic heart valves, or venous thromboembolism may be prescribed oral anticoagulation therapy (OAT
Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. Dabigatran, which is administered in a fixed dose and does not require laboratory monitoring, may be suitable for extended treatment of venous thromboembolism.In two double-blind, randomized trials, we compared dabigatran at a dose of 150 mg twice daily with warfarin (active-control study) or with placebo (placebo-control study) in patients with venous thromboembolism who had completed at least 3 initial months (...) of therapy.In the active-control study, recurrent venous thromboembolism occurred in 26 of 1430 patients in the dabigatran group (1.8%) and 18 of 1426 patients in the warfarin group (1.3%) (hazard ratio with dabigatran, 1.44; 95% confidence interval [CI], 0.78 to 2.64; P=0.01 for noninferiority). Major bleeding occurred in 13 patients in the dabigatran group (0.9%) and 25 patients in the warfarin group (1.8%) (hazard ratio, 0.52; 95% CI, 0.27 to 1.02). Major or clinically relevant bleeding was less frequent
Cost-effectiveness of clopidogrel plus aspirin for stroke prevention in patients with atrial fibrillation in whom warfarin is unsuitable Cost-effectiveness of clopidogrel plus aspirin for stroke prevention in patients with atrial fibrillation in whom warfarin is unsuitable Cost-effectiveness of clopidogrel plus aspirin for stroke prevention in patients with atrial fibrillation in whom warfarin is unsuitable Coleman CI, Straznitskas AD, Sobieraj DM, Kluger J, Anglade MW Record Status (...) atrial fibrillation, who were 65 years old, had a low risk of bleeding, and were unsuitable for warfarin. Patients had a Congestive heart failure, Hypertension, Age, Diabetes, and Stroke (CHADS 2 ) score of two. Interventions Clopidogrel, 75mg per day, plus aspirin, 75mg to 100mg per day, was compared with aspirin alone. Location/setting USA/out-patient secondary care. Methods Analytical approach: A Markov model was constructed of the ongoing risk of stroke, myocardial infarction and adverse events
Dabigatran Compared to Warfarin in the Reduction of Stroke Risk in Patients With Atrial Fibrillation "Dabigatran Compared to Warfarin in the Reduction of Stroke Risk in Pat" by Thomas S. Haslam < > > > > > Title Author Date of Graduation Summer 8-10-2013 Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies First Advisor James Ferguson, PA-C Second Advisor Annjanette Sommers, PA-C Rights . Abstract Background: Atrial fibrillation (AF) is the most common (...) cardiac arrhythmia. Presenting with a wide range of symptoms, this disease affects more than 2.66 million people in the United States. Arguably the most concerning complication faced by patients with AF, is the dramatically increased risk of stroke associated with this disease. Those with AF are five times more likely to suffer from a stroke than those without. This risk is partially mitigated by thinning the blood using anticoagulant medications. Warfarin, the most commonly used anticoagulant, has
Warfarin vs New Oral Anticoagulants (NOACs) in Non-valvular AFib Anticoagulation in Non-valvular 26 AFib www.RxFiles.ca COUMADIN PRADAXA XARELTO ELIQUIS LIXIANA SAVAYSA USA Warfarin Dabigatran 150mg Rivaroxaban Apixaban Edoxaban Stroke/Embolism ? 1 ??? 2 ?? 3 ??? 4 ??? 5 ICH X ? 6 ? 7 ? 8 ? 9 Major GI Bleed ? X 10 X 11 ? 12 X 13 Major Bleed ? ? 14 ? 15 ?? 16 ?? 17 Manage Bleed ? 14 ? 18 X? X? X? MI ? X? 19 -? -? -? DC Rate / Dyspepsia - X 20 /?GI - ? - Low renal fx (CrCl) ?? 21 CI 70%. 1 (...) ) Stroke/Embolism: absolute differences minimal when INR control with warfarin reasonable (TTR=>65%). 2) Stroke/Embolism: Dabi 150mg BID vs Warf; NNT=88/~2yr; ITT (no difference with 110mg BID dose, but less bleeding); open label RCT. (Study pop: renal fx 30+, adherence likely better than normal conditions, etc.) 3) Stroke/Embolism: Riva 20mg daily vs Warf; non-inferiority trial design (ITT analysis favoured Riva but did not achieve superiority); double-blind RCT. (Study pop: limitations similar to RE
