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Anticoagulation

Blood clots

Anticoagulants are prescribed to help prevent blood clots in those at risk of developing them, including people with artificial heart valves or atrial fibrillation, those who have had a heart attack or stroke and those at risk of deep vein thrombosis or pulmonary embolism. Warfarin is the most commonly prescribed anticoagulant but requires regular coagulation monitoring and has numerous interactions with other drugs and food. Four new oral anticoagulants (NOACs) are also available in the UK, which have a more predictable therapeutic response, a more rapid onset of action, fewer drug interactions and no requirement for regular coagulation monitoring. On this page you will find news stories and articles relating to anticoagulants, which cover the development and licensing of NOACs and the management of patients taking both NOACs and warfarin. Our research article also examines the impact of a pharmacist-led anticoagulant review clinic for high-risk patients.

Infographic

Infographic on the new oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation

New oral anticoagulants for stroke prevention in atrial fibrillationSubscription

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Around 12,500 strokes are caused by atrial fibrillation (AF) in the UK each year, and 7,100 of these are preventable with appropriate anticoagulation. Four new oral anticoagulants (NOACs) are now available in the UK in addition to warfarin.

Learning

Risk stratification and ongoing care is important in non-ST elevation acute coronary syndrome, the new collective term for unstable angina and non-ST elevation myocardial infarction. In the image, a nurse looks at the ECG results of a patient

Non-ST elevation acute coronary syndrome: an updateSubscription

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Risk stratification and ongoing care is important in non-ST elevation acute coronary syndrome, the new collective term for unstable angina and non-ST elevation myocardial infarction.

X-ray of deep vein thrombosis, pictured. Low molecular weight heparins (LMWHs) are used widely for the prophylaxis and treatment of venous thromboembolism (VTE).

Low molecular weight heparins for treating venous thromboembolismSubscription

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How to start patients on these common injected anticoagulants and optimise treatment.

Complications after cardiac surgery can be life-threatening but are manageable with appropriate drug treatment

Cardiac surgery: caring for a patient and managing complicationsSubscription

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Life-threatening complications following cardiac surgery are common, but can be managed with appropriate treatment.

CPD and research articles

Testing for blood clotting

How to identify causes of a subtherapeutic INRSubscription

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Pharmacists and healthcare professionals are often involved in the management of patients with subtherapeutic international normalised ratios (INRs), the cause of which is important to identify because this will affect decisions and the subsequent management of the patient.

Oral anticoagulant therapy and INR blood test monitor

Assessing the impact of a targeted pharmacist-led anticoagulant review clinicSubscription

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Local guidance, supported by the 2014 National Institute for Health and Care Excellence (NICE) guideline CG180 for atrial fibrillation (AF), recommends that patients receiving inadequate anticoagulation with a vitamin K antagonist (VKA), including time in therapeutic range (TTR) of <65%, should be reassessed. These patients were identified by the anticoagulation monitoring service (AMS) and highlighted to GPs for review. However, up to 59.3% of patients received ...

Close up of a leg with livedo reticular is

Antiphospholipid syndrome: pathophysiology, diagnosis and treatmentSubscription

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How antiphospholipid syndrome, also known as Hughes syndrome, is diagnosed and the appropriate therapeutic options for its management.

Micrograph of a blood filled micrograph

Bridging anticoagulation: perioperative management of patients on anticoagulantsSubscription

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How patients on anticoagulants can be effectively managed in the perioperative period, including the evidence for the need for ‘bridging’ anticoagulation therapy and introduction of direct oral anticoagulants.

The thyroid is a small gland located in the front of the neck. The thyroid hormones stimulate diverse metabolic activities, leading to regulation of the basal metabolic rate. In the image, scanning electron micrograph of follicles found in the thyroid

Thyroid dysfunction and drug interactionsSubscription

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Correcting thyroid function can require dose adjustment of common medicines to prevent serious complications.

Pomegranate and other citrus fruit juices can interact with common medicines and put patients at risk

How fruit juice interacts with common medicinesSubscription

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How fruit juices can interact with common medicines and put your patients at risk.

Doctor uses a defibrillator on a patient

Atrial fibrillation guideline updatesSubscription

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How the latest clinical guidelines change the management of a cardiac arrhythmia affecting 1% of adults in the UK.

News and events

Rivaroxaban, marketed by Xarelto

Rivaroxaban more effective than aspirin for preventing blood clots, study results suggest

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Researchers find that blood clot rates in patients taking rivaroxaban were significantly lower than those taking aspirin, and there were no significant differences between bleeding side effects.

warfarin tablets haematoma risk

Danish study confirms brain haemorrhage risk associated with anticoagulation

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Patients prescribed antithrombotic drugs, such as low-dose aspirin, clopidogrel or warfarin, are at increased risk of having a subdural haematoma, research published in JAMA has confirmed.

