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Alpesh Amin, Allison Keshishian, Lien Vo, Qisu Zhang, Oluwaseyi Dina, Chad Patel, Kevin Odell, Jeffrey Trocio
AIMS: Compare the risk of all-cause hospitalization and hospitalizations due to stroke/systemic embolism (SE) and major bleeding as well as associated health care costs for nonvalvular atrial fibrillation (NVAF) patients initiating apixaban, dabigatran, rivaroxaban, or warfarin. MATERIALS AND METHODS: NVAF patients initiating apixaban, dabigatran, rivaroxaban, or warfarin were selected from the OptumInsight Research Database from 01JAN2013-30SEP2015. Propensity score matching (PSM) was performed between apixaban and each oral anticoagulant...
October 19, 2017: Journal of Medical Economics
A John Camm, Keith A A Fox, Eric Peterson
The aim of this review is to provide context for meta-analyses interpreting data from phase III stroke prevention studies of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (NVAF). Differences between the four phase III NOAC stroke prevention studies in patients with NVAF (ROCKET AF, ARISTOTLE, RE-LY, and ENGAGE AF), their potential impact on outcomes, and inter-study differences were evaluated, as well as the potential role of real-world evidence in evaluating NOACs in this setting...
October 13, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Yulong Gu, Robert N Doughty, Ben Freedman, John Kennelly, Jim Warren, Matire Harwood, Richard Hulme, Chris Paltridge, Ruth Teh, Anna Rolleston, Natalie Walker
AIMS: Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and cardiovascular events. In New Zealand (NZ), Māori (indigenous New Zealanders) and Pacific people experience higher rates of AF compared to non-Māori/non-Pacific people. This study describes a primary care population with AF in NZ. Stroke risk and medication adherence according to ethnicity are also detailed. METHODS: Electronic medical records for adults (≥20 years, n=135,840, including 19,918 Māori and 43,634 Pacific people) enrolled at 37 NZ general practices were analysed for AF diagnosis and associated medication prescription information...
October 16, 2017: Internal Medicine Journal
Yukie Kanai, Hiroaki Oguro, Nao Tahara, Hanako Matsuda, Hiroyuki Takayoshi, Shingo Mitaki, Keiichi Onoda, Shuhei Yamaguchi
OBJECTIVE: We investigated recurrent stroke volume with nonvalvular atrial fibrillation (NVAF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) about clinical backgrounds and number of recurrent stroke. METHODS: We administered 4 NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban in 101 postcardioembolic strokes with NVAF. In a retrospective study, we measured recurrent stroke volume with magnetic resonance imaging volumetric software and compared them between 10 vitamin K anticoagulant (VKA: warfarin) cases and 13 NOAC cases under anticoagulant therapy...
October 12, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
S A Beshir, Z Aziz, L B Yap, K H Chee, Y L Lo
WHAT IS KNOWN AND OBJECTIVE: Bleeding risk scores (BRSs) aid in the assessment of oral anticoagulant-related bleeding risk in patients with atrial fibrillation. Ideally, the applicability of a BRS needs to be assessed, prior to its routine use in a population other than the original derivation cohort. Therefore, we evaluated the performance of 6 established BRSs to predict major or clinically relevant bleeding (CRB) events associated with the use of oral anticoagulant (OAC) among Malaysian patients...
October 13, 2017: Journal of Clinical Pharmacy and Therapeutics
Beenish S Manzoor, Surrey M Walton, Lisa K Sharp, William L Galanter, Todd A Lee, Edith A Nutescu
Real-world evidence focusing on medication switching patterns amongst direct oral anticoagulant (DOACs) has not been well studied. The objective of this study is to evaluate patterns of prescription switching in non-valvular atrial fibrillation (NVAF) patients initiated on a DOAC and previously naïve to anticoagulation (AC) therapy. Data was obtained from Truven Health MarketScan(®) Commercial and Medicare Supplemental database (2009-2013). AC naïve (those without prior anticoagulant use) NVAF patients initiated on a DOAC, with 6 months of continuous health plan enrollment before and after treatment initiation and maintained on continuous therapy for a minimum of 6 months were included...
October 12, 2017: Journal of Thrombosis and Thrombolysis
Xiao Xiang, Yaying Cao, Kexin Sun, Jing Song, Yaohua Tian, Qiongzhou Yin, Juan Juan, Yonghua Hu
BACKGROUND AND OBJECTIVE: Adherence to oral anticoagulants is crucial for the prevention of ischemic stroke in atrial fibrillation patients; however, evidence of oral-anticoagulant adherence from developing countries is still lacking. Our study aimed to evaluate the current situation and predictors of oral-anticoagulant adherence in non-valvular atrial fibrillation (NVAF) patients in China. METHODS: Records of NVAF patients were obtained from a regional claims database...
