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Reduction of strokes from atrial fibrillation

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https://www.readbyqxmd.com/read/29764671/stroke-type-and-severity-in-patients-with-subclinical-atrial-fibrillation-an-analysis-from-the-asymptomatic-atrial-fibrillation-and-stroke-evaluation-in-pacemaker-patients-and-the-atrial-fibrillation-reduction-atrial-pacing-trial-assert
#1
Kanjana S Perera, Mukul Sharma, Stuart J Connolly, Jia Wang, Michael R Gold, Stefan H Hohnloser, Chu Pak Lau, Isabelle C Van Gelder, Carlos Morillo, Alessandro Capucci, Carsten W Israel, Gluca Botto, Jeffery S Healey
BACKGROUND: The Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT) demonstrated that subclinical atrial fibrillation (SCAF) was associated with a 2.5-fold increased risk of stroke. However, the absolute stroke rate was only 1.7% per year and fewer than 20% patients with stroke had SCAF in the preceding 30 days. This raises the possibility that SCAF is merely a risk marker for stroke rather than the cause...
April 18, 2018: American Heart Journal
https://www.readbyqxmd.com/read/29760204/model-based-meta-analysis-to-evaluate-optimal-doses-of-direct-oral-factor-xa-inhibitors-in-atrial-fibrillation-patients
#2
Hideki Yoshioka, Hiromi Sato, Hiroto Hatakeyama, Akihiro Hisaka
The noninferiority of direct oral factor Xa (FXa) inhibitors (rivaroxaban, apixaban, and edoxaban) in treatment of atrial fibrillation were demonstrated compared with warfarin by several large clinical trials; however, subsequent meta-analyses reported a higher risk of major bleeding with rivaroxaban than with the other FXa inhibitors. In the present study, we first estimated the changes of prothrombin time (PT) in 5 randomized trials based on reported population pharmacokinetic and pharmacodynamic models and then carried out a model-based meta-analysis to obtain models describing the relationship between PT changes and the event rates of ischemic stroke/systemic embolism (SE) and of major bleeding...
May 22, 2018: Blood Advances
https://www.readbyqxmd.com/read/29754808/long-term-event-reduction-after-left-atrial-appendage-closure-results-of-the-iberian-registry-ii
#3
José R López-Mínguez, Juan M Nogales-Asensio, Eduardo Infante De Oliveira, Vasco De Gama Ribeiro, Rafael Ruiz-Salmerón, Dabit Arzamendi-Aizpurua, Marco Costa, Hipólito Gutiérrez-García, José Antonio Fernández-Díaz, Victoria Martín-Yuste, Juan Carlos Rama-Merchán, Raúl Moreno-Gómez, Amparo Benedicto-Buendía, Andrés Íñiguez-Romo
INTRODUCTION AND OBJECTIVES: Many patients with nonvalvular atrial fibrillation are still left without protection due to a contraindication for anticoagulants. This study aimed to establish the occurrence of stroke and major bleeding events in patients with nonvalvular atrial fibrillation and left atrial appendage closure with long-term follow-up and to explore the factors associated with higher long-term mortality. METHODS: Analysis of a multicenter single cohort prospectively recruited from 2009 to 2015...
May 10, 2018: Revista Española de Cardiología
https://www.readbyqxmd.com/read/29754652/risk-of-cardiovascular-events-and-incident-atrial-fibrillation-in-patients-without-prior-atrial-fibrillation-implications-for-expanding-the-indications-for-anticoagulation
#4
Xiaoxi Yao, Bernard J Gersh, Lindsey R Sangaralingham, Nilay D Shah, Peter A Noseworthy
BACKGROUND: There is growing interest in the role for non-vitamin K antagonist oral anticoagulants (NOACs) in patients without atrial fibrillation (AF). We aimed to provide a comprehensive assessment of the risks of ischemic stroke, myocardial infarction (MI), AF, and major bleeding in patients without previously diagnosed AF. METHODS: Using a large US administrative database, we identified 6,495,875 patients ≥50 years between January 1, 2011, and September 30, 2016, who were not diagnosed with AF and were not treated with oral anticoagulants or nonaspirin antiplatelet agents...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29739915/cost-effectiveness-of-left-atrial-appendage-closure-with-the-watchman-device-compared-with-warfarin-or-non-vitamin-k-antagonist-oral-anticoagulants-for-secondary-prevention-in-nonvalvular-atrial-fibrillation
#5
Vivek Y Reddy, Ronald L Akehurst, Stacey L Amorosi, Meghan B Gavaghan, Deanna S Hertz, David R Holmes
BACKGROUND AND PURPOSE: Once a patient with atrial fibrillation experiences an embolic event, the risk of a recurrent event increases 2.6-fold. New treatments have emerged as viable treatment alternatives to warfarin for stroke risk reduction in secondary prevention populations. This analysis sought to assess the cost-effectiveness of left atrial appendage closure (LAAC) compared with warfarin and the non-vitamin K antagonist oral anticoagulants dabigatran 150 mg, apixaban and rivaroxaban in the prevention of stroke in nonvalvular atrial fibrillation patients with a prior stroke or transient ischemic attack...
