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Af and anticoagulation

Tzu-Yun McDowell, John Lawrence, Jeffry Florian, Mary Ross Southworth, Stephen Grant, Norman Stockbridge
A target international normalized ratio (INR) of 2-3 has been recommended for patients with atrial fibrillation (AF) and risk factors for thromboembolism. This recommendation is largely based on evidence from observational studies a decade ago. This study utilized collective data from modern trials with warfarin controls to examine the relationship of warfarin anticoagulation, as assessed by INR, on the clinical outcome events of interest. METHODS: Data on warfarin-treated patients from 3 clinical studies supporting the approval of dabigatran (Pradaxa® ), apixaban (Eliquis® ), and edoxaban (Savaysa® ) were pooled...
June 19, 2018: Pharmacotherapy
Junya Zhu, G Caleb Alexander, Saman Nazarian, Jodi B Segal, Albert W Wu
OBJECTIVE: Since 2010, several non-vitamin K antagonist oral anticoagulants (NOACs) have been brought to the U.S. market, yet little is known regarding their evolving adoption for prophylaxis of atrial fibrillation (AF) related stroke. We examined temporal trends in choice of oral anticoagulants (OACs) among incident OAC users with AF and its association with patient demographic and clinical characteristics. METHODS: We conducted a serial cross-sectional analysis of medical and pharmacy claims for commercial and Medicare Advantage enrollees in a large, private, U...
June 19, 2018: Pharmacotherapy
Jun Huang, Hong-Tao Liao, Hong-Wen Fei, Yu-Mei Xue, Li Zhang, Qiong-Wen Lin, Si-Qi Ren, Xian-Zhang Zhan, Xian-Hong Fang, Mu-Rui Zheng, Shu-Lin Wu, Lin Xu
OBJECTIVES: The aim of the study was to examine the association of CHADS2/CHA2DS2-VASc scores with left atrial thrombus (LAT) and spontaneous echocardiographic contrast (SEC) in non-anticoagulated nonvalvular atrial fibrillation (NVAF) spontaneous patients, and to develop a new scoring system for LAT/SEC prediction. METHODS: Consecutive non-anticoagulated NVAF patients with or without LAT/SEC by transesophageal echocardiography were identified in the Guangdong General Hospital...
June 19, 2018: Cardiology
Yuliya Y Mints, Gheorghe Doros, John L Berk, Lawreen H Connors, Frederick L Ruberg
AIMS: Wild-type transthyretin (ATTRwt) cardiac amyloidosis has emerged as an important cause of heart failure in the elderly. Atrial fibrillation (AF) commonly affects older adults with heart failure and is associated with reduced survival, but its role in ATTRwt is unclear. We sought to explore the clinical impact of AF in ATTRwt. METHODS AND RESULTS: Patients with biopsy-proven ATTRwt cardiac amyloidosis (n = 146) were retrospectively identified, and clinical, echocardiographic, and biochemical data were collected...
June 19, 2018: ESC Heart Failure
Ayesha Ather, Benjamin Laliberte, Brent N Reed, Ashley Schenk, Kristin Watson, Sandeep Devabhakthuni, Vincent Y See
We set out to synthesize available data on antithrombotic strategies for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), with a focus on triple antithrombotic therapy (triple therapy [TT]; dual antiplatelet therapy plus an anticoagulant) versus dual therapy (DT; one antiplatelet agent and an anticoagulant). We searched OVID MEDLINE and PubMed from January 2005 to September 2017 using the search terms oral anticoagulant, triple therapy, dual therapy, acute coronary syndrome, percutaneous coronary intervention, and atrial fibrillation (limited to randomized controlled trials, observational studies, English language, minimum 6-12 months of follow-up, minimum 100 human patients)...
June 19, 2018: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Jose María Mostaza, Manuel Jesús Romero Jiménez, Fernando José Ruiz Laiglesia, José Antonio Díaz Peromingo, Manuel Beltrán Robles, Ernesto Guevara Sierra, Ana Santander Bilbao, Carmen Suárez
Background: Available data regarding clinical profile and management of elderly patients with atrial fibrillation (AF) according to dependency, fragility and cognitive impairment are scarce. The objective of the study was to analyze the biodemographic data, clinical profile and antithrombotic treatment according to dependency, fragility and cognitive impairment in elderly AF patients. Methods: Cross-sectional and multi-center study performed in consecutive AF patients ≥ 75 years treated with oral anticoagulants ≥ 3 months attended in Internal Medicine Departments in Spain...
April 2018: Journal of Geriatric Cardiology: JGC
Chaoyue Hu, Xumin Zhang, Yonghua Liu, Yang Gao, Xiaohong Zhao, Hua Zhou, Yu Luo, Yaling Liu, Xiaodong Wang
BACKGROUND: In a previous study, we found that titrating clopidogrel maintenance doses (MDs) according to vasodilator-stimulated phosphoprotein (VASP) monitoring minimised the rate of major adverse cardiovascular and cerebral events (MACCE) after percutaneous coronary intervention (PCI) without increasing bleeding in patients with high on-treatment platelet reaction to clopidogrel. This study aimed to investigate whether VASP-guided clopidogrel MD could reduce thromboembolism and bleeding in atrial fibrillation (AF) patients requiring anticoagulation and scheduled for PCI...
