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https://www.readbyqxmd.com/read/29143099/-left-atrial-appendage-clusure-in-nonvalvular-atrial-fibrillation-clinical-evidence-2017
#1
REVIEW
Steffen Gloekler, Bajram Hajredini, Simon Rycerz, Sebastian Jäckle, Werner Jung
Nonvalvular atrial fibrillation (AF) is the most common arrhythmia with a prevalence of 1-2% and affects approximately 15-20% of all octogenarians. Patients are at increased risk of thromboembolic stroke, with an overall risk of 5% per year. Thrombi form almost exclusively in the left atrial appendage (LAA), a blind sac-like heterogeneous structure trabeculated by pectinate muscles. In the past five decades, life-long oral anticoagulation (OAC) with vitamin K antagonists (VKA) has been the state-of-the art treatment to prevent stroke and systemic embolism from thrombi in AF...
November 15, 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/29141274/use-of-direct-oral-anticoagulants-in-the-first-year-after-market-entry-of-edoxaban-a-danish-nationwide-drug-utilization-study
#2
Anton Pottegård, Erik L Grove, Maja Hellfritzsch
OBJECTIVES: To describe the early uptake of edoxaban; the fourth direct oral anticoagulant (DOAC) to enter the market. METHODS: Using the Danish nationwide health registries, we identified new users of edoxaban (n = 609) from June 6 (day of marketing) through June 2017. For comparison, we also identified new users of dabigatran (n = 2211), rivaroxaban (n = 19 227), and apixaban (n = 14 736). Users were described regarding indication of use, previous anticoagulant experience, comorbidity, and co-medication...
November 15, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/29129259/comparison-of-prevalence-and-management-of-left-atrial-appendage-thrombi-under-old-and-new-anticoagulants-prior-to-left-atrial-catheter-ablation
#3
Antoine Da Costa, Clarisse Delolme, Jean Baptiste Guichard, Antoine Gerbay, Romain Pierrard, Cécile Romeyer-Bouchard, Karl Isaaz
BACKGROUND: The prevalence and management of left atrial appendage (LAA) thrombi associated with new anticoagulants remain to be elucidated, especially prior to atrial fibrillation (AFib) ablation. This study sought to (1) compare the prevalence of LAA thrombi and/or severe LAA contrast under vitamin K antagonist (VKA) agents and novel oral anticoagulants (NOACs), (2) evaluate the rate of LAA thrombus resolution after anticoagulation modification, and (3) determine the predictive factors of LAA thrombi and severe LAA contrast in patients prior to LA AFib ablation...
November 2017: American Heart Journal
https://www.readbyqxmd.com/read/29121522/effects-of-vitamin-k-antagonist-on-aortic-valve-degeneration-in-non-valvular-atrial-fibrillation-patients-prospective-4-year-observational-study
#4
Kazuhiro Yamamoto, Yukihiro Koretsune, Takashi Akasaka, Akira Kisanuki, Nobuyuki Ohte, Takashi Takenaka, Masaaki Takeuchi, Kiyoshi Yoshida, Kazunori Iwade, Yuji Okuyama, Yutaka Hirano, Yasuharu Takeda, Yasumasa Tsukamoto, Yoshiharu Kinugasa, Satoshi Nakatani, Takashi Sakamoto, Katsuomi Iwakura, Takashi Sozu, Tohru Masuyama
BACKGROUND: The prevalence of atrial fibrillation (AF) is high in elder subjects. Our previous observational study suggested that vitamin K antagonist (VKA) promotes aortic valve degeneration, a principal cause of aortic stenosis in the elderly, and that angiotensin receptor blocker (ARB) attenuates its progression. This study aimed to prospectively investigate these observations in non-valvular AF patients. METHODS: Of enrolled 430 patients with calcification on no or one aortic valve leaflet, all of the planned 4-year follow-up data were obtained in 122 non-valvular AF patients treated with warfarin (warfarin group) and 101 patients with cardiovascular diseases and without AF and prescription of warfarin (non-warfarin group)...
November 6, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29108127/multi-dose-drug-dispensing-as-a-tool-to-improve-medication-adherence-a-study-in-patients-using-vitamin-k-antagonists
#5
Nienke van Rein, Kristel S de Geus, Suzanne C Cannegieter, Pieter H Reitsma, Felix J M van der Meer, Willem M Lijfering
PURPOSE: Multi-dose drug dispensing (MDD) is a dosing aid that provides patients with disposable bags containing all drugs intended for 1 dosing moment. MDD is believed to increase medication adherence, but studies are based on self-reported data, and results may depend on socially desirable answers. Therefore, our purpose was to determine the effect of MDD on medication adherence in non-adherent patients taking vitamin K antagonists (VKAs), and to compare with instructing patients on medication use...
