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Source: Evidence-Based Medicine
Condition: Bleeding
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Total 19 results found since Jan 2013.
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
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
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
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
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 prophylaxis in people without prior cardiovascular disease does not lead to reductions in cardiovascular death or cancer mortality
Commentary on: Seshasai SR, Wijesuriya S, Sivakumaran R, et al.. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med 2012;172:209–16. Context Prophylactic antiplatelet therapy with aspirin reduces the risk of non-fatal myocardial infarction (MI), non-fatal stroke and vascular death in patients with known cardiovascular disease (CVD) and is of net benefit. The absolute reduction in recurrent events significantly exceeds the increase in major bleeding.1 However, the role of aspirin in primary prevention of CVD is not clear. According to the Antithrombot...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Farooq, M. U., Gorelick, P. B. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Prevention, Ischaemic heart disease Online articles 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
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
Single-tablet double-dose famotidine plus ibuprofen decreases endoscopic upper GI ulcers compared with ibuprofen alone
Commentary on: Laine L, Kivitz AJ, Bello AE, et al.. Double-blind randomized trials of single-tablet ibuprofen/high-dose famotidine vs. ibuprofen alone for reduction of gastric and duodenal ulcers. Am J Gastroenterol 2012;107:379–86. Context Non-steroidal anti-inflammatory drugs (NSAID) are widely prescribed worldwide. However, NSAID use frequently accompanies gastrointestinal (GI) injury including complications such as bleeding and perforation. Therefore co-therapy with gastroprotective drugs especially for those at risk has been advocated in current guidelines1 in which proton-pump inhibitors (PPI) and misoprostol ...
Source: Evidence-Based Medicine - January 17, 2013 Category: Internal Medicine Authors: Sugano, K. Tags: Clinical trials (epidemiology), Small intestine, Stomach and duodenum, Drugs: cardiovascular system, Stroke, Drugs: musculoskeletal and joint diseases Therapeutics Source Type: research
Tranexamic acid reduces blood transfusion in surgical patients while its effects on thromboembolic events and mortality are uncertain
Commentary on: Ker K, Edwards P, Perel P, et al.. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012;344:e3054. Context Surgical trauma leads to the activation of local fibrinolysis, and surgical bleeding can be significant in certain types of surgery leading to acute anaemia and the need for blood transfusion. Clinical trends have led to reductions in acceptable haemoglobin transfusion thresholds. However, growing evidence from clinical and experimental studies suggests that acute haemodilutional anaemia may reduce tissue oxygen delivery and increase perioperative morb...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Raveendran, R., Wong, J. Tags: Clinical trials (epidemiology), Epidemiologic studies, Haematology (incl blood transfusion), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Pulmonary embolism Therapeutics 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
Peripartum antidepressant use is associated with an increased risk of postpartum haemorrhage
Commentary on: Palmsten K, Hernández-Díaz S, Huybrechts KF, et al.. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. BMJ 2013;347:f4877. Context Increased incidence of postpartum haemorrhage (PPH) is reported in a number of high-resource settings since the 1990s. The increase appears unrelated to factors such as rising rates of caesarean sections or increasing maternal age.1 Recent studies have investigated the association between antidepressant use at different stages of pregnancy and PPH, with two studies demonstrating a 1.20-fol...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Ford, J. B., Morris, J. M. Tags: EBM Aetiology, Health policy, Epidemiologic studies, Drugs: CNS (not psychiatric), Stroke, Pregnancy, Anxiety disorders (including OCD and PTSD), Child and adolescent psychiatry, Mood disorders (including depression), Drugs: musculoskeletal and joint dise 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
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
