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https://www.readbyqxmd.com/read/27910092/management-of-atrial-fibrillation-in-elderly-adults
#1
Yaanik Desai, Mikhael F El-Chami, Angel R Leon, Faisal M Merchant
Driven in large part by the aging of the population and the increasing prevalence of cardiovascular comorbidities associated with atrial fibrillation (AF), there is a burgeoning epidemic of AF in elderly adults. Although there is a large body of literature to guide management of people with AF, elderly adults with AF are frequently underrepresented in clinical trials. This review provides a contemporary update on management of elderly adults with AF with a particular focus on the two main clinical challenges that AF poses: stroke risk reduction and control of symptoms...
December 2, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27910004/dabigatran-overdose-a-case-report-of-acute-hepatitis-extracorporeal-treatment
#2
Mariagrazia Porru, Antonella Mameli, Maria E Cianchetti, Mario Musu, Paola Schirru, Maria F Ruberto, Doris Barcellona, Francesco Marongiu
Dabigatran is an oral, direct thrombin inhibitor approved by international regulatory agencies for stroke prevention in patients with paroxysmal or persistent non-rheumatic atrial fibrillation (AF). The benefits of dabigatran are widely described, but its use in the geriatric population is not without risk. Chronic kidney disease is a common comorbidity with AF, and thus frequent checks of renal function in elderly patients are recommended. We report a case of dabigatran intoxication in an elderly man affected by heart failure and worsening renal function, who developed acute hepatitis and coma, which was successfully treated with continuous veno-venous hemodiafiltration...
December 1, 2016: International Journal of Hematology
https://www.readbyqxmd.com/read/27909544/reducing-the-risk-of-stroke-in-patients-with-nonvalvular-atrial-fibrillation-with-direct-oral-anticoagulants-is-one-of-these-not-like-the-others
#3
REVIEW
Paul P Dobesh Pharm D, John Fanikos Mba R Ph
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and increases risk of stroke by nearly 5-fold. While warfarin has been employed successfully to reduce the risk of stroke in these patients, there are a number of challenges with therapy. These include the need for therapeutic monitoring due to variability in patient response, frequent dose adjustments, numerous drug-drug, drug-food, and drug-disease interactions, and a heightened risk of thrombosis and bleeding due to these issues. Current guidelines recommend that the vitamin K antagonists (VKA) or direct oral anticoagulants (DOACs) should be used for thromboprophylaxis in patients with nonvalvular AF at risk for stroke or systemic embolic events...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909542/which-factors-influence-resident-physicians-to-prescribe-noacs-to-patients-with-non-valvular-atrial-fibrillation
#4
Zardasht Oqab Md Frcpc, William F McIntyre Md Frcpc, Wilma M Hopman Ma, Adrian Baranchuk Md Facc Frcp
The Canadian Cardiovascular Society and the European Society of Cardiology recommend the use of non-vitamin K antagonists (NOAC) in preference to warfarin for stroke prevention in most patients with non-valvular atrial fibrillation (AF). The aim of this study was to identify factors that predict selection of a NOAC by resident physicians when faced with patients with non-valvular AF. A web-based survey was distributed to residents across Canada to learn the attitudes and behaviours regarding stroke, bleeding risk and choices of therapy in different clinical scenarios involving the same patient and one additional co-morbidity...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909541/validation-of-the-has-bled-tool-in-atrial-fibrillation-patients-receiving-rivaroxaban
#5
Gorman Ew, Perkel D, Dennis D, Yates J, Heidel Re, Wortham D
Background: Atrial fibrillation (Afib) patients are at an increased risk of stroke. Patients at moderate to high risk of stroke typically receive antithrombotics, placing them at an increased risk of bleeding. The HAS-BLED tool has been validated in Afib patients receiving warfarin for prediction of major bleeding events. Although HAS-BLED has been researched in patients receiving warfarin, this tool has not been validated with the novel anticoagulant rivaroxaban. Methods: The trial design was retrospective case-control approved by the Institutional Review Board at University of Tennessee Medical Center...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909536/screening-for-atrial-fibrillation-in-the-community-using-a-novel-ecg-recorder
#6
Irma Battipaglia Md, Katrina Gilbert BSc, Andrew J Hogarth Md PhD, Muzahir H Tayebjee Md
