Pcv8 Warfarin Anticoagulation and Outcomes in Atrial Fibrillation Patients:a Systematic Review and Meta-Analysis

Reynolds, MW; Nalysnyk, Luba; Fahrbach, Kyle; Hauch, Oz; Wygant, Gail; Estok, Rhonda; Frame, Diana; Cella, Catherine; Scheye, Rachel; Ross, Sarah J.

doi:10.1016/s1098-3015(10)62374-1

Cited by 23 publications

(25 citation statements)

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“…24,25 However, higher (but variable) rates have been reported in patients on OAC in clinical routine practice. "Real-life" patients are older with less well-regulated anticoagulation therapy, and the average annual rate of major hemorrhage is 1% to 5% varying with intensity of anticoagulation and age.…”

Section: Assessing Risk Of Bleeding With Oacmentioning

confidence: 99%

Stroke Risk and Antithrombotic Strategies in Atrial Fibrillation

Medi

Hankey

Freedman

2010

Stroke

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Background and Purpose-Although the stroke rate associated with atrial fibrillation has declined over the last 10 years, the emerging atrial fibrillation epidemic threatens to increase the incidence of cardioembolic stroke. Summary of Review-Oral anticoagulants are superior antithrombotic agents but are underused due to fear of bleeding and uncertainty about which patients will benefit. Individualized decisions on antithrombotic therapy require balancing the competing risks of thromboembolism and bleeding. The CHADS 2 (Congestive heart failure, Hypertension, Age Ͼ75 years, and Diabetes mellitus, and 2 points for prior Stroke/transient ischemic attack) score and other schemes provide an estimate of thromboembolic risk; however, the external validity of these estimates in the context of well-controlled risk factors, or a hypercoagulable state, is uncertain. Moreover, it is very difficult to estimate bleeding risk. Recent studies highlight the need for meticulous international normalized ratio control to achieve optimal outcomes hampered by the high bleeding risk during oral anticoagulant inception and other limitations of warfarin. Dabigatran is at least as efficacious as warfarin in preventing stroke and systemic embolism for patients in whom the risk of thromboembolism outweighs bleeding risk. In addition, the results of ongoing trials evaluating alternative anticoagulants such as oral anti-Xa agents are awaited. In this review, we discuss emerging therapies including available and completed trials of direct antithrombins and anti-Xa agents, including ximelagatran, idraparinaux, and dabigatran; and new device therapies including left atrial appendage occlusion devices. Conclusions-In light of these promising new therapies, it is likely that atrial fibrillation thromboembolism guidelines will need to be rewritten and frequently updated.

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Section: Assessing Risk Of Bleeding With Oacmentioning

confidence: 99%

Stroke Risk and Antithrombotic Strategies in Atrial Fibrillation

Medi

Hankey

Freedman

2010

Stroke

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“…While lower levels of anticoagulation may permit I Biyik, I Mercan, O Ergene et al Ocular bleeding related to warfarin anticoagulation thromboembolic events, higher levels may increase the risk of haemorrhagic complications. 3 The efficacy and safety of anticoagulation in patients with mechanical heart valves or atrial fibrillation depend on the maintenance of the international normalized ratio (INR), as recommended by current practice guidelines. 3 The most serious complication of warfarin anticoagulation is haemorrhage, which may be seen in up to 39% of patients receiving warfarin.…”

Section: Introductionmentioning

confidence: 99%

“…3 The efficacy and safety of anticoagulation in patients with mechanical heart valves or atrial fibrillation depend on the maintenance of the international normalized ratio (INR), as recommended by current practice guidelines. 3 The most serious complication of warfarin anticoagulation is haemorrhage, which may be seen in up to 39% of patients receiving warfarin. 4 The haemorrhagic complications of warfarin therapy include gastrointestinal haemorrhage, intracranial haemorrhage, nasal and dental haemorrhage, skin bruising and ocular haemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Ocular Bleeding Related to Warfarin Anticoagulation in Patients with Mechanical Heart Valve and Atrial Fibrillation

et al. 2007

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We investigated the incidence of ocular bleeding in patients taking anticoagulant therapy (warfarin) and its association with other related factors. We examined 210 patients taking warfarin and 210 gender-and age-matched controls for ocular bleeding. Patients and controls were examined by external ocular examination and fundoscopic examination. The incidence of ocular bleeding was 11.4% in patients and 3.8% in controls. It was five times higher in patients with hypertension than in other patients. The incidence of ocular bleeding was higher in older than in younger patients. No association was found between ocular bleeding and factors such as gender, international normalized ratio, duration of warfarin therapy, concomitant aspirin use and diabetes mellitus. Thus, warfarin therapy increases the frequency of ocular bleeding. The higher incidence of ocular bleeding in the patients with hypertension and advanced age should be kept in mind and this subgroup of patients taking warfarin should be monitored closely.

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“…Results of previous studies revealed an increased risk of bleeding among patients whose ratios exceeded 4, an increased risk of stroke among patients whose ratios were 1.5-2 and a decreased risk of stroke at a ratio of 2.4. 4,5 However, the evidence supporting the range of 2-3 has some deficiencies. We sought to determine whether the risk of hemorrhagic and thromboembolic events is minimized at an international normalized ratio of 2-3 among patients taking anticoagulants.…”

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confidence: 99%

Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis

Oake¹,

Jennings²,

Forster³

et al. 2008

Canadian Medical Association Journal

148

124

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O ral anticoagulant therapy is essential for the treatment and prevention of many thromboembolic disorders. Since anticoagulants can cause serious adverse events, 1-3 physicians monitor the international normalized ratios of patients taking these drugs to ensure that their ratios fall within a target range.An international normalized ratio of 2-3 is the most common target range. Results of previous studies revealed an increased risk of bleeding among patients whose ratios exceeded 4, an increased risk of stroke among patients whose ratios were 1.5-2 and a decreased risk of stroke at a ratio of 2.4. 4,5 However, the evidence supporting the range of 2-3 has some deficiencies. We sought to determine whether the risk of hemorrhagic and thromboembolic events is minimized at an international normalized ratio of 2-3 among patients taking anticoagulants. In addition, it has been observed that patients spend more time with a ratio below 2 than above 3.6,7 The impact of such systematic underanticoagulation on patient outcomes is unknown. We sought to determine the effect of under-or overanticoagulation on the risk of thromboemboli and hemorrhage. Methods Data sourcesWe searched MEDLINE (1966MEDLINE ( -2006 for potentially pertinent studies. We then modified our strategy to include EMBASE (1980EMBASE ( -2006, the Cochrane Central Register of Controlled Trials (1980Trials ( -2006 and CINAHL (1982CINAHL ( -2006 databases. We manually searched references in the Science Citation Index. Our search strategy is outlined in Appendix 1 (available at www.cmaj.ca/cgi/content/full/179/3/235/DC2). Study selection

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Pcv8 Warfarin Anticoagulation and Outcomes in Atrial Fibrillation Patients:a Systematic Review and Meta-Analysis

Cited by 23 publications

References 0 publications

Stroke Risk and Antithrombotic Strategies in Atrial Fibrillation

Stroke Risk and Antithrombotic Strategies in Atrial Fibrillation

Ocular Bleeding Related to Warfarin Anticoagulation in Patients with Mechanical Heart Valve and Atrial Fibrillation

Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis

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