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aspirin use in af

Eric Paulus, Kathy Komperda, Gabriel Park, Julie Fusco
Factor VII (FVII) deficiency is the most prevalent rare bleeding disorder in the USA and affects approximately 1 out of every 500,000 people. Warfarin inhibits the synthesis of FVII, in addition to other clotting factors. Warfarin is contraindicated in patients with bleeding tendencies or blood dyscrasias; therefore, the literature regarding the use of warfarin in FVII deficiency is very limited. We report a successful re-challenge of warfarin therapy in a patient with FVII deficiency. A 70-year-old woman with FVII deficiency experienced a significant decrease in FVII activity and subsequent vaginal bleeding roughly 5 weeks after starting warfarin for atrial fibrillation...
December 2016: Drug Saf Case Rep
Jamshed J Dalal, Anil Dhall, Abhay Bhave
Oral vitamin K antagonists (VKA) such as warfarin have been the mainstay of therapy for stroke prevention in patients with non valvular atrial fibrillation (NVAF) while low-molecular-weight heparin, fondaparinux and adjusted-dose warfarin or aspirin have been routinely used for thromboembolism (VTE) prophylaxis in patients undergoing total hip or knee replacement. However, VKAs are associated with considerable limitations, including increased risk of bleeding and narrow therapeutic window. Novel oral anticoagulants (NOACs, now referred as Non Vit K dependent oral anticoagulants), including the direct thrombin inhibitor dabigatran and direct Factor Xa inhibitors such as rivaroxaban and apixaban are now approved alternatives to warfarin for prophylaxis of stroke and systemic embolic events (SEE) in patients with NVAF and treatment and prophylaxis of VTE...
April 2016: Journal of the Association of Physicians of India
Farah Z Dawood, Suzanne Judd, Virginia J Howard, Nita A Limdi, James F Meschia, Mary Cushman, George Howard, David M Herrington, Elsayed Z Soliman
The relation between inflammation and prothrombotic state in atrial fibrillation (AF) is well recognized. This suggests a potential role for high-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, in improving prediction of stroke in participants with AF. Cox proportional hazard analysis was used to examine the risk of stroke in 25,841 participants (40% black and 55% women) with and without AF who were enrolled in the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2007...
September 14, 2016: American Journal of Cardiology
Zanfina Ademi, Kumar Pasupathi, Danny Liew
OBJECTIVE: To determine the clinical and cost effectiveness of apixaban compared to aspirin in the prevention of thromboembolic events for patients with atrial fibrillation for whom vitamin K antagonist (VKA) therapy (warfarin) has been considered unsuitable. METHODS: A previously published Markov model with yearly cycles was updated. Information from the Apixaban Versus Acetylsalicylic acid to prevent Stroke in Atrial Fibrillation (AVERROES) trial in combination with other population data was used to simulate the costs and effects of apixaban compared to aspirin over 10 years...
October 4, 2016: Applied Health Economics and Health Policy
Daniele Gemma, Raúl Moreno Gómez, Jaime Fernández de Bobadilla, Guillermo Galeote García, Teresa López Fernandez, Jose R López-Mínguez, José L López-Sendón
Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease...
September 29, 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
E Pandya, N Masood, Y Wang, I Krass, B Bajorek
The computerized antithrombotic risk assessment tool (CARAT) is an online decision-support algorithm that facilitates a systematic review of a patient's stroke risk, bleeding risk, and pertinent medication safety considerations, to generate an individualized treatment recommendation. The CARAT was prospectively applied across 2 hospitals in the greater Sydney area. Its impact on antithrombotics utilization for thromboprophylaxis in patients with nonvalvular atrial fibrillation was evaluated. Factors influencing prescribers' treatment selection were identified...
September 26, 2016: Clinical and Applied Thrombosis/hemostasis
Charlotte H So, Mark H Eckman
The combined use of aspirin and oral anticoagulant therapy in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) has been questioned due to an increased risk of major bleeding with little to no benefit in preventing ischemic events. (1) To better understand patterns and indications for combined antiplatelet and anticoagulant therapy and identify patients who might reasonably be treated with oral anticoagulant (OAC) therapy alone. (2) To perform an updated literature review regarding the use of combined antiplatelet and OAC therapy in patients with AF and stable CAD...
September 24, 2016: Journal of Thrombosis and Thrombolysis
Guillaume Cayla, Florence Leclercq, Laurent Schmutz, Luc Cornillet, Bertrand Ledermann, Patrick Messner, Benoit Lattuca
Venous thromboembolism and atrial fibrillation are two important indications of direct oral anticoagulants. Acute coronary syndrome is another potential indication of prolonged antithrombotic therapy in addition to antiplatelet therapy. Phase 2 and 3 studies were conducted with different molecules at different doses in acute coronary syndrome in addition to dual antiplatelet therapy. Studies have not shown a reduction of ischemic events for dabigatran and apixaban, but an excess of bleeding complications was observed...
