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Latest & greatest articles for atrial fibrillation
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on atrial fibrillation or other clinical topics then use Trip today.
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Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With AtrialFibrillation: The CABANA Randomized Clinical Trial. Catheter ablation is effective in restoring sinus rhythm in atrialfibrillation (AF), but its effects on long-term mortality and stroke risk are uncertain.To determine whether catheter ablation is more effective than conventional medical therapy for improving outcomes in AF.The Catheter Ablation vs (...) Antiarrhythmic Drug Therapy for AtrialFibrillation trial is an investigator-initiated, open-label, multicenter, randomized trial involving 126 centers in 10 countries. A total of 2204 symptomatic patients with AF aged 65 years and older or younger than 65 years with 1 or more risk factors for stroke were enrolled from November 2009 to April 2016, with follow-up through December 31, 2017.The catheter ablation group (n = 1108) underwent pulmonary vein isolation, with additional ablative procedures
Blood & Clots Series: What is the optimal antithrombotic strategy for atrialfibrillation post-PCI? Blood & Clots Series: What is the optimal antithrombotic strategy for atrialfibrillation post-PCI? - CanadiEM Blood & Clots Series: What is the optimal antithrombotic strategy for atrialfibrillation post-PCI? In , by Vinai Bhagirath March 5, 2019 All the content from the Blood & Clots series can be found . CanMEDS Roles addressed: Medical Expert Main Messages P2Y12 inhibition is important (...) for the first 1-6 months after PCI insertion, and may have ongoing benefits up to 12 months or longer. Addition of anticoagulant to antiplatelet therapy increases the risk of bleeding, but reduces the risk of stroke. Use of an anticoagulant plus P2Y12 inhibitor is preferable to anticoagulant plus dual antiplatelet therapy, because of reduced bleeding risk. Case Description You are seeing a 72-year-old woman with a history of atrialfibrillation (AF), and additional stroke risk factors of hypertension
Dabigatran dual therapy with ticagrelor or clopidogrel after percutaneous coronary intervention in atrialfibrillation patients with or without acute coronary syndrome: a subgroup analysis from the RE-DUAL PCI trial After percutaneous coronary intervention (PCI) in patients with atrialfibrillation, safety and efficacy with dabigatran dual therapy were evaluated in pre-specified subgroups of patients undergoing PCI due to acute coronary syndrome (ACS) or elective PCI, and those receiving
Improving the Prescription of Oral Anticoagulants in AtrialFibrillation: A Systematic Review Oral anticoagulant (OAC) prescription for stroke prevention in atrialfibrillation (AF) patients frequently does not follow current guidelines, with underuse in patients at high risk of stroke and substantial overuse in those at low risk. This review aims to systematically evaluate the effectiveness of interventions to improve appropriate OAC prescription in eligible AF patients for stroke prevention
Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular AtrialFibrillation Patients with nonvalvular atrialfibrillation commonly have comorbidities requiring concurrent use of oral anticoagulants and antiplatelets. There are no real-world data on the comparative safety of concomitant antithrombotic treatments in the era of direct oral anticoagulant (DOACs). Thus, we compared the incidence of intracranial hemorrhage (...) , gastrointestinal bleeding, and other major bleeding between concomitant DOAC-antiplatelet use and concomitant vitamin K antagonist (VKA)-antiplatelet use in patients with nonvalvular atrial fibrillation.Using computerized health care databases from Québec, we conducted a cohort study among patients newly diagnosed with nonvalvular atrialfibrillation between January 2011 and March 2014. Cox proportional hazards models yielded hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for disease risk
