The median age of the warfarin group was 71 years (IQR 52, 81) while the median age of the OFXai group was 74 years (IQR 63, 83). T. Ahuja designed research, analyzed and interpreted data, and provided vital review, edits, and oversight of the research and the manuscript. But when abnormal blood clots form within a vein or artery, it can create, Popliteal vein thrombosis is a blood clot that affects your popliteal vein. The Rivaroxaban in Antiphospholipid Syndrome (RAPS) randomized controlled trial (RCT), which had a laboratory surrogate primary outcome measure, suggests that rivaroxaban has the potential to be an effective and convenient alternative to warfarin in thrombotic APS patients with a single venous thromboembolism event requiring standard-intensity anticoagulation. Alternatives to intravenous unfractionated heparin in the acute phase of treatment for VTE in those with advanced CKD remain limited. Response to letter regarding article, warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis. Patel M. R., Mahaffey K. W., Garg J., et al. after using it; Fatty foods do not affect the effectiveness of drug; Levitra Jelly can be used by men with various health problems, such as high cholesterol, diabetes, or high blood pressure. The primary outcome was tolerability of oral anticoagulant therapy, which was defined as a composite of safety, discontinuation of anticoagulant therapy, and efficacy. Pradaxa - dabigatran etexilate mesylate capsule. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Over the past 10 years, direct oral anticoagulants (DOACs) have emerged as effective and safe alternatives to warfarin for the prevention of stroke in non-valvular atrial fibrillation (NVAF) and prevention and treatment of venous thromboembolism (VTE). The data used to support the findings of this study are deposited in a repository that can be accessed if necessary and available upon request. The https:// ensures that you are connecting to the Savaysa - edoxaban tosylate tablet, film coated. Epub 2020 Nov 13. C. Merchan interpreted data and provided reviews of the manuscript. Apixaban and warfarin are equally safe during catheter ablation of atrial fibrillation, according to results of the AXAFA-AFNET 5 trial presented today in a late-breaking trial session at EHRA . Tolerability at 3 months was assessed in 48/56 patients (86%). Some of these drugs are oral medications. Schulman S., Kearon C. Subcommittee on control of anticoagulation of the S, standardization committee of the international society on T, haemostasis definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. See additional information. As a library, NLM provides access to scientific literature. Independent risk factors for atrial fibrillation in a populationbased cohort. All adult patients with CKD stage 4 or greater, treated with anticoagulation for VTE, were screened. However, the way they work in your body is different from the way warfarin works. Several sensitivity analyses were performed to ensure robustness of our study results. and transmitted securely. If youre moving less than normal, your blood flow becomes even slower. Cox hazard ratios from propensity score matched analysis. Cox regression analysis was performed to estimate the hazard ratio (HR) adjusted for potential confounders. There were 10/48 (21%) patients that experienced any bleeding event within 3 months from anticoagulant initiation (Table 2). In our study, we included all AF and T2DM patients with different diabetes severity and treatment intensity levels, providing a welldefined and representative cohort of patients with AF and T2DM in the UK. Furthermore, with cardiovascular comorbidities, we observed a high incidence of combination therapy with antiplatelet therapy with 29/56 (51%) on either aspirin, clopidogrel, or ticagrelor. Bethesda, MD 20894, Web Policies Would you like email updates of new search results? 2014. 