Atrial Fibrillation Paper

Coumadin (non specific name: warfarin) is an anticoagulant, or blood diminishing drug, that is endorsed to numerous patients who are at danger for creating blood clusters that could bring about heart assaults or strokes. Warfarin is near the most astounding purpose recently and simultaneous investigations of medications that provoke ER visits and occurring an expansion in healing center based offices with the affirmation of patients. Anticoagulation treatment stances perils to patients and over and over prompts unfavorable solution events in light of complex dosing, fundamental ensuing watching, and clashing patient consistence. As a result, various patients who meet current evidence based principles for warfarin treatment are not being managed

Warfarin can lead to severe bleeding risks which may lead to fatality. Those who are over the age of 65 may be more sensitive to warfarin. ( cite)

The dabigatran etexilate (DE) is a prodrug that directly competes for the active site of thrombin.1 This direct inhibition inactivates both fibrin-bound and free form of thrombin. Because of its rapid onset and offset of action, there is no need for the initial parenteral anticoagulant treatment in patients with acute thrombosis.1 On the other hand, the enoxaparin indirectly inhibits factor Xa.2 It has a shorter duration of action (12h vs 24h) and a shorter half-life (4.5-7h vs 12-14h) in comparison to DE. The DE and the enoxaparin have no interaction with diet and alcohol. There is no routine monitoring required

The usage of anticoagulant therapy is one of the most common forms of medical intervention. The CHADS2 score is the simplest and most commonly used stroke- risk assessment tool since its implementation 2001. This scale is used to determine whether or not anticoagulation therapy is required for patients with episodic atrial fib. A higher CHADS2 score is directly related to a greater risk of stroke. The level of risk from a thrombotic event is determined by a score which is tallied by including five common stroke risk factors; congestive heart failure, hypertension, age, diabetes, and history of stroke. If a patient is positive for any of these risk factors they receive one point with the history of stroke getting 2 points (Camm et al, 2010).

For many year’s patients with atrial fibrillation have been treated with anticoagulants such as Warfarin to prevent strokes and embolisms. Unfortunately, Warfarin must be closely monitored and that is an irritant for some patients. In October 2010, the FDA approved a new generational anticoagulant drug called Dabigatran (Pradaxa). This alternate medication gives patients the benefit of no dietary restrictions since dabigatran is not affected by certain foods. Another benefit of taking dabigatran is a monthly blood test is not required to measure its effectiveness, so for this particular reason many patients switch from taking other anticoagulants to dabigatran (Talati & White, 2011). Since this medication does not require close monitoring, some wonder if is it truly a better option or can more harm than good come from taking it. While the benefits of using dabigatran have shown significant improvement over warfarin, there are still risks associated with using dabigatran.

In a hospital setting, anticoagulants and antiplatelets are widely prescribed by physicians because of their greater benefits in changing the physiological homeostasis of the cardiovascular system. Anticoagulants and antiplatelets play a fundamental role in the treatment of cardiovascular diseases as they are very effective at counteracting the different symptoms cardiovascular diseases present.

Bleeding is one of warfarins most serious and harmful effects as major and fatal bleeding can be experienced by patients. A meta analysis of 33 studies concluded “The clinical impact of anticoagulant-related major bleeding in patients with venous thromboembolism is considerable” therefore the effects of bleeding should be taken into account by health care professionals when choosing whether to prescribe warfarin to a patient or to continue anti-coagulant therapy using warfarin in individual patients. In addition to bleeding another complication of warfarin is its narrow therapeutic index which makes it difficult to ensure patients stay within the required anticoagulation range. An analysis of 6454 patients taking warfarin for atrial fibrillation

As previously mentioned, cardiovascular disease has developed to become the major cause of deaths across the world. A cohort study and evidence-based management study was developed to identify the major causes of the disease, analyze key steps, including current medications used to address the disease, and identify ways for mitigating is proliferation. The study was based

Warfarin is a very common used drug worldwide. Warfarin is used to prevent harmful blood clots from forming or growing larger. Beneficial blood clots prevent or stop bleeding, but harmful blood clots can cause a heart attack, stroke, deep vein thrombosis or pulmonary embolism. Although warfarin is commonly used, its management is very challenging. First, it has a very narrow therapeutic index- increased anticoagulant effect puts the patients at a risk of bleeding, while decreased anticoagulant effect puts them at a risk of thromboembolic disorders such as heart attack and stroke. And second, the wide variation among patients in drug response. Therefore, it needs long time to determine the adequate dosage for each patient. Complications from inappropriate warfarin dosing are among the adverse events most frequently reported to the US

