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Source: Evidence-Based Medicine
Condition: Thrombosis
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Total 30 results found since Jan 2013.
Low-dose second-generation oral contraceptives are associated with the lowest increased risk of cardiovascular adverse effects
Commentary on: Weill A, Dalichampt M, Raguideau F, et al.. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ 2016;353:i2002 . Context Oral contraceptives (OCs) are associated with an increased risk of cardiovascular disease. The association varies depending on whether the cardiovascular disease is arterial or venous and with varying progestogens and dosages of the oestrogen compound ethinyloestradiol. A recent Cochrane review concluded that OCs with the progestogens gestodene, desogestrel, cyproterone acetate or d...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Lokkegaard, E. Tags: Health policy, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Contraception, Drugs: obstetrics and gynaecology, Pregnancy, Ischaemic heart disease, Venous thromboembolism, Pulmonary embolism Aetiology/Harm Source Type: research
Erythropoietin corrects anaemia and reduces the risk of blood transfusion in people with chronic kidney disease, but has uncertain effects on other patient-level outcomes
Commentary on: Cody JD, Hodson EM. Recombinant human erythropoietin versus placebo or no treatment for the anaemia of chronic kidney disease in people not requiring dialysis. Cochrane Database Syst Rev 2016;(1):CD003266 Context Anaemia frequency and severity worsen with advancing chronic kidney disease (CKD) and are associated with quality-of-life (QOL) impairment, morbidity and mortality.1 Deficient renal erythropoietin production is a major cause and can be corrected by recombinant human erythropoietin (rhEPO) administration.1 This may improve clinical outcomes, including delaying dialysis. Conversely, rhEPO therapy caus...
Source: Evidence-Based Medicine - September 22, 2016 Category: Internal Medicine Authors: Johnson, D. W. Tags: Clinical trials (epidemiology), Epidemiologic studies, Haematology (incl blood transfusion), Stroke, Hypertension, Venous thromboembolism, Renal medicine 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
New reversal agent for factor Xa inhibitors shows promise
Commentary on: Siegal DM, Curnette JT, Connolly SJ, et al.. Andexanet alfa for the reversal of Factor Xa inhibitor activity. N Engl J Med 2015;373:2413–24. Context Direct oral anticoagulants (DOACs) have emerged as alternatives to vitamin K-antagonists (eg, warfarin) for the long-term management of stroke prevention for non-valvular atrial fibrillation or venous thromboembolic disease. Favourable side-effect profiles and absence of therapeutic monitoring are important benefits of these newer agents. Warfarin is readily reversed with fresh frozen plasma (FFP) or prothrombin complex concentrates.1 The first reversal ag...
Source: Evidence-Based Medicine - May 22, 2016 Category: Internal Medicine Authors: Ghadimi, K., Welsby, I. J. Tags: Clinical trials (epidemiology), Immunology (including allergy), Drugs: cardiovascular system, Stroke, Venous thromboembolism, Unwanted effects / adverse reactions Therapeutics/Prevention Source Type: research
The risk of arterial thrombosis increases with the use of combined oral contraceptives
Commentary on: Roach RE, Helmerhorst FM, Lijfering WM, et al.. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev 2015;8:CD011054. Context While the risk of venous thrombosis with use of combined oral contraceptives (COC) is now convincingly quantified to be threefold to sixfold increased, depending mainly on the type of progestogen, there are few and less consistent studies on the risk of arterial endpoints. Therefore, a meta-analysis on available evidence might be relevant. Method This Cochrane review includes data from 24 studies assessing the risk of thrombot...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Lidegaard, O. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Contraception, Drugs: obstetrics and gynaecology, Ischaemic heart disease, Venous thromboembolism Aetiology/Harm 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
An IVC filter and anticoagulation for 3 months is unlikely to show a benefit over anticoagulation alone for high-risk patients with acute pulmonary embolism
