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Rivaroxaban Tied to Lower Brain Bleed Risk in A-Fib
A once daily oral dose of rivaroxaban significantly lowers the risk of intracranial hemorrhage in patients with atrial fibrillation at moderate to high risk of stroke, according to a study presented at the American Heart Association's International Stroke Conference, held from Feb. 1 to 3 in New Orleans.
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Apixaban more effective than aspirin in reducing stroke recurrence
The oral factor Xa inhibitor apixaban was more effective than aspirin in reducing the risks for stroke and systemic embolism in patients with atrial fibrillation who have already experienced a stroke or transient ischemic attack and are unsuitable for warfarin therapy.
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Decision Support Tools Help Optimize Acute PE Detection
Implementing evidence-based clinical decision support significantly improves the efficiency of computed tomographic angiography use to detect acute pulmonary embolism for patients presenting to an emergency department, according to a study published in the February issue of Radiology.
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ACE Inhibitors Not Linked to Improved Outcomes After ACS
For patients with acute coronary syndrome, prior chronic use of an angiotensin-converting enzyme inhibitor is not independently associated with improved in-hospital outcomes, according to a study published in the Feb. 1 issue of The American Journal of Cardiology.
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Rates of VTE after surgery vary by procedure type
Using current venous thromboembolism preventive medications, approximately 1 in every 100 patients undergoing knee replacement and 1 in every 200 patients undergoing hip replacement will develop a VTE before hospital discharge, according to a review and analysis of previous studies.
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Warfarin Patients With Head Trauma Need Second CT Scan
For patients on warfarin with minor head trauma who have an initial negative computed tomography (CT) scan, 24-hour observation followed by an additional CT scan identifies the majority of cases of delayed bleeding, according to a study published online Jan. 16 in the Annals of Emergency Medicine.
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New AF ablation consensus doc previewed at Boston AF symposium
The forthcoming international consensus statement on atrial fibrillation (AF) includes a new set of standardized definitions, indications classed by evidence-level, and more information about anticoagulant therapy, among other improvements to the first AF ablation consensus released in 2007.
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Dabigatran Tied to Increase in Heart Attack Risk
The direct thrombin inhibitor dabigatran appears to raise the risk of myocardial infarction or acute coronary syndromes, according to a meta-analysis of seven randomized clinical trials published online Jan. 9 in the Archives of Internal Medicine.
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Fondaparinux Reduces Events From Superficial Vein Thromboses
In patients with spontaneous, isolated superficial vein thrombosis, a 45-day course of fondaparinux significantly reduced the rate of systemic thromboembolic complications compared with placebo, including events linked to thrombi with extensions more than 3 cm from the saphenofemoral junction, according to results of a post hoc analysis from the CALISTO trial.
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Risk for very late stent thrombosis, late TLR rose steadily up to 5 years after stenting
After implantation of sirolimus-eluting stents, the risk for very late stent thrombosis and late target lesion revascularization remained steady up to 5 years, according to study data from the j-Cypher Registry.
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Heparin Bridging Associated With Increased Bleeding Risk
Patients who receive heparin bridging during an interruption of oral anticoagulation appear to be at a 5.4-fold increased risk of overall bleeding and a 3.6-fold increased risk of major bleeding, without a reduction in risk of thromboembolic events.
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Enoxaparin failed to reduce mortality in acutely ill patients
The use of enoxaparin in addition to graduated compression stockings for thromboprophylaxis did not improve 30-day all-cause mortality among hospitalized, acutely ill patients, according to results from the LIFENOX trial.
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Rivaroxaban approved in Europe for AF and DVT treatment
The factor Xa oral anticoagulant rivaroxaban (Xarelto, Bayer/Johnson & Johnson) has been approved in the European Union for the prevention of nonvalvular AF-related stroke and systemic embolism and for the treatment of deep venous thrombosis (DVT).
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Malaysia the first Asian country to use stroke medication
KUALA LUMPUR: Malaysia has approved the use of rivaroxaban, a once-daily oral anticoagulant for reduction of stroke-risk in patients with sustained irregular heart rhythm.
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ASH: Rivaroxaban Better in Practice than Expected
The anticoagulant drug rivaroxaban (Xarelto) has turned out better in everyday clinical practice for preventing venous thromboembolism (VTE) in surgery patients than expected from the drug's registration studies, a German researcher said here.
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ASH: Catheter-Directed Thrombolysis Cuts DVT Risks
For patients with deep vein thrombosis, additional catheter-directed thrombolysis reduces the frequency of post-thrombotic syndrome and improves iliofemoral patency, according to a study published online Dec. 13 in The Lancet.
