Antithrombotic Agents in Primary Health Care - Related Resources
Cochrane reviews
- There is insufficient evidence on the optimal loading dose of warfarin for the initiation of oral anticoagulation Optimal Loading Dose of Warfarin for the Initiation of Oral Anticoagulation.
- Adjusted-dose warfarin (INR 2-3) reduces all strokes in patients with nonvalvular atrial fibrillation. For primary prevention in AF patients with an average stroke rate of 4%/year, about 25 strokes and about 12 disabling strokes would be prevented for every 1000 given oral anticoagulation Warfarin for Preventing Stroke in Patients with Non-Valvular Atrial Fibrillation and No History of Cerebral Ischaemia.
- Adjusted-dose warfarin is more efficacious (by approximately 40%) than antiplatelet therapy for stoke prevention in patients with non-valvular atrial fibrillation. Adjusted-dose warfarin and antiplatelet agents reduce stroke by approximately 60% and by approximately 20%, respectively Warfarin or Antiplatelet Therapy for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation.
- Aspirin modestly (by about 20%) reduces stroke and major vascular events in nonvalvular atrial fibrillation. If the average stroke rate is 4.5%/year, the NNT for preventing one stroke during one year with aspirin is 100 Antiplatelet Therapy for Patients with Non-Valvular Atrial Fibrillation.
- For the long term treatment of venous thromboembolism in patients with cancer, low molecular weight heparin compared to vitamin K antagonist appears to reduce venous thromboembolic events but not death Anticoagulation for the Long Term Treatment of Venous Thromboembolism in Patients with Cancer.
- Low-molecular weight heparins appear to be equally effective and safer as vitamin K antagonists in the long-term treatment of symptomatic venous thromboembolism Vitamin K Antagonists or Low-Molecular Weight Heparin for Venous Thromboembolism.
- In patients with superficial thrombophlebitis (ST), prophylactic dose (2.5 mg sc once daily) fondaparinux given for 45 days reduces incidence of symptomatic venous thromboembolism, ST extension, and recurrence of ST compared to placebo Treatment for Superficial Thrombophlebitis of the Leg.
- Direct thrombin inhibitors (ximelagatran, dabigatran and desirudin) may be as effective as LMWH and vitamin K antagonists in the prevention of major venous thromboembolism in total hip or knee replacement but seem to show higher mortality and cause more bleeding than LMWH Dabigatran Versus Lmwhs for Thromboprophylaxis after Total Hip or Knee Replacement.
- Oral antiplatelet drugs are protective in most types of patients at increased risk of occlusive vascular events. Low-dose aspirin (75 to 150 mg daily) is an effective antiplatelet regimen for long-term use Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke.
- Long-term use of aspirin dosages greater than 75 to 81 mg/d in the setting of cardiovascular disease prevention may not better prevent events but is associated with increased risks of gastrointestinal bleeding Aspirin Dose for the Prevention of Cardiovascular Disease.
- Addition of clopidogrel to aspirin with other standard treatments reduces mortality and major vascular events in patients with acute STEMI Clopidogrel and Aspirin in Acute ST-Segment Elevation Myocardial Infarction (STEMI).
- The long-term use of clopidogrel plus aspirin reduces cardiovascular events compared with aspirin alone in patients with acute non-ST coronary syndrome Clopidogrel Plus Aspirin Versus Aspirin Alone for Preventing Cardiovascular Disease in Acute Non-ST Segment Coronary Syndromes.
- The long-term use of clopidogrel plus aspirin appears not to be more effective than aspirin alone in patients at high risk of cardiovascular disease or with established cardiovascular disease but not presenting acutely Clopidogrel Plus Aspirin Vs Aspirin Alone for Preventing Cardiovascular Events.
- Clopidogrel reduces cardiovascular events compared with aspirin in patients with stable intermittent claudication Antiplatelet Agents for Intermittent Claudication.
- Reocclusion at 6 months following peripheral endovascular treatment may be reduced by use of antiplatelet drugs compared with placebo or control Antiplatelet Drugs for Prevention of Restenosis after Peripheral Endovascular Treatment.
- The combination of aspirin and dipyridamole compared to aspirin alone reduces the risk of vascular events in patients with cerebral ischaemia. Dipyridamole alone is not more effective than aspirin alone in preventing vascular events or vascular death Dipyridamole for Preventing Vascular Events.
- Thrombolysis in acute deep vein thrombosis appears to offer advantages by reducing post-thrombotic syndrome and maintaining venous patencyThrombolysis for Acute Deep Vein Thrombosis.
- Intravenous alteplase is safe and effective for acute stroke in routine clinical use when used within 3 to 4.5 h of stroke onset in experienced centres Thrombolysis for Acute Ischaemic Stroke.
- There appears not to be difference in limb salvage or death at one year between initial surgery and initial thrombolysis for the management of acute limb ischaemia, but there is a higher incidence of major complications with thrombolysis, including stroke and major haemorrhage. The higher risk of complications must be balanced against individual risks in surgery Surgery Versus Thrombolysis for Initial Management of Acute Limb Ischaemia.
Clinical guidelines
- Doherty JU, Gluckman TJ, Hucker WJ et al. 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation: A Report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol 2017;69(7):871-898. [PubMed]
- Writing Committee., Tomaselli GF, Mahaffey KW et al. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2017 [Epub ahead of print].[PubMed]
- Guyatt GH, Akl EA, Crowther M et al. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):7S-47S. [PubMed]
- Holbrook A, Schulman S, Witt DM et al. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e152S-84S. [PubMed]
- Ageno W, Gallus AS, Wittkowsky A et al. Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e44S-88S. [PubMed]
- Garcia DA, Baglin TP, Weitz JI et al. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e24S-43S. [PubMed]
- Linkins LA, Dans AL, Moores LK et al. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e495S-530S. [PubMed]
- Weitz JI, Eikelboom JW, Samama MM et al. New antithrombotic drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e120S-51S. [PubMed]
- Eikelboom JW, Hirsh J, Spencer FA et al. Antiplatelet drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e89S-119S. [PubMed]
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