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anticoagulants plus antiplatelets atrial fibrillation

Nicolas A Geis, Christina Kiriakou, Emmanuel Chorianopoulos, Sven T Pleger, Hugo A Katus, Raffi Bekeredjian
AIMS: We aimed to assess the efficacy and safety of vitamin K antagonist (VKA) monotherapy in atrial fibrillation (AF) patients undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: In 735 TAVIs since 2008 we identified 167 patients suffering from concomitant AF who received either VKA monotherapy (n=77), VKA plus single antiplatelet therapy (SAPT, n=41) or a triple anticoagulation regimen (n=49). Thromboembolic as well as bleeding complications were analysed for six months after TAVI...
April 20, 2017: EuroIntervention
Dragana Radovanovic, Thomas Pilgrim, Burkhardt Seifert, Philip Urban, Giovanni Pedrazzini, Paul Erne
AIMS: The clinical definition and optimal treatment for myocardial infarction (MI) type 2 (T2MI) are not well established. We assessed differences in presentation, treatment and outcomes of patients with MI type 1 (T1MI) and T2MI. METHODS: The data of MI patients enrolled in the AMIS Plus cohort with T2MI were compared with T1MI using propensity score matching. RESULTS: A total of 13 829 patients had T1MI and 1091 (7.3%) T2MI. Patients with T2MI were older, often female, with more risk factors and comorbidities, and less ST segment elevation...
January 19, 2017: Journal of Cardiovascular Medicine
C Michael Gibson, Roxana Mehran, Christoph Bode, Jonathan Halperin, Freek W Verheugt, Peter Wildgoose, Mary Birmingham, Juliana Ianus, Paul Burton, Martin van Eickels, Serge Korjian, Yazan Daaboul, Gregory Y H Lip, Marc Cohen, Steen Husted, Eric D Peterson, Keith A Fox
BACKGROUND: In patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) with placement of stents, standard anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and aspirin reduces the risk of thrombosis and stroke but increases the risk of bleeding. The effectiveness and safety of anticoagulation with rivaroxaban plus either one or two antiplatelet agents are uncertain. METHODS: We randomly assigned 2124 participants with nonvalvular atrial fibrillation who had undergone PCI with stenting to receive, in a 1:1:1 ratio, low-dose rivaroxaban (15 mg once daily) plus a P2Y12 inhibitor for 12 months (group 1), very-low-dose rivaroxaban (2...
December 22, 2016: New England Journal of Medicine
Massimiliano Migliori, Vincenzo Cantaluppi, Alessia Scatena, Vincenzo Panichi
Patients affected by cardiovascular disease (CVD) are treated with antiplatelet agents (AA) and/or anticoagulant drugs, which are fundamental in the management of stroke, coronary atherosclerotic disease, peripheral vascular disease and atrial fibrillation. CVD is the most important cause of death in chronic renal failure (CRF). Death rates from myocardial infarction (MI) and from all other cardiac causes exceed those for the general population. Incidence of MI in CRF is triple that in the general population...
December 8, 2016: Journal of Nephrology
Stephan Windecker, Jan Tijssen, Gennaro Giustino, Ana H C Guimarães, Roxana Mehran, Marco Valgimigli, Pascal Vranckx, Robert C Welsh, Usman Baber, Gerrit-Anne van Es, Peter Wildgoose, Albert A Volkl, Ana Zazula, Karen Thomitzek, Melanie Hemmrich, George D Dangas
BACKGROUND: Optimal antithrombotic treatment after transcatheter aortic valve replacement (TAVR) is unknown and determined empirically. The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. DESIGN: GALILEO is an international, randomized, open-label, event-driven, phase III trial in more than 1,520 patients without an indication for oral anticoagulation who underwent a successful TAVR (ClinicalTrials...
February 2017: American Heart Journal
Mikhail S Dzeshka, Richard A Brown, Davide Capodanno, Gregory Y H Lip
Stroke prevention is the main priority in the management cascade of atrial fibrillation. Most patients require long-term oral anticoagulation (OAC) and may require percutaneous coronary intervention. Prevention of recurrent cardiac ischemia and stent thrombosis necessitate dual antiplatelet therapy (DAPT) for up to 12 months. Triple antithrombotic therapy with OAC plus DAPT of shortest feasible duration is warranted, followed by dual antithrombotic therapy of OAC and antiplatelet agent, and OAC alone after 12 months...
January 2017: Interventional cardiology clinics
Melanie Hemmrich, Eric D Peterson, Karen Thomitzek, Jeffrey I Weitz
Atrial fibrillation (AF) is a major healthcare concern, being associated with an estimated five-fold risk of ischaemic stroke. In patients with AF, anticoagulants reduce stroke risk to a greater extent than acetylsalicylic acid (ASA) or dual antiplatelet therapy (DAPT) with ASA plus clopidogrel. Non-vitamin K antagonist oral anticoagulants (NOACs) are now a widely-accepted therapeutic option for stroke prevention in non-valvular AF (NVAF). There are particular patient types with NVAF for whom treatment challenges remain, owing to sparse clinical data, their high-risk nature or a need to harmonise anticoagulant and antiplatelet regimens if co-administered...
