#Warfarin and Antiplatelet Therapy Versus Warfarin Alone for Treating Patients With Atrial Fibrillation Undergoing Transcatheter Aortic #Valve Replacement
http://www.sciencedirect.com/science/article/pii/S1936879816309347?via%3Dihub
In TAVR recipients prescribed VKA therapy for AF, concomitant antiplatelet therapy use appears not to reduce the incidence of stroke, major adverse cardiovascular events, or death, while increasing the risk of major or life-threatening bleeding.
http://www.sciencedirect.com/science/article/pii/S1936879816309347?via%3Dihub
In TAVR recipients prescribed VKA therapy for AF, concomitant antiplatelet therapy use appears not to reduce the incidence of stroke, major adverse cardiovascular events, or death, while increasing the risk of major or life-threatening bleeding.
#Warfarin use and stroke, bleeding and mortality risk in patients with end stage #renal disease and atrial fibrillation: a systematic review and meta-analysis
https://lnkd.in/eNM_4XK
Conclusions Given the absence of efficacy and an increased bleeding risk, these findings call into question the use of warfarin for AF treatment among patients with ESRD
https://lnkd.in/eNM_4XK
Conclusions Given the absence of efficacy and an increased bleeding risk, these findings call into question the use of warfarin for AF treatment among patients with ESRD
BMC Nephrology
Warfarin use and stroke, bleeding and mortality risk in patients with end stage renal disease and atrial fibrillation: a systematic…
Patients with end stage renal disease (ESRD), including stage 5 chronic kidney disease (CKD), hemodialysis (HD) and peritoneal dialysis (PD), are at high risk for stroke-related morbidity, mortality and bleeding. The overall risk/benefit balance of warfarin…
Incidence of severe #renal dysfunction among individuals taking #warfarin and implications for non–vitamin K oral anticoagulants
http://www.ahjonline.com/article/S0002-8703(16)30255-1/abstract
Acute and chronic renal dysfunction is common among individuals requiring long-term anticoagulant therapy. Patients with moderate chronic kidney disease and coronary artery disease are at the highest short-term risk of developing severe renal impairment. More frequent monitoring of these patients is warranted.
http://www.ahjonline.com/article/S0002-8703(16)30255-1/abstract
Acute and chronic renal dysfunction is common among individuals requiring long-term anticoagulant therapy. Patients with moderate chronic kidney disease and coronary artery disease are at the highest short-term risk of developing severe renal impairment. More frequent monitoring of these patients is warranted.
#Discontinuation of #Warfarin Therapy for Patients With Atrial Fibrillation
http://jamanetwork.com/journals/jamacardiology/article-abstract/2595572
The use of warfarin significantly reduces the risk of stroke among patients with atrial fibrillation (AF). Unfortunately, up to 60% of patients discontinue therapy within the first year.1 Prior studies did not assess the quality of warfarin therapy or the occurrence of electrical cardioversion (ECV) or radiofrequency ablation (RFA) as predictors of discontinuation of warfarin therapy.
http://jamanetwork.com/journals/jamacardiology/article-abstract/2595572
The use of warfarin significantly reduces the risk of stroke among patients with atrial fibrillation (AF). Unfortunately, up to 60% of patients discontinue therapy within the first year.1 Prior studies did not assess the quality of warfarin therapy or the occurrence of electrical cardioversion (ECV) or radiofrequency ablation (RFA) as predictors of discontinuation of warfarin therapy.
Association of #Warfarin Use With Lower Overall #Cancer Incidence Among Patients Older Than 50 Years
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2661703
In cancer models, warfarin inhibits AXL receptor tyrosine kinase–dependent tumorigenesis and enhances antitumor immune responses at doses not reaching anticoagulation levels. This study investigates the association between warfarin use and cancer incidence in a large, unselected population-based cohort
Of the 1 256 725 persons in the cohort, 607 350 (48.3%) were male, 649 375 (51.7%) were female, 132 687 (10.6%) had cancer, 92 942 (7.4%) were classified as warfarin users, and 1 163 783 (92.6%) were classified as nonusers. Warfarin users were older, with a mean (SD) age of 70.2 (8.2) years, and were predominantly men (57 370 61.7%) as compared with nonusers, who had a mean (SD) age of 63.9 (8.6) years and were mostly women (613 803 52.7%). Among warfarin users and compared with nonusers, there was a significantly lower age- and sex-adjusted incidence rate ratio (IRR) in all cancer sites (IRR, 0.84; 95% CI, 0.82-0.86) and in prevalent organ-specific sites (lung, 0.80 95% CI, 0.75-0.86; prostate, 0.69 95% CI, 0.65-0.72; and breast, 0.90 95% CI, 0.82-1.00). There was no observed significant effect in colon cancer (IRR, 0.99; 95% CI, 0.93-1.06). In a subgroup analysis of patients with atrial fibrillation or atrial flutter, the IRR was lower in all cancer sites (IRR, 0.62; 95% CI, 0.59-0.65) and in prevalent sites (lung, 0.39 95% CI, 0.33-0.46; prostate, 0.60 95% CI, 0.55-0.66; breast, 0.72 95% CI, 0.59-0.87; and colon, 0.71 95% CI, 0.63-0.81).
