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Atrial fibrilation, stroke

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https://www.readbyqxmd.com/read/28650000/andexanet-alfa-a-recombinant-mimetic-of-human-factor-xa-for-the-reversal-of-anticoagulant-therapies
#1
G Escolar, M Diaz-Ricart, E Arellano-Rodrigo
Activated coagulation factor X (FXa) is a common target for classic and newer anticoagulants. Parenteral anticoagulants with an indirect inhibitory action on FXa (low-molecular-weight heparins) have a well-established clinical efficacy in the prophylaxis and therapy of thromboembolic conditions. More recently developed direct oral anticoagulants (DOACs) have emerged as a new class of antithrombotic drugs. Rivaroxaban, apixaban and edoxaban are direct inhibitors of FXa approved for the management of venous thromboembolism and stroke prevention in atrial fibrillation...
May 2017: Drugs of Today
https://www.readbyqxmd.com/read/28649948/endovascular-thrombectomy-in-patients-with-acute-ischemic-stroke-and-atrial-fibrillation-a-mr-clean-subgroup-analysis
#2
Alis Heshmatollah, Puck S S Fransen, Olvert A Berkhemer, Debbie Beumer, Aad van der Lugt, Charles B L M Majoie, Robert J Oostenbrugge, Wim H van Zwam, Peter J Koudstaal, Yvo B W E M Roos, Diederik W J Dippel
AIMS: Endovascular thrombectomy (EVT) improves outcome after acute ischemic stroke (AIS) caused by an intracranial occlusion. The aim of the present study is to determine if atrial fibrillation (AF) modifies the effect of EVT. METHODS AND RESULTS: MRCLEAN was a randomized clinical trial of EVT plus usual care vs. usual care alone for patients with an intracranial occlusion. The primary outcome was the modified Rankin scale (mRS) score at 90 days. The primary effect parameter was the adjusted common odds ratio (acOR), estimated with ordinal logistic regression and adjusted for age and stroke severity at baseline...
June 27, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28649894/comparison-of-all-cause-stroke-and-bleed-specific-healthcare-resource-utilization-among-patients-with-non-valvular-atrial-fibrillation-nvaf-and-newly-treated-with-dabigatran-or-warfarin
#3
Xue Song, Pranav Gandhi, Adrienne M Gilligan, Prachi Arora, Cheng Wang, Caroline Henriques, Stephen Sander, David M Smith
OBJECTIVE: We compared healthcare utilization outcomes and persistence among non-valvular atrial fibrillation (NVAF) patients newly treated with dabigatran or warfarin. METHODS: Using a nationwide, US administrative claims database, a retrospective matched-cohort of newly diagnosed NVAF patients (age≥18 years) treated with dabigatran or warfarin (propensity score matched 1:1) in 01/01/2011-12/31/2013 was evaluated. All-cause, stroke- and bleed-specific per-patient per-month (PPPM) HCRU, incidence rate of hospitalization for stroke or bleed, 30-day readmission, and persistence were reported...
June 26, 2017: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/28649053/left-atrial-appendage-occlusion-with-the-amplatzer-amulet-device-periprocedural-and-early-clinical-echocardiographic-data-from-a-global-prospective-observational-study
#4
Ulf Landmesser, Boris Schmidt, Jens Erik Nielsen-Kudsk, Simon Cheung Chi Lam, Jai-Wun Park, Giuseppe Tarantini, Ignacio Cruz-Gonzalez, Volker Geist, Paolo Della Bella, Antonio Colombo, Tobias Zeus, Heyder Omran, Christopher Piorkowski, Juha Lund, Claudio Tondo, David Hildick-Smith
AIMS: The global, prospective AMPLATZER Amulet observational study documents real-world periprocedural, transoesophageal echocardiographic (TEE) and clinical outcomes from left atrial appendage occlusion (LAAO) using the AMPLATZER Amulet device. The aim of this report is to describe the periprocedural and early clinical/TEE results from this study. METHODS AND RESULTS: This multicentre prospective real-world registry included 1,088 patients (75±8.5 years, 64.5% male, CHA2DS2-VASc: 4...
