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Latest & greatest articles for anticoagulation
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Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. The European Atrial Fibrillation Trial Study Group. A number of studies have demonstrated the efficacy of oral anticoagulant therapy in reducing the risk of stroke and systemic embolism in patients with nonrheumatic atrial fibrillation. However, both the targeted and the actual levels of anticoagulation differed widely among the studies, and a number of studies failed to report (...) standardized prothrombin-time ratios as international normalized ratios (INRs). We therefore performed an analysis to determine the intensity of oral anticoagulant therapy in nonrheumatic atrial fibrillation that provides the best balance between the prevention of thromboembolism and the occurrence of bleeding complications.We calculated INR-specific incidence rates for both ischemic and major hemorrhagic events occurring in 214 patients who received anticoagulant therapy in the European Atrial
A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. Duration of Anticoagulation Trial Study Group. The optimal duration of oral anticoagulant therapy after a first episode of venous thromboembolism is still a matter of debate.We performed a multicenter trial comparing six weeks of oral anticoagulant treatment with six months of such therapy in patients who had a first episode of venous thromboembolism. Anticoagulant therapy (...) consisted of warfarin or dicumarol. Of the 902 patients enrolled, 5 were later excluded because they had congenital protein C deficiency; 443 were randomly assigned to receive six weeks of oral anticoagulant therapy with a targeted international normalized ratio (INR) of 2.0 to 2.85, and 454 were randomly assigned to receive six months of such therapy. The initial diagnoses were confirmed by means of venography in cases of deep-vein thromboses (n = 790) and with perfusion-ventilation scanning
Outcome analysis of a pharmacist-managed anticoagulation service Outcome analysis of a pharmacist-managed anticoagulation service Outcome analysis of a pharmacist-managed anticoagulation service Wilt V M, Gums J G, Ahmed O I, Moore L M 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. Health technology Prevention of complications, thromboembolic and haemorrhagic events, in patients receiving warfarin pharmacotherapy through monitoring by a pharmacist-managed anticoagulation service. Type of intervention Secondary prevention. Economic study type Cost-effectiveness analysis. Study population Family Practice Medical Group patients receiving warfarin therapy. Setting The study was carried out in a community based population served by the Family
Anticoagulation for stroke prevention in chronic non-valvular atrial fibrillation Anticoagulation for stroke prevention in chronic non-valvular atrial fibrillation Anticoagulation for stroke prevention in chronic non-valvular atrial fibrillation Green C J, Hadorn D, Kazanjian A Authors' objectives To assess the evidence concerning the outcomes associated with efforts to prevent the occurrence of stroke in patients with chronic non-valvular atrial fibrillation using warfarin sodium. Searching (...) MEDLINE was searched from 1987 to 1994 using the keywords: 'atrial fibrillation', 'anticoagulants', 'aspirin'). Reference lists of retrieved articles were sought. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) on the efficacy of warfarin sodium in the primary prevention of stroke in chronic non-valvular atrial fibrillation were included. Specific interventions included in the review The specific intervention was anticoagulation, i.e. warfarin
Efficacy and safety of combined anticoagulant and antiplatelet therapy versus anticoagulant monotherapy after mechanical heart-valve replacement: a metaanalysis Efficacy and safety of combined anticoagulant and antiplatelet therapy versus anticoagulant monotherapy after mechanical heart-valve replacement: a metaanalysis Efficacy and safety of combined anticoagulant and antiplatelet therapy versus anticoagulant monotherapy after mechanical heart-valve replacement: a metaanalysis Cappelleri J C (...) , Fiore L D, Brophy M T, Deykin D, Lau J Authors' objectives To compare the efficacy and safety of combined oral anticoagulant and antiplatelet therapy versus oral anticoagulants alone after prosthetic heart valve replacement. Searching MEDLINE was searched from January 1966 to September 1994 using the keywords 'heart valve prosthesis', 'anticoagulants' and 'antiplatelet agents'. The reference lists of retrieved papers, review articles, and editorials were examined. Only articles published in English
Antiarrhythmic prophylaxis vs warfarin anticoagulation to prevent thromboembolic events among patients with atrial fibrillation: a decision analysis Antiarrhythmic prophylaxis vs warfarin anticoagulation to prevent thromboembolic events among patients with atrial fibrillation: a decision analysis Antiarrhythmic prophylaxis vs warfarin anticoagulation to prevent thromboembolic events among patients with atrial fibrillation: a decision analysis Middlekauff H R, Stevenson W G, Gornbein J A Authors (...) , non-randomised trials were included, since no randomised placebo-controlled trials were found. Specific interventions included in the review Sinus rhythm maintenance with quinidine or amiodarone after cardioversion, or long-term anticoagulation with warfarin. Participants included in the review Patients with chronic or paroxysmal atrial fibrillation in a non-post-operative setting were included. Outcomes assessed in the review The outcomes assessed were successful restoration of sinus rhythm
