3,859 results match your criteria Stroke Anticoagulation and Prophylaxis


Heyde's Syndrome Complicating Management in a Patient With High Bleeding and Thrombotic Risks.

Cureus 2020 May 25;12(5):e8280. Epub 2020 May 25.

Internal Medicine/Cardiovascular Medicine/Interventional Cardiology, University of Maryland School of Medicine, Baltimore, USA.

The association of severe aortic stenosis and gastrointestinal (GI) bleeding is a well-known phenomenon. The pathogenesis involves an acquired deficiency of von Willebrand factor (vWF) due to shear stress resulting in alteration of vWF morphology. This results in in-appropriate cleavage of vWF multimers into smaller dysfunctional fragments. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.8280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317131PMC

Multimodal prophylaxis in patients with a history of venous thromboembolism undergoing primary elective hip arthroplasty.

Bone Joint J 2020 Jul;102-B(7_Supple_B):71-77

Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, New York, USA.

Aims: We studied the safety and efficacy of multimodal thromboprophylaxis in patients with a history of venous thromboembolism (VTE) who undergo total hip arthroplasty (THA) within the first 120 postoperative days, and the mortality during the first year. Multimodal prophylaxis includes discontinuation of procoagulant medications, VTE risk stratification, regional anaesthesia, an intravenous bolus of unfractionated heparin prior to femoral preparation, rapid mobilization, the use of pneumatic compression devices, and chemoprophylaxis tailored to the patient's risk of VTE.

Methods: Between 2004 to 2018, 257 patients with a proven history of VTE underwent 277 primary elective THA procedures by two surgeons at a single institution. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1302/0301-620X.102B7.BJJ-2019-1559.R1DOI Listing

Post-Discharge Prophylaxis With Rivaroxaban Reduces Fatal and Major Thromboembolic Events in Medically Ill Patients.

J Am Coll Cardiol 2020 Jun;75(25):3140-3147

Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Background: Hospitalized acutely ill medical patients are at risk for fatal and major thromboembolic events. Whether use of extended-duration primary thromboprophylaxis can prevent such events is unknown.

Objectives: The purpose of this study was to evaluate whether extended-duration rivaroxaban reduces the risk of venous and arterial fatal and major thromboembolic events without significantly increasing major bleeding in acutely ill medical patients after discharge. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jacc.2020.04.071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308003PMC

Hyperacute multi-organ thromboembolic storm in COVID-19: a case report.

J Thromb Thrombolysis 2020 Jun 6. Epub 2020 Jun 6.

Department of Neurosciences, University of Montreal, Montreal, Canada.

Acute viral pneumonia, hypoxemic respiratory failure and severe inflammatory response are hallmarks of severe coronavirus disease 2019 (COVID-19). The COVID-19-associated inflammatory state may further lead to symptomatic thromboembolic complications despite prophylaxis. We report a 66-year-old female patient with post-mortem diagnosis of COVID-19 who presented progressive livedo racemosa, acute renal failure and myocardial injury, as well as an absence of respiratory symptoms. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11239-020-02173-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275659PMC

Periprocedural Management of Oral Anticoagulation.

Med Clin North Am 2020 Jul 12;104(4):709-726. Epub 2020 May 12.

Department of Medicine, Division of General Internal Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L4N 4A6, Canada; Department of Medicine, Division of Hematology and Thromboembolism, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L4N 4A6, Canada. Electronic address:

Decisions surrounding periprocedural anticoagulation management must balance thromboembolic and procedural bleed risk. The interruption of both warfarin and DOACs requires consideration of anticoagulant pharmacokinetics, procedural bleed risk and patient characteristics. There is a diminishing role for periprocedural bridging LMWH overall and no role for bridging LMWH for the procedural interruption of DOACs. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mcna.2020.02.005DOI Listing

Thrombosis risk associated with COVID-19 infection. A scoping review.

Thromb Res 2020 08 27;192:152-160. Epub 2020 May 27.

Department of Medicine, Division of Hematology, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. Electronic address:

Background: Infection by the 2019 novel coronavirus (COVID-19) has been reportedly associated with a high risk of thrombotic complications. So far information is scarce and rapidly emerging.

Methods: We conducted a scoping review using a single engine search for studies assessing thrombosis and coagulopathy in COVID-19 patients. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.thromres.2020.05.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255332PMC

Evaluating Effectiveness and Safety in Chronic Kidney Disease with Atrial Flutter Using an Anticoagulation Strategy.

