Anticoagulation

2007-05-04T11:06:00.000+01:00

This review is a pragmatic attempt to highlight recent research and some background reading on anticoagulation. It should not be considered exhaustive, simply a way of reviewing some of the major developments and current thinking in the area.

Related review: DVT & Atrial Fibrillation

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Evidence-Based Reports

Monitoring anticoagulant therapy in primary care. WeMeReC, 2007
Anticoagulation before cardioversion of acute atrial fibrillation in the emergency department. BestBETS, 2005
Anticoagulation post- cardioversion of acute atrial fibrillation in the emergency department. BestBETS, 2005
Review: long term anticoagulation reduces recurrent venous thromboembolism. Evidence-Based Medicine (Requires free registration). 2006
Anticoagulant plus antiplatelet treatment increased the risk of bleeding in atrial fibrillation. Evidence-Based Medicine (Requires free registration), 2005

Clinical Guidelines

Venous thromboembolism. NICE, 2007
Guidelines on oral anticoagulation (warfarin) : third edition. British Committee for Standards in Haematology, 2005
An evidence-based review and guidelines for patient self-testing and management of oral anticoagulation. British Society for Haematology, 2005
Anticoagulation therapy supplement. Institute for Clinical Systems Improvement, 2006
Oral vitamin K antagonists (warfarin). Thrombosis Interest Group of Canada, 2005
Hypercoagulable/Thrombophilic States. Thrombosis Interest Group of Canada, 2006
Unfractionated Heparin. Thrombosis Interest Group of Canada, 2005
Venous thromboembolism prophylaxis. Institute for Clinical Systems Improvement, 2006
Initiation and Maintenance of Warfarin Therapy. British Columbia Ministry of Health, 2004

Systematic Reviews

Point-of-care monitoring devices for long-term oral anticoagulation therapy: clinical and cost effectiveness. HTA, 2007
Patient self-management of anticoagulation therapy: a trial-based cost-effectiveness analysis. NHS Economic Evaluation Database, 2006
Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. NCCHTA, 2005
Quality of anticoagulation control and costs of monitoring warfarin therapy among patients with atrial fibrillation in clinic settings: a multi-site managed-care study. NHS EED, 2005
Duration of anticoagulation following venous thromboebolism: a meta-analysis. DARE, 2005
Oral anticoagulation strategies after a first idiopathic venous thromboembolic event. NHS EED, 2005
Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. DARE, 2006
Treatment of excessive anticoagulation with phytonadione (vitamin K): a meta-analysis. DARE, 2006
Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy. NHS EED, 2006
Screening for thrombophilia in high-risk situations: systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilip Screening (TREATS) study. NCCHTA, 2006
Oral anticoagulants versus antiplatelet therapy for preventing further vascular events after transient ischaemic attack or minor stroke of presumed arterial origin. Cochrane Database of Systematic Reviews, 2006
Anticoagulants versus non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism. Cochrane Database of Systematic Reviews, 2005
Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database of Systematic Reviews, 2005

Recent articles in core journals

Outpatient Management of Anticoagulation Therapy. American Family Physician, 2007
Combined aspirin-oral anticoagulant therapy compared with oral anticoagulant therapy alone among patients at risk for cardiovascular disease: a meta-analysis of randomized trials. Arch Intern Med, 2007
Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Annals of Internal Medicine, 2007
Anticoagulation for three versus six months in patients with deep vein thrombosis or pulmonary embolism, or both: randomised trial. BMJ, 2007
Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials. Stroke, 2007
Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V. Arch Intern Med. 2007
D-dimer testing to determine the duration of anticoagulation therapy. NEJM, 2006
Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet, 2006
Management of venous thromboembolism: a systematic review for a practice guideline. Annals of Internal Medicine, 2007
Is recurrent venous thromboembolism after therapy reduced by low-molecular-weight heparin compared with oral anticoagulants? Chest, 2006

eTextbooks

Clinical Queries

How soon before and after surgery should prophylactic anticoagulation be stopped/restarted? NLH Q&A Service, 2006 View answer OR Can you answer this question for extra CPD?
In patients on warfarin does the presence of asymptomatic microscopic haematuria on routine dipstick testing warrant routine follow up? NLH Q&A Service, 2007 View answer OR Can you answer this question for extra CPD?
Are there any indications for use of warfarin plus low dose aspirin together? If so, what is the evidence base behind such a combination? NLH Q&A Service, 2007
What are the current recommended guidelines regarding the duration of warfarinisation in 1st episode DVT or PE? ATTRACT, 2006
Are there any evidence-based guidelines on the best way to stop warfarin at the end of a defined period of treatment? ATTRACT, 2006
For women using anticoagulants what contraceptive options are safe? FFPRHC, 2006 View answer OR Can you answer this question for extra CPD?

Drug Interaction Information

Initiation and Maintenance of Warfarin Therapy. See appendix 2 “Drugs, Herbs and Supplements: Potential Interactions with Warfarin”
Warfarin: Drug Interactions. RCGP, 2003
Interactions of Warfarin with Drugs and Food. Annals of Internal Medicine, 1994. See appendix 2 “Drug and Food Interactions with Warfarin by Level of Supporting Evidence and Type of Interaction”
Herbal remedies: adverse effects and drug interactions. American Family Physician, 1999

Patient Information

Patient Information: DVT

Patient Information: Atrial Fibrillation

TRIP Evidence Reviews: Anticoagulation

Anticoagulation