October 12, 2017: Current Medical Research and Opinion
Yorihiko Koeda, Takashi Komatsu, Yuki Matsuura, Hidemi Morioka, Yohei Uchimura, Yuya Taguchi, Kentaro Tanaka, Jun Kawakami, Marie Nakamura, Shuko Takahashi, Yuji Takahashi, Yujiro Naganuma, Hiroshi Endo, Tatsuro Ito, Yoshihiro Morino, Motoyuki Nakamura
BACKGROUND & PURPOSE: We have conducted a retrospective observational study to analyze the correlation between the CHADS2 score, the modified CHA2DS2-VASc (mCHA2DS2-VASc) score, and the incidence of all-cause death and congestive heart failure (CHF). METHODS: The study cohort consisted of 292 consecutive patients with nonvalvular atrial fibrillation (NVAF) admitted to our hospital from 2012 to 2014. Electronic medical records were used to confirm medical history including prior heart failure, hypertension, diabetes, stroke, and coronary disease...
October 2017: Journal of Arrhythmia
Masahiko Umei, Mikio Kishi, Takahiro Sato, Akito Shindo, Masayuki Toyoda, Masaaki Yokoyama, Masashiro Matsushita, Satoshi Ohnishi, Masao Yamasaki
BACKGROUND: Direct oral anticoagulants (DOACs) have been developed for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). We conducted a retrospective cohort study of patients with NVAF who were newly treated with DOACs in a real-world clinical setting. METHODS: We retrospectively analyzed patients with NVAF newly treated with one of three DOACs-dabigatran, rivaroxaban, or apixaban-between January 1, 2013, and December 31, 2015. RESULTS: A total of 670 patients with NVAF who were newly prescribed one of the three DOACs were analyzed; 74 patients (10...
October 2017: Journal of Arrhythmia
Shuk-Li Collings, Cinira Lefèvre, Michelle E Johnson, David Evans, Guido Hack, Gillian Stynes, Andrew Maguire
This study examined characteristics and treatment persistence among patients prescribed oral anticoagulants (OACs) for stroke prevention in non-valvular atrial fibrillation (NVAF). We identified 15,244 patients (51.8% male, 72.7% aged ≥70) with NVAF and no prior OAC therapy who were prescribed apixaban (n = 1,303), rivaroxaban (n = 5,742), dabigatran (n = 1,622) or vitamin-K antagonists (VKAs, n = 6,577) between 1-Dec-2012 and 31-Oct-2014 in German primary care (IMS® Disease Analyzer). We compared OAC persistence using Cox regression over patients' entire follow-up and using a data-driven time-partitioned approach (before/after 100 days) to handle non-proportional hazards...
2017: PloS One
Hanen Ghazali, Jihen Essid, Anware Yahmadi, Moez Mougaida, Mahbouba Chkir, Sami Souissi
INTRODUCTION: The vitamin K antagonists (VKAs) are currently the most effective therapeutic class for the prevention of cerebrovascular eventsin atrial fibrillation (AF) patients. However, several studies showed an under-prescription of this therapy.The aim of the study was to assess the prescription of VKAs in non-valvular AF (NVAF) patients and factors influencing the non-prescription ofsuch treatment. METHODS: We conducted a prospective, observational study in an emergency department (ED)...
November 2016: La Tunisie Médicale
Carmen Suárez Fernández, Jose María Mostaza, Luis Castilla Guerra, Jesus Cantero Hinojosa, Josep Maria Suriñach, Fernando Acosta de Bilbao, Juan José Tamarit, José Luis Diaz Diaz, Jose Luis Hernandez, Daniel Cazorla, Carles Ràfols
BACKGROUND AND OBJECTIVE: To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. PATIENTS AND METHODS: Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included...
October 6, 2017: Medicina Clínica
Antonios Douros, Christel Renoux, Janie Coulombe, Samy Suissa
PURPOSE: Studies on long-term utilization of non-vitamin K antagonist oral anticoagulants (NOACs) in non-valvular atrial fibrillation (NVAF) are scarce. We evaluated predictors of use and long-term persistence of NOACs in a real-world setting. METHODS: This population-based cohort study used the computerized databases of the Canadian Province of Quebec's health insurance. Patients with a first NVAF diagnosis from 2011 until 2014 were included. A logistic regression model yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for predictors of treatment initiation with NOACs versus VKAs...
October 6, 2017: Pharmacoepidemiology and Drug Safety
Sadık Volkan Emren, Mehdi Zoghi, Rida Berılgen, İbrahim Halil Özdemir, Oğuzhan Çelik, Nurullah Çetin, Asım Enhoş, Cemal Köseoğlu, Abdurrahman Akyüz, Volkan Doğan, Fatih Levent, Yüksel Dereli, Tolga Doğan, Özcan Başaran, Ilgın Karaca, Özkan Karaca, Yılmaz Ömür Otlu, Çağlar Özmen, Selvi Coşar, Mutlu Sümerkan, Erdal Gürsul, Sinan İnci, Ersel Onrat, Oktay Ergene
Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once- or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1:1 propensity score matched for baseline demographic characteristics and the presence of other diseases...
