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Stroke risk from atrial fibrillation

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https://www.readbyqxmd.com/read/29047342/effectiveness-and-patient-safety-of-platelet-aggregation-inhibitors-in-the-prevention-of-cardiovascular-disease-and-ischemic-stroke-in-older-adults-a-systematic-review
#1
REVIEW
Maren Meinshausen, Anja Rieckert, Anna Renom-Guiteras, Moritz Kröger, Christina Sommerauer, Ilkka Kunnamo, Yolanda V Martinez, Aneez Esmail, Andreas Sönnichsen
BACKGROUND: Platelet aggregation inhibitors (PAI) are among the most frequently prescribed drugs in older people, though evidence about risks and benefits of their use in older adults is scarce. The objectives of this systematic review are firstly to identify the risks and benefits of their use in the prevention and treatment of vascular events in older adults, and secondly to develop recommendations on discontinuing PAI in this population if risks outweigh benefits. METHODS: Staged systematic review consisting of three searches...
October 16, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/29047304/real-world-comparison-of-all-cause-hospitalizations-hospitalizations-due-to-stroke-and-major-bleeding-and-costs-for-nonvalvular-atrial-fibrillation-patients-prescribed-oral-anticoagulants-in-a-us-health-plan
#2
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
https://www.readbyqxmd.com/read/29044861/comparison-of-bleeding-risk-scores-in-patients-with-atrial-fibrillation-insights-from-the-re-ly-trial
#3
Marco Proietti, Ziad Hijazi, Ulrika Andersson, Stuart J Connolly, John W Eikelboom, Michael D Ezekowitz, Deirdre A Lane, Jonas Oldgren, Vanessa Roldan, Salim Yusuf, Lars Wallentin
BACKGROUND: Oral anticoagulation is the mainstay of stroke prevention in atrial fibrillation (AF), but must be balanced against the associated bleeding risk. Several risk scores have been proposed for prediction of bleeding events in patients with AF. OBJECTIVES: To compare the performance of contemporary clinical bleeding risk scores in 18,113 patients with AF randomized to dabigatran 110 mg, 150 mg or warfarin in the RE-LY trial. METHODS: HAS-BLED, ORBIT, ATRIA and HEMORR2 HAGES bleeding risk scores were calculated based on clinical information at baseline...
October 16, 2017: Journal of Internal Medicine
https://www.readbyqxmd.com/read/29040518/challenges-in-comparing-the-non-vitamin-k-antagonist-oral-anticoagulants-for-atrial-fibrillation-related-stroke-prevention
#4
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
https://www.readbyqxmd.com/read/29033049/usefulness-of-chads2-and-cha2ds2-vasc-scores-for-stroke-prediction-in-patients-with-cancer-and-atrial-fibrillation
#5
Rushad Patell, Alejandra Gutierrez, Lisa Rybicki, Alok A Khorana
Stroke prediction scores have not been validated in patients with cancer and atrial fibrillation (AF). We aimed to identify unique risk factors and evaluate validity of CHADS2 and CHA2DS2-VASc scores to predict risk of stroke and mortality. A retrospective review of all patients with cancer with pre-existing AF presenting from 2008 to 2014 was performed. Outcomes included ischemic stroke and mortality. Prognostic factors were identified with Fine and Gray regression for stroke and Cox proportional hazards analysis for survival...
September 20, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29029621/uncertainty-on-the-effectiveness-and-safety-of-rivaroxaban-in-premenopausal-women-with-atrial-fibrillation-empirical-evidence-needed
#6
Herbert J A Rolden, Angela H E M Maas, Gert Jan van der Wilt, Janneke P C Grutters
BACKGROUND: Novel anticoagulations (NOACs) are increasingly prescribed for the prevention of stroke in premenopausal women with atrial fibrillation. Small studies suggest NOACs are associated with a higher risk of abnormal uterine bleeds than vitamin K antagonists (VKAs). Because there is no direct empirical evidence on the benefit/risk profile of rivaroxaban compared to VKAs in this subgroup, we synthesize available indirect evidence, estimate decision uncertainty on the treatments, and assess whether further research in premenopausal women is warranted...
October 13, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/29028452/atrial-fibrillation-in-women-risks-and-management
#7
Sindhu Prabakaran, Maria Carolina Gongora Nieto, Gina Lundberg
Atrial fibrillation (AF) is one of the most commonly occurring arrhythmias and a major modifiable risk factor for stroke, especially in women. While its prevalence is similar in both men and women, women unfortunately face a greater intrinsic AF-related risk of stroke than men do. This is likely one of the reasons that more women than men die from strokes, in addition to experiencing more new and recurrent strokes. Therefore, in women especially, it is imperative to diagnose and treat AF as early as possible...
