4,275 results match your criteria Stroke Anticoagulation and Prophylaxis


Rurality and atrial fibrillation: a pathway to virtual engagement and clinical trial recruitment in response to COVID-19.

Am Heart J Plus 2021 Mar;3

Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.

Study Objective: To summarize trial adaptation from in-clinic to virtual design in response to the SARS-2 coronavirus-2 (COVID-19).

Design: A clinical trial of a mobile health intervention to improve chronic disease self-management for rural individuals with atrial fibrillation (AF). The trial has a 4-month intervention - accessible regardless of health or digital literacy - to enhance AF medication adherence and patient experience with 8- and 12-month assessments of sustainability. Read More

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A Retrospective Review of Upper Gastrointestinal Bleed Outcomes During Hospital Admission While on Oral Anticoagulation.

Cureus 2021 May 16;13(5):e15061. Epub 2021 May 16.

Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA.

Introduction Direct-acting oral anticoagulants (DOACs) are approved for stroke prevention in non-valvular atrial fibrillation and treatment of venous thromboembolism. Most recent guidelines recommend DOACs over warfarin for most diagnoses given their predictable pharmacodynamics, lack of required monitoring, and safety profile. Specific outcomes such as shock, acute renal failure, and blood transfusion requirement while on oral anticoagulation compared to no anticoagulation remain unknown in patients with upper gastrointestinal (GI) bleeds. Read More

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P2Y12 inhibitor monotherapy or dual antiplatelet therapy after coronary revascularisation: individual patient level meta-analysis of randomised controlled trials.

BMJ 2021 06 16;373:n1332. Epub 2021 Jun 16.

Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Objective: To assess the risks and benefits of P2Y inhibitor monotherapy compared with dual antiplatelet therapy (DAPT) and whether these associations are modified by patients' characteristics.

Design: Individual patient level meta-analysis of randomised controlled trials.

Data Sources: Searches were conducted in Ovid Medline, Embase, and three websites (www. Read More

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Percutaneous Left Atrial Appendage Occlusion: An Emerging Option in Patients with Atrial Fibrillation at High Risk of Bleeding.

Medicina (Kaunas) 2021 May 3;57(5). Epub 2021 May 3.

Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy.

Atrial fibrillation (AF) is a common cardiac arrhythmia with an estimated prevalence of 1% in the general population. It is associated with an increased risk of ischemic stroke, silent cerebral ischemia, and cognitive impairment. Due to the blood flow stasis and morphology, thrombus formation occurs mainly in the left atrial appendage (LAA), particularly in the setting of nonvalvular AF (NVAF). Read More

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Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study.

BMJ Open 2021 05 31;11(5):e048839. Epub 2021 May 31.

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

Objective: The study aimed to examine the association between socioeconomic factors (SEFs) and oral anticoagulation (OAC) therapy and whether it was influenced by changing guidelines. We hypothesised that inequities in initiation of OAC reduced over time as more detailed and explicit clinical guidelines were issued.

Design: Register-based observational study. Read More

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Use of Oral Anticoagulants in Patients with Valvular Atrial Fibrillation: Findings From the NCDR PINNACLE Registry®.

Am Heart J 2021 May 22. Epub 2021 May 22.

Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX.

Recent data suggest direct oral anticoagulants (DOACs) are as safe and efficacious as warfarin among select patients with valvular heart disease (VHD) and atrial fibrillation (AF). However, real-world treatment patterns of AF stroke prophylaxis in the setting of valvular AF are currently unknown. Accordingly, using the prospective, ambulatory National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) Registry®, we sought to characterize overall use, temporal trends in use, and the extent of practice-level variation in use of any DOAC and warfarin among patients with valvular AF from January 1, 2013, to March 31, 2019. Read More

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Systematic monitoring for detection of atrial fibrillation in patients with acute ischaemic stroke (MonDAFIS): a randomised, open-label, multicentre study.

Lancet Neurol 2021 06;20(6):426-436

Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Berlin, Germany; Klinik und Hochschulambulanz für Neurologie mit Abteilung für Experimentelle Neurologie, Charité, Universitätsmedizin Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany; Excellence Cluster NeuroCure, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany. Electronic address:

Background: Systematic electrocardiogram (ECG) monitoring improves detection of covert atrial fibrillation in stroke survivors but the effect on secondary prevention is unknown. We aimed to assess the effect of systematic ECG monitoring of patients in hospital on the rate of oral anticoagulant use after 12 months.

