MedWorm: Coumadin

  MM-WES: Genotyping reduces warfarin-associated hospitalizations

Genotyping patients on warfarin anticoagulation therapy reduces hospitalizations for all causes by nearly 30%, reported investigators from the Medco-Mayo Warfarin Effectiveness Study on the final day of the 59th annual Scientific Sessions of the American College of Cardiology, in Atlanta, Georgia, USA. (Source: MedWire News - Thrombosis)

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  DMET™ Microarray Technology for Pharmacogenomics-Based Personalized Medicine

Human genome sequence variation in the form of single nucleotide polymorphisms (SNPs) as well as more complex structural variation such as insertions, duplications, and deletions underlies each individual’s response to drugs and thus the likelihood of experiencing an adverse drug reaction. The ongoing challenge of the field of pharmacogenetics is to further understand the relationship between genetic variation and differential drug responses, with the overarching goal being that this will lead to improvements in both the safety and efficacy of drugs. The Affymetrix® DMET™ Plus Premier Pack (DMET stands for Drug Metabolizing Enzymes and Transporters) enables highly multiplexed genotyping of known polymorphisms in Absorption, Distribution, Metabolism, and Elimination (ADME)-r...

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  Warfarin alternative 'prevents more strokes'; Geographical variation in pollen-related allergies; Varenicline effective even in failed smoking quitters

Our update on the latest research being presented at medical conferences. (Source: Pulse)

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  Effective Hemostasis During Minor Surgery in a Case of Hereditary Combined Deficiency of Vitamin K-dependent Clotting Factors

Combined deficiency of the vitamin K-dependent clotting factors (VKCFD) is a rare bleeding disorder involving defective gamma-carboxylation of coagulation factors II , VII, IX and X as well as natural anticoagulants protein C and protein S. The disease is characterized by a cluster of different, often life threatening, bleeding symptoms occurring both spontaneously and in a surgical setting. In the present paper we describe two different treatment modalities to be used both in a programmed surgical procedure and in an emergency scenario. As this disease is a natural model that resembles oral anticoagulation, our experience discloses a possible rationale in the use of recombinant activated FVII for warfarin reversal. (Source: Clinical and Applied Thrombosis/Hemostasis)

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  Early Discharge of Patients With Venous Thromboembolism: Implications Regarding Therapy

The purpose of this investigation is to show trends in the duration of hospitalization of patients with pulmonary embolism (PE) and deep venous thrombosis (DVT). The number of patients discharged from short-stay non-Federal hospitals throughout the United States with a primary diagnostic code for PE or DVT from 1979 through 2005 was obtained from the National Hospital Discharge Survey. By 2005, 13% of patients with PE were discharged in 1 to 2 days, 30% in 3 to 4 days, 26% in 5 to 6 days, and 31% in ≥7 days. Regarding DVT, by 2005, 26% of patients with DVT were discharged in 1 to 2 days, 34% were discharged in 3 to 4 days, 20% were discharged in 5 to 6 days, and 19% were discharged in ≥7 days. The data indicate that large proportions of patients with a primary diagnosis of PE and of ...

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  Pathway Genomics Responds To Medco, Mayo Clinic Study Revealing Gene Testing Reduces Hospitalization Rates For Warfarin Patients

Pathway Genomics Inc., a U.S. based genetic testing company, responded to research released at the American College of Cardiology annual meeting that found that the number of hospitalizations for heart patients taking warfarin, the world's most-prescribed blood thinner, dropped by approximately 30 percent when genetic information for the patient was available to doctors prescribing the drug. The study was completed by Medco Health Solutions, Inc. -- in association with the Medco Research Institute™ -- and the Mayo Clinic. The Medco announcement can be found here.... (Source: Health News from Medical News Today)

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  Pathway Genomics Responds To Medco, Mayo Clinic Study Revealing Gene Testing Reduces Hospitalization Rates For Warfarin Patients

Pathway Genomics Inc., a U.S. based genetic testing company, responded to research released at the American College of Cardiology annual meeting that found that the number of hospitalizations for heart patients taking warfarin, the world's most-prescribed blood thinner, dropped by approximately 30 percent when genetic information for the patient was available to doctors prescribing the drug... (Source: Cardiovascular / Cardiology News From Medical News Today)

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  BUSM researcher receives prestigious young investigator award

(Boston University Medical Center) Adam Rose, M.D., M.Sc., F.A.C.P., an assistant professor of medicine at the Boston University School of Medicine and a core investigator at the Center for Health Quality, Outcomes, and Economic Research at the Bedford VA Medical Center, has been named a 2009 Pier M. Mannucci Young Investigator prizewinner. Rose received this award for his article titled "Warfarin dose management affects INR Control" which appeared in the Journal of Thrombosis and Haemostasis. (Source: EurekAlert! - Medicine and Health)

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  Genetic Tests for Warfarin Cuts Costs, If Women Were Treated Like Men, and More ACC Highlights

View the results of the hottest late-breaking clinical trials at the American College of Cardiology Meetings 2010 with Dr. Melissa Walton-Shirley: MM-WES, ASPIRE, DOSE, and more. Medscape Cardiology (Source: Medscape Today Headlines)

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  Genetic Tests for Warfarin Cut Costs, If Women Were Treated Like Men, and More ACC Highlights

View the results of the hottest late-breaking clinical trials at the American College of Cardiology Meetings 2010 with Dr. Melissa Walton-Shirley: MM-WES, ASPIRE, DOSE, and more. Medscape Cardiology (Source: Medscape Today Headlines)

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  Warfarin Treatment Linked to Intracerebral Hemorrhage Following Treatment With tPA

Dr. Laura Barclay discusses whether patients treated with warfarin who receive IV tissue plasminogen activator for acute ischemic stroke are at increased risk for symptomatic intracerebral hemorrhage. Medscape Neurology & Neurosurgery (Source: Medscape Today Headlines)

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  Warfarin treatment aided by gene tests

Checking patients' DNA before starting them on a popular blood thinner helps get the tricky dose right and keeps them out of the hospital, doctors say. (Source: CBC | Health)

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  Blood-thinning drug 'better than warfarin'

Around 750,000 Britons could benefit from a new type of bloodthinning drug which has been hailed as the first major advance in controlling clotting for 50 years. (Source: the Mail online | Health)

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  Dabigatran Etexilate Shows Greater Reductions Than Warfarin In Stroke In Patients With Atrial Fibrillation Across All Stroke Risk Groups

Data presented at the 59th Annual Scientific Session of the American College of Cardiology have shown greater reductions in stroke in patients with atrial fibrillation (AF) for dabigatran etexilate* compared to the current standard of care, warfarin, irrespective of a patient's risk profile for stroke.1 The new sub-group analysis from the landmark RE-LY® study** assessed the rate of stroke and systemic embolism in patients defined as being at low (n=5,775), moderate (n=6,455) and high (n=5,882) risk of such events by the validated stroke risk stratification score, CHADS2... (Source: Health News from Medical News Today)

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  Dabigatran Etexilate Shows Greater Reductions Than Warfarin In Stroke In Patients With Atrial Fibrillation Across All Stroke Risk Groups

Data presented at the 59th Annual Scientific Session of the American College of Cardiology have shown greater reductions in stroke in patients with atrial fibrillation (AF) for dabigatran etexilate* compared to the current standard of care, warfarin, irrespective of a patient's risk profile for stroke... (Source: Cardiovascular / Cardiology News From Medical News Today)

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  Warfarin Genotyping Reduces Hospitalizations

Although there was a suggestion that some of the effect could have simply been due to more attention being paid to the patients, most agree that any intervention that helps warfarin control is worthwhile. Heartwire (Source: Medscape Today Headlines)

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  Safer alternative to warfarin 'could prevent thousands of strokes a year'

THOUSANDS of strokes could be prevented in the UK each year by switching at-risk patients to a new type of blood-thinning drug, the results of a major trial suggest. (Source: Scotsman.com News - Health)

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  Conference report: Genetic screening may reduce warfarin hospitalisations

Source: Reuters Health Area: News According to the results of a study presented at the American College of Cardiology scientific meeting, use of genetic screening may help to reduce hospitalisations related to warfarin.   The study was conducted by researchers from the Mayo Clinic in conjunction with Medco, which administers prescription drug benefits for employers and health plans in the US.  Medco found that about 1 million of the 60 million people on its rolls were taking warfarin in 2007, and that around 22% of them were being hospitalised within six months of starting the drug.    The study included 896 patients taking warfarin who were screened for the genes CYP2C9 and VKORC1 and 2,688 who did not undergo such screening.  According to the Reuters rep...