June 18, 2018: BMC Cardiovascular Disorders
Jean-Baptiste Gourraud, Paul Khairy, Sylvia Abadir, Rafik Tadros, Julia Cadrin-Tourigny, Laurent Macle, Katia Dyrda, Blandine Mondesert, Marc Dubuc, Peter G Guerra, Bernard Thibault, Denis Roy, Mario Talajic, Lena Rivard
Atrial fibrillation (AF) is the most frequent arrhythmia worldwide. While mostly seen in elderly, it can also affect young adults (≤45 years of age), older adolescent and children. Areas covered: The aim of this review is to provide an overview of the current management of AF in young patients. Specific issues arise over diagnostic workup as well as antiarrhythmic and anticoagulation therapies. The future management and diagnostic strategies are also discussed. Expert commentary: Management of AF in the young adult is largely extrapolated from adult studies and guidelines...
June 18, 2018: Expert Review of Cardiovascular Therapy
Zachary DeBoard, John R Doty
BACKGROUND: Current postsurgical atrial fibrillation (AF) ablation guidelines encourage serial rhythm evaluation; however, traditional Holter monitoring may be cumbersome for patients and yield limited data. An implantable loop recorder (LR) may provide increased data on the incidence of postablation arrhythmias. We sought to evaluate the use of a new generation LR implanted during surgical AF ablation. METHODS: A retrospective analysis was performed on adult patients undergoing surgical AF ablation...
June 17, 2018: Journal of Cardiac Surgery
Herbert J A Rolden, Gert Jan van der Wilt, Angela H E M Maas, Janneke P C Grutters
OBJECTIVES: As model-based economic evaluations (MBEEs) are widely used to make decisions in the context of policy, it is imperative that they represent clinical practice. Here, we assess the relevance of MBEEs on dabigatran for the prevention of stroke in patients with atrial fibrillation (AF). METHODS: We performed a systematic review on the basis of a developed questionnaire, tailored to oral anticoagulation in patients with AF. Included studies had a full body text in English, compared dabigatran with a vitamin K antagonist, were not dedicated to one or more subgroup(s), and yielded an incremental cost-effectiveness ratio...
June 18, 2018: International Journal of Technology Assessment in Health Care
Yating Zhao, Yao Lu, Yue Qin
BACKGROUND: In patients undergoing atrial fibrillation (AF) ablation, despite uninterrupted oral anticoagulants (OACs) have been recommended, no consensus has emerged regarding to whether uninterrupted novel oral anticoagulants (NOACs) are superior to uninterrupted vitamin K antagonists (VKAs) for the periprocedural antithrombotic management. This meta-analysis aimed to compare the efficacy and safety of uninterrupted NOACs and uninterrupted VKAs in patients undergoing AF ablation. METHODS: Databases were searched for articles published up to March 20, 2018...
June 8, 2018: International Journal of Cardiology
Masaya Shinohara, Tadashi Fujino, Shinntaro Yao, Kensuke Yano, Katsuya Akitsu, Hideki Koike, Toshio Kinoshita, Hitomi Yuzawa, Takeya Suzuki, Kenzaburo Kobayashi, Takanori Ikeda
BACKGROUND: Physicians estimate the frailty in elderly patients with atrial fibrillation (AF) to aid in the decision making with respect to oral anticoagulant (OAC) therapy. There are limited data on the safety of OAC therapy in non-severe frail elderly patients. We evaluated the risk factors of bleeding among non-severe frail octogenarians with AF taking OACs. METHODS: Among 430 consecutive AF patients aged 80 years and over with non-severe frailty, we enrolled 346 patients [167 men, 83...
June 10, 2018: Journal of Cardiology
Daniele Pastori, Pasquale Pignatelli, Francesco Cribari, Roberto Carnevale, Mirella Saliola, Francesco Violi, Gregory Yh Lip
BACKGROUND: Vitamin K antagonists (VKAs) reduce cardiovascular events (CVEs) in atrial fibrillation (AF) when a time in therapeutic range (TiTR) >70% is achieved. Factors affecting the time to achieve the TR (TtTR) are unknown. METHODS: Prospective observational study including 1,406 nonvalvular AF patients starting VKAs followed for a mean of 31.3months (3,690 patient/year); TiTR, TtTR, and SAMe-TT2 R2 score were calculated, and CVEs were recorded. RESULTS: Median TtTR was 8...
