NOACs for treatment of venous thromboembolism in clinical practice

Randomised controlled trials have provided important information on the efficacy and safety of the non-vitamin K antagonist oral anticoagulants (NOACs) for treatment of venous thromboembolism (VTE), leading to registration and increasing use in clinical practice. Many questions remain to be answered, and observational studies are often more suitable for answering "real-world" questions than randomised controlled trials. Patient satisfaction, quality of life, and adherence and persistence in clinical practice with the drug regimen can only be assessed with an open-label design. Evaluation of risk for long-term sequelae of the disease requires much longer follow-up than is possible in registration trials. Treatment patterns and utilisation of health care resources can be assessed from observations in the clinical practice setting. We will review published as well as currently active observational studies with NOACs in VTE, with or without a comparator anticoagulant. These studies are based on cohorts of different sizes, registries, or administrative health care databases. We will also discuss some limitations in analysis and interpretation of observational studies

Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study

In randomized clinical trials (RCTs) of nonvitamin K antagonist oral anticoagulants (NOACs) for acute venous thromboembolism (VTE),\u2009~\u200912-13% of patients were elderly and\u2009~\u200926% had mild-to-moderate renal impairment. Observational studies are not restricted by the selection and treatment criteria of RCTs. In this ancillary analysis of the RE-COVERY DVT/PE global observational study, we aimed to describe patient characteristics, comorbidities, and anticoagulant therapy for subgroups of age (<\u2009or\u2009 65\u200975 years) and renal impairment (creatinine clearance [CrCl; estimated with Cockcroft-Gault formula]\u2009<\u200930 [severe], 30 to\u2009<\u200950 [moderate], 50 to\u2009<\u200980 [mild],\u2009 65\u200980 [normal] mL/min). Of 6095 eligible patients, 25.3% were aged\u2009 65\u200975 years; 38.2% (1605/4203 with CrCl values) had mild-to-moderate renal impairment. Comorbidities were more common in older patients (73.9% aged\u2009 65\u200975 vs. 58.1%\u2009<\u200975 years) and in those with mild or moderate versus no renal impairment (75.9%, 80.9%, and 59.3%, respectively). At hospital discharge or 14 days after diagnosis (whichever was later), most patients (53.7% and 55.1%, respectively) in both age groups received NOACs; 20.8% and 23.4%, respectively, received vitamin K antagonists, 19.0% and 21.8% parenteral therapy, 2.3% and 3.8% other anticoagulant treatments. Use of NOACs decreased with worsening renal impairment (none 58.5%, moderate 49.6%, severe 25.7%) and, in younger versus older patients with moderate renal impairment (33.1% vs. 56.1%). In routine practice, there are more elderly and renally impaired patients with VTE than represented in RCTs. Decreasing renal function, but not older age, was associated with less NOAC use. Clinical Trial Registration: http://www.clinicaltrials.gov . Unique identifier: NCT02596230. Decreasing renal function, particularly in the subgroup with CrCl\u2009<\u200930 mL/min, but not older age, was associated with less use of nonvitamin K antagonist oral anticoagulants (NOACs). Nevertheless, more than half of the older patients with moderate renal impairment received a NOAC as their oral anticoagulant

Profile of Patients Diagnosed With Acute Venous Thromboembolism in Routine Clinical Practice: The RE-COVERY DVT/PE\u2122 Study

The safety and efficacy of nonvitamin K antagonist oral anticoagulants (NOACs) for the treatment of venous thromboembolism (VTE) have been established in randomized controlled trials, but limited data are available on their use in clinical practice across geographical regions

Analysis of a Control System for DFIG Wind Generators Based on the Transmission of Power References through a GSM Wireless Network: A Smart Grid Experimental Approach

This work proposes the use of the automatic Short Message Service (SMS) of a Global System for Mobile Communication (GSM) network to transmit the control information to a Doubly Fed Induction Generator (DFIG) of a wind turbine, according to the Smart Grid (SG) concept. In the proposed strategy, the Control Center (CC) can remotely transmit the required power references (active and reactive) to the DFIG controller, in order to manage the power generation of the wind turbine dynamically. The proposed wireless network was developed in a Software Defined Radio (SDR) transceiver connected to an OpenBTS platform. The control information can be directly inserted in the Open Base Transceiver Station (OpenBTS) server (located at the CC) or sent by a wireless device (e.g., mobile phone) connected to the GSM network, and then transmitted to the wireless receiver at the wind turbine. The receiver on the turbine side was developed in a microcontroller board with a GSM card, and the DFIG controller was implemented in a Digital Signal Processor (DSP) board. The results of the tests showed that the DFIG can be satisfactorily controlled according to the power references, considering that they vary at low rates

(Non)Randomization: A Theory of Quasi-Experimental Evaluation of School Quality

Many centralized school admissions systems use lotteries to ration limited seats at oversubscribed schools. The resulting random assignment is used by empirical researchers to identify the effect of entering a school on outcomes like test scores. I first find that the two most popular empirical research designs may not successfully extract a random assignment of applicants to schools. When do the research designs overcome this problem? I show the following main results for a class of data-generating mechanisms containing those used in practice: One research design extracts a random assignment under a mechanism if and practically only if the mechanism is strategy-proof for schools. In contrast, the other research design does not necessarily extract a random assignment under any mechanism