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Reduction of strokes from atrial fibrillation

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https://www.readbyqxmd.com/read/28439778/dabigatran-etexilate-appropriate-use-in-patients-with-chronic-kidney-disease-and-in-the-elderly-patients
#1
REVIEW
Mauro Molteni, Mario Bo, Giovanni Di Minno, Giuseppe Di Pasquale, Simonetta Genovesi, Danilo Toni, Paolo Verdecchia
Dabigatran etexilate (DE) is a direct thrombin inhibitor, which has been approved for the treatment of non-valvular atrial fibrillation (AF), and for the prevention and treatment of venous thromboembolism (VTE). Despite large randomized clinical trials and independent observational studies providing robust data concerning DE safety and efficacy, some physicians still perceive mild-to-moderate renal impairment and old age as a relative contraindication to its use. In this article, we review the available scientific evidence supporting the use of DE in these clinical situations...
April 24, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28439617/-stroke-prophylaxis-in-atrial-fibrillation-when-how-and-for-whom
#2
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/28426886/risk-of-stroke-in-chronic-heart-failure-patients-with-preserved-ejection-fraction-but-without-atrial-fibrillation-analysis-of-the-charm-preserved-and-i-preserve-trials
#3
Azmil H Abdul-Rahim, Ana-Cristina Perez, Rachael L MacIsaac, Pardeep S Jhund, Brian L Claggett, Peter E Carson, Michel Komajda, Robert S McKelvie, Michael R Zile, Karl Swedberg, Salim Yusuf, Marc A Pfeffer, Scott D Solomon, Gregory Y H Lip, Kennedy R Lees, John J V McMurray
Aims: The incidence and predictors of stroke in patients with heart failure and preserved ejection fraction (HF-PEF), but without atrial fibrillation (AF), are unknown. We described the incidence of stroke in HF-PEF patients with and without AF and predictors of stroke in those without AF. Methods and results: We pooled data from the CHARM-Preserved and I-Preserve trials. Using Cox regression, we derived a model for stroke in patients without AF in this cohort and compared its performance with a published model in heart failure patients with reduced ejection fraction (HF-REF)-predictive variables: age, body mass index, New York Heart Association class, history of stroke, and insulin-treated diabetes...
March 7, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28355434/economic-analysis-of-apixaban-therapy-for-patients-with-atrial-fibrillation-from-a-us-perspective-results-from-the-aristotle-randomized-clinical-trial
#4
Patricia A Cowper, Shubin Sheng, Renato D Lopes, Kevin J Anstrom, Judith A Stafford, Linda Davidson-Ray, Sana M Al-Khatib, Jack Ansell, Paul Dorian, Steen Husted, John J V McMurray, P Gabriel Steg, John H Alexander, Lars Wallentin, Christopher B Granger, Daniel B Mark
Importance: The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial reported that apixaban therapy was superior to warfarin therapy in preventing stroke and all-cause death while causing significantly fewer major bleeds. To establish the value proposition of substituting apixiban therapy for warfarin therapy in patients with atrial fibrillation, we performed a cost-effectiveness analysis using patient-level data from the ARISTOTLE trial...
March 29, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28300870/effectiveness-and-safety-of-apixaban-versus-warfarin-in-non-valvular-atrial-fibrillation-patients-in-real-world-clinical-practice-a-propensity-matched-analysis-of-76-940-patients
#5
Xiaoyan Li, Steve Deitelzweig, Allison Keshishian, Melissa Hamilton, Ruslan Horblyuk, Kiran Gupta, Xuemei Luo, Jack Mardekian, Keith Friend, Anagha Nadkarni, Xianying Pan, Gregory Y H Lip
The ARISTOTLE trial showed a risk reduction of stroke/systemic embolism (SE) and major bleeding in non-valvular atrial fibrillation (NVAF) patients treated with apixaban compared to warfarin. This retrospective study used four large US claims databases (MarketScan, PharMetrics, Optum, and Humana) of NVAF patients newly initiating apixaban or warfarin from January 1, 2013 to September 30, 2015. After 1:1 warfarin-apixaban propensity score matching (PSM) within each database, the resulting patient records were pooled...