June 25, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28648320/cost-effectiveness-of-edoxaban-vs-warfarin-in-patients-with-atrial-fibrillation-based-on-results-of-the-engage-af-timi-48-trial-taiwanese-perspective
#5
Katherine A Vilain, Ming Chin Yang, Elise Chia Hui Tan, Kaijun Wang, Haiyan Li, Wan Hsuan Hsu, Robert P Giugliano, David J Cohen, Elizabeth A Magnuson
BACKGROUND: Novel anticoagulants, such as factor Xa inhibitors, have entered clinical practice as alternatives to warfarin for the prevention of stroke and systemic embolic event (SEE) in patients with atrial fibrillation (AF). It is not known whether edoxaban, the fourth-to-market factor Xa inhibitor approved for this indication, will be cost-effective in Taiwan, where the cost of warfarin monitoring is prohibitive. METHODS: A Markov model projecting lifetime results of edoxaban 60 mg/30 mg dose-reduced versus warfarin in patients with nonvalvular AF, based on the ENGAGE AF - TIMI 48 trial, found edoxaban to be of high value relative to warfarin, from the perspective of the US health care system...
May 2017: Value in Health Regional Issues
https://www.readbyqxmd.com/read/28648031/-impact-of-different-antithrombotic-therapy-strategy-on-prognosis-in-coronary-heart-disease-patients-combining-with-atrial-fibrillation-a-meta-analysis
#6
C Yuan, L Zhong, R C Huang
Objective: To evaluate the impact of various anticoagulation antiplatelet therapy strategies on the prognosis of patients with coronary heart disease combining with atrial fibrillation. Methods: Present meta analysis was performed according to search results on English EMBASE database by computer retrieval, Pubmed, the Cochrane Central Register of Controlled Trials, Medline, Chinese CBM database, CNKI database, Wan Fang database, China science and technology papers online electronic databases, manual retrieval for important international conference proceedings up to April 30 2016...
June 24, 2017: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/28648024/-comparison-on-the-efficacy-and-safety-of-different-occlusion-devices-for-the-treatment-of-patients-with-patent-foramen-ovale
#7
W J Liu, Y S Zhang, G S Cheng, Y J Du, L He, X Y Wang, X M He
Objective: To compare the efficacy and safety of Cardi-O-fix patent foramen ovale (PFO) occluder and Amplatzer PFO occluder for the treatment of patients with PFO. Methods: A total of 246 consecutive patients (105 males and 141 females) with PFO were prospectively enrolled from May 30, 2013 to March 30, 2015 in our hospital. PFO interventional closure was applied according to the anatomical structure of the disease and patients' wishes.Cardi-O-fix PFO occluder was used in 180 cases (COF group), Amplatzer PFO occluder was used in the remaining 66 cases (Amp group)...
June 24, 2017: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/28647723/a-retrospective-cohort-study-of-high-impact-users-among-patients-with-cerebrovascular-conditions
#8
Ahsan Rao, Alice Jones, Alex Bottle, Ara Darzi, Paul Aylin
OBJECTIVE: To apply group-based trajectory modelling (GBTM) to the hospital administrative data to evaluate, model and visualise trends and changes in the frequency of long-term hospital care use of the subgroups of patients with cerebrovascular conditions. DESIGN: A retrospective cohort study of patients with cerebrovascular conditions. SETTINGS: Secondary care of all patients with cerebrovascular conditions admitted to English National Hospital Service hospitals...
June 24, 2017: BMJ Open
https://www.readbyqxmd.com/read/28645938/practice-patterns-for-acute-ischemic-stroke-workup-a-longitudinal-population-based-study
#9
Matthew C Loftspring, Brett M Kissela, Matthew L Flaherty, Jane C Khoury, Kathleen Alwell, Charles J Moomaw, Dawn O Kleindorfer, Daniel Woo, Opeolu Adeoye, Simona Ferioli, Joseph P Broderick, Pooja Khatri
BACKGROUND: We examined practice patterns of inpatient testing to identify stroke etiologies and treatable risk factors for acute ischemic stroke recurrence. METHODS AND RESULTS: We identified stroke cases and related diagnostic testing from four 1-year study periods (July 1993 to June 1994, 1999, 2005, and 2010) of the Greater Cincinnati/Northern Kentucky Stroke Study. Patients aged ≥18 years were included. We focused on evaluation of extracranial arteries for carotid stenosis and assessment of atrial fibrillation because randomized controlled trials supported treatment of these conditions for stroke prevention across all 4 study periods...
June 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28645935/liver-cirrhosis-in-patients-with-atrial-fibrillation-would-oral-anticoagulation-have-a-net-clinical-benefit-for-stroke-prevention
#10
Ling Kuo, Tze-Fan Chao, Chia-Jen Liu, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen
BACKGROUND: Patients with liver cirrhosis have been excluded from randomized clinical trials of oral anticoagulation therapy for stroke prevention in atrial fibrillation. We hypothesized that patients with liver cirrhosis would have a positive net clinical benefit for oral anticoagulation when used for stroke prevention in atrial fibrillation. METHODS AND RESULTS: This study used the National Health Insurance Research Database in Taiwan. Among 289 559 atrial fibrillation patients aged ≥20 years, there were 10 336 with liver cirrhosis, and 9056 of them having a CHA2DS2-VASc score ≥2 were divided into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin...
