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Specialty: General Medicine
Drug: Coumadin

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Total 209 results found since Jan 2013.

Left atrial appendage thrombus with resulting stroke post-RF ablation for atrial fibrillation in a patient on dabigatran.
We report the case of a patient with documentary evidence of left atrial appendage (LAA) thrombus formation and neurological sequelae post-RF ablation despite being on dabigatran. This case highlights the concern that periprocedural dabigatran may not provide adequate protection from development of LAA thrombus and that a standardised protocol will need to be developed and undergo large multicentre trials before dabigatran can be safely used for patients undergoing RF-ablation. PMID: 25551903 [PubMed - in process]
Source: Ir Med J - November 1, 2014 Category: Journals (General) Authors: Lobo R, McCann C, Hussaini A, Meany TB, Kiernan TJ Tags: Ir Med J Source Type: research

Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: A nationwide cohort study
This study revealed, that in clinical practice, vitamin K antagonist-experienced patients with a history of stroke or transient ischemic attack who switch to dabigatran therapy may have an increased rate of a recurrent stroke compared to patients persisting with vitamin K antagonist therapy.
Source: The American Journal of Medicine - September 1, 2014 Category: Journals (General) Authors: Torben Bjerregaard Larsen, Lars Hvilsted Rasmussen, Anders Gorst-Rasmussen, Flemming Skjøth, Deirdre A. Lane, Gregory Y.H. Lip Source Type: research

Characteristics affecting oral anticoagulant therapy choice among patients with non-valvular atrial fibrillation: a retrospective claims analysis
The objective of this study was to identify patient, healthcare provider, and health plan factors associated with dabigatran versus warfarin use among NVAF patients. Methods: Administrative claims data from patients with>=2 NVAF medical claims in the HealthCore Integrated Research Database between 10/1/2009 and 10/31/2011 were analyzed. During the study intake period (10/1/2010 - 10/31/2011), dabigatran patients had>=2 dabigatran prescriptions, warfarin patients had>=2 warfarin and no dabigatran prescriptions, and the first oral anticoagulant (OAC) prescription date was the index date. Continuous enrollment for 12 months p...
Source: BMC Health Services Research - July 17, 2014 Category: Journals (General) Authors: Azza AbuDaggaJudith StephensonAn-Chen FuWinghan KwongHiangkiat TanWilliam Weintraub Source Type: research

Correspondence New oral anticoagulants in patients with atrial fibrillation
Christian Ruff and colleagues' meta-analysis reports substantial reductions in stroke and all-cause mortality by use of the new oral anticoagulants (NOACs) compared with warfarin for atrial fibrillation, justifying their increasing use, but also the unequivocal increased risk of gastrointestinal bleeding. Furthermore, the trials included patients with a presumed low risk of gastrointestinal complications and therefore the true risk might be greater outside the clinical trial setting.
Source: LANCET - July 4, 2014 Category: Journals (General) Authors: Michael J R Desborough, Vipul Jairath Tags: Correspondence Source Type: research

SAMe-TTR Score, Time in Therapeutic Range, and Outcomes in Anticoagulated Patients with Atrial Fibrillation
Oral anticoagulation is highly effective in preventing stroke and mortality in nonvalvular atrial fibrillation patients. However, the efficacy and safety of vitamin K antagonists (the main oral anticoagulation drug used) strongly depends upon the quantity of anticoagulation control, as reflected by the average percentage of the time in therapeutic range of international normalized ratio 2.0-3.0. An easy, simple prediction of which atrial fibrillation patients are likely to do well on vitamin K antagonists (with good average time in therapeutic range) could guide decision-making between using vitamin K antagonists (eg, warf...
Source: The American Journal of Medicine - May 22, 2014 Category: Journals (General) Authors: Pilar Gallego, Vanessa Roldán, Francisco Marin, José Gálvez, Mariano Valdés, Vicente Vicente, Gregory Y.H. Lip Tags: Clinical research study Source Type: research

Retrospective costing of warfarin.
Abstract In Ireland, there are four anticoagulants available for prescribing to patients with atrial fibrillation for stroke prevention. A key feature of the three most recent anticoagulants is that monitoring is redundant. Despite this, there is continued prescribing of the incumbent anticoagulant, warfarin, which requires monitoring. Lack of information regarding the cost of monitoring, and the extra burden it places on health budgets and patients, motivated this costing study. Using micro costing, the costs of warfarin treatment (including monitoring) was disaggregated and isolated from both the patients' and h...
Source: Ir Med J - May 1, 2014 Category: Journals (General) Authors: Walsh C, Murphy A, Kirby A, Vaughan C Tags: Ir Med J Source Type: research

Anticoagulation versus placebo for heart failure in sinus rhythm.
CONCLUSIONS: Based on the two major randomised trials (HELAS 2006; WASH 2004), there is no convincing evidence that oral anticoagulant therapy modifies mortality or vascular events in patients with heart failure and sinus rhythm. Although oral anticoagulation is indicated in certain groups of patients with heart failure (for example those with atrial fibrillation), the available data does not support the routine use of anticoagulation in heart failure patients who remain in sinus rhythm. PMID: 24683002 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 28, 2014 Category: Journals (General) Authors: Lip GY, Shantsila E Tags: Cochrane Database Syst Rev Source Type: research

Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation.
CONCLUSIONS: DTIs were as efficacious as VKAs for the composite outcome of vascular death and ischaemic events and only the dose of dabigatran 150 mg twice daily was found to be superior to warfarin. DTIs were associated with fewer major haemorrhagic events, including haemorrhagic strokes. Adverse events that led to discontinuation of treatment occurred more frequently with the DTIs. We detected no difference in death from all causes. PMID: 24677203 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 27, 2014 Category: Journals (General) Authors: Salazar CA, Del Aguila D, Cordova EG Tags: Cochrane Database Syst Rev Source Type: research

AFib Treatment: General Population
Abstract: When primary care physicians are presented with a patient with atrial fibrillation (AFib), there are two concerns. (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). One is the choice of strategy to treat the AFib, ie, whether to use rate control or a rhythm control strategy (to keep patients in sinus rhythm). The second concern is preventing the principal risk associated with AFib: stroke and systemic embolism. The focus of this review is stroke prevention, concentrating on risk assessment and traditional versus the new oral anticoagulation agents. For the past se...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: Steven A. Rothman Tags: CME multimedia activities Source Type: research

Novel Oral Anticoagulants
Abstract: Warfarin has a proven record as an oral anticoagulant; almost every study, however, has found that it is not prescribed for 40–60% of patients who are eligible and should receive it, and of those who do receive it, serum warfarin levels only achieved a time in therapeutic range (TTR) equal to INR 2–3 about 55–60% of the time (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). This means that only about 1 in 4 patients are adequately anticoagulated with warfarin, and thus there is a large unmet need for achieving better anticoagulation in these patients. Although...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: James A. Reiffel Tags: CME multimedia activities Source Type: research

New versus Traditional Approaches to Oral Anticoagulation in Patients with Atrial Fibrillation
Abstract: For clinicians, atrial fibrillation (AFib) is not a disease that will probably be “cured” at some point during their professional lifetime. (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). AFib is a condition that occurs in association with aging, affecting as many as 1 in 10 patients by the time they reach age 85, and therefore all physicians who read The American Journal of Medicine should be aware of AFib—its etiology, how to recognize it, and with some idea of how it is treated. Perhaps the most important aspect of AFib, however, is as a risk factor for...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: James A. Reiffel Tags: CME multimedia activities Source Type: research

Articles Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials
This meta-analysis is the first to include data for all four new oral anticoagulants studied in the pivotal phase 3 clinical trials for stroke prevention or systemic embolic events in patients with atrial fibrillation. New oral anticoagulants had a favourable risk–benefit profile, with significant reductions in stroke, intracranial haemorrhage, and mortality, and with similar major bleeding as for warfarin, but increased gastrointestinal bleeding. The relative efficacy and safety of new oral anticoagulants was consistent across a wide range of patients.
Source: LANCET - March 14, 2014 Category: Journals (General) Authors: Christian T Ruff, Robert P Giugliano, Eugene Braunwald, Elaine B Hoffman, Naveen Deenadayalu, Michael D Ezekowitz, A John Camm, Jeffrey I Weitz, Basil S Lewis, Alexander Parkhomenko, Takeshi Yamashita, Elliott M Antman Tags: Articles Source Type: research

Comment Warfarin or novel oral anticoagulants for atrial fibrillation?
Stroke prevention is central to the management of atrial fibrillation and, until recently, the focus was to identify high-risk patients who would be given a so-called inconvenient drug, warfarin. Nowadays, the landscape for stroke prevention has changed with the availability of novel oral anticoagulants, and an increased appreciation that vitamin K antagonists (eg, warfarin) work best with high-quality anticoagulation control (shown by the average individual time in therapeutic range at an international normalised ratio of 2·0–3·0).
Source: LANCET - March 14, 2014 Category: Journals (General) Authors: Torben Bjerregaard Larsen, Gregory Y H Lip Tags: Comment Source Type: research

Analysis of the Cochrane Review: Direct Thrombin Inhibitors versus Vitamin K Antagonists for Preventing Cerebral or Systemic Embolism in People with Non-Valvular Atrial Fibrillation. Cochrane Database Syst Rev. 2014,3:CD009893.
Abstract Ischemic stroke is one of the most important complications of lone (non-valvular) atrial fibrillation. Its prevention is usually accomplished through oral anticoagulation. Until a few years ago warfarin was the most used agent, but recently two new pharmacologic classes have been introduced for stroke prevention in these patients: oral direct thrombin inhibitors (dabigatran and ximelagatran) and oral factor Xa inhibitors (rivaroxaban, apixaban and edoxaban). In this systematic review, oral direct thrombin inhibitors were compared with warfarin for efficacy and safety. The results indicate that there is no...
Source: Acta Medica Portuguesa - March 1, 2014 Category: Journals (General) Authors: Vaz Carneiro A, Costa J Tags: Acta Med Port Source Type: research