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Paroxysmal atrial fibrillation oral anticoagulant

Lisette Wintgens, Aleksandr Romanov, Karen Phillips, Gabriel Ballesteros, Martin Swaans, Richard Folkeringa, Ignacio Garcia-Bolao, Evgeny Pokushalov, Lucas Boersma
Aims: Long-term freedom from atrial fibrillation (AF) after catheter ablation (CA) and consequently the potential for stroke reduction remain unpredictable. Percutaneous left atrial appendage closure (LAAC) is an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. This study aims to evaluate long-term clinical results of combined CA and LAAC in one single procedure. Methods and results: Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective compilation of independent prospective general LAAC registries at the individual centres...
March 13, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
William F McIntyre, David Conen, Brian Olshansky, Jonathan L Halperin, Emil Hayek, Menno V Huisman, Gregory Y H Lip, Shihai Lu, Jeff S Healey
BACKGROUND: Antithrombotic prophylaxis with oral anticoagulation (OAC) substantially reduces stroke and mortality in patients with atrial fibrillation (AF). HYPOTHESIS: Analysis of data in GLORIA-AF, an international, observational registry of patients with newly-diagnosed AF, can identify factors associated with treatment decisions and outcomes. METHODS: Multivariable regression identified patient, physician, and temporal factors associated with OAC prescription, versus management with antiplatelet drugs or no antithrombotic drugs in North American patients enrolled between November 2011 and February 2014...
March 15, 2018: Clinical Cardiology
Sakiko Miyazaki, Katsumi Miyauchi, Hidemori Hayashi, Ryota Tanaka, Shuko Nojiri, Tadashi Miyazaki, Masataka Sumiyoshi, Satoru Suwa, Yuji Nakazato, Takao Urabe, Nobutaka Hattori, Hiroyuki Daida
BACKGROUND: The management of atrial fibrillation (AF) has evolved with the development of direct oral anticoagulants (DOACs), but data on their clinical effectiveness and safety outside clinical trial settings are limited. METHOD: The RAFFINE registry is an observational, multicenter, prospective registry of Japanese patients with AF, designed to follow clinical events over 3 years. Patient enrollment was conducted from 2013 to 2015 at university hospitals, general hospitals, and private clinics to ensure inclusion of a broad spectrum of representative AF patients...
March 1, 2018: Journal of Cardiology
Bernard Iung, Antoine Leenhardt, Fabrice Extramiana
Atrial fibrillation (AF) is frequent in patients with rheumatic mitral stenosis (MS). Pressure overload leads to marked structural and electrical remodelling of left atrium. The frequency of persistent AF increases with age and paroxysmal, asymptomatic, AF seems even more frequent. The occurrence of AF worsens the haemodynamic tolerance of MS and markedly increases the risk of thromboembolic events. AF has a negative impact on the natural history of MS and on its outcome after commissurotomy. The respective indications of rhythm and rate control should be adapted to patient characteristics, particularly the consequences of MS, and take into account the high risk of recurrence of AF...
February 16, 2018: Heart: Official Journal of the British Cardiac Society
Yu Jeong Choi, Ki Woon Kang, Tae Hoon Kim, Myung Jin Cha, Jung Myung Lee, Junbeom Park, Jin Kyu Park, Jaemin Shim, Jae Sun Uhm, Jun Kim, Hyung Wook Park, Eue Keun Choi, Jin Bae Kim, Changsoo Kim, Young Soo Lee, Boyoung Joung
PURPOSE: Comparisons of rhythm and rate control strategies for stroke prevention in patients with atrial fibrillation (AF) are still inconclusive. We compared differences in clinical outcomes between the rhythm and rate control strategies. MATERIALS AND METHODS: The COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry prospectively enrolled 6000 patients who were treated for AF using real-world guideline adherence at multiple referral centers...
March 2018: Yonsei Medical Journal
Natale Daniele Brunetti, Nicola Tarantino, Luisa De Gennaro, Michele Correale, Francesco Santoro, Matteo Di Biase
Pharmacological or electrical cardioversion allows immediate symptoms improvement in the setting of paroxysmal or persistent atrial fibrillation (AF), although the periprocedural risk of systemic embolism should be considered. Recently, there was a great interest on the safety and efficacy of direct oral anticoagulants (DOACs) when used for the cardioversion of non-valvular AF. We performed a random-effects meta-analysis of patients undergoing both electrical and pharmacologic cardioversion for non-valvular AF in the RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE AF-TIMI 48, X-VeRT, ENSURE-AF, and EMANATE trials...