Costs and effects of long-term oral anticoagulant treatment after myocardial infarction Costs and effects of long-term oral anticoagulant treatment after myocardial infarction Costs and effects of long-term oral anticoagulant treatment after myocardial infarction van Bergen P F, Jonker J J, van Hot B A, van Domburg R T, Deckers J W, Azar A J, Hofman A 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. Health technology Oral anticoagulant drug treatment programme, including monitoring as well as drugs administered. Type of intervention Secondary prevention. Economic study type Cost-effectiveness analysis. Study population Survivors of myocardial infarction, average age 61, 80% male. Setting Outpatient clinics. The economic study was carried
Effect of long-term oral anticoagulant treatment on mortality and cardiovascular morbidity after myocardial infarction. Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis (ASPECT) Research Group. The use of long-term oral anticoagulant treatment after myocardial infarction remains controversial because of conflicting findings on mortality in previous trials and the increased risk of bleeding associated with anticoagulants. We have carried out a randomised, placebo (...) -controlled, double-blind, multicentre trial in 3404 hospital survivors of myocardial infarction. Eligible patients were randomly assigned to anticoagulant (nicoumalone or phenprocoumon) or placebo treatment within 6 weeks of discharge. The target prothrombin time was 2.8-4.8 international normalised ratio. During mean follow-up of 37 (range 6-76) months there were 170 deaths among 1700 anticoagulant-treated patients and 189 in 1704 placebo-treated patients (hazard ratio 0.90 [95% CI 0.73-1.11
1994LancetControlled trial quality: predicted high
Anticoagulant therapy in the Nordic Countries Anticoagulant therapy in the Nordic Countries Anticoagulant therapy in the Nordic Countries Joergensen T, Jespersen J (eds) Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Joergensen T, Jespersen J (eds). Anticoagulant therapy in the Nordic Countries. Danish Institute for Health Services (...) Research (DSI). 1994 Authors' objectives Describe state-of-the-art in the Nordic Countries of the use of vitamin-K antagonists in anticoagulant therapy (ACT). Authors' conclusions Quality assurance programmes for ACT should be developed and implemented in clinical departments as well as in primary care. ACT should be concentrated on fewer hands in the clinical unit. Cooperation and communication between clinical departments, the primary health sector and laboratories should be improved. More patients
Management of heart failure - IV: anticoagulation for patients with heart failure due to left ventricular systolic dysfunction Management of heart failure - IV: anticoagulation for patients with heart failure due to left ventricular systolic dysfunction Management of heart failure - IV: anticoagulation for patients with heart failure due to left ventricular systolic dysfunction Baker D W, Wright R F Authors' objectives To review the effectiveness and associated risks of anticoagulation (...) in patients with heart failure. Searching MEDLINE and EMBASE were searched from 1966 to September 1993 using the search terms given. References from identified articles, textbooks and review articles were also examined. Study selection Study designs of evaluations included in the review Observational studies comparing treated and non-treated patients. Specific interventions included in the review Anticoagulation mainly involving the use of coumarin-based drugs. Participants included in the review Patients
Prevention of one-year vein-graft occlusion after aortocoronary-bypass surgery: a comparison of low-dose aspirin, low-dose aspirin plus dipyridamole, and oral anticoagulants. The CABADAS Research Group of the Interuniversity Cardiology Institute of The Ne Aspirin, alone or in combination with dipyridamole, is known to prevent occlusion of aortocoronary vein grafts. The benefit of dipyridamole in addition to aspirin remains controversial, and the efficacy and safety of oral anticoagulants (...) for prevention of vein-graft occlusion have not been established. We assessed one-year angiographic vein-graft patency after aortocoronary-bypass surgery in 948 patients assigned to receive aspirin, aspirin plus dipyridamole, or oral anticoagulants in a prospective, randomised trial. The design was double-blind and placebo-controlled for the aspirin groups, but open for oral anticoagulant treatment. Dipyridamole (5 mg/kg per 24 h intravenously for 28 h, followed by 200 mg twice daily) and oral anticoagulants
1993LancetControlled trial quality: predicted high
Optimum duration of anticoagulation for deep-vein thrombosis and pulmonary embolism. Research Committee of the British Thoracic Society. The optimum duration of anticoagulation therapy for deep-vein thrombosis (DVT) and pulmonary embolism (PE) is not clear. We have carried out a multicentre comparison of 4 weeks' and 3 months' anticoagulation in patients admitted to hospital with acute DVT, PE, or both. Of 712 patients enrolled, 358 were assigned 4 weeks' treatment and 354 3 months'. Objective (...) the rate of treatment failure and recurrence was low (2.6%) and there was little difference between the treatment groups. By contrast, among medical patients the rate was 12.8%, with a clear difference in favour of 3 months' treatment. If venous thromboembolism arises after surgery, 4 weeks of anticoagulation should be adequate. In other settings, patients with new DVT, PE, or both, who do not have a persisting underlying cause or risk factor should receive anticoagulants for 3 months.
