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Fibrilation atrial guidelines

Vincenzo Russo, Roberta Bottino, Anna Rago, Pierpaolo Di Micco, Antonio D' Onofrio, Biagio Liccardo, Paolo Golino, Gerardo Nigro
Atrial fibrillation (AF) is commonly diagnosed in the setting of active cancer. Because of an increased risk of either thromboembolic events or bleeding, the decision to initiate therapeutic anticoagulation in patients with active cancer can be challenging. Moreover, little is still known about the optimal anticoagulation therapy in the setting of AF and cancer, and no guidelines are as yet available. Considering that nonvitamin K antagonist oral anticoagulants (NOACs) are recommended as alternatives to vitamin K antagonists for stroke prevention in AF patients with CHA2 DS2- VASc score ≥2, the authors performed a systematic review of the current literature to describe the efficacy and safety of NOACs in AF patients with malignancy...
August 17, 2018: Seminars in Thrombosis and Hemostasis
Toshiya Ohtsuka, Takahiro Nonaka, Motoyuki Hisagi, Mikio Ninomiya
BACKGROUND: We evaluated the safety and rhythm-control effectiveness in en bloc isolation of the left pulmonary vein (PV) and appendage conducted as part of the thoracoscopic procedure for bilateral PV isolation, non-PV ablation, and appendage closure for atrial fibrillation (AF). METHODS: Procedural safety was evaluated by reviewing the surgical records. The rhythm-control was examined in accordance with the Heart Rhythm Society guidelines at postoperative months 1, 3, 6, and 12 and yearly thereafter...
August 14, 2018: Annals of Thoracic Surgery
Ajmer Singh, Yatin Mehta
Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. American College of Cardiology Foundation / American Heart Association 2013 guidelines have classified HF into two categories: (i) HF with reduced (≤40%) ejection fraction (HFrEF) or systolic HF, and (ii) HF with preserved (≥50%) ejection fraction (HFpEF) or diastolic HF. Risk factors for HFpEF include age more than 70 years, female gender, hypertension, wide pulse pressure, diabetes mellitus, chronic renal insufficiency, left ventricular hypertrophy, atrial fibrillation, smoking, recent weight gain, and exercise intolerance...
April 2018: Journal of Anaesthesiology, Clinical Pharmacology
Katie Walsh, Francis Marchlinski
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Ablation is an excellent treatment option for appropriately selected patients. Catheter ablation tools and techniques have evolved since AF ablation was first introduced, but pulmonary vein isolation remains the cornerstone of the procedure. Outcomes from ablation have improved dramatically over the last twenty years, but remain less than optimal for certain patient groups. Areas covered: This review outlines the process of patient selection for AF ablation in contemporary practice, from diagnosis and AF classification to procedural risk assessment...
August 13, 2018: Expert Review of Cardiovascular Therapy
Dominik Rath, Meinrad Gawaz
Catheter-based interventions have revolutionized treatment of both coronary artery disease and aortic valve disease. Yet, these procedures are accompanied by thromboembolic and bleeding complications. Antiplatelet agents and anticoagulants with tolerable risk of bleeding complications are required to protect from recurrent thromboembolic events. Although guidelines for antithrombotic treatment in patients undergoing percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) are available, scarce evidence exists regarding therapeutic recommendations for patients at high risk for thromboembolic events or major bleeding...
August 8, 2018: Hämostaseologie
Jessie S Channell, Stephan Schug
BACKGROUND: Tapentadol is a novel atypical opioid. Anecdotal evidence suggests that tapentadol has a lower toxicity than conventional opioids. OBJECTIVES: To evaluate all single-drug mortality due to tapentadol and assess serious adverse events caused by tapentadol. METHODS: The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) reporting guidelines, an evidence-based minimum set of items for reporting in systematic reviews, were followed in this systematic review...
August 6, 2018: Pain Management
Salih Kılıç, Ahmet Çelik, Elif Çekirdekçi, Servet Altay, Deniz Elçik, Mehmet Kadri Akboğa, Mine Durukan, Çağrı Yayla, Mehdi Zoghi
Background: The use of warfarin and aspirin combination is restricted for limited patients in relevant guidelines. Aims: The aim of this study is to evaluate the prevalence of inappropriate combination of aspirin and warfarin therapy in daily practice and its risks. Study Design: Cross-section study. Methods: WARFARIN-TR study is a multi-center observational study that includes 4987 patients using warfarin for any reason between January 1, 2014 and December 31, 2014...