September 28, 2016: Thrombosis and Haemostasis
Guillaume Bonnet, Erwan Salaun, Mathieu Pankert, Thomas Cuisset, Jean-Louis Bonnet
BACKGROUND: Left atrial appendage (LAA) closure using the WATCHMAN™ device (WM) may be considered in patients with non-valvular atrial fibrillation (AF) and a high-risk of stroke who are ineligible for long-term oral anticoagulation (OAC). AIM: To report our single-centre preliminary experience, focusing on feasibility, safety and short-term efficacy of this procedure. METHODS: Patients implanted from December 2013 to February 2014 were included...
December 2016: Archives of Cardiovascular Diseases
Omar Abdul-Jawad Altisent, Eric Durand, Antonio J Muñoz-García, Luis Nombela-Franco, Asim Cheema, Joelle Kefer, Enrique Gutierrez, Luis M Benítez, Ignacio J Amat-Santos, Vicenç Serra, Helene Eltchaninoff, Sami M Alnasser, Jaime Elízaga, Antonio Dager, Bruno García Del Blanco, Maria Del Rosario Ortas-Nadal, Josep Ramon Marsal, Francisco Campelo-Parada, Ander Regueiro, Maria Del Trigo, Eric Dumont, Rishi Puri, Josep Rodés-Cabau
OBJECTIVES: The study sought to examine the risk of ischemic events and bleeding episodes associated with differing antithrombotic strategies in patients undergoing transcatheter aortic valve replacement (TAVR) with concomitant atrial fibrillation (AF). BACKGROUND: Guidelines recommend antiplatelet therapy (APT) post-TAVR to reduce the risk of stroke. However, data on the efficacy and safety of this recommendation in the setting of a concomitant indication for oral anticoagulation (due to atrial fibrillation [AF]) with a vitamin K antagonist (VKA) are scarce...
August 22, 2016: JACC. Cardiovascular Interventions
Larry R Jackson, Jonathan P Piccini, Derek D Cyr, Matthew T Roe, Megan L Neely, Felipe Martinez, Thomas F Lüscher, Renato D Lopes, Kenneth J Winters, Harvey D White, Paul W Armstrong, Keith A A Fox, Dorairaj Prabhakaran, Deepak L Bhatt, E Magnus Ohman, Ramón Corbalán
Associations between atrial fibrillation (AF), outcomes, and response to antiplatelet therapies in patients with acute coronary syndrome (ACS) managed medically without revascularization remain uncertain. We examined these associations for medically managed ACS patients randomized to dual antiplatelet therapy (DAPT) using patient data from the TRILOGY ACS trial. DAPT included aspirin plus clopidogrel 75 mg/d or prasugrel 10 mg/d (5 mg/d for those <60 kg or age ≥75 years). Patients receiving oral anticoagulants were excluded...
September 2016: Clinical Cardiology
Danilo Toni, Svetlana Lorenzano, Stefano Strano
RATIONALE: Atrial fibrillation is associated with a high risk of stroke and its prevalence increases in subjects aged ≥65 years. After an ischemic stroke, the use of standard monitoring methods may underestimate the detection rate of atrial fibrillation. Hence, it is very likely that even patients having a first atherothrombotic or lacunar stroke with high burden of vascular risk factors are exposed to increased risk of developing atrial fibrillation in the subsequent years and atrial fibrillation may be the cause underlying possible recurrent strokes AIM AND HYPOTHESIS: The Silent Atrial Fibrillation aFter Ischemic StrOke (SAFFO) trial has the objective to evaluate the detection of atrial fibrillation or atrial flutter as first diagnosis by implantable loop recorder in patients with first-ever atherothrombotic or lacunar stroke...
April 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Antonia Sambola, Maria Mutuberría, Bruno García Del Blanco, Albert Alonso, José A Barrabés, Héctor Bueno, Fernando Alfonso, Angel Cequier, Javier Zueco, Oriol Rodríguez-Leor, Pilar Tornos, David García-Dorado
BACKGROUND AND PURPOSE: Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplatelet therapy: aspirin plus clopidogrel) in patients ≥75 years of age with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI)...
2016: PloS One
Renato D Lopes, Meena Rao, DaJuanicia N Simon, Laine Thomas, Jack Ansell, Gregg C Fonarow, Bernard J Gersh, Alan S Go, Elaine M Hylek, Peter Kowey, Jonathan P Piccini, Daniel E Singer, Paul Chang, Eric D Peterson, Kenneth W Mahaffey
BACKGROUND: The role of triple antithrombotic therapy vs dual antithrombotic therapy in patients with both atrial fibrillation and coronary artery disease remains unclear. This study explores the differences in treatment practices and outcomes between triple antithrombotic therapy and dual antithrombotic therapy in patients with atrial fibrillation and coronary artery disease. METHODS: Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (n = 10,135), we analyzed outcomes in patients with coronary artery disease (n = 1827) according to treatment with triple antithrombotic therapy (defined as concurrent therapy with an oral anticoagulant, a thienopyridine, and aspirin) or dual antithrombotic therapy (comprising either an oral anticoagulant and one antiplatelet agent [OAC plus AA] or 2 antiplatelet drugs and no anticoagulant [DAP])...
