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https://www.readbyqxmd.com/read/28227051/optimal-decision-support-rules-improve-personalize-warfarin-treatment-outcomes
#1
Chih-Lin Chi, Kourosh Ravvaz, John Weissert, Peter J Tonellato, Chih-Lin Chi, Kourosh Ravvaz, John Weissert, Peter J Tonellato, Chih-Lin Chi, Kourosh Ravvaz, John Weissert, Peter J Tonellato
We tested optimization-based approaches to generate decision support rules used to improve personalized warfarin treatment based on clinical and genetic characteristics. Our approach simulated warfarin treatment outcomes using five existing treatment plans for clinical avatars (virtual patients). We used individual clinical avatar Time-in-Therapeutic-Range to represent the two-sided adverse risk to bleeding (over dosed - above therapeutic range) and thrombosis (under dosed - below therapeutic range) and as the objective function in the optimization to minimize overall risk...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28224948/predictors-of-warfarin-dose-requirements-in-south-african-patients-attending-an-anticoagulation-clinic
#2
Elise Schapkaitz, Johanna Sithole
INTRODUCTION: Warfarin is the most common oral anticoagulant for the treatment and prevention of thromboembolic disease. However, it has a wide interpatient variability in dose requirements due to various genetic and clinical factors. MATERIALS AND METHODS: This study investigated the effect of clinical and genetic factors on the variability of warfarin dose requirements in 147 South African patients (81 white and 66 black). The study was performed at a University Hospital Anticoagulation Clinic managed by nursing sisters at the Charlotte Maxeke Johannesburg Academic Hospital...
March 2017: Journal of Vascular Nursing: Official Publication of the Society for Peripheral Vascular Nursing
https://www.readbyqxmd.com/read/28224930/incidence-of-severe-renal-dysfunction-among-individuals-taking-warfarin-and-implications-for-non-vitamin-k-oral-anticoagulants
#3
Christina L Fanola, Deirdre Mooney, Andrew J Cowan, Darae Ko, Emily K Sisson, Lori E Henault, Yorghos Tripodis, Elaine M Hylek
BACKGROUND: The purpose of this study is to assess incidence and risk factors for severe renal dysfunction in patients requiring oral anticoagulation to help guide initial drug choice and provide a rational basis for interval monitoring of renal function for patients prescribed non-vitamin K oral anticoagulants. METHODS: Patients on warfarin for atrial fibrillation or venous thromboembolism were consecutively enrolled from January 2007 to December 2010. Baseline kidney function was assessed, and patients were followed to their first decline of kidney function to creatinine clearance<30 mL/min...
February 2017: American Heart Journal
https://www.readbyqxmd.com/read/28223868/assessment-of-novel-oral-anticoagulant-use-within-a-community-teaching-hospital
#4
Sultan Alghadeer, Lori Hornsby
: Background: Novel oral anticoagulants (NOACs) are considered to be at least as effective and safe as warfarin with several advantages such as predictable pharmacokinetics, allowing for standardized dosing without monitoring, a lack of food interactions and fewer drug interactions; however, their misuse could potentially result in patient harm. Objective: To evaluate the appropriate use of the NOACs within a community teaching hospital. SETTING: A community teaching hospital in the United States...
January 2017: Saudi Pharmaceutical Journal: SPJ: the Official Publication of the Saudi Pharmaceutical Society
https://www.readbyqxmd.com/read/28223782/factors-influencing-medication-knowledge-and-beliefs-on-warfarin-adherence-among-patients-with-atrial-fibrillation-in-china
#5
Shujuan Zhao, Hongwei Zhao, Xianpei Wang, Chuanyu Gao, Yuhua Qin, Haixia Cai, Boya Chen, Jingjing Cao
OBJECTIVES: Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood. METHODS: A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8(©); 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT)...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28219635/direct-oral-anticoagulant-or-warfarin-related-major-bleeding-characteristics-reversal-strategies-and-outcomes-from-a-multi-center-observational-study
#6
Yan Xu, Sam Schulman, Dar Dowlatshahi, Anne M Holbrook, Christopher S Simpson, Lois E Shepherd, Philip S Wells, Antonio Giulivi, Tara Gomes, Muhammad Mamdani, Wayne Khuu, Eliot Frymire, Ana P Johnson
BACKGROUND: Direct oral anticoagulants (DOACs) have expanded the armamentarium for antithrombotic therapy. While DOAC-related major bleeds were associated with favourable outcomes compared to warfarin in clinical trials, warfarin was reversed in <40% of cases, raising concerns about the generalizability of this finding. METHODS: Consecutive patients ≥66 years presenting to five tertiary care hospitals across three cities in Ontario, Canada with diagnoses that included hemorrhage from October 2010 to March 2015...