22 ratings on Drugs.com. Direct oral anticoagulants (DOACs), which are prescribed to treat serious blood clots, are associated with reduced risks of major bleeding compared with warfarin, according to researchers at the University of Nottingham, which . Finally, due to limited number of observed events, we were not able to study individual DOACs and different dosages. CKD was identified based on Read codes or test results (eGFR <30ml/min). A retrospective cohort study was designed, using the UK Clinical Practice Research Datalink (August 2011-June 2018). Efficacy was determined by the number of recurrent thromboembolic events including DVT, PE, or stroke within 3 months of anticoagulation therapy. For the secondary effectiveness outcome, there was no significant difference in the risk of MI (adjusted HR 1,39;95% CI 0.992.97). The median time to oral anticoagulant initiation was 3 days (IQR 0.6, 4) in the apixaban cohort, 6 days (IQR 0.4, 6) in the rivaroxaban cohort, and 2 days (IQR 0.4, 10) in the warfarin group. In the ARISTOTLE trial comparing apixaban and warfarin, diabetes was independently associated with an increased risk of bleeding events, and the reduction in bleeding with apixaban appeared to be less in diabetic patients compared with nondiabetics.11 In the study by Lip et al., the risk of major bleeding was significantly lower in apixaban users compared to warfarin among patients with AF and diabetes.36, In the ROCKETAF trial comparing rivaroxaban and warfarin, no significant interaction was observed between diabetes and the risk of bleeding.37 Moreover, no interaction between diabetes status and the benefits of DOACs was found for the risk of major bleeding, or intracranial bleeding in the metaanalysis by Patti et al.,20 and the result was consistent with two observational studies assessing the benefits and risks of rivaroxaban in patients with AF and diabetes.36, 38. Comparative effectiveness and safety of direct oral anticoagulants versus warfarin in UK patients with atrial fibrillation and type 2 diabetes: A retrospective cohort study. ICD-10-CM Code N18. Do not drink alcohol while taking View side-by-side comparisons of medication uses, ratings, cost, side effects and interactions. Secondary outcomes included safety, efficacy, and tolerability as individual endpoints. The quest for new anticoagulants: from clinical development to clinical practice. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factorbased approach: the euro heart survey on atrial fibrillation. Dosing considerations for OFXai in the setting of an acute VTE, to reduce the risk of recurrent thromboembolism remains unknown. The drugs havent been studied as well as warfarin, so long-term effects are not known. Clinical. Wang X., Tirucherai G., Marbury T. C., et al. Stratified analysis of the effectiveness and safety outcomes of DOACs compared with Warfarin. The 2 major nonsurgical bleeding events on warfarin occurred in the setting of a supratherapeutic INR, an INR of 4 with gastrointestinal bleed and INR of 7 with psoas hematoma. HHS Vulnerability Disclosure, Help This need for intravenous heparin upfront likely contributed to the differences we observed in length of hospitalization within the 2 groups, 14 days for warfarin vs. 8days for OFXai. Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, We tested the efficacy and safety of rivaroxaban compared with warfarin in high-risk patients with thrombotic antiphospholipid syndrome. official website and that any information you provide is encrypted Erectile dysfunction (ED) is often a symptom . Epub 2017 Feb 14. Learn about symptoms, treatment, and. They also reduce your chance of developing another clot. The Netherlands. The DOACs of interest included dabigatran, rivaroxaban, apixaban and edoxaban. A two-sided alpha of <0.05 was considered to be statistically significant. 2021 Oct 24;13(10):e19009. Direct oral anticoagulants (DOACs)apixaban, dabigatran, edoxaban, and rivaroxabanare preferred alternatives to warfarin for the prevention and management of many thromboembolic diseases, including atrial fibrillation (AF). . Currently, oral anticoagulation therapy is reliant on vitamin K antagonists (VKA). In our small study, we found OFXai, specifically apixaban, to be an acceptable, possibly safer, alternative to warfarin, in those with advanced CKD. The https:// ensures that you are connecting to the Get the latest in health news delivered to your inbox! Thromboembolic Antiphospholipid Syndrome (APS): Efficacy and Safety of Different Anticoagulants-Results of the APSantiCO Registry. Although the landmark VTE trials for the OFXai evaluated a lead-in with apixaban 10mg twice daily for 1 week and rivaroxaban at 15mg twice daily for 3 weeks, before going to maintenance dosing, these doses have not been evaluated even in pharmacokinetic simulations for patients with advanced CKD [79]. It will focus on the key agents that have demonstrated the most promise in clinical trials to date. Levitra Oral Jelly is one of the most powerful erectile dysfunction medications available. View more. (2013). 