Matching articles for "anticoagulants"
Addendum: Treatment of Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • February 5, 2024; (Issue 1695)
The Interruption of Anticoagulation section of our article on Treatment of Atrial Fibrillation cited the recommendations of the American College of Chest Physicians on perioperative management of antithrombotic...
The Interruption of Anticoagulation section of our article on Treatment of Atrial Fibrillation cited the recommendations of the American College of Chest Physicians on perioperative management of antithrombotic therapy (JD Douketis et al. Chest 2022; 162:e207). A reader suggested that our general statement on when to discontinue an oral anticoagulant would have benefited from inclusion of the recommendations of the American College of Cardiology/American Heart Association (JA Joglar et al. Circulation 2024; 149:e1). Recommendations for periprocedural management of oral anticoagulant therapy vary with the anticoagulant, the bleeding risk of the patient and the procedure, the patient’s thromboembolic risk (CHA2DS2-VASc score), the presence of a mechanical valve, and for some anticoagulants, the patient’s renal function. These recommendations are provided in detail in both of the above-cited guidelines.
Treatment of Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • January 8, 2024; (Issue 1693)
Atrial fibrillation (AF) is the most common arrhythmia
in the world. Risk factor modification, anticoagulation,
rhythm control, and rate control are the four pillars
of its management. American College of...
Atrial fibrillation (AF) is the most common arrhythmia
in the world. Risk factor modification, anticoagulation,
rhythm control, and rate control are the four pillars
of its management. American College of Cardiology/American Heart Association (ACC/AHA) guidelines
on management of AF were updated recently.
Drugs for Treatment and Prevention of Venous Thromboembolism
The Medical Letter on Drugs and Therapeutics • July 25, 2022; (Issue 1655)
Anticoagulants are the drugs of choice for treatment
and prevention of deep venous thrombosis (DVT) and
pulmonary embolism (PE), collectively referred to as
venous thromboembolism (VTE). US guidelines...
Anticoagulants are the drugs of choice for treatment
and prevention of deep venous thrombosis (DVT) and
pulmonary embolism (PE), collectively referred to as
venous thromboembolism (VTE). US guidelines for
treatment of VTE were updated in 2020 and 2021.
Comparison Table: Some Parenteral Anticoagulants for VTE (online only)
The Medical Letter on Drugs and Therapeutics • July 25, 2022; (Issue 1655)
...
View the Comparison Table: Some Parenteral Anticoagulants for VTE
Comparison Table: Some Oral Anticoagulants for VTE (online only)
The Medical Letter on Drugs and Therapeutics • July 25, 2022; (Issue 1655)
...
View the Comparison Table: Some Oral Anticoagulants for VTE
Apoaequorin (Prevagen) to Improve Memory
The Medical Letter on Drugs and Therapeutics • November 1, 2021; (Issue 1636)
A synthetic form of the protein apoaequorin is the
active ingredient in the over-the-counter dietary
supplement Prevagen (Quincy Bioscience), which
is heavily marketed to improve...
A synthetic form of the protein apoaequorin is the
active ingredient in the over-the-counter dietary
supplement Prevagen (Quincy Bioscience), which
is heavily marketed to improve memory.
Drugs for Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • September 9, 2019; (Issue 1580)
Treatment of atrial fibrillation includes anticoagulation,
rate control, and rhythm control. US guidelines were
recently...
Treatment of atrial fibrillation includes anticoagulation,
rate control, and rhythm control. US guidelines were
recently updated.
Drugs for Treatment and Prevention of Venous Thromboembolism
The Medical Letter on Drugs and Therapeutics • March 12, 2018; (Issue 1542)
Anticoagulants are the drugs of choice for treatment
and prevention of deep venous thrombosis (DVT) and
pulmonary embolism (PE), collectively referred to as
venous thromboembolism (VTE). Updated US...
Anticoagulants are the drugs of choice for treatment
and prevention of deep venous thrombosis (DVT) and
pulmonary embolism (PE), collectively referred to as
venous thromboembolism (VTE). Updated US guidelines
for treatment of VTE were published in 2016.
Comparison Table: Some Oral Anticoagulants for VTE (online only)
The Medical Letter on Drugs and Therapeutics • March 12, 2018; (Issue 1542)
...
