A meta-analysis of studies on recurrent venous thromboembolism; updated guidelines for management of atrial fibrillation; a meta-analysis of studies comparing generic and branded warfarin
More than 2,500 patients were included in these studies and were followed for an average of 27 months. At 1 year, the incidence of recurrence was 5.3% in women and 9.5 % in men, rising to 9.1% in women and 19.7% in men at 3 years. Men have a 2.2-fold higher risk of recurrent VTE than do women, a risk that remains 1.8-fold higher after adjusting for hormone-associated VTE in women. The risk of recurrence in patients with a provoked VTE occurring after a major risk factor such as surgery, trauma, or cancer was similar for both sexes.
The authors stated that their findings suggest that indefinite anticoagulation be considered for men who have a first episode of unprovoked VTE.
Guidelines for management of AF updated
The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Task Force on Practice Guidelines has published a focused update to revise the existing guideline recommendations for atrial fibrillation (AF). Full updates are published every 3 years; however, due to rapidly evolving science, evidence will now be reviewed every 6 months and updates issued as needed.
The most recent update addresses several issues. Areas that pertain to anticoagulation are the use of clopidogrel plus aspirin in this patient population and the use of dabigatran. The guidelines now state that "the addition of clopidogrel to aspirin (ASA) to reduce the risk of major vascular events, including stroke, might be considered in patients with AF in whom oral anticoagulation with warfarin is considered unsuitable due to patient preference or the physician's assessment of the patient's ability to safely sustain anticoagulation. (Level of Evidence: B)"
The work group did not make any specific recommendations regarding the use of dabigatran because the drug had not been approved at the time the guidelines were approved. An addendum addressing this issue is likely to be forthcoming. The full text of the new guidelines can be accessed at http://circ.ahajournals.org/cgi/content/full/123/1/104.
Source: 2011 Writing Group Members, Wann LS, Curtis AB, January CT, et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;123:104-123.