3,310 results match your criteria Stroke Anticoagulation and Prophylaxis


Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation is Achievable: First Results from Get With The Guidelines-Atrial Fibrillation (GWTG-AFIB).

Circulation 2019 Jan 31. Epub 2019 Jan 31.

Heart and Vascular Center, MetroHealth System Campus, Case Western Reserve University, United States.

Background: Efforts to improve oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) have had limited success in improving guideline adherence.

Methods: We evaluated adherence to the ACC/AHA performance measures for OAC in eligible patients with a CHA2DS2-VASc≥2 and trends in prescription over time in the American Heart Association's Get With The Guidelines (GWTG) AFIB registry. Adjusted associations with in-hospital outcomes were also determined. Read More

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https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.0
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http://dx.doi.org/10.1161/CIRCULATIONAHA.118.035909DOI Listing
January 2019
5 Reads
14.430 Impact Factor

Dementia: new vistas and opportunities.

Neurol Sci 2019 Jan 21. Epub 2019 Jan 21.

Department of Clinical Neurological Sciences, Western University, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.

Over the past four decades, Alzheimer disease has become near synonymous with dementia and the amyloid/tau hypothesis as its dominant explanation. However, this monorail approach to etiology has failed to yield a single disease-modifying drug. Part of the explanation stems from the fact that most dementias in the elderly result from interactive Alzheimer and cerebrovascular pathologies. Read More

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http://dx.doi.org/10.1007/s10072-019-3714-1DOI Listing
January 2019

Cardiac Sarcoidosis as an Uncommon Etiology for Posterior Circulation Stroke Presenting with Alexia without Agraphia.

Case Rep Neurol Med 2018 17;2018:3418465. Epub 2018 Dec 17.

Department of Neurology, Inova Fairfax Hospital, Falls Church, VA, USA.

Sarcoidosis is a systemic disease with cardiac involvement occurring in 20-50% of cases. Cardiogenic stroke caused by cardiac sarcoidosis, especially PCA infarction, is a rare clinical presentation that necessitates timely diagnosis and may warrant treatment prophylaxis against CVA. In this case report, we describe a 54-year-old Caucasian male presenting with left PCA stroke in the setting of cardiac and pulmonary sarcoidosis, and hypertension. Read More

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https://www.hindawi.com/journals/crinm/2018/3418465/
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http://dx.doi.org/10.1155/2018/3418465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311803PMC
December 2018
7 Reads

The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting.

Medicina (Kaunas) 2019 Jan 15;55(1). Epub 2019 Jan 15.

Department of Family medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.

Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. : This was a retrospective study conducted in nine primary health care centres in Lithuania. Read More

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http://dx.doi.org/10.3390/medicina55010015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6359001PMC
January 2019

Prestroke and Poststroke Antithrombotic Therapy in Patients With Atrial Fibrillation: Results From a Nationwide Cohort.

JAMA Netw Open 2018 May 18;1(1):e180171. Epub 2018 May 18.

Department of Cardiology, University Hospital of Copenhagen, Copenhagen, Denmark.

Importance: Antithrombotic therapies are effective in both primary and secondary stroke prophylaxis in high-risk patients with atrial fibrillation (AF), but they are often underused in community practice.

Objective: To examine prestroke and poststroke antithrombotic treatment patterns and long-term outcomes in patients with AF presenting with ischemic stroke.

Design, Setting, And Participants: A retrospective cohort study of Danish patients with AF, with a prestroke CHA2DS2-VASc score of 1 or higher for men and 2 or higher for women, and presenting with ischemic stroke was conducted from January 1, 2004, to January 31, 2017. Read More

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https://jamanetwork.com/article.aspx?doi=10.1001/jamanetwork
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http://dx.doi.org/10.1001/jamanetworkopen.2018.0171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324317PMC
May 2018
4 Reads

[Making balances between the risks and benefits of pharmacological treatment in dementia, chronic pain and anticoagulation in elderly persons].

Aten Primaria 2018 Nov;50 Suppl 2:39-50

Grupo de Trabajo de Neurología, Sección Demencias de la semFYC.

In dementia, specific drugs and psychotropic drugs used for psychotic and behavioral symptoms have limited efficacy. Adverse effects may be important given the age and comorbidity of the patients. It is necessary, frequently, its withdrawal, planned together with the family, monitoring the response and offering non-pharmacological treatment alternatives. Read More

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http://dx.doi.org/10.1016/j.aprim.2018.09.003DOI Listing
November 2018
2 Reads

Abstract 4: Safety of Intravenous Thrombolysis Among Patients Taking Direct Oral Anticoagulants: A Systematic Review and Meta-analysis.

Stroke 2018 Jan;49(Suppl_1):A4

Dept of Neurology, Danville, PA.

