Coagulation mixing studies: utility, algorithmic strategies and limitations for lupus anticoagulant testing or follow up of abnormal coagulation tests.

Coagulation testing underpins the investigation of hemostasis and/or monitoring of anticoagulation therapy for prevention and/or treatment of thrombosis related pathology. Assessment of coagulation results requires comparison against a normal reference […]

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Stroke and thromboembolism prevention in atrial fibrillation.

Abstract: Prevention of stroke and systemic thromboembolism remains the cornerstone for management of atrial fibrillation (AF) and flutter. Multiple risk assessment models for stroke and systemic thromboembolism are currently available. […]

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Secondary stroke prevention: a population-based cohort study on anticoagulation and antiplatelet treatments, and the risk of death or recurrence.

Abstract: Using claims databases of a public healthcare program (Quebec) for the years 2010 – 2013, we conducted a cohort study of acute ischemic stroke (AIS) patients to describe secondary […]

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Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes.

Abstract: Treatment strategies for complex patients with pulmonary embolism (PE) are often debated given patient heterogeneity, multitude of available treatment modalities, and lack of consensus guidelines. Although multidisciplinary Pulmonary Embolism […]

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Long-term antithrombotic therapy and risk of intracranial haemorrhage from cerebral cavernous malformations: a population-based cohort study, systematic review, and meta-analysis.

Abstract: Antithrombotic (anticoagulant or antiplatelet) therapy is withheld from some patients with cerebral cavernous malformations, because of uncertainty around the safety of these drugs in such patients. We aimed to […]

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Changes in Management Following Detection of Previously Unknown Atrial Fibrillation by an Insertable Cardiac Monitor (from the REVEAL AF Study).

The REVEAL AF study demonstrated a high incidence of previously undetected atrial fibrillation (AF) using insertable cardiac monitors (ICMs) in patients with risk factors for AF and stroke. This analysis evaluated whether ICM monitoring led to changes in clinical management after AF detection. Patients with CHADS2 scores ?3 (or =2 with ?1 additional AF risk factor) but no history of AF received an ICM and were followed 18 to 30 months. Physicians recorded changes in clinical management in response to AF detection at scheduled (every 6 months) and unscheduled follow-up visits. Changes in clinical management included oral anticoagulation, rhythm or rate control pharmacotherapy, cardioversion, ablation, and cardiac subspecialist referral. In 387 patients who met inclusion criteria and received an ICM, AF was found in 115. A change in clinical management was taken in 87 patients with AF (76%). In 80 of these 87, a change was taken at the first visit after AF detection. In total, 31 patients (27%) with AF had ?2 visits at which changes in clinical management were taken. The most common change was initiation of oral anticoagulation (n?=?73, 63% of patients with AF). Patients with a change in clinical management at the first visit after AF detection tended to have longer AF episodes and a higher maximal daily AF burden compared with AF patients for whom no change was taken (longest episode: 52 vs 28 minutes; maximal daily AF burden:112 vs 23 minutes). Changes in management more frequently occurred at visits where patients reported AF-compatible symptoms (65% vs 46% of visits, p?=?0.01). In conclusion, ICM monitoring to identify AF guides both immediate and long-term patient management in a population at high risk for stroke.

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Accuracy of the Ottawa score in risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. A systematic review and meta-analysis.

In patients with cancer-associated venous thromboembolism, knowledge on the estimated rate of recurrent events is important for clinical decision regarding anticoagulant therapy. The Ottawa score is a clinical prediction rule designed for this purpose, stratifying patients according to their risk of recurrent venous thromboembolism during the first 6 months of anticoagulation. We conducted a systematic review and meta-analysis of studies validating either the Ottawa score in its original or modified version. Two investigators independently reviewed the relevant articles published from 06/01/2012 to 12/15/2018 and indexed in MEDLINE and EMBASE. Nine eligible studies were identified including 14,963 patients. The original score classified 49.3% of the patients as high-risk, with a sensitivity of 0.7 (95% confidence interval 0.6-0.8), a 6-month pooled rate of recurrent venous thromboembolism of 18.6% (95% confidence interval 13.9-23.9). In the low-risk group, recurrence rate was 7.3% (95% confidence interval 3.4-12.5). The modified score classified 19.8% of the patients at low-risk, with a sensitivity of 0.9 (95% confidence interval 0.4-1.0) and a 6-month pooled rate of recurrent venous thromboembolism of 2.2% (95% confidence interval 1.6-2.9). In the high-risk group, recurrence rate was 10.1% (95% confidence interval 6.4-14.6). Limitations of our analysis included type and dosing of anticoagulant therapy. We conclude that new therapeutic strategies are needed in patients at high-risk for recurrent cancer-associated venous thromboembolism. Low-risk patients, as per the modified score, could be good candidates to oral anticoagulation (PROSPERO CRD42018099506).

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Alert-based computerized decision support for high-risk hospitalized patients with atrial fibrillation not prescribed anticoagulation: a randomized, controlled trial (AF-ALERT).

Abstract: Despite widely available risk stratification tools, safe and effective anticoagulant options, and guideline recommendations, anticoagulation for stroke prevention in atrial fibrillation (AF) is underprescribed. We created and evaluated an […]

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