Methods: In this investigator-initiated, randomised, open-label, parallel-group multicentre study with masked endpoint adjudication, we recruited patients aged at least 18 years with acute ischaemic stroke or transient ischaemic attack without known atrial fibrillation in 38 certified stroke units in Germany. Read More

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Unmet Clinical Needs in Elderly Patients Receiving Direct Oral Anticoagulants for Stroke Prevention in Non-valvular Atrial Fibrillation.

Adv Ther 2021 06 21;38(6):2891-2907. Epub 2021 May 21.

Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy.

Vitamin K antagonists have been used for many years as the treatment of choice for long-term oral anticoagulation in patients with non-valvular atrial fibrillation. Unfortunately, the use of those drugs in the real-world setting, particularly among elderly patients, is suboptimal because of their limitations in management. Therefore, many patients were not adequately anticoagulated. Read More

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Handheld ECG Tracking of in-hOspital Atrial Fibrillation (HECTO-AF): A Randomized Controlled Trial.

Front Cardiovasc Med 2021 4;8:681890. Epub 2021 May 4.

Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland.

Atrial fibrillation (AF) is frequent and causes substantial morbidity through AF-related strokes. Given the increasing prevalence of AF, screening methods are of interest given the potential to initiate timely appropriate anticoagulation. The HECTO-AF trial aims to determine the efficacy of AF screening with a single-lead electrocardiogram (ECG) handheld device in naïve in-hospital patients. Read More

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Anticoagulation versus placebo for heart failure in sinus rhythm.

Cochrane Database Syst Rev 2021 05 18;5:CD003336. Epub 2021 May 18.

Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.

Background: People with chronic heart failure (HF) are at risk of thromboembolic events, including stroke, pulmonary embolism, and peripheral arterial embolism; coronary ischaemic events also contribute to the progression of HF. The use of long-term oral anticoagulation is established in certain populations, including people with HF and atrial fibrillation (AF), but there is wide variation in the indications and use of oral anticoagulation in the broader HF population.

Objectives: To determine whether long-term oral anticoagulation reduces total deaths and stroke in people with heart failure in sinus rhythm. Read More

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Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke.

N Engl J Med 2021 06 15;384(22):2081-2091. Epub 2021 May 15.

From McMaster University (R.P.W., E.P.B.-C., J.S.H., M.S., P.J.D., J.N., K. Balasubramanian, A.L., S.Y., S.J.C.), Hamilton Health Sciences (R.P.W., E.P.B.-C., J.S.H., K. Brady, M.S., P.J.D., J.V., A.L., S.Y., S.J.C.), and the Population Health Research Institute (R.P.W., E.P.B.-C., J.S.H., K. Brady, M.S., P.J.D., J.N., K. Balasubramanian, J.V., A.L., S.Y., S.J.C.), Hamilton, ON, Southlake Regional Health Centre, Newmarket, ON (K.H.T.T.), the University of Toronto and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto (C.D.M.), and Quebec Heart and Lung Institute, Quebec, QC (P.V.) - all in Canada; University of Foggia, Foggia (D.P.), Santa Maria Hospital, Gruppo Villa Maria Care and Research, Bari (D.P.), and the University of Pisa, Pisa (A.C.) - all in Italy; Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt (W.R.), and University Hospital Giessen, Giessen (A.B.) - both in Germany; the Institute for Clinical and Experimental Medicine, Prague (P.B.), and the Center of Cardiovascular Surgery and Transplantation, Brno (P.F.) - both in the Czech Republic; "G. Papanikolaou" Hospital (A.J.B.) and Aristotle University of Thessaloniki (G.I.T.) - both in Thessaloniki, Greece; E. Meshalkin National Medical Research Center, Novosibirsk, Russia (A.B.-P.); the University of Louisville, Louisville, KY (M.S.S.); the University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia (A.G.R.); Auckland City Hospital, Auckland, New Zealand (S.M.); Amphia Ziekenhuis, Breda (M.A.), and Medical Center Leeuwarden, Leeuwarden (R.J.F.) - both in the Netherlands; the National Heart and Lung Institute, Imperial College London, London (P.P.P.); and the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (Á.A.).

Background: Surgical occlusion of the left atrial appendage has been hypothesized to prevent ischemic stroke in patients with atrial fibrillation, but this has not been proved. The procedure can be performed during cardiac surgery undertaken for other reasons.