Aims: MyDiagnostick (MDK) is a novel portable ECG recorder. We conducted this study to evaluate its role in screening for atrial fibrillation (AF). Methods: The device is a cylindrical rod with metallic electrodes at both ends recording electrocardiogram (ECG) when both electrodes are held. Individuals were requested to hold the device for approximately 15 s, the device was then connected to a laptop (with proprietary software downloaded) and analysed. Anonymised ECGs were stored for further analysis. A total of 855 ECGs were recorded and analysed offline by two arrhythmia specialists assessing ECG quality, in particular the level of noise...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909535/search-for-the-ideal-antithrombotic-drug-utopian-task-likely-is-implemented-already
#7
REVIEW
Petras Stirbys Md PhD
Atrial fibrillation is the most prevalent cardiac arrhythmia with a high risk of ischemic stroke. Thromboprophylaxis plays a key role in prevention of cardioembolic and non-cardioembolic events. Oral antithrombotic drugs are most often used to reduce hypercoagulable state. Patients may suffer from both under- and overtreatment compromising the outcomes. Medication peculiarities at large are well-known and widely debated. Non-adherence to antithrombotic drug regimen poses a significant risk of stroke. There is a pressing need for more detailed delineation of risk factors, namely by incorporation of the letter "N" (meaning "Non-adherence to drug therapy") into the well-known risk score alphanumeric display: CHA2DS2N-VASc...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909534/efficacy-and-safety-of-implantable-loop-recorder-experience-of-a-center
#8
Inês Silveira, Maria João Sousa, Nuno Antunes, Vânia Silva, Carla Roque, António Pinheiro-Vieira, Vítor Lagarto, António Hipólito-Reis, André Luz, Severo Torres
Introduction: Symptoms like syncope or palpitations frequently present a diagnostic challenge. An implantable loop recorder (ILR) is an important aid in the management of these patients. Methods: A retrospective study of patients that underwent ILR implantation from November 2007 to 2014. For each patient the indication for implantation, baseline characteristics, previous study, complications, recorded tracing and interventions were evaluated. Results: A total of 62 patients were included, 50% men, with a mean age of 62...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909518/symptoms-in-atrial-fibrillation-a-contemporary-review-and-future-directions
#9
REVIEW
Steven T Heidt Bs, Anna Kratz PhD, Kayvan Najarian PhD, Afton L Hassett PsyD, Hakan Oral Md, Richard Gonzalez PhD, Brahmajee K Nallamothu Md Mph, Daniel Clauw Md, Hamid Ghanbari Md Mph
Atrial fibrillation (AF) is the most prevalent arrhythmia leading to hospital admissions in the United States. The majority of patients with AF report symptoms associated with this condition that can lead to a decrease in health related quality of life (HRQOL) and functional status. Therefore, along with reducing the risk of stroke and mortality, improvements in such symptoms are important therapeutic goals in the management of patients with AF. Our current understanding of how AF and symptoms are linked is hampered by the dominant assessment paradigm, where symptoms thought to be associated with AF are measured at a single point in time (frequently at a clinic visit)...
June 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909516/the-role-of-noacs-in-atrial-fibrillation-management-a-qualitative-study
#10
Katherine Kirley Md Ms, Goutham Rao Md, Victoria Bauer Bs, Christopher Masi Md PhD
Patients with atrial fibrillation (AF) benefit from anticoagulation to reduce stroke risk. However, 30-60% of patients with AF are not anticoagulated. This study explored physicians' reasons for under-treatment of AF, focusing on the role of the novel oral anticoagulants (NOACs). We interviewed primary care physicians and cardiologists involved in AF management in a variety of practice settings. We conducted interviews using a semi-structured format and analyzed the data using the Framework Method. Four themes emerged...
June 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909476/atrial-fibrillation-and-risk-of-dementia-cognitive-decline
#11
REVIEW
Anand D Shah Md, Faisal M Merchant Md, David B Delurgio Md
Emerging evidence suggests a link between atrial fibrillation and subsequent development of dementia. While a majority of risk can be attributed to cardioembolic stroke secondary to atrial fibrillation, additional risk is apparent, and may be driven by vascular inflammation and changes in cerebral perfusion. Medical therapies including anticoagulation, statin therapy, and angiotensin-renin-aldosterone axis antagonists may reduce dementia risk. Procedural therapies such as atrial fibrillation catheter ablation and left atrial appendage closure may also prove to be important mediators of acute and long-term risk...