Introduction: Direct oral anticoagulants (DOACs) are increasingly being administered for atrial fibrillation and stroke prevention. The risk of symptomatic hemorrhagic transformation (sHT) following intravenous thrombolysis (IVT) among stroke patients who take DOACs is not clear.

Methods: We conducted a systematic review of literature through six different resources-PubMed, Scopus, Embase, Clinicaltrial. Read More

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http://dx.doi.org/10.1161/str.49.suppl_1.4DOI Listing
January 2018
1 Read

Quality of Anticoagulation and Treatment Satisfaction in Patients with Non-Valvular Atrial Fibrillation Treated with Vitamin K Antagonist: Result from the KORean Atrial Fibrillation Investigation II.

J Korean Med Sci 2018 Dec 21;33(49):e323. Epub 2018 Nov 21.

Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

Background: Vitamin K antagonist (VKA) to prevent thromboembolism in non-valvular atrial fibrillation (NVAF) patients has limitations such as drug interaction. This study investigated the clinical characteristics of Korean patients treated with VKA for stroke prevention and assessed quality of VKA therapy and treatment satisfaction.

Methods: We conducted a multicenter, prospective, non-interventional study. Read More

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http://dx.doi.org/10.3346/jkms.2018.33.e323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262187PMC
December 2018
1 Read

Is it safe to stop oral anticoagulation after catheter ablation for atrial fibrillation?

Expert Rev Cardiovasc Ther 2019 Jan 18;17(1):31-41. Epub 2018 Dec 18.

a Department of Cardiology , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , NY , USA.

Introduction: Atrial fibrillation is the most common arrhythmia worldwide. Its increasing prevalence has made the use of oral anticoagulants for stroke prevention routine; however, their use after the blanking period of catheter ablation remains uncertain. Areas covered: This review outlines the pros and cons of stopping oral anticoagulation after catheter ablation. Read More

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http://dx.doi.org/10.1080/14779072.2019.1550718DOI Listing
January 2019
2 Reads

Warfarin and the Risk of Death, Stroke, and Major Bleeding in Patients With Atrial Fibrillation Receiving Hemodialysis: A Systematic Review and Meta-Analysis.

Front Pharmacol 2018 6;9:1218. Epub 2018 Nov 6.

Department of Clinical Pharmacy, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Up to date, the efficacy and safety of warfarin treatment in atrial fibrillation patients receiving hemodialysis remain controversial. So we performed this meta-analysis to try to offer recommendations regarding warfarin management in this population. We searched Pubmed, Embase, and Cochrane library and reviewed relevant reference lists from 1980 to March 2018. Read More

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http://dx.doi.org/10.3389/fphar.2018.01218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232383PMC
November 2018
8 Reads

The Role of Double and Triple Therapy with Direct Oral Anticoagulants in Coronary Artery Disease, Peripheral Artery Disease, and Stroke.

Clin Ther 2018 Nov 24;40(11):1907-1917.e3. Epub 2018 Oct 24.

Brigham and Women's Hospital, Boston, MA, USA.

Purpose: Combining antiplatelet and anticoagulant therapy is often necessary in clinical practice. However, there is limited literature on tolerability and efficacy for triple therapy with the newer direct oral anticoagulants (DOACs). The objective of this study is to characterize the discharge prescribing practice of double versus triple antithrombotic therapy with a DOAC at a large, tertiary academic medical center. Read More

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http://dx.doi.org/10.1016/j.clinthera.2018.09.014DOI Listing
November 2018
14 Reads

Advances in Stroke Prevention.

Authors:
J David Spence

J Transl Int Med 2018 Sep 9;6(3):105-114. Epub 2018 Oct 9.

Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Canada.

There have been recent advances in stroke prevention in nutrition, blood pressure control, antiplatelet therapy, anticoagulation, identification of high-risk asymptomatic carotid stenosis, and percutaneous closure of patent foramen ovale. There is evidence that the Mediterranean diet significantly reduces the risk of stroke and that B vitamins lower homocysteine, thus preventing stroke. The benefit of B vitamins to lower homocysteine was masked by harm from cyanocobalamin among study participants with impaired renal function; we should be using methylcobalamin instead of cyanocobalamin. Read More

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http://dx.doi.org/10.2478/jtim-2018-0024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231304PMC
September 2018
2 Reads

[Risk factors for hypertensive and cerebral amyloid angiopathy associated intracerebral hemorrhage: a retrospective comparison].

Fortschr Neurol Psychiatr 2018 Dec 12;86(12):763-769. Epub 2018 Nov 12.

Klinik für Neurologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland.

Introduction: The aim of this study was to compare possible risk factors for the most common forms of spontaneous intracerebral hemorrhage (ICH), namely hypertensive and cerebral amyloid angiopathy (CAA) associated ICH.

