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181. Acetylsalicylic acid for venous thromboembolism prophylaxis: an update of clinical evidence

indexing assigned by CRD MeSH Anticoagulants; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Aspirin; Postoperative Complications; Risk Factors; Salicylatess; Venous Thromboembolism; Warfarin Language Published English Country of organisation Canada Province or state Ontario English summary An English language summary is available. Address for correspondence Canadian Agency for Drugs and Technologies in Health (CADTH), 865 Carling Avenue, Suite 600, Ottawa, Ontario Canada, K1S 5S8

2014 Health Technology Assessment (HTA) Database.

182. Codeine and acetylsalicylic acid for the management of post-tonsillectomy or adenoidectomy pain: a review of the clinical evidence

and ASA combination for the management of pain following tonsillectomy or adenoidectomy. Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Adenoidectomy; Aspirin; Codeine; Humans; Pain Management; Tonsillectomy Language Published English Country of organisation Canada Province or state Ontario English summary An English language summary is available. Address for correspondence Canadian Agency for Drugs and Technologies in Health (CADTH), 865 Carling Avenue, Suite 600, Ottawa

2014 Health Technology Assessment (HTA) Database.

183. Cost-effectiveness of dabigatran for stroke prevention in non-valvular atrial fibrillation in Spain

risk factors. Interventions The three preventive regimens compared were dabigatran etexilate (150mg twice daily up to 80 years of age and 110mg thereafter), warfarin (a vitamin K antagonist), and the prescribing pattern observed in the authors’ setting (60% of patients receiving vitamin K antagonists, 30% taking aspirin, and 10% receiving no treatment). Location/setting Spain/secondary care. Methods Analytical approach: The analysis was based on a previously published Markov model that assessed (...) therapy (RE-LY) trial that included 18,113 patients and compared two blinded doses of dabigatran with warfarin (Connolly 2009 see Other Publications of Related Interest). Other trials or a meta-analysis of indirect comparisons were used for treatment effect of aspirin and no treatment. Demographical and mortality rates were taken from Spanish life tables. Some assumptions were also made and were clearly reported. Monetary benefit and utility valuations: Utility valuations had already been incorporated

2012 NHS Economic Evaluation Database.

184. Using stress testing to guide primary prevention of coronary heart disease among intermediate-risk patients: a cost-effectiveness analysis Full Text available with Trip Pro

% to 20%) and focused on use of non-invasive cardiac stress testing compared with other preventive strategies. Low prices for generic statins and aspirin made a strategy of treating all intermediate-risk men and women cost-effective when compared to testing strategies unless these increased adherence to statins and aspirin. The authors’ conclusions appear robust. Type of economic evaluation Cost-utility analysis Study objective The study examined the cost-effectiveness of various strategies (...) for the primary prevention of coronary heart disease in the general population of intermediate-risk individuals (10% to 20%). Analysis focused on the use of non-invasive cardiac stress testing, which was compared against other preventive strategies. Interventions The preventive strategies were: Treat-all strategy in which all patients were treated with high-density statins (men and women) and aspirin (men only) without undergoing stress testing. Test-and-treat strategy in which the initiation

2012 NHS Economic Evaluation Database.

186. Comparative effectiveness and cost-effectiveness of computed tomography screening for coronary artery calcium in asymptomatic individuals Full Text available with Trip Pro

levels (men also received low-dose aspirin). Location/setting USA/primary and secondary care. Methods Analytical approach: The analysis was based on a Markov model, with a lifetime horizon. The authors stated that it was carried out from the perspective of society. Effectiveness data: The clinical data were from relevant studies. The patients’ characteristics and the ability of CT screening to determine low, intermediate, and high risk came from a cohort study (the Rotterdam study) of 2,028 people (...) if there was a slight lack of synergy between drugs, if treatment adherence dropped below 58%, if the effect of aspirin therapy on CHD was reduced, if the cost of a CT scan was over $200, or if the risk of radiation-induced cancer increased more than 10-fold. In women, statin therapy was the best strategy if there was a slight lack of synergy between drugs. In men, CT screening was cost-effective in most simulations at a WTP threshold of $50,000 per QALY. In women, CT screening was cost-effective in less than 20