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Warfasa: Aspirin associated with 40% reduced risk for unprovoked VTE recurrence
Aspirin, when administered 6 to 12 months after anticoagulant therapy, was associated with a significant reduced risk for recurrence of unprovoked venous thromboembolism, according to results from the Warfasa study.
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Blood clot risk halved for patients checking own warfarin dose
Patients who monitor their own treatment with warfarin or other blood-thinning drugs reduce their risk of developing blood clots by half, an Oxford University study has found.
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NEJM: Warfarin culprit for most hospitalizations in elderly; management may help
Warfarin, the most commonly prescribed and trickiest to manage anticoagulant, is the key culprit of hospitalizations for the elderly patient population, according to a study published Nov. 24 in the New England Journal of Medicine.
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Patients With Autoimmune Disorders Have Higher Risk Of Pulmonary Embolism
According to a report published Online First by The Lancet, individuals admitted to hospital for an autoimmune disorder have a significantly higher risk of experiencing a pulmonary embolism during the next 12 months.
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ELEVATE-TIMI 52: High-dose clopidogrel reduced platelet reactivity in CYP2C19*2 carriers
Higher doses of clopidogrel, up to 300 mg daily, were more effective than standard doses in patients with the CYP2C19 gene variant, according to late-breaking research from the ELEVATE-TIMI 56 trial.
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AHA: A-Fib in Sepsis Ups In-Hospital Stroke, Death Risk
Patients who develop new-onset atrial fibrillation during hospitalization for severe sepsis are at an increased risk of in-hospital stroke and mortality, according to a study published online Nov. 13 in the Journal of the American Medical Association.
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Thrombosis publications recommended by the Board of Advisers has been updated for September 2011
New Thrombosis publications available for October 2011.
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ATLAS ACS: Adding rivaroxaban to antiplatelet therapy reduced death rates in ACS
Rivaroxaban added to standard treatment reduced the risk for CV death, MI and stroke among patients with acute coronary syndrome.
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TRACER: Vorapaxar failed to reduce death, MI, stroke risks
When added to standard care in patients with non-ST-segment elevation acute coronary syndrome, the first-in-class PAR-1 agonist, vorapaxar, did not reduce CV death, MI or stroke. Conversely, the drug was associated with a significantly increased risk for bleeding, compared with placebo.
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ADOPT: Apixaban not superior to enoxaparin for thromboprophylaxis
Treatment with 30 days of low-dose apixaban was no more effective than a shorter course of enoxaparin for the prevention of venous thromboembolism, according to results of the ADOPT trial.
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NEW Survey of Atrial Fibrillation Patients Demonstrates Gaps in Awareness of Stroke Risk and Perceived Barriers Associated with Anticoagulation Therapy
While most patients affected by atrial fibrillation (AF) know what a blood clot is, more than one-quarter (27%) surveyed said they were not told by their doctor or other healthcare professional that they were at risk for blood clots that can lead to a stroke due to their irregular heartbeat, according to new survey results being unveiled by the National Blood Clot Alliance (NBCA) at the 2011 Scientific Sessions of the American Heart Association, in Orlando, FL, November 12 through 16.
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FDA approves rivaroxaban for stroke prevention in AF patients
Another oral anticoagulant will soon be available to US physicians treating patients with atrial fibrillation. Today, the US Food and Drug Administration approved rivaroxaban for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation, the agency has announced.
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Thrombosis publications recommended by the Board of Advisers has been updated for September 2011
New Thrombosis publications available for September 2011.
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Venous Thromboembolism Prophylaxis in Hospitalized Patients: A Clinical Practice Guideline From the American College of Physicians
The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on prophylaxis of venous thromboembolism for hospitalized nonsurgical patients (medical patients and patients with acute stroke).
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Clinical and genetic risk factors associated with early stent thrombosis
Patients with certain genes or specific factors related to use of the anti-clotting drug clopidogrel are more likely to experience a blood clot within a coronary stent shortly after placement, according to a study in the October 26 issue of JAMA.
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Costly clots common in cancer
As many as 1 in 5 people risk developing a venous thromboembolism (VTE) within a year after undergoing treatment for some types of cancers, researchers reported at the 2011 European Multidisciplinary Cancer Congress, held in Stockholm, Sweden, September 23-27, 2011.
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IBD May Up Postop DVT, Pulmonary Embolism Risk
Patients with inflammatory bowel disease (IBD) who are undergoing surgery appear to have a greater chance of developing deep vein thrombosis or pulmonary embolism compared with unaffected patients, a retrospective study showed.
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Stroke-Risk Factor, Atrial Fibrillation, Still Under-Treated In UK
According to research published in BMJ Open, UK doctors are still under-treating abnormal heart rhythm (atrial fibrillation), one of the major stroke risk factors, despite substantial improvements in stroke prevention made over the past decade, lower incidence rates and deaths.
