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1.
Acta Biomed ; 92(5): e2021281, 2021 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-34738603

RESUMO

AIM: To compare the demographical profile, indications, efficacy, and contributors to adverse outcome following administration of 4F-PCC in patients on warfarin with supratherapeutic INR. METHODOLOGY: Retrospective cross-sectional study was performed in a community based teaching hospital. All patients 18 years and older on warfarin with supratherapeutic INR, who had received 4F-PCC between January 2014 and December 2018 were eligible and included in the study. RESULTS: 44 patients were included in the analysis. The mean age of the patients was 79.5 years. The male to female ratio was 1:1. Patients were on warfarin for atrial fibrillation, thromboembolism in 79.5% (N-35), and 20.5% (N-9) respectively. Indications for use of 4F-PCC were active bleeding in 93% (N-41) of patients. The common sites of bleeding were gastrointestinal, intracranial, and musculoskeletal which were seen in 54.5% (N-24), 29.5% (N-13) and 6.8% (N-3) respectively. The median number of doses of 4F-PCC administered was 1 per patient. The mean dose administered was 2,883u. Clinical improvement was documented in 84% (N-37) of patients. Mortality was seen in 16% (N-7) of patients. BMI greater than 30, anemia, hypotension, presence of intracranial bleed, the requirement of blood products, and mechanical ventilation were associated with higher odds for mortality. Hypotension and requirement of mechanical ventilation were statistically significant. CONCLUSION: 4F-PCC continues to be an effective agent in the rapid reversal of warfarin therapy in patients with supratherapeutic INR presenting with major bleeding events. Most patients have clinical improvement with a single, weight-adjusted dose.


Assuntos
Estado Terminal , Varfarina , Idoso , Anticoagulantes/efeitos adversos , Fatores de Coagulação Sanguínea , Estudos Transversais , Feminino , Humanos , Coeficiente Internacional Normatizado , Masculino , Estudos Retrospectivos , Varfarina/efeitos adversos
2.
J Invasive Cardiol ; 33(11): E918, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34735357

RESUMO

A 46-year-old woman with no significant past history presented to the emergency department with history of sudden-onset central chest discomfort and diaphoresis. With a preliminary diagnosis of acute myocardial infarction, she was subjected to coronary angiography, which showed occlusion of the distal left anterior descending artery with otherwise normal epicardial coronary arteries. Aspiration was performed in the vessel and yielded pinkish friable tissue. The histopathological examination revealed fibrin-rich thrombus. The patient was treated with enoxaparin and switched to oral anticoagulation with warfarin. On follow-up, the nodular mass on the mitral valve reduced considerably in size and she was advised that life-long anticoagulation was necessary.


Assuntos
Síndrome Antifosfolipídica , Infarto do Miocárdio , Tromboembolia , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Angiografia Coronária , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Varfarina
4.
Open Heart ; 8(2)2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34785588

RESUMO

BACKGROUND: Early in the COVID-19 pandemic, the National Health Service (NHS) recommended that appropriate patients anticoagulated with warfarin should be switched to direct-acting oral anticoagulants (DOACs), requiring less frequent blood testing. Subsequently, a national safety alert was issued regarding patients being inappropriately coprescribed two anticoagulants following a medication change and associated monitoring. OBJECTIVE: To describe which people were switched from warfarin to DOACs; identify potentially unsafe coprescribing of anticoagulants; and assess whether abnormal clotting results have become more frequent during the pandemic. METHODS: With the approval of NHS England, we conducted a cohort study using routine clinical data from 24 million NHS patients in England. RESULTS: 20 000 of 164 000 warfarin patients (12.2%) switched to DOACs between March and May 2020, most commonly to edoxaban and apixaban. Factors associated with switching included: older age, recent renal function test, higher number of recent INR tests recorded, atrial fibrillation diagnosis and care home residency. There was a sharp rise in coprescribing of warfarin and DOACs from typically 50-100 per month to 246 in April 2020, 0.06% of all people receiving a DOAC or warfarin. International normalised ratio (INR) testing fell by 14% to 506.8 patients tested per 1000 warfarin patients each month. We observed a very small increase in elevated INRs (n=470) during April compared with January (n=420). CONCLUSIONS: Increased switching of anticoagulants from warfarin to DOACs was observed at the outset of the COVID-19 pandemic in England following national guidance. There was a small but substantial number of people coprescribed warfarin and DOACs during this period. Despite a national safety alert on the issue, a widespread rise in elevated INR test results was not found. Primary care has responded rapidly to changes in patient care during the COVID-19 pandemic.