RE?LY: Dabigatran versus Warfarin in Patients with Atrial Fibrillation RXFILES TRIAL SUMMARY ORIGINALLY PREPARED BY: Z.DUMONT, D.BUNKA. REVISED BY L.KOSAR – UPDATED AUG 2013 – WWW.RXFILES.CA Page 1 of 5 RE-LY: Dabigatran versus Warfarin in Patients with Atrial Fibrillation 1 Randomized Evaluation of Long-term anticoagulation therapY in patients with atrial fibrillation & who were at increased risk of stroke BOTTOM LINE In RE-LY, patients with atrial fibrillation (AF) (mean CHADS 2 score 2.1 (...) ): ? Dabigatran both doses had less hemorrhagic strokes & intracranial bleeds. ? Dabigatran 150mg po bid had: - less stroke/systemic embolism 1 ? endpoint, but more gastrointestinal (GI) bleeds compared to warfarin & dabigatran 110mg po bid - a better net clinical benefit compared to warfarin - more major bleeding than dabigatran 110mg po bid but similar to warfarin ? Dabigatran 110mg po bid was similar to warfarin for stroke & systemic embolism, but had less major bleeding than warfarin. - consider
A pharmacogenetic versus a clinical algorithm for warfarin dosing. The clinical utility of genotype-guided (pharmacogenetically based) dosing of warfarin has been tested only in small clinical trials or observational studies, with equivocal results.We randomly assigned 1015 patients to receive doses of warfarin during the first 5 days of therapy that were determined according to a dosing algorithm that included both clinical variables and genotype data or to one that included clinical variables (...) only. All patients and clinicians were unaware of the dose of warfarin during the first 4 weeks of therapy. The primary outcome was the percentage of time that the international normalized ratio (INR) was in the therapeutic range from day 4 or 5 through day 28 of therapy.At 4 weeks, the mean percentage of time in the therapeutic range was 45.2% in the genotype-guided group and 45.4% in the clinically guided group (adjusted mean difference, [genotype-guided group minus clinically guided group], -0.2
A randomized trial of genotype-guided dosing of warfarin. The level of anticoagulation in response to a fixed-dose regimen of warfarin is difficult to predict during the initiation of therapy. We prospectively compared the effect of genotype-guided dosing with that of standard dosing on anticoagulation control in patients starting warfarin therapy.We conducted a multicenter, randomized, controlled trial involving patients with atrial fibrillation or venous thromboembolism. Genotyping for CYP2C9 (...) *2, CYP2C9*3, and VKORC1 (-1639G→A) was performed with the use of a point-of-care test. For patients assigned to the genotype-guided group, warfarin doses were prescribed according to pharmacogenetic-based algorithms for the first 5 days. Patients in the control (standard dosing) group received a 3-day loading-dose regimen. After the initiation period, the treatment of all patients was managed according to routine clinical practice. The primary outcome measure was the percentage of time
Dabigatran versus Warfarin in Patients with Mechanical Heart Valves. Dabigatran is an oral direct thrombin inhibitor that has been shown to be an effective alternative to warfarin in patients with atrial fibrillation. We evaluated the use of dabigatran in patients with mechanical heart valves.In this phase 2 dose-validation study, we studied two populations of patients: those who had undergone aortic- or mitral-valve replacement within the past 7 days and those who had undergone (...) such replacement at least 3 months earlier. Patients were randomly assigned in a 2:1 ratio to receive either dabigatran or warfarin. The selection of the initial dabigatran dose (150, 220, or 300 mg twice daily) was based on kidney function. Doses were adjusted to obtain a trough plasma level of at least 50 ng per milliliter. The warfarin dose was adjusted to obtain an international normalized ratio of 2 to 3 or 2.5 to 3.5 on the basis of thromboembolic risk. The primary end point was the trough plasma level
Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in patients with atrial fibrillation and prior stroke or transient ischemic attack Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.