scispace - formally typeset
Search or ask a question
Journal ArticleDOI

Guidelines on oral anticoagulation with warfarin - fourth edition: Guideline

TL;DR: This guidance is an update of the previous guideline written in 2005 and published in 2006 and replaces the previous BCSH guidelines on oral anticoagulants.
Abstract: The writing group was selected to be representative of UK based experts. This guidance is an update of the previous guideline written in 2005 and published in 2006 (Baglin et al, 2006). The guidance is updated with reference to relevant publications since 2005. Publications known to the writing group were supplemented with additional papers identified by searching PubMed for publications in the last 5 years using the key word warfarin and limits clinical trial, randomized control trial, meta-analysis, humans, core clinical journals, and English language. The writing group produced the draft guideline, which was subsequently revised by consensus by members of the Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology. The guideline was then reviewed by a sounding board of approximately 50 UK haematologists, the BCSH (British Committee for Standards in Haematology), the British Cardiovascular Society and the British Society for Haematology Committee and comments incorporated where appropriate. The ‘GRADE’ system was used to quote levels and grades of evidence, details of which can be found at http://www.bcshguidelines.com/BCSH_PROCESS/EVIDENCE_LEVELS_AND_GRADES_OF_RECOMMENDATION/43_GRADE.html. The objective of this guideline is to provide healthcare professionals with clear guidance on the indications for and management of patients on warfarin. This guideline replaces the previous BCSH guidelines on oral anticoagulants (Baglin & Rose, 1998; Baglin et al, 2006).
Citations
More filters
Journal ArticleDOI
TL;DR: These guidelines are intended to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible.
Abstract: The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and stabilisation of the macro- and microcirculations in order to optimise the patient’s tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality and costs. The purpose of these guidelines is to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees and individual expert members of the ESA. Electronic databases were searched without language restrictions from the year 2000 until 2012. These searches produced 20 664 abstracts. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA changed to favour the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. This report includes general recommendations as well as specific recommendations in various fields of surgical interventions. The final draft guideline was posted on the ESA website for four weeks and the link was sent to all ESA members. Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

883 citations

Journal ArticleDOI
TL;DR: 4F-PCC is an effective alternative to plasma for urgent reversal of vitamin K antagonist therapy in major bleeding events, as demonstrated by clinical assessments of bleeding and laboratory measurements of international normalized ratio and factor levels.
Abstract: Background—Patients experiencing major bleeding while taking vitamin K antagonists require rapid vitamin K antagonist reversal. We performed a prospective clinical trial to compare nonactivated 4-f...

622 citations


Cites background from "Guidelines on oral anticoagulation ..."

  • ...PCCs are effective for urgent VKA reversal(12) and are considered preferable to plasma for rapid INR correction in many countries,(7,13) which is highlighted in treatment guidelines from a number of organizations, including the American College of Chest Physicians, the British Committee for Standards in Haematology, and the Task Force for Advanced Bleeding Care in Trauma.(5,6,14) This prospective, randomized, multinational clinical trial compared 4F-PCC with plasma for urgent VKA reversal in patients with acute major bleeding....

    [...]

  • ...The first step is the administration of vitamin K; however, reversal can take several hours, and therefore it is not recommended as monotherapy for acute bleeding.(5,6) VKDF replacement can be achieved by administering plasma or prothrombin complex concentrate (PCC)....

    [...]

  • ...Nonactivated PCCs are lyophilized concentrates of VKDFs, referred to as 3-factor (contain significant quantities of factors II, IX, and X) or 4-factor (4F; also contain sufficient factor VII).7,11 PCCs can be administered promptly because of their relatively small infusion volume and because there is no need for thawing or blood-type matching.7 PCCs are effective for urgent VKA reversal12 and are considered preferable to plasma for rapid INR correction in many countries,7,13 which is highlighted in treatment guidelines from a number of organizations, including the American College of Chest Physicians, the British Committee for Standards in Haematology, and the Task Force for Advanced Bleeding Care in Trauma.5,6,14 This prospective, randomized, multinational clinical trial compared 4F-PCC with plasma for urgent VKA reversal in patients with acute major bleeding....

    [...]

  • ...This preference for PCCs over plasma is reflected in many guidelines for VKA reversal.(5,6,14)...

    [...]

Journal ArticleDOI
TL;DR: The European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis as discussed by the authors have been published for the management of venous thrombotic vessels.

240 citations

Journal ArticleDOI
TL;DR: Cerebrospinal fluid collection by lumbar puncture is performed in the diagnostic workup of several neurological brain diseases due to a lack of standards and guidelines to minimize the risk of complications, such as post‐LP headache or back pain.

224 citations


Cites background from "Guidelines on oral anticoagulation ..."