Methods: Retrospectively, different parameters and factors were compared in patients with hypertensive ICH (n = 141) and patients with a CAAassociated ICH (n = 95). These included age, INR value and blood pressure at admission, cardiovascular risk factors as well as pre-medication. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/a-0732-5523
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http://dx.doi.org/10.1055/a-0732-5523DOI Listing
December 2018
10 Reads

2018 Korean Guideline of Atrial Fibrillation Management.

Korean Circ J 2018 Dec;48(12):1033-1080

Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical College, Seoul, Korea.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population. The Korean Heart Rhythm Society organized a Korean AF Management Guideline Committee and analyzed all available studies regarding the management of AF, including studies on Korean patients. This guideline is based on recent data of the Korean population and the recent guidelines of the European Society of Cardiology, European Association for Cardio-Thoracic Surgery, American Heart Association, and Asia Pacific Heart Rhythm Society. Read More

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https://synapse.koreamed.org/DOIx.php?id=10.4070/kcj.2018.03
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http://dx.doi.org/10.4070/kcj.2018.0339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221873PMC
December 2018
6 Reads

Delayed presentation of pulmonary artery perforation by an Amulet left atrial appendage closure device.

BMJ Case Rep 2018 Nov 3;2018. Epub 2018 Nov 3.

Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.

Left atrial appendage occlusion (LAAO) devices offer stroke prevention in atrial fibrillation for patients intolerant of anticoagulation. Device placement leading to bleeding and cardiac tamponade have been reported periprocedurally but delayed presentations have not been reported in the literature. We present the case of an Amulet LAAO device causing erosion and bleeding from the main pulmonary artery that presented with cardiac tamponade 6 months after device placement. Read More

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http://dx.doi.org/10.1136/bcr-2018-227098DOI Listing
November 2018
2 Reads

International Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines--Stroke Program.

J Am Heart Assoc 2018 Oct;7(20):e010623

1 Department of Neurology Duke University Medical Center Durham NC.

Background Adherence to evidence-based guidelines is an important quality indicator; yet, there is lack of assessment of adherence to performance measures in acute ischemic stroke for most world regions. Methods and Results We analyzed 19 604 patients with acute ischemic stroke in the China National Stroke Registry and 194 876 patients in the Get With The Guidelines--Stroke registry in the United States from June 2012 to January 2013. Compared with their US counterparts, Chinese patients were younger, had a lower prevalence of comorbidities, and had similar median, lower mean, and less variability in National Institutes of Health Stroke Scale (median 4 [25th percentile-75th percentile, 2-7], mean 5. Read More

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https://www.ahajournals.org/doi/10.1161/JAHA.118.010623
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http://dx.doi.org/10.1161/JAHA.118.010623DOI Listing
October 2018
15 Reads
2.882 Impact Factor

Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT-AF.

J Am Heart Assoc 2018 Sep;7(18):e008928

2 Duke Clinical Research Institute Durham NC.

Background Chronic kidney disease ( CKD ) is a common comorbidity in patients with atrial fibrillation. The presence of CKD complicates drug selection for stroke prevention and rhythm control. Methods and Results Patients enrolled in ORBIT AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) with baseline renal function and follow-up data were included (N=9019). Read More

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https://www.ahajournals.org/doi/10.1161/JAHA.118.008928
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http://dx.doi.org/10.1161/JAHA.118.008928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222961PMC
September 2018
8 Reads
2.882 Impact Factor

Patient Satisfaction with Direct Oral Anticoagulants and Warfarin.

Int Heart J 2018 Nov 25;59(6):1266-1274. Epub 2018 Oct 25.

Division of Cardiology, Nihon University Itabashi Hospital.

The burden of anticoagulation treatment affects patient satisfaction, which in turn affects adherence to treatment. Thus, we must thoroughly understand the advantages of direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs)/warfarin given for stroke prevention in patients with atrial fibrillation (AF). We compared satisfaction with anticoagulation therapy between 654 DOAC and 821 warfarin users enrolled in the SAKURA AF Registry. Read More

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http://dx.doi.org/10.1536/ihj.17-649DOI Listing
November 2018
9 Reads

Current and emerging pharmacotherapy for ischemic stroke prevention in patients with atrial fibrillation.

Expert Opin Pharmacother 2018 Oct 25:1-11. Epub 2018 Oct 25.

a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK.

Introduction: Atrial fibrillation (AF) is associated with high morbidity and mortality rates due to thromboembolic complications, and anticoagulation is central to the management of this common arrhythmia to prevent acute thromboembolic events. The traditional anticoagulants: heparin, fondaparinux, and vitamin K antagonists (VKA, e.g. Read More

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https://www.tandfonline.com/doi/full/10.1080/14656566.2018.1
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http://dx.doi.org/10.1080/14656566.2018.1537368DOI Listing
October 2018
8 Reads

Use of Oral Anticoagulation in Eligible Patients Discharged With Heart Failure and Atrial Fibrillation.

