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anticoagulants plus antiplatelets atrial fibrillation

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 14, 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...
September 1, 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
Marco G Mennuni, Jonathan L Halperin, Sameer Bansilal, Mikkel M Schoos, Kleanthis N Theodoropoulos, Omar A Meelu, Samantha Sartori, Daniele Giacoppo, Chiara Bernelli, Pedro R Moreno, Prakash Krishnan, Usman Baber, Carla Lucarelli, George D Dangas, Samin K Sharma, Annapoorna S Kini, Corrado Tamburino, Alaide Chieffo, Antonio Colombo, Patrizia Presbitero, Roxana Mehran
Patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) are at elevated risk for bleeding and thromboembolic ischemic events. Currently, guidelines on antithrombotic treatment for these patients are based on weak consensus. We describe patterns and determinants of antithrombotic prescriptions in this population. The Antithrombotic Strategy Variability in Atrial Fibrillation and Obstructive Coronary Disease Revascularized with PCI Registry was an international observational study of 859 consecutive patients with AF who underwent PCI from 2009 to 2011...
July 1, 2015: American Journal of Cardiology
Valentina Arnao, Giancarlo Agnelli, Maurizio Paciaroni
In patients with non-valvular atrial fibrillation (NVAF) and history of transient ischemic attack (TIA) or stroke, the rate of vascular events is higher in comparison to patients without history of stroke or TIA. A meta-analysis of direct oral anticoagulants (DOACs) studies, including only patients with history of stroke or TIA, report a significant reduction of 15 % in the rates of composite of stroke and systemic embolism in patients treated with DOACs, compared to those treated with warfarin. Furthermore, a reduction of 14 % for major bleeding, as well as a 56 % reduction for hemorrhagic stroke over a median follow-up of 1...
August 2015: Internal and Emergency Medicine
C Michael Gibson, Roxana Mehran, Christoph Bode, Johnathan Halperin, Freek Verheugt, Peter Wildgoose, Martin van Eickels, Gregory Y H Lip, Marc Cohen, Steen Husted, Eric Peterson, Keith Fox
BACKGROUND: Guidelines recommendations regarding anticoagulant therapy after percutaneous coronary intervention (PCI) among patients with atrial fibrillation (AF) rely on retrospective, nonrandomized observational data. Currently, patients are treated with triple-therapy (dual antiplatelet therapy [DAPT] + oral anticoagulation therapy), but neither the duration of DAPT nor the level of anticoagulation has been studied in a randomized fashion. Recent studies also suggest dual pathway therapy with clopidogrel plus oral anticoagulation therapy may be superior, and other studies suggest that novel oral anticoagulants such as rivaroxaban may further improve patient outcomes...
April 2015: American Heart Journal
Yuko Honda, Yoshiyuki Morishima
INTRODUCTION: Patients with atrial fibrillation undergoing percutaneous coronary intervention may require combination therapy with anticoagulants and antiplatelet agents. The objectives of this study were to establish an assay which can evaluate the effects of both anticoagulants and P2Y12 receptor antagonists and determine the effects of edoxaban, a direct factor Xa inhibitor, and P2Y12 receptor antagonists (clopidogrel and ticagrelor) alone and when combined. MATERIAL AND METHODS: Human platelet-rich plasma (PRP) from healthy subjects was stimulated with adenosine diphosphate (ADP) plus tissue factor...
May 2015: Thrombosis Research
T F Lüscher, J Steffel
UNLABELLED: Clot formation in the circulation is a physiological mechanism preventing bleeding at sites of loss of vascular integrity. Clot formation may also occur intravascularly under pathological conditions, e.g. leading to myocardial infarction, stroke, and critical limb ischaemia. Clot formation involves activation of the coagulation cascade and of platelets eventually leading to an occlusive clot. In the venous circulation, clots are rich in erythrocytes and fibrin, while in the arterial circulation platelets predominate...
2016: Hämostaseologie
Kurt Huber, Eric R Bates, Marco Valgimigli, Lars Wallentin, Steen Dalby Kristensen, Jeffrey L Anderson, Jose Luis Lopez Sendon, Marco Tubaro, Christopher B Granger, Christoph Bode, Erik Magnus Ohman, Philippe Gabriel Steg
Mortality and morbidity in acute coronary syndromes (ACSs), caused principally by plaque erosion or rupture leading to thrombus formation and myocardial ischemia, have been reduced by a combination of antithrombotic agents (antiplatelet drugs and anticoagulants) and early revascularization. Aspirin is the foundation antiplatelet agent. New P2Y12 receptor inhibitors (prasugrel and ticagrelor) have clear benefits compared with clopidogrel for dual antiplatelet therapy, and cangrelor or vorapaxar, a thrombin receptor inhibitor, may be of value in specific settings...
November 2014: American Heart Journal
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