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Cover of Comparative Effectiveness of Warfarin and Newer Oral Anticoagulants for the Long-Term Prevention and Treatment of Arterial and Venous Thromboembolism

Comparative Effectiveness of Warfarin and Newer Oral Anticoagulants for the Long-Term Prevention and Treatment of Arterial and Venous Thromboembolism

Evidence-Based Synthesis Program

Investigators: , MD, , PhD, , MD, PhD, , MS, and , MD, MHSc.

Evidence-based Synthesis Program (ESP) Center, Durham Veterans Affairs Healthcare System
Washington (DC): Department of Veterans Affairs; .

Excerpt

The Veterans Health Administration (VHA) System serves a largely older, male population with a high prevalence of chronic atrial fibrillation (AF) and venous thromboembolism (VTE). Many veterans with chronic AF have risk profiles for stroke that, according to current clinical guidelines, place them in a risk group where chronic anticoagulation is recommended. Adjusted-dose warfarin has been the preferred approach to chronic anticoagulation in the VHA, and in many VHA settings, specialized therapeutic drug-monitoring services provide high-quality warfarin treatment. However, the advent of newer anticoagulants with the promise of simplified long-term anticoagulation requires reconsideration of current treatment practices. The purpose of this systematic review was to study the comparative effectiveness of warfarin and the newer oral anticoagulants used for the long-term prevention and treatment of arterial and venous thromboembolism. An evaluation of newer oral anticoagulants for VTE prophylaxis in the perioperative period will be the subject of a later report.

Contents

Medical Editor: Liz Wing, MA

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Durham Veterans Affairs Healthcare System, Durham, NC, John W. Williams Jr., M.D., M.H.Sc., Director.

Suggested citation:

Adam SS, McDuffie JR, Ortel TL, Nagi A, Williams JW Jr. Comparative Effectiveness of Warfarin and Newer Oral Anticoagulants for the Long-term Prevention and Treatment of Arterial and Venous Thromboembolism. VA-ESP Project #09-010; 2012.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Durham VA Medical Center, Durham, NC, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. Potential conflicts of interest: Dr. Ortel: Grants: GlaxoSmithKline, Eisai, Daichi Sankyo, Pfizer; Consultancy: Boehringer Ingelheim. No other investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.

Bookshelf ID: NBK97541PMID: 22696783
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