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Anticoagulation in 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/28433958/feasibility-and-safety-of-vitamin-k-antagonist-monotherapy-in-atrial-fibrillation-patients-undergoing-transcatheter-aortic-valve-implantation
#3
Nicolas A Geis, Christina Kiriakou, Emmanuel Chorianopoulos, Sven T Pleger, Hugo A Katus, Raffi Bekeredjian
AIMS: We aimed to assess the efficacy and safety of vitamin K antagonist (VKA) monotherapy in atrial fibrillation (AF) patients undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: In 735 TAVIs since 2008 we identified 167 patients suffering from concomitant AF who received either VKA monotherapy (n=77), VKA plus single antiplatelet therapy (SAPT, n=41) or a triple anticoagulation regimen (n=49). Thromboembolic as well as bleeding complications were analysed for six months after TAVI...
April 20, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28433223/risk-of-intraatrial-thrombi-after-thoracoscopic-ablation-in-absence-of-heparin-and-appendage-closure
#4
Petr Budera, Pavel Osmancik, Dalibor Herman, David Talavera, Robert Petr, Zbynek Straka
BACKGROUND: Catheter and surgical ablation of atrial fibrillation (AF) can be associated with a risk of thromboembolic events. The goal of this study was to assess optimal anticoagulation management during thoracoscopic ablation of AF. METHODS: Fifty-two patients with persistent or long-standing persistent AF underwent hybrid ablation consisting of thoracoscopic ablation followed by electrophysiologic (EP) evaluation and consecutive ablation if indicated. The thoracoscopic ablation was performed using three different anticoagulation protocols: (1) without periprocedural heparin and without occlusion of the left atrial appendage; (2) with periprocedural heparin but without left atrial appendage occlusion; and (3) with periprocedural heparin and left atrial appendage occlusion...
April 19, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28431610/duration-of-paroxysmal-atrial-fibrillation-in-cryptogenic-stroke-is-not-associated-with-stroke-severity-and-early-outcomes
#5
Chrissoula Liantinioti, Konstantinos Tympas, Aristeidis H Katsanos, John Parissis, Maria Chondrogianni, Christina Zompola, Georgios Papadimitropoulos, Michael Ioakeimidis, Sokratis Triantafyllou, Andromaxi Roussopoulou, Konstantinos Voumvourakis, John Lekakis, Gerasimos Filippatos, Leonidas Stefanis, Georgios Tsivgoulis
The current definition of paroxysmal atrial fibrillation (PAF) requires an arbitrary cut-off of >30s, but in clinical practice cryptogenic stroke (CS) patients with PAF duration of ≤30s are not usually excluded from anticoagulation therapy. We sought to evaluate the clinical relevance of short-duration (≤30s) PAF in CS. Consecutive CS patients with no prior AF history and sinus-rhythm on baseline electrocardiography (ECG) were prospectively evaluated over a three-year period. Baseline stroke severity was assessed by NIHSS-scores...
May 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28429198/managing-the-perioperative-patient-on-direct-oral-anticoagulants
#6
Jordan Leitch, Janet van Vlymen
PURPOSE: Patients are increasingly treated with direct oral anticoagulants (DOACs) for the prevention of stroke due to non-valvular atrial fibrillation and for the treatment of venous thromboembolism. When these patients present for urgent or emergent surgical procedures, they present a challenge to the anesthesiologist who must manage perioperative risk due to anticoagulation. The purpose of this module is to review the literature surrounding the perioperative management of DOACs. Timing, laboratory monitoring, and availability of reversal agents are important considerations to optimize patients being treated with DOACs who require emergent surgery...
