Association of Oral Anticoagulants and Proton Pump Inhibitor Cotherapy With Hospitalization for Upper Gastrointestinal Tract Bleeding. Importance: Anticoagulant choice and proton pump inhibitor (PPI) cotherapy could affect the risk of upper gastrointestinal tract bleeding, a frequent and potentially serious complication of oral anticoagulant treatment. Objectives: To compare the incidence of hospitalization for upper gastrointestinal tract bleeding in patients using individual anticoagulants (...) with and without PPI cotherapy, and to determine variation according to underlying gastrointestinal bleeding risk. Design, Setting, and Participants: Retrospective cohort study in Medicare beneficiaries between January 1, 2011, and September 30, 2015. Exposures: Apixaban, dabigatran, rivaroxaban, or warfarin with or without PPI cotherapy. Main Outcomes and Measures: Hospitalizations for upper gastrointestinal tract bleeding: adjusted incidence and risk difference (RD) per 10 000 person-years of anticoagulant

American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy 30482765 2018 11 28 2473-9537 2 22 2018 Nov 27 Blood advances Blood Adv American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. 3257-3291 10.1182/bloodadvances.2018024893 Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous (...) thromboembolism (VTE). These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the use of anticoagulants in the management of VTE. These guidelines assume the choice of anticoagulant has already been made. ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline

No summary available

Impact of anticoagulant choice on hospitalized bleeding risk when treating cancer-associated venous thromboembolism 30240508 2018 10 25 1538-7836 2018 Sep 21 Journal of thrombosis and haemostasis : JTH J. Thromb. Haemost. Impact of anticoagulant choice on hospitalized bleeding risk when treating cancer-associated venous thromboembolism. 10.1111/jth.14303 Essentials Bleeding risk by anticoagulant choice for cancer-associated venous thrombosis (CA-VTE) is unknown. 26 894 people with CA-VTE were (...) followed for bleeding in a claims database in the United States. Hospitalized bleeding risk was similar with direct acting oral anticoagulants vs. warfarin. Relative hospitalized bleeding risk varied by cancer type and anticoagulant choice. SUMMARY: Background Direct acting oral anticoagulants (DOACs) are associated with less bleeding than traditional venous thromboembolism (VTE) treatments in the general population but are little studied in cancer-associated VTE (CA-VTE). Objective To determine

Efficacy and safety of anticoagulant agents in patients with venous thromboembolism and cancer: A network meta-analysis 30196195 2018 10 30 1879-2472 170 2018 10 Thrombosis research Thromb. Res. Efficacy and safety of anticoagulant agents in patients with venous thromboembolism and cancer: A network meta-analysis. 175-180 S0049-3848(18)30483-3 10.1016/j.thromres.2018.08.023 Low-molecular-weight heparins (LMWHs) are the recommended treatment for cancer-associated venous thrombosis (CAT). Recent (...) evidences suggest a role for direct-acting oral anticoagulants (DOACs) in this clinical setting. To evaluate the efficacy and safety of different anticoagulants we performed a network meta-analysis of RCTs including patients with CAT treated with LMWHs, vitamin K antagonists (VKAs) or DOACs. MEDLINE and EMBASE were searched up to February 2018. The primary efficacy and safety outcomes were recurrent VTE and major bleeding, respectively. Overall, 4720 CAT patients from 12 studies were included: 1430 from

Periprocedural Outcomes of Direct Oral Anticoagulants vs. Warfarin in Non-Valvular Atrial Fibrillation: A Meta-analysis of Phase III Trials 29794081 2018 10 25 1524-4539 138 14 2018 Oct 02 Circulation Circulation Periprocedural Outcomes of Direct Oral Anticoagulants Versus Warfarin in Nonvalvular Atrial Fibrillation. 1402-1411 10.1161/CIRCULATIONAHA.117.031457 Direct oral anticoagulants (DOACs) are surpassing warfarin as the anticoagulant of choice for stroke prevention in nonvalvular (...) trials (RE-LY [Randomized Evaluation of Long-Term Anticoagulation Therapy], ROCKET AF [Rivaroxaban Once Daily Oral Direct Factor Xa Inhibitor Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation], ARISTOTLE [Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation], and ENGAGE-AF [Effective Anticoagulation With Factor xA Next Generation in Atrial Fibrillation]) were included in the meta-analysis. DOACs as a group and warfarin were

Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage 30255970 2018 10 25 1531-8249 2018 Sep 26 Annals of neurology Ann. Neurol. Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage. 10.1002/ana.25342 Whether intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain. We

Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation Signal - Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation Dissemination Centre Discover Portal NIHR DC Discover Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation Published on 6 February 2018 In people with atrial fibrillation needing anticoagulant (...) treatment, deaths were fewer in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin. This study pooled the data in all trials reporting efficacy, safety and cost of anticoagulant prevention of stroke events in people with atrial fibrillation. Researchers used a technique called network

Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation Signal - Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation Dissemination Centre Discover Portal NIHR DC Discover Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation Published on 18 July 2017 General practice software that generated screen reminders for patients with atrial fibrillation did not increase the proportion taking oral (...) anticoagulants appropriately by six months. This NIHR-funded trial included GPs in 47 surgeries in England and found that at the start only 63% of eligible patients with atrial fibrillation were being prescribed anticoagulants. Six months later the rate had increased to 66% in intervention practices and 64% in those following usual practice, a non-significant difference between the groups. Use of the software was associated with increased diagnosis of transient ischemic attack, which could be due to improved

New generation anticoagulants may be safer than warfarin for people with chronic kidney disease Signal - New generation anticoagulants may be safer than warfarin for people with chronic kidney disease Dissemination Centre Discover Portal NIHR DC Discover New generation anticoagulants may be safer than warfarin for people with chronic kidney disease Published on 26 April 2016 Newer generation anticoagulants appear to reduce the risk of bleeding compared with older anticoagulants like warfarin (...) , when used to prevent clots in people who also have mild to moderate chronic kidney disease. This group of drugs, called direct oral anticoagulants, have been well researched in healthy people with atrial fibrillation or at risk of thromboembolism but this was the first review to look at their safety, in terms of bleeding and risk of bleeding within the brain, in people with kidney disease. As a group, these newer drugs appear safer than older anticoagulants such as warfarin. Evidence from

Extending anticoagulant treatment beyond three months reduces the risk of recurrent blood clots Signal - Extending anticoagulant treatment beyond three months reduces the risk of recurrent blood clots Dissemination Centre Discover Portal NIHR DC Discover Extending anticoagulant treatment beyond three months reduces the risk of recurrent blood clots Published on 1 March 2016 Warfarin, newer direct oral anticoagulants and aspirin all significantly reduced the rate of recurrent clots in patients (...) treated for more than the standard three months. Aspirin was the least effective and the number of major bleeds and deaths was low in all three groups. This review pooling seven trials found that between six and 36 months 28 in every 1000 people taking warfarin, direct oral anticoagulants or aspirin after a first blood clot developed a second clot. This was significantly fewer than the 97 per 1000 people who developed a second clot while taking placebo. The cost-effectiveness of extending treatment

An anticoagulant, bivalirudin, may not be safer than the alternative, heparin, when unblocking arteries in the heart Signal - An anticoagulant, bivalirudin, may not be safer than the alternative, heparin, when unblocking arteries in the heart Dissemination Centre Discover Portal NIHR DC Discover An anticoagulant, bivalirudin, may not be safer than the alternative, heparin, when unblocking arteries in the heart Published on 14 June 2016 Bivalirudin is currently recommended as an alternative (...) arteries. In 2013, over 92,000 procedures were carried out in the UK. It involves inserting a small tube called a stent into the heart’s arteries, to hold them open. Anticoagulant treatment is needed at the same time to reduce the risk of clotting during and after the procedure. Heparin is the long established anticoagulant, but newer bivalirudin may now be used as an alternative. To date, different trials have produced contradictory evidence comparing the safety and effectiveness of the two

No summary available

Prothrombin complex concentrate versus placebo, no intervention, or other interventions in critically bleeding patients associated with oral anticoagulant administration: a protocol for a systematic review of randomised clinical trials with meta-analysis BACKGROUND: Acute critical bleeding is one of the most feared complications during treatment with oral anticoagulating agents. As more patients undergo treatment with anticoagulating agents, critically bleeding episodes in patients with vitamin (...) . The aim of this systematic review is to synthesise the evidence of the effects of prothrombin complex concentrate compared with placebo, no intervention, or other treatment options in critically bleeding patients treated with oral anticoagulants. METHODS/DESIGN: A comprehensive search for relevant published literature will be undertaken in Cochrane Central Register of Controlled Trials, MEDLINE, Embase, WHO International Clinical Trials Registry Platform, Science Citation Index, regulatory databases

Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non-vitamin K Anticoagulant Reversal 30157037 2018 09 09 1528-1175 2018 Aug 29 Anesthesiology Anesthesiology Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non-vitamin K Anticoagulant Reversal. 10.1097/ALN.0000000000002399 Vitamin K antagonist therapy is associated with an increased bleeding risk, and clinicians often reverse anticoagulation in patients who require emergency surgical (...) procedures. Current guidelines for rapid anticoagulation reversal for emergency surgery recommend four-factor prothrombin complex concentrate and vitamin K coadministration. The authors reviewed the current evidence on prothrombin complex concentrate treatment for vitamin K antagonist reversal in the perioperative setting, focusing on comparative studies and in the context of intracranial hemorrhage and cardiac surgery. The authors searched Cochrane Library and PubMed between January 2008 and December