Conclusions and Relevance Warfarin use may have broad anticancer potential in a large, population-based cohort of persons older than 50 years. This finding could have important implications for the selection of medications for patients needing anticoagulation
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2661703
In cancer models, warfarin inhibits AXL receptor tyrosine kinase–dependent tumorigenesis and enhances antitumor immune responses at doses not reaching anticoagulation levels. This study investigates the association between warfarin use and cancer incidence in a large, unselected population-based cohort
Of the 1 256 725 persons in the cohort, 607 350 (48.3%) were male, 649 375 (51.7%) were female, 132 687 (10.6%) had cancer, 92 942 (7.4%) were classified as warfarin users, and 1 163 783 (92.6%) were classified as nonusers. Warfarin users were older, with a mean (SD) age of 70.2 (8.2) years, and were predominantly men (57 370 61.7%) as compared with nonusers, who had a mean (SD) age of 63.9 (8.6) years and were mostly women (613 803 52.7%). Among warfarin users and compared with nonusers, there was a significantly lower age- and sex-adjusted incidence rate ratio (IRR) in all cancer sites (IRR, 0.84; 95% CI, 0.82-0.86) and in prevalent organ-specific sites (lung, 0.80 95% CI, 0.75-0.86; prostate, 0.69 95% CI, 0.65-0.72; and breast, 0.90 95% CI, 0.82-1.00). There was no observed significant effect in colon cancer (IRR, 0.99; 95% CI, 0.93-1.06). In a subgroup analysis of patients with atrial fibrillation or atrial flutter, the IRR was lower in all cancer sites (IRR, 0.62; 95% CI, 0.59-0.65) and in prevalent sites (lung, 0.39 95% CI, 0.33-0.46; prostate, 0.60 95% CI, 0.55-0.66; breast, 0.72 95% CI, 0.59-0.87; and colon, 0.71 95% CI, 0.63-0.81).
Conclusions and Relevance Warfarin use may have broad anticancer potential in a large, population-based cohort of persons older than 50 years. This finding could have important implications for the selection of medications for patients needing anticoagulation
Jamanetwork
Warfarin Use and Lower Cancer Incidence Among Older Patients
This population-based cohort study uses the Norwegian national registries to determine the association between warfarin use and cancer incidence among persons aged 52 to 82 years.
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Risks and benefits of direct oral #anticoagulants versus #warfarin in a real world setting: cohort study in primary care
https://www.bmj.com/content/362/bmj.k2505
In patients with atrial fibrillation, compared with warfarin, apixaban was associated with a decreased risk of major bleeding (adjusted hazard ratio 0.66, 95% confidence interval 0.54 to 0.79) and intracranial bleeding (0.40, 0.25 to 0.64); dabigatran was associated with a decreased risk of intracranial bleeding (0.45, 0.26 to 0.77). An increased risk of all cause mortality was observed in patients taking rivaroxaban (1.19, 1.09 to 1.29) or on lower doses of apixaban (1.27, 1.12 to 1.45). In patients without atrial fibrillation, compared with warfarin, apixaban was associated with a decreased risk of major bleeding (0.60, 0.46 to 0.79), any gastrointestinal bleeding (0.55, 0.37 to 0.83), and upper gastrointestinal bleeding (0.55, 0.36 to 0.83); rivaroxaban was associated with a decreased risk of intracranial bleeding (0.54, 0.35 to 0.82). Increased risk of all cause mortality was observed in patients taking rivaroxaban (1.51, 1.38 to 1.66) and those on lower doses of apixaban (1.34, 1.13 to 1.58).