Commentary on: Mismetti P, Laporte S, Pellerin O, et al; PREPIC2 Study Group. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA 2015;313:1627–35. Context Placement of an inferior vena cava (IVC) filter to prevent pulmonary embolism (PE) is recommended by multidisciplinary consensus guidelines only when anticoagulation is contraindicated, has resulted in a complication or has failed.1 2 Oddly, the only prospective randomised long-term filter efficacy study that demonstrated a reduction in the recurr...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: Hoffer, E. K. Tags: Journalology, Clinical trials (epidemiology), Drugs: cardiovascular system, Heart failure, Stroke, Venous thromboembolism, Pulmonary embolism, Ethics 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
Combined oral contraceptives and risk of venous thromboembolism: there is higher risk in new generations compared to second generations, but paradoxically not in norgestimate-containing-pills
This study examines the VTE risk associated with COC use in two large UK databases. Methods...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: Plu-Bureau, G. Tags: Smoking and tobacco, Epidemiologic studies, General practice / family medicine, Drugs: cardiovascular system, Stroke, Contraception, Drugs: obstetrics and gynaecology, Family planning, Alcohol, Health education, Smoking Aetiology/Harm Source Type: research
Coronary artery bypass surgery continues to remain the treatment of choice for multivessel coronary artery disease even in the era of new-generation drug-eluting stents
Commentary on: Park SJ, Ahn JM, Kim YH, et al; BEST Trial Investigators. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015;372:1204–12. Context Multivessel coronary artery disease (MVCAD) may be found in patients subjected to coronary angiography. It is treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). The expanded use of PCI, following development of drug-eluting stents (DES), necessitated comparison of its outcomes with CABG (gold standard therapy). The SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) trial favoured...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Mohr, F. W., Davierwala, P. M. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics/Prevention Source Type: research
High-sensitivity cardiac troponin T in isolation has limited diagnostic utility in identifying cardiac causes of syncope
This study examines the diagnostic accuracy of high-sensitivity cardiac troponin T (cTnThs) for cardiac syncope and its predictive value for short-term (30 days) or medium-term (180 days) adverse events. Methods This was a secondary analysis of pre-existing prospective observational data of adult syncope patients from a single-centre...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Thiruganasambandamoorthy, V., Perry, J. J. Tags: EBM Diagnosis, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Venous thromboembolism, Pulmonary embolism, Surgical diagnostic tests 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
Meta-analysis compares anticoagulant strategies in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention
Commentary on: Bangalore S, Toklu B, Kotwal A, et al. Anticoagulant therapy during primary percutaneous coronary intervention for acute myocardial infarction: a meta-analysis of randomised trials in the era of stents and P2Y12 inhibitors. BMJ 2014;349:g6419 Context Optimal anticoagulant therapy in patients receiving primary intervention for acute myocardial infarction (MI) is widely debated. Prior studies have been heterogeneous in doses and concomitant treatments such that it has been unclear whether effects have been those of newer medication or a result of changes in these co-interventions. A meta-analytic approach can ...
Source: Evidence-Based Medicine - March 17, 2015 Category: Internal Medicine Authors: Patti, G. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests Therapeutics/Prevention Source Type: research
Risk of warfarin-associated intracerebral haemorrhage after ischaemic stroke is low and unchanged during the 2000s
Commentary on: Asberg A, Erisksson M, Henriksson KM, et al.. Warfarin-associated intracerebral hemorrhage after ischemic stroke. Stroke 2014;45:2118–20. Context Since its isolation during the early half of the 20th century from the mouldy hay responsible for ‘sweet clover disease’ in cattle, warfarin has become the most widely used oral anticoagulant.1 Indications include atrial fibrillation (AF), mechanical prosthetic valves and venous thromboembolism treatment.2 Warfarin reduces stroke risk in patients with AF by nearly two-thirds; AF accounts for 20% of ischaemic strokes, which tend to be more severe t...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Ruland, S., Biller, J. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Alcohol-related disorders, Drugs misuse (including addiction), Arrhythmias, Alcohol, Health education Aetiology/Harm 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
