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Latest & greatest articles for warfarin
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Non-major bleeding with apixaban versus warfarin in patients with atrial fibrillation 27798052 2016 10 31 2017 03 29 1468-201X 103 8 2017 Apr Heart (British Cardiac Society) Heart Non-major bleeding with apixaban versus warfarin in patients with atrial fibrillation. 623-628 10.1136/heartjnl-2016-309901 We describe the incidence, location and management of non-major bleeding, and assess the association between non-major bleeding and clinical outcomes in patients with atrial fibrillation (AF (...) bleeding was less frequent with apixaban (6.4 per 100 patient-years) than warfarin (9.4 per 100 patient-years) (adjusted HR 0.69, 95% CI 0.63 to 0.75). The most frequent sites of non-major bleeding were haematuria (16.4%), epistaxis (14.8%), gastrointestinal (13.3%), haematoma (11.5%) and bruising/ecchymosis (10.1%). Medical or surgical intervention was similar among patients with non-major bleeding on warfarin versus apixaban (24.7% vs 24.5%). A change in antithrombotic therapy (58.6% vs 50.0
Warfarin treatment quality and prognosis in patients with mechanical heart valve prosthesis 27590664 2016 09 03 2017 01 14 1468-201X 103 3 2017 Feb Heart (British Cardiac Society) Heart Warfarin treatment quality and prognosis in patients with mechanical heart valve prosthesis. 198-203 10.1136/heartjnl-2016-309585 To study the impact of time in therapeutic range (TTR) and international normalised ratio (INR) variability on the risk of thromboembolic events, major bleeding complications (...) -years on warfarin, were included. High INR variability (above mean ≥0.40) or lower TTR (≤70%) was associated with a higher risk of bleeding (rate per 100 years 4.33 (95% CI 3.87 to 4.82) vs 2.08 (1.78 to 2.41); HR 2.15 (1.75 to 2.61) and 5.13 (4.51 to 5.82) vs 2.30 (2.03 to 2.60); HR 2.43 (2.02 to 2.89)), respectively. High variability and low TTR combined was associated with an even higher risk of bleedings (rate per 100 years 4.12 (95% CI 3.68 to 4.51) vs 2.02 (1.71 to 2.30); HR 2.16 (1.71 to 2.58
Net clinical benefit of warfarin in individuals with atrial fibrillation across stroke risk and across primary and secondary care 27580623 2016 09 01 2017 03 24 1468-201X 103 3 2017 Feb Heart (British Cardiac Society) Heart Net clinical benefit of warfarin in individuals with atrial fibrillation across stroke risk and across primary and secondary care. 210-218 10.1136/heartjnl-2016-309910 To investigate net clinical benefit (NCB) of warfarin in individuals with atrial fibrillation (AF) across (...) (95% CI)/100 PY) of IS and HS, with and without use of warfarin, and the NCB (ie, number of IS avoided) per 100 PYs of warfarin use (NCB (95% CI)/100 PY). Compared with individuals with initial record of diagnosis in secondary care, those in primary care had lower scores of IS risk (CHA2DS2-VASc≤2: 30.8% vs 20.6%), and lower overall incidence of IS (IR (95% CI)/100 PY: 2.3 (2.2 to 2.4) vs 4.3 (4.2 to 4.4), p value=0.00); however among individuals with CHA2DS2-VASc=0, 1 or 2 there were
Major bleeding risk among non-valvular atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban or warfarin: a "real-world" observational study in the United States 27550177 2016 09 07 2017 02 20 1742-1241 70 9 2016 Sep International journal of clinical practice Int. J. Clin. Pract. Major bleeding risk among non-valvular atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban or warfarin: a "real-world" observational study in the United States. 752-63 (...) 10.1111/ijcp.12863 Limited data are available about the real-world safety of non-vitamin K antagonist oral anticoagulants (NOACs). To compare the major bleeding risk among newly anticoagulated non-valvular atrial fibrillation (NVAF) patients initiating apixaban, warfarin, dabigatran or rivaroxaban in the United States. A retrospective cohort study was conducted to compare the major bleeding risk among newly anticoagulated NVAF patients initiating warfarin, apixaban, dabigatran or rivaroxaban
Treatment of acute pulmonary embolism with dabigatran versus warfarin. A pooled analysis of data from RE-COVER and RE-COVER II 27411591 2016 09 27 2016 09 27 0340-6245 116 4 2016 Sep 27 Thrombosis and haemostasis Thromb. Haemost. Treatment of acute pulmonary embolism with dabigatran versus warfarin. A pooled analysis of data from RE-COVER and RE-COVER II. 714-21 10.1160/TH16-04-0271 Dabigatran was non-inferior to warfarin for prevention of recurrent venous thromboembolism (VTE), and dabigatran (...) had a lower rate of bleeding compared with warfarin in two large-scale randomised trials, RE-COVER and RE-COVER II. In this study, we investigate the efficacy and safety of dabigatran versus warfarin according to the index event that qualified the patient for enrollment, either symptomatic pulmonary embolism (PE) with or without deep-vein thrombosis (DVT), or DVT alone. We then analyse the anticoagulant effect of dabigatran vs warfarin on patients enrolled with PE. The pooled dataset
Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. BACKGROUND: Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled warfarin therapy. Few safety data about edoxaban in patients undergoing electrical cardioversion are available. METHODS: We did (...) a multicentre, prospective, randomised, open-label, blinded-endpoint evaluation trial in 19 countries with 239 sites comparing edoxaban 60 mg per day with enoxaparin-warfarin in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. The dose of edoxaban was reduced to 30 mg per day if one or more factors (creatinine clearance 15-50 mL/min, low bodyweight [≤60 kg], or concomitant use of P-glycoprotein inhibitors) were present. Block randomisation (block size four)-stratified
The effect of low-dose oral vitamin K supplementation on INR stability in patients receiving warfarin. A randomised trial 27346552 2016 08 30 2017 02 03 0340-6245 116 3 2016 Aug 30 Thrombosis and haemostasis Thromb. Haemost. The effect of low-dose oral vitamin K supplementation on INR stability in patients receiving warfarin. A randomised trial. 480-5 10.1160/TH16-04-0320 The anticoagulant effect of warfarin is influenced by variations in vitamin K intake. Concomitant use of daily low-dose oral (...) vitamin K (LDVK) and warfarin may improve INR stability. We hypothesise that administration of LDVK improves INR control. To test this hypothesis we performed a multi-centre, placebo-controlled, randomised trial conducted at four university-affiliated hospitals in Canada. Patients on chronic warfarin therapy received oral vitamin K 150 mcg daily or a matching placebo for a total of six months after a one-month run in period. The primary outcome was a comparison of mean time in therapeutic range (TTR
Efficacy and Safety of Apixaban Compared With Warfarin in Patients With Atrial Fibrillation in Relation to Renal Function Over Time: Insights From the ARISTOTLE Randomized Clinical Trial. 27438322 2016 07 21 2017 02 03 2380-6591 1 4 2016 Jul 01 JAMA cardiology JAMA Cardiol Efficacy and Safety of Apixaban Compared With Warfarin in Patients With Atrial Fibrillation in Relation to Renal Function Over Time: Insights From the ARISTOTLE Randomized Clinical Trial. 451-60 10.1001/jamacardio.2016.1170 (...) Renal impairment confers an increased risk of stroke, bleeding, and death in patients with atrial fibrillation. Little is known about the efficacy and safety of apixaban in relation to renal function changes over time. To evaluate changes of renal function over time and their interactions with outcomes during a median of 1.8 years of follow-up in patients with atrial fibrillation randomized to apixaban vs warfarin treatment. The prospective, randomized, double-blind Apixaban for Reduction in Stroke
Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study. OBJECTIVE: To study the effectiveness and safety of the non-vitamin K antagonist oral anticoagulants (novel oral anticoagulants, NOACs) dabigatran, rivaroxaban, and apixaban compared with warfarin in anticoagulant naïve patients with atrial fibrillation. DESIGN: Observational nationwide cohort study. SETTING: Three (...) Danish nationwide databases, August 2011 to October 2015. PARTICIPANTS: 61 678 patients with non-valvular atrial fibrillation who were naïve to oral anticoagulants and had no previous indication for valvular atrial fibrillation or venous thromboembolism. The study population was distributed according to treatment type: warfarin (n=35 436, 57%), dabigatran 150 mg (n=12 701, 21%), rivaroxaban 20 mg (n=7192, 12%), and apixaban 5 mg (n=6349, 10%). MAIN OUTCOME MEASURES: Effectiveness outcomes defined
Incidence and Determinants of Traumatic Intracranial Bleeding Among Older Veterans Receiving Warfarin for Atrial Fibrillation 27437657 2018 04 24 2018 11 13 2380-6591 1 1 2016 04 01 JAMA cardiology JAMA Cardiol Incidence and Determinants of Traumatic Intracranial Bleeding Among Older Veterans Receiving Warfarin for Atrial Fibrillation. 65-72 10.1001/jamacardio.2015.0345 Traumatic intracranial bleeding, which is most commonly attributable to falls, is a common concern among health care (...) professionals, who are hesitant to prescribe oral anticoagulants to older adults with atrial fibrillation. To describe the incidence of and risk factors for traumatic intracranial bleeding in a large cohort of older adults who were newly prescribed warfarin sodium. Retrospective cohort study at the US Department of Veterans Affairs (VA). Participants included 31 951 veterans with atrial fibrillation 75 years or older who were new referrals to VA anticoagulation clinics (for warfarin therapy) between January
Warfarin initiation nomograms for venous thromboembolism. BACKGROUND: Venous thromboembolism (VTE) is a common condition in hospital patients. Considerable controversy is ongoing regarding optimal initial warfarin dosing for patients with acute deep venous thrombosis (DVT) and pulmonary embolism (PE). Achieving a therapeutic international normalized ratio (INR) with warfarin as soon as possible is important because this minimizes the duration of parenteral medication necessary to attain (...) immediate anticoagulation, and it potentially decreases the cost and inconvenience of treatment. Although a 5-mg loading-dose nomogram tends to prevent excessive anticoagulation, a 10-mg loading-dose nomogram may achieve a therapeutic INR more quickly. This is an update of a review first published in 2013. OBJECTIVES: To evaluate the efficacy of a 10-mg warfarin nomogram compared with a 5-mg warfarin nomogram among patients with VTE. SEARCH METHODS: For this update the Cochrane Vascular Trials Search Co
Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for Pharmacogenetics-guided Warfarin Dosing Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Pharmacogenetics-Guided Warfarin Dosing: 2017 Update JAJohnson 1 , KECaudle 2 , LGong 3 ,M Whirl-Carrillo 3 , CMStein 4 , SAScott 5 , MTLee 6 , BFGage 7 , SEKimmel 8,9 , MAPerera 10 , JLAnderson 11 , MPirmohamed 12 , TEKlein 3 , NALimdi 13 , LHCavallari 1 and MWadelius 14 This document is an update to the 2011 (...) Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2C9 and VKORC1 genotypes and warfarin dosing. Evidence from the published literature is presented for CYP2C9,VKORC1,CYP4F2, andrs12777823genotype-guided warfarindosingtoachieveatargetinternationalnormalizedratio of 2–3 when clinical genotype results are available. In addition, this updated guideline incorporates recommendations for adult andpediatricpatientsthatarespeci?ctocontinentalancestry. Warfarin is a widely used
Is long-term Rivaroxaban superior to Warfarin in pulmonary embolism at 6 months? BestBets: Is long-term Rivaroxaban superior to Warfarin in pulmonary embolism at 6 months? Is long-term Rivaroxaban superior to Warfarin in pulmonary embolism at 6 months? Report By: Chris Morgan - Medical Student Y5 Search checked by Rick Body - Consultant in Emergency Medicine Institution: University of Manchester, Manchester, UK Original institution: Manchester Royal Infirmary Date Submitted: 21st October 2015 (...) Date Completed: 21st October 2015 Last Modified: 21st October 2015 Status: Green (complete) Three Part Question In [patients with proven pulmonary embolism (PE)] is [Rivaroxaban better than warfarin] at [reducing mortality and recurrence of venous thromboembolism at 6 months]? Clinical Scenario A 52-year-old lady has presented to the Emergency Department with a suspected PE. This is confirmed by CT pulmonary angiography (CTPA). Consequently she requires anticoagulation. Hospital guidelines suggest
Warfarin Therapy Management Guidelines & Protocols Advisory Committee Warfarin Therapy Management Effective Date: April 1, 2015 Scope This guideline provides recommendations for the long-term management of warfarin therapy in patients aged =19 years in the primary care setting. The guideline describes: 1) warfarin initiation, 2) international normalized ratio (INR) monitoring with optimal ranges, and 3) warfarin dosage adjustment. This guideline assumes the physician has reviewed (...) the indications for warfarin and the duration of therapy as these are not discussed in this guideline. Perioperative management of warfarin is covered in the BCGuidelines.ca – Warfarin Therapy – Management During Invasive Procedures and Surgery. This guideline is part of the BCGuidelines.ca – Stroke and Atrial Fibrillation series. The series includes three other guidelines: Stroke and Transient Ischemic Attack – Acute and Long-Term Management; Atrial Fibrillation – Diagnosis and Management; and Use of Non
Warfarin Therapy - Management During Invasive Procedures and Surgery Guidelines & Protocols Advisory Committee Warfarin Therapy – Management During Invasive Procedures and Surgery Effective Date: April 1, 2015 Scope This guideline provides recommendations for the management of warfarin therapy in adults aged = 19 years requiring invasive procedures and surgery. Perioperative management of non-vitamin K antagonist oral anticoagulants can be found in BCGuidelines.ca – Use of NOACs in Non-Valvular (...) Atrial Fibrillation. Non-perioperative management of warfarin is covered in BCGuidelines.ca – Warfarin Therapy Management. Key Recommendations • Warfarin discontinuation prior to invasive procedures is necessary for all interventional procedures except for minor skin procedures, routine dental work, cataract surgery, endoscopies without biopsy, and percutaneous venous access. • For elective procedures, warfarin should be stopped for 5 to 6 days prior to the procedure to allow gradual normalization
Report in Brief - Optimal Warfarin Management for Prevention of Thromboembolic Events in Patients with Atrial Fibrillation Warfarin Management for Thromboembolic Events in Atrial Fibrillation | CADTH.ca Find the information you need Warfarin Management for Thromboembolic Events in Atrial Fibrillation Warfarin Management for Thromboembolic Events in Atrial Fibrillation Published on: August 15, 2011 Project Number: OP0508 Product Line: Result type: Report Warfarin has been the mainstay of oral (...) anticoagulant therapy for more than 60 years. The effectiveness of warfarin for the prevention of stroke in patients with atrial fibrillation is well established. In Canada, an estimated 200,000 to 250,000 people have this condition. Need for Recommendations Managing warfarin therapy is challenging because warfarin interacts with many foods and other drugs. Each patient needs an individualized warfarin dose, which takes time to determine and requires patients to go in for frequent laboratory testing