Assuntos
Anticoagulantes/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , COVID-19 , Substituição de Medicamentos/normas , Inibidores do Fator Xa/administração & dosagem , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Medicina Estatal/normas , Varfarina/administração & dosagem , Idoso , Anticoagulantes/efeitos adversos , Testes de Coagulação Sanguínea , Monitoramento de Medicamentos , Prescrições de Medicamentos , Substituição de Medicamentos/efeitos adversos , Uso de Medicamentos/normas , Inglaterra , Inibidores do Fator Xa/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Atenção Primária à Saúde/normas , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Varfarina/efeitos adversos
5.
BMC Med Inform Decis Mak ; 21(1): 281, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641870

RESUMO

BACKGROUND: An Informatics Consult has been proposed in which clinicians request novel evidence from large scale health data resources, tailored to the treatment of a specific patient. However, the availability of such consultations is lacking. We seek to provide an Informatics Consult for a situation where a treatment indication and contraindication coexist in the same patient, i.e., anti-coagulation use for stroke prevention in a patient with both atrial fibrillation (AF) and liver cirrhosis. METHODS: We examined four sources of evidence for the effect of warfarin on stroke risk or all-cause mortality from: (1) randomised controlled trials (RCTs), (2) meta-analysis of prior observational studies, (3) trial emulation (using population electronic health records (N = 3,854,710) and (4) genetic evidence (Mendelian randomisation). We developed prototype forms to request an Informatics Consult and return of results in electronic health record systems. RESULTS: We found 0 RCT reports and 0 trials recruiting for patients with AF and cirrhosis. We found broad concordance across the three new sources of evidence we generated. Meta-analysis of prior observational studies showed that warfarin use was associated with lower stroke risk (hazard ratio [HR] = 0.71, CI 0.39-1.29). In a target trial emulation, warfarin was associated with lower all-cause mortality (HR = 0.61, CI 0.49-0.76) and ischaemic stroke (HR = 0.27, CI 0.08-0.91). Mendelian randomisation served as a drug target validation where we found that lower levels of vitamin K1 (warfarin is a vitamin K1 antagonist) are associated with lower stroke risk. A pilot survey with an independent sample of 34 clinicians revealed that 85% of clinicians found information on prognosis useful and that 79% thought that they should have access to the Informatics Consult as a service within their healthcare systems. We identified candidate steps for automation to scale evidence generation and to accelerate the return of results. CONCLUSION: We performed a proof-of-concept Informatics Consult for evidence generation, which may inform treatment decisions in situations where there is dearth of randomised trials. Patients are surprised to know that their clinicians are currently not able to learn in clinic from data on 'patients like me'. We identify the key challenges in offering such an Informatics Consult as a service.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Humanos , Informática , Encaminhamento e Consulta , Acidente Vascular Cerebral/tratamento farmacológico , Resultado do Tratamento , Varfarina/uso terapêutico
6.
BMJ Case Rep ; 14(10)2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34649859

RESUMO

Dabigatran, a novel oral anticoagulant, is a direct thrombin inhibitor and is being increasingly used owing to the advantage of dosing without the need for laboratory monitoring. While extensive skin necrosis is known to be associated with oral anticoagulants such as warfarin and factor Xa inhibitors, dabigatran toxicity typically manifests with bleeding, especially in the elderly. We describe a 70-year-old woman who was prescribed dabigatran for the treatment of unprovoked deep venous thrombosis. She developed bleeding diathesis along with extensive skin necrosis and acute kidney injury shortly after commencing the drug. Haemodialysis was given in view of dabigatran toxicity and complications of kidney dysfunction which resolved promptly over a week. However, the patient succumbed to severe sepsis from secondary skin infections. It is crucial to closely monitor for signs of dabigatran toxicity, especially in the elderly patients.