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  Dabigatran versus Warfarin for Venous Thromboembolism

To the Editor: The article by Schulman et al. (Dec. 10 issue)1 shows that a fixed dose of the thrombin ... (Source: New England Journal of Medicine)

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  ACC: Novel Anticoagulant Seems Safe and Effective (CME/CE)

ATLANTA (MedPage Today) -- An investigational, selective factor Xa inhibitor -- betrixaban -- demonstrated apparent safety and efficacy in a phase II trial, making it yet another contender being developed as an alternative to warfarin (Coumadin). (Source: MedPage Today Cardiovascular)

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  Gene testing helps set dose for blood-thinner warfarin

Doctors are reporting an exciting win for gene testing and personalized medicine: Checking patients' DNA before starting them on warfarin, a popular blood thinner, helps get the tricky dose right and keep them out of the hospital. (Source: CTV Health)

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  Dabigatran etexilate shows greater reductions than warfarin in stroke in patients with atrial fibrillation across all stroke risk groups

Dabigatran etexilate shows greater reductions than warfarin in stroke in patients with atrial fibrillation across all stroke risk groups   - Compared to well-controlled warfarin, dabigatran etexilate provided consistent benefits in stroke... (Source: Drugs.com - Clinical Trials)

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  Warfarin genotyping reduces hospitalizations

Although there was a suggestion that some of the effect could have simply been due to more attention being paid to the patients, most agree that any intervention that helps warfarin control is... For complete story visit theheart.org. (Source: theHeart.org)

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  Gene test cuts complications from blood thinner warfarin

Doctors who used a genetic test to personalize treatment with blood thinner warfarin cut patients' hospitalization rates by almost ... (Source: USATODAY.com Health)

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  Study: Gene test helps get dose right for blood thinner warfarin

Doctors are reporting an exciting win for gene testing and personalized medicine: Checking patients' DNA before starting them ... (Source: USATODAY.com Health)

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  EXPLORE-Xa: Betrixaban bleeding outcomes comparable to warfarin in dose-finding trial

The investigational anticoagulant betrixaban has a comparable safety profile to that of warfarin in patients with non-valvular atrial fibrillation or flutter, according to the results of EXPLORE-Xa trial. (Source: MedWire News - Thrombosis)

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  EXPLORE-Xa: Betrixaban bleeding outcomes comparable to warfarin in dose-finding trial

The investigational anticoagulant betrixaban has a comparable safety profile to that of warfarin in patients with non-valvular atrial fibrillation or flutter, according to the results of EXPLORE-Xa trial. (Source: MedWire News - Stroke)

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  Medco, Mayo Clinic study finds reduced hospitalization rates with genetic testing

A simple genetic test can reduce hospitalization rates by almost a third for heart patients taking warfarin, the world's most-prescribed blood thinner, according to a study released today by researchers from Medco Health Solutions, Inc. (in association with the Medco Research Institute) and the Mayo Clinic. (Source: Healthcare IT News)

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  Gene test can cut warfarin hospitalizations

ATLANTA (Reuters) - Use of genetic screening on heart patients helped cut hospitalizations related to the widely used blood thinner warfarin by nearly a third, according to a large study that marks a step forward in the fledgling field of personalized medicine. (Source: Reuters: Health)

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  Gene test can cut warfarin hospitalizations

ATLANTA (Reuters) - Use of genetic screening on heart patients helped cut hospitalizations related to the widely used blood thinner warfarin by nearly a third, according to a large study that marks a step forward in the fledgling field of personalized medicine. (Source: Reuters: Health)

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  Sub-group analysis of RE-LY study suggests greater reductions in stroke risk with dabigatran than warfarin across all stroke risk groups of AF patients

Source: BioSpace Area: News According to data from a sub-group analysis of the RE-LY study presented at the 59th Annual Scientific Session of the American College of Cardiology, dabigatran etexilate was associated with greater reductions in stroke in patients with atrial fibrillation (AF) compared to warfarin, irrespective of a patient's risk profile for stroke.   The sub-group analysis assessed the rate of stroke and systemic embolism in patients defined as being at low (n=5,775), moderate (n=6,455) and high (n=5,882) risk of such events by the validated stroke risk stratification score, CHADS2 and the following results were presented:   . Dabigatran 150mg bd reduced the rate of stroke and systemic embolism when compared with well-controlled warfarin across all str...

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  ACC: New Anticoagulants Signal Start of Post-Warfarin Era

ATLANTA (MedPage Today) -- Atrial fibrillation is both a major stroke risk and a looming public health problem in an aging population. The standard treatment -- warfarin -- is also difficult to manage. ACC President Ralph Brindis discusses new, post-warfarin therapies in this exclusive InFocus™ report. (Source: MedPage Today Cardiovascular)

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  New Factor Xa Inhibitor Betrixaban Safe in Phase 2 AF Trial

A novel oral factor Xa inhibitor, betrixaban, was safe and well tolerated when compared with warfarin in a phase 2 trial in patients with AF. Along with other new anticoagulants, this could represent an advance on warfarin, but betrixaban first needs to be evaluated in a much larger phase 3 trial, said the lead researcher. Heartwire (Source: Medscape Today Headlines)

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  Portola Pharmaceuticals and Merck Announce that Phase 2 Study Showed Investigational Factor Xa Inhibitor, Betrixaban, Reduced Incidence of Bleeding Compared to Warfarin in Patients with Atrial Fibrillation

ATLANTA--(BUSINESS WIRE)--Mar 15, 2010 - Portola Pharmaceuticals and Merck today announced the results of EXPLORE-Xa, a Phase 2 exploratory, dose finding study of betrixaban, an investigational oral direct Factor Xa inhibitor. Results showed that a... (Source: Drugs.com - Clinical Trials)

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  New factor Xa inhibitor betrixaban safe in phase 2 AF trial

A novel oral factor Xa inhibitor, betrixaban, was safe and well tolerated when compared with warfarin in a phase 2 trial in patients with AF. Along with other new anticoagulants, this could represent... For complete story visit theheart.org. (Source: theHeart.org)

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  Design evaluation and optimisation in multiple response nonlinear mixed effect models: PFIM 3.0

Abstract: Nonlinear mixed effect models (NLMEM) with multiple responses are increasingly used in pharmacometrics, one of the main examples being the joint analysis of the pharmacokinetics (PK) and pharmacodynamics (PD) of a drug. Efficient tools for design evaluation and optimisation in NLMEM are necessary. The R functions PFIM 1.2 and PFIMOPT 1.0 were proposed for these purposes, but accommodate only single response models. The methodology used is based on the Fisher information matrix, developed using a linearisation of the model. In this paper, we present an extended version, PFIM 3.0, dedicated to both design evaluation and optimisation for multiple response models, using a similar method as for single response models. In addition to handling multiple response models, several features ...

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  Merck blood thinner appears safe, effective

ATLANTA (Reuters) - An experimental blood thinner being developed by Merck & Co from a new class of drugs appeared to be safe and effective in a mid-stage study that compared three doses against widely used warfarin in patients with atrial fibrillation. (Source: Reuters: Health)

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  Merck blood thinner appears safe, effective: study

ATLANTA (Reuters) - An experimental blood thinner being developed by Merck & Co from a new class of drugs appeared to be safe and effective in a mid-stage study that compared three doses against widely used warfarin in patients with atrial fibrillation. (Source: Reuters: Health)

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  Portola Pharmaceuticals And Merck Announce That Phase 2 Study Showed Investigational Factor Xa Inhibitor, Betrixaban, Reduced Incidence Of Bleeding Compared To Warfarin In Patients With Atrial Fibrillation

Portola Pharmaceuticals and Merck today announced the results of EXPLORE-Xa, a Phase 2 exploratory, dose finding study of betrixaban, an investigational oral direct Factor Xa inhibitor. Results showed that a once-daily dose of oral betrixaban, given to patients with non-valvular atrial fibrillation or atrial flutter and at least one risk factor for stroke, reduced the incidence of major and clinically relevant non-major (CRNM) bleeds* compared to dose-adjusted warfarin. The data were presented during a (Source: Pharmaceutical Online News)

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  Portola Pharmaceuticals and Merck Announce that Phase 2 Study Showed Investigational Factor Xa Inhibitor, Betrixaban, Reduced Incidence of Bleeding Compared to Warfarin in Patients with Atrial Fibrillation

(Source: Merck.com - Research & Development News)

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  Warfarin May Raise Hemorrhage Risk After Stroke Treatment

Warfarin-treated patients may be at a higher risk for symptomatic intracerebral hemorrhage after treatment for acute ischemic stroke with intravenous tissue plasminogen activator than their counterparts not being prescribed warfarin, according to a study published online March 8 in the Archives of Neurology. (Source: Modern Medicine)

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  ACC: Plavix+aspirin, for those who can’t take warfarin, doesn't increase costs

