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Reduction of strokes from atrial fibrillation

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https://www.readbyqxmd.com/read/28645443/once-or-twice-daily-non-vitamin-k-antagonist-oral-anticoagulants-in-asian-patients-with-atrial-fibrillation-a%C3%A2-meta-analysis-of-randomized-controlled-trials
#1
Kang-Ling Wang, Chun-Chih Chiu, Doreen Su-Yin Tan, Chun-Yi Lin, En-Yu Lai, Shinya Goto, Robert P Giugliano, Chern-En Chiang
BACKGROUND/PURPOSE: Non-vitamin K antagonist oral anticoagulants (NOACs) have a half-life of around 12 h. We aimed to clarify if there was any effect modification by dosing (once- or twice-daily) regimens in Asian patients. METHODS: Phase III randomized controlled trials of NOACs compared with warfarin in Asian patients with atrial fibrillation (AF) were identified and extracted from PubMed, CENTRAL, and CINAHL databases through November 2016. Outcomes were pooled by dosing regimens with the Mantel-Haenszel fixed-effects model...
June 20, 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/28642017/patterns-of-care-and-temporal-trends-in-ischemic-stroke-management-a-brazilian-perspective
#2
Monique Bueno Alves, Gisele Sampaio Silva, Renata Carolina Acri Miranda, Rodrigo Meireles Massaud, Andreia Maria Heins Vaccari, Miguel Cendoroglo-Neto, Solange Diccini
BACKGROUND AND PURPOSE: Demonstration of an improvement process of quality indicators in stroke care is essential to obtain certification as a primary stroke center (PSC). Our aim was to evaluate factors that influence temporal trends in quality indicators of ischemic stroke (IS) in a Brazilian hospital. METHODS: We evaluated patients discharged with IS from a tertiary hospital from January 2009 to December 2013. Ten predefined performance measures selected by the Get With the Guidelines-Stroke program were assessed...
June 20, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28625370/rationale-and-design-of-the-apixaban-for-the-reduction-of-thrombo-embolism-in-patients-with-device-detected-sub-clinical-atrial-fibrillation-artesia-trial
#3
Renato D Lopes, Marco Alings, Stuart J Connolly, Heather Beresh, Christopher B Granger, Juan Benezet Mazuecos, Giuseppe Boriani, Jens C Nielsen, David Conen, Stefan H Hohnloser, Georges H Mairesse, Philippe Mabo, A John Camm, Jeffrey S Healey
BACKGROUND: Device-detected subclinical atrial fibrillation (AF) refers to infrequent, short-lasting, asymptomatic AF that is detected only with long-term continuous monitoring. Subclinical AF is common and associated with an increased risk of stroke; however, the risk of stroke with subclinical AF is lower than for clinical AF, and very few patients with subclinical AF alone have been included in large AF anticoagulation trials. The net benefit of anticoagulation in patients with subclinical AF is unknown...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28615986/mortality-stroke-and-heart-failure-in-atrial-fibrillation-cohorts-after-ablation-versus-propensity-matched-cohorts
#4
Julian We Jarman, Tina D Hunter, Wajid Hussain, Jamie L March, Tom Wong, Vias Markides
BACKGROUND: We sought to determine from key clinical outcomes whether catheter ablation of atrial fibrillation (AF) is associated with increased survival. METHODS AND RESULTS: Using routinely collected hospital data, ablation patients were matched to two control cohorts using direct and propensity score methodology. Four thousand nine hundred ninety-one ablation patients were matched 1:1 with general AF controls without ablation. Five thousand four hundred seven ablation patients were similarly matched to controls who underwent cardioversion...
2017: Pragmatic and Observational Research
https://www.readbyqxmd.com/read/28595859/left-atrial-appendage-occlusion-in-patients-with-atrial-fibrillation-and-previous-major-gastrointestinal-bleeding-from-the-amplatzer-cardiac-plug-multicenter-registry
#5
Mathieu Lempereur, Adel Aminian, Xavier Freixa, Sameer Gafoor, Samera Shakir, Heyder Omran, Sergio Berti, Gennaro Santoro, Joelle Kefer, Ulf Landmesser, Jens Erik Nielsen-Kudsk, Ignacio Cruz-Gonzalez, Prapa Kanagaratnam, Fabian Nietlispach, Reda Ibrahim, Horst Sievert, Wolfgang Schillinger, Jai-Wun Park, Steffen Gloekler, Apostolos Tzikas
History of major gastrointestinal (GI) bleeding may represent a frequent clinical indication for left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (AF). This study aims to investigate the procedural safety and long-term outcome of patients with previous major GI bleeding (MGIB) who underwent LAAO. Data from the Amplatzer Cardiac Plug multicenter registry on 1,047 patients were analyzed. Patients with previous MGIB as indication for LAAO were compared with patients without previous MGIB...
May 12, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28595459/percutaneous-closure-of-the-left-atrial-appendage-in-patients-with-diabetes-mellitus
#6
Obayda Azizy, Christos Rammos, Nils Lehmann, Tienush Rassaf, Hagen Kälsch
BACKGROUND: Left atrial appendage closure is a preventive treatment of atrial fibrillation-related thrombo-embolism. Patients with diabetes mellitus have increased risk for a negative outcome in percutaneous cardiac interventions. We assessed whether percutaneous left atrial appendage closure is safe and effective in patients with diabetes mellitus. METHODS: We included 78 patients (mean age of 74.4 ± 8.3 years) with indication for left atrial appendage closure in an open-label observational single-centre study...