Assuntos
Anticoagulantes , Dabigatrana , Idoso , Anticoagulantes/efeitos adversos , Dabigatrana/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Feminino , Humanos , Necrose/induzido quimicamente , Varfarina
11.
J Hematol Oncol ; 14(1): 172, 2021 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666811

RESUMO

BACKGROUND: Thromboembolism has been reported as a consequence of severe COVID-19. Although warfarin is a commonly used anticoagulant, it acts by antagonising vitamin K, which is low in patients with severe COVID-19. To date, the clinical evidence on the impact of regular use of warfarin on COVID-19-related thromboembolism is lacking. METHODS: On behalf of NHS England, we conducted a population-based cohort study investigating the association between warfarin and COVID-19 outcomes compared with direct oral anticoagulants (DOACs). We used the OpenSAFELY platform to analyse primary care data and pseudonymously linked SARS-CoV-2 antigen testing data, hospital admissions and death records from England. We used Cox regression to estimate hazard ratios (HRs) for COVID-19-related outcomes comparing warfarin with DOACs in people with non-valvular atrial fibrillation. We also conducted negative control outcome analyses (being tested for SARS-CoV-2 and non-COVID-19 death) to assess the potential impact of confounding. RESULTS: A total of 92,339 warfarin users and 280,407 DOAC users were included. We observed a lower risk of all outcomes associated with warfarin versus DOACs [testing positive for SARS-CoV-2, HR 0.73 (95% CI 0.68-0.79); COVID-19-related hospital admission, HR 0.75 (95% CI 0.68-0.83); COVID-19-related deaths, HR 0.74 (95% CI 0.66-0.83)]. A lower risk of negative control outcomes associated with warfarin versus DOACs was also observed [being tested for SARS-CoV-2, HR 0.80 (95% CI 0.79-0.81); non-COVID-19 deaths, HR 0.79 (95% CI 0.76-0.83)]. CONCLUSIONS: Overall, this study shows no evidence of harmful effects of warfarin on severe COVID-19 disease.


Assuntos
Anticoagulantes/uso terapêutico , COVID-19/epidemiologia , Tromboembolia/tratamento farmacológico , Tromboembolia/virologia , Varfarina/uso terapêutico , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/farmacologia , COVID-19/sangue , COVID-19/tratamento farmacológico , COVID-19/virologia , Estudos de Coortes , Inglaterra/epidemiologia , Humanos , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Tromboembolia/sangue , Tromboembolia/epidemiologia , Resultado do Tratamento , Adulto Jovem
13.
Pan Afr Med J ; 39: 212, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34630824

RESUMO

Introduction: left ventricular thrombus (LVT) may lead to thromboembolism and has been associated with increased morbidity and mortality. Little is known about the incidence, etiology and outcomes in patients with LVT in Africa. The objective was to determine the etiology, treatment practices, rate of resolution and clinical outcomes in patients with LVT in the region. Methods: a review of all echocardiograms performed in 2017 and 2018 at the Aga Khan University Hospital, Nairobi was carried out and patients with LVT identified. Physician review of charts was performed to document clinical characteristics and outcomes. Results: during the study period 100 patients with LVT were identified (1.3% of adult echoes). The mean LVEF was 28.5% (±11.0%) and 88 (88%) patients had an LVEF of less than 40%. Underlying etiology of LV dysfunction was post myocardial infarction (MI) in 28 (28%), chronic ischemic cardiomyopathy in 42(42%) and non-ischemic cardiomyopathy in 30 (30%) patients. In 15 (15%) patients a stroke or TIA predated the diagnosis of LVT. Long term anticoagulation was given to 92 (92%) patients. Among these, 34 (37%) received warfarin while 58 (63%) were treated with a DOAC. In the 64 patients who had reassessment imaging (median duration 177 days), complete thrombus resolution was noted in 38 (59.4%). One-year clinical outcome data was available for 85 patients: 13 (15.3%) patients had died, 4 (4.7%) had suffered a stroke, and 8(9.4%) had had a bleeding episode. Rates of thrombus resolution (warfarin 64%, DOAC 55.6%, p=0.51), stroke (warfarin 2.9%, DOAC 1.7%, p=1.0) and bleeding (warfarin 5.9%, DOAC 5.2%, p = 1.00 were not significantly different among patients treated with warfarin and DOAC. Conclusion: we noted a high incidence of LVT compared to contemporary Western series. The majority of our patients were treated with DOACs. There were no significant differences in outcomes between patients treated with a DOAC and those receiving warfarin. Prospective evaluation on the efficacy and safety of DOACs for this indication is needed.