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Thrombosis publications recommended by the Board of Advisers has been updated for August 2011
New Thrombosis publications available for August 2011.
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Aspirin should not be used for stroke prevention in AF patients
More evidence that aspirin is neither safe nor effective for the prevention of stroke in AF patients has come from a new Danish registry study. The study was published in the October 2011 issue of Thrombosis and Haemostasis.
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Dabigatran: Australia issues bleeding warning
The Australian regulatory authority, the Therapeutic Goods Administration (TGA), has issued a "safety advisory" on the new oral anticoagulant dabigatran because of an increase in the number of bleeding-related adverse events reports received since more people starting taking the drug.
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JCE: Dabigatran proves safe, effective post-AF ablation
A study published online Sept. 28 in the Journal of Cardiovascular Electrophysiology found that dabigatran may be safe and well tolerated in atrial fibrillation (AF) patients after ablation. Dabigatran also was safe in terms of bleeding complications and thromboembolic events, leaving the authors to conclude that the drug may be a good alternative to warfarin.
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Rivaroxaban Meets Primary Endpoint in ATLAS ACS TIMI 51
Bayer AG announced today that the ATLAS ACS TIMI 51 trial of rivaroxaban in patients with acute coronary syndrome (ACS) had met its primary efficacy endpoint, “showing a statistically significant reduction in the rate of events for the primary composite endpoint of cardiovascular death, myocardial infarction and stroke in patients with ACS, compared to standard therapy plus placebo.”
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EMA committee gives nod to rivaroxaban for AF, DVT
The European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use has recommended the use of the anticoagulant rivaroxaban to prevent stroke and systemic embolism in non-valvular atrial fibrillation (AF) patients and to treat deep vein thrombosis (DVT).
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Possible rivaroxaban antidote identified
Results of a small study published online September 6, 2011 in Circulation show that prothrombin complex concentrate (PCC) appears to be an effective antidote for rivaroxaban that could be used to stop or prevent serious bleeding in patients taking this new anticoagulant.
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Warfarin patients should be monitored for acetaminophen interactions
An interaction between warfarin and acetaminophen may result in significant elevations of international normalized ratio (INR), putting patients at increased risk for hemorrhagic complications, reported a literature review published in the June issue of Pharmacotherapy.
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FDA panel recommends approval for rivaroxaban
The FDA's Cardiovascular and Renal Drugs Advisory Committee voted 9-2, with one abstention, to approve the use of rivaroxaban for the reduction of stroke and non-CNS systemic embolism in patients with non-valvular atrial fibrillation, according to a press release.
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Thrombosis publications recommended by the Board of Advisers has been updated for Juli 2011
New Thrombosis publications available for Juli 2011
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Stroke Prevention Therapy Use Low Among High-Risk Patients With Atrial Fibrillation (AF)
New data show that, worldwide, one in three patients with atrial fibrillation (AF) who are at high risk for stroke are not being prescribed anticoagulant therapy, particularly vitamin K antagonists (VKA) - medicines known to significantly lower stroke risk in these patients.
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ESC: Apixaban Better than Warfarin at Preventing Stroke in Afib
The investigational direct factor Xa inhibitor apixaban was better than warfarin at preventing stroke in patients with atrial fibrillation, the large, randomized ARISTOTLE trial showed.
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Study: Pharamacist-directed care improves warfarin management
A pharmacist-directed anticoagulation service improved the transition of care from an inpatient to outpatient setting for patients who received the anticoagulant warfarin, according to a study published in the July/August issue of Journal of Hospital Medicine.
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VTE prophylaxis may be needed during traumatic shoulder arthroplasty procedures
Venous thromboembolism prophylaxis may be necessary after traumatic shoulder arthroplasty, according to a study conducted by shoulder specialists at Southern California Permanente Medical Group.
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Upper extremity injury not a risk factor for VTE in lower extremities, study finds
Investigators from Philadelphia have found similar rates of lower extremity venous thromboembolism among patients who have sustained an upper extremity injury and those who have not.
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Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation
The use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Rivaroxaban, an oral factor Xa inhibitor, may provide more consistent and predictable anticoagulation than warfarin.
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Venous thromboembolism in cancer: What is the optimal treatment?
The hypercoagulable state induced by cancer and its treatment is likely to cause venous thromboembolism (VTE), which responds less well to standard treatment when the patient has cancer. The incidence of VTE is 4 to 6 times higher in cancer patients than in the general population, and cancer itself is considered to be an independent risk factor for VTE.
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Joint replacement surgery increases blood clot formation risk in certain patients
A study published in the Journal of Bone and Joint Surgery reports that despite treatment with blood thinners prior to and immediately after joint replacement surgery, the risk of clot formation is still relatively high in certain patients.