  • ..., amyloid positron emission tomography instead of LP to analyze AD biomarkers in CSF) [28]....

    [...]

Journal ArticleDOI
TL;DR: This research presents a probabilistic picture of the immune system’s response to transplants, and some examples of how these responses can be influenced by environmental factors.
Abstract: NHS Blood and Transplant, Imperial College Healthcare NHS Trust, London, University College Hospitals NHS Trust, London, Serious Hazards of Transfusion, NHS Blood and Transplant, Manchester, Royal Hospital for Sick Children, Glasgow, NHS Blood and Transplant, St. Mary’s Hospital, Manchester/University of Manchester, Manchester, Royal Brompton Hospital, London, UK, Mater Research Institute, University of Queensland, Brisbane, Australia, Addenbrookes Hospital/NHS Blood and Transplant, Cambridge, and Oxford University Hospitals NHS Trust/NHS Blood and Transplant, Oxford, UK

218 citations

References
More filters
Journal ArticleDOI
TL;DR: An updated meta-analysis of all currently available randomized trials that extends observations about the efficacy and safety of antithrombotic therapies for preventing stroke in patients who have atrial fibrillation is presented.
Abstract: Hart and colleagues provide an update of a previous meta-analysis of antithrombotic agents for stroke prevention in patients with atrial fibrillation. The updated meta-analysis shows that, compared...

4,265 citations


"Guidelines on oral anticoagulation ..." refers background in this paper

  • ...• The target INR should be 2Æ5 in patients with antiphosp- holipid antibodies (1A)....

    [...]

  • ...Patients at low risk of cardio-embolic stroke may be treated with aspirin while increasing stroke risk favours treatment with the more effective warfarin (Hart et al, 2007; Andersen et al, 2008)....

    [...]

Journal ArticleDOI
TL;DR: Guidelines and Expert Consensus Documents aim to present management recommendations based on all of the relevant evidence on a particular subject in order to help physicians select the best possible management strategies for the individual patient suffering from a specific condition, taking into account the impact on outcome and also the risk–benefit ratio of a particular diagnostic or therapeutic procedure.
Abstract: Guidelines and Expert Consensus Documents aim to present management recommendations based on all of the relevant evidence on a particular subject in order to help physicians select the best possible management strategies for the individual patient suffering from a specific condition, taking into account the impact on outcome and also the risk–benefit ratio of a particular diagnostic or therapeutic procedure. Numerous studies have demonstrated that patient outcomes improve when guideline recommendations, based on the rigorous assessment of evidence-based research, are applied in clinical practice. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) and also by other organizations or related societies. The profusion of documents can put at stake the authority and credibility of guidelines, particularly if discrepancies appear between different documents on the same issue, as this can lead to confusion in the minds of physicians. In order to avoid these pitfalls, the ESC and other organizations have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents. The ESC recommendations for guidelines production can be found on the ESC website.1 It is beyond the scope of this preamble to recall all but the basic rules. In brief, the ESC appoints experts in the field to carry out a comprehensive review of the literature, with a view to making a critical evaluation of the use of diagnostic and therapeutic procedures and assessing the risk–benefit ratio of the therapies recommended for management and/or prevention of a given condition. Estimates of expected health outcomes are included, where data exist. The strength of evidence for or against particular procedures or treatments is weighed according to predefined scales for grading recommendations and levels of evidence, as outlined in what follows. The Task Force members of the writing panels, …

3,707 citations


"Guidelines on oral anticoagulation ..." refers background or methods in this paper

  • ...A finite period of anticoagulation is required to prevent extension of thrombus and prevent early recurrence (within *Prosthesis thrombogenicity: Low: Carbomedics (aortic position), Medtronic Hall, St Jude Medical (without silzone); Medium: BjorkShiley, other bileaflet valves; High: Starr-Edwards, Omniscience, Lillehei-Kaster....

    [...]

  • ...To minimize cardioversion cancellations due to low INRs on the day of the procedure a target INR of 3Æ0 can be used prior to the procedure....

    [...]

  • ...…is required to prevent extension of thrombus and prevent early recurrence (within *Prosthesis thrombogenicity: Low: Carbomedics (aortic position), Medtronic Hall, St Jude Medical (without silzone); Medium: BjorkShiley, other bileaflet valves; High: Starr-Edwards, Omniscience, Lillehei-Kaster....

    [...]

  • ...The benefit of anticoagulation continues only for as long as therapy is continued (Agnelli et al, 2001, 2003; Pinede et al, 2001; Ost et al, 2005; Schulman et al, 2006; Campbell et al, 2007) therefore continued anticoagulation effectively equates to long-term treatment....

    [...]

