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Pharmacological interventions for asymptomatic carotid stenosis
CONCLUSIONS: Although there is no high-certainty evidence to support pharmacological intervention, this does not mean that pharmacological treatments are ineffective in preventing ischaemic cerebral events, morbidity, and mortality. High-quality RCTs are needed to better inform the best medical treatment that may reduce the burden of carotid stenosis. In the interim, clinicians will have to use other sources of information.PMID:37565307 | PMC:PMC10401652 | DOI:10.1002/14651858.CD013573.pub2
Source: Cochrane Database of Systematic Reviews - August 11, 2023 Category: General Medicine Authors: Caroline Nb Clezar Carolina Dq Flumignan Nicolle Cassola Luis Cu Nakano Virginia Fm Trevisani Ronald Lg Flumignan Source Type: research

Antiplatelet agents and anticoagulants for hypertension
CONCLUSIONS: There is no evidence that antiplatelet therapy modifies mortality in patients with elevated BP for primary prevention. ASA reduced the risk of cardiovascular events and increased the risk of major bleeding events. Antiplatelet therapy with ASA probably reduces the risk of non-fatal and all cardiovascular events when compared to clopidogrel. Clopidogrel increases the risk of major bleeding events compared to ASA in patients with elevated BP for secondary prevention. There is no evidence that warfarin modifies mortality in patients with elevated BP for secondary prevention. The benefits and harms of the newer dr...
Source: Cochrane Database of Systematic Reviews - July 28, 2022 Category: General Medicine Authors: Eduard Shantsila Monika Kozie ł-Siołkowska Gregory Yh Lip Source Type: research

Anticoagulation versus placebo for heart failure in sinus rhythm
CONCLUSIONS: Based on the three RCTs, there is no evidence that oral anticoagulant therapy modifies mortality in people with HF in sinus rhythm. The evidence is uncertain if warfarin has any effect on all-cause death compared to placebo or no treatment, but it may increase the risk of major bleeding events. There is no evidence of a difference in the effect of rivaroxaban on all-cause death compared to placebo. It probably reduces the risk of stroke, but probably increases the risk of major bleedings. The available evidence does not support the routine use of anticoagulation in people with HF who remain in sinus rhythm.PMI...
Source: Cochrane Database of Systematic Reviews - May 18, 2021 Category: General Medicine Authors: Eduard Shantsila Monika Kozie ł Gregory Yh Lip Source Type: research

Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome.
CONCLUSIONS: The evidence identified indicates that NOACs compared with standard-dose VKAs may increase the risk of stroke and do not appear to alter the risk of other outcomes (moderate-certainty evidence). Using high-dose VKA versus standard-dose VKA did not alter the risk of any thromboembolic event or major bleeding but may increase the risk of any form of bleeding (low-certainty evidence). Standard-dose VKA combined with an AP agent compared with standard-dose VKA alone may increase the risk of any thromboembolic event and does not appear to alter the risk of major bleeding or other outcomes (low-certainty evidence). ...
Source: Cochrane Database of Systematic Reviews - October 12, 2020 Category: General Medicine Authors: Bala MM, Celinska-Lowenhoff M, Szot W, Padjas A, Kaczmarczyk M, Swierz MJ, Undas A Tags: Cochrane Database Syst Rev Source Type: research

Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation.
CONCLUSIONS: Treatment with factor Xa inhibitors significantly reduced the number of strokes and systemic embolic events compared with warfarin in people with AF. The absolute effect of factor Xa inhibitors compared with warfarin treatment was, however, rather small. Factor Xa inhibitors also reduced the number of ICHs, all-cause deaths and major bleedings compared with warfarin, although the evidence for a reduction in the latter is less robust. PMID: 29509959 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 6, 2018 Category: General Medicine Authors: Bruins Slot KM, Berge E Tags: Cochrane Database Syst Rev Source Type: research

Secondary prevention of recurrent venous thromboembolism after initial oral anticoagulation therapy in patients with unprovoked venous thromboembolism.
CONCLUSIONS: Evidence is currently insufficient to permit definitive conclusions concerning the effectiveness and safety of extended thromboprophylaxis in prevention of recurrent VTE after initial oral anticoagulation therapy among participants with unprovoked VTE. Additional good-quality large-scale randomised controlled trials are required before firm conclusions can be reached. PMID: 29244199 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 15, 2017 Category: General Medicine Authors: Robertson L, Yeoh SE, Ramli A Tags: Cochrane Database Syst Rev Source Type: research

