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use of warfarin in AF in renal patients

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https://www.readbyqxmd.com/read/28290837/-the-choice-of-anticoagulant-therapy-in-patients-with-non-valvular-atrial-fibrillation-and-chronic-kidney-disease
#1
N A Koziolova, E A Polyanskaya, I I Kolegova
The review shows the prevalence of atrial fibrillation (AF) in patients with chronic kidney disease (CKD), depending on the severity of the disease. Patients with non-valvular AF and CKD have a significantly increased risk of both bleeding and thromboembolic complications, and death from all causes. Evaluation of the results of randomized clinical trials (RCTs), meta-analyzes of RCTs demonstrated the advantages of the new oral anticoagulants (NOAC), such as dabigatran, rivaroxaban, apixaban, compared with warfarin in reducing the risk of bleeding in patients with AF and CKD in predialysis stage...
January 2017: Kardiologiia
https://www.readbyqxmd.com/read/28120282/treatment-of-atrial-fibrillation-with-warfarin-among-older-adults-with-end-stage-renal-disease
#2
Jingwen Tan, Sunjae Bae, Jodi B Segal, Junya Zhu, Dorry L Segev, G Caleb Alexander, Mara McAdams-DeMarco
BACKGROUND: There is increasing evidence questioning the use of warfarin for atrial fibrillation (AF) among older adults with end stage renal disease (ESRD). We assessed the patterns and determinants of warfarin utilization among these patients in the US. METHODS: We assembled a cohort of older adults (age ≥65) undergoing dialysis with incident AF from July 2007 to November 2011 from the US Renal Data System (USRDS). We used descriptive statistics to characterize warfarin utilization within 30 days of AF discharge, and logistic regression to quantify patient characteristics associated with warfarin initiation...
January 24, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/27988374/safety-of-warfarin-in-high-risk-populations-a-meta-analysis-of-randomized-and-controlled-trials
#3
Matteo Nicola Dario Di Minno, Pasquale Ambrosino, Francesco Dentali
INTRODUCTION: Few data are available about safety of vitamin K antagonists (VKAs) in patients with clinical/demographic characteristics predisposing to an increased risk of bleeding. We performed a meta-analysis to evaluate the safety of VKAs in patients with atrial fibrillation (AF) or venous thromboembolism (VTE) in the following subgroups of "high-risk" patients: elderly patients, patients with low body weight and patients with impaired renal function. MATERIALS AND METHODS: Major electronic databases were systematically searched to identify randomized controlled trials (RCTs) addressing this issue...
February 2017: Thrombosis Research
https://www.readbyqxmd.com/read/27819149/clinical-relevance-of-pharmacokinetic-and-pharmacodynamic-properties-of-edoxaban-when-treating-patients-with-atrial-fibrillation-and-heart-failure
#4
REVIEW
Nadia Aspromonte, Furio Colivicchi
Atrial fibrillation (AF) is an independent risk factor for stroke. It is most prevalent in the elderly and frequently coexists with heart failure (HF). The joint occurrence of AF and HF further worsens prognosis. The prevention of thromboembolism is crucial in the management of AF. In recent years, new oral anticoagulants (NOACs) have been licensed for the prevention of stroke and systemic embolism in patients with AF. Areas covered: This article reviews the key published studies on the pharmacology, clinical efficacy and safety of edoxaban, the latest NOAC to receive approval for the AF indication...
January 2017: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/27769175/warfarin-use-and-stroke-bleeding-and-mortality-risk-in-patients-with-end-stage-renal-disease-and-atrial-fibrillation-a-systematic-review-and-meta-analysis
#5
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
https://www.readbyqxmd.com/read/27716554/efficacy-and-safety-of-novel-anticoagulants-versus-vitamin-k-antagonists-in-patients-with-mild-and-moderate-to-severe-renal-insufficiency-focus-on-apixaban
#6
REVIEW
Francesco Pelliccia, Salvatore Rosanio, Giuseppe Marazzi, Sara Poggi, Alessandra Tanzilli, Cesare Greco, Carlo Gaudio, Giuseppe Rosano
The high risk of both stroke and major bleeding in atrial fibrillation (AF) patients with chronic kidney disease (CKD) defines an important population for whom the assessment of the balance between the risk of ischemic stroke and of bleeding is essential. The use of novel oral anticoagulants (NOACs) may be a viable option in this population due to their greater net clinical benefit than warfarin, as demonstrated by the results of the clinical phase III trials. NOACs have been found to have a greater net clinical benefit than warfarin in patients at high risk of either stroke (CHADS2≥1 or CHA2DS2-VASc score≥2) or bleeding (HAS-BLED≥3)...