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909475/ablation-of-atrial-fibrillation-in-combination-with-left-atrial-appendage-occlusion-in-a-single-procedure-rationale-and-technique
#12
REVIEW
Ignacio García-Bolao, Naiara Calvo, Alfonso Macias, Joaquin Barba, Nahikari Salterain, Pablo Ramos, Gabriel Ballesteros, Renzo Neglia
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and is associated with a fivefold increase in the risk of ischemic stroke and systemic embolism. Left atrial appendage (LAA) is the source of thrombi in up to 90% of patients with nonvalvular atrial fibrillation (AF). Although thromboembolic prophylaxis by means of oral anticoagulants (OAC) has been shown to be very effective (OAC), they also confer an inevitably risk of serious bleeding. Catheter ablation (CA) is an effective treatment for symptomatic AF but its role in stroke prevention remains unproved...
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909474/efficacy-high-procedural-safety-and-rapid-optimization-of-cryoballoon-atrial-fibrillation-ablation-in-the-hands-of-a-new-operator
#13
Eberhard Scholz, Patrick Lugenbiel, Patrick A Schweizer, Panagiotis Xynogalos, Claudia Seyler, Edgar Zitron, Rüdiger Becker, Hugo A Katus, Dierk Thomas
BACKGROUND: Cryoballoon (CB) ablation is successful in eliminating atrial fibrillation (AF). PURPOSE: The purpose of this study was to assess procedural efficacy and safety of CB ablation performed by a newly trained operator. METHODS: Forty patients with documented paroxysmal AF (58 ± 11 years, 26 male) undergoing CB catheter ablation were prospectively enrolled. RESULTS: Electrical pulmonary vein (PV) isolation was achieved in all patients (156 PVs)...
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909470/clinical-and-economic-implications-of-af-related-stroke
#14
REVIEW
Dr Ali N Ali, Dr Ahmed Abdelhafiz
A major cause of morbidity and mortality among patients with atrial fibrillation (AF) relates to the increased risk of stroke. The burden of illness that AF imparts on stroke is likely to increase with our aging populations and increasingly sophisticated cardiac monitoring techniques. Understanding the clinical and economic differences between AF related ischaemic stroke and non-AF related stroke is important if we are to improve future cost effectiveness analyses of potential preventative treatments, but also to help educate clinical and policy decision makers on use or availability of treatments to prevent AF related stroke...
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909200/anticoagulation-use-and-clinical-outcomes-after-major-bleeding-on-dabigatran-or-warfarin-in-atrial-fibrillation
#15
Inmaculada Hernandez, Yuting Zhang, Maria M Brooks, Paul K L Chin, Samir Saba
BACKGROUND AND PURPOSE: Little is known about the clinical outcomes associated with posthemorrhage anticoagulation resumption for atrial fibrillation. This study had 2 objectives: first, to evaluate anticoagulation use after a first major bleed on warfarin or dabigatran and, second, to compare effectiveness and safety outcomes between patients discontinuing anticoagulation after a major bleed and patients restarting warfarin or dabigatran. METHODS: Using 2010 to 2012 Medicare Part D data, we identified atrial fibrillation patients who experienced a major bleeding event while using warfarin (n=1135) or dabigatran (n=404) and categorized them by their posthemorrhage use of anticoagulation...
December 1, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27909151/cerebrovascular-disease-associated-risk-factors-and-antithrombotic-therapy-in-a-population-screening-cohort-insights-from-the-belgian-heart-rhythm-week-programme
#16
Marco Proietti, Georges H Mairesse, Peter Goethals, Christophe Scavee, Johan Vijgen, Ivan Blankoff, Yves Vandekerckhove, Gregory Yh Lip
BACKGROUND: Cerebrovascular disease confers a major healthcare burden worldwide and is a major cause of death and disability. Several well-established risk factors, such as atrial fibrillation (AF), are associated with cerebrovascular disease and antithrombotic therapy reduces risk. DESIGN: This study was a subgroup analysis from the Belgian Heart Rhythm Week, a nationwide AF awareness programme. METHODS: We studied subjects screened between 2012 and 2014 with available data on clinical risk factors and antithrombotic treatment...