Methods: We conducted a multicenter, randomized trial involving participants with atrial fibrillation and a CHADS-VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating greater risk of stroke) who were scheduled to undergo cardiac surgery for another indication. Read More

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Intramuscular hematoma in rhabdomyolysis patients treated with low-molecular-weight heparin: Report of two cases.

World J Clin Cases 2021 Apr;9(12):2838-2844

Department of Critical Care Medicine, Nanping First Hospital Affiliated to Fujian Medical University, Nanping 353000, Fujian Province, China.

Background: Rhabdomyolysis is a serious complication of heat stroke. Unlike that in acute kidney injury, the risk of muscle bleeding in rhabdomyolysis is often ignored and can substantially increase the widespread use of anticoagulants, leading to the formation of intramuscular hematoma.

Case Summary: During the summer, a middle-aged man and an elderly man were diagnosed with heat stroke, rhabdomyolysis, and acute renal impairment. Read More

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Use of Non-Vitamin K Antagonist Oral Anticoagulants Among Patients with Nonvalvular Atrial Fibrillation and Multimorbidity.

Adv Ther 2021 06 7;38(6):3166-3184. Epub 2021 May 7.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.

Introduction: Non-valvular atrial fibrillation (NVAF) is often accompanied by multiple comorbid conditions, which increase the associated risks and complexity of patient management. This study evaluated the risk of stroke/systemic embolism (SE) and major bleeding (MB) among multimorbid patients with NVAF who were prescribed non-vitamin K antagonist oral anticoagulants (NOACs) or warfarin.

Methods: A retrospective study of patients with NVAF and high multimorbidity who initiated apixaban, dabigatran, rivaroxaban, or warfarin from 1 January 2013 to 30 September 2015 was conducted using five insurance claims databases. Read More

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Influence of gender on the clinical outcomes of Asian non-valvular atrial fibrillation patients: insights from the prospective multicentre COOL-AF registry.

BMJ Open 2021 05 6;11(5):e043862. Epub 2021 May 6.

Division of Cardiology, Department of Medicine, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.

Objective: To determine the effect of gender on clinical outcomes of Asian non-valvular atrial fibrillation patients.

Design: This is a cohort study.

Setting: 27 university and regional hospitals in Thailand. Read More

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[Interdisciplinary aspects of oral anticoagulation with NOACs in atrial fibrillation].

Dtsch Med Wochenschr 2021 May 6;146(S 01):S2-S16. Epub 2021 May 6.

Kardiologie, Universitäts-Herzzentrum Freiburg.

Stroke prophylaxis with non-vitamin K-dependent oral anticoagulants (NOAKs) in patients with non-valvular atrial fibrillation (nvVHF) is now firmly established in routine clinical practice. The definition of nvVHF includes the absence of a mechanical heart valve and AF not associated with moderate- or high-grade mitral valve stenosis. The management of oral anticoagulation (OAC) requires a high degree of interdisciplinarity. Read More

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A prospective survey of atrial fibrillation management in Iran: Baseline results of the Iranian Registry of Atrial Fibrillation (IRAF).

Int J Clin Pract 2021 May 5:e14313. Epub 2021 May 5.

Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Atrial fibrillation. (AF) is the most common sustained arrhythmia globally and its prevalence is likely to increase in the next decades as a result of increasing age and co-morbidities. There are no data on demographic features, clinical characteristics, associated comorbidities, and practice patterns of AF in Iran. Read More

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Failure of Anticoagulation to Prevent Stroke in Context of Lupus-Associated Anti-Phospholipid Syndrome and Mild COVID-19.

J Stroke Cerebrovasc Dis 2021 Jul 12;30(7):105817. Epub 2021 Apr 12.

Department of Neurology, University of Florida, Gainesville, USA. Electronic address:

Hypercoagulability and virally-mediated vascular inflammation have become well-recognized features of the SARS-CoV-2 virus infection, COVID-19. Of growing concern is the apparent ineffectiveness of therapeutic anticoagulation in preventing thromboembolic events among some at-risk patient subtypes with COVID-19. We present a 43-year-old female with a history of seropositive-antiphospholipid syndrome and systemic lupus erythematosus who developed an acute ischemic stroke in the setting of mild COVID-19 infection despite adherence to chronic systemic anticoagulation. Read More

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[Left Atrial Appendage Closure - step by step].

Dtsch Med Wochenschr 2021 Apr 30;146(9):613-617. Epub 2021 Apr 30.