Medicina (Kaunas) 2020 May 28;56(6). Epub 2020 May 28.

Division of Gastroenterology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung 95054, Taiwan.

Recent randomized trials of oral antithrombotic drugs with atrial flutter (AFL) excluded patients with renal impairment because of their increased risk of bleeding. To date, no relevant studies have assessed the effectiveness and safety of different antithrombotic drugs in chronic kidney disease (CKD) patients with AFL. This cohort study evaluated the effectiveness and safety of different antithrombotic drugs in CKD patients with AFL. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.3390/medicina56060266DOI Listing

Meta-analysis of efficacy and safety of new oral anticoagulants compared with warfarin in Japanese patients undergoing catheter ablation for atrial fibrillation.

J Interv Card Electrophysiol 2020 May 27. Epub 2020 May 27.

Department of Cardiology, Affiliated Hangzhou First People's Hospital, Nanjing Medical University, #261 Huansha Road, Shangcheng District, Hangzhou, 310000, Zhejiang Province, China.

Objectives: This meta-analysis was designed to evaluate the efficacy and safety of new oral anticoagulants (NOACs) for perioperative anticoagulation of atrial fibrillation (AF) catheter ablation (CA) in Japanese patients with non-valvular atrial fibrillation (NVAF).

Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched for articles published up to June 30, 2019. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of the included studies according to the inclusion and exclusion criteria. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10840-020-00784-0DOI Listing
May 2020
1.552 Impact Factor

Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020.

Emerg Infect Dis 2020 May 26;26(9). Epub 2020 May 26.

We describe 2 cases in coronavirus disease patients in France involving presumed thrombotic stroke that occurred during ongoing anticoagulation treatment for atrial fibrillation stroke prophylaxis; 1 patient had positive antiphospholipid antibodies. These cases highlight the severe and unique consequences of coronavirus disease-associated stroke. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.3201/eid2609.201791DOI Listing

Antithrombotic and hemostatic stewardship: evaluation of clinical outcomes and adverse events of recombinant factor VIIa (Novoseven) utilization at a large academic medical center.

Ther Adv Cardiovasc Dis 2020 Jan-Dec;14:1753944720924255

Department of Pharmacy, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA.

Background: Recombinant factor VIIa (rFVIIa) (Novoseven®) is utilized for the reversal of anticoagulation-associated bleeding and refractory bleeding in cardiac surgery. In August 2015, rFVIIa was transferred from the blood bank to the pharmacy at New York University (NYU) Langone Health. Concordantly, an off-label dosing guideline was developed. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1177/1753944720924255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249557PMC

Anticoagulation control in different ethnic groups receiving vitamin K antagonist therapy for stroke prevention in atrial fibrillation.

Thromb Res 2020 Aug 6;192:12-20. Epub 2020 May 6.

Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address:

Background: Efficacy and safety of vitamin K antagonists (VKAs) is optimised in atrial fibrillation (AF) patients when the International Normalised Ratio (INR) is 2.0-3.0. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.thromres.2020.04.001DOI Listing

[Left atrial appendage closure for stroke prevention in atrial fibrillation : An update].

Herz 2020 Jun;45(4):397-406

Medizinische Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.

Atrial fibrillation (AF) is one of the most frequent causes of ischemic stroke. Without treatment the annual risk of ischemic stroke is on average approximately 5-6%/year in patients with atrial fibrillation, depending on the overall cardiovascular risk profile. Oral anticoagulation with new oral anticoagulants (NOAC) or vitamin K antagonists (VKA) is recommended for patients with AF and an elevated risk for stroke (CHADS-VASc score ≥1); however, severe bleeding complications are potential reasons for discontinuation of this treatment. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00059-020-04930-2DOI Listing

Cerebral Venous Sinus Thrombosis as a Presentation of COVID-19.

Eur J Case Rep Intern Med 2020 29;7(5):001691. Epub 2020 Apr 29.

Betsi Cadwaladr University Health Board, Bangor, Wales, UK.

Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the case of a 59-year-old man who presented with headache, hypertension and a single episode of fever with no other symptoms. He subsequently developed unilateral weakness. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.12890/2020_001691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213833PMC

Ischemic Stroke in Patients With Sinus Node Disease, Atrial Fibrillation, and Other Cardiac Conditions.

