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Af and anticoagulation

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https://www.readbyqxmd.com/read/29681165/gender-differences-in-efficacy-and-safety-of-direct-oral-anticoagulants-in-atrial-fibrillation-systematic-review-and-network-meta-analysis
#1
Bruria Hirsh Raccah, Amichai Perlman, Donna R Zwas, Sarit Hochberg-Klein, Reem Masarwa, Mordechai Muszkat, Ilan Matok
BACKGROUND: Studies indicate that women with atrial fibrillation (AF) are less likely to receive anticoagulants despite their higher risk of stroke compared with men. OBJECTIVE: To evaluate whether the efficacy and safety of direct oral anticoagulants (DOACs) differ in women with AF as compared with men. Our secondary aim was to examine gender differences regarding the safety and efficacy of specific DOACs. DATA SOURCES: MEDLINE, EMBASE, Cochrane, and ClinicalTrials...
April 1, 2018: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29680999/current-state-of-left-atrial-appendage-closure
#2
REVIEW
Ricardo Kosturakis, Matthew J Price
PURPOSE OF REVIEW: Atrial fibrillation (AF), the most common sustained arrhythmia, is a major cause of stroke and systemic embolism, and is increasing in prevalence. Device closure of the left atrial appendage (LAA) represents a non-pharmacologic approach to stroke prevention in AF patients. This review presents the rationale for LAA closure (LAAC), describes current transcatheter approaches to LAAC, and summarizes the current evidence for LAAC for stroke prevention, highlighting the main randomized trials and the most recent data available...
April 21, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29679301/contemporary-antithrombotic-treatment-in-patients-with-non-valvular-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-rationale-and-design-of-the-greek-antiplatelet-atrial-fibrillation-grape-af-registry
#3
Ioanna Xanthopoulou, Vasiliki-Maria Dragona, Periklis Davlouros, Costas Tsioufis, Efstathios Iliodromitis, Dimitrios Alexopoulos
BACKGROUND: Approximately 5 to 7% of patients undergoing percutaneous coronary intervention (PCI) for the treatment of coronary artery disease require chronic oral anticoagulation (OAC) on top of aspirin and a P2Y12 receptor antagonist, mainly due to non-valvular atrial fibrillation (AF). The advent of non-vitamin K antagonist oral anticoagulants (NOACs) increased treatment options, while there is cumulative evidence that dual combination of a NOAC and a P2Y12 receptor antagonist attenuates risk of bleeding, compared to traditional triple therapy, consisting of a vitamin K antagonist (VKA), aspirin, and a P2Y12 receptor antagonist, without significantly compromising efficacy...
April 20, 2018: Cardiovascular Drugs and Therapy
https://www.readbyqxmd.com/read/29679144/antithrombotic-therapy-in-patients-with-non-valvular-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-should-we-change-our-practice-after-the-pioneer-af-pci-and-re-dual-pci-trials
#4
D Duerschmied, J Brachmann, H Darius, N Frey, H A Katus, W Rottbauer, A Schäfer, H Thiele, C Bode, Uwe Zeymer
The number of patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) is increasing. Since these patients have a CHA2 DS2 -VASc score of 1 or higher, they should be treated with oral anticoagulation to prevent stroke. However, combination therapy with oral anticoagulation for prevention of embolic stroke and dual platelet inhibition for prevention of coronary thrombosis significantly increases bleeding complications. The optimal combination, intensity and duration of antithrombotic combination therapy is still not known...
April 20, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29678813/prognostic-significance-of-nuisance-bleeding-in-anticoagulated-patients-with-atrial-fibrillation
#5
Emily C O'Brien, DaJuanicia N Holmes, Laine E Thomas, Gregg C Fonarow, Larry A Allen, Bernard J Gersh, Peter R Kowey, Daniel E Singer, Michael D Ezekowitz, Gerald V Naccarelli, Jack E Ansell, Paul S Chan, Kenneth W Mahaffey, Alan S Go, James V Freeman, James A Reiffel, Eric D Peterson, Jonathan P Piccini, Elaine M Hylek
Background -Bleeding is commonly cited as a reason for stopping oral anticoagulants (OAC). Whether minor bleeding events ("nuisance bleeding", NB) in patients with atrial fibrillation (AF) on OAC are associated with OAC discontinuation, major bleeding and stroke/systemic embolism (SSE), is unknown. Methods -Within the ORBIT-AF prospective, outpatient registry, we identified 6771 patients ≥18 years of age at 172 sites with AF and eligible followup visits. NB was ascertained from the medical record and was defined as minor bleeding that did not require medical attention (e...