Journal ArticleDOI
TL;DR: In patients with cancer and acute venous thromboembolism, dalteparin was more effective than an oral anticoagulant in reducing the risk of recurrent thrombosis without increasing therisk of bleeding.
Abstract: Background Patients with cancer have a substantial risk of recurrent thrombosis despite the use of oral anticoagulant therapy. We compared the efficacy of a low-molecular-weight heparin with that of an oral anticoagulant agent in preventing recurrent thrombosis in patients with cancer. Methods Patients with cancer who had acute, symptomatic proximal deep-vein thrombosis, pulmonary embolism, or both were randomly assigned to receive low-molecular-weight heparin (dalteparin) at a dose of 200 IU per kilogram of body weight subcutaneously once daily for five to seven days and a coumarin derivative for six months (target international normalized ratio, 2.5) or dalteparin alone for six months (200 IU per kilogram once daily for one month, followed by a daily dose of approximately 150 IU per kilogram for five months). Results During the six-month study period, 27 of 336 patients in the dalteparin group had recurrent venous thromboembolism, as compared with 53 of 336 patients in the oral-anticoagulant group (haza...

2,224 citations


"Guidelines on oral anticoagulation ..." refers background in this paper

  • ...Patients with cancer-associated VTE are at high risk of recurrence and LMWH has been shown to be more effective than warfarin for the first 6 months of treatment (Lee et al, 2003)....

    [...]

Journal ArticleDOI
TL;DR: In patients with atrial fibrillation for whom vitamin K-antagonist therapy was unsuitable, the addition of clopidogrel to aspirin reduced the risk of major vascular events, especially stroke, and increased the riskof major hemorrhage.
Abstract: Background Vitamin K antagonists reduce the risk of stroke in patients with atrial fibrillation but are considered unsuitable in many patients, who usually receive aspirin instead. We investigated the hypothesis that the addition of clopidogrel to aspirin would reduce the risk of vascular events in patients with atrial fibrillation. Methods A total of 7554 patients with atrial fibrillation who had an increased risk of stroke and for whom vitamin K–antagonist therapy was unsuitable were randomly assigned to receive clopidogrel (75 mg) or placebo, once daily, in addition to aspirin. The primary outcome was the composite of stroke, myocardial infarction, non–central nervous system systemic embolism, or death from vascular causes. Results At a median of 3.6 years of follow-up, major vascular events had occurred in 832 patients receiving clopidogrel (6.8% per year) and in 924 patients receiving placebo (7.6% per year) (relative risk with clopidogrel, 0.89; 95% confidence interval [CI], 0.81 to 0.98; P = 0.01). The difference was primarily due to a reduction in the rate of stroke with clopidogrel. Stroke occurred in 296 patients receiving clopidogrel (2.4% per year) and 408 patients receiving placebo (3.3% per year) (relative risk, 0.72; 95% CI, 0.62 to 0.83; P<0.001). Myocardial infarction occurred in 90 patients receiving clopidogrel (0.7% per year) and in 115 receiving placebo (0.9% per year) (relative risk, 0.78; 95% CI, 0.59 to 1.03; P = 0.08). Major bleeding occurred in 251 patients receiving clopidogrel (2.0% per year) and in 162 patients receiving placebo (1.3% per year) (relative risk, 1.57; 95% CI, 1.29 to 1.92; P<0.001). Conclusions In patients with atrial fibrillation for whom vitamin K–antagonist therapy was unsuitable, the addition of clopidogrel to aspirin reduced the risk of major vascular events, especially stroke, and increased the risk of major hemorrhage. (ClinicalTrials.gov number, NCT00249873.)

2,075 citations


"Guidelines on oral anticoagulation ..." refers background in this paper

  • ...There is clear evidence from both randomized controlled trials (RCTs) and population registries that such combination therapies are associated with an increased risk of major bleeding (Connolly et al, 2006, 2009; Flaker et al, 2006; Sorensen et al, 2009; Hansen et al, 2010) (Table II)....

    [...]

Journal ArticleDOI
01 Jun 2008-Chest
TL;DR: This chapter about treatment for venous thromboembolic disease is part of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) and indicates that the benefits do or do not outweigh risks, burden, and costs.

1,985 citations


"Guidelines on oral anticoagulation ..." refers background in this paper

  • ...It is now clear that the circumstances in which proximal lower limb DVT and/or PE occurs is the strongest predictor of likelihood of recurrence (Baglin, 2007; Kearon, 2007; Kearon et al, 2008)....

    [...]

  • ...Given that this risk exceeds the risk of warfarin-related bleeding, patients with a first unprovoked or recurrent unprovoked episodes of proximal DVT or PE should be considered for long term anticoagulation (Kearon et al, 2008)....

    [...]

Related Papers (5)