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Reduction of strokes from atrial fibrillation

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https://www.readbyqxmd.com/read/29153246/usefulness-of-the-american-heart-association-s-life-simple-7-to-predict-the-risk-of-atrial-fibrillation-from-the-reasons-for-geographic-and-racial-differences-in-stroke-regards-study
#1
Parveen K Garg, Wesley T O'Neal, Adedotun Ogunsua, Evan L Thacker, George Howard, Elsayed Z Soliman, Mary Cushman
The American Heart Association has identified metrics of ideal cardiovascular (CV) health known as Life's Simple 7 (LS7). We determined the prospective relationship between the LS7 and the incident atrial fibrillation (AF) in a biracial cohort. The REasons for Geographic And Racial Differences in Stroke (REGARDS) study enrolled non-Hispanic black and white adults 45 years or older. This analysis included 9,576 REGARDS participants (mean age 63 ± 8.4 years; 57% women; 30% black) who were free of AF at baseline and completed a follow-up examination 9...
October 19, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29150698/surgical-techniques-for-left-atrial-appendage-exclusion
#2
REVIEW
Sacha P Salzberg, Maximilian Y Emmert, Etem Caliskan
The increasing prevalence of atrial fibrillation with the aging population and its associated major morbidity and mortality due to thromboembolic stroke have resulted in intensive research on stroke prevention or stroke risk reduction strategies. Several surgical techniques for left atrial appendage (LAA) occlusion have evolved over the past decades. Surgeons have been using different techniques leading to highly variable and, in particular, poor data on outcomes. LAA closure is performed either as a concomitant procedure during open-heart surgery or as a stand-alone surgical procedure as part of minimally invasive (mini-thoracotomy or thoracoscopy) arrhythmia surgery...
November 17, 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/29148156/long-term-outcomes-for-different-surgical-strategies-to-treat-left-ventricular-outflow-tract-obstruction-in-hypertrophic-cardiomyopathy
#3
Richard Collis, Oliver Watkinson, Constantinos O'Mahony, Oliver P Guttmann, Antonis Pantazis, Maria Tome-Esteban, Victor Tsang, Venkatachalam Chandrasekaran, Christopher G A McGregor, Perry M Elliott
AIMS: Surgical intervention is used to treat dynamic left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy. This study assesses the effect of different surgical strategies on long-term mortality and morbidity. METHODS AND RESULTS: In total, 347 patients underwent surgical intervention for LVOTO (1988-2015). Group A (n = 272) underwent septal myectomy; Group B (n = 33), septal myectomy and mitral valve (MV) repair; Group C (n = 22), myectomy and MV replacement; and Group D (n = 20), MV replacement alone...
November 16, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29122636/clinical-outcomes-and-history-of-fall-in-patients-with-atrial-fibrillation-treated-with-oral-anticoagulation-insights-from-the-aristotle-trial
#4
Meena P Rao, Dragos Vinereanu, Daniel M Wojdyla, John H Alexander, Dan Atar, Elaine M Hylek, Michael Hanna, Lars Wallentin, Renato D Lopes, Bernard J Gersh, Christopher B Granger
PURPOSE: We assessed outcomes among anticoagulated patients with atrial fibrillation (AF) and a history of falling, and whether the benefits of apixaban versus warfarin are consistent in this population. METHODS: Of the 18,201 patients in ARISTOTLE, 16,491 had information about history of falling - 753 with history of falling and 15,738 without history of falling. The primary efficacy outcome was stroke or systemic embolism; the primary safety outcome was major bleeding...
