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https://www.readbyqxmd.com/read/28514878/anticoagulant-cessation-following-atrial-fibrillation-ablation-limits-of-the-ecg-guided-approach
#1
Matteo Anselmino, Chiara Rovera, Giovanni Marchetto, Federico Ferraris, Davide Castagno, Fiorenzo Gaita
Long-term cessation of oral anticoagulation (OAC) following successful catheter or surgical ablation of atrial fibrillation (AF) is debated. Usually, in the presence of sinus rhythm at serial ECG recordings, the CHADS2, CHA2DS2VASc, and HAS-BLED scores are adopted to guide decision regarding OAC management. Areas covered: The safety of OAC cessation in patients without recurrent AF but with historically elevated risk for thromboembolism remains largely unknown. Taking the cue from two clinical cases, we provide an updated summary of the latest evidence regarding how to manage OAC after a successful atrial fibrillation ablation...
May 18, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28495117/first-experience-with-the-watchman-flx-occluder-for-percutaneous-left-atrial-appendage-closure
#2
Julia Seeger, Ralf Birkemeyer, Wolfgang Rottbauer, Jochen Wöhrle
BACKGROUND: We aimed to evaluate efficacy and safety of left atrial appendage (LAA) closure with the new Watchman FLX and analyze procedural features in a consecutive series of high risk non-valvular atrial fibrillation patients. METHODS AND RESULTS: Twelve consecutive non-valvular atrial fibrillation patients (age 76.6±7.8years) at high risk for stroke (CHA2DS2-VASc-Score 5.5±0.9) and bleeding (HAS-BLED-Score 3.8±0.9), received LAA closure with the Watchman FLX...
April 29, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28480507/initiation-of-anticoagulation-in-atrial-fibrillation-which-factors-are-associated-with-choice-of-anticoagulant
#3
Anna Gundlund, Laila Staerk, Emil Loldrup Fosbøl, Kasper Gadsboel, Caroline Sindet-Pedersen, Anders Nissen Bonde, Gunnar H Gislason, Jonas Bjerring Olesen
BACKGROUND: The use of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prophylaxis in atrial fibrillation (AF) is increasing rapidly. We compared characteristics of AF patients initiated on NOACs versus vitamin K antagonists (VKAs). METHODS: Using Danish nationwide registry data we identified AF patients initiating either a VKA or a NOAC from 22 August 2011 until 30 September 2016. We compared patient characteristics including age, gender, comorbidities, concomitant pharmacotherapy and CHA2 DS2 -VASc and HAS-BLED scores in patients initiated on a VKA, dabigatran, rivaroxaban or apixaban...
May 8, 2017: Journal of Internal Medicine
https://www.readbyqxmd.com/read/28477098/predictors-of-thrombus-formation-after-percutaneous-left-atrial-appendage-closure-using-the-watchman-device
#4
Hidehiro Kaneko, Michael Neuss, Jens Weissenborn, Christian Butter
Percutaneous left atrial appendage (LAA) closure using the WATCHMAN device is a novel option for prevention of stroke associated with atrial fibrillation. However, device-related thrombus (DRT) formation is a concern after WATCHMAN implantation and the predictors of DRT still remain unclear. We aimed to clarify the predictors of DRT after WATCHMAN implantation by analyzing 78 patients (50 males, 72 ± 8 years, average CHA2DS2-VASc score of 4.3 + 1.8) who had undergone WATCHMAN implantation. WATCHMAN was successfully implanted in all patients and four (5%) developed DRT...
May 5, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28472104/prediction-of-bleeding-risk-in-patients-taking-vitamin-k-antagonists-using-thrombin-generation-testing
#5
Saartje Bloemen, Suzanne Zwaveling, Hugo Ten Cate, Arina Ten Cate-Hoek, Bas de Laat
Until recently, vitamin K antagonists (VKAs) were the mainstay of oral anticoagulant treatment with bleeding as the most prevalent adverse effect. One to four percent of patients experience major bleeding episodes, while clinically relevant bleeding occurs in up to 20%. At this moment no laboratory assays are available to identify patients at risk for bleeding. With this study we aimed to investigate whether thrombin generation tests might identify a bleeding risk in patients taking VKAs. This prospective cohort study included 129 patients taking VKAs for more than three months...
