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2014 9os 04
Learning new practical tools for deciding which anti coagulation treatment to use in AF patients, in the Israeli Association of Family Physicians conference in Eilat.
Try it yourself! | go |
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New "HAS-BLED" Tool Identifies Those with Atrial Fibrillation at Risk for Bleeding From Coumadin or Warfarin
| go |
HAS-BLED Score for Major Bleeding Risk
online caLculator | go |
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2014 8os 30
Updated advice regarding when to use prasugrel from NICE..
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September 30, 2013
September 30, 2013
N Engl
J Med
Edoxaban versus Warfarin for the Treatment
of Symptomatic Venous Thromboembolism
Author(s): The Hokusai-VTE Investigators
Treatments discussed: edoxaban, heparin,warfarin
Background Whether the oral factor Xa inhibitor edoxaban can
be an alternative to warfarin in patients with venous thromboembolism is
unclear. Methods In a randomized, double-blind, noninferiority study, we
randomly assigned patients with acute venous thromboembolism, who had
initially received heparin, to receive edoxaban at a dose of 60 mg once
daily, or 30 mg once daily (e.g., in the case of patients with creatinine
clearance of 30 to 50 ml per minute or a body weight below 60 kg), or to
receive warfarin. Patients received the study drug for 3 to 12 months. The
primary efficacy outcome was recurrent symptomatic venous thromboembolism.
The principal safety outcome was major or clinically relevant nonmajor
bleeding. Results A total of 4921 patients presented with deep-vein
thrombosis, and 3319 with a pulmonary embolism. Among patients receiving
warfarin, the time in the therapeutic range was 63.5%.
Edoxaban was
noninferior to warfarin with respect to the primary efficacy outcome, which
occurred in 130 patients in the edoxaban group (3.2%) and 146 patients in
the warfarin group (3.5%) (hazard ratio, 0.89; 95% confidence interval
[CI], 0.70 to 1.13; P<0.001 for noninferiority). The safety outcome
occurred in 349 patients (8.5%) in the edoxaban group and 423 patients
(10.3%) in the warfarin group (hazard ratio, 0.81; 95% CI, 0.71 to 0.94;
P=0.004 for superiority). The rates of other adverse events were similar in
the two groups. A total of 938 patients with pulmonary embolism had right
ventricular dysfunction, as assessed by measurement of N-terminal pro-brain
natriuretic peptide levels; the rate of recurrent venous thromboembolism in
this subgroup was 3.3% in the edoxaban group and 6.2% in the warfarin group
(hazard ratio, 0.52; 95% CI, 0.28 to 0.98).
Conclusions : Edoxaban
administered once daily after initial treatment with heparin was
noninferior to high-quality standard therapy and caused significantly less
bleeding in a broad spectrum of patients with venous thromboembolism,
including those with severe pulmonary embolism. (Funded by Daiichi-Sankyo;
Hokusai-VTE ClinicalTrials.gov number, NCT00986154 .).
PubMed abstract