December 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27555569/primary-and-key-secondary-results-from-the-rocket-af-trial-and-their-implications-on-clinical-practice
#7
REVIEW
Rohan Shah, Manesh R Patel
BACKGROUND: The safety and efficacy of the oral anticoagulant rivaroxaban were studied in the 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 trial). A number of subanalyses of the ROCKET AF trial have subsequently analyzed the use of rivaroxaban in special patient populations. METHODS: The outcomes of the ROCKET AF trial were reviewed. The use of rivaroxaban in higher risk populations, as determined by the presence of co-morbidities included in the CHADS2 criteria, was analyzed...
August 23, 2016: Therapeutic Advances in Cardiovascular Disease
https://www.readbyqxmd.com/read/27520093/direct-oral-anticoagulant-use-and-the-incidence-of-bleeding-in-the-very-elderly-with-atrial-fibrillation
#8
Fatima Khan, Hans Huang, Yvonne H Datta
Atrial fibrillation (AF) is a major risk factor for stroke in the elderly population. The use of anticoagulation in patients with AF greatly reduces the risk for stroke, but results in an increased risk of bleeding. Over the past several years, direct oral anticoagulants (DOACs, dabigatran, rivaroxaban, and apixaban) have been used in place of warfarin for stroke prevention in AF. We conducted a retrospective cohort study to assess the safety of DOACs in very elderly patients (75+) managed in a health care system encompassing both community and academic settings...
November 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27472258/atrial-fibrillation-and-chronic-kidney-disease-requiring-hemodialysis-does-warfarin-therapy-improve-the-risks-of-this-lethal-combination
#9
Lohit Garg, Charity Chen, David E Haines
INTRODUCTION: Warfarin therapy for stroke prevention is recommended for patients with AF, but its value in patients with chronic kidney disease on HD is unknown. METHODS: The anticoagulation regimens of patients with a prior history of AF hospitalized for initiation of chronic HD, and of patients receiving chronic HD who had a new diagnosis of AF between 2009 and 2012 were reviewed. Exclusions were renal transplant, peritoneal dialysis, rheumatic valve disease, prosthetic heart valve, GI bleeding, malignancy with chemotherapy in last 6months or still undergoing treatment, a history of AF ablation, a history of ICD implantation, or those receiving warfarin for non-AF indications...
November 1, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27437888/outcomes-in-a-warfarin-treated-population-with-atrial-fibrillation
#10
Fredrik Björck, Henrik Renlund, Gregory Y H Lip, Per Wester, Peter J Svensson, Anders Själander
IMPORTANCE: Vitamin K antagonist (eg, warfarin) use is nowadays challenged by the non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF). NOAC studies were based on comparisons with warfarin arms with times in therapeutic range (TTRs) of 55.2% to 64.9%, making the results less credible in health care systems with higher TTRs. OBJECTIVES: To evaluate the efficacy and safety of well-managed warfarin therapy in patients with nonvalvular AF, the risk of complications, especially intracranial bleeding, in patients with concomitant use of aspirin, and the impact of international normalized ratio (INR) control...
