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9

Peri-procedural management of patients taking oral anticoagulants

The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking. Existing data suggest that the use of bridging therapy may increase the risk of bleeding for some patients without reducing the risk of thrombosis. Clinical trials are currently under way to answer these questions. Because the half lives and time to anticoagulant activity of newer oral anticoagulants are shorter than for warfarin, bridging therapy is not thought to be necessary with these agents. Peri-procedural management of patients taking these agents is complicated by the lack of demonstrated reversal agents in emergency situations, although specific antidotes are being developed and tested. Existing guidelines for peri-procedural management of patients on oral anticoagulants highlight the importance of individualized patient decision making and suggest strategies to minimize complications. From a patient’s perspective, given the uncertainties surrounding optimal management, explicit discussions regarding risks and benefits of treatment options and demonstration of effective communication among medical and surgical providers are essential.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
15

Peri-procedural management of patients taking oral anticoagulants

The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking. Existing data suggest that the use of bridging therapy may increase the risk of bleeding for some patients without reducing the risk of thrombosis. Clinical trials are currently under way to answer these questions. Because the half lives and time to anticoagulant activity of newer oral anticoagulants are shorter than for warfarin, bridging therapy is not thought to be necessary with these agents. Peri-procedural management of patients taking these agents is complicated by the lack of demonstrated reversal agents in emergency situations, although specific antidotes are being developed and tested. Existing guidelines for peri-procedural management of patients on oral anticoagulants highlight the importance of individualized patient decision making and suggest strategies to minimize complications. From a patient’s perspective, given the uncertainties surrounding optimal management, explicit discussions regarding risks and benefits of treatment options and demonstration of effective communication among medical and surgical providers are essential.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
19

Patients can self monitor oral anticoagulation, study shows

The study, reported in the British Journal of General Practice, included 296 patients requiring oral anticoagulation who had bought a device to self monitor their international normalised ratio (INR). Most patients (97%) had warfarin prescribed, and this was for a range of conditions including thrombosis (35.8%), having a mechanical heart valve (32.8%), atrial fibrillation (23.0%), and …  
feeds.bmj.com
almost 5 years ago
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0
12

Patients can self monitor oral anticoagulation, study shows

The study, reported in the British Journal of General Practice, included 296 patients requiring oral anticoagulation who had bought a device to self monitor their international normalised ratio (INR). Most patients (97%) had warfarin prescribed, and this was for a range of conditions including thrombosis (35.8%), having a mechanical heart valve (32.8%), atrial fibrillation (23.0%), and …  
feeds.bmj.com
almost 5 years ago
Preview
0
6

Meta-analysis should not be subject to selectivity and imbalance

The final study sample of 46 163 patients included 4907 using dabigatran, 1649 using rivaroxaban, and 39 607 using warfarin. After adjustment for potentially confounding covariates, there was no …  
feeds.bmj.com
almost 5 years ago
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0
5

A man with rust coloured urine and normocytic anaemia

A 65 year old man presented to the emergency department with a 10 day history of dark urine, general malaise, and progressive shortness of breath. He had a history of rheumatic heart disease and had been on warfarin since he had a metallic mitral valve replacement in 1984. He was a retired teacher, drank a minimal amount of alcohol, and was a non-smoker. He had no family history of cancer.  
feeds.bmj.com
almost 5 years ago
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0
15

A man with rust coloured urine and normocytic anaemia

A 65 year old man presented to the emergency department with a 10 day history of dark urine, general malaise, and progressive shortness of breath. He had a history of rheumatic heart disease and had been on warfarin since he had a metallic mitral valve replacement in 1984. He was a retired teacher, drank a minimal amount of alcohol, and was a non-smoker. He had no family history of cancer.  
feeds.bmj.com
almost 5 years ago
Www.bmj
0
0

A man with rust coloured urine and normocytic anaemia

A 65 year old man presented to the emergency department with a 10 day history of dark urine, general malaise, and progressive shortness of breath. He had a history of rheumatic heart disease and had been on warfarin since he had a metallic mitral valve replacement in 1984. He was a retired teacher, drank a minimal amount of alcohol, and was a non-smoker. He had no family history of cancer.  
feeds.bmj.com
almost 5 years ago
Www.bmj
0
6

Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study

Objective To determine the real world risk of gastrointestinal bleeding associated with the use of the novel oral anticoagulants dabigatran and rivaroxaban compared with warfarin.  
feeds.bmj.com
almost 5 years ago
Preview
0
1

