Anticoagulation

Infographic

Infographic on the new oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation

New oral anticoagulants for stroke prevention in atrial fibrillationSubscription

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Around 12,500 strokes are caused by atrial fibrillation (AF) in the UK each year, and 7,100 of these are preventable with appropriate anticoagulation. Four new oral anticoagulants (NOACs) are now available in the UK in addition to warfarin.

CPD and research articles

SEM of activated platelets

Heparin-induced thrombocytopeniaSubscription

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Heparin is widely used for thromboprophylaxis or as a treatment in many clinical situations, however, it can cause serious adverse effects. Heparin-induced thrombocytopenia (HIT), an immune-mediated adverse drug reaction, is associated with high morbidity and mortality if undiagnosed.

Testing for blood clotting

How to identify causes of a subtherapeutic INRSubscription

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Pharmacists and healthcare professionals are often involved in the management of patients with subtherapeutic international normalised ratios (INRs), the cause of which is important to identify because this will affect decisions and the subsequent management of the patient.

Oral anticoagulant therapy and INR blood test monitor

Assessing the impact of a targeted pharmacist-led anticoagulant review clinicSubscription

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Local guidance, supported by the 2014 National Institute for Health and Care Excellence (NICE) guideline CG180 for atrial fibrillation (AF), recommends that patients receiving inadequate anticoagulation with a vitamin K antagonist (VKA), including time in therapeutic range (TTR) of <65%, should be reassessed. These patients were identified by the anticoagulation monitoring service (AMS) and highlighted to GPs for review. However, up to 59.3% of patients received ...

Close up of a leg with livedo reticular is

Antiphospholipid syndrome: pathophysiology, diagnosis and treatmentSubscription

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How antiphospholipid syndrome, also known as Hughes syndrome, is diagnosed and the appropriate therapeutic options for its management.

Micrograph of a blood filled micrograph

Bridging anticoagulation: perioperative management of patients on anticoagulantsSubscription

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How patients on anticoagulants can be effectively managed in the perioperative period, including the evidence for the need for ‘bridging’ anticoagulation therapy and introduction of direct oral anticoagulants.

News and events

Apixaban molecular structure

Direct oral anticoagulants carry lower risk of major bleeding versus warfarin, data showSubscription

Research from primary care suggests apixaban may be the safest of the direct oral anticoagulants overall.

Human blood clotting light micrograph

Andexanet shows promise in patients taking new anticoagulants Subscription

Results from an ongoing trial of 228 patients with acute major bleeding show that patients taking andexanet experienced a reduction in anti-FXa activity.

Cross section of micrograph kidney

Uncertainty over anticoagulation risks and benefits in CKD patients with AF Subscription

The risk of both stroke and haemorrhage increases as chronic kidney disease progresses, which can complicate the decision on whether to begin anticoagulation in those with concomitant atrial fibrillation.

Warfarin anticoagulation monitoring in a pharmacy

Pharmacy-run anticoagulation service delivers 'enhanced clinical outcomes'

By Kathy Oxtoby

Community pharmacy is “ideally placed” to provide a safe anticoagulation service for patients needing warfarin monitoring

Warfarin tablet

Warfarin use associated with lower incidence of cancer in people aged 50 or olderSubscription

A Norwegian cohort study finds that warfarin has broad anticancer potential, which could have implications for medication choice for patients needing anticoagulation

Coloured angiograms (X-rays) taken from the front (left) and side (right) of a leg showing deep vein thrombosis in the calf

Pharmacomechanical therapy does not lower long-term risks in DVTSubscription

A study in The New England Journal of Medicine has shown no significant difference in results following pharmacomechanical therapy for deep-vein thrombosis

Person takes INR pin-prick blood test

Genotype-guided warfarin dosing could improve safetySubscription

Patients receiving genotype-guided dosing of warfarin were less likely to have a major bleed or die than patients whose dosing was clinically guided.

warfarin blood thinner for atrial fibrillation

Anticoagulants could cut the risk of dementia for patients with atrial fibrillation, researchers find

Oral anticoagulants are associated with a significant reduction in the risk of dementia in patients with atrial fibrillation (AF), according to a study published in the European Heart Journal.

anticoagulation monitoring ss sept 17

RPS endorses community pharmacy oral anticoagulant safety audit

A new community pharmacy oral anticoagulant safety audit, developed by the NHS’s Specialist Pharmacy Service (SPS), has been endorsed by the SalvaDore.

3D structure of the anticoagulant, dabigatran

Idarucizumab rapidly reverses dabigatran anticoagulationSubscription

Researchers find that idarucizumab effectively counteracts the workings of anticoagulant dabigatran in emergency situations.

anticoagulation monitoring of older patient

Row breaks out on whether GP practices should be funded for warfarin monitoring

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Clinical commissioning groups have been offloading responsibility for prescribing specialist drugs onto GPs, but many GPs say they have not been trained or paid to provide this service.

warfarin tablets anticoagulation treatment for atrial fibrillation

Delaying anticoagulation treatment for atrial fibrillation increases dementia risk, study suggests

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Results reinforce the importance of starting anticoagulation treatment as soon as possible after diagnosis, researchers conclude.