February 5, 2018: Journal of Thrombosis and Thrombolysis
Gianluigi Savarese, Ulrik Sartipy, Leif Friberg, Ulf Dahlström, Lars H Lund
OBJECTIVE: Atrial fibrillation (AF) is common in patients with heart failure (HF), and oral anticoagulants (OAC) are indicated. The aim was to assess prevalence of, predictors of and consequences of OAC non-use. METHODS: We included patients with AF, HF and no previous valve replacement from the Swedish Heart Failure Registry. High and low CHA2DS2-VASc and HAS-BLED scores were defined as above/below median. Multivariable logistic regressions were used to assess the associations between baseline characteristics and OAC use and between CHA2DS2-VASc and HAS-BLED scores and OAC use...
January 25, 2018: Heart: Official Journal of the British Cardiac Society
Iwona Gorczyca-Michta, Beata Wożakowska-Kapłon, Katarzyna Starzyk, Anna Szpotowicz, Anna Stec
BackgroundAccording to the applicable guidelines for stroke prevention patients with a high risk of thromboembolic complications should receive oral anticoagulants. The objective of the present study is to evaluate the prevention of thrombosis in patients with diagnosed atrial fibrillation on discharge and a high risk of stroke.Methods and materialsThe present study is a retrospective single-centre registry. The analysis was carried out on the basis of the data on 4099 patients with non-valvular atrial fibrillation who were discharged from the cardiology department in years 2004-2012...
January 3, 2018: Kardiologia Polska
Mark H Eckman, Alexandru Costea, Mehran Attari, Jitender Munjal, Ruth E Wise, Carol Knochelmann, Matthew L Flaherty, Pete Baker, Robert Ireton, Brett M Harnett, Anthony C Leonard, Dylan Steen, Adam Rose, John Kues
BACKGROUND: Appropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. The recent availability of direct oral anticoagulants (DOACs) with comparable efficacy and improved safety compared with warfarin alters the balance between risk factors for stroke and benefit of anticoagulation. Our objective was to examine the impact of DOACs as an alternative to warfarin on the net benefit of oral anticoagulant therapy (OAT) in a real-world population of AF patients...
December 2017: American Heart Journal
George Degheim, Abeer Berry, Marcel Zughaib
A 57 year old gentleman with a history of non-ischemic cardiomyopathy and paroxysmal atrial fibrillation presented with worsening lower extremity edema and dyspnea on exertion. He had been compliant with his medications including rivaroxaban (Xarelto) for atrial fibrillation that he takes with the evening meal daily. His echocardiogram showed an ejection fraction of 10-15% and a new left ventricle (LV) apical thrombus. During his hospital stay, he developed right sided weakness. Magnetic Resonance Imaging showed a subacute infarct involving the left parietal lobe...
2017: American Journal of Cardiovascular Disease
Hyeongsoo Kim, Tae Hoon Kim, Myung Jin Cha, Jung Myung Lee, Junbeom Park, Jin Kyu Park, Ki Woon Kang, Jaemin Shim, Jae Sun Uhm, Jun Kim, Hyung Wook Park, Eue Keun Choi, Jin Bae Kim, Changsoo Kim, Young Soo Lee, Boyoung Joung
BACKGROUND AND OBJECTIVES: The aging population is rapidly increasing, and atrial fibrillation (AF) is becoming a significant public health burden in Asia, including Korea. This study evaluated current treatment patterns and guideline adherence of AF treatment. METHODS: In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 6,275 patients with nonvalvular AF were consecutively enrolled between June 2016 and April 2017 from 10 tertiary hospitals in Korea...
November 2017: Korean Circulation Journal
Adem Adar, Orhan Onalan, Fahri Cakan
: Left ventricular (LV) thrombi are mostly formed in the aneurysmal or akinetic segment of the LV apex. Thromboembolism to the brain is usually fatal. There is not enough information available regarding the use of these new oral anticoagulant agents in LV thrombi. In this case, we present a 56-year-old male patient who was given dabigatran (150 mg, twice a day) for paroxysmal atrial fibrillation after experiencing anterior myocardial infarction. During the use of dabigatran, thrombus formation, which was not present earlier, was observed in the LV apical aneurysm...
October 7, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Monika Gawałko, Agnieszka Kapłon-Cieślicka, Monika Budnik, Aldona Babiarz, Aleksandra Bodys, Robert Uliński, Maciej Żochowski, Michał Peller, Piotr Scisło, Janusz Kochanowski, Krzysztof J Filipiak, Grzegorz Opolski
INTRODUCTION    Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative to vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF). OBJECTIVES    The aim of the study was to assess the incidence of left atrial appendage (LAA) thrombus and dense spontaneous echo contrast (SEC), as well as to compare the clinical characteristics of patients with AF treated with different anticoagulant regimens. PATIENTS AND METHODS    We studied 1033 consecutive patients with AF, who underwent transesophageal echocardiography (TEE) before AF ablation or cardioversion...