October 13, 2017: Journal of Women's Health
https://www.readbyqxmd.com/read/29028119/comparison-of-treatment-persistence-with-dabigatran-or-rivaroxaban-versus-vitamin-k-antagonist-oral-anticoagulants-in-atrial-fibrillation-patients-a-competing-risk-analysis-in-the-french-nationwide-healthcare-databases
#8
Géric Maura, Cécile Billionnet, François Alla, Joshua J Gagne, Antoine Pariente
BACKGROUND: Direct oral anticoagulants (DOACs) have been proposed as a more convenient alternative to vitamin K antagonists (VKAs), which are commonly associated with poor treatment persistence in nonvalvular atrial fibrillation (nv-AF). METHODS: Using data from the French National Healthcare databases (Régime Général, 50 million beneficiaries), a cohort study was conducted to compare the 1-year non-persistence rates in nv-AF patients initiating dabigatran (N=11,141) or rivaroxaban (N=11,126) versus VKA (N=11,998)...
October 13, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29024624/the-prognostic-impact-of-mild-hypokalemia-in-terms-of-death-and-stroke-in-the-general-population-a-prospective-population-study
#9
Nick Mattsson, Olav Wendelboe Nielsen, Linda Johnson, Eva Prescott, Peter Schnohr, Gorm Boje Jensen, Lars Køber, Ahmad Sajadieh
BACKGROUND: Potassium supplementation reduces the risk of cardiovascular mortality and stroke in population studies; however, the prognostic impact of mild hypokalemia in the general population has not been thoroughly investigated. We aimed to investigate associations between mild hypokalemia and endpoints in the general population. METHODS: participants (48-76 year old) from the general population study "Copenhagen City Heart Study" (n=5916) were studied. Participants were divided into groups according to baseline-values of plasma-potassium (potassium); Hypokalemia (<3...
October 9, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29022745/real-world-adherence-to-oral-anticoagulant-in-non-valvular-atrial-fibrillation-patients-in-china
#10
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
https://www.readbyqxmd.com/read/29021855/chads2-and-modified-cha2ds2-vasc-scores-for-the-prediction-of-congestive-heart-failure-in-patients-with-nonvalvular-atrial-fibrillation
#11
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
https://www.readbyqxmd.com/read/29018536/efficacy-and-safety-of-non-vitamin-k-antagonist-oral-anticoagulants-compared-with-warfarin-in-patients-with-atrial-fibrillation
#12
Leif Friberg, Jonas Oldgren
AIMS: Non-vitamin K antagonist oral anticoagulants (NOACs) were in pivotal randomised controlled trials at least non-inferior to warfarin for stroke prevention in atrial fibrillation, but time in therapeutic range (TTR) for warfarin was lower (mean 55%-65%) than in Swedish general care where TTR is >70%. We compared efficacy and safety of NOACs and warfarin treatment for stroke prevention in Sweden. METHODS: Retrospective cohort study of all non-selected oral anticoagulation naïve atrial fibrillation patients with first prescription for NOACs or warfarin between December 2011 and December 2014, excluding patients with mitral stenosis or mechanical valvular prosthesis...
2017: Open Heart
https://www.readbyqxmd.com/read/29017957/lifetime-risks-projected-numbers-and-adverse-outcomes-in-asian-patients-with-atrial-fibrillation-a-report-from-the-taiwan-nationwide-af-cohort-study
#13
Tze-Fan Chao, Chia-Jen Liu, Ta-Chuan Tuan, Tzeng-Ji Chen, Ming-Hsiung Hsieh, Gregory Y H Lip, Shih-Ann Chen
BACKGROUND: Most data on the clinical epidemiology of atrial fibrillation (AF) comes from Western populations, and data for Asians are limited. We investigated the lifetime risk and projected number of AF among Asians. The annual risks of adverse events amongst AF patients, time trends and the risks compared to non-AF patients were analyzed. METHODS: From year 2000 to 2011, 289,559 patients aged ≥ 20 years experienced new-onset AF in Taiwan. The incidence, prevalence and lifetime risk of AF were calculated...
October 7, 2017: Chest
https://www.readbyqxmd.com/read/29016813/epicardial-left-atrial-appendage-atriclip-occlusion-reduces-the-incidence-of-stroke-in-patients-with-atrial-fibrillation-undergoing-cardiac-surgery
#14
Etem Caliskan, Ayhan Sahin, Murat Yilmaz, Burkhardt Seifert, Ricarda Hinzpeter, Hatem Alkadhi, James L Cox, Tomas Holubec, Diana Reser, Volkmar Falk, Jürg Grünenfelder, Michele Genoni, Francesco Maisano, Sacha P Salzberg, Maximilian Y Emmert
Aims: Left atrial appendage (LAA) occlusion has emerged as an interesting alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). We report the safety, efficacy, and durability of concomitant device-enabled epicardial LAA occlusion during open-heart surgery. In addition to long-term follow-up, we evaluate the impact on stroke risk in this selected population. Methods and results: A total of 291 AtriClip devices were deployed epicardially in patients (mean CHA2DS2-VASc-Score: 3...
