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Latest & greatest articles for anticoagulation
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Post-Operative Anticoagulation of Elderly Surgical Patients with Impaired Renal Function: Clinical Effectiveness and Guidelines Post-Operative Anticoagulation of Elderly Surgical Patients with Impaired Renal Function: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Post-Operative Anticoagulation of Elderly Surgical Patients with Impaired Renal Function: Clinical Effectiveness and Guidelines Post-Operative Anticoagulation of Elderly Surgical Patients with Impaired (...) Renal Function: Clinical Effectiveness and Guidelines Published on: November 9, 2015 Project Number: RA0816-000 Product Line: Research Type: Drug Report Type: Reference List Result type: Report Question What is the comparative clinical effectiveness of various low weight molecular heparins for post-operative anticoagulation of elderly (aged 65 years) surgical patients with impaired renal function? What is the comparative clinical effectiveness of unfractionated heparin versus low weight molecular
Antidote for Factor Xa Anticoagulants. 26559124 2016 01 05 2018 12 02 1533-4406 373 25 2015 Dec 17 The New England journal of medicine N. Engl. J. Med. Antidote for Factor Xa Anticoagulants. 2471-2 10.1056/NEJMe1513258 Connors Jean M JM From the Hematology Division, Brigham and Women's Hospital, and Harvard Medical School - both in Boston. eng Editorial Comment 2015 11 11 United States N Engl J Med 0255562 0028-4793 0 Factor Xa Inhibitors 0 Recombinant Proteins EC 126.96.36.199 Factor Xa AIM IM N
The benefit of D-Dimer testing to decide on stopping anticoagulation after a first unprovoked VTE: a matter of sex or of test sensitivity? 26317262 2015 10 27 2015 08 31 0301-1526 44 5 2015 Sep VASA. Zeitschrift fur Gefasskrankheiten VASA The benefit of D-Dimer testing to decide on stopping anticoagulation after a first unprovoked VTE: a matter of sex or of test sensitivity? 399 10.1024/0301-1526/a000461 Czihal Michael M 1 Munich, Germany. Reinecke Holger H eng Journal Article Multicenter Study (...) Randomized Controlled Trial Switzerland Vasa 0317051 0301-1526 0 Anticoagulants 0 Fibrin Fibrinogen Degradation Products 0 fibrin fragment D IM Adult Anticoagulants therapeutic use Blood Coagulation Blood Coagulation Tests methods Female Fibrin Fibrinogen Degradation Products metabolism Germany epidemiology Humans Incidence Male Risk Factors Sex Factors Venous Thromboembolism blood epidemiology prevention & control 2015 8 29 6 0 2015 9 1 6 0 2015 10 28 6 0 ppublish 26317262 10.1024/0301-1526/a000461
Do patients with a clinically suspected subsegmental pulmonary embolism need anticoagulation therapy? BestBets: Do patients with a clinically suspected subsegmental pulmonary embolism need anticoagulation therapy? Do patients with a clinically suspected subsegmental pulmonary embolism need anticoagulation therapy? Report By: Chris Morgan, Hyun Choi - TBC Institution: University of Manchester, Manchester, UK and Emergency Department, Lewisham and Greenwich NHS Trust, London, UK Date Submitted (...) : 26th August 2015 Last Modified: 26th August 2015 Status: Green (complete) Three Part Question In [a symptomatic patient with an isolated subsegmental pulmonary embolism] does [anticoagulation therapy or no treatment] lead to [lower rates of mortality and recurrent venous thromboembolism?] Clinical Scenario A 62-year-old gentleman attends your Emergency Department with shortness of breath and chest pain. You suspect a pulmonary embolism (PE) and request a CT pulmonary angiogram. The radiologist
Targeted Anti-Anticoagulants. 26095632 2015 08 14 2018 12 02 1533-4406 373 6 2015 Aug 06 The New England journal of medicine N. Engl. J. Med. Targeted Anti-Anticoagulants. 569-71 10.1056/NEJMe1506600 Bauer Kenneth A KA From Harvard Medical School and Beth Israel Deaconess Medical Center - both in Boston. eng Editorial Comment 2015 06 22 United States N Engl J Med 0255562 0028-4793 0 Antibodies, Monoclonal, Humanized 0 Anticoagulants 0 Benzimidazoles 11P2JDE17B beta-Alanine AIM IM N Engl J Med (...) . 2015 Aug 6;373(6):511-20 26095746 Antibodies, Monoclonal, Humanized administration & dosage Anticoagulants Benzimidazoles antagonists & inhibitors Female Hemorrhage drug therapy Humans Male beta-Alanine analogs & derivatives 2015 6 23 6 0 2015 6 23 6 0 2015 8 15 6 0 ppublish 26095632 10.1056/NEJMe1506600
Treating deep vein thrombosis: novel ways to anticoagulate Treating deep vein thrombosis: novel ways to anticoagulate - Evidently Cochrane Search and hit Go By August 3, 2015 // A blog written by retired GP, Dr Lynda Ware, for clinicians. The novel oral anticoagulants – or NOACs – are the new kids on the block in anticoagulation. They appear to be as effective as warfarin but with a better safety profile. A published in June 2015 (1) explores the role of NOACs in the treatment of deep vein (...) , with high quality evidence and a low risk of bias. A meta-analysis of the three studies (7596 participants) comparing oral DTIs with standard anticoagulation showed no difference in the rate of recurrent VTE, recurrent DVT, fatal and non-fatal PE or all-cause mortality. Oral DTIs were, however, associated with a reduced risk of bleeding. A meta-analysis of the eight studies (16356 participants) comparing oral Factor Xa inhibitors with standard anticoagulation showed no difference in the rate