May 8, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29723207/benefit-risk-and-cost-of-new-oral-anticoagulants-and-warfarin-in-atrial-fibrillation-a-multicriteria-decision-analysis
#6
Jose Mendoza-Sanchez, Federico Silva, Lady Rangel, Linda Jaramillo, Leidy Mendoza, Jenny Garzon, Andrea Quiroga
INTRODUCTION: Warfarin and new oral anticoagulants are effective in reducing stroke in atrial fibrillation; however, the benefits and risks rates in clinical trials show heterogeneity for each anticoagulant, and is unknown the cost influence on a model considering most of the treatment consequences. We designed a benefit-risk and cost assessment of oral anticoagulants. DESIGN: We followed the roadmap proposed by IMI-PROTECT and the considerations of emerged good practice to perform Multi-Criteria Decision Analysis (MCDA)...
2018: PloS One
https://www.readbyqxmd.com/read/29706429/heart-failure-subtypes-and-thromboembolic-risk-in-patients-with-atrial-fibrillation-the-prefer-in-af-hf-substudy
#7
Jolanta M Siller-Matula, Ladislav Pecen, Giuseppe Patti, Markus Lucerna, Paulus Kirchhof, Maciej Lesiak, Kurt Huber, Freek W A Verheugt, Irene M Lang, Giulia Renda, Renate B Schnabel, Rolf Wachter, Dipak Kotecha, Jean-Marc Sellal, Miklos Rohla, Fabrizio Ricci, Raffaele De Caterina
BACKGROUND AND OBJECTIVES: To assess thromboembolic and bleeding risks in patients with heart failure (HF) and atrial fibrillation (AF) according to HF type. METHODS: We analyzed 6170 AF patients from the Prevention of thromboembolic events - European Registry in Atrial Fibrillation (PREFER in AF), and categorized patients into: HF with reduced left-ventricular ejection fraction (HFrEF; LVEF < 40%); mid-range EF (HFmrEF; LVEF: 40-49%); lower preserved EF (HFLpEF; LVEF: 50-60%), higher preserved EF (HFHpEF; LVEF > 60%), and no HF...
April 22, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29694285/real-world-health-care-costs-based-on-medication-adherence-and-risk-of-stroke-and-bleeding-in-patients-treated-with-novel-anticoagulant-therapy
#8
Chinmay G Deshpande, Stephen Kogut, Cynthia Willey
BACKGROUND: With the lack of real-world evidence, the challenge for drug reimbursement policy decision makers is to understand medication adherence behavior among users of novel oral anticoagulants (NOACs) and its effect on overall cost savings. No study has examined and quantified the burden of cost in high-risk patients taking NOAC therapy. OBJECTIVE: To examine the association of cost with adherence, comorbidity, and risk of stroke and bleeding in patients taking NOACs (rivaroxaban and dabigatran)...
May 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29676780/retrospective-evaluation-of-a-restrictive-transfusion-strategy-in-older-adults-with-hip-fracture
#9
Lorene Zerah, Lucile Dourthe, Judith Cohen-Bittan, Marc Verny, Mathieu Raux, Anthony Mézière, Frédéric Khiami, Cendrine Tourette, Christian Neri, Yannick Le Manach, Bruno Riou, Hélène Vallet, Jacques Boddaert
OBJECTIVES: To compare the association between a restrictive transfusion strategy and cardiovascular complications during hospitalization for hip fracture with the association between a liberal transfusion strategy and cardiovascular complications, accounting for all transfusions from the emergency department to postacute rehabilitation settings. DESIGN: Retrospective study. SETTING: Perioperative geriatric care unit. PARTICIPANTS: All individuals aged 70 and older admitted to the emergency department for hip fracture and hospitalized in our perioperative geriatric care unit (N=667; n=193 in the liberal transfusion group, n=474 in the restrictive transfusion group) from July 2009 to April 2016...
