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Heparin bridging in warfarin anticoagulation therapy initiation could increase bleeding in nonvalvular atrial fibrillation patients: A multicenter propensity-matched analysis.
CONCLUSIONS: The heparin bridging therapy increased bleeding without the benefit of preventing stroke at the initiation of OAC in NVAF. Our data suggest that heparin bridging should not be considered at the initiation of OAC in NVAF patients. This article is protected by copyright. All rights reserved. PMID: 25472735 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - December 4, 2014 Category: Hematology Authors: Kim TH, Kim JY, Mun HS, Lee HY, Roh YH, Uhm JS, Pak HN, Lee MH, Joung B Tags: J Thromb Haemost Source Type: research

Perioperative bridging anticoagulation during dabigatran or warfarin interruption among patients with an elective surgery or procedure. Substudy of the RE-LY trial.
In conclusion, in patients who interrupted dabigatran or warfarin for a surgery/procedure in the RE-LY trial, use of bridging anticoagulation appeared to increase the risk for major bleeding irrespective of dabigatran or warfarin interruption. PMID: 25472710 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - December 4, 2014 Category: Hematology Authors: Douketis JD, Healey JS, Brueckmann M, Eikelboom JW, Ezekowitz MD, Fraessdorf M, Noack H, Oldgren J, Reilly P, Spyropoulos AC, Wallentin L, Connolly SJ Tags: Thromb Haemost Source Type: research

Organ-specific bleeding patterns of anticoagulant therapy: lessons from clinical trials.
Abstract Anticoagulants are effective at preventing and treating thrombosis, but can cause bleeding. For decades, vitamin K antagonists (VKAs) have been the only available oral anticoagulants. The development of non-VKA oral anticoagulants (NOACs), which inhibit either factor Xa or thrombin stoichiometrically, has provided alternatives to VKAs for several indications. The results of recent large-scale randomised controlled trials comparing NOACs with VKAs for the prevention of stroke in patients with non-valvular atrial fibrillation (AF) have produced some unexpected results. As a group, NOACs showed similar effic...
Source: Thrombosis and Haemostasis - September 4, 2014 Category: Hematology Authors: Vanassche T, Hirsh J, Eikelboom JW, Ginsberg JS Tags: Thromb Haemost Source Type: research

Efficacy and safety of early parenteral anticoagulation as a bridge to warfarin after mechanical valve replacement.
In conclusion, we found that early after mechanical valve replacement, therapeutic dose bridging was associated with a similar risk of thromboembolic complications, but a 2.5 to 3-fold increased risk of major bleeding compared with prophylactic dose bridging. PMID: 25183209 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - August 28, 2014 Category: Hematology Authors: Mathew JG, Spyropoulos AC, Yusuf A, Vincent J, Eikelboom J, Shestakovska O, Fremes S, Noora J, Guo L, Peterson M, Pai M, Whitlock R Tags: Thromb Haemost Source Type: research

Comparing Mortality in Patients with Atrial Fibrillation who are Receiving a Direct Oral Anticoagulant or Warfarin: A Meta-analysis of Randomized Trials.
CONCLUSION: Compared with warfarin therapy for stroke prevention in patients with AF, DOACs significantly reduce all-cause mortality, vascular mortality and bleeding mortality. This mortality benefit appears to be driven by the reduction in vascular- and bleeding-related mortality which, in turn, may be related to the reduction in intracranial bleeding. This article is protected by copyright. All rights reserved. PMID: 24986568 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - July 1, 2014 Category: Hematology Authors: Liew A, O'Donnell M, Douketis J Tags: J Thromb Haemost Source Type: research

D-dimer and risk of thromboembolic and bleeding events in patients with atrial fibrillation - observations from the ARISTOTLE trial.
CONCLUSION: In anticoagulated patients with AF the level of D-dimer is related to the risk of stroke, death and bleeding and adds to the predictive value of clinical risk scores. The benefits of apixaban were consistent regardless of the baseline D-dimer level. This article is protected by copyright. All rights reserved. PMID: 24942912 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - June 18, 2014 Category: Hematology Authors: Christersson C, Wallentin L, Andersson U, Alexander JH, Ansell J, De Caterina R, Gersh BJ, Granger CB, Hanna M, Horowitz JD, Huber K, Husted S, Hylek EM, Lopes RD, Siegbahn A Tags: J Thromb Haemost Source Type: research

Feasibility and cost effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. The SEARCH-AF study.
Abstract Atrial fibrillation (AF) causes a third of all strokes, but often goes undetected before stroke. Identification of unknown AF in the community and subsequent anti-thrombotic treatment could reduce stroke burden. We investigated community screening for unknown AF using an iPhone electrocardiogram (iECG) in pharmacies, and determined the cost-effectiveness of this strategy.Pharmacists performedpulse palpation and iECG recordings, with cardiologist iECG over-reading. General practitioner review/12-lead ECG was facilitated for suspected new AF. An automated AF algorithm was retrospectively applied to collecte...
Source: Thrombosis and Haemostasis - April 1, 2014 Category: Hematology Authors: Lowres N, Neubeck L, Salkeld G, Krass I, McLachlan AJ, Redfern J, Bennett AA, Briffa T, Bauman A, Martinez C, Wallenhorst C, Lau JK, Brieger DB, Sy RW, Freedman SB Tags: Thromb Haemost Source Type: research

