Long-Term, Low-Intensity Warfarin Therapy for the Prevention of Recurrent Venous Thromboembolism

Ridker, Paul M.; Goldhaber, Samuel Z.; Danielson, Eleanor; Rosenberg, Yves; Eby, Charles S.; Deitcher, Steven R.; Cushman, Mary; Moll, Stephan; Kessler, Craig M.; Elliott, C. Gregory; Paulson, Rolf; Wong, Turnly; Bauer, Kenneth A.; Schwartz, Bruce A.; Miletich, Joseph P.; Bounameaux, Henri; Glynn, Robert J.

doi:10.1056/nejmoa035029

Cited by 751 publications

(411 citation statements)

References 29 publications

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“…Ten completed RCTs with 11 references, 206,[213][214][215][216][217][218][219][220][221][222] one ongoing trial 223 and one trial 224 reported in insufficient detail to include in the quantitative synthesis met the eligibility criteria for the review (see Figure 32). A summary of the characteristics of the 10 studies included in the analyses is presented in Table 134.…”

Section: Included Studiesmentioning

confidence: 99%

“…The mean age of patients was similar across studies that compared NOACs, ranging from 54.7 to 58 years. The mean age of patients across all the 10 included studies 206,[213][214][215][216][217][218][219][220][221][222] ranged from 53 to 67.3 years. The percentage of male patients was similar across studies that compared NOACs, ranging from 55.5% to 61%.…”

Section: Included Studiesmentioning

confidence: 99%

“…The proportion of patients with comorbidities was not well reported. Three studies 216,222 reported the proportion of patients who were diabetic, which ranged from 6.7% to 10.5%. Two studies 221,222 reported proportions with hypertension and cancer, which ranged from 36.3% to 41.3% and from 1% to 4%, respectively.…”

Section: Included Studiesmentioning

confidence: 99%

“…Efficacy and safety outcomes reported across studies were similar irrespective of the intervention examined, and were reported at the end of the treatment periods. All 10 studies 206,[213][214][215][216][217][218][219][220][221][222] reported data on symptomatic VTE and major bleeding. Nine studies each reported data on symptomatic DVT, symptomatic PE and all-cause mortality.…”

Section: Included Studiesmentioning

confidence: 99%

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Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis

Sterne

Bodalia

Bryden

et al. 2017

Health Technol Assess

126

175

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outside the submitted work, and AntiCoagulation Europe (ACE), a registered charity, the aims of which include raising awareness of the risk and prevention of thrombosis, and providing information, education and support to people who are on anticoagulation therapy for any duration, including long term for those with chronic conditions. Diane Eaton works with ACE in an associate consultant capacity in the role of Project Development Manager. She has over 40 years of personal experience of anticoagulation therapy and represents ACE as a patient expert at the National Institute for Health and Care Excellence (NICE). On behalf of the charity, she has provided the patient perspective for the submissions for the technology appraisals for the novel oral anticoagulants (NOACs) and Diagnostic Guidance for Coagulometers over a 4-year period. Please note that the financial information has been prepared by Eve Knight, Chief Executive of AntiCoagulation Europe, for the purpose of inclusion in this document. Published March 2017 DOI: 10.3310/hta21090This report should be referenced as follows:Sterne JAC, Bodalia PN, Bryden PA, Davies PA, López-López JA, Okoli GN, et al. Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2017;21(9). Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Health Technology Assessment is indexed and abstracted inReviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 11/92/17. The contractual start date was in October 2013. The draft report began editorial review in May 2015 and was accepted for publication in...

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Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

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Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis

Sterne

Bodalia

Bryden

et al. 2017

Health Technol Assess

126

175

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“…It was administrated orally in the form of racemic mixture R-and S-WAR as treatment and prophylaxis of Venous Thromboembolism [1][2][3]. S-WAR is 3-5 times potent that Renantiomer, metabolised by P450 (CYP) 2C9 to form inactive S-7-hydroxy metabolite (7-OH-WAR) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Enantiomeric separation and quantitation of warfarin and its metabolites in human plasma by LC-MS/MS

Mostafa

2016

Eur. J. Chem.

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The enantiomeric separation of warfarin (WAR) enantiomers and its hydroxy metabolites positional isomers is described in this work. The utilization of chiral chromatography coupled to Tandem mass spectrometry helps to achieve that. The developed method was able to separate R,S-warfarin and enantiomers of 4,7,10-hydroxy warfarin in human plasma. Plasma samples were processed with simple protein precipitation with acetonitrile. The chromatographic separation was done on chiral Astec Chirobiotic V column with gradient flow of 0.1% aqueous formic acid and 0.1% formic in acetonitrile:water (95:5, v:v). The mass spectroscopic detection was done via negative mode multiple reaction monitoring (MRM) on a triple quadrupole mass spectrometer coupled with positive electrospray ionization (ESI). Linearity of the method was valid over a concentration range of 125.00-0.13 µg/mL for racemic WAR, 47.000-0.088 µg/mL for racemic 4'-OH-WAR, 56.00-0.18 µg/mL for racemic 7-OH-WAR and 56.00-0.02 µg/mL for racemic 10-OH-WAR. The LLOQs were found to be 0.13 µg/mL for racemic WAR, 0.088 µg/mL for racemic 4'-OH-WAR, 0.18 µg/mL for racemic 7-OH-WAR and 0.02 µg/mL for racemic 10-OH-WAR. The method was validated for matrix effect, intra-and inter-day precision, freeze/thaw and storage stability. Accuracy and precision were within acceptable range (<15%). Enantiomeric forms of WAR and its metabolites were separated by the chiral column. Standards for R-and S-WAR identified peak 2 as S-WAR while metabolite peaks could not be definitively identified. Peak 2 for 7-OH-WAR gave higher blood levels, while the opposite applied to 10-OH-WAR. KEYWORDS

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Anticoagulation in Acute Pulmonary Embolism

Kelly¹,

Rudd²,

Hunt³

et al. 2002

Archives of Internal Medicine

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Long-Term, Low-Intensity Warfarin Therapy for the Prevention of Recurrent Venous Thromboembolism

Abstract: Long-term, low-intensity warfarin therapy is a highly effective method of preventing recurrent venous thromboembolism.

Cited by 751 publications

References 29 publications

Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis

Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis

Enantiomeric separation and quantitation of warfarin and its metabolites in human plasma by LC-MS/MS

Anticoagulation in Acute Pulmonary Embolism

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