ATLANTA—In high-risk patients with atrial fibrillation who can’t tolerate standard blood thinners, such as warfarin, a combination treatment of aspirin and the more expensive clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis) is clinically effective for preventing stroke as well as being cost-effective, according to an ACTIVE-A economic substudy presented Sunday at the American College of Cardiology’s (ACC) 59th annual scientific session.  Slides» (Source: Cardiovascular Business News)

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  Warfarin users appear more likely to develop brain bleeding following stroke treatment

Patients already taking warfarin who develop an acute stroke appear more likely to experience a brain hemorrhage following treatment with an intravenous clot-dissolving medication, even if their blood clotting function appears normal, according to a new study. (Source: ScienceDaily Headlines)

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  Warfarin-treated patients at higher risk of ICH following tPA for stroke

Researchers say their study provides important new information about a group of patients excluded from major trials of tPA for stroke, who yet represent a growing proportion of patients. For complete story visit theheart.org. (Source: theHeart.org)

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  Treatment of neovascular age-related macular degeneration with a variable ranibizumab dosing regimen and one-time reduced-fluence photodynamic therapy: the TORPEDO trial at 2 years

Conclusion  Combined PDT and ranibizumab injection the same day was well tolerated in all patients. Eighty-four percent of patients had stable or improved vision at month 24. Content Type Journal ArticleCategory Retinal DisordersDOI 10.1007/s00417-009-1256-6Authors Leigh Spielberg, University Hospital Leuven Department of Ophthalmology Kapucijnenvoer 33 3000 Leuven BelgiumAnita Leys, University Hospital Leuven Department of Ophthalmology Kapucijnenvoer 33 3000 Leuven Belgium Journal Graefe's Archive for Clinical and Experimental OphthalmologyOnline ISSN 1435-702XPrint ISSN 0721-832X (Source: Graefe's Archive for Clinical and Experimental Ophthalmology)

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  Warfarin-Treated Patients at Higher Risk for ICH Following tPA for Stroke

The surprising finding is calling current practice into question. Medscape Medical News (Source: Medscape Today Headlines)

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  New and Emerging Anticoagulant Therapies for Venous Thromboembolism

Opinion statement  Anticoagulation therapy remains the cornerstone for prevention and treatment of venous thromboembolism. Currently available parenteral anticoagulants, such as heparin, low molecular weight heparin, and fondaparinux, are used widely for short-term therapy, but the need for parenteral administration limits their utility for long-term use. Vitamin K antagonists, such as warfarin, are the only oral anticoagulants available for long-term use. Although effective, these drugs produce a variable anticoagulant response and require routine coagulation monitoring and frequent dose adjustments. New anticoagulants that can be given in fixed doses without monitoring have been developed to overcome the limitations of existing agents. These drugs are in advanced stages o...

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  Alarm raised over INR threshold in stroke thrombolysis

Stroke patients undergoing thrombolysis are at increased risk for symptomatic intracerebral hemorrhage if they are taking warfarin, even if their international normalized ratio is within recommended limits, research suggests. (Source: MedWire News - Stroke)

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  Warfarin-flucloxacillin interaction presenting as cardioembolic ischemic stroke

Content Type Journal ArticleCategory Letter to the EditorsDOI 10.1007/s00228-010-0802-9Authors Áine Merwick, Mater Misericordiae University Hospital Neurovascular Clinical Science Unit, Catherine McAuley Centre Nelson St Dublin 7 IrelandNiamh Hannon, Mater Misericordiae University Hospital Neurovascular Clinical Science Unit, Catherine McAuley Centre Nelson St Dublin 7 IrelandPeter J. Kelly, Mater Misericordiae University Hospital Neurovascular Clinical Science Unit, Catherine McAuley Centre Nelson St Dublin 7 IrelandKillian O’Rourke, Mater Misericordiae University Hospital Neurovascular Clinical Science Unit, Catherine McAuley Centre Nelson St Dublin 7 Ireland Journal European Journal of Clinical PharmacologyOnline ISSN 1432-1041Print ISSN 0031-6970 (Source: European Journal...

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  Accuracy assessment of pharmacogenetically predictive warfarin dosing algorithms in patients of an academic medical center anticoagulation clinic

In conclusion, the algorithms published by Gage et al. 2008 and the IWPC 2009 were the two most accurate pharmacogenetically based equations available in the medical literature in predicting therapeutic warfarin dose in our study population. However, the degree of accuracy demonstrated does not support the routine use of genotyping to prospectively dose all patients newly started on warfarin. Content Type Journal ArticleDOI 10.1007/s11239-010-0459-3Authors Paul B. Shaw, UMass Memorial Medical Center Pharmacy Specialty Resident—Cardiology Worcester MA USAJennifer L. Donovan, Massachusetts College of Pharmacy and Health Sciences Worcester MA USAMaichi T. Tran, UMass Memorial Medical Center Cardiovascular Services Worcester MA USAStephenie C. Lemon, University of Massachusetts Med...

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  New oral anticoagulants may replace warfarin

With some agents already approved in Europe and Canada, the long-awaited move away from warfarin may be starting. (Source: HemOncToday.com)

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  Warfarin use increased risk for brain bleed after IV tissue plasminogen activator use

(Source: HemOncToday.com)

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  Increased Incidence of Gastrointestinal Bleeding Following Implantation of the HeartMate II LVAD

Conclusions: Although definitive source identification remains elusive, we believe that the majority of bleeding arises in the small bowel, possibly due to angiodysplasias, similar to the pathophysiology encountered in patients with aortic stenosis and GI bleeding. As we move toward wider use of the HMII and other axial continuous-flow devices in both bridge-to-transplant patients and for destination therapy, more studies will be necessary to understand the mechanisms of this obscure GI bleeding and develop treatment strategies to minimize its development. (J Card Surg ****;**:**-**) (Source: Journal of Cardiac Surgery)

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  Effect of Casopitant, a Novel NK-1 Receptor Antagonist, on the Pharmacokinetics and Pharmacodynamics of Steady-State Warfarin.

Authors: Kirby LC, Johnson BM, Adams LM, Eberwein DJ, Zhang K, Murray SC, Lates CD, Blum RA, Morris SR Casopitant, a novel NK-1 receptor antagonist under investigation for the prevention of postoperative and chemotherapy-induced nausea and vomiting, is a weak to moderate inhibitor of CYP3A and a moderate inducer of CYP2C9 in vitro. Furthermore, both CYP enzymes are involved in the metabolism of R- and S-warfarin, respectively. This clinical study was conducted to explore the potential drug-drug interaction between casopitant and warfarin. In total, 97 healthy participants were enrolled and 54 completed the study. Participants received individualized daily dosing of warfarin to an international normalized ratio (INR) of 1.3 to 2.3 over a 14-day period (period 1). Immediately following p...

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  Deep vein and intracardiac thrombosis during the post-partum period in Behçet's disease.

Deep vein and intracardiac thrombosis during the post-partum period in Behçet's disease. Int J Hematol. 2010 Mar 10; Authors: Hiwarkar P, Stasi R, Sutherland G, Shannon M A 22-year-old woman presented on the 10th post-partum day with deep vein thrombosis involving the right ilio-femoral and popliteal veins. This thrombosis was refractory to conventional anticoagulation and subsequently over a period of 6 weeks progressed to involve inferior vena cava and right ventricle. A diagnosis of Behçet's disease was made on the clinical grounds of fever, night sweats, and recurrent oral ulcers. In view of refractory thrombosis, anticoagulation with lepirudin was commenced followed by thrombolysis with streptokinase. After thrombolysis, anticoagulation was switched to fondaparin...

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  Comparison of assay systems for warfarin-related CYP2C9 and VKORC1 genotyping.

CONCLUSIONS: All assays gave comparable results for common variants. Each system offered unique advantages and disadvantages, whose relative importance depends on the needs of the adopting clinical laboratory. PMID: 20226775 [PubMed - as supplied by publisher] (Source: International Journal of Clinical Chemistry)

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  Lateral sinus thrombosis as a complication of acute mastoiditis in children

We have read with great interest the recent article by Christensen et al. , which presents important clinical observations for otogenic intracranial complications. It was a well-conducted study of lateral sinus thrombosis of otitis media in children. We would like to present some comments on this problem based on our experience and literature review. Authors presented seven cases of lateral sinus thrombosis (LST) in children as complications of acute otitis media (AOM)—four cases and chronic otitis media (COM)—three cases. LST is a rare intracranial complication of otitis media which contributes to lack of clear guidelines of how to manage this entity, i.e. the time of introduction of antibiotic therapy, whether to remove clot from the sinus or to ligate internal jugular vein (IJV), et...