June 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28645934/repeated-measurements-of-cardiac-biomarkers-in-atrial-fibrillation-and-validation-of-the-abc-stroke-score-over-time
#11
Ziad Hijazi, Bertil Lindahl, Jonas Oldgren, Ulrika Andersson, Johan Lindbäck, Christopher B Granger, John H Alexander, Bernard J Gersh, Michael Hanna, Veli-Pekka Harjola, Elaine M Hylek, Renato D Lopes, Agneta Siegbahn, Lars Wallentin
BACKGROUND: Cardiac biomarkers are independent risk markers in atrial fibrillation, and the novel biomarker-based ABC stroke score (age, biomarkers, and clinical history of prior stroke) was recently shown to improve the prediction of stroke risk in patients with atrial fibrillation. Our aim was to investigate the short-term variability of the cardiac biomarkers and evaluate whether the ABC stroke risk score provides a stable short-term risk estimate. METHODS AND RESULTS: According to the study protocol, samples were obtained at entry and also at 2 months in 4796 patients with atrial fibrillation followed for a median of 1...
June 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28645805/pre-admission-cha2ds2-vasc-score-and-outcome-of-patients-with-acute-cerebrovascular-events
#12
Guy Topaz, David Pereg, Mony Shuvy, Stefan Mausbach, Itzhak Kimiagar, Gregory Telman, Yona Kitay-Cohen, Dina Vorobeichik, Nir Shlomo, David Tanne
BACKGROUND: The CHA2DS2-VASc score has been recommended for the assessment of thromboembolic risk in patients with atrial fibrillation. Data regarding the association between the pre-admission CHA2DS2-VASc score and the outcome of patients with stroke and TIA are scarce. We aimed to assess the predictive value of pre-admission CHA2DS2-VASc score for early risk stratification of patients with acute cerebrovascular event. METHODS: The study group consisted of 8309 patients (53% males, mean age of 70±13...
June 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28645473/efficacy-and-safety-of-rivaroxaban-versus-warfarin-in-patients-taking-nondihydropyridine-calcium-channel-blockers-for-atrial-fibrillation-from-the-rocket-af-trial
#13
Jeffrey B Washam, Anne S Hellkamp, Yuliya Lokhnygina, Jonathan P Piccini, Scott D Berkowitz, Christopher C Nessel, Richard C Becker, Günter Breithardt, Keith A A Fox, Jonathan L Halperin, Graeme J Hankey, Kenneth W Mahaffey, Daniel E Singer, Manesh R Patel
Non-dihydropyridine calcium channel blockers (non-DHP CCBs) possess combined P-glycoprotein and moderate CYP3A4 inhibition, which may lead to increased exposure of medications that are substrates for these metabolic pathways, such as rivaroxaban. We evaluated the use and outcomes of non-DHP CCBs in patients with atrial fibrillation (AF) 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)...
May 29, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28645443/once-or-twice-daily-non-vitamin-k-antagonist-oral-anticoagulants-in-asian-patients-with-atrial-fibrillation-a%C3%A2-meta-analysis-of-randomized-controlled-trials
#14
Kang-Ling Wang, Chun-Chih Chiu, Doreen Su-Yin Tan, Chun-Yi Lin, En-Yu Lai, Shinya Goto, Robert P Giugliano, Chern-En Chiang
BACKGROUND/PURPOSE: Non-vitamin K antagonist oral anticoagulants (NOACs) have a half-life of around 12 h. We aimed to clarify if there was any effect modification by dosing (once- or twice-daily) regimens in Asian patients. METHODS: Phase III randomized controlled trials of NOACs compared with warfarin in Asian patients with atrial fibrillation (AF) were identified and extracted from PubMed, CENTRAL, and CINAHL databases through November 2016. Outcomes were pooled by dosing regimens with the Mantel-Haenszel fixed-effects model...
June 20, 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/28643004/effectiveness-and-safety-of-apixaban-therapy-in-daily-care-patients-with-atrial-fibrillation-results-from-the-dresden-noac-registry
#15
Sindy Helmert, Sandra Marten, Heike Mizera, Antje Reitter, Kurtulus Sahin, Luise Tittl, Jan Beyer-Westendorf
The effectiveness and safety of apixaban for stroke prevention in atrial fibrillation (SPAF) demonstrated in ARISTOTLE needs to be confirmed in daily care. To evaluate effectiveness and safety of apixaban therapy in SPAF patients in daily care, we used data from an ongoing, prospective, non-interventional registry of more than 3000 patients on novel oral anticoagulants in daily care. Between 1 December 2012 and 31 August 2015, 514 patients receiving apixaban were enrolled. During a mean follow-up of 803.5 ± 228...