Peri-procedural management of patients taking oral anticoagulants. The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers (...) because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking. Existing data suggest that the use of bridging therapy may increase the risk of bleeding for some patients without reducing the risk of thrombosis. Clinical trials are currently under way to answer these questions. Because the half lives and time
Six Months vs Extended Oral Anticoagulation After a First Episode of Pulmonary Embolism: The PADIS-PE Randomized Clinical Trial. The optimal duration of anticoagulation after a first episode of unprovoked pulmonary embolism is uncertain.To determine the benefits and harms of an additional 18-month treatment with warfarin vs placebo, after an initial 6-month nonrandomized treatment period on a vitamin K antagonist.Randomized, double-blind trial (treatment period, 18 months; median follow-up, 24 (...) %) in the placebo group (HR, 0.75; 95% CI, 0.47-1.18). Rates of recurrent venous thromboembolism, major bleeding, and unrelated death did not differ between groups.Among patients with a first episode of unprovoked pulmonary embolism who received 6 months of anticoagulant treatment, an additional 18 months of treatment with warfarin reduced the composite outcome of recurrent venous thrombosis and major bleeding compared with placebo. However, benefit was not maintained after discontinuation of anticoagulation
Antidote Treatments for the Reversal of Direct Oral Anticoagulants Issue 138 ? June 2015 Issues in Emerging Health Technologies 1 Antidote Treatments for the Reversal of Direct Oral Anticoagulants Summary ? There are three intravenous antidotes currently under development for the reversal of direct oral anticoagulants. ? Idarucizumab is a humanized, monoclonal, antibody fragment that reverses the direct thrombin inhibitor dabigatran. Andexanet alfa is a modified recombinant factor Xa molecule (...) that reverses oral direct (e.g., apixaban, edoxaban, rivaroxaban) and injectable indirect (e.g., enoxaparin, fondaparinux) factor Xa inhibitors. Aripazine is a small, synthetic molecule with potentially universal anticoagulant reversal activity. ? Clinical evidence to support the use of individual antidotes is currently limited to phase 1 and phase 2 trials in healthy volunteers. All three antidotes were well tolerated during these studies and no pro-coagulant activity was observed. Phase 3 trials
Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate – Clinical Correlations Search Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate July 10, 2015 7 min read By Shannon Chiu, MD Peer Reviewed The annual incidence of infective endocarditis (IE) [1-2]. Neurologic complications are the most severe and frequent [3-4 (...) of anticoagulation in patients with IE and how to balance the risk of thromboembolism against that of hemorrhagic transformation of stroke. Specific risk factors have been associated with increased risk of symptomatic embolic events. Embolic risk is especially high within the first 2 weeks after diagnosis, . Size, location and mobility of vegetations are key predictors; in fact, surgery may be indicated for prevention of embolism with involvement of anterior mitral leaflet, vegetation size >10mm
Antidote Treatments for the Reversal of Direct Oral Anticoagulants Antidote Treatments for the Reversal of Direct Oral Anticoagulants | CADTH.ca Find the information you need Antidote Treatments for the Reversal of Direct Oral Anticoagulants Antidote Treatments for the Reversal of Direct Oral Anticoagulants Published on: June 23, 2015 Project Number: EH0028 Product Line: Issue: 138 Result type: Report Summary There are three intravenous antidotes currently under development for the reversal (...) of direct oral anticoagulants. Idarucizumab is a humanized, monoclonal, antibody fragment that reverses the direct thrombin inhibitor dabigatran. Andexanet alfa is a modified recombinant factor Xa molecule that reverses oral direct (e.g., apixaban, edoxaban, rivaroxaban) and injectable indirect (e.g., enoxaparin, fondaparinux) factor Xa inhibitors. Aripazine is a small, synthetic molecule with potentially universal anticoagulant reversal activity. Clinical evidence to support the use of individual
Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior (...) to bridging with respect to major bleeding.We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure
Duration of Triple Therapy in Patients Requiring Oral Anticoagulation After Drug-Eluting Stent Implantation: The ISAR-TRIPLE Trial Patients receiving oral anticoagulation (OAC) who undergo drug-eluting stent (DES) implantation require additional dual antiplatelet therapy with aspirin and clopidogrel. Such triple therapy confers an elevated bleeding risk, and its optimal duration is not known.The goal of this study was to evaluate whether shortening the duration of clopidogrel therapy from 6 (...) . 13 [4.3%]; HR: 0.93; 95% CI: 0.43 to 2.05; p=0.87) or the secondary bleeding endpoint of TIMI major bleeding (16 [5.3%] vs. 12 [4.0%]; HR: 1.35; 95% CI: 0.64 to 2.84; p=0.44).Six weeks of triple therapy was not superior to 6 months with respect to net clinical outcomes. These results suggest that physicians should weigh the trade-off between ischemic and bleeding risk when choosing the shorter or longer duration of triple therapy. (Triple Therapy in Patients on Oral Anticoagulation After Drug
Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. Although retrievable inferior vena cava filters are frequently used in addition to anticoagulation in patients with acute venous thromboembolism, their benefit-risk ratio is unclear.To evaluate the efficacy and safety of retrievable vena cava filters plus anticoagulation vs anticoagulation alone for preventing pulmonary embolism (...) recurrence in patients presenting with acute pulmonary embolism and a high risk of recurrence.Randomized, open-label, blinded end point trial (PREPIC2) with 6-month follow-up conducted from August 2006 to January 2013. Hospitalized patients with acute, symptomatic pulmonary embolism associated with lower-limb vein thrombosis and at least 1 criterion for severity were assigned to retrievable inferior vena cava filter implantation plus anticoagulation (filter group; n = 200) or anticoagulation alone
Anticoagulant Drugs Do Not Increase Risk of Postoperative Bleeding after Implant Placement UTCAT2875, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Anticoagulant Drugs Do Not Increase Risk of Postoperative Bleeding after Implant Placement Clinical Question Will a patient on anticoagulant drugs who is receiving a dental implant have a higher risk of postoperative bleeding than a patient who discontinues the medication (...) ? Clinical Bottom Line Discontinuation of oral anticoagulant drugs is “not recommended for minor oral surgery, such as ….implant placement, provided that this does not involve autogenous bone grafts, extensive flaps or osteotomy preparations extending outside the bony envelope.” 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) Madrid/2009 19 Studies Total Systematic Review Key results In this systemic review
Interruption in Use of the New Class of Direct Thrombin Inhibitors and Factor Xa Inhibitors is Not Indicated for the Anticoagulated Patient Undergoing Simple Dental Procedures UTCAT2828, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Interruption in Use of the New Class of Direct Thrombin Inhibitors and Factor Xa Inhibitors is Not Indicated for the Anticoagulated Patient Undergoing Simple Dental Procedures Clinical (...) were proposed: Interruption of rivaroxaban and dabigatran is not indicated. The only recommendation regarding their regimen is for the patient to not take their medication 1-3 hours prior to their appointment. Patient needs to be informed that bleeding is normal because their anticoagulation medication was not ceased. #2) Firriolo/2012 Narrative Review Key results If kidney function is normal, and there are no other risks for compromised hemostasis, then discontinuation of Xarelto and Pradaxa
Pharmacology of antithrombotic drugs: an assessment of oral antiplatelet and anticoagulant treatments. Antithrombotic drugs, which include antiplatelet and anticoagulant therapies, prevent and treat many cardiovascular disorders and, as such, are some of the most commonly prescribed drugs worldwide. The first drugs designed to inhibit platelets or coagulation factors, such as the antiplatelet clopidogrel and the anticoagulant warfarin, significantly reduced the risk of thrombotic events (...) variability in their antithrombotic effects than previous antithrombotic drugs. Treatment options now include the next-generation antiplatelet drugs prasugrel and ticagrelor, and, in terms of anticoagulants, inhibitors that directly target factor IIa (dabigatran) or Xa (rivaroxaban, apixaban, edoxaban) are available. In this Series paper we review the pharmacological properties of these most commonly used oral antithrombotic drugs, and explore the development of antiplatelet and anticoagulant therapies
Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs. In patients with non-valvular atrial fibrillation, oral anticoagulation with vitamin K antagonists reduces the risk of stroke by more than 60%. But vitamin K antagonists have limitations, including causing serious bleeding such as intracranial haemorrhage and the need for anticoagulation monitoring. In part related to these limitations, they are used in only about half (...) of patients who should be treated according to guideline recommendations. In the past decade, oral agents have been developed that directly block the activity of thrombin (factor IIa), as well as drugs that directly inhibit activated factor X (Xa), which is the first protein in the final common pathway to the activation of thrombin. These novel non-vitamin K antagonist oral anticoagulants (NOACs) have been shown to be at least as good as warfarin for stroke prevention in atrial fibrillation and they have
Should Atrial Fibrillation Patients With 1 Additional Risk Factor of the CHA2DS2-VASc Score (Beyond Sex) Receive Oral Anticoagulation? Although the CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score is recommended by both American and European guidelines for stroke risk stratification in atrial fibrillation (AF), the treatment recommendations (...) for a CHA2DS2-VASc score of 1 are less clear.This study aimed to investigate the risk of ischemic stroke in patients with a single additional stroke risk factor (i.e., CHA2DS2-VASc score = 1 [males] or 2 [females]) and the impact of different component risk factors.We used the National Health Insurance Research Database in Taiwan. Among 186,570 AF patients not on antiplatelet or anticoagulant therapy, we evaluated males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2. The clinical