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Latest & greatest articles for warfarin
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A pharmacogenetic versus a clinical algorithm for warfarin dosing. 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.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.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 minus clinically guided group], -0.2
A randomized trial of genotype-guided dosing of warfarin. 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.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 of time
Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in patients with atrial fibrillation and prior stroke or transient ischemic attack Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Dabigatran versus Warfarin in Patients with Mechanical Heart Valves. 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.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 was the trough plasma level
Apixaban reduced stroke or systemic embolism more than warfarin in AF regardless of renal function. 23247956 2013 04 12 2012 12 18 1539-3704 157 12 2012 Dec 18 Annals of internal medicine Ann. Intern. Med. ACP Journal Club. Apixaban reduced stroke or systemic embolism more than warfarin in AF regardless of renal function. JC6-7 10.7326/0003-4819-157-12-201212180-02007 Jones Melvyn M MM University College London Medical School, London, England, UK. eng Comment Journal Article United States Ann
Bleeding risk in randomized controlled trials comparing warfarin and aspirin: a systematic review and meta-analysis Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Comparative effectiveness of warfarin and new oral anticoagulants for the management of atrial fibrillation and venous thromboembolism: a systematic review Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Comparative Effectiveness of Warfarin and Newer Oral Anticoagulants for the Long-Term Prevention and Treatment of Arterial and Venous Thromboembolism Management Briefs Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Management Briefs Health Services Research & Development Management Briefs Management eBriefs: Provide VA senior managers with results from VA Health Services Research in a concise
A placebo-controlled randomized trial of warfarin in idiopathic pulmonary fibrosis Animal and human studies support the importance of the coagulation cascade in pulmonary fibrosis.In a cohort of subjects with progressive idiopathic pulmonary fibrosis (IPF), we tested the hypothesis that treatment with warfarin at recognized therapeutic doses would reduce rates of mortality, hospitalization, and declines in FVC.This was a double-blind, randomized, placebo-controlled trial of warfarin targeting (...) an international normalized ratio of 2.0 to 3.0 in patients with IPF. Subjects were randomized in a 1:1 ratio to warfarin or matching placebo for a planned treatment period of 48 weeks. International normalized ratios were monitored using encrypted home point-of-care devices that allowed blinding of study therapy.The primary outcome measure was the composite outcome of time to death, hospitalization (nonbleeding, nonelective), or a 10% or greater absolute decline in FVC. Due to a low probability of benefit
Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding. The need for anticoagulation after surgical aortic valve replacement (AVR) with biological prostheses is not well examined.To perform a nationwide study of the association of warfarin treatment with the risk of thromboembolic complications, bleeding incidents, and cardiovascular deaths after bioprosthetic AVR surgery.Through a search (...) in the Danish National Patient Registry, 4075 patients were identified who had bioprosthetic AVR surgery performed between January 1, 1997, and December 31, 2009. Concomitant comorbidity and medication were retrieved. Poisson regression models were used to determine risk.Incidence rate ratios (IRRs) of strokes, thromboembolic events, cardiovascular deaths, and bleeding incidents by discontinuing warfarin as opposed to continued treatment 30 to 89 days, 90 to 179 days, 180 to 364 days, 365 to 729 days
Impact of a pharmacist-led warfarin self-management program on quality of life and anticoagulation control: a randomized trial To evaluate the impact of a pharmacist-led warfarin patient self-management program on quality of life and anticoagulation control compared with management in a physician-led specialized anticoagulation clinic.Prospective, randomized, controlled, open-label trial.Tertiary care academic medical center.A total of 114 patients aged 18-75 years who were followed (...) at a specialized anticoagulation clinic, had received warfarin for at least 6 months, and were expected to continue warfarin for a minimum of 4 months.All patients attended an educational session on anticoagulation provided by a pharmacist. Patients randomized to the self-management group (58 patients) also received practical training to use the CoaguChek XS device and a self-management dosing algorithm. Patients in the control group (56 patients) continued to undergo standard management at the anticoagulation
