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use of warfarin in AF in renal patients

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https://www.readbyqxmd.com/read/29898845/predictors-of-oral-anticoagulant-non-prescription-in-patients-with-atrial-fibrillation-and-elevated-stroke-risk
#1
Steven A Lubitz, Shaan Khurshid, Lu-Chen Weng, Gheorghe Doros, Joseph Walker Keach, Qi Gao, Anil K Gehi, Jonathan C Hsu, Matthew R Reynolds, Mintu P Turakhia, Thomas M Maddox
BACKGROUND: Many patients with atrial fibrillation (AF) and elevated stroke risk are not prescribed oral anticoagulation (OAC) despite evidence of benefit. Identification of factors associated with OAC non-prescription could lead to improvements in care. METHODS AND RESULTS: Using NCDR PINNACLE, a United States-based ambulatory cardiology registry, we examined factors associated with OAC non-prescription in patients with non-valvular AF at elevated stroke risk (CHA2 DS2 -VASc ≥2) between January 5, 2008 and December 31, 2014...
June 2018: American Heart Journal
https://www.readbyqxmd.com/read/29860595/is-the-prescription-right-a-review-of-non-vitamin-k-antagonist-anticoagulant-noac-prescriptions-in-patients-with-non-valvular-atrial-fibrillation-safe-prescribing-in-atrial-fibrillation-and-evaluation-of-non-vitamin-k-oral-anticoagulants-in-stroke-prevention
#2
Rebabonye B Pharithi, Deepti Ranganathan, Jim O'Brien, Emmanuel E Egom, Cathie Burke, Daniel Ryan, Christine McAuliffe, Marguerite Vaughan, Tara Coughlan, Edwina Morrissey, John McHugh, David Moore, Ronan Collins
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) are a major advance for stroke prevention in atrial fibrillation (AF). Use of the vitamin K antagonist (VKA), warfarin, has dropped 40% since 2010 in our institution. There is limited Irish hospital data on NOAC prescribing for stroke prevention. METHOD: Single centre, retrospective observational cohort study of consecutive AF patients at increased risk of stroke and/or awaiting electrical cardioversion...
June 2, 2018: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/29785661/atrial-fibrillation-in-dialysis-patients-is-there-a-place-for-non-vitamin-k-antagonist-oral-anticoagulants
#3
REVIEW
Elzbieta Mlodawska, Paulina Lopatowska, Jolanta Malyszko, Maciej Banach, Bożena Sobkowicz, Adrian Covic, Anna Tomaszuk-Kazberuk
Atrial fibrillation (AF) occurs approximately in 3% of general population, with greater prevalence in elderly. Non-vitamin K-dependent oral anticoagulant agents (NOACs) according to the current European guidelines are recommended for patients with AF at high risk for stroke as a first-choice treatment. NOACs are not inferior to warfarin or some of them are better than warfarin in reducing the rate of ischemic stroke. Moreover, they significantly reduce the rate of intracranial hemorrhages, major bleedings, and mortality compared with warfarin...
May 21, 2018: International Urology and Nephrology
https://www.readbyqxmd.com/read/29782263/-nonvalvular-atrial-fibrillation-and-diabetic-nephropathy-epidemiology-prognosis-and-choice-of-anticoagulant-therapy
#4
N A Koziolova, E A Polyanskaya, M V Surovtseva, P G Karavaev
In this review we present data on prevalence of atrial fibrillation (AF) among patients with type 2 diabetes (T2D), diabetic nephropathy and chronic kidney disease (CKD). Patients with nonvalvular AF and T2D combined with CKD have elevated risk of both bleeding and thromboembolic complications, as well as of all cause death. Efficacy and safety of novel oral anticoagulants (NOAC) depend on comorbidities and can be determined by the presence of T2D and/or diabetic nephropathy. Use of warfarin in CKD in some cases provides no preventive effect relative to risk of stroke and is characterized by increased risk of bleeding because of poor INR control, and possibly development of calcification of arteries...
April 2018: Kardiologiia
https://www.readbyqxmd.com/read/29753377/antithrombotic-therapy-in-nonvalvular-atrial-fibrillation-consensus-and-challenges
#5
REVIEW
Furqan Khattak, Mian B Alam, Timir K Paul, Shasank Rijal, Shoaib Wazir, Carl J Lavie, Samir Saba
Atrial fibrillation (AF) is associated with high risk of systemic thromboembolism leading to significant morbidity and mortality. Warfarin, previously the mainstay for stroke prevention in AF, requires close monitoring because of multiple food and drug interactions. In recent years, food and drug administration has approved several direct oral anticoagulants (DOACs) for use in patients with nonvalvular AF. These agents have not been studied in patients with valvular AF who are at an even higher risk of systemic thromboembolism...