November 6, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29117873/implementation-of-an-emergency-department-atrial-fibrillation-and-flutter-pathway-improves-rates-of-appropriate-anticoagulation-reduces-length-of-stay-and-thirty-day-revisit-rates-for-congestive-heart-failure
#5
David Barbic, Chris DeWitt, Devin Harris, Robert Stenstrom, Eric Grafstein, Crane Wu, Cristian Vadeanu, Brett Heilbron, Jenelle Haaf, Stanley Tung, Dan Kalla, Julian Marsden, Jim Christenson, Frank Scheuermeyer
OBJECTIVES: An evidence-based emergency department (ED) atrial fibrillation and flutter (AFF) pathway was developed to improve care. The primary objective was to measure rates of new anticoagulation (AC) on ED discharge for AFF patients who were not AC correctly upon presentation. METHODS: This is a pre-post evaluation from April to December 2013 measuring the impact of our pathway on rates of new AC and other performance measures in patients with uncomplicated AFF solely managed by emergency physicians...
November 9, 2017: CJEM
https://www.readbyqxmd.com/read/29106834/-left-atrial-appendage-closure-and-embolic-events
#6
M Akodad, P Garot
Atrial fibrillation (AF) is frequent and responsible for embolic events. Currently, the gold standard to prevent such embolic events is anticoagulant therapy with vitamin K antagonist (VKA) or direct oral anticoagulant in nonvalvular AF. Recently, left atrial appendage closure was proposed as an alternative to anticoagulant inpatient with high embolic risk and contraindication to anticoagulant therapy. Data from randomized trials were consistent with a non-inferiority of left atrial appendage closure in comparison to VKA in terms of stroke and cardiovascular death...
October 26, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29105666/-low-or-reduced-semantics-of-the-doses-of-new-oral-anticoagulants
#7
Andrea Rubboli
The four new oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban and edoxaban are marketed in two doses each for the prevention of stroke and/or systemic thromboembolism in non-valvular atrial fibrillation (NVAF). The meaning and indications for use of the lower dose compared with the higher dose are, however, different between the thrombin-inhibitor dabigatran on the one hand and the activated factor X (Xa) inhibitors on the other. These differences stem from the different design of the registration studies where NOACs were compared with warfarin for the prevention of stroke and/or systemic thromboembolism in patients with NVAF...
September 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29103847/5-year-outcomes-after-left%C3%A2-atrial%C3%A2-appendage-closure-from-the-prevail-and-protect-af-trials
#8
Vivek Y Reddy, Shephal K Doshi, Saibal Kar, Douglas N Gibson, Matthew J Price, Kenneth Huber, Rodney P Horton, Maurice Buchbinder, Petr Neuzil, Nicole T Gordon, David R Holmes
BACKGROUND: The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in atrial fibrillation, but had a high rate of complications. In a second randomized trial, PREVAIL (Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), the complication rate was low...
November 4, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29101289/the-efficacy-and-safety-of-the-use-of-non-vitamin-k-antagonist-oral-anticoagulants-in-patients-with-non-valvular-atrial-fibrillation-and-concomitant-aspirin-therapy-a-meta-analysis-of-randomized-trials
#9
Naoual Bennaghmouch, Anne J W M de Veer, Kerstin Bode, Bakhtawar K Mahmoodi, Willem J M Dewilde, Gregory Y H Lip, Martina Brueckmann, Eva Kleine, Jurriën M Ten Berg
Background -Current guidelines recommend non-vitamin-K antagonist oral anticoagulants (NOACs) as the first choice therapy in patients with non-valvular atrial fibrillation, as these drugs have several benefits over the vitamin-K antagonists (VKA). It is unknown whether these benefits remain when NOACs have to be combined with aspirin therapy. To assess the efficacy and safety of NOACs compared with VKA in patients with AF and concomitant aspirin therapy, we conducted a systematic review and study based meta-analysis of published randomized controlled trials (RCTs)...