70% of reviewers reported a positive effect, while 14% reported a negative effect. Our results on risks of stroke, MI and major bleeding are in line with a large metaanalysis of RCTs of the four DOACs in which the rates associated with DOACs were overall comparable to warfarin, and no significant interaction was shown between diabetes and rates of stroke and major bleeding.12, In a metaanalysis of RCTs of DOACs in the subgroup of diabetic patients by Patti et al, the prevention of thromboembolic and major bleeding complications by DOACs compared with warfarin was irrespective of diabetes status.20, Our findings of similar risks of stroke in patients taking apixaban or rivaroxaban compared to warfarin are not in line with a large observational study in patients with AF and diabetes by Lip et al., were apixaban and rivaroxaban were associated with a lower risk of stroke compared to warfarin.36, Contradictory results have been shown for bleeding risks in diabetic patients with AF treated with individual DOACs. Careers, Unable to load your collection due to an error. Finally, we repeated the analysis in all patients diagnosed with AF, including both patients with and without T2DM, and performed a stratified analysis per diabetes status to evaluate whether there is an interaction between diabetes status and the benefits and risks of DOACs. Careers, Unable to load your collection due to an error. Warfarin tablets are effective at "thinning" the blood; however, several factors affect warfarin blood levels including diet (particularly the intake of vitamin K), ethnicity, other medications or Specific antidotes (idarucizumab for dabigatran and andexanet alfa for FXa inhibitors) and hemostatic reversal agents were used for lowering bleeding, but their efficacies were still uncertain. Bar graph of number of patients who had a bleed event, thromboembolic event, and/or discontinued anticoagulation therapy n = 14/48 (29%). This includes vitamins, herbal and natural products. A retrospective cohort study was designed, using the UK Clinical Practice Research Datalink (August 2011June 2018). Cox proportional hazard regression analysis was used to estimate the adjusted hazard ratio (aHR) of events with warfarin as the primary reference. Also, the long-term effects of these newer drugs are not as well-known as they are for warfarin. For stroke outcomes, we additionally adjusted for comorbidities from the CHA2DS2VASc score (congestive heart failure, hypertension, peripheral vascular disease, previous stroke, previous MI),31 and prescriptions of the following drugs were evaluated in the 6months prior to index date: aspirin, antiplatelet drugs, statins, calcium channel blockers, ACEinhibitors, angiotensin II receptor blockers, diuretics, blockers, selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal antiinflammatory drugs (NSAIDs). The .gov means its official. HHS Vulnerability Disclosure, Help Then, it can enter the small blood vessels of your lungs, where it can lodge and block your blood flow. People may experience pain in their legs and pelvis. Uses. 2020 Jan;18(1):259-261. doi: 10.1111/jth.14674. To exclude patients with type 1 diabetes, Read codes were not used as there are known problems with coding errors.29 Instead, we excluded patients with an age at diagnosis <35years, or patients only treated with insulin, patients who were prescribed insulin as their first treatment or within 1year of diagnosis.30 Figure1 shows the inclusion and exclusion criteria to identify T2DM patients. 55 ratings on Drugs.com. There remains a paucity of data evaluating anticoagulation therapy for treatment of acute VTE in the setting of advanced CKD stage IV or greater. Bethesda, MD 20894, Web Policies St. Joseph 81 mg Aspirin Enteric Safety-Coated. Safety and efficacy of nonvitamin K antagonist oral anticoagulants versus warfarin in diabetic patients with atrial fibrillation: a studylevel metaanalysis of phase III randomized trials. This is called a pulmonary embolism, and it may be fatal. DOAC trials involving homogeneous thrombotic APS populations, with the antiphospholipid antibody status well defined, will help to optimize the appropriate treatment in APS patient subgroups. Resseguier AS, Pereira B, Rieu