2017: PloS One
https://www.readbyqxmd.com/read/28464181/utility-of-hemoccult-testing-before-therapeutic-anticoagulation-in-venous-thromboembolism
#6
Ryan Urbas, Marwan Badri, Nicole E Albert, Catherine Prince, Barani Mayilvaganan
OBJECTIVES: Fecal occult blood testing (FOBT) is performed routinely before starting therapeutic anticoagulation in patients despite it never being validated to predict gastrointestinal bleeding (GIB) risk. Our objective was to determine the utility in checking the guaiac FOBT test (gFOBT) before initiating therapeutic anticoagulation in patients with a new diagnosis of venous thromboembolism (VTE). METHODS: This was a retrospective chart review that examined patients with a diagnosis of VTE admitted during a 2-year period in one mid-sized tertiary care center...
May 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28456792/implications-of-cha2ds2-vasc-score-in-stroke-patients-with-atrial-fibrillation-an-analysis-of-938-korean-patients
#7
Jaechun Hwang, Jong-Won Chung, Mi Ji Lee, Gyeong-Moon Kim, Chin-Sang Chung, Kwang Ho Lee, Oh Young Bang
BACKGROUND AND AIMS: The aim of this study was to investigate the stroke mechanisms and associated conditions influencing the decision regarding stroke thromboprophylaxis in patients with atrial fibrillation (AF) plus ischemic stroke, according to the CHA2DS2-VASc score. METHODS: We evaluated 938 consecutive patients with a diagnosis of AF plus transient ischemic attack/ischemic stroke. Based on the CHA2DS2-VASc scores, patients were stratified as score 0 or 1 (n = 151), score 2 (n = 146), score 3 (n = 213), score 4 (n = 185), or score ≥5 (n = 243)...
April 29, 2017: European Neurology
https://www.readbyqxmd.com/read/28418196/clinical-frailty-is-independently-associated-with-non-prescription-of-anticoagulants-in-older-patients-with-atrial-fibrillation
#8
Isuru Induruwa, Nicholas R Evans, Ayesha Aziz, Snigdha Reddy, Kayvan Khadjooi, Roman Romero-Ortuno
AIM: Anticoagulants are underused in older patients with atrial fibrillation (AF). Scoring systems, such as CHA2 DS2 -VASc and HAS-BLED, are recommended to guide clinicians in anticoagulation decisions, but patients' frailty might be an underrecognized factor. We investigated the association between the Clinical Frailty Scale (CFS) and community anticoagulant prescribing habits in patients aged ≥75 years with AF admitted acutely to hospital. METHODS: Data were gathered retrospectively over 3 months on individuals admitted under a medical team to a tertiary teaching hospital in the UK...
April 18, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28416976/rationale-and-design-of-assaf-k-a-study-of-the-safety-and-efficacy-of-anticoagulant-therapy-in-the-treatment-of-atrial-fibrillation-in-kanagawa
#9
Yutaka Hatori, Hiroyuki Sakai, Tomoyuki Kunishima, Nobuo Hatori, Lin Chen, Tomoaki Ishigami, Naoki Satoh
BACKGROUND: Atrial fibrillation (AF) is one of the most prevalent cardiac arrhythmias associated with substantially increased risks of ischemic stroke and thromboembolism. Oral anticoagulants (OACs) are the cornerstone of AF management and effectively prevent AF-related stroke. As new non-vitamin K antagonist OACs (NOACs) have become available, the landscape of stroke prevention in AF has changed. However, there are considerable gaps between daily clinical practice and current guideline-based recommendations for anticoagulant therapy in Japan...
April 2017: Journal of Arrhythmia
https://www.readbyqxmd.com/read/28407216/real-world-stroke-prevention-strategies-in-nonvalvular-atrial-fibrillation-in-patients-with-renal-impairment
#10
Kadir Uğur Mert, Gurbet Özge Mert, Özcan Başaran, Osman Beton, Volkan Dogan, Mehmet Tekinalp, Ahmet Çağrı Aykan, Ezgi Kalaycıoğlu, Ismail Bolat, Onur Taşar, Özgen Şafak, Macit Kalçık, Mehmet Yaman, Cevat Kırma, Murat Biteker
BACKGROUND: The data regarding stroke prevention strategies in non-valvular atrial fibrillation (NVAF) is limited especially in patients with renal impairment (RI). We sought to evaluate management dilemmas in patients with concurrent NVAF and RI in RAMSES (ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies inTurkey) study. METHODS: We conducted a prospective, multicenter, nation-wide registry in NVAF patients in outpatient cardiology clinics. All consecutive patients with nonvalvular atrial fibrillation were enrolled in RAMSES Study (ClinicalTrials...