April 20, 2018: Circulation
https://www.readbyqxmd.com/read/29678635/high-incidence-of-occult-atrial-fibrillation-in-asian-patients-with-cryptogenic-stroke
#6
Swee-Chong Seow, Ann-Kee How, Siew-Pang Chan, Hock-Luen Teoh, Toon-Wei Lim, Devinder Singh, Wee-Tiong Yeo, Pipin Kojodjojo
BACKGROUND: Occult atrial fibrillation (AF) is not uncommon in patients with stroke. In western cohorts, insertable loop recorders (ILRs) have been shown to be the gold-standard and are cost-effective for AF detection. Anticoagulation for secondary stroke prevention is indicated if AF is detected. The incidence of occult AF among Asian patients with cryptogenic stroke is unclear. METHODS: Patients with cryptogenic stroke referred between August 2014 and February 2017 had ILRs implanted...
April 17, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29678618/concomitant-surgical-atrial-fibrillation-ablation-is-safe-and-efficacious-in-patients-undergoing-double-valve-replacement-a-cohort-study
#7
Guang Tong, Hao Yu, Xuan Zhou, Ben Zhang, Shenghui Bi, Lin Luo, Tao Yan, Xianyue Wang, Hua Lu, Tao Ma, Xiaowu Wang, Zhongchan Sun, Weida Zhang
BACKGROUND: Current European Society of Cardiology Guidelines recommend concomitant atrial fibrillation (AF) ablation for all symptomatic patients undergoing other cardiac surgeries, but the safety and potential benefits of concomitant atrial fibrillation (AF) ablation at the time of double valve replacement (DVR: aortic and mitral valve replacement) remains unexamined. MATERIALS AND METHODS: We conducted a retrospective review of 238 patients with AF who underwent DVR with or without concomitant surgical ablation (Ablation group, n=113; Non-ablation group, n=125) at a single institute from April 2006 to September 2011...
April 17, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29678338/current-trends-in-anticoagulation-bridging-for-patients-with-chronic-atrial-fibrillation-on-warfarin-undergoing-endoscopy
#8
Jeremy A Slivnick, Raymond Y Yeow, Colin McMahon, David G Paje, Jacob E Kurlander, Geoff D Barnes
For warfarin-treated patients with atrial fibrillation (AF) at low thromboembolic risk, recent studies have shown harm associated with periprocedural bridging using low-molecular-weight heparin. Clinician surveys have indicated a preference toward excessive bridging, especially among noncardiologists; however, little is known about actual practice patterns in these patients. We performed a retrospective evaluation of bridging in the setting of gastrointestinal endoscopy. We identified 938 patients with AF on warfarin who underwent esophagogastroduodenoscopy or colonoscopy between 2012 and 2016 at a tertiary health center...
March 16, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29672731/amaze-a-randomized-controlled-trial-of-adjunct-surgery-for-atrial-fibrillation
#9
Samer A M Nashef, Simon Fynn, Yasir Abu-Omar, Tomasz J Spyt, Christine Mills, Colin C Everett, Julia Fox-Rushby, Jeshika Singh, Malcolm Dalrymple-Hay, Catherine Sudarshan, Massimiliano Codispoti, Peter Braidley, Francis C Wells, Linda D Sharples
OBJECTIVES: Atrial fibrillation (AF) reduces survival and quality of life (QoL). It can be treated at the time of major cardiac surgery using ablation procedures ranging from simple pulmonary vein isolation to a full maze procedure. The aim of this study is to evaluate the impact of adjunct AF surgery as currently performed on sinus rhythm (SR) restoration, survival, QoL and cost-effectiveness. METHODS: In a multicentre, Phase III, pragmatic, double-blinded, parallel-armed randomized controlled trial, 352 cardiac surgery patients with >3 months of documented AF were randomized to surgery with or without adjunct maze or similar AF ablation between 2009 and 2014...
April 17, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29672182/oral-anticoagulant-use-in-cardiovascular-disorders-a-perspective-on-present-and-potential-indications-for-rivaroxaban
#10
A John Camm, Keith A A Fox
BACKGROUND: Four nonvitamin K antagonist oral anticoagulants (NOACs) have been approved for use in various cardiovascular indications. The direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors apixaban, edoxaban, and rivaroxaban are now increasingly used in clinical practice. For some of these agents, available data from real-world studies support the efficacy and safety data in phase III clinical trials. OBJECTIVES: This review aims to summarize the current status of trials and observational studies of oral anticoagulant use over the spectrum of cardiovascular disorders (excluding venous thrombosis), provide a reference source beyond stroke prevention for atrial fibrillation (AF) and examine the potential for novel applications in the cardiovascular field...