Comparison of idrabiotaparinux with vitamin K antagonists for prevention of thromboembolism in patients with atrial fibrillation: the Borealis-AF study.
CONCLUSION: If anything, despite its early termination the idrabiotaparinux regimen studied suggested a comparable efficacy to dose-adjusted warfarin, with a lower bleeding risk. This article is protected by copyright. All rights reserved. PMID: 24597472 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - March 5, 2014 Category: Hematology Authors: Buller HR, Halperin J, Hankey GJ, Pillion G, Prins MH, Raskob GE Tags: J Thromb Haemost Source Type: research

Efficacy and safety of edoxaban in comparison with dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation. An indirect comparison analysis.
Abstract Large Phase 3 clinical trials for stroke prevention in atrial fibrillation (AF) have compared non-vitamin K antagonist oral anticoagulants (NOACs) against warfarin, with the edoxaban trial only recently reported. In the absence of head to head trials directly comparing these NOACs against each other, we compared the efficacy and safety of edoxaban to other agents by an indirect comparison analysis. We performed an indirect comparison analysis of edoxaban (2 dose strategies) against apixaban (1 dose), dabigatran etexilate (2 doses) and rivaroxaban (1 dose), for their relative efficacy and safety against ea...
Source: Thrombosis and Haemostasis - February 28, 2014 Category: Hematology Authors: Skjøth F, Larsen TB, Rasmussen LH, Lip GY Tags: Thromb Haemost Source Type: research

Gaps in translation from trials to practice: Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation.
The objectives of this review are to 1) identify gaps in our current knowledge regarding use of these single target anticoagulant drugs; 2) outline the potential implications of these gaps for clinical practice, and thereby, 3) highlight areas of research to further optimise their use for stroke prevention in AF. PMID: 24573511 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - February 27, 2014 Category: Hematology Authors: Hylek EM, Ko D, Cove CL Tags: Thromb Haemost Source Type: research

New oral anticoagulants for stroke prevention in atrial fibrillation: impact of study design, double counting and unexpected findings on interpretation of study results and conclusions.
Abstract Four recently introduced new oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban) have been shown to be at least as efficacious and safe as warfarin for stroke prevention in patients with atrial fibrillation in their respective trials. The first three have been approved, while edoxaban is awaiting regulatory approval. Several guidelines have endorsed the approved new oral anticoagulants over warfarin because of their favourable risk-benefit ratio, low propensity for food and drug interactions, and lack of requirement for routine coagulation monitoring. In this invited review, we summarise ...
Source: Thrombosis and Haemostasis - February 20, 2014 Category: Hematology Authors: Chan NC, Paikin JS, Hirsh J, Lauw MN, Eikelboom JW, Ginsberg JS Tags: Thromb Haemost Source Type: research

Stroke prevention in atrial fibrillation: An Asian perspective.
Abstract Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. In 2050, it is estimated that there will be 72 million AF patients in Asia, accounting for almost 2.9 million patients suffering from AF-associated stroke. Asian AF patients share similar risk factor profiles as non-Asians, except that more Asians have a history of previous stroke. Clinical challenges are evident in the field of stroke prevention in AF, amongst Asians. Existing stroke and bleeding risk scores have not been well-validated in Asians. Asians are prone to bleeding when treated with warfarin, and the optimal internationa...
Source: Thrombosis and Haemostasis - February 6, 2014 Category: Hematology Authors: Chiang CE, Wang KL, Lip GY Tags: Thromb Haemost Source Type: research

New oral anticoagulant agents - general features and outcomes in subsets of patients.
Abstract During the past four years the phase III trials on stroke prophylaxis in atrial fibrillation and in treatment of venous thromboembolism have been completed for four new oral anticoagulants - dabigatran, apixaban, edoxaban and rivaroxaban. The studies have revealed advantages in terms of a reduced risk of bleeding, most importantly of intracranial bleeding. These anticoagulants also have favourable pharmacokinetics, eliminating the need for routine laboratory monitoring and dose adjustments. There are, however, some differences between the drugs in certain subsets of patients, according to patient characte...
Source: Thrombosis and Haemostasis - January 23, 2014 Category: Hematology Authors: Schulman S Tags: Thromb Haemost Source Type: research

Patient outcomes using the European label for dabigatran. A post-hoc analysis from the RE-LY database.
In conclusion, this post-hoc simulation of dabigatran usage based on RE-LY trial dataset indicates that "EU label simulated dabigatran treatment" may be associated with superior efficacy and safety compared to warfarin, and are in support of the EU label and the 2012 European Society of Cardiology AF guideline recommendations. Thus, adherence to European label/guideline use results in a clinically relevant benefit for dabigatran over warfarin, for both efficacy and safety. PMID: 24326736 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - December 11, 2013 Category: Hematology Authors: Lip GY, Clemens A, Noack H, Ferreira J, Connolly SJ, Yusuf S Tags: Thromb Haemost Source Type: research

Unanswered questions and research priorities to optimise stroke prevention in atrial fibrillation with the new oral anticoagulants.
Abstract This review article discusses the following, as yet unanswered, questions and research priorities to optimise patient management and stroke prevention in atrial fibrillation with the new direct oral anticoagulants (NOACs): 1. In patients prescribed a NOAC, can the anticoagulant effects or plasma concentrations of the NOACs be measured rapidly and reliably and, if so, can "cut-off points" between which anticoagulation is therapeutic (i.e. the "therapeutic range") be defined? 2. In patients who are taking a NOAC and bleeding (e.g. intracerebral haemorrhage), can the anticoagulant effects of the direct NOACs...
Source: Thrombosis and Haemostasis - November 28, 2013 Category: Hematology Authors: Hankey GJ Tags: Thromb Haemost Source Type: research

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