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Atrial fibrillation stroke prophylaxis

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https://www.readbyqxmd.com/read/28439617/-stroke-prophylaxis-in-atrial-fibrillation-when-how-and-for-whom
#1
T Maurer, C Sohns
In patients suffering from atrial fibrillation (AF), modern antithrombotic therapy and anticoagulation strategies should be individualized based on shared decision making including patient preferences and the absolute and relative risks of stroke and bleeding. Estimation of the individual risk for stroke is still based on the CHA2DS2-VASc score. Based on the most recent guidelines for the management of AF, oral anticoagulation therapy should be considered for men with a CHA2DS2-VASc score ≥1 and women with a score ≥2, balancing the expected stroke reduction, risk of bleeding and patient preference...
April 24, 2017: Herz
https://www.readbyqxmd.com/read/28389612/benefits-of-emergency-departments-contribution-to-stroke-prophylaxis-in-atrial-fibrillation-the-emerg-af-study-emergency-department-stroke-prophylaxis-and-guidelines-implementation-in-atrial-fibrillation
#2
Blanca Coll-Vinent, Alfonso Martín, Juan Sánchez, Juan Tamargo, Coral Suero, Francisco Malagón, Mercedes Varona, Manuel Cancio, Susana Sánchez, José Carbajosa, José Ríos, Georgina Casanovas, Carles Ràfols, Carmen Del Arco
BACKGROUND AND PURPOSE: Long-term benefits of initiating stroke prophylaxis in the emergency department (ED) are unknown. We analyzed the long-term safety and benefits of ED prescription of anticoagulation in atrial fibrillation patients. METHODS: Prospective, multicenter, observational cohort of consecutive atrial fibrillation patients was performed in 62 Spanish EDs. Clinical variables and thromboprophylaxis prescribed at discharge were collected at inclusion...
May 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28381197/assessment-and-provision-of-rehabilitation-among-patients-hospitalized-with-acute-ischemic-stroke-in-china-findings-from-the-china-national-stroke-registry-ii
#3
Janet Prvu Bettger, Zixiao Li, Ying Xian, Liping Liu, Xingquan Zhao, Hao Li, Chunxue Wang, Chunjuan Wang, Xia Meng, Anxin Wang, Yuesong Pan, Eric D Peterson, Yilong Wang, Yongjun Wang
Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed...
April 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28379461/current-practice-trends-for-use-of-early-venous-thromboembolism-prophylaxis-after-intracerebral-hemorrhage
#4
Laurel J Cherian, Eric E Smith, Lee H Schwamm, Gregg C Fonarow, Phillip J Schulte, Ying Xian, Jingjing Wu, Shyam K Prabhakaran
BACKGROUND: Venous thromboembolism (VTE) is common after intracerebral hemorrhage (ICH). Guidelines recommend early VTE prophylaxis. OBJECTIVE: To determine characteristics associated with early chemoprophylaxis (CP) after ICH in the Get With The Guidelines-Stroke registry. METHODS: In this observational cohort study, we identified patients with ICH between January 1, 2009 and September 30, 2013, who (1) were non-ambulatory and/or not comfort care measures by hospital day 2; (2) were not transferred to another acute care facility; and (3) had known VTE prophylaxis status at end of hospital day 2...
April 4, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28369234/postoperative-atrial-fibrillation-following-cardiac-surgery-a-persistent-complication
#5
Jason W Greenberg, Timothy S Lancaster, Richard B Schuessler, Spencer J Melby
Postoperative atrial fibrillation (POAF) is a common, expensive and potentially morbid complication following cardiac surgery. POAF occurs in around 35% of cardiac surgery cases and has a peak incidence on postoperative day 2. Patients who develop POAF incur on average $10 000-$20 000 in additional hospital treatment costs, 12-24 h of prolonged ICU time, and an additional 2 to 5 days in the hospital. POAF has been identified as an independent predictor of numerous adverse outcomes, including a 2- to 4-fold increased risk of stroke, reoperation for bleeding, infection, renal or respiratory failure, cardiac arrest, cerebral complications, need for permanent pacemaker placement, and a 2-fold increase in all-cause 30-day and 6-month mortality...