April 20, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28429136/is-there-an-alternative-treatment-for-patients-intolerant-to-antiplatelet-therapy-if-percutaneous-left-atrial-appendage-closure-is-considered
#7
F Akca, N J Verberkmoes, S E Verstraeten, C van Laar, B P van Putte, A H M van Straten
INTRODUCTION: Left atrial appendage (LAA) closure has become of major interest for patients with atrial fibrillation intolerant to oral anticoagulation therapy (OAC). Patients with a contraindication to both OAC and antiplatelet therapy are not eligible for percutaneous LAA closure. We aimed to find an alternative treatment for these specific patients. METHODS: From March 2014 until December 2015 five patients were referred for percutaneous LAA closure. Alternative treatment was necessary due to an absolute contraindication to OAC and antiplatelet therapy (n = 4) or after previous failed percutaneous device implantation (n = 1)...
April 20, 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/28429033/clinics-in-diagnostic-imaging-176-acute-embolic-occlusion-of-the-coeliac-artery
#8
Chinthaka Appuhamy, Justin Kwan, Martin Weng Chin H'ng, Sriram Narayanan, Sundeep Punamiya
A 52-year-old man, who had a background of chronic heart disease and atrial fibrillation, as well as non-compliance with warfarin therapy, presented with a two-week history of worsening upper abdominal pain. Computed tomography mesenteric angiography showed complete embolic occlusion of the coeliac artery with resultant segmental splenic infarction, and thrombus within the left ventricle. A decision was made to proceed with catheter-directed thrombolysis. Subsequent follow-up angiogram at 12 hours showed successful treatment with complete dissolution of the coeliac embolus...
April 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28428449/current-status-and-outcomes-of-direct-oral-anticoagulant-use-in-real-world-atrial-fibrillation-patients%C3%A3-fushimi-af-registry
#9
Yugo Yamashita, Ryuji Uozumi, Yasuhiro Hamatani, Masahiro Esato, Yeong-Hwa Chun, Hikari Tsuji, Hiromichi Wada, Koji Hasegawa, Hisashi Ogawa, Mitsuru Abe, Satoshi Morita, Masaharu Akao
BACKGROUND: The current status and outcomes of direct oral anticoagulant (DOAC) use have not been widely evaluated in unselected patients with atrial fibrillation (AF) in the real world.Methods and Results:The Fushimi AF Registry is a community-based prospective survey of AF patients who visited the participating medical institutions (n=80) in Fushimi, Kyoto, Japan. Follow-up data with oral anticoagulant (OAC) status were available for 3,731 patients by the end of November 2015. We evaluated OAC status and clinical outcomes according to OAC status...
April 19, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28428444/impact-of-atrial-fibrillation-on-the-clinical-course-of-apical-hypertrophic-cardiomyopathy
#10
Sang-Eun Lee, Jin-Kyu Park, Jae-Sun Uhm, Jong Youn Kim, Hui-Nam Pak, Moon-Hyoung Lee, Boyoung Joung
BACKGROUND: Apical hypertrophic cardiomyopathy (ApHCM) is considered a 'benign' form of hypertrophic cardiomyopathy, with limited data on the long-term outcome. However, the clinical impact of atrial fibrillation (AF) in ApHCM is largely unknown. The hypothesis was that AF is common and has a prognostic implication in ApHCM. METHODS: The occurrence of AF and outcome was assessed in 306 consecutive patients with ApHCM (68% male, 62±11 years). RESULTS: AF occurred in 77 patients with ApHCM (prevalence, 25...
April 20, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28427852/circumferential-pulmonary-vein-isolation-with-second-generation-multipolar-catheter-in-patients-with-paroxysmal-or-persistent-atrial-fibrillation-procedural-and-one-year-follow-up-results
#11
Stefan G Spitzer, Patrick Leitz, Anke Langbein, Laszlo Karolyi, Frank Scharfe, Thomas Weinmann, Carola Rämmler, Christian Pott, Gerold Mönnig, Lars Eckardt
BACKGROUND: There is a lack of procedural and follow-up data on pulmonary vein isolation (PVI) with the second-generation pulmonary vein ablation catheter® (PVAC Gold) in patients with atrial fibrillation (AF). This study provides data on PVI procedures and 1-year follow-up results with PVAC Gold in patients with AF treated in clinical practice. METHODS AND RESULTS: Three hundred and eighty four patients with documented symptomatic paroxysmal (n=198) or persistent (n=186) AF were included in a non-randomized prospectively designed database...