May 1, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27428440/chronic-kidney-disease-time-in-therapeutic-range-and-adverse-clinical-outcomes-in-anticoagulated-patients-with-non-valvular-atrial-fibrillation-observations-from-the-sportif-trials
#11
Marco Proietti, Deirdre A Lane, Gregory Y H Lip
BACKGROUND: Chronic kidney disease (CKD) is highly prevalent in atrial fibrillation (AF) patients and associated with an increased risk of adverse outcomes. Our objectives were to study clinical features associated with CKD in AF patients and the impact of CKD on anticoagulation control, as reflected by time in therapeutic range (TTR). We also determined the impact of CKD and TTR in predicting adverse outcomes. METHODS AND RESULTS: We analysed pooled datasets from SPORTIF III and V trials, including 3646 patients assigned to warfarin with data on renal function...
June 2016: EBioMedicine
https://www.readbyqxmd.com/read/27424804/factors-driving-the-use-of-warfarin-and-non-vitamin-k-antagonist-oral-anticoagulants-in-patients-with-atrial-fibrillation
#12
Mu-Mei Hu, Jui Wang, Kuo-Liong Chien, Chin-Ling Su, Shin-Yi Lin, Fe-Lin Lin Wu, Zhen-Fang Lin
BACKGROUND/PURPOSE: In the past, warfarin was the drug of choice for stroke prevention in patients with atrial fibrillation (AF). Recently, non-vitamin K antagonist oral anticoagulants (NOACs) have been approved as an alternative to warfarin in nonvalvular AF. However, there is a limited amount of real-world data on how NOACs are currently being used in Taiwan. This study was conducted to investigate the factors driving the initiation of anticoagulants and the selection of different anticoagulants in patients with AF...
July 14, 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/27401780/safety-and-feasibility-of-treatment-with-rivaroxaban-for-non-canonical-indications-a-case-series-analysis
#13
Domenico Acanfora, Chiara Acanfora, Pietro Scicchitano, Marialaura Longobardi, Giuseppe Furgi, Gerardo Casucci, Bernardo Lanzillo, Ilaria Dentamaro, Annapaola Zito, Raffaele Antonelli Incalzi, Marco Matteo Ciccone
BACKGROUND AND OBJECTIVES: The new oral anticoagulants (NOACs) are used for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF) and those at risk of deep venous thrombosis. Their rapid onset of action and predictable pharmacokinetic and pharmacodynamic profiles make them the optimal alternative to warfarin in the treatment of these two categories of patients. Unfortunately, however, NOACs cannot be used in patients with valvular AF or valvular cardiac prostheses...
October 2016: Clinical Drug Investigation
https://www.readbyqxmd.com/read/27358434/impact-of-renal-function-on-outcomes-with-edoxaban-in-the-engage-af-timi-48-trial
#14
RANDOMIZED CONTROLLED TRIAL
Erin A Bohula, Robert P Giugliano, Christian T Ruff, Julia F Kuder, Sabina A Murphy, Elliott M Antman, Eugene Braunwald
BACKGROUND: Edoxaban, an oral factor Xa inhibitor with 50% renal clearance, was noninferior to well-managed warfarin for stroke or systemic embolism (S/SE) prevention and reduced bleeding in patients with atrial fibrillation. We evaluated the efficacy and safety of edoxaban versus warfarin across the range of baseline creatinine clearance (CrCl) in the ENGAGE AF-TIMI 48 trial (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction Study 48) with a focus on the higher-dose edoxaban regimen (HDER) and the upper range of CrCl...
July 5, 2016: Circulation
https://www.readbyqxmd.com/read/27243343/management-of-patients-with-atrial-fibrillation-and-chronic-kidney-disease-in-light-of-the-latest-guidelines
#15
REVIEW
Elżbieta Młodawska, Anna Tomaszuk-Kazberuk, Paulina Łopatowska, Włodzimierz J Musiał, Jolanta Małyszko
Atrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD), and the rate reaches even 30% in patients with end-stage renal disease (ESRD). Patients with AF and CKD have a significantly higher risk of thrombotic complications, particularly ischemic stroke, and at the same time, a higher bleeding risk (proportionally to the grade of renal failure). In addition, AF and CKD share a number of comorbidities and risk factors, which results in increased mortality rates. Moreover, disturbances in hemostasis are common complications of kidney disease...