View the Comparison Table: Some Oral Anticoagulants for VTE
Comparison Table: Some Parenteral Anticoagulants for VTE (online only)
The Medical Letter on Drugs and Therapeutics • March 12, 2018; (Issue 1542)
...
View the Comparison Table: Some Parenteral Anticoagulants for VTE
Betrixaban (Bevyxxa) for VTE Prophylaxis in Acute Medical Illness
The Medical Letter on Drugs and Therapeutics • January 1, 2018; (Issue 1537)
The FDA has approved betrixaban (Bevyxxa –
Portola), a once-daily, oral, direct factor Xa inhibitor,
for prophylaxis of venous thromboembolism (VTE)
in adults hospitalized for an acute medical illness
who...
The FDA has approved betrixaban (Bevyxxa –
Portola), a once-daily, oral, direct factor Xa inhibitor,
for prophylaxis of venous thromboembolism (VTE)
in adults hospitalized for an acute medical illness
who have moderately or severely restricted mobility
and other risk factors for VTE. Betrixaban is the
first oral anticoagulant to be approved in the US for
this indication.
Anticoagulation of Elderly Patients at High Risk for Falls with Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • February 27, 2017; (Issue 1515)
With the widespread adoption of the CHA2DS2-VASc
scoring system, oral anticoagulation therapy is
now recommended for all patients ≥75 years old
with nonvalvular atrial fibrillation. Atrial...
With the widespread adoption of the CHA2DS2-VASc
scoring system, oral anticoagulation therapy is
now recommended for all patients ≥75 years old
with nonvalvular atrial fibrillation. Atrial fibrillation
has, however, been associated with an increased
risk of falls, and older patients starting warfarin for
atrial fibrillation have a high rate of hospitalization
for intracranial bleeding. Many practitioners are
reluctant, therefore, to prescribe an oral anticoagulant
for elderly patients who are at high risk for falls.
Drug Interaction: Dabigatran (Pradaxa) and Statins
The Medical Letter on Drugs and Therapeutics • January 30, 2017; (Issue 1513)
The results of a recently published study suggest that
taking the oral direct thrombin inhibitor dabigatran
etexilate (Pradaxa) with either simvastatin (Zocor, and
others) or lovastatin (Altoprev, and...
The results of a recently published study suggest that
taking the oral direct thrombin inhibitor dabigatran
etexilate (Pradaxa) with either simvastatin (Zocor, and
others) or lovastatin (Altoprev, and others) increases the
risk of major hemorrhage.
Which Oral Anticoagulant for Atrial Fibrillation?
The Medical Letter on Drugs and Therapeutics • April 11, 2016; (Issue 1492)
Direct-to-consumer advertisements continue to
urge patients who take warfarin (Coumadin, and
others) for atrial fibrillation to ask their doctors
about the benefits of one or another of the newer
oral...
Direct-to-consumer advertisements continue to
urge patients who take warfarin (Coumadin, and
others) for atrial fibrillation to ask their doctors
about the benefits of one or another of the newer
oral anticoagulants.
Edoxaban (Savaysa) - The Fourth New Oral Anticoagulant
The Medical Letter on Drugs and Therapeutics • March 30, 2015; (Issue 1465)
The FDA has approved edoxaban (Savaysa – Daiichi
Sankyo), a once-daily, oral, direct factor Xa inhibitor,
for treatment of venous thromoboembolism (VTE)
and for prevention of stroke and systemic...
The FDA has approved edoxaban (Savaysa – Daiichi
Sankyo), a once-daily, oral, direct factor Xa inhibitor,
for treatment of venous thromoboembolism (VTE)
and for prevention of stroke and systemic embolism
in patients with nonvalvular atrial fibrillation. It is the
fourth new oral anticoagulant to be approved for VTE
and nonvalvular atrial fibrillation.
Antithrombotic Drugs
The Medical Letter on Drugs and Therapeutics • October 27, 2014; (Issue 1454)
Antiplatelet drugs are the drugs of choice for
prevention and treatment of arterial thrombosis.
Anticoagulants are the drugs of choice for prevention
and treatment of venous thromboembolism and...
Antiplatelet drugs are the drugs of choice for
prevention and treatment of arterial thrombosis.