2012 NHS Economic Evaluation Database.

187. Comparative Effectiveness of Warfarin and Newer Oral Anticoagulants for the Long-term Prevention and Treatment of Arterial and Venous Thromboembolism

marked renal impairment, aspirin use of more than 100 to 165 mg, uncontrolled hypertension, prior stroke, significant anemia, and platelet count lower than 90,000 to 100,000. In the control groups, the percentage of time in the INR target range was 55 to 68 percent (median 66%). Table ES-1 summarizes the findings and SOE for each major outcome. In brief, newer anticoagulants were associated with a lower rate of all-cause mortality compared with warfarin (high SOE). Newer anticoagulants were also (...) percent of suitable patients with AF. 12-14 Guidelines on the management of AF from the American College of Cardiology/American Heart Association/ recommend treatment with aspirin or warfarin according to the degree of stroke risk, which can be estimated by the CHADS2 scoring system. 15 CHADS2 is a clinical score ranging from 0 to 6 used to predict the annual risk of stroke in individuals with chronic nonvalvular AF. Guidelines recommend aspirin for patients with a CHADS2 score of 0, aspirin

2012 Veterans Affairs Evidence-based Synthesis Program Reports

188. Effect of pharmacological therapies for stroke prevention on major gastrointestinal bleeding in patients with atrial fibrillation Full Text available with Trip Pro

-conducted review found that adjusted-dose vitamin K antagonists increased the risk of major gastrointestinal bleeding compared with placebo or aspirin when used for stroke prevention in atrial fibrillation patients; combining vitamin K antagonists with aspirin also increased this risk. The authors' findings are generally reliable but limited by the small number of trials and rarity of events. Authors' objectives To investigate the incidence of major gastrointestinal bleeding when using various (...) were eligible for inclusion. Eligible trials had to report the incidence of major gastrointestinal bleeding. Trials of patients with postoperative atrial fibrillation or valvular disease were excluded. The included trials evaluated the following agents: aspirin, clopidogrel, dabigatran, triflusal, vitamin K antagonists (adjusted-dose or low-intensity), warfarin (adjusted-dose or low-intensity) and ximelagatran. There were five placebo or control arms, nine aspirin (or triflusal or indoprofen) arms

2012 DARE.

189. Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis

drugs (all but study one used aspirin; clopidogrel and glycoprotein IIb/IIIa inhibitors were also frequently used). The authors did not state how many reviewers selected studies. Assessment of study quality Randomised controlled trials (RCTs) were assessed based on sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting, and other sources of bias. A global assessment of risk of bias was graded as being low, unclear, or high. A quality score (out

2012 DARE.

190. Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation: a Canadian payer perspective Full Text available with Trip Pro

, Bradley-Kennedy C, Plumb JM 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 investigated the cost-effectiveness of dabigatran etexilate versus warfarin (trial data) or usual care (warfarin, aspirin, or no treatment) for stroke (...) and health outcomes of the anticoagulant dabigatran etexilate, for the prevention of stroke and systemic embolism, in patients with atrial fibrillation. Interventions The interventions were dabigatran etexilate, warfarin (trial data), and usual care (real-world warfarin). The usual care consisted of prevention with warfarin or aspirin, or no treatment. This was examined using real-world data, with suboptimal therapeutic outcomes, according to those observed in clinical practice. The dose of dabigatran

2012 NHS Economic Evaluation Database.

191. Dabigatran etexilate versus warfarin in management of non-valvular atrial fibrillation in UK context: quantitative benefit-harm and economic analyses

and warfarin in patients with non-valvular atrial fibrillation who were at a moderate-to-high risk of stroke. Interventions The three preventive interventions were dabigatran 110mg twice daily, dabigatran 150mg twice daily, and warfarin. Patients who discontinued dabigatran because of a bleed or who discontinued warfarin for any reason were switched to aspirin. Patients who discontinued dabigatran for reasons other than bleeds were switched to warfarin. Location/setting UK/primary or secondary care