Stroke 2020 Jun 11;51(6):1674-1681. Epub 2020 May 11.

From the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine (A.B., A.B., J.H., N.C., D.B., L.F.), Université François Rabelais, Tours, France.

Background and Purpose- Atrial fibrillation (AF) is known to increase risk of ischemic stroke (IS), but the risk of IS in isolated sinus node disease (SND) is unclear. We compared the incidence of IS in patients with SND, patients with AF, and in a control population with other cardiac diseases (disease of the circulatory system using the ). Methods- This French longitudinal cohort study was based on the national database covering hospital care for the entire population from 2008 to 2015. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.120.029048DOI Listing

Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients: An NATF Anticoagulation Action Initiative.

Am J Med 2020 05;133 Suppl 1:1-27

Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.

Hospitalized patients with acute medical illnesses are at risk for venous thromboembolism (VTE) during and after a hospital stay. Risk factors include physical immobilization and underlying pathophysiologic processes that activate the coagulation pathway and are still present after discharge. Strategies for optimal pharmacologic VTE thromboprophylaxis are evolving, and recommendations for VTE prophylaxis can be further refined to protect high-risk patients after hospital discharge. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjmed.2019.12.001DOI Listing

A case report of recurrent transient ischaemic attacks on dabigatran for atrial fibrillation: real-world insight into treatment failure.

Eur Heart J Case Rep 2020 Apr 3;4(2):1-4. Epub 2020 Mar 3.

Department of Cardiology, Concord Repatriation General Hospital, 1 Hospital Road, Concord, New South Wales 2139, Australia.

Background : Non-valvular atrial fibrillation (AF) is an important risk factor for acute ischaemic stroke. There has been an increase in the use of direct-acting oral anticoagulants (DOAC therapy) in stroke prophylaxis due to their convenience and rapid action of onset. However, there is a lack of information in the literature regarding management options and possible mechanisms with the apparent failure of DOAC therapy. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1093/ehjcr/ytaa041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180529PMC

Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-ST-elevation acute coronary syndrome (POPular AGE): the randomised, open-label, non-inferiority trial.

Lancet 2020 04;395(10233):1374-1381

Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands. Electronic address:

Background: Current guidelines recommend potent platelet inhibition with ticagrelor or prasugrel in patients after an acute coronary syndrome. However, data about optimal platelet inhibition in older patients are scarce. We aimed to investigate the safety and efficacy of clopidogrel compared with ticagrelor or prasugrel in older patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/S0140-6736(20)30325-1DOI Listing

The difference of burden of ectopic beats in different types of atrial fibrillation and the effect of atrial fibrillation type on stroke risk in a prospective cohort of patients with atrial fibrillation (CODE-AF registry).

Sci Rep 2020 Apr 14;10(1):6319. Epub 2020 Apr 14.

Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

The relationship between atrial fibrillation (AF) type and stroke risk is still controversial. We investigated the difference of burden of atrial ectopic beats in different types of AF and the effect of the AF type on stroke risk in patients with non-valvular AF. In the prospective, multicenter observational registry with more than about 10,000 AF patients, 8883 non-valvular AF patients (mean age, 67. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-63370-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156648PMC

Patient perception of anticoagulant treatment for stroke prevention (RE-SONANCE study).

Open Heart 2020 24;7(1):e001202. Epub 2020 Mar 24.

Department of Cardiology, General Hospital Celje, Celje, Slovenia.

Objective: We evaluated atrial fibrillation (AF) patients' perceptions of anticoagulation treatment with dabigatran or a vitamin K antagonist (VKA) for stroke prevention, according to accepted indications.

Methods: The RE-SONANCE observational, prospective, multicentre, international study used the validated Perception on Anticoagulant Treatment Questionnaire (PACT-Q) to assess patients with AF already taking a VKA who were switched to dabigatran (cohort A), and newly diagnosed patients initiated on either dabigatran or a VKA (cohort B). Visit 1 (V1) was at baseline, and visit 2 (V2) and visit 3 (V3) were at 30-45 and 150-210 days after baseline, respectively. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1136/openhrt-2019-001202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103803PMC

Limitations of transoesophageal echocardiogram in acute ischaemic stroke.