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  Warfarin Users Appear More Likely To Develop Brain Bleeding Following Stroke Treatment

CHICAGO, March 8, 2010-Patients already taking warfarin who develop an acute stroke appear more likely to experience a brain hemorrhage following treatment with an intravenous clot-dissolving medication, even if their blood clotting function... (Source: Drugs.com - Clinical Trials)

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  TPA raised intracerebral bleeding risk in stroke patients on warfarin

Read the full story on MD Consult: TPA raised intracerebral bleeding risk in stroke patients on warfarin (Source: MD Consult: News: Top Stories)

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  Symptomatic intracerebral haemorrhage among warfarin-treated patients receiving TPA for acute ischaemic stroke

Source: Arch Neurol Area: News A North American retrospective study was conducted to determine whether warfarin-treated patients with an INR < 1.7 who receive intravenous tissue plasminogen activator (TPA) for acute ischaemic stroke are at increased risk for symptomatic intracerebral haemorrhage (sICH).   The study included 107 patients with the following characteristics:   . Mean age 69.2 years . 43.9% men . Median National Institutes of Health Stroke Scale score (NIHSS) = 14 . Median onset-to-treatment time = 140 minutes . Baseline warfarin use = 12.1% . Median INR = 1.04 (range, 0.82-1.61)   The overall rate of sICH was 6.5%, but it was higher among patients taking warfarin compared with those not taking warfarin at baseline (...

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  Symptomatic Intracerebral Hemorrhage Among Eligible Warfarin-Treated Patients Receiving Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke [Original Contribution]

Conclusions  Despite an international normalized ratio less than 1.7, warfarin-treated patients are more likely than those not taking warfarin to experience symptomatic intracerebral hemorrhage following treatment with intravenous tissue plasminogen activator. Larger studies in this subgroup are warranted.Published online March 8, 2010 (doi:10.1001/archneurol.2010.25). (Source: Archives of Neurology)

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  What's Going to Be Hot at ACC 2010?

Highlights include two ACCORD analyses looking at blood pressure and lipids, the EVEREST II results with the MitraClip, the MM-WES study of warfarin genotyping, plus a range of DES, HF, and atrial-fibrillation studies that may help answer the question of what therapies work best and at the best price. Heartwire (Source: Medscape Today Headlines)

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  Tasigna 200mg capsules (nilotinib) - Revised SPC

This study suggests that a clinically meaningful drug-drug interaction between nilotinib and warfarin is less likely up to a dose of 25 mg of warfarin. Due to lack of steady-state data, control of warfarin pharmacodynamic markers (INR or PT) following initiation of nilotinib therapy (at least during the first 2 weeks) is recommended.   In addition, single-dose administration of Tasigna with orally administered midazolam ... (Source: NeLM - SPC Changes)

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  Personalized medicine in warfarin therapy

Researchers have developed a rapid, multiplexed genotyping method to identify the single nucleotide polymorphisms (SNPs) that affect warfarin dose. (Source: ScienceDaily Headlines)

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  Prevention of stroke in patients with patent foramen ovale

Patent foramen ovale is found in 24% of healthy adults and 38% of patients with cryptogenic stroke. This ratio and case reports indicate that patent foramen ovale and stroke are associated, probably because of paradoxical embolism. In healthy people with patent foramen ovale, embolic events are not more frequent than in controls, and therefore no primary prevention is needed. However, once ischaemic events occur, the risk of recurrence is substantial and prevention becomes an issue. Acetylsalicylic acid and warfarin reduce this risk to the same level as in patients without patent foramen ovale. Patent foramen ovale with a coinciding atrial septal aneurysm, spontaneous or large right-to-left shunt, or multiple ischaemic events potentiates the risk of recurrence. Transcatheter device closure...

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  Distribution of CYP2C9 and VKORC1 Risk Alleles for Warfarin Sensitivity and Resistance in the Israeli Population.

Conclusions: Individualized genotype based warfarin therapy is highly relevant in the Israeli population due to the high incidence of genetic variations associated with warfarin sensitivity in all 3 non-mixing subpopulations tested. PMID: 20210733 [PubMed - as supplied by publisher] (Source: Current Drug Safety)

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  Comparison of Different Antithrombotic Regimens for Patients With Atrial Fibrillation Undergoing Drug-Eluting Stent Implantation.

Conclusions: The cardiovascular benefits of triple antithrombotic therapy were confirmed by reducing the MACCE rate, and its major bleeding risk might be acceptable if the INR is closely monitored. PMID: 20208381 [PubMed - as supplied by publisher] (Source: Circulation Journal)

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  Journal Scan: Warfarin and Aspirin Use in Atrial Fibrillation Among Practicing Cardiologists (From the AFFECTS Registry) (Am J Cardiol 2010;Feb 22:[Epub ahead of print].)

This was an analysis of 1,461 patients (mean age 66 years) who had AF (paroxysmal in 80%) without structural heart disease and who were enrolled in a multicenter registry. Participating cardiologists were trained in the practice guidelines of the American College of Cardiology/American Heart Associa. . . (Source: Cardiosource)

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  Enlargement of Acute Intracerebral Hematomas in Patients on Long-Term Warfarin Treatment

Cerebrovasc Dis 2010;29:446–453 (DOI:10.1159/000289348) (Source: Karger Publishers)

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  RE-LY subanalysis suggests similar benefit, fewer bleeds with dabigatran in AF patients with prior stroke or TIA

A subanalysis shows that dabigatran is at least as efficacious and may be even safer than warfarin in this higher-risk subgroup. A trend toward increased MI in the overall study with dabigatran was... For complete story visit theheart.org. (Source: theHeart.org)

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  Daily aspirin 'not for the healthy'

Conclusion This trial has tried to answer an important question regarding who should be given aspirin to prevent a heart attack or stroke. It used a systematic method to screen people and followed a reasonably large group of patients for up to 10 years in some cases. The finding of “no statistical significance” can be an important result, and in this case suggests that any benefits from taking aspirin for this group of people are likely to be small. The risk of bleeding was also small and not technically of statistical significant. There is a non-significant trend in the results towards aspirin being harmful. As there is also a suggestion that the study may have been underpowered (planned for too few people), this implies that a larger study may have detected a significant increase ...

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  A Polymorphism in the VKORC1 Regulator Calumenin Predicts Higher Warfarin Dose Requirements in African Americans.

Authors: Voora D, Koboldt DC, King CR, Lenzini PA, Eby CS, Porche-Sorbet R, Deych E, Crankshaw M, Milligan PE, McLeod HL, Patel SR, Cavallari LH, Ridker PM, Grice GR, Miller RD, Gage BF Warfarin demonstrates a wide interindividual variability in response that is mediated partly by variants in cytochrome P450 2C9 (CYP2C9) and vitamin K 2,3-epoxide reductase complex subunit 1 (VKORC1). It is not known whether variants in calumenin (CALU) (vitamin K reductase regulator) have an influence on warfarin dose requirements. We resequenced CALU regions in a discovery cohort of dose outliers: patients with high (>90th percentile, n = 55) or low (<10th percentile, n = 53) warfarin dose requirements (after accounting for known genetic and nongenetic variables). One CALU variant, rs339097, was...

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  Fecal Occult Blood Test in Patients on Low-Dose Aspirin, Warfarin, Clopidogrel, or Non-steroidal Anti-inflammatory Drugs

Conclusion  Anticoagulants and antiplatelet medications lower the positive-predictive-value of FOBT for advance colonic neoplasia and should be stopped if clinically feasible prior to stool collection. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10620-010-1150-4Authors Mandeep S. Sawhney, Minneapolis Veterans Affairs Medical Center Division of Gastroenterology Minneapolis MN USAHeather McDougall, Minneapolis Veterans Affairs Medical Center Division of Gastroenterology Minneapolis MN USADouglas B. Nelson, Minneapolis Veterans Affairs Medical Center Division of Gastroenterology Minneapolis MN USAJohn H. Bond, Minneapolis Veterans Affairs Medical Center Division of Gastroenterology Minneapolis MN USA Journal Digestive Diseases and SciencesOnl...

