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Source: Evidence-Based Medicine
Condition: Bleeding
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Total 19 results found since Jan 2013.
Resumption of anticoagulation after major bleeding decreases the risk of stroke in patients with atrial fibrillation
This study aimed to (1) evaluate anticoagulation use after a major bleeding event on dabigatran or warfarin and (2) compare outcomes between patients discontinuing anticoagulation and those restarting dabigatran or warfarin. Methods This was...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Smit, M. D., Van Gelder, I. C. Tags: Therapeutics/Prevention Source Type: research
Aspirin reduces cardiovascular events in primary prevention of cardiovascular disease but at a near equivalent risk of increased bleeding
Commentary on: Guirguis-Blake JM, Evans CV, Senger CA, et al.. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the US Preventive Services Task Force. Ann Intern Med 2016;164:804–13 . Context The use of aspirin in primary prevention of cardiovascular disease (CVD) remains controversial, as randomised controlled trials (RCTs) have produced mixed results. Recently, the United States Preventive Services Task Force (USPSTF) published updated recommendations on the use of aspirin for primary prevention of CVD and colorectal cancer.1 This systematic review and meta-analysis serv...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Miedema, M. D., Virani, S. S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease Therapeutics/Prevention Source Type: research
Restarting oral anticoagulation among patients with atrial fibrillation with gastrointestinal bleeding was associated with lower risk of all-cause mortality and thromboembolism
This study assesses risks of all-cause mortality, thromboembolism, major bleeding and recurrent GIB associated with resuming antithrombotic treatment after GIB among patients with AF. Methods This prospective cohort study included non-valvular patients with AF who experienced GIB while receiving single or combined antithrombotic treatment with an antiplatelet and/or anticoagulant in a Danish cohort from 1996...
Source: Evidence-Based Medicine - July 25, 2016 Category: Internal Medicine Authors: Qureshi, W. T., Nasir, U. Tags: EBM Prognosis, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Stroke, Venous thromboembolism, Pulmonary embolism Source Type: research
Longer dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has higher anti-ischaemic efficacy than shorter DAPT but is associated with more frequent bleeding
Commentary on: Spencer FA, Prasad M, Vandvik PO, et al.. Longer- versus shorter-duration dual-antiplatelet therapy after drug-eluting stent placement: a systematic review and meta-analysis. Ann Intern Med 2015;163:118–26. Context Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y12 receptor antagonist is recommended after drug eluting stent implantation (DES) for at least 12 months by the American College of Cardiology/American Heart Association1 and for 6–12 months by European guidelines. Recent randomised controlled trials (RCT) suggested comparable efficacy of short-term DAPT versus therapy o...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Navarese, E. P. Tags: Journalology, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests, Ethics Therapeutics/Prevention Source Type: research
Interruption of all anticoagulation is non-inferior to the use of short-term parenteral bridging in patients with atrial fibrillation undergoing invasive procedures
Commentary on: Douketis JD, Spyropoulos AC, Kaatz S, et al., BRIDGE Investigators. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 2015;373:823–33 . Context Oral anticoagulation (OAC) has been demonstrated to reduce stroke in patients with atrial fibrillation (AF), however, its use conveys an increased risk of bleeding.1 Therefore, patients receiving OAC who undergo invasive procedures often ‘interrupt’ OAC. Use of short-term ‘bridging’ anticoagulants during such interruptions has been the source of significant debate.2 Although guidelines support a ri...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Steinberg, B. A. Tags: Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Valvar diseases, Arrhythmias Therapeutics/Prevention Source Type: research
NSAIDs increase bleeding risk in patients with atrial fibrillation on antithrombotic therapy
This study determined the risk...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: McGrath, E. R. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Drugs: musculoskeletal and joint diseases, Arrhythmias Aetiology/Harm Source Type: research
Long-term ticagrelor therapy in patients with prior myocardial infarction significantly reduces ischaemic events, albeit with increased bleeding
Commentary on: Bonaca MP, Bhatt DL, Cohen M, et al., PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015;372:1791–800. Context Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor antagonist constitute the cornerstone of treatment in patients with acute coronary syndrome (ACS) with a recommended duration of 1 year.1 Nevertheless, high rates of atherothrombotic events, for which platelet activation is heavily implicated, still occur at later stages.2 Therefore, a longer duration of DAPT appears intuitive, a...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Alexopoulos, D. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes Therapeutics/Prevention Source Type: research
Prolonged dual antiplatelet therapy after drug-eluting stent reduces the risk of stent thrombosis and major cardiovascular events but increases the rate of bleeding
This study is an international, randomised, placebo-controlled trial that was designed to determine the benefits and risks of continuing DAPT beyond 1 year after the placement of a coronary stent. The study enrolled 9961 patients. After 12 months of DAPT, patients were randomly assigned to continue thienopyridine treatment or to receive placebo for another 18 months, all...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Helft, G. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Guidelines Therapeutics/Prevention Source Type: research