July 18, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29016776/atrial-fibrillation-is-associated-with-decreased-total-cerebral-blood-flow-and-brain-perfusion
#15
Marianna Gardarsdottir, Sigurdur Sigurdsson, Thor Aspelund, Hrafnhildur Rokita, Lenore J Launer, Vilmundur Gudnason, David O Arnar
Aims: Atrial fibrillation (AF) has been associated with cognitive impairment. Additionally, brain volume may be reduced in individuals with AF. Potential causes may include cerebral micro-embolism or reduced stroke volume due to the beat-to-beat variation in AF. The aims of this study were to measure cerebral blood flow and estimate whole brain perfusion in elderly individuals with and without AF. Methods and results: Blood flow in the cervical arteries was measured with phase contrast MRI and brain perfusion estimated in a large cohort from the AGES-Reykjavik Study...
August 9, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28992764/use-of-guidelines-for-reducing-stroke-risk-in-patients-with-nonvalvular-atrial-fibrillation-a-review-from-a-latin-american-perspective
#16
Carlos Cantú-Brito, Gisele Sampaio Silva, Sebastián F Ameriso
Atrial fibrillation (AF) is a prominent risk factor for stroke and a leading cause of death and disability throughout Latin America. Contemporary evidence-based guidelines for the management of AF and stroke incorporate the use of practical and relatively simple scoring methods to estimate both stroke and bleeding risk, in order to assist in matching patients with appropriate interventions. This review examines consistencies and differences among guidelines for reducing stroke risk in patients with AF, assessing the role of user-friendly scoring methods to determine appropriate patients for anticoagulation and other treatment options...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28990646/-clinical-profile-and-satisfaction-with-anticoagulated-treatment-in-patients-with-non-valvular-atrial-fibrillation-attended-in-internal-medicine-and-neurology-departments-of-spain
#17
(no author information available yet)
AIM: To determine the clinical profile, management of anticoagulant treatment and satisfaction related to anticoagulation in outpatients with nonvalvular atrial fibrillation attended in Neurology or Internal Medicine departments of Spain. PATIENTS AND METHODS: Cross-sectional and multicenter study, in which 1,337 outpatients were included. Patients fulfilled ACTS, SAT-Q and EQ-5D questionnaires. RESULTS: 865 patients (64.7%) were recruited from Neurology department and 472 (35...
October 16, 2017: Revista de Neurologia
https://www.readbyqxmd.com/read/28988597/dosing-issues-with-non-vitamin%C3%A2-k-antagonist-oral-anticoagulants-for-the-treatment-of-non-valvular-atrial-fibrillation-why-we-should-not-underdose-our-patients
#18
Jean-Guillaume Dillinger, Boris Aleil, Saida Cheggour, Ygal Benhamou, Yannick Béjot, Sylvestre Marechaux, Aurelien Delluc, Laurent Bertoletti, Nicolas Lellouche
Non-vitamin K antagonist oral anticoagulants (NOACs) - dabigatran, rivaroxaban, apixaban and edoxaban - are well established in terms of preventing stroke or systemic embolism in patients with non-valvular atrial fibrillation and high thromboembolism risk. When prescribed incorrectly, NOACs are associated with an increased risk of ischaemic events and bleeding. Current NOAC labels explicitly address dose adjustments according to age, body weight, renal function and concomitant treatment with P-glycoprotein inhibitors...
October 2, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28985686/are-older-adults-willing-to-consider-new-strategies-to-reduce-stroke-risk
#19
Stuart W Grande, Elizabeth S O'Neill, Ariel E Sherman, Megan Coylewright
Atrial fibrillation (AF) is a common arrhythmia that increases patients' risk of stroke, and determining an optimal prevention therapy is a preference-sensitive decision appropriate for shared decision making (SDM). Utilizing community-based focus groups, we explored beliefs and values around options for stroke prevention. Interview transcripts from five independent focus groups were qualitatively assessed and organized into themes. Most participants were taking a blood thinner (93%) and more than half of participants (64%) reported having AF...
October 1, 2017: Qualitative Health Research
https://www.readbyqxmd.com/read/28983076/atrial-fibrillation-and-the-risk-of-myocardial-infarction-a-nation-wide-propensity-matched-study
#20
Hye Young Lee, Pil-Sung Yang, Tae-Hoon Kim, Jae-Sun Uhm, Hui-Nam Pak, Moon-Hyoung Lee, Boyoung Joung
In addition to being an established complicating factor for myocardial infarction (MI), recent studies have revealed that atrial fibrillation (AF) increased risk of MI. This study is to evaluate the risk of MI associated with AF in a nationwide population based cohort. We examine the association between AF and incident MI in 497,366 adults from the Korean National Health Insurance Service database, who were free of AF and MI at baseline. AF group (n = 3,295) was compared with propensity matched no-AF group (n = 13,159)...
October 5, 2017: Scientific Reports
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