Osteoporotic Fractures in Patients With Atrial Fibrillation Treated With Conventional Versus Direct Anticoagulants Elderly patients in long-term treatment with vitamin K antagonists (VKAs) are at high risk of osteoporotic fractures compared with the background population. It has been speculated that the choice of oral anticoagulant (OAC) may affect the risk of osteoporotic fractures.The risk of osteoporotic fractures was evaluated among patients with atrial fibrillation treated with VKA (...) or direct oral anticoagulants (DOACs).Patients were identified using the Danish national registries. Patients were included only if they had no prior use of osteoporosis medication and they had undergone 180 days of OAC treatment. Outcomes were hip fracture, major osteoporotic fracture, any fracture, initiation of osteoporosis medication, and a combined endpoint.Overall, 37,350 patients were included. The standardized absolute 2-year risk of any fracture was low among DOAC-treated patients (3.1%; 95% CI

Association of Anticoagulant Therapy With Risk of Fracture Among Patients With Atrial Fibrillation Warfarin is prescribed to patients with atrial fibrillation (AF) for the prevention of cardioembolic complications. Whether warfarin adversely affects bone health is controversial. The availability of alternate direct oral anticoagulant (DOAC) options now make it possible to evaluate the comparative safety of warfarin in association with fracture risk.To test the hypothesis that, among patients (...) with nonvalvular AF, use of DOACs vs warfarin is associated with lower risk of incident fracture.This comparative effectiveness cohort study used the MarketScan administrative claims databases to identify patients with nonvalvular AF and who were prescribed oral anticoagulants from January 1, 2010, through September 30, 2015. To reduce confounding, patients were matched on age, sex, CHA2DS2-VASc (congestive heart failure, hypertension, age [>65 years = 1 point; >75 years = 2 points], diabetes, and previous

What Is the Incidence of Intracranial Hemorrhage Among Anticoagulated Patients With Minor Head Trauma? What Is the Incidence of Intracranial Hemorrhage Among Anticoagulated Patients With Minor Head Trauma? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 74, Issue 1, Pages 98–100 What Is the Incidence of Intracranial Hemorrhage Among Anticoagulated Patients With Minor Head Trauma? x Michael Gottlieb (...) , MD (EBEM Commentator) , x Somy M. Thottathil , MD (EBEM Commentator) , x Jacob P. Holton , MD (EBEM Commentator) Department of Emergency Medicine, Rush University Medical Center, Chicago, IL DOI: | Publication History Published online: December 20, 2018 Expand all Collapse all Article Outline Take-Home Message Among anticoagulated patients presenting with minor head trauma, 9% may have an intracranial hemorrhage. Methods Data Sources PubMed, EMBASE, the Cochrane databases, and the Database

Direct oral anticoagulant for the prevention of thrombosis in ambulatory patients with cancer: A systematic review and meta-analysis It is unclear if direct oral anticoagulant (DOAC) is efficacious and safe for prophylaxis of venous thromboembolism (VTE) in ambulatory patients with cancer.We performed a systematic review using EMBASE, MEDLINE, and CENTRAL. Inclusion criteria included adult ambulatory patients with cancer, prophylactic use of DOAC, and randomized controlled trials. Exclusion

Meta-Analysis of Oral Anticoagulant Monotherapy as an Antithrombotic Strategy in Patients With Stable Coronary Artery Disease and Nonvalvular Atrial Fibrillation Guidelines recommend oral anticoagulant (OAC) monotherapy without antiplatelet therapy (APT) in patients with nonvalvular atrial fibrillation (AF) with stable coronary artery disease (CAD) of >1 year after myocardial infarction or percutaneous coronary intervention. More evidences are required for the safety and efficacy of OAC

The role of anticoagulation in venous thromboembolism primary prophylaxis in patients with malignancy: A systematic review and meta-analysis of randomized controlled trials Venous thromboembolism (VTE) is a common cause of morbidity and mortality among patients with cancer. As such, we conducted a meta-analysis of randomized controlled trials (RCTs) that evaluated anticoagulants as primary prophylaxis against VTE in cancer patients.Pubmed/MEDLINE, Embase, and the Cochrane Library were screened (...) for all RCTs that used anticoagulation therapy in cancer patients for primary prevention of VTE. The primary outcomes were VTE events. Secondary outcomes included all-cause mortality, VTE-related mortality and major bleeding. A random effects model was used to report the risk ratios (RR) with 95% confidence intervals (CIs), and odds ratios (ORs) with Bayesian 95% credible intervals for both direct and network meta-analyses, respectively.Twenty-four RCTs were included totaling 13,338 patients (7197

Benefits and Harms of Oral Anticoagulant Therapy in Chronic Kidney Disease: A Systematic Review and Meta-analysis. Effects of oral anticoagulation in chronic kidney disease (CKD) are uncertain.To evaluate the benefits and harms of vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs) in adults with CKD stages 3 to 5, including those with dialysis-dependent end-stage kidney disease (ESKD).English-language searches of MEDLINE, EMBASE, and Cochrane databases (inception (...) to February 2019); review bibliographies; and ClinicalTrials.gov (25 February 2019).Randomized controlled trials evaluating VKAs or NOACs for any indication in patients with CKD that reported efficacy or bleeding outcomes.Two authors independently extracted data, assessed risk of bias, and rated certainty of evidence.Forty-five trials involving 34 082 participants who received anticoagulation for atrial fibrillation (AF) (11 trials), venous thromboembolism (VTE) (11 trials), thromboprophylaxis (6 trials

