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Atrial fibrilation, stroke

Stefan Reers, Tolga Agdirlioglu, Michael Kellner, Matthias Borowski, Holger Thiele, Johannes Waltenberger, Michael Reppel
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran or rivaroxaban are alternatives to vitamin K antagonists (VKAs) for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) and atrial flutter (AFL). Incidences of risk factors for left atrium (LA) and left atrial appendage (LAA) thrombus formation, such as dense spontaneous echo contrast (SEC), low LAA velocity (LAAV) <20 cm/s under treatment with dabigatran and rivaroxaban in comparison with VKAs are unknown...
October 21, 2016: European Journal of Medical Research
Jingwen Tan, Shuiqing Liu, Jodi B Segal, G Caleb Alexander, Mara McAdams-DeMarco
BACKGROUND: Patients with end stage renal disease (ESRD), including stage 5 chronic kidney disease (CKD), hemodialysis (HD) and peritoneal dialysis (PD), are at high risk for stroke-related morbidity, mortality and bleeding. The overall risk/benefit balance of warfarin treatment among patients with ESRD and AF remains unclear. METHODS: We systematically reviewed the associations of warfarin use and stroke outcome, bleeding outcome or mortality in patients with ESRD and AF...
October 21, 2016: BMC Nephrology
Viraj Suvarna
Stroke prevention in atrial fibrillation (AF) has reached an exciting phase with a plethora of newer, potentially more efficacious and safer agents being introduced for physicians to select from. Dabigatran belongs to a class of anticoagulants called direct thrombin inhibitors, while rivaroxaban, apixaban, and edoxaban are direct Factor Xa inhibitors. Purely from a therapeutic endpoint perspective-based on the action of anticoagulants in reducing cardioembolic stroke-in clinical trials, one should look at whether a new anticoagulant in patients with AF prevents ischemic stroke...
October 2016: Journal of the Association of Physicians of India
Kishan A Manani, Kim Christensen, Nicholas S Peters
Atrial fibrillation (AF) increases the risk of stroke by a factor of 4-5 and is the most common abnormal heart rhythm. The progression of AF with age, from short self-terminating episodes to persistence, varies between individuals and is poorly understood. An inability to understand and predict variation in AF progression has resulted in less patient-specific therapy. Likewise, it has been a challenge to relate the microstructural features of heart muscle tissue (myocardial architecture) with the emergent temporal clinical patterns of AF...
October 2016: Physical Review. E
Kathryn F Flack, Jay Desai, Jennifer M Kolb, Prapti Chatterjee, Lars C Wallentin, Michael Ezekowitz, Salim Yusuf, Stuart Connolly, Paul Reilly, Martina Brueckmann, John Ilgenfritz, James Aisenberg
BACKGROUND & AIMS: Gastrointestinal (GI) bleeding in patients receiving anticoagulation agents can be caused by occult malignancies. We investigated the proportions and features of major GI bleeding (MGIB) events related to occult GI cancers in patients receiving anticoagulation therapy. METHODS: We analyzed data from the Randomized Evaluation of Long Term Anticoagulant Therapy study (conducted between December 2005 and March 2009 in 951 clinical centers in 44 countries worldwide), which compared the abilities of dabigatran vs warfarin to prevent stroke and systemic embolism in 18,113 patients with atrial fibrillation...
October 17, 2016: Clinical Gastroenterology and Hepatology
L Deville, M Konan, A Hij, L Goldwirt, O Peyrony, F Fieux, P Faure, I Madelaine, S Villiers, D Farge-Bancel, C Frère
Direct oral anticoagulants (DAOC) are indicated for the treatment of venous thromboembolism and the prevention of stroke or systemic embolism in patients with non-valvular atrial fibrillation. Given their advantages and friendly use for patient, the prescription of long term DOAC therapy has rapidly increased both as first line treatment while initiating anticoagulation and as a substitute to vitamins K antagonist (VKA) in poorly controlled patients. However, DOAC therapy can also be associated with significant bleeding complications, and in the absence of specific antidote at disposal, treatment of serious hemorrhagic complications under DOAC remains complex...
July 2016: Current Research in Translational Medicine
T S Liu, B T Chen, R Dong, Y Li, Y Zhao, K Hua
Objective: To discuss the clinical safety and efficacy about off-pump coronary artery bypass grafting (OPCABG) in octogenarians. Methods: From June 2005 to July 2014, 252 patients (male 208, female 44, with a mean age of 81.7 years old) underwent OPCABG in Beijing Anzhen Hospital who were aged 80 years or older were enrolled. Results: Eight (3.2%) patients were diagnosed as single vessel coronary artery disease (CAD), 29 cases (11.5%) were diagnosed as bifurcation vessel CAD, and 215 cases (85.3%) were multivessel CAD...