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  Rifampicin/warfarin interaction: Coagulation disorders: case report

(Source: Reactions)

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  Warfarin: Epiglottis and arytenoids haematoma in an elderly patient: case report

(Source: Reactions)

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  Warfarin: Skin necrosis in an elderly patient: case report

(Source: Reactions)

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  Newspath March, 2009 - SNP Testing for Warfarin Sensitivity

Pharmacogenomics is the study of genetic variation as it relates to a patient’s response to a given drug. Single nucleotide polymorphisms are examples of such genetic variation and can serve as a guide for the therapeutic dosing of pharmaceuticals. (Source: NewsPath - Pathology News for the Medical Community)

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  Warfarin Therapy And Personalized Medicine

Researchers from the Ohio State University have developed a rapid, multiplexed genotyping method to identify the single nucleotide polymorphisms (SNPs) that affect warfarin dose. The related report by Yang et al, "Rapid Genotyping of SNPs Influencing Warfarin Drug Response by SELDI-TOF Mass Spectrometry," appears in the March 2010 issue of the Journal of Molecular Diagnostics. Warfarin is an anti-coagulant that is commonly used to prevent blood clots and embolism... (Source: Health News from Medical News Today)

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  Warfarin Therapy And Personalized Medicine

Researchers from the Ohio State University have developed a rapid, multiplexed genotyping method to identify the single nucleotide polymorphisms (SNPs) that affect warfarin dose. The related report by Yang et al, "Rapid Genotyping of SNPs Influencing Warfarin Drug Response by SELDI-TOF Mass Spectrometry," appears in the March 2010 issue of the Journal of Molecular Diagnostics... (Source: Genetics News From Medical News Today)

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  Why pharmaceuticals might be called Weapons of Mass Prescription

(NaturalNews) Most people are familiar with traditional weapons of mass destruction such biological weapons, nuclear weapons and chemical weapons. The point of all such weapons of mass destruction is to inflict a large number of casualties on civilian populations as a way to cripple a nation into political or military submission.When it comes to actually deploying weapons of mass destruction (WMDs) against civilian populations, no country has murdered more innocent civilians than the United States of America through its bombing of two Japanese cities during World War II. (This isn't rhetoric, it's an historical fact.)Atomic bombs were very visible WMDs deployed in World War II as a way to force the empire of Japan to surrender to western forces. Since that time, full-scale nuclear weapons ...

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  Pharmaceuticals are Weapons of Mass Prescription (comic)

(NaturalNews) Most people are familiar with traditional weapons of mass destruction such biological weapons, nuclear weapons and chemical weapons. The point of all such weapons of mass destruction is to inflict a large number of casualties on civilian populations as a way to cripple a nation into political or military submission.When it comes to actually deploying weapons of mass destruction (WMDs) against civilian populations, no country has murdered more innocent civilians than the United States of America through its bombing of two Japanese cities during World War II. (This isn't rhetoric, it's an historical fact.)Atomic bombs were very visible WMDs deployed in World War II as a way to force the empire of Japan to surrender to western forces. Since that time, full-scale nuclear weapons ...

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  Risk Factors of Drug Interaction between Warfarin and Nonsteroidal Anti-Inflammatory Drugs in Practical Setting.

In conclusion, special caution is required when an NSAID is administered to warfarin users if patients are taking warfarin >40 mg/week and other medications interacting with warfarin. PMID: 20191029 [PubMed - in process] (Source: J Korean Med Sci)

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  Perioperative coagulation management – fresh frozen plasma

Clinical studies support the use of perioperative fresh frozen plasma (FFP) in patients who are actively bleeding with multiple coagulation factor deficiencies and for the prevention of dilutional coagulopathy in patients with major trauma and/or massive haemorrhage. In these settings, current FFP dosing recommendations may be inadequate. However, a substantial proportion of FFP is transfused in non-bleeding patients with mild elevations in coagulation screening tests. This practice is not supported by the literature, is unlikely to be of benefit and unnecessarily exposes patients to the risks of FFP. The role of FFP in reversing the effects of warfarin anticoagulation is dependent on the clinical context and availability of alternative agents. Although FFP is commonly transfused in patien...

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  Long-term Effect of Chronic Oral Anticoagulation with Warfarin after Acute Myocardial Infarction

Abstract: Background: Antiplatelet therapy is the principal component of the antithrombotic regimen after acute myocardial infarction. It remains unclear whether additional chronic oral anticoagulation (OAC) improves outcomes. We set out to evaluate the risk and benefit of long-term OAC after myocardial infarction.Methods: We pooled 10 randomized clinical trials comparing warfarin-containing regimens (OAC) with or without aspirin with non-OAC regimens with or without aspirin (No OAC) for patients with recent infarction. The primary endpoint was all-cause mortality. Other endpoints included recurrent infarction, stroke, and major bleeding. We calculated the odds ratio (OR) (fixed effect, OR (Source: The American Journal of Medicine)

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  Apixaban for Reduction In Stroke and Other ThromboemboLic Events in Atrial Fibrillation (ARISTOTLE) trial: Design and rationale

Atrial fibrillation (AF) is associated with increased risk of stroke that can be attenuated with vitamin K antagonists (VKAs). Vitamin K antagonist use is limited, in part, by the high incidence of complications when patients' international normalized ratios (INRs) deviate from the target range. The primary objective of ARISTOTLE is to determine if the factor Xa inhibitor, apixaban, is noninferior to warfarin at reducing the combined endpoint of stroke (ischemic or hemorrhagic) and systemic embolism in patients with AF and at least 1 additional risk factor for stroke. We have randomized 18,206 patients from over 1,000 centers in 40 countries. Patients were randomly assigned in a 1:1 ratio to receive apixaban or warfarin using a double-blind, double-dummy design. International normalized ra...

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  Rivaroxaban—Once daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation: Rationale and Design of the ROCKET AF study

Conclusion: The ROCKET AF study will determine the efficacy and safety of rivaroxaban as an alternative to warfarin for the prevention of thromboembolism in patients with AF. (Source: American Heart Journal)

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  Rationale and design of AVERROES: Apixaban versus acetylsalicylic acid to prevent stroke in atrial fibrillation patients who have failed or are unsuitable for vitamin K antagonist treatment

Conclusions: By evaluating the use of apixaban as a replacement for ASA in AF patients who are not treated with a VKA, the AVERROES study is addressing an important unmet clinical need. The results of AVERROES will be complementary to those of a parallel noninferiority trial comparing apixaban with VKA therapy in patients with AF who are able to receive a VKA. (Source: American Heart Journal)

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  Relationships between emerging measures of heart failure processes of care and clinical outcomes

Conclusions: Several evidence-based processes of care are associated with improved outcomes, can discriminate hospital-level quality of care, and could be considered as clinical performance measures. (Source: American Heart Journal)

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  Stroke registry: hemorrhagic vs ischemic strokes

Conclusion: There were a much greater percentage of hemorrhagic strokes in this population than would have been predicted from previous studies. This finding may be due to improvement of CT scan availability and implementation unmasking a previous underestimation of the actual percentage or to an increase in therapeutic use of antiplatelet agents and warfarin causing an increase in the incidence of hemorrhage. (Source: The American Journal of Emergency Medicine)

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  Blacks Much Less Likely To Know They Have Heart Condition Or To Use Treatment For It

A large nationwide study that includes neurologists from Mayo Clinic has found that blacks are substantially less likely than whites to know that they have atrial fibrillation or to use warfarin, the most common treatment for the condition. Atrial fibrillation, an abnormal heart rhythm, significantly increases risk of stroke. Warfarin is known to reduce that risk. Researchers say the findings could help explain why the black population in the U.S. has a higher incidence of both stroke and death from strokes, compared to the white population... (Source: Health News from Medical News Today)

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  Blacks Much Less Likely To Know They Have Heart Condition Or To Use Treatment For It

A large nationwide study that includes neurologists from Mayo Clinic has found that blacks are substantially less likely than whites to know that they have atrial fibrillation or to use warfarin, the most common treatment for the condition. Atrial fibrillation, an abnormal heart rhythm, significantly increases risk of stroke. Warfarin is known to reduce that risk... (Source: Cardiovascular / Cardiology News From Medical News Today)

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  Transient Global Amnesia as the Presenting Feature of Heparin-Induced Thrombocytopenia

A 57-year-old man developed transient global amnesia within an hour of bolus unfractionated heparin administration on day 4 post-mitral valve replacement. Both immunoglobulin G-specific enzyme-linked immunosorbent assay and serotonin release assay were strongly positive for the antibodies that cause heparin-induced thrombocytopenia. The patient's cognitive functions returned to normal following discontinuation of unfractionated heparin and warfarin and commencement of lepirudin infusion. (J Card Surg ****;**:**-**) (Source: Journal of Cardiac Surgery)

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  Warfarin sensitivity falls after valve surgery

Research indicates that a decrease in sensitivity to warfarin in the months after heart valve surgery may place patients at risk for receiving subtherapeutic anticoagulant therapy. (Source: MedWire News - Thrombosis)

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  Pre-eclampsia Associated with Carotid Dissection and Stroke in a Young Woman

We report a 24-year-old woman who developed an acute stroke 14 days postpartum after a complicated pregnancy. Her left internal carotid artery was found to be occluded, presumably secondary to a carotid dissection. Her neurologic symptoms resolved and she was treated with short-term warfarin therapy and blood pressure control. (Source: Journal of Stroke and Cerebrovascular Diseases)

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  The Stroke Practice Improvement Network: A Quasiexperimental Trial of a Multifaceted Intervention to Improve Quality

