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Reduction of strokes from atrial fibrillation

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https://www.readbyqxmd.com/read/27900868/-rivaroxaban-use-in-prevention-of-stroke-in-patients-with-non-valvular-atrial-fibrillation-in-clinical-practice-results-of-observational-studies-and-our-experience
#1
Filip Málek
Rivaroxaban is direct oral factor Xa inhibitor indicated for tromboembolic event rate reduction in patients with non-valvular atrial fibrillation. Knowledge of rivaroxaban efficacy and safety comes from a phase III randomized clinical trial ROCKET AF. In the present, we have more evidence of rivaroxaban efficacy from real-life clinical studies. XANTUS study was first international prospective observational real-life study documenting use of rivaroxaban in stroke prevention in a broad population of patients with non-valvular atrial fibrillation...
2016: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/27892885/vitamin-k-antagonists-for-stroke-prevention-in-hemodialysis-patients-with-atrial-fibrillation-a-systematic-review-and-meta-analysis
#2
Hans Van Der Meersch, Dirk De Bacquer, An S De Vriese
BACKGROUND: The use of vitamin K antagonists (VKAs) in hemodialysis patients with atrial fibrillation (AF) is controversial. No randomized trials are available and observational studies have yielded conflicting results, engendering a large clinical practice variability and physician uncertainty. An unresolved but highly relevant question is whether AF poses a true risk of ischemic stroke in hemodialysis and whether any form of oral anticoagulation is therefore warranted. METHODS: We conducted a systematic review of studies that compared the incidence of ischemic stroke and bleeding in hemodialysis patients with AF taking VKA and those not taking VKA...
October 4, 2016: American Heart Journal
https://www.readbyqxmd.com/read/27868275/effectiveness-and-safety-of-drugs-used-for-stroke-prevention-in-a-cohort-of-non-valvular-atrial-fibrillation-patients-from-a-primary-care-electronic-database
#3
Maria Giner-Soriano, Albert Roso-Llorach, Cristina Vedia Urgell, Xavier Castells, Dolors Capellà, Ignacio Ferreira-González, Josep Maria Elorza-Ricart, Marc Casajuana, Amelia Troncoso Mariño, Eduard Diògene, Bonaventura Bolíbar, Concepció Violan, Rosa Morros
PURPOSE: The aim of this study was to assess effectiveness and safety of antithrombotics for stroke prevention in non-valvular atrial fibrillation in real-use conditions. METHODS: We used a population-based retrospective cohort study. Information emerges from SIDIAP, a database containing anonymized information from electronic health records from 274 primary healthcare centres of the Catalan Health Institute, Catalonia (Spain), with a reference population of 5 835 000 people...
November 20, 2016: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/27843104/left-atrial-dysfunction-in-the-pathogenesis-of-cryptogenic-stroke-novel-insights-from-speckle-tracking-echocardiography
#4
Darryl P Leong, Emer Joyce, Philippe Debonnaire, Spyridon Katsanos, Eduard R Holman, Martin J Schalij, Jeroen J Bax, Victoria Delgado, Nina Ajmone Marsan
BACKGROUND: Myocardial strain analysis by speckle-tracking echocardiography, which can detect subtle abnormalities in left atrial (LA) function, may offer unique insights into LA pathophysiology in patients with cryptogenic stroke (CS). The aim of this study was to investigate whether LA reservoir strain by speckle-tracking echocardiography, as a measure of LA compliance, is impaired in patients with CS and no history of atrial fibrillation. METHODS: A retrospective case-control study of 742 patients (mean age, 59 ± 13 years; 54% men; 371 with CS and 371 control subjects) was conducted...
November 11, 2016: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/27836133/impact-of-baseline-stroke-risk-and-bleeding-risk-on-warfarin-international-normalized-ratio-control-in-atrial-fibrillation-from-the-treat-af-study
#5
Jessica A Hellyer, Farnaz Azarbal, Claire T Than, Jun Fan, Susan K Schmitt, Felix Yang, Susan M Frayne, Ciaran S Phibbs, Celina Yong, Paul A Heidenreich, Mintu P Turakhia
Warfarin prevents stroke and prolongs survival in patients with atrial fibrillation and flutter (AF, collectively) but can cause hemorrhage. The time in international normalized ratio (INR) therapeutic range (TTR) mediates stroke reduction and bleeding risk. This study sought to determine the relation between baseline stroke, bleeding risk, and TTR. Using data from The Retrospective Evaluation and Assessment of Therapies in Atrial Fibrillation (TREAT-AF) retrospective cohort study, national Veterans Health Administration records were used to identify patients with newly diagnosed AF from 2003 to 2012 and subsequent initiation of warfarin...
