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This generally well-conducted review concluded that higher efficacy in prevention of symptomatic venous thromboembolism in new anticoagulants following total knee or hip replacement was associated with a higher risk of bleeding. This conclusion accurately reflects the evidence and is likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

This summary covers what research says about the possible benefits and side effects of treatments to help prevent a blood clot after hip or knee surgery. Treatment options include medicines that thin your blood and devices that increase blood flow in your legs (leg or foot coverings that inflate and deflate or elastic stockings). This summary can help you discuss these options with your doctor.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: August 30, 2012

This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center (EPC) examining the comparative efficacy and safety of prophylaxis for venous thromboembolism in major orthopedic surgery (total hip replacement [THR], total knee replacement [TKR], and hip fracture surgery [HFS]) and other nonmajor orthopedic surgeries (knee arthroscopy, injuries distal to the hip requiring surgery, and elective spine surgery).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2012

The study found that the use of novel oral anticoagulants has advantages over warfarin in patients with atrial fibrillation, but there was no strong evidence that they should replace warfarin or low-molecular-weight heparin in the primary prevention, treatment or secondary prevention of venous thromboembolic disease.

Health Technology Assessment - NIHR Journals Library.

Version: March 2017

Atrial fibrillation (AF) is a common cardiac arrhythmia associated with increased morbidity and mortality. Patients with AF are at increased risk of systemic embolism (SE) and stroke, which can cause death, disability, and impaired quality of life. Antithrombotic therapies, such as oral anticoagulant and antiplatelet drugs, can reduce the risk for stroke and systemic thromboembolism and are recommended for most AF patients with risk factors for stroke. Antithrombotic therapies are also associated with a risk of bleeding, and their efficacy for stroke prevention should always be balanced against a patient’s risk of hemorrhage.

CADTH Therapeutic Review - Canadian Agency for Drugs and Technologies in Health.

Version: March 2013

Venous thromboembolic (VTE) events are important causes of morbidity in elective total hip replacement (THR) and total knee replacement (TKR) procedures. Current guidelines recommend thromboprophylaxis in patients undergoing THR or TKR, although the American Academy of Orthopaedic Surgeons (AAOS) guidelines suggest individual assessment of patients when choosing the specific thromboprophylaxis strategy. Low molecular weight heparin (LMWH) and adjusted-dose warfarin are the most commonly used anticoagulants for thromboprophylaxis in the United States, but a number of other treatment options are available, including unfractionated heparin, aspirin, mechanical devices, and newer oral anticoagulants.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: December 2012

To summarize publically available guidance for, and current use of, meta-analytic methods for mixed treatment comparison (MTC) evidence synthesis; to identify analyses using these methods and summarize their characteristics; to gain insight regarding the rationale for selection, implementation, and reporting of such methods from investigators.

Methods Research Reports - Agency for Healthcare Research and Quality (US).

Version: August 2012

These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care.

World Health Organization.

Version: 2016

Atrial fibrillation (AF), the most common cardiac rhythm abnormality, is associated with substantial morbidity. AF-related mortality is mainly attributable to complications of stroke. Stroke risk can be quantified using a validated tool such as the CHADS2 score. Warfarin, a vitamin K antagonist, is the standard of care for patients with AF and has demonstrated efficacy in the prevention of stroke. Warfarin has a narrow therapeutic window, produces varied responses among patients, and interacts with some types of food and other drugs, all of which necessitates routine laboratory monitoring.

CADTH Therapeutic Review - Canadian Agency for Drugs and Technologies in Health.

Version: June 2012

Atrial fibrillation (AF) is a common cardiac arrhythmia associated with increased morbidity and mortality. Patients with AF are at risk of stroke and systemic embolism (SSE), which can cause death, disability, and impaired quality of life. Antithrombotic therapies, such as oral anticoagulant and antiplatelet drugs, can reduce the risk for stroke and systemic thromboembolism and are recommended for most AF patients with risk factors for stroke. The risk of stroke varies considerably across patients; therefore, major guidelines recommend antithrombotic therapy based on risk assessment, quantified using a validated tool such as the CHADS2 score.

