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Oct 15, 2017 Issue
Rivaroxaban vs. Warfarin for Treatment of DVT and PE [FPIN's Clinical Inquiries]
Rivaroxaban, along with the other factor Xa inhibitors, is as effective as or better in the short term (three months) than warfarin (Coumadin) for preventing recurrent DVT, nonfatal PE, and fatal PE, with no differences in mortality or bleeding events.
Anticoagulation is the mainstay of therapy for venous thromboembolism. Most patients can be treated in the outpatient setting with low-molecular-weight heparin and a vitamin K antagonist (warfarin) or direct-acting oral anticoagulants.
There is no advantage to adding CT of the abdomen and pelvis to a basic screening protocol for occult malignancy in patients with unprovoked VTE.
Continuing warfarin therapy for 18 months after an unprovoked PE reduces the risk of recurrent symptomatic venous thromboembolism (VTE). However, benefit beyond 18 months is not maintained after the warfarin is discontinued.
Aspirin improves long-term cardiovascular and thrombotic outcomes in patients who have had an initial unprovoked episode of VTE. The risk of bleeding was no higher in the aspirin group, perhaps because those at risk of bleeding were “uncovered” during the initial period of anticoagulation.
This complex network meta-analysis of eight treatment regimens for acute venous thromboembolism found that a combination of unfractionated heparin and vitamin K antagonists is associated with the least effective strategy with the highest risk of recurrent events.
A 45-year-old man presented with worsening left-sided, sharp pleuritic chest pain that began one week earlier.
A number of clinical decision rules have been released recently. The PERC rule is an example of one that works well because it was derived from a large number of patients, and it was internally and externally validated.
Although this ASPIRE study was underpowered to detect a difference in the primary outcome, when the results were combined with those of the WARFASA trial, the data show that daily low-dose aspirin prevents recurrent VTE as well as major vascular events without increasing bleeding in patients who hav...
The American College of Chest Physicians provides recommendations for the use of anticoagulant medications for several indications that are important in the primary care setting. Warfarin, a vitamin K antagonist, is recommended for the treatment of venous thromboembolism and for the prevention of st...