Modern technology has led to extreme advances in all aspects of medicine and the research that goes into making new discoveries. It has especially been useful in developing greater steps for prevention of further injury ranging from simple prophylactic treatments to major invasive surgery. Specifically, anticoagulants have made great strides in their development over the past decade, and have played huge roles in increasing the survival rate of patients and people in and out of the operating room. The longstanding problem however with anticoagulants has been that many have lacked a truly specific reversal agent for their blood clotting actions, which has led to complications in patient’s health and well-being over time. For some time now researchers

INR values, ventricular ejection fraction, body mass index) were not included in the dataset, clinical determinants such as CHA2DS2VASC and CCI helped to control for disease severity by considering hypertension, prior cardiovascular disease, diabetes and other co-morbidities. Furthermore, adherence assessment based on 3, 6, 9, and 12 month windows might lead to truncation of the data, therefore the windows were kept close at every 3 months. It is also important to understand dosing of warfarin is variable and frequently adjusted. We also looked at the distribution of days of supply to explore a potential bias. The distribution of the days of supply for warfarin and NOAC was primarily around 30 and 60 day dosing which substantiated that the therapies might be comparable. Prior use of anti-hypertensive drugs was also accounted and selection of the drugs was based on recommended AF therapy by American Heart Association.(AHA). These drugs were also used as covariates to understand the individual effects in the dabigatran and rivaroxaban pivotal trials. However, aspirin use was not comprehensively captured in claims database due to its availability as OTC drug. Differences in the descriptive charaterstics might be explained by the fact that NOACs might be prescribed to patients who have unmet need after warfarin therapy, this might lead to potential channeling or selection bias, in our study we did not control the selection bias using propensity

The causes of premature discontinuation are adverse events, consent withdrawal, and loss to follow-up. Patient demographics are reported as well, and the authors provide a useful table with basic patient information including age, weight, gender, and renal function. There are some very miniscule differences in groups for both studies, but these differences should not affect the results because of randomization. The trial results are reported in percentages of event occurrence in a population. While these are useful in understanding the frequency of harmful effects or successful treatment, a surrogate measurement and use of INR measurements may provide a better idea of the extent of safety or efficacy. In the Acute DVT Study, the primary efficacy endpoint occurred in 2.1% of rivaroxaban patients and in 3.0% of standard therapy patients (Hazard ratio 0.68; 95% CI 0.44 to 1.04; P<0.001 for non-inferiority with a one-sided test, and P = 0.08 for superiority with a two-sided test). The principal safety endpoint of clinically significant bleeding occurred in 8.1% of rivaroxaban patients and in 8.1% of standard therapy patients (hazard ratio with rivaroxaban 0.97; 95% CI 0.76 to 1.22; P =

There are many disadvantages for the use of warfarin. These include the effect of a given dose of warfarin is delayed by several days because of its mechanism of action as an inhibitor of the production of a clotting cascade factor. Many factors lead to a changing dose in warfarin for each specific

Coagulation is a natural physiological process and is required for the normal functioning of the body. At sites where there is injury to the blood vessels, blood clots are formed as a result of activation of coagulation pathway. Platelets are attracted to the site of injury and a network of tissues is formed. It gets dissolved as the wound heals. However, if the clotting plug increases in size and does not dissolve, there are chances of thrombotic episodes. LMWH are modulators of the coagulation pathway. Enoxaparin is a LMWH, hance, used to treat patients with myocardial infarction or related thrombotic disorders. An effective dose of the drug need to be provided to the patient. ‘Therapeutic dosing period’ is the time period calculated on a

Warfarin and novel anticoagulants are increasingly utilized for the prevention of clotting in various increased risk disease states or anatomic changes including atrial fibrillation, the presence of artificial heart valves, and development of repeated deep venous thromboses (1-3). While the potential benefits of anticoagulation are useful, the risk of hemorrhage increases significantly (4). The incidence of major bleeding has been estimated at 1–3% annually and is even greater when the international normalized ratio (INR) is greater than 4.5 (4). Coinciding with the increased utilization of anticoagulant medications is the increasing incidence of emergency general surgery (EGS) disease such as acute cholecystitis, peptic ulcer