May 2018: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/29745996/how-do-anticoagulated-atrial-fibrillation-patients-who-suffer-ischemic-stroke-or-spontaneous-intracerebral-hemorrhage-differ
#6
Heidi Lehtola, Juha Hartikainen, Päivi Hartikainen, Tuomas Kiviniemi, Ilpo Nuotio, Antti Palomäki, Antti Ylitalo, K E Juhani Airaksinen, Pirjo Mustonen
BACKGROUND: Atrial fibrillation (AF) increases risk of ischemic stroke, and oral anticoagulation (OAC) increases risk of intracerebral hemorrhage (ICH). This study aimed to compare OAC-treated AF patients with an ischemic stroke/transient ischemic attack (TIA) or spontaneous ICH as their first lifetime cerebrovascular event, especially focusing on patients with therapeutic international normalized ratio (INR). HYPOTHESIS: We assumed that in AF patients suffering ischemic stroke/TIA or ICH, patient characteristics could be different in patients with therapeutic INR than in patients with warfarin...
May 10, 2018: Clinical Cardiology
https://www.readbyqxmd.com/read/29728318/non-vitamin-k-dependent-oral-anticoagulants-for-nonvalvular-atrial-fibrillation-in-patients-with-ckd-pragmatic-considerations-for-the-clinician
#7
Gautam R Shroff, Rachel Stoecker, Allyson Hart
Management of atrial fibrillation (AF) in patients with advanced chronic kidney disease (CKD) poses a complex conundrum because of higher risks for both thromboembolic and bleeding complications compared to the general population. This makes it particularly important for clinicians to carefully weigh the risks versus benefits of anticoagulation therapy to determine the individualized net clinical benefit for every patient. During the past few years, 4 non-vitamin K-dependent oral anticoagulant (NOAC) agents have supplemented warfarin in the therapeutic armamentarium for the prevention of systemic thromboembolism in nonvalvular AF...
May 2, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29578207/use-of-oral-anticoagulants-in-patients-with-atrial-fibrillation-and-renal-dysfunction
#8
REVIEW
Tatjana S Potpara, Charles J Ferro, Gregory Y H Lip
Atrial fibrillation (AF) and chronic kidney disease (CKD) are increasingly prevalent in the general population and share common risk factors such as older age, hypertension and diabetes mellitus. The presence of CKD increases the risk of incident AF, and, likewise, AF increases the risk of CKD development and/or progression. Both conditions are associated with substantial thromboembolic risk, but patients with advanced CKD also exhibit a paradoxical increase in bleeding risk. In the landmark randomized clinical trials that compared non-vitamin K antagonist oral anticoagulants (NOACs) with warfarin for thromboprophylaxis in patients with AF, the efficacy and safety of NOACs in patients with mild-to-moderate CKD were similar to those in patients without CKD...
May 2018: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/29577340/safety-and-efficacy-of-apixaban-versus-warfarin-in-patients-with-end-stage-renal-disease-meta-analysis
#9
Ronpichai Chokesuwattanaskul, Charat Thongprayoon, Tanyanan Tanawuttiwat, Wisit Kaewput, Pavida Pachariyanon, Wisit Cheungpasitporn
BACKGROUND: At the present, apixaban is the only nonvitamin K oral anticoagulant approved by the Food and Drug Administration for use with patients with creatinine clearance <15 mL/min or end-stage renal disease (ESRD). However, the recommendations are based on pharmacokinetic and pharmacodynamic data and there was lack of clinical trial evidence. We aimed to assess safety and efficacy of apixaban in patients with advanced chronic kidney disease (CKD) or ESRD. METHODS: Databases were searched through November 2017...
March 25, 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29460334/variation-of-renal-function-over-time-is-associated-with-major-bleeding-in-patients-treated-with-direct-oral-anticoagulants-for-atrial-fibrillation
#10
C Becattini, M Giustozzi, M G Ranalli, G Bogliari, F Cianella, M Verso, G Agnelli, M C Vedovati
Essential In patients on treatment with direct anticoagulants (DOACs) variation of renal function is common. The effect of variations of renal function over time on major bleeding is not well defined. Variation of renal function over time is an independent predictor of major bleeding. Identifying conditions associated with variation of renal function may increase safety of DOACs. SUMMARY: Background Chronic kidney disease is a risk factor for major bleeding in patients with atrial fibrillation (AF) treated with warfarin...
