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Latest & greatest articles for warfarin
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Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. IMPORTANCE: While effective in preventing stroke in patients with atrial fibrillation (AF), warfarin is limited by a narrow therapeutic profile, a need for lifelong coagulation monitoring, and multiple drug and diet interactions. OBJECTIVE: To determine whether a local strategy of mechanical left atrial appendage (LAA) closure was noninferior to warfarin. DESIGN, SETTING (...) event rates between treatment groups. INTERVENTIONS: Left atrial appendage closure with the device (n = 463) or warfarin (n = 244; target international normalized ratio, 2-3). MAIN OUTCOMES AND MEASURES: A composite efficacy end point including stroke, systemic embolism, and cardiovascular/unexplained death, analyzed by intention-to-treat. RESULTS: At a mean (SD) follow-up of 3.8 (1.7) years (2621 patient-years), there were 39 events among 463 patients (8.4%) in the device group for a primary event
In nonvalvular atrial fibrillation, effects of rivaroxaban compared with warfarin did not differ by patient age 25402538 2014 11 18 2015 04 14 2016 10 25 1539-3704 161 10 2014 Nov 18 Annals of internal medicine Ann. Intern. Med. ACP Journal Club: in nonvalvular atrial fibrillation, effects of rivaroxaban compared with warfarin did not differ by patient age. JC5 10.7326/0003-4819-161-10-201411180-02005 Rondina Matthew M eng K23 HL092161 HL NHLBI NIH HHS United States R01 AG048022 AG NIA NIH HHS (...) United States R01 HL126547 HL NHLBI NIH HHS United States R03 AG040631 AG NIA NIH HHS United States Comment Journal Article United States Ann Intern Med 0372351 0003-4819 0 Factor Xa Inhibitors 0 Morpholines 0 Thiophenes 12001-79-5 Vitamin K 5Q7ZVV76EI Warfarin AIM IM Eur Heart J. 2014 Jul 21;35(28):1864-72 24561548 Circulation. 2011 May 31;123(21):2363-72 21576658 Circulation. 2014 Jul 8;130(2):138-46 24895454 Atrial Fibrillation drug therapy Embolism prevention & control Factor Xa Inhibitors Female
Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis Providencia R, Albenque JP, Combes S (...) , Bouzeman A, Casteigt B, Combes N, Narayanan K, Marijon E, Boveda S CRD summary This review indicated that dabigatran for catheter ablation in patients with atrial fibrillation had a similar incidence of thromboembolic events and major bleeding to that of warfarin, with low event rates overall. The observational nature of nearly all the studies in the review, coupled with the few events, mean that the authors' conclusions should not be seen as definitive. Authors' objectives To compare the efficacy
Factor Xa Inhibitors vs Warfarin for Preventing Stroke and Thromboembolism in Patients With Atrial Fibrillation. CLINICAL QUESTION: Is treatment with factor Xa inhibitors associated with better efficacy and safety compared with the vitamin K antagonist warfarin for preventing strokes or other systemic embolic events in patients with atrial fibrillation? BOTTOM LINE: Compared with warfarin, factor Xa inhibitors are associated with a lower risk of stroke and other systemic embolic events (...) in patients with atrial fibrillation. Factor Xa inhibitors were associated with lower rates of intracranial hemorrhage and mortality compared with warfarin. Factor Xa inhibitors were associated with a reduction in major bleeding events, but there was heterogeneity between the included studies, and the reduction was not statistically significant in a prespecified sensitivity analysis.
