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Specialty: General Medicine
Drug: Coumadin

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Total 209 results found since Jan 2013.

Warfarin therapy for atrial fibrillation in general practice - is bleeding risk underestimated?
Abstract BACKGROUND Atrial fibrillation causes a five-fold increase in the risk of thromboembolic stroke. Warfarin therapy reduces the risk by 64 %, but increases the risk of serious bleeding. We aimed to investigate the quality of warfarin therapy in a general practice and determine which patients would be likely to benefit from the treatment.MATERIAL AND METHOD We carried out retrospective registration of patients with atrial fibrillation, and calculated the risk of thromboembolism (CHA2DS2-VASc score) and of bleeding (HAS-BLED score) for each patient. Two alternative methods were used for calculating the absol...
Source: Tidsskrift for den Norske Laegeforening - January 28, 2014 Category: Journals (General) Authors: Bratland B, Hornnes MB Tags: Tidsskr Nor Laegeforen Source Type: research

Update on the management of atrial fibrillation.
Abstract Atrial fibrillation (AF) is a common arrhythmia, with a prevalence that increases markedly with increasing age. Presence of AF has implications for management of future stroke risk. If the patient's pulse is irregular, an electrocardiogram should be ordered. Key management decisions are whether to adopt a rhythm control or a rate control strategy and whether to initiate anticoagulation. The primary aim of a rhythm control strategy is improved symptom control. AF ablation may be considered in younger patients (aged < 65 years) with paroxysmal or early persistent AF. AF increases the risk of stroke, an...
Source: Med J Aust - November 4, 2013 Category: Journals (General) Authors: Amerena JV, Walters TE, Mirzaee S, Kalman JM Tags: Med J Aust Source Type: research

Systemic treatments for the prevention of venous thrombo-embolic events in paediatric cancer patients with tunnelled central venous catheters.
CONCLUSIONS: We found no significant effects of systemic treatments compared with no intervention in preventing (a)symptomatic VTE in paediatric oncology patients with CVCs. However, this could be a result of the low number of included participants, which resulted in low power. In one CCT, which compared one systemic treatment with another systemic treatment, we identified a significant reduction in symptomatic VTE with the addition of LMWH to AT supplementation.All studies investigated the prevalence of major and/or minor bleeding episodes, and none found a significant difference between study groups. None of the studies ...
Source: Cochrane Database of Systematic Reviews - September 11, 2013 Category: Journals (General) Authors: Schoot RA, Kremer LC, van de Wetering MD, van Ommen CH Tags: Cochrane Database Syst Rev Source Type: research

Comment Genetics of warfarin dosing—one polymorphism at a time
Few drugs define a narrow therapeutic index better than warfarin. With a typical therapeutic international normalised ratio (INR) of 2·0–3·0 for most indications (2·5–3·5 for mechanical heart valves), clinicians are challenged to define and implement dosing regimens that achieve therapeutic anticoagulation. The stakes could hardly be higher: too low a dose places the patient at an increased risk of a life-altering ischaemic event (ie, stroke or pulmonary embolism); and too high a dose can lead to a fatal cerebral or gastrointestinal haemorrhage.
Source: LANCET - August 30, 2013 Category: Journals (General) Authors: Mark J Alberts Tags: Comment Source Type: research

Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation.
CONCLUSIONS: Factor Xa inhibitors significantly reduced the number of strokes and systemic embolic events compared with warfarin in patients with AF. Factor Xa inhibitors also seem to reduce the number of major bleedings and ICHs compared with warfarin, though the evidence for a reduction of major bleedings is somewhat less robust. There is currently no conclusive evidence to determine which factor Xa inhibitor is more effective and safer for long-term anticoagulant treatment of patients with AF as head-to-head studies of the different factor Xa inhibitors have not yet been performed. PMID: 23925867 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 8, 2013 Category: Journals (General) Authors: Bruins Slot KM, Berge E Tags: Cochrane Database Syst Rev Source Type: research

Atrial fibrillation and stroke.
This article describes the risk for ischemic stroke in patients with atrial fibrillation, and discusses who should receive prophylactic treatment and which therapy provides the best prevention.METHOD The article is based on recently published European, American and Canadian guidelines, a search in PubMed and the authors' own clinical experience.RESULTS The new risk score CHA2DS2-VASc is better than the CHADS2 score for identifying patients with atrial fibrillation who have a truly low risk of ischemic stroke and are not in need of antithrombotic treatment. Oral anticoagulation therapy is recommended for patients with two o...
Source: Tidsskrift for den Norske Laegeforening - August 6, 2013 Category: Journals (General) Authors: Aamodt AH, Sandset PM, Atar D, Tveit A, Russell D Tags: Tidsskr Nor Laegeforen Source Type: research