June 22, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28642210/rationale-and-design-for-a-randomized-comparison-of-efficacy-and-safety-between-aspirin-and-clopidogrel-in-atrial-fibrillation-patients-with-low-stroke-risk-cesac-af-trial
#16
Sang Min Park, Haemin Jeong, Mi-Hyang Jung, Kyung Soon Hong, Myeong-Ki Hong, Chang Seok Bang, Christopher Y Kim
BACKGROUND: Atrial fibrillation (AF) increases the risk of thromboembolic stroke. An oral anticoagulant should be administrated to prevent stroke in patients with moderate stroke risk (ie, CHA2DS2-VASc score>2). If the stroke risk is low (i.e. the score=1), however, antiplatelet agent such as aspirin is widely used. Aspirin can cause peptic ulcer disease (PUD) while its alternative, clopidogrel, theoretically does not. OBJECTIVE: To elucidate the efficacy and safety between aspirin and clopidogrel, a multicenter randomized controlled trial was designed in AF patients with low stroke risk...
June 19, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28642017/patterns-of-care-and-temporal-trends-in-ischemic-stroke-management-a-brazilian-perspective
#17
Monique Bueno Alves, Gisele Sampaio Silva, Renata Carolina Acri Miranda, Rodrigo Meireles Massaud, Andreia Maria Heins Vaccari, Miguel Cendoroglo-Neto, Solange Diccini
BACKGROUND AND PURPOSE: Demonstration of an improvement process of quality indicators in stroke care is essential to obtain certification as a primary stroke center (PSC). Our aim was to evaluate factors that influence temporal trends in quality indicators of ischemic stroke (IS) in a Brazilian hospital. METHODS: We evaluated patients discharged with IS from a tertiary hospital from January 2009 to December 2013. Ten predefined performance measures selected by the Get With the Guidelines-Stroke program were assessed...
June 20, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28639873/anesthetic-management-of-patients-undergoing-percutaneous-endocardial-and-epicardial-left-atrial-appendage-occlusion
#18
Zeena Husain, Payam Safavi-Naeini, Abdi Rasekh, Mehdi Razavi, Charles D Collard, James M Anton, Daniel A Tolpin
Atrial fibrillation is the most common cardiac arrhythmia in adults affecting almost 6 million adults in the United States. The 2 most common comorbidities associated with atrial fibrillation are heart failure and thromboembolic events. Heart failure symptoms may be treated with rate control, antiarrhythmic medications or by catheter ablation. Unfortunately, despite optimal medical management, thromboembolic events still occur. Recently, there has been a great deal of interest and innovation in finding an alternative to chronic anticoagulation...
June 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28639436/a-high-hasbled-score-identifies-poor-warfarin-control-in-patients-treated-for-non-valvular-atrial-fibrillation-in-australia-and-singapore
#19
Nijole Bernaitis, Ching Chi Keong, Chen Liping, Hon Jin Shing, Teo Siew Chong, Tony Badrick, Andrew K Davey, Shailendra Anoopkumar-Dukie
Warfarin reduces stroke risk in atrial fibrillation (AF) patients. The quality of warfarin control, measured by time in therapeutic range (TTR), impacts outcomes and adverse events. One tool evaluating risk of adverse events and potential warfarin control would simplify risk-benefit assessment of warfarin. Recently, HASBLED was demonstrated effective for this purpose but this was in well-controlled patients with deep vein thrombosis. HASBLED as a predictor of warfarin control has not been validated in other populations including differing indications, warfarin control levels and ethnicities...
June 21, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/28637460/healthcare-utilization-and-costs-for-patients-initiating-dabigatran-or-warfarin
#20
Shannon L Reynolds, Sameer R Ghate, Richard Sheer, Pranav K Gandhi, Chad Moretz, Cheng Wang, Stephen Sander, Mary E Costantino, Srinivas Annavarapu, George Andrews
BACKGROUND: Novel oral anticoagulants (NOAC) such as dabigatran, when compared to warfarin, have been shown to potentially reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF) together with lower healthcare resource utilization (HCRU) and similar total costs. This study expands on previous work by comparing HCRU and costs for patients newly diagnosed with NVAF and newly initiated on dabigatran or warfarin, and is the first study specifically in a Medicare population...
June 21, 2017: Health and Quality of Life Outcomes
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