March 16, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28290558/-real-world-data-on-novel-oral-anticoagulants-the-added-value-of-registries-and-observational-studies-focus-on-apixaban
#6
Francesco Pelliccia, Gaetano Tanzilli, Michele Schiariti, Nicola Viceconte, Cesare Greco, Carlo Gaudio
Anticoagulant therapy has been used with great effect for decades for the prevention of stroke among patients with atrial fibrillation. In recent years, the therapeutic armamentarium has been strengthened considerably, with the addition of anticoagulants acting through novel pathways. The currently available novel agents are apixaban, rivaroxaban and dabigatran. These novel oral anticoagulants (NOACs) were approved for use on the basis of major clinical trials clearly demonstrating improved risk reductions compared to warfarin for stroke and/or major bleeding events...
December 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28273786/influence-of-statin-therapy-at-time-of-stroke-onset-on-functional-outcome-among-patients-with-atrial-fibrillation
#7
Darae Ko, Jonathan L Thigpen, James A Otis, Kristen Forster, Lori Henault, Emily Quinn, Yorghos Tripodis, Peter B Berger, Nita Limdi, Elaine M Hylek
BACKGROUND: Statin pretreatment has been associated with reduced infarct volume in nonlacunar strokes. The effect of statins on functional outcomes of strokes related to atrial fibrillation (AF) is unknown. We aimed to define the influence of prestroke statin use on functional outcome in AF. METHODS: We assembled a cohort of consecutive ischemic stroke patients from 2006 to 2010. All patients underwent CT or MRI and were adjudicated by site investigators. AF was confirmed by electrocardiogram in 100% of patients...
January 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28267467/anemia-is-associated-with-bleeding-and-mortality-but-not-stroke-in-patients-with-atrial-fibrillation-insights-from-the-apixaban-for-reduction-in-stroke-and-other-thromboembolic-events-in-atrial-fibrillation-aristotle-trial
#8
B Daan Westenbrink, Marco Alings, Christopher B Granger, John H Alexander, Renato D Lopes, Elaine M Hylek, Laine Thomas, Daniel M Wojdyla, Michael Hanna, Matyas Keltai, P Gabriel Steg, Raffaele De Caterina, Lars Wallentin, Wiek H van Gilst
BACKGROUND: Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes. METHODS: We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin <13...
March 2017: American Heart Journal
https://www.readbyqxmd.com/read/28264833/impact-of-gender-on-event-rates-at-1%C3%A2-year-in-patients-with-newly-diagnosed-non-valvular-atrial-fibrillation-contemporary-perspective-from-the-garfield-af-registry
#9
A John Camm, Gabriele Accetta, Wael Al Mahmeed, Giuseppe Ambrosio, Samuel Z Goldhaber, Sylvia Haas, Petr Jansky, Gloria Kayani, Frank Misselwitz, Seil Oh, Ali Oto, Pekka Raatikainen, Jan Steffel, Martin van Eickels, Ajay K Kakkar
OBJECTIVES: Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) explored the impact of gender, risk factors and anticoagulant (AC) treatment on 1-year outcomes in patients with non-valvular atrial fibrillation (NVAF). DESIGN: GARFIELD-AF is a prospective non-interventional registry. SETTING: Investigator sites (n=1048) are representative of the care settings/locations in each of the 35 countries. PARTICIPANTS: Patients ≥18yrs with newly diagnosed (≤6 weeks' duration) NVAF and ≥1 investigator-determined stroke risk factors...
March 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/28241151/outcomes-associated-with-resuming-warfarin-treatment-after-hemorrhagic-stroke-or-traumatic-intracranial-hemorrhage-in-patients-with-atrial-fibrillation
#10
Peter Brønnum Nielsen, Torben Bjerregaard Larsen, Flemming Skjøth, Gregory Y H Lip
Importance: The increase in the risk for bleeding associated with antithrombotic therapy causes a dilemma in patients with atrial fibrillation (AF) who sustain an intracranial hemorrhage (ICH). A thrombotic risk is present; however, a risk for serious harm associated with resumption of anticoagulation therapy also exists. Objective: To investigate the prognosis associated with resuming warfarin treatment stratified by the type of ICH (hemorrhagic stroke or traumatic ICH)...
