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Atrial fibrillation stroke prophylaxis

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https://www.readbyqxmd.com/read/27909475/ablation-of-atrial-fibrillation-in-combination-with-left-atrial-appendage-occlusion-in-a-single-procedure-rationale-and-technique
#1
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/27846983/gender-specific-differences-for-risk-of-disability-and-death-in-atrial-fibrillation-related-stroke
#2
Ryan C Martin, W Scott Burgin, Matthew B Schabath, Bonnie Kirby, Sanders H Chae, Michael G Fradley, David Z Rose, Arthur J Labovitz
In the latest American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation (AF) guidelines, CHA2DS2-VASc replaced the CHADS2 stroke risk assessment to determine prophylactic anticoagulation, reflecting female gender's association with stroke incidence in AF. However, little investigation has been pursued of potential risk factors associated with worsened stroke severity. In this study, we examined patients with AF with ischemic stroke patient characteristics associated with increased stroke severity...
October 8, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27811198/the-efficacy-and-safety-of-edoxaban-for-vte-prophylaxis-post-orthopedic-surgery-a-systematic-review
#3
Lamia AlHajri, Sima Jabbari, Hind AlEmad, Khawla AlMahri, Maryam AlMahri, Noora AlKitbi
BACKGROUND: Venous thromboembolism (VTE) is a common complication that manifests during and/or after hospitalization, as well as postsurgeries including orthopedic surgeries. Edoxaban is a new oral direct factor Xa inhibitor that has been recently approved for treating VTE in patients who have already been treated with a parenteral anticoagulant and for the prevention of stroke and non-central nervous system systemic embolism in patients with nonvalvular atrial fibrillation. OBJECTIVES: The purpose of this systematic review was to evaluate the safety and efficacy of edoxaban for VTE prophylaxis after lower limb orthopedic surgery...
November 2, 2016: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/27797891/use-of-oral-anticoagulation-in-the-management-of-atrial-fibrillation-in-patients-with-esrd-con
#4
Vaibhav Keskar, Manish M Sood
Among patients with atrial fibrillation, prophylaxis for stroke prevention with the use of anticoagulation is well established in the general population. A number of randomized controlled trials and evidence-based risk prediction tools clearly delineate the benefit and risks of therapy. Despite the high incidence of atrial fibrillation in the late stage CKD and ESRD populations, little high quality evidence exists in these populations. Is it appropriate then to extrapolate findings from the general population to those with CKD/ESRD? In our view, too much uncertainty exists regarding proof of efficacy with clear signals of harm...
November 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27789043/comparison-of-adherence-to-rivaroxaban-versus-apixaban-among-patients-with-atrial-fibrillation
#5
Colleen A McHorney, Eric D Peterson, François Laliberté, Guillaume Germain, Winnie W Nelson, Concetta Crivera, Jeffrey Schein, Patrick Lefebvre
PURPOSE: Non-vitamin K antagonist oral anticoagulant medications are increasingly used for stroke prophylaxis in patients with nonvalvular atrial fibrillation (NVAF). This study aimed to compare adherence with rivaroxaban and apixaban among patients with NVAF in routine clinical practice. METHODS: Using pharmacy and medical claims from Truven Health Analytics MarketScan databases, we identified NVAF patients aged ≥18 years treated with rivaroxaban or apixaban...
October 24, 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27742807/ischaemic-and-haemorrhagic-stroke-associated-with-non-vitamin-k-antagonist-oral-anticoagulants-and-warfarin-use-in-patients-with-atrial-fibrillation-a-nationwide-cohort-study
#6
Laila Staerk, Emil Loldrup Fosbøl, Gregory Y H Lip, Morten Lamberts, Anders Nissen Bonde, Christian Torp-Pedersen, Brice Ozenne, Thomas Alexander Gerds, Gunnar Hilmar Gislason, Jonas Bjerring Olesen
BACKGROUND: Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) are widely used as stroke prophylaxis in non-valvular atrial fibrillation (AF), but comparative data are sparse. PURPOSE: To compare dabigatran, rivaroxaban, and apixaban vs. VKA and the risk of stroke/thromboembolism (TE) and intracranial bleeding in AF. METHODS: Using Danish nationwide registries (2011-15), anticoagulant-naïve AF patients were identified when initiating VKA or an NOAC...
October 14, 2016: European Heart Journal
https://www.readbyqxmd.com/read/27734642/current-perspective-on-use-of-noac-in-clinical-practice-in-india
#7
Jamshed J Dalal, Anil Dhall, Abhay Bhave
Oral vitamin K antagonists (VKA) such as warfarin have been the mainstay of therapy for stroke prevention in patients with non valvular atrial fibrillation (NVAF) while low-molecular-weight heparin, fondaparinux and adjusted-dose warfarin or aspirin have been routinely used for thromboembolism (VTE) prophylaxis in patients undergoing total hip or knee replacement. However, VKAs are associated with considerable limitations, including increased risk of bleeding and narrow therapeutic window. Novel oral anticoagulants (NOACs, now referred as Non Vit K dependent oral anticoagulants), including the direct thrombin inhibitor dabigatran and direct Factor Xa inhibitors such as rivaroxaban and apixaban are now approved alternatives to warfarin for prophylaxis of stroke and systemic embolic events (SEE) in patients with NVAF and treatment and prophylaxis of VTE...