Thrombus formation due to atrial fibrillation is the most common cause of embolic stroke. Anticoagulation offers an effective prophylaxis. However, anticoagulation in turn has an inherent increased risk of bleeding. Read More

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Oral Anticoagulant Treatment in Patients with Atrial Fibrillation and Chronic Kidney Disease.

Medicina (Kaunas) 2021 Apr 27;57(5). Epub 2021 Apr 27.

Department of Nephrology/Internal Medicine, Mures County Clinical Hospital, 540103 Târgu Mureș, Romania.

Over the past few decades, a series of innovative medicines have been developed in order to optimize anticoagulation therapy for atrial fibrillation (AF). As a result, a number of nonvitamin K antagonist oral anticoagulants (NOAC) that directly target the enzymatic activity of factor II and factor Xa have been successfully licensed providing a more predictable effect and better safety profile compared to conventional anticoagulants (heparins and vitamin K antagonists (VKAs)). However, comparative efficacy and safety data is limited in patients with advanced chronic kidney disease (i. Read More

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[Secondary stroke prevention after TIA or ischemic stroke].

Herz 2021 Jun 29;46(3):293-302. Epub 2021 Apr 29.

Herzzentrum, Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Deutschland.

Stroke is one of the main causes of mortality and permanent disability. Secondary prevention of stroke recurrence therefore has a high priority. Secondary prevention of ischemic stroke includes optimization of the lifestyle and diet, treatment of risk factors, such as hypertension, diabetes mellitus and hyperlipidemia, prophylaxis of recurrence with antiplatelet treatment in patients with high vascular risk and anticoagulation in atrial fibrillation. Read More

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Ibrutinib in patients with atrial fibrillation - the challenge of thromboembolic prophylaxis.

Rom J Intern Med 2021 Apr 27. Epub 2021 Apr 27.

University Hospital Colentina, Bucharest, Romania.

Ibrutinib is a novel drug used in haematological malignancies. Its use is associated with an increased risk of atrial fibrillation (AF), which, in turn, exposes patients to embolic risk, including stroke. Reducing this risk requires anticoagulant therapy which is a matter of concern in the context of the increased bleeding risk of patients with haematological malignancies. Read More

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Five-Year Outcomes and Cardiac Remodeling Following Left Atrial Appendage Occlusion.

Clin Interv Aging 2021 19;16:655-663. Epub 2021 Apr 19.

Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.

Purpose: LAAO has been an alternative therapy to oral anticoagulants (OACs) for stroke prophylaxis in patients with nonvalvular atrial fibrillation (NVAF) with elevated CHADS-Vasc score, but the long-term outcomes of LAAO and its impacts on cardiac electrical and mechanical remodeling remain to be learned. We aimed to describe the impact of left atrial appendage occlusion (LAAO) on atrial remodeling and cardiovascular outcomes within 5-year follow-up.

Patients And Methods: A total of 107 patients with nonvalvular atrial fibrillation (NVAF) undergoing LAAO in the Shanghai Tenth People's Hospital between January 2014 and July 2017 were included. Read More

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Randomized clinical trial to evaluate a routine full anticoagulation Strategy in Patients with Coronavirus Infection (SARS-CoV2) admitted to hospital: Rationale and design of the ACTION (AntiCoagulaTlon cOroNavirus)-Coalition IV trial.

Am Heart J 2021 Aug 20;238:1-11. Epub 2021 Apr 20.

Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, Brazil.

Background: Observational studies have suggested a higher risk of thrombotic events in patients with coronavirus disease 2019 (COVID-19). Moreover, elevated D-dimer levels have been identified as an important prognostic marker in COVID-19 directly associated with disease severity and progression. Prophylactic anticoagulation for hospitalized COVID-19 patients might not be enough to prevent thrombotic events; therefore, therapeutic anticoagulation regimens deserve clinical investigation. Read More

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Can the CHA DS -VA schema be used to decide on anticoagulant therapy in Aboriginal and other Australians with non-valvular atrial fibrillation?

Intern Med J 2021 Apr;51(4):600-603

School of Population and Global Health, University of Western Australia and Telethon Kids Institute, UWA, Perth, Western Australia, Australia.