Open Heart 2020 24;7(1):e001176. Epub 2020 Mar 24.

Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, Texas, USA.

Objective: The role of transoesophageal echocardiography (TOE) in identifying ischaemic stroke aetiology is debated. In 2018, the American Heart Association/American Stroke Association (AHA/ASA) issued class IIa recommendation for echocardiography, with the qualifying statement of use in cases where it will alter management. Hence, we sought to determine the rate at which TOE findings altered management in cases of confirmed ischaemic stroke. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1136/openhrt-2019-001176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103838PMC

Trends in anticoagulant prescribing: a review of local policies in English primary care.

BMC Health Serv Res 2020 Apr 3;20(1):279. Epub 2020 Apr 3.

National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK.

Background: Oral anticoagulants are prescribed for stroke prophylaxis in patients with atrial fibrillation, which is the most common heart arrhythmia worldwide. The vitamin K antagonist (VKA) warfarin is a long-established anticoagulant. However, newer direct oral anticoagulants (DOACs) have been recently introduced as an alternative. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12913-020-5058-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7126454PMC

Atrial Fibrillation and Cognitive Impairment: An Associated Burden or Burden by Association?

Angiology 2020 07 1;71(6):498-519. Epub 2020 Apr 1.

First and Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.

Growing evidence suggests that atrial fibrillation (AF), in addition to its thromboembolic risk, is a risk factor for cognitive impairment (CI) via several pathways and mechanisms, further contributing to morbidity/mortality. Prior stroke is a contributor to CI, but AF is also associated with CI independently from prior stroke. Silent brain infarctions, microemboli and microbleeds, brain atrophy, cerebral hypoperfusion from widely fluctuating ventricular rates, altered hemostatic function, vascular oxidative stress, and inflammation may all exacerbate CI, particularly in patients with persistent/permanent rather than paroxysmal AF and with increased duration/burden of the arrhythmia. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003319720910669DOI Listing

Medical Management for Secondary Stroke Prevention.

Authors:
Anthony S Kim

Continuum (Minneap Minn) 2020 Apr;26(2):435-456

Purpose Of Review: This article reviews the evidence base and recommendations for medical management for secondary stroke prevention.

Recent Findings: Recent developments for secondary stroke prevention include evidence to support the use of short-term dual antiplatelet therapy after minor stroke and transient ischemic attack, direct oral anticoagulants for nonvalvular atrial fibrillation, reversal agents for direct oral anticoagulant-associated hemorrhage, and aspirin rather than presumptive anticoagulation with a direct oral anticoagulant for embolic stroke of undetermined source.

Summary: Most strokes are preventable. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1212/CON.0000000000000849DOI Listing

Atrial fibrillation for internists: current practice.

Swiss Med Wkly 2020 Mar 22;150:w20196. Epub 2020 Mar 22.

Division of Cardiology, Department of Medicine, University Hospital Basel, Switzerland / Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.

Atrial fibrillation (AF) has become a global epidemic and puts affected patients at high risk of adverse events. In this review we summarise the current evidence on risk factors and complications of AF, describe current treatment strategies, and outline new fields of research. Current evidence shows that hypertension and obesity are the two most important modifiable risk factors for the development of AF. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.4414/smw.2020.20196DOI Listing

Risk factor modification for the primary and secondary prevention of atrial fibrillation. Part 2.

Kardiol Pol 2020 03 19;78(3):192-202. Epub 2020 Mar 19.

Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Clinic for Physical Medicine and Rehabilitation, Clinical Center of Serbia, Belgrade, Serbia

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of death, stroke, and heart failure. Prevalence and incidence of AF are rising due to better overall medical treatment, longer survival, and increasing incidence of cardiometabolic and lifestyle risk factors. Treatment of AF and AF‑related complications significantly increases healthcare costs. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15240DOI Listing

Early Atrial Fibrillation During Acute Myocardial Infarction May Not Be an Indication for Long-Term Anticoagulation.

Angiology 2020 07 27;71(6):559-566. Epub 2020 Feb 27.

Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Patients with new-onset of atrial fibrillation (NOAF) during acute myocardial infarction (AMI) currently receive long-term oral anticoagulation. The risk for stroke of "early" versus "late" onset of atrial fibrillation (AF) has not been elucidated. Consecutively, AMI patients admitted to a tertiary medical center were analyzed. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003319720908760DOI Listing

[Predicting atrial fibrillation through a sinus-rhythm electrocardiogram; useful or not?]