The new oral anticoagulant drugs Dabigatran, Rivaroxaban and Apixaban pills and pill boxes

Safety issues highlighted with newer oral anticoagulant drugs

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Analysis of ‘real-life’ data comparing newer direct oral anticoagulants with warfarin has identified adverse drug reactions (ADRs) ‘not previously associated’ with the new treatments, including hip fracture.

Rivaroxaban (Xarelto)

The BMJ accuses drug company of withholding data on faulty test device in rivaroxaban trial

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Janssen may have withheld data from the US Food and Drug Administration about a faulty blood testing device used in a trial of the anticoagulation drug rivaroxaban, according to the results of an investigation by The BMJ.

Blood cells in an artery

Most long-term warfarin patients won’t retain stable blood levels

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Only a third of patients taking warfarin will retain stable blood levels in the long term, research published in JAMA has revealed (online, 9 August 2016).

Blood clot illustration

Apixaban more effective than warfarin regardless of polypharmacySubscription

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The oral anticoagulant apixaban is consistently more effective than warfarin for patients with atrial fibrillation regardless of the number of other drugs they take, a study has found. 

Stroke MRI scan brain

Many atrial fibrillation patients at risk of stroke treated with aspirin over anticoagulantsSubscription

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Around 40% of atrial fibrillation patients who have an intermediate or high risk of stroke are treated only with aspirin, even though aspirin is less effective than oral anticoagulation, according to new research.

MRI scan of a brain with stroke

Early aspirin use after transient ischaemic attack cuts severe stroke risk by 90%Subscription

Large analysis of data shows taking aspirin within two weeks of transient ischaemic attack or stroke cuts risk of secondary stroke by over 90%.

An MRI scan of Alzheimer's disease in the brain

Atrial fibrillation patients on warfarin have increased risk of dementia

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Patients with atrial fibrillation (AF) being treated with warfarin have higher rates of dementia compared with those taking the drug for other conditions, research shows.

CT scan of a brain showing intracranial bleeding

Well-managed warfarin still useful for stroke preventionSubscription

A study of 40,000 patients with atrial fibrillation suggests that warfarin is a valid treatment for stroke prevention.

Testing for blood clotting

Patients' education plays part in how they manage anticoagulants Subscription

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The educational background of patients with atrial fibrillation directly influences how they manage their anticoagulation, according to research. 

The European Medicines Agency (EMA) has reiterated the overall safety of rivaroxaban (Xarelto), an anticoagulant, despite a defect in a device used in a pivotal study behind the drug’s marketing approval in the European Union and the United States

European regulator says anticoagulant is safe, despite question marks over its pivotal trialSubscription

The European Medicines Agency has reiterated the overall safety of rivaroxaban (Xarelto), an anticoagulant, despite a defect in a device used in a pivotal study behind the drug’s marketing approval in the European Union and the United States.

The validity of data produced by a pivotal trial to gain approval for direct oral anticoagulant rivaroxaban (Xarelto) from US and European regulators has been called into question by an investigation published by The BMJ.

Concerns raised about trial supporting top selling anticoagulant drugSubscription

The validity of the data produced by a pivotal trial to gain approval for the direct oral anticoagulant, rivaroxaban (Xarelto), from the US and European regulators, has been called into question by an investigation.

New anti-platelet drug set for phase II study after success in patients with coronary heart disease. Pictured, a blood clot in coronary artery.

Novel anti-platelet therapy shows promise in first human trialsSubscription

New anti-platelet drug set for phase II study after success in patients with coronary heart disease.

Findings show that andexanet could provide a rapid antidote to factor Xa inhibitors (molecular structure pictured) for patients who experience bleeding or need emergency surgery

Antidote to new oral anticoagulants proves effective Subscription

Anticoagulant effects of factor Xa inhibitors can be reversed by inactive recombinant factor Xa protein, andexanet, study shows.

The US medicines safety watchdog has given fast-track approval to idarucizumab (Praxbind), a drug that can neutralise the effects of the anticoagulant dabigatran etexilate (Pradaxa). In the image, light micrograph of human blood clotting

FDA approves idarucizumab as antidote to dabigatranSubscription

The US medicines safety watchdog has given fast-track approval to idarucizumab (Praxbind), a drug that can neutralise the effects of the anticoagulant dabigatran etexilate (Pradaxa).

Idarucizumab, a unique drug which can neutralise the effect of the anticoagulant dabigatran etexilate, is being recommended for marketing authorisation across the EU. In the image, micrograph of a blood clot in the heart

Anticoagulant antidote idarucizumab gets European regulator’s initial approvalSubscription

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Idarucizumab (Praxbind), a unique drug that can neutralise the effect of anticoagulant dabigatran etexilate (Pradaxa), has been recommended for marketing authorisation by the European medicines safety watchdog.