April 13, 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28394435/real-world-clinical-characteristics-and-treatment-patterns-of-individuals-aged-80-and-older-with-nonvalvular-atrial-fibrillation-results-from-the-real-life-multicenter-survey-evaluating-stroke-study
#11
Murat Biteker, Özcan Başaran, Volkan Doğan, İbrahim Altun, Fatma Özpamuk Karadeniz, Ahmet İlker Tekkesin, Yasin Çakıllı, Ceyhan Türkkan, Mehmet Hamidi, Vahit Demir, Mustafa Ozan Gürsoy, Müjgan Tek Öztürk, Gökhan Aksan, Sabri Seyis, Mehmet Ballı, Mehmet Hayri Alıcı, Serdar Bozyel
OBJECTIVES: To compare the clinical characteristics of and use of oral anticoagulant (OAC) therapy in individuals aged 80 and older with atrial fibrillation (AF) with those of individuals younger than 80 with AF in clinical practice. DESIGN: Observational study. SETTING: The ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey trial (NCT02344901), a national observational registry. PARTICIPANTS: Turkish adults with nonvalvular AF (NVAF)...
April 10, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28359135/scoring-systems-for-estimating-the-risk-of-anticoagulant-associated-bleeding
#12
Anna L Parks, Margaret C Fang
Anticoagulant medications are frequently used to prevent and treat thromboembolic disease. However, the benefits of anticoagulants must be balanced with a careful assessment of the risk of bleeding complications that can ensue from their use. Several bleeding risk scores are available, including the Outpatient Bleeding Risk Index, HAS-BLED, ATRIA, and HEMORR2HAGES risk assessment tools, and can be used to help estimate patients' risk for bleeding on anticoagulants. These tools vary by their individual risk components and in how they define and weigh clinical factors...
March 30, 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28314875/safety-of-catheter-ablation-for-atrial-fibrillation-in-patients-with-intracranial-hemorrhage
#13
H Lin, S-N Li, R Bai, S-N Wen, N Liu, D-Y Long, R-H Yu, R-B Tang, C-H Sang, X Du, J-Z Dong, C-S Ma
BACKGROUND: The safety of anticoagulation and radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF) and a history of intracranial hemorrhage (ICH) remains unclear. We investigated the risks and benefits of this approach in AF patients with a history of ICH. PATIENTS AND METHODS: The ICH group included 45 AF patients with a history of ICH who underwent RFCA. Five of these patients were excluded because ICH occurred spontaneously after cerebral infarction...
March 17, 2017: Herz
https://www.readbyqxmd.com/read/28300870/effectiveness-and-safety-of-apixaban-versus-warfarin-in-non-valvular-atrial-fibrillation-patients-in-real-world-clinical-practice-a-propensity-matched-analysis-of-76-940-patients
#14
Xiaoyan Li, Steve Deitelzweig, Allison Keshishian, Melissa Hamilton, Ruslan Horblyuk, Kiran Gupta, Xuemei Luo, Jack Mardekian, Keith Friend, Anagha Nadkarni, Xianying Pan, Gregory Y H Lip
The ARISTOTLE trial showed a risk reduction of stroke/systemic embolism (SE) and major bleeding in non-valvular atrial fibrillation (NVAF) patients treated with apixaban compared to warfarin. This retrospective study used four large US claims databases (MarketScan, PharMetrics, Optum, and Humana) of NVAF patients newly initiating apixaban or warfarin from January 1, 2013 to September 30, 2015. After 1:1 warfarin-apixaban propensity score matching (PSM) within each database, the resulting patient records were pooled...
March 16, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28284524/evaluation-of-atrial-fibrillation-management-and-cardiovascular-risk-profile-in-atrial-fibrillation-patients-a-cross-sectional-survey
#15
Gediminas Račkauskas, Vytautas Zabiela, Germanas Marinskis, Arvydas Baranauskas, Deimilė Balkutė, Justina Alunderytė, Aras Puodžiūkynas, Tomas Kazakevičius, Vilius Kviesulaitis, Audrius Aidietis
OBJECTIVE: The aim of this study to investigate the most frequent risk factors of atrial fibrillation (AF), co-morbidities, complications associated with AF and the use of anticoagulants and other medications in patients who were referred to university hospitals in Lithuania. MATERIALS AND METHODS: This cross-sectional study enrolled consecutive inpatients and outpatients with AF presenting to cardiologists in the two biggest Lithuanian university hospitals from November 2013 to May 2014...