Ned Tijdschr Geneeskd 2019 11 28;163. Epub 2019 Nov 28.

Martini Ziekenhuis, afd. Cardiologie, Groningen.

In patients with cryptogenic stroke, the detection of atrial fibrillation (AF) is important, since it is an indication for the prescription of oral anticoagulation, instead of anti-platelet therapy, to decrease the chance of a recurrent ischaemic cerebral event. The presence of permanent AF is easily detected by means of an electrocardiogram (ECG). However, in paroxysmal AF patients, expensive long-term rhythm monitoring might be necessary to detect the arrhythmia. Read More

View Article

Download full-text PDF

Source
November 2019

Epicardial versus Endocardial Closure: Is One Better than the Other?

Card Electrophysiol Clin 2020 Mar;12(1):97-108

The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA. Electronic address:

Left atrial appendage occlusion is an evolving technology with demonstrable benefits of stroke prophylaxis in patients with atrial fibrillation unsuitable for anticoagulation. This has resulted in the development of a plethora of transcatheter devices to achieve epicardial exclusion and endocardial occlusion. In this review, the authors summarize the differences in technique, target patient population, outcomes, and complication profiles of endocardial and epicardial techniques. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ccep.2019.11.011DOI Listing

Role of the Left Atrial Appendage in Systemic Homeostasis, Arrhythmogenesis, and Beyond.

Card Electrophysiol Clin 2020 Mar;12(1):21-28

The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA. Electronic address:

The left atrial appendage (LAA) affects body homeostasis via atrial natriuretic peptide and the renin-angiotensin-aldosterone system and plays an important role in atrial compliance. Approximately 90% of clots in nonvalvular atrial fibrillation (AF) are formed in the LAA. AF is the most common sustained cardiac arrhythmia and is frequently associated with stroke. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ccep.2019.11.004DOI Listing

Reasons for discontinuation of novel oral anticoagulant therapy in patients with atrial fibrillation.

Curr Med Res Opin 2020 Apr 17;36(4):547-553. Epub 2020 Feb 17.

Department of Pharmacotherapy, Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, The Netherlands.

We sought to investigate the reasons for, and rates of, novel oral anticoagulant (DOAC) therapy discontinuation. This was an observational cohort study of patients with atrial fibrillation (AF) referred to a regional DOAC outpatient clinic between February 2013 and October 2017. The study population consisted of 875 consecutive patients with AF who visited the DOAC outpatient unit to initiate treatment with apixaban ( = 303), dabigatran ( = 267) or rivaroxaban ( = 305) for long-term ischemic stroke prophylaxis. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1080/03007995.2020.1725743DOI Listing

Ischemic Stroke and Bleeding: Clinical Benefit of Anticoagulation in Atrial Fibrillation After Intracerebral Hemorrhage.

Stroke 2020 03 31;51(3):808-814. Epub 2020 Jan 31.

From the Department of Neurology and Rehabilitation Medicine (R.J.S., D.W., C.J.M., M.H., M.L.F., D.O.K.), University of Cincinnati College of Medicine, OH.

Background and Purpose- Patients with intracerebral hemorrhage (ICH) and atrial fibrillation (AF) are at risk for ischemic events. While risk calculators (CHADS-VASc and HAS-BLED) have been validated to assess risk for ischemic stroke and major bleeding in AF patients, decisions about anticoagulation must consider the net clinical benefit of anticoagulation. Furthermore, stroke and bleeding risk are highly correlated, making decisions more difficult. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.119.027370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7112469PMC
March 2020
5.723 Impact Factor

Endovascular Stroke Treatment and Risk of Intracranial Hemorrhage in Anticoagulated Patients.

Stroke 2020 03 29;51(3):892-898. Epub 2020 Jan 29.

Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (J.K.).

Background and Purpose- We aimed to determine the safety and mortality after mechanical thrombectomy in patients taking vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). Methods- In a multicenter observational cohort study, we used multiple logistic regression analysis to evaluate associations of symptomatic intracranial hemorrhage (sICH) with VKA or DOAC prescription before thrombectomy as compared with no anticoagulation. The primary outcomes were the rate of sICH and all-cause mortality at 90 days, incorporating sensitivity analysis regarding confirmed therapeutic anticoagulation. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.119.026606DOI Listing

Influence of oral anticoagulation on stroke severity and outcomes: A propensity score matching case-control study.