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The Use of Dabigatran in Elderly Patients
Recent approval by the US Food and Drug Administration (FDA) of dabigatran etexilate, an oral direct thrombin inhibitor, for the prevention of stroke in patients with atrial fibrillation will likely extend its administration in elderly patients. The risk of major overdosage of dabigatran etexilate in this population is, however, much increased owing to frequent renal function impairment, low body weight, drug interactions that cannot be detected with a routine coagulation test, and no antagonist available. We report herein 2 clinical cases, including 1 fatal case, illustrating our concern regarding the risk of bleeding events in elderly patients.
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Apixaban dual antiplatelet study in ACS terminated due to adverse event rate
A large controlled trial of apixaban plus low-dose aspirin in the treatment of patients with acute coronary syndrome (ACS) has been terminated early due to an increased incidence of major bleeds without an increase in therapeutic benefit.
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Dabigatran May Cut Recurrent VTE
Treatment with dabigatran following six to 18 months of conventional anticoagulation therapy in patients with venous thromboembolism (VTE) reduced the risk of recurrent VTE, but increased bleeding events, researchers found.
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A-Fib Ups Risk of Upper-Limb Thromboembolectomy
Atrial fibrillation is associated with an increased risk of upper-limb thromboembolectomy, according to a study published online July 7 in the Journal of Thrombosis and Haemostasis.
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NSAIDs and atrial fibrillation linked
A possible link between atrial fibrillation and NSAIDs is another reason to use anti-inflammatories with caution in older people with hypertension or heart failure, a new study suggests.
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New atrial fibrillation guidelines simplify primary care treatment
The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) published practice guidelines for the condition in 2006. In the years since, several new drugs have received approval for use in patients with the disorder, and additional evidence has become available to support or modify existing treatments. This year the AACF and the AHA published two new updates, entitled Focused Updates on the Management of Patients with Atrial Fibrillation.
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Rivaroxaban Wins FDA Approval for DVT Prevention
The FDA has approved rivaroxaban, an oral, once-daily, factor Xa inhibitor, for prevention of deep vein thrombosis in patients undergoing knee or hip replacement surgery.
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Prevention of venous thromboembolism after major orthopedic surgery: indirect comparison of three new oral anticoagulants
Our results indicates that, despite the indirect nature of this type of evidence and the limitations of this technique[1,2], rivaroxaban tends to be more effective than the other two innovative oral anticoagulants (dabigatran and apixaban) and proves also to be superior to enoxaparin on the basis of a direct comparison.
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Report: Atrial Fibrilation as “new epidemic“
A new report by the German Competence Network on Atrial Fibrilation and the European Heart Rhythm Association states AF as the “new epidemic” in cardiovascular diseases. The report will be published at the EHRA EUROPACE 2011 congress in Madrid (26-29 June).
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ARISTOTLE Makes Its Case: Apixaban Noninferior to Warfarin in A-fib
In early news from the randomized ARISTOTLE trial, the novel oral direct Factor Xa inhibitor apixaban met the primary endpoint of noninferiority to warfarin for prevention of stroke and systemic embolism in patients with atrial fibrillation (A-fib). Main findings of the study were announced by Bristol-Myers Squibb and Pfizer, the drug’s codevelopers, in a June 22, 2011, statement.
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Risk of recurrent VTE higher in men
A recent meta-analysis comparing the risk of recurrence of venous thromboembolism (VTE) in men and women supports previous findings of studies suggesting men have a higher risk of recurrence after an initial unprovoked clot.
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New Diagnostic Strategy for Patients With Suspected PE
A proposed diagnostic strategy combines clinical assessment, D-dimer testing, ultrasonography, and lung scan to give a noninvasive diagnosis for the majority of outpatients with suspected pulmonary embolism, according to a study published in the June issue of Chest.
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Performance of 4 Clinical Decision Rules in the Diagnostic Management of Acute Pulmonary Embolism
All 4 CDRs show similar performance for exclusion of acute PE in combination with a normal d-dimer result. This prospective validation indicates that the simplified scores may be used in clinical practice.
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Patients Unaware of DVT Risk, Survey Shows
A new survey of patients showing that less than one-third reported receiving DVT prophylaxis, even though 2 out of every 5 had a family member who previously had an embolism clot in their leg or lung, is a sign physicians need to improve their communication skills, one hospitalist says.
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Study on entire Swedish population affirms significance of hereditary factors for venous thromboembolism
Venous thromboembolism (VTE) is the third most common type of cardiovascular disease after coronary heart disease and stroke. Researchers at the Centre for Primary Health Care Research in Malmö have mapped the significance of hereditary factors for venous thromboembolism in the entire Swedish population by studying the risk of VTE in children of parents with VTE compared with the children of parents who have not had VTE.
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