April 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27706224/comparison-of-approaches-for-stroke-prophylaxis-in-patients-with-non-valvular-atrial-fibrillation-network-meta-analyses-of-randomized-controlled-trials
#8
Navkaranbir S Bajaj, Rajat Kalra, Nirav Patel, Taimoor Hashim, Hemant Godara, Sameer Ather, Garima Arora, Tilak Pasala, Thomas T Whitfield, David C McGiffin, Mustafa I Ahmed, Steven G Lloyd, Nita A Limdi, Pankaj Arora
BACKGROUND: Multiple novel oral anticoagulants and left atrial appendage closure devices (WATCHMAN) have been tested against dose-adjusted vitamin K antagonists in randomized controlled trials for stroke prophylaxis in non-valvular atrial fibrillation. No direct comparisons of these strategies are available from randomized controlled trials. We conducted the current analyses by combining efficacy and safety characteristics of all FDA approved stroke prophylaxis treatment strategies for patients with non-valvular atrial fibrillation...
2016: PloS One
https://www.readbyqxmd.com/read/27703066/overcoming-global-challenges-in-stroke-prophylaxis-in-atrial-fibrillation-the-role-of-non-vitamin-k-antagonist-oral-anticoagulants
#9
Ayrton Massaro, Robert P Giugliano, Bo Norrving, Ali Oto, Roland Veltkamp
Atrial fibrillation is the world's most common sustained cardiac arrhythmia and is associated with a significantly increased risk of stroke. The global burden of atrial fibrillation is rising, commensurate with the ageing population. Well-controlled vitamin K antagonist-based anticoagulation has been shown to reduce the risk of stroke secondary to atrial fibrillation by two-thirds. However, patients with atrial fibrillation have frequently been denied anticoagulation because of a variety of perceived risks related to bleeding, falls, chronological age, and poor compliance...
October 4, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27694266/early-start-of-doac-after-ischemic-stroke-risk-of-intracranial-hemorrhage-and-recurrent-events
#10
David J Seiffge, Christopher Traenka, Alexandros Polymeris, Lisa Hert, Nils Peters, Philippe Lyrer, Stefan T Engelter, Leo H Bonati, Gian Marco De Marchis
OBJECTIVE: In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non-vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up. METHODS: We included consecutive patients with nonvalvular atrial fibrillation admitted to our hospital for AIS or TIA (index event) who received secondary prophylaxis with DOAC or vitamin K antagonists (VKAs)...
November 1, 2016: Neurology
https://www.readbyqxmd.com/read/27681577/update-on-hypertrophic-cardiomyopathy-and-a-guide-to-the-guidelines
#11
Srijita Sen-Chowdhry, Daniel Jacoby, James C Moon, William J McKenna
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder, affecting 1 in 500 individuals worldwide. Existing epidemiological studies might have underestimated the prevalence of HCM, however, owing to limited inclusion of individuals with early, incomplete phenotypic expression. Clinical manifestations of HCM include diastolic dysfunction, left ventricular outflow tract obstruction, ischaemia, atrial fibrillation, abnormal vascular responses and, in 5% of patients, progression to a 'burnt-out' phase characterized by systolic impairment...
November 2016: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/27671867/impact-of-cha2ds2vasc-score-on-candidacy-for-anticoagulation-in-patients-with-atrial-fibrillation-a-multipayer-analysis
#12
Aarti A Patel, Winnie W Nelson, Jeff Schein
PURPOSE: The purpose of this study is to report on the effect of using CHA2DS2VASc (congestive heart failure, hypertension, age ≥75 years [doubled], type 1 or type 2 diabetes mellitus, stroke or transient ischemic attack or thromboembolism [doubled], vascular disease [prior myocardial infarction, peripheral artery disease, or aortic plaque], age 65-75 years, sex category [female]) rather than CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke) to determine candidacy for anticoagulant prophylaxis in insured patients with atrial fibrillation (AF)...
September 23, 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27651407/apixaban-induced-liver-injury
#13
Sherri-Anne Clarke, Ali A Alsaad, Anwar Mack, Michael B Phillips
An 81-year-old woman with well-controlled hypertension presented to the emergency department with new-onset atrial fibrillation with rapid ventricular response. Treatment for atrial fibrillation was initiated, including rate control and anticoagulation with 5 mg of apixaban two times per day for primary stroke prophylaxis. Three days after initiation of apixaban, the patient noted new-onset abdominal pain, worsening shortness of breath and weakness. Laboratory results showed elevated liver enzymes. Workup for elevated transaminase did not reveal any underlying infectious or autoimmune process...
September 20, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27611114/atrial-fibrillation-anticoagulant-stroke-prophylaxis-and-bleeding-risk-with-ibrutinib-therapy-for-chronic-lymphocytic-leukaemia-and-lymphoproliferative-disorders
#14
EDITORIAL
Stephen P Mulligan, Christopher M Ward, David Whalley, Sarah N Hilmer
No abstract text is available yet for this article.