March 27, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28301912/potential-causes-and-implications-of-low-target-therapeutic-ratio-in-warfarin-treated-patients-for-thrombosis-prophylaxis
#6
Halil Atas, Ahmet Anıl Sahin, Dilek Barutçu Atas, Murat Sunbul, Alper Kepez, Mehmet Agirbasli
Time in therapeutic range (TTR) of international normalized ratio is crucial for the safety and efficacy of anticoagulation with warfarin and it is influenced by many factors. There are limited data about the quality of warfarin therapy and its effects on clinical outcomes in Turkey. The aim of this study is to demonstrate the quality of anticoagulant therapy with warfarin and evaluate the parameters that affect the quality of warfarin therapy. A total of 170 patients with atrial fibrillation (AF; mean age: 62...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28293117/the-use-status-of-anticoagulation-drugs-for-inpatients-with-nonvalvular-atrial-fibrillation-in-southwest-china
#7
Huan Jie Zheng, Shu Kun Ouyang, Yue Zhao, Kai Lu, Su Xin Luo, Hua Xiao
BACKGROUND: Oral anticoagulants (OACs) are effective for the prophylaxis of stroke in patients with atrial fibrillation (AF). This cross-sectional study aimed to investigate the status of anticoagulation treatment for hospitalized AF patients in Southwest China. METHODS: A total of 4760 hospitalized patients with AF were enrolled from 21 hospitals in Chongqing city from January 1 to December 31, 2013. RESULTS: Among the enrolled patients, 3785 were diagnosed with nonvalvular AF...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/28281227/patient-preferences-regarding-atrial-fibrillation-stroke-prophylaxis-in-patients-at-potential-risk-of-atrial-fibrillation
#8
Nicholas T Edwards, Erica D Greanya, I Fan Kuo, Peter S Loewen, Celia L Culley
Background With an increasing number of options for atrial fibrillation (AF) stroke prophylaxis, there are several medication-related factors to consider. This study aimed to gain a better understanding of which preference factors influence patient decisions when selecting AF stroke prophylaxis. Objective To determine the factors that influence patient stroke prophylaxis decisions and preferred therapeutic options. Methods A questionnaire about AF stroke prophylaxis medication options was distributed to participants at risk of AF...
March 9, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28198520/twelve-month-follow-up-of-left-atrial-appendage-occlusion-with-amplatzer-amulet
#9
Caroline Kleinecke, Jai-Wun Park, Martin Gödde, Konstantin Zintl, Steffen Schnupp, Johannes Brachmann
BACKGROUND: The Amplatzer Amulet (St. Jude Medical, Minneapolis, MN, USA) is a second generation Amplatzer device for left atrial appendage occlusion for stroke prophylaxis in patients with atrial fibrillation. This research sought to assess the clinical performance of the Amplatzer Amulet device and in follow up for 12 months. METHODS: In this single-center registry patients with atrial fibrillation and contraindication to oral anticoagulation underwent left atrial appendage occlusion (LAAO) with the Amplatzer Amulet device...
February 15, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28196815/major-bleeding-complications-and-persistence-with-oral-anticoagulation-in-non-valvular-atrial-fibrillation-contemporary-findings-in-real-life-danish-patients
#10
Morten Lamberts, Laila Staerk, Jonas Bjerring Olesen, Emil Loldrup Fosbøl, Morten Lock Hansen, Louise Harboe, Cinira Lefevre, David Evans, Gunnar Hilmar Gislason
BACKGROUND: The nonvitamin K antagonist oral anticoagulants have recently become available as an alternative to warfarin as stroke prophylaxis in atrial fibrillation, but data on real-life patient experience, including bleeding risk, are lacking. Our objective was to compare major bleeding events and nonpersistence between the nonvitamin K antagonist oral anticoagulant apixaban and other nonvitamin K antagonist oral anticoagulants (dabigatran and rivaroxaban) and warfarin in a contemporary, nation-wide cohort of patients with nonvalvular atrial fibrillation...
February 14, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28185918/warfarin-use-and-the-risk-of-mortality-stroke-and-bleeding-in-hemodialysis-patients-with-atrial-fibrillation
#11
Brandon Kai, Yuliya Bogorad, Leigh-Anh N Nguyen, Su-Jau Yang, Wansu Chen, Hillard T Spencer, Albert Y-J Shen, Ming-Sum Lee
BACKGROUND: The optimal management of stroke prophylaxis in hemodialysis patients with atrial fibrillation is controversial. OBJECTIVE: The purpose of this study was to determine the risk of mortality, stroke, and bleeding associated with the use of warfarin in hemodialysis patients with atrial fibrillation. METHODS: This was a retrospective, population-based study of hemodialysis patients with atrial fibrillation between January 1, 2006, and September 30, 2015...
May 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28110293/increased-use-of-oral-anticoagulants-in-patients-with-atrial-fibrillation-temporal-trends-from-2005-to-2015-in-denmark
#12
Kasper Gadsbøll, Laila Staerk, Emil Loldrup Fosbøl, Caroline Sindet-Pedersen, Anna Gundlund, Gregory Y H Lip, Gunnar Hilmar Gislason, Jonas Bjerring Olesen
AIM: The aim of this study is to examine temporal trends in the use oral anticoagulants (OAC) as stroke prophylaxis in patients with atrial fibrillation (AF) and to examine factors associated with OAC initiation. METHODS AND RESULTS: From Danish nationwide registries, we identified patients diagnosed with AF at Danish hospitals and outpatient clinics between January 2005 and June 2015. OAC initiation was assessed from prescription fills ±180 days from date of AF diagnosis...
