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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. 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.To determine whether a local strategy of mechanical left atrial appendage (LAA) closure was noninferior to warfarin.PROTECT AF was a multicenter, randomized (2:1), unblinded (...) with the device (n = 463) or warfarin (n = 244; target international normalized ratio, 2-3).A composite efficacy end point including stroke, systemic embolism, and cardiovascular/unexplained death, analyzed by intention-to-treat.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 rate of 2.3 events per 100 patient-years, compared with 34 events among 244 patients (13.9%) for a primary event rate of 3.8 events
In nonvalvular atrial fibrillation, effects of rivaroxaban compared with warfarin did not differ by patient age 25402538 2015 04 14 2018 12 02 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 Journal Article Comment 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 Circulation. 2014 Jul 8;130(2):138-46 24895454 Atrial Fibrillation drug therapy Embolism prevention & control Factor Xa Inhibitors Female Humans Male Morpholines administration & dosage Stroke prevention & control Thiophenes administration
Factor Xa Inhibitors vs Warfarin for Preventing Stroke and Thromboembolism in Patients With Atrial Fibrillation. 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?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. 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.To study outcomes associated with warfarin treatment in relation to kidney function among patients with established cardiovascular disease and atrial fibrillation.Observational (...) , prospective, multicenter cohort study from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry (2003-2010), which includes all Swedish hospitals that provide care for acute cardiac diseases. Participants included consecutive survivors of an acute myocardial infarction (MI) with atrial fibrillation and known serum creatinine (N = 24,317), including 21.8% who were prescribed warfarin at discharge
High-sensitivity troponin T and risk stratification in patients with atrial fibrillation during treatment with apixaban or warfarin The aim of this study was to evaluate the prognostic value of high-sensitivity troponin T (hs-TnT) in addition to clinical risk factors and the CHA2DS2VASc (congestive heart failure, hypertension, 75 years of age and older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, 65 to 74 years of age, female) risk score in patients (...) with atrial fibrillation (AF).The level of troponin is a powerful predictor of cardiovascular events and mortality.A total of 14,897 patients with AF were randomized to treatment 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
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
Warfarin USE OF WARFARIN IN PREGNANCY 0344 892 0909 USE OF WARFARIN IN PREGNANCY (Date of issue: December 2017 , Version: 3 ) 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 and vitamin K antagonist which acts by inhibiting clotting factors II, VII, IX and X. It is indicated (...) for: the prevention of systemic embolism in patients with rheumatic heart disease and atrial fibrillation, prophylaxis after insertion of prosthetic heart valves, prophylaxis and treatment of venous thrombosis and pulmonary embolism, and treatment of transient cerebral ischaemic attacks. Fetal warfarin syndrome (FWS) or warfarin embryopathy, characterised by nasal hypoplasia and skeletal abnormalities, including short limbs and digits, and stippled epiphyses, is a well-recognised complication of first trimester
Edoxaban versus Warfarin in Patients with Atrial Fibrillation. 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.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.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) and 1.61% with low-dose edoxaban
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 | The Medical Journal of Australia mja-search search Use the for more specific terms. Title contains Body contains Date range from Date range to Article type Author's surname Volume First page doi: 10.5694/mja__.______ Search Reset close Individual Login Purchase options Connect person_outline Login keyboard_arrow_down Individual Login Purchase options menu search Advertisement (...) close 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 Published online: 4 March 2013 Topics Abstract , Therefore, strategies to manage over-warfarinisation and warfarin during invasive procedures are important. , Despite the associated bleeding risk, warfarin remains
Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism. Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear.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.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%. Edoxaban was noninferior
Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation Harrington AR, Armstrong EP, Nolan PE, Malone DC Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion (...) on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary This study evaluated the cost-effectiveness of new oral anticoagulants, for stroke prevention, in patients with nonvalvular atrial fibrillation, compared with warfarin. The authors concluded that the anticoagulants were more cost-effective than warfarin, and apixaban was preferred. The study
Warfarin initiation nomograms for venous thromboembolism. 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.To evaluate the efficacy of a 10-mg warfarin nomogram compared with a 5-mg warfarin nomogram among patients with VTE.The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched January 2013) and the Cochrane
Genetic variants associated with warfarin dose in African-American individuals: a genome-wide association study. VKORC1 and CYP2C9 are important contributors to warfarin dose variability, but explain less variability for individuals of African descent than for those of European or Asian descent. We aimed to identify additional variants contributing to warfarin dose requirements in African Americans.We did a genome-wide association study of discovery and replication cohorts. Samples from African (...) -American adults (aged ≥18 years) who were taking a stable maintenance dose of warfarin were obtained at International Warfarin Pharmacogenetics Consortium (IWPC) sites and the University of Alabama at Birmingham (Birmingham, AL, USA). Patients enrolled at IWPC sites but who were not used for discovery made up the independent replication cohort. All participants were genotyped. We did a stepwise conditional analysis, conditioning first for VKORC1 -1639G→A, followed by the composite genotype of CYP2C9*2
Point-of-Care Testing of the International Normalized Ratio (INR) for Patients Taking Warfarin or Other Vitamin K Antagonists Point-of-Care Testing of the International Normalized Ratio (INR) for Patients Taking Warfarin or Other Vitamin K Antagonists | CADTH.ca Find the information you need Point-of-Care Testing of the International Normalized Ratio (INR) for Patients Taking Warfarin or Other Vitamin K Antagonists Point-of-Care Testing of the International Normalized Ratio (INR) for Patients (...) Taking Warfarin or Other Vitamin K Antagonists Published on: April 18, 2013 Project Number: OP0515 Product Line: Result type: Report CADTH has undertaken an optimal use project to assess the clinical and economic impact of point-of-care (POC) testing of the international normalized ratio (INR) for patients taking warfarin or other vitamin K antagonists. Patients with atrial fibrillation, prosthetic heart valves, or venous thromboembolism may be prescribed oral anticoagulation therapy (OAT
Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. Dabigatran, which is administered in a fixed dose and does not require laboratory monitoring, may be suitable for extended treatment of venous thromboembolism.In two double-blind, randomized trials, we compared dabigatran at a dose of 150 mg twice daily with warfarin (active-control study) or with placebo (placebo-control study) in patients with venous thromboembolism who had completed at least 3 initial months (...) of therapy.In the active-control study, recurrent venous thromboembolism occurred in 26 of 1430 patients in the dabigatran group (1.8%) and 18 of 1426 patients in the warfarin group (1.3%) (hazard ratio with dabigatran, 1.44; 95% confidence interval [CI], 0.78 to 2.64; P=0.01 for noninferiority). Major bleeding occurred in 13 patients in the dabigatran group (0.9%) and 25 patients in the warfarin group (1.8%) (hazard ratio, 0.52; 95% CI, 0.27 to 1.02). Major or clinically relevant bleeding was less frequent
Cost-effectiveness of clopidogrel plus aspirin for stroke prevention in patients with atrial fibrillation in whom warfarin is unsuitable Cost-effectiveness of clopidogrel plus aspirin for stroke prevention in patients with atrial fibrillation in whom warfarin is unsuitable Cost-effectiveness of clopidogrel plus aspirin for stroke prevention in patients with atrial fibrillation in whom warfarin is unsuitable Coleman CI, Straznitskas AD, Sobieraj DM, Kluger J, Anglade MW Record Status (...) atrial fibrillation, who were 65 years old, had a low risk of bleeding, and were unsuitable for warfarin. Patients had a Congestive heart failure, Hypertension, Age, Diabetes, and Stroke (CHADS 2 ) score of two. Interventions Clopidogrel, 75mg per day, plus aspirin, 75mg to 100mg per day, was compared with aspirin alone. Location/setting USA/out-patient secondary care. Methods Analytical approach: A Markov model was constructed of the ongoing risk of stroke, myocardial infarction and adverse events