Cardiology

Warfarin bleeding rates in “real world” Afib

This large observational study of ~125,000 patients on warfarin for Afib found the rate of bleeding to be ~4% per person-year (which is higher than rates reported in randomized controlled trials). Bleeding was highest in the first 30 days (12%), and much higher in the first 30 days in those with a CHADS2 score of 4+ (17%). In addition, over 5 years, 9% of patients were admitted for bleeding, and 18% of those died in the hospital, or within 7 days of discharge (abstract).

Warfarin for 6 months after bioprosthetic aortic valves

In this observational cohort of patients s/p bioprosthetic aortic valve surgery, those on warfarin had significantly lower rates of cardiovascular death, stroke, or thromboemboli, compared to those not on warfarin; these benefits persisted up to 6 months after the surgery. Patients appear to benefit from warfarin for 6 months after bioprosthetic aortic valve surgery (abstract).

Trends in in-hospital cardiac arrest

In this analysis from 2000-2009 from the Get with the Guidelines registry of patients with in-hospital cardiac arrest, 80% had asystole or PEA, and 20% Vfib/Vtach. Survival to discharge increased from 14% to 22% over the time period. Neurological disability also decreased from 33% to 28% over the time period. Advances in in-hospital arrest have improved survival and reduced neurological disability rates (abstract).

Ultrafiltration not helpful in acute CHF

In this randomized trial of patients with acute decompensated CHF and renal insufficiency, patients were randomized to either ultrafiltration or medical therapy; ultrafiltration was not more effective than medical therapy in weight loss, was worse with respect to a change in creatinine, and was associated with more serious adverse events. There does not appear to be a role for ultrafiltration in the treatment of acute decompensated CHF with renal insufficiency (abstract).

Dabigatran not associated with higher bleeding than warfarin

The FDA has released updated information about post-marketing reports of bleeding associated with dabigatran. They found the risk of bleeding does NOT appear to be higher than warfarin; similar to the results of randomized controlled trials. They will continue to monitor this and other anticoagulants, but for now there does not appear to by any reason to prohibit prescribing, if done for FDA approved indications (Afib), at doses appropriate for creatine clearance (FDA site)
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