November 6, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/29106834/-left-atrial-appendage-closure-and-embolic-events
#6
M Akodad, P Garot
Atrial fibrillation (AF) is frequent and responsible for embolic events. Currently, the gold standard to prevent such embolic events is anticoagulant therapy with vitamin K antagonist (VKA) or direct oral anticoagulant in nonvalvular AF. Recently, left atrial appendage closure was proposed as an alternative to anticoagulant inpatient with high embolic risk and contraindication to anticoagulant therapy. Data from randomized trials were consistent with a non-inferiority of left atrial appendage closure in comparison to VKA in terms of stroke and cardiovascular death...
October 26, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29106831/-transcatheter-aortic-valve-thrombosis
#7
D Leguay, S Duval, M Leroux, A Monnier, Y Davienne, C Brasselet
GOALS: Transcatheter aortic valve or leaflets thrombosis are mainly misapprehended. It negatively impacts the long-term efficiency of such prosthesis. Moreover, its incidence is presumably higher than previously described. EPIDEMIOLOGY: Recently reported subclinical leaflet thrombosis, occurring between first to third months after implantation, is about 10to 15%. All prosthesis are concerned by potential thrombosis. DIAGNOSIS: Transcatheter aortic valve thrombosis is usually detected on the basis of increased transvalvular pressure gradients or symptoms at routine follow-up...
October 26, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29101289/the-efficacy-and-safety-of-the-use-of-non-vitamin-k-antagonist-oral-anticoagulants-in-patients-with-non-valvular-atrial-fibrillation-and-concomitant-aspirin-therapy-a-meta-analysis-of-randomized-trials
#8
Naoual Bennaghmouch, Anne J W M de Veer, Kerstin Bode, Bakhtawar K Mahmoodi, Willem J M Dewilde, Gregory Y H Lip, Martina Brueckmann, Eva Kleine, Jurriën M Ten Berg
Background -Current guidelines recommend non-vitamin-K antagonist oral anticoagulants (NOACs) as the first choice therapy in patients with non-valvular atrial fibrillation, as these drugs have several benefits over the vitamin-K antagonists (VKA). It is unknown whether these benefits remain when NOACs have to be combined with aspirin therapy. To assess the efficacy and safety of NOACs compared with VKA in patients with AF and concomitant aspirin therapy, we conducted a systematic review and study based meta-analysis of published randomized controlled trials (RCTs)...
November 3, 2017: Circulation
https://www.readbyqxmd.com/read/29100908/quality-of-life-in-children-participating-in-a-non-selective-inr-self-monitoring-vka-education-programme
#9
Pascal Amedro, Fanny Bajolle, Helena Bertet, Radhia Cheurfi, Dominique Lasne, Erika Nogue, Pascal Auquier, Marie-Christine Picot, Damien Bonnet
BACKGROUND: The quality of life (QoL) of children receiving vitamin K antagonist (VKA) treatment has been scarcely studied. AIM: To assess QoL of children, and its evolution, throughout our non-selective international normalized ratio (INR) self-monitoring education programme. METHODS: Children and parents completed QoL questionnaires (Qualin, PedsQL) during education sessions. Scores were compared with those from controls. RESULTS: A total of 111 children (mean±standard deviation age 8...
October 31, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/29096024/antithrombotic-therapy-in-atrial-fibrillation-associated-with-valvular-heart-disease-a-joint-consensus-document-from-the-european-heart-rhythm-association-ehra-and-european-society-of-cardiology-working-group-on-thrombosis-endorsed-by-the-esc-working-group
#10
Gregory Y H Lip, Jean Philippe Collet, Raffaele de Caterina, Laurent Fauchier, Deirdre A Lane, Torben B Larsen, Francisco Marin, Joao Morais, Calambur Narasimhan, Brian Olshansky, Luc Pierard, Tatjana Potpara, Nizal Sarrafzadegan, Karen Sliwa, Gonzalo Varela, Gemma Vilahur, Thomas Weiss, Giuseppe Boriani, Bianca Rocca
Atrial fibrillation (AF) is a major worldwide public health problem, and AF in association with valvular heart disease (VHD) is also common. However, management strategies for this group of patients have been less informed by randomized trials, which have largely focused on 'non-valvular AF' patients. Thrombo-embolic risk also varies according to valve lesion and may also be associated with CHA2DS2VASc score risk factor components, rather than only the valve disease being causal. Given marked heterogeneity in the definition of valvular and non-valvular AF and variable management strategies, including non-vitamin K antagonist oral anticoagulants (NOACs) in patients with VHD other than prosthetic heart valves or haemodynamically significant mitral valve disease, there is a need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD...