Conclusion: Implementation of site-specific interventions for quality improvement of specific measures in stroke was difficult to achieve in a 6-month time frame and led to improved adherence for only one of 3 PMs. Studies with a longer intervention period and more sites are required to determine whether tailored interventions can enhance stroke improvement. (Source: Journal of Stroke and Cerebrovascular Diseases)

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  New Drug As Effective As Warfarin In Preventing Strokes In Atrial Fibrillation Patients With Prior Stroke Or TIA

The drug dabigatran was as effective as the currently recommended drug warfarin in preventing a subsequent stroke among people with atrial fibrillation and prior stroke or transient ischemic attack and it did so with less bleeding according to late-breaking science presented at the American Stroke Association's International Stroke Conference 2010. Dabigatran is a member of a new class of anti-clotting drugs called direct thrombin inhibitors... (Source: Health News from Medical News Today)

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  New Drug As Effective As Warfarin In Preventing Strokes In Atrial Fibrillation Patients With Prior Stroke Or TIA

The drug dabigatran was as effective as the currently recommended drug warfarin in preventing a subsequent stroke among people with atrial fibrillation and prior stroke or transient ischemic attack and it did so with less bleeding according to late-breaking science presented at the American Stroke Association's International Stroke Conference 2010... (Source: Stroke / Neuroprotection News From Medical News Today)

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  Current Blood Thinners Face Tough Competition

Studies provide more evidence that newcomers hold mettle against warfarin, aspirin Source: HealthDay Related MedlinePlus Pages: Blood Thinners, Stroke (Source: MedlinePlus Health News)

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  Personalized warfarin therapy developed

COLUMBUS, Ohio, Feb. 26 (UPI) -- U.S. researchers say their new rapid, genotyping method can help clinicians choose appropriate doses of the blood thinner warfarin for individual patients. (Source: Health News - UPI.com)

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  Decreasing warfarin sensitivity during the first three months after heart valve surgery: Implications for dosing

Conclusions: Patients steadily become less sensitive to warfarin during the first months after heart valve surgery. This leads to subtherapeutic anticoagulation. A dosing algorithm that takes increasing requirements into account is proposed. This algorithm will need to be validated prospectively. (Source: Thrombosis Research)

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  Blacks much less likely to know they have heart condition or to use treatment for it, says Mayo Clinic researcher

A large nationwide study that includes neurologists from Mayo Clinic has found that blacks are substantially less likely than whites to know that they have atrial fibrillation or to use warfarin, the most common treatment for the condition. (Source: Mayo Clinic Research News)

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  Blacks much less likely to know they have heart condition or to use treatment for it, says Mayo Clinic researcher

A large nationwide study that includes neurologists from Mayo Clinic has found that blacks are substantially less likely than whites to know that they have atrial fibrillation or to use warfarin, the most common treatment for the condition. (Source: Mayo Clinic Jacksonville News)

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  Blacks much less likely to know they have heart condition or to use treatment for it, says Mayo Clinic researcher

A large nationwide study that includes neurologists from Mayo Clinic has found that blacks are substantially less likely than whites to know that they have atrial fibrillation or to use warfarin, the most common treatment for the condition. (Source: News from Mayo Clinic)

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  Blacks less likely to know they have heart condition or to use treatment for it, says Mayo Clinic

(Mayo Clinic) A large nationwide study that includes neurologists from Mayo Clinic has found that blacks are substantially less likely than whites to know that they have atrial fibrillation or to use warfarin, the most common treatment for the condition. Atrial fibrillation, an abnormal heart rhythm, significantly increases risk of stroke. Warfarin is known to reduce that risk. (Source: EurekAlert! - Medicine and Health)

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  Blacks less likely to know they have heart condition or to use treatment for it, study suggests

A large nationwide study has found that blacks are substantially less likely than whites to know that they have atrial fibrillation or to use warfarin, the most common treatment for the condition. Atrial fibrillation, an abnormal heart rhythm, significantly increases risk of stroke. Warfarin is known to reduce that risk. (Source: ScienceDaily Headlines)

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  Thrombus in the distal aortic arch after apicoaortic conduit for severe aortic stenosis [Case report - Valves]

We report an uncommon case of thrombogenesis in the distal aortic arch after apicoaortic conduit (AAC) for severe aortic stenosis (AS). A 71-year-old woman underwent AAC with a bioprosthetic valve for severe AS because of heavy calcification of the ascending aorta. Although anticoagulant therapy with warfarin was performed, a postoperative computed tomographic (CT) scan revealed a thrombus in the distal aortic arch. Cine magnetic resonance imaging (MRI) revealed stagnation of the blood flow at that site. Administration of warfarin was continued. A follow-up CT-scan showed a marked reduction of the thrombus at six months after the surgery. A follow-up MRI revealed that the antegrade flow through the native aortic valve was decreased at one year after the surgery. We suggest that thrombogene...

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  Racial Disparities in Awareness and Treatment of Atrial Fibrillation. The REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

CONCLUSIONS: Blacks were less likely than whites to be aware of having AF or to be treated with warfarin. Potential reasons for the racial disparity in warfarin treatment warrant further investigation. PMID: 20190000 [PubMed - as supplied by publisher] (Source: Stroke)

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  Heart failure

New evidence; conclusions changed for: Angiotensin II receptor blockers for diastolic heart failure One RCT added comparing irbesartan versus placebo found no significant difference between irbesartan and placebo in all-cause mortality or in hospital admission for cardiovascular causes at a mean follow-up of 49.5 months. Evidence for effect of irbesartan on hospital admission for cardiovascular disease differs from evidence previously reported for candesartan for this outcome. Effects of angiotensin II receptor blockers as a class in treatment of diastolic heart failure is unclear. Categorisation changed from Likely to be beneficial to Unknown effectiveness. New evidence; conclusion confirmed for: Multidisciplinary intervent...

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  Bleeding Risk on Warfarin Among Elderly Patients With Atrial Fibrillation

Poli et al. () observed different rates of major hemorrhage between patients younger than 80 years of age and 80 years of age and older. As discussed by the authors, these rates differed considerably from the rates of major hemorrhage observed among similarly aged cohorts by Hylek et al. (). We want to highlight an important methodological issue in the authors' calculation of event rates. The authors state, “the overall exposure to warfarin for each patient was calculated in relation to aging, before and after his/her 80th birthday.” Thus, the authors allowed crossover of prevalent warfarin survivors from the younger cohort to the age ≥80 years inception cohort. At the time of enrollment, the baseline age ≥80 years cohort numbered 180 patients. Yet, in Table 1 of their article (), ...

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  Reply

We studied a cohort of atrial fibrillation patients on oral anticoagulant treatment for stroke prophylaxis (). Our patients were routinely followed by the Anticoagulation Clinic of our institution with a median follow-up of 2.7 years, and some of them for as long as 13 years. At the beginning of warfarin treatment, the mean age of our cohort was 75 years; therefore, many patients reached the age of 80 years during follow-up. As stated in the article, we decided to analyze the occurrence of adverse events in relation to aging to evaluate whether aging itself could be correlated with an increase in bleeding risk that exceeds the advantages of stroke prevention. In reporting clinical characteristics of patients, we referred to baseline patients' conditions as well as for those who switched fr...

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  Personalized medicine in warfarin therapy

(American Journal of Pathology) Researchers from the Ohio State University have developed a rapid, multiplexed genotyping method to identify the single nucleotide polymorphisms (SNPs) that affect warfarin dose. The related report by Yang et al., "Rapid Genotyping of SNPs Influencing Warfarin Drug Response by SELDI-TOF Mass Spectrometry," appears in the March 2010 issue of the Journal of Molecular Diagnostics. (Source: EurekAlert! - Medicine and Health)

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  Treatment of Coagulopathy in Intracranial Hemorrhage

Opinion statement  Intracranial hemorrhage (ICH) complicated by coagulopathy is a medical emergency, which can delay neurosurgical intervention, lead to larger hematoma size, and increase mortality until the coagulopathy is corrected. Prompt recognition of coagulopathy during ICH is essential for correct, rapid treatment to reduce ongoing bleeding and improve survival. The proper treatment of a coagulopathic ICH patient is centered on rapid identification of the coagulopathic defect and correction of the underlying coagulopathy to stop acute bleeding. Patients with coagulopathic ICH require admission to a neuro-intensive unit care with management of airway, oxygenation, and systemic arterial and cerebral perfusion pressure; optimization of serum glucose; aggressive treatmen...

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  Dabigatran: An End to Warfarin?