May 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29391805/role-of-rivaroxaban-in-the-management-of-atrial-fibrillation-insights-from-clinical-practice
#11
REVIEW
Kavitha Vimalesvaran, Seth J Dockrill, Diana A Gorog
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and it leads to significant morbidity and mortality, predominantly from ischemic stroke. Vitamin K antagonists, mainly warfarin, have been used for decades to prevent ischemic stroke in AF, but their use is limited due to interactions with food and other drugs, as well as the requirement for regular monitoring of the international normalized ratio. Rivaroxaban, a direct factor Xa inhibitor and the most commonly used non-vitamin K oral anticoagulant, avoids many of these challenges and is being prescribed with increasing frequency for stroke prevention in non-valvular AF...
2018: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/29387335/contemporary-utilization-of-antithrombotic-therapy-for-stroke-prevention-in-patients-with-atrial-fibrillation-an-audit-in-an-australian-hospital-setting
#12
Ekta Yogeshkumar Pandya, Elizabeth Anderson, Clara Chow, Yishen Wang, Beata Bajorek
Background: To document antithrombotic utilization in patients with nonvalvular atrial fibrillation (NVAF), particularly, recently approved NOACs (nonvitamin K antagonist oral anticoagulants) and warfarin; and identify factors predicting the use of NOACs versus warfarin. Methods: A retrospective audit was conducted in an Australian hospital. Data pertaining to inpatients diagnosed with atrial fibrillation (AF) admitted between January and December 2014 were extracted...
February 2018: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/29381974/stroke-risks-and-patterns-of-warfarin-therapy-among-atrial-fibrillation-patients-post-radiofrequency-ablation-a-real-world-experience
#13
Juan Zhang, Xingpeng Liu, Xiaoqing Liu, Xiandong Yin, Yanjiang Wang, Xiaoying Lu, Xinchun Yang
We assessed the thromboembolic risks of atrial fibrillation (AF) patients who had undergone radiofrequency ablation (RFA) using the CHADS2-VASc risk scoring system and further investigated the patterns of warfarin use for thromboprophylaxis according to patient thromboembolic risk scores.In this study, we analyzed the stroke risks of patients who had undergone RFA for AF at our hospital between March 2014 and June 2016 using the CHADS2, CHADS2-VASc, and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years) (HAS-BLED) scoring systems...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29304513/nonvitamin-k-antagonist-oral-anticoagulants-use-in-patients-with-atrial-fibrillation-and-bioprosthetic-heart-valves-prior-surgical-valve-repair-a-multicenter-clinical-practice-experience
#14
Vincenzo Russo, Emilio Attena, Carmine Mazzone, Francesca Esposito, Valentina Parisi, Ciro Bancone, Anna Rago, Gerardo Nigro, Raffaele Sangiuolo, Antonio D' Onofrio
This is an observational study to investigate the efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with bioprosthetic valves or prior surgical valve repair in clinical practice. A total of 122 patients (mean age: 74.1 ± 13.2; 54 females) with bioprosthetic heart valve or surgical valve repair and AF treated with NOACs were included in the analysis. The mean CHA2 DS2 -VASc (Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, prior Stroke or transient ischemic attack, Vascular disease) and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR [international normalized ratio], Elderly, Drugs or alcohol) score values were 3...
January 5, 2018: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/29251360/laboratory-characteristics-of-ischemic-stroke-patients-with-atrial-fibrillation-on-or-off-therapeutic-warfarin
#15
Raghav V Aachi, Lee A Birnbaum, Christopher H Topel, Ali Seifi, Shaheryar Hafeez, Réza Behrouz
BACKGROUND: In patients with atrial fibrillation (AF), despite adequate anticoagulation, ischemic stroke (IS) is an uncommon yet concerning occurrence. HYPOTHESIS: Specific laboratory parameters may affect the efficacy of warfarin despite therapeutic international normalized ratio (INR) in patient with AF who present with IS. METHODS: We used the database from a multicenter clinical trial to identify AF patients who presented with IS. We trichotomized the cohort into patients with therapeutic INR on warfarin, subtherapeutic INR on warfarin, and on no anticoagulants...