September 2, 2016: La Presse Médicale
Rohan Shah, Anne Hellkamp, Yuliya Lokhnygina, Richard C Becker, Scott D Berkowitz, Günter Breithardt, Werner Hacke, Jonathan L Halperin, Graeme J Hankey, Keith A A Fox, Christopher C Nessel, Kenneth W Mahaffey, Jonathan P Piccini, Daniel E Singer, Manesh R Patel
BACKGROUND: We aimed to investigate the relationship between aspirin use and clinical outcomes in patients enrolled in Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF), in particular, those with known coronary artery disease (CAD). METHODS: Patients in ROCKET AF, comparing rivaroxaban and warfarin, were analyzed. Aspirin use was assessed at baseline...
September 2016: American Heart Journal
Vivian Wing-Yan Lee, Ronald Bing-Ching Tsai, Ines Hang-Iao Chow, Bryan Ping-Yen Yan, Mehmet Gungor Kaya, Jai-Wun Park, Yat-Yin Lam
BACKGROUND: Transcatheter left atrial appendage occlusion (LAAO) is a promising therapy for stroke prophylaxis in non-valvular atrial fibrillation (NVAF) but its cost-effectiveness remains understudied. This study evaluated the cost-effectiveness of LAAO for stroke prophylaxis in NVAF. METHODS: A Markov decision analytic model was used to compare the cost-effectiveness of LAAO with 7 pharmacological strategies: aspirin alone, clopidogrel plus aspirin, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban...
2016: BMC Cardiovascular Disorders
Daniele Pastori, Pasquale Pignatelli, Francesco Perticone, Angela Sciacqua, Roberto Carnevale, Alessio Farcomeni, Stefania Basili, Gino R Corazza, Giovanni Davì, Gregory Y H Lip, Francesco Violi
BACKGROUND: In experimental models, thromboxane (Tx)A2 reduced renal perfusion and accelerated renal failure. The aim of the study was to investigate the association between the use of aspirin, which inhibits TxA2 production, and the incidence of an estimated Glomerular Filtration Rate (eGFR) <60 and <45ml/min/1.73m(2) in patients with atrial fibrillation (AF) and chronic kidney disease (CKD). METHODS: Prospective multicentre observational cohort study including 800 anticoagulated AF patients; CKD was defined as an eGFR <90ml/min/1...
November 15, 2016: International Journal of Cardiology
Omar Abdul-Jawad Altisent, Eric Durand, Antonio J Muñoz-García, Luis Nombela-Franco, Asim Cheema, Joelle Kefer, Enrique Gutierrez, Luis M Benítez, Ignacio J Amat-Santos, Vicenç Serra, Helene Eltchaninoff, Sami M Alnasser, Jaime Elízaga, Antonio Dager, Bruno García Del Blanco, Maria Del Rosario Ortas-Nadal, Josep Ramon Marsal, Francisco Campelo-Parada, Ander Regueiro, Maria Del Trigo, Eric Dumont, Rishi Puri, Josep Rodés-Cabau
OBJECTIVES: The study sought to examine the risk of ischemic events and bleeding episodes associated with differing antithrombotic strategies in patients undergoing transcatheter aortic valve replacement (TAVR) with concomitant atrial fibrillation (AF). BACKGROUND: Guidelines recommend antiplatelet therapy (APT) post-TAVR to reduce the risk of stroke. However, data on the efficacy and safety of this recommendation in the setting of a concomitant indication for oral anticoagulation (due to atrial fibrillation [AF]) with a vitamin K antagonist (VKA) are scarce...
August 22, 2016: JACC. Cardiovascular Interventions
Ariel Dogliotti, Robert P Giugliano
BACKGROUND: Anti-thrombotic reduces thromboembolic events but increases bleeding in patients with atrial fibrillation (AF). We evaluated the benefit-risk of anti-platelet and anti-coagulant therapies, weighing these conflicting effects of treatment. METHODS: Randomized controlled trials in patients with AF were identified from MEDLINE, Embase, and Cochrane Central Register of Controlled Trials through April 2014. We performed a stochastic multi-criteria acceptability analysis, which allowed us to compute a comprehensive benefit-risk profile...
January 2015: European Heart Journal. Cardiovascular Pharmacotherapy
Ayrton R Massaro, Gregory Y H Lippp
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention...