October 8, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27807780/retroperitoneal-haematoma-in-a-postoperative-alif-patient-taking-rivaroxaban-for-atrial-fibrillation
#6
Praveena Deekonda, Oliver M Stokes, Daniel Chan
BACKGROUND: Novel oral anticoagulants (NOACs) are being increasingly used in the secondary prevention of thromboembolic stroke in patients with atrial fibrillation. Patients taking NOACs are difficult to manage perioperatively, and several unexpected complications have been reported in these patients. CASE REPORT: We report a case of a rivaroxaban-induced retroperitoneal haematoma in a 72-year-old man who underwent an L5/S1 anterior lumbar interbody fusion (ALIF) for grade 1 spondylolytic spondylolisthesis...
November 2, 2016: European Spine Journal
https://www.readbyqxmd.com/read/27798365/atrial-fibrillation-in-new-zealand-primary-care-prevalence-risk-factors-for-stroke-and-the-management-of-thromboembolic-risk
#7
Andrew M Tomlin, Hywel S Lloyd, Murray W Tilyard
BACKGROUND: Atrial fibrillation is a major risk factor for stroke and heart disease but there is limited information on its prevalence in New Zealand primary care or the treatment provided to manage thromboembolic risk. Our aim was to estimate the prevalence of atrial fibrillation, assess patient risk for thromboembolism and evaluate the appropriateness of risk reduction using antiplatelet and oral anticoagulation therapy. DESIGN: A retrospective cohort study utilising electronic medical records for 739,000 patients registered with 170 general practices in 2014...
October 19, 2016: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/27695821/stroke-bleeding-and-mortality-risks-in-elderly-medicare-beneficiaries-treated-with-dabigatran-or-rivaroxaban-for-nonvalvular-atrial-fibrillation
#8
David J Graham, Marsha E Reichman, Michael Wernecke, Ya-Hui Hsueh, Rima Izem, Mary Ross Southworth, Yuqin Wei, Jiemin Liao, Margie R Goulding, Katrina Mott, Yoganand Chillarige, Thomas E MaCurdy, Chris Worrall, Jeffrey A Kelman
Importance: Dabigatran and rivaroxaban are non-vitamin K oral anticoagulants approved for stroke prevention in patients with nonvalvular atrial fibrillation (AF). There are no randomized head-to-head comparisons of these drugs for stroke, bleeding, or mortality outcomes. Objective: To compare risks of thromboembolic stroke, intracranial hemorrhage (ICH), major extracranial bleeding including major gastrointestinal bleeding, and mortality in patients with nonvalvular AF who initiated dabigatran or rivaroxaban treatment for stroke prevention...
October 3, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27683276/direct-oral-anticoagulants-in-the-elderly-systematic-review-and-meta-analysis-of-evidence-current-and-future-directions
#9
Angelique H Sadlon, Dimitrios A Tsakiris
BACKGROUND: Concerns regarding the use of direct oral anticoagulants (DOACs: apixaban, dabigatran, edoxaban, rivaroxaban) in the elderly persist owing to the lack of randomised controlled trials targeting this age group. OBJECTIVES: The aim of this study was to assess the efficacy and safety of DOACs in elderly patients (aged 75 years or more) with atrial fibrillation or venous thromboembolism (VTE), based on already published large randomised trials. METHODS: EMBASE, MEDLINE and the Cochrane Library were searched from inception to June 2015 for phase III trials...
2016: Swiss Medical Weekly
https://www.readbyqxmd.com/read/27671097/the-sex-age-medical-history-treatment-tobacco-use-race-risk-same-tt2r2-score-predicts-warfarin-control-in-a-singaporean-population
#10
Nijole Bernaitis, Chi Keong Ching, Liping Chen, Jin Shing Hon, Siew Chong Teo, Andrew K Davey, Shailendra Anoopkumar-Dukie
BACKGROUND: Warfarin reduces stroke risk in atrial fibrillation (AF) patients but requires ongoing monitoring. Time in therapeutic range (TTR) is used as a measure of warfarin control, with a TTR less than 60% associated with adverse patient outcomes. The Sex, Age, Medical history, Treatment, Tobacco use, Race (SAMe-TT2R2) score has been identified as a model able to predict warfarin control, but this has been tested in mainly Caucasian populations. Therefore, the aim of this study was to determine the ability of the SAMe-TT2R2 score to predict warfarin control in a Singaporean population consisting of Chinese, Malay, and Indian race...