Circ Heart Fail 2018 Oct;11(10):e005356

Division of Cardiovascular Medicine, University of California (Davis) Medical Center, Sacramento (N.L.).

Background: Stroke prophylaxis in patients with atrial fibrillation (AF) and heart failure (HF) in the era of direct oral anticoagulants is not well characterized. Using data from American Heart Association Get With The Guidelines-AFIB, we sought to evaluate oral anticoagulation (OAC) use at discharge among AF patients with concomitant HF.

Methods And Results: AF patients with a diagnosis of HF hospitalized from January 2013 to March 2017 were included. Read More

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https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.118
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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.118.005356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319668PMC
October 2018
6 Reads
5.891 Impact Factor

Risk of Thromboembolism Associated With Atrial Fibrillation Following Noncardiac Surgery.

J Am Coll Cardiol 2018 Oct;72(17):2027-2036

Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Background: The long-term risk of thromboembolism in patients developing new-onset post-operative atrial fibrillation (POAF) following noncardiac surgery is unknown, and data on stroke prophylaxis in this setting are lacking.

Objectives: The purpose of this study was to assess the long-term risk of thromboembolism in patients developing new-onset POAF following noncardiac surgery relative to patients with nonsurgical, nonvalvular atrial fibrillation (NVAF).

Methods: Using Danish nationwide registries, the authors identified all patients who developed POAF following noncardiac surgery from 1996 to 2015. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S07351097183707
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http://dx.doi.org/10.1016/j.jacc.2018.07.088DOI Listing
October 2018
10 Reads

Management of atrial fibrillation: easy as ABC.

Minerva Med 2019 Feb 11;110(1):27-34. Epub 2018 Oct 11.

Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK -

Atrial fibrillation (AF) is the commonest sustained arrhythmia with increasing incidence worldwide. AF is a major cause of morbidity (resulting from heart failure, stroke and hospitalization) and mortality. The aim of primary and specialist care is to improve patient outcome through early detection of AF and optimal clinical management. Read More

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https://www.minervamedica.it/index2.php?show=R10Y9999N00A181
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http://dx.doi.org/10.23736/S0026-4806.18.05824-XDOI Listing
February 2019
10 Reads

Stroke prevention within primary care: management of atrial fibrillation using oral anticoagulation.

Sao Paulo Med J 2018 Jul-Aug;136(4):273-275

MD, DrPH. Full Professor, Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil.

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http://www.scielo.br/scielo.php?script=sci_arttext&pid=S
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http://dx.doi.org/10.1590/1516-3180.2018.1364110718DOI Listing
December 2018
2 Reads

Atrial fibrillation and chronic kidney disease: A review of options for therapeutic anticoagulation to reduce thromboembolism risk.

Clin Cardiol 2018 Oct 25;41(10):1395-1402. Epub 2018 Oct 25.

Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York.

Atrial fibrillation and chronic kidney disease (CKD) commonly occur together, which poses a therapeutic dilemma due to increased risk of both systemic thromboembolism and bleeding. Chronic kidney disease also has implications for medication selection. The objective of this review is to evaluate the options for anticoagulation for thromboembolism prevention in patients with atrial fibrillation and chronic kidney disease. Read More

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http://doi.wiley.com/10.1002/clc.23085
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http://dx.doi.org/10.1002/clc.23085DOI Listing
October 2018
6 Reads

Stroke prevention in atrial fibrillation: State of the art.

Int J Cardiol 2018 Sep 19. Epub 2018 Sep 19.

Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom; Department of Cardiology, Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, China; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address:

Stroke prevention is the cornerstone of the management of patients with atrial fibrillation (AF). Individual stroke risk stratification is generally the first step of deciding whether oral anticoagulation (OAC) will benefit patients with AF. Given that existing approaches to the prediction of 'high-risk' subjects are of limited value, the initial focus should be the identification of 'low-risk' patients who do not need antithrombotic therapy. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S01675273183217
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http://dx.doi.org/10.1016/j.ijcard.2018.09.057DOI Listing
September 2018
12 Reads

The cessation of oral anticoagulation following left atrial appendage surgery.

Future Cardiol 2018 09 20;14(5):407-415. Epub 2018 Sep 20.

NHLI Cardiothoracic Surgery, B Block BN2/15, Hammersmith Hospital Campus, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, England.