May 31, 2016: Polskie Archiwum Medycyny Wewnętrznej
https://www.readbyqxmd.com/read/27218240/risk-factors-and-outcome-of-stroke-in-renal-transplant-recipients
#16
Mark D Findlay, Peter C Thomson, Rachael MacIsaac, Alan G Jardine, Rajan K Patel, Kathryn K Stevens, Elaine Rutherford, Marc Clancy, Colin C Geddes, Jesse Dawson, Patrick B Mark
Stroke incidence is high in end-stage renal disease, and risk factors differ between the dialysis and general populations. However, risk factors and outcomes following renal transplantation remain unclear. We analyzed all adult patients with a functioning renal transplant from 01/01/2007 to 12/31/2012. Data were extracted from the electronic patient record. Variables associated with stroke were identified by survival analyses; demographic, clinical, and imaging and laboratory variables were assessed and case fatality determined...
August 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27079417/atrial-fibrillation-in-dialysis-patients-time-to-abandon-warfarin
#17
REVIEW
Diego Brancaccio, Luca Neri, Francesco Bellocchio, Carlo Barbieri, Claudia Amato, Flavio Mari, Bernard Canaud, Stefano Stuard
Atrial fibrillation (AF) is a frequent clinical complication in dialysis patients, and warfarin therapy represents the most common approach for reducing the risk of stroke in this population. However, current evidence based on observational studies, offer conflicting results, whereas no randomized controlled trials have been carried out so far. Additionally, many clinicians are wary of the possible role of warfarin as vascular calcification inducer and its potential to increase the high risk of bleeding among patients on dialysis...
May 16, 2016: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/27043881/effect-of-renal-function-on-whole-blood-and-fibrin-clot-formation-in-atrial-fibrillation-patients-on-warfarin
#18
Yee Cheng Lau, Qinmei Xiong, Gregory Y H Lip, Andrew D Blann
OBJECTIVE: Atrial fibrillation (AF) brings a risk of thrombosis, requiring oral coagulation, and is associated with renal impairment. The two processes may be linked, as altered fibrin clot structure is present in end-stage renal failure. We hypothesised that progressively deteriorating renal function is linked to altered whole blood and fibrin clot properties and fibrinolysis. METHODS: Thrombogenesis and fibrinolysis in 200 warfarinised AF patients was assessed by thromboelastography (TEG), a micro-plate assay (MPA) and the international normalized ratio (INR)...
2016: Annals of Medicine
https://www.readbyqxmd.com/read/27015873/cost-effectiveness-of-high-dose-edoxaban-compared-with-adjusted-dose-warfarin-for-stroke-prevention-in-non-valvular-atrial-fibrillation-patients
#19
Elaine Nguyen, Florence Egri, Elizabeth S Mearns, Charles M White, Craig I Coleman
OBJECTIVE: To estimate the quality-adjusted life-years (QALYs), costs, and cost-effectiveness of high-dose edoxaban compared with adjusted-dose warfarin in patients at risk for stroke who have nonvalvular atrial fibrillation (NVAF) and a creatinine clearance (Clcr ) of 15-95 ml/minute. METHODS: A Markov model was created to compare the cost-effectiveness of high-dose edoxaban and adjusted-dose warfarin in patients with a Clcr of 15-95 ml/minute. The model was performed from a U...
May 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27001354/a-tailored-treatment-strategy-a-modern-approach-for-stroke-prevention-in-patients-with-atrial-fibrillation
#20
REVIEW
G Y H Lip, T Potpara, G Boriani, C Blomström-Lundqvist
The main priority in atrial fibrillation (AF) management is stroke prevention, following which decisions about rate or rhythm control are focused on the patient, being primarily for management of symptoms. Given that AF is commonly associated with various comorbidities, risk factors such as hypertension, heart failure, diabetes mellitus and sleep apnoea should be actively looked for and managed in a holistic approach to AF management. The objective of this review is to provide an overview of modern AF stroke prevention with a focus on tailored treatment strategies...
May 2016: Journal of Internal Medicine
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