June 2018: American Heart Journal
Steven A Lubitz, Shaan Khurshid, Lu-Chen Weng, Gheorghe Doros, Joseph Walker Keach, Qi Gao, Anil K Gehi, Jonathan C Hsu, Matthew R Reynolds, Mintu P Turakhia, Thomas M Maddox
BACKGROUND: Many patients with atrial fibrillation (AF) and elevated stroke risk are not prescribed oral anticoagulation (OAC) despite evidence of benefit. Identification of factors associated with OAC non-prescription could lead to improvements in care. METHODS AND RESULTS: Using NCDR PINNACLE, a United States-based ambulatory cardiology registry, we examined factors associated with OAC non-prescription in patients with non-valvular AF at elevated stroke risk (CHA2 DS2 -VASc ≥2) between January 5, 2008 and December 31, 2014...
June 2018: American Heart Journal
Renato D Lopes, Amit N Vora, Danny Liaw, Christopher B Granger, Harald Darius, Shaun G Goodman, Roxana Mehran, Stephan Windecker, John H Alexander
BACKGROUND: The optimal antithrombotic strategy for patients with atrial fibrillation (AF) who develop acute coronary syndrome (ACS) and/or the need for percutaneous coronary intervention (PCI) is uncertain. The risk of bleeding is a major concern when oral anticoagulation is required to prevent stroke, and concomitant therapy with antiplatelet agents is required to minimize recurrent ischemic events. DESIGN: AUGUSTUS is an international, multicenter randomized trial with a 2 × 2 factorial design to compare apixaban with vitamin K antagonists and aspirin with placebo in patients with AF who develop ACS and/or undergo PCI and are receiving a P2Y12 inhibitor...
June 2018: American Heart Journal
Wael Alqarawi, David H Birnie, Stewart Spence, F Daniel Ramirez, Calum J Redpath, Robert Lemery, Girish M Nair, Pablo B Nery, Darryl R Davis, Martin S Green, Luc Beauchesne, Kwan Chan, Kathryn Ascah, Ian Burwash, Mouhannad M Sadek
Aims: There is ongoing controversy about the need for routine transoesophageal echocardiography (TOE) prior to atrial fibrillation (AF) ablation. Recently, the debate was reignited by the publication of a large series of patients showing a prevalence of left atrial appendage thrombus (LAAT) on TOE of 4.4%. We sought to assess the prevalence of LAAT on TOE before AF ablation at our institution. Methods and results: Consecutive patients scheduled for AF ablation at our institution between January 2009 and December 2016 were included...
June 11, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Ngai-Yin Chan, Chi-Chung Choy, Chi-Kin Chan, Chung-Wah Siu
BACKGROUND: Opportunistic screening for atrial fibrillation (AF) in patients over 65 years of age is currently recommended. OBJECTIVE: We aim to examine the effectiveness of a non-governmental organization (NGO)-led, community-based AF screening program carried out by trained layperson volunteers. METHODS: AF screening was performed by using smartphone ECG in 11,574 participants. RESULTS: Among all participants, smartphone ECG's were interpretable in 10,735 (92...
June 8, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Emily C O'Brien, DaJuanicia N Holmes, Laine Thomas, Gregg C Fonarow, Peter R Kowey, Jack E Ansell, Kenneth W Mahaffey, Bernard J Gersh, Eric D Peterson, Jonathan P Piccini, Elaine M Hylek
BACKGROUND: Oral anticoagulation (OAC) reduces stroke risk in atrial fibrillation, but bleeding is a frequent side effect. The decision to discontinue or modify medication regimens in response to a bleeding event may differ according to bleeding site and severity. METHODS AND RESULTS: We used data from a large, national outpatient registry, ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation; 2010-2011), to evaluate event characteristics and OAC management following the first bleeding event occurring during follow-up...
June 9, 2018: Journal of the American Heart Association
Gene R Quinn, Olivia N Severdija, Yuchiao Chang, Liane O Dallalzadeh, Daniel E Singer
BACKGROUND: Guidelines for anticoagulation in atrial fibrillation (AF) assume that stroke risk scheme point scores correspond to fixed stroke rates. However, reported stroke rates vary widely across AF cohort studies, including studies from the same country. Reasons for this variation are unclear. This study compares methodologies used to assemble and analyze large AF cohorts worldwide and assesses potential bias in estimating stroke rates. METHODS AND RESULTS: From a previous systematic review of AF cohorts, we analyzed studies including at least 5000 patients...
June 9, 2018: Journal of the American Heart Association
Geetanjali Rangnekar, Celine Gallagher, Geoffrey R Wong, Simon Rocheleau, Anthony G Brooks, Jeroen M L Hendriks, Melissa E Middeldorp, Adrian D Elliott, Rajiv Mahajan, Prashanthan Sanders, Dennis H Lau
INTRODUCTION: Recent registry data suggests oral anticoagulation (OAC) usage remains suboptimal in atrial fibrillation (AF) patients. The aim of our study was to determine if rates of appropriate use of OAC in individuals with AF differs between the emergency department (ED) and cardiac outpatient clinic (CO). METHODS: This was a retrospective study of consecutive AF patients over a 12-month period. Data from clinical records, discharge summaries and outpatient letters were independently reviewed by two investigators...
April 4, 2018: Heart, Lung & Circulation
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