June 1, 2017: Diabetes & Vascular Disease Research
https://www.readbyqxmd.com/read/28545542/recognition-and-treatment-of-sleep-disordered-breathing-an-important-component-of-chronic-disease-management
#7
REVIEW
Peter C Farrell, Glenn Richards
Sleep-disordered breathing (SDB) is a highly prevalent condition, and is associated with many debilitating chronic diseases. The role of untreated obstructive sleep apnea (OSA) in arterial hypertension has been recognized in international guidelines. Treatment with continuous positive airway pressure (CPAP) is associated with clinically-relevant reductions in blood pressure. In heart failure (HF), SDB is associated with worse prognosis and increased mortality. Major HF guidelines recommend that patients should be treated for sleep apnea to improve their HF status...
May 25, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28516318/effect-of-apixaban-on-all-cause-death-in-patients-with-atrial-fibrillation-a-meta-analysis-based-on-imputed-placebo-effect
#8
Patrícia O Guimarães, Renato D Lopes, Daniel M Wojdyla, Azmil H Abdul-Rahim, Stuart J Connolly, Greg C Flaker, Junyuan Wang, Michael Hanna, Christopher B Granger, Lars Wallentin, Kennedy R Lees, John H Alexander, John J V McMurray
PURPOSE: Vitamin K antagonists (VKAs) are the standard of care for stroke prevention in patients with atrial fibrillation (AF); therefore, there is not equipoise when comparing newer oral anticoagulants with placebo in this setting. METHODS: To explore the effect of apixaban on mortality in patients with AF, we performed a meta-analysis of apixaban versus placebo using a putative placebo analysis based on randomized controlled clinical trials that compared warfarin, aspirin, and no antithrombotic control...
May 18, 2017: Cardiovascular Drugs and Therapy
https://www.readbyqxmd.com/read/28511557/impact-of-a-perioperative-prophylaxis-guideline-on-post-cardiothoracic-surgery-atrial-fibrillation
#9
Rosanna Li, C Michael White, Jola Mehmeti, Spencer T Martin, Laura C Hobbs
BACKGROUND: National practice guidelines do not provide clear recommendations on combination pharmacological regimens to reduce cardiothoracic surgery (CTS) postoperative atrial fibrillation (POAF). OBJECTIVE: This study examines if there is a reduction in POAF rates after implementing a perioperative prophylaxis guideline that includes amiodarone, β-blockers, and high-intensity statins. METHODS: Data were retrospectively collected on 400 adults (200 patients pre-guideline implementation and 200 patients post-guideline implementation) with a CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age, Diabetes Mellitus, and Vascular Disease) score of at least 3 points after CTS...
May 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28471498/thromboembolic-risk-and-effect-of-oral-anticoagulation-according-to-atrial-fibrillation-patterns-a-systematic-review-and-meta-analysis
#10
REVIEW
Alessio Lilli, Andrea Di Cori, Valerio Zacà
Oral anticoagulation (OAC) is recommended in both paroxysmal atrial fibrillation (pxAF) and nonparoxysmal AF (non-pxAF), but disagreement exists in classes of recommendation. Data on incidence/rate of stroke in pxAF are conflicting, and OAC is often underused in this population. The objectives of the meta-analysis were to investigate different impact on outcomes of pxAF and non-pxAF, with and without OAC. Two reviewers searched for prospective studies on risk of stroke and systemic embolism (SE) in pxAF and non-pxAF, with and without OAC...
May 4, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28456775/atrial-natriuretic-peptide-and-brain-natriuretic-peptide-changes-after-epicardial-percutaneous-left-atrial-appendage-suture-ligation-using-lariat-device
#11
K Bartus, J Podolec, R J Lee, B Kapelak, J Sadowski, M Bartus, K Oles, P Ceranowicz, R Trabka, R Litwinowicz
Percutaneous left atrial appendage closure is an alternative treatment for stroke and systemic thromboembolism risk reduction in non-valvular atrial fibrillation (AF). However, the neurohormonal impact of epicardial exclusion of the left atrial appendage (LAA) with the LARIAT procedure is unknown. Evaluation of changes in atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels in AF patients underwent percutaneous LAA suture ligation. Sixty six patients underwent successfully percutaneous LAA suture ligation using LARIAT device...
February 2017: Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society
https://www.readbyqxmd.com/read/28455344/temporal-trends-in-incidence-prevalence-and-mortality-of-atrial-fibrillation-in-primary-care
#12
Deirdre A Lane, Flemming Skjøth, Gregory Y H Lip, Torben B Larsen, Dipak Kotecha
BACKGROUND: Incidence and prevalence of atrial fibrillation (AF) are expected to increase dramatically; however, we currently lack comprehensive data on temporal trends in unselected clinical populations. METHODS AND RESULTS: Analysis of the UK Clinical Practice Research Datalink (CPRD) from 1998 to 2010 of patients with incident AF, excluding major valvular disease, linked to hospital admission data and national statistics. Fifty-seven thousand eight hundred eighteen adults were identified with mean age 74...
April 28, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28439778/dabigatran-etexilate-appropriate-use-in-patients-with-chronic-kidney-disease-and-in-the-elderly-patients
#13
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
#14
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
#15
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
#16
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...
May 1, 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
#17
Xiaoyan Shawn 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...
June 2, 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
#18
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
#19
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
#20
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
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