Anticoagulants are the drugs of choice for prevention
and treatment of venous thromboembolism and for
prevention of cardioembolic events in patients with
atrial fibrillation.
Treatment of Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • July 7, 2014; (Issue 1446)
The treatment of atrial fibrillation includes anticoagulation,
rate control, and rhythm control. New US
guidelines for the management of atrial fibrillation
have recently been...
The treatment of atrial fibrillation includes anticoagulation,
rate control, and rhythm control. New US
guidelines for the management of atrial fibrillation
have recently been published.
Rethinking Warfarin for Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • September 30, 2013; (Issue 1426)
Full-page newspaper advertisements and a series of television
commercials have urged patients with atrial fibrillation
to "rethink warfarin" in favor of Eliquis (apixaban –
Bristol-Myers Squibb). Apixaban...
Full-page newspaper advertisements and a series of television
commercials have urged patients with atrial fibrillation
to "rethink warfarin" in favor of Eliquis (apixaban –
Bristol-Myers Squibb). Apixaban is the latest of 3 new oral
anticoagulants now competing with warfarin (Coumadin,
and others) for the oral anticoagulant market.
Antithrombotic Drugs
The Medical Letter on Drugs and Therapeutics • October 1, 2011; (Issue 110)
Arterial thrombi are composed mainly of platelet
aggregates held together by small amounts of fibrin.
Antiplatelet drugs are the drugs of choice for prevention
and treatment of arterial thrombosis, but...
Arterial thrombi are composed mainly of platelet
aggregates held together by small amounts of fibrin.
Antiplatelet drugs are the drugs of choice for prevention
and treatment of arterial thrombosis, but anticoagulants
are also effective, and their effects can add to those of
antiplatelet drugs. Venous thrombi are composed
mainly of fibrin and trapped red blood cells, with relatively
few platelets. Anticoagulants are the agents of
choice for prevention and treatment of venous thromboembolism
and for prevention of cardioembolic
events in patients with atrial fibrillation.
Prasugrel (Effient) vs. Clopidogrel (Plavix)
The Medical Letter on Drugs and Therapeutics • September 7, 2009; (Issue 1320)
The FDA has approved prasugrel (Effient - Lilly/Daiichi Sankyo), an oral antiplatelet drug, for use with aspirin to reduce the rate of thrombotic cardiovascular events in patients with acute coronary syndromes...
The FDA has approved prasugrel (Effient - Lilly/Daiichi Sankyo), an oral antiplatelet drug, for use with aspirin to reduce the rate of thrombotic cardiovascular events in patients with acute coronary syndromes (ACS) being managed with percutaneous coronary intervention (PCI). It will compete with clopidogrel (Plavix) for such use.
Addendum: Warfarin-Acetaminophen Interaction
The Medical Letter on Drugs and Therapeutics • June 16, 2008; (Issue 1288)
A reader expressed disappointment that our recent listing of “Some Warfarin Drug Interactions”1 did not include acetaminophen. Perhaps it should have. Acetaminophen can increase the anticoagulant effect of...
A reader expressed disappointment that our recent listing of “Some Warfarin Drug Interactions”1 did not include acetaminophen. Perhaps it should have. Acetaminophen can increase the anticoagulant effect of warfarin, particularly with continued use, but it does so inconsistently. The mechanism of this interaction has not been established, but may be related to an acetaminophen metabolite inhibiting vitamin K-epoxide reductase, the target for warfarin’s anticoagulant effect.2
Patient susceptibility varies, possibly on a genetic basis; occasional use of acetaminophen generally has little or no effect on the international normalized ratio (INR) in patients on chronic warfarin therapy, but in some, even a few grams of the drug may cause a dramatic increase in INR. One study in healthy subjects found no effect of acetaminophen 4 g per day for 2 weeks, while another study in patients with the same acetaminophen dose for the same period of time found a moderate increase in INR.3,4 It might be prudent to monitor INR in patients on chronic warfarin therapy more closely than usual when they take more than 2 g per day of acetaminophen for more than a few days.