Warfarin, kidney dysfunction, and outcomes following acute myocardial infarction in patients with atrial fibrillation. IMPORTANCE: Conflicting evidence exists regarding the association between warfarin treatment, death, and ischemic stroke incidence in patients with advanced chronic kidney disease (CKD) and atrial fibrillation. OBJECTIVE: To study outcomes associated with warfarin treatment in relation to kidney function among patients with established cardiovascular disease (...) ), including 21.8% who were prescribed warfarin at discharge. Chronic kidney disease stages were classified according to estimated glomerular filtration rate (eGFR). MAIN OUTCOMES AND MEASURES: (1) Composite end point analysis of death, readmission due to MI, or ischemic stroke; (2) bleeding (composite of readmission due to hemorrhagic stroke, gastrointestinal bleeding, bleeding causing anemia, and others); or (3) the aggregate of these 2 outcomes within 1 year from discharge date. RESULTS: A total of 5292
High-sensitivity troponin T and risk stratification in patients with atrial fibrillation during treatment with apixaban or warfarin 24055845 2014 01 10 2014 03 11 2015 11 19 1558-3597 63 1 2014 Jan 7-14 Journal of the American College of Cardiology J. Am. Coll. Cardiol. High-sensitivity troponin T and risk stratification in patients with atrial fibrillation during treatment with apixaban or warfarin. 52-61 10.1016/j.jacc.2013.07.093 S0735-1097(13)05241-8 The aim of this study was to evaluate (...) with apixaban or warfarin in the ARISTOTLE (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation) trial. The associations between baseline hs-TnT levels and outcomes were evaluated using adjusted Cox regression models. Levels of hs-TnT were measurable in 93.5% of patients; 75% had levels >7.5 ng/l, 50% had levels >11.0 ng/l, and 25% had levels >16.7 ng/l. During a median 1.9-year period, the annual rates of stroke or systemic embolism ranged from 0.87% in the lowest hs-TnT quartile
Low-molecular weight heparins versus warfarin for the long-term prevention or treatment of deep vein thrombosis or pulmonary embolism: a review of the clinical and cost-effectiveness Low-molecular weight heparins versus warfarin for the long-term prevention or treatment of deep vein thrombosis or pulmonary embolism: a review of the clinical and cost-effectiveness Low-molecular weight heparins versus warfarin for the long-term prevention or treatment of deep vein thrombosis or pulmonary (...) embolism: a review of the clinical and cost-effectiveness CADTH Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation CADTH. Low-molecular weight heparins versus warfarin for the long-term prevention or treatment of deep vein thrombosis or pulmonary embolism: a review of the clinical and cost-effectiveness. Ottawa: Canadian Agency for Drugs and Technologies
Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials Ruff CT, Giugliano RP, Braunwald E (...) , Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM CRD summary This review concluded that new oral anticoagulants offered significant reductions in stroke, intracranial haemorrhage, and mortality, compared with warfarin, with a similar risk of major bleeding and an increased risk of gastrointestinal bleeding. Despite shortcomings in the reporting, these conclusions are likely to be reliable. Authors' objectives To assess the efficacy and safety
Warfarin USE OF WARFARIN IN PREGNANCY 0344 892 0909 USE OF WARFARIN IN PREGNANCY (Date of issue: July 2012 , Version: 2 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . Summary Warfarin is a coumarin anticoagulant which acts as a vitamin K antagonist. It is licensed for prevention of systemic embolism in people (...) with rheumatic heart disease, atrial fibrillation, prosthetic heart valves, and transient cerebral ischaemic attacks, and for prevention and treatment of venous thrombosis and pulmonary embolism. Fetal warfarin syndrome (FWS) or warfarin embryopathy is a well recognised complication following warfarin exposure in pregnancy. The critical period for the development of FWS has not been defined, although data suggests that the risk period covers gestational weeks 6-12. The risk of warfarin embryopathy following
A pharmacogenetic versus a clinical algorithm for warfarin dosing. BACKGROUND: The clinical utility of genotype-guided (pharmacogenetically based) dosing of warfarin has been tested only in small clinical trials or observational studies, with equivocal results. METHODS: We randomly assigned 1015 patients to receive doses of warfarin during the first 5 days of therapy that were determined according to a dosing algorithm that included both clinical variables and genotype data or to one (...) that included clinical variables only. All patients and clinicians were unaware of the dose of warfarin during the first 4 weeks of therapy. The primary outcome was the percentage of time that the international normalized ratio (INR) was in the therapeutic range from day 4 or 5 through day 28 of therapy. RESULTS: At 4 weeks, the mean percentage of time in the therapeutic range was 45.2% in the genotype-guided group and 45.4% in the clinically guided group (adjusted mean difference, [genotype-guided group