Assuntos
Anticoagulantes/administração & dosagem , Trombose/tratamento farmacológico , Disfunção Ventricular Esquerda/tratamento farmacológico , Varfarina/administração & dosagem , Adulto , Idoso , Anticoagulantes/efeitos adversos , Ecocardiografia , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Trombose/diagnóstico por imagem , Trombose/etiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Varfarina/efeitos adversos
15.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(9): 1133-1138, 2021 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-34619933

RESUMO

This study explored whether clinical pharmacists can improve patients' medication compliance with the use of warfarin medication checklist and the correlation between them. A total of 147 inpatients discharged from Shanghai Tongren Hospital with warfarin from July 2018 to September 2019 were randomly divided into the control group and the intervention group by random number table, including 75 in the control group and 72 in the intervention group. There were no statistically significant differences in gender, age, marital status, drinking history, smoking history, department distribution, type of thromboembolic disease, comorbidity and combined medication between the two groups (P>0.05). The control group received routine warfarin medication education at discharge, while the intervention group received clinical pharmacist's assessment of bleeding risk and targeted medication education using warfarin medication checklist at discharge. The monitoring time and value of the international normalized ratio (INR) between the two groups during hospitalization and within 6 months after discharge were recorded, as well as warfarin-related adverse events. The Morisky Medication Adherence Scale was used to evaluate the medication compliance of patients in the two groups. Spearman correlation analysis was used to study the relationship between warfarin compliance and variables in the warfarin medication checklist. The intervention group had better follow-up regularity than the control group (χ²=34.3, P<0.001), and the medication compliance in the intervention group was better than that in the control group (χ²=38.6, P<0.001). There were significant correlations between warfarin compliance and duration of warfarin therapy (R=-0.275, P=0.027), number of comorbidities (R=-0.335, P=0.004), bleeding risk (R=-0.433, P<0.001). In conclusion, using warfarin medication checklist can improve patients' medication compliance. Patients' medication compliance was significantly negatively correlated with duration of warfarin therapy, number of comorbidities and bleeding risk. Clinical pharmaceutical care can improve the medication compliance of patients with warfarin, so as to improve the medication results, which may be helpful for the drug treatment of patients with chronic diseases.


Assuntos
Lista de Checagem , Varfarina , China , Humanos , Coeficiente Internacional Normatizado , Adesão à Medicação , Varfarina/uso terapêutico
16.
Int J Cardiol ; 345: 90-97, 2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34688719