August 6, 2018: Balkan Medical Journal
Jeffrey M Ashburner, Steven J Atlas, Shaan Khurshid, Lu-Chen Weng, Olivia L Hulme, Yuchiao Chang, Daniel E Singer, Patrick T Ellinor, Steven A Lubitz
BACKGROUND: Oral anticoagulants reduce the risk of stroke in patients with atrial fibrillation. However, many patients with atrial fibrillation at elevated stroke risk are not treated with oral anticoagulants. OBJECTIVE: To test whether electronic notifications sent to primary care physicians increase the proportion of ambulatory patients prescribed oral anticoagulants. DESIGN: Randomized controlled trial conducted from February to May 2017 within 18 practices in an academic primary care network...
August 3, 2018: Journal of General Internal Medicine
John J Atherton, Andrew Sindone, Carmine G De Pasquale, Andrea Driscoll, Peter S MacDonald, Ingrid Hopper, Peter Kistler, Tom G Briffa, James Wong, Walter P Abhayaratna, Liza Thomas, Ralph Audehm, Phillip J Newton, Joan O'Loughlin, Cia Connell, Maree Branagan
Heart failure (HF) is a clinical syndrome that is secondary to an abnormality of cardiac structure or function. These clinical practice guidelines focus on the diagnosis and management of HF with recommendations that have been graded on the strength of evidence and the likely absolute benefit versus harm. Additional considerations are presented as practice points. Main recommendations: Blood pressure and lipid lowering decrease the risk of developing HF. Sodium-glucose cotransporter 2 inhibitors decrease the risk of HF hospitalisation in patients with type 2 diabetes and cardiovascular disease...
August 2, 2018: Medical Journal of Australia
David Brieger, John Amerena, John R Attia, Beata Bajorek, Kim H Chan, Cia Connell, Ben Freedman, Caleb Ferguson, Tanya Hall, Haris M Haqqani, Jeroen Hendriks, Charlotte M Hespe, Joseph Hung, Jonathan M Kalman, Prashanthan Sanders, John Worthington, Tristan Yan, Nicholas A Zwar
Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work-up; acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies; stroke prevention and optimal use of anticoagulants; and integrated multidisciplinary care...
August 2, 2018: Medical Journal of Australia
Kazuo Miyazawa, Yan-Guang Li, Wafa A Rashed, Wael Al Mahmeed, Abdullah Shehab, Mohammad Zubaid, Gregory Y H Lip
BACKGROUND: Anticoagulation therapy in patients with atrial fibrillation (AF) is well established as effective thromboprophylaxis. However, AF patients with prior stroke are often treated with suboptimal antithrombotic treatment (ATT). In the present study, we investigated clinical characteristics and outcomes in AF patients with versus without prior stoke, in relation to guideline adherence in ATT. METHODS: We used data from the Gulf SAFE registry, which included patients with AF who presented to hospitals in Gulf countries of the Middle East...
July 24, 2018: International Journal of Cardiology
Tove Fredriksson, Viveka Frykman, Leif Friberg, Faris Al-Khalili, Johan Engdahl, Emma Svennberg
According to the present European Society of Cardiology's guidelines for atrial fibrillation (AF), the definition of AF contains a 30-second time criterion, based on consensus. The aim of this cohort study is to evaluate whether very short-lasting episodes of AF, micro-AF, are risk factors for developing AF and to compare AF detection between continuous and intermittent ECG recordings applied in parallel. All participants, n = 102, were identified from the STROKESTOP study, a Swedish mass-screening study for AF...
July 4, 2018: American Journal of Cardiology
Katja Schumacher, Jelena Kornej, Eduard Shantsila, Gregory Y H Lip
PURPOSE: Ischemic stroke significantly contributes to morbidity and mortality in heart failure (HF). The risk of stroke increases significantly, with coexisting atrial fibrillation (AF). An aggravating factor could be asymptomatic paroxysms of AF (so-called silent AF), and therefore, the risk stratification in these patients remains difficult. This review provides an overview of stroke risk in HF, its risk stratification, and stroke prevention in these patients. RECENT FINDINGS: Stroke risk stratification in HF patients remains an important issue...