November 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29095971/quality-of-oral-anticoagulation-with-vitamin-k-antagonists-in-real-world-patients-with-atrial-fibrillation-a-report-from-the-prospective-multicentre-fantasiia-registry
#11
María Asunción Esteve-Pastor, José Miguel Rivera-Caravaca, Inmaculada Roldán-Rabadán, Vanessa Roldán, Javier Muñiz, Paula Raña-Míguez, Martín Ruiz-Ortiz, Ángel Cequier, Vicente Bertomeu-Martínez, Lina Badimón, Manuel Anguita, Gregory Y H Lip, Francisco Marín
Aims: The efficacy and safety of oral anticoagulation (OAC) using the vitamin K antagonists (VKA) are closely associated with the quality of anticoagulation, reflected by time in therapeutic range (TTR). The SAMe-TT2R2 is a risk score developed to predict the quality of anticoagulation control among VKA users. To analyse the quality of anticoagulation and its clinical determinants based on different methods in a prospective cohort of atrial fibrillation patients on VKA treatment participating in the multicentre Spanish observational registry FANTASIIA...
October 31, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29092916/use-of-oral-anticoagulants-in-combination-with-antiplatelet-s-in-atrial-fibrillation
#12
Caroline Sindet-Pedersen, Laila Staerk, Morten Lamberts, Thomas Alexander Gerds, Jeffrey S Berger, Anders Nissen Bonde, Jannik Langtved Pallisgaard, Morten Lock Hansen, Christian Torp-Pedersen, Gunnar H Gislason, Jonas Bjerring Olesen
OBJECTIVES: To investigate temporal trends in the use of non-vitamin K oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) in combination with aspirin and/or clopidogrel in patients with atrial fibrillation (AF) following acute myocardial infarction (MI) and/or percutaneous coronary intervention (PCI). METHODS: Using Danish nationwide registries, all patients with AF who survived 30 days after discharge from MI and/or PCI between 22 August 2011 and 30 September 2016 were identified...
November 1, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29092116/unexpected-problems-of-antithrombotic-therapy-with-an-unusual-side-effect-of-vitamin-k-antagonists-after-mitral-valve-replacement
#13
Benjamin Marchandot, Nathan Messas, Laurence Jesel, Annie Trinh, Marion Kibler, Antje Reydel, Patrick Ohlmann, Olivier Morel
Except for bleeding complications, vitamin K antagonists (VKAs) are known to have few undesirable side effects. Herein is presented the case of a 45-year-old woman in whom liver damage was induced by fluindione and warfarin after mitral valve replacement. Hepatotoxicity is a rare complication of VKAs, both in the French National and Drug Safety registry and the medical literature. A diagnosis of VKA-induced drug damage was confirmed by the absence of other etiologies, the chronological sequence, recurrence after re-exposure to VKA, and rapid improvements after discontinuation of the drug...
May 2017: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/29082583/the-risk-of-ischaemic-stroke-in-primary-aps-patients-a-prospective-study
#14
Massimo Radin, Karen Schreiber, Irene Cecchi, Dario Roccatello, Maria José Cuadrado, Savino Sciascia
BACKGROUND: The most common neurological manifestation of APS is ischaemic stroke. Identifying patients with APS at high risk for developing any thrombotic event remains a major challenge. In this study, we aimed to identify predictive factors of ischaemic stroke in a cohort of primary APS (PAPS) patients who presented with new onset symptoms suggestive of acute stroke. METHODS: This prospective multicenter study included 36 consecutive PAPS patients who presented with new onset symptoms suggestive of an acute stroke...
October 30, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29080549/predicted-risk-of-stroke-and-bleeding-and-use-of-oral-anticoagulants-in-atrial-fibrillation-danish-nationwide-temporal-trends-2011-2016
#15
Alexandar Dukanovic, Laila Staerk, Emil Loldrup Fosbøl, Kasper Gadsbøll, Gunnar Hilmar Gislason, Jonas Bjerring Olesen
INTRODUCTION, MATERIALS AND METHODS: We used Danish nationwide registries to examine temporal trends in the predicted stroke and bleeding risks (mean CHA2DS2-VASc and HAS-BLED scores per year, respectively) as well as the combination of selected stroke and bleeding risk factors per year among atrial fibrillation (AF) patients initiated for the first time between 2011 and 2016 on vitamin K antagonists (VKAs), dabigatran, rivaroxaban, or apixaban. RESULTS: In total, 53,860 AF patients were included (VKA 37...
