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Latest & greatest articles for warfarin
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Warfarin, kidney dysfunction, and outcomes following acute myocardial infarction in patients with atrial fibrillation. Conflicting evidence exists regarding the association between warfarin treatment, death, and ischemic stroke incidence in patients with advanced chronic kidney disease (CKD) and atrial fibrillation.To study outcomes associated with warfarin treatment in relation to kidney function among patients with established cardiovascular disease and atrial fibrillation.Observational (...) , prospective, multicenter cohort study from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry (2003-2010), which includes all Swedish hospitals that provide care for acute cardiac diseases. Participants included consecutive survivors of an acute myocardial infarction (MI) with atrial fibrillation and known serum creatinine (N = 24,317), including 21.8% who were prescribed warfarin at discharge
High-sensitivity troponin T and risk stratification in patients with atrial fibrillation during treatment with apixaban or warfarin The aim of this study was to evaluate the prognostic value of high-sensitivity troponin T (hs-TnT) in addition to clinical risk factors and the CHA2DS2VASc (congestive heart failure, hypertension, 75 years of age and older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, 65 to 74 years of age, female) risk score in patients (...) with atrial fibrillation (AF).The level of troponin is a powerful predictor of cardiovascular events and mortality.A total of 14,897 patients with AF were randomized to treatment with apixaban or warfarin in the ARISTOTLE (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation) trial. The associations between baseline hs-TnT levels and outcomes were evaluated using adjusted Cox regression models.Levels of hs-TnT were measurable in 93.5% of patients; 75% had levels >7.5 ng/l, 50% had
Low-molecular weight heparins versus warfarin for the long-term prevention or treatment of deep vein thrombosis or pulmonary embolism: a review of the clinical and cost-effectiveness Low-molecular weight heparins versus warfarin for the long-term prevention or treatment of deep vein thrombosis or pulmonary embolism: a review of the clinical and cost-effectiveness Low-molecular weight heparins versus warfarin for the long-term prevention or treatment of deep vein thrombosis or pulmonary embolism (...) : a review of the clinical and cost-effectiveness CADTH 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 CADTH. Low-molecular weight heparins versus warfarin for the long-term prevention or treatment of deep vein thrombosis or pulmonary embolism: a review of the clinical and cost-effectiveness. Ottawa: Canadian Agency for Drugs and Technologies
Warfarin USE OF WARFARIN IN PREGNANCY 0344 892 0909 USE OF WARFARIN IN PREGNANCY (Date of issue: December 2017 , Version: 3 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . Summary Warfarin is a coumarin anticoagulant and vitamin K antagonist which acts by inhibiting clotting factors II, VII, IX and X. It is indicated (...) for: the prevention of systemic embolism in patients with rheumatic heart disease and atrial fibrillation, prophylaxis after insertion of prosthetic heart valves, prophylaxis and treatment of venous thrombosis and pulmonary embolism, and treatment of transient cerebral ischaemic attacks. Fetal warfarin syndrome (FWS) or warfarin embryopathy, characterised by nasal hypoplasia and skeletal abnormalities, including short limbs and digits, and stippled epiphyses, is a well-recognised complication of first trimester
Edoxaban versus Warfarin in Patients with Atrial Fibrillation. Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known.We conducted a randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation (median follow-up, 2.8 years). The primary (...) efficacy end point was stroke or systemic embolism. Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period. The principal safety end point was major bleeding.The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P<0.001 for noninferiority) and 1.61% with low-dose edoxaban
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
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
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
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