Major Bleeding Rates in AtrialFibrillation Patients on Single, Dual, or Triple Antithrombotic Therapy Patients with atrialfibrillation generally require anticoagulant therapy and, at times, therapy with additional platelet aggregation inhibitors. Data are scarce on bleeding rates in high-risk groups receiving combination therapy, such as the elderly or patients with a high CHA2DS2-VASc score.We conducted a nationwide cohort study of Danish patients with atrialfibrillation ≥50 years of age (...) patients with atrialfibrillation. Median age was 75 years (interquartile range, 67-83) and 47% were women. Over a total follow-up period of 1 373 131 patient-years (PYs), 31 459 major bleeds occurred (IR 2.3/100 PYs; 95% CI, 2.3-2.3/100 PYs). In comparison with vitamin K antagonist monotherapy, adjusted hazard ratios of major bleeding were 1.13 (95% CI, 1.06-1.19) for dual antiplatelet therapy, 1.82 (95% CI, 1.76-1.89) for therapy with a vitamin K antagonist and an antiplatelet drug, 1.28 (95% CI
Effectiveness and safety of rivaroxaban vs. warfarin in patients with non-valvular atrialfibrillation and heart failure. Heart failure (HF) is a common co-morbidity in non-valvular atrialfibrillation (NVAF) patients and a potent risk factor for stroke, bleeding, and a decreased time-in-therapeutic range with warfarin. We assessed the real-world effectiveness and safety of rivaroxaban and warfarin in NVAF patients with co-morbid HF.Using US Truven MarketScan Commercial and Medicare
CHA2DS2-VASc Score and Stroke Prediction in AtrialFibrillation in Whites, Blacks, and Hispanics Background and Purpose- Despite modest predictive ability for ischemic stroke (IS), the CHA2DS2-VASc score is widely used for stroke prediction in atrialfibrillation. Among patients with atrialfibrillation, we aimed to (1) compare the IS or transient ischemic attack (TIA) incidence by CHA2DS2-VASc in blacks and Hispanics versus whites; (2) compare predictive ability of CHA2DS2-VASc score (...) for IS or TIA in blacks and Hispanics versus whites; and (3) determine improvement in predictive ability of CHA2DS2-VASc score from addition of race/ethnicity. Methods- Using data from Optum Clinformatics, a large administrative claims database, we analyzed patients with atrialfibrillation enrolled in commercial and Medicare Advantage health plans from 2009 to 2015. We computed IS or TIA incidence rates, improvement in C statistic, continuous and categorical net reclassification improvement, and relative
Decreased risk of renal impairment in atrialfibrillation patients receiving non-vitamin K antagonist oral anticoagulants: A pooled analysis of randomized controlled trials and real-world studies Patients with warfarin have a potential risk of warfarin-related nephropathy, which could result in the discontinuation of anticoagulation therapy. The question of whether non-vitamin K antagonist oral anticoagulants (NOACs) use is associated with increased risk of renal impairment in atrial (...) fibrillation (AF) patients remains unanswered.Studies were systematically searched through Medline, Embase, Cochrane Library databases, and ClinicalTrials.gov Website. Randomized controlled trials (RCTs) reporting renal impairment events and observational nationwide database studies presenting adjusted hazard ratio (HR) in AF patients with NOACs were identified. The Primacy outcome was renal impairment, defined as a composite of any renal disorder. The secondary outcomes were narrow definition of renal
Refining Prediction of AtrialFibrillation-Related Stroke Using the P2-CHA2DS2-VASc Score In people with atrialfibrillation (AF), periods of sinus rhythm present an opportunity to detect prothrombotic atrial remodeling through measurement of P-wave indices (PWIs)-prolonged P-wave duration, abnormal P-wave axis, advanced interatrial block, and abnormal P-wave terminal force in lead V1. We hypothesized that the addition of PWIs to the CHA2DS2-VASc score would improve its ability to predict AF (...) -1.44) and 0.82 (0.36-1.39), respectively.Abnormal P-wave axis-an ECG correlate of left atrial abnormality- improves ischemic stroke prediction in AF. Compared with CHA2DS2-VASc, the P2-CHA2DS2-VASc is a better prediction tool for AF-related ischemic stroke.