February 20, 2017: Medicina
https://www.readbyqxmd.com/read/28284508/geographical-differences-in-thromboembolic-and-bleeding-risks-in-patients-with-non-valvular-atrial-fibrillation-an-ancillary-analysis-from-the-sportif-trials
#16
Marco Proietti, Gregory Yh Lip
BACKGROUND: Atrial fibrillation (AF) is associated with an increased risk of stroke, and the use of oral anticoagulation reduces stroke and all-cause mortality. Geographical differences may exist in AF risk factors, risk stratification and treatment strategies. METHODS: A post-hoc subgroup analysis derived from randomized controlled trials, the SPORTIF III and V trials, studying differences between European and North American warfarin-assigned non-valvular AF patients...
February 27, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28267467/anemia-is-associated-with-bleeding-and-mortality-but-not-stroke-in-patients-with-atrial-fibrillation-insights-from-the-apixaban-for-reduction-in-stroke-and-other-thromboembolic-events-in-atrial-fibrillation-aristotle-trial
#17
B Daan Westenbrink, Marco Alings, Christopher B Granger, John H Alexander, Renato D Lopes, Elaine M Hylek, Laine Thomas, Daniel M Wojdyla, Michael Hanna, Matyas Keltai, P Gabriel Steg, Raffaele De Caterina, Lars Wallentin, Wiek H van Gilst
BACKGROUND: Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes. METHODS: We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin <13...
March 2017: American Heart Journal
https://www.readbyqxmd.com/read/28244558/assessing-the-appropriateness-of-oral-anticoagulation-for-atrial-fibrillation-in-advanced-frailty-use-of-stroke-and-bleeding-risk-prediction-models
#18
R O'Caoimh, E Igras, A Ramesh, B Power, K O'Connor, R Liston
BACKGROUND: Atrial fibrillation (AF) is common among frail older adults. Oral anticoagulation (OAC) is particularly challenging for these due to overlapping stroke and bleeding risk factor profiles. OBJECTIVE: To compare the utility of stroke and haemorrhage risk-prediction instruments in the treatment of AF among frail older adults. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: Frail residents in four nursing homes with a Clinical Frailty Scale score ≥5 (median 7±0)...
2017: Journal of Frailty & Aging
https://www.readbyqxmd.com/read/28237286/comparison-of-has-bled-and-has-bed-versus-chads2-and-cha2ds2vasc-stroke-and-bleeding-scores-in-patients-with-atrial-fibrillation
#19
MULTICENTER STUDY
Daniela Poli, Emilia Antonucci, Vittorio Pengo, Sophie Testa, Gualtiero Palareti
Anticoagulation is recommended in patients with atrial fibrillation (AF) for stroke prevention, and the bleeding risk associated suggests the need for a bleeding risk stratification. HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio (INR), elderly >65 years, drugs/alcohol concomitantly) score includes "labile INR" referred to quality of anticoagulation. However, in naïve patients, this item is not available. In addition, stroke and bleeding risk prediction scores shared several risk factors...
April 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28228120/findings-of-transoesophageal-echocardiogram-in-appropriately-anticoagulated-patients-with-persistent-atrial-fibrillation-prior-to-planned-cardioversion
#20
Jūratė Barysienė, Aistė Žebrauskaitė, Dovilė Petrikonytė, Germanas Marinskis, Sigita Aidietienė, Audrius Aidietis
BACKGROUND: To evaluate a diagnostic value of transoesophageal echocardiogram (TEE) in appropriately anticoagulated patients with a non-valvular atrial fibrillation (AF) and to establish possible additional indications for TEE; to evaluate the incidence of left atrial (LA) thrombi in appropriately anticoagulated patients in daily clinical practice. METHODS: This retrospective study analyses data of 432 patients who had been anticoagulated by means of oral anticoagulants (OACs) prior to planned cardioversion during the period from 2012 to 2015...
February 23, 2017: BMC Cardiovascular Disorders
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