Patent foramen ovale closure, antiplatelet therapy or anticoagulation in patients with patent foramen ovale and cryptogenic stroke: a systematic review and network meta-analysis incorporating complementary external evidence 30049703 2018 08 03 2044-6055 8 7 2018 Jul 25 BMJ open BMJ Open Patent foramen ovale closure, antiplatelet therapy or anticoagulation in patients with patent foramen ovale and cryptogenic stroke: a systematic review and network meta-analysis incorporating complementary (...) external evidence. e023761 10.1136/bmjopen-2018-023761 To examine the relative impact of three management options in patients aged <60 years with cryptogenic stroke and a patent foramen ovale (PFO): PFO closure plus antiplatelet therapy, antiplatelet therapy alone and anticoagulation alone. Systematic review and network meta-analysis (NMA) supported by complementary external evidence. Medline, EMBASE and Cochrane CENTRAL. Randomised controlled trials (RCTs) addressing PFO closure and/or medical

Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation. Background: Stroke rates in patients with nonvalvular atrial fibrillation (AF) who are not receiving anticoagulant therapy vary widely across published studies; the resulting effect on the net clinical benefit of anticoagulation in AF is unknown. Objective: To determine the effect of variation in published AF stroke rates on the net clinical benefit of anticoagulation. Design (...) : Markov model decision analysis. Warfarin was the base case, and non-vitamin K antagonist oral anticoagulants (NOACs) were modeled in a secondary analysis. Setting: Community-dwelling adults. Patients: 33 434 adults with incident AF. Measurements: Quality-adjusted life-years (QALYs). Results: Of the 33 434 patients, 27 179 had a CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke, and vascular disease) score of 2 or more. The population benefit of warfarin anticoagulation

Meta-Analysis Comparing the Efficacy, Safety, and Cost-Benefit of Direct Acting Oral Anticoagulants Versus Enoxaparin Thromboprophylaxis to Prevent Venous Thromboembolism Among Hospitalized Patients 30082040 2018 08 07 1879-1913 2018 Jul 05 The American journal of cardiology Am. J. Cardiol. Meta-Analysis Comparing the Efficacy, Safety, and Cost-Benefit of Direct Acting Oral Anticoagulants Versus Enoxaparin Thromboprophylaxis to Prevent Venous Thromboembolism Among Hospitalized Patients. S0002 (...) -9149(18)31327-4 10.1016/j.amjcard.2018.06.035 Venous thromboembolism (VTE) is a potentially fatal complication of hospitalization. Thromboprophylaxis using subcutaneous low molecular weight heparin (LMWH) can result in local irritation, pain, and ecchymoses, leading to nonadherence. Direct acting oral anticoagulants (DOACs) are an alternative, but their efficacy and safety for short-term inpatient-only use versus LMWH, in medically hospitalized patients, has not been rigorously assessed. We

"HERDOO2" clinical decision rule to guide duration of anticoagulation in women with unprovoked venous thromboembolism. Can I use any d-Dimer? 30031290 2018 09 17 1879-2472 169 2018 09 Thrombosis research Thromb. Res. "HERDOO2" clinical decision rule to guide duration of anticoagulation in women with unprovoked venous thromboembolism. Can I use any d-Dimer? 82-86 S0049-3848(18)30435-3 10.1016/j.thromres.2018.07.020 The "HERDOO2 rule" is a prospectively validated clinical decision rule used (...) to identify low-risk women who can safely discontinue anticoagulants after completing 5-12 months of anticoagulant treatment for unprovoked venous thromboembolism. The VIDAS ® d-Dimer (DD) assay, a component of the rule, was used in the derivation and validation of the rule at half the usual diagnostic cut-point for exclusion of venous thrombosis. It is unknown if other commercial DD assays used at a corresponding cut-point will categorize patients at high concordance with the VIDAS ® DD. To determine

The efficacy and safety of anticoagulation in cerebral vein thrombosis: A systematic review and meta-analysis 30056293 2018 09 17 1879-2472 169 2018 09 Thrombosis research Thromb. Res. The efficacy and safety of anticoagulation in cerebral vein thrombosis: A systematic review and meta-analysis. 135-139 S0049-3848(18)30440-7 10.1016/j.thromres.2018.07.023 Anticoagulation with unfractionated heparin (UFH) or low molecular weight heparin (LMWH) is the mainstay for the treatment of patients (...) with acute cerebral vein thrombosis (CVT) with or without intracranial hemorrhage (ICH). We conducted a systematic review and meta-analysis to determine the efficacy and safety of LMWH compared to UFH for the treatment of acute CVT. An electronic search of MEDLINE, Pubmed, CENTRAL and Google Scholar was performed. Randomized controlled trials (RCT) reporting on the efficacy and safety of anticoagulation for acute treatment of CVT were included. Outcomes of interest included mortality, disability, new ICH