Dabigatran Versus Warfarin in the Treatment of Acute Venous Thromboembolism

Schulman, S.; Kearon, Clive; Kakkar, AK

doi:10.1016/j.jvs.2009.12.054

Cited by 432 publications

(706 citation statements)

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“…In human medicine, multiple iterations of evidence‐based guidelines for the management of venous and arterial thrombosis have been published . These guidelines are based on a wealth of high‐quality evidence resulting from large‐scale randomized controlled trials . Although some of these guidelines may be applicable to small animals, it is clear that the underlying physiology, the overall burden of disease, and the most frequently associated disease processes are substantially different between people and small animals .…”

Section: Introductionmentioning

confidence: 99%

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal

Goggs

Blais

Brainard

et al. 2019

J Vet Emergen Crit Care

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Objectives: To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics. Design: Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence-based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi-style surveys.Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. Settings: Academic and referral veterinary medical centers.Results: Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations. Conclusions:Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field. K E Y W O R D S ) for their dedicated contributions to this effort. We would also like to thank the members of the veterinary community who attended and contributed to the discussion of the guidelines during the 2018 EVECC Congress and IVECCS sessions and subsequently during the online open-comment stages. CONFLICT OF INTERESTThe authors declare that they have no conflicts of interest.

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Section: Introductionmentioning

confidence: 99%

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal

Goggs

Blais

Brainard

et al. 2019

J Vet Emergen Crit Care

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“…Second, clinical trial protocols of the four available DOACs each mandated frequent clinic visits and/or phone contacts with patients. However, these practices have not been routinely adopted in “real world” practice for patients taking a DOAC . To help address this concern, the European Heart Rhythm Association recommends clinical follow up of DOAC‐treated patients at least every 6 months, but suggests that every 1‐3 months may be appropriate for many patients .…”

Section: Discussionmentioning

confidence: 99%

Out‐of‐range INR results lead to increased health‐care utilization in four large anticoagulation clinics

Barnes

Kline–Rogers

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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BackgroundThe impact on health‐care costs and utilization of a single out‐of‐range (OOR) INR value not associated with bleeding or thromboembolic complication among chronic warfarin‐treated patients is not well described.MethodsAt four large phone‐based anticoagulation clinics (total 14 948 patients), warfarin‐treated patients with atrial fibrillation (AF) or venous thromboembolism were retrospectively propensity matched into an OOR INR group (n = 116) and a control group (n = 58). Types and frequency of contacts (eg, phone, voicemail, facsimile) and personnel involved were identified. A prospective time study analysis of 59 OOR and 92 control patients was performed over 8.5 days to record the time required to care for these patients. 2016 USD cost estimates were generated from average salaries.ResultsOOR and in‐range INR patients experienced an average of 4.2 and 3.2 (P < .001) INR lab draws until two sequential tests were in range. OOR INR patients required an average of 5.3 interactions with the anticoagulation clinic vs 3.7 for in‐range INR patients (P < .001). OOR INR patients more often required phone calls, fewer mailed letters, and more often required multiple types of contact than in‐range INR patients. In the prospective analysis, total median time involved for each OOR INR value was 5.1 minutes (IQR 3.7‐9.5) vs 2.9 minutes (IQR 1.8‐5.8) for control INR values (P < .001). At the clinic level, OOR INR values were associated with a yearly staff cost of $17 938 (IQR $8969‐$31 391).ConclusionsWe quantified the amount of extra anticoagulation staff effort required to manage warfarin‐treated patients who experience a single OOR INR value without bleeding or thromboembolic complications, which leads to higher healthcare utilization costs.

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“…Patients with non‐valvular atrial fibrillation and risk of stroke, treated with 150 mg dabigatran twice daily had lower rates of stroke and systemic embolism with similar rates of major haemorrhage in comparison to patients on warfarin (RE‐LY trial) . A fixed dose of dabigatran was as effective as warfarin for the treatment of acute venous embolism – with comparable occurrence of major and minor bleeding (RE‐COVER trial) …”

Section: Discussionmentioning

confidence: 99%

Dabigatran anticoagulation and Stanford type A aortic dissection: lethal coincidence

Stein

Bosshart

Brand

et al. 2014

Acta Anaesthesiol Scand

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Dabigatran Versus Warfarin in the Treatment of Acute Venous Thromboembolism

Cited by 432 publications

References 0 publications

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal

Out‐of‐range INR results lead to increased health‐care utilization in four large anticoagulation clinics

Dabigatran anticoagulation and Stanford type A aortic dissection: lethal coincidence

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