Atrial fibrillation is associated with a significantly increased risk of stroke, and oral anticoagulation is the mainstay of preventative treatment. Scenarios arise where the risks of treatment with oral anticoagulation may outweigh the benefits, most commonly when there is an elevated risk of bleeding. Studies of percutaneous closure of the left atrial appendage have strongly implicated this structure in the etiology of stroke in atrial fibrillation, and provide some rationale for the discontinuation of oral anticoagulation following percutaneous closure device implantation. Read More

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http://dx.doi.org/10.2217/fca-2018-0010DOI Listing
September 2018
4 Reads

Management of Venous Sinus Thrombosis.

Neurosurg Clin N Am 2018 Oct;29(4):585-594

Adult Hydrocephalus Program, Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Adult Hydrocephalus Clinical Research Network, Foothills Hospital, 12th Floor, 1403 - 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada. Electronic address:

Cerebral venous sinus thrombosis (CVST) is a rare subtype of cerebrovascular disease representing 0.5% of strokes. The signs and symptoms of CVST are often nonspecific, and variable in duration, with the common results being delayed diagnosis and treatment. Read More

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http://dx.doi.org/10.1016/j.nec.2018.06.011DOI Listing
October 2018
3 Reads
1.542 Impact Factor

INR Control of Patients with Mechanical Heart Valve on Long-Term Warfarin Therapy.

Glob Heart 2018 12 10;13(4):241-244. Epub 2018 Sep 10.

Department of Cardiology, Sarawak Heart Centre, Kota Samarahan, Sarawak, Ministry of Health, Malaysia.

Background: Warfarin is an anticoagulant indicated for patients who had undergone mechanical heart valve(s) replacement (MHVR). In these patients, time in therapeutic range (TTR) is important in predicting the bleeding and thrombotic risks.

Objective: This study aimed to describe the anticoagulation control of warfarin using TTR in patients with MHVR in a tertiary health care referral Center. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S22118160183013
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http://dx.doi.org/10.1016/j.gheart.2018.08.003DOI Listing
December 2018
12 Reads

Triple antithrombotic therapy in patients with atrial fibrillation undergoing PCI: current evidence and practice.

Expert Rev Cardiovasc Ther 2018 Oct 20;16(10):715-723. Epub 2018 Sep 20.

c Division of Cardiology, Department of Medicine , University Hospital Limerick, Graduate Entry Medical School (GEMS), University of Limerick , Limerick , Ireland.

Introduction: Patients with atrial fibrillation taking oral anticoagulation and undergoing percutaneous coronary intervention with stent insertion are recommended to receive antithrombotic therapy with aspirin and P2Y receptor antagonist. This combinatory regime encompasses triple therapy (TT). Although TT reduces the risk of ischemic events such as stroke and stent thrombosis, it is associated with an increased bleeding risk. Read More

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https://www.tandfonline.com/doi/full/10.1080/14779072.2018.1
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http://dx.doi.org/10.1080/14779072.2018.1521721DOI Listing
October 2018
17 Reads

Anticoagulation in the cardiac patient: A concise review.

Eur J Haematol 2019 Jan 14;102(1):3-19. Epub 2018 Nov 14.

The Division of Hematology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.

Anticoagulation has multiple roles in the treatment of cardiovascular disease, including in management of acute myocardial infarction, during percutaneous coronary intervention, as stroke prophylaxis in patients with atrial arrhythmias, and in patients with mechanical heart valves. Clinical anticoagulation choices in the aforementioned diseases vary widely, due to conflicting data to support established agents and the rapid evolution of evidence-based practice that parallels more widespread use of novel oral anticoagulants. This review concisely summarizes evidence-based guidelines for anticoagulant use in cardiovascular disease, and highlights new data specific to direct oral anticoagulants. Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1111/ejh.13171
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http://dx.doi.org/10.1111/ejh.13171DOI Listing
January 2019
9 Reads

When are the cardiovascular and stroke risks too high? Pharmacotherapy for stroke prophylaxis.

Expert Opin Pharmacother 2018 Sep 8;19(13):1427-1440. Epub 2018 Sep 8.

b UGC de Cardiología y Cirugía Cardiovascular , Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria , Málaga , Spain.

Introduction: Stroke is a significant source of morbidity and mortality in developed countries. Cardioembolic strokes represent approximately 15-30% of all ischemic strokes. They are frequently related to atrial fibrillation (AF) and have a worse prognosis and high recurrence rates when compared to other causes (e. Read More

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https://www.tandfonline.com/doi/full/10.1080/14656566.2018.1
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http://dx.doi.org/10.1080/14656566.2018.1511703DOI Listing
September 2018
9 Reads

The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: Rationale and methods.

Int J Stroke 2019 Feb 10;14(2):207-214. Epub 2018 Sep 10.

13 Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.

Rationale: Recent data suggest that a thrombogenic atrial substrate can cause stroke in the absence of atrial fibrillation. Such an atrial cardiopathy may explain some proportion of cryptogenic strokes.