Open-Label Randomized Trial Comparing Oral Anticoagulation With and Without Single Antiplatelet Therapy in Patients With AtrialFibrillation and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent Implantation Despite recommendations in the guidelines and consensus documents, there has been no randomized controlled trial evaluating oral anticoagulation (OAC) alone without antiplatelet therapy (APT) in patients with atrialfibrillation and stable coronary artery disease beyond 1 (...) year after coronary stenting.This study was a prospective, multicenter, open-label, noninferiority trial comparing OAC alone to combined OAC and single APT among patients with atrialfibrillation beyond 1 year after stenting in a 1:1 randomization fashion. The primary end point was a composite of all-cause death, myocardial infarction, stroke, or systemic embolism. The major secondary end point was a composite of the primary end point or major bleeding according to the International Society
AtrialFibrillation (Focused Update) Accepted Manuscript 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With AtrialFibrillation Craig T. January, MD, PhD, FACC, Chair, Writing Group, L. Samuel Wann, MD, MACC, FAHA, Vice Chair, Writing Group, Hugh Calkins, MD, FACC, FAHA, FHRS, Writing Group Member, Lin Y. Chen, MD, MS, FACC, FAHA, FHRS, Writing Group Member, Joaquin E. Cigarroa, MD, FACC, Writing Group Member, Joseph C. Cleveland, Jr., MD, FACC (...) the content, and all legal disclaimers that apply to the journal pertain.MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT January CT, et al. 2019 Focused Update on AtrialFibrillation Page 1 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With AtrialFibrillation A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society Developed in Collaboration With the Society of Thoracic
Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrialfibrillation Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrialfibrillation Discover Portal Discover Portal Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrialfibrillation Published on 6 February 2018 doi: In people with atrialfibrillation needing anticoagulant treatment, deaths were fewer (...) in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin. This study pooled the data in all trials reporting efficacy, safety and cost of anticoagulant prevention of stroke events in people with atrialfibrillation. Researchers used a technique called network meta-analysis to compare
Alternative drug may prevent atrialfibrillation following heart surgery Alternative drug may prevent atrialfibrillation following heart surgery Discover Portal Discover Portal Alternative drug may prevent atrialfibrillation following heart surgery Published on 12 December 2017 doi: After heart surgery around a third of people have atrialfibrillation, an abnormal heart rhythm, which impedes their recovery and lengthens hospital stay. Colchicine treatment could reduce this complication (...) by about a third. About 11 people would need this treatment to prevent one of them developing atrialfibrillation. Using amiodarone, an alternative drug commonly used in this situation, other research shows that about seven people would be treated to prevent one person suffering fibrillation. Colchicine is a drug licensed for the treatment of gout that combines both anti-inflammatory and heart rate control properties. As an older drug, it might be a cheaper alternative and could be safer. Further study
Screen reminders for GPs did not improve anticoagulant prescribing in atrialfibrillation Screen reminders for GPs did not improve anticoagulant prescribing in atrialfibrillation Discover Portal Discover Portal Screen reminders for GPs did not improve anticoagulant prescribing in atrialfibrillation Published on 18 July 2017 doi: General practice software that generated screen reminders for patients with atrialfibrillation did not increase the proportion taking oral anticoagulants (...) appropriately by six months. This NIHR-funded trial included GPs in 47 surgeries in England and found that at the start only 63% of eligible patients with atrialfibrillation were being prescribed anticoagulants. Six months later the rate had increased to 66% in intervention practices and 64% in those following usual practice, a non-significant difference between the groups. Use of the software was associated with increased diagnosis of transient ischemic attack, which could be due to improved detection
Rhythm control drugs after catheter ablation for atrialfibrillation give short-term but not long term benefits Rhythm control drugs after catheter ablation for atrialfibrillation give short-term but not long term benefits Discover Portal Discover Portal Rhythm control drugs after catheter ablation for atrialfibrillation give short-term but not long term benefits Published on 27 September 2016 doi: When treating atrialfibrillation, short-term use of rhythm control drugs after catheter (...) ablation reduced the risk of abnormal heart rhythms in the three months after the procedure. They were of no benefit in preventing recurrence of atrialfibrillation in the longer term. Atrialfibrillation is a common abnormal heart rhythm that carries a high risk of stroke. Catheter ablation can be used to destroy the electrical pathways in the heart muscle that cause the abnormal rhythm, but recurrence is common. Several factors could influence the likelihood of abnormal rhythms returning after
Antithrombotic therapy use and clinical outcomes following thrombo-embolic events in patients with atrialfibrillation: insights from ARISTOTLE. We investigated baseline characteristics, antithrombotic use, and clinical outcomes of patients with atrialfibrillation (AF) and a thrombo-embolic event in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in AtrialFibrillation (ARISTOTLE) study to better inform the care of these high-risk patients.Thrombo-embolic events were
Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in AtrialFibrillation? A Report from the Western Denmark Heart Registry Patients with atrialfibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included. This article
Meta-Analysis of Effects of Digoxin on Survival in Patients with AtrialFibrillation or Heart Failure: An Update In 2015, 3 independent meta-analyses raised concerns about digoxin therapy being associated with an increased mortality risk in patients with atrialfibrillation (AF) and with heart failure (HF). Although several other studies have been published since then fostering these safety issues, the most recent 2016 European guidelines for AF still recommend this therapy as a class I