October 16, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29072911/the-design-of-small-molecule-active-site-inhibitors-of-the-s1a-family-proteases-as-procoagulant-and-anticoagulant-drugs
#16
Peter M Fischer
Vitamin K antagonists (VKA) have long been the default drugs for anticoagulant management in venous thrombosis. While efficacious, they are difficult to use due to interpatient dose-response variability and the risks of bleeding. The approval of fondaparinux, a heparin-derived factor Xa (fXa) inhibitor, provided validation for the development of direct oral anticoagulants (DOAC), and currently such inhibitors of thrombin and fXa are in clinical use. These agents can be used without regular coagulation monitoring but the inherent risk of bleeding complications associated with blocking the common coagulation pathway remains...
October 26, 2017: Journal of Medicinal Chemistry
https://www.readbyqxmd.com/read/29071124/management-of-anticoagulation-in-hip-fractures-a-pragmatic-approach
#17
Rafik Yassa, Mahdi Yacine Khalfaoui, Ihab Hujazi, Hannah Sevenoaks, Paul Dunkow
Hip fractures are common and increasing with an ageing population. In the United Kingdom, the national guidelines recommend operative intervention within 36 hours of diagnosis. However, long-term anticoagulant treatment is frequently encountered in these patients which can delay surgical intervention. Despite this, there are no set national standards for management of drug-induced coagulopathy pre-operatively in the context of hip fractures.The aim of this study was to evaluate the management protocols available in the current literature for the commonly encountered coagulopathy-inducing agents...
September 2017: EFORT open reviews
https://www.readbyqxmd.com/read/29068809/advances-in-managing-and-preventing-thromboembolic-disease-in-cancer-patients
#18
Anthony Maraveyas, Iqtedar Muazzam, Simon Noble, George Bozas
PURPOSE OF REVIEW: To update on new data for low-molecular weight heparins (LMWHs) and the direct oral anticoagulants (DOACs) for the treatment and prevention of cancer-associated thrombosis (CAT), to discuss progress with the risk-adaptive management scores (RAMS) and update on increased dose primary thromboprophylaxis (IDPTP). RECENT FINDINGS: In a pooled meta-analysis of 1132 cancer patients who received DOACs vs. vitamin K analogues (VKAs), recurrence of venous thromboembolism (VTE) was reduced from 6...
December 2017: Current Opinion in Supportive and Palliative Care
https://www.readbyqxmd.com/read/29066371/harmful-and-beneficial-effects-of-anti-coagulants-in-patients-with-cirrhosis-and-portal-vein-thrombosis
#19
Vincenzo La Mura, Simon Braham, Giulia Tosetti, Federica Branchi, Niccolò Bitto, Marco Moia, Anna Ludovica Fracanzani, Massimo Colombo, Armando Tripodi, Massimo Primignani
BACKGROUND & AIMS: Vitamin K antagonists (VKAs) promote recanalization of portal vein thrombosis (PVT) in patients with cirrhosis. However, the benefit of PVT recanalization might be offset by major and minor bleeding associated with use of anti-coagulants. We evaluated harmful and beneficial effects of VKA in patients with PVT and cirrhosis. METHODS: We performed a retrospective study of 63 consecutive patients with cirrhosis given anti-coagulants for a first detection of non-neoplastic PVT from 2003 to 2015 in Italy...
October 21, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29057123/four-factor-prothrombin-complex-concentrate-reduces-time-to-procedure-in-vitamin-k-antagonist-treated-patients-experiencing-gastrointestinal-bleeding-a-post-hoc-analysis-of-two-randomized-controlled-trials
#20
Majed A Refaai, Truptesh H Kothari, Shana Straub, Jacob Falcon, Ravi Sarode, Joshua N Goldstein, Andres Brainsky, Laurel Omert, Martin L Lee, Truman J Milling
INTRODUCTION: To investigate the impact of a 4-factor prothrombin complex concentrate (4F-PCC [Beriplex®/Kcentra®]) versus plasma on "time to procedure" in patients with acute/severe gastrointestinal bleeding requiring rapid vitamin K antagonist (VKA) reversal prior to invasive procedure. METHODS: A post hoc analysis of two phase III trials of 4F-PCC versus plasma in patients with acute/severe gastrointestinal bleeding. The treatment arms were compared for study treatment volume, infusion times, and time from start of study treatment to procedure...
2017: Emergency Medicine International
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