J Neurol Sci 2020 Mar 14;410:116685. Epub 2020 Jan 14.

La Paz University Hospital, Department of Neurology, Autonomous University of Madrid, Spain. Electronic address:

Background: Oral anticoagulants (OAC) such as vitamin K antagonists (VKA) and direct-acting OACs (DOAC) remain the mainstay for prevention of cardioembolic stroke. The influence of previous OAC treatment on stroke severity and outcomes is not well stablished. We compared patients with incident cardioembolic strokes according to pre-stroke treatment. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jns.2020.116685DOI Listing

Atrial fibrillation in acute heart failure: A position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association of the European Society of Cardiology.

Eur Heart J Acute Cardiovasc Care 2020 01 24:2048872619894255. Epub 2020 Jan 24.

Liverpool Centre for Cardiovascular Science, University of Liverpool, UK.

Atrial fibrillation and acute heart failure frequently co-exist and can exacerbate each other. Their combination leads to increased morbidity and mortality. However, the prevalence and significance, as well as the treatment, of atrial fibrillation in acute heart failure are not well studied. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1177/2048872619894255DOI Listing
January 2020

Age-Related Differences in the Clinical Characteristics and Treatment of Elderly Patients With Atrial Fibrillation in Japan - Insight From the ANAFIE (All Nippon AF In Elderly) Registry.

Circ J 2020 02 23;84(3):388-396. Epub 2020 Jan 23.

Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University.

Background: Atrial fibrillation (AF) is increasing as the global population ages. Elderly AF patients (≥75 years) have a worse prognosis than younger patients, and effective management is often difficult due to multiple comorbidities. This analysis examined the age-related differences in clinical characteristics and treatment in real-world elderly Japanese AF patients. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1253/circj.CJ-19-0898DOI Listing
February 2020

Risk stratification in patients undergoing interventional left atrial appendage occlusion-Prognostic impact of EuroSCORE II.

Clin Cardiol 2020 May 22;43(5):508-515. Epub 2020 Jan 22.

Department of Cardiology, Marien Hospital Witten, Ruhr University, Bochum, Germany.

Background: Interventional closure of the left atrial appendage (LAA) is an alternative option to stroke prophylaxis, particularly in multimorbid patients with a high risk of bleeding under oral anticoagulation. Due to the multiple comorbidities, the prognosis of patients is reduced, and the clinical benefit of the procedure is therefore questionable in the individual patient.

Hypothesis: The present study aims to identify independent preprocedural risk factors to improve risk stratification in these highly selected patients. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1002/clc.23338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244292PMC

Geriatric Conditions Predict Discontinuation of Anticoagulation in Long-Term Care Residents With Atrial Fibrillation.

J Am Geriatr Soc 2020 Apr 22;68(4):717-724. Epub 2020 Jan 22.

Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.

Background: Anticoagulation (AC) for stroke prevention in long-term care (LTC) residents with atrial fibrillation (AF) involves a challenging risk-benefit evaluation. We measured the association of geriatric conditions with discontinuation of AC.

Design: Retrospective cohort analysis. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1111/jgs.16335DOI Listing

Meta-analysis Comparing Direct Oral Anticoagulants Versus Vitamin K Antagonists After Transcatheter Aortic Valve Implantation.

Am J Cardiol 2020 04 8;125(7):1102-1107. Epub 2020 Jan 8.

Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.

Atrial fibrillation (AF) is a common co-morbidity in patients undergoing transcatheter aortic valve implantation (TAVI), but whether direct oral anticoagulants (DOACs) confer similar safety and efficacy compared with vitamin K antagonist (VKA) remains unclear in this population. The aim of our study was to investigate the safety and efficacy of DOACs compared with VKA in patients undergoing TAVI with concomitant indication of oral anticoagulation. PUBMED and EMBASE were searched through October 2019 for studies comparing DOACs versus VKA in patients undergoing TAVI with indication of oral anticoagulation. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2019.12.039DOI Listing

Anaphylaxis-induced atrial fibrillation and anesthesia: Pathophysiologic and therapeutic considerations.

Ann Card Anaesth 2020 Jan-Mar;23(1):1-6

Department of Cardiology, Patras University School of Medicine, Patras, Greece.