RESUMO

BACKGROUND: Rivaroxaban is a direct inhibitor of activated Factor X (FXa), an anti-inflammatory protein exerting a protective effect on the cardiac valve and vascular endothelium. We compare the effect of Warfarin and Rivaroxaban on inflammation biomarkers and their contribution to heart valve calcification progression and renal preservation in a population of atrial fibrillation (AF) patients with chronic kidney disease (CKD) stage 3b - 4. METHODS: This was an observational, multicenter, prospective study enrolling 347 consecutive CKD stage 3b - 4 patients newly diagnosed with AF: 247 were treated with Rivaroxaban and 100 with Warfarin. Every 12 months, we measured creatinine levels and cardiac valve calcification via standard trans-thoracic echocardiogram, while plasma levels of inflammatory mediators were quantified by ELISA at baseline and after 24 months. RESULTS: Over a follow-up of 24 months, long-term treatment with Rivaroxaban was associated with a significative reduction of cytokines. Patients treated with Rivaroxaban experienced a more frequent stabilization/regression of valve calcifications comparing with patients treated with Warfarin. Rivaroxaban use was related with an improvement in kidney function in 87.4% of patients, while in those treated with Warfarin was reported a worsening of renal clearance in 98% of cases. Patients taking Rivaroxaban experienced lower adverse events (3.2% vs 49%, p-value <0.001). CONCLUSIONS: Our findings suggest that Rivaroxaban compared to Warfarin is associated with lower levels of serum markers of inflammation. The inhibition of FXa may exert an anti-inflammatory effect contributing to reduce the risk of cardiac valve calcification progression and worsening of renal function.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Anticoagulantes/efeitos adversos , Inibidores do Fator Xa , Humanos , Rim/fisiologia , Estudos Prospectivos , Rivaroxabana , Resultado do Tratamento , Varfarina/efeitos adversos
17.
Khirurgiia (Mosk) ; (9): 54-62, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480456

RESUMO

OBJECTIVE: To analyze an effectiveness of algorithm for complex treatment of patients with surgical complications of prolonged warfarin therapy in a general surgical hospital. MATERIAL AND METHODS: The study included 138 patients with surgical complications of prolonged warfarin therapy. All patients received warfarin for at least 6 months (49.5% of patients - over 5 years). Warfarin therapy was indicated for deep vein thrombosis in 54 patients and various cardiac diseases in 84 patients. Examination included clinical and instrumental survey, laboratory tests and coagulation tests - thromboelastography (TEG) and thrombodynamics test (TT). RESULTS: Recurrent VTEC occurred in 24 out of 138 patients, hemorrhagic complications - in 114 patients. Therapeutic management was applied in 111 patients, 27 ones underwent surgery (emergency treatment - 25 patients, after two days - 2 patients). Ten patients underwent endoscopic hemostasis, two patients - ultrasound-assisted percutaneous drainage of hematoma. Recurrent VTECs were caused by inadequate laboratory control and violations of warfarin therapy. Most of these patients underwent therapeutic management (only 3 patients required surgery for life-threatening flotation in great veins). Treatment of 114 patients with hemorrhagic complications of prolonged warfarin therapy depended on features of bleeding and severity of warfarin-induced coagulopathy. Depending on these factors, warfarin was discontinued and intravenous administration of vitamin K / FFP / prothrombin complex concentrate was applied. This approach ensured successful therapeutic measures in 90 patients of this group. Twenty-four patients underwent surgery after correction of hemostatic disorders. TT was characterized by high efficiency in analysis of thrombotic predisposition and prediction of the risk of VTEC. TEG was valuable for assessment of warfarin-induced coagulopathy and treatment of patients with hemorrhagic complications of prolonged warfarin therapy. CONCLUSION: The developed clinical and diagnostic algorithm for management of hemorrhagic complications of prolonged warfarin therapy ensures positive clinical results even in a general surgical hospital.


Assuntos
Anticoagulantes , Varfarina , Anticoagulantes/efeitos adversos , Testes de Coagulação Sanguínea , Hemorragia , Hospitais , Humanos , Varfarina/efeitos adversos
18.
Nutrients ; 13(9)2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34579096