Aims: The aim of the ARCADIA trial is to test the hypothesis that apixaban is superior to aspirin for the prevention of recurrent stroke in subjects with cryptogenic ischemic stroke and atrial cardiopathy. Read More

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http://dx.doi.org/10.1177/1747493018799981DOI Listing
February 2019
4 Reads

[Catheter-based atrial appendage closure-current data and future developments].

Internist (Berl) 2018 Oct;59(10):1028-1040

Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12003, Berlin, Deutschland.

In Germany more than 1.6 million patients suffer from atrial fibrillation (AF). Within the next decades this number will substantially increase due to current demographic trends with the increasing average age of the population. Read More

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http://link.springer.com/10.1007/s00108-018-0483-5
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http://dx.doi.org/10.1007/s00108-018-0483-5DOI Listing
October 2018
15 Reads

Non-vitamin-K oral anticoagulants (NOACs) for the prevention of secondary stroke.

Expert Opin Pharmacother 2018 Oct 17;19(14):1597-1602. Epub 2018 Sep 17.

d Department of Neurology , University of California-San Francisco , San Francisco , CA , USA.

Introduction: In patients with atrial fibrillation (AF), oral anticoagulation with vitamin K antagonists (VKA) (warfarin, phenprocoumon) is effective both for primary and secondary stroke prevention with a 60-70% relative reduction in stroke risk compared with placebo. Mortality is reduced by 26%. VKA have a number of well-documented shortcomings which were overcome by non-vitamin-K oral anticoagulants (NOACs). Read More

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http://dx.doi.org/10.1080/14656566.2018.1515913DOI Listing
October 2018
1 Read

Comparison of Stroke Outcomes of Hub and Spoke Hospital Treated Patients in Mayo Clinic Telestroke Program.

J Stroke Cerebrovasc Dis 2018 Nov 23;27(11):2940-2942. Epub 2018 Aug 23.

Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN; Health Sciences Research, Mayo Clinic, Scottsdale, AZ.

Purpose: To examine telemedicine as it applies to acute ischemic stroke care at a spoke hospital and the effect on patient outcomes, including the timeliness of response, quality of care, safety, morbidity, and mortality when compared to standard hub hospital stroke center care.

Methods: Retrospective review of prospectively entered quality/performance stroke/telestroke patient catalog data were completed for 1000 adult patients who presented with an acute ischemic stroke to the Mayo Clinic Hospitals (500 patients) or to one of thirteen Mayo Clinic affiliated telestroke spoke hospitals in the regions (500 patients). The primary outcome of interest was the percentage of accurate decision making for eligibility of IV alteplase administration assessed by blinded adjudication and the secondary outcomes pertained to complications, discharge parameters, and standard quality metrics. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10523057183034
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.06.024DOI Listing
November 2018
15 Reads

Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness.

N Engl J Med 2018 Sep 26;379(12):1118-1127. Epub 2018 Aug 26.

From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institute for Medical Research, and the Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital (A.C.S.), and the Cardiovascular Institute, Mount Sinai Medical Center (J.L.H.) - all in New York; the Department of Medicine and Surgery, University of Insubria, Varese, Italy (W.A.); the Stanford Stroke Center, Stanford University Medical Center, Stanford (G.W.A.), and the University of California at Davis, Sacramento (G.A.M.) - both in California; the Department of Medicine, Intermountain Medical Center, and Department of Medicine, University of Utah, Salt Lake City (C.G.E.); Division of Cardiology, University of Colorado School of Medicine, and CPC Clinical Research, Aurora (W.R.H.); Département Hospitalo-Universitaire FIRE (Fibrose Inflammation Remodelage), University Paris Diderot, Assistance Publique-Hôpitaux de Paris, and INSERM Unité 1148, Paris (P.G.S.); Imperial College, Royal Brompton Hospital, London (P.G.S.); McMaster University and the Thrombosis and Atherosclerosis Research Institute - both in Hamilton, ON, Canada (J.I.W.); Janssen Research and Development, Raritan (E.S., E.S.B.), and the Thrombosis and Hematology Therapeutic Area, Clinical Development, Pharmaceuticals, Bayer U.S., Whippany (T.E.S.) - both in New Jersey; and the College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City (G.E.R.).

Background: Patients who are hospitalized for medical illness remain at risk for venous thromboembolism after discharge, but the role of extended thromboprophylaxis in the treatment of such patients is a subject of controversy.