January 21, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28050712/optimizing-the-use-of-oral-anticoagulant-therapy-for-atrial-fibrilation-in-primary-care-a-pharmacist-led-intervention
#13
Mandeep S Virdee, Derek Stewart
Background Updated evidence-based guidelines for the management of atrial fibrillation (AF) necessitate patient review, particularly with respect to oral anticoagulants, to ensure maximum health gain around stroke prophylaxis. Objective To quantify the level of anticoagulation utilisation in patients with a CHA2DS2-VASc ≥1/≥2 (male/female) according to evidence-based guidelines and to assess the impact of a pharmacist-led intervention to optimise therapy. Setting Fifteen general medical practices in Liverpool, North-West England with a practice population of 99,129...
February 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28017326/the-association-of-anticoagulation-ischemic-stroke-and-hemorrhage-in-elderly-adults-with-chronic%C3%A2-kidney-disease-and-atrial-fibrillation
#14
Vaibhav Keskar, Eric McArthur, Ron Wald, Ziv Harel, Deborah Zimmerman, Amber O Molnar, Amit X Garg, Ngan N Lam, Megan K McCallum, Sarah E Bota, Jeffrey Perl, Manish M Sood
The utility of anticoagulants for ischemic stroke prophylaxis in elderly patients with chronic kidney disease (CKD) and atrial fibrillation remains uncertain. In this population-based retrospective cohort study, we determined the association of anticoagulant use with ischemic stroke or hemorrhage in elderly patients (66 years and older) with advanced chronic kidney disease (eGFR under 45 ml/min/1.73m(2)) and atrial fibrillation. We followed 6,544 patients with CKD and new onset atrial fibrillation, of whom 1,475 filled a prescription for an anticoagulant...
April 2017: Kidney International
https://www.readbyqxmd.com/read/28008771/stroke-risk-reduction-outweighed-bleeding-risk-increase-from-vitamin-k-antagonist-treatment-among-nonvalvular-atrial-fibrillation-patients-with-high-stroke-risk-and-low-bleeding-risk
#15
Winnie W Nelson, François Laliberté, Aarti A Patel, Guillaume Germain, Dominic Pilon, Nora McCormick, Patrick Lefebvre
OBJECTIVE: Warfarin is widely used for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). We compared the rates of stroke and major bleeding in NVAF patients with a high stroke risk and low bleeding risk profile during warfarin treated (W+) and warfarin untreated (W-) periods. METHOD: Insurance claims from six commercial, Medicaid or Medicare databases were analyzed from 2000 to 2014. NVAF patients treated with warfarin, with a CHADS2/CHA2DS2-VASc score ≥2, and an ATRIA score ≤3 at baseline were identified...
April 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/27932513/improving-incidence-of-postoperative-atrial-fibrillation-after-cardiac-surgery-using-simplified-clinical-practice-guidelines
#16
Amr S Omar, Hesham Ewila, Mahmoud Allam, Sameh Aboulnagah, Samy Hanoura, Praveen C Sivadasan, Ousama Bilal, Abdul Rasheed A Pattath, Abdulaziz AlKhulaifi
OBJECTIVES: Postoperative atrial fibrillation (POAF) remains a major risk after cardiac surgery. Twelve percent patients admitted to this unit postcardiac surgery experienced POAF, which led to hemodynamic instability, increased risk of stroke, and increased length of postoperative intensive care unit stay. Our aim was to decrease the incidence of POAF in the cardiothoracic intensive care unit by the end of April 2014. METHODS: Design-Retrospective data analysis...
December 8, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27914497/acute-management-of-stroke-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants-addressing-real-world-anticoagulant-management-issues-in-stroke-aramis-registry-design-and-rationale
#17
Ying Xian, Adrian F Hernandez, Tina Harding, Gregg C Fonarow, Deepak L Bhatt, Robert E Suter, Yosef Khan, Lee H Schwamm, Eric D Peterson
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban) have been increasingly used as alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation. Yet there is substantial lack of information on how patients on NOACs are currently treated when they have an acute ischemic stroke and the best strategies for treating intracerebral hemorrhage for those on chronic anticoagulation with warfarin or a NOAC. These are critical unmet needs for real world clinical decision making in these emergent patients...
December 2016: American Heart Journal
https://www.readbyqxmd.com/read/27909475/ablation-of-atrial-fibrillation-in-combination-with-left-atrial-appendage-occlusion-in-a-single-procedure-rationale-and-technique
#18
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
#19
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...
January 15, 2017: 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
#20
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
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