Trial of different intensities of anticoagulation in patients with prosthetic heart valves. We compared the efficacy and complications of anticoagulation with warfarin in 258 patients with prosthetic heart valves treated with regimens of "moderate intensity" (prothrombin-time ratio, 1.5; international normalized ratio, 2.65) or "high intensity" (prothrombin-time ratio, 2.5; international normalized ratio, 9) in a prospective, randomized study. The two patient groups were followed up for 421 (...) , as compared with 10.1 episodes in the high-intensity group (P less than 0.01). Major bleeding was also more common in the high-intensity group (2.1 episodes per 100 patient-years--including the only two fatal hemorrhages--as compared with 0.95 episode in the moderate-intensity group), but the difference was not statistically significant. We conclude that a moderate anticoagulant effect (prothrombin-time ratio, about 1.5) in patients with a mechanical prosthetic heart valve offers protection equivalent
The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. Nonrheumatic atrial fibrillation increases the risk of stroke, presumably from atrial thromboemboli. There is uncertainty about the efficacy and risks of long-term warfarin therapy to prevent stroke.We conducted an unblinded, randomized, controlled trial of long-term, low-dose warfarin therapy (target prothrombin
Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. We carried out a placebo-controlled, double-blind, randomized study of the hemostatic effect of tranexamic acid mouthwash after oral surgery in 39 patients receiving anticoagulant agents because of the presence of cardiac valvular stenosis, a prosthetic cardiac valve, or a vascular prosthesis. Surgery was performed with no change in the level of anticoagulant therapy, and treatment (...) with the anticoagulant agent was continued after surgery. Before it was sutured, the operative field was irrigated in 19 patients with 10 ml of a 4.8 percent aqueous solution of tranexamic acid (an inhibitor of fibrinolysis) and in 20 patients with a placebo solution. For seven days thereafter, patients were instructed to rinse their mouths with 10 ml of the assigned solution for two minutes four times a day. There were no significant differences between the two treatment groups in base-line variables, including
Trial of low-dose aspirin plus dipyridamole versus anticoagulants for prevention of aortocoronary vein graft occlusion. In a prospective randomised trial, 249 patients who had aortocoronary vein bypass surgery were assigned either to a platelet inhibitory drug regimen or to standard anticoagulant therapy. Treatment was replaced by placebo in half of the patients in each group after 3 months. The platelet inhibitory drug regimen--very low-dose aspirin combined with dipyridamole--was as effective (...) as standard anticoagulant therapy to prevent early and late graft occlusion. Death, myocardial infarction, and severe bleeding occurred significantly more often in patients receiving anticoagulants, whereas mild drug-related gastrointestinal and cerebral side-effects were more common in patients taking platelet inhibitory drugs. Antithrombotic treatment should be continued for at least 1 year after coronary artery bypass graft surgery.
Randomised comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. After tissue heart valve replacement 108 patients were randomised to standard anticoagulant control with rabbit brain thromboplastin (Dade C reagent, therapeutic range 18-24 s; international normalised ratio 2.5-40) and 102 to a less intensive regimen controlled with human brain thromboplastin (Manchester Comparative Reagent, therapeutic range 26-30 s; INR 2.0-2.25). Treatment (...) complications, all were in the standard treatment group, again a significant difference. The less intensive regimen is thus no less effective and safer than standard anticoagulant therapy in patients with tissue heart valve replacement.
Influence of postoperative anticoagulant treatment on patient survival after femoropopliteal vein bypass surgery. To examine whether anticoagulants given after autologous saphenous bypass surgery influenced patient survival 119 patients who received such a graft for obliterative arterial disease were recruited for a controlled clinical trial. Patients were randomly assigned to start, in the second postoperative week, phenprocoumon (60 patients) or no treatment (59 patients). The median duration
Is a controlled trial of long-term oral anticoagulants in patients with stroke and non-rheumatic atrial fibrillation worthwhile? A controlled randomised trial large enough to assess the value of anticoagulating stroke patients in atrial fibrillation would be difficult to conduct in the UK and the results would be applicable to only a small proportion of stroke patients. It would be more worthwhile to organise a trial that also assessed the value of other treatments that are simpler (...) and applicable to all stroke patients. A trial that assessed the value of aspirin and beta-blockers against control in all stroke patients would not cost much more than one restricted to comparing anticoagulants against control in patients with stroke and atrial fibrillation but would provide information of more relevance to the management of patients with stroke in the UK.
Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis. The need for oral anticoagulation in patients with calf-vein thrombosis was examined in a randomised study of 51 patients, of whom 23 received warfarin for 3 months and 28 did not. Both groups received an initial course of heparin and all wore compression stockings. Progress was monitored by the use of serial isotope tests and physical examination. Phlebography was repeated if recurrence was suspected. During (...) the first 3 months, 8 patients in the non-warfarin group (29%) had recurrences compared with none in the warfarin group (p less than 0.01). 5 patients had recurrence with proximal extension and 1 patient had a pulmonary embolus. After 1 year, 22 out of 23 patients in the warfarin group had not had a recurrence, compared with 19 out of 28 (p less than 0.02). The findings indicate that oral anticoagulants should be given to all patients with thrombi that produce symptoms. Treatment for 3 months seems