Atrial fibrillation is the most common cardiac arrhythmia in western society affecting more than 35 million individuals worldwide annually. It is a common postoperative complication and may also occur spontaneously during general and local anesthesia administration. Aging, diabetes mellitus, hypertension, and cardiovascular diseases including cardiomyopathies, congenital cardiac anomalies, heart failure, myocardial ischemia, pericarditis, previous cardiac surgery, vascular disease, and valvular heart disease are some correlated factors. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.4103/aca.ACA_100_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034217PMC
January 2020

A Systematic Review of Network Meta-Analyses and Real-World Evidence Comparing Apixaban and Rivaroxaban in Nonvalvular Atrial Fibrillation.

Clin Appl Thromb Hemost 2020 Jan-Dec;26:1076029619898764

Guy's and St. Thomas' Hospitals, King's College, London, United Kingdom.

There is no direct evidence comparing the 2 most commonly prescribed direct oral anticoagulants, apixaban and rivaroxaban, used for stroke prevention in nonvalvular atrial fibrillation (NVAF). A number of network meta-analyses (NMAs) of randomized control trials and real-world evidence (RWE) studies comparing the efficacy, effectiveness, and safety of apixaban and rivaroxaban have been published; however, a comprehensive evidence review across the available body of evidence is lacking. In this study, we aimed to systematically review and evaluate the clinical outcomes of apixaban and rivaroxaban using a combination of data gleaned from both NMAs and RWE studies. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1177/1076029619898764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098208PMC
January 2020

Stroke Prophylaxis in Patients with Atrial Fibrillation and End-Stage Renal Disease.

J Clin Med 2020 Jan 2;9(1). Epub 2020 Jan 2.

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.

Atrial fibrillation (AF) is an important comorbidity in patients with end-stage renal disease (ESRD) undergoing dialysis that portends increased health care utilization, morbidity, and mortality in this already high-risk population. Patients with ESRD have a particularly high stroke risk, which is further compounded by AF. However, the role of anticoagulation for stroke prophylaxis in ESRD and AF is debated. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9010123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019832PMC
January 2020

Gastrointestinal bleeding in patients with atrial fibrillation treated with Apixaban or warfarin: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial.

Am Heart J 2020 03 31;221:1-8. Epub 2019 Oct 31.

Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC. Electronic address:

Objectives: A history of gastrointestinal bleeding (GIB) in patients with atrial fibrillation (AF) may impact decisions about anticoagulation treatment. We sought to determine whether prior GIB in patients with AF taking anticoagulants was associated with an increased risk of stroke or major hemorrhage.

Methods: We analyzed key efficacy and safety outcomes in patients with prior GIB in ARISTOTLE. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ahj.2019.10.013DOI Listing

Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation.

J Diabetes Res 2019 6;2019:5158308. Epub 2019 Dec 6.

Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.

Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF), and T2D patients with AF-associated stroke seem to have worse clinical outcome and higher risk of unfavorable clinical course compared to individuals without this metabolic disorder. Long-term anticoagulation is indicated in majority of T2D patients with AF to prevent adverse AF-associated embolic events. Direct oral anticoagulants (DOACs), direct oral thrombin inhibitor dabigatran, and direct oral factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, have emerged as a preferred choice for long-term prevention of stroke in AF patients offering potent and predictable anticoagulation and a favorable pharmacology with low risk of interactions. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1155/2019/5158308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925766PMC

Depression and Uptake of Oral Anticoagulation Therapy in Patients With Atrial Fibrillation: A Danish Nationwide Cohort Study.

Med Care 2020 03;58(3):216-224

Research Unit for General Practice.

Background: Oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF) is a highly important preventive intervention, perhaps especially in those with comorbid depression, who have a worse prognosis. However, OAT may pose particular challenges in depressed patients.

Objectives: To assess whether AF patients with depression have lower OAT uptake. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/MLR.0000000000001268DOI Listing

Secondary stroke prophylaxis in atrial fibrillation patients with chronic kidney disease: a nationwide cohort study.

Europace 2020 May;22(5):716-723

Department of Cardiology, Research Unit 1, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark.