V, Le Guenno G, Grobost V, Ruivard M. Lupus. Unable to load your collection due to an error, Unable to load your delegates due to an error. Future studies should evaluate either a parenteral anticoagulation lead-in or a higher OFXai dose for safety and tolerability in patients with advanced CKD. Biomedicines. The proportional hazards assumption was tested on the basis of Schoenfeld residuals and was valid for all outcomes.33. Femoral vein thrombosis refers to a blood clot that occurs in the femoral vein in your leg. Lopes R. D., Heizer G., Aronson R., et al. The bleeding event on apixaban occurred on a dose of 2.5mg twice daily with no interacting medications identified. Efficacy and safety of rivaroxaban in patients with diabetes and nonvalvular atrial fibrillation: the Rivaroxaban Oncedaily, Oral, Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF Trial), Comparison of dabigatran versus warfarin in diabetic patients with atrial fibrillation: results from the RELY trial, Clinical outcomes of patients with diabetes and atrial fibrillation treated with apixaban: results from the ARISTOTLE trial. Comparative effectiveness and safety of direct oral anticoagulants versus warfarin in UK patients with atrial fibrillation and type 2 diabetes: A retrospective cohort study, Atrial fibrillation as an independent risk factor for stroke: the Framingham Study, 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation developed with the special contribution of the European Heart Rhythm Association, Diabetes and stroke: epidemiology, pathophysiology, pharmaceuticals and outcomes. Harris P. A., Taylor R., Thielke R., Payne J., Gonzalez N., Conde J. G. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. Circulation. FOIA Abbreviations: ACE, angiotensin converting enzyme; BMI, body mass index; CKD, chronic kidney disease; DOAC, direct oral anticoagulant; GI, gastrointestinal; H2RA, histamine 2 receptor antagonists; NSAIDs, nonsteroidal antiinflammatory drugs; PPIs, proton pump inhibitors; SD, standardized; SSRIs, selective serotonin reuptake inhibitors. 86% of reviewers reported a positive effect, while 10% reported a negative effect. We comply with the HONcode standard for trustworthy health information. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The effectiveness is not changed by your diet. Tolerability at 3 months was assessed in 48/56 patients (86%). Warfarin Alternatives Compared. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. Healthline Media does not provide medical advice, diagnosis, or treatment. MeSH The most common VTE indication for oral anticoagulation therapy was treatment of acute DVT (OFXai n=14 (82%) vs. warfarin n=29 (74%), p=0.733) followed by acute PE (OFXai n=4 (24%) vs. warfarin n=10 (26%), p=1.000). Lower extremity DVT was more common in both groups compared to upper extremity DVT (OFXai n=11 (65%) vs. warfarin n=20 (51%)). "Most experts would argue that from a safety perspective, for the things you really care about, these new drugs are much better than warfarin."-Dr. 2018 Jul;44(5):427-438. doi: 10.1055/s-0036-1597902. Thus evaluating a direct oral strategy with apixaban or rivaroxaban should be explored. 2020. eCollection 2021. Out of the 17 patients in our OFXai arm, 14/17 were on apixaban, which is likely due to the limited renal clearance and benefit seen in patients with advanced CKD in preventing SSE in the setting of AF [16]. The https:// ensures that you are connecting to the All data presented as n (%) unless otherwise stated, BMI: body mass index, EGFR: estimated glomerular filtration rate, AF: atrial fibrillation, DVT: deep vein thrombosis, PE: pulmonary embolism, CAD: coronary artery disease, PAD: peripheral artery disease, PVD: peripheral vascular disease, DM: diabetes mellitus, HTN: hypertension, CHA2DS2-VASc: congestive heart failure, hypertension, age, diabetes mellitus, stroke/TIA/TE, vascular disease (prior MI, PAD, or aortic plaque), and sex category. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. Therefore, we aimed to provide a realworld assessment of the effectiveness and safety of DOACs in patients with AF and T2DM in the UK general practice population, to offer clinicians a more comprehensive understanding of DOACs as a therapeutic option for patients with both conditions. Received 2020 Jul 20; Revised 2021 Jan 8; Accepted 2021 Jan 13. These new anticoagulants target specific factors in the hemostatic network and appear to overcome some of the difficulties seen with VKA. Therefore, clinicians may be interested in evaluating alternatives such as intravenous heparin at the time of diagnosis of VTE. However, this treatment strategy has not been evaluated in a randomized trial. The mean duration of followup was shorter for users of DOACs (1.39 and 1.37years for main stroke and bleeding outcomes, respectively), than for users of warfarin (2.1 and 2.03years). Patients who received less than three doses of an oral anticoagulant and patients with CKD less than IV were excluded. 2021 Jan;20(1):102711. doi: 10.1016/j.autrev.2020.102711. Nutrition and diet can affect your treatment with warfarin. All acute DVTs were diagnosed with a venous duplex ultrasound, and all acute PEs were diagnosed with computed tomography scans. Oral anticoagulation for patients with atrial fibrillation on long-term dialysis. Direct Oral Anticoagulants for Thromboprophylaxis in Patients with Antiphospholipid Syndrome. The blood flow in your veins is slower than the blood flow in your arteries because it doesnt have as much momentum from your heartbeat. In the comparison of dabigatran 150 mg twice daily with warfarin for the endpoint of ischemic events, there was a nonsignificant decrease in the relative superiority of dabigatran compared with warfarin with the use of antiplatelet therapy (HR 0.52, 95% CI 0.38-0.72 and HR 0.80, 95% CI 0.59-1.08, comparing dabigatran with warfarin in the no . Despite the potential impact of patients' compliance to their prescribed treatment on our study, we obtained consistent results in the intention to treat analysis and sensitivity analyses using different discontinuation definitions. Analysis of the projected utility of dabigatran, rivaroxaban, and apixaban and their future impact on existing Hematology and Cardiology Anticoagulation Clinics at The Johns Hopkins Hospital. This is likely due to warfarin's slow onset of action, with a recommendation to bridge with new initiation of warfarin for a minimum of 5days. Main effectiveness outcome was defined as a composite of ischaemic stroke, unspecified stroke and haemorrhagic stroke. Carter KL, Streiff MB, Ross PA, Wellman JC, Thomas ML, Kraus PS, Shermock KM. FOIA The risk of thromboembolism within 3 months of diagnosis of an acute VTE may be greater than those placed on oral anticoagulation to decrease the risk of SSE in the setting of AF. In conclusion, the preferred oral anticoagulant for the treatment of VTE in patients with CKD stage IV or greater remains unknown. You should check with your insurance company to see if they cover these medications and how much your copay will be. Anticoagulants (blood thinners) can help prevent these blood clots from forming. Alternative treatment regimens to warfarin remain desirable based on the risk of bleeding and warfarin-induced calciphylaxis in patients with ESRD on dialysis [4]. Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 5 June 2023), ASHP (updated 10 Apr 2023) and others. Prescriptions of the following drugs were also evaluated in the 6months prior to index date: aspirin, antiplatelet drugs, NSAIDs, and SSRIs. All other baseline demographics were similar between the two treatment groups (Table 1). 47 ratings on Drugs.com. Three ways to refill emotionally, Give praise to the elbow: A bending, twisting marvel, Sneezy and dopey? The Einstein-PE Investigators. Role of Direct Oral Anticoagulation Agents as Thromboprophylaxis in Antiphospholipid Syndrome. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. HHS Vulnerability Disclosure, Help Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health, plus the latest advances in preventative medicine, diet and exercise, pain relief, blood pressure and cholesterol management, andmore. Only your doctor can tell you if these drugs are right for you. (2019). Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. HHS Vulnerability Disclosure, Help This means that your doctor may have to contact the insurance company and provide information before you can fill the prescription. A total of 34/48 (71%) patients tolerated anticoagulation therapy at 3 months, 12 (80%) in the OFXai arm, and 22 (67%) in the warfarin arm (p=0.498) (Figure 2). The use of a large pharmacoepidemiological database to study exposure to oral corticosteroids and risk of fractures: validation of study population and results. Schulman S., Kearon C., Kakkar A. K., et al. Abbreviations: CI, confidence interval; DOACs, direct oral anticoagulants; GI, gastrointestinal; HR, hazard ratio; MI, myocardial infarction. Health Alerts from Harvard Medical School. Patients with liver disease are at increased risks of both thrombotic and bleeding complications. AF, atrial fibrillation; CPRD, Clinical Practice Research Datalink; DOAC, direct oral anticoagulant; OAC, oral anticoagulant; OAD, oral antidiabetics; T2DM, type 2 diabetes mellitus. There are both advantages and disadvantages to these drugs. Warfarin is effective, but there are some downsides. To account for baseline differences, we adjusted the models for the aforementioned covariates. The median duration of intravenous UFH was 2.2 days (IQR 0.5, 15) in the apixaban cohort, 2.7 days (IQR 0.2, 6) in the rivaroxaban cohort, and 7.4 days (IQR 2.2, 36.6) in the warfarin group. Miao B., Sood N., Bunz T. J., Coleman C. I. Rivaroxaban versus apixaban in nonvalvular atrial fibrillation patients with endstage renal disease or receiving dialysis. Oral vitamin K antagonists (VKAs), warfarin, have been in routine clinical use for almost 70 years for various cardiovascular conditions. As treatment allocation was not randomly, adjustment for baseline covariates was required. Therefore, evaluating all options would be worthwhile to evaluate the most optimal anticoagulant tolerated. (2017). 2018 International Society on Thrombosis and Haemostasis. Direct oral anticoagulants: an alternative treatment for thrombotic antiphospholipid syndrome? Six patients were lost to follow-up at 3 months in the warfarin arm, and 2 patients were lost to follow-up in the OFXai arm. The evidence on DOACs' effectiveness and safety in patients with both AF and T2DM in the clinical practice is scarce. 2012 Nov;34(4):437-45. doi: 10.1007/s11239-012-0781-z. Abstract. The .gov means its official. If it breaks loose, it can flow in your bloodstream through your heart. Learn more about the symptoms and how you can prevent a, Find information on blood thinners, including what they do, how they work, and who should take them. Available for Android and iOS devices. government site. ICD-10-CM Code N18. Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight lossfrom exercises to build a stronger core to advice on treating cataracts. Hanni C., Petrovitch E., Ali M., et al. Bookshelf Sign up now and get a FREE copy of theBest Diets for Cognitive Fitness. Antithrombins / therapeutic use Blood Coagulation / drug effects* Drugs, Investigational / adverse effects Drugs, Investigational / therapeutic use* Factor Xa Inhibitors Humans Treatment Outcome Vitamin K / antagonists & inhibitors Warfarin / adverse effects Warfarin / therapeutic use* Substances Anticoagulants Antithrombins Only patients with followup time between 1st August 2011, when the first DOAC was approved by EMA for stroke prevention in AF patients, and 20 June 2018 were included. This site needs JavaScript to work properly. New oral anticoagulants in addition to single or dual antiplatelet therapy after an acute coronary syndrome: a systematic review and meta-analysis. Cohort definition flow chart. Apixaban versus warfarin in patients with atrial fibrillation. But they work in very different ways, and each has its own benefits and risks. Dahal K., Kunwar S., Rijal J., Schulman P., Lee J. Stroke, major bleeding, and mortality outcomes in warfarin users with atrial fibrillation and chronic kidney disease. On the other hand, Cialis has a slightly higher risk of muscle pain than Viagra and vardenafil. 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[X]Preexisting diabetes mellitus, unspecified, Other specified diabetes mellitus with other spec comps, Diabetes mellitus during pregnancy/childbirth/puerperium, Other specified diabetes mellitus with renal complications, Diabetes mellitus, juvenile type, no mention of complication, Steroid induced diabetes mellitus without complication, Syndrome of infant of mother with gestational diabetes, Diabetes mellitus with other specified manifestation, Malnutritionrelated diabetes mellitus with ketoacidosis, Diabetes mellitus during pregnancy baby delivered, Other specified diabetes mellitus with ketoacidosis, Diabetes mellitus, juvenile type, with hyperosmolar coma, Diabetes mellitus, juvenile type, with ketoacidotic coma, Other specified diabetes mellitus with multiple comps, Other