Left atrial appendage occlusion in patients older than 85 years. Safety and efficacy in the EWOLUTION registry
Publication date: Available online 5 April 2019Source: Revista Española de Cardiología (English Edition)Author(s): Ignacio Cruz-Gonzalez, Hueseyin Ince, Stephan Kische, Thomas Schmitz, Boris Schmidt, Tommaso Gori, David Foley, Tom De Potter, Wladimir Tschishow, Elisa Vireca, Kenneth Stein, Lucas V. BoersmaAbstractIntroduction and objectivesElderly patients with atrial fibrillation are at greater risk of both cardioembolic events and major bleeding than younger patients. Left atrial appendage occlusion (LAAO) could be an attractive alternative for these patients, but there are limited data on outcomes with LAAO in patients ≥ 85 years old. The aim of the present study was to assess the safety and efficacy of LAAO in patients ≥ 85 years old.MethodsA total of 1025 patients included in the EWOLUTION registry who underwent LAAO were analyzed and 84 patients ≥ 85 years old were identified and compared with the younger cohort.ResultsPatients ≥ 85 years old had higher estimated stroke and hemorrhagic risks than younger patients (CHA2DS2-VASc: 5.2 ± 1.2 vs 4.4 ± 1.6, P
In conclusion, current published data suggest that th e use of reduced-dose NOACs is non-inferior to warfarin in patients with AF (in particular Asians).
Publication date: Available online 31 October 2019Source: American Heart JournalAuthor(s): David A. Garcia, Deborah A. Fisher, Hillary Mulder, Lisa Wruck, Raffele De Caterina, Sigrun Halvorsen, Christopher B. Granger, Claes Held, Lars Wallentin, John H. Alexander, Renato D. LopesAbstractObjectivesA history of gastrointestinal bleeding (GIB) in patients with atrial fibrillation (AF) may impact decisions about anticoagulation treatment. To sought to determine whether prior GIB in patients with AF taking anticoagulants was associated with an increased risk of stroke or major hemorrhage.MethodsWe analyzed key efficacy and safe...
This study evaluated and compared the safety outcomes of DOACs versus warfarin in patients with non-valvular AF and concomitant CKD. Patients in our health system with AF prescribed oral anticoagulants during 2010 to 2017 were identified. All-cause mortality, bleeding, and hemorrhagic and ischemic stroke were evaluated based on degree of renal impairment and method of anticoagulation.
AbstractThe role of non-vitamin K antagonist oral anticoagulants (NOACs) in stroke prevention remains unclear in Asian patients with atrial fibrillation (AF). Therefore, we performed a meta-analysis to compare the efficacy and safety outcomes of NOACs in Asian patients with AF from the real-world settings. The PubMed and Embase databases were systematically searched to identify eligible observational studies until June 2019. The odds ratios (OR) and 95% confidence intervals (CIs) were calculated and then pooled by a random-effects model. A total of 18 observational studies were included. Compared with warfarin, dabigatran ...
AbstractThe optimal management of oral anticoagulation (OAC) in the acute phase of non valvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) remains controversial, especially in very old patients. Therefore, the aim of our study was to evaluate the practical management of OAC in this context. We conducted an observational retrospective study on patients 85-years old and older admitted to two Italian hospitals for NVAF-related AIS. For each patient, clinical and brain computed tomography data were recorded. Type of OAC (vitamin K antagonists, VKAs or Direct Oral Anticoagulants, DOACs), dosage and starting ...
Oral anticoagulants are the preferred therapy for the treatment of venous thromboembolism and for stroke prevention among patients with atrial fibrillation. Given their widespread use, clinicians must balance efficacy of anticoagulation with their associated bleeding risks. Specifically, intracranial hemorrhage (ICH) is the most feared complication as this form of bleeding has the highest mortality and morbidity. To date, clinical trials suggest a lower incidence of ICH and better safety profile among patients prescribed the direct oral anticoagulants (DOACs) compared with traditional vitamin k antagonists (VKAs).
Conclusions: The Strat-AF study may be an essential step towards the exploration of the role of a combined clinical biomarker or multiple biomarker models in predicting stroke risk in AF, and might sustain the incorporation of such new markers in the existing stroke prediction schemes by the demonstration of a greater incremental value in predicting stroke risk and improvement in clinical outcomes in a cost-effective fashion. PMID: 31548494 [PubMed - in process]
ConclusionFor patients with AF at high risk of both thromboembolic and hemorrhagic events, NOACs as compared to Warfarin, seem to be safe and effective for short ‐term anticoagulation following LAAC with the WATCHMAN device. Further validation in large randomized controlled trials is required.
ConclusionThe majority of strokes occurring in anticoagulated patients are related to warfarin use. We observed an almost significant reduction in the proportion of ischaemic strokes due to under-dosing of OAC over the study period. Warfarin continues to be recommended as the first line anticoagulant for stroke prevention in atrial fibrillation by the HSE Medicines Management Programme, a decision which we would argue warrants review.
ConclusionThere has been a significant increase in primary prevention practices for AF and this is reflected in the number of stroke patients presenting with known AF on a NOAC, however more needs to be done as there are still patients who have AF that are not being anticoagulated in the community.