December 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/29239808/drug-class-renal-elimination-and-outcomes-of-direct-oral-anticoagulants-in-asian-patients-a-meta-analysis
#16
Kang-Ling Wang, Chun-Chih Chiu, Robert P Giugliano, Doreen Su-Yin Tan, Chun-Yi Lin, En-Yu Lai, Shinya Goto, Chern-En Chiang
BACKGROUND: Direct oral anticoagulants (DOACs) have a better risk benefit profile in Asian patients with atrial fibrillation (AF). Whether treatment effects could be modified by drug class and dependency on renal elimination of studied agents has not yet been explored. METHODS: We searched PubMed, CENTRAL, and CINAHL databases through November 2016 for phase III randomized controlled trials comparing DOACs with warfarin in patients with AF. Efficacy and safety outcomes were pooled according to drug class and dependency on renal elimination of DOACs and were compared with the Mantel-Haenszel fixed-effects model...
April 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29219209/warfarin-use-and-the-risk-of-stroke-bleeding-and-mortality-in-older-adults-on-dialysis-with-incident-atrial-fibrillation
#17
Jingwen Tan, Sunjae Bae, Jodi B Segal, Junya Zhu, G Caleb Alexander, Dorry L Segev, Mara McAdams-DeMarco
AIM: There is conflicting evidence regarding the safety and effectiveness of warfarin for atrial fibrillation (AF) treatment among older end-stage renal disease (ESRD) patients, and differences among subgroups are unclear. METHODS: Older dialysis patients who were newly diagnosed with AF (7/2007-12/2011) were identified in the United States Renal Data System. The adjusted hazard ratios (HR) of the outcomes (any stroke, ischemic stroke, major bleeding, severe gastrointestinal bleeding, and death) by time-varying warfarin use were estimated using Cox regression accounting for the inverse probability of treatment weight...
December 8, 2017: Nephrology
https://www.readbyqxmd.com/read/29169468/renal-outcomes-in-anticoagulated-patients-with-atrial-fibrillation
#18
Xiaoxi Yao, Navdeep Tangri, Bernard J Gersh, Lindsey R Sangaralingham, Nilay D Shah, Karl A Nath, Peter A Noseworthy
BACKGROUND: Lifelong oral anticoagulation, either with warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC), is indicated for stroke prevention in most patients with atrial fibrillation (AF). Emerging evidence suggests that NOACs may be associated with better renal outcomes than warfarin. OBJECTIVES: This study aimed to compare 4 oral anticoagulant agents (apixaban, dabigatran, rivaroxaban, and warfarin) for their effects on 4 renal outcomes: ≥30% decline in estimated glomerular filtration rate (eGFR), doubling of the serum creatinine level, acute kidney injury (AKI), and kidney failure...
November 28, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29132650/non-vitamin-k-antagonist-oral-anticoagulants-in-patients-with-atrial-fibrillation-and-end-stage-renal-disease
#19
REVIEW
Marin Nishimura, Jonathan C Hsu
Over the past decade, there have been tremendous advancements in anticoagulation therapies for stroke prevention in patients with atrial fibrillation (AF). Although the non-vitamin K antagonist oral anticoagulants (NOACs) demonstrated favorable clinical outcomes compared with warfarin overall, the decision to anticoagulate and the choice of appropriate agent in patients with AF and concomitant chronic kidney disease (CKD) or end-stage renal disease (ESRD) are a particularly complex issue. CKD and ESRD increase both the risk of stroke and bleeding, and since all of the NOACs undergo various levels of renal clearance, renal dysfunction inevitably affects the pharmacokinetics of the drug in each patient...
January 1, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29107192/renal-function-and-risk-of-stroke-and-bleeding-in-patients-undergoing-catheter-ablation-for-atrial-fibrillation-comparison-between-uninterrupted-direct-oral-anticoagulants-and-warfarin-administration
#20
Satoshi Yanagisawa, Yasuya Inden, Aya Fujii, Monami Ando, Junya Funabiki, Yosuke Murase, Masaki Takenaka, Noriaki Otake, Yoshihiro Ikai, Yusuke Sakamoto, Rei Shibata, Toyoaki Murohara
BACKGROUND: The effect of uninterrupted oral anticoagulant use in patients with chronic kidney disease (CKD) during catheter ablation for atrial fibrillation (AF) is not fully understood. OBJECTIVE: The present study aimed to evaluate the safety and efficacy of periprocedural uninterrupted direct oral anticoagulant (DOAC) use compared with those of uninterrupted warfarin use in patients undergoing catheter ablation for AF stratified by various renal function groups...
March 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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