Aims: Oral anticoagulation (OAC) therapy as secondary stroke prophylaxis in atrial fibrillation (AF) patients with chronic kidney disease (CKD) remains unexplored and poses a clinical treatment dilemma. We assessed the long-term risk of thromboembolic events according to post-stroke OAC therapy in AF patients with CKD after their first ischaemic stroke.

Methods And Results: We identified Danish AF patients with CKD who presented with first-time ischaemic stroke from 2005 to 2014. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1093/europace/euz340DOI Listing

Non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention: a network meta-analysis.

Cochrane Database Syst Rev 2019 12 19;12:CD013252. Epub 2019 Dec 19.

University of Freiburg, Department of Cardiology and Angiology I, Heart Center, Freiburg, Germany.

Background: Clinicians must balance the risks of bleeding and thrombosis after percutaneous coronary intervention (PCI) in people with an indication for anticoagulation. The potential of non-vitamin K antagonists (NOACs) to prevent bleeding complications is promising, but evidence remains limited.

Objectives: To review the evidence from randomised controlled trials assessing the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) compared to vitamin K antagonists post-percutaneous coronary intervention (PCI) in people with an indication for anticoagulation. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1002/14651858.CD013252.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923523PMC
December 2019

Anticoagulant treatment in elderly patients with atrial fibrillation: position paper.

Geriatr Psychol Neuropsychiatr Vieil 2019 12;17(4):341-355

CHU Nantes, Pôle hospitalo-universitaire de gérontologie clinique, France, Gérontopôle Autonomie Longévité Pays de la Loire, France.

Atrial fibrillation (AF) is common in the elderly. The treatment of this condition is based on anticoagulation in preventing Stroke and systemic arterial embolism. Vitamin K antagonists (VKAs) have long been the only anticoagulants available for the management of AF. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1684/pnv.2019.0834DOI Listing
December 2019

Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation.

Circ Arrhythm Electrophysiol 2019 12 13;12(12):e007612. Epub 2019 Dec 13.

Duke Clinical Research Institute, Durham, NC (P.S., K.S.P., E.D.P., J.P.P.).

Background: Studies evaluating the effects of atrial fibrillation (AF) catheter ablation versus antiarrhythmic therapy on outcomes have shown mixed results. In addition, guidelines recommend continuing oral anticoagulation (OAC) after ablation for those at risk of stroke, but real-world data are lacking.

Methods: We evaluated outcomes including death, myocardial infarction, stroke or systemic embolism, intracranial bleeding, major bleeding, and hospitalization in patients undergoing AF ablation compared with a propensity score matched cohort of patients treated with anti-arrhythmic medications only in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation registries. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCEP.119.007612DOI Listing
December 2019

Racial Differences in Atrial Fibrillation Epidemiology, Management, and Outcomes.

Curr Treat Options Cardiovasc Med 2019 Dec 10;21(12):85. Epub 2019 Dec 10.

Division of Cardiology, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.

Purpose Of The Review: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice and is associated with significant morbidity and healthcare cost. Most of the AF studies have predominantly included white population, with under-representation of minority population. In this review, we analyze the racial differences in epidemiology, disease awareness, risk factors, genetics, treatments, and outcomes of AF. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11936-019-0793-5DOI Listing
December 2019

Prescribing of oral anticoagulants in the emergency department and subsequent long-term use by older adults with atrial fibrillation.

CMAJ 2019 Dec;191(49):E1345-E1354

ICES Central (Atzema, Jackevicius, Chong, Ivers, Austin); Division of Emergency Medicine, Department of Medicine (Atzema), Division of Cardiology, Department of Medicine (Dorian), Department of Family Medicine (Ivers) and Institute for Health Policy, Management and Evaluation (Jackevicius, Dorian, Ivers, Austin), University of Toronto; Sunnybrook Health Sciences Centre (Atzema); Women's College Hospital (Ivers); St. Michael's Hospital (Dorian), Toronto, Ont.; Western University of Health Sciences, Pomona, Calif. (Jackevicius); QEII Health Sciences Centre (Parkash), Halifax, NS.

Background: Patients with atrial fibrillation frequently seek emergency care. Rates of guideline-concordant oral anticoagulant therapy for stroke prevention are suboptimal in the community. We assessed the association between prescribing of oral anticoagulants in the emergency department (relative to referral to a longitudinal care provider for treatment initiation) and long-term use of oral anticoagulants. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1503/cmaj.190747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901271PMC
December 2019