December 1, 2016: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/27907893/factors-impacting-complication-rates-for-catheter-ablation-of-atrial-fibrillation-from-2003-to-2015
#17
Eunice Yang, Esra Gucuk Ipek, Muhammad Balouch, Yuliya Mints, Jonathan Chrispin, Joseph E Marine, Ronald D Berger, Hiroshi Ashikaga, Jack Rickard, Hugh Calkins, Saman Nazarian, David D Spragg
AIMS: Complications from catheter ablation for atrial fibrillation (AF) are well described. Changing aspects of AF ablation including patient populations referred, institutional experience, and emerging catheter and pharmacological options may impact complication rates. We assessed procedural complication trends in AF ablation patients from 2003-2015 to identify what factors affect adverse event rates. METHODS AND RESULTS: We evaluated consecutively enrolled patients undergoing initial AF ablation from 2003 through 2015...
October 6, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27904005/study-design-and-baseline-characteristics-of-the-expand-study-evaluation-of-effectiveness-and-safety-of-xa-inhibitor-rivaroxaban-for-the-prevention-of-stroke-and-systemic-embolism-in-a-nationwide-cohort-of-japanese-patients-diagnosed-as-non-valvular-atrial
#18
Takanori Ikeda, Hirotsugu Atarashi, Hiroshi Inoue, Shinichiro Uchiyama, Takanari Kitazono, Takeshi Yamashita, Wataru Shimizu, Masahiro Kamouchi, Koichi Kaikita, Koji Fukuda, Hideki Origasa, Ichiro Sakuma, Keijiro Saku, Yasuo Okumura, Yuichiro Nakamura, Hideo Morimoto, Naoki Matsumoto, Akihito Tsuchida, Junya Ako, Nobuyoshi Sugishita, Shogo Shimizu, Hiroaki Shimokawa
The use of rivaroxaban, a factor Xa inhibitor, has been increasing for prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF) in Japan. We conducted the nationwide multicenter study, termed as the EXPAND Study, to address its effectiveness and safety in the real-world practice of patients with non-valvular AF in Japan. The EXPAND Study is a prospective, non-interventional, observational cohort study to evaluate the effectiveness and safety of rivaroxaban in non-valvular AF patients in a real-world clinical practice...
2016: Tohoku Journal of Experimental Medicine
https://www.readbyqxmd.com/read/27903589/impact-of-left-atrial-appendage-closure-during-cardiac-surgery-on-the-occurrence-of-early-postoperative-atrial-fibrillation-stroke-and-mortality-a-propensity-score-matched-analysis-of-10-633-patients
#19
Rowlens M Melduni, Hartzell V Schaff, Hon-Chi Lee, Bernard J Gersh, Peter A Noseworthy, Kent R Bailey, Naser M Ammash, Stephen S Cha, Kaniz Fatema, Waldemar E Wysokinski, James B Seward, Douglas L Packer, Charanjit S Rihal, Samuel J Asirvatham
BACKGROUND: -Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive. METHODS: -Out of 10,633 adults who underwent CABG and/or valve surgery between January 2000 and December 2005, 9,792 patients with complete baseline characteristics, surgery procedure and follow-up data were included in this analysis. A propensity-score matching analysis based on 28 pretreatment covariates was performed and 461 matching pairs were derived and analyzed to estimate the association of LAA closure with early postoperative atrial fibrillation (POAF) (AF ≤30 days of surgery), ischemic stroke and mortality...
November 30, 2016: Circulation
https://www.readbyqxmd.com/read/27903389/-dabigatran-versus-warfarin-for-the-prevention-of-stroke-in-chinese-patients-with-nonvalvular-atrial-fibrillation-chinese-subpopulation-analysis-of-re-ly
#20
X Gao, Y M Yang, J Zhu, Y Dai, H Q Tan
Objective: This analysis was performed to evaluate the efficacy in stroke prevention and safety of dabigatran in Chinese nonvalvular atrial fibrillation(NVAF) patients enrolled in RE-LY trial. Methods: RE-LY was an prospective, open-label, randomized, multicenter study. From March 2006 to March 2009, 541 atrial fibrillation patients at risk of stroke were recruited from 13 medical centers in China. Patients randomly received, in a blinded fashion, fixed doses of dabigatran-110 mg or 150 mg twice daily or, in an unblinded fashion, adjusted-dose warfarin...
November 24, 2016: Zhonghua Xin Xue Guan Bing za Zhi
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