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Latest & greatest articles for atrial fibrillation
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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
Performance of the ABC Scores for Assessing the Risk of Stroke or Systemic Embolism and Bleeding in Patients With AtrialFibrillation in ENGAGE AF-TIMI 48 The ABC (age, biomarker, clinical history)-stroke and ABC-bleeding risk scores incorporate clinical variables and cardiovascular biomarkers to estimate risk of stroke or systemic embolic events and bleeding, respectively, in patients with atrialfibrillation. These scores have been proposed for routine clinical use, but their performance (...) in external cohorts remains uncertain.ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in AtrialFibrillation-Thrombolysis in Myocardial Infarction 48) was a multinational randomized trial of the oral factor Xa inhibitor edoxaban in patients with atrialfibrillation and a CHADS2 score ≥2. We performed a nested prospective biomarker study in 8705 patients, analyzing baseline high-sensitivity troponin T (hsTnT), NT-proBNP (N-terminal B-type natriuretic peptide), and growth
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
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.
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
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
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
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
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
General medicine: Uncertainty surrounds anticoagulation risks and benefits in patients with chronic kidney disease with atrialfibrillation Uncertainty surrounds anticoagulation risks and benefits in patients with chronic kidney disease with atrialfibrillation | BMJ Evidence-Based Medicine Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu (...) Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Uncertainty surrounds anticoagulation risks and benefits in patients with chronic kidney disease with atrialfibrillation Article Text Commentary General medicine Uncertainty surrounds anticoagulation risks and benefits in patients with chronic kidney disease with atrialfibrillation David Massicotte-Azarniouch 1 , Manish M Sood 1 , 2
A randomized, double-blind, placebo-controlled trial assessing the efficacy of S66913 in patients with paroxysmal atrialfibrillation. Antiarrhythmic drugs (AADs) for the treatment of atrialfibrillation (AF) are associated with limited efficacy and adverse effects. Inhibition of the atrial current IKur, absent from the ventricle, is expected to be antiarrhythmic, without adverse cardiac effects, particularly ventricular pro-arrhythmic effects.A randomized clinical trial in symptomatic (...) related preclinical safety concerns, after 58 patients had been enrolled. The median AFB ranged from 4.3% to 10.3% at baseline in the four treatment groups. S66913 had no significant effect on AFB or on AFB plus atrial tachycardia (AT) burden, at any dosage; nor on any secondary endpoints including the number and duration of AT or AF episodes, and symptoms. The drug was well tolerated with no safety concern during the treatment or the extended clinical follow-up.DIAGRAF-IKUR was the first study
Development and validation of a score to detect paroxysmal atrialfibrillation after stroke Prolonged monitoring times (72 hours) are recommended to detect paroxysmal atrialfibrillation (pAF) after ischemic stroke but this is not yet clinical practice; therefore, an individual patient selection for prolonged ECG monitoring might increase the diagnostic yield of pAF in a resource-saving manner.We used individual patient data from 3 prospective studies (ntotal = 1,556) performing prolonged
Dialysis Modality and Incident AtrialFibrillation in Older Patients With ESRD Atrialfibrillation (AF) is common in patients with kidney failure treated by maintenance dialysis. Whether the incidence of AF differs between patients receiving hemodialysis and peritoneal dialysis is uncertain.Retrospective cohort study.Using the US Renal Data System, we identified older patients (≥67 years) with Medicare Parts A and B who initiated dialysis therapy (1996-2011) without a diagnosis of AF during
Relation of the CHA2DS2-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without AtrialFibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study) Recent hospital-based cohort studies found the CHA2DS2-VASc score to be associated with ischemic stroke in individuals without atrialfibrillation (AF). Our aim was to determine the distribution of embolic and thrombotic strokes and association with the CHA2DS2-VASc score, among community-dwelling
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
AtrialfibrillationAtrialfibrillation - NICE CKS Share Atrialfibrillation: Summary Atrialfibrillation (AF) is an arrhythmia. It results from irregular, disorganized electrical activity in the atria, leading to an irregular ventricular rhythm. The ventricular rate of untreated AF often averages between 160–180 beats per minute (although this is typically slower in older people). The most common causes of AF are ischaemic heart disease, hypertension, valvular heart disease (...) Excellence (NICE) guideline: Atrialfibrillation: the management of atrialfibrillation [ ]. This CKS topic covers the management of people with atrialfibrillation (AF), including people with paroxysmal AF, and covers management issues such as rate control, anticoagulation treatment, and when to admit or refer to a cardiologist. This CKS topic does not cover the management of AF in children, AF during pregnancy, AF causing haemodynamic instability, postoperative AF, or atrial flutter. This guideline
Association Between Titin Loss-of-Function Variants and Early-Onset AtrialFibrillation. Atrialfibrillation (AF) is the most common arrhythmia affecting 1% of the population. Young individuals with AF have a strong genetic association with the disease, but the mechanisms remain incompletely understood.To perform large-scale whole-genome sequencing to identify genetic variants related to AF.The National Heart, Lung, and Blood Institute's Trans-Omics for Precision Medicine Program includes
Antithrombotic Therapy for AtrialFibrillation: CHEST Guideline and Expert Panel Report Antithrombotic Therapy for AtrialFibrillation CHEST Guideline and Expert Panel Report Gregory Y. H. Lip, MD; Amitava Banerjee, MD, DPhil; Giuseppe Boriani, MD, PhD; Chern en Chiang, MD, PhD; Ramiz Fargo, MD, FCCP; Ben Freedman, MD, PhD; Deirdre A. Lane, PhD; Christian T. Ruff, MD, MPH; Mintu Turakhia, MD; David Werring, PhD; Sheena Patel, MPH; and Lisa Moores, MD, FCCP BACKGROUND (...) disease, age 65-74 and sex category ABBREVIATIONS: ABC = Atrial ?brillation Better Care; ACS = acute coronary syndrome; ACTIVE W = AtrialFibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events; ACUTE = Assessment of Cardioversion Using Transesophageal Echocardiog- raphy; AFFIRM= AtrialFibrillationFollow-upInvestigationofSinus Rhythm Management; AHRE = atrial high-rate episode; aPTT = activated partial thromboplastin time; ARISTOTLE = Apixaban for Reduction of Stroke and Other