MRI scan showing intracranial haemorrhage

Intracranial haemorrhage risk of warfarin unrelated to INR controlSubscription

Study results show that choosing apixaban over warfarin could reduce the risk of anticoagulation-related intracranial haemorrhage.

Xray of a femur with a fracture from osteoporosis

Dagibatran carries reduced fracture risk compared with warfarinSubscription

Among patients with nonvalvular atrial fibrillation, study data show the use of dabigatran rather than warfarin was associated with a lower risk of osteoporotic fracture.

Screen shot of the warfarin dosing web application

Genotype-guided dosing improves safety of warfarin Subscription

Older adults who received a genotype-guided dose of warfarin via a web application were less likely to experience adverse effects compared with clinical dosing, trial results show.

Electrocardiogram machine

Atrial fibrillation patients not receiving guideline-recommended drugs to reduce stroke riskSubscription

Retrospective data analysis results show that the 16% of patients who were given anticoagulant prior to stroke showed reduction in stroke severity, lower odds of mortality and better functional outcomes.

Rivaroxaban, marketed by Xarelto

Rivaroxaban more effective than aspirin for preventing blood clots, study results suggest

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Researchers find that blood clot rates in patients taking rivaroxaban were significantly lower than those taking aspirin, and there were no significant differences between bleeding side effects.

warfarin tablets haematoma risk

Danish study confirms brain haemorrhage risk associated with anticoagulation

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Patients prescribed antithrombotic drugs, such as low-dose aspirin, clopidogrel or warfarin, are at increased risk of having a subdural haematoma, research published in JAMA has confirmed.

The new oral anticoagulant drugs Dabigatran, Rivaroxaban and Apixaban pills and pill boxes

Safety issues highlighted with newer oral anticoagulant drugs

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Analysis of ‘real-life’ data comparing newer direct oral anticoagulants with warfarin has identified adverse drug reactions (ADRs) ‘not previously associated’ with the new treatments, including hip fracture.

Rivaroxaban (Xarelto)

The BMJ accuses drug company of withholding data on faulty test device in rivaroxaban trial

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Janssen may have withheld data from the US Food and Drug Administration about a faulty blood testing device used in a trial of the anticoagulation drug rivaroxaban, according to the results of an investigation by The BMJ.

Blood cells in an artery

Most long-term warfarin patients won’t retain stable blood levels

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Only a third of patients taking warfarin will retain stable blood levels in the long term, research published in JAMA has revealed (online, 9 August 2016).

Blood clot illustration

Apixaban more effective than warfarin regardless of polypharmacySubscription

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The oral anticoagulant apixaban is consistently more effective than warfarin for patients with atrial fibrillation regardless of the number of other drugs they take, a study has found. 

Stroke MRI scan brain

Many atrial fibrillation patients at risk of stroke treated with aspirin over anticoagulantsSubscription

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Around 40% of atrial fibrillation patients who have an intermediate or high risk of stroke are treated only with aspirin, even though aspirin is less effective than oral anticoagulation, according to new research.

MRI scan of a brain with stroke

Early aspirin use after transient ischaemic attack cuts severe stroke risk by 90%Subscription

Large analysis of data shows taking aspirin within two weeks of transient ischaemic attack or stroke cuts risk of secondary stroke by over 90%.

An MRI scan of Alzheimer's disease in the brain

Atrial fibrillation patients on warfarin have increased risk of dementia

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Patients with atrial fibrillation (AF) being treated with warfarin have higher rates of dementia compared with those taking the drug for other conditions, research shows.

CT scan of a brain showing intracranial bleeding

Well-managed warfarin still useful for stroke preventionSubscription

A study of 40,000 patients with atrial fibrillation suggests that warfarin is a valid treatment for stroke prevention.

Testing for blood clotting

Patients' education plays part in how they manage anticoagulants Subscription

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The educational background of patients with atrial fibrillation directly influences how they manage their anticoagulation, according to research. 

The European Medicines Agency (EMA) has reiterated the overall safety of rivaroxaban (Xarelto), an anticoagulant, despite a defect in a device used in a pivotal study behind the drug’s marketing approval in the European Union and the United States

European regulator says anticoagulant is safe, despite question marks over its pivotal trialSubscription

The European Medicines Agency has reiterated the overall safety of rivaroxaban (Xarelto), an anticoagulant, despite a defect in a device used in a pivotal study behind the drug’s marketing approval in the European Union and the United States.

The validity of data produced by a pivotal trial to gain approval for direct oral anticoagulant rivaroxaban (Xarelto) from US and European regulators has been called into question by an investigation published by The BMJ.

Concerns raised about trial supporting top selling anticoagulant drugSubscription

The validity of the data produced by a pivotal trial to gain approval for the direct oral anticoagulant, rivaroxaban (Xarelto), from the US and European regulators, has been called into question by an investigation.

New anti-platelet drug set for phase II study after success in patients with coronary heart disease. Pictured, a blood clot in coronary artery.

Novel anti-platelet therapy shows promise in first human trialsSubscription

New anti-platelet drug set for phase II study after success in patients with coronary heart disease.

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