December 22, 2017: Polish Archives of Internal Medicine
Syeda Atiqa Batul, Rakesh Gopinathannair
Atrial fibrillation (AF) and heart failure (HF) are growing cardiovascular disease epidemics worldwide. There has been an exponential increase in the prevalence of AF and HF correlating with an increased burden of cardiac risk factors and improved survival rates in patients with structural heart disease. AF is associated with adverse prognostic outcomes in HF and is most evident in mild-to-moderate left ventricular (LV) dysfunction where the loss of "atrial kick" translates into poorer quality of life and increased mortality...
September 2017: Korean Circulation Journal
Miney Paquette, Lionel Riou França, Christine Teutsch, Hans-Christoph Diener, Shihai Lu, Sergio J Dubner, Chang Sheng Ma, Kenneth J Rothman, Kristina Zint, Jonathan L Halperin, Menno V Huisman, Gregory Y H Lip, Robby Nieuwlaat
BACKGROUND: Guidelines recommend long-term oral anticoagulation therapy for stroke prevention in patients with atrial fibrillation (AF). Treatment discontinuation rates in vitamin K antagonist (VKA)-treated patients are high but may be lower with non-VKA oral anticoagulant agents. OBJECTIVES: The goal of this study was to describe and explore predictors of dabigatran etexilate persistence in patients with newly diagnosed AF over 2 years of follow-up. METHODS: Consecutive patients newly diagnosed with AF and ≥1 stroke risk factor were followed up for 2 years...
September 26, 2017: Journal of the American College of Cardiology
Daniela Dubois Marques, Vicente Mora Llabata, Julián Pacheco Arroyo, Salvador Gasull Insertis, Manuela Vicente Cañizares, Ildefonso Roldán Torres
OBJECTIVE: To determine whether antithrombotic treatment (ATT) in patients with non-valvular atrial fibrillation in a health area complies with the recommendations of current clinical guidelines. DESIGN: Prospective observational study. LOCATION: Primary Health Care Centres and Cardiology Department of a Health Department of the Valencian Community, Spain. PARTICIPANTS: A total of 505 patients with nonvalvular atrial fibrillation were included in the study...
August 31, 2017: Atencion Primaria
Masashi Mikubo, Dai Sonoda, Hirotsugu Yamazaki, Masahito Naito, Yoshio Matsui, Kazu Shiomi, Yukitoshi Satoh
INTRODUCTION: Mediastinal hematoma is usually caused by thoracic trauma or a ruptured aortic aneurysm. Spontaneous non-traumatic mediastinal hematomas are rare but potentially life-threatening conditions that can occur in patients taking anticoagulants. PRESENTATION OF CASE: We report a case of 72-year-old man with a massive mediastinal hematoma associated with anticoagulant therapy. He had complained of acute chest discomfort and subsequent tarry diarrhea. Because he had been taking warfarin for paroxysmal atrial fibrillation, an upper gastrointestinal hemorrhage was initially suspected, but no bleeding was detected by upper endoscopy...
2017: International Journal of Surgery Case Reports
Gabor Göndör, Claudia Stöllberger
Thrombosis after cessation of anticoagulation, also named rebound thrombosis, is a matter of concern and controversy. There are only few published data about occurrence of rebound thrombosis associated with non-vitamin K-antagonist oral anticoagulant drugs (NOACs). We report on a 58-year-old male with paroxysmal atrial fibrillation (AF) with a CHA2DS2VASC score of 4 who developed central pulmonary embolism four days after interruption of rivaroxaban because of parotid surgery. He had received 40 mg enoxaparin/d...
October 26, 2017: Hämostaseologie
Roderick W Treskes, Willem Gielen, Marieke J Wermer, Robert W Grauss, Anouk P van Alem, Reza Alizadeh Dehnavi, Charles J Kirchhof, Enno T van der Velde, Arie C Maan, Ron Wolterbeek, Onno M Overbeek, Martin J Schalij, Serge A Trines
BACKGROUND: Recently published randomised clinical trials indicate that prolonged electrocardiom (ECG) monitoring might enhance the detection of paroxysmal atrial fibrillation (AF) in cryptogenic stroke or transient ischaemic attack (TIA) patients. A device that might be suitable for prolonged ECG monitoring is a smartphone-compatible ECG device (Kardia Mobile, Alivecor, San Francisco, CA, USA) that allows the patient to record a single-lead ECG without the presence of trained health care staff...
August 29, 2017: Trials
João Primo, Helena Gonçalves, Ana Macedo, Paula Russo, Telma Monteiro, João Guimarães, Ovídio Costa
INTRODUCTION: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice and a major cause of morbidity, due to the associated risk of stroke. However, since it is often paroxysmal, it is commonly underdiagnosed and undertreated. OBJECTIVES: The primary objective of this prospective study was to determine the prevalence of paroxysmal atrial fibrillation (PAF) in patients aged 40 and above in a population who underwent continuous 24-hour electrocardiographic monitoring...
July 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
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