Oral Anticoagulation for Patients With Atrial Fibrillation on Long-Term Hemodialysis Patients on long-term dialysis are at increased risk of bleeding. Although oral anticoagulants (OACs) are recommended for atrial fibrillation (AF) to reduce the risk of stroke, randomized trials have excluded these populations. As such, the net clinical benefit of OACs among patients on dialysis is unknown.This study aimed to investigate the efficacy and safety of OACs in patients with AF on long-term (...) for dabigatran and rivaroxaban were limited to major bleeding events. Compared with no anticoagulants, apixaban and warfarin were not associated with a significant decrease in stroke and/or systemic thromboembolism (apixaban 5 mg, hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.30 to 1.17; apixaban 2.5 mg, HR: 1.00; 95% CI: 0.52 to 1.93; warfarin, HR: 0.91; 95% CI: 0.72 to 1.16). Apixaban 5 mg was associated with a significantly lower risk of mortality (vs. warfarin, HR: 0.65; 95% CI: 0.45 to 0.93

High thrombotic risk and antiphospholipid antibodies: avoid direct oral anticoagulants Prescrire IN ENGLISH - Spotlight ''High thrombotic risk and antiphospholipid antibodies: avoid direct oral anticoagulants'', 1 February 2020 {1} {1} {1} | | > > > High thrombotic risk and antiphospholipid antibodies: avoid direct oral anticoagulants Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 most recent :  |   |   |   |   |   |    (...) |   |   |  Spotlight In the February issue of Prescrire International - High thrombotic risk and antiphospholipid antibodies: avoid direct oral anticoagulants FREE DOWNLOAD In the Adverse Effects section this month: should patients taking a direct oral anticoagulant switch to a vitamin K agonist such as warfarin, in light of the French drug regulatory agency's recent advisory? Full text available for free download. Summary In mid-2019, the French drug regulatory agency, ANSM

Kidney Pre-biopsy medication: Antiplatelet and anticoagulant agents ____________________________________________________________________________________________________________ Renal Biopsy - Desmopressin Acetate July 2018 Page 1 of 15 2. PRE – BIOPSY MEDICATION – ANTIPLATELET AND ANTICOAGULANT AGENTS Date written: March 2018 Authors: Emily See, Paul Champion de Crespigny, Pamela Lopez-Vargas, Talia Gutman, Karine Manera, Solomon Menahem, John Saunders, David Voss, Jeffrey Wong and Rob (...) (to prevent major bleeding) or 7 days (to prevent minor bleeding) prior to the renal biopsy (1C). c. We suggest the use of bridging anticoagulation in patients at highest risk for thromboembolism. This includes patients with a mechanical mitral valve, a mechanical aortic valve and additional stroke risk factors, antiphospholipid syndrome, an embolic event within the previous 3 months, atrial fibrillation (CHADS2 score 5 or 6), and a previous thromboembolic event with interruption of anticoagulation (2C

What is the appropriate anticoagulation for patients with antiphospholipid syndrome? Chiefs’ Inquiry Corner – 1/6/19 – Clinical Correlations Search Chiefs’ Inquiry Corner – 1/6/19 January 6, 2020 2 min read Direct oral anticoagulants (DOACs) have replaced warfarin for many indications because they are effective and easier to use. Antiphospholipid syndrome is a notable exception to this trend. In a trial of 120 high risk patients with antiphospholipid syndrome randomized to rivaroxaban versus

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

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

Patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke Patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke - NIPH Search for: Søk Menu To top level Close Infectious diseases & Vaccines Mental & Physical health Environment & Lifestyle Health in Norway Quality & Knowledge Research & Access to data About NIPH Close Patent foramen ovale closure, antiplatelet therapy (...) or anticoagulation therapy alone for management of cryptogenic stroke Order Download: Key message We are constantly trying to make our products better. On this publication we have tried out a new presentation: Patent foramen ovale (PFO) represents an opening in the heart placing people at risk of ischemic stroke. This report evaluates catheter-based PFO closure as an alternative treatment to antiplatelet therapy or anticoagulation for patients with a PFO having suffered a stroke. Our findings: PFO closure plus

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

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

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

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

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

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.