September 23, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27651124/percutaneous-left-atrial-appendage-occlusion-using-different-technologies-in-the-united-kingdom-a-multicenter-registry
#11
Timothy R Betts, Milena Leo, Sandeep Panikker, Prapa Kanagaratnam, Michael Koa-Wing, David Wyn Davies, David Hildick-Smith, Dylan G Wynne, Oliver Ormerod, Oliver R Segal, Anthony W Chow, Derick Todd, Sandra Cabrera Gomez, Graeme J Kirkwood, David Fox, Chris Pepper, John Foran, Tom Wong
OBJECTIVES: This study aimed at assessing the feasibility and long-term efficacy of left atrial appendage occlusion (LAAO) in a "real world" setting. BACKGROUND: Although LAAO has recently emerged as an alternative to oral anticoagulants in patients with atrial fibrillation for the prevention of thromboembolic stroke, "real world" data about the procedure with different devices are lacking. METHODS: Eight centers in the United Kingdom contributed to a retrospective registry for LAAO procedures undertaken between July 2009 and November 2014...
September 21, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27633045/real-world-evidence-of-stroke-prevention-in-patients-with-nonvalvular-atrial-fibrillation-in-the-united-states-the-revisit-us-study
#12
Craig I Coleman, Matthias Antz, Kevin Bowrin, Thomas Evers, Edgar P Simard, Hendrik Bonnemeier, Riccardo Cappato
BACKGROUND: Little data exists regarding the effectiveness and safety of rivaroxaban or apixaban versus warfarin in nonvalvular atrial fibrillation (NVAF) patients treated outside of clinical trials. METHODS: This was a retrospective study using MarketScan claims from January 2012 to October 2014. We included adults, newly initiated on rivaroxaban, apixaban or warfarin, with a baseline CHA2DS2-VASc score ≥2, ≥2 diagnosis codes for NVAF and ≥180 days of continuous medical and prescription benefits...
September 20, 2016: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/27629776/antiplatelet-versus-anticoagulation-treatment-for-patients-with-heart-failure-in-sinus-rhythm
#13
Eduard Shantsila, Gregory Yh Lip
BACKGROUND: Morbidity in patients with chronic heart failure is high, and this predisposes them to thrombotic complications, including stroke and thromboembolism, which in turn contribute to high mortality. Oral anticoagulants (e.g. warfarin) and antiplatelet agents (e.g. aspirin) are the principle oral antithrombotic agents. Many heart failure patients with sinus rhythm take aspirin because coronary artery disease is the leading cause of heart failure. Oral anticoagulants have become a standard in the management of heart failure with atrial fibrillation...
September 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27617088/individualising-anticoagulant-therapy-in-atrial-fibrillation-patients
#14
Marco Alings
Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have emerged as alternatives to VKAs for the prevention of stroke in patients with non-valvular atrial fibrillation. Four NOACS: dabigatran, apixaban, rivaroxaban and edoxaban, have received regulatory approval in Europe from the European Medicines Agency. Numerous factors can influence the decision to prescribe a NOAC, the most important of which are assessment of stroke and bleeding risks. Given the variation in design of the pivotal phase III clinical trials investigating the efficacy and safety of NOACs, and in the absence of head-to-head comparative data, it is impossible to recommend one NOAC over the other...
August 2016: Arrhythmia & Electrophysiology Review
https://www.readbyqxmd.com/read/27614026/standard-versus-low-dose-non-vitamin-k-antagonist-oral-anticoagulants-in-asian-patients-with-atrial-fibrillation-a-meta-analysis-of-contemporary-randomized-controlled-trials
#15
Kang-Ling Wang, Robert Giugliano, Shinya Goto, Chun-Chih Chiu, Chun-Yi Lin, En-Yu Lai, Chern-En Chiang
BACKGROUND: Although randomized controlled trials (RCTs) indicated that standard dose non-vitamin K antagonist oral anticoagulants (NOACs) were more compelling, low-dose NOACs are commonly used in clinical practice in Asia. OBJECTIVE: The purpose of this study was to assess the relative therapeutic benefits and risks of standard vs low-dose NOACs in Asian patients enrolled in contemporary RCTs. METHODS: We performed a prespecified meta-analysis of 3155 Asian patients with NOACs in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) and ENGAGE AF-TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48) trials...
