Anticoagulation

Jun 10, 2017

Whether – or not - to continue anticoagulation therapy to prevent venous thromboembolism (VTE) after the initial acute treatment period requires shared decision making.  The risks and benefits are patient and situation-specific.  Numerous factors need to be considered. And the risks and benefits change over time. The EINSTEIN CHOICE study provides some important new insights to help inform this decision.1

 

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Mar 24, 2017

Many patients with atrial fibrillation (AF) received triple antithrombotic therapy after undergoing a percutaneous coronary intervention (PCI) and receiving cardiac stent. Triple therapy consists of warfarin plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and low-dose aspirin. But is triple therapy the best approach? This practice, while widely employed, is not entirely evidence-based.

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Mar 25, 2016

A 76 year-old male with a past medical history of hypertension, diabetes, and atrial fibrillation on warfarin management is undergoing elective surgery that requires warfarin to be held. The patient’s CHADS2 score is 3 with no history of stroke. Should this patient be bridged with low molecular weight heparin (LMWH)?

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Oct 16, 2015

The recommended treatment duration for a first episode of unprovoked venous thromboembolism (VTE) is, at a minimum, 3 months with extended anticoagulation favored for those who are not at high risk for bleeding.  However, the optimal duration of anticoagulation therapy remains unknown.1  Earlier studies have shown that an extended course of oral anticoagulation (OAC) with warfarin reduced VTE recurrence but at the expense of increased bleeding.2,3  The Prolonged Anticoag

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Oct 3, 2015

Many clinicians are questioning the role pharmacists should play in anticoagulation therapy management as direct oral anticoagulants (DOACs) increasingly replace warfarin for a variety of indications. When we say “anticoagulation clinic” most of us envision a group of practitioners — often pharmacists — delivering coordinated care, providing ongoing patient education, and using laboratory data to make adjustments in warfarin doses.

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Jun 17, 2015

The results of the PEGASUS-TIMI 54 (Long-Term Use of Ticagrelor in patients with Prior Myocardial Infarction) trial were presented to a capacity audience at the opening session of the March 2015 American College of Cardiology meeting.  But after hearing the much anticipated results and reading the simultaneously published manuscript we’re left wondering if PEGASUS is a landmark clinical trial or simply a trial that validates what we have known for years.1

 

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May 4, 2015

We all have an innate desire for clarity in our decisions. Often, however, we are faced with controversy and uncertainty.  Grey areas where there is a gap between clinical practice, logical reasoning, and evidence.  One of these grey areas is the “right” approach to the peri-procedural management of chronic anticoagulation.  There are so many clinical decisions involved (See Table 1) and little clarity about any of them!

 

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Mar 12, 2013

Patients with a history of a single unprovoked venous thromboembolism (VTE) have a 10-30% risk of a recurrence within 5 years following cessation of anticoagulation.1 The decision to extended anticoagulation beyond 6-12 months in patients with a previous VTE must weigh the benefit of reducing recurrent VTEs versus the burdens of anticoagulation therapy (e.g. bleeding, drug costs, need for monitoring).

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Mar 22, 2012

AB is a 64 year old man with a past medical history of hypertension, diabetes, and ischemic cardiomyopathy.  He presented to his cardiologist, Dr.

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Mar 14, 2012

The American College of Chest Physicians Antithrombotic Guidelines, 9th edition are now available.  Here's a short summary about what every clinician should know.

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Feb 29, 2012

“See you in four weeks!” This has been a common ending to most anticoagulation clinic appointments over the years.  But perhaps it’s time for this routine to change?

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Sep 8, 2011

The wait for alternatives to warfarin for stroke prevention in atrial fibrillation has been a long one.

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May 10, 2011

For patients with atrial fibrillation, what’s the best scoring system to estimate stroke risk? Clinicians have long relied on the CHADS2 [congestive heart failure, hypertension, age ≥ 75 years, diabetes, and previous stroke or TIA] scoring system to make antithrombotic treatment decisions.

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Nov 4, 2010

Clinicians and patients alike have been anxiously waiting for an oral alternative to warfarin. That wait appears to be finally over. On October 19, 2010 dabigatran (Pradaxa®) was approved by the FDA and became the first oral direct thrombin inhibitor available in the United States. Unlike its predecessor ximelagatran, dabigatran doesn’t seem to cause liver toxicity.

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