Methods: In this randomized, double-blind trial, medically ill patients who were at increased risk for venous thromboembolism on the basis of a modified International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score of 4 or higher (scores range from 0 to 10, with higher scores indicating a higher risk of venous thromboembolism) or a score of 2 or 3 plus a plasma d-dimer level of more than twice the upper limit of the normal range (defined according to local laboratory criteria) were assigned at hospital discharge to either once-daily rivaroxaban at a dose of 10 mg (with the dose adjusted for renal insufficiency) or placebo for 45 days. The primary efficacy outcome was a composite of symptomatic venous thromboembolism or death due to venous thromboembolism. Read More

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http://dx.doi.org/10.1056/NEJMoa1805090DOI Listing
September 2018
5 Reads

Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.

Chest 2018 Nov 22;154(5):1121-1201. Epub 2018 Aug 22.

Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, MD.

Background: The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios.

Methods: Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). Read More

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http://dx.doi.org/10.1016/j.chest.2018.07.040DOI Listing
November 2018
21 Reads

Sulodexide for Secondary Prevention of Recurrent Venous Thromboembolism: A Systematic Review and Meta-Analysis.

Front Pharmacol 2018 8;9:876. Epub 2018 Aug 8.

Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.

Patients with venous thromboembolism have high risk of recurrence after discontinuation of anticoagulant treatment. Extended anticoagulation, such as traditional anticoagulants, can reduce the risk of recurrence but is associated with increased risk of hemorrhage. Sulodexide is a natural glycosaminoglycan mixture which can prevent recurrent venous thromboembolism. Read More

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http://dx.doi.org/10.3389/fphar.2018.00876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092709PMC
August 2018
2 Reads

Intra- and interatrial conduction abnormalities: hemodynamic and arrhythmic significance.

J Interv Card Electrophysiol 2018 Aug 20;52(3):293-302. Epub 2018 Aug 20.

Cardiology Division, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.

Alterations of normal intra- and interatrial conduction are a common outcome of multiple cardiovascular conditions. They arise most commonly in the context of advanced age, cardiovascular risk factors, organic heart disease, atrial fibrosis, and left atrial enlargement. Interatrial block (IAB), the most frequent and extensively studied atrial conduction disorder, affects up to 20% of the general primary care population. Read More

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http://dx.doi.org/10.1007/s10840-018-0413-4DOI Listing
August 2018
3 Reads

Inequality in oral anticoagulation use and clinical outcomes in atrial fibrillation: a Danish nationwide perspective.

Eur Heart J Qual Care Clin Outcomes 2018 07;4(3):189-199

Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 3, Silkeborg, Denmark.

Aim: To explore the potential of small-area variation analysis as a tool for identifying unwarranted variation in oral anticoagulation (OAC) use and clinical outcomes in patients with atrial fibrillation (AF) and thereby identify locations with opportunity for improvement in AF care.

Methods And Results: Based on Danish health care registries, we conducted a nationwide historical cohort study including first-time AF patients with a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75, diabetes, thromboembolism, vascular disease, age 65-74, and sex category) score ≥ 2 between 2007 and 2014 (n = 94 482). For each administrative region and municipality, we assessed OAC initiation and persistence as well as the risk of ischaemic stroke, haemorrhagic stroke, and other major bleeding, respectively. Read More

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http://dx.doi.org/10.1093/ehjqcco/qcy011DOI Listing
July 2018
1 Read

Antithrombotic strategies after interventional left atrial appendage closure: an update.

Expert Rev Cardiovasc Ther 2018 Sep 29;16(9):675-678. Epub 2018 Aug 29.

a Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main , Frankfurt am Main , Germany.

Introduction: Interventional left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation (OAC) therapy for the prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). Areas covered: Antithrombotic therapy following interventional LAAO is critical in balancing the risk of thromboembolism and bleeding during the endothelialization of the implanted devices. In this article, the most recent clinical trials are reviewed and the current real-world antithrombotic strategies following LAAO device implantation are discussed. Read More

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http://dx.doi.org/10.1080/14779072.2018.1510316DOI Listing
September 2018
1 Read

Left Atrial Appendages Occlusion: Current Status and Prospective.

Korean Circ J 2018 Aug;48(8):692-704

Kansas City Heart Rhythm Institute, Overland Park, KS, USA.

Stroke continues to be a major cause of morbidity and mortality in atrial fibrillation (AF) patients. Oral anticoagulation (OAC) provides protection against stroke and peripheral embolization in AF but significant proportion of patients could not be started on anticoagulation because of bleeding complications. Left atrial appendage harbors clot in about 90% of nonvalvular AF. Read More

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http://dx.doi.org/10.4070/kcj.2018.0231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6072669PMC
August 2018
2 Reads

Edoxaban Management in Diagnostic and Therapeutic Procedures (EMIT-AF/VTE)-Trial design.

Clin Cardiol 2018 Sep 21;41(9):1123-1129. Epub 2018 Sep 21.

Global Medical Affairs, Daiichi Sankyo, Inc, Basking Ridge, New Jersey, USA.

