2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation

Publication date: Available online 27 June 2017 Source:Journal of Arrhythmia Author(s): Chern-En Chiang, Ken Okumura, Shu Zhang, Tze-Fan Chao, Chung-Wah Siu, Toon Wei Lim, Anil Saxena, Yoshihide Takahashi, Wee Siong Teo Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing o...
Source: Journal of Arrhythmia - Category: Cardiology Source Type: research

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AbstractAtrial fibrillation (AF) is the most common arrhythmia in clinical practice and its prevalence increases with age. Few data are available about the clinical performance of direct oral anticoagulant (DOACs) in patients aged  ≥ 80 years with AF. The aim of our propensity score matched cohort study was to compare the safety and efficacy of DOACs versus well-controlled VKA therapy among octogenarians with AF in real life setting. Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation Research Database (NCT03760874), which includes all AF patients followe...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
The prevalence of atrial fibrillation (AF), the most common cardiac arrhythmia, increases with age, predisposing elderly patients to an increased risk of embolic stroke. With an increasingly aged population the number of people who experience a stroke every year, overall global burden of stroke, and numbers of stroke survivors and related deaths continue to increase. Anticoagulation with vitamin K antagonists (VKAs) reduces the risk of ischemic stroke in patients with AF; however, increased bleeding risk is well documented, particularly in the elderly.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Review Article Source Type: research
Conclusions: Trans-apical off-pump MV repair with the NeoChord system is a safe, minimally invasive procedure, with few minor complications. In well-selected candidates it provides successful treatment of degenerative MR. Results are anatomy dependent, so preoperative patient selection is crucial. PMID: 31119000 [PubMed]
Source: Videosurgery and Other Miniinvasive Techniques - Category: Surgery Tags: Wideochir Inne Tech Maloinwazyjne Source Type: research
Overestimating the bleeding risk of anticoagulants may lead to poor compliance.
Source: ConsultantLive - Category: Internal Medicine Authors: Tags: Anticoagulants Arrhythmia Atrial Fibrillation Cardiology Clinical News Community Practice Geriatrics Health System News Oral Anti-Coagulants Stroke The Latest Source Type: news
Abstract: Atrial fibrillation is the most common arrhythmia in clinical practice, and age is one of the strongest predictors/risk factors for ischemic stroke in patients with atrial fibrillation. Elderly patients, in particular patients aged 80 years and older, are at higher risk of both ischemic and bleeding events compared with younger patients. Vitamin K antagonists (VKAs) reduce the risk of ischemic stroke, especially in the elderly, but increase the bleeding risk. In addition, frequent international normalized ratio monitoring is needed to ensure the optimal level of anticoagulation. Furthermore, VKAs have multiple ...
Source: Journal of Cardiovascular Pharmacology - Category: Cardiology Tags: Review Article Source Type: research
AbstractBackgroundDigitalis glycosides are employed for rate control of atrial fibrillation. Recent studies suggested potential harmful effects of digitalis monotherapy and combination with antiarrhythmic drugs. The aim of the present study was to assess the prevalence and potential impact of digitalis therapy on outcome in patients undergoing catheter ablation of supraventricular arrhythmias.Methods and resultsThe German Ablation Registry is a nationwide, prospective registry with a 1-year follow-up investigating 12,566 patients receiving catheter ablations of supraventricular arrhythmias in 52 German centres. The present...
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
Authors: Papakonstantinou PE, Simantirakis EN Abstract Although atrial fibrillation (AF) is an arrhythmia with a variable clinical profile (symptomatic and asymptomatic episodes), the first symptomatic episode leads to its initial diagnosis in most cases. Nowadays, continuous and remote long- term cardiac rhythm monitoring is feasible by the use of implantable loop recorders. The data concerning the AF recurrences and progression after the first ECG- documented clinical AF episode demonstrates that a high percentage of patients may not suffer any other AF recurrence, or may present a low recurrence rate of the arrh...
Source: Minerva Cardioangiologica - Category: Cardiology Tags: Minerva Cardioangiol Source Type: research
Conclusion In real-life conditions, NVAF patients treated with apixaban show rates of treatment discontinuation and major bleedings, which are comparable to those found in the ARISTOTLE pivotal study, thus supporting its external validity.
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Research articles: Arrhythmias Source Type: research
Authors: Romero J, Avendano R, Diaz JC, Taveras J, Lupercio F, Di Biase L Abstract INTRODUCTION: Atrial fibrillation is the most common arrhythmia worldwide. Its increasing prevalence has made the use of oral anticoagulants for stroke prevention routine, however the use of them after the blanking period of catheter ablation remains uncertain. Areas covered: This review outlines the pros and cons of stopping oral anticoagulation after catheter ablation. Major databases such as Pubmed or Embase were used. The most relevant articles published were used along with major recommendations of society guidelines. Authors wi...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
Authors: Székely O, Miyazawa K, Lip GYH Abstract INTRODUCTION: Atrial fibrillation (AF) is associated with high morbidity and mortality rates due to thromboembolic complications, and anticoagulation is central to the management of this common arrhythmia to prevent acute thromboembolic events. The traditional anticoagulants: heparin, fondaparinux, and vitamin K antagonists (VKA, e.g. warfarin, acenocoumarol or phenprocoumin) have long served as pharmacotherapy for ischemic stroke prophylaxis. Areas covered: In this review article, the authors provide an overview on current and emerging pharmacotherapy for isc...
Source: Expert Opinion on Pharmacotherapy - Category: Drugs & Pharmacology Tags: Expert Opin Pharmacother Source Type: research
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