April 12, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28426920/dabigatran-enhances-platelet-reactivity-and-platelet-thrombin-receptor-expression-in-patients-with-atrial-fibrillation-comment
#12
Laurent Bonello, Marc Laine, Laurence Camoin-Jau, Corinne Frere
We read with interest the article by Achilles et al. [1] in a recent issue of the Journal of Thrombosis and Haemostasis, in which the authors raised a concern regarding the safety of the oral direct thrombin inhibitor (ODTI) dabigatran. The authors aimed to investigate a potential mechanism involved in the increased risk of myocardial infarction (MI) observed in several trials of patients treated with dabigatran when compared head-to-head with patients treated with indirectly acting therapeutic anticoagulants...
April 20, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28426914/recommended-dose-of-idarucizumab-may-not-always-be-sufficient-for-sustained-reversal-of-dabigatran
#13
Alexander Simon, Hans Domanovits, Cihan Ay, Gürkan Sengölge, Jerrold H Lewy, Alexander O Spiel
Idarucizumab is a monoclonal antibody fragment designed for reversing the anticoagulant effects of dabigatran. Administration is recommended as two intravenous boluses of 2.5 g within 15 minutes of each other or as a single 5 g bolus. However, in certain situations a second dose of the drug could be necessary. We report the case of a 77-year old man, treated with dabigatran for paroxysmal atrial fibrillation. He presented at our department with acute renal failure, concomitant massive dabigatran accumulation, and subsequent acute gastrointestinal bleeding...
April 20, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28426737/incidence-and-predictors-of-excessive-warfarin-anticoagulation-in-patients-with-atrial-fibrillation-the-ewa-study
#14
Samuli Jaakkola, Ilpo Nuotio, Tuomas O Kiviniemi, Raine Virtanen, Melina Issakoff, K E Juhani Airaksinen
Vitamin K antagonist warfarin is widely used in clinical practice and excessive anticoagulation is a well-known complication of this therapy. Little is known about permanent and temporary predictors for severe overanticoagulation. The aim of this study was to investigate the occurrence and predicting factors for episodes with very high (≥9) international normalized ratio (INR) values in warfarin treated patients with atrial fibrillation (AF). Excessive Warfarin Anticoagulation (EWA) study screened all patients (n = 13618) in the Turku University Hospital region with an INR ≥2 between years 2003-2015...
2017: PloS One
https://www.readbyqxmd.com/read/28425296/medium-to-long-term-persistence-with-non-vitamin-k-oral-anticoagulants-in-patients-with-atrial-fibrillation-australian-experience
#15
Leon A Simons, Michael Ortiz, S Ben Freedman, Benjamin J Waterhouse, David Colquhoun
OBJECTIVE: Long-term anticoagulant therapy with non-valvular atrial fibrillation (AF) is essential to prevent thromboembolic complications, especially ischemic stroke. This study examines medium-term persistence in AF patients using a non-vitamin K antagonist oral anticoagulant drug (NOAC). RESEARCH DESIGN AND METHODS: We assessed national Pharmaceutical Benefit Scheme records December 2013 through September 2016 for initial prescription of a NOAC in a 10% random sample of concessional patients...
April 20, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28420481/safety-and-feasibility-of-subcutaneous-purse-string-suture-of-the-femoral-vein-after-electrophysiological-procedures-on-uninterrupted-oral-anticoagulation
#16
Marc Kottmaier, Felix Bourier, Tilko Reents, Alina Reiter, Marielouise Kornmayer, Verena Semmler, Martha Telishevska, Katharina Koch-Büttner, Michael Deiss, Stephanie Brooks, Christian Grebmer, Carsten Lennerz, Christoph Kolb, Gabriele Hessling, Isabel Deisenhofer
The aim of this study was to compare safety and feasibility of a subcutaneous purse-string suture (PSS) with manual compression (MC) to gain hemostasis in patients after multiple femoral venous punctures undergoing electrophysiological procedures on uninterrupted oral anticoagulation (OAK). A total of 784 patients who underwent catheter ablation for atrial fibrillation (n = 564) or (a)typical atrial flutter (n = 220) were assessed. Four hundred sixty-two patients received PSS (58.9%) and 322 patients (41...