specified diabetes mellitus with ophthalmic complication, Diabetes mellitus during pregnancy baby not yet delivered, Transitory metabolic disturbanceinfant prediabetic mother, Diabetes mellitus, juvenile type, with ketoacidosis, Other specified diabetes mellitus with coma, Diabetes mellitus induced by nonsteroid drugs, Other specified diabetes mellitus with neurological comps, Diabetes mellitus, adult, + other specified manifestation, Other specified diabetes mellitus with unspecified comps, Malnutritionrelated diabetes mellitus with coma, Diabetes mellitus, juvenile, + neurological manifestation, Diabetes mellitus, juvenile type, + unspecified complication, Diabetes mellitus, juvenile type, + ophthalmic manifestation, Diabetes mellitus, juvenile +peripheral circulatory disorder, Diabetes mellitus NOS with other specified manifestation, Cystic fibrosis related diabetes mellitus, Diabetes mellitus, juvenile type, with renal manifestation, Secondary diabetes mellitus without complication, Latent autoimmune diabetes mellitus in adult, Secondary pancreatic diabetes mellitus without complication, Diabetes mellitus in pueperium baby previously delivered, Malnutritnrelat diabetes melitus wth periph circul complctn, Gestational diabetes information leaflet given, Gestational diabetes mellitus annual review, Diab insipidus,diab mell,optic atrophy and deafness, Preexisting malnutritionrelated diabetes mellitus, Diabetes mellitus, juvenile, + other specified manifestation, Other specified diabetes mellitus with periph circ comps, Stroke and cerebrovascular accident unspecified, CVA Cerebrovascular accident unspecified, Stroke due to cerebral arterial occlusion, CVA cerebrovascular accid due to intracerebral haemorrhage, Subarachnoid haemorrhage from posterior communicating artery, Subarachnoid haemorrh from intracranial artery, unspecified, Right sided intracerebral haemorrhage, unspecified, Subarachnoid haemorrhage from middle cerebral artery, Cerebral infarction due to embolism of cerebral arteries, Left sided intracerebral haemorrhage, unspecified, Intracerebral haemorrhage, intraventricular, Intracerebral haemorrhage in hemisphere, unspecified, Other and unspecified intracranial haemorrhage, Cerebral infarction due to thrombosis of cerebral arteries, Cerebral infarction due cerebral venous thrombosis, nonpyogenic, Subarachnoid haemorrhage from basilar artery, Subarachnoid haemorrhage from anterior communicating artery, Multiple and bilateral precerebral artery syndromes, Subarachnoid haemorrhage from carotid siphon and bifurcation, Intracerebral haemorrhage, multiple localized, Subarachnoid haemorrhage from vertebral artery, [X]Cerebral infarction due/unspecified occlusion or stenos/cerebral arteries, [X]Cerebral infarct due unspecified occlusion/stenos precerebral arteries, [X]Intracerebral haemorrhage in hemisphere, unspecified, [X]Subarachnoid haemorrh from intracranial artery, unspecified, [X]Subarachnoid haemorrhage from other intracranial arteries, Unspecified duodenal ulcer with haemorrhage, Unspec duodenal ulcer; unspec haemorrhage and/or perforation, Subarachnoid haemorrhage following injury, [X]Vitreous haemorrhage in diseases classified elsewhere, Closed traumatic subarachnoid haemorrhage, Other cerebral haemorrhage following injury NOS, Acute peptic ulcer with haemorrhage and perforation, Cerebral haemorrhage following injury NOS, Acute duodenal ulcer with haemorrhage and perforation, Traumatic subdural haematoma without open intracranial wound, Haemophthalmos (excluding current injury), Unspecified gastric ulcer with haemorrhage, Unspecified gastrojejunal ulcer with haemorrhage, Acute and subacute haemorrhagic leukoencephalitis [Hurst], Unspecified peptic ulcer with haemorrhage, Acute gastric ulcer with haemorrhage and perforation, Chronic duodenal ulcer with haemorrhage and perforation, Chronic gastric ulcer with haemorrhage and perforation, Unspecified duodenal ulcer with haemorrhage and perforation, Unspec gastric ulcer; unspec haemorrhage and/or perforation, Unspecified peptic ulcer with haemorrhage and perforation, Acute gastrojejunal ulcer with haemorrhage, Traumatic subdural haematoma with open intracranial wound, Oesophageal varices with bleeding in diseases EC, Acute gastrojejunal ulcer with haemorrhage and perforation, Chronic gastrojejunal ulcer with haemorrhage and perforation. 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