April 20, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29667208/the-use-of-cardiac-ct-alone-to-exclude-left-atrial-thrombus-before-atrial-fibrillation-ablation-efficiency-safety-and-cost-analysis
#10
Wassim Mosleh, Ali Sheikh, Zaid Said, Mohamed A Abdel-Aal, Siri Gadde, Tanvi Shah, Michael F Wilson, Hiroko Beck, Chee Kim, Umesh C Sharma
BACKGROUND: Atrial fibrillation (AF) is a growing financial burden on the healthcare system. Cardiac computed tomographic angiography (CCTA) is needed for pulmonary vein mapping before AF ablation (AFA). CCTA has shown to be an alternative to transesophageal echocardiogram (TEE) to rule-out left atrial appendage thrombus (LAAT) pre-AFA. We aim to examine the safety, cost-effectiveness, and time-efficiency of utilizing CCTA alone to rule out LAAT before AFA. METHODS: We prospectively screened patients with paroxysmal AF undergoing cryoablation...
April 17, 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29644412/patent-foramen-ovale-closure-versus-medical-therapy-for-prevention-of-recurrent-cryptogenic-embolism-updated-meta-analysis-of-randomized-clinical-trials
#11
Brunilda Alushi, Alexander Lauten, Salvatore Cassese, Roisin Colleran, Stefanie Schüpke, Himanshu Rai, Heribert Schunkert, Bernhard Meier, Ulf Landmesser, Adnan Kastrati
BACKGROUND: We performed an updated meta-analysis of all randomized-controlled trials (RCTs) comparing patent foramen ovale (PFO) closure with medical therapy for prevention of recurrent ischemic stroke. METHODS AND RESULTS: We searched Medline, EMBASE, and Cochrane databases, and proceedings of international meetings for RCTs of patients with cryptogenic stroke and PFO comparing percutaneous PFO closure versus medical therapy for prevention of recurrent ischemic stroke...
April 11, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29606361/direct-oral-anticoagulants-versus-vitamin-k-antagonists-in-real-life-patients-with-atrial-fibrillation-a-systematic-review-and-meta-analysis
#12
Carlos Escobar, Julio Martí-Almor, Alejandro Pérez Cabeza, M José Martínez-Zapata
INTRODUCTION AND OBJECTIVES: To assess the effectiveness of direct oral anticoagulants vs vitamin K antagonists in real-life patients with atrial fibrillation. METHODS: A systematic review was performed according to Cochrane methodological standards. The results were reported according to the PRISMA statement. The ROBINS-I tool was used to assess risk of bias. RESULTS: A total of 27 different studies publishing data in 30 publications were included...
March 29, 2018: Revista Española de Cardiología
https://www.readbyqxmd.com/read/29590333/patent-foramen-ovale-closure-vs-medical-therapy-for-cryptogenic-stroke-a-meta-analysis-of-randomized-controlled-trials
#13
Yousif Ahmad, James P Howard, Ahran Arnold, Matthew Shun Shin, Christopher Cook, Ricardo Petraco, Ozan Demir, Luke Williams, Juan F Iglesias, Nilesh Sutaria, Iqbal Malik, Justin Davies, Jamil Mayet, Darrel Francis, Sayan Sen
Aims: The efficacy of patent foramen ovale (PFO) closure for cryptogenic stroke has been controversial. We undertook a meta-analysis of randomized controlled trials (RCTs) comparing device closure with medical therapy to prevent recurrent stroke for patients with PFO. Methods and results: We systematically identified all RCTs comparing device closure to medical therapy for cryptogenic stroke in patients with PFO. The primary efficacy endpoint was recurrent stroke, analysed on an intention-to-treat basis...
March 24, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29570900/temporal-trends-in-safety-and-complication-rates-of-catheter-ablation-for-atrial-fibrillation
#14
Rahul G Muthalaly, Roy M John, Benjamin Schaeffer, Shinichi Tanigawa, Tomofumi Nakamura, Sunil Kapur, Paul C Zei, Laurence M Epstein, Usha B Tedrow, Gregory F Michaud, William G Stevenson, Bruce A Koplan
INTRODUCTION: Atrial fibrillation (AF) ablation is increasingly common, but is associated with potential major complications. Technology, experience and protocols have evolved significantly in recent times, and may have impacted procedural safety. We sought to compare AF ablation safety profiles, including complication rates and fluoroscopy times in a 'modern' versus 'historical' cohort. METHODS AND RESULTS: We evaluated consecutive patients undergoing AF ablation from a modern cohort (MC) from 2014 to 2015 and a historic cohort (HC) from 2009 to 2011 for complications...
March 23, 2018: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/29570894/prophylactic-pulmonary-vein-isolation-during-isthmus-ablation-for-atrial-flutter-three-year-outcomes-of-the-prevent-af-i-study
#15
Alexander Romanov, Evgeny Pokushalov, Sevda Bayramova, Dmitry Ponomarev, Vitaliy Shabanov, Denis Losik, Ilya Stenin, Dmitry Elesin, Igor Mikheenko, Jonathan S Steinberg
INTRODUCTION: The PREVENT AF I study demonstrated that prophylactic pulmonary vein isolation (PVI) in patients with pure typical atrial flutter (AFL) resulted in substantial reduction of new onset atrial fibrillation (AF) during 1-year follow-up as assessed by continuous implantable cardiac monitor (ICM). The objective of this study was to assess 3-year outcomes. METHODS AND RESULTS: Fifty patients with documented AFL were randomized to either cavotricuspid isthmus (CTI) ablation alone (n = 25) or CTI with concomitant PVI (n = 25)...
