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Anticoagulation in atrial fibrillation

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https://www.readbyqxmd.com/read/28812917/predictive-role-of-cha2ds2-vasc-score-for-cardiovascular-events-and-death-in-patients-with-arterial-hypertension-and-stable-sinus-rhythm
#1
Carmine Mazzone, Giovanni Cioffi, Cosimo Carriere, Giulia Barbati, Giorgio Faganello, Giulia Russo, Antonella Cherubini, Gianfranco Sinagra, Nadia Zeriali, Andrea Di Lenarda
Background The CHA2DS2-VASc score well stratifies the risk for thromboembolic events in non-valvular atrial fibrillation (NVAF) patients. This score may also predict thromboembolic events in sinus rhythm populations. Purpose The purpose of this study was to assess the prognostic role of CHA2DS2-VASc in a Caucasian community population of patients with arterial hypertension and sinus rhythm. Methods A total of 12,599 arterial hypertension residents not receiving anticoagulation were selected from a community population in Trieste between November 2009 and October 2014: 11,159 sinus rhythm and 1440 NVAF patients...
January 1, 2017: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/28811871/do-all-patients-with-atrial-fibrillation-need-long-term-anticoagulation
#2
Munish Sharma, Rohit Masih, Daniel A N Mascarenhas
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide with an estimated number of 2.7-6.1 million cases in the United States (US) alone. The incidence of AF is expected to increase 2.5 fold over the next 50 years in the US. The management of AF is complex and includes mainly three aspects; restoration of sinus rhythm, control of ventricular rate and prevention of systemic thromboembolism. AF as a cause of systemic embolization has been well known for many years, and majority of patients are on oral anticoagulants (OACs) to prevent this...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28811393/analysis-of-geographical-variations-in-the-epidemiology-and-management-of-non-valvular-atrial-fibrillation-results-from-the-ramses-registry
#3
Volkan Doğan, Özcan Başaran, Murat Biteker, Fatma Özpamuk Karadeniz, Ahmet İlker Tekkesin, Yasin Çakıllı, Ceyhan Türkkan, Mehmet Hamidi, Vahit Demir, Mustafa Ozan Gürsoy, Müjgan Tek Öztürk, Gökhan Aksan, Sabri Seyis, Mehmet Ballı, Mehmet Hayri Alıcı, Serdar Bozyel, Cevat Kırma
OBJECTIVE: This study aimed to determine the differences in terms of demographic characteristics and preferred stroke prevention strategies for patients with non-valvular atrial fibrillation living in seven geographical regions of Turkey. METHODS: In total, 6273 patients were enrolled to this prospective, observational RAMSES study. The patients were divided into seven groups based on the geographical region of residence. RESULTS: In terms of the geographical distribution of the overall Turkish population, the highest number of patients were enrolled from Marmara (1677, 26...
August 11, 2017: Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/28811092/direct-oral-anticoagulants-in-patients-with-hypertrophic-cardiomyopathy-and-atrial-fibrillation
#4
Fernando Dominguez, Vicente Climent, Esther Zorio, Tomás Ripoll-Vera, Joel Salazar-Mendiguchía, Jose Manuel García-Pinilla, Jose Angel Urbano-Moral, Xusto Fernández-Fernández, David Lopez-Cuenca, Raquel Ajo-Ferrer, Jorge Sanz-Sanchez, Yolanda Gomez-Perez, Miguel A López-Garrido, Roberto Barriales-Villa, Juan Ramón Gimeno, Pablo Garcia-Pavia
BACKGROUND: Chronic anticoagulation with vitamin K antagonists (VKAs) is recommended in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). Direct oral anticoagulants (NOACs) are an alternative to VKAs but there are limited data to support their use in HCM. We sought to describe the pattern of use, thromboembolic events, bleeding and quality of life in patients with HCM and AF treated with NOACs. METHODS: Data from patients treated with NOACs (n=99) and VKA (n=433) at 9 inherited cardiac diseases units were retrospectively collected...
