Evidence map›Paper›PMID 30952383›Full record

ReviewTrends in cardiovascular medicine2020

A review of oral anticoagulants, old and new, in major bleeding and the need for urgent surgery.

Truman J Milling, Christopher M Ziebell

Open access · greenAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Trends in cardiovascular medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 4 pooled it
4.5field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 4 syntheses or guidelines pooled it, 77 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

2 authors at 1 institution in 1 country.

Truman J MillingDepartment of Surgery and Perioperative Care, Dell Medical School, Austin, TX, USA; Department of Neurology, Seton Dell Medical School Stroke Institute, 1400 N IH 35 Suite C3.400, Austin, Texas 78701. Electronic address: tmilling@ascension.org.
Christopher M ZiebellDepartment of Surgery and Perioperative Care, Dell Medical School, Austin, TX, USA.
Dell Children's Medical Center of Central Texas · US

Funding

A Patient Centered Approach to Restarting Oral Anticoagulant Therapy After Major HemorrhageK23HL127227 · NHLBI · SETON HEALTHCARE · PI MILLING, TRUMAN · 2016 to 2021
$764k
NHLBI NIH HHS K23 HL127227
6 · The paper itself

Abstract

Oral anticoagulants, old and new, are effective therapies for prevention and treatment of venous thromboembolism and reduction of stroke risk in patients with atrial fibrillation. However, blocking elements of the clotting cascade carries an inherent risk of bleeding. Also, anticoagulated patients sometimes require urgent surgery or invasive procedures. This has led to the emergence of a body of scientific literature on the reversal of anticoagulation in these two settings. Traditionally, vitamin K antagonists (VKAs), which indirectly inactivate clotting factors II, VII, IX and X (and natural anticoagulant proteins C and S), had been the mainstay of oral anticoagulation for half a century. Only a few years ago, the US Food and Drug Administration (FDA) approved a specific VKA reversal agent, 4-Factor Prothrombin Complex Concentrate (4F-PCC). The last decade has seen the rise of non-Vitamin K oral anticoagulants (NOACs), which target specific factors, i.e. Factors IIa and Xa. Investigators have rapidly developed reversal agents for these agents as well, idarucizumab for the Factor IIa inhibitor dabigatran (Pradaxa) and andexanet alfa for the entire class of Factor Xa inhibitors (FXaIs), currently four drugs: rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Savaysa) and betrixaban (Bevyxxa). Clinicians still use off-label PCC for reversing FXaIs in some settings, and a universal reversal agent, ciraparantag, remains in development. This review summarizes the safety and efficacy of these reversal agents in the setting of anticoagulant-associated major bleeding and the need for urgent surgery.

Indexed as

Perioperative CareAdministration, OralAnticoagulantsAntidotesAtrial FibrillationBlood CoagulationBlood Loss, SurgicalClinical Decision-MakingCoagulantsDrug Administration ScheduleHumansPostoperative HemorrhageRisk AssessmentRisk FactorsStrokeTreatment OutcomeAnticoagulantsAntidotesCoagulantsAndexanet alfaAnticoagulantApixabanCoumadinDabigatranDirect oral anticoagulantsIdarucizumabKcentra, 4-factor prothrombin complex concentrateMajor bleedingNon-Vitamin K oral anticoagulantsReversalRivaroxabanVitamin K antagonistsWarfarin

Identifiers

PMID30952383
PMCPMC6763385
OpenAlexW2923040560

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.