February 17, 2017: Chest
https://www.readbyqxmd.com/read/28218217/efficacy-and-safety-of-the-watchman-left-atrial-appendage-system-for-stroke-prevention-in-chinese-patients-with-nonvalvular-atrial-fibrillation-a-single-center-prospective-observational-study
#7
Wei-Ping Huang, Yong-Hua Zhang, Lei He, Xi Su, Xin-Wei Yang, Zai-Xiong Guo
BACKGROUND: In patients with nonvalvular atrial fibrillation (NVAF), embolic stroke is thought to be associated with left atrial appendage (LAA) thrombi. The WATCHMAN LAA Occlusion Device has been shown to be noninferior to conventional oral anticoagulation with warfarin for stroke prevention in patients with NVAF. This study aimed to evaluate the procedural feasibility, safety and 12-month outcomes of the WATCHMAN LAA Occlusion Device in NVAF patients with high risk for stroke in China...
2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28217549/anticoagulation-control-among-patients-with-nonvalvular-atrial-fibrillation-a-single-tertiary-cardiac-center-experience
#8
Shaban Mohammed, Amer H S Aljundi, Mohamed Kasem, Mohammed Alhashemi, Ayman El-Menyar
There is a limited knowledge about the predictors of anticoagulation control in patients with nonvalvular atrial fibrillation (NVAF). Furthermore, few reports addressed the role of time in therapeutic range (TTR) that could reflect the safety and efficacy of anticoagulation therapy. We aimed to assess factors that affect the quality of anticoagulation therapy utilizing TTR in patients with NVAF. A retrospective observational study was conducted for patients with NVAF who were maintained on warfarin >6 months at a tertiary cardiac care hospital...
January 2017: Journal of Advanced Pharmaceutical Technology & Research
https://www.readbyqxmd.com/read/28217222/non-vitamin-k-antagonist-oral-anticoagulants-versus-warfarin-for-cardioversion-of-atrial-fibrillation-in-clinical-practice-a-single-center-experience
#9
Naoki Shibata, Itsuro Morishima, Kenji Okumura, Yasuhiro Morita, Kensuke Takagi, Ruka Yoshida, Hiroaki Nagai, Toshiro Tomomatsu, Yoshihiro Ikai, Kazushi Terada, Kazuhito Tsuzuki, Hideyuki Tsuboi, Takahito Sone, Toyoaki Murohara
BACKGROUND: Anticoagulation therapy with the vitamin K antagonist (VKA) warfarin has been demonstrated to reduce thromboembolic risk after electrical cardioversion (ECV). However, data concerning ECV with non-VKA oral anticoagulants (NOACs) is limited. The objective of this study was to determine the efficacy and safety of NOACs in patients undergoing ECV in a real-world clinical practice at a single center in Japan. METHODS: We retrospectively analyzed the data of 406 consecutive patients who underwent ECV for atrial fibrillation (AF) or flutter under anticoagulation with one of the three NOACs (n=149) or with a VKA (n=257)...
February 2017: Journal of Arrhythmia
https://www.readbyqxmd.com/read/28216623/development-of-a-novel-individualized-warfarin-dose-algorithm-based-on-a-population-pharmacokinetic-model-with-improved-prediction-accuracy-for-chinese-patients-after-heart-valve-replacement
#10
Yu-Bin Zhu, Xian-Hua Hong, Meng Wei, Jing Hu, Xin Chen, Shu-Kui Wang, Jun-Rong Zhu, Feng Yu, Jian-Guo Sun
The gene-guided dosing strategy of warfarin generally leads to over-dose in patients at doses lower than 2 mg/kg, and only 50% of individual variability in daily stable doses can be explained. In this study, we developed a novel population pharmacokinetic (PK) model based on a warfarin dose algorithm for Han Chinese patients with valve replacement for improving the dose prediction accuracy, especially in patients with low doses. The individual pharmacokinetic (PK) parameter - apparent clearance of S- and R-warfarin (CLs) was obtained after establishing and validating the population PK model from 296 recruited patients with valve replacement...