1. Pharmacogenetic-based dosing of warfarin. Med Lett Drugs Ther 2008; 50:39.
2. HH Thijssen et al. Paracetamol (acetaminophen) warfarin interaction: NAPQI, the toxic metabolite of paracetamol, is an inhibitor of enzymes in the vitamin K cycle. Thromb Haemost 2004; 92:797.
3. D Kwan et al. The effects of acetaminophen on pharmacokinetics and pharmacodynamics of warfarin. J Clin Pharmacol 1999; 39:68.
4. I Mahe et al. Paracetamol: A haemorrhagic risk factor in patients on warfarin. Br J Clin Pharmacol 2005; 59:371.
Download U.S. English
Patient susceptibility varies, possibly on a genetic basis; occasional use of acetaminophen generally has little or no effect on the international normalized ratio (INR) in patients on chronic warfarin therapy, but in some, even a few grams of the drug may cause a dramatic increase in INR. One study in healthy subjects found no effect of acetaminophen 4 g per day for 2 weeks, while another study in patients with the same acetaminophen dose for the same period of time found a moderate increase in INR.3,4 It might be prudent to monitor INR in patients on chronic warfarin therapy more closely than usual when they take more than 2 g per day of acetaminophen for more than a few days.
1. Pharmacogenetic-based dosing of warfarin. Med Lett Drugs Ther 2008; 50:39.
2. HH Thijssen et al. Paracetamol (acetaminophen) warfarin interaction: NAPQI, the toxic metabolite of paracetamol, is an inhibitor of enzymes in the vitamin K cycle. Thromb Haemost 2004; 92:797.
3. D Kwan et al. The effects of acetaminophen on pharmacokinetics and pharmacodynamics of warfarin. J Clin Pharmacol 1999; 39:68.
4. I Mahe et al. Paracetamol: A haemorrhagic risk factor in patients on warfarin. Br J Clin Pharmacol 2005; 59:371.
Download U.S. English
Pharmacogenetic-Based Dosing of Warfarin
The Medical Letter on Drugs and Therapeutics • May 19, 2008; (Issue 1286)
Warfarin sodium (Coumadin, and others) and other coumarin anticoagulants prevent thrombosis, but patient response is highly variable and overanticoagulation can lead to hemorrhage. Genotyping patients for...
Warfarin sodium (Coumadin, and others) and other coumarin anticoagulants prevent thrombosis, but patient response is highly variable and overanticoagulation can lead to hemorrhage. Genotyping patients for single nucleotide polymorphisms (SNPs) that affect coumarin metabolism and sensitivity may help clinicians estimate the therapeutic warfarin dose. The FDA has added a note to warfarin labeling recommending lowrange doses for patients with such genetic variations. Commercial tests for these variants are now available and cost about $500 per test.
Antiplatelet and Anticoagulant Drugs
The Medical Letter on Drugs and Therapeutics • May 1, 2008; (Issue 69)
Arterial and venous thrombosis are major causes of morbidity and mortality. Arterial thrombi consist of platelet aggregates held together by small amounts of fibrin. Antiplatelet drugs are the drugs of choice...
Arterial and venous thrombosis are major causes of morbidity and mortality. Arterial thrombi consist of platelet aggregates held together by small amounts of fibrin. Antiplatelet drugs are the drugs of choice for prevention and treatment of arterial thrombosis, but anticoagulants are also effective, and their effects can add to those of antiplatelet drugs. Venous thrombi are composed mainly of fibrin and trapped red blood cells, with relatively few platelets. Anticoagulants are the agents of choice for prevention and treatment of venous thromboembolism and for prevention of cardioembolic events in patients with atrial fibrillation.
Antifungal Drugs
The Medical Letter on Drugs and Therapeutics • February 1, 2005; (Issue 30)
The drugs of choice for treatment of some fungal infections are listed in the table that begins on page 8. Some of the indications and dosages recommended here have not been approved by the...
The drugs of choice for treatment of some fungal infections are listed in the table that begins on page 8. Some of the indications and dosages recommended here have not been approved by the FDA.
Drugs for Percutaneous Coronary Interventions
The Medical Letter on Drugs and Therapeutics • December 6, 2004; (Issue 1197)
Percutaneous coronary intervention (PCI), such as balloon angioplasty or stent placement, predisposes to subsequent thrombosis. The current pharmacologic approach to prevention of this problem combines an...