Canadian Agency for Drugs and Technologies in Health.

Version: March 2013

Approximately 250,000 Canadians are affected by atrial fibrillation (AF). Stroke is a complication of AF, and Canadians with AF are five times more likely to have a stroke and are twice as likely to die than individuals without AF. AF and stroke are more common among the elderly.

CADTH Therapeutic Review - Canadian Agency for Drugs and Technologies in Health.

Version: April 9, 2012

In order to inform policy work and clinical decisions, a health technology assessment was undertaken by CADTH. For this project CADTH worked in partnership with the Canadian Collaboration for Drug Safety, Effectiveness and Network Meta-Analysis (ccNMA), funded by the Drug Safety and Effectiveness Network (DSEN) of the Canadian Institutes of Health Research (CIHR). The health technology assessment includes both a clinical and an economic evaluation. The clinical component was conducted by ccNMA, and the economic evaluation was conducted by CADTH. This report provides findings from the economic evaluation.

CADTH Technology Review - Canadian Agency for Drugs and Technologies in Health.

Version: March 2016

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010

Study found that the post D-dimer model performed strongly and could be useful to predict individuals’ risk of recurrence of venous thromboembolism at any time up to 2–3 years, thereby aiding patient counselling and treatment decisions.

Health Technology Assessment - NIHR Journals Library.

Version: February 2016

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.

Evidence-Based Synthesis Program - Department of Veterans Affairs (US).

Version: April 2012

Due to a high risk of thromboembolism in patients undergoing major orthopaedic surgery it has become standard practice to give thromboprophylactic treatment to these patients. Pharmaceutical interventions with or without addition of mechanical methods are recommended.

Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH).

Version: June 2011

A systematic review of 179 articles published between January 1980 and May 2011 sought to determine the comparative effectiveness, benefits, and adverse effects of venous thromboembolism (VTE) prophylaxis for patients undergoing orthopedic surgery. The review did not cover the effectiveness of the oral direct factor Xa inhibitor, rivaroxaban. However, after the report was prepared, rivaroxaban was approved by the U.S. Food and Drug Administration (FDA). The comparative effectiveness of rivaroxaban versus enoxaparin from four large phase III trials are briefly reviewed in a separate section of this summary. This summary is provided to inform discussions of options with patients and to assist in decisionmaking that considers a patient’s values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. The full report is available at www.effectivehealthcare.ahrq.gov/thrombo.cfm.

Comparative Effectiveness Review Summary Guides for Clinicians [Internet] - Agency for Healthcare Research and Quality (US).

Version: August 30, 2012

This review aimed to find out which type of treatment works best for preventing future stroke and other blood clotting (thrombotic) events, in people with antiphospholipid syndrome (APS).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

The objective of the systematic review is to compare the clinical and cost-effectiveness of oral antithrombotic agents (i.e., anticoagulant and antiplatelet agents) for the prevention of stroke and other thromboembolic events in patients with atrial fibrillation.

CADTH Therapeutic Review - Canadian Agency for Drugs and Technologies in Health.

Version: August 2012

Daily aspirin reduces the incidence of heart attacks to a small degree, but increases the incidence of major bleeding events to a similar degree in patients treated for high blood pressure who have not had a prior stroke or heart attack. In patients with high blood pressure who have had a stroke or heart attack, the benefits of daily low‐dose aspirin outweigh the harms. There is no evidence of benefit for antithrombotic therapy with warfarin alone or in combination with aspirin in patients with high blood pressure. The benefits and harms of the newer drugs glycoprotein IIb/IIIa inhibitors, clopidogrel, prasugrel, ticagrelor and oral antithrombotic agents such as dabigatran and rivaroxaban for patients with high blood pressure have not been studied in clinical trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Systematic Reviews in PubMed

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Systematic Review Methods in PubMed

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