For patients admitted to hospital, the most common cause of preventable death is venous thromboembolism. Researchers found that 36% of high-risk patients were not receiving prophylactic anticoagulation. In the image, a patient on a hospital bed

Under treatment of venous thromboembolism persists in cardiac unitSubscription

Researchers introduced a new protocol in a cardiology unit to help ensure patients at risk were put on anticoagulants, but there were still high rates of under treatment.

Since 2010, four new direct oral anticoagulant drugs (DOACs) have been rapidly adopted and contributed to an increase in atrial fibrillation patients treated with anticoagulants. In the image, micrograph of a blood clot showing erythrocytes and leukocytes

Rapid uptake of new oral anticoagulants in the United States Subscription

More patients with atrial fibrillation are being protected against blood clots after the introduction of new direct oral anticoagulant drugs.

Patients recovering from their first pulmonary embolism who received an extra 18-months of anticoagulant (warfarin) treatment lost the benefit of that treatment once their treatment came to an end. In the image, x-ray of a pulmonary embolism

Researchers suggest indefinite anticoagulation for patients with unprovoked pulmonary embolismSubscription

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Research into the benefits of warfarin for patients who have suffered a blockage in a lung artery suggest that the anticoagulant should be administered indefinitely.

People on oral anticoagulation therapy can successfully self-monitor and even self-manage their international normalised ratio (INR) using commercially available devices, research shows. In the image, micrograph of a blood clot

Study finds favour in self-monitoring for patients on oral anticoagulantsSubscription

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People using oral blood thinning therapy such as warfarin can successfully monitor and manage their own international normalised ratio (INR) using commercially available devices, research shows.

Researchers find that patients’ reasons for not taking their medicines are multifactorial, with some reporting financial hardship because of the expense of drugs. In the image, a man on a hospital bed being assessed for heart attack risk

Recovering heart attack patients fail to adhere to prescribed medicationsSubscription

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Some patients who survive a heart attack fail to take the drugs they are prescribed after being discharged from hospital, a large US study has found.

EMA recommends edoxaban for prevention of stroke in atrial fibrillationSubscription

The European Medicines Agency is recommending that edoxaban be made available for the prevention of stroke in atrial fibrillation and the prevention and treatment of venous thromboembolism.

Safeguarding patients against the risk of bleeding and the management of polypharmacy are vital roles for pharmacists when dealing with patients taking new oral anticoagulants (NOACs), according to speakers at the annual congress of the EAHP in Hamburg

Managing the risk of bleeding with new oral anticoagulantsSubscription

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Safeguarding patients against the risk of bleeding is a vital role for pharmacists when dealing with patients taking new oral anticoagulants.

Adherence to the oral anticoagulant dabigatran varies substantially among clinics and is higher at sites with pharmacist-led monitoring and appropriate patient selection, a US study finds. In the image, a pharmacist consults with a patient

Pharmacist-led monitoring improves adherence to dabigatranSubscription

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Adherence to the oral anticoagulant dabigatran varies substantially among clinics and is higher at sites with pharmacist-led monitoring and appropriate patient selection, a US study has found.

Genetic analysis can predict patients at increased risk of suffering from bleeding during treatment with the blood thinner warfarin, confirms a new study.

Genetic analysis can predict bleeding risk in warfarin usersSubscription

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Genetic analysis can point to patients who are at increased risk of suffering from bleeding during treatment with the blood thinner warfarin, a study published in The Lancet confirms.

Survey shows that in patients who have taken aspirin as primary prevention, treatment was inappropriate in nearly 11.6% of cases

Aspirin inappropriately used for CVD prevention in just over 10% of casesSubscription

A survey of nearly 70,000 patients taking aspirin for primary prevention has found that, for the overall cohort, treatment was inappropriate in nearly 11.6% of cases.

Light micrograph of patient with chronic kidney disease

Major bleeding risk higher for dabigatran than for warfarin, study suggestsSubscription

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Research suggests that dabigatran is associated with a higher risk of bleeding compared with warfarin in a US population sample.

Patients receiving warfarin therapy should have access to blood clotting tests to monitor their coagulation status

Patients taking warfarin should self-monitor their coagulation status, says NICESubscription

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NICE recommends two point-of-care coagulometers for use by patients – Roche Diagnostic’s CoaguChek XS system and Alere’s INRatio2 PT/INR monitor.

Aspirin can be used to prevent venous thromboembolism

Daily aspirin cuts venous thromboembolism recurrenceSubscription

A daily dose of 100mg aspirin cuts venous thromboembolism recurrence by up to 42% over two years, without significantly increasing bleeding risk.

The BMJ warns over withheld dabigatran analyses

Boehringer Ingelheim failed to share information about the potential safety benefits of monitoring the anticoagulant activity of dabigatran with regulators, an investigation by The BMJ has claimed.

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