November 3, 2017: Circulation
https://www.readbyqxmd.com/read/29089455/echocardiographic-risk-factors-for-stroke-and-outcomes-in-patients-with-atrial-fibrillation-anticoagulated-with-apixaban-or-warfarin
#10
Dragos Vinereanu, Renato D Lopes, Hillary Mulder, Bernard J Gersh, Michael Hanna, Pedro G M de Barros E Silva, Dan Atar, Lars Wallentin, Christopher B Granger, John H Alexander
BACKGROUND AND PURPOSE: Few data exist on the long-term outcomes of patients with spontaneous echo contrast (SEC), left atrial/left atrial appendage (LA/LAA) thrombus, and complex aortic plaque (CAP), in patients with atrial fibrillation receiving oral anticoagulation. We explored the relationship between these 3 echocardiographic findings and clinical outcomes, and the comparative efficacy and safety of apixaban and warfarin for each finding. METHODS: Patients from the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) with SEC, LA/LAA thrombus, or CAP diagnosed by either transthoracic or transesophageal echocardiography were compared with patients with none of these findings on transesophageal echocardiography...
October 31, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29040518/challenges-in-comparing-the-non-vitamin-k-antagonist-oral-anticoagulants-for-atrial-fibrillation-related-stroke-prevention
#11
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/29016813/epicardial-left-atrial-appendage-atriclip-occlusion-reduces-the-incidence-of-stroke-in-patients-with-atrial-fibrillation-undergoing-cardiac-surgery
#12
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/28992468/dronedarone-exerts-anticoagulant-and-antiplatelet-effects-independently-of-its-antiarrhythmic-actions
#13
M Urooj Zafar, Carlos G Santos-Gallego, Donald A Smith, Jonathan L Halperin, Juan J Badimon
BACKGROUND AND AIMS: Dronedarone reduced the rate of stroke and transient ischemic attack in patients with paroxysmal atrial fibrillation (AF) in the ATHENA trial. This cannot be explained by its antiarrhythmic effect alone and may involve alternative mechanisms. This study aimed to investigate any direct effect of dronedarone on blood thrombogenicity, independent of its antiarrhythmic effects. METHODS: Blood samples from patients with cardiovascular disease (n = 30) taking no anticoagulant or antiplatelet medication except aspirin were incubated with dronedarone's active metabolite (SR35021A) at 66 ng/ml (am-L) and 119 ng/ml (am-H), i...
November 2017: Atherosclerosis
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
#14
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/28969538/triple-therapy-versus-dual-antiplatelet-therapy-for-patients-with-atrial-fibrillation-and-acute-coronary-syndromes-a-systematic-literature-review
#15
Aimee Louise Fake, Anil Ranchord, Scott Harding, Peter Larsen
BACKGROUND: Patients with acute coronary syndromes (ACS) and a history of atrial fibrillation (AF) have indications for both dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC). Triple therapy (TT), the combination of DAPT and OAC, is recommended in guidelines. We examined studies comparing clinical outcomes on DAPT versus TT for patients with AF and ACS. METHODS: We searched Medline, Medline pending, EMBASE and Evidence-Based Medicine Reviews databases for studies published between January 2000 to December 2016 in AF patients with ACS that compared DAPT and TT that reported ischaemic and/or bleeding outcomes...
September 27, 2017: Current Cardiology Reviews
https://www.readbyqxmd.com/read/28966159/transcatheter-left-atrial-appendage-occlusion-for-stroke-prevention-in-patients-with-atrial-fibrillation-results-from-the-belgian-registry
#16
Joelle Kefer, Adel Aminian, Paul Vermeersch, Tom De Potter, Francis Stammen, Edouard Benit, Werner Budts, Luc Missault, Benny Drieghe, Ian Buysschaert, Kristoff Cornelis, Jean-Manuel Herzet, Antoine Guedes, Nadia Debbas, Maximo Rivero, Mathieu Lempereur, Stijn Lochy, Ruben Casado-Arroyo, Christophe Laruelle, Philippe Debruyne, Thierry Ledent
AIMS: This study aimed at assessing the safety and efficacy at mid-term follow-up of left atrial appendage occlusion (LAAO) using different devices, in real life in Belgium. METHODS AND RESULTS: Between June 2009 and November 2016, 457 consecutive patients (63% males, 75±12 yrs, CHA2DS2-VASc 4±0.6, HASBLED 3.5±0.7) undergoing LAAO were included. Technical success was 97.1%. There were 19 periprocedural major adverse events (4.1%) including three deaths (0.6%), nine tamponades (1...