Non-vitamin K dependent oral anticoagulants (NOAC) are now widely used in patients with nonvalvular atrial fibrillation (NVAF) for stroke prevention and in patients with venous thromboembolism (VTE) for the treatment and secondary prevention of the disease. Among NOAC, edoxaban demonstrated noninferiority to warfarin for stroke prevention in NVAF and for VTE treatment, with superior safety. EMIT-AF/VTE (Edoxaban Management in Diagnostic and Therapeutic Procedures) (NCT02950168) is a multicenter, prospective, and noninterventional registry study designed to collect detailed information on the periprocedural management of patients with NVAF and VTE receiving edoxaban. Read More

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http://doi.wiley.com/10.1002/clc.23037
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http://dx.doi.org/10.1002/clc.23037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221054PMC
September 2018
1 Read

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018.

Med J Aust 2018 Oct 2;209(8):356-362. Epub 2018 Aug 2.

University of Wollongong, Wollongong, NSW.

Introduction: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Read More

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October 2018
22 Reads

Introduction of Non-Vitamin K Antagonist Anticoagulants Strongly Increased the Rate of Anticoagulation in Hospitalized Geriatric Patients with Atrial Fibrillation.

Drugs Aging 2018 09;35(9):859-869

Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.

Background: The benefit of anticoagulative treatment to prevent thromboembolism has been established in patients with atrial fibrillation and flutter of all age groups. Traditionally, anticoagulation was underused in geriatric patients with atrial fibrillation and flutter.

Objective: The aim of this study was to assess whether the broad introduction of non-vitamin K antagonist oral anticoagulants into clinical medicine has changed the rate of older patients treated with anticoagulants for atrial fibrillation and flutter. Read More

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http://dx.doi.org/10.1007/s40266-018-0571-1DOI Listing
September 2018
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Incidence, Risk Factors, and Clinical Effects of Recurrent Diverticular Hemorrhage: A Large Cohort Study.

Gastroenterology 2018 11 26;155(5):1416-1427. Epub 2018 Jul 26.

Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Background & Aims: Although recurrent diverticular hemorrhage is common, its incidence and risk factors have not been measured outside of small institutional cohorts. We analyzed the incidence of and risk factors for recurrent diverticular hemorrhage and whether discontinuing anticoagulation after diverticular hemorrhage is associated with ischemic stroke.

Methods: We performed a retrospective cohort study of patients enrolled in the OptumInsight Clinformatics database from 2000 through 2016. Read More

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http://dx.doi.org/10.1053/j.gastro.2018.07.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219900PMC
November 2018
5 Reads

Early therapeutic persistence on dabigatran versus warfarin therapy in patients with atrial fibrillation: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.

J Thromb Thrombolysis 2018 Nov;46(4):435-439

Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.

Anticoagulation is highly effective for the prevention of stroke in patients with atrial fibrillation (AF) but it is dependent on patients continuing therapy. While studies have demonstrated suboptimal therapeutic persistence on warfarin, few have studied persistence rates with non vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran. We examined rates of continued use of dabigatran versus warfarin over 1 year among AF patients in the ORBIT-AF registry between June 29, 2010 and August 09, 2011. Read More

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http://dx.doi.org/10.1007/s11239-018-1715-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182370PMC
November 2018
19 Reads
2.040 Impact Factor

Safety and effectiveness of apixaban compared to warfarin in dialysis patients.

Res Pract Thromb Haemost 2018 Apr 26;2(2):291-298. Epub 2018 Mar 26.

Division of Hematology & Oncology University of Virginia Charlottesville VA USA.

The use of apixaban for stroke prophylaxis or for the treatment of venous thromboembolism in end stage renal disease (ESRD) patients maintained on dialysis is based on one single-dose pharmacokinetic study. There is a deficiency of clinical evidence supporting safety in this population. The purpose of this study was to determine the safety and efficacy of apixaban compared with warfarin in dialysis patients. Read More

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http://dx.doi.org/10.1002/rth2.12083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055495PMC
April 2018
3 Reads

[Percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation: is left atrial appendage closure an alternative for anticoagulation?]

Ned Tijdschr Geneeskd 2018 Jun 15;162. Epub 2018 Jun 15.

St. Antonius Ziekenhuis, afd. Cardiologie, Nieuwegein.

The left atrial appendage (LAA) is the main source of cardioembolic stroke in patients with atrial fibrillation without valvular disease. Oral anticoagulation (OAC) has proven effective for preventing strokes associated with atrial fibrillation but is complicated by inherent bleeding risk and therapeutic compliance. Mechanical closure of the left atrial appendage seems an attractive alternative, especially in patients for whom long-term oral anticoagulation is not a good option. Read More

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June 2018
5 Reads