Meta-Analysis of Safety and Efficacy of Uninterrupted Warfarin Compared to Heparin-Based Bridging Therapy During Implantation of Cardiac Rhythm Devices Optimal management of perioperative anticoagulation in patients undergoing pacemaker or implantable cardioverter-defibrillator implantation is not yet established. We performed a meta-analysis of the published literature to assess the safety and efficacy of perioperative heparin-based bridging therapy versus uninterrupted warfarin therapy (...) in patients undergoing pacemaker or implantable cardioverter-defibrillator implantation. We performed a systematic review of MEDLINE (1950 to 2012), EMBASE (1988 to 2012), Cochrane Controlled Trials Register (fourth quarter 2011), and reports presented at scientific meetings (1994 to 2011). Randomized controlled trials, case-control, or cohort studies comparing the safety and efficacy of uninterrupted warfarin therapy to heparin-based bridging therapy were eligible. Outcomes reported in eligible studies
Optimal warfarin management for the prevention of thromboembolic events in patients with atrial fibrillation: a systematic review of the clinical evidence. 23002382 2012 09 25 2018 11 13 1481-4501 2 3 2012 CADTH technology overviews CADTH Technol Overv Optimal warfarin management for the prevention of thromboembolic events in patients with atrial fibrillation: a systematic review of the clinical evidence. e2304 eng Journal Article 2012 09 01 Canada CADTH Technol Overv 101566385 1203-9012 2012 9
Review: New oral anticoagulants reduced stroke and systemic embolism compared with warfarin in AF. 22986394 2012 12 03 2012 09 18 1539-3704 157 6 2012 Sep 18 Annals of internal medicine Ann. Intern. Med. ACP Journal Club. Review: new oral anticoagulants reduced stroke and systemic embolism compared with warfarin in AF. JC3-2 10.7326/0003-4819-157-6-201209180-02002 Klein Liviu L eng Comment Journal Article United States Ann Intern Med 0372351 0003-4819 Am J Cardiol. 2012 Aug 1;110(3):453-60
Warfarin and aspirin did not differ for death or stroke in heart failure and sinus rhythm. 22910961 2012 10 19 2012 08 22 1539-3704 157 4 2012 Aug 21 Annals of internal medicine Ann. Intern. Med. ACP Journal Club: warfarin and aspirin did not differ for death or stroke in heart failure and sinus rhythm. JC2-7 10.7326/0003-4819-157-4-201208210-02007 Ahmad Tariq T Duke University School of Medicine, Durham, North Carolina, USA. Felker G Michael GM eng Comment Journal Article United States Ann
Periprocedural Bleeding and Thromboembolic Events With Dabigatran Compared With Warfarin: Results From the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) Randomized Trial Dabigatran reduces ischemic stroke in comparison with warfarin; however, given the lack of antidote, there is concern that it might increase bleeding when surgery or invasive procedures are required.The current analysis was undertaken to compare the periprocedural bleeding risk of patients in the Randomized (...) Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial treated with dabigatran and warfarin. Bleeding rates were evaluated from 7 days before until 30 days after invasive procedures, considering only the first procedure for each patient. A total of 4591 patients underwent at least 1 invasive procedure: 24.7% of patients received dabigatran 110 mg, 25.4% received dabigatran 150 mg, and 25.9% received warfarin, P=0.34. Procedures included: pacemaker/defibrillator insertion (10.3%), dental procedures
INR Online Software for the Management of Warfarin Dosing in Patients Requiring Warfarin Treatment: Clinical Evidence Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within (...) for the Management of Warfarin Dosing in Patients Requiring Warfarin Treatment: Clinical Evidence DATE: 8 August 2012 RESEARCH QUESTION What is the clinical evidence regarding the use of the INR Online Software, in conjunction with point of care testing, for the management of international normalized ratio dosing in patients requiring warfarin treatment? KEY MESSAGE No relevant information was identified regarding the INR Online Software, in conjunction with point of care testing, for the management
Comparative Effectiveness of Warfarin and Newer Oral Anticoagulants for the Long-term Prevention and Treatment of Arterial and Venous Thromboembolism Evidence-based Synthesis Program Department of Veterans Affairs Health Services Research & Development Service April 2012 Comparative Effectiveness of Warfarin and Newer Oral Anticoagulants for the Long-term Prevention and Treatment of Arterial and Venous Thromboembolism Prepared for: Department of Veterans Affairs Veterans Health Administration (...) . Warfarin and Newer Oral Anticoagulants: Long-term Prevention and Treatment of Arterial and VTE Evidence-based Synthesis Program PREFACE Quality Enhancement Research Initiative’s (QUERI’s) Evidence-based Synthesis Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare topics of particular importance to Veterans Affairs (V A) managers and policymakers, as they work to improve the health and healthcare of Veterans. The ESP disseminates these reports throughout V
Warfarin in Heart Failure. 22551103 2012 05 24 2018 12 01 1533-4406 366 20 2012 May 17 The New England journal of medicine N. Engl. J. Med. Warfarin in heart failure. 1936-8 10.1056/NEJMe1202504 Eikelboom John W JW Connolly Stuart J SJ eng Editorial Comment 2012 05 02 United States N Engl J Med 0255562 0028-4793 0 Anticoagulants 0 Platelet Aggregation Inhibitors 5Q7ZVV76EI Warfarin R16CO5Y76E Aspirin AIM IM N Engl J Med. 2012 May 17;366(20):1859-69 22551105 Anticoagulants therapeutic use (...) Aspirin therapeutic use Female Heart Failure drug therapy Humans Male Platelet Aggregation Inhibitors therapeutic use Warfarin therapeutic use 2012 5 4 6 0 2012 5 4 6 0 2012 5 25 6 0 ppublish 22551103 10.1056/NEJMe1202504
Current trial-associated outcomes with warfarin in prevention of stroke in patients with nonvalvular atrial fibrillation: a meta-analysis Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.