February 20, 2017: Acta Pharmacologica Sinica
https://www.readbyqxmd.com/read/28215108/antithrombotic-therapy-in-aortic-diseases-a-narrative-review
#11
Francois Caron, Sonia S Anand
Aortic diseases are a heterogeneous group of disorders, including atherothrombotic conditions like aortic atheroma, cholesterol embolization syndrome, aortic mural thrombus, thrombus within an aneurysm, and large vessel vasculitis. In this review, we provide a summary of the current evidence regarding atherothrombotic diseases of the aorta, focusing on therapeutic avenues. In patients with previous stroke, aortic arch atheroma is recognized as a strong predictor of recurrent atheroembolism, and antiplatelet therapy alone is still associated with a high (11...
February 2017: Vascular Medicine
https://www.readbyqxmd.com/read/28215062/left-atrial-appendage-occlusion-for-stroke-prevention-in-patients-with-atrial-fibrillation-a-systematic-review-and-network-meta-analysis-of-randomized-controlled-trials
#12
Hasib Hanif, Emilie P Belley-Cote, Abdullah Alotaibi, Nazari Dvirnik, Binod Neupane, Joseph Beyene, John W Eikelboom, David Holmes, Richard P Whitlock
INTRODUCTION: Atrial fibrillation (AF) is one of the leading causes of stroke. Risks associated with oral anticoagulation limit adherence to recommended therapy. Left atrial appendage (LAA) occlusion is a treatment alternative in patients with AF. We performed a network meta-analysis (NMA) of randomized trials evaluating the efficacy of LAA occlusion compared with oral anticoagulant, antiplatelet, and placebo for stroke prevention. We also assessed the impact of LAA occlusion on mortality, major bleeding, and operative time...
February 17, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28214948/reduced-anticoagulation-variability-in-patients-on-warfarin-monitored-with-fiix-prothrombin-time-associates-with-reduced-thromboembolism-the-fiix-trial
#13
Alma Rut Oskarsdóttir, Brynja R Gudmundsdottir, Olafur S Indridason, Sigrun H Lund, David O Arnar, Einar S Bjornsson, Magnus K Magnusson, Hulda M Jensdottir, Brynjar Vidarsson, Charles W Francis, Pall T Onundarson
Fiix-prothrombin time (Fiix-PT) differs from traditional PT in being affected by reduced factor (F) II or FX only. In the randomized controlled Fiix-trial, patients on warfarin monitored with Fiix-PT (Fiix-warfarin patients) had fewer thromboembolisms (TE), similar major bleeding (MB) and more stable anticoagulation than patients monitored with PT (PT-warfarin patients). In the current Fiix-trial report we analyzed how reduced anticoagulation variability during Fiix-PT monitoring was reflected in patients with TE or bleeding...
February 18, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28214485/outcome-of-peripheral-venous-reconstructions-during-tumor-resection
#14
Philip Y Sun, Mark D Fleming, Kendall Stauffer, Manju Kalra, Gustavo Oderich, Thomas Bower, Peter Gloviczki, Randall R DeMartino
OBJECTIVE: Peripheral venous reconstruction surgery may be necessary for appropriate oncologic resection; however, the operative approach and surgical outcomes are not well described. We report our experience with these complex reconstructions to identify best practice. METHODS: We retrospectively reviewed all adult patients who underwent peripheral vein reconstruction for tumor resection at Mayo Clinic, Rochester (2000-2015). Patients were classified into three subgroups by the location: iliac (IL), lower extremity (LE), and upper extremity (UE)...
March 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28214287/association-of-warfarin-with-congestive-heart-failure-and-peripheral-artery-occlusive-disease-in-hemodialysis-patients-with-atrial-fibrillation
#15
Kuo-Hua Lee, Szu-Yuan Li, Jin-Sin Liu, Chi-Ting Huang, Ying-Ying Chen, Yao-Ping Lin, Chih-Cheng Hsu, Der-Cherng Tarng
BACKGROUND: The effect of warfarin on the risk of cardiovascular (CV) disease is unknown among chronic hemodialysis patients with atrial fibrillation (HD-AF). METHODS: Population-based propensity score and prescription time-distribution matched cohort study including 6719 HD-AF patients with CHA2DS2-VASc score ≥ 2 were divided into warfarin users and nonusers and followed-up for CV events and death. RESULTS: Warfarin treatment in HD-AF patients with AF preceding HD was associated with higher risks of developing congestive heart failure [hazard ratio (HR)=1...