April 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28215464/patients-with-intracranial-bleeding-and-atrial-fibrillation-treated-with-left-atrial-appendage-occlusion-results-from-the-amplatzer-cardiac-plug-registry
#11
Apostolos Tzikas, Xavier Freixa, Laura Llull, Sameer Gafoor, Samera Shakir, Heyder Omran, George Giannakoulas, Sergio Berti, Gennaro Santoro, Joelle Kefer, Adel Aminian, Steffen Gloekler, Ulf Landmesser, Jens Erik Nielsen-Kudsk, Ignacio Cruz-Gonzalez, Prapa Kanagaratnam, Fabian Nietlispach, Reda Ibrahim, Horst Sievert, Wolfgang Schillinger, Jai-Wun Park, Bernhard Meier, Haralampos Karvounis
BACKGROUND: In patients with non-valvular atrial fibrillation (NVAF), intracranial bleeding (ICB) constitutes a very challenging situation in which the rate of both ischemic and hemorrhagic events is increased. In these patients, left atrial appendage occlusion (LAAO) might represent a very valid alternative. OBJECTIVES: To investigate the procedural safety and long-term outcome of patients undergoing LAAO therapy due to previous ICB. METHODS: Data from the Amplatzer Cardiac Plug multicenter registry on 1047 consecutive patients were analyzed...
June 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28128883/early-canadian-multicenter-experience-with-watchman-for-percutaneous-left-atrial-appendage-closure
#12
Jacqueline Saw, Peter Fahmy, Lorenzo Azzalini, Jean-Francois Marquis, Benjamin Hibbert, Carlos Morillo, Aldo Carrizo, Reda Ibrahim
BACKGROUND: There are limited data with WATCHMAN (Boston Scientific Corporation, Natick, MA, USA) for left atrial appendage (LAA) closure in patients with nonvalvular atrial fibrillation (AF) and contraindications to anticoagulation. The purpose of this study was to evaluate the safety and efficacy of WATCHMAN in our early Canadian experience. METHODS: We report our pooled consecutive series of patients who underwent WATCHMAN implantation at four major Canadian centers...
April 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28096100/efficacy-and-safety-of-apixaban-compared-with-warfarin-in-patients-with-atrial-fibrillation-and-peripheral-artery-disease-insights-from-the-aristotle-trial
#13
Peter T Hu, Renato D Lopes, Susanna R Stevens, Lars Wallentin, Laine Thomas, John H Alexander, Michael Hanna, Basil S Lewis, Freek W A Verheugt, Christopher B Granger, W Schuyler Jones
BACKGROUND: We studied (1) the rates of stroke or systemic embolism and bleeding in patients with atrial fibrillation and peripheral artery disease (PAD) and (2) the efficacy and safety of apixaban versus warfarin in patients with atrial fibrillation with and without PAD. METHODS AND RESULTS: The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial randomized 18 201 patients with atrial fibrillation to apixaban or warfarin for stroke/systemic embolism prevention; 884 (4...
January 17, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28065908/ticagrelor-but-not-clopidogrel-active-metabolite-displays-antithrombotic-properties-in-the-left-atrial-endocardium
#14
Martin F Reiner, Alexander Breitenstein, Erik W Holy, Martina Glanzmann, Heidi Amstalden, Simon F Stämpfli, Nicole R Bonetti, Volkmar Falk, Stephan Keller, Gianluigi Savarese, Stefano Benussi, Francesco Maisano, Thomas F Lüscher, Jürg H Beer, Jan Steffel, Giovanni G Camici
AIMS: Oral anticoagulation is considered standard therapy for stroke prevention in atrial fibrillation (AF). Endocardial activation triggers expression of pro-thrombotic mediators including tissue factor (TF) and plasminogen activator inhibitor-1 (PAI-1), and contributes to thrombus formation in the left atrial appendage (LAA) of AF patients. Recently, pleiotropic effects of specific P2Y12 receptor antagonists were demonstrated; however, whether these drugs possess antithrombotic effects on LAA endocardial cells currently remains unknown...
