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The American Academy of Family Physicians, with the American College of Physicians, has updated its 2003 guideline to provide guidance on atrial fibrillation treatment via medication in the primary care setting. The guideline focuses on adults with nonvalvular atrial fibrillation as diagnosed by ele...
Idarucizumab is the only anticoagulant reversal agent for dabigatran. Because of its high cost and limited data regarding clinical benefit, therapy should be reserved for patients taking dabigatran who have life-threatening bleeding or are in need of emergency surgery.
Jun 1, 2017 Issue
Self-Monitoring and Self-Management of Oral Anticoagulation [Cochrane for Clinicians]
In patients taking warfarin (Coumadin) for anticoagulation, there is moderate-quality evidence that both self-monitoring (number needed to treat [NNT] = 100) and self-management (NNT = 53) reduce thromboembolic events, and that self-management reduces all-cause mortality (NNT = 67).
Bridging anticoagulation worsens outcomes for patients with atrial fibrillation who undergo an elective invasive procedure, resulting in more episodes of major bleeding and no difference in the rate of stroke or venous thromboembolism.
In this well-designed observational study, older patients given an initial prescription of dabigatran had lower all-cause mortality and fewer ischemic and hemorrhagic strokes, but a higher risk of gastrointestinal (GI) bleeding, than a matched group of patients given warfarin.
This study provides more evidence that bridging in patients with nonvalvular atrial fibrillation does not improve outcomes, and is actually associated with a higher risk of bleeding complications and cardiovascular events.
The use of concomitant NSAIDs in adults who receive antithrombotic therapy after MI increases the risk of serious bleeding complications and recurrent adverse CV events. This study found the highest risk among users of celecoxib (Celebrex) and diclofenac, and the lowest risk among users of ibuprofen...
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.
The risk of bleeding increases (though remains small) when patients with atrial fibrillation are switched from warfarin to dabigatran to prevent stroke or transient ischemic attack. This study, conducted almost exclusively in male veterans, found an increase in gastrointestinal (GI) bleeding, but not in intracranial bleeds.
In this meta-analysis, newer anticoagulants appear to be slightly more effective than warfarin in the short term (two years) in preventing strokes of all kinds in patients with atrial fibrillation. However, they are no more effective than warfarin in preventing ischemic strokes, and they cause more ...