February 14, 2017: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/28213573/rivaroxaban-versus-dabigatran-or-warfarin-in-real-world-studies-of-stroke-prevention-in-atrial-fibrillation-systematic-review-and-meta-analysis
#16
Ying Bai, Hai Deng, Alena Shantsila, Gregory Y H Lip
BACKGROUND AND PURPOSE: This study was designed to evaluate the effectiveness and safety of rivaroxaban in real-world practice compared with effectiveness and safety of dabigatran or warfarin for stroke prevention in atrial fibrillation through meta-analyzing observational studies. METHODS: Seventeen studies were included after searching in PubMed for studies reporting the comparative effectiveness and safety of rivaroxaban versus dabigatran (n=3), rivaroxaban versus Warfarin (n=11), or both (n=3) for stroke prevention in atrial fibrillation...
February 17, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28213368/effects-of-dabigatran-according-to-age-in-atrial-fibrillation
#17
Mandy N Lauw, John W Eikelboom, Michiel Coppens, Lars Wallentin, Salim Yusuf, Michael Ezekowitz, Jonas Oldgren, Juliet Nakamya, Jia Wang, Stuart J Connolly
OBJECTIVE: The prevalence of atrial fibrillation (AF) and the risk of stroke and bleeding vary according to age. To estimate effects of dabigatran, compared with warfarin, on stroke, bleeding and mortality in patients with AF in the Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial according to age, we analysed treatment effects using age as a continuous variable and using age categories. METHODS: RE-LY included 10 855 (59.9%) patients aged <75 years, 4231 patients (23...
February 17, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28210989/net-clinical-benefit-of-dabigatran-vs-warfarin-in-venous-thromboembolism-analyses-from-re-cover-%C3%A2-re-cover%C3%A2-ii-and-re-medy%C3%A2
#18
Martin Feuring, Sam Schulman, Henry Eriksson, Ajay J Kakkar, Sebastian Schellong, Stefan Hantel, Elke Schueler, Jörg Kreuzer, Samuel Z Goldhaber
The direct oral anticoagulants, e.g., dabigatran etexilate (DE), are effective and well tolerated treatments for venous thromboembolism (VTE). Net clinical benefit (NCB) is a useful concept in weighing potential benefits against potential harm of comparator drugs. The NCB of DE vs. warfarin in VTE treatment was compared. Post-hoc analyses were performed on pooled data from the 6-month RE-COVER® and RE-COVER™ II trials, and data from the RE-MEDY™ trial (up to 36 months), to compare the NCB of DE (150 mg twice daily) and warfarin [target international normalized ratio (INR) 2...
February 16, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28210634/potential-of-a-pharmacogenetic-guided-algorithm-to-predict-optimal-warfarin-dosing-in-a-high-risk-hispanic-patient-role-of-a-novel-nqo1-2-polymorphism
#19
Dagmar F Hernandez-Suarez, Karla Claudio-Campos, Javier E Mirabal-Arroyo, Bianca A Torres-Hernández, Angel López-Candales, Kyle Melin, Jorge Duconge
Deep abdominal vein thrombosis is extremely rare among thrombotic events secondary to the use of contraceptives. A case to illustrate the clinical utility of ethno-specific pharmacogenetic testing in warfarin management of a Hispanic patient is reported. A 37-year-old Hispanic Puerto Rican, non-gravid female with past medical history of abnormal uterine bleeding on hormonal contraceptive therapy was evaluated for abdominal pain. Physical exam was remarkable for unspecific diffuse abdominal tenderness, and general initial laboratory results-including coagulation parameters-were unremarkable...
October 2016: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28210454/managing-patients-taking-edoxaban-in-dentistry
#20
REVIEW
Adrian Curto, Daniel Curto, Jorge Sanchez
BACKGROUND: Anticoagulation therapy is used in several conditions to prevent or treat thromboembolism. A new group of oral anticoagulants with clear advantages over classic dicoumarin oral anticoagulants (warfarin and acenocoumarol) has been developed in recent years. The Food and Drug Administration has approved edoxaban, dabigatran, rivaroxaban and apixaban. Their advantages include: predictable pharmacokinetics, drug interactions and limited food, rapid onset of action and short half-life...
February 2017: Journal of Clinical and Experimental Dentistry
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