September 27, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Anders Nissen Bonde, Gregory Y H Lip, Anne-Lise Kamper, Emil L Fosbøl, Laila Staerk, Nicholas Carlson, Christian Torp-Pedersen, Gunnar Gislason, Jonas Bjerring Olesen
BACKGROUND AND PURPOSE: We sought to determine the risk of stroke/thromboembolism and bleeding associated with reduced renal function in patients with atrial fibrillation and the risk of stroke and bleeding associated with warfarin treatment in specific estimated glomerular filtration rate (eGFR) groups. METHODS: We conducted a register-based cohort study and included patients discharged with nonvalvular atrial fibrillation from 1997 to 2011 with available eGFR...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
Zixiao Li, Chunjuan Wang, Xingquan Zhao, Liping Liu, Chunxue Wang, Hao Li, Haipeng Shen, Li Liang, Janet Bettger, Qing Yang, David Wang, Anxin Wang, Yuesong Pan, Yong Jiang, Xiaomeng Yang, Changqing Zhang, Gregg C Fonarow, Lee H Schwamm, Bo Hu, Eric D Peterson, Ying Xian, Yilong Wang, Yongjun Wang
BACKGROUND AND PURPOSE: Stroke is a leading cause of death in China. Yet the adherence to guideline-recommended ischemic stroke performance metrics in the past decade has been previously shown to be suboptimal. Since then, several nationwide stroke quality management initiatives have been conducted in China. We sought to determine whether adherence had improved since then. METHODS: Data were obtained from the 2 phases of China National Stroke Registries, which included 131 hospitals (12 173 patients with acute ischemic stroke) in China National Stroke Registries phase 1 from 2007 to 2008 versus 219 hospitals (19 604 patients) in China National Stroke Registries phase 2 from 2012 to 2013...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
Giovanni Filardo, Gorav Ailawadi, Benjamin D Pollock, Briget da Graca, Danielle M Sass, Teresa K Phan, Debbie E Montenegro, Vinod Thourani, Ralph Damiano
BACKGROUND: New-onset atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) is associated with increased morbidity and poorer long-term survival. Although many studies show differences in outcome in women versus men after CABG, little is known about the sex-specific incidence and characteristics of post-CABG AF. METHODS AND RESULTS: Overall, 11 236 consecutive patients without preoperative AF underwent isolated CABG from 2002 to 2010 at 4 US academic medical centers and 1 high-volume specialty cardiac hospital...
October 18, 2016: Circulation. Cardiovascular Quality and Outcomes
F Lanas, C Castro, C Vallejos, L Bustos, C de La Puente, M Velasquez, C Zaror
: Nonvalvular atrial fibrillation (NVAF) is a risk factor for ischemic stroke and systemic embolism. New oral anticoagulants are currently available. OBJECTIVE: to assess the incremental cost-utility ratio (ICUR) for apixaban versus acenocoumarol in patients treated in Chile's public health system. STUDY DESIGN AND SETTING: We assessed cost-utility from the payer perspective with a lifetime Markov model. Epidemiologic characteristics, costs, and utilities were obtained from a Chilean cohort; data were completed with information from international literature...
October 15, 2016: Journal of Clinical Epidemiology
James E Dalen, Joseph S Alpert
A new suspected cause of cryptic strokes is "silent atrial fibrillation". Pacemakers and other implanted devices allow continuous recording of cardiac rhythm for months or years. They have discovered that short periods of atrial fibrillation lasting minutes or hours are frequent and usually are asymptomatic. A meta-analysis of 50 studies involving more than 10,000 patients with a recent stroke found that 7.7% had atrial fibrillation on their admitting EKG. In 3 weeks during and after hospitalization, another 16...
October 15, 2016: American Journal of Medicine
Ömer Erküner, Roy Claessen, Ron Pisters, Germaine Schulmer, Roos Ramaekers, Laura Sonneveld, Elton Dudink, Theo Lankveld, Ione Limantoro, Bob Weijs, Laurent Pison, Yuri Blaauw, Cees B de Vos, Harry Jgm Crijns
BACKGROUND: Patients undergoing elective electrical cardioversion (ECV) for atrial fibrillation have a temporarily increased risk of thromboembolism. Current guidelines recommend adequate anticoagulation for ≥3 consecutive weeks precardioversion, i.e. consecutive INR values 2.0-3.0 in patients with vitamin K antagonists (VKA). We aimed to evaluate the occurrence and impact of subtherapeutic INRs precardioversion and to study factors associated with these unwanted fluctuations. METHODS: We recruited 346 consecutive patients undergoing elective ECV in the Maastricht University Medical Centre between 2008 and 2013...