March 16, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28418196/clinical-frailty-is-independently-associated-with-non-prescription-of-anticoagulants-in-older-patients-with-atrial-fibrillation
#17
Isuru Induruwa, Nicholas R Evans, Ayesha Aziz, Snigdha Reddy, Kayvan Khadjooi, Roman Romero-Ortuno
AIM: Anticoagulants are underused in older patients with atrial fibrillation (AF). Scoring systems, such as CHA2 DS2 -VASc and HAS-BLED, are recommended to guide clinicians in anticoagulation decisions, but patients' frailty might be an underrecognized factor. We investigated the association between the Clinical Frailty Scale (CFS) and community anticoagulant prescribing habits in patients aged ≥75 years with AF admitted acutely to hospital. METHODS: Data were gathered retrospectively over 3 months on individuals admitted under a medical team to a tertiary teaching hospital in the UK...
April 18, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28416977/trends-in-physiological-coagulation-factors-in-japanese-patients-receiving-novel-oral-anticoagulants
#18
Tomoyuki Nagao, Hiroshi Hunakubo, Mayu Suzuki, Takashi Kataoka, Satoshi Okumura, Norihiro Shinoda, Ken Harada, Bunichi Kato, Masataka Kato, Nobuyuki Marui, Shinichi Sakai, Tetsuya Amano, Toyoaki Murohara
BACKGROUND: Little is known about physiological anticoagulation effects via antithrombin III (AT III) and protein C/S (PC/PS) in patients using new oral anticoagulants (NOACs). METHODS: We evaluated 120 consecutive patients with non-valvular atrial fibrillation (AF) receiving NOACs. Patients were randomly divided into three groups: a dabigatran group (DG, N=40), a rivaroxaban group (RG, N=40) or an apixaban group (AG, N=40). A warfarin group (WG, N=40) was matched with NOAC groups for age, sex and type of AF during the same time period...
April 2017: Journal of Arrhythmia
https://www.readbyqxmd.com/read/28416976/rationale-and-design-of-assaf-k-a-study-of-the-safety-and-efficacy-of-anticoagulant-therapy-in-the-treatment-of-atrial-fibrillation-in-kanagawa
#19
Yutaka Hatori, Hiroyuki Sakai, Tomoyuki Kunishima, Nobuo Hatori, Lin Chen, Tomoaki Ishigami, Naoki Satoh
BACKGROUND: Atrial fibrillation (AF) is one of the most prevalent cardiac arrhythmias associated with substantially increased risks of ischemic stroke and thromboembolism. Oral anticoagulants (OACs) are the cornerstone of AF management and effectively prevent AF-related stroke. As new non-vitamin K antagonist OACs (NOACs) have become available, the landscape of stroke prevention in AF has changed. However, there are considerable gaps between daily clinical practice and current guideline-based recommendations for anticoagulant therapy in Japan...
April 2017: Journal of Arrhythmia
https://www.readbyqxmd.com/read/28416975/effectiveness-and-safety-of-dabigatran-versus-warfarin-in-real-world-japanese-patients-with-atrial-fibrillation-a-single-center-observational-study
#20
Miyoko Naganuma, Tsuyoshi Shiga, Takehiko Nagao, Atsushi Suzuki, Kagari Murasaki, Nobuhisa Hagiwara
BACKGROUND: In "real-world" practice, anticoagulant therapy is indicated for patients whose clinical profiles are not addressed in randomized clinical trials. We assessed the effectiveness and safety of dabigatran versus warfarin in "real-world" Japanese patients with non-valvular atrial fibrillation (NVAF). METHODS: Among 613 NVAF patients who initiated dabigatran or warfarin therapy during the period between 2011 and 2013, 362 patients were included in the study after propensity score adjustment...
April 2017: Journal of Arrhythmia
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