Medscape: Bleeding Rates and Medical Costs of New Oral Anticoagulants (warfarin, dabigatran...)

Bleeding Rates and Medical Costs of New Oral Anticoagulants

April 2, 2012 (Chicago, Illinois) — Firsthand experience with the new oral anticoagulants, coupled with excitement over those yet to be widely in use, has inspired a range of studies examining real-world risk/benefits, as well as the potential costs of replacing warfarin with the new agents.

In a poster session at last week's American College of Cardiology 2012 Scientific Sessions, investigators presented two separate experiences with dabigatran from different US centers--showing very different results--while others presented new cost analyses comparing different oral agents with warfarin.

One US report of patients switched to dabigatran showed a much higher rate of major bleeding than in the RE-LY trial, but a lower rate of dyspepsia, while a second report showed a lower rate of both major and minor bleeding compared with RE-LY trial.

Bridging Anticoagulation: Is it Needed When Warfarin Is Interrupted Around the Time of a Surgery or Procedure?

Bridging Anticoagulation
 Cardiology Patient Page

Is it Needed When Warfarin Is Interrupted Around the Time of a Surgery or Procedure?

1. The BRIDGE Study Investigators

abstract - EvidenceUpdates: Cochrane Review: Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy (including professional commentaries)

Abstract

BACKGROUND:  Venous thromboembolism (VTE) often complicates the clinical course of cancer disease. The risk is further increased by chemotherapy but the safety and efficacy of primary thromboprophylaxis in cancer patients treated with chemotherapy is uncertain. OBJECTIVES:  To assess the efficacy and safety of primary thromboprophylaxis in ambulatory cancer patients receiving chemotherapy.  AUTHORS' CONCLUSIONS:   Primary thromboprophylaxis with LMWH significantly reduced the incidence of symptomatic VTE in ambulatory cancer patients treated with chemotherapy. However, the lack of power hampers definite conclusions on the effects on major safety outcomes, which mandates additional studies to determine the risk to benefit ratio of LMWH in this setting.

Comments from Clinical Raters
Oncology - Breast

abstract: the Oncologist - Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

 Abstract

Background. Evidence-based treatment guidelines recommend low molecular weight heparin (LMWH) monotherapy for cancer-associated venous thromboembolism (VTE). This analysis assessed the first-line treatment strategies for VTE in patients with advanced solid tumors.


Conclusions. Adoption of LMWH monotherapy as initial treatment for cancer-associated VTE was low but increased steadily over the study period. Future studies should explore reasons underlying the underutilization of this preferred evidence-based treatment as well as the comparative effectiveness of LMWH versus warfarin-based anticoagulation in real-world cancer patients with VTE.

Table 1. Baseline cohort patient characteristics, risk factors and comorbidities,....

Brand name versus generic warfarin: a systematic review [Pharmacotherapy. 2011]

Warfarin (Coumadin)- fp notebook update

Coumadin (Warfarin Sodium) Drug Information: User Reviews, Side Effects, Drug Interactions and Dosage at RxList

Coumadin

• Coumadin Drug Description
• Coumadin Indications & Dosage
• Coumadin Side Effects & Drug Interactions
• Coumadin Warnings & Precautions
• Coumadin Overdosage & Contraindications
• Coumadin Clinical Pharmacology
• Coumadin Medication Guide
• Coumadin Consumer
• Coumadin Patient

Check Your Warfarin | C3: Colorectal Cancer Coalition

Warfarin Samples Recalled

New blood thinners can cause dangerous drug interactions, study finds

""A high proportion of adults in the United States consume at least one of the drugs known to have some level of interaction with one of the new oral anticoagulants," the Loyola researchers write."

EvidenceUpdates-Cochrane Collaboration review/commentaries: Self-monitoring and self-management of oral anticoagulation (Warfarin)

Note - warfarinCONCLUSIONS:
Compared to standard monitoring, patients who self-monitor or self-manage can improve the quality of their oral anticoagulation therapy. The number of thromboembolic events and mortality were decreased without increases in harms. However, self-monitoring or self-management were not feasible for up to half of the patients requiring anticoagulant therapy. Reasons included patient refusal, exclusion by their general practitioner, and inability to complete training.

Drug interactions with antiretrovirals and warfarin; Expert Opinion on Drug Safety