Conclusions Overall, apixaban was found to be the safest drug, with reduced risks of major, intracranial, and gastrointestinal bleeding compared with warfarin. Rivaroxaban and low dose apixaban were, however, associated with increased risks of all cause mortality compared with warfarin
Risks and benefits of direct oral #anticoagulants versus #warfarin in a real world setting: cohort study in primary care
https://www.bmj.com/content/362/bmj.k2505
In patients with atrial fibrillation, compared with warfarin, apixaban was associated with a decreased risk of major bleeding (adjusted hazard ratio 0.66, 95% confidence interval 0.54 to 0.79) and intracranial bleeding (0.40, 0.25 to 0.64); dabigatran was associated with a decreased risk of intracranial bleeding (0.45, 0.26 to 0.77). An increased risk of all cause mortality was observed in patients taking rivaroxaban (1.19, 1.09 to 1.29) or on lower doses of apixaban (1.27, 1.12 to 1.45). In patients without atrial fibrillation, compared with warfarin, apixaban was associated with a decreased risk of major bleeding (0.60, 0.46 to 0.79), any gastrointestinal bleeding (0.55, 0.37 to 0.83), and upper gastrointestinal bleeding (0.55, 0.36 to 0.83); rivaroxaban was associated with a decreased risk of intracranial bleeding (0.54, 0.35 to 0.82). Increased risk of all cause mortality was observed in patients taking rivaroxaban (1.51, 1.38 to 1.66) and those on lower doses of apixaban (1.34, 1.13 to 1.58).
Conclusions Overall, apixaban was found to be the safest drug, with reduced risks of major, intracranial, and gastrointestinal bleeding compared with warfarin. Rivaroxaban and low dose apixaban were, however, associated with increased risks of all cause mortality compared with warfarin
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Association of Adding #Aspirin to #Warfarin Therapy Without an Apparent Indication With Bleeding and Other Adverse Events
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2726050
At 1 year, patients receiving combination warfarin and aspirin compared with those receiving warfarin only had higher rates of overall bleeding (cumulative incidence, 26.0%; 95% CI, 23.8%-28.3% vs 20.3%; 95% CI, 18.3%-22.3%; P < .001), major bleeding (5.7%; 95% CI, 4.6%-7.1% vs 3.3%; 95% CI, 2.4%-4.3%; P < .001), emergency department visits for bleeding (13.3%; 95% CI, 11.6%-15.1% vs 9.8%; 95% CI, 8.4%-11.4%; P = .001), and hospitalizations for bleeding (8.1%; 6.8%-9.6% vs 5.2%; 4.1%-6.4%; P = .001). Rates of thrombosis were similar
Conclusions and Relevance Compared with warfarin monotherapy, receipt of combination warfarin and aspirin therapy was associated with increased bleeding and similar observed rates of thrombosis. Further research is needed to better stratify which patients may benefit from aspirin while anticoagulated with warfarin for atrial fibrillation or venous thromboembolism; clinicians should be judicious in selecting patients for combination therapy
Association of Adding #Aspirin to #Warfarin Therapy Without an Apparent Indication With Bleeding and Other Adverse Events
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2726050
At 1 year, patients receiving combination warfarin and aspirin compared with those receiving warfarin only had higher rates of overall bleeding (cumulative incidence, 26.0%; 95% CI, 23.8%-28.3% vs 20.3%; 95% CI, 18.3%-22.3%; P < .001), major bleeding (5.7%; 95% CI, 4.6%-7.1% vs 3.3%; 95% CI, 2.4%-4.3%; P < .001), emergency department visits for bleeding (13.3%; 95% CI, 11.6%-15.1% vs 9.8%; 95% CI, 8.4%-11.4%; P = .001), and hospitalizations for bleeding (8.1%; 6.8%-9.6% vs 5.2%; 4.1%-6.4%; P = .001). Rates of thrombosis were similar
Conclusions and Relevance Compared with warfarin monotherapy, receipt of combination warfarin and aspirin therapy was associated with increased bleeding and similar observed rates of thrombosis. Further research is needed to better stratify which patients may benefit from aspirin while anticoagulated with warfarin for atrial fibrillation or venous thromboembolism; clinicians should be judicious in selecting patients for combination therapy