October 2, 2017: Bosnian Journal of Basic Medical Sciences
Taesong An, Eiji Kose, Akihiko Kikkawa, Hiroyuki Hayashi
Background/Aims Our previous study showed that time in therapeutic range (TTR) control of warfarin therapy was negatively affected in non-valvular atrial fibrillation (NVAF) patients with heart failure. This study assesses the effect of intervention by hospital pharmacists on TTR control in Japanese NVAF patients with heart failure. Method This retrospective cohort study included NVAF patients with heart failure admitted and discharged from the cardiovascular internal medicine ward between March 2011 and July 2013...
2017: Journal of Medical Investigation: JMI
A Gullón, F Formiga, M Camafort, J M Mostaza, J Díez-Manglano, J M Cepeda, I Novo-Veleiro, A Pose, C Suárez Fernández
OBJECTIVES: Atrial fibrillation (AF) has been associated with higher mortality. We aimed to identify the baseline predictors of in-hospital mortality among elderly patients with non-valvular AF (NVAF) hospitalised for any reason. METHODS: Observational, prospective and multicentre study was carried out on patients with NVAF over the age of 75, who had been admitted for any acute medical condition to Internal Medicine departments in Spain. RESULTS: We evaluated 804 patients with a mean age of 85±5...
September 24, 2017: European Journal of Internal Medicine
Waldemar E Wysokinski, Kevin P Cohoon, Ewa A Konik, Rowlens M Melduni, Naser M Ammash, Samuel J Asirvatham, Robert D McBane
AIMS: Von Willebrand factor (VWF) is an independent risk factor for adverse events in patients with non-valvular atrial fibrillation (NVAF). However, it is unclear if VWF level remains elevated and predictive of stroke during entire course of NVAF. METHODS AND RESULTS: In order to determine if VWF is a time-dependent blood variable, VWF antigen measured by latex immunoassay in 425 NVAF patients and 100 controls with normal sinus rhythm (NSR) were analyzed according to NVAF duration (< 1 month: n=76, 1-12 months: n=98, and >12 months: n=251)...
September 26, 2017: European Journal of Haematology
Laure Lacoin, Matthew Lumley, Essra Ridha, Marta Pereira, Laura McDonald, Sreeram Ramagopalan, Cinira Lefèvre, David Evans, Julian P Halcox
OBJECTIVE: To describe the changes in prescribing of oral anticoagulant (AC) and antiplatelet (AP) agents in patients with non-valvular atrial fibrillation (NVAF) in the UK and to identify the characteristics associated with deviation from guideline-based recommendations. DESIGN: Five cross-sectional analyses in a large retrospective population-based cohort study. SETTING: General practices contributing data to the UK Clinical Practice Research Datalink...
September 25, 2017: BMJ Open
Eitaro Kodani, Hirotsugu Atarashi, Hiroshi Inoue, Ken Okumura, Takeshi Yamashita, Hideki Origasa
Aim: To clarify the influence of renal function on adverse outcomes in patients with non-valvular atrial fibrillation (NVAF), a post hoc analysis of the J-RHYTHM Registry was performed. Methods: A consecutive series of outpatients with atrial fibrillation (AF) was enrolled from 158 institutions and followed for 2 years or until the occurrence of an event. Among 7406 patients with non-valvular AF, 6052 patients (69.8±10.0 years, 71.2% men) with creatinine clearance (CrCl) value at baseline were divided into 4 groups according to CrCl level (<30, 30-49...
September 1, 2017: European Heart Journal. Quality of Care & Clinical Outcomes
Vincenzo Russo, Anna Rago, Andrea A Papa, Valter Bianchi, Vincenzo Tavoletta, Stefano DE Vivo, Ciro Cavallaro, Gerardo Nigro, Antonio D'Onofrio
BACKGROUND: Rivaroxaban is the first novel oral anticoagulant to receive regulatory approval for non-valvular atrial fibrillation (NVAF) patients who require cardioversion. The MonaldiVert real life experience showed positive benefit-risk profile of short term rivaroxaban administration for transesophageal echocardiogram guided cardioversion in patients who had not achieved adequate pre-procedural vitamin k antagonist (VKA) anticoagulation. METHODS: Aim of our study was to perform a budget impact analysis of MonaldiVert anticoagulation strategy for direct current cardioversion in NVAF patients and to compare the following costs borne by the Regional Healthcare System (RHS) with those for a hypothetical cohort of identical patients underwent from the beginning to early rivaroxaban treatment before direct current cardioversion...
September 25, 2017: Minerva Cardioangiologica
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