August 7, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28808519/rectus-sheath-hematoma-associated-with-apixaban
#5
Kulothungan Gunasekaran, Amanda R McFee Winans, Swetha Murthi, Mudassar Raees Ahmad, Scott Kaatz
Apixaban is an oral anticoagulant that directly inhibits Factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in non-valvular atrial fibrillation. Rectus sheath hematoma is a rare, life-threatening complication of anticoagulant treatment. We describe a case of an elderly patient on apixaban for the treatment of deep venous thrombosis who developed severe abdominal pain during hospitalization. Computed tomography of the abdomen revealed left rectus sheath hematoma...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28807511/prevalence-and-predictors-of-inappropriate-anticoagulation-in-patients-with-a-cha2ds2-vasc-score-of-0-and-atrial-fibrillation
#6
Sepehr Saberian, Auroa Badin, Vince Siebert, Ashish Roy, Sandeep Banga, Harshavardhan R Ghadiam, Rebecca R Wigant, Ashim Aggarwal, Timir S Baman
BACKGROUND: Previous studies have shown underutilization of anticoagulation therapy in patients with atrial fibrillation and a CHA2DS2-VASc score ≥2; however there exists little data regarding the inappropriate use of anticoagulation in patients with a CHA2DS2-VASc score of 0. We aimed to determine the true prevalence and predictors of inappropriate anticoagulation therapy in patients with atrial fibrillation and a CHA2DS2-VASc score of 0. METHODS: A retrospective chart review was performed on all patients with atrial fibrillation and a CHA2DS2-VASc score of 0 in our institution from January 2009 to January 2016...
August 2, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28806993/successful-intravenous-thrombolysis-for-ischemic-stroke-after-reversal-of-dabigatran-anticoagulation-with-idarucizumab-a-case-report
#7
Sergio Agosti, Laura Casalino, Enrico Rocci, Gabriele Zaccone, Eugenia Rota
BACKGROUND: Non-vitamin K antagonist oral anticoagulants, including dabigatran, are currently widely used for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Recently, idarucizumab, a monoclonal antibody fragment for immediate reversal of dabigatran-induced anticoagulation, has been introduced into the market to be used in life-threatening bleeding or urgent surgery, allowing for rapid normalization of clotting parameters. The use of idarucizumab is not yet well established in patients presenting with acute ischemic stroke on dabigatran who are candidates for thrombolytic therapy...
August 15, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28805957/stroke-or-left-atrial-thrombus-prediction-using-antithrombin-iii-and-mean-platelet-volume-in-patients-with-nonvalvular-atrial-fibrillation
#8
Seo-Won Choi, Bo-Bae Kim, Dong-Hyun Choi, Geon Park, Byung Chul Shin, Heesang Song, DongHun Kim, Dong-Min Kim
BACKGROUND: CHADS2 (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke) and CHA2 DS2 -VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke, vascular disease, age 65 to 74 years, sex category) scores showed just moderate discrimination ability in predicting thromboembolic complications in patients with nonvalvular atrial fibrillation (AF). HYPOTHESIS: To determine the association of antithrombin III (AT-III) deficiency and mean platelet volume (MPV) with the development of stroke or left atrial (LA) thrombus in patients with AF...
August 14, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28805310/use-of-direct-oral-anticoagulants-for-stroke-prevention-in-elderly-patients-with-nonvalvular-atrial-fibrillation
#9
Lynn B Oertel, Annemarie E Fogerty
BACKGROUND AND PURPOSE: Four direct oral anticoagulants (DOACs) are available for the prevention of stroke in nonvalvular atrial fibrillation (NVAF): dabigatran (a direct thrombin inhibitor); and rivaroxaban, apixaban, and edoxaban (factor Xa inhibitors). This article summarizes the safety and efficacy of DOACs for the prevention of stroke in elderly NVAF patients. METHODS: PubMed was searched to identify published results of randomized, controlled trials evaluating DOACs for stroke prevention in elderly NVAF patients...
August 14, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/28805299/dissociation-between-the-pharmacokinetics-and-pharmacodynamics-of-once-daily-rivaroxaban-and-twice-daily-apixaban-a-randomized-crossover-study
#10
Reinhold Kreutz, Pontus B Persson, Dagmar Kubitza, Kirstin Thelen, Stefan Heitmeier, Stephan Schwers, Michael Becka, Melanie Hemmrich
BACKGROUND: The anticoagulant actions of the oral direct factor Xa inhibitors, rivaroxaban and apixaban, have not previously been directly compared. OBJECTIVES: To compare directly the steady-state pharmacokinetics and anticoagulant effects of rivaroxaban and apixaban at doses approved for stroke prevention in nonvalvular atrial fibrillation. METHODS: Twenty-four healthy Caucasian male volunteers were included in this open-label, two-period crossover, phase 1 study (EudraCT number: 2015-002612-32)...
