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Source: Evidence-Based Medicine
Condition: Thrombosis
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Total 30 results found since Jan 2013.
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
Vitamin E is ineffective in preventing stroke
Stroke is a leading cause of death and long-term disability worldwide. Vitamin E (tocopherol) is an antioxidant which may protect against atherogenesis by acting as a scavenger of free radicals with subsequent reduced oxidation of low-density lipoprotein cholesterol and several other favourable effects on plaque stability, platelet aggregation and tendency to thrombosis. However, a recent meta-analysis of 13 randomised controlled trials (166 282 participants) showed that, compared with placebo, vitamin E supplementation does not significantly prevent stroke of any type (RR 1.01; 95% CI 0.96 to 1.07).1 The statistical quest...
Source: Evidence-Based Medicine - November 21, 2013 Category: Internal Medicine Authors: Brigo, F., Storti, M., Tezzon, F., Nardone, R. Tags: Letters Source Type: research
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
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
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
Novel anticoagulants in patients with mechanical heart valves
Commentary on: Eikelboom JW, Connolly SJ, Brueckmann M, et al.. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med 2013;369:1206. Context Novel anticoagulants (including the direct thrombin inhibitor dabigatran etixilate) and oral factor Xa inhibitors have similar or superior efficacy and safety to warfarin for reducing thromboembolic stroke in patients with atrial fibrillation, and for prevention of deep venous thrombosis. Eikelboom and colleagues set out to examine whether these novel anticoagulants could be used as an alternative to warfarin in patients with mechanical heart valves. Method...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Stewart, R. A. H. Tags: Drugs: cardiovascular system, Stroke, Venous thromboembolism Therapeutics 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
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
Prophylactic dose fondaparinux for 6 weeks in superficial thrombophlebitis of the legs reduces the risk for symptomatic thromboembolic complications
Commentary on: Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2012;3:CD004982. Context Superficial thrombophlebitis (ST), an inflammatory-thrombotic disorder in a superficial vein, is relatively common and estimated to occur in 1 per 1000 persons.1 The classic symptoms include pain, oedema, erythema and occasionally a palpable cord in the area of the thrombosed vein. Risk factors for ST include surgery, pregnancy and puerperium, female hormones, malignancy, infection, varicose veins, autoimmune disorders and thrombophilia.2 ST is a risk factor for dee...
Source: Evidence-Based Medicine - January 17, 2013 Category: Internal Medicine Authors: DeSancho, M. T., Pastores, S. M. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Pain (neurology), Stroke, Pregnancy, Venous thromboembolism, Renal medicine, Pulmonary embolism, Drugs: musculoskeletal and joint diseases, Dermatology Therapeutics Source Type: research
Oral treatment of acute pulmonary embolism with a fixed dose of rivaroxaban is non-inferior to standard treatment
Commentary on: EINSTEIN-PE Investigators, Büller HR, Prins MH, Lensin AW, et al.. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 2012;366:1287–97. Context Pulmonary embolism (PE) is a common disease with potentially life-threatening consequences. Current guidelines1 recommend immediate start of anticoagulation with heparin for at least 5 days. Thereafter, heparin may be replaced by vitamin K antagonists (VKAs). The EINSTEIN-PE study tested rivaroxaban for the treatment of acute PE. Rivaroxaban, an oral anti-Xa antagonist, has the major advantage of oral administration wit...
Source: Evidence-Based Medicine - January 17, 2013 Category: Internal Medicine Authors: Niessner, A. Tags: Drugs: cardiovascular system, Stroke, Hypertension, Venous thromboembolism, Pulmonary embolism, Drugs: musculoskeletal and joint diseases Therapeutics Source Type: research
Thrombolytic therapy with or without a vena cava filter results in a lower case fatality rate in unstable patients with acute pulmonary embolism
Commentary on: Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med 2012;125:465–70. Context Acute pulmonary embolism (PE) is a major health problem and is associated with significant morbidity and mortality. This is particularly true for patients with acute PE who are haemodynamically unstable.1 For instance, acute PE is associated with a 70% risk of death if cardiopulmonary arrest occurs and up to a 50% risk of death in those with shock secondary to PE.1 2 Several trials have evaluated the prognostic impact of thrombolytic therapy compared w...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Mean, M., Ibrahim, S. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Venous thromboembolism, Radiology, Pulmonary embolism, Clinical diagnostic tests Online articles 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
Thromboprophylaxis in heart failure patients with sinus rhythm: aspirin and warfarin lead to similar cardiovascular outcomes
Commentary on: Homma S, Thompson JL, Pullicino PM, et al.. WARCEF Investigators. Warfarin and aspirin in patients with heart failure and sinus rhythm. N Engl J Med 2012;366:1859–69. Context Chronic heart failure (CHF) is common, affecting 1–2% of the population and 10% of people >70 years. Patients with CHF have an increased risk of thromboembolism. Those with atrial fibrillation (AF) should receive warfarin but whether CHF patients with sinus rhythm (SR), whose risk is 1.5–3.5%,1 should receive thromboprophylaxis is unclear. Previous studies, Warfarin/Aspirin Study in Heart failure (warfarin, asp...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Witte, K. K. A., Jamil, H. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes, Arrhythmias Therapeutics Source Type: research
Hormone therapy not recommended for chronic disease prevention in menopausal women
Commentary on: Nelson HD, Walker M, Zakher B, et al.. Menopausal hormone therapy for the primary prevention of chronic conditions: a systematic review to update the US Preventive Services Task Force recommendations. Ann Intern Med 2012;157:104–13. Context In 2005, the US Preventive Services Task Force (USPSTF) updated its 2002 hormone replacement therapy recommendations, advising against the routine use of oestrogen and progestin (E+P) and unopposed oestrogen (E) to prevent chronic conditions in menopausal women. Menopausal hormone therapy (MHT) had been commonly prescribed to prevent conditions such as cardiovascula...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Wenger, N. K. Tags: Pancreas and biliary tract, Epidemiologic studies, Drugs: cardiovascular system, Dementia, Stroke, Contraception, Drugs: obstetrics and gynaecology, Menopause (including HRT), Ischaemic heart disease, Venous thromboembolism, Memory disorders (psychiatry), Source Type: research
N-3 fatty acids did not reduce major cardiovascular events in patients with dysglycaemia
Commentary on Bosch J, Gerstein HC, Dagenais GR, et al.. ORIGIN Trial Investigators. n-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med 2012;367:309–18 Context N-3 fatty acids have beneficial effects on elevated triglyceride levels, impaired endothelial function, inflammation, atherosclerotic plaque and severe arrhythmias. Prospective cohort studies have shown a lower risk of cardiovascular events among persons who consumed fish regularly. These studies were followed by clinical trials evaluating the effects of supplements with the fish fatty acids eicosapentaenoic acid (EPA) and d...
Source: Evidence-Based Medicine - July 5, 2013 Category: Internal Medicine Authors: Kromhout, D. Tags: Epidemiologic studies, Immunology (including allergy), Drugs: cardiovascular system, Stroke, Hypertension, Diet, Ischaemic heart disease, Venous thromboembolism, Drugs: musculoskeletal and joint diseases, Diabetes, Lipid disorders Prevention Source Type: research