Safety of new oral anticoagulants

Two linked papers (doi:10.1136/bmj.h1857, doi:10.1136/bmj.h1585) report additional evidence on the risks of gastrointestinal bleeding among patients taking the novel oral anticoagulants dabigatran and rivaroxaban.1 2 From a database of more than 100 million US adults, Abraham and colleagues identified almost 220 000 new users of dabigatran, rivaroxaban, or warfarin between November 2010 and September 2013.1 In their comparison of propensity score matched patients, the risk of gastrointestinal bleeding increased significantly with age for both new oral anticoagulants, relative to warfarin. By age 75, the risk of gastrointestinal bleeding associated with rivaroxaban exceeded that with warfarin, for patients with or without atrial fibrillation. Among patients taking dabigatran, the association between older age and higher risk was confined to those with atrial fibrillation, although the data included very few patients without atrial fibrillation taking this drug.  
feeds.bmj.com
almost 5 years ago
Preview
0
0

A man with rust coloured urine and normocytic anaemia

A 65 year old man presented to the emergency department with a 10 day history of dark urine, general malaise, and progressive shortness of breath. He had a history of rheumatic heart disease and had been on warfarin since he had a metallic mitral valve replacement in 1984. He was a retired teacher, drank a minimal amount of alcohol, and was a non-smoker. He had no family history of cancer.  
feeds.bmj.com
almost 5 years ago
Preview
0
1

A man with rust coloured urine and normocytic anaemia

A 65 year old man presented to the emergency department with a 10 day history of dark urine, general malaise, and progressive shortness of breath. He had a history of rheumatic heart disease and had been on warfarin since he had a metallic mitral valve replacement in 1984. He was a retired teacher, drank a minimal amount of alcohol, and was a non-smoker. He had no family history of cancer.  
feeds.bmj.com
almost 5 years ago
Preview
1
13

Warfarin Side Effects in Detail - Drugs.com

Learn about the potential side effects of warfarin. Includes common and rare side effects information for consumers and healthcare professionals.  
drugs.com
almost 5 years ago
D2c071a5552599c7f6359e89638fd360b93a6e833876766676945077
1
145

The story of the discovery of heparin and warfarin

Douglas Wardrop and David Keeling Oxford Haemophilia and Thrombosis Centre, Oxford Radcliffe Hospitals, Oxford, UK  
Nicole Chalmers
almost 5 years ago
Www.bmj
0
6

Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study

Objective To determine the real world risk of gastrointestinal bleeding associated with the use of the novel oral anticoagulants dabigatran and rivaroxaban compared with warfarin.  
feeds.bmj.com
almost 5 years ago
Preview
0
1

Risk of gastrointestinal bleeding associated with oral anticoagulants: population based retrospective cohort study

Objectives To determine the real world safety of dabigatran or rivaroxaban compared with warfarin in terms of gastrointestinal bleeding.  
feeds.bmj.com
almost 5 years ago
Www.bmj
0
14

Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study

Objective To determine the real world risk of gastrointestinal bleeding associated with the use of the novel oral anticoagulants dabigatran and rivaroxaban compared with warfarin.  
feeds.bmj.com
almost 5 years ago
Preview
0
0

Safety of new oral anticoagulants

Two linked papers (doi:10.1136/bmj.h1857, doi:10.1136/bmj.h1585) report additional evidence on the risks of gastrointestinal bleeding among patients taking the novel oral anticoagulants dabigatran and rivaroxaban.1 2 From a database of more than 100 million US adults, Abraham and colleagues identified almost 220 000 new users of dabigatran, rivaroxaban, or warfarin between November 2010 and September 2013.1 In their comparison of propensity score matched patients, the risk of gastrointestinal bleeding increased significantly with age for both new oral anticoagulants, relative to warfarin. By age 75, the risk of gastrointestinal bleeding associated with rivaroxaban exceeded that with warfarin, for patients with or without atrial fibrillation. Among patients taking dabigatran, the association between older age and higher risk was confined to those with atrial fibrillation, although the data included very few patients without atrial fibrillation taking this drug.  
feeds.bmj.com
almost 5 years ago
Preview
0
4

Risk of gastrointestinal bleeding associated with oral anticoagulants: population based retrospective cohort study

Objectives To determine the real world safety of dabigatran or rivaroxaban compared with warfarin in terms of gastrointestinal bleeding.  
feeds.bmj.com
almost 5 years ago
Www.bmj
0
6

Risk of gastrointestinal bleeding associated with oral anticoagulants: population based retrospective cohort study

Objectives To determine the real world safety of dabigatran or rivaroxaban compared with warfarin in terms of gastrointestinal bleeding.  
feeds.bmj.com
almost 5 years ago