Left atrial appendage occlusion (LAAO) in patients with atrial fibrillation who have contraindications to oral anticoagulation SHTG Advice | 1 SHTG Advice 06-19 August 2019 In response to an enquiry from the National Advisory Committee for Heart Disease Left atrial appendage occlusion (LAAO) in patients with atrial fibrillation who have contraindications to oral anticoagulation Advice for NHSScotland Left atrial appendage occlusion (LAAO) may be offered to patients with non-valvular atrial (...) fibrillation deemed to be at high risk of ischaemic stroke, who have absolute contraindications to oral anticoagulation with warfarin and direct oral anticoagulants. Prior to undergoing the LAAO procedure, an individual patient risk assessment must be carried out by a multidisciplinary team. The potential future benefits of LAAO, the risks associated with the procedure, and the need for long- term antiplatelet therapy, should be discussed with each patient prior to making a treatment decision. LAAO

Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis. To determine the rate of a first recurrent venous thromboembolism (VTE) event after discontinuation of anticoagulant treatment in patients with a first episode of unprovoked VTE, and the cumulative incidence for recurrent VTE up to 10 years.Systematic review and meta-analysis.Medline, Embase (...) , and the Cochrane Central Register of Controlled Trials (from inception to 15 March 2019).Randomised controlled trials and prospective cohort studies reporting symptomatic recurrent VTE after discontinuation of anticoagulant treatment in patients with a first unprovoked VTE event who had completed at least three months of treatment.Two investigators independently screened studies, extracted data, and appraised risk of bias. Data clarifications were sought from authors of eligible studies. Recurrent VTE events

Continuous Anticoagulation and Cold Snare Polypectomy Versus Heparin Bridging and Hot Snare Polypectomy in Patients on Anticoagulants With Subcentimeter Polyps: A Randomized Controlled Trial. Management of anticoagulants for patients undergoing polypectomy is still controversial. Cold snare polypectomy (CSP) is reported to cause less bleeding than hot snare polypectomy (HSP).To compare outcomes between continuous administration of anticoagulants (CA) with CSP (CA+CSP) and periprocedural heparin (...) bridging (HB) with HSP (HB+HSP) for subcentimeter colorectal polyps.Multicenter, parallel, noninferiority randomized controlled trial. (University Hospital Medical Information Network Clinical Trials Registry: UMIN000019355).30 Japanese institutions.Patients receiving anticoagulant therapy (warfarin or direct oral anticoagulants) who had at least 1 nonpedunculated subcentimeter colorectal polyp.Patients were randomly assigned to undergo HB+HSP or CA+CSP and followed up 28 days after polypectomy.The

Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome - GOV.UK GOV.UK uses cookies to make the site simpler. Accept cookies You’ve accepted all cookies. You can at any time. Hide Search Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients (...) with antiphospholipid syndrome A clinical trial has shown an increased risk of recurrent thrombotic events associated with rivaroxaban compared with warfarin, in patients with antiphospholipid syndrome and a history of thrombosis. Other direct-acting oral anticoagulants (DOACs) may be associated with a similarly increased risk. Published 19 June 2019 From: Therapeutic area: , , Contents Advice for healthcare professionals: direct-acting oral anticoagulants (DOACs) are not recommended in patients

Extended Anticoagulation for VTE: A Systematic Review and Meta-Analysis The efficacy and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) during extended anticoagulation for a VTE remains largely unknown, especially in terms of potential survival benefit. The goal of this study was to assess the effects of VKAs and DOACs on overall mortality and VTE-related mortality, as well as VTE recurrence and safety.PubMed, EMBASE, and the Cochrane Library were searched from (...) January 1990 through September 2018 for randomized controlled trials evaluating the effect of extended anticoagulants as secondary prevention for VTE compared with placebo. The primary outcome was the specific effects of standard-intensity VKAs and DOACs on overall mortality.Sixteen studies (12,458 patients) were included. DOACs were associated with a reduction in overall (risk ratio [RR], 0.48; 95% CI, 0.27-0.86; P = .01) and VTE-related (RR, 0.36; 95% CI, 0.15-0.89; P = .03) mortality, whereas VKAs

Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves Current guidelines endorse the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF). However, little is known about their safety and efficacy in valvular heart disease (VHD). Similarly, there is a paucity of data regarding NOACs use in patients with a bioprosthetic heart valve (BPHV). We, therefore, performed a network meta-analysis

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part I: Review of Anticoagulation Agents and Clinical Considerations Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part I: Review of Anticoagulation Agents and Clinical (...) Considerations - Journal of Vascular and Interventional Radiology Email/Username: Password: Remember me Available now: Use your SIR login to access JVIR. Search Terms Search within Search Share this page Access provided by Article in Press Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part I: Review of Anticoagulation Agents and Clinical Considerations Endorsed