March 23, 2018: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/29547910/facilitating-technologies-in-minimally-invasive-aortic-valve-replacement-a-propensity-score-analysis
#16
Konstadinos Plestis, Oleg Orlov, Vishal N Shah, Joshua Wong, Matthew Thomas, Alon Aharon, Cinthia Orlov, Georgia Panagopoulos, Scott Goldman
OBJECTIVES: Minimally invasive aortic valve replacement (MIAVR) can be technically demanding and may lead to prolonged operative time. We evaluated the intraoperative and postoperative patient outcomes following implementation of 2 facilitating technologies (FT) in MIAVR: the Cor-Knot titanium fastener and Custodiol-histidine-tryptophan-ketoglutarate solution. METHODS: A total of 299 patients underwent MIAVR from 2008 to 2016; 172 (57.5%) patients were included in the FT group and 127 (42...
March 14, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29547906/combined-atrial-fibrillation-ablation-and-left-atrial-appendage-closure-long-term-follow-up-from-a-large-multicentre-registry
#17
Lisette Wintgens, Aleksandr Romanov, Karen Phillips, Gabriel Ballesteros, Martin Swaans, Richard Folkeringa, Ignacio Garcia-Bolao, Evgeny Pokushalov, Lucas Boersma
Aims: Long-term freedom from atrial fibrillation (AF) after catheter ablation (CA) and consequently the potential for stroke reduction remain unpredictable. Percutaneous left atrial appendage closure (LAAC) is an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. This study aims to evaluate long-term clinical results of combined CA and LAAC in one single procedure. Methods and results: Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective compilation of independent prospective general LAAC registries at the individual centres...
March 13, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29509959/factor-xa-inhibitors-versus-vitamin-k-antagonists-for-preventing-cerebral-or-systemic-embolism-in-patients-with-atrial-fibrillation
#18
REVIEW
Karsten Mh Bruins Slot, Eivind Berge
BACKGROUND: Factor Xa inhibitors and vitamin K antagonists (VKAs) are now recommended in treatment guidelines for preventing stroke and systemic embolic events in people with atrial fibrillation (AF). This is an update of a Cochrane review previously published in 2013. OBJECTIVES: To assess the effectiveness and safety of treatment with factor Xa inhibitors versus VKAs for preventing cerebral or systemic embolic events in people with AF. SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group and the Cochrane Heart Group (September 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (August 2017), MEDLINE (1950 to April 2017), and Embase (1980 to April 2017)...
March 6, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29464356/weighing-the-anti-ischemic-benefits-and-bleeding-risks-from-aspirin-therapy-a-rational-approach
#19
REVIEW
Sagar Dugani, Jeffrey M Ames, JoAnn E Manson, Samia Mora
PURPOSE OF REVIEW: The role of aspirin in secondary cardiovascular prevention is well understood; however, the role in primary prevention is less clear, and requires careful balancing of potential benefits with risks. Here, we summarize the evidence base on the benefits and risks of aspirin therapy, discuss clinical practice guidelines and decision support tools to assist in initiating aspirin therapy, and highlight ongoing trials that may clarify the role of aspirin in cardiovascular disease prevention...
February 21, 2018: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/29458408/catheter-ablation-versus-thoracoscopic-surgical-ablation-in-long-standing-persistent-atrial-fibrillation-casa-af-study-protocol-for-a-randomised-controlled-trial
#20
Habib Rehman Khan, Ines Kralj-Hans, Shouvik Haldar, Toufan Bahrami, Jonathan Clague, Anthony De Souza, Darrel Francis, Wajid Hussain, Julian Jarman, David Gareth Jones, Neeraj Mediratta, Raad Mohiaddin, Tushar Salukhe, Simon Jones, Joanne Lord, Caroline Murphy, Joanna Kelly, Vias Markides, Dhiraj Gupta, Tom Wong
BACKGROUND: Atrial fibrillation is the commonest arrhythmia which raises the risk of heart failure, thromboembolic stroke, morbidity and death. Pharmacological treatments of this condition are focused on heart rate control, rhythm control and reduction in risk of stroke. Selective ablation of cardiac tissues resulting in isolation of areas causing atrial fibrillation is another treatment strategy which can be delivered by two minimally invasive interventions: percutaneous catheter ablation and thoracoscopic surgical ablation...
February 20, 2018: Trials
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