August 11, 2016: Arquivos Brasileiros de Cardiologia
Larry R Jackson, Jonathan P Piccini, Derek D Cyr, Matthew T Roe, Megan L Neely, Felipe Martinez, Thomas F Lüscher, Renato D Lopes, Kenneth J Winters, Harvey D White, Paul W Armstrong, Keith A A Fox, Dorairaj Prabhakaran, Deepak L Bhatt, E Magnus Ohman, Ramón Corbalán
Associations between atrial fibrillation (AF), outcomes, and response to antiplatelet therapies in patients with acute coronary syndrome (ACS) managed medically without revascularization remain uncertain. We examined these associations for medically managed ACS patients randomized to dual antiplatelet therapy (DAPT) using patient data from the TRILOGY ACS trial. DAPT included aspirin plus clopidogrel 75 mg/d or prasugrel 10 mg/d (5 mg/d for those <60 kg or age ≥75 years). Patients receiving oral anticoagulants were excluded...
September 2016: Clinical Cardiology
Sarah Nelson, Lisa Cloonan, Allison S Kanakis, Kaitlin M Fitzpatrick, Kelsey I Shideler, Adriana S Perilla, Karen L Furie, Natalia S Rost
BACKGROUND: Aspirin is known to reduce stroke risk; however, its role in reducing severity of ischemic syndrome is not clear. We sought to investigate the relationship between antecedent aspirin use and stroke severity in patients presenting with acute ischemic stroke (AIS). METHODS: We retrospectively analyzed a prospectively collected database of consecutive AIS patients presenting to our center. Clinical characteristics (including antecedent aspirin use), imaging findings, and laboratory data were assessed in association with presenting stroke severity, as measured by the National Institutes of Health Stroke Scale (NIHSS)...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Tomoya Hoshi, Akira Sato, Akihiko Nogami, Masahiko Gosho, Kazutaka Aonuma
BACKGROUND: Patients with atrial fibrillation who undergo coronary stenting require triple antithrombotic therapy, including aspirin, a P2Y12 inhibitor, and anticoagulation, to prevent both stroke and stent thrombosis. However, triple therapy may increase the risk of bleeding complications. The optimal management of triple therapy still presents a challenge in these patients. HYPOTHESIS: We hypothesized that 1-month P2Y12 inhibitor treatment after drug-eluting stent (DES) implantation, as compared with 6-month P2Y12 inhibitor treatment, in combination with aspirin and apixaban, would be associated with a decrease in the incidence of bleeding complications in patients with atrial fibrillation who undergo DES implantation...
July 18, 2016: Journal of Cardiology
David Conen, Jorge A Wong, Roopinder K Sandhu, Nancy R Cook, I-Min Lee, Julie E Buring, Christine M Albert
IMPORTANCE: A substantial proportion of patients with atrial fibrillation (AF) die of noncardiovascular causes, and recent studies suggest a link between AF and cancer. OBJECTIVE: To evaluate the associations between AF and cancer in a large, long-term prospective cohort study. DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, a total of 34 691 women 45 years or older and free of AF, cardiovascular disease, and cancer at baseline were prospectively followed up between 1993 and 2013, for incident AF and malignant cancer within the Women's Health Study, a randomized clinical trial of aspirin and vitamin E for the prevention of cardiovascular disease and cancer...
July 1, 2016: JAMA Cardiology
Fredrik Björck, Henrik Renlund, Gregory Y H Lip, Per Wester, Peter J Svensson, Anders Själander
IMPORTANCE: Vitamin K antagonist (eg, warfarin) use is nowadays challenged by the non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF). NOAC studies were based on comparisons with warfarin arms with times in therapeutic range (TTRs) of 55.2% to 64.9%, making the results less credible in health care systems with higher TTRs. OBJECTIVES: To evaluate the efficacy and safety of well-managed warfarin therapy in patients with nonvalvular AF, the risk of complications, especially intracranial bleeding, in patients with concomitant use of aspirin, and the impact of international normalized ratio (INR) control...
May 1, 2016: JAMA Cardiology
Marco Proietti, Deirdre A Lane, Gregory Y H Lip
BACKGROUND: Chronic kidney disease (CKD) is highly prevalent in atrial fibrillation (AF) patients and associated with an increased risk of adverse outcomes. Our objectives were to study clinical features associated with CKD in AF patients and the impact of CKD on anticoagulation control, as reflected by time in therapeutic range (TTR). We also determined the impact of CKD and TTR in predicting adverse outcomes. METHODS AND RESULTS: We analysed pooled datasets from SPORTIF III and V trials, including 3646 patients assigned to warfarin with data on renal function...
June 2016: EBioMedicine
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