May 15, 2014 Issue
Fewer Major Bleeds with Edoxaban Than with Warfarin, but Treatment Benefit Unclear [POEMs]

Edoxaban provides similar effectiveness and a somewhat lower rate of major gastrointestinal and intracranial bleeding than warfarin. It is worth reading the supplemental appendices to this report for a look at the subgroups. For almost all subgroups, low-dose edoxaban caused less major bleeding than...

Sep 15, 2013 Issue
Continued Warfarin Better Than Bridging Therapy for Pacemaker or Defibrillator Surgery [POEMs]

This is the best and largest single trial comparing continued warfarin with a bridging strategy. Patients with an annual risk of thromboembolic events of 5% or more undergoing pacemaker or defibrillator surgery who continued to use warfarin had fewer device-pocket hematomas than patients who received bridging therapy with heparin.

Jun 15, 2013 Issue
Is Rivaroxaban Noninferior to Standard Warfarin Therapy in Preventing Recurrent PE and DVT? [AFP Journal Club]

A trial showing that one drug is noninferior to another does not mean that these drugs are equivalent. The noninferiority margin allows researchers to choose their own benchmark for what is considered a clinically significant difference between two drugs.

Jun 1, 2013 Issue
Aspirin Following Anticoagulation Therapy Prevents Recurrent VTE [POEMs]

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...

Apr 15, 2013 Issue
Updated Guidelines on Outpatient Anticoagulation [Article]

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...

Mar 15, 2012 Issue
Rivaroxaban vs. Warfarin for Stroke Prevention in Patients with Nonvalvular Atrial Fibrillation [AFP Journal Club]

How does rivaroxaban compare with warfarin for stroke prevention in patients with nonvalvular atrial fibrillation? This study concluded that rivaroxaban is noninferior to warfarin. However, noninferiority trials do not meet the same rigorous design and statistical format of traditional superiority trials.

Aug 1, 2011 Issue
Self-Monitoring and Self-Management of Anticoagulation Therapy [Cochrane for Clinicians]

Self-monitoring and self-management of long-term oral anticoagulation therapy reduce the risks of thromboembolism, all-cause mortality, and minor hemorrhage for appropriately selected patients.

Feb 1, 2011 Issue
Recurrent Venous Thromboembolism [Article]

A previous venous thromboembolism is the most important risk factor for predicting recurrence of the condition. Several studies have shown that routine testing for inherited thrombophilias is not helpful in predicting the risk of recurrence or altering treatment decisions, and therefore is not cost-...

Mar 15, 2010 Issue
Predicting the Risk of Bleeding in Patients Taking Warfarin [Point-of-Care Guides]

When considering anticoagulation therapy in patients with atrial fibrillation or venous thromboembolism (VTE), physicians and patients must balance the benefits of anticoagulation with the risk of bleeding, particularly major bleeding complications. For example, in patients who are at high risk of b...

Jul 1, 2009 Issue
Anticoagulation for the Long-term Treatment of VTE in Patients with Cancer [Cochrane for Clinicians]

Although LMWH appears to be more effective than oral anticoagulants in the prevention of recurrent VTE, this does not translate into a survival benefit. LMWH and oral anticoagulants have the same reported adverse events of bleeding and thrombocytopenia.

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