October 11, 2016: International Journal of Cardiology
Steven Swiryn, Michael V Orlov, David G Benditt, John P DiMarco, Donald M Lloyd-Jones, Edward Karst, Fujian Qu, Mara T Slawsky, Melanie Turkel, Albert L Waldo
BACKGROUND: The RATE Registry (Registry of Atrial Tachycardia and Atrial Fibrillation Episodes) is a prospective, outcomes-oriented registry designed to document the prevalence of atrial tachycardia and/or fibrillation (AT/AF) of any duration in patients with pacemakers and implantable cardioverter defibrillators (ICDs) and evaluate associations between rigorously adjudicated AT/AF and predefined clinical events, including stroke. The appropriate clinical response to brief episodes of AT/AF remains unclear...
October 18, 2016: Circulation
Michael L James, Margueritte Cox, Ying Xian, Eric E Smith, Deepak L Bhatt, Phillip J Schulte, Adrian Hernandez, Gregg C Fonarow, Lee H Schwamm
BACKGROUND: Compared to ischemic stroke, sex differences in response to intracerebral hemorrhage (ICH) are largely unexplored, and their potential interactions with patient age have not been examined. This study hypothesized that risk for poor outcome is greater in women with increasing age. METHODS AND RESULTS: The Get With The Guidelines(®)-Stroke database was used to assess differences between men and women with ICH. Data from 192,826 ICH patients admitted from January 1, 2009 through March 31, 2014 to 1,728 fully participating sites were analyzed using logistic regression to test interactions between age/sex and outcome...
October 18, 2016: Journal of Women's Health
Sun-Wook Kim, Sol-Ji Yoon, Jung-Yeon Choi, Min-Gu Kang, Kwang-Il Kim, Cheol-Ho Kim
OBJECTIVE: Atrial fibrillation is the common arrhythmia in the elderly, and the average age of atrial fibrillation patients is rising. Elderly patients with atrial fibrillation have high incidence of thromboembolic complication and increasing age is associated with stroke severity. Assessing CHADS-VASc score is pivotal to evaluate substantial morbidity and mortality, especially regarding the increased risk of stroke. In addition, considering bleeding risk with HAS-BLED score is important to balance the benefit against the risk of bleeding...
September 2016: Journal of Hypertension
Tsukasa Saito, Yuichiro Kawamura, Nobuyuki Sato, Naoyuki Hasebe
OBJECTIVE: Atrial fibrillation (AF) is a cardiac arrhythmia that does not infrequently induce ischemic strokes; however, little research has been reported on focal cerebral microangiopathic lesions in patients with AF. Recently cerebral microbleeds (CMBs) have been noticed for their potential implication in cerebral small vessel dis- ease. Therefore, we had 2 goals in the present study: (1) to compare the prevalence of CMBs in patients with AF with that in patients without AF, and (2) to prove that CMBs could be a clinical predictive factor for the development of future cerebral microangiopathy in patients with AF without a history of symptomatic cerebral infarction in a prospective manner...
September 2016: Journal of Hypertension
Jürgen Bohlender, Jürg Nussberger, Beate Bohlender
OBJECTIVE: In elderly hypertensive patients, systolic blood pressure (sBP) goals recommended by US and European guidelines (ESH) for the initiation of treatment are more liberal than in younger patients because of an increased risk of treatment-associated side-effects and hypotension. Carotid stenosis increases with age and poses a risk of brain ischemia if hypotension occurs. Its relevance for the routine care of elderly hypertensives, however, remains unclear. We analyzed data on precerebral artery morphology and BP evolution from a survey of aged hospitalized patients...
September 2016: Journal of Hypertension
Giulia Renda, Fabrizio Ricci, Raffaele De Caterina
BACKGROUND: Non-vitamin K oral anticoagulants (NOACs) are now proven alternatives to vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF). However, there are few data on the efficacy and safety of their use around cardioversion, where the risk of thromboembolic events is heightened. METHODS: We performed a random-effects meta-analysis of patients undergoing both electrical and pharmacological cardioversion for AF in the RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE AF-TIMI 48, X-VeRT and ENSURE-AF trials...
October 14, 2016: American Journal of Medicine
Tetsuo Yamaguchi, Takamichi Miyamoto, Takamasa Iwai, Junji Yamaguchi, Sadahiro Hijikata, Ryoichi Miyazaki, Naoyuki Miwa, Masahiro Sekigawa, Nobuhiro Hara, Yasutoshi Nagata, Toshihiro Nozato, Yasuteru Yamauchi, Toru Obayashi, Mitsuaki Isobe
BACKGROUND: The prognosis of super-elderly patients (age≥85 years) who undergo bradycardia pacemaker (PM) implantation remains unknown. METHODS: We retrospectively enrolled 868 patients (men 49.0%, 76.6±10.6 years) who could walk unassisted and whose expected life expectancy was more than 1 year, receiving their first bradycardia PM implantation between January 1, 2006, and June 30, 2013. Clinical outcomes were compared between super-elderly patients (n=201, mean age 88...
October 15, 2016: Journal of Cardiology
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