A randomized trial of genotype-guided dosing of warfarin. BACKGROUND: The level of anticoagulation in response to a fixed-dose regimen of warfarin is difficult to predict during the initiation of therapy. We prospectively compared the effect of genotype-guided dosing with that of standard dosing on anticoagulation control in patients starting warfarin therapy. METHODS: We conducted a multicenter, randomized, controlled trial involving patients with atrial fibrillation or venous thromboembolism (...) . Genotyping for CYP2C9*2, CYP2C9*3, and VKORC1 (-1639G→A) was performed with the use of a point-of-care test. For patients assigned to the genotype-guided group, warfarin doses were prescribed according to pharmacogenetic-based algorithms for the first 5 days. Patients in the control (standard dosing) group received a 3-day loading-dose regimen. After the initiation period, the treatment of all patients was managed according to routine clinical practice. The primary outcome measure was the percentage
Edoxaban versus Warfarin in Patients with Atrial Fibrillation. BACKGROUND: Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known. METHODS: We conducted a randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation (median follow-up, 2.8 (...) years). The primary efficacy end point was stroke or systemic embolism. Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period. The principal safety end point was major bleeding. RESULTS: The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P<0.001 for noninferiority
Preoperative discontinuation of Warfarin for dental surgery not indicated for most patients UTCAT2600, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Preoperative Discontinuation of Warfarin for Dental Surgery Not Indicated for Most Patients Clinical Question In patients being treated with warfarin, should anticoagulant treatment routinely be interrupted before undergoing dental extractions or is local hemostasis (...) an adequate method to reduce risk of excessive bleeding? Clinical Bottom Line Patients being therapeutically anti-coagulated with warfarin (at an International Normalized Ratio (INR) of less than 4), can undergo dental extractions without discontinuation of anticoagulant therapy considering proper local hemostatic measures are used. 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) Rodriguez-Cabrera/2011
An update of consensus guidelines for warfarin reversal An update of consensus guidelines for warfarin reversal | Medical Journal of Australia Search form Search Articles Topics MJA team Author centre Multimedia Centenary Place an ad secondlevel Clinical focus An update of consensus guidelines for warfarin reversal Huyen A Tran, Sanjeev D Chunilal, Paul L Harper, Huy Tran, Erica M Wood and Alex S Gallus, on behalf of the Australasian Society of Thrombosis and Haemostasis Med J Aust 2013; 198 (4 (...) ): 198-199. doi: 10.5694/mja12.10614 Abstract Despite the associated bleeding risk, warfarin is the most commonly prescribed anticoagulant in Australia and New Zealand. Warfarin use will likely continue for anticoagulation indications for which novel agents have not been evaluated and among patients who are already stabilised on it or have severe renal impairment. Strategies to manage over-warfarinisation and warfarin during invasive procedures can reduce the risk of haemorrhage. For most warfarin
Dabigatran versus warfarin in patients with mechanical heart valves. BACKGROUND: Dabigatran is an oral direct thrombin inhibitor that has been shown to be an effective alternative to warfarin in patients with atrial fibrillation. We evaluated the use of dabigatran in patients with mechanical heart valves. METHODS: In this phase 2 dose-validation study, we studied two populations of patients: those who had undergone aortic- or mitral-valve replacement within the past 7 days and those who had (...) undergone such replacement at least 3 months earlier. Patients were randomly assigned in a 2:1 ratio to receive either dabigatran or warfarin. The selection of the initial dabigatran dose (150, 220, or 300 mg twice daily) was based on kidney function. Doses were adjusted to obtain a trough plasma level of at least 50 ng per milliliter. The warfarin dose was adjusted to obtain an international normalized ratio of 2 to 3 or 2.5 to 3.5 on the basis of thromboembolic risk. The primary end point
Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism. BACKGROUND: Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear. METHODS: In a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received heparin, to receive edoxaban at a dose of 60 mg once daily, or 30 mg once daily (e.g., in the case of patients (...) with creatinine clearance of 30 to 50 ml per minute or a body weight below 60 kg), or to receive warfarin. Patients received the study drug for 3 to 12 months. The primary efficacy outcome was recurrent symptomatic venous thromboembolism. The principal safety outcome was major or clinically relevant nonmajor bleeding. RESULTS: A total of 4921 patients presented with deep-vein thrombosis, and 3319 with a pulmonary embolism. Among patients receiving warfarin, the time in the therapeutic range was 63.5