Direct oral anticoagulants versus warfarin for preventing stroke and systemic embolic events among atrial fibrillation patients with chronic kidney disease.
CONCLUSIONS: Our findings indicate that DOAC are as likely as warfarin to prevent all strokes and systemic embolic events without increasing risk of major bleeding events among AF patients with kidney impairment. These findings should encourage physicians to prescribe DOAC in AF patients with CKD without fear of bleeding. The major limitation is that the results of this study chiefly reflect CKD stage G3. Application of the results to CKD stage G4 patients requires additional investigation. Furthermore, we could not assess CKD stage G5 patients. Future reviews should assess participants at more advanced CKD stages. Additio...
Source: Cochrane Database of Systematic Reviews - November 6, 2017 Category: General Medicine Authors: Kimachi M, Furukawa TA, Kimachi K, Goto Y, Fukuma S, Fukuhara S Tags: Cochrane Database Syst Rev Source Type: research

Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome.
CONCLUSIONS: There is not enough evidence for or against NOACs or for high-intensity VKA compared to the standard VKA therapy in the secondary prevention of thrombosis in people with APS. There is some evidence of harm for high-intensity VKA regarding minor and any bleeding. The evidence was also not sufficient to show benefit or harm for VKA plus antiplatelet agent or dual antiplatelet therapy compared to a single antiplatelet drug. Future studies should be adequately powered, with proper adherence to treatment, in order to evaluate the effects of anticoagulants, antiplatelets, or both, for secondary thrombosis prevention...
Source: Cochrane Database of Systematic Reviews - October 2, 2017 Category: General Medicine Authors: Bala MM, Celinska-Lowenhoff M, Szot W, Padjas A, Kaczmarczyk M, Swierz MJ, Undas A Tags: Cochrane Database Syst Rev Source Type: research

Antiplatelet versus anticoagulation treatment for patients with heart failure in sinus rhythm.
CONCLUSIONS: There is evidence from RCTs to suggest that neither oral anticoagulation with warfarin or platelet inhibition with aspirin is better for mortality in systolic heart failure with sinus rhythm (high quality of the evidence for all-cause mortality and moderate quality of the evidence for non-fatal cardiovascular events and major bleeding events). Treatment with warfarin was associated with a 20% reduction in non-fatal cardiovascular events but a twofold higher risk of major bleeding complications (high quality of the evidence). We saw a similar pattern of results for the warfarin versus clopidogrel comparison (lo...
Source: Cochrane Database of Systematic Reviews - September 14, 2016 Category: Journals (General) Authors: Shantsila E, Lip GY Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Antiplatelet agents versus control or anticoagulation for heart failure in sinus rhythm.
CONCLUSIONS: At present there is little evidence from long term RCTs to recommend the use of antiplatelet therapy to prevent thromboembolism in patients with heart failure in sinus rhythm. A possible interaction with ACE inhibitors may reduce the efficacy of aspirin, although this evidence is mainly from retrospective analyses of trial cohorts and two RCTs. There is also no current evidence to support the use of oral anticoagulation (when compared to aspirin/clopidogrel) in patients with heart failure in sinus rhythm. Anticoagulation/antiplatelet therapy should be reserved for heart failure patients with other comorbiditie...
Source: Cochrane Database of Systematic Reviews - May 2, 2016 Category: Journals (General) Authors: Lip GY, Wrigley BJ, Pisters R Tags: Cochrane Database Syst Rev Source Type: research

Anticoagulation versus placebo for heart failure in sinus rhythm.
CONCLUSIONS: Based on the two major randomised trials (HELAS 2006; WASH 2004), there is no convincing evidence that oral anticoagulant therapy modifies mortality or vascular events in patients with heart failure and sinus rhythm. Although oral anticoagulation is indicated in certain groups of patients with heart failure (for example those with atrial fibrillation), the available data does not support the routine use of anticoagulation in heart failure patients who remain in sinus rhythm. PMID: 24683002 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 28, 2014 Category: Journals (General) Authors: Lip GY, Shantsila E Tags: Cochrane Database Syst Rev Source Type: research

Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation.
CONCLUSIONS: DTIs were as efficacious as VKAs for the composite outcome of vascular death and ischaemic events and only the dose of dabigatran 150 mg twice daily was found to be superior to warfarin. DTIs were associated with fewer major haemorrhagic events, including haemorrhagic strokes. Adverse events that led to discontinuation of treatment occurred more frequently with the DTIs. We detected no difference in death from all causes. PMID: 24677203 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 27, 2014 Category: Journals (General) Authors: Salazar CA, Del Aguila D, Cordova EG Tags: Cochrane Database Syst Rev Source Type: research

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