August 14, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28803520/probable-rivaroxaban-induced-full-body-rash-a-case-report
#11
Evan Sasson, Marian James, Mark Russell, Darko Todorov, Henry Cohen
INTRODUCTION: Rivaroxaban is a novel oral anticoagulant with several indications, one of which is for stroke prevention in nonvalvular atrial fibrillation. We present a case of probable rivaroxaban-induced rash. CASE SUMMARY: A 79-year-old female with a medical history of atrial fibrillation experienced a stroke, after which she was prescribed rivaroxaban 20 mg. After several days, she developed a rash requiring admission to the emergency department and several days of treatment...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28803231/in-potential-stroke-patients-on-warfarin-the-international-normalized-ratio-predicts-ischemia
#12
Cathy Cao, Ashley Martinelli, Brian Spoelhof, Rafael H Llinas, Elisabeth B Marsh
BACKGROUND: Stroke can occur in patients on warfarin despite anticoagulation. Patients with a low international normalized ratio (INR) should theoretically be at greater risk for ischemia than those who are therapeutic. Therefore, INR may be able to indicate whether new neurological deficits are more likely strokes or stroke mimics in patients on warfarin. This study evaluates the association and predictive value of INR in determining the likelihood of ischemia. METHODS: Patients were identified using the acute stroke registry at a Primary Stroke Center from January 2013 through December 2014...
August 11, 2017: Cerebrovascular Diseases Extra
https://www.readbyqxmd.com/read/28803036/relationship-between-atrial-fibrillation-and-cognitive-decline-in-individuals-aged-80-and-older-a-narrative-review
#13
REVIEW
Marco Proietti, Angela Recchia, Emma Riva, Ugo Lucca, Mauro Tettamanti, Pier Mannuccio Mannucci, Alessandro Nobili
BACKGROUND: Atrial fibrillation (AF) and dementia are largely prevalent and incident in progressively older subjects, suggesting a link between the two conditions. While in the general population there are several findings supporting a causal relationship between AF and dementia, it is unclear whether or not this association is still present in individuals aged 80 and older. RESULTS: So far, the few studies that analysed this issue did not provide enough evidence supporting the causative role of AF in increasing the risk of cognitive decline or dementia in patients aged 80 and older...
August 9, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28802808/novel-oral-anticoagulants-in-direct-current-cardioversion-for-atrial-fibrillation
#14
Giuseppe Femia, Taufik Fetahovic, Pratap Shetty, Astin Lee
BACKGROUND: For some patients with atrial fibrillation, direct current cardioversion (DCCV) is one strategy that can be used to establish sinus rhythm but appropriate anticoagulation is mandatory to prevent thromboembolic events. Historically, patients were anticoagulated with warfarin with bridging with unfractionated or low molecular weight heparin, however, recently novel oral anticoagulants (NOACs), apixaban, dabigatran and rivaroxaban have become more popular. Despite the increase in use, real world data on safety and efficacy is limited...
July 17, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28800833/bleeding-risk-scores-in-atrial-fibrillation-and-venous-thromboembolism
#15
REVIEW
Hanis Zulkifly, Gregory Y H Lip, Deirdre A Lane
Patients receiving oral anticoagulant (OAC) therapy for stroke prevention in atrial fibrillation (AF) and prevention of venous thromboembolism (VTE) face an increased risk of bleeding with OAC treatment. Clinicians need to weigh the benefits of OAC treatment against the risk of bleeding. To help formalize bleeding risk assessment, various bleeding risk scores have been developed to help predict the risk of bleeding in AF and VTE patients receiving OAC therapy. This review summarizes the literature involving original studies deriving bleeding risk scores and validation studies of these scores for stroke prevention in AF and treatment/prevention of VTE...