April 19, 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29671285/effect-of-non-vitamin-k-antagonist-oral-anticoagulants-in-atrial-fibrillation-patients-with-newly-diagnosed-cancer
#11
Kyu Kim, Yong Joon Lee, Tae Hoon Kim, Jae Sun Uhm, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung
BACKGROUND AND OBJECTIVES: There are limited data on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer. We aimed to assess the efficacy and safety of NOACs in AF patients with cancer in this study. METHODS: In 2,568 consecutive non-valvular AF patients with newly diagnosed cancer, we analyzed ischemic stroke/systemic embolism (SE), major bleeding, and all-cause death. Based on propensity score matching, 388 matched pairs were included in the NOAC and warfarin groups...
February 26, 2018: Korean Circulation Journal
https://www.readbyqxmd.com/read/29670888/computational-fluid-dynamic-analysis-of-the-left-atrial-appendage-to-predict-thrombosis-risk
#12
Giorgia Maria Bosi, Andrew Cook, Rajan Rai, Leon J Menezes, Silvia Schievano, Ryo Torii, Gaetano Burriesci
During Atrial Fibrillation (AF) more than 90% of the left atrial thrombi responsible for thromboembolic events originate in the left atrial appendage (LAA), a complex small sac protruding from the left atrium (LA). Current available treatments to prevent thromboembolic events are oral anticoagulation, surgical LAA exclusion, or percutaneous LAA occlusion. However, the mechanism behind thrombus formation in the LAA is poorly understood. The aim of this work is to analyse the hemodynamic behaviour in four typical LAA morphologies - "Chicken wing", "Cactus", "Windsock" and "Cauliflower" - to identify potential relationships between the different shapes and the risk of thrombotic events...
2018: Frontiers in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29670471/atrial-fibrillation-in-hypertension-patients-characteristics
#13
Styliani Koutsaki, Ioannis Koutelekos, Georgia Gerogianni, Maria Koutsaki, Aggeliki Koukouzeli, Georgia Fouka, Maria Polikandrioti
Background: The most common risk factor for Atrial Fibrillation (AF) development is hypertension. Purpose: to explore patients' characteristics associated with AF caused by hypertension. Methods: The sample of the study included 170 patients with AF caused by hypertension. Data collection was performed by the method of interview using a questionnaire developed by the researchers of the study for the collection of demographic, clinical and other patients' characteristics...
March 2018: Materia Socio-medica
https://www.readbyqxmd.com/read/29669504/atrial-fibrillation-in-autoimmune-rheumatic-diseases-from-the-pathogenesis-to-the-treatment
#14
Giuseppe Ciconte, Manuel Conti, Martina Evangelista, Carlo Pappone
BACKGROUND: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the general population and is associated with an increased number of adverse outcomes. The onset and maintenance of this arrhythmia requires a trigger event and the presence of a predisposing substrate. Atrial fibrosis, a major characteristic of AF-related structural remodeling, represents a process closely related to inflammation as demonstrated by emerging evidence. Aim of this article is to review the evidence linking AF to systemic autoimmune diseases...
April 17, 2018: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/29664236/use-of-non-vitamin-k-antagonist-oral-anticoagulants-2008-2016-a-danish-nationwide-cohort-study
#15
Simone Haastrup, Maja Hellfritzsch, Lotte Rasmussen, Anton Pottegård, Erik Lerkevang Grove
We aimed to provide detailed utilization data on the total use of non-vitamin K antagonist oral anticoagulants (NOACs) since their introduction in 2008. Using the nationwide Danish National Prescription Registry, we identified all individuals filling prescriptions for NOACs 2008-2016. We reported the development in incident and prevalent users and explored baseline characteristics and treatment persistence according to treatment indication. A total of 126,691 NOAC users were identified within the Danish population of 5...
April 17, 2018: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/29663464/uninterrupted-administration-of-edoxaban-vs-vitamin-k-antagonists-in-patients-undergoing-atrial-fibrillation-catheter-ablation-rationale-and-design-of-the-eliminate-af-study
#16
Stefan H Hohnloser, John Camm, Riccardo Cappato, Hans-Christoph Diener, Hein Heidbuchel, Hans-Joachim Lanz, Lluís Mont, Carlos A Morillo, Rüdiger Smolnik, Ophelia Q P Yin, Josef Kautzner
Patients with atrial fibrillation (AF) are at an approximately 0.5% to 3% increased risk of thromboembolism during and immediately after catheter ablation. Treatment guidelines recommend periprocedural oral anticoagulation plus unfractionated heparin during ablation. Rivaroxaban and dabigatran are the only non-vitamin K oral anticoagulants for which there are randomized controlled trials assessing uninterrupted anticoagulation in patients undergoing catheter ablation of AF. Edoxaban, a direct factor Xa inhibitor, is noninferior vs warfarin for the prevention of stroke or systemic embolism with less major bleeding in patients with nonvalvular AF...