The Australasian guidelines recommend use of the CHA DS -VA schema to stratify ischaemic stroke risk in patients with non-valvular atrial fibrillation (N-VAF) and determine risk thresholds for recommending oral anticoagulant (OAC) therapy. However, the CHA DS -VA score has not been validated in a representative Australian population cohort with N-VAF, including in Aboriginal people who are known to have a higher age-adjusted stroke risk than other Australians. In a retrospective data-linkage study of 49 114 patients aged 24-84 years with N-VAF, 40. Read More

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[Anticoagulant and bone fragility: which implications for clinical practice?]

Rev Med Suisse 2021 Apr;17(735):766-769

Centre interdisciplinaire des maladies osseuses, CHUV, 1011 lausanne.

The role of certain treatments in the development of bone fragility is well known. Since the 2000s, several studies, conducted in patients on long-term anticoagulants have suggested the involvement of vitamin K antagonist (VKA) in the occurrence of osteoporotic fractures. Since their launch in 2008, the new oral anticoagulants (NOACs) have been widely used. Read More

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Ischemic Stroke in the Young.

Clin Appl Thromb Hemost 2021 Jan-Dec;27:10760296211002274

Department of Neurology, Comprehensive Stroke Center Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

The purpose of this article is to address several challenging questions in the management of young patients (those age 60 and under) who present with ischemic stroke. Do genetic thrombophilic states, strongly associated with venous thrombosis, independently cause arterial events in adults? Should cases of patent foramen ovale be closed with mechanical devices in patients with cryptogenic stroke? What are the optimal treatments for cerebral vein thrombosis, carotid artery dissection, and antiphospholipid syndrome and are DOACs acceptable treatment for these indications? What is the mechanism underlying large vessel stroke in patients with COVID-19? This is a narrative review. We searched PubMed and Embase and American College of physicians Journal club database for English language articles since 2000 looking mainly at randomized clinical trials, Meta analyses, Cochran reviews as well as some research articles viewed to be cutting edge regarding anticoagulation and cerebrovascular disease. Read More

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Real-world effects of medications for stroke prevention in atrial fibrillation: protocol for a UK population-based non-interventional cohort study with validation against randomised trial results.

BMJ Open 2021 04 15;11(4):e042947. Epub 2021 Apr 15.

Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

Introduction: Patients with atrial fibrillation experience an irregular heart rate and have an increased risk of stroke; prophylactic treatment with anticoagulation medication reduces this risk. Direct-acting oral anticoagulants (DOACs) have been approved providing an alternative to vitamin K antagonists such as warfarin. There is interest from regulatory bodies on the effectiveness of medications in routine clinical practice; however, uncertainty remains regarding the suitability of non-interventional data for answering questions on drug effectiveness and on the most suitable methods to be used. Read More

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Screening and management of atrial fibrillation in primary care.

BMJ 2021 04 12;373:n379. Epub 2021 Apr 12.

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

Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. Read More

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Primary Outcome Evaluation of a Next-Generation Left Atrial Appendage Closure Device: Results From the PINNACLE FLX Trial.

Circulation 2021 May 6;143(18):1754-1762. Epub 2021 Apr 6.

Boston Scientific Corporation, Marlborough, MA (R.D.S., N.T.G., D.J.A.).

Background: Left atrial appendage (LAA) occlusion provides an alternative to oral anticoagulation for thromboembolic risk reduction in patients with nonvalvular atrial fibrillation. Since regulatory approval in 2015, the WATCHMAN device has been the only LAA closure device available for clinical use in the United States. The PINNACLE FLX study (Protection Against Embolism for Nonvalvular AF Patients: Investigational Device Evaluation of the Watchman FLX LAA Closure Technology) evaluated the safety and effectiveness of the next-generation WATCHMAN FLX LAA closure device in patients with nonvalvular atrial fibrillation in whom oral anticoagulation is indicated, but who have an appropriate rationale to seek a nonpharmaceutical alternative. Read More

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Prognostic role of left ventricular apical aneurysm in hypertrophic cardiomyopathy: A systematic review and meta-analysis.

Int J Cardiol 2021 06 29;332:127-132. Epub 2021 Mar 29.

Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.

Objectives: The aim of this study was to systematically review and quantitatively synthesize existing evidence about the prognostic value of LV apical aneurysm in patients with HCM.

Background: Hypertrophic cardiomyopathy (HCM) represents a common inherited heart disease associated with enormous diversity in morphologic expression and clinical course. With the increasing penetration of advanced high resolution cardiovascular imaging into routine HCM practice, a subset of HCM patients with left ventricular (LV) apical aneurysm have become more widely recognized. Read More

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