July 14, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28800176/catheter-ablation-of-left-atrial-arrhythmias-on-uninterrupted-oral-anticoagulation-with-vitamin-k-antagonists-how-is-the-relationship-between-international-normalized-ratio-activated-clotting-time-and-procedure-related-complications
#16
Marc Kottmaier, Felix Bourier, Verena Semmler, Martha Telishevska, Katharina Koch-Büttner, Carsten Lennerz, Sarah Lengauer, Marielouise Kornmayer, Elena Rousseva, Stephanie Brooks, Amir Brkic, Christian Grebmer, Christoph Kolb, Gabriele Hessling, Isabel Deisenhofer, Tilko Reents
BACKGROUND: Ablation of atrial fibrillation (AF) on uninterrupted phenprocoumon reduces periprocedural thromboembolic and bleeding complications. Heparin is administered intraprocedurally to achieve activated clotting times (ACT) of 300-400 seconds. We investigated the effect of international normalized ratio (INR) on ACT and intraprocedural heparin requirements. Moreover, safety of a target ACT of 250-300 seconds was investigated. METHODS AND RESULTS: We studied 949 patients referred for AF or left atrial tachycardia ablation...
August 11, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28799998/use-of-direct-oral-anticoagulants-for-treatment-of-atrial-fibrillation-in-patients-with-hiv-a-review
#17
Timothy A West, Jacinta Perram, Cameron J Holloway
PURPOSE OF REVIEW: Atrial fibrillation is increasingly common in the ageing population. Patients with atrial fibrillation and HIV have a higher stroke risk, with guidelines recommending anticoagulation in the majority. Whilst anticoagulation options have diversified in the last decade for the general population, there is limited evidence for the safety and efficacy of these medications when used concurrently with antiretroviral therapy. We review the potential for patients with HIV on antiretroviral therapy to have direct-acting oral anticoagulations (DOACs)...
August 10, 2017: Current Opinion in HIV and AIDS
https://www.readbyqxmd.com/read/28799620/long-term-bleeding-risk-prediction-in-real-world-patients-with-atrial-fibrillation-comparison-of-the-has-bled-and-abc-bleeding-risk-scores-the-murcia-atrial-fibrillation-project
#18
María Asunción Esteve-Pastor, José Miguel Rivera-Caravaca, Vanessa Roldan, Vicente Vicente, Mariano Valdés, Francisco Marín, Gregory Y H Lip
Risk scores in patients with atrial fibrillation (AF) based on clinical factors alone generally have only modest predictive value for predicting high risk patients that sustain events. Biomarkers might be an attractive prognostic tool to improve bleeding risk prediction. The new ABC-Bleeding score performed better than HAS-BLED score in a clinical trial cohort but has not been externally validated. It was the aim of this study to compare the predictive performance of the ABC-Bleeding score compared to HAS-BLED score in an independent "real-world" anticoagulated AF patients with long-term follow-up...
August 11, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28799449/the-impact-of-the-latest-echocardiographic-chamber-quantification-recommendations-on-the-prediction-of-left-atrial-appendage-thrombus-presence-by-transthoracic-echocardiography
#19
Karolina Kupczynska, Jaroslaw D Kasprzak, Blazej W Michalski, Dawid L Miskowiec, Piotr Lipiec
INTRODUCTION: The latest recommendations for echocardiographic chamber quantification have implemented updated normal values for all cardiac chambers. PURPOSE: To evaluate the incidence of normal and abnormal values of routine echocardiographic parameters such as left ventricular ejection fraction (LVEF) and left atrial volume indexed to body surface area (LAVi) in patients with non-valvular atrial fibrillation (AF) and to determine the influence of LVEF and LAVi reclassification on the prediction of LAAT by transthoracic echocardiography...
August 11, 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28799408/assessment-of-apixaban-prescribing-patterns-for-nonvalvular-atrial-fibrillation-in-hospitalized-patients
#20
Caitlin M Gibson, Carmen B Smith, Sondra Davis, Michael J Scalese
BACKGROUND: Apixaban is a direct oral anticoagulant (DOAC) for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). Other DOACs require renal dose adjustments based solely on creatinine clearance. Apixaban differs in that its dose adjustments are more complex, potentially leading to prescribing errors. OBJECTIVE: To determine if adherence to Food and Drug Administration (FDA)-approved dosing for apixaban is maintained in hospitalized patients with NVAF...
August 1, 2017: Annals of Pharmacotherapy
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