Author
Michael J. Kovacs
Other affiliations: London Health Sciences Centre, University of California, Los Angeles, Lawson Health Research Institute
Bio: Michael J. Kovacs is an academic researcher from University of Western Ontario. The author has contributed to research in topics: Warfarin & Low molecular weight heparin. The author has an hindex of 48, co-authored 173 publications receiving 10816 citations. Previous affiliations of Michael J. Kovacs include London Health Sciences Centre & University of California, Los Angeles.
Papers published on a yearly basis
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TL;DR: In this article, the authors focus on the common important management questions for which, at a minimum, low-quality published evidence is available to guide best practices and provide guidance for many common anticoagulation-related management problems.
1,061 citations
TL;DR: Patients with a first episode of idiopathic venous thromboembolism should be treated with anticoagulant agents for longer than three months, according to a prespecified interim analysis of efficacy.
Abstract: Background Patients who have a first episode of venous thromboembolism in the absence of known risk factors for thrombosis (idiopathic thrombosis) are often treated with anticoagulant therapy for three months. Such patients may benefit from longer treatment, however, because they appear to have an increased risk of recurrence after anticoagulant therapy is stopped. Methods In this double-blind study, we randomly assigned patients who had completed 3 months of anticoagulant therapy for a first episode of idiopathic venous thromboembolism to continue receiving warfarin, with the dose adjusted to achieve an international normalized ratio of 2.0 to 3.0, or to receive placebo for a further 24 months. Our goal was to determine the effects of extended anticoagulant therapy on rates of recurrent symptomatic venous thromboembolism and bleeding. Results A prespecified interim analysis of efficacy led to the early termination of the trial after 162 patients had been enrolled and followed for an average of 10 months....
1,046 citations
TL;DR: Monthly infusions of pamidronate provide significant protection against skeletal complications and improve the quality of life of patients with stage III multiple myeloma.
Abstract: Background Skeletal complications are a major clinical manifestation of multiple myeloma. These complications are caused by soluble factors that stimulate osteoclasts to resorb bone. Bisphosphonates such as pamidronate inhibit osteoclastic activity and reduce bone resorption. Methods Patients with stage III multiple myeloma and at least one lytic lesion received either placebo or pamidronate (90 mg) as a four-hour intravenous infusion given every four weeks for nine cycles in addition to antimyeloma therapy. The patients were stratified according to whether they were receiving first-line (stratum 1) or second-line (stratum 2) antimyeloma chemotherapy at entry into the study. Skeletal events (pathologic fracture, irradiation of or surgery on bone, and spinal cord compression), hypercalcemia (symptoms or a serum calcium concentration >12 mg per deciliter [3.0 mmol per liter]), bone pain, analgesic-drug use, performance status, and quality of life were assessed monthly. Results Among 392 treated patients, th...
1,024 citations
TL;DR: Conventional- intensity warfarin therapy is more effective than low-intensity warFarin therapy for the long-term prevention of recurrent venous thromboembolism and the low- intensity regimen does not reduce the risk of clinically important bleeding.
Abstract: Background Warfarin is very effective in preventing recurrent venous thromboembolism but is also associated with a substantial risk of bleeding. After three months of conventional warfarin therapy, a lower dose of anticoagulant medication may result in less bleeding and still prevent recurrent venous thromboembolism. Methods We conducted a randomized, double-blind study, in which 738 patients who had completed three or more months of warfarin therapy for unprovoked venous thromboembolism were randomly assigned to continue warfarin therapy with a target international normalized ratio (INR) of 2.0 to 3.0 (conventional intensity) or a target INR of 1.5 to 1.9 (low intensity). Patients were followed for an average of 2.4 years. Results Of 369 patients assigned to low-intensity therapy, 16 had recurrent venous thromboembolism (1.9 per 100 person-years), as compared with 6 of 369 assigned to conventional-intensity therapy (0.7 per 100 person-years; hazard ratio, 2.8; 95 percent confidence interval, 1.1 to 7.0)....
727 citations
TL;DR: Long-term monthly infusions of pamidronate as an adjunct to chemotherapy are superior to chemotherapy alone in reducing skeletal events in stage III multiple myeloma patients, and may improve the survival of patients on salvage therapy.
Abstract: PURPOSETo determine the efficacy and safety of 21 monthly cycles of pamidronate therapy in patients with advanced multiple myeloma.PATIENTS AND METHODSPatients with stage III myeloma and at least one lytic lesion received either placebo or pamidronate 90 mg intravenously administered as a 4-hour infusion monthly for 21 cycles. At study entry, the patients were stratified according to whether they were to receive first-line (stratum 1) or second-line (stratum 2) antimyeloma chemotherapy. Skeletal events (pathologic fracture, radiation or surgery to bone, and spinal cord compression) and hypercalcemia were assessed monthly.RESULTSThe results of the first nine previously reported cycles are extended to 21 cycles. Of the 392 randomized patients, efficacy could be evaluated in 198 who received pamidronate and 179 who received placebo. After 21 cycles, the proportion of patients who developed any skeletal event was lower in the pamidronate-group (P = .015). The mean number of skeletal events per year was less i...
640 citations
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TL;DR: It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management, and management of diseases.
Abstract: PREAMBLE......e4
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It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,
8,362 citations
TL;DR: The current guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation are based on the findings of the ESC Task Force on 12 March 2015.
Abstract: ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).
6,866 citations
TL;DR: Strong recommendations apply to most patients, whereas weak recommendations are sensitive to differences among patients, including their preferences.
5,924 citations
TL;DR: The approach of GRADE to rating quality of evidence specifies four categories-high, moderate, low, and very low-that are applied to a body of evidence, not to individual studies.
5,228 citations
McMaster University1, American University of Beirut2, University of Alcalá3, University of Geneva4, Leiden University Medical Center5, Virginia Commonwealth University6, University of California, San Diego7, Ohio State University8, University of Utah9, UCLA Medical Center10, Ottawa Hospital Research Institute11, Uniformed Services University of the Health Sciences12
TL;DR: Recommendations on 12 topics that were in the 9th edition of these guidelines are updated, and 3 new topics are addressed.
3,934 citations