Oral anticoagulation in patients with chronic kidney disease: A systematic review and meta-analysis Data regarding the efficacy and safety of warfarin and non-vitamin K antagonist oral anticoagulant (NOAC) among patients with chronic kidney disease (CKD) remain scarce.Systematic review and meta-analysis of studies involving patients with CKD treated with oral anticoagulants were conducted to evaluate the following outcomes: ischemic stroke, intracerebral hemorrhage (ICH), combined ischemic (...) and hemorrhagic stroke (strokecombined), stroke or systemic embolism, mortality, and major bleeding events. CKD was defined based on creatinine clearance (CrCl) ranging from mild (CrCl: 60-89 mL/min), moderate (CrCl: 30-59 mL/min), to severe (CrCl: 15-29 mL/min).Fifteen studies (7 comparing NOAC vs warfarin and 8 comparing warfarin vs no anticoagulant) were identified comprising 78,053 patients. Warfarin (vs no anticoagulant) was associated with reduced risk of ischemic stroke (risk ratio [RR] = 0.68; 95

Direct oral anticoagulants in patients undergoing cardioversion: insight from randomized clinical trials. Anticoagulation, reducing the risk of thromboembolic events in patients undergoing cardioversion, is a cornerstone of peri-cardioversion management in patients with atrial fibrillation. We aimed to analyse published data on the efficacy and safety of direct oral anticoagulants (DOACs) in patients undergoing cardioversion. We performed a systematic review of randomized prospective clinical (...) ). The incidence rate of adverse events during DOAC treatment was found to be very similar to that observed with warfarin anticoagulation. In RCTs DOAC treatment in patients undergoing cardioversion appears to be effective and safe. However, because evidence in this clinical setting is still weak, observational reports could be useful in providing further data about peri-procedural outcomes.

Incident Atrial Fibrillation, Dementia and the Role of Anticoagulation: A Population-Based Cohort Study  Atrial fibrillation (AF) is associated with dementia. Anticoagulation may modify this relationship, but it is unclear if this is due to stroke reduction alone. Age- and sex-matched individuals from the U.K. Clinical Practice Research Datalink (2008-2016) with and without an incident diagnosis of AF were followed for a new dementia diagnosis. We estimated adjusted hazard ratios (aHRs (...) ) for incident dementia diagnosis in the AF cohort, overall and stratified by anticoagulation status, using the matched non-AF cohorts as reference. We performed a sensitivity analysis excluding individuals with stroke/transient ischaemic attack (TIA) before the observation period. Over 193,082 person-years (mean follow-up 25.7 ± 0.1 months), 347/15,276 AF (2.3%) and 1,085/76,096 non-AF (1.4%) were newly diagnosed with dementia (aHR, 1.31, 95% confidence interval, 1.15-1.49). The AF group had more co

Anticoagulation therapy in heart failure and sinus rhythm: a systematic review and meta-analysis Heart failure is a prothrombotic state, and it has been hypothesised that thrombosis and embolism cause non-fatal and fatal events in heart failure and reduced ejection fraction (HFrEF). We sought to determine the effect of anticoagulant therapy on clinical outcomes in patients with HFrEF who are in sinus rhythm.We conducted an updated systematic review and meta-analysis to examine the effect (...) of anticoagulation therapy in patients with HFrEF in sinus rhythm. Our analysis compared patients randomised to anticoagulant therapy with those randomised to antiplatelet therapy, placebo or control, and examined the endpoints of all-cause mortality, (re)hospitalisation for worsening heart failure, non-fatal myocardial infarction, non-fatal stroke of any aetiology and major haemorrhage.Five trials were identified that met the prespecified search criteria. Compared with control therapy, anticoagulant treatment

Meta-Analysis of Direct-Acting Oral Anticoagulants Compared With Warfarin in Patients >75 Years of Age Older patients with atrial fibrillation (AF) are at higher risk of thromboembolic events and oral anticoagulant (OAC)-related bleeding complications. This meta-analysis evaluates the efficacy and safety of direct-acting OACs (DOACs) compared with warfarin in older patients with nonvalvular AF. PubMed, Embase, and Cochrane Central databases were searched for randomized controlled trials

Canadian Urological Association guideline: Perioperative thromboprophylaxis and management of anticoagulation CUAJ • April 2019 • Volume 13, Issue 4 © 2019 Canadian Urological Association 105 CUA GUIDELINE Cite as: Can Urol Assoc J 2019;13(4):105-14. http://dx.doi.org/10.5489/cuaj.5828 Published online December 14, 2018 Supplementary material available at cuaj.ca Introduction Surgery exposes patients to a risk of venous thromboembo- lism (VTE) and bleeding. VTE includes deep vein thrombosis (...) - laxis are considered. The first is prophylaxis used for primary prevention VTE for patients undergoing surgery. The second is management of an anticoagulant or antiplatelet agent used for treatment or as a form of secondary prevention dur - ing the perioperative period. The CUA thromboprophylaxis guideline panel feels that it is important for urologists to be engaged in the discussion and management in each of these situations. The panel recognizes that in many clinical contexts, other specialists