June 2016: American Journal of Medicine
Renato De Vecchis, Claudio Cantatrione, Damiana Mazzei
BACKGROUND: Chronic atrial fibrillation (AF), coexisting with a history of recent coronary angioplasty with stent (PCI-S), represents an encoded indication for oral anticoagulation (OAC) with warfarin plus dual antiplatelet therapy (DAPT). METHODS: Using a retrospective cohort study, we determined the respective impacts on cardiovascular outcomes of three different pharmacologic regimens, i.e., triple therapy (TT) with warfarin + clopidogrel and aspirin, dual therapy (DT) with warfarin + clopidogrel or aspirin, and DAPT with clopidogrel + aspirin...
February 2016: Journal of Clinical Medicine Research
Antonia Sambola, Maria Mutuberría, Bruno García Del Blanco, Albert Alonso, José A Barrabés, Fernando Alfonso, Héctor Bueno, Angel Cequier, Javier Zueco, Oriol Rodríguez-Leor, Eduard Bosch, Pilar Tornos, David García-Dorado
BACKGROUND: The effects of dual antiplatelet therapy (DAPT) and triple therapy (TT: DAPT plus oral anticoagulation) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) regarding to CHA2DS2-VASc score remain undefined.We compare the effect of TT vs. DAPT in this setting regarding the CHA2DS2-VASc score. METHODS AND RESULTS: In a prospective multicenter registry, 585 patients (75.2% male, 73.2 ± 8.2 years) with AF undergoing PCI were followed up during 1 year...
2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Durga Bista, Leanne Chalmers, Gregory M Peterson, Luke R E Bereznicki
Limited data are available on atrial fibrillation (AF) and its clinical management and outcomes from an Australian perspective. This study was designed to examine the patient characteristics and antithrombotic treatment patterns among patients with AF in Tasmania, Australia. This retrospective observational study reviewed and followed patients with AF admitted to Tasmania's 3 major hospitals between January 2011 and June 2012. Patients were excluded if they had only 1 episode of AF that reverted spontaneously or upon cardioversion without any documented recurrences...
December 23, 2015: Clinical and Applied Thrombosis/hemostasis
J Steffel, M Gwechenberger, M W H Müller, B Ammentorp, H Darius, P Kirchhof
BACKGROUND: The management of patients with atrial fibrillation (AF) has substantially improved in recent years, among others due to the introduction of new risk scores for the stratification of patients, as well as the availability of the non-vitamin K oral antagonists (NOAC). The PREFER-in-AF study aimed to document the management of AF patients with particular focus on stroke prevention on the basis of anticoagulants. METHODS AND RESULTS: In Germany, Austria and Switzerland a total of 1771 patients were enrolled between January 2012 and January 2013 (mean age 71...
November 2015: Deutsche Medizinische Wochenschrift
Chirag Bavishi, Anna Koulova, Sripal Bangalore, Ashwin Sawant, Saurav Chatterjee, Sameer Ather, Jose Valencia, Nikolaus Sarafoff, Andrea Rubboli, Juhani K Airaksinen, Gregory Y H Lip, Jacqueline E Tamis-Holland
OBJECTIVE: To compare the efficacy and safety of dual antiplatelet therapy (DAPT) and triple therapy (TT, dual antiplatelet plus warfarin) in patients with myocardial infarction (MI) or PCI with stenting (PCI-S) who also require chronic oral anticoagulation. BACKGROUND: Recommendations for the optimal antiplatelet/anticoagulant treatment regimen for patients undergoing PCI-S or MI who also require oral anticoagulation are largely based on evidence from observational studies and expert opinions...
July 2016: Catheterization and Cardiovascular Interventions
Chao-Feng Chen, Bin Chen, Jue Zhu, Yi-Zhou Xu
AIM: The aim of this meta-analysis was to evaluate the benefits and risks of triple therapy (TT) compared with dual therapy (DT) for patients with an indication for anticoagulation who had undergone percutaneous coronary intervention. BACKGROUND: An increasing number of patients undergoing percutaneous coronary intervention have atrial fibrillation or other indications for oral anticoagulants. For these patients, TT (oral anticoagulants plus aspirin and clopidogrel) is indicated, but this type of treatment increases the risk of bleeding...
December 2015: Herz
(no author information available yet)
Aspirin is the antithrombotic drug of choice for preventing recurrences after a first acute coronary syndrome. The addition of clopidogrel, another antiplatelet agent, is helpful in case of angioplasty with stenting. Following the acute phase, warfarin, an anticoagulant, alone or in combination with aspirin, may be used only in specific situations, particularly for patients with a high thrombotic risk (due to atrial fibrillation for example). Rivaroxaban, an oral factor Xa inhibitor anticoagulant, has been authorised for use following an acute coronary syndrome, but at a new dose strength of 2...
October 2014: Prescrire International
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