November 2016: British Journal of Haematology
https://www.readbyqxmd.com/read/27581874/cost-effectiveness-analysis-of-left-atrial-appendage-occlusion-compared-with-pharmacological-strategies-for-stroke-prevention-in-atrial-fibrillation
#15
Vivian Wing-Yan Lee, Ronald Bing-Ching Tsai, Ines Hang-Iao Chow, Bryan Ping-Yen Yan, Mehmet Gungor Kaya, Jai-Wun Park, Yat-Yin Lam
BACKGROUND: Transcatheter left atrial appendage occlusion (LAAO) is a promising therapy for stroke prophylaxis in non-valvular atrial fibrillation (NVAF) but its cost-effectiveness remains understudied. This study evaluated the cost-effectiveness of LAAO for stroke prophylaxis in NVAF. METHODS: A Markov decision analytic model was used to compare the cost-effectiveness of LAAO with 7 pharmacological strategies: aspirin alone, clopidogrel plus aspirin, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban...
2016: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/27565120/warfarin-persistence-among-atrial-fibrillation-patients-why-is-treatment-ended
#16
Fredrik Björck, Agnes Ek, Lars Johansson, Anders Själander
BACKGROUND AND AIM: Warfarin treatment discontinuation is significant among patients with atrial fibrillation (AF). Studies mainly focused on whether the proportion of warfarin persistence and discontinuation are clinically appropriate are absent. This study evaluates warfarin persistence with focus on predictors for, and reasons to, warfarin discontinuation in AF patients. METHODS: From the national quality register AuriculA, all AF patients in Sundsvall, Sweden, on warfarin treatment on January 1, 2010 were included...
December 2016: Cardiovascular Therapeutics
https://www.readbyqxmd.com/read/27559189/antithrombotic-usage-patterns-in-the-era-of-new-oral-anticoagulant-options-for-atrial-fibrillation
#17
Jacob Marler, Justin B Usery, Shambria Nolan, Carrie S Oliphant
BACKGROUND: Appropriate treatment reduces the risk of stroke in patients with atrial fibrillation (AF). Despite the known benefits of warfarin, anticoagulation prescribing rates remain inadequate in high-risk patients. Over the last 6 years, 4 novel oral anticoagulants have been approved for use for stroke prophylaxis in non-valvular AF (NVAF), which may allow prescribers to tailor therapy for each NVAF patient. OBJECTIVE: The goal of this investigation was to determine the effect of dabigatran and rivaroxaban availability on the rate of anticoagulant prescribing at hospital discharge in patients with a principal diagnosis of NVAF...
July 2016: Hospital Pharmacy
https://www.readbyqxmd.com/read/27540038/percutaneous-left-atrial-appendage-occlusion-the-munich-consensus-document-on-definitions-endpoints-and-data-collection-requirements-for-clinical-studies
#18
Apostolos Tzikas, David R Holmes, Sameer Gafoor, Carlos E Ruiz, Carina Blomström-Lundqvist, Hans-Christoph Diener, Riccardo Cappato, Saibal Kar, Randal J Lee, Robert A Byrne, Reda Ibrahim, Dhanunjaya Lakkireddy, Osama I Soliman, Michael Nabauer, Steffen Schneider, Johannes Brachmann, Jeffrey L Saver, Klaus Tiemann, Horst Sievert, A John Camm, Thorsten Lewalter
The increasing interest in left atrial appendage occlusion (LAAO) for ischaemic stroke prevention in atrial fibrillation (AF) fuels the need for more clinical data on the safety and effectiveness of this therapy. Besides an assessment of the effectiveness of the therapy in specific patients groups, comparisons with pharmacological stroke prophylaxis, surgical approaches, and other device-based therapies are warranted. This paper documents the consensus reached among clinical experts in relevant disciplines from Europe and North America, European cardiology professional societies, and representatives from the medical device industry regarding definitions for parameters and endpoints to be assessed in clinical studies...
August 18, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27529595/cardiology-residents-anticoagulation-preferences-for-stroke-prophylaxis-in-atrial-fibrillation-patients
#19
Jessica Patzer, Zardasht Oqab, William F McIntyre, Wilma M Hopman, Adrian Baranchuk
No abstract text is available yet for this article.
November 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27487456/practice-patterns-and-outcomes-associated-with-use-of-anticoagulation-among-patients-with-atrial-fibrillation-during-sepsis
#20
Allan J Walkey, Emily K Quinn, Michael R Winter, David D McManus, Emelia J Benjamin
IMPORTANCE: Atrial fibrillation (AF) during sepsis is associated with an increased risk of ischemic stroke during hospitalization, but risks and benefits associated with anticoagulation for AF during sepsis are unclear. OBJECTIVE: To determine clinician practice patterns and patient risk of stroke and bleeding associated with use of anticoagulation for AF during sepsis. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study using enhanced administrative claims data from approximately 20% of patients hospitalized in the United States July 1, 2010, to June 30, 2013, examined patients with AF during sepsis who did not have additional indications for therapeutic anticoagulation...
September 1, 2016: JAMA Cardiology
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