September 8, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/27595680/apixaban-compared-with-parenteral-heparin-and-or-vitamin-k-antagonist-in-patients-with-nonvalvular-atrial-fibrillation-undergoing-cardioversion-rationale-and-design-of-the-emanate-trial
#16
Michael D Ezekowitz, Charles V Pollack, Paul Sanders, Jonathan L Halperin, Judith Spahr, Nilo Cater, William Petkun, Andrei Breazna, Paulus Kirchhof, Jonas Oldgren
BACKGROUND: Stroke prevention in anticoagulation-naïve patients with atrial fibrillation undergoing cardioversion has not been systematically studied. OBJECTIVE: To determine outcomes in anticoagulation-naïve patients (defined as those receiving an anticoagulant for <48 hours during the index episode of atrial fibrillation) scheduled for cardioversion. METHODS: This is a randomized, prospective, open-label, real-world study comparing apixaban to heparin plus warfarin...
September 2016: American Heart Journal
https://www.readbyqxmd.com/read/27588731/residual-ischemic-risk-and-its-determinants-in-patients-with-previous-myocardial-infarction-and-without-prior-stroke-or-tia-insights-from-the-reach-registry
#17
Jérémie Abtan, Deepak L Bhatt, Yedid Elbez, Emmanuel Sorbets, Kim Eagle, Yasuo Ikeda, David Wu, Mary E Hanson, Hakima Hannachi, Puneet K Singhal, Philippe Gabriel Steg, Gregory Ducrocq
BACKGROUND: Although the rate of in-hospital ischemic events after myocardial infarction (MI) has dramatically decreased, long-term residual risk may remain substantial. However, most of the information on current residual risk is derived from highly selected randomized trials. HYPOTHESIS: In patients with previous MI and no prior ischemic stroke/transient ischemic attack (TIA), residual ischemic risk increases over time. METHODS: Using the international Reduction of Atherothrombosis for Continued Health (REACH) registry, we analyzed baseline characteristics and 4-year follow-up of patients with previous MI and no history of stroke/TIA to describe annual rates of recurrent ischemic events globally and by geography...
September 2, 2016: Clinical Cardiology
https://www.readbyqxmd.com/read/27579542/metformin-nonglycemic-effects-and-potential-novel-indications
#18
Abeer Anabtawi, John M Miles
OBJECTIVE: Metformin is the most commonly prescribed drug for the treatment of type 2 diabetes because of its apparent robust effects in reducing cardiovascular risk. This review examines the current literature regarding the nonglycemic effects and potential novel indications for metformin. METHODS: Review of the literature, with a focus on metformin use in Stage 3 chronic kidney disease (CKD-3) and heart failure (HF). RESULTS: The United Kingdom Prospective Diabetes Study suggests that metformin reduces the risk of myocardial infarction, and more recent retrospective studies have shown an association between metformin use and a reduction in stroke, atrial fibrillation and all-cause mortality...
August 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27571718/cost-effectiveness-of-implantable-cardiac-monitor-guided-intermittent-anticoagulation-for-atrial-fibrillation-an-analysis-of-the-react-com-pilot-study
#19
Daniel A Steinhaus, Peter J Zimetbaum, Rod S Passman, Peter Leong-Sit, Matthew R Reynolds
INTRODUCTION: Anticoagulation guidelines for patients with atrial fibrillation (AF) disregard AF burden. A strategy of targeted anticoagulation with novel oral anticoagulants (NOACs) based on continuous rhythm assessment with an implantable cardiac monitor (ICM) has recently been explored. We evaluated the potential cost-effectiveness of this strategy versus projected outcomes with continuous anticoagulation. METHODS AND RESULTS: We developed a Markov model using data from the Rhythm Evaluation for AntiCoagulaTion With COntinuous Monitoring (REACT...
August 30, 2016: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/27502862/effect-of-apixaban-on-brain-infarction-and-microbleeds-averroes-mri-assessment-study
#20
Martin J O'Donnell, John W Eikelboom, Salim Yusuf, Hans-Christoph Diener, Robert G Hart, Eric E Smith, David J Gladstone, Mukul Sharma, Rafael Dias, Greg Flaker, Alvaro Avezum, Jun Zhu, Gayle Lewis, Stuart Connolly
BACKGROUND: Clinical and subclinical (covert) stroke is a cause of cognitive loss and functional impairment. In the AVERROES trial, we performed serial brain magnetic resonance imaging (MRI) scans in a subgroup to explore the effect of apixaban, compared with aspirin, on clinical and covert brain infarction and on microbleeds in patients with atrial fibrillation. METHODS: We performed brain MRI (T1, T2, fluid-attenuated inversion recovery, and T2* gradient echo sequences) in 1,180 at baseline and in 931 participants at follow-up...
August 2016: American Heart Journal
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