The Assassin: Chagas Cardiomyopathy
A 35-year-old Salvadoran woman had been hospitalized for heart failure multiple times over a 5-year period, yet the etiology of her disease remained elusive. She also had a history of stroke. Again, she presented to the emergency department with shortness of breath, chest pain, and fatigue. Although these symptoms were chronic, they had been increasing for 3 weeks prior to admission. The patient denied fevers, chills, cough, or gastrointestinal complaints. She had no history of smoking, alcohol consumption, or illicit drug use. Her medications included carvedilol, furosemide, and warfarin.
Source: The American Journal of Medicine - July 19, 2013 Category: Journals (General) Authors: Uppinder K. Mattu, Gagan D. Singh, Jeffrey A. Southard, Ezra A. Amsterdam Tags: Diagnostic dilemma Source Type: research

Antithrombotic therapy in atrial fibrillation: aspirin is rarely the right choice
Atrial fibrillation, the commonest cardiac arrhythmia, predisposes to thrombus formation and consequently increases risk of ischaemic stroke. Recent years have seen approval of a number of novel oral anticoagulants. Nevertheless, warfarin and aspirin remain the mainstays of therapy. It is widely appreciated that both these agents increase the likelihood of bleeding: there is a popular conception that this risk is greater with warfarin. In fact, well-managed warfarin therapy (INR 2-3) has little effect on bleeding risk and is twice as effective as aspirin at preventing stroke. Patients with atrial fibrillation and a further...
Source: Postgraduate Medical Journal - May 17, 2013 Category: Journals (General) Authors: Sabir, I. N., Matthews, G. D. K., Huang, C. L.-H. Tags: Open access Reviews Source Type: research

In-hospital case management to increase anticoagulation therapy for stroke patients with atrial fibrillation: A hospital-based registry.
CONCLUSION: Our study indicates that in-hospital case management may be an effective strategy to improve anticoagulation for eligible stroke patients. PMID: 23660222 [PubMed - in process]
Source: J Formos Med Assoc - May 1, 2013 Category: Journals (General) Authors: Sun MC, Hsiao PJ Tags: J Formos Med Assoc Source Type: research

National Heart Foundation of Australia consensus statement on catheter ablation as a therapy for atrial fibrillation.
Abstract Atrial fibrillation (AF) is estimated to affect 1%-2% of the population. It is increasing in prevalence and is associated with excess mortality, considerable morbidity and hospitalisations. AF is responsible for a significant and growing societal financial burden. Catheter ablation is an increasingly used therapeutic strategy for the management of AF; however, some confusion exists among those caring for patients with this condition about the role and optimal use of ablative treatments for AF. Our aim in this consensus statement is to provide recommendations on the use of primary catheter ablation for AF ...
Source: Med J Aust - January 21, 2013 Category: Journals (General) Authors: Kalman JM, Sanders P, Brieger DB, Aggarwal A, Zwar NA, Tatoulis J, Tay AE, Wilson A, Branagan MG Tags: Med J Aust Source Type: research

Department of Error Department of Error
Lopes RD, Al-Khatib SM, Wallentin L, et al. Efficacy and safety of apixaban compared with warfarin according to patient risk of stroke and of bleeding in atrial fibrillation: a secondary analysis of a randomised controlled trial. Lancet 2012; 380: 1749–58—In table 3 and table 5 of this Article (Nov 17), the %s per person-year in the ischaemic stroke (overall results) row were incorrect. The values should have been 0·84% (apixaban) and 0·82% (warfarin) in both tables. These corrections have been made to the online version as of Jan 18, 2013.
Source: LANCET - January 18, 2013 Category: Journals (General) Authors: The Lancet Tags: Department of Error Source Type: research

Dabigatran, a Cause of Hematologic Emergency.
Abstract ABSTRACT:: Dabigatran etexilate, a direct thrombin inhibitor, has become an alternative to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation. There remains a concern about its overdose and life-threatening hemorrhage because of unavailability of appropriate coagulation tests to monitor and antidotes to reverse its effects. There are no clinical data about its safety in patients with fluctuating renal function. Multiple bleeding events reported with dabigatran have prompted the U.S. Food and Drug Administration to further investigate these reports. Four clinical cases with lif...
Source: The American Journal of the Medical Sciences - December 5, 2012 Category: Journals (General) Authors: Lal Y, Van Heukelom J Tags: Am J Med Sci Source Type: research

Elderly female with CHF complains of abdominal pain, nausea and vomiting, dizziness, and confusion for 5 days. What is the cause?
Author: V. Dimov, M.D.Reviewer: S. Randhawa, M.D.A 96-year-old African American female (AAF) was admitted from a nursing home with complaints of abdominal pain, nausea and vomiting (N/V), dizziness, confusion and double vision for 5 days. She was discharged from the hospital just 4 days ago. Digoxin was started during that previous hospitalization for control of tachycardia in atrial fibrillation. One day prior to discharge, digoxin level was 1.8 mg/mL and digoxin dose was decreased to 125 mcg PO Q 48 hr.Past medical history (PMH)Hypertension, atrial fibrillation, coronary artery disease, stroke, congestive heart failure.M...
Source: Clinical Cases and Images - August 2, 2009 Category: General Medicine Tags: Cardiology Intensive Care Toxicology Source Type: news