(Source: AccessMedicine Updates)

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  Eptacog (recombinant Factor VIIa) for warfarin-induced intracranial bleeding

Source: American Journal of Health-System Pharmacy Area: News A narrative review concludes that eptacog may be a potential alternative or adjunct to standard therapy with fresh-frozen plasma and vitamin K in patients with warfarin-induced intracranial bleeding.   Intracranial haemorrhage (ICH) is a serious condition and will be exacerbated by warfarin and related anticoagulant drugs. Prompt reversal of anticoagulation is essential to allow surgical procedures to be carried out if necessary: administration of fresh-frozen plasma and vitamin K is the current standard, however eptacog may be a possible alternative as it rapidly affects the INR and is easily administered. The authors review the limited published evidence for eptacog in this situation, which is restricted to case repo...

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  Dilated Cardiomyopathy and Role of Antithrombotic Therapy.

CONCLUSIONS:: To date, there is no agreement on appropriate antithrombotic treatment (if any) for primary thromboembolism prophylaxis in patients with dilated cardiomyopathy with sinus rhythm. In recent years, several promising prospective trials were terminated prematurely due to inadequate enrollment. The Warfarin Aspirin-Reduced Cardiac Ejection Fraction trial may provide evidence regarding the use of anticoagulation for patients with decreased myocardial function. PMID: 20186041 [PubMed - as supplied by publisher] (Source: The American Journal of the Medical Sciences)

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  Chronic Atrial Fibrillation Is Associated With Reduced Survival After Aortic and Double Valve Replacement [ORIGINAL ARTICLES: ADULT CARDIAC]

Conclusions Chronic AF negatively affects survival after AVR with or without CABG and DVR with a mechanical prosthesis. Prospective randomized evaluation of AF ablation is suggested for these patients. (Source: The Annals of Thoracic Surgery)

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  Warfarin Can Be Stopped at Three to Six Months Postablation of AF, But Editorial Urges Caution

Despite the positive findings, an editorial calls the study hypothesis-generating, and notes that the AF field needs a prospective randomized clinical trial, one that includes standardized methods to assess and characterize recurrence of AF and to determine the incidence/prevalence of stroke. Heartwire (Source: Medscape Today Headlines)

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  Coagulation factor VIIa (recombinant) for warfarin-induced intracranial hemorrhage.

Conclusion Use of factor VIIa (recombinant) may be considered for reversal of anticoagulation in patients with warfarin-associated ICH. However, patients should be screened for increased risk of thrombosis before administration of the drug. PMID: 20172985 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

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  Man With Painful Skin Lesion

[Ann Emerg Med. 2010;55:302.] A 53-year-old man presented with a painful skin lesion on his left lower leg, without trauma. The lesion was initially pruritic and had appeared spontaneously 2 weeks earlier. The patient had been evaluated 1 week earlier and was prescribed clindamycin for presumed cellulitis. Despite this, the lesion continued to grow. The patient had a history of peripheral vascular disease and had resumed receiving warfarin sodium for this 1 week before appearance of the lesion. On physical examination, the patient was afebrile, with a 5-cm-×-7-cm nonraised area of ecchymosis with an erythematous border on the anterior left lower leg (). (Source: Annals of Emergency Medicine)

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  Chronic Atrial Fibrillation Is Associated With Reduced Survival After Aortic and Double Valve Replacement.

CONCLUSIONS: Chronic AF negatively affects survival after AVR with or without CABG and DVR with a mechanical prosthesis. Prospective randomized evaluation of AF ablation is suggested for these patients. PMID: 20172119 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)

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  Herbal products may pose danger for heart patients

3 out of 5 stars Use of Herbal Products and Potential Interactions in Patients with Cardiovascular Diseases. Tachjian A et al.  J Am Coll Cardiol Feb 9, 2010;55:515-25. Abstract Use of unregulated herbal remedies is common and increasing dramatically among patients also taking prescription medicines. Unfortunately, these herbal products can have detrimental effects of their own, as well as potential interactions with other medications.  This review, form the Mayo Clinic, searched PubMed and Medline databases for the years 1966 to 2009 to identify medical literature related to herbs and cardiovascular disease. Among the authors’ findings: • Many herbal products can potentially increase bleeding, especially in patients on warfarin, aspirin, and anti-platelet drugs.  Such herbal pr...

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  Urgent warfarin reversal: know your options.

Authors: Pendergrast J PMID: 20177848 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

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  Choosing the right statin/fibrate for warfarin users

(Source: Reactions)

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  Why Are We So Bad in Primary Care at Initiating Warfarin in Atrial Fibrillation Patients?

“The Auricle” provides support for primary care physicians in initiating and managing anticoagulation for patients with atrial fibrillation. British Journal of Cardiology (Source: Medscape Today Headlines)

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  Sex-Related Differences in the Risk Factor Profile and Medications of Patients With Atrial Fibrillation Recruited in J-TRACE.

Conclusions: Sex-related differences were observed in the risk factor profile and medications of Japanese patients with AF. CHADS2 score was higher in women than in men. PMID: 20173301 [PubMed - as supplied by publisher] (Source: Circulation Journal)

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  Warfarin can be stopped at three to six months postablation of AF, but editorial urges caution

Despite the positive findings, an editorial calls the study hypothesis-generating, and notes that the AF field needs a prospective randomized clinical trial, one that includes standardized methods to... For complete story visit theheart.org. (Source: theHeart.org)

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  Skin exposure to micro- and nano-particles can cause haemostasis in zebrafish larvae.

Authors: McLeish JA, Chico TJ, Taylor HB, Tucker C, Donaldson K, Brown SB Low mass ambient exposure to airborne particles is associated with atherothrombotic events that may be a consequence of the combustion-derived nanoparticle content. There is concern also over the potential cardiovascular impact of manufactured nanoparticles. To better understand the mechanism by which toxic airborne particles can affect cardiovascular function we utilised zebrafish as a genetically tractable model. Using light and confocal fluorescence video-microscopy, we measured heart-rate and blood flow in the dorsal aorta and caudal artery of zebrafish larvae that had been exposed to a number of toxic and non-toxic microparticles and nanoparticles. Diesel exhaust particles (DEP), carboxy-charged LatexTM bead...

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  Do Not Stop the Warfarin Until …⁎

Prevention of thromboembolism is a principal aim of atrial fibrillation management. Although the mechanisms underlying thrombogenesis in atrial fibrillation are clearly complex and remain only partly understood, it is intuitive that restoration and reliable maintenance of sinus rhythm is probably the best preventive strategy against thromboembolism. Over the past decade, catheter ablation has emerged as a potential cure for atrial fibrillation. Many centers worldwide have been reporting relatively high success rates with few associated complications after ablation of atrial fibrillation in selected patient populations. Particularly with increasing use of this therapy has come an obvious need finally to answer one of the most important questions related to this therapy, namely does long-ter...

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  Cardiac Resynchronization Therapy Device Implantation in Patients with Therapeutic International Normalized Ratios

Conclusions: Our findings suggest that implantation of CRT-Ds without interruption of warfarin therapy in patients at high risk of thromboembolic events is a safe alternative to routine bridging therapy. This strategy is associated with reduced risk of pocket hematomas and shorter length of hospital stay. (PACE 2010; 1[ndash]7) (Source: Pacing and Clinical Electrophysiology : PACE)

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  Characteristics of ambulatory anticoagulant adverse drug events: a descriptive study

Conclusions: Ambulatory warfarin-related ADEs have significant patient and healthcare utilization consequences in the form of bleeding events and associated hospital admissions. Recommendations for improvement in anticoagulation management include use of information technology to assist monitoring and follow-up documentation, avoid drug interactions, and engage patients in their care. (Source: Thrombosis Journal)

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  New Insights into the Structural Features and Functional Relevance of Human Cytochrome P450 2C9. Part II.

Authors: Mo SL, Zhou ZW, Yang LP, Wei MQ, Zhou SF Part I of this article published in the previous issue of Current Drug Metabolism discussed the substrate specificity, inhibitor selectivity and structure-activity relationship (SAR) of human CYP2C9. The features of CYP2C9 pharmacophore and SAR models have been elaborated. Part II of this article will address the homology models of CYP2C9, data from site-directed mutagenesis studies, and crystal structural features of CYP2C9. The heteroactivation of CYP2C9 and its interactions with other CYPs will also be discussed. A number of ligand-based and homology models of CYP2C9 have been reported and this has provided insights into the binding of ligands to the active site of CYP2C9. Site-directed mutagenesis studies have revealed that a number...

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  Do 5-fluorouracil therapies alter CYP2C19 metaboliser status?