2012 NHS Economic Evaluation Database.

192. Cost-effectiveness of statin therapy for primary prevention in a low-cost statin era Full Text available with Trip Pro

Heart Disease Policy Model. American Journal of Public Health 1987; 77: 1417-1426. Gaspoz JM, Coxson PG, Goldman PA, Williams LW, Kuntz KM, Hunink MG, Goldman L. Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. New England Journal of Medicine 2002; 346: 1800-1806. Indexing Status Subject indexing assigned by NLM MeSH Adult; Aged; Cholesterol /blood; Coronary Disease /drug therapy /economics; Costs and Cost Analysis; Diabetes Mellitus /chemically

2012 NHS Economic Evaluation Database.

193. Comparison of efficacy and safety of dabigatran, rivaroxaban and apixaban in patients with atrial fibrillation using network meta-analysis

35 to 40. The use of aspirin ranged from 31 to 40%. Trials were published between 2009 and 2011. The percentage of patients with a CHADS2 score of three or more, ranged from 30 to 87, where reported. The authors did not state how many reviewers selected the trials. Assessment of study quality The authors did not state that they assessed trial quality, but they did discuss the quality of blinding and randomisation. Data extraction The data were extracted for stroke, systemic embolism

2012 DARE.

194. Cost-effectiveness of prasugrel in a US managed care population

reporting of clinical data and some methods mean that the conclusions should not be considered robust. Type of economic evaluation Cost-effectiveness analysis Study objective To compare the cost-effectiveness of two antiplatelet drugs in patients with acute coronary syndromes (ACS) who underwent percutaneous coronary intervention (PCI). Interventions The two comparators were daily prasugrel plus aspirin and daily clopidogrel plus aspirin. Location/setting USA/secondary prevention. Methods Analytical (...) , Cohen DJ, Meadows ES. Cost-effectiveness of prasugrel in a US managed care population. Journal of Medical Economics 2012; 15(1): 166-174 PubMedID DOI Original Paper URL Indexing Status Subject indexing assigned by NLM MeSH Acute Coronary Syndrome /drug therapy; Aged; Aspirin /therapeutic use; Cost Control; Cost-Benefit Analysis /methods; Drug Therapy, Combination /economics; Female; Humans; Interviews as Topic; Male; Managed Care Programs; Middle Aged; Models, Economic; Outcome Assessment (Health

2012 NHS Economic Evaluation Database.

195. Dual or mono antiplatelet therapy for patients with acute ischemic stroke or transient ischemic attack: systematic review and meta-analysis of randomized controlled trials Full Text available with Trip Pro

Randomised controlled trials (RCTs) that compared mono versus dual antiplatelet therapy in non-cardioembolic ischaemic stroke or transient ischaemic attack were eligible for inclusion. Trials had to include patients over 18 years of age recruited within three days of stroke/transient ischaemic attack onset. Most trials compared aspirin plus either clopidogrel or dipyridamole against aspirin alone. Dipyridamole and clopidogrel were also used as mono antiplatelet therapies. One study compared aspirin plus (...) dipyridamole versus aspirin versus dipyridamole. Treatment duration (where reported) ranged from seven days to 42 months. Most studies included patients with both ischaemic stroke or transient ischaemic attack. Patient age (where reported) ranged from 55 to 69 years (measure not reported). The percentage of male patients (where reported) ranged from 53% to 78%. Two authors selected studies for inclusion. Assessment of study quality The quality of trials was assessed for randomisation and allocation

