Renal Function and the Risk of Stroke and Bleeding in Patients With Atrial Fibrillation Clinical Sciences

Background and Purpose—We sought to determine the risk of stroke/thromboembolism and bleeding associated with reduced renal function in patients with atrial fibrillation and the risk of stroke and bleeding associated with warfarin treatment in specific estimated glomerular filtration rate (eGFR) groups.Methods—We conducted a register-based cohort study and included patients discharged with nonvalvular atrial fibrillation from 1997 to 2011 with available eGFR.Results—A total of 17 349 patients were identified with eGFR available at baseline. All levels of lower eGFR were associated with higher risk of stroke/thromboembolism and bleeding. Use of warfarin was associated with higher bleeding risk in all eGFR groups; hazard ratios 1.23 (95% confidence interval [CI], 0.97–1.56), 1.26 (95% CI, 1.14–1.40), 1.18 (95% CI, 1.07–1.31), 1.11 (95% CI, 0.87–1.42), 2.01 (95% CI, 1.14–3.54) in patients with eGFR ≥90, 60 to 89, 30 to 59, 15 to 29, and
Source: Stroke - Category: Neurology Authors: Tags: Atrial Fibrillation Original Contributions Source Type: research

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Abstract Cardiogenic stroke (CS), characteristic causes of which include atrial fibrillation (AF) and right-to-left shunting due to a patent foramen ovale (PFO), has a well-known tendency to be associated with a more extensive ischemic area. This may result in severe neurological damage, and require strict life-long antithrombotic therapy. However, the fact that some patients have problems complying with the requirement for extended oral antithrombotic treatment has motivated the development of alternative approaches for stroke prevention. Heart structures such as the left atrial appendage (LAA) and PFO are potent...
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research
ConclusionsGPs and patients are waiting for the other to mention issues surrounding AF treatment such as switching, use of thrombosis service, and number of pills to take first. The perceptions and experiences of patients with AF regarding their disease and treatment highly influence the decisions GPs make, together with these patients, as well as considerations that patients have regarding their treatment; GPs need to be aware of their AF patients ’ perceptions and experiences with their condition and medication’ in order to facilitate discussions with patients and improve clinical outcomes.
Source: Cardiology and Therapy - Category: Cardiology Source Type: research
CONCLUSIONS: In patients with kidney failure and nonvalvular atrial fibrillation, treatment with apixaban was not associated with a lower incidence of new stroke, transient ischemic attack, or systemic thromboembolism but was associated with a higher incidence of fatal or intracranial bleeding. PMID: 32444398 [PubMed - as supplied by publisher]
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
Authors: Zimmermann F, Landmesser U Abstract 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 (CHA2DS2-VASc score ≥1); however, severe bleeding complications are potential reasons for discontinuation of this treatment. Overall, up to 30 % of the p...
Source: Herz - Category: Cardiology Tags: Herz Source Type: research
This post introduces a column I wrote over at TheHeart.org | Medscape Cardiology — The good news is that most people infected with coronavirus don’t need a hospital or doctor. But some do. Some get very ill. The maddening thing is that doctors don’t have an effective treatment for the virus. There are no cures. The Worldmeter today shows nearly 5 million infections and more than 300,000 deaths. And no effective therapy. Excluding a possibly modest effect of Remdesivir, our care is supportive, which is medical jargon for giving simple things like oxygen, acetaminophen, IV fluids and letting ...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs
In conclusion, more and more patients who suffer a hematuria while on oral anticoagulant therapy resume NOAC. Patients resuming NOAC have similar risks of ischemic stroke/systemic embolism and major bleeding compared with those resuming VKA.
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
This article reviews current evidence and focuses on the optimal approach to antithrombotic treatment in patients with AF undergoing PCI in acute and chronic/stable phases. PMID: 32389534 [PubMed - as supplied by publisher]
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research
Int J Angiol DOI: 10.1055/s-0040-1708477Atrial fibrillation (AF), the most prevalent arrhythmic disease, tends to foster thrombus formation due to hemodynamic disturbances, leading to severe disabling and even fatal thromboembolic diseases. Meanwhile, patients with AF may also present with acute coronary syndrome (ACS) and coronary artery disease (CAD) requiring stenting, which creates a clinical dilemma considering that majority of such patients will likely receive oral anticoagulants (OACs) for stroke prevention and require additional double antiplatelet treatment (DAPT) to reduce recurrent cardiac events and in-stent th...
Source: International Journal of Angiology - Category: Cardiology Authors: Tags: Invited Papers Source Type: research
ConclusionThe results of our meta ‐analysis show that NOACs are as efficacious and safe as warfarin in the treatment of left atrial appendage thrombus in patients with non‐valvular atrial fibrillation.
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ARTICLES Source Type: research
ConclusionsFactor Xa inhibitors may be viable treatment options for CF-LVAD patients for whom warfarin therapy has failed. Large prospective studies are necessary to confirm these results.
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
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