October 3, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28950374/non-vitamin-k-antagonist-oral-anticoagulants-in-patients-with-atrial-fibrillation-and-valvular-heart-disease-systematic-review-and-meta-analysis
#17
Daniel Caldeira, Cláudio David, João Costa, Joaquim J Ferreira, Fausto J Pinto
BACKGROUND: The non-vitamin K antagonist oral anticoagulants (NOACs) were approved for non-valvular atrial fibrillation (AF) but this term may be misnomer. Thus, the term non-mechanical and rheumatic mitral valvular (non-MARM) AF was proposed to exclude patients with valvular heart disease (VHD) without contraindications for NOACs. We aimed to review the efficacy and safety of NOACs in patients with AF and VHD compared to Vitamin K Antagonists (VKA). METHODS: A systematic review with meta-analysis (PROSPERO CRD42015024837) including data from randomized controlled trials (RCTs) retrieved in November 2016...
September 6, 2017: European Heart Journal. Cardiovascular Pharmacotherapy
https://www.readbyqxmd.com/read/28948451/a-diagnostic-approach-to-stroke-in-young-adults
#18
REVIEW
Christopher A Stack, John W Cole
Optimal diagnosis and management of stroke in young adults benefit from a multidisciplinary team, including a vascular neurology specialist. In addition to the "standard" vascular risk factors including smoking, hypertension, diabetes, and hyperlipidemia, one needs to consider alternative etiologies including substance abuse, carotid/vertebral artery dissections, and rare genetic conditions among others. Once a young patient is determined to have had a stroke, the next question a clinician should ask is why did this patient have a stroke? A "heart to head" diagnostic approach is recommended...
September 25, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28942389/left-atrial-appendage-occlusion
#19
Fabian Nietlispach, Igal Moarof, Maurizio Taramasso, Francesco Maisano, Bernhard Meier
Left atrial appendage occlusion (LAAO) is a first-line therapy for stroke prevention in patients suffering from atrial fibrillation (AF). While patients at high risk for bleeding or patients with previous bleeding have the highest relative risk reduction from LAAO, it is the younger patients with a high lifetime bleeding risk who benefit from the highest absolute risk reduction after LAAO. Therefore, LAAO should be discussed with every AF patient, as an alternative to lifelong oral anticoagulation. The patient needs to be informed about the risks and benefits of each treatment strategy in order to take an informed treatment decision...
September 24, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28940485/anatomical-and-electrical-remodeling-with-incomplete-left-atrial-appendage-ligation-results-from-the-laala-af-registry
#20
Mohit Turagam, Donita Atkins, Matthew Earnest, Randall Lee, Jayant Nath, Ryan Ferrell, Krzysztof Bartus, Nitish Badhwar, Abdi Rasekh, Jie Cheng, Luigi Di Biase, Andrea Natale, David Wilber, Dhanunjaya Lakkireddy
BACKGROUND: The anatomical, electrical and clinical impact of incomplete Lariat left atrial appendage ligation remains unclear. METHODS: We studied LAA anatomy pre-and post-ligation using contrast enhanced- computed tomography (CT) scans in 91 patients with atrial fibrillation (AF) who subsequently underwent catheter ablation (CA). RESULTS: Eleven patients had an incomplete exclusion (12%) with a central leak ranging from 1-5 mm. Despite incomplete ligation; the LAA volume were reduced by 67% post-procedurally when compared to pre-procedure...
September 21, 2017: Journal of Cardiovascular Electrophysiology
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