January 8, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28025962/the-cost-savings-of-newer-oral-anticoagulants-in-atrial-fibrillation-related-stroke-prevention%C3%A2
#15
Norliana Masbah, Mary Joan Macleod
BACKGROUND: Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fibrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial. AIM: This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings...
March 2017: International Journal of Clinical Pharmacology and Therapeutics
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
#16
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/28004413/direct-oral-anticoagulant-use-in-nonvalvular-atrial-fibrillation-with-valvular-heart-disease-a-systematic-review
#17
REVIEW
Ryan E Owens, Rajesh Kabra, Carrie S Oliphant
Direct oral anticoagulants (DOACs) are indicated for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF), which, according to the American College of Cardiology/American Heart Association/Heart Rhythm Society atrial fibrillation (AF) guidelines, excludes patients with rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair. However, the data regarding use of DOACs in AF patients with other types of valvular heart disease (VHD) are unclear. We aimed to summarize and evaluate the literature regarding the safety and efficacy of DOAC use in NVAF patients with other types of VHD...
December 22, 2016: Clinical Cardiology
https://www.readbyqxmd.com/read/27956113/efficacy-and-safety-of-vitamin-c-for-atrial-fibrillation-after-cardiac-surgery-a-meta-analysis-with-trial-sequential-analysis-of-randomized-controlled-trials
#18
REVIEW
Xiaolan Hu, Linhui Yuan, Hongtao Wang, Chang Li, Junying Cai, Yanhui Hu, Changhua Ma
OBJECTIVES: Antioxidant supplement is an option in preventing postoperative atrial fibrillation (AF) after cardiac surgery. However, the benefits and adverse effects of vitamin C have not been well assessed. We aimed to systematically evaluate the efficacy and safety of vitamin C in preventing postoperative AF in adult patients after cardiac surgery. METHODS: PubMed, EMBASE, and the Cochrane library databases from inception to September 2016 were searched. Randomized controlled trials (RCTs) that evaluated the efficacy and safety of vitamin C in preventing postoperative AF in adult patients after cardiac surgery were identified...
January 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/27933569/decision-making-in-clinical-practice-oral-anticoagulant-therapy-in-patients-with-non-valvular-atrial-fibrillation-and-a-single-additional-stroke-risk-factor
#19
REVIEW
Tatjana S Potpara, Nikolaos Dagres, Nebojša Mujović, Dragan Vasić, Milika Ašanin, Milan Nedeljkovic, Francisco Marin, Laurent Fauchier, Carina Blomstrom-Lundqvist, Gregory Y H Lip
Approximately 1 in 3-4 patients presenting with an ischemic stroke will also have atrial fibrillation (AF), and AF-related strokes can be effectively prevented using oral anticoagulant therapy (OAC), either with well-controlled vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs). In addition, OAC use (both VKAs and NOACs) is associated with a 26% reduction in all-cause mortality (VKAs) or an additional 10% mortality reduction with NOACs relative to VKAs. The decision to use OAC in individual AF patient is based on the estimated balance of the benefit from ischemic stroke reduction against the risk of major OAC-related bleeding [essentially intracranial hemorrhage (ICH)]...
February 2017: Advances in Therapy
https://www.readbyqxmd.com/read/27931607/causes-of-death-in-anticoagulated-patients-with-atrial-fibrillation
#20
Antonio Gómez-Outes, Julián Lagunar-Ruíz, Ana-Isabel Terleira-Fernández, Gonzalo Calvo-Rojas, Maria Luisa Suárez-Gea, Emilio Vargas-Castrillón
BACKGROUND: Oral anticoagulation reduces the risk of mortality in atrial fibrillation (AF), but examination of the causes of death is essential to design new strategies to further reduce the high mortality rates observed in this population. OBJECTIVES: The authors sought to analyze and compare causes of death in patients receiving direct oral anticoagulants (DOAC) or warfarin for prevention of stroke and systemic embolism (SE) in AF. METHODS: The authors systematically searched for randomized trials of DOAC versus warfarin for prevention of stroke/SE in AF...
December 13, 2016: Journal of the American College of Cardiology
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