Conclusions  Although 5FU is not a substrate for hepatic drug metabolising CYP enzymes, it may interfere with the synthesis of CYP2C19. Decreased activity of a related enzyme, CYP2C9, following 5FU has been reported previously. Down regulation of CYP2C9 and CYP2C19 synthesis by 5FU therapies may explain the adverse effect of 5FU on the clinical disposition of warfarin and phenytoin. Content Type Journal ArticleCategory Short CommunicationDOI 10.1007/s00280-010-1277-1Authors N. A. Helsby, The University of Auckland Faculty of Medical and Health Sciences Auckland New ZealandW. Y. Lo, The University of Auckland Faculty of Medical and Health Sciences Auckland New ZealandP. Thompson, Auckland District Health Board Auckland Regional Cancer and Blood Service Auckland New Ze...

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  Review: Antithrombotic drugs for patients with ischaemic stroke and transient ischaemic attack to prevent recurrent major vascular events

Source: Lancet Neurology Area: News The Lancet Neurology has featured a review of the evidence for use of antithrombotic therapies to prevent stroke and other major vascular events among patients with transient ischaemic attack (TIA) and ischaemic stroke.  The following topics and evidence supporting these are discussed:   . Prevention of recurrent ischaemic stroke of arterial origin, using aspirin, clopidogrel, aspirin plus extended-release dipyridamole, other antithrombotic regimens, and promising future antithrombotic regimens . Prevention of recurrent ischaemic stroke of cardiac origin using aspirin, warfarin, aspirin and clopidogrel versus warfarin, aspirin and clopidogrel versus aspirin alone, aspirin and warfarin, direct thrombin inhibitors, factor Xa inhibi...

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  The net clinical benefit of warfarin anticoagulation in atrial fibrillation.

Authors: Budhraja V PMID: 20157146 [PubMed - in process] (Source: Annals of Internal Medicine)

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  The net clinical benefit of warfarin anticoagulation in atrial fibrillation.

Authors: Singer DE, Chang Y, Go AS PMID: 20157145 [PubMed - in process] (Source: Annals of Internal Medicine)

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  The net clinical benefit of warfarin anticoagulation in atrial fibrillation.

Authors: Bussey H PMID: 20157144 [PubMed - in process] (Source: Annals of Internal Medicine)

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  Duplication of the inferior vena cava in a patient presenting for IVC filter placement.

We present the case of a 45- year-old male with factor V leiden and protein C deficiency, who required cessation of warfarin anticoagulation in preparation for cervical laminectomy. The patient had a duplicated IVC and required placement of a caval filter in each IVC. PMID: 20175061 [PubMed - as supplied by publisher] (Source: The Journal of Vascular Access)

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  Delayed Epistaxis in External Dacryocystorhinostomy: Rate and Risk Factors [Original Article]

Conclusion  The risk of delayed epistaxis should be similar for patients taking or not taking anticoagulant agents if their use is stopped within a defined period of time before DCR. (Source: Archives of Otolaryngology)

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  Warfarin after anterior myocardial infarction in current era of dual antiplatelet therapy: a randomized feasibility trial

Abstract  In the current era of early revascularization and routine use of dual antiplatelet therapy, the incremental benefit of warfarin to reduce the incidence of left ventricular thrombus (LVT) in patients with impaired left ventricular ejection fraction post anterior ST-elevation myocardial infarction (aSTEMI), remains uncertain. The purpose of this study is to assess the feasibility of evaluating the added benefit and safety of triple therapy (TT-warfarin, ASA, and clopidogrel) versus dual therapy (DT-ASA and clopidogrel) in patients at risk of LVT post aSTEMI. Design: Open-label randomized controlled trial. Inclusion: aSTEMI, ejection fraction <40%, and no evidence of LVT. Exclusion: contraindication to, or alternate indication for anticoagulation. Intervention: TT...

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  Incidence of recurrent venous thromboembolism and of chronic thromboembolic pulmonary hypertension in patients after a first episode of pulmonary embolism

Abstract  After a first episode of pulmonary embolism (PE), two major problems need to be considered: risk of recurrence when anticoagulation is stopped, and risk of chronic thromboembolic pulmonary hypertension (CTPH). We followed prospectively consecutive patients who survived a first episode of PE, with or without deep vein thrombosis, to assess the incidence of venous thromboembolism (VTE) recurrences and of symptomatic and asymptomatic CTPH. After 3–6 months of oral anticoagulant therapy (OAT) patients underwent transthoracic echocardiography for measuring transtricuspid (rV-rA) gradient. When rV-rA gradient was >35 mmHg further evaluations were performed to rule in or out CTPH. During follow-up patients who developed persistent dyspnea were re-evaluated....

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  Nevirapine/fluindione/warfarin interaction: Fluindione inefficacy and decreased plasma warfarin concentration following an interaction with nevirapine: case report

(Source: Reactions)

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  Warfarin: Haemocholecyst in an elderly patient: case report

(Source: Reactions)

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  [Review] Antithrombotic drugs for patients with ischaemic stroke and transient ischaemic attack to prevent recurrent major vascular events

Aspirin is widely used for the prevention of recurrent stroke in patients with transient ischaemic attack (TIA) and ischaemic stroke of arterial origin, because it is effective and inexpensive. Clopidogrel and the combination of aspirin and extended-release dipyridamole are more effective than aspirin, but are also much more expensive. No other antithrombotic regimens provide significant advantages over aspirin, although cilostazol and the novel platelet protease activated receptor-1 antagonist, SCH 530348, are currently being evaluated. For patients with TIA and ischaemic stroke of cardiac origin due to atrial fibrillation, vitamin K antagonists (VKAs) are highly effective in preventing recurrent ischaemic stroke but have important limitations and are thus underused. Antiplatelet therapy ...

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  Fibrate/statin Initiation in Warfarin Users Ups Risk of GI Bleeding

Initiation of a fibrate or statin that inhibits CYP3A4 enzymes -- including fenofibrate, gemfibrozil, fluvastatin, simvastatin, and atorvastatin -- increases the risk of hospitalization for GI bleeding in chronic warfarin users, according to a report in the February issue of the American Journal of Medicine. Reuters Health Information (Source: Medscape Medical News Headlines)

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  Malabsorption-Associated Warfarin Resistance

An unusual case of warfarin malabsorption is described. American Journal of Health-System Pharmacy (Source: Medscape Today Headlines)

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  Combined renal cancer drugs help some patients

Combined therapy doesn't increase survival but may improve remissionsRelated items from OnMedicaHerceptin of benefit in more breast cancer casesMortality higher if using paroxetine and tamoxifenCancer survival rates not improved much in a decade Warfarin is not the answer for thromboses in cancer patientsChemo plus tamoxifen better than tamoxifen alone (Source: OnMedica Latest News)

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  Maintaining vascular access: the management of hemodialysis arteriovenous grafts.

Authors: Schild AF For the nephrologist and surgeon, maintaining vascular access is a significant challenge in hemodialysis (HD), because the portal is vulnerable to infection, stenosis, and thrombus. Vascular access options for HD include the placement of arteriovenous (AV) fistulas, AV grafts, and double-lumen, cuffed central vein catheters. Catheter use is generally associated with higher rates of infection and could compromise the adequacy of HD. Primary AV fistulas, which are generally recommended and provide excellent HD access, are not always the ideal choice for certain patients, such as the elderly or patients with diabetes mellitus. AV grafts allow for a large surface area available for cannulation, and thrombosed grafts have longer patency rates after revision than do revise...

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  Combined oral anticoagulants and antiplatelets: benefits and risks

Abstract  Combined antiplatelet and anticoagulant therapy has been suggested for those clinical conditions in which conventional antithrombotic regimens have shown suboptimal efficacy, and in patients with indication for both: antiplatelet and anticoagulant therapy. Clinical trials aimed at assessing the clinical benefit of the association with respect to mono-therapy have been conducted in patients with atrial fibrillation, in patients with recent myocardial infarction, and in patients with prosthetic heart valves. Overall, a favorable benefit-risk profile of combined therapy in comparison to anticoagulant alone has been observed in patients with mechanical prosthetic heart valves and in those with coronary artery disease while no clear advantage has been shown in patients...

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  Prevalence and Clinical Characteristics Associated With Left Atrial Appendage Thrombus in Fully Anticoagulated Patients Undergoing Catheter-Directed Atrial Fibrillation Ablation

Conclusion: Despite full anticoagulation, 3.6% of patients undergoing AF ablation had LAA thrombus. We recommend that all patients, regardless of LV function or left atrial size, should undergo preprocedural TEE to exclude the presence of LAA thrombus. (J Cardiovasc Electrophysiol, Vol. pp. 1-4) (Source: Journal of Cardiovascular Electrophysiology)

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  Intermedin inhibits vascular calcification by increasing the level of matrix {gamma}-carboxyglutamic acid protein

Conclusion Reduced endogenous IMD levels are associated with increased mineralization in vivo, and administration of IMD inhibits VC development by increasing cMGP levels. IMD may be an endogenous vasoprotective factor for VC. (Source: Cardiovascular Research)

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