April 17, 2018: Clinical Cardiology
https://www.readbyqxmd.com/read/29661944/atrial-fibrillation-burden-moving-beyond-atrial-fibrillation-as-a-binary-entity-a-scientific-statement-from-the-american-heart-association
#17
REVIEW
Lin Y Chen, Mina K Chung, Larry A Allen, Michael Ezekowitz, Karen L Furie, Pamela McCabe, Peter A Noseworthy, Marco V Perez, Mintu P Turakhia
Our understanding of the risk factors and complications of atrial fibrillation (AF) is based mostly on studies that have evaluated AF in a binary fashion (present or absent) and have not investigated AF burden. This scientific statement discusses the published literature and knowledge gaps related to methods of defining and measuring AF burden, the relationship of AF burden to cardiovascular and neurological outcomes, and the effect of lifestyle and risk factor modification on AF burden. Many studies examine outcomes by AF burden classified by AF type (paroxysmal versus nonparoxysmal); however, quantitatively, AF burden can be defined by longest duration, number of AF episodes during a monitoring period, and the proportion of time an individual is in AF during a monitoring period (expressed as a percentage)...
April 16, 2018: Circulation
https://www.readbyqxmd.com/read/29659797/apixaban-compared-to-heparin-vitamin-k-antagonist-in-patients-with-atrial-fibrillation-scheduled-for-cardioversion-the-emanate-trial
#18
Michael D Ezekowitz, Charles V Pollack, Jonathan L Halperin, Richard D England, Sandra VanPelt Nguyen, Judith Spahr, Maria Sudworth, Nilo B Cater, Andrei Breazna, Jonas Oldgren, Paulus Kirchhof
Aim: The primary objective was to compare apixaban to heparin/vitamin K antagonist (VKA) in patients with atrial fibrillation (AF) and ≤48 h anticoagulation prior to randomization undergoing cardioversion. Methods: One thousand five hundred patients were randomized. The apixaban dose of 5 mg b.i.d. was reduced to 2.5 mg b.i.d. in patients with two of the following: age ≥ 80 years, weight ≤ 60 kg, or serum creatinine ≥ 133 µmol/L...
April 6, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29657592/design-and-baseline-characteristics-of-the-xarelto-post-authorization-safety-effectiveness-study-in-japanese-patients-with-atrial-fibrillation-xapass
#19
Satoshi Ogawa, Kazuo Minematsu, Takanori Ikeda, Takanari Kitazono, Jyoji Nakagawara, Susumu Miyamoto, Yuji Murakawa, Yohei Ohashi, Makiko Takeichi, Yutaka Okayama, Satoshi Yamanaka, Lyo Inuyama
Background: The phase III Japanese Rivaroxaban Once-Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (J-ROCKET AF) showed that the rivaroxaban group had a lower event rate of intracranial bleeding than the warfarin group and that rivaroxaban was noninferior to warfarin for the principal safety outcome. However, safety and effectiveness data from unselected patients with AF in everyday clinical practice in Japan are lacking...
April 2018: Journal of Arrhythmia
https://www.readbyqxmd.com/read/29657590/comparison-of-uninterrupted-anticoagulation-with-dabigatran-etexilate-or-warfarin-in-the-periprocedural-period-for-atrial-fibrillation-catheter-ablation-results-of-the-japanese-subgroup-of-the-re-circuit-trial
#20
Yukihiko Yoshida, Masato Watarai, Kenshi Fujii, Wataru Shimizu, Kazuhiro Satomi, Yasuya Inden, Yoshimasa Murakami, Masato Murakami, Atsushi Iwasa, Masaomi Kimura, Nobuko Yamada, Tomofumi Nakagawa, Matias Nordaby, Ken Okumura
Background: There are limited data on uninterrupted anticoagulation with direct oral anticoagulants during catheter ablation for atrial fibrillation (AF), particularly in Japan. We planned a subgroup analysis of the RE-CIRCUIT study, comparing the use of uninterrupted dabigatran therapy with warfarin therapy during catheter ablation among the Japanese subgroup and with that in the total population. Methods: The RE-CIRCUIT study utilized a prospective, randomized, open-label, blinded endpoint design, and the primary endpoint was the incidence of major bleeding events (MBEs)...
April 2018: Journal of Arrhythmia
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