July 30, 2018: Current Heart Failure Reports
Letizia Riva, Walter Ageno, Giuseppe Di Pasquale, Giancarlo Agnelli, Andrea Rubboli
The management of antithrombotic therapy in patients on oral anticoagulation (OAC) for atrial fibrillation (AF) undergoing percutaneous coronary intervention with stent (PCI) is currently addressed by expert consensus documents and official Guidelines. No specific data, nor management suggestions, are available for OAC patients undergoing PCI in whom the indication for OAC is venous thromboembolism (VTE). In this article, the available evidence on VTE patients undergoing PCI, as obtained from studies where patients with various indications for PCI were included, is evaluated, and an algorithm for the management of antithrombotic therapy in this unique population is proposed...
July 26, 2018: International Journal of Cardiology
Steffen Massberg, Amin Polzin
DAPT DURATION DEPENDS ON THE INDIVIDUAL ISCHEMIC- VS. BLEEDING RISK: The updated ESC guidelines on dual antiplatelet therapy (DAPT) focus on individualization of therapy. It is recommended to plan DAPT duration depending on the individual ischemic- vs. bleeding risk of the patient. Evaluation of ischemic- and bleeding risk may be done using heart teams and risk scores respectively. It is underlined that the decision regarding DAPT duration is dynamic and should be re-assessed on a regular basis...
August 2018: Deutsche Medizinische Wochenschrift
Michele Massimo Gulizia, Roberto Cemin, Furio Colivicchi, Leonardo De Luca, Andrea Di Lenarda, Giuseppe Boriani, Giuseppe Di Pasquale, Federico Nardi, Marino Scherillo, Donata Lucci, Gianna Fabbri, Aldo Pietro Maggioni
Aims: To assess the number of admissions to the emergency room (ER) of patients with atrial fibrillation (AF) or atrial flutter (af) and their subsequent management. To evaluate the clinical profile and the use of antithrombotics and antiarrhythmic therapy in patients with AF admitted to cardiology wards. Methods and results: BLITZ-AF is a multicentre, observational study conducted in 154 centres on patients with AF/af. In each centre, data were collected, retrospectively for 4 weeks in ER and prospectively for 12 weeks in cardiology wards...
July 27, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Federico Rea, Giovanni Corrao, Luca Merlino, Giuseppe Mancia
Aims: Guidelines support use of drug combinations in most hypertensive patients, and recently treatment initiation with two drugs has been also recommended. However, limited evidence is available on whether this leads to greater cardiovascular (CV) protection compared to initial monotherapy. Methods and results: Using the healthcare utilization database of the Lombardy Region (Italy), the 44 534 residents of the region (age 40-80 years) who in 2010 started treatment with one antihypertensive drug (n = 37 078) or a two-drug fixed-dose combination (FDC, n = 7456) were followed for 1 year after treatment initiation to compare the risk of hospitalization for CV disease associated with the two treatment strategies...
July 27, 2018: European Heart Journal
Peter Brønnum Nielsen, Tatjana S Potpara, Gregory Y H Lip
No abstract text is available yet for this article.
July 12, 2018: Trends in Cardiovascular Medicine
Nelson Telles-Garcia, Khagendra Dahal, Cyrus Kocherla, Gregory Y H Lip, Pratap Reddy, Paari Dominic
BACKGROUND: Current guidelines recommend anticoagulation using warfarin with bridging parenteral anticoagulation or one of the non-vitamin K antagonist oral anticoagulants (NOACs) to prevent thromboembolic events in patients undergoing cardioversion for atrial fibrillation (AF). We aimed to compare by meta-analytical techniques, the safety and efficacy of NOACs versus warfarin in patients undergoing cardioversion. METHODS: PUBMED, EMBASE, Cochrane CENTRAL and CINAHL were searched electronically in addition to manual search for randomized controlled trials (RCTs) comparing NOACs and warfarin in patients undergoing cardioversion for AF...
October 1, 2018: International Journal of Cardiology
Leonardo Bencivenga, Klara Komici, Graziamaria Corbi, Antonio Cittadini, Nicola Ferrara, Giuseppe Rengo
Anticoagulation is superior to dual antiplatelet therapy (DAPT) in the prevention of thromboembolic events in patients with atrial fibrillation (AF), otherwise the prevention of ischemic risk and stent thrombosis after percutaneous coronary intervention (PCI) is warranted by DAPT. The coexistence of conditions requiring combined antithrombotic therapies is becoming an increasing relevant clinical problem, whose therapeutic management has long been found in the medical experience rather than in guidelines and consensus...
2018: Frontiers in Physiology
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