Using the Watchman device to close the left atrial appendage reduces risk of stroke in atrial fibrillation, compared to using warfarin
Commentary to: Reddy VY, Sievert H, Halperin J, et al.; PROTECT AF Steering Committee and Investigators. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA 2014;312:1988–98 . Context Atrial fibrillation (AF) is a common arrhythmia in clinical practice. The major complication of AF is thromboembolic stroke. Patients with AF have a fivefold higher risk of stroke and a twofold increase in mortality.1 As complete cure for AF is never certain, the aims of AF therapy are symptom relief and prevention of thromboembolic events. The latter can be managed by vitami...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Swaans, M. J., Alipour, A., Boersma, L. V. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Arrhythmias Therapeutics/Prevention Source Type: research
Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin to dabigatran increased their rate of recurrent stroke/transient ischaemic attack compared with those on warfarin
Commentary on: Larsen TB, Rasmussen LH, Gorst-Rasmussen A, et al. Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: a nationwide cohort study. Am J Med 2014;127:1172–8 . Context Randomised trials have shown that patients with atrial fibrillation (AF) who are treated with a non-vitamin K antagonist oral anticoagulant (NOAC), compared with warfarin, have similar or lower rates of stroke and major bleeding, markedly reduced rates of intracranial bleeding and a consistent pattern of reduced mortality.1 Dabigatran 150 mg two times a day is the only NOAC that can significantly...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Eikelboom, J. W., Bosch, J. Tags: Epidemiologic studies, Time-to-event methods, Drugs: cardiovascular system, Stroke, Arrhythmias Aetiology/Harm Source Type: research
For patients who underwent elective non-cardiac surgery, a history of stroke is associated with an increased risk of major adverse cardiovascular events and death, particularly if time elapsed between stroke and surgery is less than 9 months
Commentary on: Jørgensen ME, Torp-Pedersen C, Gislason GH, et al.. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014;312:269–77. Context Non-cardiac surgeries (NCS) performed in patients with a recent myocardial infarction or coronary stent implantation have been associated with increased risk of perioperative cardiac events and bleeding compared with patients with more distant myocardial infarction or stent placement.1 2 Whether a similar time-dependent relationship exists for stroke is not known, and recommendations on ...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Biteker, M. Tags: EBM Prognosis, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ophthalmology, Ischaemic heart disease, Radiology, Clinical diagnostic tests Source Type: research
Evidence suggests dabigatran is an effective and safe treatment for patients with VTE requiring early parenteral therapy
Commentary on: Schulman S, Kakkar AK, Goldhaber SZ, et al.. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 2014;129:764–72. Context Until recently, an initial course of parenteral anticoagulation followed by vitamin K antagonist (VKA) was the standard of care for the treatment of venous thromboembolism (VTE). In the past few years, direct oral anticoagulants (DOAC) have been found to be non-inferior to VKA.1–3 The RE-COVER study found dabigatran to be non-inferior to warfarin, with a reduced risk for clinically relevant bleeding.4 In order to confirm these...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Granziera, S., Cohen, A. T. Tags: Drugs: cardiovascular system, Stroke, Venous thromboembolism, Radiology, Pulmonary embolism, Clinical diagnostic tests Therapeutics Source Type: research
Dual antiplatelet therapy in recurrent stroke prevention: do the benefits outweigh the risks?
This study assessed seven randomised controlled trials, comprising 39 574 patients and comparing dual versus single antiplatelet therapies. Medications used included aspirin (50–325 mg daily), clopidogrel (75 mg daily), aspirin plus dipyridamole (50/400 mg daily) and ticlopidine (100 mg daily). Patients had a history of ischaemic stroke (three trials) or TIA (four...
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Farooq, M. U., Gorelick, P. B. Tags: Clinical trials (epidemiology), Stroke Therapeutics Source Type: research
Intermittent pneumatic compression is effective in reducing venous thromboembolism risk in hospitalised patients
Commentary on: Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation 2013;128:1003–20. Context The Center for Disease Control and Prevention reports incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in 1–2 patients/1000/year. A total of 60–100 000 patients in the USA die of DVT or PE annually, with 10–30% expiring within 1 month of diagnosis. Recurrence rates of DVT/PE are as high as 33% within 10 years.1 Increased incidence of DVT and PE has been report...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Pascarella, L. Tags: EBM Prognosis, Medical education, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Venous thromboembolism, Pulmonary embolism, Medical humanities Prevention Source Type: research
Perioperative selective serotonin reuptake inhibitor administration is a marker of poor outcomes after surgery
Commentary on: Auerbach AD, Vittinghoff E, Maselli J, et al.. Perioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery. JAMA Intern Med 2013;173:1075–81. Context With a lifetime prevalence of 6–11%, depression is a common comorbidity in surgical patients. Owing to their high efficacy and safety, selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants.1 Some studies suggest that SSRIs may increase surgical bleeding. However, SSRI discontinuation may exacerbate psychiatric illness or precipitate withdrawal symptoms. Therefore, ...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Holt, N. F. Tags: EBM Aetiology, Epidemiologic studies, Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Heart failure, Stroke, Obesity (nutrition), Interventional cardiology, Drugs: musculoskeletal and joint diseases, Health education Source Type: research