Percutaneous coronary intervention (PCI), such as balloon angioplasty or stent placement, predisposes to subsequent thrombosis. The current pharmacologic approach to prevention of this problem combines an anticoagulant with one or more antiplatelet drugs.
Sildenafil for Pulmonary Hypertension
The Medical Letter on Drugs and Therapeutics • March 1, 2004; (Issue 1177)
Several recent case reports suggest that oral sildenafil may be effective for treatment of pulmonary arterial hypertension (PAH). Sildenafil is currently marketed as Viagra for treatment of erectile dysfunction...
Several recent case reports suggest that oral sildenafil may be effective for treatment of pulmonary arterial hypertension (PAH). Sildenafil is currently marketed as Viagra for treatment of erectile dysfunction (Medical Letter 1998; 40:51).
Fondaparinux (Arixtra), A New Anticoagulant
The Medical Letter on Drugs and Therapeutics • May 13, 2002; (Issue 1130)
Fondaparinux (Arixtra - Organon Sanofi-Synthelabo), a synthetic analog of heparin, has been approved by the FDA for prevention of deep vein thrombosis (DVT) after hip fracture surgery or knee or hip...
Fondaparinux (Arixtra - Organon Sanofi-Synthelabo), a synthetic analog of heparin, has been approved by the FDA for prevention of deep vein thrombosis (DVT) after hip fracture surgery or knee or hip replacement.
Bivalirudin (Angiomax) For Angioplasty
The Medical Letter on Drugs and Therapeutics • April 30, 2001; (Issue 1103)
Bivalirudin is being promoted as an intravenous (IV) anticoagulant that can be used instead of heparin in patients with unstable angina undergoing coronary...
Bivalirudin is being promoted as an intravenous (IV) anticoagulant that can be used instead of heparin in patients with unstable angina undergoing coronary angioplasty.
Fenofibrate for Hypertriglyceridemia
The Medical Letter on Drugs and Therapeutics • July 3, 1998; (Issue 1030)
Micronized fenofibrate (Tricor - Abbott), a fibric acid derivative structurally similar to clofibrate (Atromid-S, and others) and gemfibrozil (Lopid, and others), has been approved by the FDA for treatment of...
Micronized fenofibrate (Tricor - Abbott), a fibric acid derivative structurally similar to clofibrate (Atromid-S, and others) and gemfibrozil (Lopid, and others), has been approved by the FDA for treatment of hypertriglyceridemia. Increased serum triglyceride concentrations have been associated with an increased risk of coronary heart disease (J Jeppesen et al, Circulation, 97:1029, 1998).
Systemic Antifungal Drugs
The Medical Letter on Drugs and Therapeutics • September 12, 1997; (Issue 1009)
The drugs of choice for treatment of deep fungal infections are listed in the table below. Some of the indications and dosages recommended here have not been approved by the...
The drugs of choice for treatment of deep fungal infections are listed in the table below. Some of the indications and dosages recommended here have not been approved by the FDA.
Systemic Antifungal Drugs
The Medical Letter on Drugs and Therapeutics • February 2, 1996; (Issue 967)
The drugs of choice for treatment of deep fungal infections are listed in the table on page 101. Some of the indications and dosages recommended here have not been approved by the US Food and Drug...
The drugs of choice for treatment of deep fungal infections are listed in the table on page 101. Some of the indications and dosages recommended here have not been approved by the US Food and Drug Administration. More detailed guidelines are available from the Infectious Diseases Society of America (J Sobel et al, Clin Infect Dis, volume 30, April 2000).
Nizatidine (Axid)
The Medical Letter on Drugs and Therapeutics • August 12, 1988; (Issue 772)
Nizatidine (Axid - Lilly), a new H2-receptor antagonist similar to cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid), was recently approved by the US Food and Drug Administration for treatment...
Nizatidine (Axid - Lilly), a new H2-receptor antagonist similar to cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid), was recently approved by the US Food and Drug Administration for treatment of active duodenal ulcer and for maintenance therapy after healing. Cimetidine, ranitidine and famotidine are also approved for treatment of pathological hypersecretory conditions such as Zollinger- Ellison syndrome; cimetidine is approved in addition for treatment of gastric ulcers.