RESUMO

Cranberry is a dietary supplement popularly used for the prophylaxis of urinary tract infection. Interestingly, cranberry-warfarin interactions in clinical reports have shown bidirectional outcomes. (±) Warfarin, a widely prescribed anticoagulant, but with a narrow therapeutic index, contains equal amounts of S- and R-warfarin, of which S-warfarin is more active. The aim of this study was to investigate the effects of different ingestion times of cranberry on the pharmacokinetics and pharmacodynamics of warfarin. Rats were orally administered (±) warfarin (0.2 mg/kg) with and without cranberry (5.0 g/kg) at 0.5 h prior to the warfarin, and at 10 h after the warfarin. The plasma concentrations of S- and R-warfarin were determined by LC/MS. The results indicate that cranberry ingested at 0.5 h before (±) warfarin significantly decreased the systemic exposures of S-warfarin and R-warfarin. Conversely, when cranberry was ingested at 10 h after (±) warfarin, the elimination of S-warfarin was significantly inhibited, and the anticoagulation effect of (±) warfarin was significantly enhanced. The results of the mechanism studies indicate that cranberry activated the breast cancer resistance protein (BCRP), which mediated the efflux transports of S-warfarin and R-warfarin. Moreover, the metabolites of cranberry inhibited cytochrome P450 (CYP) 2C9, the main metabolizing enzyme for S-warfarin. In conclusion, cranberry affected the pharmacokinetics of (±) warfarin in a bidirectional manner by activating the BCRP by CJ during absorption and inhibiting the BCRP and CYP2C9 by CMs during elimination, depending on the ingestion time of CJ. The combined use of cranberry with warfarin should be avoided.


Assuntos
Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/metabolismo , Sistema Enzimático do Citocromo P-450/metabolismo , Sucos de Frutas e Vegetais , Regulação da Expressão Gênica/efeitos dos fármacos , Proteínas de Neoplasias/metabolismo , Vaccinium macrocarpon , Varfarina/farmacocinética , Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Administração Oral , Animais , Sistema Enzimático do Citocromo P-450/genética , Cães , Interações Alimento-Droga , Humanos , Células Madin Darby de Rim Canino , Masculino , Proteínas de Neoplasias/genética , Ratos , Ratos Sprague-Dawley , Varfarina/sangue
20.
Am J Ther ; 28(5): e531-e539, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34491953

RESUMO

BACKGROUND: Direct oral anticoagulants (DOACs) have been increasingly preferred over warfarin; however, The International Society of Thrombosis and Hemostasis recommended avoiding the use of DOACs in morbidly obese patients (body mass index >40 or weight >120 kg) because of limited clinical data. STUDY QUESTION: Are DOACs effective and safe in morbidly obese patients with nonvalvular atrial fibrillation (NVAF). DATA SOURCES: We performed a comprehensive search for published studies indexed in PubMed/MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials that evaluated the efficacy and safety of DOACs in morbidly obese patients with NVAF. STUDY DESIGN: Information on patient characteristics, comorbidities, primary anticoagulation indications, pharmacologic treatment, and outcomes were collected. The primary outcome of interest was stroke or systemic embolism (SSE) rate. The secondary outcome was major bleeding (MB). RESULTS: A total of 10 studies including, 89,494 morbidly obese patients with NVAF on oral anticoagulation therapy (45,427 on DOACs vs. 44,067 on warfarin) were included in the final analysis. The SSE rate was significantly lower in DOACs group compared with warfarin group [odds ratio: 0.71; 95% confidence interval (CI): 0.62-0.81; P < 0.0001; I2 = 0%]. MB rate was also significantly lower in DOACs group compared with the warfarin group (odds ratio: 0.60; 95% CI: 0.46-0.78; P < 0.0001; I2 = 86%). On subgroup analysis, SSE and MB event rates were significantly lower in rivaroxaban and apixaban than warfarin; however, dabigatran showed noninferiority to warfarin in SSE rate but superiority in the safety outcome. CONCLUSIONS: Our meta-analysis demonstrated that DOACs are effective and safe with statistical superiority when compared with warfarin in morbidly obese patients. Large-scale randomized clinical trials are needed to further evaluate the efficacy and safety of DOACs in this cohort of patients.


Assuntos
Fibrilação Atrial , Obesidade Mórbida , Acidente Vascular Cerebral , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Dabigatrana/uso terapêutico , Humanos , Obesidade Mórbida/complicações , Estudos Retrospectivos , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Varfarina/efeitos adversos
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