2012 DARE.

196. Meta-analysis of statin effects in women versus men Full Text available with Trip Pro

cardiovascular disease and 5% to 63% were current smokers. Some trials were primary prevention and some were secondary prevention. Intervention treatments were lovastatin, pravastatin, atorvastatin, rosuvastatin and simvastatin. Doses ranged from 8.3mg and 320.0mg. Controls received placebo, usual care (not specified) or a smaller dose of a statin. Aspirin was administered to 57.6% patients. Primary endpoints of the included studies were reported in the review. The authors reported that the review followed (...) ) and men (OR 0.77, 95% CI 0.71 to 0.83). There was a non-significant trend towards greater benefit in men. Sensitivity analysis did not significantly alter the findings. Analyses by type of prevention, level of baseline risk and type of endpoint did not significantly alter the findings. Meta-regression indicated factors that may influence the observed differences between women and men: percentage of men, percentage with cardiovascular disease, percentage of smokers, percentage taking aspirin and mean

2012 DARE.

197. Treatment strategies for patients with peripheral artery disease

, preservation of walking and functional status, and prevention of amputation is not known. This review assessed the comparative effectiveness of antiplatelet therapy, medical therapy, exercise, and endovascular and surgical revascularization in PAD patients with intermittent claudication (IC) or critical limb ischemia (CLI). Authors' conclusions From a limited number of studies, it appears that aspirin has no benefit over placebo in the asymptomatic PAD patient; clopidogrel monotherapy is more beneficial (...) than aspirin in the IC patient; and DAPT is not significantly better than aspirin at reducing cardiovascular events in patients with IC or CLI. For IC patients, exercise therapy, cilostazol, and endovascular intervention all had an effect on improving functional status and quality of life; the impact of these therapies on cardiovascular events and mortality is uncertain. The comparisons of endovascular and surgical revascularization in CLI are primarily from observational studies

2013 Health Technology Assessment (HTA) Database.

198. Atrial fibrillation: medicines to help reduce your risk of a stroke ? what are the options?

be fatal, especially if it happens inside the brain or if it is not treated straight away. Atrial fibrillation: anticoagulant options decision aid Copyright © NICE 2014. All rights reserved. Last updated June 2014 Page 5 of 36 Aspirin In the past, some people with AF were offered aspirin to reduce their risk of having a stroke. Like anticoagulants, aspirin helps to prevent blood clots from forming and blocking blood vessels, but new evidence shows that it is much less effective at preventing ischaemic (...) strokes in people with AF than was previously thought. It is also more likely to cause major bleeding than was previously thought. Therefore NICE no longer recommends that people with AF should take aspirin just to reduce their risk of stroke. If you have been taking aspirin for this reason, you may be considering changing anticoagulant treatment. You might also be taking aspirin for another reason (for example, because you have had a heart attack in the past). If either of these situations applies

2014 Health Information and Quality Authority

199. Procedure site bleeding complications following percutaneous coronary interventions or angioplasty: a review of clinical evidence and guidelines

receiving prolonged post-procedural heparin compared with the patients not receiving post-procedural heparin following PCI. No relevant PCI studies on aspirin, clopidogrel, tenecteplase or bivulirudin and no relevant evidence-based guidelines regarding the management of procedure site bleeding complications following PCI were identified. Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Angioplasty, Balloon, Coronary; Hemorrhages; Myocardial Infarction; Postoperative Hemorrhage

2012 Health Technology Assessment (HTA) Database.

200. Antiplatelet and Anticoagulant Treatments for Unstable Angina/Non-?ST-Elevation Myocardial Infarction

from 0.69 to 0.80; in-hospital, 9 months, and 1 year) and nonfatal myocardial infarction (DAPT 2.3% to 5.8% vs. aspirin 3.0% to 8.5%; 9 months and 1 year) compared with single antiplatelet therapy (high SOE). Meta-analyses using adjusted or propensity-scored hazard ratios from observational studies showed an association between proton pump inhibitor (PPI) use (any type with dual antiplatelet use) and increased rates of composite ischemic endpoints, death, nonfatal myocardial infarction, stroke

2013 Effective Health Care Program (AHRQ)

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